“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 19th 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.”
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