Sunday, September 18, 2016

Type 2 Diabetes, a Dietary Disease #347: Lowering glucose in T2D is largely useless, unless…

If my last post (#346 here) left you, dear reader, in a quandary, that was not my purpose. Nor do I think it was Dr. Jason Fung’s intention. The title of his blog post, “Futility of Blood Sugar Lowering in T2D,” was an accurate reflection of this premise: lowering blood glucose by using medications that cause weight gain (such as insulin and sulfonylureas), is demonstrably harmful to the patient. So, lowering blood glucose by that method, as is still the standard of practice, is worse than useless; it is malpractice. There, I said it (if he didn’t).
To see that conclusively, you have only to read #346, or Dr. Fung’s blog, or acquaint yourself with the cardiovascular outcomes of the UKPDS and ACCORD studies. On the other hand, Metformin does suppress unwanted hepatic (liver) glucose production and improve insulin sensitivity/glucose uptake, and thus lower blood glucose, without weight gain. Dr. Fung concludes his blog, however, with the lamentation: “Yet, here we sit in 2016, with no better idea of how to treat type 2 diabetes than to lower blood sugars.” However, his implication goes further.
Dr. Fung’s point was that lowering blood glucose alone, as practiced today by most clinicians, though well-intentioned, has negative consequences and is insufficient; it must instead be in conjunction with lowering blood insulin levels. “It only makes sense to reduce BOTH glucotoxicity and insulin toxicity,” he says here in an earlier blog post. “Drugs such as SGLT2 Inhibitors do this, but diet is obviously the best way. Low Carb diets. Intermittent Fasting.” For the mechanism of action, see here or read Dr. Fung’s book, “The Obesity Code.”
Why is an elevated blood insulin (from the ingestion of carbs) considered “toxic”? Because it is the impetus for a constellation of metabolic disorders, starting with Insulin Resistance, that have come to be known as Metabolic Syndrome. They have all been precipitated by the changed dietary practices of the last century, during which we have seen the introduction and proliferation of highly processed carbohydrate “foods” and vegetable oils.
These two developments have been abetted by an officialdom who, in a misguided effort to protect our arteries from foods containing saturated fat and cholesterol, has encouraged us, since 1977, to avoid them and instead eat more highly processed carbs and vegetable oils. The Dietary Guidelines for Americans were first published in 1980 and have changed little since. Recently they dropped the limitation on total fats, and are struggling with the guideline on dietary cholesterol, but they have doubled down on replacing saturated fat with vegetable oils. And the Nutrition Facts panel on processed foods is still based on 60% carbohydrate, 30% fat and 10% protein.
The effect of these guidelines has been an accelerated introduction of manufactured food products to conform to them and a mass movement in the culture to adopt them. The outcome, as we develop the markers of metabolic disease – obesity, hypertension, type 2 diabetes, hypercholesterolemia, dyslipidemia, and NAFLD – is a growing body of evidence that this nationwide dietary experiment has, tragically, gone awry (see chart).
All of these chronic metabolic disorders are related, and all of them can be traced back to a chronic elevated blood insulin, i.e. Insulin Resistance (IR). They are caused by what we eat. Carbohydrates start the process by signaling the pancreas to secrete insulin. Insulin is required to transport the glucose (digested carbs) and to open the door to the cells that take up the glucose for energy. While more and more insulin is circulating, trying to “open the door,” it signals our other source of energy, stored body fat, that they are not needed. They are in fact blocked from use. So, while the glucose and insulin circulate, we do not burn body fat for energy. And any glucose from overeating that is not needed for immediate energy is converted by the liver to more body fat.
An elevated insulin starts it: insulin resistance, obesity, hypertension, type 2 diabetes, hypercholesterolemia, ED and NAFLD all follow. So, as Jason Fung says, “It only makes sense to reduce BOTH glucotoxicity and insulin toxicity,” and “diet is obviously the best way” to do it. “Low Carb diets. Intermittent Fasting.”

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