Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
27 Jun

The Definitive Guide to Insulin, Blood Sugar & Type 2 Diabetes (and you’ll understand it)

BITE ME, ADA

We all know by now that type 2 diabetes is an epidemic. We’re seeing words like crisis and runaway all over the news and in the journals. Heart disease rates have been cut in half since the staggering margarine days of the 1980s, but diabetes has swiftly risen to fill that gaping void and meet the challenge of Completely Unnecessary Disease Epidemic.

Here’s my ultra-simple explanation of the entire insulin/blood sugar/type 2 diabetes mess. Big Agra could really care less about you. That’s just business. The pharmaceutical industry is not in it for the love of life. If that were the case, drugs would be much cheaper. The FDA has to think about public health, but it also has to think about treading carefully on the toes of corporate interests, because that’s how it works when you’re the biggest economy in the world.

Print this explanation out, stick it on your fridge, email it to your aunt. And put down the pasta.

When you eat food, the body digests the macronutrients: carbohydrates, proteins – actually many different amino acids – and fats. (Anything it can’t digest, like alcohol or fiber or toxins, either passes right on through or, if it makes it into the bloodstream, gets filtered by your liver, a beast of an organ if there ever was one.) We measure these macronutrients in grams and calories, but your body operates in terms of fuel. If you eat more fuel than your body needs – which most people do – the body is forced to store this excess. This ability to store excess fuel was an evolutionary imperative in a world that was in a state of constant “feast or famine” 50,000 years ago. In terms of Primal Health and our DNA blueprint, humans became very efficient fuel storage specialists and were able to survive the rigors of a hostile environment and pass those very same genes down to you and me. Thanks a lot, Grok!

Bear in mind that every type of carbohydrate you eat is eventually converted to a simple form of sugar known as glucose, either directly in the gut or after a brief visit to the liver. The truth is, all the bread, pasta, cereal, potatoes, rice (stop me when you’ve had enough), fruit, dessert, candy, and sodas you eat and drink eventually wind up as glucose. While glucose is a fuel, it is actually quite toxic in excess amounts unless it is being burned inside your cells, so the body has evolved an elegant way of getting it out of the bloodstream quickly and storing it in those cells.

It does this by having the liver and the muscles store some of the excess glucose as glycogen. That’s the muscle fuel that hard anaerobic exercise requires. Specialized beta cells in your pancreas sense the abundance of glucose in the bloodstream after a meal and secrete insulin, a peptide hormone whose job it is to allow glucose (and fats and amino acids) to gain access to the interior of muscle and liver cells.

But here’s the catch: once those cells are full, as they are almost all the time with inactive people, the rest of the glucose is converted to fat. Saturated fat.

Insulin was one of the first hormones to evolve in living things. Virtually all animals secrete insulin as a means of storing excess nutrients. It makes perfect sense that in a world where food was often scarce or non-existent for long periods of time, our bodies would become so incredibly efficient. How ironic, though, that it’s not fat that gets stored as fat – it’s sugar. And that’s where insulin insensitivity and this whole type 2 diabetes issue get confusing for most people, including your very own government.

If we go back 10,000 or more years, we find that our ancestors had very little access to sugar – or any carbohydrates for that matter. There was some fruit here and there, a few berries, roots and shoots, but most of their carbohydrate fuel was locked inside a very fibrous matrix. In fact, some paleo-anthropologists suggest that our ancestors consumed, on average, only about 80 grams of carbohydrate a day. Compare that to the 350-600 grams a day in the typical American diet today. The rest of their diet consisted of varying degrees of fat and protein. And as fibrous (and therefore complex) as those limited carbohydrate foods were, their effect on raising insulin was minimal. In fact, there was so little carbohydrate/glucose in our ancestor’s diet that we evolved four ways of making extra glucose ourselves and only one way of getting rid of the excess we consume!

Today when we eat too many carbohydrates, the pancreas pumps out insulin exactly as the DNA blueprint tell it to (hooray pancreas!), but if the liver and muscle cells are already filled with glycogen, those cells start to become resistant to the call of insulin. The insulin “receptor sites” on the surface of those cells start to decrease in number as well as in efficiency. The term is called “down regulation.” Since the glucose can’t get into the muscle or liver cells, it remains in the bloodstream. Now the pancreas senses there’s still too much toxic glucose in the blood, so it frantically pumps out even more insulin, which causes the insulin receptors on the surface of those cells to become even more resistant, because excess insulin is also toxic! Eventually, the insulin helps the glucose finds it way into your fat cells, where it is stored as fat. Again – because it bears repeating – it’s not fat that gets stored in your fat cells – it’s sugar.

Over time, as we continue to eat high carbohydrate diets and exercise less, the degree of insulin insensitivity increases. Unless we take dramatic steps to reduce carbohydrate intake and increase exercise, we develop several problems that only get worse over time – and the drugs don’t fix it.

Ready for this? Let’s go:

1) The levels of blood glucose stay higher longer because the glucose can’t make it into the muscle cells. This toxic glucose is like sludge in the bloodstream clogging arteries, binding with proteins to form harmful AGEs (advanced glycated end-products) and causing systemic inflammation. Some of this excess glucose contributes to a rise in triglycerides, increasing risk for heart disease.

2) More sugar gets stored as fat. Since the muscle cells are getting less glycogen (because they are resistant), and since insulin inhibits the fat-burning enzyme lipase, now you can’t even burn stored fat as easily. You continue to get fatter until eventually those fat cells become resistant themselves.

3) It just gets better. Levels of insulin stay higher longer because the pancreas thinks “if a little is not working, more would be better.” Wrong. Insulin is itself very toxic at high levels, causing, among many other maladies, plaque build-up in the arteries (which is why diabetics have so much heart disease) and increasing cellular proliferation in cancers.

4) Just as insulin resistance prevents sugar from entering muscle cells, it also prevents amino acids from entering. So now you can’t build or maintain your muscles. To make matters worse, other parts of your body think there’s not enough stored sugar in the cells, so they send signals to start to cannibalizing your precious muscle tissue to make more – you guessed it – sugar! You get fatter and you lose muscle. Woo hoo!

5) Your energy level drops, which makes you hungry for more carbohydrates and less willing to exercise. You actually crave more of the poison that is killing you.

6) When your liver becomes insulin resistant, it can’t convert thyroid hormone T4 into the T3, so you get those mysterious and stubborn “thyroid problems”, which further slow your metabolism.

7) You can develop neuropathies (nerve damage) and pain in the extremities, as the damage from the excess sugar destroys nerve tissue, and you can develop retinopathy and begin to lose your eyesight. Fun.

8) Eventually, the pancreas is so darn exhausted, it can’t produce any more insulin and you wind up having to inject insulin to stay alive. Lots of it, since you are resistant. Congratulations, you have graduated to insulin-dependent Type 2 diabetes.

That’s the bad news. And it’s seriously bad. But the good news is that there is a way to avoid all this. It’s all right there in your DNA blueprint. First off, exercise does have a major impact on improving insulin sensitivity since muscles burn your stored glycogen as fuel during and after your workout. Muscles that have been exercised desperately want that glucose inside and will “up regulate” insulin receptors to speed the process. That’s one reason exercise is so critical for type 2 diabetics in regaining insulin sensitivity. It’s also the reason why endurance athletes can eat 400 or 600 grams of carbs a day and stay lean – they burn it all off and make room for more.

Resistance training seems to be as effective as aerobic activity, but a mix of the two is the best. And because you are now “insulin sensitive”, you don’t require as much insulin to store the excess, which “up regulates” all the fat burning enzymes, so you burn your stored fats at a much higher rate throughout the day. Important amino acids and other vital nutrients have access to the cells when insulin sensitivity is high, so you’re building or maintaining muscle and losing fat weight. Go team.

Second, cutting back on carbohydrates, especially the obvious sugars and refined stuff is absolutely essential. Make fresh vegetables the base of your food pyramid. I get rip-roaring furious when I see our government suggesting that we get 60% of our calories from carbohydrates. That’s ridiculous, bordering on criminal. Think about what is optimal for human health from a “primal” perspective. Look at the genetic blueprint. Look at the statistics and studies if you like – or simply observe what’s going on around you at restaurants, movie theaters and school cafeterias – and you’ll begin to understand the implications of a diet out of whack with our design. The evidence is nothing short of overwhelming: carbohydrate intake of the refined, sugary sort is enormously stressful to the body.

Not only should diabetics limit carbohydrate intake – everyone should. We are all, in an evolutionary sense, predisposed to becoming diabetic.

Mainstream opinion is, of course, partly correct in that sugar does not necessarily “cause” diabetes – increasingly, scientific evidence is showing that genetic susceptibility plays a huge role in individuals’ potential for developing diabetes. Well, no kidding! The entire mainstream argument boils down to this: sugar does not cause diabetes; it’s genetic. I couldn’t agree more. I would simply say that our shared genetic susceptibility to insulin resistance, inflammation, cardiovascular disease and obesity shows that any sort of refined sugar or grain is the last thing humans should be eating. Our genetic “primal blueprint” indicates that we are not meant to consume sugar.

Next week, I’ll be discussing cortisol, stress, and the adrenals in light of our “primal” blueprints. See you then. I welcome your comments and questions as always.

Further reading:

What I eat

My Carb Pyramid

More Primal Health columns

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Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. Brilliant; Its about time someone laid out the over consumption of carbohydrates,and what it is doing to us, in simple easy to understand terms.
    I like it , thank you

    Gary Clark wrote on July 29th, 2007
    • I think it is the word Carbohydrate that is misunderstood. Protein, Fat and Carbohydrate, simple.

      For most people it is as if it only describes grains and starchy vegetables and puts fruit and vegetable as another category altogether. Most people seem to get it if I call my way of eating low starch rather than low carb…….saves me getting on the defensive or them on the attack.

      When I explain I am [self diagnosed but I don’t tell them that….saving another argument] Lactose, Glucose and Gluten ‘intolerant’ the most common response is poor you what do you eat…..I have a laugh and tell them whatever was available before HI [Human Interference] food landed on the supermarket shelf……Everything our DNA was built on.

      And before you ask….how do I know I am ‘intolerant’ with out lab test….I am the Lab….those are the foods I Crave and can’t stop eating when I start even when I am not hungry any more and as I don’t think I have a famine in my foreseeable future there is no need to lay down the stores of fat my DNA thinks I need because of how I am eating. There is also a noticeable physiological, emotional, mental change for the worse.

      I don’t crave butter, beef or beetroot but body and soul sure knows the difference…..sigh….so I say No or just a little or share when the birthday cake is handed out.

      Thank you for this great site that I refer to whenever I think I can stray from my natural birthright and try to maintain good, natural health with un-natural food.

      Jo-Anne wrote on March 1st, 2012
  2. “Congratulations, you have graduated from Type 2 to Type 1 diabetes.”

    Great article, but the above statement is inaccurate. You never graduate from Type 2 to Type 1 diabetes. Though both are diseases of excess blood sugar, the mechanism is different. Type 1 diabetes almost always develops in childhood/adolescence/young adulthood. The pancreas stops making insulin (there is usually a honeymoon period where the body still makes small amounts, but eventually will make none). Insulin injections (or insulin via a pump) are always necessary. As you described, Type 2 diabetes is a disease of insulin resistance. We used to only see it develop in adults (usually middle-aged), but with our messed up world we are now seeing it, along with other lifestyle related diseases like heart disease, in children.

    Some people with T2D are able to manage their disease through lifestyle, some with oral medications that increase insulin sensitivity, and some need insulin injections. People with T2D who are insulin-dependent and make serious lifestyle changes are often able to come off of injected insulin. The thing is, very few people make the major changes necessary.

    Amy wrote on August 15th, 2007
    • I’m glad you wrote this correction Amy, though mentioning that Type1 Diabetes is an auto-immune disease would have clarified things a bit better. Type2 is an insulin resistance problem.
      In Type1, the body’s immune system attacks the insulin producing islet cells and destroys them. The body cannot make any insulin whatsoever. Complete dependence on an outside source of insulin is then required for life. No time off for good behavior, like exercise or eating right.

      I was diagnosed with Type1 at age 24. Most people assume I have type2, when I mention it, and question if I know which version I have. Believe me, Type1’s KNOW what they have. If they didn’t, they’d be dead.

      On a happier note, the primal way of eating is definitely a help with blood sugars and health, no matter what type of diabetes you have.

      Heather wrote on June 24th, 2009
      • So glad to see another type one who is trying this out. I’ve been looking for a good diet in which will give me energy and help me loose weight and gain some strength. I feel like so many other diets forget the Type 1’s. Have you been able to cut back on insulin? Have many lows?

        Amanda wrote on January 20th, 2012
        • Amanda, please see the work of Dr. Richard Bernstein, himself a T1 diabetic who has lived a long and healthy life by keeping carbs to 30 and under a day.

          Cassandra wrote on February 8th, 2012
        • I am so glad to see T1 showing up – i too feel left out of every convo about healthy living as a diabetic- its all about T2 as they can “prevent” what is happening to them, wheres i am told i can only cope with mine (however, i have been CrossFit’ing for sometime and training for a marathon, and doing the paleo thing and my BS has been great)

          Lockard wrote on June 15th, 2012
        • Many people who take our Argi+ supplement have reported significant cutting back on insulin injections. E-mail me for more info.

          Selda wrote on February 25th, 2013
    • In Type 2 DM your beta cells can eventually “burnout” making your disease behave like DM1. MOst of the confusion comes from archaic nomeclature for diabetes, ie insulin dependent diabetes mellitus (IDDM) , non insulin dependent diabetes mellitus (NIDDM).

      While it is true that some can off insulin in type 2 DM, there are other who cannot. Your doctor will test for protein C levels to ensure that your pancreas is functioning.

      G Pachoir m.d. wrote on October 1st, 2009
    • You are absolutely correct in saying that Type 1 Diabetics can never suddenly change to Type 2, but they can become Type 1 AND Type 2, if they become insulin resistant.

      A Type 2 diabetic can ruin his/her pancreas to the point that it no longer makes insulin. He then would be Type 2 AND Type 1 at the same time. It could happen (theoretically).

      Laurie wrote on November 17th, 2009
    • hiiiiiiiiii sir,
      i am from india . iwant some tables to decrease my glucose levels in my body i am type 2 diabetes boy pls help me out how to increse my insulin in my body

      hayagriva wrote on March 9th, 2010
    • I’m in the very small percentile of adults that develop Type 1, I found out when I was 34.

      Roxie wrote on January 28th, 2011
      • Roxie,

        Do note that you may not be a true type I diabetic, even though that was the initial diagnosis. There are also LADA and MODY variants, the latter of which is what about 2-3% of diabetics actually are. It mimics the effects of type I, to an extent, and many patients are immediately put on insulin and can sometimes be switched over to sulphonylureas to stimulate insulin production. Diagnosis usually happens by 25, but it can show up through 50. If your doctor didn’t do a c-peptide test to confirm the natural production of insulin, you shoukd ask for one. If you have very hard to control glucose levels, especially after the typical “honeymoon” period, your body may still be producing insulin.

        In my case, my doctor put me on 5mg of Glyburide after my initial A1c of 16.9 and it nearly killed me with repeated BG crashes. I’m now maintaining on .5mg of Glimepiride. This is pretty rare, indeed, but being properly diagnosed is important and provides options for treatment.

        Take a look at the link, and good luck!

        MODYman wrote on April 6th, 2014
    • Amy, Mark never stated, “Congratulations, you have graduated from Type 2 to Type 1 diabetes.” No. The actual quote is, “Congratulations, you have graduated to insulin-dependent Type 2 diabetes.”

      This is a very different statement from the one you claim he made. While the symptoms of a T1 diabetic are nearly identical to the insulin-dependent T2, they arrived at the same place through very different paths. But the outcome is the same–up a creek without a boat! Nice article Mark.

      Ken wrote on February 1st, 2012
    • ummm pretty sure he said “Congratulations, you have graduated to insulin-dependent Type 2 diabetes” not from T2 to T1 :)

      cwb wrote on May 10th, 2013
    • He doesn’t say “from type 1 to type 2.” He says, “congrats you have graduated to type 2.” You put words in his mouth then formed an argument against something he didn’t say.

      Scott The Caveman wrote on October 23rd, 2014
  3. Excellent breakdown of the insulin mechanism and very easily understandable. Thanks very much! :)

    Linda wrote on September 6th, 2007
  4. i thing all diabetics should try to manage their diabetes not only with insulin, but natural cures can give one hand more in manage blood sugar lever in controll.

    taulandi wrote on February 14th, 2008
  5. Great information. Pls check out my page too about kids dealing with diabetes.

    wayne wrote on April 7th, 2008
  6. Hi, Mr. Sisson. I enjoy your blog thoroughly as there is great overlap in our beliefs in the nutrition/exercise arena. I was wondering if you could provide a bit of clarification on this for me–“…In fact, some paleo-anthropologists suggest that our ancestors consumed, on average, only about 80 grams of carbohydrate a day…” I didn’t happen to see mention of any specific numbers concerning theorized carbohydrate intake in the clickable link provided. Is this data contained in one of Miller/Colagiuri’s full publications, or is it somewhere within the beyondveg site?

    Thanks in advance,
    Randy

    Randy F. wrote on April 16th, 2008
  7. I am living proof that what you shared really works. Nine months ago I was diagnosed with Type 2 diabetes. At that time I began to walk an hour everyday and I seriously modified my diet. I basically followed a plan similar to the one you describe above. In three weeks my blood glucose levels dropped from over 400 down to 85 to 90. I have lost 57 pounds from the change in diet and adding daily exercise. I feel at least 10 years younger and plan to never return back to the old habits that made me ill. One of the best benefits is that I no longer have to take blood pressure meds and I also do not take any diabetes meds. I totally believe that many with diabetes 2 could have the same outcome if they would commit to permanent lifestyle changes. It is totally worth it!!!

    Happy 2B Well wrote on April 30th, 2008
    • I was diagnosed with T2 on March 9th, 2010 with a BSL of 427. They told me to take metformin(500ml) twice daily and eat less sugar. THATS IT! I did some research on my own and decided to not take the pills. I modified my diet and started to exercise. To date (4/16/10) I have lost 64 lbs (298 from 360)and my BSL is never over 130. I will admit I do not eat refined sugar or sweets, and I try to eat lean meats and more fresh fruits and veggies. It is a life long change that needs to take place. Money is very tight for me, but I have found ways to eat healful food on the cheap, it just takes some effort. On my last visit my doctor he told me I should be fine to return to my normal diet. FAT CHANCE! I am into healthy eating from now on. No more McD’s for me. Everyone is different, and you should do what works for you, but a more balanced diet and moderate exercise can’t hurt!

      Jonathan wrote on April 16th, 2010
      • Congrats on the dropping weight (fat) and blood glucose. Now cut out the fruit and get into the normal range to speed up healing and further fat loss. Again…good job Brother.

        Andre Chimene wrote on September 14th, 2010
    • i would like to know how you did this .
      what sort of diet do you eat now ?can you show me your daily menu please.and what did you cut out ….other than sugars.
      thanks
      ken

      ken wrote on October 17th, 2012
  8. Happy,

    Thanks for sharing your story. If more people like you can provide testimonials like this, I bet the medical community would be much more willing to jump on board. Keep up the great work.

    Mark Sisson wrote on April 30th, 2008
  9. I appreciate your encouraging words. Thanks for your wonderful website. I have gleaned alot of knowledge that I will use as I continue my journey to health.

    Happy 2B Well wrote on April 30th, 2008
  10. I loved reading this piece on diabetes. I’m sure much of what I misunderstand is the paradox of obese people who are not diabetic and normal weight people who have developed type II diabetes. I am certain genetics plays a large role in these situations, but is there something akin to a simple explanation?
    Thanks, Mel

    Mel wrote on May 1st, 2008
  11. Mel,

    Some “thin” people have very little muscle mass. Muscles that are not used (atrophied) lose their sensitivity to insulin and become resistant, which leads to type 2. Typically these people are “skinny fat” meaning they look thin, but their percentage of body fat is higher than it looks. The fact that they don’t store as much excess toxic sugar in their fat cells can put them often at greater risk for damage done directly by excess sugar in the bloodstream

    Mark Sisson wrote on May 4th, 2008
  12. I was diagnosed with T2 in 2000. The medication the physician put me on did no good and in the process of researching diet and diabetes I discovered many like me who did well with a lower carb diet. I quit taking the medications, started walking at least one mile twice a day, and followed a plan of 20 to 30 grams of carbs a day. I lost 45 pounds and controlled the blood glucose with diet and exercise alone for five years.

    Unfortunately, my efforts stopped working about three years ago and now I take two types of insulin, ever increasing amounts. And I weigh slightly more than I did when I was diagnosed. I’m increasing exercise and trying to wean myself off the insulins and am not having a lot of luck but I’m keeping at it.

    Thank you for such a great article. Hopefully more people will try exercise and diet before resorting to medication. It does work, even if for just a few years for some of us.

    Denise wrote on July 2nd, 2008
    • You know, some people have a very slow onset of Type 1. Usually they are diagnosed adults, and they may or may not be overweight. It LOOKS like type 2, but it may not be truly Type 2. Sometimes it is referred to as LADA or Type 1.5. With these people, the oral medications work for a little while, but they eventually become ineffective. After a while (sometimes it takes years) they become a true Type 1 diabetic, and insulin is unavoidable.

      I’m not saying this is your case, but it is something to google and see if it fits.

      Laurie wrote on November 17th, 2009
      • That happened with me! They only figured it out when I was sent to the hospital with a bloodsugar of over 700 and tested for antibodies from my body attacking itself. Best of luck though! Keep trying to lose the excess!

        Amanda wrote on January 20th, 2012
  13. Denise,

    Thanks for relating your story. I’m intrigued as to why your T2 would return with a vengeance despite all your efforts and the early success. If you would like to contact me privately, maybe we could discover a hidden problem that could be remedied.

    Mark Sisson wrote on July 2nd, 2008
    • I’d immediately think about healing the gut, because Type 1 is an auto-immune disease. Our immunity resides in the gut and auto-immune issues are generally the result of a damaged gut. A protocol like the GAPS diet or SCD diet is ideal for gut healing and has resulted in the reversal of many issues, including auto-immune diseases. It’s very similar to a Primal way of eating, but specific starches are removed (that may be allowed on Primal/paleo/real food diets) for a time in order for the gut to heal.

      Amy Love, NTP wrote on August 1st, 2012
    • I realize this is a very old article and you may not see my reply but this has happened with my husband. He was diagnosed with type2 brought on by use of prednisone approximately 7 years ago. After stopping the prednisone he began taking metformin among other oral meds. These did not work approx 3 years ago after several med changes and frustrations we began the paleo diet changes. He stopped his meds exercised and lost alot of weight from 240 to currently 189 exercises daily mixing up cardio and weight training and has been consistent the last 3 years but mostly the last year religiously. His hba1c was over 14 3 months ago and he resumed metformin and glypicide. Yesterday his sugar after lunch was 300. This has been extremely frustrating. He’s doing all the right things but not seeing the results we are reading about. Any advice would be fabulous.

      Francine wrote on March 26th, 2014
      • Francine,
        This happened to my son in law. His insulin producing cells were being destroyed by his immune system. Since he was an adult they simply assumed that he was developing Type 2. Eventually his medication failed to work and then, after a year, they tested for antibodies and made a correct diagnosis. This autoimmune reaction against the pancreas produces certain antibodies. Have them test for those antibodies. If they are found, nothing he can do will eliminate the need for insulin because he is irreversibly being converted into an insulin-dependent diabetic.

        If there are no antibodies, then I have no idea.

        Ol' Will wrote on April 28th, 2014
  14. Hi Mark
    And thanks for the above article. I now understand what “fat” is blocking cells as there are doctors based in USA which say it is too much animal fat and putting people with type 2 diabetes on a strict vegan “low fat” diet.
    On another article you suggest eating 50-80 grams of carbs a day to effectively burn stored fat? Yeah?
    The exercise part makes sense and thanks for information. As I cant walk right now I have to increase my resistance training.
    Thanks again.

    sandra wrote on July 14th, 2008
    • please..! please..! see your dotcor again or get a second opinion .There are medical breakthroughs occurring within diebetes types recently and while doing this, follow a sensible diet you know what is good for you!I am not a medical practitioner and dont pretend to be one..so I was hesitant about your question. You need to speak with a professional and use your common sense untill you do!

      Beatriz wrote on December 7th, 2012
  15. Hi Mark,
    So I understand insulin resistance that results in elevated blood glucose levels and then diabetes. What about insulin resistance that results in a blunted blood glucose response and elevated insulin levels? For ex. on a 3 hour glucose test, insulin spikes but blood glucose rise to about 80 mg/ml, plateaus and then drops to below 60. Correspondingly, insulin continues to rise throughout the 3 hour test, resulting in hypoglycemia. Patient is healthy, (overly cardio-active :), 150 lb female with <20% body fat, diagnosed with PCOS on an 1800 cal diet with unrestricted veg/fruit/meat, limited carbohydrates.
    Thanks,
    Rebecca

    Rebecca wrote on July 28th, 2008
  16. Hi Mark,

    I’m a naturopathy student in Australia. I’m looking for some credible evidence against the World Health Organisations ‘2 fruits’ per day recommendation.

    I’m convinced that 2 pieces of fruit A DAY is too little. I understand that fruits can be high in fructose (fruit sugar), however with all its benefits (rich in vitamins and minerals, antioxidants (anti-cancer), fibre (cholesterol lowering), etc, etc), should we not be eating more fruit?

    4-6 pieces of fresh fruit per day as healthy in-between meal snacks with daily exercise (min 1 hr per day) sounds like a much sounder recommendation to me.??

    Rick :)

    Rick wrote on August 9th, 2008
  17. Rick, obviously you are new to this site. I would not espouse 4-6 servings of fruit a day nor 1 hr. minimum exercise. Sorry, I can’t help :-)

    Mark Sisson wrote on August 9th, 2008
  18. Awesome article. Thank you for helping people (like me!) understand.

    Ladyevidence wrote on September 30th, 2008
  19. This post ought to be on the front page of the ADA and Diabetes UK sites (well except for the bit about Type 2 progressing to Type 1) replacing the anodyne crap about how we brought it upon ourselves.

    Some “thin” people have very little muscle mass. Muscles that are not used (atrophied) lose their sensitivity to insulin and become resistant, which leads to type 2. Typically these people are “skinny fat” meaning they look thin, but their percentage of body fat is higher than it looks. The fact that they don’t store as much excess toxic sugar in their fat cells can put them often at greater risk for damage done directly by excess sugar in the bloodstream

    ZING!!!

    That pretty much explains what happens in my family, “metabolic obesity”, the more overweight people tend to have lower BG and better lipids and BP presumably because they have the fat cells to store the excess glucose and lipids, which in us skinny ones stay rattling around in the bloodstream causing harm.

    Even high levels of exercise don’t help as much as they might in other individuals, the secret is in not eating toxic levels of carbs. We are genetic throwbacks designed to survive famines but feasts kill us.

    And in this context the dietician-approved Heart Healthy High Carb Low Fat diet is the worst kind of feast.

    Trinkwasser wrote on February 3rd, 2009
  20. …Not only is it nearly impossible to accurately gauge your exact meal-to-meal calorie and macronutrient requirements, doing so will drive you crazy…

    Thank you so much! I try to ‘zone’ but it makes me nuts. Now I know why.

    katy wrote on February 4th, 2009
  21. I’m sorry but it’s dietary fat that gets converted to body fat not carbohydrates.

    Dozen of studies has shown that de novo glucogenesis (conversion of carbs to fats) simply doesn’t occur to any significant extent in humans.

    A study even fed the subjected 400 grams of carbohydrates daily and no glucogenesi (carbs to fats conversion occurred) it was the dietary fat to be stored as body fat.

    De Novo Glucogenesis might be an efficient pathway in other animals but not in humans.

    Daniel wrote on April 21st, 2009
    • Hi Daniel.

      I’m sorry, but first could you clarify/confirm the term you’re using.

      I’m not sure if you meant to say Glycogenesis (with a ‘y’) or Glucogenesis. Both of which are real terms, but neither of which mean what you say they do.

      Glycogenesis is the conversion of glucose into glycogen (not fat). Glucogenesis is the reverse: the formation of glucose via the breakdown of glycogen.

      Lipogenesis is the conversion of glucose into fatty acid (and then subsequently into triglycerides). And it is a key component of lipid metabolism.

      I’m not a doctor nor a nutritionist, but I’ve never ever heard anybody suggest that Lipogenesis doesn’t even occur in humans. The body couldn’t store energy effectively without it.

      Justin wrote on May 19th, 2009
      • Thanks for correcting me, I meant De Novo Lipogenesis. Lipogenesis is the convertion of fat to body fat (a very easy process for the body) De Novo Lipogenesis is the convertion of carbs to fats (a very unefficient process in humans)

        The body could store energy efficiently without lipogensis, since it is exceptially good at storing dietary fat.
        If your diet were lacking in dietary fat then indeed de novo lipogenesis would increase to the point that a good amount of sugar could be converted to body fat.

        But take a diet which is both high in fat and both high in carbs/sugar and the first thing to be converted into body fat is fat.

        Take a diet which is low in carbs/sugar and high in fat and still a good amount of that dietary fat will converted to body fat.

        The idea that the huamn body turns sugar into fat before storing dietary fats has body fat is one used by many nutritional gurus but it’s not true nor proved.

        The confusion is caused by looking at animal studies. While de novo lipogenesis is important in animals its contribution to fat deposition in humans is relatively unimportant

        There was a study in 1988 in which they fed a group of subjects 500 grams of carb and measured the convertion of sugars to fat. The researchers found out it was insignifanct and basically not occurring, the only thing being turned to body fat was dietary fat.

        Check this study:

        Am J Clin Nutr 2001 Dec;74(6):707-8

        Daniel wrote on May 19th, 2009
        • Daniel, you are misinterpreting this information and the discussion at hand.

          First, nobody (that I see) is saying that “the huamn body turns sugar into fat before storing dietary fats as body fat.” At all. What is being said is that *excess* glucose will be turned to fat. And that’s a very important distinction that I’ll get to in a moment.

          Second, just to clarify, Lipogenesis is not the conversion of fat to fat. It is the synthesis of fat from acetyl CoA (a molecule which even glucose becomes on the way to being metabolized). Now, during the breakdown of fat for energy it is converted to acetyl CoA. At that point I suppose it could reverse course, and via lipogenesis become fat again (I’m not a doctor, so I don’t know for sure). “De Novo” is a prefix that indicates “anew”. So all that is saying is that it’s a new source—glucose.

          The study you cited and others I looked up do NOT support at all what you’re saying. In fact it seems to support this page’s content. You’re mixing up the significance of fat vs glucose in human digestion. Glucose is the body’s preferred fuel source. It’s what the body first uses from the food you eat each day. Fat on the other hand, is not and is almost always stored. And as your studies have shown, de novo lipogenesis (DNL) does not occur so longs as *carb energy intake remains less than total energy expenditure*.

          In fact the study you mentioned dealt with that very idea. It used two groups: one group was energy neutral (expended as much as they ate) and the other overate by 50%. And guess what? Those nice fit people who overate by 50% had a 2-3 time increase in DNL. But that wasn’t even the focus of the study. The focus was on Obese vs Lean and how that affects the rate. And it does. Obese people who weren’t overeating still had a higher rate of DNL. Perhaps due to resistant cells like Mark is talking about in his guide?

          The point of a lot of these studies, it seems, is to clarify the energy economy in our bodies. They show that fat and carbs are not interchangeable energy sources and they have certain roles. But they also bring to light a very important fact. The body has a pathway by which to turn carbs into fat. But it does *not* have the reverse. No fat to carb pathway.

          I find it rather interesting that the body has evolved to not allow for the creation of excess glucose in the system. Perhaps the body knows it’s detrimental to your health?

          Justin wrote on May 20th, 2009
  22. Daniel –

    Your comment reminds me of a section in Good Calories Bad Calories that didn’t quite make sense (I’m not a scientist). Can you please provide a reference to the study involving the 400 grams of carb stuffing?

    And Mark:
    I’m new to your site and just want to congratulate you on a terrific achievement – I’ll certainly be back for more!

    Regards,
    D

    Donald wrote on April 29th, 2009
  23. Hi there,

    I’ve been fighting a weight problem for the last three years, that I’m convinced was caused by an anti-depressant. No amount of exercise and healthy eating made any difference, although I did stop gaining weight when I came of the meds.

    As I’m also a woman in my mid forties, it certainly doesn’t help. Recently my menopause doc suggested I may be insulin resistant (My mum is type 2 diabetic) and I’ve been looking into insulin resistance more. That led me to looking into the part carbs play on this and I was trying to find out more about the amount of carbs I should be eating when I came across your site.

    This site is so informative I wanted to leave you a message to say thank you for providing such clear information, in real terms, not medical jargon.

    Lorrii

    Lorrii wrote on June 24th, 2009
  24. I’m bewildered. I eat an extremely low protein diet, yet my glucose numbers are always around 98-101. Any thoughts?

    Thanks in advance!

    Jan wrote on July 14th, 2009
  25. I’m bewildered. I eat an extremely low carb, high protein diet and my glucose numbers are always around 98-101. MY A1C is 5.6. I jog at least 1 hr. 6-7 days a week. Any thoughts?

    Many thanks in advance!

    Jan wrote on July 14th, 2009
  26. 1. By “glucose numbers” do you mean fasting?
    2. Why are you jogging so much? Not a part of the primal thing. Start doing high intensity intermittent. Better results with much less time.
    3. Do you “lift heavy things occasionally”? If not, start. This is very important if you’re trying to burn sugar, especially those large muscle groups.
    I used to have blood sugar problems too. Totally solved with primal. You can do it!

    Dave, RN wrote on July 14th, 2009
  27. Yes, I learned today that my last fasting glucose was 101. Last year, it was 88. In the past, always around 98. What disturbs me is that it’s creeping up. My insulin level is well below 10…something like 4.5.

    I’m jogging so much to try and get an extra 10 pounds off that crept up after I began taking Synthroid for an underactive thyroid two years ago. I used to take Armour.

    I do moderate weight lifting (8 lb. free weights, 2 or 3 times a week for approx. 10 minutes. I just happened upon this site and am not familiar with “the primal thing.” Will start reading more.

    Right now, I’m just upset to learn that my glucose level is up to 101. It’s discouraging with all I do to optimize my health. Your support means a lot. Many thanks!

    Jan wrote on July 14th, 2009
    • I have the same problem. Ive only been primal for about 4 months and my blood work came back with fasting glucose at 109. Last Nov it was 87. I eat around 40g carbs a day and exercise (sprint, lift heavy things, walk) every day for around 30 min. I eat no dairy, no grains of any kinds, no sugars, high proteins and fats and minimal veggies/fruits and only drink water. My Doc told me to start “eating a healthy diet, exercising daily, and losing weight.”. I have been primal for 4 months and haven’t lost any weight. And even my blood pressure is high 0_0 How much more “healthy” in my eating can I get? And same for exercising? So frustrated!!

      Becky wrote on September 14th, 2010
      • Probably not good timing in my answer, but I see nobody is mentioning this: for the really insulin resistant people out there, it seems that you need to also restrict protein to a moderate amount. Part of the excess protein is converted to sugar by the liver. Look into “ketogenic diet” and the explanation behind it all.

        Izzy wrote on May 8th, 2013
  28. i think the author should focus on writing articles about running marathons instead, as this seems to be the area of his expertise…

    being a pre-med candiate with a degree in Biology is hardly enough credentials to postulate (without providing any proof) on the inner mechanics of Diabetes.

    Erhan Hosca wrote on August 2nd, 2009
    • @Erhan: an appeal to authority is not a good argument. As for proof, one can never prove a hypothesis, only disprove it. Anyway, Mark is not a lone voice in this, the web is full of papers and studies by scientists who make a convincing case, and as Mark’s work shows, the anecdotal evidence is increasing, and becoming too big to ignore.

      Gary Katch wrote on August 30th, 2009
    • I think the author (Erhan) should focus on writing comments about children’s fantasy books on the Medical Health Industry instead, as this seems to be the area of his expertise…

      I am a Type 2 now insulin dependant precisely because I didn’t have Mark’s info available to me. Instead I worked with Top Endos in Los Angeles, followed the ADAs dietary recommendations and nearly died twice with blood sugars over 800 and 700.

      Erhan, put up your own blog and become part of the solution not part of the problem.

      Andre Chimene wrote on August 21st, 2010
    • I hear you loudly and clearly Erhan:
      It simply amazes me that there is such vehement hatred of and vilanization of carbs. Being inactive is criminal not carbs. I have had type1 diabetes for over 29 yrs. I eat at least 500g carb/day and fight to maintain 139lbs with extremely low body fat. My blood sugars are superb and my insulin doses quite low. My secret is tremendous daily activity. We evolved to be extremely active not to hide from HEALTHY carbs as if they were monsters.

      It really is scary that people today are so greatly afraid of being very active that they point at whole grains and lots of fruits daily as poison. The poison is your lack of MOVEMENT. Wow… laziness…

      freethinkr wrote on February 25th, 2012
    • As the author of the beauty book soon to be released on Kindle about yeast and aging, I feel that yeast, candida, is hidden in the mix;either in its yeast form or its fungal form ,most of us are destined to be yeastie beasties and we do not even know it.

      donna wrote on March 8th, 2012
  29. “If you eat more fuel than your body needs … the body is forced to store this excess.”

    In GCBC (p.300) Taubes argues against this supposition: “Just as we decrease energy expenditure in response to caloric surplus, we will also increase expenditure in response to caloric surplus.” (He also does a good job busting the “thrifty gene” hypothesis, and the “feast or famine” idea.)

    This makes sense to me, as it demonstrates that the body regulates fat deposition; it is not forced to store the extra calories, there is the option of burning them (or even excreting them).

    The real question is why the normal up-regulation of energy does not occur in obese people.

    Gary Katch wrote on August 30th, 2009
  30. I cant belive there exist people like you who care about our health and give us informations for FREe.

    Long life Mark, you are really special man.

    Sorin wrote on August 30th, 2009
  31. This is great. After my mom and two brothers were diagnosed with Type 2 diabetes, I cut out most grains. I soon lost the 10 pounds I’d been struggling with for about 10 years. I finally feel like I’m the weight I should be. I can’t believe I fed my kids so many carbs as they were growing up. Gov’t said to. Shame on them

    Anne Fell wrote on October 28th, 2009
    • Well Anne, usually it pays to always (let me stress this ALWAYS) double-check anything the government tells you. Their interests are usually not congruent with ours (the regular folks).

      You are responsible for yourself and your family. Not the government. Regardless of what the leftist establishment tries to tell you.

      As an individual with free will it is up to you to proofread anything that’s presented to you. (This post of mine included).

      I’d like to think that most folks on this website are here because they like to think for themselves. They like to question and evaluate issues instead of just blindly following someones directives. Especially when it’s from any governmental body.

      So I’d like to applaud you for cleaning the cob webs off of your critical thinking skills! :)

      No offense was meant in typing this post. Mea culpa if I cam across a little too strong…

      lrd wrote on July 18th, 2012
  32. Question: Is there a way to reverse/or to halt the progression to Type II diabetes before you get there? If you’re at pre, initial or type I, can dietary changes help?

    If you’re already at Type II diabetes can dietery changes help?

    William wrote on December 30th, 2009
    • The answer is yes! Change your food and change your epigenetis. Epigenetics is the music your genes play. They either play the music for diabetes or health. What you eat controls the music. Bring your carbs down below 50 grams per day or less, up the beneficial fats, coconut oil, ghee, butter, Sat fats, olive oil, mono fats. Keep your protein adequate…divide your LEAN mass (you without fat) in half. If you are 100 lbs LEAN…then eat 50 grams of protein. Veggies, Beneficial Fats (lots) and some protein. You will reverse the damage by having healthy normal adult blood sugars, fasting 83 and after meals never over 130. That gives you normal insulin, leptin and better than normal health. Go get your health…it is waiting for you.

      Andre Chimene wrote on April 11th, 2013
      • Hi, does anyone know if neropathy can be reversed..My feet have been burning terrible and they put my on Nerotin..I don’t like taking any meds..does anyone know of any natural remedies?…I do control my type 2 diabetes with diet…no meds…very low carbs..Thanks

        Patti wrote on July 11th, 2013
        • I have been diabetic type 2 (insulin dependent for 5 years) and for several months I had increasing numbness/burning in my feet and toes and twitchy/ sometimes sharp little stabs of pain in my lower legs. and I felt like I had to stretch my feet a lot. ( especially in bed- kept me from sleeping.) I read about horse chestnut extract for edema lower extremeties and butchers broom for circulation. I can’t speak for anyone else but my foot /ankle edema is gone and I have had no pain/twitching in my lower legs for a few weeks now. no numbness in toes. my doctor was thrilled.
          maybe that will help you.
          my doctor was very pleased with those results and 12 lb weight loss since 1st of june. and I gave her a copy of primal blueprint and she said she would read it :) she is a md- internal medicine.
          good luck to you

          carol wrote on July 11th, 2013
        • Thank you Carol!! This burning has been horrible..have not been able to sleep.I am going to try these..thanks again!!

          Patti wrote on July 11th, 2013
        • According to Dr, Bernstein, neuropathy can be reversed, but it can take years with normal blood glucose. By normal he means an A1c between 4.2 and 4.6 with a tight average blood glucose of 85 mg/dl.

          Dr Bernstein is now 80 years old and has been living with type I since 1946. In the 70’s he had so many complications that he was not expected to live much longer. That is when he got access to a meter and started ‘eating to his meter’. His book is Diabetes Solutions.

          I was diagnosed last December and am close to meeting his requirements for normal blood glucose. Most of the symptoms that I had at diagnosis, including mild neuropathy (phantom itching on my feet), have either gone or are going.

          OldTech wrote on August 5th, 2014
  33. Question:

    The article was very informative, and sounds like very sound information. My question is that whenever I decrease my sugars too low, my bloodsugar goes up! I theorize that my Liver is somehow sensing that it’s not receiving no sugars, and pumps it into my bloodstream!

    Or if I exercise without eating enough carbs before, my sugars GOES UP!!! That’s even if my sugars are high before I start. Can anyone help with this delima????

    rose wrote on January 17th, 2010
    • Yes. You are burning sugar for fuel and not ketones. Thru metabolic momentum, you body wants to do what it has done. Up the beneficial fat, Ghee, coconut oil, grass fed butter, monos and Sat fats, cold water fatty fish, bring your carbs below 50 to kick you into ketosis. Now your body prefers to burn ketones (fats) instead of sugar. This will also calm your brain and moods down so you reduce the adrenaline output. Less chance to punch your liver into releasing stored sugars.

      Andre Chimene wrote on April 11th, 2013
  34. I thank the internet Gods for directing me to Mark’s website, especially this article. My fasting glucose is 97 and very alarmed with it. I’m trying to get pregnant but with no success for more than a year now and my ob-gyn said, it could be because of insulin resistance.

    I’m physically active, working out 45mins, 6 days/week and have totally cut out wheat/gluten, sugar, caffeine, processed food in my diet since Jan 2009. We have the diabetic genetic factor, however. I’m going for Primal living because all I’ve read here makes a lot of sense.

    Grace wrote on January 27th, 2010
  35. Dearest Mark,

    I really need your help. My mom is type 2 diabetic. She does not take care of herself! She gets sicker each day as well has a very hard time walking because her feet are so bad. Here is the problem, she drinks coffee all day long with 4 sugar in each cup. She is always eating something with chocolate. I have told her a thousand times it is killing her but i always get ” Stop harping on me. who is the mom here” she does not listen to me about how serious her surgar intake can be on her body. Please I need you to tell her in terms she can understand because she does not understand docters terms how serious her diet is. I almost need someone to scare the heck out of her to make her understand!! I love my mom with all my heart and soul and it is killing me to see her so sick when there is something she can do about it!!! Please help!!!!!!!!!!!!

    cheryl wrote on February 4th, 2010
  36. Cheryl, I’m sorry, but there’s not much I can do from where I sit. Health is about personal responsibility, and until your mom is willing to learn and make adjustments, all you can really do is lead by example, show her (and tell her) you love her and offer your support when she is ready.

    Mark Sisson wrote on February 5th, 2010
  37. i still cant understand the sugar readings everybody seems to talk 90 to 100 my accu check readind says 6.9 or 11 . or 15.5 what is correct ???????

    bernard browne wrote on March 5th, 2010
    • Bernard, to convert blood sugar from mmol/l to mg/dl multiply by 18.

      My girlfriend is diabetic and I’ve taken a some readings using her meter. I am trying to follow a low carb diet but my fasting blood sugar is around 115 but this drops to around 85 1 hour after a low carb breakfast.

      Should I be worried ? Has anyone got any ideas on reducing my fasting blood sugar? Incidentally my triglycerides are also high.

      james wrote on March 19th, 2010
  38. Wow, thank you thank you thank you for the most concise, readable, and comprehensible guide to how the whole carb/insulin thing works. It’s worth passing on to the universe.

    Robin wrote on March 26th, 2010
  39. All of you people with diabetes should check out knowthecause.com I got rid of my diabetes by taking anti-fungals and staying on Doug’s diet.

    Sheila Coon wrote on April 16th, 2010
  40. Men with type II diabetes would do well-in addition to diet change, of course!- to verify that their testosterone levels are at or near optimal ranges-not normal, optimal. If you just google ‘low testosterone diabetes’, you’ll find all manner of articles-from LEF.org, to CBS. Well-publicized link.

    Another thing to look at is cancer markers. I lost my father to cancer three years ago; He was a normal, healthy man (albeit with undiagnosed AI and celiac)with normal testosterone levels…yet by the time he was actually diagnosed with cancer, it was stage IV. Had they done a full cancer marker workup with the tests that are currently available when he was diagnosed with ‘idiopathic NIDDM’ (current meaning 2006) he might still be alive. Cancer cells have as many as 40 times the insulin receptors as normal cells, and can cause type II diabetes through that mechanism. It isn’t quite type II, but as there is no other ‘type’, that’s what it’s referred to. Dad was very active, not overweight, well-muscled, and ate a good-by these standards, even-diet. Obviously, his immune system wasn’t up to snuff, but on the outside, he wasn’t a diabetic type.

    You’ll probably have to really push for it, but the alternative is much worse.

    Laurel wrote on April 27th, 2010

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