T2 Diabetes – Have we got it all Wrong?

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In this article, read about the current medical model for Type 2 Diabetes and how its underlying logic seems to be failing us both nutritionally and medically.

Then read an alternative paradigm shattering view – the Overflow hypothesis, that addresses the logical weaknesses of the Lock-and-key model, and is showing great promise with it’s nutritional recommendations for addressing diabetes (and obesity).

Our Problems Start with Metabolic Dysfunction

Diabetes, Obesity and Heart Disease Risk go hand in hand. They really are one of the same thing, as one often leads to another. They are clustered together to describe overall metabolic dysfunction called Metabolic Syndrome.

The conditions that form Metabolic Syndrome include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels.

Symptoms of Metabolic Syndrome
Clustered symptoms of Metabolic Syndrome

Having just one of these conditions doesn’t mean you have metabolic syndrome. But if you develop more of these conditions, your risk of complications and serious disease, such as type 2 Diabetes and heart disease, rises even higher.

The Obesity & Diabetes Crisis

These conditions are so closely linked, with the most likely cause being metabolic and hormonal disregulation. Worryingly, both are reaching epidemic proportions and increasing exponentially.

The Obesity Crisis

1.9 billion adults globally are overweight and 650 million are obese. These numbers have tripled in the last 45 years.

In the US, 39.8% of adults (93 million) are obese, and in the the UK, 1 in 4 adults and 1 in 5 children are overweight.

Disease is the New Normal

Western ‘affluence’ diseases such as Cancer, Heart Disease, Metabolic Syndrome and Diabetes are taking lives at an epidemic rate and feature strongly in the top 10 causes of death.

Diabetes, has seen a 400% increase in 40 years, affecting a minimum of 422 million people, and has directly and indirectly claimed the lives of 3.8 million people in 2016 alone.

What Causes Type 2 Diabetes?

The Current (outdated?) View of Diabetes

The traditional medical view of Type 2 Diabetes is often called the Lock-and-Key or Internal Starvation hypothesis, and infers that the cells in our body become resistant to the effects of Insulin due to some malfunction of the cell, or our insulin production itself.

The Lock-And-Key Insulin Resistance Model
The Lock-And-Key Insulin Resistance Model

In this model, blood glucose levels rise when we eat. However, due to some form of cell damage, the insulin receptors are non-responsive to the effects of insulin, or take up glucose too slowly. This causes blood sugar levels to elevate, followed by higher and higher amounts of insulin secreted by our pancreas.

It’s this inability to clear glucose fast enough in the blood or liver that is the essence behind Type 2 Diabetes and all associated symptoms and linked conditions – such as obesity, hypertension and heart disease.

Insulin’s Role in Healthy Bodies

In a healthy well-functioning body, insulin helps create glycogen and fatty acids from glucose (carbs) within the liver and promotes their absorption, in addition to amino acids (protein), via the bloodstream to muscle cells and other tissues for immediate energy use and storage.

Once glycogen stores are full, insulin helps store the surplus energy into existing or new fat (adipose) cells.

Insulin also suppresses the breakdown of fat within adipocytes. The total effect of Insulin is one of fat-sparing and anabolism (building up) – both preferentially using carbohydrates for fuel and stimulating the accumulation of fat within fat cells.

Insulin responds most robustly to carbohydrates, as high blood sugar levels are toxic to the bloodstream. The blood sugar (glucose) must be cleared as quickly as possible and stored as readily available energy – in the form of glycogen within the liver and muscles, or converted into triglycerides within fat cells for later use.

normal glucose regulation
Insulins Role: to regulate blood glucose and shuttle energy to our cells

Insulin is secreted in response to protein consumption, but to a significantly less extent. Amino Acids and Fatty Acids can hang around within lipoproteins in the blood safely, as they have greater (i.e. essential) utility to cells beyond energy and are readily absorbed without insulin. [read more on effects of insulin here]

A couple of hours after a meal, the majority of your blood glucose levels should have cleared, and you are considered in a fasted state. Insulin production drops to a low baseline level, and other hormones and enzymes amplify to assist with liberating the energy from your fat cells and into the cells that need it.

Fasted and Fed States
Graph depicting fasted (green) and fed states (red), and insulin’s response to macronutrients

It’s a constant ebb and flow, one of accumulating fatty acids and glycogen when eating, followed by liberating and using them for energy between meals and when sleeping.

If your hormones are not disregulated, the dance of hunger, eating, physical activity and burning energy stores is perfectly orchestrated, and it is relatively effortless to manage weight by eating sufficiently to cover the energy demands of your lifestyle.

The Issues with the Current Lock-And-Key Hypothesis

The biggest issue with the current model of Diabetes is that it assumes some damage and malfunction of either insulin or the insulin receptors of our cells. It’s been speculated that this damage is caused by oxidative damage or inflammation, but these are not causes – they are effects.

What causes this systemic damage is multi factorial and not clear cut, however a high carbohydrate diet, seed oils and fatness itself are in the firing line…

It’s understood that chronically elevated blood sugar and insulin levels additionally create AGE’s (Advanced Glycation End products) – causing oxidative stress, stiffening of the arteries and premature ageing. On top of that, the insulin-induced expanding fat cells release inflammatory molecules called cytokines.

Sound like malfunctioning insulin / insulin receptors, or just too much insulin triggered by excessive carbs??

Moreover, this assumption that insulin or the receptors are malfunctioning doesn’t stack up, because insulin continues to fulfil some of its primary duties – the accumulation of fat via De Novo Lipogenesis (production of new fat) within the liver.

De Novo Lipogenesis by increased insulin
Insulin functions as expected: inducing De Novo Lipogenesis (creation of new body fat) in healthy AND diabetic individuals.

The hypothesis goes on to speculate that our cells are internally starved of energy, as the blood glucose cannot get into the cells due to this ‘insulin resistance’. But the cells are not starved – we have more than enough energy to function.

And let’s be clear, we have failed to either curb the rise of Diabetes based on this understanding, nor do we really help pre-diabetic or diabetic patients get better. They end up on lifetime escalating levels of prescribed insulin medication, and their diabetic symptoms worsen in concert with getting fatter.

This represents US Diabetes costs only! Up from $174bn in 2007. Is it working? [source: ADA]
This represents US Diabetes costs only! Up from $174bn in 2007. Is it working? [source: ADA]
Clearly, our dietary recommendations are failing large swaths of people as Diabetes is at epidemic proportions, and our treatment protocols subject patients to lifelong prescriptions of drugs that worsen their health outcomes in the long run.

So, that begs the question – are diabetic cells misbehaving, making our insulin production somehow non-effective, or is something else going on?…

The diabetes paradigm shift

 

An Alternative Model – the Overflow Hypothesis

As we see the expected effects of insulin on our fat cells, it would suggest that there is something else at play. That it’s less about resistance, and instead to do with excess.

It would seem that our cells aren’t starved, but the exact opposite. They are overloaded with glycogen. They are literally full to the brim. They can’t take up anymore blood glucose, so when the next high-carb meals comes along, the otherwise normal insulin levels are insufficient to quickly clear the blood.

In panic stations, our pancreas produces yet more insulin. However, the muscle and liver cells are still full, so we’re quickly running out of options. There’s only one thing to do… ramp up the fat production in our liver and fat cells to convert and store this otherwise toxic level of glucose in our bloodstream.

The Diabetes Paradigm - resistant vs overflowing
The Overflow Hypothesis – an alternative and logical explanation to Insulin Resistance in Diabetics

And this is what we see in most diabetic individuals. Their internal escalating production of insulin makes them fatter, and once they are prescribed medicinal insulin they get fatter still. All this extra insulin is just helping store away more of our consumed energy as fat, as opposed to convincing our liver, muscle and other cells to take up yet more glucose.

The Carbs are Making us Fat… and Ill

You might be asking, why is the overall glucose in the blood and glycogen stores in our muscle / liver cells not dropping? Not everyone is diabetic, so how are non-diabetic people clearing out their glucose?

The issue is that increasingly more and more people are on incredibly carb-dominant diets. It’s not uncommon to see people’s diets consist of 55%+ carbs by calories – and the majority of these carbs are easily processed and digested refined carbs.

We’re talking about the cheapest ingredients that have long shelf lives. Refined flours (bread, pasta and cereals), sugary foods, sugary drinks (beers, fruit juices and sodas), combined with starches (potatoes, rice and corn).

UK Eatwell Plate Guide Full of Carbs
UK Eatwell Guide: Recommends a whopping ~50% Carbs by calories, and promotes many highly processed and easily digested carbs. The above plates comply with the guidelines…

Having a carb dominant diet is a vicious circle. When your primary source of energy is refined carbs, your body preferentially uses glucose first. It does this because of its toxicity in the bloodstream. It’s a quick fuel. Easy to digest, and easy to use. This sends your blood sugar levels on a rollercoaster of being far too high, followed by crashing below baseline as it’s cleared.

And because your body is conditioned to depend on this fast fuel, when it runs out your body is starving for more energy. In a carb-dominant diet, your ability to effectively tap into your fat stores is seriously impaired. You need more carbs, and soon, albeit you have tons of energy in your inaccessible fat stores.

This drives you to want a snack, have another meal, or generally to overeat. You are hungry for energy, because you are relying on this futile energy source. These yoyo’ing blood sugar levels are how a prediabetic, diabetic, and many many others are feeding their lives. This leads to overeating, which leads to more fat, and ever increasing levels of blood glucose.

Blood Sugar Graph for Carb Eaters
Carb-Dominant Diet: when we’re consuming high amounts of refined and easily processed carbs, this can be a typical morning!

What Happens When Carbs Are Reduced 

The evidence is building across many successful clinical trials (e.g. VIRTA study) and tens of thousands of general practice patient results. Not to mention the hundreds of thousands worldwide that are taking matters in to their own hands by transitioning to one of many low carb lifestyle diets.

Diabetics are going into remission after following a LCHF (Low Carb High Fat) dietary change, and these results are improved further still when fasting protocols are used – such as intermittent fasting and multi-day fasts.

Virta LCHF results on Diabetes markers
Low Carb Diabetes Treatment: Above shows the mean % improvement Diabetes after one year of using Virta’s Low Carb approach vs the typical standard of care [ source: virta ]
The reason is simple. It’s not malfunctioning insulin receptors, but instead that these cells are overflowing.

If you stop pouring carbs into the bloodstream, you give your body a chance to start burning through your stored up glycogen. From there, you start to liberate the fatty liver cells and other fat cells to release their triglycerides, and start to once again run on your natural fat burning machinery.

Using Fats Again – What does this mean?

It means you are lowering your insulin production due to less carbs coming in. You are clearing out and normalising your liver and muscle cells to become more receptive to insulins signal to store glucose when it comes through.

And, you are now mostly reliant on using your dietary and stored body fat to fuel your day-to-day activities.

Becoming fat adapted does a number of positive things.

  1. As fat is a more steady slow burning and usually abundantly available energy source, your energy levels smooth out
  2. You get less hungry. Carb cravings subside, as your cells have the energy they need.
  3. Your brain runs more clearly, smoothly and with greater clarity.
  4. You can go longer and longer without meals – making 1-2 meals a day or even fasting completely doable without much drama
  5. Helps you lose weight and keep it off by returning your fat and blood regulatory systems back to an evolutionary healthy state
Benefits of being fat adapted
Benefits of being fat adapted and metabolically flexible

What have you got to lose, other than the extra weight?

Authors have written extensively about the health, cognitive and weight management benefits of embracing fat and protein whilst minimising carbs. They describe the optimal human diet falling somewhere between Meat-Dominant and IIFYM+ Thrive, whilst including Fasting practices.

They all go to great lengths to demonstrate the old and new science that show without doubt the hormonal and fat cell disregulation that occurs with a carb-dominant diet – where refined flours, refined sugar and seed oils feature strongly.

Authors such as Gary Taubes, Jason Fung, Nina Teilcholz, Cate Shanahan, Nora Gedgaudas, Sally Fallon Morell, Mark Sisson, Jeff Volke and many many others.

Low Carb Authors
Low Carb Researchers and Authors who have done great work to change the conversation regarding optimal human nutrition

As you let the logic above set in, hopefully you’ll begin to question the failed nutritional and pharmaceutical status quo we find ourselves in. If we’ve got it so right, how is obesity, diabetes, dementia, heart disease, hypertension and cancer continuing to swell to epidemic proportions?

You know what else is swelling? Pharmaceutical industry profits, processed food industry profits, and our waistlines.

The Lock-and-Key and Internal Starvation model for insulin resistance leaves too many questions unanswered and contradictions unresolved. Keeping people on high-carb diets and giving them lifelong prescriptions of insulin makes no sense.

We deserve a better life. We deserve better health outcomes.

We should not be destined to decline into old age with various chronic diseases and conditions.

These chronic conditions will remain chronic for as long as we keep eating the same way that got us in trouble. They will remain chronic as long as we continue to use the same ineffective drugs that do not address the cause… but just temporarily alleviate the immediate symptoms.

We will continue to spin our wheels with yoyo diets, feeling guilty, and assuming the problem is us. That we’re too Slothful or Gluttonous (or both). That we just need to “Eat Less and Move more” and be in a constant Calorie Deficit. How does that seem to be working out?

Keeping in shape never used to be this difficult… until we screwed up our insulin signalling with copious amount of refined carbs. Fix this, and the puzzle pieces start to effortless fall into place.

It’s time to try something different…

The Definition of Insanity
What he said. We’ve given the current model of diabetes and obesity treatment long enough…

Article inspired by Jason Fung’s Overflow Hypothesis model of Insulin Resistance

Useful Resources

2 thoughts on “T2 Diabetes – Have we got it all Wrong?

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  1. As a former 80s bodybuilder, I used to follow a low fat and high carb diet. I could get competitively lean for a show, but was constantly battling the feeling of low blood sugar, dieting for a show and off season. So at 40 yrs. old, changed to high protein, mod fat and low carb diet. Mostly by eating from the meat counter and produce market without any processed carbs at all. I quickly evened out my blood sugar, stay very lean without feeling hungry and able to maintain a good amt of muscle mass at 58 yrs. old. I also noticed my HDL has increased to 80+ and LDL decreased to 40s, as well as triglycerides to the 40s. So I have been following the above suggestions for nearly 20 yrs while my brothers are all following the normal American diet and have all of the above medical issues, so I know my health is not a genetic gift.

    1. Love this! Thanks so much for sharing William. There’s your studies people… an 18 year walking talking study on the value of a happy healthy low carb lifestyle! 👊🏻

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