Type 2 diabetes is insulin resistance: your body still makes insulin but can’t use it as well as it should. So glucose builds up in the blood. The modern lifestyle created this disease. The metabolic inflammation of overconsumption drives it. Insulin resistance, not the blood sugar number, is the disease to reverse.
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 related to the malnutrition of overconsumption. That leads to metabolic inflammation, or metainflammation. This series of articles provides a recipe on how to make a healthy society, and create metainflammation. Metainflammation results in severe chronic disease. That disease needs expensive lifelong treatment.
Whether by coincidence or concerted action, this chronic disease model produces tremendous revenue. It pays 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.
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.
Obesity, Prediabetes, and Diabetes are a new phenomenon in the United States. Obesity and type 2 diabetes were nearly unheard of in the 1940s. 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 the national health care spending. Obesity is the second leading cause of death. It 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). Obese people do not only have a shorter life span. They also have a significantly shorter health span (healthy living before a disabling illness). This lowers their quality of life. It also 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. The modern lifestyle created this disease. The American Diabetes Association currently estimates the total costs of diagnosed diabetes. It says they 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 yearly medical spending is about $16,752 per year:
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%. Annual medical and societal costs will increase 53%. By 2050, nearly 1/3 of the United States population is predicted to be diabetic.
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.
The focus of this discussion is 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. The body senses when a carbohydrate load is coming. Then 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 puts it into the cells. Inside the cells, glucose is rapidly converted to energy. Or it is 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.”
Fat cells take up too much circulating glucose. Then they overflow their capacity to use glucose for energy. They overflow their limited glycogen storage too. The cells 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.
The cell may become overwhelmed with glucose and run out of fat storage capacity. If so, 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 the cells by a process of 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.
Insulin resistance due to glycation occurs because the cell receptors can no longer move efficiently, 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. Until then the 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. This only leads to even more insulin production, worsening insulin resistance, and more fat storage.
Insulin resistance also occurs because constant stimulation of biological receptors makes the receptors down-regulate (turn down). These transporters get tired if there is too much insulin or if insulin is released too often.
Eventually, the huge excess fat storage and cell structure disruption become so great that the liver and pancreas get 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. Unfortunately, most patients do not realize they have diabetes until some significant symptom causes them to seek care. That symptom is usually pain, which is the common pathway of tissue damage in metainflammation.
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. Meanwhile 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 this learned helplessness. It almost seems to relish 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 who 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
Agents that reduce glucose, including insulin, are absolutely necessary in certain cases. But they do not address the disease of diabetes, which is insulin resistance.
Conventional dietary advice suggests that patients should eat 3 meals per day plus snacks. That adds up to eating about five times per day. This dietary recommendation is baseless in the normal adult population. It is also inconsistent from an evolutionary perspective.
Hunter-gatherers ate in an on-and-off pattern. It depended entirely on food availability. They needed an extraordinarily high level of physical and mental capacity during the long periods without food. Their organs adapted to rapidly take up and store glucose when available, as fat and glycogen. They could then mobilize these reserves as glucose, fatty acid, and ketones in times of need.
Less than 10,000 years ago, people converted from a hunter-gatherer eating pattern to an agrarian eating pattern. This 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. It began in the 1950s. It closely tracks with the loss of healthy eating patterns and food overconsumption. It also tracks with the epidemic of obesity, metabolic syndrome, and diabetes. The Agriculture Department and the Department of Health and Human Services did a study on food consumption behavior. The percent of Americans eating three or more snacks a day increased 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. The media has only advocated breakfast as the “most important meal of the day” since 1917. 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 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)
BMJ 2019;364:l42
Insulin is a fat-storage hormone that clears glucose from the bloodstream (lipogenesis). The pancreas makes it in anticipation of a carbohydrate load. Its main job is to rapidly clear excess glucose from the bloodstream after a feast. It converts that glucose to long term fat storage for later use in a time of famine. Keeping insulin high, both in 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. It blocks the cellular stress responses that remove damaged cells and organelles (autophagy). 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 permits a cyclical ebb and flow. This keeps insulin receptors sensitive. It also minimizes excess fat storage due to chronically high insulin. In other words, eating less often exercises your insulin system and prevents insulin resistance. Constantly eating results in lipogenesis (making fat) and a buildup of cellular debris.
The Dietary Guidelines for Americans published by the USDA recommends that carbohydrates make up 45 to 65 percent of total daily calories. On a 2,000-calorie daily diet, 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. It sets a floor of 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 humans have an absolute requirement for carbohydrate. They suggest the majority of nutrition should come from carbohydrates.
However, the lower limit of carbohydrate intake is likely zero. There are no essential carbohydrates required for living. The Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids (2005) set the Recommended Dietary Allowance (RDA) for carbohydrate. It is 130 g/day for adults and children. This RDA is considered to be 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 it uses roughly 20% of the total daily calories. Historically the brain has been considered the only organ that required glucose as a fuel source. It uses about 100-140 g glucose per day. However, with keto-adaptation, the CNS reduces its obligatory glucose requirement 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 through gluconeogenesis (the body making its own glucose) is about 2.8-3.6 g/kg/d, or about 210-270 g/d in a 70kg human. This is 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.
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 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 do 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 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 inside of the brain cell. Being lightheaded is the symptom of intracellular hypoglycemia (low sugar inside the cells). The temporary fix at that moment is to control the symptom of hypoglycemia with a fast-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 cutting back on carbohydrates. Consider a fuel source such as ketones as a rescue (ketones do not require insulin to get inside the cell). Excess ketones are rapidly exhaled through your breath.
Type 2 Diabetes is a lifestyle choice that requires conscious decision making. That is because accepting today’s nutrition advice by default has resulted in a catastrophic failure. It has disproportionately injured the urban minority communities.
Yes. Type 2 diabetes is insulin resistance, a disease created by the modern lifestyle. Insulin resistance is the disease to reverse. Drugs that push the blood sugar number down treat the symptom, not the disease. Two levers work on the cause. Eat less often, which exercises your insulin system. And drop the idea that half your calories must come from carbohydrates.
In both, glucose builds up in the blood. In type 1 diabetes the body does not make enough insulin. In type 2 diabetes the body still makes insulin but cannot use it as well as it should. That is insulin resistance. Over 95% of all diabetics are type 2, a disease created by the modern lifestyle.
Often there are none you can feel. It can take up to 12 years to develop decompensated diabetes. Until then fasting blood sugars look normal while the body sits in metainflammation. Less than 11 percent of adults with prediabetes know they have it. Hemoglobin A1C shows how much glucose is sticking to your red blood cells. The higher the number, the greater the glycation.
Fruit juice is near the top. Minute Maid 100 percent apple juice has nearly 66 grams of fructose per liter. That is more than the 62.5 grams in Coca-Cola. Juicing also strips out the fiber that slows sugar absorption. Constant snacking and a diet that is more than half carbohydrates keep insulin chronically elevated. Leaning on rescue sugars only worsens insulin resistance.
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 16, 2026