<div><span> Sarah Hallberg is the Medical Director at Virta Health and a physician who has spent nearly two decades treating patients with obesity and type 2 diabetes. In the first half of this episode, Sarah discusses how she became a huge believer in the efficacy of carbohydrate restriction for the treatment of type 2 diabetes through her research and clinical experience. Sarah challenges the common beliefs about the role of dietary fat and carbohydrate on the plasma makeup of fatty acids and triglycerides. She also expresses the importance of understanding early predictors of metabolic illness—highlighting one particular fatty acid as the most important early predictor—before finishing with a discussion about how doctors might be able to personalize patients' metabolic management in the future. In the second half of this episode, Sarah tells the personal story of her own lung cancer diagnosis. She talks about dealing with her grief, deciding to continue her work while prioritizing her family, and how she devised a plan to extend her survival as long as possible. </span></div> <div> <p> </p> <p>We discuss:</p> <ul type="disc"> <li>How Sarah discovered the profound impact of carbohydrate restriction for reversing obesity and type 2 diabetes [<a href="2021-05-11%2003:15:00%20EDT">3:15</a>];</li> <li>Prediabetes and metabolic syndrome: prevalence, early signs, and the importance of treating early [<a href="2021-05-11%2016:00:00%20EDT">16:00</a>];</li> <li>Overview of fatty acids, how they are metabolized, and understanding what you see in a standard blood panel [29:15];</li> <li>The relationship between diet composition and metabolic markers [35:15];</li> <li>Why palmitoleic acid is such an important biomarker [48:15];</li> <li>The best early indicators of metabolic disease [<a href="2021-05-11%2001:00:00%20EDT">1:00</a>:00];</li> <li>Personalized management of metabolic illness [<a href="2021-05-11%2001:07:00%20EDT">1:07</a>:00];</li> <li>Sarah's cancer diagnosis and the beginning of her journey [<a href="2021-05-11%2001:15:15%20EDT">1:15:15</a>];</li> <li>The emotional impact of a devastating diagnosis [<a href="2021-05-11%2001:27:15%20EDT">1:27:15</a>];</li> <li>Sarah's plan to extend survival [<a href="2021-05-11%2001:36:45%20EDT">1:36:45</a>];</li> <li>Sarah's aggressive treatment plan [<a href="2021-05-11%2001:47:30%20EDT">1:47:30</a>];</li> <li>Life-threatening complications and the return of her cancer [<a href="2021-05-11%2001:59:00%20EDT">1:59</a>:00];</li> <li>Sarah's reflections on her approach to life with chronic cancer and balancing her time [<a href="2021-05-11%2002:11:00%20EDT">2:11</a>:00]; and</li> <li>More.</li> </ul> <p>Learn more: <a href="https://peterattiamd.com/">https://peterattiamd.com/</a><br /> <br /> Show notes page for this episode: <a href="https://peterattiamd.com/SarahHallberg">https://peterattiamd.com/SarahHallberg</a> <br /> <br /> Subscribe to receive exclusive subscriber-only content: <a href="https://peterattiamd.com/subscribe/">https://peterattiamd.com/subscribe/</a><br /> <br /> Sign up to receive Peter's email newsletter: <a href="https://peterattiamd.com/newsletter/">https://peterattiamd.com/newsletter/</a><br /> <br /> Connect with Peter on <a href="http://Facebook.com/PeterAttiaMD"><u>Faceboo</u></a><u>k</u> | <a href="http://Twitter.com/PeterAttiaMD"><u>Twitter</u></a> | <a href="http://Instagram.com/PeterAttiaMD"><u>Instagram</u></a>.</p> </div>
Actionable Insights
1. Optimize Sleep, Exercise, Nutrition
Prioritize optimizing the “sleep, exercise, nutrition trifecta” and managing cortisol, as getting these right can significantly reduce the risk of heart disease, cancer, and Alzheimer’s disease.
2. Consider Therapeutic Carb Restriction
For individuals with type 2 diabetes or metabolic syndrome, a therapeutic carbohydrate-restricted diet (e.g., less than 50 grams/day) can significantly decrease triglycerides, improve glycemic control, and in many cases, reverse type 2 diabetes.
3. Monitor Palmitoleic Acid (POA) Levels
Consider monitoring palmitoleic acid (POA) levels as a biomarker, as elevated POA can indicate that an individual has consumed carbohydrates above their personal tolerance, even with normal blood sugar, serving as an early warning sign of metabolic trouble.
4. Be Hypervigilant About Blood Sugar
Physicians and patients should not ignore any elevation in blood sugar, even in the pre-diabetic range, as it indicates a long-standing underlying problem that requires immediate attention.
5. Understand Individual Carb Tolerance
Determine your individual carbohydrate tolerance, as this is key to personalized nutrition and health management, rather than relying solely on population-level data.
6. Utilize Continuous Glucose Monitoring
Consider using continuous glucose monitoring (CGM) even if not diabetic, to maintain a high standard of average glucose and manage glucose excursions, as an early detection tool for metabolic health.
7. Reduce Insulin Dependency
Understand that insulin is not benign; aim to reduce insulin requirements as much as possible, as a lower daily dose to achieve normal glycemia represents a significant improvement in health outcomes.
8. Reframe Obesity as a Disease
Understand that obesity is a disease process that often begins before significant weight gain and is not the patient’s fault, requiring providers to approach and treat these patients without bias.
9. Address Provider Bias in Obesity Care
Healthcare providers should self-reflect on and address any biases they hold against patients struggling with weight, recognizing that obesity is a complex disease process and not the patient’s fault.
When experiencing anger or frustration from life’s challenges, channel that emotion into productive action and advocacy rather than allowing it to consume you.
11. Choose to Live Fully
When faced with profound adversity or a terminal diagnosis, choose to actively live and make the most of your time, as this approach can positively impact your family and your own well-being.
12. Be Honest with Children
When dealing with a serious illness, commit to always telling children the truth about the situation, as constant uncertainty can be more detrimental than knowing the facts.
13. Become an Expert Patient Advocate
Develop strong self-advocacy skills in healthcare, especially when facing complex diagnoses like cancer, as the system may not always provide optimal support without persistent pushing.
14. Educate Stakeholders on New Approaches
When introducing an unconventional treatment or approach, proactively educate all relevant departments and stakeholders with evidence-based presentations to address potential resistance and gain buy-in.
15. Offer Carb Restriction Option
Physicians should provide all patients with metabolic disease the option of trying a carbohydrate-restricted diet, as it is based on evidence and can lead to significant improvements.
16. Access In-Depth Health Content
To take your knowledge of health and wellness to the next level, consider subscribing to the membership program at peteratiyahmd.com/subscribe for more in-depth content and benefits.
17. Acknowledge Personal Reality
Be realistic and honest about your emotional state and challenges, especially when facing severe illness, rather than pretending everything is “great” or adopting a “superwoman” facade.