Cyrus Khambatta was diagnosed with type 1 diabetes when he was 22 years old and alopecia, during his final year of college at Stanford University. Today, at the age of 32 with a PhD in nutritional biochemistry, he recalls that he was truly in denial for the first year of his diagnosis, and then, frustrated with his lack of energy and rollercoaster blood sugars, he started studying “everything under the sun” and concluded that he wanted to try following a vegan diet for the sake of his diabetes.

Today, Cyrus is known as “The Mango Man”—and you can visit his nutritional coaching website at MangoManNutrition.com—because he eats over 600 grams of carbohydrate per day, primarily from fruit and other whole-food raw sources.

His primary philosophy behind his nutritional coaching method revolves around this scientific concept:

Decrease the dietary fat in your diet, increase your unprocessed carbohydrate consumption = decrease insulin resistance, increase your body’s ability to use carbohydrates as fuel, improve overall blood glucose control.

Cyrus explains further: “Stop fighting diabetes, start fighting insulin resistance. The ability to use carbohydrates as fuel doubles, triples when you reduce fat and increase healthy carbohydrates…which is why someone like me can consume 600 grams of carbohydrates on 13 units of insulin, because my insulin resistance is so low insulin has an extremely profound effect on my body.”

A typical lunch for Cyrus looks like:

7 bananas

7 bananas large handful of dates

2 tablespoons of hemp protein powder

a little honey

=250 grams just for lunch

=6 units of insulin

1:40 insulin/ratio

A key aspect of Cyrus’s diet is that he does not consume “fake carbohydrates”…meaning anything processed and manufactured such as breads, pastas, etc.

He currently works with both type 1 and type 2 diabetics (read a variety of client testimonials here) in his nutrition coaching and shares this type 2 client as an example of his strategy:

“More often than not, type 2 diabetics are insulin resistant because they’re either consuming too much fat in their diet or they’re not utilizing muscle tissue enough to stimulate the burning of carbohydrates for fuel.”

“Larry is a type 2 diabetic client who went from a fasting glucose of 185 mg/dL to losing 45 pounds and being completely off his meds. His blood sugars are completely normal and he no longer needs to test. He generally eats between 10-15 fruits per day and 10 vegetables, 250-300 grams carbohydrates total. He came to me because he had developed type 2 diabetes after being diagnosed with lung cancer…we fixed his diabetes and his lung cancer is in a state of remission as well.”

Dr. Neal Barnard actually wrote an approach to diabetes management almost identical to Cyrus’ and Cyrus is now a big fan of his work – you can check out his variety of diabetes books here.

How Cyrus Began on His High-Carb/Low-Fat Mission

“My diet before veganism…,” explains Cyrus, “I grew up as the Standard American Diet, eating meat 1 to 2 times per day, drinking a pint of milk a day, eating lots of cheese, breads, pastas, cereals. A very typical American diet.”

Cyrus says he had tried to follow a low-carb diet but looking back on what he was eating realized it wasn’t actually an accurate low-carb diet at all. But before digging deeper into low-carb diets, Cyrus’ research led him to veganism and, even further, raw food.

“One of the single greatest things I’d ever learn in my life is this: a lot of people in San Francisco were talking about being a vegetarian/vegan and one thing lead to another, I met a guy named Doug Graham, and he’s a raw food vegan and educator. He was putting on a Sports Camp and I went and talked to him about nutrition.”

Doug Graham had been following a raw food vegan diet for over 10 years at the time Cyrus met him, and he certainly had his own concerns but was also drawn to the science of this way of eating and how it would likely impact his diabetes:

“Am I joining a cult? I don’t want to join a cult,” explained Cryus on his initial concerns. “He approaches things from a very scientific angle. The idea here is that it’s very high in fruits and vegetables, and it’s extremely low in fats (nuts, avocados, seeds). If you were to look at the macronutrient proportions 80/10/10 in carb/protein/fat.”

“Once I made that transition, the amount of insulin I was using (40 to 45 units per day) kept starting to fall. Down to 23 to 28 units of insulin per day. I lost a little bit of weight but not enough to explain the decrease in insulin.”

Cyrus was pleased with the benefits he was seeing in his health compared to his previous standard American diet.

“From that point I said, okay this is working well. Not only were my blood sugars normalizing and my fasting blood sugar was very predictable. I regained my ability to be athletic again. I grew up as an athlete but dealing with my diabetes. It takes a toll on your mental state, not being able to exercise and be an athlete.”

Cyrus pursued his PhD in nutritional biochemistry with very specific intentions:

“When I want to grad school I went with one question in mind: what causes type 2? Because I don’t believe it’s just caused by sugar. And with type 1, what are the environmental triggers that can cause the auto-immune reaction?”

Cyrus’ research led him to this conclusion: “The thing I uncovered that is mind-blowing to me: the way diabetics are instructed to eat using a carbohydrate restriction and thus eat more protein and fat, I knew inherently that there was something very different about food and well-being. The cause of insulin resistance, as I was learning from my research, is actually that dietary fat influences insulin resistance. I was skeptical at first but was reading entire books on this that have hundreds of references. There’s a connection here that has a lot of validity that are not integrated into the medical paradigm in treating diabetes.”

A Brief (& simplified) Science Lesson from Cyrus:

“The muscle tissue can run on three fuels: fat, carbs, glucose. It takes a lot of work for the body to run off protein. Carbs or fatty acids are the higher choices for fuel. At all times the muscle is determining how much energy should it take from the pool of energy from carbs or fatty acids.”

“When carbohydrates are low, protein and fat are both high, therefore the less carbs are being consumed the less carbs are converted into glucose, and less insulin is required.”

“The problem with this approach is that when you consume large amounts of fat or protein is that the fat itself can lead to insulin resistance long-term, the use of fatty acids for fuel over and over and over tends to damage mitochondria.”

“The mitochondria is the power cell…but when you turn off on the usage of carbohydrate and you rely solely on fatty acids, the mitochondria result in cellular inflammation. This process puts the entire muscle tissue in a state of distress. In the end, this leads to mitochondrial dysfunction.”

“When fats are in oversupply it actually blocks the ability of insulin to do its job. Thus more fat = insulin resistance. The cell loses its ability to allow glucose to come in and thus needs more and more insulin to come in. The insulin receptors become dumber. As a result of that, more glucose accumulates in the bloodstream.”

Would Cyrus ever switch back to a low-carb diet? Heck, no, he says.

“I wouldn’t go back because I understand both the acute and chronic affect it has on fatty acids and liver tissue. I might have a time when I cheat and I binge eat a bunch of plant-based fats, avocado or nuts, etc.”

As for those hardcore Paleo fans, Cyrus says, “In 5 to 10 years, Paleo is going to come crashing down on itself and the reason for that is because eating that quantity of meat and bacon that the Paleo community eats, it’s not sustainable in the long-term. It doesn’t show effects in short-term like endocrine destruction: thyroid hates the high-fat diet.”

Now if only we could get Dr. Bernstein on the phone and ask him what he’s seen in terms of long-term effects from low-carb dieting in his patients! Alas, that’s not happening today.

Another Scientific Perspective on Low-Carb vs. High-Carb Diets for People with Diabetes

Gretchen Becker, type 2 diabetic author of The First Year: Type 2 Diabetes and journalist, shared her own perspective on this high-carb/low-fat approach from her background in diabetes research:

“Everyone agrees that when you follow a low-carb diet, your insulin resistance actually goes up. It makes sense. When glucose is scarce, the body wants to save it for the brain, and the muscles can work quite well using fatty acids for energy. In some people fasting blood sugars go up. I’ve written extensively on this science in this blog post at THCN. There was also a graph showing results of a non-diabetic on a low-carb diet, and then a low-fat diet. Her numbers were much better on the low-fat diet. But because she isn’t diabetic, she can tolerate more carbs.

I’m sure that future research will help to refine our understanding of the various diets. People have been arguing about this for almost 100 years. But for now, I vote for the low-carb. Bernstein is pretty healthy after years on a diet I’m sure is much stricter than mine. As far as comparing a low-fat, high-carb diet to the standard American diet…almost any whole foods diet is better than the Standard American Diet, which is generally a combination of poor quality processed carbohydrates and lots of unhealthy fats.”

Ginger’s Concerns, Questions, and Thoughts

While I don’t personally feel inclined to follow this approach to managing my life with type 1 diabetes, I do greatly admire Cyrus’ dedication to both his own disciplined nutrition and the rigorous amount of research and studying he has put into his coaching philosophy! I also consider him a newfound friend because despite that our approaches to managing diabetes are drastically different, we agree on many things, primarily: eat whole foods and make your health through nutrition a big priority in your life!

If this approach to nutrition and diabetes management intrigues you and feels like something that you’d like to learn more about for your own health, definitely contact Cyrus! He’s had great success with his past clients and within his own diabetes management.

In addition to my questions and concerns stated below in a discussion with Cyrus, I still struggle to really embrace that eating that many carbohydrates actually leads to better blood sugar control, particularly for someone on insulin. No matter how sensitive to insulin I might become, I still don’t produce any of my own insulin, and therefore…as a person with type 1 diabetes, I would still need to count carbs properly and take precise doses of insulin to cover those carbs. It doesn’t matter if your insulin-to-carbohydrate ratio is 1:10 or 1:60, you still need to measure your carbs carefully and be able to dose carefully (which would be much harder with such extreme sensitivity to insulin).

I think part of Cyrus’ success in attaining a 6.0 average A1C (which is not “normal” for a non-diabetic but is definitely excellent for a person with type 1 diabetes) on this plan is the result of eating the same meals repeatedly, so he knows the exact carbs and the exact doses of insulin he needs — and additionally, he is a big fan endurance aerobic activity which will help make use of all those carbohydrates significantly. If I were using a 1:60 carbohydrate ratio, I’d actually have a very difficult time dosing insulin via syringe for any meal less than 60 grams of carbohydrate…but that’s a whole other issue!

In my own experiences with low-carb dieting, and my hard-core paleo friend, Ryan Attar, who lives with type 1 diabetes, I also feel that near-normal non-diabetic blood sugars can be achieved through healthy low-carb diets that are fully of vegetables, and high quality sources of proteins and fats. I’ve achieved A1Cs in the 5.0 range, and Ryan has an A1C in the 4.0 range. Additionally, he experiences nearly no low blood sugars because the less insulin you’re taking, the less easily you can actually experience a low blood sugar. (Many folks confuse hypoglycemia with a lack of carbohydrates, when in reality it is excess insulin that causes low blood sugar.)

Additionally, from my own experience on a more lenient but whole-foods-bsed low-carb diet (50-75 grams per day) and from Ryan’s severely low-carb diet, he and I both use the exact same amount of insulin per day that Cyrus uses–in fact, I believe Ryan uses even less. So as far as achieving certain levels of blood sugar levels and insulin quantities, I don’t see a profound difference in Cyrus’s approach compared to the paleo or generalized low-carb approach. (And I don’t eat meat generally more than once or rarely twice per day, but my cholesterol levels are: HDL 80, LDL 70, Trigs 66, BP 104/60 — all above healthy numbers!)

Regardless, I had a few more questions for Cyrus on his approach to treating diabetes by making the body ultra-sensitive to insulin rather than the approach that removes the primary ingredient diabetics can’t naturally process, carbs.

QUESTIONS for CYRUS

Ginger: So yes, adding more fats to your diet, even healthy fats, would increase your need for insulin..but is that so bad? Insulin itself is not evil…excessive insulin is harmful. It seems extreme to me to nearly wipe out an essential macronutrient just for the sake of extreme insulin sensitivity…especially when that amount of daily insulin could be achieved in other ways that include a wider variety of foods as well.

Cyrus: First off, my intention is not to “wipe out” an essential macronutrient, it is simply to reduce it to a level that promotes increased insulin sensitivity without resulting in a nutrient deficiency. Unfortunately, the way diet information is communicated in our society is to find a villain, then to crucify that villain endlessly. Atkins did it with carbs, and he created an entire nation (and world) of people deathly afraid of carbohydrates, even though most people still don’t know what a carbohydrate is.

Fat is not an enemy at all; it is simply a macronutrient that increases insulin requirements. Most people with diabetes are taught to believe that there is only one macronutrient that influences insulin requirements: carbohydrates. Because of that, many people with diabetes are taught to restrict carbohydrate intake and eat large amounts of fat and protein. When I started studying biochemistry, one of the first lessons that I learned is that a person’s insulin requirements are certainly influenced by their carbohydrate intake, but more influenced by their fat intake. If I had to summarize it, I would state the following:

Carbohydrates may increase insulin requirements today, but fat increases insulin requirements in the long term.

It turns out that diets that are high in plant foods tend to be low in fat (in general), and diets that are high in animal foods tend to be higher in fat (in general). Because of this, people who increase their consumption of plants generally decrease their consumption of fat, and this simple change can profoundly reduce the amount of insulin required to regulate blood glucose values.

My entire program and education is focused on teaching people with diabetes how to reduce insulin resistance. The reason for this is simple: insulin resistance is not considered a “chronic disease” or even a diagnosable health condition. In my opinion, insulin resistance should be tested for at the doctor’s office and treated very seriously, simply because insulin resistance can set the stage for other chronic health conditions that increase morbidity, including diabetes, heart disease, atherosclerosis, obesity and certain types of cancer.

In short, insulin resistance is strongly associated with serious health conditions, and often silently sets the stage for metabolic dysfunctions such as diabetes, heart disease, atherosclerosis, obesity and certain types of cancer.

You’ve probably heard the statement, “you can’t control what you can’t measure.” I strongly believe that insulin resistance is a perfect example of a condition that currently does not have a routine clinical or consumer-facing test, and because of that there are millions of people who are unaware that they are insulin resistant. If insulin resistance were a benign condition, then it wouldn’t matter.

But because insulin resistance has a very strong association with chronic disease, reversing insulin resistance is not only important, but required for long-term health.

Ginger: Interesting. From the way you first described your own diet, it sounded as though dietary fat and protein was consumed in an extremely low quantity. You’ve mentioned that you eat, at most, the amount of fat that comes from 7 or so almonds per day. If a person is severely limiting their fat and protein intake, what kinds of supplements will they need to take to make sure their body still has what it needs to function properly?

Cyrus: Again, I do not promote severely limiting protein and fat intake, rather I promote consuming reduced amounts of protein and fat simply because it results in increased insulin sensitivity.

Too often, plant-based diets and vegan diets are viewed as fundamentalist approaches to nutrition, and are often labeled as “extreme” diets. The purpose of eating a diet that contains more plants solves many problems at once. Plant based diets are (a) high in unrefined carbohydrates (what I refer to as “real carbohydrates”), (b) they are high in water content, (c) they are high in bioavailable antioxidants which are easily absorbed and reduce inflammation, (d) they are high in fiber content 9for improved digestive function), and (e) they are low but not deficient in protein and fat.

That last point is very important to understand. Plants contain both protein and fat, and eating a diet high in plants does not mean that protein or fat consumption becomes deficient. That is a misnomer.

The Standard American Diet has a carbohydrate-fat-protein ratio of about 40%-40%-20%, and many studies have shown that consumption of 40% fat in the diet can result in the storage of fat in the liver and muscle, significantly impairing glucose uptake. Consuming a diet containing between 10-15% plant-based fats is not only sufficient for normal tissue function, but preferred by tissues like the liver and muscle that function more efficiently off of carbohydrates. In addition, consuming between 10-15% protein from plant sources is sufficient to meet the protein demands of even competitive athletes.

In short, I have come to realize 3 things. Please note that these are observations and not “judgements” and are not intended to sound that way:

Carbohydrates are under-appreciated Protein is overemphasized Fat is overhyped

I will say that plant-based diets should certainly supplement two things: (1) omega 3 fatty acids and (2) vitamin B12. Thousands of studies have shown that proper intake of omega 3 fatty acids is cardio-protective and anti-inflammatory, and omega 3s are incredibly important for both meat eaters and plant eaters alike. Vitamin B12 is manufactured by microorganisms in the soil that are eaten by land-grazing animals. When you eat the animal, you absorb the vitamin B12 indirectly. Plant-based diets often do not contain a sufficient quantity of vitamin B12, and in order to prevent neurological dysfunction, I highly recommend supplementing with vitamin B12.

Ginger: On that same note, it’s very well known and clear that women need a certain level of fat in their diets in order for their body to experience menstrual cycles. Severely low-fat diets are notorious for putting menstruation on pause. And men and women both need essential fatty acids for absorbing vitamins A, D, E, and K, as well as for simply human functions such as growing healthy nails, hair, and skin…

….so I would fear that a diet so low in fats would impair the many bodily functions mentioned above?

Cyrus: I couldn’t agree with you more in that men and women both need an adequate intake of essential fatty acids (EFAs) for proper absorption of vitamins A, D, E and K, and for a host of other metabolic functions. True statement. Plant based diets often have higher levels of bioavailable EFAs including omega 3 fatty acids, which are potent inflammation reducers. And from what I understand, proper absorption of vitamins A, D, E and K is not significantly reduced by consuming a low fat diet.

As for women requiring a certain percentage of fat in their diet to regulate menstruation, I agree and I disagree. First off, proper menstrual function is dependent on a woman’s body fat percentage, since estrogen and related sex hormones are produced in proportion to fat mass. Body fat percentages bordering on about 12% or lower in women can result in impaired reproduction.

However, if a woman is eating a diet that contains 10-15% fat from plant sources that does not imply that her body fat percentage will fall into a dangerously low level and prevent menstruation. Often times, women who start consuming a plant-based diet become more fertile and reduce the risk of breast cancer due in part to a reduction in total body inflammation and the rate of cell division.

References:

Ginger: I think would actually disagree with the point that a women’s ability to menstruate relies solely on her body-fat percentage. I’ve known many competitive figure athletes with very low body-fat percentages that only stop menstruating when they reduce their fat intake, even if their body-fat percentage remains the same. As soon as they put the fat back on their plate, their menstrual cycle returns.

You mentioned that you feel the Paleo diet is not sustainable, but in reality the Paleo diet, when done properly, is full of whole foods (veggies and fruits), limited grains, healthy fats (nuts, avocado, etc.), slow-cooked legumes, and high-quality meats….that’s a list of some pretty darn healthy foods and it offers quite a variety as well. To me, I don’t see how a diet so limited like the Raw-Vegan-Fruitarian diet can be considered sustainable while the Paleo diet is being said to be unsustainable…?

Cyrus: This could be one of my favorite subjects of all time. I think that the paleo diet is genius in its design, because it limits the foods that generally cause digestive inflammation and metabolic dysfunction.

On paper, the paleo diet is fantastic: no alcohol, no grains, no dairy, no legumes, no artificial sugars. I think this is a genius approach to nutrition altogether. Just fruits, vegetables, nuts, seeds, meat and seafood.

Unfortunately, the execution of the paleo diet is different from the original design. What I mean by that is simple: many paleo eaters use the paleo diet as an excuse to eat meat 2-3 times a day, and don’t make much of an effort to incorporate more fruits and vegetables. Too often I see paleo eaters opting for meat, and some paleo eaters eat meat with every meal, with a limited intake of vegetables and fruits.

In short, I believe that the design of the paleo diet is fantastic and 100% sustainable, and I do believe that when the proper macronutrient proportions are followed (35-45% carbohydrates), abundant health can be enjoyed. In my experience however, I have observed that many paleo eaters consume a diet containing less than 20% carbohydrates, and this simple change can promote negative effects on long term health as mentioned above.

Ginger: Hmm, okay, I think that could be making just as many assumptions about paleo eaters as are often made about vegan diets. Anybody can screw up any type of diet, right? For instance, when you were younger you’d thought you were on a low-carb diet for a short period of time when you were actually consuming over 100 grams of carbs per day. Vegans can perform a vegan diet in just as imbalanced a fashion as one can mis-follow the paleo guidelines, so that argument in itself I don’t think really takes anything away from paleo but perhaps just reveals that in all diet approaches, people are bound to screw it up.

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Interested in learning more from Cyrus? Visit MangoManNutrition and schedule a consult! Be sure to check out the Mango Man Nutrition & Fitness Facebook page, too!

Read more about A1c, exercise, Fasting Blood Sugars, insulin, low blood sugar (hypoglycemia), low-carb diet, Medtronic, paleo, vegan diet.