Saturday, December 21, 2019

Retrospective #308: What Causes Type 2 Diabetes?

Google “type 2 diabetes” and, in a split second, you get 118,000,000 “results.” The very first “result,” after a brief description of the condition, asks, “What Causes Diabetes?” Their answer to the Google search was, “Usually a combination of things causes [emphasis added by me] type 2 diabetes,” What followed on their list were 6 symptoms, effects and parallel conditions associated with type 2 diabetes, NONE of which is the cause of type 2 diabetes. Only the first named “cause” on the list, “genes,” is relevant in that genes are a precondition, making you susceptible to developing type 2 diabetes, BUT GENES ARE NOT THE CAUSE OF TYPE 2 DIABETES.
Geneticists will tell you the genetic aspect of the origins of Type 2 Diabetes is still in its infancy. Although some genes associated with Type 2 Diabetes have been indentified, no one has yet deciphered the complex combination of genes that have been modified – not mutated – by our EATING A “WESTERN” (“Standard American”) DIET. Certain genes (in those of us who have them) express themselves in a way that compromises the ability of cells to accept glucose. This modified genetic “expression” is called “Insulin Resistance.”
Insulin in the blood, secreted by the pancreas when we eat carbohydrates, carries glucose throughout the body, delivering it to our cells. If glucose can’t enter the cells, because of Insulin Resistance, it continues to circulate. The pancreas releases more insulin to help with the problem, and eventually the pancreas stops working.
An elevated blood sugar (glucose), over time, causes the complications of diabetes. And elevated insulin in the blood signals that there is still 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  carbohydrates that we eat to fat and adds them to our body’s stores. INSULIN RESISTANCE, resulting in high levels of circulating insulin in the blood, is thus THE CAUSE OF BOTH TYPE 2 DIABETES AND OBESITY, not the other way around. Insulin Resistance causes diabetes, Insulin Resistance causes obesity, and OBESITY is usually a signal that your blood glucose is NOT under control.
What then is the best “treatment” for type 2 diabetes caused by Insulin Resistance? The Googled website I searched listed 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 you, or 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, and there’s not much you can do to change your history.
Then the Googled 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 other suggestions: “Lose weight. Get active. Eat right. Quit smoking.” Okay, but NOT AN EFFECTIVE TREATMENT PLAN FOR INSULIN RESISTANCE.
The best way to think of Insulin Resistance is that your body has become intolerant of dietary – especially processed – 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. By lowering your blood GLUCOSE, this will 1) minimize your risk of pre-diabetes, frank type 2 diabetes and all the later complications, and by lowering your blood INSULIN, this will 2) enable your body to access your fat stores for energy. 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 laboratory genetic test as yet, but if you are overweight there is a strong likelihood (true, it’s just an “association”) that you have developed a degree of Insulin Resistance sufficient to cause that buildup of body fat. Remember, IT IS INSULIN RESISTANCE THAT CAUSES BOTH OBESITY AND TYPE 2 DIABETES. A good metric to assess this is a waist/hip ratio greater than 1.0. 

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