Obesity: A cause or symptom of Type 2 Diabetes?Tuesday 30 April 2019
It is widely accepted and repeated in the literature that obesity is a cause of diabetes. This is repeated in advice for overweight individuals which centres around losing weight through calorie control in order to stave off diabetes. However, this paradigm ignores important physiological processes for maintaining blood sugar homeostasis and the multiple roles that insulin plays in metabolism.
Before discussing this further, one must understand the term 'homeostasis' as it will be repeated. Homeostasis is the range within which the internal mechanisms and every cell of the body operate. Examples of such internal mechanisms include blood pressure, body temperature, Ph, blood glucose levels.
Normal fasting blood glucose levels are in the range between 4.0 to 5.4 mmol/L (72 to 99 mg/dL) or up to 7.8 mmol/L (140 mg/dL) 2 hours after eating. When blood glucose levels drop below a threshold, the pancreas releases glucagon which stimulates the liver to boost blood glucose levels by releasing glucose into the blood stream.
Normal blood glucose (homeostasis) is maintained by a balancing act between the secretion of insulin and glucagon by the pancreas. All cells require glucose as a fuel, but most cannot absorb it unless insulin has attached to the insulin receptor on the cell allowing glucose to pass through the cell wall. There is a base level of circulating insulin in the blood that allows cells to absorb what they need to function, so that they do not run out of fuel and die.
With insulin resistant diabetes the insulin receptors do not respond efficiently to insulin so blood glucose levels remain elevated causing the pancreas to increases insulin secretion. Now, for the link to obesity: in addition its role in glucose metabolism, insulin is also a fat storage hormone and it blocks the release of fat from fat storage, thus preventing fat from being used as a fuel.
Most diabetics are told to continue eating carbohydrates, eat fewer calories and eat small portions throughout the day and take medication to lower blood glucose levels. The problem with this is that frequent carbohydrate rich small meals creates a circle of spikes in the blood glucose levels, food craving, hunger and eating. The body has no option but to release more insulin in an attempt to regulate blood glucose levels, but in so doing, increases fat storage.
As previously stated, your body’s own insulin is a fat-storage hormone. That is also true for insulin that has been prescribed to you, whether delivered by injection or by pump. That is why a common side effect of prescribed insulin is weight gain. Another class of medicine for type 2 diabetes, Sulfonylureas, work by stimulating the pancreas to produce more insulin. And once again, more insulin in your body means more fat storage and more weight gain.
So What is the Answer?
Nutritional Ketosis - turn your body into a fat burner rather than a carbohydrate burner. While carbohydrate consumption triggers spikes in blood sugar, fat consumption does not, making it a better source of fuel for people with insulin resistance.