A Silent Killer

Type 2 diabetes, believed to affect 40-60% of most western populations, and to be more prevalent in the US than in Europe — as well as insulin resistance (IR), a precursor to type 2 diabetes, effecting another 25-35% — can and likely will lead to coronary vascular disease, obesity, and dementia, as well as diminishing your immune system, making you more vulnerable to everything else, including cancer. Guys, erectile dysfunction has been labeled type 3 diabetes (how’s that for motivation?). If you do the math, improper sugar metabolism and insulin overload may be affecting 95% of the American public. It's more than just a little bit likely that if you’re with five good friends, at least four of you are affected and three don’t even know it or don’t think they have a problem. I like to think that wouldn’t be true for me, because I harp on the subject and hope my four friends (that’s YOU, dummy) are listening, but who knows?

The real tragedies of type 2 diabetes (or IR) are threefold. First, few people realize how dangerous they are, most people don’t think they need to worry about it, and finally, that most people can rid themselves of either one in 60 days or less, something your family doctor will probably deny. I’ll tell you how in just a minute. Since current medical practices don’t generally discuss or concern themselves with insulin resistance, I’ll be the one to tell you that type 2 diabetes is nothing more than insulin resistance that has progressed to a level where your doctor might finally notice it. By then you’ve probably had it for a while, because HbA1C, the metric that physicians use is such a poor choice.

It works like this: you temporarily elevate your insulin levels through your diet. This is how it’s supposed to work. Insulin should cycle up and down, up to help control blood sugar after a meal high in sugar or starch, and down between meals. Eating too often, by snacking or drinking sugary drinks, will cause insulin levels to stay higher than they should be for most of the day, and then it is unlikely that your insulin will cycle down adequately, which can interfere with proper sleep cycles. Insulin helps drive energy into cells and too much of it can prevent proper levels of REM and deep sleep. Improper sleep cycling can lead to excess cortisol (one of your stress hormones) which will promote visceral fat, the most dangerous kind.

Every meal you eat, regardless of the sugar and starch content, causes an insulin release, although a high sugar, high starch meal will release more. In fact, thinking about tasty food, or smelling it, can release insulin as your body expects blood sugar levels to increase, and that spontaneous increase will depend on whether or not your body is accustomed to a diet that is regularly too high in sugars and starches. Eating rapidly digested carbohydrates, which goes beyond sugar to include starchy foods like potatoes (including fries or chips), rice, bread, and breakfast cereals, elevates insulin and will generally result in the overproduction of it, so that you are left with a circulating surplus. Part of the reason for this overproduction is that several of the items that have become staples in the western diet, like bread, fruit juices, and breakfast cereal, are relatively new inventions that trigger a strong insulin response. If you’re surprised by the inclusion of fruit juice on that list, fruits contain fiber that slows the absorption of sugar, resulting in a significantly lower glycemic load than fruit juice. I’m sure you’ve been taught that bread is OK and whole-grain bread is good for you, but that’s not accurate for reasons I’ve discussed in the book and in previous posts. It has to do with the way commercial bakeries make bread these days.

One extremely illogical yet true problem is that if you ingest artificial sweeteners, your body is very likely to think they’re sugar and act accordingly, while insulin isn’t needed to regulate aspartame, acesulfame, or any of the other popular artificial sweeteners. So the insulin thus generated simply stays in circulation, with nothing much to do except restrict your ability to burn off stored body fat. Am I saying artificial sweeteners can cause obesity or retard your ability to lose weight? Yes, that’s exactly what I’m saying. Just one more reason to remember the acronym JERF, Just Eat (or drink) Real Food!

Surplus insulin, insulin with no sugar to break down, will cause the insulin receptors on many of your cells to down regulate, to close up shop, because they’re tired of being overused or being told by your metabolic central command that they’re not needed. A bolus (blast) of sugar or artificial sweetener, which can be caused by drinking a large soda, eating a candy bar, or just a lot of snacking between meals, will cause an insulin spike which will quite often exceed the insulin need. This is one MoA (mechanism of action) credited with causing insulin resistance. It’s like building up calluses on your pancreas.

Excessive blood sugar can be extremely dangerous, and your body knows this. Hence, when that bolus arrives, your pancreas goes into overdrive. In nature, before processed foods and back when the average person consumed less than two pounds of sugar annually, a sugar bolus was an extreme rarity. These days, with the average American consuming more sugar and glucose elevating starches in a week than we used to consume in a year, it is the rare person whose insulin regulation isn’t haywire, and the consequences can be dire.

So, for the umpteenth time, my disclaimer: I’m not a doctor; this isn’t medical advice, blah, blah, blah. HOWEVER, if you have diabetes, even if it’s “only” type 2 use caution when embarking on a fasting, intermittent fasting, or time-restricted eating program. My experience has been that, other than type 1 diabetics, a carefully designed program of attaining metabolic flexibility, followed by time restricted eating and then fasting, once you’re ready for it, can often produce miraculous results. The same can be true for type 1 but requires precautions and should also include careful glucose monitoring.

A lot of you are thinking to yourselves, “I’m in the clear; I just had my HbA1C tested, and it was 5.6.” Well bully for you. A1C is an extremely poor marker for insulin resistance, I’d go so far as to call it useless, but if it’s really high, it should be heeded. If it’s “normal,” that doesn’t mean it’s all good. A test that is 1000X better at ferreting out insulin problems is one you can read about here: The HOMA-IR calculation, which your family doctor will likely pooh-pooh or denigrate, assuming they’re even aware of it. The HOMA-IR calculation is a ratio of fasting insulin to fasting blood sugar, whereas the standard HbA1C simply measures fasting glucose. If you fast, your glucose will drop (duh!). You’re supposed to fast overnight before being tested for this, but if you fast for six hours (late night snack or alcoholic beverage) you’ll get one reading, and if you’re last meal was mostly fat and protein and you fast for ten to twelve hours, you’ll almost certainly get a good reading for A1C. If you’re insulin resistant (type 3 diabetic) your A1C can test out at 5.6 while your HOMA-IR could read 6 or higher, indicating borderline or perhaps full-blown type 2. A good HOMA-IR is <2.

If you’re interested, I previously published about aberrant insulin cycling here, with some explanation of how time-restricted eating can help regulate it. Incidentally, no one had type 2 diabetes five hundred years ago.

OK, you have a problem, because your HOMA-IR is too high and maybe you’re just also frustrated because you can’t lose weight, a likely sign of IR, but you should still get the HOMA-IR number for two reasons. First, to be certain of the problem, and second to have a benchmark in order to know that this worked (when you retest). What’s the quick fix I alluded to earlier? It’s the same solution that I offer to weight-loss clients who say they can’t fast due to extreme hunger pangs and fatigue (hypoglycemia). The trick is attaining metabolic flexibility, which is your body not having a preference for sugar but being able to use fat or ketones equally as well as glucose. If you’re not metabolically flexible, fasting will be extremely difficult and possibly even detrimental. To attain metabolic flexibility:

For seven to ten days, eat exactly zero sugar, imbibe zero alcohol, and eat only protein (preferably animal protein) and green vegetables, no grains, and no fruit, remembering that anything with seeds on the inside is a fruit (squash, tomatoes, etc., although avocados are the one fruit that’s OK in this equation). If you’re famished, chew on some jerky, eat a strip of bacon, a chunk of meat, some broccoli, a bunless burger, or anything that will digest and release slowly. One of my favorite dishes for this diet is to caramelize some onions, then sauté (using low heat) some cabbage along with some ground meat (I’m partial to bison). Some cajun or creole seasoning can really liven this recipe up. Tossing in some mushrooms near the end of the process is good, too. You can make a skillet full and keep some in the refrigerator for snacking.

Part of your hunger could well be caused simply by the habit of eating too often, so don’t eat just because you feel a bit peckish or your mouth is watering for a taste of something. During this period, eat only if you feel symptoms of hypoglycemia, like fatigue or dizziness. By “depriving” your body of those sugar spikes, your insulin should realign itself in short order.

Once you’ve gotten through the first ten days, start making it a point to skip morning breakfast, and start breaking your overnight fast later in the day, perhaps only by an hour or two at first, but the objective is a daily break from eating of about sixteen hours. Stay away from sugar, hopefully forever, because sugar helps you eat things you shouldn’t eat, and it’s not a part of ancient diets. It may seem like a natural substance, but it’s artificial in the sense that it doesn’t come with the food you’re adding it to. Remember that paleo man basically never ate breakfast and didn’t have sugar, other than a bit of high fiber sugar cane in some tropical locations. They didn’t have pantries or refrigerators in Alley Oop’s days. (OK, youngsters may need to look that one up; Alley Oop was a comic strip about a cave man.)

Go with a moderately high fat and moderately high protein diet with zero sugars, starches and, grains for the rest of the thirty to sixty days of your self test, as well as abstaining from alcohol, which you can add back later (in moderation) and then get your HOMA-IR rechecked or, if your HbA1C was off the chart on your last blood test, you could repeat that, because your doctor may not sign off on the HOMA-IR, meaning that you’ll need to pay for it out of pocket. In either event you should feel better, and you should see your weight drop, either a little or a lot, depending on factors that aren’t all that pertinent to today’s topic, but the weight loss (assuming you’re not already underweight) will be good for you. I’ve seen clients lose over ten pounds almost overnight by eliminating many of the non-food items from their daily routine, things that shouldn’t have been there in the first place.

To further lock in the gains, as well as to aid you if your goal is weight loss, try extended fasting. The key to true fasting is that your mind will want food, more for taste than for energy. The crucial point in an extended fast comes between thirty and thirty-six hours. Once you get past that, your hunger response should be significantly blunted. If you begin your fast right after a high-fat, near-zero-carb meal at around noon, you probably won’t feel hungry by bedtime, so that part is easy. If you wake up hungry, tough it out; the hunger should abate. Then you’ll go to bed after your first full day of fasting, and sleep right through that problematic 30-36-hour window, and wake up the next morning probably not hungry, although perhaps longing for the taste of food.

Once your insulin metabolism is where it should be, just avoid anything that isn’t food, which is just about anything you buy in a package. While it’s OK to go back to eating fruit (in moderation) grains should be minimized, even the ones like quinoa, that you’ve heard are good for you. Bread should be eliminated unless you make it yourself, or get some good San Francisco sourdough, because the sourdough process neutralizes the lectins in the wheat flour, rendering them harmless. This will also happen if you make bread at home, but bread is still an item with a high glycemic load, because it digests rapidly and raises blood sugar.