THE TRUTH ABOUT INSULIN RESISTANCE AND DIABETES

How carb intolerance, and not obesity, is the actual cause of Insulin Resistance.

Dr Alok Chopra, Founder & Medical Director of Metabalance Healthcare, shares his insights into one of the fastest growing diseases in the world: Diabetes. According to the International Diabetes Federation, more than 425 million people worldwide are directly affected, with 70 millions – and rising – living in India. In this sharply written opinion piece, Dr Alok busts the myth of common beliefs about DIABESITY (the acronym stands for Diabetes, Obesity and Heart disease) and how Nutrition, Lifestyle, and Mental Attitudes play a crucial role in its reversal.

Around the world, we can observe a dramatic rise in obesity. Even though being over-weight has become statistically the new normal, people suffering from obesity get shamed, blamed, prejudiced and discriminated against. I strongly believe, however, that if someone has to be blamed, it’s not the people but the medical advice they get.

Obesity is a hormonal disease, and neither stems from gluttony or idleness, nor from lack of caring, or a ‘weak character’. The vicious cycle of obesity starts because we have activated our ‘fat switch’, similar to the process animals use to increase fat storage for a rainy day. One example is the Arctic Penguin, who survives 3-6 months without any food in a state known as hibernation.

Insulin resistance (IR) is the condition that is responsible for all cardiometabolic diseases and is synonymous with obesity.

What does it mean to be Insulin Resistant …it means that our cells are not responding or are resistant to the action of insulin and in other words they are not letting insulin to do its job, which is to push the glucose ( sugar) into the cell to give it energy…you see glucose cannot hang around in the blood or else we would be diabetic 3 times a day.

Insulin has a more important function, which comes from our Paleolithic ancestors (since our genetic code has not changed for 30,000 years, so we are stuck with their DNA). Insulin acts as an anabolic entity, ie a body building hormone which is meant to store fat and to reduce fat burning, so as to carry us through the times when food was scarce. Thus, just like the Arctic Penguin, our human bodies are primed to store fat, and any excess sugar is mopped up by insulin and stored as fat.

The true job of Insulin is Fat partioning ie burn fat – or store it.

In my medical practice, I found that there are some major obesity myths which I have to regularly clarify:

• Myth 1: The more calories we eat and the less we exercise, the more likely we become us obese, regardless of the type of calories that we take.
  NOT TRUE. As obesity is a disorder of fat tissue regulation, and not of energy balance and the calories stemming from carbs are different from those coming from fats and proteins, due to the different hormonal responses they create.
• Myth 2: We become obese because we over-eat fatty food.
  NOT TRUE. We get fat because of over-eating carbs – sugar, refined grains, fructose in some fruits, high fructose corn syrup (HFCS), pasta, bread, biscuits, and so on. Also, the energy in our body is made by our MITOCHONDRIA, which are little batteries which take energy from food and oxygen from the air to produce ATP, which is the energy which runs all our bodily functions, and wherein resides our ‘fat switch’, which, when turned on, preferentially shunts energy from food to fat.

So as we start to eat sugary foods many times in a day, the body releases a proportionate amount of insulin every time, each with a message to store fat. Slowly but steadily, the cells demand increasing amounts of insulin to respond – and this is the starting point of what we understand as ‘Insulin Resistance’.

This slowly progressing state may carry on undetected for years or even decades, in a so-called ‘pre-‘ or even ‘pre-pre-diabetic state’ – until the cell, like a nagged husband, stops to respond. At the height of Insulin Resistance, a person becomes fully diabetic as the pancreas (the organ where insulin is created ) temporarily runs dry, initially by overcrowding the pancreas with fat and later by inflaming the insulin producing cells. Hence, Insulin Resistance creates a reduced capacity of the body to do its job of ‘fuel partitioning’, while the body got fat and obese.

So what if we doctors are fighting the wrong war…is Obesity the cause of IR or the other way around

Does obesity then lie at the root of Insulin Resistance? If it is, then we should eat less and exercise more – but it doesn’t work like that. What if obesity is not the cause but a symptom of a bigger disorder, a coping mechanism of a more sinister issue, a proxy of an underlying epidemic – what if we are fighting the wrong war?

There is another paradox, no one ever talks about. Insulin Resistance also makes a person hungry because one of its bodily actions is to store fat. So when the energy from sugar is not available, the cells get a command to burn fat, so the fat cell say ‘no thanks – I rather store the energy I have as fats, for myself so that the energy is not available for the body to use, so one keeps on eating carbs and also as instructed by your doctor so as to get more energy’.

And yet, as the sugar taken into the body cannot enter the cell, the person keeps craving, and, as a result, eating more. The cell is trying to protect itself from Insulin Resistance, paradoxically, not allowing the sugar to get in, nor letting the fat out. Hence, the obese person is both obliged to eat more, while not having the energy or motivation to exercise.

What I try to tell my clients: It is not that you are a glutton, your body is asking for it.

Most of my clients suffer from Insulin Resistance, and maybe more than 50% of obese people are part of this group – without being diabetic. When you tell someone this fact, their usual response is ‘Not me’, but the truth is that one remains in a quiet Insulin Resistance for years before becoming overtly diabetic.

To bust this obesity myth further, there are lots of obese people who are not Insulin Resistant (without the risk of diabetes or Heart disease), and a lot of skinny fat lean people with IR, with a higher risk, which we call thin outside and fat inside (TOFI).

Another fat myth is…. After Bariatric surgery (Fat loss surgery for diabetes which can be fairly debilitating and should be used only for morbid obesity)it takes a few months for weight loss.
However, the biomarkers for recovery and reversal of diabetes takes place long before the weight loss.

So how did this happen…One simply ate more sugary carbs and no good fats This is the usual sugar rise response:

• Eat carbs -huge insulin response
• Eat proteins – minor response
• Eat fat – nearly nothing

So eat carbs – high insulin – sugar falls – food craving – eat more carbs – fat storage- more cravings – fat storage – IR –Frank Diabetes

Right here lies the starting point of this vicious Insulin Resistance circle:

• Start: When you have no energy, you are asked to eat more carbs, aiming to get instant energy.
• Process: Over time, you will become diabetic, and as a result, you eat medicines, some of them work by trying to release more insulin, but already have too much of it. As time goes on, and also to protect you from side effects of medicines such as the fall of blood sugar, you eat again, which as a consequence increases the intake of medicines, resulting in more sugar release – and so on.
• Result: Worsening of diabetes…So Enters Insulin by multiple injections which is added to control sugar, and the story continues, on and on, with more modern medicine, and fancier versions of insulins

So what happens next …we give insulin……..what does it do…….it tries to do its job…that is to push glucose back into the cell.. but it cant as the cell is full of fat….. this unhealthy mix of inflamed fat and wrong sugars cause further inflammation and a whole cascade of complications ( heart attacks, kidney failure , strokes , blindness , gangrene ..to name a few ) take place.. and we say that this sadly is the life history of this dreaded Disease ( BUT POTENTIALLY A REVERSIBLE DISEASE )…just carry on with your mess and insulin

So what’s happening here ..We doctors are giving to our obese diabetic patients, sugar and Insulin, the same two chemical agents which caused DM in the first place – Does that make sense – NO – Are we doing the right thing– NO – It’s truly a  travesty, a misrepresentation of the right response .

So what makes sense ….???

If I ask you a simple question ‘Do we need carbs?’, what will be your response?

Most people are shocked, and ask me ‘What about carbs, don’t we need them, the answer is NO… what’s the minimum requirement of carbs…a big fat ZERO. …. WHY……?because Carbs are not essential nutrients …what are essential nutrients?.. ..those which we can’t live without or those which cannot be made by our body.

The truth is that we cant make fats and proteins within our body as they are all by products of carb metabolisum. The reality is that human body produces lots of carbs through a process called ‘neoglucogenesis’ which means new glucose formation by the body, by hormonal mechanisms or by protein burning from muscle and bone – and that’s the other thing that happens to diabetes later – from obese to withering away their health.

So what really makes sense …So no or very low carbs ( only the non net carbs which are the complex ones with fibre , timed eating, eating less often ie Intermittent Fasting, replacing carbs with good fats), fats make you happier and more satisfied, along with moderate protein intake … no processed or packaged or refined foods… no unhealthy grains , no potatoes, no sugar or sugar substitutes ..So no medicines also means no insulin ,means no DM ,means no pricks on fingers….No DM… All of it is gone.

We as doctors want to cure the cause of disease, not treat the effects.

As a doctor, it is one of my greatest joys to see a diabetic becoming back to normal, and I have had this joy many times especially in the last few years. If a client might returns to ones original habits, DM may come back, but for the moment, the metabolic state stands reversed. The illness caused by carb toxicity and Insulin Resistance, which is actually a carb intolerance, is gone.

Let me give you an analogy of the implication of Insulin Resistance causing obesity, versus obesity causing Insulin Resistance: the distinction is subtle but the implication is profound. Peter Attia, a Guru of metabolic medicine enunciated this analogy. Let’s assume you hit your knee on the coffee table, and you get a bruise. It hurts, gets uglier and discolored, but the bruise is not the problem. The body simply reacts with a healthy response to trauma by the immune cells, trying to salvage the injury and prevent the spread of infection. So is the bruise the real problem? …Is it the cause?…. we just keep on finding a way to protect and cure the bruise? Isn’t it better to treat the cause than the effect – and remove the coffee table?

Getting the cause and effect right makes all the difference, but getting the cause and effect wrong may fill the pockets of the pharma shareholders, but does nothing for the ‘ bruised individual’. My colleagues and I support this view, which is purely scientific and understandable, and are willing to stake our careers and reputation on this, since we “can’t afford the luxury of arrogance, and the  uncertainty of what will happen, as we already are feeling apologetic and humbled by the fact that we fed you the wrong advice”. Let’s do better from here….yes we are sorry ..we don’t want to blame the suffering obese patient , no judgements or long sermons , only compassion and empathy , and the courage to stand up to the fact that we were wrong and we want to repair our mistake