Link to #308: Introduction
to What Causes Type 2 Diabetes
Vignette 1: What is Type 2
Diabetes?
Answer: Type 2 Diabetes is a metabolic disorder in which insulin, the
glucose transporter in the bloodstream, is blocked on the surface of
destination cells, preventing the glucose from being taken up for energy. This
condition is called Insulin Resistance. As a result of Insulin Resistance,
circulating glucose levels become elevated. If untreated, elevated blood sugars
eventually cause serious microvascular and macrovascular complications.
Secondarily, as the disease develops, when more insulin is secreted to help
with the take up, the pancreas increasingly has diminished capacity to make
insulin and insulin replacement therapy is required.
Vignette 2: How Did I Get
Type 2 Diabetes?
Answer: You, along with about half the population of the Western World,
were unlucky. First, you have a certain genetic predisposition such that some
complex combination of your genes makes them vulnerable to a genetic
modification. This is not the same as a “mutation.” Second, you unwittingly
participated in a large uncontrolled government experiment of eating a low-fat,
high-carb, dietary pattern and, being genetically predisposed, your genes have
“expressed” this modification, causing you to become Insulin Resistant, and
thus Carbohydrate Intolerant and a Type 2 Diabetic.
Vignette 3: What Can I Do
If I’m Pre-Diabetic?
Answer: If you’ve been told, or you suspect, that you’re “Pre-Diabetic,”
to avoid becoming a Type 2 Diabetic you must modify your dietary pattern to
reduce, as much as possible, carbohydrates. Carbohydrates are a non-essential
macronutrient. There is no minimum
requirement for carbs. Carbohydrates include both simple sugars and complex
carbohydrates, particularly refined and processed carbohydrates. You must also avoid
sugary soft drinks, fruit juices and drinks, and all baked goods, starches,
cereals, and desserts. That’s anything with flour, sugar (by any name) or
starch. This is of course difficult to do, at first, but it’s an easy way to
lose weight without hunger, and, if you do it, you will lose weight and you will avoid developing type 2 diabetes.
Vignette
4: How Can I Prevent Type 2 Diabetes?
Answer: Easy! Type 2 Diabetes is
a dietary disease. If you take charge
of what you eat, and seriously restrict your carbohydrate intake, you will avoid developing this disease. Even
if you are already somewhat overweight and/or have been told you are “Pre-Diabetic,”
you can reverse your Pre-Diabetes and
put your Insulin Resistance in remission.
By seriously restricting your carbohydrates, you will also lose weight rather
easily and do it without hunger! And as long as you stick to your carbohydrate
restriction/reduction, and eat 2 or 3 small meals a day without snacks, you will remain protected from developing
this disease.
Vignette
5: How Can I Prevent Type 2 Diabetes From Being Progressive?
Answer: If you are already a diagnosed Type 2 Diabetic, you must do just one thing: ignore
the advice to “eat a balanced diet.”
Continuing to eat beaucoup carbs will only assure
that your disease will be progressive. You will
become dependent on more and more medications, possibly become “insulin
dependent,” and eventually develop the dreaded complications. The easy way to
prevent Type 2 Diabetes from becoming progressive is to eliminate carbohydrates
from your diet: all carbohydrates become
glucose in your bloodstream. You have Insulin Resistance, and you are
Carbohydrate Intolerant. Your body just can’t handle carbohydrates any more.
Answer: The only way to reverse Type 2 Diabetes is
to largely eliminate carbohydrates from your diet. They all become glucose in your bloodstream. If you are Pre-Diabetic or
have been diagnosed a Type 2 Diabetic, you have Insulin Resistance and you have
become Carbohydrate Intolerant. Your body can’t handle carbohydrates any more.
So long as you continue to restrict the carbohydrates you eat, your Pre-Diabetes
or frank Type 2 Diabetes will go into and remain in remission. You’re not
cured, but while your disease is in remission, you are not at risk for the
microvascular and macrovascular diseases associated with this disease.
Vignette 7: How Can I Cure
My Type 2 Diabetes?
Answer: You can’t.
People who use the word “cure” are misleading you. You were genetically
predisposed and your genes have “expressed,” i.e., already been modified,
permanently, as far as anyone knows at this time. That’s history, and you can’t
change your genes back to their “normal” expression. However, you can take
those genes “out of play” by avoiding the foods that “express” them: carbohydrates. So long as you eat a diet
of primarily fats and limited protein, as your body was designed to do, your
body will adapt. You will have plenty of good energy, healthy food for the
heart and brain and every other need the body has, and your blood sugar and
serum insulin levels will decline to “normal.” Your Type 2 Diabetes will be in
remission.
Vignette 8: How Can an
Overweight Type 2 Lose Weight Safely?
Answer: That’s easy
too, and you can “kill two birds with one stone.” The most difficult part of
any “restricted calorie, balanced”
weight loss program is being hungry all the time. The reason is that when you
eat carbs, insulin circulating in your blood, secreted for the purpose of
transporting glucose (the digested carbs) to your cells, blocks your body from
using body fat for energy. Your body thinks, “If you have carbs to eat, you
don’t need to use your precious body-fat reserves.” So your stored fat is “saved”
for a famine or for winter. If you instead restrict carbs, instead of calories, you will naturally eat less and your body,
sensing lower blood glucose and transporter-hormone insulin in the bloodstream,
will break down your body fat for energy. As a result, your body will be fed
your broken down body fat. You will not
be hungry, and you will lose weight!
Vignette 9: Is Being
Overweight a Cause of Type 2 Diabetes?
Answer: No, it’s
the other way around, and the explanation is simple. When you eat a
“balanced” diet, as most weight loss programs and “experts” advocate, glucose
from digested carbs is accompanied in the bloodstream by the transporter hormone
insulin. The liver, which controls metabolic homeostasis, perceives that since you
have dietary carbs available for energy, you don’t need body fat to maintain
energy balance. So, the fat stays locked up around you belly. As you develop
Insulin Resistance (see #1 above), your serum insulin levels remain high so
added calories from carbs and fat (and unused protein stored in the liver), are
converted by the liver to additional fat stores. You got fat because you’re
Insulin Resistant, which means you are a Type Diabetic or at very serious risk
of becoming one.
Vignette 10: Is Being a
Type 2 Diabetic like being Gluten or Lactose Intolerant?
Answer: Yes and No. Each
involves food intolerance. Gluten Intolerance means the body is intolerant of
the protein portion of the wheat, barley or rye grain. It rapidly results in
intestinal distress. Lactose Intolerance means the body is intolerant of foods
containing the milk fat lactose because of the absence of the enzyme lactase to
help digest it. Lactose intolerance rapidly results in intestinal distress.
Carbohydrate Intolerance, the result of a person developing Insulin Resistance
expressed as the metabolic disorder, Type 2 Diabetes, results in long term
microvascular and macrovascular complications often leading to death. All three
intolerances – gluten, lactose and carbohydrate – are dietary diseases and are
best addressed by avoiding the dietary cause.
Vignette
11: Won’t Eating So Much Fat Make Me Fatter?
Answer: No, unless you eat too many carbs and too much fat. Fat, eaten with or without limited protein, is
filling. You quickly become satiated (satisfied), so eating fat is
self-limiting. You will eat less if you eat just energy dense, real foods
containing full fat, limited protein and minimal or no carbohydrates. Carbs that
have been processed are depleted of nutrients along the way, including
essential fat-soluble vitamins and minerals. Carbs that are eaten to the
exclusion of healthy fats will not satisfy your hunger and will lead to
cravings. Eating excessive nutrient-deficient processed carbs will lead to overeating
carbs, which the liver will convert to body fat. Eating carbs will make you
fat. Think about how livestock is fattened before slaughter.
Vignette
12: Won’t Eating Saturated Fat Make My Cholesterol Rise?
Answer: Actually, no! Eating a high-fat, low-carb diet will be good for
your cholesterol. It will raise your HDL cholesterol (the “good” cholesterol),
in some cases, like mine, more than doubling it. If your Total Cholesterol, an obsolete
value in modern lipidology, rises slightly, it will be because your HDL went
up. The formula: TC = HDL + LDL + TG/5. Your LDL cholesterol (the “bad”
cholesterol) will probably remain constant, but their particle size and density
will improve, from “small dense” to “large fluffy.” And your triglycerides,
measured at the same time as your cholesterol, will decline dramatically. Mine
did, dropping by more than two-thirds.
Vignette
13: Won’t Eating Dietary Cholesterol Block My Arteries?
Answer: Absolutely not! Dietary cholesterol, from animal foods like
eggs, shrimp and meat, has nothing to do with serum cholesterol (cholesterol in
your blood). Cholesterol is an essential compound. It is present in every cell
in your body. Your liver makes cholesterol as your body needs it, accounting
for about 90 percent of the cholesterol in your body. If you eat less
cholesterol, your body will make more. Cholesterol actually repairs erosion in
the surface layer of your veins caused by inflammation, preventing small, dense
oxidized LDL particles from being trapped. HDL clears LDL, returning it to the
liver for disposal. In 2014 the Dietary
Guidelines Advisory Committee said, “Cholesterol as a nutrient is no longer a
concern for overconsumption.”
Vignette
14: Aren’t Carbohydrates Necessary for Energy?
Answer: No. Carbohydrates, however, are a major source of “quick”
energy, in that they digest quickly, converting primarily to glucose, a necessary and essential
nutrient molecule for certain organs and tissue that do not contain ATP, the
little energy factories. However, because only a small amount of glucose is
necessary but because it is essential
for those parts of the body, the body has developed multiple mechanisms and
pathways to make glucose from protein
and fat. The liver can make glucose from amino acids that are the breakdown
products of protein. In addition, glucose can be made from the glycerol
molecule which is cut loose when a triglyceride (fat) molecule is oxidized to
free up fatty acids for fuel. Furthermore, the byproducts of this oxidation are
ketone bodies which the brain actually prefers to glucose. In the absence of
carbs, after a period of adjustment, the body does very well on a diet almost exclusively
of fat and protein. Some athletes report big improvements: http://eatingacademy.com/how-a-low-carb-diet-affected-my-athletic-performance.
Vignette
15: What About Macronutrient Ratios?
Answer: The three macronutrients, carbohydrates, protein, and fat, were
eaten in various ratios by different cultures around the world, until
governments got involved. Starting in the mid 20th century, epidemiological
evidence suggested that dietary saturated fat and cholesterol were a cause of
coronary artery disease (CAD) and cardiovascular disease (CVD). In 1977, the
U.S. government intervened, and in 1980 it produced the first Dietary
Guidelines for Americans. The food packaging laws followed, resulting in the
Nutrition Facts panel on processed and packaged foods. To this day, the
macronutrient distribution on that panel recommends that the entire American
populace (except children under the age of 2) eats a diet consisting of 60%
carbohydrate, 10% protein, and 30% fat (of that mostly polyunsaturated fat from
vegetable oils like soy bean and corn oil). That, in a nutshell, is why almost
half the Western world is now overweight or obese…and has Insulin Resistance.
Answer: A Low-Carb, High-Fat (LCHF) diet is designed primarily to lower
serum insulin and blood glucose, thus preventing and/or reversing the onset of
prediabetes or Type 2 Diabetes. It also enables the adherent to lose weight, if
needed, without hunger. Secondary outcomes include higher HDL cholesterol and
lower LDL cholesterol, triglycerides, and chronic systemic inflammation. Definitions vary but generally a LCHF diet
entails eating less than 50 grams of carbohydrate a day. That’s 10% carbohydrate vs. 300g/day (60%) carbohydrates in
the 2,000 kcal Standard American Diet recommended on the Nutrition Facts panel
on processed food in the U.S. Even 100g/day (20% carb) would be a very
substantial improvement over the Federal Dietary Guidelines.
Vignette
17: What is a VLC Ketogenic Diet?
Answer: A VLC Ketogenic Diet is a Very Low Carb Ketogenic Diet in which
the adherent eats fewer carbohydrates than in LCHF. Generally, the carb count
is between 15 and 30 grams a day. Thirty grams is the daily total in the
Bernstein 6-12-12 Diet designed for diabetics. Twenty grams per day is the
amount in the Atkins Diet Induction Phase. I followed Atkins Induction for 9
months in 2002-2003 and lost 60 pounds. I also, within a few days of starting
Atkins Induction, found it necessary, to avoid hypos, to eliminate almost all
of the oral anti-diabetes medications I had been prescribed. A few years later,
I followed the Bernstein’s 6-12-12 program and lost 100 pounds in 50 weeks.
Today, I try to eat ≤ 15g/day of carbohydrates to be in a perpetual state of
mild ketosis, producing a low level of ketone bodies from the breakdown
(catabolism) of my body fat. I find that my body likes this state best. I am always
full of energy, get excellent rest, and am never hungry, even after an
overnight fast. So long as I adhere to this program, my blood sugars are
stellar, and I lose weight.
Vignette
18: What Foods Must I Strive To Avoid To Stay Healthy?
Answer: Foods that contain carbohydrates, obviously. Carbs include
simple sugars, both added and naturally occurring, unfortunately. That means
fruit, especially fruit juices and fruit drinks, and all sugary drinks. Baked
goods, including all breads, pasta and rice.
The more processed the grain or the sugar, the more damage it can
cause. Flours and sugars are not your
friends. Avoiding inflammatory foods is
also very helpful.. Some oils are high in PUFA and these are very inflammatory,
doubly so if used for frying. Foods that are deep fried in vegetable oils, corn
and soy bean oil in particular, are loaded with Advance Glycation End products
(AGE’s) that are known to damage your blood vessels and thus cause CVD.
Vignette
19: Is Type 2 Diabetes a Lifelong Disease?
Answer: Regrettably, once you get Type 2 Diabetes, you’ll have it for
life. Your genes have been modified. Whenever you eat a lot of carbohydrates, they
will express the Insulin Resistance that has caused your Type 2 Diabetes.
However, if you eat an absolute minimum amount of carbohydrates, your body will
be able to handle it. Unlike in Type 1 Diabetes, your body still produces some
insulin, and in response to ingesting carbs it will produce enough insulin to
circulate the glucose and eventually see it absorbed. When eating Very Low Carb
your insulin sensitivity will improve. Then, when the glucose is absorbed by
your cells and your serum insulin drops, you will return to burning fat for
energy; your body will be happy, and you will not be hungry. As long as you
follow this Way of Eating (WOE), your Type 2 Diabetes will be in remission.
Vignette
20: When I Reach My Goal Weight, What About Maintenance?
Answer: For me this is still a hypothetical question. I have never
(yet) reached my goal weight. In theory, according to the scientists I most
admire, you are supposed to keep constant, in terms of grams, both carbohydrates
and proteins and increase your fat to stop losing and stabilize your weight. I
imagine that increasing fat would be fairly easy. I could snack before dinner
on buttered radishes or cream cheese filled celery, or add olive oil to meat
and vegetables. For now, however, I am working on getting to my goal weight.
Thanks, shane. I'm glad you found my blog. In addition to reading my future posts, I hope you'll Google thenutritiondebate.com to read some of the previous 308 posts.
ReplyDelete