If you are like most people, you are probably thinking that I have confused diabetes for diabesity, or you are probably wondering whether I intended to say obesity. You are not so far away from the truth as diabesity is a modern disease that links obesity with type 2 diabetes. Diabesity should be a concern for people with normal blood sugars who may be accustomed to unhealthy eating and lifestyle patterns. It is unfortunate that much is not mentioned about diabesity, which can predispose you to severe obesity, diabetes, and other fatal chronic conditions.

What Is Diabesity?

Diabesity is a sequence of events that starts with optimal blood sugar balance, to progressive insulin resistance, to being overweight, then becoming obese, and finally to full-blown Type-2 Diabetes. It comes in a spectrum that includes elevated blood sugar, elevated blood pressure, high cholesterol, and other health complications. These problems stem from diet, lifestyle, and environmental toxins interacting with our unique genetic susceptibilities. A study published in NCBI in 2013 concluded that “(diabesity) makes a strong call for utilizing indigenous, low-cost means of enhancing healthy dietary and physical activity habits.” Diabesity can also be described as the coexistence of obesity and type 2 diabetes.

What Are The Triggers For Diabesity?

Diabesity occurs following the development of insulin resistance and obesity. When your diet is full of empty calories: quickly absorbed sugars, liquid calories (soda, juice, sports drinks), and refined carbohydrates, you are likely to develop a resistance to insulin. Insulin (produced by beta cells in the pancreas) is the hormone that is responsible for grabbing glucose out of the bloodstream and storing it in cells. This ensures that blood sugar remains even in the blood. When the body starts ignoring the signal sent out by insulin, we call this insulin resistance. A high insulin level is one of the first signs because beta cells will keep releasing more and more insulin to try to remedy the situation. Unfortunately, the higher your insulin levels are, the worse your insulin resistance becomes.  High insulin levels will also cause a spike in appetite which leads to overeating. Very soon, you develop weight gain around the belly, more inflammation and oxidative stress, and other effects such as high blood pressure, high cholesterol, low HDL, atherosclerosis, and increased risk of cancer, Alzheimer’s, and depression.

It is important t note here that the root cause of the problem is insulin resistance and not elevated blood sugar. Fortunately, insulin resistance can be reversed since it is strongly linked to a poor diet and an unhealthy lifestyle.

Most people can save themselves from diabesity by eliminating the factors that send their biology out of balance and replacing them with what’s needed to help the body re-balance itself.

Diabesity and Genetics

Many people believe that insulin resistance and diabesity are genetic conditions that cannot be extraneously controlled. True enough, our genetic predisposition plays a role in how we choose what to eat and how to live. It also plays a role in the development of insulin resistance. However, insulin resistance and diabesity are greatly influenced by diet and lifestyle. By controlling these factors, you can greatly minimize your chances of developing the conditions.

How To Reverse Diabesity

Before reversing diabesity, there are a few things you can do to keep safe. They include:

1. Know the signs of insulin resistance.

One of the first tell-tale signs of insulin resistance is uncontrollable weight gain. You might also experience increased blood pressure and skin discoloration (acanthosis nigricans) on rare occasions. Unfortunately, insulin resistance may go unnoticed for years. Hence, you may be better off having some tests done.

2. Get the right tests done

You should get tested if you have a positive family history of type 2 diabetes and are affected by a poor diet as well as a sedentary lifestyle. An insulin response test is the best test to tease out the condition.

If you have already been diagnosed with diabesity, here are three things you can do to start your reversal journey.

Make healthy diet choices

This may involve the input of your physician, nutritionist/ dietician, and yourself to come up with the right meal plan. A healthy diet will start with the elimination of sugary and processed foods. Opt for wholesome grains, fresh vegetables and fruits, nuts, white meat, and unsaturated fats. You can read more about this type of diet here. (hyperlink to foods that improve insulin sensitivity).

Get adequate rest

Stress is a major contributor to insulin resistance and blood sugar imbalance.  Stress also contributes to making unhealthy food choices and overeating. You need to make a conscious effort to distress frequently by:

• Sleeping for at least 7 hours daily
• Practicing relaxation techniques such as yoga
• Taking breaks in between work, like every two hours
• Taking sabbaticals and vacationing periodically

Quit a sedentary lifestyle

Modern jobs involve sitting at an office desk and hitting the keypad for hours on end. In a world where work is compensated by the hour, it can be difficult to make time for exercise. However, when you consider the negative long-term effects of a sedentary lifestyle, you will be forced to reconsider the value of the extra money. What is the point if it’s going to cost your health in the long run? Quitting a sedentary lifestyle involves making deliberate choices about exercise and fitness. This may mean walking at least 30 minutes every day or engaging in more vigorous aerobic exercise 4-6 times a week.

References

1.   Science Daily (2012): Genetic variants are linked to obesity and insulin resistance. Retrieved from https://www.sciencedaily.com/releases/2012/06/120626151107.htm

2.   NCBI (2011): Is fast food addictive? Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21999689

3.   NCBI (2013): Diabesity. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23905459

4.   NCBI (2008): High-fat diets cause insulin resistance despite an increase in muscle mitochondria. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2409421/

Insulin is a vital hormone that controls the levels of sugar in our bodies. In a nutshell, it removes excess glucose from 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 that the effects of insulin cannot be appreciated leading to a buildup of sugar in the bloodstream. About 100 million Americans are affected by insulin resistance. Fortunately,   dietary and lifestyle changes can dramatically improve this condition.

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

What Is Insulin?

Insulin is a hormone that is produced by beta cells in the pancreas. Its main function is to regulate the amount of glucose circulating in your bloodstream. However, it also affects fat and protein metabolism. When you eat a slice of bread, which definitely contains carbohydrates, the amount of sugar in your blood increases. Consequently, the beta cells in your pancreas are stimulated to produce insulin. The insulin is released to your bloodstream, where it removes the sugar and stores it in cells. This process results in reduced blood sugar levels.

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

Diabetes type 2 occurs when your cells become increasingly resistant to insulin, resulting in a rise in both insulin and blood sugar levels. If this persists for long, your beta cells may become damaged, leading to decreased insulin production.

Insulin resistance is the main cause of type 2 diabetes.

What About Insulin Sensitivity?

Insulin sensitivity is just the opposite of insulin resistance. When you have insulin resistance, it also means that you have low insulin sensitivity. While insulin resistance is harmful to your health, insulin sensitivity is beneficial.

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 that mostly accumulates around your waist 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.

Other possible causes of insulin resistance include:

• High sugar diet. Artificial sugars have been linked to inflammation and insulin resistance.
• Inactivity. Regular physical activity can reduce insulin resistance by stimulating weight loss.
• Gut microbiota. A disruption in the bacterial environment of your digestive system 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 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 insulin resistance. It is estimated that by the time a diagnosis is made, 50% of insulin-producing cells may have lost function. This means that the person is not only resistant to insulin, but they are also unable to produce adequate amounts of insulin.

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 of reducing insulin resistance. Making drastic dietary changes is also necessary so that you are consuming more of the beneficial foods and less of the harmful ones. Exercise also helps to shed off extra weight and maintain health. Lastly, doing away with harmful habits such as smoking and excessive drinking also plays a significant role.

• Engage in regular exercise such as brisk walking or jogging for 30 minutes each day.
• Lose belly fat
• Stop smoking
• Reduce intake of artificial sugar, such as from artificially sweetened beverages
• Increase intake of omega-3 fatty acids

For more on improving insulin sensitivity with dietary changes, read our previous article here.

The bottom line

Insulin resistance is responsible for a number of chronic health complications. Often it can go on undetected for a number of years without causing alarm. When insulin resistance is not detected early enough, it is likely to wreck a person’s health. Fortunately, a number of things can be done to prevent or stop the progression of insulin resistance. If insulin resistance can be prevented we will definitely have millions of people living healthier and more fulfilled lives that are free of disease.

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/

Obesity, Prediabetes, and Diabetes Type 2 are associated with most of the diseases of modern society (cardiovascular/cerebrovascular disease, cancer, Alzheimer’s disease). These are all metabolic dysfunctions related to the malnutrition of overconsumption which leads to metabolic inflammation, or metal inflammation. This series of articles provides a recipe on how to make a healthy society, and create metal inflammation, which results in severe chronic disease and requires expensive lifelong treatment.

Whether by coincidence or concerted action, this chronic disease model produces tremendous revenue for the medical-industrial complex, big pharma, big food, and reduces upward mobility. I would even contend that generational metal inflammation is a primary driver of economic disparity and plays a significant role in violence and incarceration rates.

Type 2 Diabetes hits African American populations especially hard.

• African Americans are 1.7 times more likely to develop diabetes compared to non-Hispanic whites.
• The prevalence of Type 2 Diabetes among African Americans has quadrupled during the past 30 years
• African Americans with diabetes are more likely than non-Hispanic whites to develop greater diabetes-related complications such as amputations, adult blindness, kidney failure, and increased risk of heart disease and stroke due to a delay in diagnosis. Being Prediabetic starts the injury, even before becoming Diabetic five years later.
• Death rates for African Americans with diabetes are 27 percent higher than for non-Hispanic whites.

Metainflammation is the lynchpin for over 80% of human suffering and healthcare expense in the United States. Understanding the common root causes, which appear unrelated on the surface, is the first actionable step in preventing and reversing the disease and restoring health to a community.

Are Obesity, Prediabetes, and Diabetes Type 2 really a significant problem?

Obesity, Prediabetes, and Diabetes are a new phenomenon in the United States. Obesity and Diabetes type 2 in the 1940s was nearly unheard of. In the 1970s only 13% of adults and 5% of children were obese. Today 35% of adults and 17% of children are obese.

Diabetes Obesity disproportionately affects certain racial and ethnic minority groups. By 2035 nearly 100% of African American females will be overweight or obese, which is only 16 years from now.

Nearly 72% of adults in the United States are now overweight or obese. Obesity is a contributing factor to approximately 100,000–400,000 deaths in the United States per year, and directly accounts for 5% to 10% of the national health care expenditure. Obesity is the second leading cause of death and is likely to become the first (Mokdad, Marks, Stroup, & Gerberding, 2004). Statistics predict that 86% of the United States population will be overweight or obese by 2030. It is highly likely that future adults will have shorter life-spans than the current generation (Olshansky et al., 2005). Not only do obese individuals have a shorter life span, but they also have a significantly shorter health span (healthy living before getting a debilitating illness) which reduces their quality of life and worsens economic disparity. They are far more likely to suffer from stroke, breast, and colorectal cancer, osteoarthritis, and depression (Jebb, 2004).

There are 84.1 million Prediabetics in the United States (34% of the population), a condition that if left untreated leads to type 2 diabetes within five years. Less than 11 percent of adults with Prediabetes know they have it.

There are about 30.3 million diabetics in the United States (9% of the population), 23.1 million are diagnosed and 7.2 million are undiagnosed diabetics. Over 95% of all diabetics are type 2 diabetics, which is a disease created by the modern lifestyle. The American Diabetes Association currently estimates the total costs of diagnosed diabetes have risen from $245 billion in 2012 to $327 billion in 2017, a 26% increase over a five-year period. For diagnosed diabetics, the average annual medical expenditure is approximately $16,752 per year:

• hospital inpatient care (30% of the total medical cost)
• prescription medications to treat complications of diabetes (30%)
• anti-diabetic agents and diabetes supplies (15%)
• physician office visits (13%)

Statistics predict that the prevalence of diabetes will increase by 54% to more than 54.9 million Americans between 2015 and 2030; annual deaths attributed to diabetes will climb by 38%, and annual medical and societal costs will increase 53%. By 2050, nearly 1/3 of the United States population is predicted to be diabetic.

So, what exactly is diabetes?

Diabetes is a condition in which glucose sugar builds up in your blood. When you have diabetes, your body either doesn’t make enough insulin (Type 1 Diabetes) or can’t use its own insulin as well as it should (Type 2 Diabetes). Other than the fact that there is too much glucose in the bloodstream, Type 1 diabetes and Type 2 Diabetes is not the same disease.

The focus of this discussion is Type 2 Diabetes, what causes it and how to reverse it.

Our bodies normally use a combination of carbohydrates (sugars such as glucose), fats, and proteins for energy.  When the body senses that it is going to receive a carbohydrate load, the Beta cells of the pancreas release a hormone called Insulin. Insulin works through specialized receptors and transporters to clear the bloodstream of glucose, and deposit the glucose into the cells. Glucose inside the cells is rapidly converted to energy or stored for later use as glycogen or converted to fat. Insulin specifically triggers a series of enzymes to cause fat storage. Whenever you hear the word insulin, think “fat-storage hormone.”

 

As the fat cells uptake excessive circulating glucose, they overflow their capacity to use glucose for energy and their limited glycogen storage. The cells produce chemical inflammatory signaling compounds that leech into the bloodstream, activating the immune system, contributing to the onset of metal inflammation. The cell also begins to leech out stored fats as triglycerides.

If the cell becomes overwhelmed with glucose and runs out of fat storage capacity, it eventually reaches a critical size and will literally explode. This cell death also causes an inflammatory reaction or metal inflammation.

Extra glucose outside the cells quickly damages the cells by a process of glycation, making cell walls, proteins, and receptors sticky and function poorly. Imagine putting sugar into your car’s gas tank, as the clean gas is burned it would leave a sticky residue in the engine and over time your engine would seize up and all the parts would stop moving.

Insulin resistance due to glycation occurs as the cell receptors can no longer efficiently move and the circulating proteins such as insulin become sticky. We measure this as Hemoglobin A1C, which tells us how much glucose is sticking to the hemoglobin in the red blood cells, the higher the number, the greater the glycation.

It can take up to 12 years for a patient to develop decompensated diabetes until then the fasting blood sugars appear normal, but the patient is in a state of metal inflammation.

Trajectories of glycemia, insulin sensitivity, and insulin secretion before the diagnosis of type 2 diabetes: an analysis from the Whitehall II study. Lancet 2009; 373: 2215–2221.

The body compensates by increasing the production of insulin, even more, to clear out the toxic glucose, which only leads to even more insulin production and worsening insulin resistance, and more fat storage.

Insulin resistance also occurs because of the constant stimulation of biological receptors causes the receptors to down-regulate. These transporters become fatigued if there is too much insulin or the frequency of insulin release becomes too often.

Eventually, the tremendous excessive fat storage and cell structure disruption become so great that the liver and pancreas become congested with fat, and blood flow to the pancreas decreases so insulin production is severely reduced, and the patient now becomes dependent on injected insulin.

Diabetes results in metal inflammation because your body is trying to clean out the sticky residue, or glycated parts.  Diabetes can cause serious health complications including heart disease, blindness, kidney failure, amputations, and pain. Unfortunately, the most patient does not realize they have diabetes until some significant symptom causes them to seek care, usually pain which is the common pathway of tissue damage in metal inflammation.

What is wrong with the standard of care treatment for diabetes?

Current medical guidelines specifically consider Type 2 Diabetes a chronic and progressive disease, in which the patient has little choice.

http://www.diabetes.org/diabetes-basics/myths/

The standard of care usually starts with one drug, then two, then three and sequentially increasing insulin. Most people assume that we are treating their diabetes with medications to make their disease better. It’s simply not true, we are not actually treating the disease. We are treating the symptom of diabetes, the elevated blood sugar; the disease of insulin resistance is getting worse year after year. Diabetes is getting worse, not better. The complications of diabetes track insulin resistance over time, not just the glucose level.

In fact, the American Diabetes Association almost seems to relish in this learned helplessness and dependence on insulin.

“Using insulin to get blood glucose levels to a healthy level is a good thing, not a bad one. For most people, type 2 diabetes is a progressive disease. When first diagnosed, many people with type 2 diabetes can keep their blood glucose at a healthy level with a combination of meal planning, physical activity, and taking oral medications. But over time, the body gradually produces less and less of its own insulin, and eventually, oral medications may not be enough to keep blood glucose levels in a healthy range.”

The American Diabetes Association is definitely dependent on insulin, or at least dependent on the companies who manufacture insulin and fund the Association.

Eli Lilly

Novo Nordisk

Sanofi

http://www.diabetes.org/about-us/corporate-support/our-corporate-supporters.html
and
http://www.diabetes.org/about-us/corporate-support/banting-circle-supporters.html

While the use of agents, including insulin, to reduce glucose is absolutely necessary for certain circumstances, it does not address the disease of diabetes, which is insulin resistance.

What’s wrong with conventional dietary advice of multiple small meals per day?

Conventional dietary advice suggests that patients should eat 3 meals per day plus snacks, resulting in a feeding frequency of approximately five times per day. This dietary recommendation is baseless in the normal adult population, and inconsistent from an evolutionary perspective.

Hunter-gatherer eating patterns were characterized by intermittent energy intake depending entirely upon food availability and required an extraordinarily high level of physical and mental functional capacity during the extended periods without food. These adaptations allowed for organs to rapidly uptake and store glucose when available, as fat and glycogen storage, and mobilize these reserves as needed as glucose, fatty acid, and ketones in times of need.

Less than 10,000 years ago, converting from a hunter-gatherer eating pattern to an agrarian eating pattern resulted in year-round availability of food and the current three meals per day eating pattern.

The concept of multiple snacks between meals is a modern development, which began in the 1950s and closely tracks with the loss of healthy eating patterns, food overconsumption and the epidemic of obesity, metabolic syndrome, and diabetes.  In a study conducted by the Agriculture Department and the Department of Health and Human Services on food consumption behavior, the percent of the American population eating three or more snacks a day increased from 11% to 42% between 1977 to 2002. Snacks now constitute more than 27 percent of children’s daily calories.

Adapted from the American Journal of Clinical Nutrition, March 1, 1999

In fact, there is no actual data supporting even three meals per day. Breakfast as a meal has only been advocated as the “most important meal of the day” in the media since 1917, and there is no evidence that breakfast consumption promotes weight loss or that skipping breakfast leads to weight gain. In fact, people who eat breakfast consume on average 260 calories/day more than those who skip breakfast and are heavier.

Effect of breakfast on weight and energy intake: systematic review and meta-analysis of randomized controlled trials. BMJ 2019; 364 DOI: https://doi.org/10.1136/bmj.l42 (Published 30 January 2019)

Insulin is a fat-storage that clears glucose from the bloodstream (lipogenesis). It is produced by the pancreas in anticipation of a carbohydrate load. Its primary function is to rapidly clear the bloodstream of excessive glucose after a feast, and convert it to long term fat storage for later use in a time of famine. Maintaining elevated levels of insulin, both as in terms of spikes and for a proportionate period of time, causes a continuous shunting of circulating glucose to fat storage. When insulin is decreased, the body automatically shifts to burning fat as a fuel source (lipolysis).

Insulin acts as a growth hormone, preventing the cellular stress responses involved in removing damaged cells and organelles (autophagy). Allowing dysfunctional cells and organelles to accumulate is the hallmark of aging and the common pathway for diabetes, cardiovascular/cerebrovascular disease, cancers, and Alzheimer’s disease. When insulin is decreased, autophagy is increased.

Intermittent energy restriction permits a cyclical ebb and flow which maintains insulin receptor sensitivity and minimizes excessive fat storage due to chronically elevated insulin. In other words, eating less frequently exercise your insulin system and prevents insulin resistance. Constantly eating results in lipogenesis and accumulation of cellular debris.

What’s wrong with the conventional dietary advice to consume carbohydrates?

The Dietary Guidelines for Americans published by the USDA recommends that carbohydrates make up 45 to 65 percent of total daily calories. Based upon a  2,000 calories/day, between 900 and 1,300 calories should be from carbohydrates (225 and 325 grams of carbohydrates a day). The Institute of Medicine also recommends 45 to 65 percent calorie intake as carbohydrates, with at least 130 grams of consumed carbs per day. The American Heart Association recommends that refined sugar should be limited to 6 to 9 teaspoons per day. All of these organizations suggest that there is an absolute requirement of carbohydrate necessary for human function, with the majority of nutrition coming from carbohydrates.

However, the lower limit of carbohydrate consumption is likely zero, there are no essential carbohydrates required for living.  According to the Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids (2005), the Recommended Dietary Allowance (RDA) for carbohydrate,  considered to be the average minimum amount of glucose needed by the brain or central nervous system (CNS), is 130 g/day for adults and children.

The CNS comprises less than 2% of total body weight but consumes roughly 20% of the total daily calories.  Historically the brain has been considered the only organ that required glucose as a fuel source, utilizing approximately 100-140 g glucose per day.  However, with keto-adaptation, the CNS reduces the obligatory glucose requirement by approximately 80%, resulting in a true utilization of 20-28 g glucose/d.

Traditional civilizations (Masai, the Greenland, and Alaskan Inuit and Pampas indigenous people) survive on a “minimal amount of carbohydrate for extended periods of time with no apparent effect on health or longevity“.

“In the absence of dietary carbohydrate, de novo synthesis of glucose requires amino acids derived from the hydrolysis of endogenous or dietary protein or glycerol derived from fat. Therefore, the marginal amount of carbohydrate required in the diet in an energy-balanced state is conditional and dependent upon the remaining composition of the diet.”

Endogenous glucose production through gluconeogenesis is approximately 2.8-3.6 g/kg/d, or approximately 210-270 g/d in a 70kg human, far greater than the obligatory requirement of 20-28g glucose/d of the keto-adapted human.

“The lower limit of dietary carbohydrate compatible with life apparently is zero, provided that adequate amounts of protein and fat are consumed” (pg. 275). There is no essential need for dietary carbohydrate, provided that “adequate amounts of protein and fat are consumed”.

This does not mean that patients should strive to be zero carbohydrates, what it means is that half your calories don’t need to come from carbohydrates.

What’s wrong with the conventional dietary advice to diabetics?

Newly diagnosed diabetics are instructed to eat “multiple” small meals per day to have a steady-state glucose level. This sounds reasonable until you examine what the patient is being recommended to eat.

Diabetics are often instructed to consume more than 50% of their calories as carbohydrates. They are often instructed to consume “healthy” fruits and vegetables, as if “fruits and vegetables” was a single food group. Selective breeding of plants over the last 9,000 years has resulted in fruit that is sweeter, and bigger. Modern fruits are genetically engineered to contain sugars at or above the level of soda.

Patients often think that fruit juices, or “juicing” is healthy. That’s understandable, given that it is natural and has the word “fruit” in it. Fruit juice contains just as much sugar and calories as a sugary soft drink… and sometimes even more. Minute Maid 100 percent apple contains nearly 66 grams of fructose per liter. That’s more than the 62.5 grams per liter in Coca-Cola and the 61 grams per liter in Dr. Pepper. The fructose in fruit comes with fiber, which slows down and reduces the absorption of the sugar in the body, and juicing the fruit removes the fiber. The minimal amount of vitamins and antioxidants in the juice do not make up for a large amount of sugar, and the sugars may actually prevent vitamin absorption.

https://doi.org/10.1016/S2213-8587(14)70013-0

Diabetics are often instructed to use rescue sugars when they feel light-headed. Many diabetic patients automatically consume sugar, but when you actually look at their glucose level, it’s often in the normal ranges. What’s happened is that their brain is insulin resistant. The normal or even high blood sugar can’t get from the bloodstream to the interior of the brain cell. Being lightheaded is the symptom of intracellular hypoglycemia. The temporary fix at that moment is to control the symptom of hypoglycemia by consuming a rapidly absorbed fuel source. The issue is that if you constantly use rescue sugars, the insulin resistance only worsens. The better option is to reduce medications while reducing carbohydrate consumption and consider a fuel source such as ketones as a rescue (ketones do not require insulin to get inside the cell) and excess ketones are rapidly exhaled through your breath.

Type 2 Diabetes is a lifestyle choice that requires conscious decision making, because the default acceptance of the current nutritional recommendations has resulted in a catastrophic failure, disproportionately injuring the urban minority communities.

The diabetes state of affairs has taken the world by storm. With easy to access processed foods and a sedentary lifestyle, obesity has become all too common. As in many chronic diseases, people are always looking for a cure. Though many diabetics are often under treatment, it is well understood that conventional medicine only manages the diabetic condition but does not offer any hope for reversal or a cure. Is the carnivore diet the missing piece in this puzzle?  How can adapting the carnivore diet start reversing the effects of this disease? In this article, we will look at the possibilities of these statements and shed some light on how the carnivore diet can actually help.

1. What about the carnivore diet that would make it ideal for reversing Type 2 Diabetes?

The carnivore diet is very effective in achieving two common aims of diabetes control, lowering blood glucose levels and reducing weight.

The all-meat diet, also known as the carnivore diet, is exactly what its name suggests: a diet that consists of 100% of meat. Think of the keto diet without any salads or low carb vegetables.

The carnivore diet has been claimed to have a variety of benefits including:

• lower blood pressure
• improved insulin sensitivity
• reduced dependency on medication
• reduction in weight
• improvements in high-density lipoprotein (HDL), or “good” cholesterol, without adding to low-density lipoprotein (LDL), or “bad” cholesterol
• a drop in insulin

Proponents of the diet tout its ability to aid in weight loss, cure autoimmune diseases, decrease digestive issues, and improve heart health.

The idea with this diet is to stay away from carbohydrate-rich foods that could spike insulin levels. Typically, carbohydrates are totally eliminated from a carnivore diet.

The carnivore diet should consist of the following types of food:

• Meats: Fatty meats are acceptable, but should be eaten in moderation to be mindful of heart health. Also, be mindful of consuming too much protein. Combining a high level of protein with low levels of carbohydrates may cause the liver to convert the protein into glucose. This would raise blood sugar levels.
• Eggs: Eggs are low in carbohydrates, as well as being an excellent source of protein.
• Fish: This is a good source of protein.
• Poultry: Also a good source of protein
• Organ parts: Apart from giving nutrition, they also have nutrients important for the body
• Cheese: Not everyone on a carnivore diet takes cheese but it can be included.

There has been anecdotal evidence that people with diabetes have been able to stabilize their blood sugar using this diet. From a biochemistry standpoint, if you’re eating only meat, you’re largely not taking in glucose, so your blood glucose levels are likely to be the table.

2. What are the effects of Carbohydrates on a diabetic?

Foods containing carbohydrates, such as bread, rice, pasta, milk, and fruit, are the main fuel source for many bodily processes. The body uses insulin to help bring glucose from the blood into the cells for energy.

Type 2 Diabetes is a disease of insulin resistance, people suffering from this condition produce too much insulin and their receptors don’t work. This disrupts the body’s ability to use carbohydrates effectively and, in turn, causes high blood sugar levels.

When a person with Type 2 Diabetes eats a high-carb meal, this can lead to a spike in blood glucose.

Because the carnivore diet totally eliminates carbohydrates, glucose spikes are avoided. In fact, the body starts using the stored up fat for energy. This leads to weight loss and stable sugars.

In a nutshell, the carnivore diet might:

• reduce the risk of diabetes in people who do not yet have it
• improve glycemic control in people with diabetes
• help people to lose excess weight

3. What impact would the carnivore diet have on a diabetics’ medication?

The carnivore diet may help reduce blood sugar levels. As such, some people with type 2 diabetes who start this diet may be able to reduce their need for medication. One should have their blood glucose levels constantly monitored so as to adjust medication accordingly.

Hypoglycemia occurs when blood sugar levels fall to 70 milligrams per deciliter (mg/dL) or less.

4. What is the impact of a carnivore diet on weight loss?

People on a carnivore diet tend to lose weight because:

• They totally eliminate carbohydrates and sugar, which are converted to fat very readily.
• Their bodies start burning fat for energy. Naturally, this leads to reduced weight.

Diabetes has been linked to obesity and one of the factors that help in the prevention and management of this disease is keeping one’s weight within their BMI. As such, this aspect of the carnivore diet can go a long way in managing, and even reversing Type 2 Diabetes.

Does the Carnivore dirt have side effects?

The Carnivore diet may be a viable glucose management option for some people with type 2 diabetes. However, as it involves switching to a different source of energy, it can lead to some adverse effects.

Short-term side effects

The dietary change might cause symptoms that resemble withdrawal from a substance, such as caffeine.

These symptoms may include:

• keto-flu, a short-term group of symptoms that resemble those of flu
• noticeable changes in bowel habits, such as a running stomach
• uncomfortable leg cramps
• a noticeable loss of energy
• mental fogginess
• frequent urination
• headaches
• loss of salts

In most instances, the side effects are temporary. People often experience no long-term health problems.

5. Are there any long-term side effects?

Measuring blood sugar looks at the short-term, immediate effect of food. But over time, eating a diet of mostly or only meat can have long-term health consequences.

Long-term effects might include the development of kidney stones and an increased risk of bone fractures due to acidosis.

Other complications include the risk of dyslipidemia and a possible increase in hypoglycemic episodes.

Some animal studies have suggested that, since a low-carb diet often involves additional fat, there might be a higher risk of cardiovascular disease (CVD), due to a buildup of fats in the arteries. People with diabetes already have an increased risk of CVD.

There is a lack of evidence about the long-term safety and effectiveness of the carnivore diet, and researchers have called for more primary studies and more evidence before recommending this diet.

6. Are there alternatives to this diet?

A doctor may recommend a specific meal plan rather than suggesting a diet. The carnivore diet is one of many eating plans that might help people manage their weight.

However, a majority of health professionals do not recommend the carnivore diet for managing diabetes. There are many other nutrient-dense diets available that aim to balance carbohydrate, protein, and fat intake, control body weight, and keep blood sugar within a healthful range.

7. What are the Criticisms of this diet?

Critics of the carnivore diet focus on the adverse effects, including the possibility of kidney damage, CVD, and hypoglycemic episodes.

Maintaining this type of diet can also be difficult on a long-term basis, as it is highly restrictive.

This may lead to weight gain later on, particularly if an individual starts to eat unbalanced levels of carbohydrates once they switch back to a regular diet.

Critics also note that there is no evidence to support the long-term benefits of the carnivore diet.

8. So, is it advisable for a diabetic to go on a carnivore diet?

Unlike the other diets, the carnivore diet is easy to track and maintain because it involves eating all kinds of meat in any quantities. It is thus easier to follow and much harder to fall off the wagon than being on diets such as the keto diet and others that need careful monitoring and measuring in some.

Much remains to be discovered about how this way of eating impacts our health, but it’s certainly worth a try if you’re struggling with autoimmune diseases, obesity, diabetes or psychiatric issues. Going on a carnivore diet as a short-term experiment is reasonable and safe, albeit socially challenging.

Therefore, at this point in time, without scientific studies to back the safety of this diet, and without substantial anecdotal evidence about long-term success, there isn’t really any way to say for certain if the all-meat diet is good for people with diabetes. One thing it won’t do, however, raises blood sugar levels. And that’s a good thing!

References:

1. A sweet life (2018): Is the All Meat Diet Good for People With Diabetes? Retrieved from https://asweetlife.org/is-the-all-meat-diet-good-for-people-with-diabetes/

2. Nutrita (2019): The ultimate guide to the carnivore diet. Retrieved from https://nutrita.app/guide-to-the-carnivore-diet/

3. Healthline (2019): All Meat, All the Time: Should People with Diabetes Try the Carnivore Diet? Retrieved from https://www.healthline.com/health/diabetes/carnivore-diet-for-diabetes#1

4. NCBI (2017): Effects of Ketogenic Diets on Cardiovascular Risk Factors: Evidence from Animal and Human Studies. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5452247/

About 30 million people in the US have diabetes, of these; about one 8 million don’t know that they have it. Early diagnosis of diabetes can help in the treatment and possibly reversal of diabetes. But what is diabetes reversal?

Diabetes reversal is similar to long-term diabetes remission. As much as it is not a definite cure for diabetes, it means that a person with diabetes type 2 can have normal blood sugar levels for a number of years without having to take any diabetic medication. This can be achieved through a number of factors which we shall discuss below. Before getting there, let’s shed some light on type 2 diabetes.

Diabetes type 2 Reversal

Diabetes type two used to be a disease of the elderly. But with the adoption of a modern lifestyle, even young children are being plagued by this debilitating disease. Genetics and ethnicity play a role in the acquisition of diabetes type two, but diet and lifestyle factors are great contributors as well. And by controlling the later, a person predisposed to the disease can be able to avoid it in some cases.

Diabetes type 2 occurs due to the gradual build-up of insulin resistance. Insulin is the hormone that removes sugar from the bloodstream and stores it in cells. Over time, a person becomes less sensitive to the effects of insulin leading to a buildup of sugar in the blood. Beta cells are further stimulated to produce more and more insulin until eventually they are exhausted and depleted.

Reversal of diabetes type 2 targets the restoration of insulin sensitivity and in some cases the regeneration of beta cells. This means that a person with reversed diabetes should be able to maintain normal blood sugar levels without the use of diabetes medication. Research has shown that weight loss is one of the most effective approaches to achieving diabetes reversal.

Here are four ways to achieve healthy weight loss and diabetes reversal:

1.    Very Low-Calorie Diet

Several studies have looked at the effects of a very low-calorie diet on diabetes. In one study, two people followed a mostly liquid diet of 625-850 calories a day for 2-5 months, followed by a less restricted diet designed to help them keep off the weight they lost. Results showed that a low-calorie diet helps to reduce weight and improve insulin sensitivity. In another study, seven obese patients with type 2 diabetes were put on a very low-calorie diet of 900kcal and 115g of protein. This led to significant improvement in blood sugar control that was mainly attributed to improvements in insulin sensitivity.

Note that these types of diets are extreme. You have to work with a professional who will assess your fitness for undertaking such a drastic approach. Most people who have had success in reversing diabetes with this approach are those who have not had diabetes or a long time. This makes it important to start the weight loss journey as soon as possible after you’re diagnosed.

2.    Exercise

Regular exercise is another way of improving diabetes, but this has to be combined with diet and other measures in order to achieve diabetes reversal. Exercise needs commitment and dedication in order to bear fruits.

Regular exercise is associated with decreased demand for insulin as well as increased sensitivity to insulin. A 2015 study published showed that 67% of participants were able to achieve partial remission by taking part in a 6-months diet and exercise regimen. All the study participants were newly diagnosed with type 2 diabetes.

3.    Bariatric Surgery

Bariatric surgery helps one achieve weight loss by reducing their food intake. This, in the long run, has helped diabetes type 2 patients achieve reversal.

A 2010 study showed that bariatric surgery can help in diabetes reversal. Another 2013 study reported that 24% of participants with type 2 diabetes achieved remission six years after receiving gastric bypass surgery. The study concluded that:

“Bariatric surgery can induce a significant and sustainable remission and improvement of T2DM and other metabolic risk factors in severely obese patients. Surgical intervention within 5 years of diagnosis is associated with a high rate of long-term remission.”

Bariatric surgery is suitable only when your BMI is 35 or higher. It works best for people who’ve had diabetes for less than 5 years and they are not on insulin.

For newly diagnosed type 2 diabetics who are obese, this can be a suitable option to help them reverse diabetes.

4.    Intermittent Fasting

Intermittent means going without any food or drink with calories for a given amount of time. For example, you can restrict your eating to eight hours each day and you starve for the remaining sixteen hours. Caution: you need to consult with your doctor before embarking on a fast, even if it’s partial and for medical reasons.

A small study looked at three men between the ages of 40 and 67 who tried intermittent fasting for approximately 10 months. All were able to stop insulin treatment within a month of the study period. According to the author of the study Jason Fung, this study showed that intermittent fasting could be effective in reversing type 2 diabetes.

However, this result can only be used as anecdotal. Larger clinical trials need to be conducted to determine the clear effectiveness of this approach.

What Doesn’t Work?

There is a lot of hype when it comes to diabetes reversal. Shrewd businessmen have tried to exploit vulnerable patients by selling magic pills that they purport to cure for diabetes. They come in all forms of preparations such as:

• Over-the-counter pills
• Herbs
• Supplements
• Alternative medicines
• Homeopathic products
• Prescription drugs

If you or a loved one is living with type 2 diabetes it is important that you consult with your healthcare provider before embarking on any diabetes reversal program. As much as diabetes reversal is achievable, you need to be wary of greedy scammers eager to make a dishonest buck.

References

1. Healthline: Type 2 Diabetes Statistics and Facts. Retrieved from https://www.healthline.com/health/type-2-diabetes/statistics#1
2. NCBI (2019): Reversing Type 2 Diabetes: A Narrative Review of the Evidence. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520897/
3. NCBI (1998): Early and long-term effects of acute caloric deprivation in obese diabetic patients. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/3291612
4. Diabetes UK: Reversing Type 2 Diabetes. Retrieved from https://www.diabetes.co.uk/reversing-diabetes.html
5. NCBI (2013): Can diabetes be surgically cured? Long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes mellitus. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24018646

Flour is hard to avoid during meal times. Breakfast options mainly consist of toast, bagels, cereal, and pancakes. A convenient lunch is sandwiches, wraps, pasta or pizza. Dinner might come with its own temptations too. As a result, the average American now eats 10 servings of refined grains each day. What effect do these refined grains have on your health? Do consuming refined grains predispose you to Type 2 Diabetes? In this article, we will have a look at factors that could put you at risk.

1. 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:

1. Bran: The hard outer layer, containing fiber, minerals and
2. Germ: The nutrient-rich core, containing carbs, fat, protein, vitamins, minerals, antioxidants and plant compounds.
3. 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 contain high amounts of many nutrients, such as fiber, B vitamins, iron, magnesium, phosphorus, manganese, and selenium.

During the refining process, the bran and germ are removed, along with all the nutrients they contain. Removing the nutrients from the grain has implications. On the upside, it makes things like bread doughy and spongy — textures we like and have come to crave. On the downside, the nutritional value of the food is severely compromised, and these striped grain products actually deplete our body’s reserves of important vitamins and minerals.

The nutrient content of refined flour is determined by the ‘extraction rate’ (the proportion of the grain retained after milling). Refined flour produced in Australia is milled to an extraction rate of 78-80% resulting in higher nutrient content (prior to fortification) than flour produced in countries using 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 rapidly digested starch with small amounts of protein.

2. What are the effects of consuming refined grains on our health?

• Blood sugar spikes: Because flour is easily digestible, it causes our blood sugar to spike, which could lead to a rise in insulin. The pancreas has to crank out a lot of insulin to metabolize the glucose in flour-rich foods, which can set the body up for insulin resistance, diabetes, and bodywide inflammation.Refined grains have a higher glycemic index, which is how quickly the body turns food into fuel or glucose.  A carbohydrate in wheat, called amylopectin A, is more easily converted to blood sugar than most other carbohydrates. Two slices of bread made with whole-wheat flour could raise blood sugar higher than six teaspoons of table sugar and 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. As they are low in fiber and digested quickly, eating refined carbs can cause major swings in blood sugar levels. This can contribute to overeating.
• As we have discussed above, foods high on the glycemic index promote short-term fullness, lasting about one hour. On the other hand, foods that are low on the glycemic index promote a sustained feeling of fullness, which lasts about two to three Blood sugar levels drop about an hour or two after eating a meal high in refined carbs. This promotes hunger and stimulates parts of the brain associated with reward and craving.
• These signals make you crave more food, and are known to cause overeating. This constant eating leads to obesity, a pre-diabetic state, and eventual diabetes.
• Slower Metabolism: Research shows that the body may shift nutrients into fat storage and away from muscle burning in the presence of high-glycemic-index foods. In 2004, Ludwig and his colleagues at Harvard conducted a study, published in the journal Lancet, in which 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. When glucose drifts in the blood, it could attach itself to nearby proteins. The result is a chemical reaction called glycation, 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 fissures between cells. Also, when whole-kernel grains are refined, 80 percent of the fiber is lost, and gut health suffers. Without the fiber, you end up with rapid-release carbs in these grains, which is a bad thing for the gut. Fiber helps sweep the gut of debris and supports the body’s critically important elimination and detoxification processes, which also play a role in keeping high cholesterol and inflammation at bay.
• Food Allergies/Intolerances: Wheat, in particular, is one of the biggest dietary triggers of food allergies and intolerances. While the exact reason is unclear, many experts blame the higher gluten content of modern wheat varieties. A type of protein found in many grains, including wheat, gluten gives dough elasticity, trapping air bubbles and creating a soft texture. Because soft is considered desirable, wheat today is bred to have more gluten than ever before.
• Acid-Alkaline Imbalance: The body has an elaborate 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 on an even keel. When 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 chips away at our cellular vitality and immunity in ways that can make us vulnerable to chronic disease. Grains are the only plant foods that generate acidic byproducts. Wheat, in particular, is among the most potent sources of sulfuric acid, a powerful substance that quickly overcomes the neutralizing effects of alkaline bases.

3. How can we have grains in their most healthy form?

Whole grains deliver fiber, healthy fats, vitamins, minerals, plant enzymes and hundreds of phytochemicals. For those seeking a dense source of carbohydrate energy, they can be a healthy choice — but only if they are unrefined and minimally processed. Here are a few steps toward upgrading your own grain options:

• Choose whole-kernel grains when possible.
• Try sprouted grains.
• While baking, replace part of the flour with nut or seed meals.
• Stick with truly whole-grain flours.
• Don’t overdose on gluten-free foods.
• Try going flour-free.
• Consider a grain sabbatical.

4. Are refined grains a culprit in Insulin resistance and Type 2 Diabetes?

When ground into flours, most grains act like sugar in the body, triggering weight gain, inflammation, and blood-sugar imbalances. Studies show that high consumption 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 increase blood triglyceride levels. This is a risk factor for both heart disease and type 2 diabetes. It is therefore advisable to keep our refined grain consumption at a minimum and if we do indulge, check that what we are having is fortified.

References

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

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

3. 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

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

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

Risk factors, the following factors increase your chances of developing insulin resistance metabolic inflammation:

Ethnicity may be a genetic factor or a lifestyle factor.

All of these diseases are increased when you develop Insulin Resistance & Metabolic Inflammation

Prevention: 

A healthy lifestyle prevents conditions that cause metabolic syndrome:

• Eat only when really hungry, don’t snack.
• Get at least 30 minutes of physical activity per day.
• Eat real food and avoid all processed foods.
• Avoid sugars and artificial sweeteners.
• Avoid industrial seed oils.
• Maintain a healthy weight and build muscle.
• Sleep well.
• Avoid screens.
• Have real friends.
• Don’t smoke.

The interplay between immunity, inflammation, and metabolic changes is a growing field of research. Exciting new evidence is emerging with regard to their role in the regulation of metabolism and the activation of inflammatory pathways during the progression of metabolic disorders such as Type 2 Diabetes and Atherosclerosis.

1. The innate immune system

The innate immune system is an evolutionarily conserved system that senses and defends against infection and irritation. Innate immune signaling is a complex cascade that quickly recognizes infectious threats through multiple germline-encoded cell surface or cytoplasmic receptors and transmits signals for the deployment of proper countermeasures through adaptors, kinases, and transcription factors, resulting in the production of cytokines.

As the first response of the innate immune system to pathogenic signals, inflammatory responses must be rapid and specific to establish a physical barrier against the spread of infection and must subsequently be terminated once the pathogens have been cleared. Long-lasting and low-grade chronic inflammation is a distinguishing feature of type 2 diabetes and cardiovascular diseases, which are currently major public health problems.

2. How does the innate immune system work?

The ability of organisms to mount a response to infectious challenge without prior exposure is regulated by the coordinated interaction of components of the innate immune system. This preformed system is important to respond to exogenous stimuli such as bacterial, viral, and fungal infections. Beyond the initial response to a stressor, the innate immune system coordinates the resolution of inflammation, tissue repair, and the activation of the adaptive immune system to provide memory for future challenges.

While much of our understanding of innate immunity comes from models of infection, it is also clear that immune responses can be triggered by endogenous stimuli. Such mechanisms play a wide role in health and disease from the response to tissue injury, the direction of tissue remodeling, and the response to tumors.

3. The Innate Immune Response to Obesity

The increased prevalence of obesity and overweight in adults continues to rise and contributes to morbidity and mortality that is estimated to cost $147 billion dollars a year in the U.S. (Finkelstein et al., 2009) and up to 0.6% of the gross domestic product of European countries (Muller-Riemenschneider et al., 2008). More ominous is the high rates of childhood obesity which is a strong predictor of adult obesity (Lee et al., 2009). This has also shifted the prevalence of adult diseases such as type 2 diabetes and pre-diabetes into childhood and has generated new treatment and prevention challenges (Lee, 2006; Lee et al., 2006). Relevant to this review, increases in inflammatory biomarkers such as C-reactive Protein (CRP) and neutrophilia are seen in obese children as young as 3 years of age (Skinner et al., 2010). This indicates that many of the origins of obesity-induced inflammation may actually be initiated during childhood. Therefore, many people will face a lifetime threat to health from obesity.

The long term duration of obesity-induced inflammation makes it challenging to describe this unique type of inflammatory activation based on classical models of innate immunity. Applying such models may be inaccurate and insufficient to encompass the events that are triggered by obesity in metabolic tissues such as fat. Furthermore, it is clear that the inflammation generated by obesity is not as high in amplitude as those seen in acute infectious settings (Hotamisligil, 2006). These unique challenges have led to the coining of the term “metal inflammation” to describe the chronic low-grade inflammatory events that occur in obesity and its associated diseases.

A frequently asked question is why would obesity trigger an immune response? For the most part, this question remains unanswered, but one answer to this may lie in the fact that many of the key regulators of metabolism also play critical roles in regulating inflammatory responses.

4. Inflammation as a link between obesity and disease

The interest in obesity-induced inflammation relates to the understanding that inflammatory mechanisms are central to the pathogenesis of diseases such as heart disease that is modified by obesity.

It is impossible to cover the scope of all of these diseases so we will focus our attention on the inflammatory mechanisms of fatty liver disease and Type 2 Diabetes-related diseases with fundamental alterations in nutrient control derived from pro-inflammatory inputs. This will set the stage for future discussion of the innate immune components activated in obesity. I will highlight both clinical and pre-clinical studies in animal models of obesity that have built our understanding of the mechanisms that drive obesity-associated diseases.

4.1 Non-alcoholic Fatty Liver Disease (NAFLD)

The liver plays a critical role in the regulation of glucose and lipids levels in the blood. Obesity generates a number of physiologic changes in hepatocyte glucose production as well as lipid oxidation and storage. Unusual hepatic lipid accumulation is connected to many obesity-associated illnesses that include non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome. The metabolic changes that occur with hepatic lipid accumulation include hepatic insulin resistance which is related to inflammatory cytokine signals.

4.2 Type 2 Diabetes (T2D)

The regulation of glucose metabolism is securely coordinated between nutrient inputs regulated by the liver and gut, nutrient utilization and storage in muscle and fat, insulin secretion by the pancreas, and central signals from the hypothalamus that coordinate these responses. The dysregulation of almost all of these processes with obesity is now known to be associated with the activation of innate pro-inflammatory pathways. The net result of this is the generation of systemic insulin resistance and hyperglycemia.

5. Why obesity affects the innate immune system

The blend of a sedentary lifestyle and surplus energy intake has led to an increased occurrence of obesity which constitutes a major risk factor for several comorbidities including type 2 diabetes and cardiovascular diseases. Intensive research during the last two decades has revealed that a characteristic feature of obesity linking it to insulin resistance is the presence of chronic low-grade inflammation being indicative of activation of the innate immune system.

Recent evidence suggests that activation of the innate immune system in the course of obesity is mediated by metabolic signals, such as free fatty acids (FFAs), being elevated in many obese subjects, through activation of pattern recognition receptors thereby leading to stimulation of critical inflammatory signaling cascades, like IκBα kinase/nuclear factor-κB (IKK/NF- κB), endoplasmic reticulum (ER) stress-induced unfolded protein response (UPR) and NOD-like receptor P3 (NLRP3) inflammasome pathway, that interfere with insulin signaling.

Exercise is one of the main prescribed interventions in obesity management improving insulin sensitivity and reducing obesity-induced chronic inflammation. A deeper understanding of the effects of exercise on inflammatory signaling pathways in obesity is useful to optimize preventive and therapeutic strategies to combat the increasing incidence of obesity and its comorbidities.

References:

1. Journal of Biological Chemistry (2013): How Metabolism Generates Signals during Innate Immunity and Inflammation. Retrieved from http://www.jbc.org/content/288/32/22893.full.html
2. Physiological Reviews (2018): Innate Immune Signaling and Its Role in Metabolic and Cardiovascular Diseases. Retrieved from https://www.physiology.org/doi/abs/10.1152/physrev.00065.2017
3. NCBI (2012): Innate Immune Activation in Obesity. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3888776/
4. NCBI (2015): Metabolic signals and innate immune activation in obesity and exercise. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25825956

In previous articles, I have discussed the role of metabolic Inflammation in obesity and diabetes. Today, we will narrow down to the specifics of what insulin resistance is, its effects and how metabolic inflammation increases the chances of one developing it.

1. What is Insulin resistance?

Approximately 30% of Americans, and up to 50% in the 60 years and over the bracket, have a silent blood sugar problem known as insulin resistance. Insulin resistance increases the risk for prediabetes, Type 2 diabetes and a host of other serious health problems, including heart attacks, strokes, and cancer.

What therefore is Insulin Resistance? It is when cells in your muscles, body fat and liver start repelling or ignoring the signal being sent out by the hormone, insulin—which is to take glucose from the bloodstream into our cells for breakdown or storage. Glucose, commonly called blood sugar, is the body’s main source of fuel.

1. How does Insulin Resistance Develop?

Some factors that determine 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 sleep depravity.

With time, and as the insulin resistance develops, more insulin is produced by your body as it tries to fight back. After an accumulated period of time, several years even, the beta cells in your pancreas get worn out because of all the extra work and can no longer keep pace with the increased demand for insulin. Then – years after insulin resistance stealthily started – your blood sugar may spike and you may manifest prediabetes or type 2 diabetes. You are also at risk of developing the non-alcoholic fatty liver disease (NAFLD), a condition that increases your risk for liver damage and heart disease.

2. What are the Signs and Symptoms of Insulin Resistance?

Insulin resistance does not always manifest to the naked eye but here are some signs to look out for:

• A large waist. Experts say the best way to tell whether you’re at risk for insulin resistance involves a tape measure and moment of truth in front of the bathroom mirror. A waist that measures 35 inches or more for women, 40 or more for men (31.5 inches for women and 35.5 inches for men if you’re of Southeast Asian, Chinese or Japanese descent)6 increases the odds of insulin resistance and metabolic syndrome, which is also linked to insulin resistance.
• You have additional signs of metabolic syndrome. According to the National Institutes of Health, in addition to a large waist, if you 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. Low-density lipoprotein 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 develop dark skin patches. If insulin resistance is severe, you may have visible skin changes. These include patches of darkened skin on the back of your neck or on your elbows, knees, knuckles or armpits. This discoloration is called acanthosis nigricans.8

3. Chronic low-grade inflammation and the development of insulin resistance

As early as the 1950’s, there was epidemiological evidence suggesting a correlation between inflammation and insulin-resistant states such as obesity, but the mechanistic links were unknown. In the last decade, however, it has become increasingly evident that obesity and the concomitant development of inflammation are major components of insulin resistance. Studies in human obesity and insulin resistance have revealed a clear association between the chronic activation of pro-inflammatory signaling pathways and decreased insulin sensitivity. For example, elevated levels of tumor necrosis factor-α (TNF), interleukin-6 (IL-6) and interleukin (IL-8) have all been reported in various diabetic and insulin-resistant states. In addition, the inflammatory marker C-reactive protein (CRP), a non-specific acute phase reactant, is commonly elevated in human insulin-resistant states. Also, experiments in naturally occurring rodent models of obesity, knockout and transgenic mice, as well as detailed studies of insulin signaling at the molecular level have begun to elucidate the mechanistic links between obesity-induced inflammation and insulin-resistant states.

4. 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. In addition, up to 80% of people with type 2 diabetes have NAFLD. But those aren’t the only threats posed by insulin resistance.

Thanks to years of high insulin levels followed by an onslaught of cell-damaging high blood sugar, people with insulin resistance, prediabetes, and type 2 diabetes are at high risk for cardiovascular disease. Insulin resistance doubles your risk for heart attack and stroke – and triples the odds that your heart attack or ‘brain attack’ will be deadly, according to the International Diabetes Federation.

Meanwhile, insulin resistance and metabolic syndrome are also linked with higher risk for cancers of the bladder, breast, colon, cervix, pancreas, prostate and uterus.11, 12  The connection: High insulin levels early in insulin resistance seem to fuel the growth of tumors and to suppress the body’s ability to protect itself by killing off malignant cells. 13

Research has also found a strong association between insulin resistance and memory function decline, increasing the risk of Alzheimer’s disease.

5. Can understand the causes of Insulin Resistance aid in future preventive approaches?

As obesity-associated chronic low-grade inflammation is responsible for the decrease of insulin sensitivity, obesity is a major risk factor for insulin resistance and related diseases such as type 2 diabetes mellitus and metabolic syndromes. The state of low-grade inflammation is caused by over-nutrition which leads to lipid accumulation in adipocytes.

Obesity might increase the expression of some inflammatory cytokines and activate several signaling pathways, both of which are involved in the pathogenesis of insulin resistance by interfering with insulin signaling and action. It has been suggested that specific factors and signaling pathways are often correlated with each other; therefore, both of the fluctuations of cytokines and the status of relevant signaling pathways should be considered during studies analyzing inflammation-related insulin resistance.

References

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

3. NCBI (2006): Inflammation and Insulin Resistance. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1483173/
4. 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
5. Hindawi (2015): Mechanisms Linking Inflammation to Insulin Resistance. Retrieved from https://www.hindawi.com/journals/ije/2015/508409/

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

The modern diet contains a large number of simple sugars. From bread to donuts, to carbonated drinks to chocolate, cookies, and candy, everywhere you look, temptation abounds. The potential impact on the health of diets rich in free sugars, and particularly fructose, is of major concern. Does the sugar we take have an impact on insulin resistance and obesity? In this article, we look at this risk and the effects of insulin resistance.

1. Sugar and Insulin resistance….

Sugar has a bittersweet reputation when it comes to health. It occurs naturally in all foods that contain carbohydrates, such as fruits and vegetables, grains, and dairy. Consuming whole foods that contain natural sugar is safe. Plant foods also have high amounts of fiber, essential minerals, and antioxidants, and dairy foods contain protein and calcium.

Where does the problem with sugar come about? Added sugar, which is usually extracted or synthesized ……

There is plenty of evidence to suggest that consuming too much sugar can have a negative effect on our metabolic health. Regular sugar consumption produces a constant release of the hormone insulin. Over a period of time, it can lead to serious problems, such as the synthesis of triglycerides, insulin resistance, fatty liver disease, type II diabetes, an increase in very-low-density lipoprotein (the bad kind of cholesterol), and the accumulation of fat on all tissues.

Added sugar intake may contribute to and certainly does exacerbate insulin resistance. For example, added sugar intake is associated with higher blood pressure, inflammation, weight gain, fatty liver disease, health issues that can lead to insulin resistance, and further exacerbation of these issues. Added sugars cater to particularly energy-hungry but metabolically inefficient cells, including senescent cells, cancerous cells, and even quickly proliferating pathogenic bacteria in the gut.

Several genetic and lifestyle factors can contribute to how likely you are to develop insulin resistance. But even if you have a genetic risk, you can help yourself with regular exercise, a balanced diet, avoidance of added dietary sugars, healthy sleep patterns, and stress reduction activities.

Risk factors for insulin resistance and prediabetes include:

• Obesity
• Aging
• physical inactivity
• high cholesterol
• blood pressure
• sleep disorders or circadian rhythm disruption

It is said that one in three Americans—including half of those age 60 and older— have insulin resistance.

2. What exactly is Insulin Resistance?

Insulin resistance is when cells in your muscles, body fat, and liver start resisting or ignoring the signal that the hormone insulin is trying to send out—which is to grab glucose out of the bloodstream and put it into our cells. Glucose, also known as blood sugar, is the body’s main source of fuel. We get glucose from grains, fruit, vegetables, dairy products, and drinks that bring break down into carbohydrates.

3. How does Insulin Resistance develop?

While genetics, aging, and ethnicity play roles in developing insulin sensitivity, the driving forces behind insulin resistance include excess body weight, too much belly fat, a lack of exercise, smoking, and even not getting enough sleep.

As insulin resistance develops, your body fights back by producing more insulin. Over months and years, the beta cells in your pancreas have been working so hard to make insulin get worn out and can no longer keep pace with the demand for more and more insulin. Then – years after insulin resistance silently began – your blood sugar may begin to rise, and you may develop prediabetes or type 2 diabetes. You may also develop non-alcoholic fatty liver disease (NAFLD), a growing problem associated with insulin resistance that boosts your risk for liver damage and heart disease.

4. What are the Signs and Symptoms of Insulin Resistance?

Insulin resistance can be triggered by a combination of factors linked to weight, age, genetics, being sedentary, and smoking.

– Polycystic ovary syndrome (PCOS): Insulin resistance can worsen the symptoms of PCOS, which can include irregular menstrual cycles, infertility, and periods that cause pain.

– A large waist. Experts say the best way to tell whether you’re at risk for insulin resistance involves a tape measure and a moment of truth in front of the bathroom mirror. A waist that measures 35 inches or more for women and 40 or more for men (31.5 inches for women and 35.5 inches for men if you’re of Southeast Asian, Chinese, or Japanese descent) increases the odds of insulin resistance and metabolic syndrome, which is also linked to insulin resistance.

– You have additional signs of metabolic syndrome. According to the National Institutes of Health, in addition to a large waist, if you 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. Low-density lipoprotein 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.

– Acanthosis nigricans: This skin condition can develop in people with insulin resistance. It involves dark patches forming on the groin, armpits, and the back of the neck.

5. What health conditions are related to Insulin Resistance?

The most common health condition related to Insulin Resistance is prediabetes and the resultant Type 2 Diabetes. Insulin resistance also doubles your risk for heart attack and stroke – and triples the odds that your heart attack or ‘brain attack’ will be deadly.
Insulin resistance and metabolic syndrome are also linked with a higher risk for cancers of the bladder, breast, colon, cervix, pancreas, prostate, and uterus. This is because the high insulin levels early in insulin resistance seem to fuel the growth of tumors and suppress the body’s ability to protect itself by killing off malignant cells.

Furthermore, research has found a strong association between insulin resistance and memory function decline, increasing the risk of Alzheimer’s disease.

6. Can you prevent or reverse insulin resistance?

The good news is that, yes, insulin resistance can be prevented and also reversed in some cases. Here is what you can do:

• Get recommended amounts of physical activity and structured exercise
• Get adequate sleep
• eat when the sun is up(we are more insulin resistant at night and after a night of poor sleep, due to disrupted circadian rhythms that help regulate our metabolic state)
• Reducing stress and, therefore stress-related inflammation
• Maintaining a healthy weight
• Increasing your plant fiber intake.

All of the above can help improve your insulin sensitivity. It has been shown that combining both diet and exercise have the most impact on insulin sensitivity.

In a fascinating University of New Mexico School of Medicine, study published in the International Journal of Obesity, overweight people who lost 10% of their weight through diet plus exercise saw insulin sensitivity improve by an impressive 80%. Those who lost the same amount of weight through diet alone got a 38% increase. And those who simply got more exercise, but didn’t lose much weight, saw almost no shift in their level of insulin resistance.

Intermittent fasting is also another way in which you can reverse your insulin resistance. This is because it gives your body a break from insulin and glucose signaling pathways that promote cell proliferation and inflammation and may help increase insulin sensitivity.

7. What, therefore, is the relationship between sugar and Insulin Resistance?

There is an association between diets high in sugars (predominantly sucrose) and the risk of disease, and experimental studies have shown that high intakes of fructose (over 100 g/d) can reduce insulin sensitivity. However, somewhat lower intakes may affect serum TG. The mechanisms for such associations or effects have not been convincingly demonstrated.

References:

1. NCBI (2016): A review of recent evidence relating to sugars, insulin resistance, and diabetes. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5174139/

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

3. Medical News Today (2019): What to know about insulin resistance. Retrieved from https://www.medicalnewstoday.com/articles/305567.php

4. The Sugar Movement (2016): Sugar vs Fat. Retrieved from https://thatsugarmovement.com/sugar-vs-fat/

5. Harvard Health Publishing (2017): The sweet danger of sugar. Retrieved from https://www.health.harvard.edu/heart-health/the-sweet-danger-of-sugar

6. NCBI (2014): Weight Loss, Exercise, or Both and Cardiometabolic Risk Factors in Obese Older Adults: Results of a Randomized Controlled Trial https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3835728/