The Triangle Method for Metabolic Syndrome

Transcript generated by AI:

Announcer: 0:00

Welcome to MedEvidence, where we help you navigate the truth behind medical research with unbiased evidence-proven facts, hosted by cardiologist and top medical researcher, Dr. Michael Koren.

Dr. Michael Koren: 0:11

Hello, I'm Dr. Michael Koren, the executive editor of MedEvidence. And I'm here today with Dr. Gagandeep Singh from New Delhi, India. And we have him on MedEvidence today because he has a really fascinating story about how his clinic in New Delhi, India, has been able to help people with diabetes, in fact, reverse diabetes. So, Dr. Singh, welcome to MedEvidence. And I'm so interested to hear about your background first, and then about how you're actually reversing diabetes. So tell us just a little bit about yourself and and how you got involved in diabetes work in in India to start.

Dr. Gagandeep Singh: 0:51

So thank you, Dr. Koren. Thanks for having me on the show. And I'll try to take the viewers through my journey into diabetes reversal. So when I did my MBBS here, that's that's um like the basic medicine degree here in India.

Dr. Michael Koren: 1:10

Equivalent of our MD degree, yes.

Dr. Gagandeep Singh: 1:13

Yes, equivalent to your MD degree, yes. So post that I was looking at a lot of diabetes, hypertension, and obesity patients because we're in the middle of an epidemic, right? And uh the prevalence of these diseases is it's like growing and growing. So, like any other uh, I would say conventionally trained doctor, I started, you know, with a very, very medication-focused approach to treating these people, and there were always targets and there were always drugs. This is way back. I'm talking, you know, 2011-2012. So whilst I was treating these people, what I found was that the drugs were keeping the sugar levels, the blood glucose levels, and the HbB A1C levels under a certain degree. But their problems far exceeded blood glucose and HBA1C. One I realized that uh there was really no exit plan from the medication per se.

Dr. Michael Koren: 2:28

Right.

Dr. Gagandeep Singh: 2:28

So if somebody gets on a medication and uh it's like a kid who's trying not to fail, right? So they're always uh, as we call it in medicine, it's a treat-to-failure approach. Okay, so you treat it till the HBA1C rises or the blood glucose crosses a certain threshold, and then you counter that failure, and that cycle starts again. And whilst this whole yo-yoing of HBA1C and glucose was going on, their organs were getting damaged. So the kidneys are getting damaged, the nerves are getting damaged, the people are still getting heart attacks. So essentially we were treating them, but we were not healing them, is the realization I came to. So I decided to dig deeper. And I found a lot of literature on you know how lifestyle interventions, typically diet and exercise, have a big impact on the energy metabolism, the insulin cascade, and how it could be a great tool to intervene and get actually lasting results and reduce dependency on medication.

Dr. Michael Koren: 3:46

Okay.

Dr. Gagandeep Singh: 3:47

And uh I'll tell you, serendipitously, I started with treating obesity patients because I I was a very obese kid all throughout my childhood and my teenage years. I mean, at my peak I weighed 100 kgs plus.

Dr. Michael Koren: 4:04

Wow.

Dr. Gagandeep Singh: 4:04

And uh so my family carries all the time.

Dr. Michael Koren: 4:09

That is 220 lbs. For those of us that don't understand kilograms. So how tall are you?

Dr. Gagandeep Singh: 4:14

Yeah. So I'm 5'8, 176 centimeters.

Dr. Michael Koren: 4:20

Got it. Okay, so you were you were looking at a BMI well into the 30s.

Dr. Gagandeep Singh: 4:25

Yes. So I was in the obese category. So when I came into this education, the first thing I did was try and bring my weight down to a healthy level. And in that process, I realized um, you know, how powerful lifestyle intervention really is. So when a lot of patients saw my transformation, they came to me primarily for obesity. Like you, you know, and the request from their side was that you help us lose weight and uh help us do it without any medication and without you know any adverse effects. And the best thing was that a lot of them were diabetic as well. So when I decided and I was working at their obesity and um recomposing their body per se, trying to reduce the body fat percentage, up the muscle mass, what I found was that even without me targeting it, HBA1C was dropping. Their postmeal glucose was dropping, their fasting glucose was dropping, their lipid profile was getting better. So I thought there's something there. So I did a lot of my own research, I worked with over a thousand patients, and I ended up developing my own uh protocol for lifestyle intervention per se, in which you know you do not target blood glucose and HBA1C directly, but try and target insulin resistance instead. So the battle is against metabolic syndrome, and the ideology we follow is that diabetes, hypertension, obesity, PCOS, they're different facets or different symptoms of the same underlying metabolic disorder. That's metabolic syndrome, and the hallmark is insulin resistance. So we try and work at insulin resistance rather than trying to suppress HBA1C or glucose below a certain level. So it's a treat-to-success approach rather than a treat-to-failure approach.

Dr. Michael Koren: 6:38

Got it. So that's yeah, so that's a good overview. So let's dig in a little bit more. Before I dig in with some questions, though, I just want to make the point that this obesity epidemic and the metabolic syndrome problems in India, as you pointed out, have become so big that they're actually larger than in the U.S., which I found fascinating. So I I mentioned to you before we got on air that I I visited your country in India and did a tour throughout the country, including New Delhi, and I learned that the actual incidence of heart disease in India was significantly higher than in the U.S. And now it's approximately 50 percent higher than in the U.S. And again, I think this is being driven by the obesity epidemic and this problem with metabolic syndrome. So just pointing out how big of a problem it problem it is, not only in Western countries, but also in developing countries. A really, really big problem. And as India has become more affluent and people, I guess, are eating richer diets, this is one of the consequences that we're seeing. So thank you for the work you're doing in India. And now give us a little bit more detail about what your secret sauce is. How are you successful with these patients?

Dr. Gagandeep Singh: 7:56

The funny thing is I tell my patients that, you know, whatever I wanted to give to you in terms of knowledge, I practically give away in the first hour from the first consultation. So there is nothing secret under the sun. All the knowledge and all the secret sauce per se is out there on YouTube and on Instagram and free for anyone to follow. Why we succeed is that we provide a system, we provide a structure in which they have a dietary intervention, they have an exercise intervention, plus there is also a doctor on board taking care of the medication, reviewing the lab data, and everything is data-driven and results-oriented. So the secret source, if you would permit that, is that we work on what we call the triangle model, which is a doctor, a nutritionist, and a trainer working in tandem and attacking the same disease. And the biggest thing I would like to point out here is that traditionally these are seen as very separate fields, right? So doctors would not talk much about diet and exercise. You know, they would just refer you to the nutritionist, and the nutritionist would not talk much about exercise, and similarly, the trainer would not talk about medication. So it is these three separate people treating one patient whose inherent disorder requires coordination from all three. But sadly, in the conventional system, that's not very much there. So this is where we close the gap. It's a coordinated effort between the three, which eventually helps us to get the result.

Dr. Michael Koren: 9:43

Gotcha. So tell us a little bit more about the structure. Do when people come to your office, do they visit with each person during the course of one visit, the physician, the trainer, and the nutritionist? Or do is there a handoff or is there a schedule? Give us a little bit more details about what that quote secret sauce looks like.

Dr. Gagandeep Singh: 10:03

So when the patient first comes to us, we'll do a detailed blood work and an assessment that'll not only include his lab tests, but his lifestyle data, his food logs, his activity logs, his anthropometric data, various body measurements from the waist circumference to the midarm circumference to his body fat percentage. And then we kind of have a metabolic snapshot of the patient. You know that this is where he's at, this is his body composition, this is the problem with his metabolism. And then the first thing we do as a team is set some goals. There are some short-term goals, there would be some medium-term goals, and definitely there would be some long-term goals. Then they would be individually assessed by the doctor and the nutritionist and the trainer to understand what are the gaps in the current, you know, medication, diet, and exercise, respectively, and how best they can be filled in parallel. So rather than working sequentially, you know, maybe medicine first and then diet and then exercise, we try and have a holistic approach and work on all the three areas in parallel. And again, we ask the patient to track a lot of things. So in the first maybe two to four weeks, the key step is putting in place certain habits. There are people who don't even track their glucose, you know, more often than once a month or once every couple of months. You would be surprised to know how many people uh, you know, just track their fasting glucose once in a couple of months and use that as an index of their diabetes. So we put a tracking framework in place where every week they're giving us data, and on the basis of the data, we are refining their plan. So instead of it being a unidirectional plan from our side, it ends up being a bidirectional plan with a real-time response from their bodies. I see.

Dr. Michael Koren: 12:10

So that's very helpful. A lot of interaction based on the data that comes in with each visit. And what are the frequencies of the visits typically?

Dr. Gagandeep Singh: 12:22

Typically, we have weekly reviews. So there are many reviews that we do weekly, and there are bigger reviews that we do monthly. And the master review happens every quarter. So we work in blocks of three months. So after three months, the entire deep metabolic assessment would be done again. And at all times, all the progress is available on a dashboard which the patient can see. So that just gives them the incentive and motivation to continue with the program because they can see live, you know, what is happening in their bodies, how their metabolism is changing, whether they are proceeding in the correct direction or not.

Dr. Michael Koren: 13:05

Interesting. So I'm going to call this Dr. Singh's triangular method for reversing diabetes. I think that has a nice ring to it. So, Dr. Singh, what's the success rate of reversing diabetes using your triangular method?

Dr. Gagandeep Singh: 13:22

So we define the success rate as being directionally better at the end of a three-month block. So let us say you came to us with an HBA1C of 9 or 10, right? And at the end of three months, you drop a couple of points on the HBA1C with lesser medication. So there are multiple um, you know, indicators of progress. Let's say you dropped maybe three to five body fat percentage points. Maybe you dropped a point or two of your HBA1C, maybe you could let go of a couple of your pills. So all these are indicators of progress. So over a period of three to six months, we are able to successfully achieve. Now it's debatable whether you would call it remission or reversal. I would like to call it reversal. So over a period of six months, we are able to achieve reversal in more than 80% of our patients.

Dr. Michael Koren: 14:19

Wow, that's very impressive.

Dr. Gagandeep Singh: 14:21

These are the patients who stick through with the plan. There are a lot of people who would drop out in the first two to four weeks because, again, incorrect expectations, there's a lot of misinformation out there. It's an intense program, requires a lot of discipline, requires a lot of lifestyle changes. But the ones that do persevere, they do get good results.

Dr. Michael Koren: 14:45

Excellent. Well, that that's that's encouraging that you have such a great success rate, but it also shows the challenges of getting that level of commitment from patients because sometimes people are looking for just an easy fix. And as you mentioned, this type of thing is not an easy fix. So uh one last question. We are a a podcast platform that advocates evidence-based medicine. And evidence-based medicine often involves doing studies. I'm wondering have you ever subjected your triangular approach to some sort of study to see how it compares in terms of success with other ways of trying to lose weight or trying to quote "reverse diabetes?"

Dr. Gagandeep Singh: 15:31

Absolutely. So we are in the middle of, you know, it'll be maybe a couple of months from now that we'll be publishing a white paper and we'll be applying for uh this thing, a research study for a clinical nutrition journal as well, wherein we would be documenting more than a hundred cases. And to our credit, these would not be cherry-picked, you know, mild diabetes or HBA1C 6 or 7. You've got the whole spectrum here. I have uh stage 4 kidney disease, I have liver cirrhosis patients, I have HBA1Cs 11, HBA1Cs 13, I have insulin-dependent patients who we've managed to get rid of insulin injections for. So the aim is to publish a subset which covers the whole spectrum of diabetes, right from prediabetes to advanced insulin-dependent patients. So very soon you should see that getting published.

Dr. Michael Koren: 16:33

Well, good luck with that. It's obviously very important to get your information out to other physicians and to the general public. So we do appreciate that. Uh evidence-based medicine, as you know, is the cornerstone of progress in the medical field. So again, thank you for your work, not only helping the patients, but also publishing the results. Dr. Singh, any last words of wisdom for our mid-evidence audience?

Dr. Gagandeep Singh: 16:58

Yes, I would like to leave them with one line as food for thought. So, this is what we tell all our patients that your diagnosis is not your destiny. And the aim of the whole process and the whole philosophy of chronic disease reversal is that you must be empowered. Do not call yourself a patient. I tell them, you know, you're not a diabetes patient, you're a diabetes warrior. So if you do make a sincere effort and you get good guidance, you can reclaim control of your blood glucose, and diabetes need not be a lifelong condition. You can definitely get rid of it.

Dr. Michael Koren: 17:44

I love that. Your diagnosis is not your destiny. So we'll finish up on that really, really powerful note. Dr. Singh, thank you so much for being a guest here on MedEvidence!

Dr. Gagandeep Singh: 17:56

My pleasure, Dr. Koren, and look forward to seeing you in India.

Dr. Michael Koren: 18:00

It'd be my pleasure as well.

Announcer: 18:02

Thanks for joining the MedEvidence Podcast. To learn more, head over to MedEvidence.com or subscribe to our podcast on your favorite podcast platform.