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

[Chris24Main]

Anyone up for a quick thought experiment?
I've been playing around with the way that we talk about the food groups, and how that influences how we feel about them.
Because we think in terms of carbs, protein and fat - that tends to be the key differentiators, but there is much more, about whether they are digested in the intestine or stomach, whether they are plant or animal in structure, whether they are even digestible at all, what hormone response they generate... and if we were to think of the foods along different lines - would that have any effect in the way that companies provide food, or what you would be inclined to go out and buy?

So - Just thinking about the term carb - it just means composed of carbon, hydrogen and oxygen molecules - and that applies also to fats - they are just in a different shape (which is linked more to animal or plant) -

Simple sugars tend to be organised in rings:

Where fats tend to be organised in strings:

Protiens contain Nitrogen, so that's clearly different, but even these, there is an "amino" section and then another carbohydrate section:

So - imagine if all foods were talked about as "carbohydrates" - but now we talked about

1 Ring Carbs - mainly plant structure.​

Simple Ring Carbs,
Glucose (triggers high insulin and blood glucose)
Fructose (converts to fat, inflammatory)
Chains of Ring Carbs, (Starches, converts to fat)
Complex Ring Carbs, (leafy greens and cruciferous veg etc)
Indigestible Ring Carbs (Fibre, can reduce rate of absorption of simple ring carbs)

2 String Carbs - Mainly animal structure, but with some plant structure which tend to rancidity​

Stable String Carbs (non inflammatory)
Mono-unstable String Carbs (anti inflammatory)
Unstable String Carbs (inflammatory and prone to rancidity)

3 Amino Carbs​

Animal sourced (usually coupled with stable string carbs)
Plant sourced (usually coupled with unstable string carbs)
Ultra-Processed Amino Carb extract (converts to Fat in liver)


This is all strictly true (as in, not just my opinion, based purely on chemistry and biology) - I was planning on adding things that for example show that "simple string carbs" are used for healthy brain tissue, but I don't think it's necessary - it is of course highly biased, and deliberately so... it's intended to be somewhat provocative - but not in a tribal way. I don't say that this is "the right" way to think of food, but it is interesting (for example like maps that show the true area of countries rather than an "unfolded globe" show just how much bigger Africa is than what we assume) as a way of examining our own predjudices about the food groups.

If this was the way that foods were described, what would you gravitate to?

 

[Melgar]

Fascinating. I’ll jump in a bit later @Chris24Main . Still early here on the Canadian west coast.

 

[zand]

I would simply eat what I liked as it's way too complicated for me.

 

[Chris24Main]

Well thanks for your input @zand - but you're hardly getting into the spirit here... <grin>

The point is that most of us do - or have eaten what we like as it's way too complicated for us - that's why we are diabetic...

That (to state the obvious because I really have to here) - is not to say that we have done anything wrong - but think about the general advice on foods - plenty of fruits and whole grains, stay away from saturated fats and red meat...

Then look down the list where I'm stressing how - when you strip out all the emotion that comes from everything we learn from that association (fruit = good, fat = bad) and how difficult it is to avoid thought patterns that go along with it.... if you were coming at food from a totally fresh perspective; if you came out of a coma, remembering nothing, and the robot nurse helping you up gave you that list of food types - instinctively does it make you feel the same as the conventional narrative?

No - you would gravitate to animal fat and protein. Physiologically, these are the only macronutrients that don't come with any baggage.

You may like fruit - you may like doughnuts - but you also may like caffeine and vodka and maybe the odd cigarette - the point is that the centre of gravity of what should be the bulk of the food that you eat is in a totally different direction than the generally accepted advice, no?

 

[zand]

For the last 13 years I have accepted that my body needs protein and fat to survive. It doesn't need carbs. That's not hard to understand. Fat on it's own doesn't make you fat. That's easy too.

However Ring Carbs, String Carbs and Amino Carbs don't mean a thing to me and I don't think they ever could.

 

[Lamont D]

I a!says ask a simple question.....

would production food pass the really stringent tests for now safe it is?
as meds are suppodd to be?
Every food label has many ingredients in bold letters drawing our attention to what you may be allergic or intolerant to.
if you add in T2 and other metabolic conditions.
This is a quite a big percentage of the population.

I'm my experience, a carb is a carb, and I am intolerant to them.
Regardless of structure or high or low GI....

We need protein and good saturated fats.
We need fresh food.
Why make it complicated?

 

[Chris24Main]

I'll have one more go, and then drop this...
I'm 100% not offering a new taxonomy, or suggesting there is any merit in thinking about actual food in this way.. ring, string.. it's just a silly thought experiment.

All I'm saying is that ...because of the way language works... there is an inbuilt negative association to the word "fat" and sugar gets wrapped up in all sorts of complications regarding carbs.. so we give it a pass when it was viewed as a powerful drug for hundreds of years.

Imagine if there was nothing at all negative associated with eating fat and protein together and that all the negative association was with sugars and starches..

Sound implausible? Well, thats the way it was for most of human history.. it's all the complication today that makes it difficult to understand what's important.

@Lamont D ... I'm 100% saying the same thing, why make it complicated? The answer is that the more complicated it seems, the more people say.. "well it's too complicated for me, I'm just going to eat what I want"

 

[Antje77]

All I'm saying is that ...because of the way language works... there is an inbuilt negative association to the word "fat"

Imagine if there was nothing at all negative associated with eating fat and protein together and that all the negative association was with sugars and starches..

For many of us who have been playing this game for a bit longer, this is exactly how it is. The 'inbuilt negative association' with the word fat simply is not there.

 

[Chris24Main]

Indeed.. maybe I should repeat.. this isn't about preaching to anyone here.. Of course people on this forum will understand the importance of protein and fat. I'm not trying to suggest this is something new, or clever. I'm really reacting to reading up on the history of food and treatment, and wondering at the way we (the general public, or even.. just me a year ago) have been nudged toward feeling that fat is to be avoided, and why it's just so difficult to come up with a story that combats this narrative.

Clearly I've failed in this one though.. I think I have to admit defeat...

 

[zand]

Indeed.. maybe I should repeat.. this isn't about preaching to anyone here.. Of course people on this forum will understand the importance of protein and fat. I'm not trying to suggest this is something new, or clever. I'm really reacting to reading up on the history of food and treatment, and wondering at the way we (the general public, or even.. just me a year ago) have been nudged toward feeling that fat is to be avoided, and why it's just so difficult to come up with a story that combats this narrative.

Clearly I've failed in this one though.. I think I have to admit defeat...

No, you haven't failed. I feel the point you have missed is the calorie element in all of this. We have been taught the very logical theory re calories in and calories out.
1g protein = 4 calories
1g carbohydrate = 4 calories
1g fat = 9 calories
Therefore fat is fattening.
Except it isn't, because our bodies are not furnaces. Yes, I know the scientific brains here like to have it all neatly wrapped up, but life isn't like that. Our bodies use chemical, physical and biological processes.

 

[Chris24Main]

I completely agree....
Where I have failed though is communicating, because what seemed like a whimsical thought experiment to poke at why we are nudged into thinking about food in a certain way is generating comments like "the point I think you've missed is.."

I'm not (at least in this apparently doomed line of thought) making a complete argument about anything....

One of the biggest "complications" is the "a calorie is just a calorie" line.. the sugar industry has been pushing that for a long long time, and I agree completely that it can only be true if we work like a steam engine. We don't.. we work under the influence of hormones. I totally, totally agree.

It's fascinating how (and why..) these narrative position have taken hold, and the story goes back much further than I could have imagined.

Partly, this thread is an attempt to find things that can be easily agreed on, and might be used to turn that narrative around. I honestly believe that opinions are shifting and that within a generation what @Antje77 said will be widely accepted, but I can't help but admit that it's a big hill to push the boulder up...

 

[AloeSvea]

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.

I like Dr Robert Lustig's take on this phenomenon, and it comes with a handy easy to remember percentage statistic . Twenty percent of the human population do not get metabolically sick/deranged/dysregulated from high excess carbs and sugar/ultra processed food. But 80% do. And the trouble is, and it's a big 'trouble' - we don't know if we are a member of the 20% or the 80% until we get metabolically ill. Ditto tooth decay and gum disease re sugar? Something we don't refer to often enough.

But yeah. I like that percentage. And enjoy giving my metabolically well friends and loved ones positives in that regard! (Remember to include some cancers and CVD in the realm of metabollic illness sensitive to UPF and high sugar and excess carbs consumption I might add.)

 

[MrsA2]

Diets, and low fat diets in particular are a very 20th century invention.
As too is mass marketing and businesses focusing on profits.

Prior to then most human populations survived on local produce and eating enough to fuel a body at lowest cost. There wasn't much excess
Hence carb heavy, think rice, porridge, bread but most people didn't get fat.
They didn't need to know what the constituted their food

It's only the overabundance of readily available, sugar added foods and the ubiquitous "snacks" 24/7 that have turned on the T2 tap.

If we had stayed with 2 or 3 meals a day with simple starches, yet limited cakes biscuits and eating for pleasure (rather than need), we wouldn't need to be learning all this now.

Your research and communication is great @Chris24Main but perhaps just too detailed and scientific for the majority? Don't stop though! I'm just about keeping up

 

[RachelG.]

Diets, and low fat diets in particular are a very 20th century invention.
As too is mass marketing and businesses focusing on profits.

Prior to then most human populations survived on local produce and eating enough to fuel a body at lowest cost. There wasn't much excess
Hence carb heavy, think rice, porridge, bread but most people didn't get fat.
They didn't need to know what the constituted their food

It's only the overabundance of readily available, sugar added foods and the ubiquitous "snacks" 24/7 that have turned on the T2 tap.

If we had stayed with 2 or 3 meals a day with simple starches, yet limited cakes biscuits and eating for pleasure (rather than need), we wouldn't need to be learning all this now.

Your research and communication is great @Chris24Main but perhaps just too detailed and scientific for the majority? Don't stop though! I'm just about keeping up

I see where you’re going with this but it’s not strictly true, I ate like that and still got diabetes (diagnosed type 2 but currently trying to push the NHS on this as they haven’t given me a c-peptide test) plus I had a great aunt who had diabetes and in her generation, I doubt it was because of diet. Neither of us are/were overweight. I think maybe some people’s bodies can’t handle carbs like grains, potatoes, etc which has little to do with the tendency to eat junk food instead of real food, comfort eat etc that lead other people towards diabetes.

 

[RachelG.]

It’s an interesting idea but a bit off puttingly technical! I think maybe the approach that might work with more people is to eat real food (avoid things in packets especially if you don’t understand things in the ingredients), choose unrefined over refined foods, even with unrefined carbs be careful with amounts and eat small portions until you don’t feel hungry. If you get hungry you can eat more later. Eat regular meals, don’t snack. Get plenty of exercise so you get hungry, and don’t mistake hunger for boredom, cravings or the expectation you should eat as it’s a conventional time for a meal.

Anyone up for a quick thought experiment?
I've been playing around with the way that we talk about the food groups, and how that influences how we feel about them.
Because we think in terms of carbs, protein and fat - that tends to be the key differentiators, but there is much more, about whether they are digested in the intestine or stomach, whether they are plant or animal in structure, whether they are even digestible at all, what hormone response they generate... and if we were to think of the foods along different lines - would that have any effect in the way that companies provide food, or what you would be inclined to go out and buy?

So - Just thinking about the term carb - it just means composed of carbon, hydrogen and oxygen molecules - and that applies also to fats - they are just in a different shape (which is linked more to animal or plant) -

Simple sugars tend to be organised in rings:
View attachment 70606

Where fats tend to be organised in strings:
View attachment 70607

Protiens contain Nitrogen, so that's clearly different, but even these, there is an "amino" section and then another carbohydrate section:
View attachment 70608

So - imagine if all foods were talked about as "carbohydrates" - but now we talked about

1 Ring Carbs - mainly plant structure.​

Simple Ring Carbs,
Glucose (triggers high insulin and blood glucose)
Fructose (converts to fat, inflammatory)
Chains of Ring Carbs, (Starches, converts to fat)
Complex Ring Carbs, (leafy greens and cruciferous veg etc)
Indigestible Ring Carbs (Fibre, can reduce rate of absorption of simple ring carbs)

2 String Carbs - Mainly animal structure, but with some plant structure which tend to rancidity​

Stable String Carbs (non inflammatory)
Mono-unstable String Carbs (anti inflammatory)
Unstable String Carbs (inflammatory and prone to rancidity)

3 Amino Carbs​

Animal sourced (usually coupled with stable string carbs)
Plant sourced (usually coupled with unstable string carbs)
Ultra-Processed Amino Carb extract (converts to Fat in liver)


This is all strictly true (as in, not just my opinion, based purely on chemistry and biology) - I was planning on adding things that for example show that "simple string carbs" are used for healthy brain tissue, but I don't think it's necessary - it is of course highly biased, and deliberately so... it's intended to be somewhat provocative - but not in a tribal way. I don't say that this is "the right" way to think of food, but it is interesting (for example like maps that show the true area of countries rather than an "unfolded globe" show just how much bigger Africa is than what we assume) as a way of examining our own predjudices about the food groups.

If this was the way that foods were described, what would you gravitate to?

 

[Outlier]

I think maybe the approach that might work with more people is to eat real food (avoid things in packets especially if you don’t understand things in the ingredients), choose unrefined over refined foods, even with unrefined carbs be careful with amounts and eat small portions until you don’t feel hungry. If you get hungry you can eat more later. Eat regular meals, don’t snack. Get plenty of exercise so you get hungry, and don’t mistake hunger for boredom, cravings or the expectation you should eat as it’s a conventional time for a meal.

I did all that and still got T2. Nowadays we can medicate diabetes (although I chose not to) but it has always killed people. It's even mentioned in the writings of ancient Greek and Latin medics. There are many imperfectly understood illnesses nowadays too, and plenty of culs-de-sac to go down before stumbling onto what would really help. I feel very fortunate to live nowadays where I can make these choices.

 

[Chris24Main]

Your research and communication is great @Chris24Main but perhaps just too detailed and scientific for the majority? Don't stop though! I'm just about keeping up

Many thanks for the input.

I'm totally sure that a great deal of what I say will be too detailed and scientific for the majority. And I say that with the greatest of respect.

I should take a minute to reiterate - I see my role here to be something like Jack Skellington in Christmastown - I'm blundering around in bewildered excitement, exclaiming "what's this?" with every new shiny thing I learn. Some of the older, more experienced members have had to nudge me back on track when I've gone totally off the rails, but for me, this is a genuine attempt to share in real time as I venture further down the rabbit hole - I think I've read 30 books this year, and I'm constantly digesting some podcast, or YouTube series or other. I don't ever want to come across as preaching something, or condescending, but rather invite anyone who is interested to observe, challenge or learn alongside me as I go.

Part of it is the kind of training I have - I need to understand how the machine works, but man, we are some complicated machine... It just frustrates me when we get given (or rather when I get given) lines like "well, we don't really know why this happens, but take this pill". That doesn't work for me, I want to know what's going on... and the starting point of this thread was "I'm going to figure out what insulin resistance really means".

I'm still working on that...

I should also note that this kind of "let's scratch under the surface and see what we find" may be difficult for some. This thread kind of assumes a generally positive, inquisitive outlook; and that isn't where some people are. There are lots of people on this forum really struggling, and it is not my intent to make it worse for anyone. As soon as anyone deliberately uses words to describe foods, there is a danger, and what I'm trying in this line of thought is just to poke at the way that language effects emotion, because I have an opinion about the way that this has been channelled over the years and centuries (and not in a conspiracy-like way). A big chunk of this is because ...cake is great... the human capacity to create and sell marvellous things to eat and drink is astounding.

I'm a huge coffee nerd. How we went from a little shrub berry on an Ethiopian hillside to the complex, gorgeous espresso I've just drunk is an amazing story that says a lot about the human condition. Yet, caffeine is the most widely abused psychotropic drug in existence.

Sipping on a properly aged single malt is like walking into a gothic cathedral - it just stops you in your tracks and makes you appreciate how amazing people can be.

But the stories we tell ourselves about food are different, and I'm fascinated why... My own story is very much one of "I did everything I was supposed to - and still got diabetes" - so I'm absolutely carrying zero sense of self-righteousness here, my opinion is worth nothing more than anyone else.

and, at the end of it, there is a selfish element - I personally get a lot out of expressing, testing my thoughts - all this bouncing around my head with no escape, that isn't healthy - I need some help (push back/ challenge/ whatever) to stay sane...

 

[RachelG.]

I did all that and still got T2. Nowadays we can medicate diabetes (although I chose not to) but it has always killed people. It's even mentioned in the writings of ancient Greek and Latin medics. There are many imperfectly understood illnesses nowadays too, and plenty of culs-de-sac to go down before stumbling onto what would really help. I feel very fortunate to live nowadays where I can

Yes, assuming I really do have type 2 I would be the same - did all the sensible stuff and wound up with it anyway. I understand the genetics (sort of - as in they are complicated, over many chromosomes and can be recessive which is why not everyone in affected families gets diabetes ) he triggering is another thing. No idea what triggered mine.

My Mum died of primary liver cancer despite not drinking much, not eating spoiled grain (!) and not having hepatitis- we were confused but the medics said a majority of liver cancer cases have nothing to do with alcohol and were not surprised. I think a lot of diseases with a lifestyle factor get labelled in the public view as being determined by that factor rather than having a correlation to it.

 

[RachelG.]

Part of it is the kind of training I have - I need to understand how the machine works, but man, we are some complicated machine... It just frustrates me when we get given (or rather when I get given) lines like "well, we don't really know why this happens, but take this pill". That doesn't work for me, I want to know what's going on... and the starting point of this thread was "I'm going to figure out what insulin resistance really means".

I'm still working on that...

Hi Chris,

So something that doesn't quite make sense to me about the whole treatment of diabetes is that there seem to almost be two separate processes which end up causing the same issue and we call them both diabetes. I can understand that it is possible to become insulin resistant but capable of producing a lot of it - the pancreas works but the cells won't let the insulin in. That can be caused by excess weight or having eaten a larger amount of carbs and/or sugar over a lifetime than the body could handle to the point where the cycle of the pancreas producing insulin to push blood glucose down and then the liver reacting by dumping stored glucose pushed it back up, etc, etc such a lot that it 'wore out' the system. Excess weight can also be caused by metabolic issues as not everyone feels hungry in proportion to what their body needs so it can be a vicious cycle.

I can also understand how the pancreas does not work in some people, it either never worked very well (type 1) or it did for a while and then crapped out (LADA) or was damaged (type 3) or some other category I haven't mentioned. Genetics seem to change the likelihood of developing either a ****** pancreas or insulin resistance.

I am wondering in terms of narrative if it's best to think of these two mechanisms as distinct and it seems sensible that the NHS should be testing everyone's insulin (c-peptide test) at diagnosis to check which pathway their body has gone down but at the moment it feels they'd rather save money and assume everyone is Type 2 because that's easier for them to 'manage'.

In terms of food advice, I have never shied away from eating fat, including saturated fat, but was brought up by a somewhat hippy, pescatarian family who ate wholefoods (before it became trendy), avoided sugar and artificial sweeteners. The whole 'high carb low fat' con didn't really affect us because no one needed to diet and we avoided most UPF type food. I can't speak for other people but I am 40 and the 'high carb low fat' advice seems dated to me. Sugar was considered dangerous in my childhood, even though many families didn't restrict it enough, and certainly we didn't have government policies like the sugar tax. I think where the dietary advice seems to really go wrong and people are trying hard to do 'all the right things' is where companies market them 'diet foods' full of additives that are 'low fat'. But that's usually because those people are a generation older than me or because they aren't very educated about nutrition at all. It is shocking that the NHS is pushing this lifestyle in its diabetes programming but until I encountered that, most health messaging around me was broadly in line with what I consider sensible advice - eat lots of veg and some fruit, whole foods, high protein-low carb, healthy fat is okay but not things like margerine, etc. But then I'm in London and I'm mixing with a lot of mostly affluent, health conscious, sporty people so maybe it's not typical.

 

[Chris24Main]

@RachelG. - let me answer in 2 parts.

You are extremely well informed, but the liver is a slippery thing - as soon as you think you understand a thing, there are three more levels of more complex processes that appear, and you have to start again.

The big thing to get your head around is that insulin has hundreds of "jobs" to do around the body, and affects cells (ie, has receptors for it) all over the body. One of those jobs is to allow Glucose to enter the cell. Insulin itself does not enter the cell - it's really a signalling hormone that "tells" cells how to manage energy.

There are many complex explanations of what insulin resistance is, and how it can be caused (fructose directly causing insulin resistance without involving any insulin, for example, and ...puberty...) but the simplest way to think about it, and the most obvious cause, is elevated blood glucose causing elevated insulin.. too much of a thing requiring more to have the same effect, then requiring the pancreas to create more.. and that spiral becoming insulin resistance over time.

- that isn't the whole story - but it works as a first step.

Most of the wider problem of modern diets is that the risk of T2DM is only one consequence of regularly elevated insulin, because of the effect is has all over the body and the brain.

The "is it the insulin resistance or is it the Pancreas failing" question is something medical research bounces between, and something I really struggled with because I couldn't get a straight answer about. One can look like the other. Clearly damage to the pancreas in various forms is a problem, and one of the bigger questions is "well, can a pancreas recover?" - and there are, let's say conflicting views. In my case, I think my pancreas did recover, and the big issue with treating T2DM with additional insulin is that you can (again, this is only what happened to me) - create a situation where it looks like the pancreas is failing, but really you are only increasing insulin resistance.

Genetics is important, but we are learning all the time that Genetic expression is more important. What that means is... you may have a genetic disposition for something, but your environment will affect whether that gene leads to an effect or not. DNA is just information, and there are processes that take that information and make things happen - or not.

I deliberately sometimes use the phrase "diabetes" and sometimes T2DM - historically it was always diabetes, simply meaning "too much fluid passing out" - it has the same root as diarrhea - the "mellitus" was added in the 16th century - and I've read in several sources that thinking about T1 and T2 as being linked was one of the worst things that could have happened - they are diseases of opposites, and we should focus on insulin - Type 1; not enough, and T2; too much.

There are historical reasons why it's thought of this way, and surprisingly based on dumb luck of what was discovered and in what order. You are absolutely correct (IMHO) about the C-Peptide test. When I was diagnosed Type 1 - it took 8 months to get the result of antibody tests, and to order a C-Peptide, that showed quite definitively that I was not Type 1.

There is so much confusion and so much "cross-think" - that I was simply treated for what would be the most dangerous option more quickly (Type 1 untreated so likely to be heading to Ketoacidosis) - and that stuck. I suspect that happens quite often.

My issue, bizarrely, was that I was not overweight, so "it couldn't be type 2" - I cringe at the level of ignorance that represents now....