The unfolding grim reality
Diabetes has today emerged as a fast spreading chronic disease across the world. While as per IHME it’s the 9th major cause of death in India, it’s the 7th major cause of death in the US (as per CDC) and world over (as per WHO). Further its steadily climbing up the ladder.
The situation in India is grim and getting worse steadily.
With 49% of the world diabetes burden India has emerged as the diabetes capital of the world!
While 72 million cases were recorded in India in 2017, the figure expected to nearly double by 2025!
The annual increase which was 0.7% between 1982 to 1996, has climbed over 9 times to 6.5% between 1996 to 2009 and is moving rapidly on an upward trajectory!
Diabetes has today spread its tentacles across both urban and rural areas and different sections of the population, striking younger and younger victims.
We also know for a fact that Diabetes heavily compromises our immunity and paves the way for other Chronic Diseases like Heart Disease and Cancer, and also leads to severe symptoms and complications in case of viral/bacterial infections like Covid19 and Influenza.
Do carbs cause diabetes?
It’s a common misconception that carbohydrates cause diabetes. But as the graph on the left shows it’s the fat in the diet that’s the culprit and not the carbs.
So, US with the highest fats and lowest carbs has the highest diabetes vs Japan with the highest carbs and lowest fats which has the lowest diabetes!
But when the Japanese migrate to US within 1 to 2 generations they inherit the local risk factors due to lifestyle-diet changes, which dispels another misconception that genes are the cause of Diabetes.
Genes are certainly not a determining factor and do not cause diabetes, especially Type 2 Diabetes, on their own, without the fuel provided by a high fat-protein-sugar based diet!
We can see see a similar pattern repeating itself in the case of war time Scotland during the 1st WW.
In the pre war period as the fats go up and carbs go down gradually, diabetes deaths rose steadily.
But during the war, due to war time shortages and restrictions, as the percentage of fats fell and the percentage of carbs rose, we observe a corresponding dip in the diabetes deaths!
A second short lived dip we observe in 1925 was due to introduction of Insulin. But as the fat in the diet increased insulin wasn’t able to hold back the upward trend\
A similar pattern has been playing out in China, where the Diabetes burden has been rising steadily.
In 1970s, The China Study, had found that fat was ~10%, protein ~5-10% and carbohydrates 80-85% of the Chinese diet and Diabetes was almost nil.
But in the 90s as China started adopting western diet habits, carbs in their diet have been falling, and protein-fat increasing, with the increase coming from added oils, animal foods, processed foods and sugar.
And diabetes has been rising steadily from 2.5% of the population in 1991 to 11.6% (5 fold increase) in 2011 and rising rapidly!
What causes Diabetes
Lets look at the process in some detail.
Type 1 Diabetes
We break down starch into glucose in the digestive tract and it circulates as blood glucose/blood sugar which is taken up by our muscles to be stored or burned for energy.
But blood sugar, needs an invitation to enter our muscle cells, and that invitation is insulin.
Insulin is the key that unlocks the door to let the glucose in the blood enter the muscle cell!
When insulin attaches to the insulin receptor, it activates a series of enzymes which activates glucose transport, which acts as a gateway for glucose to enter into the cell.
If there’s no insulin, Blood sugar would just get stuck in the bloodstream knocking on the door to our muscles but not being able to get inside.
And so with nowhere to go, blood sugar levels would rise and rise. And that’s what happens in type 1 diabetes.
The cells in the pancreas just don’t make insulin. The cells that do make insulin get destroyed and so without insulin, sugar in the blood can’t get out of the blood into the muscles and blood sugar rises.
Type 1 diabetes represents a small fraction of the overall diabetes cases and has a stronger genetic connection. But several studies do show that diet does play a role in promoting as well as ameliorating its progression and severity
Type 2 Diabetes
Our focus here is on Type 2 diabetes which represents over 90% of the diabetes cases worldwide. Also this is where the diet and lifestyle play a pivotal role in both promoting as well as preventing and curing the disease.
Insulin Resistance
Unlike in Type 1 Diabetes, here the process starts with Insulin resistance.
Insulin resistance means that there’s enough insulin, but the insulin doesn’t work, because something is jamming up the lock! Our muscles become resistant to the effect of insulin!
What causes Insulin Resistance?
It’s the Intramyocellular lipid fat inside our muscle cells that is jamming up the lock. Fat in the blood stream can build up inside the muscle cell, and create these toxic fatty breakdown products and free radicals that block the insulin signaling process.
So, no matter how much insulin we have in our blood, it’s not able to open up the glucose gates and blood sugar levels build up in the blood
This can happen within 3 hours of eating a high fat meal!
Increased fat in blood is an important contributor to insulin resistance. on the other hand, if you lower the level of fat in people’s blood, insulin resistance comes right down.
Clear the fat out of the blood and you can clear the sugar out of the blood!
Sugar tolerance of even healthy individuals can be impaired by administering a low carb, high fat diet. But we can decrease insulin resistance by decreasing fat intake. As the level of fat rises, the body’s ability to clear sugar from the blood drops.
Obesity & diabetes
The number of fat cells in our body remain the same throughout our adult life. So for example after massive weight loss our fat cells shrink as they offload fat. Conversely, as we gain weight, our fat cells just stretch as we pack more and more fat into each individual fat cell.
At a certain point our fat cells become so bloated that they start spilling fat back into the bloodstream!
Not only do obese persons have more fat, they’re constantly spilling that fat into their bloodstream. So that explains the link between obesity and diabetes.
Fat spilling from our fat cells, gets lodged in our muscle cells, leading to the insulin resistance that promotes the onset of type 2 diabetes!
Studies clearly demonstrate that fat in the blood directly inhibits glucose transport and usage in our muscles, which is responsible for clearing about 85% of the glucose out of our blood
Saturated vs unsaturated fats
But not all fats affect muscles the same. The type of fat, saturated versus unsaturated, is critical.
Saturated fat like palmitate, found mostly in meat, dairy, and eggs, causes insulin resistance; whereas oleate, found mostly in plant foods like nuts, avocados, etc. actually improves insulin sensitivity!
Saturated fat causes these toxic breakdown products and mitochondrial dysfunction and increases oxidative stress and inflammation.
A vicious cycle is established in which saturated fat induces free radicals, causing a dysfunction in the little power plants within our cells, the mitochondria; which causes further increase in free radical production and impairment of insulin signaling causing insulin resistance!
Monounsaturated fats are more likely to be detoxified.
Saturated trans fats contribute to the progression of other diseases too like autoimmune diseases, cancer, heart disease. But they can also cause insulin resistance, the underlying cause of prediabetes and type 2 diabetes
In human diet, saturated fats are derived from animal sources, while trans fats originate in meat and milk, in addition to the partially hydrogenated and refined vegetable oils.
Role of saturated & trans fats
They cause an alteration in gene expression leading to a suppression of key mitochondrial enzymes, like carnitine palmitoyltransferase.
‘That’s why people eating plant-based diets have higher metabolism, burn more calories while they sleep, because of this higher expression of the fat burning enzyme and the mitochondria thanks to their decreased saturated fat intake!
Research at the Imperial College of London compared the insulin resistance and muscle fat of vegans versus omnivores. They found significantly less fat trapped in the muscle cells of vegans compared to omnivores at the same body weight, better insulin sensitivity, better blood sugar levels, better insulin levels, and significantly improved beta cell function, the cells in the pancreas that make insulin in the first place
The journey from Insulin resistance to Type 2 Diabetes
Insulin resistance starts over a decade before diabetes is actually diagnosed, as blood sugar level slowly start creeping up.
1st vicious cycle
At first the pancreas pumps out more insulin trying to overcome the fat induced insulin resistance in our muscles
Resultant high insulin levels lead to accumulation of fat in the liver, called fatty liver disease!
As fat builds up in our liver, it becomes resistant to insulin too. Normally, the liver is producing blood sugar to keep our brain alive between meals. But as soon as we eat breakfast, the sugar released from the meal turns off liver glucose production.
But filled with fat, the liver becomes insulin resistant like our muscles and doesn’t respond to that breakfast signal. So, it keeps pumping out blood sugar all day long on top of whatever we’re eating.
So, the pancreas pumps out even more insulin to deal with the high sugars and our liver gets fatter and fatter. That’s one of the twin vicious cycles of diabetes!
Fatty muscles, lead to a fatty liver, which leads to an even fattier liver. And all this starts before diabetes.
The 2nd vicious cycle
But then the next vicious cycle starts. Fatty liver can be deadly, so the liver starts trying to offload the fat by dumping it back into the bloodstream in the form of VLDL. And that starts building up in the cells of the pancreas, that produce the insulin in the first place.
Fatty muscles lead to a fatty liver which then leads to a fatty pancreas. It is now clear that type 2 diabetes is a condition of excess fat inside our organs!
The only thing that was keeping us from diabetes, from unchecked skyrocketing blood sugars is that the pancreas was working overtime, pumping out extra insulin to overcome insulin resistance.
But as the beta cells in the pancreas are killed off by the fat build up, insulin production starts to fail and we’re left with a worst of both worlds. Insulin resistance combined with a failing pancreas.
Unable to then overcome the resistance, blood sugar levels go up and up, and we have type 2 diabetes!
To conclude
Diabetes is a lifestyle disease linked primarily to our diet and lifestyle.
Fat – saturated animal fat and trans fat plays a pivotal role in causing diabetes
Preventing and reversing Diabetes is possible through changes in our diet and lifestyle
Whole food plant based diet coupled with moderate exercise, stress management, community living and pursuit of inner spirituality – are the best options to both prevent and cure Diabetes as well as all other lifestyle diseases!
This coupled with simple natural living, consuming organic natural food, and avoiding toxic chemical in other facets of life – will go a long way in ensuring our overall health and well being – physical, mental, emotional, spiritual.
This approach, unlike the symptomatic short term remedies and interventions provided by modern medicine, it doesn’t cost us anything and has no side effects!
And most importantly addresses the root cause of the disease and hence has the best chance of preventing and/or curing it!
Note: What is explained here are scientific facts based on numerous scientific studies and conclusions derived by scientists and doctors based on such facts. It is not a personal medication guideline. Anyone wanting to pursue this approach to cure their diabetes should consult a qualified medical practitioner and proceed ahead under his/her guidance.
Source:
Dr. Colin Campbell Centre for Nutrition Studies
Dr. Michael Greger, MD, FACLM
Comments