8.2 DIABETES TYPE-2

8.2 DIABETES TYPE-2

Type-2 Diabetes (hereafter referred as diabetes) generally develops in adults. It used to be known as adult-onset diabetes, but lately more and more children are affected by it.

Diabetes is the body’s reduced sensitivity to insulin. Insulin is a hormone produced by pancreas and it’s main function is to help store sugar from blood into muscle cells and fat from blood (triglycerides) into fat cells (adipose tissues).

When we consume food in excess of our ability to burn off (excess calories) the extra energy circulates in the blood as triglycerides and is stored as fat in our fat cells. If extra calories are from carbohydrates, they are first converted into sugar in the liver. Readily available sugar in the food is stored in the liver and muscle cells in the form of glycogen. There is a limit to how much sugar can be stored in the body. Generally, we can store up-to 1,000 calories worth of sugar in body. If there is more sugar, it gets converted into triglycerides in the liver to be stored into fat cells.

When we consume food in natural form the sugar and fat are attached to the fiber and are released slowly and as they are released the body burns them requiring very little insulin to do its job. When food is eaten in refined form the sugar and fat are released quickly in the body requiring higher amounts of insulin to do its job. Also, when our eating window is long saying from 7:00 in the morning to 11:00 at night the body has insulin present from the first meal to 2-3 hours after last meal. That makes it more like 18 hours. So, it acts as a double whammy; refined processed food combined with long eating window keeps the level of insulin high in the blood for long durations. This slowly reduces the body’s sensitivity to insulin.

When this continues on a regular basis, the body’s ability to deposit sugar into muscle cells and fat into fat cells, using insulin, declines and it requires more and more insulin to do the job. Triglycerides accumulation in fat- buffering adipose tissues becomes limited by the development of the “adipose tissue insulin resistance”.

The excessive level of sugar and insulin cause many problems. Three main problems are.

1. The first sign of diabetes is frequent urination. This is body’s way of compensating by getting rid of excess sugar.
2. Kidney problems (Nephropathy which leads to kidney failure).
3. Eye Retina problems (Retinopathy which leads to blindness).
4. Nerve damage to peripheral body parts like the feet and toes (Neuropathy which leads to amputation).

Some explain diabetes in simpler words as following:

“The Pancreas is making insulin, but the body is not able to deposit the sugar into muscles because the muscles have been clogged with fat deposits”. This is only partially correct.

I want to give here the example of drinking alcohol. When one drinks whiskey for the first time one feels intoxicated after the very first drink. But as one increases the consumption frequency, one-needs two or three drinks. Over time, one may find that more and more drinks are needed to get the same level of intoxication. This is because the body becomes less and less sensitive to alcohol. The level of alcohol in the blood required to give one the feeling of intoxication keeps going up. Finally, one gets to a point where other body parts are unable to process well, the large amounts of alcohol one is consuming, and liver and kidney begin to malfunction.

Human body is a self-healing organism. It has an ability to compensate. When one eats refined/processed food in their younger years and the body starts developing insensitivity to insulin, it compensates by producing more and more insulin and it is successful in maintaining sugar and triglyceride level in blood. At this stage one does not see any symptoms of diabetes. Fasting sugar level remains under 100. However, if one tests the blood for insulin level it would show elevated levels of insulin. (Smart doctors have started doing this test now.) This stage is called pre-pre-diabetes. If no corrective measures are taken at this stage insulin insensitivity keeps on increasing and reaches a point where the pancreas reach their maximum capacity and the blood sugar level now begins to rise to 100-120 (fasting). This stage is called pre-diabetes. If unchecked even at this stage, the fasting sugar rises above 120 and A1 c rises above 6.5; the patient is diagnosed as diabetic.

TREATMENT FOR DIABETES

There are two radically different approaches in the treatment of diabetes.

As per American Diabetes Association, diabetes is a progressive disease and can not be cured and goal of any treatment should be to maintain blood sugar level. The treatment consists of following:

1. A single medication of Metformine (or equivalent), the dose of which is increased over time. Later a second medication is added. One side effect of this medication is that the patient puts on more weight. (The sugar that was peed out earlier is now not retained and converted to fat.)

2. Patients are also advised to avoid certain high glycemic foods like potatoes, rice, pasta and many fruits.

3. Patients are advised to take frequent smaller meals.

4. Increase physical activity.

5. A target is set for patients to achieve a fasting glucose level of under 120 and PP level of 180 and A1-c level of 6.5-7.0.

The priority in this approach is to focus on the symptoms of high blood sugar and control it. The problem here is that the cause of insulin insensitivity is not addressed and in fact it keeps on increasing throughout the treatment. The effect on the body is as following:

1. Frequent meals means the body is constantly releasing more insulin every 2-3 hours.

2. The focus on glycemic index means reducing carbohydrates and increasing fat and protein consumption.

3. Higher protein consumption affects kidneys.

4. Higher and higher doses of medications affect the kidneys.

5. Side effects of medication along with unmodified food habits increase the risk of Cardiovascular Diseases (CVD).

(As a result, there is a very high correlation between diabetes and CVD.)

6. Many patients are put on statin drugs as a preventative measure against CVD.

7. As time progresses patients are eventually prescribed insulin shots.

As you can see, the original prognosis, that diabetes is a progressive disease, comes true. The doctor takes the credit that he was successful in keeping the blood sugar low throughout the treatment. It is important to point out here that most diabetic patients do not die of diabetes. They die of other causes like kidney failure or heart attack or other CVD.

So far, we discussed, what causes type-2 diabetes and what the conventional approach is to its treatment. Now we will discuss the alternative approach to treatment. I share the view of PBWF doctors on this subject and recommend as following:

1. Diabetes is a curable disease.

2. One must first eliminate the root cause of the problem and once that is done the body will heal itself.

3. One must not focus on controlling the symptoms because they are the result of the body compensating the ill effects of unhealthy diet (and environment in some cases). When we only control symptoms, it can interfere with the body’s self-healings mechanisms.

4. Excess protein consumption and medications can be more harmful to the body than high levels of blood sugar. (It has finally been accepted by American College of Physicians as they released their revised guidelines in March 2018. See the link at the end of this post.)

5. Aggressive intervention without diet modification results in higher all-cause mortality. This has been proven in several research studies.

The alternate approach to diabetes treatment is as following:

1. Do not consume food that has no fiber. We must eliminate consumption of refined fats(oils and ghee) and refined carbs (sugar, white flour etc) and increase consumption of fiber rich food (vegetables, fruits, cereals, beans, lentils and nuts & seeds).

It is important to understand that fats and carbs in natural form are not the culprits because they come packaged with fiber and when consumed, release energy slowly into the blood over several hours. This reduces the demand on insulin.

However, when one eats refined food, even if no extra calories are consumed on a daily basis (say one is eating only 2,000 calories a day and also spending 2,000 calories a day) and one is not overweight, one is likely to develop diabetes.

2. Avoid all animal food including dairy and eggs.

3. One must maintain a high level of activity by walking and exercising daily so that fat in the muscles and visceral fat can be reduced from your Adipose.

(Recent research has shown that adipose tissues act as an endocrine and secrete hormones such as, Leptin, Estrogen, Resistin and Cytokines and play lot more important role then previously understood). Try to maintain a minimum of 10,000 steps daily. More the better.

4. Practice “Intermittent Fasting” by narrowing down the eating window to under 8 hours. Finish dinner early and start the first caloric meal late in the morning .

5. Practice of Yoga and Pranayama affects the endocrine system in the human body and can help in curing diabetes when combined with dietary controls.

Some Other Points:

1. The fasting glucose reading, which has been used as an indicator for diabetes is flawed. Generally this test is done first thing in the morning and if your reading is above the cutoff point of 120, you are declared diabetic. This cutoff used to be 140 till 1997 when it was reduced to 120. As you can imagine this one change alone classified millions of people, who were otherwise healthy, as diabetics. Often these decisions are motivated by greed rather than medical evidence. The nexus of drug industry and the Health Care Providers, has major influence on such decisions.

2. The assumption that after a gap of 8-10 hrs from the previous night’s meal, the blood glucose should be at it’s lowest level, is flawed.

The blood glucose level can begin to rise starting few hours before you get up in anticipation of physical activity in the morning. How much it rises may vary from person to person and may depend upon how rigorous the morning routine is. The change can be as much as 20-60 points.

3. Blood sugar spikes after meals of 250 and occasionally even 350 should not be alarming as long as you are maintaining dietary controls.

4. There are now continuous glucose monitoring devices in the form of a patch available, that measures continuously for 10-14 days and you can wirelessly get the reading on a small handheld monitor. I strongly recommend everyone who is on diabetic medication to get one.

5. The other more reliable marker for diabetes has been the A1-c test which is done at the lab and is recommended every 3-6 months. The conventional wisdom has been that if your A1-c reading is 6.5 or more you are diabetic and if it is 5.7-6.4 you are prediabetic. But these guidelines have been revised by American College of Physicians as of March 2018. They now recommend that diabetics on medications should maintain A1-c between 7.0 and 8.0. If your A1-c is below 7.0 and you are taking medications, you must cut down your medications dosages.
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I urge everyone who is on diabetic medication or who knows someone who is, to pay attention to this and take control of your diabetes in your hand. Many doctors and Endocrinologists are not happy with this new guideline because their business is impacted in a negative way. They will advise you against following this new ACP advisory. One must get off diabetic medications ASAP by making dietary changes PBWF doctors recommend. (Reduce the medication dose gradually). Medications may be doing you more harm than good.