In remembrance of Sarah Hallberg, D.O., M.S. (Ep. #162 Rebroadcast)

**Peter Attia** (0:02)
Welcome to a special episode of The Drive. Today's episode is going to be a re-broadcast from an episode released in May of 2021 in memory of the guest, Dr. Sarah Hallberg. This podcast, Sarah and I really talk about two completely different things. In the first half of the podcast, Sarah discusses how she became a believer in the efficacy of carbohydrate restriction and the treatment of type 2 diabetes through her clinical experience. She challenges the common beliefs about the role of dietary fat and carbohydrates on the plasma makeup of fatty acids and triglycerides, and also expresses importance in the understanding of the early predictors of metabolic illness. But it's the second half of my conversation with Sarah that I really want to highlight. The second half of this episode is perhaps one of the most emotionally riveting discussions I've had on this podcast. It's one in which Sarah tells the personal story of her own lung cancer diagnosis and her journey through that. Sarah was diagnosed with lung cancer at the end of June of 2017, despite having never smoked and only being in her 40s. The time she was diagnosed, she already had stage four metastatic disease. And I'm very sad to say that I just learned yesterday at the time of my recording this introduction that Sarah passed away from a very long battle with lung cancer. For those reasons, I wanted to rebroadcast my conversation with Sarah as I believe it's something that frankly, everyone would benefit from listening to, even if you've heard it once before. While it was admittedly a very difficult discussion to have with Sarah, and while I can't even imagine how difficult it was for Sarah to have that discussion with me, I feel like it was an enormous privilege.
And I think that those of us who knew Sarah will be forever grateful. And I think that many people listening who did not have the privilege of knowing Sarah will still be indebted to her for what she shared in terms of her zest for life and the manner in which she fought this disease and didn't really let it rob her of who she was.
So without further delay, here's a special rebroadcast in memory of Dr. Sarah Hallberg.
Welcome to the show. I'm super excited to be speaking with you today. This has the potential, of course, to be a 10-hour podcast, which it won't be, but I think that speaks to the depth of insight that you've got into so many topics that I actually want to talk about.

**Sarah Hallberg** (2:20)
Thank you. It's great to be here.

**Peter Attia** (2:22)
Well, in thinking long and hard about how to navigate all the threads I want to pull on, I figured we would just start with the nerdiest of all topics, which is something that I know you're so passionate about, and yet I don't think gets nearly enough attention.
And that is basically the role of dietary intake of both carbohydrate and fats and the relationship that has on the distribution of fatty acids within the body. So let me just start by asking, why is that even of interest to you?

**Sarah Hallberg** (2:56)
Well, it's significant interest because it really hits at one of the things people criticize a low carb, high fat diet about is, oh my goodness, you'll get more fat in your muscles, in your liver, and it's going to lead to increased insulin resistance and thereby default going to lead to increased cardiovascular disease.
And we know that a therapeutic carbohydrate restricted diet brings down so many cardiovascular risk biomarkers that we're all used to hearing about. Okay, it decreases triglycerides. Okay, it actually can reverse type two diabetes in most cases, and certainly significantly improve glycemic control in all. But fatty acids, that's not something that's talked about all that often.
And what is talked about all that often is this idea of you are what you eat, right? We hear that still every day. Remember, you are what you eat. And this example of what happens when you consume saturated fat in the matrix of a diet that includes carbohydrate restriction is so against that long worn out idea of you are what you eat. And so fatty acids play a critical role. Study after study will show us in cardiovascular risk and in future diabetes risk as well. But again, it's not discussed because fatty acids are confusing, let's face it. Okay. And most people would rather just fall back on this idea, you are what you eat, which just really flies counter to what the evidence in the peer reviewed published literature says.

**Peter Attia** (5:00)
So maybe taking even a greater step back from that, Sarah, what is it that attracted you personally as a physician towards the management of type two diabetes? Because I mean, that's how you and I got to know each other was through a company that you're a big part of called Virta Health, which I'm sure at some point today we will talk about.