Retrospective #212: Everything I (ch)eat turns to fat.

“Once you develop diabetes, your metabolism is deeply committed to converting as many calories as it can into fat.”

We’ve all heard this sentiment expressed, or felt this depressing thought, many times, but I was especially affected recently when I read this quote on page 241 of Cate Shanahan’s Deep Nutrition. I urge you to read this book, or at least my review in Retrospective #205 and her deeply troubling observations about the medical “business” in #206.

Shanahan’s book has hundreds of references, so I lament that the above quote is not sourced. I suppose it should be understood as a summation of the totality of the material presented in her book. In any case, the quote can be read as an expression of exasperation that we, overweight and obese Type 2 diabetics, feel in our unremitting efforts to lose weight. It does seem that everything we eat turns to fat, and it is damnably difficult to lose that fat.

As my readers know, I am always interested (from self-interest as well as for educational purposes) in understanding the mechanisms behind our complex metabolic environment, or milieu intérior as the 19^th century French physiologist, Claude Bernard, described it. And I have gained some insights into why it is that “everything I (ch)eat turns to fat” and why people with impaired glucose tolerance (IGT) gain weight easily and lose weight with great difficulty.

In lay terms, IGT is the equivalent of “carbohydrate intolerance,” described in Retrospective #84, “Carbohydrate Intolerance – the new ‘buzz’ words.”” They are the outward manifestation of a metabolic change called Insulin Resistance (IR), described in more detail in Retrospective #99, “Natural History of Type 2 Diabetes.”

Bottom line: as our bodies transition from a normal metabolism to a dysfunctional metabolism, very commonly accompanied by weight gain as an effect of this dysfunction, not a cause, our bodies undergo several physiological changes. Laboratory reports detail these changes. The most frequently tested are fasting glucose, hemoglobin A1c (HgA1c), and the lipid panel (Total Cholesterol, LDL, HDL, and TC/HDL ratio) and triglycerides. Sometimes, when these markers are “out of range,” a diagnosis of Metabolic Syndrome is made. All too often, though, the doctor prescribes a statin and tells the patient to “exercise and eat a low-fat diet” to lose weight. There’s no pill for that prescription.

How have I come to this conclusion? Have you had a similar experience? When I have been very good – that is, when I not only talked-the-talk but walked-the-walk, every day – my fasting blood sugars are consistently in the 80s. I can point to weeks, even months, of never or very rarely having a Fasting Blood Glucose over 100mg/dl. And since it is an elevated blood glucose that causes the pancreas to produce insulin, to transport to and facilitate uptake of that blood glucose in their destination cells, it is an elevated blood glucose level that causes an elevated blood insulin level.

As my readers know, and as anyone who has read Taubes’ Good Calories-Bad Calories (The Diet Delusion in the UK), or his more approachable Why We Get Fat, elevated blood insulin CAUSES FAT STORAGE and PREVENTS FAT BREAKDOWN for energy. Retrospective #5 presents Taubes’s “10 certain conclusions” from the GC-BC (pg. 453-454). It is a very succinct and compelling explanation of the functional role of insulin in homeostasis, and a must read.

Anyway, recently my fasting blood glucose readings were in the 100 to 125 range. Obviously, while I have been talking-the-talk, I have not always been walking-the-walk. I admit it. I “cheated” a little almost every day; always just before or at any time after dinner. And I pay the price. It was just a little “cheat,” so I didn’t gain weight, BUT NEITHER DO I LOSE ANY WEIGHT, EVEN THOUGH I AM EATING NO MORE THAN +/- 1200-1800 CALORIES MOST DAYS.

What’s happening is that my serum insulin levels are slightly elevated – elevated just enough to turn everything I (ch)eat to fat and stop the breakdown of body fat in storage even though I am eating below my homeostatic level. My body “gets the message” that as long as I have a supply of quick energy every night (the “cheats” that break down to glucose), it can conserve my body fat, and lay on more with every calorie that isn’t needed to maintain my basal metabolism while I sleep. The “signal” is: the slightly elevated blood insulin circulating my slightly elevated blood glucose. If this is still unclear to you, I urge you to read Retrospective #5 with Taubes’s “10 Certain Conclusions.”