The secret to becoming a type 2 diabetic is the modern lifestyle. Frequent carbohydrate loads keep insulin, the fat-storage hormone, high until the cells stop responding to it. Prediabetes left untreated leads to type 2 diabetes within five years. And fewer than 11 percent of adults with prediabetes know they have it.
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. They are tied to the malnutrition of overconsumption. That leads to metabolic inflammation, or metainflammation. This series of articles gives a recipe. It shows how to take a healthy society and create metainflammation. The result is severe chronic disease that needs costly lifelong treatment.
Whether by coincidence or concerted action, this chronic disease model makes tremendous revenue for the medical-industrial complex, big pharma and big food. And it reduces upward mobility. I would even contend that generational metainflammation is a primary driver of economic disparity. It also plays a significant role in violence and incarceration rates.
Are African Americans more likely to get type 2 diabetes?
- African Americans are 1.7 times more likely to develop diabetes than 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 worse diabetes-related complications. These include amputations, adult blindness, kidney failure, and higher risk of heart disease and stroke. This is 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 linchpin for over 80% of human suffering and healthcare expense in the United States. Its common root causes appear unrelated on the surface. Understanding them 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. In the 1940s, Obesity and Diabetes type 2 were 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 and obesity disproportionately affect certain racial and ethnic minority groups. By 2035, nearly 100% of African American females will be overweight or obese. That 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 about 100,000–400,000 deaths in the United States per year. It directly accounts for 5% to 10% of national health care spending. 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 lifespans than the current generation (Olshansky et al., 2005). Obese people not only have a shorter life span. They also have a significantly shorter health span, meaning healthy living before a disabling illness. That lowers 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). If left untreated, this condition 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). Of these, 23.1 million are diagnosed and 7.2 million are undiagnosed diabetics. Over 95% of all diabetics are type 2 diabetics. That is a disease created by the modern lifestyle. The American Diabetes Association currently estimates that the total costs of diagnosed diabetes rose from $245 billion in 2012 to $327 billion in 2017. That is a 26% increase over a five-year period. For diagnosed diabetics, the average medical spending is about $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 diabetes will increase by 54% to more than 54.9 million Americans between 2015 and 2030. Annual deaths blamed on diabetes will climb by 38%. 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). Both have too much glucose in the bloodstream. Other than that, Type 1 diabetes and Type 2 Diabetes are not the same disease.
This discussion focuses on Type 2 Diabetes, what causes it and how to reverse it.
Our bodies normally use a mix of carbohydrates (sugars such as glucose), fats, and proteins for energy. When the body senses that a carbohydrate load is coming, the Beta cells of the pancreas release a hormone called Insulin. Insulin works through special receptors and transporters. It clears glucose from the bloodstream and deposits it into the cells. Inside the cells, glucose is quickly turned into energy, or stored for later as glycogen, or turned into fat. Insulin specifically triggers a series of enzymes that cause fat storage. Whenever you hear the word insulin, think “fat-storage hormone.”
Fat cells take up too much of the glucose in the blood. They overflow their capacity to use glucose for energy and their limited glycogen storage. The cells then make chemical inflammatory signals that leach into the bloodstream. These activate the immune system, contributing to the onset of metainflammation. The cell also begins to leach out stored fats as triglycerides.
Say the cell becomes overwhelmed with glucose and runs out of room to store fat. Then it eventually reaches a critical size and will literally explode. This cell death also causes an inflammatory reaction, or metainflammation.
Extra glucose outside the cells quickly damages them through a process called glycation. It makes cell walls, proteins, and receptors sticky, so they work poorly. Imagine putting sugar into your car’s gas tank. As the clean gas burned, it would leave a sticky residue in the engine. Over time your engine would seize up and all the parts would stop moving.
Glycation causes insulin resistance. The cell receptors can no longer move well, and circulating proteins such as insulin become sticky. We measure this as Hemoglobin A1C. It 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 (diabetes the body can no longer hold in check). Until then, fasting blood sugars appear normal, but the patient is in a state of metainflammation.
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 making even more insulin to clear out the toxic glucose. That only leads to even more insulin production, worsening insulin resistance, and more fat storage.
Insulin resistance also occurs because constant stimulation of biological receptors causes them to down-regulate (become less responsive). These transporters become fatigued if there is too much insulin, or if insulin is released too often.
Eventually, the huge excess of fat storage and the damage to cell structure become so great that the liver and pancreas become congested with fat. Blood flow to the pancreas decreases, so insulin production is severely reduced. The patient now becomes dependent on injected insulin.
Diabetes results in metainflammation 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. Sadly, most patients do not realize they have diabetes until some significant symptom causes them to seek care. That is usually pain, which is the common pathway of tissue damage in metainflammation.
What is wrong with the standard of care treatment for diabetes?
Current medical guidelines specifically treat Type 2 Diabetes as a chronic and progressive disease. In that view, 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 then step-by-step increases in 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 high blood sugar. Meanwhile the disease of insulin resistance gets 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 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 it is dependent on the companies that make 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
Using agents, including insulin, to reduce glucose is absolutely necessary in certain circumstances. But 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 patients should eat 3 meals per day plus snacks. That adds up to eating about five times per day. This advice is baseless in the normal adult population, and it does not fit from an evolutionary point of view.
Hunter-gatherers ate on and off, depending entirely on what food was available. They needed an extraordinarily high level of physical and mental function during the long stretches without food. Their organs adapted. They could rapidly take up and store glucose when it was available, as fat and glycogen. Then they could release these reserves as glucose, fatty acids, and ketones in times of need.
Less than 10,000 years ago, people switched from a hunter-gatherer eating pattern to an agrarian (farming) one. That made food available year-round and led to the current three meals per day eating pattern.
The idea of multiple snacks between meals is a modern development. It began in the 1950s. It closely tracks the loss of healthy eating patterns, food overconsumption, and the epidemic of obesity, metabolic syndrome, and diabetes. The Agriculture Department and the Department of Health and Human Services ran a study on food consumption behavior. The percent of Americans eating three or more snacks a day rose from 11% to 42% between 1977 and 2002. Snacks now make up 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 has only been promoted as the “most important meal of the day” in the media since 1917. There is no evidence that eating breakfast promotes weight loss, or that skipping breakfast leads to weight gain. In fact, people who eat breakfast eat on average 260 calories/day more than those who skip it, and they 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 hormone that clears glucose from the bloodstream (lipogenesis). The pancreas makes it in anticipation of a carbohydrate load. Its primary job is to rapidly clear excess glucose from the bloodstream after a feast. It turns that glucose into long-term fat storage for later use in a time of famine. Keeping insulin high, both in spikes and for long stretches of time, causes a constant 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. It blocks the cell stress responses that remove damaged cells and organelles (autophagy, the body’s cleanup process). Letting dysfunctional cells and organelles pile up is the hallmark of aging. It is also the common pathway for diabetes, cardiovascular/cerebrovascular disease, cancers, and Alzheimer’s disease. When insulin is decreased, autophagy is increased.
Intermittent energy restriction allows a cyclical ebb and flow. That keeps insulin receptors sensitive and minimizes excess fat storage due to chronically high insulin. In other words, eating less often exercises your insulin system and prevents insulin resistance. Constant eating results in lipogenesis and a buildup of cell debris.
What’s wrong with the conventional dietary advice to consume carbohydrates?
The USDA publishes the Dietary Guidelines for Americans. They recommend that carbohydrates make up 45 to 65 percent of total daily calories. On 2,000 calories/day, that means between 900 and 1,300 calories from carbohydrates (225 and 325 grams of carbohydrates a day). The Institute of Medicine also recommends 45 to 65 percent of calories as carbohydrates. It sets a floor of at least 130 grams of carbs eaten per day. The American Heart Association recommends limiting refined sugar to 6 to 9 teaspoons per day. All of these groups suggest there is an absolute need for carbohydrate for human function. And they suggest most nutrition should come from carbohydrates.
However, the lower limit of carbohydrate intake is likely zero. There are no essential carbohydrates required for living. The source is the Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids (2005). It sets the Recommended Dietary Allowance (RDA) for carbohydrate at 130 g/day for adults and children. That figure is considered the average minimum amount of glucose needed by the brain or central nervous system (CNS).
The CNS makes up less than 2% of total body weight but uses roughly 20% of total daily calories. Historically, the brain has been considered the only organ that needs glucose as a fuel source. It uses about 100-140 g glucose per day. But with keto-adaptation, the CNS cuts its required glucose by about 80%. That results in a true use 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 (the body making its own glucose) through gluconeogenesis is about 2.8-3.6 g/kg/d, or about 210-270 g/d in a 70kg human. It is far greater than the 20-28g glucose/d that the keto-adapted human requires.
“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 patients should strive for 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 told to eat “multiple” small meals per day to keep a steady-state glucose level. This sounds reasonable until you look at what the patient is being told to eat.
Diabetics are often told to get more than 50% of their calories from carbohydrates. They are often told to eat “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 made fruit 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 juice 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. Juicing the fruit removes the fiber. The minimal amount of vitamins and antioxidants in the juice does not make up for a large amount of sugar. The sugars may actually prevent vitamin absorption.
https://doi.org/10.1016/S2213-8587(14)70013-0
Diabetics are often told to use rescue sugars when they feel light-headed. Many diabetic patients automatically eat sugar. But when you actually look at their glucose level, it’s often in the normal range. What’s happened is that their brain is insulin resistant. The normal or even high blood sugar can’t get from the bloodstream into the brain cell. Being lightheaded is the symptom of intracellular hypoglycemia (low sugar inside the cells). The temporary fix in that moment is to control the symptom by eating 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 intake. 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. It takes conscious decision making. That is because accepting the current nutrition advice by default has led to a catastrophic failure. That failure is disproportionately injuring urban minority communities.
Frequently asked questions
What is the biggest contributor to type 2 diabetes?
The modern lifestyle. More than 95 percent of diabetics have type 2, a disease the modern lifestyle creates. Frequent carbohydrate loads and constant snacking keep insulin, the fat-storage hormone, high until the cells stop responding to it. The share of Americans eating three or more snacks a day rose from 11 percent to 42 percent between 1977 and 2002. The diabetes epidemic tracks that shift.
What are the first warning signs of type 2 diabetes?
Usually none you would notice. It can take up to 12 years to develop decompensated diabetes. Fasting blood sugar looks normal the whole time while metainflammation does its damage. Most patients learn they have diabetes only when a significant symptom, usually pain, sends them in. Fewer than 11 percent of adults with prediabetes know they have it. A hemoglobin A1C test shows how much glucose is sticking to red blood cells.
Can a healthy person get type 2 diabetes?
A person can look healthy and already be on the way. There are 84.1 million prediabetic Americans, 34 percent of the population. Untreated prediabetes becomes type 2 diabetes within five years. Fasting sugar stays normal for years while insulin resistance builds. Because of that, a normal checkup does not rule it out. The injury starts in the prediabetic stage, before the diagnosis ever arrives.
Can type 2 diabetes go away?
Type 2 diabetes is a lifestyle disease. So changing the lifestyle that created it is how it reverses. Standard care treats the symptom, high blood sugar, with one drug, then two, then three, then insulin. Meanwhile the actual disease, insulin resistance, worsens year after year. Eating less often and cutting carbohydrates lowers insulin. That keeps the receptors sensitive and lets the body shift to burning fat.
Related reading
- Reverse Diabetes MD presentation for providers
- Time-restricted feeding and diabetes
- Insulin for Type 2 Diabetes
Sources
- Tabák AG, Jokela M, Akbaraly TN, et al. Trajectories of glycaemia, insulin sensitivity, and insulin secretion before diagnosis of type 2 diabetes: an analysis from the Whitehall II study. Lancet. 2009. PMID 19515410
- Tabák AG, Herder C, Rathmann W, et al. Prediabetes: a high-risk state for diabetes development. Lancet. 2012. PMID 22683128
- Hotamisligil GS. Inflammation, metaflammation and immunometabolic disorders. Nature. 2017. PMID 28179656
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
