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Joseph Kraft and hidden diabetes

There seems to be a cleavage in this field between doctors/clinicians OTOH and surgeons/pathologists who cut people up and see their atherosclerotic bits on the other. There's a heart surgeon called Dwight Lundell on the DietDoctor site who has a heretical theory of what causes atherosclerosis, formed by cutting people's bits open and having a look.
 
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It's also clear that diabetes is much more complex than the binary playoff between glucose and insulin. Ir's a much more complicated story.
 
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LucySW said:
There seems to be a cleavage in this field between doctors/clinicians OTOH and surgeons/pathologists who cut people up and see their atherosclerotic bits on the other. There's a heart surgeon called Dwight Lundell on the DietDoctor site who has a heretical theory of what causes atherosclerosis, formed by cutting people's open and having a look.
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I think Dr Lundell is basically saying the standard western diet (lots of refined carbs and industrial seed oils) cause it, not high cholesterol.
 
NoCrbs4Me said:
I think Dr Lundell is basically saying the standard western diet (lots of refined carbs and industrial seed oils) cause it, not high cholesterol.
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Yes I think I agree with this statement. The cholesterol changes are just an indicator to the damage from multiple directions but have been blamed as the culprit
 
Could we get back to Kraft and his apparently discovering that most people are severely insulin resistant?
 
LucySW said:
Could we get back to Kraft and his apparently discovering that most people are severely insulin resistant?
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Well it's all related really. If 71% of people are "Insulin resistant", is our understanding of what is normal wrong?

Especially when you take into account the following, which shows that ~6% of the US population is Diabetic. (Chart comes from the CDC)

dsdiabetestrends_600px.gif


Should the issue really be about preventing Hyperinsulinimea in the prevention of CVD rather than directly worrying about diabetes, as those 71% of insulin resistant subjects clearly aren't all diabetic.
 
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tim2000s said:
Well it's all related really. If 71% of people are "Insulin resistant", is our understanding of what is normal wrong?
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Yes absolutely, I think that's the real point.

Perhaps we should change our picture and see T1 and T2 diabetes as the late stages of the disease of insulin abnormality. The very late, finally visible stages. And insulin resistance as a stage in this process that people go thru to varying times and intensity.

One question would then be, when do you get appreciable vascular damage / when does damage become important and structural ...

Actually I suppose T1 doesn't fit that picture. But then you get Kraft's other point in the book, that once T1s are taking exogenous insulin, they can become insulin resistant too ...
- "My question is what "Randomly referred for OGTT" means"

Perhaps Ivor Cummins can ask him? As he interviewed him last month.
 
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LucySW said:
Yes absolutely, I think that's the real point.

Perhaps we should change our picture and see T1 and T2 diabetes as the late stages of the disease of insulin abnormality. The very late, finally visible stages. And insulin resistance as a stage in this process that people go thru to varying times and intensity.

The question would then be, when do you get appreciable vascular damage / when does damage become important and structural ...

Actually I suppose T1 doesn't fit that picture. But then you get Kraft's other point in the book, that once T1s are taking exogenous insulin, they can become insulin resistant too ...
- "My question is what "Randomly referred for OGTT" means"

Perhaps Ivor Cummins can ask him? As he interviewed him last month.
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There are a few OGTT, differing in what you are trying to diagnose.
Fasting 2 hour
Non fasting 2 hour
Fasting prolonged 5 hours
Non fasting prolonged
Breakfast OGTT. Where the patient is given bread, butter, jam to see the response. It has a scientific name but can't think of it without looking it up.

Does it say which one was used?
 
It makes no sense to me to say that 70% plus of the population is "not normal". Right from the off there's a problem with the definition of "normal" there. And this may explain why his work has found no acceptance in the evidence-based scientific community.
 
The majority of overweight and obese people are normoglycaemic . They produce more insulin than their diabetic counterparts of a similar weight. Whilst they continue to be able to produce sufficient insulin then they do not become diabetic. Their pancreas can compensate (at least to a point, which in some cases can be extremely high)
We see this compensatory increase in production during pregnancy and during adolescence when energy needs increase.

It is only when insulin resistance has also increased and reached the point that the beta cells can't compensate that we get hyperglycemia. It's then that beta cells may be killed by gluco and lipo toxicity (or perhaps in some cases just made dysfunctional)

Insulin resistance is by some researchers today thought to be a defence by cells against too much energy. When fat or muscle cells get too full so they can't take any more they become resistant to insulin preventing energy from entering . They are protecting themselves and don't 'think' of the upstream consequences for the rest of the organism. This happens at a different threshold in different individuals; some people might have to became mega obese before it happens and others may be of 'normal' weight .

This is in a way demonstrated by those very rare cases where people have almost no fat cells. They are diabetic and extremely insulin resistant. http://www.bbc.com/news/health-22903537
It's also demonstrated when we exercise, we use up some of the cells energy stores we become less insulin resistant.
Conversely Giving injected insulin when the cells are more resistant causes weight gain since it's forcibly overcoming that insulin resistance with more insulin and allowing more energy into the cell. (and thus more is able to be stored)
(I've very much simplified the resistance as a defence against obesity hypothesis; leptin also plays a part http://www.lsi.umich.edu/newsevents/lsinews/2012-06-05)
 
fascinating discussion. did watch Ivor's interview but only about halfway through..i pulverized my pancreas for more than 30 years. My fasting insulin recently was 12 which was smack in the middle of the 4-25 range which the lab determined as "normal" but based on my research, i thought that was "high". During this period I did however manage to lose 6 stone. Jeff Volek published an interesting graph that showed fat breakdown falling off a cliff when insulin levels were above around 4-5. i am now actively trying to bring my fasting insulin down to that level with supplementation of fish oil, chromium & berberine. been on these for about a month. will report back after two months if anyone is interested.
 
msmi1970 said:
fascinating discussion. did watch Ivor's interview but only about halfway through..i pulverized my pancreas for more than 30 years. My fasting insulin recently was 12 which was smack in the middle of the 4-25 range which the lab determined as "normal" but based on my research, i thought that was "high". During this period I did however manage to lose 6 stone. Jeff Volek published an interesting graph that showed fat breakdown falling off a cliff when insulin levels were above around 4-5. i am now actively trying to bring my fasting insulin down to that level with supplementation of fish oil, chromium & berberine. been on these for about a month. will report back after two months if anyone is interested.
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Have you seen Marty Kendall's blog on optimising diet based on the insulin index?

https://optimisingnutrition.wordpress.com/2015/03/23/most-ketogenic-diet-foods/
 
RuthW said:
It makes no sense to me to say that 70% plus of the population is "not normal". Right from the off there's a problem with the definition of "normal" there. And this may explain why his work has found no acceptance in the evidence-based scientific community.
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How could Kraft's evidence possibly be bettered, Ruth? Nor would I describe the medical community as evidence-based. Closed-minded, rather.

Yes, it's the question 'What is normal' where the importance of his research lies. It certainly tells us something - the question is, what, isn't it. My best make of it so far is above: we redefine diabetes as the later end of a disorder of insulin metabolism.
 
LucySW said:
we redefine diabetes as the later end of a disorder of insulin metabolism
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That only holds true if what 71% of the population tested showed was abnormal. By very definition, the data shows that statistically, those with the "Kraft Normal" response are, if you like, the lowest quartile on the distribution.

Is what they have actually the abnormal?

Does it demonstrate that what has always been believed to be normal, by the evidence presented, is really the abnormal?
 
tim2000s said:
That only holds true if what 71% of the population tested showed was abnormal. By very definition, the data shows that statistically, those with the "Kraft Normal" response are, if you like, the lowest quartile on the distribution.

Is what they have actually the abnormal?

Does it demonstrate that what has always been believed to be normal, by the evidence presented, is really the abnormal?
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But optimal.
 
LucySW said:
But optimal.
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Not even that. What is believed to be optimal until enough evidence is gathered otherwise...

There has long been a belief that optimal cholesterol is as low a level as possible with very little proof, a lot of drugs sold and side effects like Alzheimers.....
 
Great point, tho insulin sensitivity can be increased without drugs by exercising, as you yourself do.
 
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