T2 or NAFLD? ...or, a funny thing happened on the way to the surgery

[Chris24Main]

Many thanks @Peanut234 ... a unique and fascinating insight. I've been building up to a post on homeostasis and the more general question of why any organ "decides" to do anything.. your post has shown (again) that it all just keeps getting more complicated the more you think you know..

 

[Chris24Main]

Quick personal one - blood test day, and this is one where I'm hoping to be listed as in remission, so I'm just a little excited about that.

I've taken up the "pro tip" to do a full fast leading up, so I'll see whether that makes a difference in my serum lipid panel results - but I'm not too worried about that, even if my LDL levels show higher than the recommended - I think I have a good enough relationship with my GP to get around that, and I plan to send some info (ketone levels vs fasting glucose, and blood pressure over time, and weight control, sleep patterns, that kind of thing) for context.

I'm more worried about the possibility that under my current regime, it's likely that my blood cells are lasting longer.. so it may appear that my HbA1c results look like they are going up again. That would be a more difficult conversation to get on top of. But - my morning finger prick test is definitely showing that my levels are more stable (very little dawn effect) and are generally around 5.5 mmol/L - which would map to an HbA1c of below 35mmol/mol - now I know that isn't a safe comparison to make, but we'll see soon enough.

 

[Chris24Main]

So - on the topic of Homeostasis.

This is actually something that I've been grappling with for most of the year, but I have to declare my biases first. As an engineer at heart, I can't help but see things as a series of machines. Machines do things because people pull levers on the machines, or not, depending on what instructions they have.

As an analogy, that is a somewhat useful way to think of the body - the organs are machines and hormones pull the levers, because...

.. because..

and that's kind of where it breaks down, because why ? - because our DNA tell them to ? - well no, DNA is just information, DNA cannot make a decision. Because our thoughts tell us - well we instinctively know that cannot be true.

Because of reaction to what's in the blood - well, maybe, but then you have to have a way of measuring what's in the blood, and bodies don't work like that, but there are places that do measure things, and they do produce the hormones...

and some hormones act against other hormones... what does that even mean.?

The liver can turn stored Glycogen into glucose, but it can also create new glucose from available amino acids, or tun them into Ketones - by what mechanism does it "decide" what to do?

The answer is - spoiler alert - homeostasis, but what does that mean?

Well - imagine a lever - it sticks straight up, and is in the shape of a paddle, and is attached to a dimmer switch - you push the paddle and the light dims, pull it and the light gets brighter. So far so good.

Now, to the side of the paddle end is a beer barrel, with beer flowing out of the spout (or water if you can't bear the thought of good beer being wasted in a terrible analogy) on to the paddle.

To the other side is a taller barrel - with it's spout also pointed at the paddle. Because it's a taller keg - the pressure at the spout is greater, so the jet of beer is faster.

Both spouts of beer hit the paddle from either side, and both cause the paddle to move.. but since they are opposite each other, the paddle only moves a little away from the taller barrel - it's effect in the moment is more powerful than the smaller barrel, so the light gets slightly brighter.

But the paddle moves, and the pressure equalises as the paddle moves closer to the weaker stream and further from the more powerful.

This is a state of balance - of equal pressure - or homeostasis.

Now, all that beer that's just leaking away - imagine now, that there is a container capturing it, and pumping it back into the small barrel - after a little while the level of beer is going to get higher than the level of beer in the taller keg - cause they are both draining from the taps - at some point the paddle is going to feel more pressure from the other side, and the lever will move into the dimmed state..


So - this analogy quickly runs away like a snowball - but the basic idea holds -

At the cellular level - once you start getting into the chemical reaction, or chains of reactions that have glucose molecules or fatty acid molecules turn into energy - some of the intermediary molecules fight against the "opposing" reaction, so if there are a lot of glucose molecules around, that's like having a taller beer barrel, and so the lever is pulled toward glucose metabolism.... more fatty acids available, and the reverse happens.

In the organ level, it's similar, stuff (be it molecules of glucose dissolved in blood, or sodium in the lymphatic system, or interstitial fluid) has an effect of creating a pressure to do a thing, and also to stop doing another thing. The result, is a combination of the amount of the various stuffs.. and the sensitivity to creating that pressure..

Now you can think of insulin resistance as being like turning down the tap on the taller barrel (tall barrel now is insulin) - there is more of it, the pressure should be higher, but it just isn't having the same effect - we need a new pump to pump more beer in to raise the barrel higher and create more pressure... but now the more we use that extra pump, the more the tap is turned to close it off... (is the barrel going to overflow before this analogy falls apart - who knows?)

To some extent, this is all unnecessarily complicated - but I think as people, we tend to reach for simple explanations to complicated things; For example - how does the sun move across the sky every day - well, a God in a Chariot must be pulling it from place to place... Ah, right you are... So, when presented with the complication of circadian rhythm, evolutionary need to be alert in the early hours, physiology of stress etc.. we say things like "the liver dumps glucose into the blood to get ready for the day" - oh, right you are...

And the problem comes with - if we don't try to understand the mechanism just a little - we have no way of affecting it - that dammed liver of mine, it just keeps dumping glucose every morning, I'm fed up with it, it makes me so angry...

It's a totally human way to think - even if it's really part of the problem...

My problem right now, is that I started this post off without any plan of how to tie it off - I'm kind of spent just trying to keep the lever analogy in check - I don't really know if this is helpful to anyone; it is to me - just the effort of trying to explain a thing helps make sense of it in my head; so there's that... but I hope that somebody finds this helpful. I'd rather stop there than take it to the next step - like how would you use this knowledge to reduce a dawn phenomenon, or the like. I'm minded also that I can only really relate back to my own experiences, and I don't want to sound like I know what may happen to anyone else (or even me, for that matter, I'm only really guessing all the time).

 

[Outlier]

I love your in-depth engineering analogy. I offer an in-shallow very basic addition:

All living creatures need to survive long enough to reproduce. What we reproduce needs to be at least as healthy as us and it's desirable that they are healthier. Our design spec. is not any more complicated than that, which is why we deteriorate once we are on the foothills of no longer being able to breed. Which is why often illnesses manifest that have hitherto been kept at bay by youthful vigour.

Health dynamics are geared to adaptation, because there are many variables in life circumstances. Some creatures can grow a new limb if one is lost. It might not be as big or strong but it's better than nothing. More complex beings have finer adaptation skills if "finer" is seen as smaller. Thus we can, if right-handed and suffering loss or damage to the right hand, to some extent can make more use of the left one. We can exist on less food or water. We can be social beings but adapt to solitude when we find that safer.

Homeostasis represents the ability to resist physical changes that might make us vulnerable. Our minds can see the long-term but our bodies take longer to adapt because adaptation might be a bad change. In time these adaptations happen to the extent of their ability. So IMO homeostasis is natural if not always desirable, because it is the body's "safe place".

 

[Chris24Main]

Thanks @Outlier - If I'm listing homeostasis at the cellular, organic, and total person level - that's the societal equivalent.

Maybe longevity should be my next topic ... <you have been warned>

 

[Melgar]

Thank you so much for the information @Peanut234. I really do appreciate you taking the time to respond. And on that note sorry I didn’t respond earlier I went down with flu , well flu symptoms, high fever, throwing up, headache and aching body with high blood sugars, fasting bloods at 11.5 with zero food intake . I’ve definitely got something going on. I have an appointment with my GP in a couple of weeks, so hopefully I will have answers.

 

[Chris24Main]

Virtual hugs @Melgar - it hasn't been a great few weeks for you...

 

[Chris24Main]

Quick personal one - blood test day, and this is one where I'm hoping to be listed as in remission

Update on this - the new entry in "remission and success stories" speaks for itself - but to some extent, in the safety of this little thread, I want to move swiftly on from the good news (BG at 35 and now officially in remission) to the interesting bit; the text from my GP was again super swift, and really encouraging on the Diabetic front, and again; not demanding statins, but noting that "if anything your cholesterol has gone up".

Now - I don't know what I would have measured if I hadn't fasted the day prior, so maybe it's just as well I did, and otherwise my GP would have been on the phone demanding I stopped this extreme diet and listened to reason...

... joking by the way... I have nothing but respect for my GP, and recognise that in these circumstances, I believe she is skating just as close to the edge that she can and still show she is following the NICE guidelines. Ie - I think she is as much in support as she can be.

Anyway - my Serum Cholesterol is now 7.8 mmol/L - (high ref limit is 6.5) - also my calculated LDL cholesterol level is 5.6 (high ref limit is 4) - so on that basis, my "cholesterol level" is worse than it was at the very peak of my diabetes - just before being re-diagnosed as T2, injecting insulin and feeling very poorly.

But - if you buy into the general narrative (and as a GP, you have no choice, really) - it should be kind of alarming that my "cholesterol" is still going up.

However, back at that peak, my triglycerides were quite literally off the chart - too high to measure, and since then they have been tracking down. Similarly, my HDL levels are raising slightly.

So - there are two alternative views to this -

1 - the "Zoe Harcombe" view - it's all pretty much nonsense. Cholesterol is Cholesterol; there is no difference between good and bad, it's the same stuff, your body needs it, creates most of it, and the amount you have is the amount you need. There is no basis to the "small and fluffy LDL" either - it's all nonsense.

2 - the LDL size distribution view - it's all about the purpose and health of the lipoprotein particles. The presence of Carbs and Seed oils (and the combination of them, think tinder and spark both to make a fire) produce malformed LDL particles that can damage the Glycocalyx and expose the Endothelium to injury, and thus trigger an inflammatory response that could lead to plaque formation - under this view, the triglyceride/ HDL ratio is critical, but almost nothing else matters.

I have sympathy with both - I see some people talking about small dense LDL and how that can get 'caught in the arterial wall' compared with the light fluffy variety which will float - and that to me just exposes ignorance - We cannot help but think of an artery like a drainpipe, and these things like golf balls or tennis balls - as humans, our imagination goes to what we know... but the relative size is all wrong...

For an LDL particle to "get stuck" in the arterial wall, is like (and I steal from Dr Malcolm Kendrick here) sticking a harpoon in the side of a whale, and going round the other side and expecting to find it there. The arterial wall is lined with cells which are massive in comparison, and more than that, have receptors which are designed to capture LDL particles to take in the needed cholesterol and consume the LDL in the process - in a healthy artery, there is zero chance of an LDL just slipping past the endothelial cell and getting stuck in the wall behind - biologically it just cannot happen, and if it could, we would all be in big trouble.

However - if you understand that this super amazing layer of cells also has another protective layer of it's own - the Glycocalyx - which is kind of like what the Cillia do in the lungs - a layer of little hair-like structures that act as protection and lubricant. It wasn't even known about when the saturated fat, heart heath hypothesis was developed, but you can actually measure the damage, by weight, caused by a single cigarette to the glycocalyx. Now - a cigarette smoke particle is still at least 5 times the size of an LDL particle - but it's not beyond the realms of possibility that a malformed or glycated LDL could damage the glycocalyx. Sickle cells definitely do, but they are bigger again, so maybe the Zoe view wins out...

Let's draw this to a conclusion - what does it mean?
Well - on the one hand, I am deliberately and definitely becoming more 'fat adapted' - meaning that I'm more able to shift into fat metabolism rather that glucose metabolism, my fat storage tissue is more able to release fats for my body's cells for fuel, to use that fuel and to generate ketones for the parts of my body that cannot burn fat. All of this is easily thought of as "the opposite of insulin resistance" - where you operate mainly on glucose, and lock away the fat in whatever storage is available. (more to it of course, but if you like, that's the starting point)

So - that has to mean that there is more fat (or fatty acids in free form or in triglycerides) mobilised and being transported around my body than there used to be - what do they get transported in? Lipoproteins. What are these when they are emptied of the fats? Lower density Lipoproteins, or LDL - should I be worried that there is more measurable LDL? no - because I can also see less glucose, and more ketones.

As for the rest, well - it's all interesting, but I cannot see a scenario where it looks like it's getting "bad" - it's either irrelevant or it's getting better.

 

[MrsA2]

Now - I don't know what I would have measured if I hadn't fasted the day prior

So, excuse my ignorance, are lipid levels higher if one fasts before a test?
Disclaimer, I'm still trying to understand my last results which panicked my gp, but I did go well fasted, I always do for blood tests as that way I know I'm always being tested from the same baseline. Everything was up the total, the hdl, the ldl and the trigs

 

[Melgar]

Thanks for your words @Chris24Main. I always appreciate your input. Hopefully I’ll get some answers now.

 

[Le Duan]

Has anyone tried Intuitive Eating? https://www.intuitiveeating.org/about-us/10-principles-of-intuitive-eating/

 

[Wilbach]

Has anyone tried Intuitive Eating? https://www.intuitiveeating.org/about-us/10-principles-of-intuitive-eating/

Mmmh! Looks dodgy to me, perhaps fine if you are non diabetic, no insulin resistance etc! Certainly will not put your diabetes T2 into remission!
That is my take.

 

[Chris24Main]

Yup - for the purposes of T2DM, "intuitive eating" is really, don't worry, have another pull on that crack pipe and feel good about it.

Learn about the things that happen when you eat the foods you eat, and how you can use that to your advantage, so that you can become happy with what you are eating, and that this is making you better. I'm afraid that this webpage is propaganda for ... well, I don't know who it's for.. but I know that there are critical points it's missing.

I've been reading a lot of history recently, and there are really two separate ways to look at the entire history of Diabetes management.

The first is "people really like eating sugar, what we need to do with diabetes is use drugs to allow people to continue to enjoy sugar".​

Looking at the development of the sugar industry, and the way that diabetes treatment tends to avoid the critical link between sugars-insulin-outcomes (only one outcome being loss of control of blood glucose that characterises T2DM) - it's hard to avoid the conclusion that the general sense is that sugar is just such a powerfully desired food, that denial of it borders on cruelty, so all that the medical system needs to focus on is how to allow people to continue to eat what they want, including sugar, while minimising the effects via drugs.

The idea that there is a fundamental imbalance in hormones caused by vastly more sugar (in the form of sugar and starches) than we are evolved to cope with, so the response must include reducing or eliminating that sugar and starch; is just too difficult - because people want to eat sugar so badly. (I don't offer an opinion there, only a summary of the meta-history, if you like)

The second is the way that the two critical discoveries of artificial insulin and cholesterol have on the history of treatment.​

For hundreds of years, it was taken as fact that in order to successfully treat diabetes, you had to limit carbs. It was much rarer (and sugar was also much rarer) - but that was as far as it went. Unfortunately, a certain number of diabetics, particularly kids, just died. (we of course now know that as T1)

Insulin was a revelation, and suddenly the dying kids could be miraculously saved, so it must be a wonder drug for all. The consequence of this is that we are still in the grip of "these drugs are amazing and getting better all the time, they can control your symptoms" and the previous way of thinking, that you have to reduce carbs, is now seen as niche and untested.

The discovery of insulin revolutionised T1 - with universally amazing results - but to some extent the close association of T1 and T2 (being almost totally opposite conditions where insulin is concerned) led the entire thinking about treatment for a while to revolve about how insulin could be used to treat both conditions. This is trying to summarise the understanding of what diabetes was and how it should be treated over a long period of time, so please understand that I'm only trying to lay out my understanding of the way opinions formed here, not offering my own.

Then - the link between heart health and cholesterol has a lot to do with the discovery of an easy way to measure cholesterol at a particular time when a "villain" was needed. Despite the science (even at the time) pointing more at sugar, the narrative that "saturated fat leads to heart disease" has become so embedded, from congressional dietary guidelines to the one thing your GP knows for sure... that it's simply impossible for the entire industry to conceive of a diet of anything other than low-fat being healthy. That doesn't point to conspiracy, it makes total sense. If one is true, you cannot recommend anything that would lead in the opposite direction. I believe this to be wrong, and all the direction of available evidence points in this direction, but it will take time for the narrative to change. The consequence of this is that any approach to diabetes that focuses on low-carb immediately goes head-to-head with more than a generation of everyone involved believing to their core, that the resultant high-fat side of the equation, is more dangerous.

At the most simple level, this one fact has blocked any trial from properly comparing a low-carb dietary approach to treatment (simply on the basis that the starting point is dangerous and unethical) with anything else. This is one repeating fact that you need to be aware of when evaluating studies and the interpretation of those studies.

Both of these perspectives make it easier to understand a lot about the way that these diseases are increasing, but also that none of it stops anyone from learning how foods affect you personally, and to try things on your own. It may genuinely be unethical to run a long-term trial comparing (for example) the difference in all cause morbidity with a low-carb high-fat eating regime compared to short term meal-replacement, but that doesn't stop anyone from trying and seeing what results - we are all different anyway; there is an inherent problem with mass studies because they treat us all as statistics.

Bizarrely - the more I learn, the less angry I become, because it's easy to see a conspiracy, but in the end, it's only lots of people doing the best they can with the information available to them, and this is a complicated topic.

 

[Chris24Main]

Quick update on this last post.
It really is a distillation of at least 6 books on the history of the growth of various adjacent industries, diabetes treatment and the understanding of what diabetes is, as well as the history of the saturated fat - heart health hypothesis, and how that affects diabetes treatment as well as driving the focus of trials and funding for trials.

There is an obvious danger in trying to condense so much into a few paragraphs - and some points need to be clarified.

1 - if there is anyone who has read this and felt that I'm pointing the finger of blame for T2DM on them - I whole heartedly apologise; never my intention and not at all what I'm getting at.
2 - is it fair to focus on sugar, and what do I mean by that?. Surely diabetes is not a new thing after all.
3 - What about all the other possible cause of Diabetes, office jobs, sedentary lifestyles and the Body’s inability to burn off excess energy consumption, as examples.


So, as usual, in as much of a spirit of humility as I can muster, and this being a place for challenging each other and trying to learn - particularly trying to learn what are the commonalities that we can agree on...

1 - Blame.
No, not at all. Sugar, in the form that you can add it to something, as opposed to just sucking it out of fruits; refined sucrose (being a pair of glucose and fructose molecules) has been around for hundreds of years - the Egyptians were instrumental in developing the technique for refining it, so that's a fair amount of time. Almost all the time it has been around, it was considered to be something of a wonder drug - the cure for all ills, the reviving spirit, the essence of energy and joy (all my words, I try to write from my head rather than copy pasting from source). Not a food.
As the refining (as well as the control of growing and distribution, or more simply, empire) takes a more industrial form, it becomes more widely available, and the sense quickly becomes that this is indeed wonderful stuff, and that it would be a form of cruelty to withhold it, particularly from children, who clearly derive such pleasure from sugar.
There has always been a suspicion that the attendant rise in what we now know as Type 2 diabetes was linked to over consumption of sugar. A suspicion, because there has always been a corresponding cry that it cannot possibly have anything to do with something so beneficial as sugar. Both from well minded "influencers" and people deriving wealth from the sugar industry; I really tend away from conspiracy, and it's clear from the record that sugar was very highly thought of (personally, it's a dosage thing for me).
How this affects diabetes treatment, is that the priority has often been about allowing sufferers of diabetes to enjoy sugar as much as the rest of "us" do - rather than seeing it as an intolerance to sugar that is best served by avoiding it, and becoming well.

2 - Sugar, or other carbs.
So, in many of these pages, I've used the term "sugars and starches are fattening" - because that was how it was always put, historically speaking, and that is still true. However, having read more deeply on the sugar (specifically refined sucrose) industry, again, every time in history that a community of people have given themselves the ability to increase their consumption of sugar, diabetes has followed. It really is unique, and difficult to avoid the conclusion. Every single anomaly is explainable - World War sugar rationing, diabetes rates fall. Diabetes in the landed gentry classed of Victorian Britain, but also pre-empire India. Diabetes sweeping into every country that adopts the Western diet. And so on.
When you are trying to reverse T2DM and insulin resistance, I truly believe that you absolutely must consider all starches, because they will turn into glucose - but sugar; refined sugar - gives the body both the double whammy of glucose and fructose (which is metabolically unique, and turns into triglycerides, leading directly to insulin resistance in adipose tissue - this is the fatty liver route) as well as the emotional desire for more sugar. There is not a single case of a population gaining access to sugar and not increasing consumption at a rate higher than any other substance.

3 - what about all these other causes.
Well, yes - lifestyle is clearly a factor, and thinking about reversal of T2DM, I personally have raised my game on sleep, stress and exercise; so of course I cannot simultaneously claim that they are not a factor.
However, when you see the same line being put out time and time again; "it can't be sugar, the mental stress and corpulence of the upper classes is to blame" - two hundred years ago when sugar was the privilege of the rich; and really at every point since - it surely cannot be sugar, what about (insert modern reference)?
Yet, there was a reason the term Mellitus (meaning "honey") was added in the 17th century. There is a current line of thought that "all calories are equal" - but this thinking really predates the understanding of endocrinology, and that a calorie's worth of sugar will do different things in the body compared to a calorie's worth of protein or fat. (or that protein with carbs will have a totally different effect than protein without...).

As for exercise, one of the most notable groups of diabetes sufferers was historically slaves working in sugar plantations. Indeed, President John Adams was primarily excited about Maple Syrup because it could be produced without the large need for slaves to work the plantations. Now - is anyone going to volunteer that this population was too sedentary?

In many ways the way that the entire narrative is steered toward Carbs and not Sugars is interesting. Even the momentous 1977 congressional report that lead to the changing of dietary guidelines and that we should shift 20% of total energy from fat to carbs - (and I've only just gotten to the bottom of this, but it's been bugging me for months since I found the original report) -

Goal 5 clearly talks about reducing sugar consumption by 40% (and that's by 40% of what people were consuming in the seventies)

By 1980 (I think) - that had been dropped, and all we are really left with is the increase carbs, and reduce fat.
Think what available food would be like if we were all as fixed on limiting sugar to 40% of what was normal in the seventies...

 

[Chris24Main]

So, excuse my ignorance, are lipid levels higher if one fasts before a test?
Disclaimer, I'm still trying to understand my last results which panicked my gp, but I did go well fasted, I always do for blood tests as that way I know I'm always being tested from the same baseline. Everything was up the total, the hdl, the ldl and the trigs

You know - I'm not 100% sure on this one way or the other...
It is advised to not eat anything for the 12 or so hours before taking the test - that's essentially just taking the test before breakfast though.

There is a train of thought that it doesn't matter - that after eating is more representative of "normal" - but that totally ignores the evidence that we all eat too often, and actually the fasted state should be considered "normal"

Then, I was really following a tip to do a full day fast prior to the test...

but, thinking through the likelihood of what is going on.. I know (on account of having done a day fast) that I was in heavy ketosis (or solid ketosis) - so I was metabolising fat for sure... that fat has to be mobile, so wouldn't there be more fat carriers (LDL) in my blood, and wouldn't there be more triglycerides in those LDL - or by dint of that, would the carriers be less dense, so not be measured (being intermediate lipoproteins or ILDL) - or even under the action of the various hormones that drive fat metabolism, are the fats transported as free fatty acid chains, or is it simply that my body is at that point running on ketones..?

... you know, just in case anyone is under the impression that I think I know what's going on <grin>

 

[Outlier]

And missing from a lot of "research" and opinion is a "control" of people who eat lots of carbs and sugars and don't get any health issues from it. I'm married to one. As a control experiment, he's pretty interesting. His whole known family are the same. We can learn as much about illness from those who don't get it as those who do.

 

[Chris24Main]

Sure - I'm absolutely not saying that anyone who eats sugar is doomed.

But - the historical data is pretty clear on this, any society that starts to consume more than a small amount of sugar, very quickly develops not just a problem with diabetes, but all the "modern, chronic diseases".
Opinion, research and control, are all surprisingly malleable, and are affected more by profit margin than I was willing to admit.

Actually, I was shocked to discover that some of the big food companies were bought by the tobacco industry in the eighties. Digging further, it's clear that the sugar industry actually took a detour into tobacco (literally, the modern cigarette is not possible without sugar) and dropped out again once it became indefensible. They have been doing what we think the Tobacco industry were doing, but for a couple of hundred years.

Again - I do not see conspiracy, only people making a fair profit. I have a huge sense of admiration for the success of the sugar industry. Christmas is what it is because of Coca Cola; it's remarkably successful at what it does; but a big part of what it does is hide how dangerous sugar is in quantity, by obfuscating sugars with all carbs, and all foods together, so that we believe that the problem is simply too much energy in and not enough out, and that it has nothing to do with hormone response. (until we have to come here and learn how to reverse the problem)

 

[Melgar]

I enjoyed reading your clarification @Chris24Main . This is more a reaction than a response to the points raised. It’s not about theory or what I’ve read. It’s a personal reaction.

I am always mindful of apportioning blame for diseases because there is always a context. Even smoking has a context. Very few people set out to destroy their own bodies, unless addiction kicks in. Then we are in the sphere of Societal v medical.
Simple sugars , single molecule chains that demand the pancreas release insulin at break neck speed. It always reminds me of horse racing, horse and jockey at the start gate, bang and they’re off. Just like our pancreas’. A sprint down the track and then it’s all over. Horses sweating and gasping for breath from that sprint. That momentary rush of Adrenalin horse and rider feels, short lived but real. That is how I see the consumption of simple sugars, be it Cocacola, *******, fruit juice or just raw sugar.I can imagine it as I write. I’m an adrenaline junkie.

From a personal perspective I steer well clear of simple sugars even though I enjoy the dopamine rush. Dopamine is never far from my ADHD addled brain. Dopamine that feel good factor, a chemical we enjoy. I have a lack of it, so that rush gives me a big high, a feeling of elation. It’s a cheap mind drug. My CGM tells it all really. Within minutes my body has absorbed these single chain molecules, a rush of insulin, a feeling of elation, then the crash and it’s all over. My CGM graph plotting the whole sorry episode. The high spike (the dopamine rush), the sudden plunge (the crash), the low sugar episode (urgh). If I’m really unlucky then my brain, starved of glucose goes into a spin, I sweat, I feel anxious, nightmares if I’m sleeping through the event. The pancreas is left wondering what the hell just happened as it puts the breaks on insulin release and now all that excess insulin is in our system taking our blood glucose lower and lower for what our brain needs to function at optimum. If we are Type 2 it usually recovers.

I know all this because I can see it on my CGM graph. It’s a big hit in a small space of time. That thin needle like spike. No wonder it’s a quick hypo fix. I know why it occurred and I know the science behind it.

We live in a world where finding joy is like looking for diamonds in the rough. We are always looking to feel good. And why not. Sugar does it for a lot of people it’s Cheap and readily available. It’s in our face. It’s everywhere, along with carb ridden fast food dripping with fat in a carb filled bun. I could throw up thinking about it. My own reaction a part, fast food is exactly that, quick and easy. No preparing or cooking, all ready for us. Kids are satisfied we can enjoy the evening. In a world of long hours, sitting at a desk, and let’s face it a lot if office work is repetitive and boring, I can see the allure. I worked in a windowless office, I never moved from my seat. I ate at my desk, I ate candies at my desk. I never moved. I didn’t talk to anyone because that was the nature of my work. I would jump on the treadmill after work and do a quick 5 k Run as a release.

We have become reliant on Manufactured flavours, full of salt, sugars and chemicals that activate the tastebuds , the dopamine flooding the brain , a feeling of fullness and well-being. That, in my opinion, is where we are at as a society. It’s not just simple sugars, it the complex ones too, complex chains, not water soluble. We often eat then with fats, that unholy combo of carbs and fat. The fat slows the metabolism of the sugars, causing raised and longer periods of insulin release. The body takes no prisoners.

For most people it doesn’t matter how our bodies are dealing with these foods, people don’t think about what chemicals and hormones are released in response to the food we are consuming, we simply enjoy it. Then it’s payback, years later we are dealing with excess weight, high blood pressure, elevated blood sugars and goodness know what else. Excess energy supply, the by-product of a body out of whack, but is it? The body naturally puts it all away for a rainy day, because we are all primal beings when all said and done. Insulin resistance, a primal reaction; fat storage, a primal response, these are all primal responses to an unknown future. Our bodies are still in primal mode. In days gone by we would have worked it all off in the fields, the work houses, the mills or what ever. It was a physical world we lived in not a desk bound office. Yes, @Chris24Main you used sugar cane plantations as an example of why this theory can be challenged, but in my view you can’t really pluck out a single example. We don’t know the context of this particular group of workers. During world war 2 people were out working the fields, growing food for a nation at war.

Im not sure where I am going with this. We seem to live in a world where food is the driver of well being. Even if we have had a great time out, the insatiable desire to eat something, whether it’s a late night curry after a night out with friends, or a glug of a sugary fizzy drink on a hot summers day, we never seem satisfied with just being.

I don‘t think we have changed other than what makes us feel good about ourselves. What is available to give us that dopamine rush, that happy feeling. Food - fast food, processed food, carbs, sugar and salt have taken the place of simple external pleasures. We can no longer feel satisfied going to the beach with a flask of tea and an apple maybe a sandwich no we want chips and a burger. I might be doing a lot of people an injustice here so I apologize. Just my humble none scientific take. I am prone to turn to theory, but here Is a societal take. No answers really, just thoughts.

 

[Chris24Main]

Passionate response, really enjoyed reading that.
In the sense that it isn't often that anyone these days allows you to see real emotion; and it's an honour to share.

I didn't want to reply immediately, but let it marinade a bit. It's insightful, and kind of gets to the "real human need" response that I think drives a lot of what we think of as modern chronic disease, but are really about - we just like good stuff, dammit, now give me that. And I say that because I know it to be true in myself.
I don't drink at all these days, but - cards on the table - mainly because I`ve done so many shameful things when drunk and gotten in to so much trouble that the feeling of being hungover is so wrapped up in bad emotions that I can't deal with it any more.
I spent a decade smoking, and not just Tabacco, and felt totally entitled to do so, **** the consequences.
I'm a thrill seeker - I actually gave up white water kayaking in my twenties, largely because I was about to get back into a river fed by two glaciers in summer afternoon sun - so the river was more like a travelling bomb site- you could hear the boulders rumbling under the water, and the water simply exploded around you. Any way - the thing that scared me was how unconcerned I was - I should have been terrified, and I was happy to jump in again - that thought wore away at me...

So - I'm the last person in the world with the right to be sanctimonious. There are several instances I can point to that I think - "how on earth did I get away with that?"

But - Dopamine and "the rush" - we all know it. I just wonder if we have our thinking the wrong way around. I know the conventional wisdom is that "you can't produce enough" - but I think about the way we talk about dopamine, and you know - it's just another hormone, what if we get resistant to it's effects, the way that we get insulin resistant.
Because - why not ? We crave sugars because of that dopamine hit, Wingsuit divers do it because of the dopamine hit, lots of runners talk about the dopamine. Why would it be any different with dopamine? why would we not expect it to become necessary to have more of it to achieve the same effect?

This is almost certainly going to sound a bit dodgy and new-wave nonsensical, but I swear; I can more and more create that kind of good-feeling, first glass of wine, talk starting to flow, sensation just by relaxing and allowing it - It could be that I'm just kidding myself, or that I'm convincing myself of a phenomenon that doesn't really happen, or it could be that cells in my brain are more responsive to smaller amounts of dopamine, and absent the kind of hormonal fluctuations we all take for granted, I can simply see more signal than noise.. I have no way of knowing which is more likely, but the effect is the same.

Could you sell that? - not likely... Drink nothing and eat no sugars or starch, and after 9 months you'll start to just naturally feel more joyous... how can you sell that? - but it's true, for me anyway.

Single examples.
Yes - I take your general point that one can cherry-pick - but in this case it's deliberate - it's the "Black Swan proposition". Say I've ever only seen white swans. I may be tempted to say - "all swans are white" - and over years, each time I see a white swan, I feel it's more and more true. However - as soon as I see one black swan, I have to immediately give up the hypothesis that all swans are white.
The workers on various sugar plantations suffering diabetes is in my mind the black swan to the "diabetes could be a caused by sedentary lifestyles" hypothesis. But - there are many, many other examples - the Pima native American population being the most clearly documented, but almost any indigenous population that has taken on the "western diet" - really meaning much much higher levels of sugar than before (ie, could be processing, but not in the last century, could be more fat, but not the Inuit or Maasai who ate mainly fat) and many other. But not just indigenous populations, every time you get more sugar you get more diabetes.

At every point - the narrative has twisted, because it has become important to preserve the "truth" about saturated fat being the problem, so you have the French paradox - "must be something to do with the cooking - when the French were consuming 1/5th the sugar of the UK per head" - or the Inuit paradox - Must be something in the fish you can't get anywhere else, Omega-3? - and so on, but at each point, including then very first trial that established saturated fat - sugar is a better and more obvious explanation, that has stayed better and more obvious, each time the fat explanation gets more twisted and convoluted.

In some ways - something I read while on the river at the weekend brings this thread full circle, because I had been struggling with the role of Fructose, why is it such a big deal and what happens at the liver?

and the answer is so clear and revelatory that I feel like it's a whole new line of investigation for me.
I, we, focus on glucose and it's effect on insulin.

But - Fructose doesn't create an insulin response. at all. It just goes straight to the liver, which packs it up as fat, which it stores, itself - causing the fat storage cells to expand... and thus become directly insulin resistant.

So - sugar (being half glucose half fructose) is a double whammy, given that fructose (like alcohol) must be metabolised in the liver as a priority - but doing so makes the liver itself resistant to the insulin that the glucose triggers.

The bizarre side story is that historically, the sugar industry was initially unhappy about the term Glycaemic index, but soon came around... because sugar is a relatively low glycaemic index substance, because half of it produces no insulin response!!

 

[Chris24Main]

Predictably enough, doing a short deep dive on Fructose metabolism in the liver is pretty shocking. High levels of fructose (and I should stress the word "high" - and that I have no real sense for how high is "high") - drive all the bad things - dislipideamia, inflammation and oxidative stress. Dislipidemia is actually worse than what I wrote above, because of the types of fatty acids that are generated from fructose, so it's a question of not just needing to store fats, but production of Ceramides and other nasties (Ceramides may be great in skincare cream, but not so much when you have to store it in your liver).

Increased Uric acid and direct inflammation - this all from the way that energy is produced from fructose, I'll spare you the details, but if you like, burning fat is like burning coal, where burning glucose is more like burning cardboard.. very fast but smoky. Fructose is then more like burning paper in your stove.

Also - from the same basic line, direct oxidative stress due to production of reactive oxygen species, or "free radicals" - again, not in a "general sense because I think it does" but directly because of the energy transfer chain - the raw chain of events that turns molecules of fuel into energy. With Fructose comes ROS, and that means oxidative stress.

I would post the NIH article on this, but you can Google it if you want. It's pretty thorough, and quite heavy on the jargon. I would not have understood a word of it a year ago, but it all makes sense to me now.

In fact, there is even a line of thought that - even in this thread there have been various members saying things along the lines of "it's all about the bodies ability to process some types of fat" - and I've pushed back, saying variations along the lines of "it has nothing to do with eating fat"

I'm coming to the conclusion that both can be true, it's just that the combination of fats that the liver produce from lots of sugar (this time meaning specifically glucose and fructose) are really the problematic kind.