Sunday, December 20, 2015

Type 2 Diabetes, a Dietary Disease #308: Introduction to What Causes Type 2 Diabetes

Google “type 2 diabetes” and, in one third of a second, you get 118,000,000 “hits.” On my search the very first, after a brief description of the biological condition, asks, “What Causes Diabetes?” Their answer: “Usually a combination of things cause [emphasis added by me] type 2 diabetes,” What follows is a list of 6 symptoms, effects and parallel conditions associated with type 2 diabetes, none of which is a cause of type 2 diabetes. Only the first “cause” listed, “genes,” is relevant in that it is a precondition, but not a cause of this disease.
I am not a microbiologist or geneticist, but geneticists will tell you the genetic aspect of the science of Type 2 Diabetes is in its infancy. Although some genes associated with Type 2 Diabetes have been identified, no one has yet deciphered the complex combination of genes that have been modified by our Western diet to express themselves in a way that compromises the ability of our cells to accept glucose. This modification is called “insulin resistance.” Insulin carries glucose through the bloodstream, delivering it to cells throughout the body. If glucose can’t enter the cells, it continues to circulate. The pancreas releases still more insulin to solve the problem and eventually (after years) it wears out.
Elevated blood sugar, again over time, causes the complications of diabetes. And elevated insulin in the blood signals that there is glucose (energy primarily from carbs) circulating in the blood so there is no need to burn fat reserves for energy. So the body keeps our fat in storage, and the liver converts excess dietary carbohydrates (and fats) to triglycerides (fat) and adds them to our stores. Insulin resistance, resulting in high levels of circulating insulin in the blood, is thus the cause of diabetes and obesity, not the other way around. IR causes diabetes, IR causes obesity.  And obesity is usually a signal that your blood glucose is not under control.
What then is the “treatment” for type 2 diabetes caused by insulin resistance? The website cited lists 18 generalized “risk factors:” 3 are “things you can’t control,” and 11 others are “related to your health and medical history,” things that are epidemiologically associated with those who develop Type 2 Diabetes. That may be helpful to your doctor if he or she is otherwise clueless about whether to diagnose you as “pre-diabetic” or a frank Type 2. But let’s face it: they are history. There’s not much you can do to change the past.
Then the website lists 4 “Other risk factors (that) have to do with your daily habits and lifestyle.” It suggests, “These are the ones you can really do something about.” The site’s advice (amid pop-ups for anti-diabetic drugs): “Take medications and follow your doctor's suggestions to be healthy.” The site’s suggestions: “Lose weight, Get active, Eat right, Quit smoking.” Not bad advice, but not an effective treatment plan for IR.
The best way to think of Insulin Resistance is that you have become intolerant of dietary carbohydrates, i.e., you are Carbohydrate Intolerant. So, an “eating pattern” that reduces dietary carbohydrates to a minimum, or as few as you are willing to eat, will reduce the levels of both glucose and insulin circulating in your blood. This will, by lowering your blood glucose, 1) minimize your risk of pre-diabetes, frank type 2 diabetes and later complications, and, by lowering your blood insulin, 2) enable your body to access fat stores. You’ll lose weight and, in the bargain, avoid diabetes. Why doesn’t your doctor tell you this, instead of writing a prescription?
* If you’ve been wondering if you are one of those who is genetically predisposed, there is no genetic test as yet, but if you are overweight there is a very strong likelihood (true, just an association) that you have developed a degree of Insulin Resistance sufficient to cause that buildup of adipose tissue (body fat). This is particularly true for those with a waist/hip ratio greater than 1.0.


  1. I think there is something missing there. IR is a reaction of each cell to sufficient glucose, aka, this cell is full. When the fat cells become IR, then you have T2D with high insulin. The cause of IR is too much carbohydrates.

    1. Sorry, Fred, but I must disagree with your first sentence. "Skeletal muscle IR is the primary defect in Type 2 Diabetes," according to Ralph DeFronzo, MD, and my guru on the "history" of the pathogenesis of T2DM.

      "nsulin promotes glucose uptake into the cells by activating a complex cascade of phosphorylation-dephosphorylation reactions." In simpler words, the
      "The insulin mediated glucose uptake" in the muscle (and liver and fat cells) is impaired because "multiple metabolic abnormalities are present in individuals with type 2 diabetes." The IR presents itself on the surface of the receptor cells. As a result, "Insulin resistance begets insulin resistance." Then, "The normal β-cell response to insulin resistance, irrespective of the etiology of the insulin resistance, is to increase its secretion of insulin. However, a chronic physiologic increase in the plasma insulin concentration has a detrimental effect on skeletal muscle insulin sensitivity." Etc, etc. etc.

      DeFronzo published this paper is the ADA Journal in 2009, the year after he gave the ADA Annual Convention Keynote speech in San Francisco. I wrote about him multiple times, including this one, "The NUtrition Debate #99:

      I do agree with you that "the cause of IR is too much carbohydrates." It's just that the mechanism that ultimately results in IR is, I think the science will show, is an epigenetic expression in those who are genetically predisposed AND who then eat too many carbs.

  2. You can include non-starchy foods such as cabbage, beats, radishes, green peas, mushrooms, cucumber, bean sprouts, cauliflower, tomatoes, onions, turnips, and green beans in your daily diet.foods to lower a1c

    1. Mueeid, thanks for commenting. In principle I agree, but in the dwtaiks in depends on the degree of IR you have developed. Peas and beets are two nonstarchy vegetables that I avoid because of their very high sugar content. Agribusiness actually makes sugar from beets more than from sugar cane. Corn (maize) and carrots too.