June
2007
The Definitive Guide to Insulin, Blood Sugar & Type 2 Diabetes (and you’ll understand it)
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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 aerobic 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.
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 from Type 2 to Type 1 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:
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Technorati Tags: evolution, DNA, blood sugar, type 2, diabetes, insulin, sugar
[...] West Nile Virus Link to Article diabetes The Definitive Guide to Insulin, Blood Sugar & Type 2 Diabetes (and you’ll understand it) » Posted at Mark’s Daily Apple on Wednesday, June 27, 2007 BITE ME, ADA We all know by now that type 2 diabetes is an epidemic … rates have been cut in half since the staggering margarine days of the 1980s, but diabetes … . Here’s my ultra-simple explanation of the entire insulin/blood sugar/type 2 diabetes mess. Big Agra View Entire Article » [...]
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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
“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.
[...] The Definitive Guide to Insulin, Blood Sugar and Type 2 Diabetes [...]
Excellent breakdown of the insulin mechanism and very easily understandable. Thanks very much!
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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.
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Great information. Pls check out my page too about kids dealing with diabetes.
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
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,
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.
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.
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,
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
[...] Bulletin Board software! I cannot find it - but here is a concise explanation that I found instead: Mark’s Daily Apple » Blog Archive » The Definitive Guide to Insulin, Blood Sugar & Type 2… __________________ Mike LL started Jan 10th 2008 Please contribute to my "create a VLCD [...]
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,
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.
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.
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
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, 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
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Awesome article. Thank you for helping people (like me!) understand.
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