Retrospective #347: Lowering glucose in T2D is largely useless, unless…

If yesterday’s post left you, dear reader, in a quandary, that was not my purpose. Nor do I think was it 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 (such as insulin and sulfonylureas) that cause weight gain, is demonstrably harmful to the patient. So, lowering blood glucose by that method, as is still the Standard of Care, is worse than useless; it is malpractice. There, I said it (if he didn’t).

To see that conclusively, you have only to read Retrospective #346, or Dr. Fung’s blog, or acquaint yourself with the cardiovascular outcomes of the UKPDS and ACCORD studies. On the other hand, the drug 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.” If you haven’t guessed it, this statement is just prelude. He goes much 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 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 #328 or read Dr. Fung’s very good book, “The Obesity Code.”

Why is an elevated blood insulin considered “toxic”? Because it is the lynch pin and impetus for a constellation of metabolic disorders, starting with Insulin Resistance, that have come to be known as Metabolic Syndrome. An elevated insulin leading to Insulin Resistance has been caused by the changed dietary practices of the last century, in which highly processed carbohydrate “foods” and vegetable (seed) oils have proliferated.

These two developments have been abetted by an officialdom who, in a misguided effort to protect our arteries, has encouraged us, since 1977, to avoid foods containing saturated fat and cholesterol. Instead, they have replaced them with more highly processed carbs and vegetable oils. The Dietary Guidelines for Americans were first published in 1980 and have changed little since. In 2015 the DGA did however drop the limitation on total fats, and the 300mg/day cap on dietary cholesterol, but they doubled down on replacing saturated fat with vegetable oils. And the % DV on the Nutrition Facts panel on food boxes and bags is still 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, high cholesterol, dyslipidemia, and non-alcoholic fatty liver disease (NAFLD) – is a growing body of evidence that this nationwide dietary experiment has, tragically, gone awry.

All of these chronic metabolic disorders are related, and all of them can be traced back to a chronically elevated blood INSULIN, i.e. INSULIN RESISTANCE (IR) that is caused by what we eat. Carbohydrates start the process by signaling the pancreas to secrete insulin. Insulin is required to transport the digested carbs (as glucose) 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 the body’s other source of energy, stored body fat, that it is not needed. Body fat is, in fact, blocked from use. So, while both glucose and insulin circulate, we do not burn body fat for energy, we are in energy imbalance, we are hungry and we eat. And any carbs or fat we overeat is converted by the liver to more body fat.

An elevated blood insulin starts it: insulin resistance, obesity, hypertension, type 2 diabetes, high cholesterol, 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.”