Insulin – Best Way To Reverse Diabetes – Reverse Diabetes MD

You stop insulin on a low-carb diet in steps, with your doctor running the doses. The 2026 guideline from the Society of Metabolic Health Practitioners says the insulin dose comes down the same day the carbs come down. Many adults with type 2 diabetes can then stop once they need less than 10 units a day.

Here is the part most people miss. The danger is not the diet. The danger is the old dose meeting the new plate. Your insulin dose was set for the food you used to eat. Cut the bread, rice and soda, and that same dose now has far less sugar to cover. Blood sugar can fall too far, and it can fall fast.

I know how hard it is to drop a habit you were trained to defend. For years I was a strict vegetarian who taught the official high-carb plate. A bite of beef at Gates Bar-B-Q in Kansas City started to undo that. What replaced it is simple: the plate sets the dose. Change the plate, and the dose has to change with it.

Why does insulin have to drop on the first day?

When carbs fall, your body needs less insulin right away. The guideline says it plainly: when a patient on insulin starts a low-carb diet, doses are generally cut at once to prevent low blood sugar.

Its medication table gives a starting point. Insulin is cut by half on day one. Mealtime insulin is stopped if the person starts a very-low-carb diet. From there the dose is adjusted up or down until blood sugar is steady.

Timing matters most at the start. In the guideline’s words, “The first 2–3 days, when metabolic shifts are large, carry the greatest risk of severe lows.” That is the window when we watch closest and talk most often.

These are the doctor’s moves, not yours. Never change an insulin dose on your own. That goes for every glucose-lowering drug and every blood-pressure pill too.

What do I check at home while the dose comes down?

The guideline asks for two readings every day. Check your blood pressure daily. Check your blood sugar daily, and take some readings one to two hours after a meal.

Why blood pressure? As insulin falls, your kidneys let go of extra salt and water. That lowers blood pressure, sometimes enough that a pill which was right last month is now too strong. Write every number down. A log of real readings is what lets your doctor lower a dose with confidence instead of guessing.

What happens to my other diabetes pills?

Insulin is not the only drug that can push sugar too low. The guideline’s table sorts the common ones:

Sulfonylureas and meglitinides: stopped right away, because they can drive blood sugar too low once carbs fall.
SGLT2 inhibitors: stopped or used with caution. Their effect can last up to a week, and ketone checks have a real use here.
Thiazolidinediones: usually stopped.
Metformin, DPP-4 inhibitors and GLP-1 drugs: listed as safe to keep.
Blood-pressure drugs: reviewed at the start, then every two to four weeks, using your home log.

Read that list as a map of the talk you will have with us, not as a to-do list.

When can I stop insulin completely?

The guideline gives a clear line. Adults with type 2 diabetes whose blood sugar is stable can often stop insulin once their dose is under 10 units a day.

There is one check first. A blood test called C-peptide shows how much insulin your own pancreas still makes. If that number is healthy, your body can carry the load. If it is low, stopping insulin is not safe, no matter how good your diet is.

What if my type 2 diabetes is really something else?

Some people told they have type 2 diabetes are really short on insulin. This can be type 1 that showed up late in adult life, often called LADA. Stopping insulin in that case is dangerous. The guideline lists the warning signs to rule out before any insulin comes off:

You were young when you were diagnosed.
You needed insulin within five years of diagnosis.
You still needed insulin after major weight loss or weight-loss surgery.
Your blood sugar swings widely from reading to reading.
You were not overweight when diagnosed. The weight cutoffs are lower for people of Asian descent.
Your triglycerides are normal and your HDL is high.
You or your family have an autoimmune disease.
You have had diabetic ketoacidosis (DKA).
You have had pancreatitis or pancreas surgery.

If any of these fit, tell us. That is when C-peptide stops being a box to check and becomes the deciding test.

What do I eat while insulin comes down?

The guideline defines low-carb as less than 130 grams of carbohydrate a day. Protein is set first, about 25 to 30 grams per meal. The base is meat, fish, eggs, full-fat dairy and vegetables that grow above the ground. Bread, pasta, rice, cereal and sugary fruit come off the plate. Fat is eaten until you are full, and counting calories is generally not needed.

Our own position goes further. In a population that is already metabolically sick, refined grains and industrial seed oils do harm. Red meat and fish are good food for our patients. Real olive oil is fine. Butter and tallow, both named in the guideline, are fine too.

We also measure more than A1C. A fasting insulin above 10 µIU/mL is high risk in our clinic. LP-IR tends to rise before A1C does. A GGT above 20 U/L is our early signal of a fatty liver. These are the practice’s markers, not the guideline’s.

Why is this so hard to do alone?

High insulin keeps fat locked in storage and keeps hunger loud. Insulin resistance then asks for more insulin, and the loop feeds itself. The guideline lists fewer cravings and less appetite among the benefits of cutting carbs, which is how the loop starts to break.

The food around you pushes the other way. A cheap plate of rice, bread and soda is easy to buy on every corner. The insulin to cover it is billed every month for years. That is why we coach the family, not just the patient. A kitchen that changes together is a kitchen that stays changed.

One honest note on the guideline itself. It is an expert consensus, not a clinical trial. Twenty-six people voted on its 18 statements, and its first author is a paid consultant to the society. Its insulin advice matches what we see in practice, and we use it that way.

What should I do next?

Do not start by cutting insulin. Start by getting a plan. Bring your meter, your pill bottles and your last lab results to a visit. We will check C-peptide, set your day-one doses, and give you a log to fill in. Then we lower the dose as your numbers earn it. To learn why extra insulin feeds the problem in the first place, read our page on insulin for type 2 diabetes.

Waiting costs you more years on a drug that keeps the loop running. Acting in steps protects you from the one real danger, a low you did not see coming. When you are ready, book a visit.

Frequently asked questions

Do I need a continuous glucose monitor?

Not to do this safely. The guideline cites a study that found a continuous monitor worked no better than finger-stick checks. A plain meter and a written log are enough, so cost does not have to stand in the way.

Will a low-carb diet give me ketoacidosis?

The ketosis from eating low-carb is a normal state. It also happens after an overnight fast. It is not diabetic ketoacidosis, and the levels do not come close. People who take SGLT2 inhibitor drugs are the exception that needs care, which is why the guideline gives ketone checks a real use for them.

How can I naturally control insulin resistance?

Lower the thing that drives insulin up: carbohydrate. The guideline credits low-carb eating with better blood sugar even without major weight loss, and with possible remission of prediabetes and type 2 diabetes. Learn more on our page about what insulin resistance is.

Sources

Rice SM, Buchanan LA, Calkins MW, Cucuzzella MT, Cywes R, Devine PL, Kalamian M, Kalayjian T, Reynolds DB, Westman EC. A Delphi consensus-based guideline for the implementation of therapeutic carbohydrate reduction in metabolic disorders. Journal of Metabolic Health. 2026;9(1):a152. doi:10.4102/jmh.v9i1.152

Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP
Interventional pain physician, addiction medicine specialist and obesity medicine diplomate.
Licensed in Missouri and Illinois.
Last reviewed October 4, 2026

Sugar is bad for your health because it drives insulin resistance, weight gain and inflammation. These raise your risk of type 2 diabetes, heart disease, kidney disease and gout. Sugar also spikes and crashes your blood sugar. That drains your energy, feeds cravings and crowds out essential nutrients.

Chances are you already know that eating too much sugar isn’t good for you. Yet you’re probably still overdoing it. Sugary drinks, candy, baked goods, and sweetened dairy are the main sources of added sugar. Added sugars can be hard to spot on nutrition labels. That is because they can be listed under a number of names, such as corn syrup, agave nectar, palm sugar, cane juice, or sucrose. No matter the name, sugar is sugar, and it can negatively affect your body in many ways. Here’s a closer look at how sugar can affect your health negatively.

What are the negative effects of sugar?

How much sugar a person should eat varies, depending on their sex and age. Sugar appears in our food in many forms, including sucrose, lactose, and fructose. Sweet as it is, it sometimes has a negative impact on our health. Let’s look at some of these:

Can cause weight gain: Rates of obesity are rising worldwide. Added sugar, especially from sugar-sweetened drinks, is thought to be one of the main culprits. Sugar-sweetened drinks like sodas, juices and sweet teas are loaded with fructose, a type of simple sugar.
Can drain your energy: Your glucose levels spike and plummet. Because of this, the unstable blood sugar can leave you with mood swings, fatigue, and headaches. It also contributes to cravings, which begin the cycle of false hunger. By contrast, those who avoid sugar report fewer cravings and feel more emotionally balanced and energized.
Sugar affects cognition in children: Let’s not forget about our little ones! New York City public schools reduced the amount of sugar in their lunches and breakfasts. When they did, their academic ranking increased by 15.7% (before that, the greatest improvement ever seen had been 1.7%). The study also removed artificial colors, synthetic flavoring, and two preservatives, showing the importance of natural ingredients for children.
Increases Your Risk of Type 2 Diabetes: There is a clear link between eating too much sugar and diabetes risk. Obesity, which is often caused by eating too much sugar, is considered the strongest risk factor for diabetes. Also, prolonged high-sugar eating drives resistance to insulin. Insulin is a hormone made by the pancreas that regulates blood sugar levels. Insulin resistance causes blood sugar levels to rise and strongly increases your risk of diabetes.
Your immune function can be affected by sugar: As if being sick wasn’t bad enough, studies have shown that sugar can interfere with the way your body fights disease. Bacteria and yeast feed on sugar. So excess glucose in the body causes these organisms to build up and cause infections.
A high-sugar diet can lead to chromium deficiency: Chromium is a trace mineral that helps regulate blood sugar in the body. It can be found in meats, seafood, and plant foods. Yet 90% of Americans still don’t get enough chromium because of refining processes. Other carbohydrates can also rob foods of their chromium supplies. So limiting your carbs is your best bet for increasing those mineral levels.
Sugar accelerates aging: You probably know that sugars can affect your body composition. But they can also mess with your skin by contributing to wrinkles and sagging. After sugar hits your bloodstream, it attaches to proteins. The mix of these proteins with sugar causes the skin to lose elasticity and leads to premature aging.
Sugar causes tooth decay: With all of sugar’s other life-threatening effects, we sometimes forget the most basic cosmetic damage it does. When sugar sits on your teeth, it causes decay more efficiently than any other food. It’s important to brush your teeth at least twice a day to stop sugars from fueling plaque and bacteria.
Sugar can cause gum disease, which can lead to heart disease: Increasing evidence shows that chronic infections, like those that result from dental problems, play a role in the development of heart disease. The connection is believed to stem from the body’s inflammatory response to infection. Luckily, this works both ways. A healthy lifestyle will decrease your risk of common illnesses. That reduces the chance that they’ll become a more serious condition later on.
Sugar takes the place of important nutrients: According to USDA data, people who consume the most sugar have the lowest intakes of essential nutrients, especially vitamins A, C, B-12, and calcium. This is because the body needs these vitamins to process the sugar. The body uses up its reserves, and so “negative calories” and loss of vitamins occur. The trade-off is especially dangerous for children and teens. That is because they consume the most sugar and need the most nutrients at the same time.
May Increase Your Risk of Heart Disease: High-sugar diets have been associated with an increased risk of many diseases, including heart disease. Heart disease is the number one cause of death worldwide. Evidence suggests that high-sugar diets can lead to obesity, inflammation and high triglyceride, blood sugar, and blood pressure levels. These are all risk factors for heart disease. Also, consuming too much sugar, especially from sugar-sweetened drinks, has been linked to atherosclerosis. Atherosclerosis is a disease marked by fatty, artery-clogging deposits.
Can cause acne: Foods with a high glycemic index, such as processed sweets, raise your blood sugar faster than foods with a lower glycemic index. Sugary foods quickly spike blood sugar and insulin levels. This causes increased androgen secretion, oil production, and inflammation, all of which play a role in acne development.
May Increase Your Risk of Cancer: Eating excessive amounts of sugar may increase your risk of developing certain cancers. First, a diet rich in sugary foods and drinks can lead to obesity, which significantly raises your risk of cancer. Also, diets high in sugar increase inflammation in your body and may cause insulin resistance. Both of these increase cancer risk.
Can Accelerate the Skin Aging Process: Wrinkles are a natural sign of aging. They appear eventually, regardless of your health. However, poor food choices can worsen wrinkles and speed the skin aging process.
Increase kidney disease risk: Blood sugar levels that are consistently high can damage the delicate blood vessels in your kidneys. This can lead to an increased risk of kidney disease.
Increase the risk of developing gout: Gout is an inflammatory condition marked by pain in the joints. Added sugars raise uric acid levels in the blood. This increases the risk of developing or worsening gout.
Accelerate cognitive decline: High-sugar diets can lead to impaired memory. They have also been linked to an increased risk of dementia.

How can you reduce your sugar intake?

Eating small amounts now and then is perfectly healthy. But excessive added sugar has many negative health effects, so you should try to cut back on sugar whenever possible. Simply focusing on eating whole, unprocessed foods automatically lowers the amount of sugar in your diet, which has huge gains.

What are easy swaps to cut added sugar?

Swap sodas, energy drinks, juices and sweetened teas for water or unsweetened seltzer.
Drink your coffee black or use Stevia for a zero-calorie, natural sweetener.
Sweeten plain yogurt with fresh or frozen berries instead of buying flavored, sugar-loaded yogurt.
Consume whole fruits instead of sugar-sweetened fruit smoothies.
Replace candy with a homemade trail mix of fruit, nuts and a few dark chocolate chips.
Use real olive oil and vinegar in place of sweet salad dressings like honey mustard.
Choose marinades, nut butter, ketchup and marinara sauce with zero added sugars.
Skip cereals, granolas and granola bars. Most are refined grains with added sugar.
Swap your morning cereal for eggs, or an omelet made with fresh greens.
Instead of a jelly sandwich, spread peanut butter on apple or banana slices.
Use natural nut butter in place of sweet spreads like Nutella.
Avoid alcoholic beverages that are sweetened with soda, juice, honey, sugar or agave.
Shop the perimeter of the grocery store, focusing on fresh, whole ingredients.
Eating fruit can help ensure a person gets enough fiber, vitamins, and minerals. However, many fruits are high in natural sugars. They may not suit those looking to lower their sugar intake. Some low-sugar fruits include strawberries, peaches, blackberries, lemons, limes, honeydew melon, oranges, and grapefruit.

Is it better to never eat sugar?

Sugar is not unhealthful in itself. However, having excess sugar in the diet can cause a range of conditions, including heart disease, weight gain, and diabetes. To be aware of added sugars in food products, it is important to read labels carefully. Also, eliminating sugar from the diet can help prevent weight gain, diabetes, heart disease, and other problems. For these reasons, keep added sugar to a minimum whenever possible. That is easy when you follow a healthy diet based on whole foods. If you need to cut added sugar from your diet, try some of the small changes listed above. You will slowly realize that you don’t need as much sugar as you once did.

Frequently asked questions

What are signs of too much sugar?

When blood sugar spikes and then plummets, the swing shows up as mood swings, fatigue, headaches and cravings that start a cycle of false hunger. Over time, a high-sugar diet shows on the outside too. Signs include acne from the insulin and androgen surge, tooth decay and gum disease, and skin that loses elasticity and wrinkles early. Steady weight gain, especially from sweet drinks, is another sign.

What will happen if I cut sugar out of my diet?

People who avoid sugar report fewer cravings and feel more emotionally balanced and energized. That is because their blood sugar stops swinging up and down. Cutting added sugar also helps prevent weight gain, type 2 diabetes and heart disease. Start with the small swaps above, such as water instead of soda and berries instead of flavored yogurt. You will slowly realize you don’t need as much sugar as you once did.

What kills the urge for sugar?

Cutting back is what quiets the urge. Sugar spikes and crashes your blood sugar, and each crash sets off cravings and false hunger. People who avoid sugar report fewer cravings. Build meals from whole, unprocessed foods. Drink your coffee black or sweeten it with stevia. And keep a homemade trail mix of fruit, nuts and a few dark chocolate chips on hand instead of candy.

Is the natural sugar in fruit bad for you?

Whole fruit is not the problem that added sugar is. Eating fruit helps you get enough fiber, vitamins and minerals, so choose whole fruit over sugar-sweetened smoothies. Many fruits are still high in natural sugar. So if you are lowering your sugar intake, lean on low-sugar choices such as strawberries, blackberries, peaches, lemons, limes, honeydew melon, oranges and grapefruit.

Related reading

References

Healthline (2018): 11 Reasons Why Too Much Sugar Is Bad for You. Retrieved from https://www.healthline.com/nutrition/too-much-sugar#section2
Atkins (2019): 10 Reasons Why Sugar Is Bad for Your Health. Retrieved from https://www.atkins.com/how-it-works/library/articles/10-ways-sugar-harms-your-health
WebMD: How Does Too Much Sugar Affect Your Body? Retrieved from https://www.webmd.com/diabetes/features/how-sugar-affects-your-body
Medical News Today (2019): 5 reasons why sugar is bad for you. Retrieved from https://www.medicalnewstoday.com/articles/324854.php

Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP
Interventional pain physician, addiction medicine specialist and obesity medicine diplomate.
Licensed in Missouri and Illinois.
Last reviewed June 18, 2026

Insulin resistance is when your cells stop responding to insulin. So sugar builds up in the bloodstream, and the pancreas pumps out even more insulin to make up for it. It is the main cause of type 2 diabetes. Weight loss, dietary change and exercise reduce it.

Insulin is a vital hormone that controls how much sugar is in our bodies. In a nutshell, it pulls extra glucose out of the blood through a process known as glycogenesis.

However, problems with insulin are at the heart of many medical conditions. Insulin resistance occurs when your cells stop responding to insulin. This means insulin cannot do its job, so sugar builds up in the bloodstream. About 100 million Americans are affected by insulin resistance. Luckily, changes in diet and lifestyle can dramatically improve it.

This article explains all you need to know about insulin and insulin resistance.

What Is Insulin?

Insulin is a hormone made by beta cells in the pancreas. Its main job is to control how much glucose moves through your bloodstream. But it also affects fat and protein metabolism (how your body uses fat and protein). When you eat a slice of bread, which definitely contains carbs, the sugar in your blood goes up. So the beta cells in your pancreas are prompted to make insulin. The insulin is released into your bloodstream. There it takes the sugar and stores it in cells. This lowers blood sugar.

However, cells sometimes become less sensitive to insulin. When this happens, sugar begins to build up in the bloodstream. Your pancreas makes even more insulin to lower the blood sugar levels. This leads to high insulin levels in your blood, which is called hyperinsulinemia.

Diabetes type 2 occurs when your cells become more and more resistant to insulin. As a result, both insulin and blood sugar levels rise. If this goes on for long, your beta cells may become damaged. That leads to less insulin being made.

Insulin resistance is the main cause of type 2 diabetes.

What About Insulin Sensitivity?

Insulin sensitivity is the opposite of insulin resistance. If you have insulin resistance, you also have low insulin sensitivity. Insulin resistance harms your health. Insulin sensitivity is good for it.

What Causes Insulin Resistance?

Insulin resistance is caused by many factors.

A number of studies have shown that high amounts of free fatty acids in your blood can cause insulin resistance. This is caused by eating too many calories. Being overweight or obese is also linked to insulin resistance. Visceral fat (the fat packed around your organs) mostly builds up around your waist. It can release free fatty acids into your blood and trigger inflammation. However, even people with moderate weight can develop insulin resistance, possibly due to genetic predisposition (traits they were born with).

Other possible causes of insulin resistance include:

High sugar diet. Artificial sugars have been linked to inflammation and insulin resistance.
Inactivity. Regular exercise can reduce insulin resistance because it helps you lose weight.
Gut microbiota. Upsetting the mix of bacteria in your gut can cause inflammation and insulin resistance.
Genetic factors: African American, Hispanic, and Asian peoples are at higher risk for insulin resistance.

What Are The Complications Of Insulin Resistance?

Insulin resistance is the precursor (the early stage that comes before) for diabetes type 2 and metabolic syndrome. Metabolic syndrome is a group of risk factors associated with type 2 diabetes and heart disease.

By the time a person is diagnosed with type 2 diabetes, they are likely to have developed chronic (long-lasting) insulin resistance. It is estimated that by then, 50% of the cells that make insulin may have stopped working. So the person is not only resistant to insulin. They also cannot make enough of it.

Insulin resistance is also strongly associated with heart disease, which is the leading cause of death in the US.

Other diseases linked to insulin resistance include:

Non-alcoholic fatty liver disease (NAFLD)
Cancer
Polycystic ovarian syndrome (PCOS)
Alzheimer’s disease

How To Reduce Insulin Resistance

Weight loss is one of the most effective ways to reduce insulin resistance. Drastic changes in diet are also needed, so you eat more of the good foods and less of the harmful ones. Exercise also helps you shed extra weight and stay healthy. Lastly, dropping harmful habits such as smoking and heavy drinking also plays a significant role.

Get regular exercise, such as brisk walking or jogging, for 30 minutes each day.
Lose belly fat
Stop smoking
Eat less artificial sugar, such as from artificially sweetened drinks
Eat more omega-3 fatty acids

For more on how diet changes improve insulin sensitivity, read our article on foods that improve insulin sensitivity.

The bottom line

Insulin resistance is behind a number of chronic health problems. Often it can go unnoticed for years without causing alarm. When insulin resistance is not caught early enough, it is likely to wreck a person’s health. Luckily, a number of things can be done to prevent insulin resistance or stop it from getting worse. If insulin resistance can be prevented, we will definitely have millions of people living healthier, fuller lives that are free of disease.

Related reading

References

1. NCBI (2005): Dose-response effect of elevated plasma free fatty acid on insulin signaling. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/15919784

2. CDC (2017): New CDC report: More than 100 million Americans have diabetes or prediabetes. Retrieved from https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html

3. NCBI (2005): Dose-response effect of elevated plasma free fatty acid on insulin signaling. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/15919784

4. NCBI (2013): The Role of Gut Microbiota on Insulin Resistance. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705322/

Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP
Interventional pain physician, addiction medicine specialist and obesity medicine diplomate.
Licensed in Missouri and Illinois.
Last reviewed June 18, 2026

Refined grains drive insulin resistance and type 2 diabetes. Stripped of bran and germ, flour digests into fast starch. That spikes blood sugar and forces the pancreas to pump out insulin. It also fuels overeating and stokes inflammation.

Flour is hard to avoid at meal times. Breakfast is mostly toast, bagels, cereal, and pancakes. A handy lunch is sandwiches, wraps, pasta or pizza. Dinner might bring its own temptations too. As a result, the average American now eats 10 servings of refined grains each day. What do these refined grains do to your health? Does eating refined grains set you up for type 2 diabetes? In this article, we look at factors that could put you at risk.

What Is the Difference Between Whole Grains and Refined Grains?

While whole grains are very high in dietary fiber, refined grains are much lower in fiber and micronutrients.

Whole grains consist of three main parts:

Bran: The hard outer layer, containing fiber and minerals.
Germ: The nutrient-rich core, containing carbs, fat, protein, vitamins, minerals, antioxidants and plant compounds.
Endosperm: The middle layer, containing mostly carbs and small amounts of protein.

The bran and germ are the most nutritious parts of whole grains. They hold large amounts of many nutrients, such as fiber, B vitamins, iron, magnesium, phosphorus, manganese, and selenium.

Refining removes the bran and germ, along with all the nutrients they hold. Taking out those nutrients has effects. On the upside, it makes things like bread doughy and spongy — textures we like and have come to crave. On the downside, the food’s nutritional value is severely reduced. These stripped grain products actually drain our body’s stores of important vitamins and minerals.

The nutrient content of refined flour depends on the ‘extraction rate’ (the share of the grain kept after milling). Refined flour made in Australia is milled to an extraction rate of 78-80%. That gives it more nutrients (before fortification) than flour from countries that use a lower extraction rate (e.g. 73-75% in the USA).

This leaves almost no fiber, vitamins or minerals in the refined grains. What’s left is fast-digesting starch with small amounts of protein.

Why are refined grains bad for you?

Blood sugar spikes: Because flour is easy to digest, it makes our blood sugar spike, which could lead to a rise in insulin. The pancreas has to crank out a lot of insulin to process the glucose in flour-rich foods. That can set the body up for insulin resistance, diabetes, and bodywide inflammation. Refined grains have a higher glycemic index, which measures how quickly the body turns food into fuel, or glucose. A carbohydrate in wheat, called amylopectin A, turns into blood sugar more easily than most other carbohydrates. Two slices of bread made with whole-wheat flour could raise blood sugar higher than six teaspoons of table sugar. They could also raise it higher than many candy bars.

Overeating and Obesity: Obesity is the leading factor in insulin resistance, type 2 diabetes, and other chronic diseases. Eating too many refined carbs may be one of the main culprits. They are low in fiber and digest quickly, so eating them can cause major swings in blood sugar levels. This can contribute to overeating.
As we said above, foods high on the glycemic index keep you full only a short time, about one hour. Foods low on the glycemic index keep you full longer, about two to three hours. Blood sugar levels drop about an hour or two after a meal high in refined carbs. This drives hunger. It also fires up parts of the brain associated with reward and craving.
These signals make you crave more food, and they are known to cause overeating. This constant eating leads to obesity, a pre-diabetic state, and finally diabetes.
Slower Metabolism: Research shows that the body may shift nutrients into fat storage and away from muscle burning when it gets high-glycemic-index foods. In 2004, Ludwig and his colleagues at Harvard ran a study, published in the journal Lancet. They fed rats diets with identical nutrients, except for the type of starch. By the end of the study, rats in both groups weighed roughly the same. But those eating a high-glycemic diet had 71 percent more fat than the low-glycemic-index group.
Inflammation: A diet high in grains stokes inflammation. When blood sugar spikes, glucose builds up in the blood. As glucose drifts in the blood, it could attach itself to nearby proteins. The result is a chemical reaction called glycation. Glycation is a pro-inflammatory process that plays a role in a host of inflammatory diseases — everything from Type 2 diabetes to arthritis to heart disease.
GI Disorders: Studies show that the lectins in grains inflame the lining of the gut and create cracks between cells. Also, when whole-kernel grains are refined, 80 percent of the fiber is lost, and gut health suffers. Without the fiber, these grains become fast-release carbs, which is bad for the gut. Fiber helps sweep debris out of the gut. It supports the body’s vital elimination and detox processes. Those processes also help keep high cholesterol and inflammation in check.
Food Allergies/Intolerances: Wheat, in particular, is one of the biggest food triggers of allergies and intolerances. The exact reason is unclear, but many experts blame the higher gluten content of modern wheat. Gluten is a type of protein found in many grains, including wheat. It gives dough its stretch, trapping air bubbles and creating a soft texture. Because soft is seen as desirable, wheat today is bred to have more gluten than ever before.
Acid-Alkaline Imbalance: The body has a detailed system of checks and balances to keep its pH level at a steady 7.4. A diet high in acidic foods, such as grains, forces the body to pull calcium from the bones to keep things balanced. Researchers looked at how the diets of more than 500 women affected their bone density. They found that a diet high in refined grains, among other nutrient-poor foods, was linked to bone loss. A highly acidic diet also wears away at our cells’ health and our immunity in ways that can leave us open to chronic disease. Grains are the only plant foods that create acidic byproducts. Wheat, in particular, is among the most potent sources of sulfuric acid. Sulfuric acid is a powerful substance that quickly overwhelms the neutralizing effects of alkaline bases.

What are the healthiest grains to eat?

Whole grains keep more fiber, vitamins and minerals than refined grains. But they are still starch, and wheat, barley and rye still carry gluten and gliadin. In chronic pain, gluten and gliadin drive a leaky gut and autoimmune trouble. Here are a few steps to cut back on grains:

While baking, replace the flour with nut or seed meals.
Don’t overdose on gluten-free foods.
Try going flour-free.
Consider a grain sabbatical.

Do refined grains cause insulin resistance and type 2 diabetes?

When ground into flours, most grains act like sugar in the body. They trigger weight gain, inflammation, and blood-sugar imbalances. Studies show that high intake of refined carbs is linked with insulin resistance and high blood sugar levels. These are some of the main symptoms of type 2 diabetes.

Refined carbs also raise blood triglyceride (blood fat) levels. This is a risk factor for both heart disease and type 2 diabetes. So we recommend no refined grains for our patients.

Frequently asked questions

What are examples of refined grains?

Anything made from refined flour. That covers most of the American menu: toast, bagels, cereal and pancakes at breakfast, then sandwiches, wraps, pasta and pizza later in the day. Refining strips out the bran and germ and leaves the starchy middle layer. The average American now eats 10 servings of refined grains every day.

What are the health effects of refined grains?

Refined flour digests fast, so blood sugar spikes and the pancreas has to pump out extra insulin. That sets the body up for insulin resistance and type 2 diabetes. The drop in blood sugar an hour or two later drives hunger and overeating. Refined grains also stoke inflammation through glycation. They strip away the fiber your gut needs and raise blood triglycerides.

Which grains are not refined?

Whole-kernel grains that keep all three parts: the bran, the germ and the endosperm. Sprouted grains and truly whole-grain flours also count. Whole grains are still starch, and wheat, barley and rye still carry gluten, so we do not build meals around them. When you bake, replace the flour with nut or seed meals. Or go flour-free and take a grain sabbatical.

Related reading

References

Grains & legumes Nutrition Council (2019): Refined grains. Retrieved from https://www.glnc.org.au/grains/grains-and-nutrition/refined-grains/

NCBI (2002): Effect of whole grains on insulin sensitivity in overweight hyperinsulinemic adults. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/11976158

Popsugar (2019): 4 Reasons to Eat Whole Grains Instead of Refined. Retrieved from https://www.popsugar.com/fitness/Why-You-Should-Eat-Whole-Grains-Instead-Refined-18361716

Healthline (2017): Why Refined Carbs Are Bad For You. Retrieved from https://www.healthline.com/nutrition/why-refined-carbs-are-bad

Experience Life (2019): The Truth about Refined Grains. Retrieved from https://experiencelife.com/article/the-truth-about-refined-grains/

Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP
Interventional pain physician, addiction medicine specialist and obesity medicine diplomate.
Licensed in Missouri and Illinois.
Last reviewed June 18, 2026

Metabolic inflammation causes insulin resistance by jamming insulin’s signal. Over-nutrition packs fat into fat cells. That fat drives inflammatory cytokines (immune signal proteins). Then muscle, fat and liver cells start ignoring insulin. The pancreas overworks until its beta cells wear out, and prediabetes or type 2 diabetes follows.

In past articles, I have talked about the role of metabolic inflammation in obesity and diabetes. Today we zoom in on insulin resistance. What is it? What does it do? And how does metabolic inflammation raise the chances that one gets it?

What is Insulin resistance?

About 30% of Americans, and up to 50% of those 60 and over, have a silent blood sugar problem called insulin resistance. Insulin resistance raises the risk for prediabetes, Type 2 diabetes and a host of other serious health problems. These include heart attacks, strokes, and cancer.

So what is Insulin Resistance? It is when cells in your muscles, body fat and liver start pushing back on or ignoring insulin’s signal. That signal tells cells to take glucose from the blood to burn or store. Glucose, often called blood sugar, is the body’s main fuel.

How does Insulin Resistance Develop?

Some factors that shape insulin resistance are aging and ethnicity. But the driving forces seem to be excess body weight, too much belly fat, a lack of exercise, smoking, and even lack of sleep.

Over time, as insulin resistance builds, your body makes more insulin to fight back. After a long stretch, even several years, the beta cells in your pancreas get worn out from all the extra work. They can no longer keep up with the higher demand for insulin. Then, years after insulin resistance quietly started, your blood sugar may spike. You may show prediabetes or type 2 diabetes. You are also at risk of non-alcoholic fatty liver disease (NAFLD). That condition raises your risk for liver damage and heart disease.

What are the Signs and Symptoms of Insulin Resistance?

You can’t always see insulin resistance, but here are some signs to watch for:

A large waist. Experts say the best way to tell if you’re at risk for insulin resistance takes a tape measure and a moment of truth in front of the bathroom mirror. Some waist sizes raise the odds of insulin resistance and metabolic syndrome, which is also linked to insulin resistance. For women, that is 35 inches or more. For men, it is 40 or more. If you’re of Southeast Asian, Chinese or Japanese descent, it is 31.5 inches for women and 35.5 inches for men.
You have other signs of metabolic syndrome. The National Institutes of Health says to look beyond a large waist. If you also have three or more of the following, you likely have metabolic syndrome, which creates insulin resistance.
High triglycerides. Levels of 150 or higher or taking medication to treat high levels of these blood fats.
Low HDLs. HDL (good cholesterol) levels below 50 for women and 40 for men – or taking medication to raise low high-density lipoprotein (HDL) levels.
High blood pressure. Readings of 130/85 mmHg or higher, or taking medication to control high blood pressure
High blood sugar. Levels of 100-125 mg/dl (the prediabetes range) or over 125 (diabetes).
High fasting blood sugar (or you’re on medicine to treat high blood sugar). Mildly high blood sugar may be an early sign of diabetes.
You get dark skin patches. If insulin resistance is severe, you may see skin changes. These include patches of darker skin on the back of your neck or on your elbows, knees, knuckles or armpits. This darkening is called acanthosis nigricans.

Does inflammation cause insulin resistance?

As early as the 1950s, there was epidemiological evidence suggesting a correlation between inflammation and insulin-resistant states such as obesity. But no one knew how they were linked. In the last decade, however, it has become more and more clear that obesity, and the inflammation that comes with it, are major parts of insulin resistance. Studies of human obesity and insulin resistance have shown a clear association between two things. One is pro-inflammatory signaling pathways that stay switched on. The other is lower insulin sensitivity. For example, high levels of tumor necrosis factor-α (TNF), interleukin-6 (IL-6) and interleukin-8 (IL-8) have all been reported in various diabetic and insulin-resistant states. Also, the inflammatory marker C-reactive protein (CRP), a general marker of acute inflammation, is commonly high in human insulin-resistant states. Experiments have used rodents that are naturally obese, as well as knockout and transgenic mice. Detailed studies of insulin signaling at the molecular level have also been done. Together, they have begun to show how obesity-driven inflammation links to insulin-resistant states.

What Health Conditions are Related to Insulin Resistance?

An estimated 87 million American adults have prediabetes; 30-50% will go on to develop full-blown type 2 diabetes. Also, up to 80% of people with type 2 diabetes have NAFLD. But those aren’t the only threats posed by insulin resistance.

Years of high insulin are followed by a flood of cell-damaging high blood sugar. Because of that, people with insulin resistance, prediabetes, and type 2 diabetes are at high risk for cardiovascular (heart and blood vessel) disease. The International Diabetes Federation says insulin resistance doubles your risk for heart attack and stroke. It also triples the odds that your heart attack or ‘brain attack’ will be deadly.

Insulin resistance and metabolic syndrome are also linked with higher risk for cancers of the bladder, breast, colon, cervix, pancreas, prostate and uterus. The connection: high insulin levels early in insulin resistance seem to fuel tumor growth. They also seem to hold back the body’s ability to protect itself by killing cancer cells.

Research has also found a strong association between insulin resistance and a decline in memory. That raises the risk of Alzheimer’s disease.

Can understanding the causes of Insulin Resistance aid in future preventive approaches?

Chronic low-grade inflammation associated with obesity is responsible for the drop in insulin sensitivity. That is why obesity is a major risk factor for insulin resistance and related diseases such as type 2 diabetes mellitus and metabolic syndromes. This low-grade inflammation is caused by over-nutrition, which leads to fat building up in adipocytes (fat cells).

Obesity might raise the expression of some inflammatory cytokines and turn on several signaling pathways. Both play a part in causing insulin resistance, because they get in the way of insulin’s signal and action. It has been suggested that specific factors and signaling pathways are often correlated with each other. So studies of inflammation-related insulin resistance should look at both the shifts in cytokines and the state of the related signaling pathways.

Frequently asked questions

What causes insulin resistance?

The driving forces are excess body weight, too much belly fat, a lack of exercise, smoking and sleep deprivation. Aging and ethnicity add risk. Underneath them sits metabolic inflammation. Over-nutrition packs fat into fat cells. That fat raises inflammatory cytokines such as TNF and IL-6. Those signals jam insulin’s message to muscle, fat and liver cells.

Why am I insulin resistant but not diabetic?

Because your pancreas is still keeping up. As your cells ignore insulin, your body makes more of it to force the message through. For years, that extra insulin holds blood sugar in range. After years of overwork, the beta cells in the pancreas wear out. Only then does blood sugar climb into prediabetes or type 2 diabetes.

What are the warning signs of insulin resistance?

Often there is nothing you can see. The clearest clues are a waist of 35 inches or more for women or 40 inches or more for men, high triglycerides, low HDL, blood pressure of 130/85 or higher, and fasting blood sugar of 100 or above. When it is severe, dark patches of skin appear on the neck, elbows, knees, knuckles or armpits.

Related reading

References

NCBI (2007): Inflammation and Insulin Resistance. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2246086/
Scientific American (2009): Does Inflammation Trigger Insulin Resistance and Diabetes? Retrieved from https://www.scientificamerican.com/article/inflammatory-clues/

NCBI (2006): Inflammation and Insulin Resistance. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1483173/
Physiology.org (2008): Skeletal muscle insulin resistance: role of inflammatory cytokines and reactive oxygen species. Retrieved from https://www.physiology.org/doi/full/10.1152/ajpregu.00561.2007
Hindawi (2015): Mechanisms Linking Inflammation to Insulin Resistance. Retrieved from https://www.hindawi.com/journals/ije/2015/508409/

Endocrineweb (2019): Insulin Resistance Causes and Symptoms. Retrieved from https://www.endocrineweb.com/conditions/type-2-diabetes/insulin-resistance-causes-symptoms

Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP
Interventional pain physician, addiction medicine specialist and obesity medicine diplomate.
Licensed in Missouri and Illinois.
Last reviewed June 18, 2026

Your body can handle very little sugar at once. Your bloodstream carries less than 5 grams of glucose at any moment. That is under 1 1/2 teaspoons, or about 20 calories. Glycogen stores hold only about 100 grams in the liver and 400 grams in muscle. Insulin moves the excess into fat.

We have very limited room to store glucose, either as glycogen or as glucose in the blood. Glycogen: Glycogen is a large branched chain of glucose. It is stored mainly in the liver and in skeletal muscle. Stored glycogen can be turned back into blood glucose during fasting. It can also feed the muscle cells when muscles contract. This process is called glycogenolysis. In a fasted healthy 70kg human, the body can store 100 g of glycogen in the liver and 400 g in the muscle. Glycogen reserves can supply approximately 2,000 calories in total. Circulating glucose: Our blood normally carries less than 1 1/2 teaspoons of glucose at any given time (less than 5 g of glucose circulates in the blood of a 70kg human). Circulating glucose can supply 20 calories in total. The exact circulating glucose math: Average blood volume for an adult is 70ml/kg. Assuming a 70kg male=4,900 ml=49 dl or 4.9l 1 liter is 10dl, therefore we have 50dl. A nondiabetic glucose concentration is <100mg/dL. Therefore 100mg/dl multiplied by 49dl equals 4900mg of circulating glucose. 4900mg equals 4.9 g of circulating glucose, where each tsp =4.2gm Total circulating glucose=1.16tsp As a comparison, 1 gummy bear contains 1.3g of usable sugar. Eating 4 gummy bears could double the glucose in your blood. That doesn’t happen only because insulin quickly moves the glucose out of the blood and into fat stores. We have nearly unlimited room to store fat. The main job of insulin is to pull glucose out of the blood and turn it into stored fat. Glucose in the blood oxidizes fast. It goes through a non-enzymatic Maillard reaction. That causes spontaneous glycation (sugar sticking to proteins), which we measure as HbA1c. The Maillard reaction was first used to describe the browning and crisping of bread. This glycation effect makes cell membranes less fluid. It gets in the way of proteins and enzymes, and it often bends receptors and channels out of shape. The end result of too much glucose is sticky cells that do not work. Other advanced glycation end-products are measured as fructosamine. When blood glucose goes above 180 mg/dl, the kidney quickly flushes the extra out. That causes too much urination, or polyuria. The body keeps tight control of glucose because it can quickly oxidize and damage cell walls. That wreaks havoc on our enzyme pathways. What is glycemic index? The GI gives a score to how fast glucose from a certain food enters the blood. Foods are ranked on a scale of 0 to 100, with glucose at 100. The lower a food’s glycemic index, the slower blood sugar rises after you eat it. In general, cooking and processing a food raises its GI. The higher the GI of a food, the more insulin is released. And so the more blood glucose is turned into stored fat. How fast glucose rises after a meal, and how high it peaks, is often expressed as Glycemic Index (GI). Glycemic load (GL) measures two things: how fast glucose enters the blood (GI) and how much glucose is in each serving. Glycemic Load (GL) is a calculated number. It gives a patient a better idea of how a food acts at its usual serving size. Watermelon has a high glycemic index of 80. But a serving of watermelon has so little carbohydrate that its total glycemic load is only 5. When glucose levels drop, insulin production drops too. Then stored fat is turned into ketone bodies and triglycerides in the blood. Ketone bodies are a fuel source, like glucose, but they do not need insulin to get into the cells. The point is this: our blood can hold very little glucose, only about 5g or about 20 calories. Our constant eating of processed, carb-rich food clashes with how the human body works. The body tries to pull glucose out of the blood fast to prevent tissue damage. The constant high load in time overwhelms our ability to clear it. That leads to metabolic inflammation, and in the end diabetes. Wasserman D. H. (2008). Four grams of glucose. American journal of physiology. Endocrinology and metabolism, 296(1), E11-21. 10.1152/ajpendo.90563.2008

Related reading

Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP
Interventional pain physician, addiction medicine specialist and obesity medicine diplomate.
Licensed in Missouri and Illinois.
Last reviewed June 18, 2026

Is obesity just calories in versus calories out? No. Obesity is a disorder of excess fat accumulation driven by insulin. Insulin is the principal regulator of fat metabolism. We secrete insulin mainly in response to the carbohydrates we eat. Overeating and inactivity are compensatory effects of fat gain, not its cause. Here is the conventional wisdom this page takes apart:

“…from a thermodynamic perspective, it is clear that obesity is generally the consequence of small cumulative imbalances of energy intake and expenditure.”

2017, Obesity Pathogenesis: An Endocrine Society Scientific Statement

calories in > calories out

We overeat

Too much food, too little physical activity

Overeating

(Energy in > Energy out)

Obesity and the obesity epidemic

1880s: Max Rubner demonstrates the laws of thermodynamics hold true for living organisms and establishes the isodynamic law of calories

1890s: Atwater and Benedict show thermodynamics holds true for humans and pioneer the science of calorimetry

1900s: von Noorden declares caloric imbalance as the cause of obesity

“The ingestion of a quantity of food greater than that required by the body leads to an accumulation of fat, and to obesity, should the disproportion be continued over a considerable period.”

Louis Newburgh’s revelation:

“All obese persons are alike in one fundamental respect—they literally overeat.”*

Therefore…

Obesity is caused by either a “perverted appetite” (eating too much) or “lessened outflow of energy” (insufficient expenditure).

Why don’t obese people make up for it by eating less or exercising more? After all, those are under conscious control, too. Because, says Newburgh, they suffer from various human weaknesses such as overindulgence and ignorance.

Focus of attention? Full-Body Energy Balance

How big is the calorie imbalance behind weight gain?

“Weight management is all about balance— balancing the number of calories you consume with the number of calories your body uses or ‘burns off.’”

The Centers for Disease Control

20 lbs/decade?

2 lbs/year

1 lb of fat ~ 3500 kcal

(2 * 3500 kcal)/365 days

19.2 Kcal/day

The average American consumes about 2700 kcal/day

Are we really talking about a .007 positive energy imbalance causing 2/3 of all healthcare expenditure in the United States????

The average American is now 30 pounds heavier than in 1960 — an average weight gain of .53 pounds per year.

5 kcal/day or a .002 positive energy imbalance

There are no stranger phenomena than the maintenance of constant body weight under marked variation in bodily activity and food consumption.

Eugene Du Bois, Basal Metabolism in Health and Disease, 1936

Eating less doesn’t work

Weight loss achieved in trials of calorie-restricted diets is “so small as to be clinically insignificant.”

Cochrane Collaboration, 2002

Exercising more doesn’t work

“It is reasonable to assume that persons with relatively high daily energy expenditures would be less likely to gain weight over time, compared with those who have low energy expenditures. So far, data to support this hypothesis are not particularly compelling.”

AHA/ACSM 2007, Physical activity guidelines

What is wrong with the energy balance theory?

Remember this?

“The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended.”

The World Health Organization

an analogy? Wealth?

“The fundamental cause of wealth is a money imbalance between dollars earned and dollars spent.”

The World Economic Forum

dollars in > dollars out

The Alternative Hypothesis

Obesity is a disorder of excess fat accumulation

(Not energy balance, not over-eating, not sedentary behavior)

Gluttony and sloth are compensatory effects; they are not causes

German/Austrian hypothesis, pre-World War II

Gustav von Bergmann (1908), Julius Bauer

What is the hormonal theory of obesity?

“Like a malignant tumor or like the fetus, the uterus or the breasts of a pregnant woman, the abnormal lipophilic tissue seizes on foodstuffs, even in the case of undernutrition. It maintains its stock and may increase it independent of the requirements of the organism. A sort of anarchy exists; the adipose tissue lives for itself and does not fit into the precisely regulated management of the whole organism… a lipomatous subject may die of starvation and still remain lipomatous.” Bauer, Archives of Internal Medicine, 1941.

“The effect after meals of withdrawing from the circulation even a little more fat than usual might well account both for the delayed sense of satiety and for the frequently abnormal taste for carbohydrate encountered in obese persons… A slight tendency in this direction would have a profound effect on the course of time.”

Russell Wilder, Mayo Clinic, 1938

The hormonal/regulatory hypothesis

“…now more or less fully accepted, chiefly in Germany, by a number of leading investigators of metabolic diseases…”

Hugo Rony, Obesity and Leanness, 1940

“The current energy theory of obesity, which considers only an imbalance between intake of food and expenditure of energy, is unsatisfactory.”

“It is the distribution of energy in the body too which counts, not alone the rough imbalance between its intake and output.”

“The adipose tissue is not merely a passive storing place for reserve fat, but a living and active part of the body, with its own physiologic and pathologic processes.”

“An increased appetite with a subsequent imbalance between intake and output of energy is the consequence of the abnormal anlage rather than the cause of obesity.”

Bauer (1941)

The alternative hypothesis is another victim of World War II.

Insulin is “the principal regulator of fat metabolism.”

Rosalyn Yalow, Solomon Berson, 1965

Frayn, K.N. 2010. Metabolic Regulation: A Human Perspective, 3rd edition

Suppression of fat mobilization

The release of fatty acids from fat cells “requires only the negative stimulus of insulin deficiency.”

When insulin is secreted or chronically elevated, fat accumulates in the fat tissue.

When insulin levels drop, fat escapes from the fat tissue and the fat depots shrink.

We secrete insulin primarily in response to the carbohydrates in our diet.

“Carbohydrate is driving insulin is driving fat.”

George Cahill, 2005

“The most striking finding is that adipose tissue is exquisitely sensitive to the inhibitory effect of insulin on FFA release….”

“…insulin regulation of plasma FFA turnover/ oxidation is maximally manifest at low physiological plasma insulin concentrations….”

Bonadonna et al. 1990. Dose-dependent effect of insulin on plasma free fatty acid turnover and oxidation in humans. Am. J. Physiol. 259:E736-750.

Refined grains, starches and sugars

Dysregulation of insulin signaling

Metabolic Dysfunction: Excess fat accumulation, obesity, and the obesity epidemic, metainflammation, pain, cellular degradation

So why does dieting fail… statistically, only 1:167 patients succeed

“All diets that result in weight loss do so on one basis and one basis only: they reduce total calorie intake.”

Textbook of Obesity, 2012

Diets that work?

Insulin reduction?

Calorie restriction (with carbohydrate restriction)

Carbohydrate restriction (without calorie restriction — i.e., LCHF/Keto)

Intermittent Fasting (TRF)

Fasting…

Raymond Greene, The Practice of Endocrinology, 1951

Foods to be avoided:

Bread and everything else made with flour…
Cereals, including breakfast cereals and milk puddings
Potatoes and all other white root vegetables
Foods containing much sugar
All the sweets…

You can eat as much as you like of the following foods:

Meat, fish, birds
All green vegetables
Eggs, dried or fresh
Cheese
Fruit…except bananas and grapes

The AMA trivializes this science as a debate about fad diets.

“fat is mobilized when insulin secretion diminishes” and yet low carbohydrate diets are “bizarre concepts of nutrition that should not be promoted to the public as if they were established scientific principles.”

JAMA, June 4, 1973. Vol 224, No 10.

Frequently asked questions

What does “calories in, calories out” mean?

It is the energy balance theory of obesity. You gain fat when the calories you eat exceed the calories you burn. You lose it when the reverse is true. The Endocrine Society, the Centers for Disease Control and the World Health Organization all frame obesity this way: as too much food and too little physical activity.

Has calories in, calories out been debunked?

The numbers do not hold up. Gaining 20 pounds a decade takes an imbalance of about 19 calories a day. The average American has gained 30 pounds since 1960. On a 2,700-calorie diet, that works out to about 5 calories a day. Trials of calorie-restricted diets produce weight loss “so small as to be clinically insignificant,” and the data for exercise are “not particularly compelling.”

Why am I eating 1,200 calories but not losing weight?

Fat leaves your fat cells when insulin levels drop. Insulin rises mainly in response to carbohydrates. When insulin is chronically elevated, fat stays locked in the fat tissue, even on fewer calories. That is why the diets that lower insulin work: carbohydrate restriction, with or without calorie restriction, time-restricted eating and fasting. Bread, cereal, potatoes and sugar go first.

Related reading

Sources

Ludwig DS, Aronne LJ, Astrup A, et al. The carbohydrate-insulin model: a physiological perspective on the obesity pandemic. American Journal of Clinical Nutrition. 2021. PMID 34515299
Fildes A, Charlton J, Rudisill C, et al. Probability of an obese person attaining normal body weight: cohort study using electronic health records. American Journal of Public Health. 2015. PMID 26180980
Sumithran P, Prendergast LA, Delbridge E, et al. Long-term persistence of hormonal adaptations to weight loss. New England Journal of Medicine. 2011. PMID 22029981

Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP
Interventional pain physician, addiction medicine specialist and obesity medicine diplomate.
Licensed in Missouri and Illinois.
Last reviewed June 18, 2026

Beta cells are the insulin-making cells of the pancreas, clustered in the islets of Langerhans. In type 1 diabetes, the immune system destroys them. In type 2, years of insulin resistance and high blood sugar burn them out until insulin production dries up.

The pancreas is an endocrine gland (a gland that releases hormones into the blood). It makes two key hormones that control blood sugar: insulin and glucagon. Beta cells are special cells in the pancreas that make insulin. Why should you know about beta cells? Beta cells are linked to diabetes, which is a disease of insulin resistance. Beta cells sit in the islets of Langerhans (part of the pancreas). They are one of at least five different types of islet cells that release hormones straight into the blood. What is the role of beta cells? The main job of beta cells is to make insulin and release it into the bloodstream when needed. When blood sugar starts to rise (for example, when you eat a meal), beta cells respond quickly. They release insulin into the bloodstream to take up the incoming glucose and store it in cells. Beta cells also make more insulin as glucose in the blood rises. This fast response to a blood sugar spike usually takes about 10 minutes. In people with diabetes, though, these cells run into trouble. In type 1 diabetes, the immune system attacks or destroys them. In type 2 diabetes, they become resistant to the effects of insulin. What Are Amylin and C-peptide? Besides insulin, beta cells also make two other products: Amylin and C-peptide, a byproduct of making insulin.

Amylin slows how fast glucose enters the blood. That makes it a short-term regulator of blood sugar levels.
C-peptide prevents vascular neuropathy (nerve damage from poor blood supply). It also prevents damage to arteries. You may have noticed that people with severe diabetes have problems with their nerves and feeling, as well as their arteries. This is due to the loss of this molecule when beta cells are destroyed. C-peptide is released into the blood in equal amounts to insulin.

What happens to beta cells in diabetes?

Type 1 Diabetes

In this type of diabetes, beta cells die from an immune attack. Immune cells that normally fight harmful bacteria and viruses destroy beta cells in the pancreas by mistake. How and why that happens is not clear. However, the results of a study published in early 2011 show that these beta cells become stressed at the earliest stages of the illness. In mouse studies, cells respond to this stress by setting off a death pathway. That leads to the loss of beta-cell function, and in the end the loss of cell mass. Here, stress on beta cells from an immune attack may be responsible for type 1 diabetes, which mostly occurs in children. Type 1 diabetes has strong genetic links. Type 2 Diabetes In this type of diabetes, the body becomes resistant to the effects of insulin. It loses sensitivity to insulin over time. So the body tries to make up for it by producing more insulin. Research has shown that blood sugar that stays high for a long time (chronic hyperglycemia) will result in beta-cell burnout. This is also called cell turnover. The exact cause is unclear. However, factors such as chronic low-grade inflammation could be contributing significantly. Glucotoxicity (damage from a buildup of high glucose levels) is another factor as well. Other factors include the effects of lipoproteins, leptin, and cytokines, which play a role in controlling glucose. Insulin Resistance in Type 2 Diabetes The beta cells of the pancreas work as tightly linked clusters called islets. Their responses to rising blood sugar are coordinated by small groups of “leader cells.” Once blood sugar levels peak, the leader cells direct the other beta cells to launch the right response. It is possible that the leader cells are more metabolically active and more sensitive to glucose than the rest. They may be the main target for insulin resistance. Insulin resistance in type 2 diabetes starts with falling sensitivity to insulin. That leads the beta cells to overproduce insulin. As insulin resistance keeps rising, patients go on living with high blood glucose levels, and the effects reach far and wide. After a few years of sickness, the body’s own insulin production dries up, and patients need to start injecting insulin. New Drug To Stimulate Growth of Beta Cells Researchers from Mount Sinai Hospital have discovered a unique mix of medicines that makes beta cells grow. The lead author of the study, Andrew Stewart MD, said: “We have discovered a drug combination that makes beta cells regenerate at rates that are suitable for treatment. The next big hurdle is figuring out how to deliver them directly to the pancreas.” If beta cells can be made to regrow, then insulin resistance will no longer be a wall that diabetics cannot get past. If this new treatment is put to use, it can bring the breakthrough diabetes care has long needed.

Frequently asked questions

What do beta cells do in the body?

Beta cells make insulin and release it into the blood when blood sugar rises, such as during a meal. Insulin moves glucose out of the blood and into cells for storage. The response to a spike usually takes about 10 minutes. Beta cells also make amylin, which slows how fast glucose enters the blood. They also make C-peptide, a byproduct of making insulin.

Where are beta cells found?

Beta cells sit in the pancreas, inside clusters called the islets of Langerhans. They are one of at least five types of islet cells that release hormones straight into the blood. The islets work as tightly linked clusters. Small groups of “leader cells” direct how the other beta cells respond when blood sugar climbs.

What kills beta cells in the pancreas?

In type 1 diabetes, the immune system attacks and destroys beta cells by mistake. In type 2 diabetes, years of insulin resistance and chronically high blood sugar burn them out. Glucotoxicity and chronic low-grade inflammation all add to the damage. So do the effects of lipoproteins, leptin and cytokines. After a few years, the body’s own insulin production dries up. Then insulin shots become necessary.

Can beta cells grow back?

Researchers at Mount Sinai Hospital found a drug combination that makes beta cells regenerate at rates suitable for treatment. The next hurdle is getting those drugs straight to the pancreas. Suppose beta cells can be made to regrow. Then insulin resistance would no longer be a wall that people with diabetes cannot get past. That would be the breakthrough diabetes treatment needs.

Related reading

References

Mayo Clinic: Type 2 diabetes. Retrieved from https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193
Mayo Clinic: Type 1 diabetes. Retrieved from https://www.mayoclinic.org/diseases-conditions/type-1-diabetes-in-children/symptoms-causes/syc-20355306
NCBI (2008): Insulin signaling in the pancreatic beta-cell. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/18481923
Science Daily (2018): Diabetes: New drug cocktail increases human beta cell proliferation at rapid rates. Retrieved from https://www.sciencedaily.com/releases/2018/12/181220111759.htm

Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP
Interventional pain physician, addiction medicine specialist and obesity medicine diplomate.
Licensed in Missouri and Illinois.
Last reviewed June 18, 2026

Metabolic syndrome is the cluster of obesity, raised fasting glucose, high cholesterol and high blood pressure. Insulin resistance drives it, along with the inflammation running through all of them. It is an early warning of type 2 diabetes. It builds for years while routine blood work still looks normal.

Obesity does not cause metabolic syndrome. Obesity is a marker for it. That is why the syndrome shows up in people of entirely normal weight. It is also why treating the weight without treating the metabolism so often disappoints.

What is happening underneath

In the early phase, the body makes up for insulin resistance by making more insulin. That keeps blood glucose near normal. Nothing looks wrong on a routine panel. This goes on until the pancreas and liver overflow with fat, driven by insulin that stays high. At that point the change is sudden. Hyperinsulinemia (too much insulin) can no longer keep up, and glucose finally rises.

By then the process has been running for years. That is the main reason metabolic syndrome is worth finding early. The damage builds up while the body is still keeping up, not after the diagnosis.

The cluster

Together, obesity, raised fasting plasma glucose, high cholesterol and hypertension (high blood pressure) make up metabolic syndrome. Inflammation is the thread running through all of them. It is a key response to infection and injury. It turns harmful when it fails to resolve. Excessive acute inflammation damages tissue. Inflammation that never resolves leads to long-term tissue problems.

Risk factors

These raise your odds of developing insulin resistance and metabolic inflammation:

Carrying excess weight, especially around the belly, where extra fat cells drive insulin resistance directly.
Lack of physical activity, which usually goes with the above.
A close relative with type 2 diabetes.
Ethnicity, which may act as a genetic factor, a lifestyle factor, or both.
A diet built on refined carbohydrates, industrial seed oils and ultra-processed food.

Prevention

A healthy pattern prevents the conditions that cause metabolic syndrome. The parts are plain and simple:

Eat only when genuinely hungry. Do not snack.
Get at least thirty minutes of physical activity daily.
Eat real food and avoid processed food.
Avoid sugars and artificial sweeteners.
Give your body an interval each day in which insulin is genuinely low.

Why this sits in a pain practice

Pain is the top reason people come to this practice. It is the common link between untreated metabolic syndrome and untreated diabetes. Several thousand patients a year are evaluated here for chronic pain. This is a city setting with ready access to high-level healthcare through several large academic centers and government-funded clinics.

Despite that access, public health has kept getting worse. Cutting-edge treatment has not made up for a metabolic environment that nothing in the standard pathway addresses.

Related reading

Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP
Interventional pain physician, addiction medicine specialist and obesity medicine diplomate.
Licensed in Missouri and Illinois.
Last reviewed August 25, 2026

Glucose is used by nearly every cell in the body, and its arrival triggers insulin. Fructose is handled mainly in the liver. It does not send the same “I’m full” signal. And it has about ten times the glycation activity of glucose. The type of sugar matters, not just the amount.

Sucrose, or table sugar, is a disaccharide (a two-part sugar) of 50% fructose and 50% glucose. Factory-made high-fructose corn syrup shifts that ratio, often to 55:45 fructose to glucose. The gap between the two molecules matters more than the small change in ratio suggests.

What is the difference between fructose and glucose?

Glucose can be used by nearly every cell in the body, and its arrival triggers insulin release. Fructose is handled mostly in the liver. That difference in where each one goes is the root of nearly everything else that sets them apart.

Fructose does not trigger insulin release the way glucose does. It does not send the same satiety (fullness) signals either. The result is a sugar that can be eaten in large amounts without the feedback that would normally make you stop.

Why is fructose worse than glucose?

Fructose has approximately ten times the glycation activity of glucose. Glycation is when a sugar bonds to a protein or fat without an enzyme. It is a random process that damages whatever it touches. It is also the basis of the HbA1c test.

Different effects on the brain

Glucose and fructose have measurably different effects on the brain. That includes the areas that control appetite and reward. So a drink with both acts on two systems at once: the metabolic and the motivational.

The unlabeled increase

Fructose intake has risen a great deal, and much of the rise is hidden from the buyer. It comes in products not sold as sweet. It hides under names that do not read as sugar. And it comes in ratios that are not disclosed. Calling that rise intentional is not a conspiracy claim. Recipe choices are made on purpose, and taste is the goal.

Sugar-sweetened drinks need special attention because they deliver fructose in liquid form, fast. There is no fiber or food structure to slow absorption. And they do not replace anything else you eat.

Is refined carbohydrate as bad as sugar?

Acellular refined carbohydrate means flour and the products made from it. It arrives stripped of the cell structure that would slow its digestion. So it gives a glucose curve closer to sugar than to the grain it came from.

Why stopping matters more than moderating

Cutting out refined carbohydrate and added sugar is the step that most reliably reverses obesity, prediabetes and type 2 diabetes. That is because it removes the signal that drives fat storage instead of trying to out-exercise it. Sugar and fat are often cast as opponents. A more useful way to see it: refined carbohydrate and industrial seed oil arrived together, and so did the metabolic damage.

Frequently asked questions

Is high-fructose corn syrup worse than table sugar?

Table sugar is half fructose and half glucose. High-fructose corn syrup often shifts that to 55 parts fructose to 45 parts glucose. The small change in ratio matters less than this: both deliver a large dose of fructose. That is the sugar your liver handles, and it does not send the same fullness signal. Much of it comes in products not sold as sweet, under names that do not read as sugar.

Why doesn’t fructose make you feel full?

Glucose triggers insulin release. Fructose is handled mainly by the liver. It does not trigger insulin the same way, and it does not send the same fullness signals. So you can keep eating it in large amounts without the feedback that would normally shut the meal down. That is a big part of why it is so easy to overeat.

What is the worst form of sugar for your blood sugar?

Sugar-sweetened drinks top the list. They deliver fructose in liquid form, fast, with none of the fiber or food structure that would slow absorption. And they do not replace anything else you eat. Refined flour is the same problem in another form. Stripped of its cell structure, it gives a glucose curve closer to sugar than to the grain it came from.

Do fructose and glucose affect the brain differently?

Yes. Glucose and fructose have measurably different effects on the brain, including in the areas that control appetite and reward. A soda or sweet drink that delivers both acts on two systems at once: the metabolic one and the motivational one. That is why the type of sugar matters, not just the amount. And it is why cutting it out works better than trying to cut back.

Related reading

Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP
Interventional pain physician, addiction medicine specialist and obesity medicine diplomate.
Licensed in Missouri and Illinois.
Last reviewed August 25, 2026