For a limited time only, PBS is streaming a free documentary on America’s diabetes epidemic
More than 114
million American adults have diabetes or prediabetes and the economic
ramifications of this condition are enormous. The U.S. spent $350
billion treating diabetes in 2019 alone
One of the best
strategies to beat COVID-19 is to get any underlying chronic conditions
under control; Type 2 diabetes and high blood pressure can often be
reversed via healthy diet and lifestyle
Type 2 diabetes
is a diet-derived condition. It’s rooted in insulin resistance and
faulty leptin signaling, caused by chronically elevated insulin and
leptin levels. As such, it can be effectively treated and reversed
through dietary and other lifestyle means
Research has
shown fasting and a cyclical ketogenic diet can improve insulin
sensitivity and reverse diabetes. Staying physically active is also
important, as excessive sitting blocks a number of insulin-mediated
systems, including muscular and cellular systems that process blood
sugar
For a limited time only, PBS is
streaming a free documentary on America’s diabetes epidemic (it may not
be available in all areas; check your local PBS to see if it’s in your
area). Coincidentally, diabetes is a comorbidity that can increase your
chances of contracting and even dying from COVID-19,1 making this documentary particularly timely.
One of the best strategies to beat COVID-19 is to get any underlying
chronic conditions under control. Type 2 diabetes and high blood
pressure — both of which have been implicated as underlying factors
causing serious COVID-19 disease — can often be reversed via healthy
diet and lifestyle.
According to a January 2019 update by the U.S. Centers for Disease
Control and Prevention, more than 122 million American adults have
diabetes or prediabetes,2
and the economic ramifications of this condition are enormous. The U.S.
spent $350 billion treating diabetes in 2019 alone, according to the
film.
Also according to the film, projections predict half the American
population will be prediabetic or diabetic by 2025. Such predictions
reflect poor research because if you use insulin resistance as your
definition, 80% of the country is diabetic or prediabetic already.3,4
Glucose Metabolism Influences Cytokine Storms
An April 15, 2020, article5 in The Scientist reviews evidence6,7 that helps explain why obesity and diabetes are such potent risk factors for severe COVID-19 infection.
In a nutshell, higher blood glucose levels appear to play a
significant role in viral replication and the development of cytokine
storms. While the research in question looked at influenza A-induced
cytokine storms, these findings may well be applicable in COVID-19 as
well.
Cytokines are signaling molecules that are released by your immune
system in response to foreign invaders. They, in turn, act as
messengers that instruct other immune cells to fight the pathogen. In
some cases, this immune response goes into overdrive, resulting in
what’s known as a “cytokine storm” that can cause severe tissue damage
and lead to death.
A cytokine storm response
is typically the primary reason why people die from infections, be it
the seasonal flu, Ebola, urinary tract infection or COVID-19. A
critical player in cytokine production is the transcription factor
interferon regulatory factor 5 (IRF5). In mice, genetically eliminating
IRF5 protects them from influenza-induced cytokine storms.8
Interestingly, “the inflammatory response to influenza infections
is also known to drive up glucose metabolism,” The Scientist reports,9
“in part so that immune cells have the necessary energy to mount a
strong response, and also because the virus needs the sugar to
replicate.”
According to researchers at the State Key Laboratory of Virology at
Wuhan University, the hexosamine biosynthesis pathway — a glucose
metabolism pathway — is responsible for activating IRF5-induced
cytokine production in cells and mice. The same pathway is also
responsible for viral replication, they say.10,11,12 As reported by The Scientist:13
“Hexosamine biosynthesis starts with glucose and
results in an end product called uridine diphosphate N-acetylglucosamine
(UDP-GlcNAc) … Liu’s team now shows that O-GlcNAcylation of IRF5 is
necessary for the transcription factor’s cytokine-producing activity …
The
team also showed that patients infected with influenza have higher
blood glucose levels and more O-GlcNacylation of IRF5 than healthy
controls. Furthermore, blood glucose levels correlated tightly with
levels of inflammatory cytokines.
The
results show that ‘there is a connection [between] influenza virus
infection, enhanced glucose metabolism and cytokine storm, all linked
through O-GlcNAcylation of IFR-5,’ Mengji Lu, a virologist at the
University Hospital Essen and a coauthor of the study, writes in an
email to The Scientist ...”
In a Science Advances press release, co-author Shi Liu states:14
“We believe that glucose metabolism contributes to
various COVID-19 outcomes since both influenza and COVID-19 can induce a
cytokine storm, and since COVID-19 patients with diabetes have shown
higher mortality.”
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Insulin Resistance Is the Real Pandemic
So, the real pandemic here appears to be dysregulated glucose
metabolism; in other words, insulin resistance, which is exceedingly
prevalent in the U.S.15,16
Insulin resistance, in turn, is a diet-induced condition. Unless
addressed, insulin resistance eventually develops into full-blown Type 2
diabetes. As mentioned earlier, if you use sensitive measure for
insulin resistance, approximately 80% of the population has this
metabolic dysfunction.17,18
Processed foods — which are loaded with added sugars, processed
grains and industrially processed omega-6 vegetable oils — are the
primary culprits causing insulin resistance, Type 2 diabetes and
obesity and, according to FoodNavigator.com,19 doctors are finally starting to talk about the food industry’s role in the COVID-19 pandemic:
“A cardiologist has blamed the food industry for
‘normalizing’ ultra-processed junk food as more evidence emerges
suggesting poor diet is the root cause behind increased mortality from
COVID-19,” FoodNavigator states, adding:20
“In
light of the mounting evidence that obesity and poor diet increases
the risk of a severe response to COVID-19 infection, medical
professionals now want the public health message urgently updated. And
this, they warn, means the food industry bracing itself for regulation,
such as bans on advertising and taxes …
Dr. Aseem Malhotra, a London-based cardiologist, told the BBC
that a Government and Public Health England failure to tell the public
to change its diet would represent an act of ‘negligence and ignorance’
… For him, the pandemic highlighted that it was in the interest of
everybody, including those in the food industry, to make sure the
population was as healthy as possible.”
Diabetes Is Reversible
As noted by PBS, Type 2 diabetes can be very difficult to control
when relying on drugs alone and not doing anything about the underlying
lifestyle factors actually causing the problem. While not addressed in
the film, the use of insulin in Type 2 diabetes is particularly problematic.
If the underlying lifestyle factors are properly addressed, Type 2
diabetes is entirely reversible in most people, and rather easily so.
The reason for this is because Type 2 diabetes is a diet-derived
condition. It’s rooted in insulin resistance and faulty leptin
signaling, caused by chronically elevated insulin and leptin levels. As
such, it can be effectively treated and reversed through dietary and
other lifestyle means.
For example, as detailed in my 2019 article “Fasting Prevents and Halts Diabetes,” research has shown fasting can improve insulin sensitivity,21 reverse diabetes22 and support your weight management efforts when combined with exercise.23 While “Blood Sugar Rising” discusses the foundational role of diet in this disease, it does not touch on fasting at all.
This is unfortunate, considering how effective it can be. In a case series paper24,25
published in BMJ Case Reports, Dr. Jason Fung and associates details
how fasting can actually be used as a therapeutic alternative for Type 2
diabetes. As noted by the authors, their paper:
“… demonstrates the effectiveness of therapeutic
fasting to reverse insulin resistance, resulting in cessation of
insulin therapy while maintaining control of blood sugars. In addition,
these patients were able to lose significant amounts of body weight,
reduce their waist circumference and also reduce their glycated
hemoglobin levels.”
Now, a case series paper is not a controlled study; rather, it
simply presents the case history of one or more patients and may
propose a hypothesis for why a treatment did or did not work. In this
case, three diabetic patients between the ages of 40 and 67 participated
in a supervised fasting regimen to evaluate the effects on their
insulin requirements.
The patients had been diagnosed with Type 2 diabetes for 10, 20 and
25 years respectively, and were taking insulin daily. Of the three
patients, two did alternating-day, 24-hour fasts, while one fasted for
24 hours three times a week over a period of several months. The
complete manual of the fasting regimen used is described in Fung’s
book, “The Complete Guide to Fasting.”26
Two of the patients were able to discontinue all of their diabetes
medications while the third was able to discontinue three of his four
drugs. All three also lost between 10% and 18% of their body weight.
With another similar trial, The Guardian reported on,27
Type 2 diabetics were placed on a severely restricted calorie diet
where they ate just 600 calories a day for eight weeks. By the end of
their fast, all were disease-free, and three months later, having
returned to their regular diet, seven of the 11 participants remained
free of diabetes.
There’s Hope Even for Severe Diabetes
Several studies have even found that repeated episodes of fasting can induce cell growth of pancreatic beta cells in mice.28 The growth is associated with an increased expression of Ngn3,29
a protein involved in converting DNA into RNA critical for endocrine
cells in the pancreatic islets of langerhans, the cells responsible for
producing insulin.
The increase in islet beta cells induced through intermittent
fasting was accompanied by a marked improvement in blood sugar control
in the animals. While individuals suffering from Type 1 diabetes often
experience near complete inflammatory destruction of the islet beta
cells, the same occurs in the later stages of severe Type 2 diabetes as well.
In a BMJ editorial,30 research scientist James DiNicolantonio, PharmD.,31
discusses these results, noting the findings may open the path to
reversing Type 2 diabetes in those with “enough discipline and
commitment to adopt a lifestyle that would have prevented diabetes in
the first place.”32
As a first step, he recommends you first practice a diabetes
preventive lifestyle — eating a diet primarily of whole foods,
complemented with regular exercise. This will help improve your insulin
sensitivity and may prove sufficient for those with a recent diagnosis
of diabetes to reverse their condition over time.
In those who fail to respond, he recommends a time-restricted eating
protocol, which provides many of the same benefits as longer fasting
while being much easier to comply with. Supplemental measures may also
be implemented to shield the beta cells from toxicity so they retain
functional capacity. For example, reducing islet oxidative stress may
be accomplished using spirulina, NAC and/or berberine.33
Ultimately, the goal is to achieve normal blood sugar control
without drugs and maintain compliance with a diabetic preventive diet
and lifestyle. This also includes physical activity.
Chronic inactivity such as extended sitting
is one of the primary risk factors for insulin resistance and Type 2
diabetes. The reason for this is because sitting shuts down or blocks a
number of insulin-mediated systems, including muscular and cellular
systems that process blood sugar, triglycerides and cholesterol.
Standing up activates all of these systems at the molecular level. Dr.
James Levine detailed the science of this in our 2014 interview.
Diabetes Takes a Heavy Toll on Health
As detailed in the film, chronically high blood sugar from poor
nutrition and lack of exercise can trigger long-term damage to your
body and make you more prone to other chronic health problems and
diseases, including but not limited to:34,35,36
Neuropathy (nerve damage) and amputation
Glaucoma, cataracts and blindness
Infections
Kidney disease and kidney failure
High blood pressure, heart disease, heart attacks and stroke
Dementia and Alzheimer’s disease
Sugar-Rich Diets Are a Primary Culprit
While PBS largely focuses on the conventional treatment of diabetes,
which typically involves insulin and other drugs, it thankfully
highlights the fact that sugar- and carb-rich diets are a primary
driver.37 Research38
shows that once you reach 18% of your daily calories from sugar,
there’s a twofold increase in metabolic harm that promote prediabetes
and diabetes.
As a standard recommendation, I strongly advise keeping your total
sugar consumption below 25 grams per day, which is about 6 teaspoons. If
you have signs of insulin resistance such as hypertension, obesity or
heart disease, you’d be wise to limit sugar to 15 grams or less until
your weight and other health conditions have normalized.
Sadly, as noted by PBS, “the game is rigged.” Food products are
allowed to state “sugar free” on the package, even though they’re loaded
with carbohydrates and sugar alternatives. As noted in the film, it’s
not just sugar itself that must be avoided, but anything that turns
into sugar in your body as well, most notably grains.
In short, a high-grain, low-fat diet is a perfect prescription for
diabetes, yet these kinds of foods are allowed to make a number of
health claims. This kind of misleading labeling is causing many to
think they’re making wise food choices when in fact they’re not.
It would help to remember that just about all processed foods are
best avoided. Rather than trying to decipher labels, ditch the
processed foods and fast food restaurants and cook from scratch using
whole, unprocessed foods. This is by far the easiest and most effective
way to improve your diet.
Soybean Oil Promotes Diabetes
One dietary factor not directly addressed in the film is processed
vegetable oils. These may actually be worse than fructose in terms of
the metabolic harm they cause.39 Soybean oil in particular has a questionable safety profile, and processed foods are positively loaded with it.
Whether partially hydrogenated, organic or genetically modified to be low in linoleic acid,
soybean oil can cause dysfunction at a cellular level. Unfortunately,
many health authorities have insisted omega-6-rich vegetable oils like
soybean oil are healthier than saturated animal fats such as butter,
lard and coconut oil, and this myth has been a tough one to dismantle,
despite the evidence against it.
Most recently, research40,41,42
published in the January 2020 issue of Endocrinology found soybean oil
— the most widely consumed cooking oil in America — can cause
metabolic changes associated with:
Autism
Alzheimer’s disease
Anxiety
Depression
Obesity
Insulin resistance
Type 2 diabetes
Fatty liver disease
According to the authors, both conventional and genetically
engineered soybean oil caused dysfunction in about 100 different genes
in the hypothalamus, including genes associated with “inflammation,
neuroendocrine, neurochemical and insulin signaling.”
Similar results were reported in a 2015 study,43
in which soybean oil was found to increase weight gain, body fat,
diabetes, glucose intolerance and insulin resistance. Here too, soybean
oil diets upregulated genes involved in diabetes, obesity,
inflammation, mitochondrial function and cancer.
Ketogenic Diet Improves Insulin Sensitivity
Aside from fasting or time-restricted eating, a cyclical ketogenic diet is an effective way to improve your insulin sensitivity and reverse diabetes. A cyclical ketogenic diet — as detailed in my book “KetoFast” — shifts your body's metabolic engine from burning carbohydrates to burning fats.
Your cells have the metabolic flexibility to adapt from using
glucose for fuel to using ketone bodies, which come from the breakdown
of fats, hence, the name "ketogenic." Another term for this is
nutritional ketosis. One of the fastest ways to prevent nutritional
ketosis is by consuming sugar or refined carbohydrates.
A ketogenic diet calls for 50% to 70% of your daily calories to come
from beneficial fats such as coconut oil, grass-pastured butter,
organic pastured eggs, avocado or ketone producing fats like MCT oils,
particularly C-8, while restricting your carbohydrates to 30 or 40
grams per day. Along with an appropriate amount of protein, this is typically enough to get you into ketosis.
Watch ‘Blood Sugar Rising’
“Blood Sugar Rising” provides an eye-opening glimpse into the very
real struggles of Type 2 diabetics, as well as the around-the-clock
challenges faced by those with Type 1 diabetes — a genetic condition in
which your body produces no insulin at all — and groundbreaking
inventions such as a bionic pancreas that automatically delivers the
appropriate insulin dose as needed.
The film also reviews the real-world ramifications of skyrocketing
insulin prices. The two types of diabetes differ in terms of their
origin, and while insulin is typically ill advised for Type 2
diabetics,44 Type 1 diabetics die without it.
It also highlights the role of food as a cultural component, and how
food-centered cultures can be guided to make healthier choices. For
example, saying you have to abstain from rice, pasta or potatoes can be
nearly impossible in certain families and cultures. Instead, you may
need to approach it in terms of better and worse ways of preparing
these foods, and restricting the amounts.
Diabetes, or more accurately insulin resistance with metabolic
inflexibility, is a health accident waiting to happen, but it’s
important to realize that you have control and can do something about
it. In virtually all cases, it will require making more or less drastic
changes to your diet and lifestyle, but the payoff goes beyond
preventing diabetes. Concomitant with that, you’re also protecting your
vision and lowering your risk of most of the chronic diseases that lead
to an early grave.
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