hello my name is ali benito i am an endocrinologist in private practice in princeton new jersey i practice integrative in the chronology which is a combination of the best of western medicine with the best of any other discipline including mind body i was struck by these pieces an opinion piece in the new york times in october two thousand and sixteen returned by a woman with diabetes and she spoke about the burden of the disease about the burden of constantly checking numbers and keeping those numbers within a particular range and that's important because as clinicians and patients we sometimes get focused in very narrow on just looking at the numbers next there's a recent study that questions that practice of just trying to look at the numbers only when in fact diabetes is much larger than just keeping numbers within the range next so to understand how to preserve function how to preserve to improve the odds of success we need to functional they don't make as much insulin as they should the second effect is what we call insulin resistance and that means that your cells can't not use that insulin properly so you have to defect one not making enough insulin to and that means that sugar by itself is toxic to your pancreas it creates more better cell dysfunction it creates more insulin resistance and at the core of all that is inflammation so if we target inflammation we can important and then age in and some dietary nutrients are important for insulin resistance next this is a bit of more of a complicated slight just not to make things a simple as i made in the previous slide to tell you that the the defects in diabetes are global they are all through your body they are in the fat cells in the gut and the liver the pancreas the brain and the muscle and the kidneys next but at the bottom at the end of the day what we're looking at is at that balance the balance between in sort of assistance and beta cell function so if you have a very low beta cell function because of your genetics or whatever else you need to lower your in sort of assistance in order to keep that balance next that's important because when somebody is diagnosed with diabetes which is this point here at that point somebody has lost already abou fifty percent of their beta cells that pancreatic function so if somebody is here this is normal somebody with diabetes is down at the point and if you get diagnosed with diabetes not just when you develop it but years later because you're not caught early you could even a fifteen percent function only so remember the lower your beta cell function below or you have to keep that insulin resistance in order to keep your sugars are reasonable range next so there's a study a re study that has brought up the thought of this very low calorie diet and this is something that was not as a research study not something that i see you do at home but it just gave us some ideas of what we can do in order to reverse diabetes were subjected to a very low calorie diet and they remain they got their win back on a lower calorie but more normal and they were able to reverse diabetes can you go the next page the next light so what we can learn from this study is that the one who responded to the treatment the once a reversal diabetes they were younger they had diabetes for fewer years they had they were taking the were fewer medications and they have lower fasting glucose and c and higher insulin levels what that tells me they were earlier in the b c s progression so the earlier you catch it the better you will do so if motivation to do something when you're diagnosed now it's important also to note that the that some of the people who went to remission had diabetes for more than eight years so it doesn't mean that if you've had diabetes for a long time you can reverse it you still could but easter if you're early in the b c s next so if we look at why this worked what happened with thing that is perhaps how your body stores fat and that has to do with the liver and the pancreas so when you put fat around your liver that goes into the pancreas and it doesn't allow dipendra to work well it doesn't allow you to make insulin as well so if you go on a very low calorie diet you start to use the fat from the liver so that it decreases the fat around the pancreas and he wakes up that capacity of the pancreas to make insulin so you improve the beta cell function next so we've talked about that balance of insulin and beta cell function and i want to work a little bit on talking about inflammation and how that's important how we can work with inflammation so i want to introduce the concept of dietary ages ages stands for advanced product and those are chemicals that make your body inflamed the increase inflammation if you have low ages in your diet you will improve inflammation specially in diabetes where do you get those ages how do they come into your world well processed foods are high in ages and that's because ages this advanced like a solution and products are formed whenever you dry heat something in most of your ready to eat foods your breakfast cereals your cookies your snacks they're all produced but these high temperature dry heating process you can also produce ages when you're cooking at home mostly if you cook protein at high temperatures so a way for you to control those ages when you're cooking at home is to use more heat shorter cooking times cooking with lower temperatures and then use a city can greta's like vinegar or lemon next so what these polyphenols can do in your body and were they can work in to work on glucose and in the metabolism of sugar so they work in your gut in the muscle in the fat cells in the pancreas in the liver pretty much at every single stage every single organ or an organ system in your body that can metabolize glucose and the benefits are incredible the next these are all the police fields that we know off all these good chemicals that you want in your body so and tea that's ok or wine you want to include your curly kale you want to put some parsley and lee can tomatoes and broccoli and berries and the goons as parkas the penguin and how they work in your system but you should try to aim to incorporate foods that are also how full in diabetes in trying to preserve that function and one of them is magnesium reach foods so magnesium rich foods work because magnesium lowers your insulin resistance and also all those are might miss in bridge next now beyond food there are other things we can do to improve the body's ability to either produce insulin or reduce that insulin resistance and one of them is exercise exercise  both so exercise will promote that preserve ation of the beta cells you keep them longer healthier but it also decreases the inflammatory cytokines in the body so it works at the inflammation exercises such as resistance training tight she she gone have been looked at and all of them will do those things for those with diabetes next we cannot forget about sleep when people have looked at lack of sleep they found that lack direction you're not trying to keep your chin you're really off if you've been sleep even one night without sleep has been shown to increase that insulin resistance in healthy people since that is worse for men than it is for women but i'm going to say make sure you sleep my concern is that if emulsifiers can induce a state of prediabetes in animals i think it could do the same thing in humans is a concern and those are most of fires are what keeps your sources and your ice cream's fluffy if you omega three s which also affect the fat and you definitely want to increase your mega three consumption in the diet and for the liver you also want to work on the police as well as decrease in fear of toes in your diet next so i want to go back to that initial slide at that burden that person who was trying to be perfect with her numbers and i want to end with this quote by a friend of mine who just wrote a book called silent leaders and she says perfection is black and white we are either perfect or not and calls forth judgment but excellence evokes a work in progress inviting us to continually strive toward our best while learning from the process as it unfolds when we work to i you will take some of the recommendations and that you will improve those odds of success and preserve the function of your pancreas and you better self thank you