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.
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.
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.
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.