#41 - Jake Kushner, M.D.: How to thrive with type 1 diabetes and how everyone can benefit from the valuable insights

The Peter Attia Drive

Peter Attia, MD

Health & Fitness, Medicine, Fitness

4.7 • 7.3K Ratings

🗓️ 18 February 2019

⏱️ 128 minutes

🔗️ Recording | iTunes | RSS

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Summary

In this episode, Jake Kushner, pediatric endocrinologist specializing in helping people with type 1 diabetes, discusses the best strategies to live and thrive with T1D, especially as it relates to diet and exercise. We also discuss why many patients who control their blood sugar with high amounts of exogenous insulin are at a substantially higher risk than people who can control their blood sugar at lower levels of insulin. This concept has great implications for non-diabetics as well considering the increasing prevalence of diseases related to insulin resistance. We also cover some of the basics, the history, the increasing prevalence of type 1 diabetes, and more importantly, what we can do to help kids with this disease, and their families.

We discuss:

How Jake became interested in type 1 diabetes [5:30];
The pathophysiology of type 1 diabetes, the increase in prevalence, and the role of beta cells [17:00];
The role of body weight and BMI in the risk of developing T1D [27:00];
Genetics of T1D and the risk of inheritance [32:00];
Hemoglobin A1c [36:15];
Insulin: the amazing story of its discovery, its effect on cellular metabolism and IGF-1, and why the hell it’s so expensive [39:15];
Diabetes Control and Complication Trial: blood glucose and the complications associated with diabetes [54:45];
Cognitive impairment, epigenetic changes, and other dangers associated with high, peak blood glucose, and big swings in blood glucose levels [1:09:15];
Depression, anxiety, and other challenges of living with T1D [1:15:30];
Jake’s realization that the current standard of care of T1D is inadequate [1:26:15];
Managing diabetes with exercise [1:30:15];
The Bernstein method, and protein’s impact on glucose and insulin [1:36:15];
Jake radically changes his approach to treating patients [1:45:00];
What other tools are there for controlling T1D? [1:49:45];
Is the ketogenic diet appropriate for those with T1D? [1:52:45];
The most important lessons that can be applied by the non-diabetic population [1:59:00];
The two dream measurements Peter wishes were available [2:04:00]; and
More.

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Transcript

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0:00.0	Hey everyone, welcome to the Peter Atia Drive. I'm your host, Peter Atia.
0:10.0	The drive is a result of my hunger for optimizing performance, health, longevity, critical thinking,
0:15.7	along with a few other obsessions along the way. I've spent the last several years working
0:19.6	with some of the most successful top performing individuals in the world, and this podcast
0:23.8	is my attempt to synthesize what I've learned along the way to help you live a higher quality
0:28.3	more fulfilling life. If you enjoy this podcast, you can find more information on today's
0:32.4	episode and other topics at peteratiamd.com.
0:35.3	Hey everybody, welcome to this week's episode of The Drive. I'd like to take a couple of
0:45.6	minutes to talk about why we don't run ads on this podcast, and why instead we've chosen
0:50.2	to rely entirely on listener support. If you're listening to this, you probably already
0:54.8	know, but the two things I care most about, professionally, are how to live longer and
0:59.7	how to live better. I have a complete fascination and obsession with this topic. I practice it
1:05.1	professionally, and I've seen firsthand how access to information is basically all people
1:09.9	need to make better decisions and improve the quality of their lives. Curating and sharing
1:14.8	this knowledge is not easy, and even before starting the podcast, that became clear to me.
1:19.6	The sheer volume of material published in this space is overwhelming. I'm fortunate to
1:24.0	have a great team that helps me continue learning and sharing this information with you.
1:28.9	To take one example, our show notes are in a league of their own. In fact, we now have
1:33.6	a full-time person that is dedicated to producing those, and the feedback has mirrored this.
1:39.0	So all of this raises a natural question. How will we continue to fund the work necessary
1:44.0	to support this? As you probably know, the tried and true way to do this is to sell ads,
1:49.4	but after a lot of contemplation, that model just doesn't feel right to me for a few reasons.
	...

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