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You Did NOT Eat Your Way to Diabetes!

You Did NOT Eat Your Way to Diabetes!

Don't fall for the toxic myth that you caused your diabetes by reckless overeating


While people with diabetes often are seriously overweight, there is accumulating evidence that their overweight is yet another symptom, not the cause of the process that leads to type 2 diabetes.

But the chances are that you've been told that you caused your diabetes by letting yourself get fat.

This is a truly toxic myth. By blaming you for your condition it causes guilt and hopelessness. Even worse, the belief that people with diabetes have brought their disease on themselves inclines doctors to assume that since you did nothing to prevent your disease, you won't make the effort to control it--a belief that may lead to your getting extremely poor care.

The myth that diabetes is caused by overeating also hurts the one out of five people who are not overweight when they contract type 2 diabetes. Because doctors only think "Diabetes" when they see a patient who fits the stereotype--the grossly obese inactive patient--they often neglect to check people of normal weight for blood sugar disorders even when they show up with classic symptoms of high blood sugar such as recurrent urinary tract infections or neuropathy.

Where Did This Toxic Myth Come From?
The way this myth originated is this. Because people with type 2 diabetes are often overweight, and because many people who are overweight have a syndrome called "insulin resistance" in which their cells do not respond strongly to insulin and require larger amounts of insulin to process blood sugar, the conclusion was drawn years ago that insulin resistance is the cause of type 2 diabetes.

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Why Obesity Doesn't Necessarily Cause Diabetes
While people who have diabetes are often heavy, one out of five people diagnosed with diabetes are thin or normal weight. And though heavy people with diabetes are likely to be insulin resistant, the majority of people who are overweight will never develop diabetes, though they are likely to be just as insulin resistant as those who do--or even more so.

In fact, the message that diabetes researchers in academic laboratories are coming up with about what really causes diabetes is quite different from what you read in the media. What they are finding is that there are many different metabolic flaws that appear to develop into the syndrome that we call type 2 diabetes. Most of them appear to be genetic in origin. This means that unless you have damaged or abnormal genes, you can eat until you drop and never develop diabetes.

Twin Studies Back up a Genetic Cause for Diabetes
Studies of identical twins showed that twins have an 80% concordance for Type 2 diabetes. In other words, if one twin has type 2 diabetes, the chance that the other will have it two are 4 out of 5. While you might assume that this might simply point to the fact that twins are raised in the same home by mothers who feed them the same unhealthy diets, studies of non-identical twins found NO such correlation. The chances that one non-identical twin might have type 2 diabetes were much lower, though these twins, born at the same time and raised by the same caregivers were presumably also exposed to the same unhealthy diets.

This kind of finding begins to hint that there is more than just bad habits to blame here.

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Insulin Resistance Develops in Thin Children of People with Type 2 Diabetes
Lab research has come up with some other intriguing findings that challenge the idea that obesity causes insulin resistance which causes diabetes.

One of these studies took two groups of thin subjects with normal blood sugar who were evenly matched for height and weight. The two groups differed only in that one group had close relatives who had developed type 2 diabetes, and hence, if there were a genetic component to the disorder, were more likely to have it. The other group had no relatives with type 2 diabetes. The researchers then and examined the subjects' glucose and insulin levels during a glucose tolerance test and calculated their insulin resistance. They found that the thin relatives of the people with Type 2 diabetes already had much more insulin resistance than did the thin people with no relatives with diabetes. (4)

Mitochondrial Dysfunction is Found in Lean Relatives of People with Type 2 Diabetes
Why this might be was made clear by a landmark 2004 study which looked at the cells of the "healthy, young, lean" but insulin-resistant relatives of people with type 2 diabetes and found that their mitochondria, the "power plant of the cells" that is the part of the cell that burns glucose, appeared to have a defect. While the mitochondria of people with no relatives with diabetes burned glucose well, the mitochondria of the people with an inherited genetic predisposition to diabetes were not able to burn off glucose as efficiently, but instead caused the glucose they could not burn and to be stored in the cells as fat.(5)

More Evidence that Abnormal Insulin Resistance Precedes Weight Gain and Probably Causes it
Thanks to Susan of alt.support.diabetes for posting about this study the day it was published. A study done at Yale University School of Medicine by Gerald I. Shulman and Kitt Falk Petersen, published in the prestigeous Proceedings of the National Academy of Science (PNAS) journal on July 16, 2007 reports on a study that compared energy usage by lean people who were insulin resistant and lean people who were insulin sensitive.

Using new imaging technologies, the researchers found that lean but insulin resistant subjects converted glucose from high carbohydrate meals into triglycerides--i.e. fat. Lean insulin-sensitive subjects, in contrast, stored the same gluocse in the form of muscle and liver glycogen.

The researchers conclude that "the insulin resistance, in these young, lean, insulin resistant individuals, was independent of abdominal obesity and circulating plasma adipocytokines, suggesting that these abnormalities develop later in the development of the metabolic syndrome."

In short, obesity looked to be a result, not a cause of the metabolic flaw that led these people to store high carb meals as fat rather than burn the glucose from these meals for energy.

The researchers suggested controlling insulin resistance with exercise. It would also be a good idea for people who are insulin resistant, or have a family history of Type 2 diabetes to cut back on their carb intake, knowing that the glucose from the carbs they eat is more likely to turn into fat.

Beta Cells Fail to Reproduce in People with Diabetes

A study of pancreas autopsies that compared the pancreases of thin and fat people with diabetes with those of thin and fat normal people found that fat, insulin-resistant people who did not develop diabetes apparently were able to grow new beta-cells to produce the extra insulin they needed. In contrast, the beta cells of people who developed diabetes were unable to reproduce. This failure was independent of their weight.(6)

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A New Model For How Diabetes Develops


These research findings open up a new way of understanding the relationship between obesity and diabetes.

Perhaps people with the genetic condition underlying type 2 diabetes inherit a defect in the beta cells that make those cells unable to reproduce normally to replace cells damaged by the normal wear and tear of life.

Perhaps, too, a defect in the way that their cells burn glucose inclines them to turn excess blood sugar into fat rather than burning it off as a person with normal mitochondria might do.

Put these two facts together and you suddenly get a fatal combination that is almost guaranteed to make a person fat.

Studies have shown that blood sugars only slightly over 100 mg/dl are high enough to render beta cells dysfunctional.(7) In a normal person who had the ability to grow new beta cells, any damaged beta cells would be replaced by new ones, which would keep the blood sugar at levels low enough to avoid further damage. But the beta cells of a person with a genetic heritage of diabetes are unable to reproduce So once blood sugars started to rise, more beta cells would succumb to the resulting glucose toxicity, and that would, in turn raise blood sugar higher.

As the concentration of glucose in their blood rose, these people would not be able to do what a normal person does with excess blood sugar--which is to burn it for energy. Instead their defective mitochondria will cause the excess glucose to be stored as fat. As this fat gets stored in the muscles it causes the insulin resistance so often observed in people with diabetes--long before the individual begins to gain visible weight. This insulin resistance puts a further strain on the remaining beta cells by making the person's cells less sensitive to insulin. Since the person with an inherited tendency to diabetes' pancreas can't grow the extra beta cells that a normal person could grow when their cells become insulin resistant this leads to ever escalating blood sugars which further damage the insulin-producing cells, and end up in the inevitable decline into diabetes.

Low Fat Diets Promote the Deterioration that Leads to Diabetes in People with the Genetic Predisposition
In the past two decades, when people who were headed towards diabetes begin to gain weight, they were advised to eat a low fat diet. Unfortunately, this low fat diet is also a high carbohydrate diet--one that exacerbates blood sugar problems by raising blood sugars dangerously high, destroying more insulin-producing beta-cells, and catalyzing the storage of more fat in the muscles of people with dysfunctional mitochondria. Though they may have stuck to diets to low fat for weeks or even months these people were tormented by relentless hunger and when they finally went off their ineffective diets, they got fatter. Unfortunately, when they reported these experiences to their doctors, they were almost universally accused of lying about their eating habits.

It has only been documented in medical research during the past two years that that many patients who have found it impossible to lose weight on the low fat high carbohydrate can lose weight--often dramatically--on a low carbohydrate diet while improving rather than harming their blood lipids. (8)

The low carb diet does two things. By limiting carbohydrate, it limits the concentration of blood glucose which often is enough to bring moderately elevated blood sugars down to normal or near normal levels. This means that there will be little excess glucose left to be converted to fat and stored.

It also gets around the mitochondrial defect in processing glucose by keeping blood sugars low so that the body switches into a mode where it burns ketones rather than glucose for muscle fuel.
Relentless Hunger Results from Roller Coaster Blood Sugars


There is one last reason why you may believe that obesity caused your diabetes, when, in fact, it was undiagnosed diabetes that caused your obesity.

Long before a person develops diabetes, they go through a phase where they have what doctors called "impaired glucose tolerance." This means that after they eat a meal containing carbohydrates, their blood sugar rockets up and may stay high for an hour or two before dropping back to a normal level.

What most people don't know is that when blood sugar moves swiftly up or down most people will experience intense hunger. The reasons for this are not completely clear. But what is certain is that this intense hunger caused by blood sugar swings can develop years before a person's blood sugar reaches the level where they'll be diagnosed as diabetic.

This relentless hunger, in fact, is often the very first diabetic symptom a person will experience, though most doctors do not recognize this hunger as a symptom. Instead, if you complain of experiencing intense hunger doctors may suggest you need an antidepressant or blame your weight gain, if you are female, on menopausal changes.

This relentless hunger caused by impaired glucose tolerance almost always leads to significant weight gain and an increase in insulin resistance. However, because it can take ten years between the time your blood sugar begins to rise steeply after meals and the time when your fasting blood sugar is abnormal enough for you to be diagnosed with diabetes, most people are, indeed, very fat at the time of diagnosis.

With better diagnosis of diabetes (discussed here) we would be able to catch early diabetes before people gained the enormous amounts of weight now believed to cause the syndrome. But at least now people with diabetic relatives who are at risk for developing diabetes can go a long way towards preventing the development of obesity by controlling their carbohydrate intake long before they begin to put on weight.

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