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

[Melgar]

Okay and in no particular order.

I used the electricity analogy, I guess I could have used another analogy. You say you came out of nutritional ketosis. Absolutely , but were you still producing low levels of ketones? I suspect you were. I am always producing ketones, not at levels that would put me in nutritional ketosis, but I am definitely producing them regardless of my energy intake. Hence my analogy around electricity and varying levels of conductivity. Does my body put on fat when my insulin is high? I don’t think that is so black and white. I have a tendency to lose weight very easily. My triglyceride levels are low. Would they not be high if I had an energy imbalance with fat accumulation?
Fats, the stomach digestive process for fatty foods is slower. It takes the stomach longer to digest fatty foods. It requires more imput from the body both in the stomach and the duodenum. I think that involves a particular enzyme - lipase. I’m assuming from that fats are not as easily digested as food that can be easily converted to a glucose energy source and used by the body very quickly.

I’m thinking it is the hypothalamus that drives your endocrine system. Your pancreas of course is a major part of that system, but it is the tag team relationship between the hypothalamus and the pituitary gland that orchestrates the endocrine system. Your hormones are not out there doing their own thing they are not autonomous, in my view. Everything is controlled. It might be dysfunctional because of metabolic issues, but they are controlled.
Your circadian rhythm via your hypothalamus orchestrates digestive hormones.

I will have find you the link to beta cell sensitivity. Beta cells contain far more glucose receptors, I’m not sure if that is the right word for the mechanism that makes these cells particularly sensitive than any other cell, but they are hypersensitive to glucose levels.

More of a splurge of thoughts as I sit here ‘at work’.

 

[Peanut234]

I think you'll like this very long thread on exercise and T1, which likely will apply to your T3C as well: https://www.diabetes.co.uk/forum/threads/managing-exercise-and-insulin.127691/

Thankyou - I'll dive into it

 

[Peanut234]

What I find interesting is that along with the 'gang' going round targeting your first described particular brand convenience store resulting in the T1, there is another gang going round (covid, and other virus') taking out the same chain of convenience stores, with a totally different method, resulting in T3C's ( via non autoimmune, but still inflammatory pancreatitis process) What determines which gang/pathway/result?

There are also some interesting papers suggesting that Thiamine is protective of Beta cells during inflammation. I wonder if thiamine status affects which/percentage/extent of cells are damaged.


Another interesting note. My dad's Thyroid function went AWOL, and then later got diabetes, and then Mum had to have hers removed (not autoimmune). The specialist said by the way, the chances of her getting diabetes down the track are really high too. So it may not be a purely autoimmune /HLA relationship.

 

[Chris24Main]

Okay and in no particular order.

I used the electricity analogy, I guess I could have used another analogy. You say you came out of nutritional ketosis. Absolutely , but were you still producing low levels of ketones? I suspect you were. I am always producing ketones, not at levels that would put me in nutritional ketosis, but I am definitely producing them regardless of my energy intake. Hence my analogy around electricity and varying levels of conductivity. Does my body put on fat when my insulin is high? I don’t think that is so black and white. I have a tendency to lose weight very easily. My triglyceride levels are low. Would they not be high if I had an energy imbalance with fat accumulation?
Fats, the stomach digestive process for fatty foods is slower. It takes the stomach longer to digest fatty foods. It requires more imput from the body both in the stomach and the duodenum. I think that involves a particular enzyme - lipase. I’m assuming from that fats are not as easily digested as food that can be easily converted to a glucose energy source and used by the body very quickly.

I’m thinking it is the hypothalamus that drives your endocrine system. Your pancreas of course is a major part of that system, but it is the tag team relationship between the hypothalamus and the pituitary gland that orchestrates the endocrine system. Your hormones are not out there doing their own thing they are not autonomous, in my view. Everything is controlled. It might be dysfunctional because of metabolic issues, but they are controlled.
Your circadian rhythm via your hypothalamus orchestrates digestive hormones.

I will have find you the link to beta cell sensitivity. Beta cells contain far more glucose receptors, I’m not sure if that is the right word for the mechanism that makes these cells particularly sensitive than any other cell, but they are hypersensitive to glucose levels.

More of a splurge of thoughts as I sit here ‘at work’.

Ok - now we're getting into the good stuff...

So, we may just have to agree to disagree, but the "orchestration" thing is where I have to get off the train. You're invoking a kind of "Mickey Mouse in Fantasia" - which is appealing and seductive - but just not the way that homeostasis works, more than that, in my view that's the kind of thinking that gets you (us) in trouble, because you (we) cannot help but attribute emotion to the decision-making that we invoke - this is precisely my issue with the term about the liver "dumping" glucose. There is no emotion behind any kind of decision, simply cells acting in response to their specialisation, and to the substances and concentrations surrounding them.

The second you (we) invoke a deus-ex-machina; we cannot help but see that as a character with it's own motivation, and we simplify that motivation into something that makes sense, but is often ignoring some other mechanism and so we fool ourselves that one thing is going to happen, and we get frustrated when something else happens.

All of what happens to energy comes back to the key equation - in the presence of elevated insulin and sufficient energy, adipose tissue will hypertrophy.

So - read back your first paragraph. In your case, I humbly submit that you simply never have sufficient energy. You burn so much and you can't tolerate much fat, so you just never get to that tipping point. Bizarrely (and again, this is just me riffing) I think that a lot of the confusion you express comes from the fact that in your case you don't get what you expect, because of the lack of effect of insulin in the presence of low energy.

Then - the hypothalamus. Yes, it's hugely important, but again, I just see it all the other way around. Even the hypothalamus is not working if it isn't supplied with energy - that means that the role it plays is dependent on metabolic health - not the other way around. This is why ketogenic therapy (deliberate term requiring a much higher level of ketones than I get to) is so successful in all sorts of mental health disorders - get your mitochondria on your side, and everything is better, period. The problem, is that so many of us have become used to badly treating our mitochondria - because - who ever even knew anything about metabolic health at the cellular level? - certainly, I didn't.

For sure I agree on the circadian rhythm - but for me it's just another set of variables in homeostasis that change over time.

I'll look into β cell sensitivity - it cannot be glucose receptors - if glucose binds to a thing, that thing becomes glycated - but that's typically proteins - scale is important here - a molecule of glucose and a protein or peptide are in the same ballpark, say a child (glucose) getting on a school bus (protein) - but in that scale, the β cell is the size of the entire town the bus is driving in. I'm guessing you are talking about glucose transports - like Glut 4 (main portal for glucose in muscle cells, which "opens" under the action of insulin - or directly during exercise) - My sense is that we are both correct in a way - β cells have to have an affinity for glucose in some way, but there has also to be a concentration of glucose for that sensitivity to do anything.

 

[Chris24Main]

Then - "Fats, the stomach digestive process for fatty foods is slower. It takes the stomach longer to digest fatty foods. It requires more input from the body both in the stomach and the duodenum. I think that involves a particular enzyme - lipase. "

Yes - but in this case I think it's actually simpler.
The stomach cannot digest fatty foods - that's kind of the point. At least if you define that to mean food with long chain fatty acids and protein (like meat)

The reason the vast bulk of the pancreas is where it is, and what it does, is because once the stomach has absorbed the easy stuff, it (the pancreas) flushes digestive enzymes into what the stomach passes down, so that the intestines can get to work.

This, in fact, is what makes bullet proof coffee so effective, because the stomach can absorb short and medium chain fatty acids like you get in butter and coconut oil. Not having any long chain fatty acid or protein, you can have a bullet proof coffee without your (intestinal) digestive system being activated - yet at the same time, those medium chain fatty acids hit the adipose tissue, releasing leptin - and you feel satiated -

This is where getting to grips with the way that all the mechanisms interact really gets fun, because now we can be the conductor...

And then, yes - lipase - most enzymes end with "ase" and fats are lipids - so, lipase. Also made in the pancreas, to be flushed into the food coming out of the stomach; (this is really what defines the duodenum) - if it's needed.

Interestingly - the pancreas also produces enzymes to break down proteins; which work together (you can think of the way that detergents break down grease, it's pretty similar when we describe digestive juices) - so, you can absorb much more useful stuff from protein if it's in food that also contains fats.

There is even a theory that because we as a species, specialised in eating meat (ie protein and fat together) and it's such an efficient method of getting nutrition, that our digestive system shrunk (compared to the other great apes who have much, much longer intestines) because there was less need to process the plant material.

 

[Chris24Main]

What I find interesting is that along with the 'gang' going round targeting your first described particular brand convenience store resulting in the T1, there is another gang going round (covid, and other virus') taking out the same chain of convenience stores, with a totally different method, resulting in T3C's ( via non autoimmune, but still inflammatory pancreatitis process) What determines which gang/pathway/result?

There are also some interesting papers suggesting that Thiamine is protective of Beta cells during inflammation. I wonder if thiamine status affects which/percentage/extent of cells are damaged.


Another interesting note. My dad's Thyroid function went AWOL, and then later got diabetes, and then Mum had to have hers removed (not autoimmune). The specialist said by the way, the chances of her getting diabetes down the track are really high too. So it may not be a purely autoimmune /HLA relationship.

I will double back to this - you make some really interesting points.
But - the one thing I wanted to respond to - anything ending in "itis" is direct inflammation. So - pancreatitis - is direct inflammation of the pancreas cells themselves.
When you get down to the cellular level, then you start to talk about the inflammatory particles themselves - Cytokynes, Macrophages etc.. these can be thought of as little fires in the building, being put out, leaving the room unusable.

An auto-immune cascade - that's more like acute, whole-body inflammation, which results in a flood of these inflammatory particles (thus the "mob" analogy) which just destroy the entire building..

This is where you get the "totally different method" - but - it's all still revolving around inflammation (though clearly with a connection to genetic disposition)

 

[Peanut234]

I will double back to this - you make some really interesting points.
But - the one thing I wanted to respond to - anything ending in "itis" is direct inflammation. So - pancreatitis - is direct inflammation of the pancreas cells themselves.
When you get down to the cellular level, then you start to talk about the inflammatory particles themselves - Cytokynes, Macrophages etc.. these can be thought of as little fires in the building, being put out, leaving the room unusable.

An auto-immune cascade - that's more like acute, whole-body inflammation, which results in a flood of these inflammatory particles (thus the "mob" analogy) which just destroy the entire building..

This is where you get the "totally different method" - but - it's all still revolving around inflammation (though clearly with a connection to genetic disposition)

Yes, sorry, my wording was unclear. Unfortunately I'm familiar with a selection of the itis'/and non organ inflammation too.
As a side note, look up Losartan, and adhesions. It's quite interesting stuff. It's now being used post surgery to interrupt the inflammation pathway and reduce adhesions in various types of surgery. It started out as a blood pressure medication.

 

[Chris24Main]

ok - so do you agree that pancreatitis is direct inflammation inside the pancreatic cells themselves? (Stretching the analogy a bit now, but therefore not "another gang" looking for trouble, it's direct pathology of the pancreas..)

- genuine question, I'm not an expert on pancreatitis - not an expert on anything really -

 

[Melgar]

Emotion doesn’t come into it, @Chris24Main only in the sense that it affects your amygdala. In general, I personally do not think it helpful to elevate a particular component in a system above another. There is no emotion attached to it, it just is. A failure in one component is detrimental to the whole. Of course, to understand it you have to break it down, but then you run the risk of over emphasizing the role of one particular component above the rest.

Yes I know what homeostasis is and I know how it works - ‘Homeostasis is the ability of a biological system to maintain internal stability through coordinated regulatory mechanisms, ensuring optimal conditions for survival and function.‘ Voila!

"Mickey Mouse in Fantasia" I’m not sure what that means? other than I’m immediately drawn to Maurice Ravel’s Bolero. I was meaning to ‘orchestrate’ in a biological context ”to plan and organize a complicated event or action, especially without being noticed ……. “. I mean it in the sense of its action, not its role. I guess we all see and interpret our world differently in our bid to understand it. Our bodies are worlds in themselves, to my way of thinking. I attempt to see the whole, whilst you appear to focus on the minutia. I’m not sure if that is a fair or reasonable observation. To labour my point, my partner is mathematical. I married into the world of math and abstract thought. They interpret and understand the world through math. When we kayak, I’m enjoying the breeze, the water, the mountains. My partner is counting the paddle strokes between two fixed points.

I’m pursuing your paper still. I’m definitely following the rabbit and Alice down the hole!

 

[Chris24Main]

We may well be saying the same thing with different words - I read your first paragraph and think - "yes, that's exactly what I'm saying"...

Fantasia is one of the very first Disney animations, with Mickey in sorcerer's robes, conducting the mops to clean the floor etc - you'll have seen it. (Actually that segment is called "the sorcerer's apprentice")

What I'm saying is that the danger of using phrases like "the hypothalamus is orchestrating everything" - is to give it more responsibility than it really has, like that scene, where the mops get out of hand..

and the definition of Homeostasis you use, is the end result - the mechanism is all the stuff mixing together, and each element affecting the other till it reaches balance. I just take exception to the "plan and organize" bit - but honestly, it still comes back to arguing about chickens and eggs - I don't think we are really all that far apart, if at all.

If you can get to it, this is the article that the researcher pointed me at, this person is T1 - and Celiac, and has Graves - so they have a pretty unique perspective, and I thought you may want to read too..

https://www.researchgate.net/publication/51823457_Leaky_Gut_and_Autoimmune_Diseases

For what it's worth - I can take the "minutiae" comment on the chin - I'm sure that's how it comes across - but I do try to keep repeating that one needs to constantly think about the whole body - the organs - and the cellular mechanism, all the time. It's really a result of the kind of engineering I was trained in, which is more about production lines - you have to see both the big picture and the little details as equally important.

So - I'm just naturally suspicious if there is an explanation that seems to make sense on one level, but is all a bit "hand wavy" at another - I have to keep chewing away at the problem until I feel I can understand it at all the levels, and use one argument as a devil's advocate for another; and arguing against my own thoughts more often than is probably healthy.. That's why I keep repeating that this is all a voyage of discovery - absolutely not me laying out something that "I know" - I'm more suspicious of anything I say than most.

 

[Chris24Main]

I married into the world of math and abstract thought. They interpret and understand the world through math.

I know people who think in maths equations - I've sat in rooms where someone goes "look, the thing is, it's like this...." and then writes an equation - and everyone else goes "hmmn, yeah, I see what you mean now..."

I'm the guy at the back, taking things apart and putting them back together again, to see how they work...

 

[Melgar]

I totally get what you are saying @Chris24Main and we do agree, we just say it differently. Your strength however, is my weakness in that I can get frustrated with detail. I’m not sure if I can pin that on my ADHD or my character.

Yes I have seen Fantasia, but a long time ago. I loved it for Ravel. Actually I found the use of a classical piece of music used in an animated show fascinating. Although now, all these years later, I only think of it for the music.

I will have a look at that paper the researcher sent you. Having the full set, coeliac, graves and T1 is unfortunate. It’s bad enough having coeliac.
As an aside, I also have the DR 3/4 haplotype for Hashimotos. So it’s probably a common trio of gene variants.

Math, if you know one mathematician you have access to dozens more!

 

[Chris24Main]

I get it now - when I think of Ravel's Bolero, I'm afraid that tends to bring Bo Derek to mind. That's a whole other story ...

 

[Chris24Main]

Let me introduce you to Edward Bernays.
Bernays was Sigmund Freud's nephew, and was the father of public relations, indeed both coined the phrase and wrote the book.

"We are governed, our minds are moulded, our tastes formed, our ideas suggested, largely by men we have never heard of."
from Propaganda - 1928, Bernays.

All of this is public record, but this guy is probably the single most influential character of the 20th century, as far as what you take for granted has always been true. He understood well before anyone else, that in order to sell a thing, you don't persuade a person to buy it, you make it obvious beyond reason that everyone needs that thing. You do not manufacture a product; you manufacture an image.

Somewhat ironically, one of his successful campaigns was to bring back the humble breakfast of bacon and eggs as the first meal of choice in America, post second world war, when the times were hard and people had scaled back. Working for both the poultry and pork industry, Bernays commissioned a flurry of polls and correspondence with doctors - Is it preferrable for a man to go to work having had bacon and eggs compared to coffee and a bun? He wrote countless newspaper and magazine articles and called them "press releases" to get them published almost unedited as legitimate articles - seeding the concept of the "hearty breakfast".

His most famous, in the 1920s, was to popularise cigarette smoking for women (who till that point had mainly avoided the habit, it being a "male" vice; taboo for women) leaning into the idea that a woman holding a "torch of freedom" would be seen as a sign of liberation. I'm not making this up - this is all based on women holding something phallic - about as Freudian as it gets. Google "torches of freedom"

Another example was when first working for Proctor & Gamble - at the time a medium-sized soap maker (but on the verge of finding that one of the cast-off waste products could be re-processed and sold as first pig feed, and then Crisco, or "crystallized cottonseed oil" - starting the vegetable oil revolution) - he commissioned polls in hospitals asking if doctors and nurses preferred chemically scented soaps - the results were positive, and he used that to bombard the media with news that "Ivory soap was the choice of the medical profession".

Still under retainer to P&G, who were looking for ways to expand the market for Crisco (and I believe that there may be copies of the original memo, but just haven't found it yet) he made the case, that all you need to do is get the doctors on side, and the population will follow. This led to the initial funding of the American Heart Association, allowing Ancel Keys to do the Seven Countries Study and to the popularisation of the "clean" cooking oils that P&G were selling. The first AHA official recommendations to avoid saturated fats, and to focus instead on polyunsaturated fats, was released in 1961.

This is much better written in Catherine Shanahan's book - Dark Calories, but quoting directly from an interview with Bernays in 1993; "You can get practically any idea accepted, if doctors are in favour, the public is willing to accept it."

This is a man who believed to his core that the population generally was better off being manipulated by educated elites - in fact it was essential for the proper functioning of democratic society. One of Bernays’s favourite tactics for promoting new ideas and products to the public was to stress a claimed public health benefit. He described its effectiveness as “child’s play.”

Essentially, everything you (and by you, I really mean me, for my whole life) think of about fat, and saturated fat in particular; is based on using psychology to overcome the objections that people had about eating industrial vegetable oils; and it was spectacularly successful. I'm not getting into the science itself - it was more that this section about Edward Bernays really stuck with me, and I had to go digging to pull all of this together, so I thought I would share.

 

[Outlier]

Another example of this was in the 1950s mothers were told that their breast milk wasn't good enough for their babies and they should feed a commercial preparation. This preparation was full of powdered wheat.

 

[Chris24Main]

So - I have another thing to get off my mind:
And it's relating to the chemical structure of fats.

It's one of my recurring "bones", and I keep coming back to worry on this problem, which is that most of us hold in our head, the wrong idea about what fats are.
For me, the most striking image is still the idea of fats Clogging up my pipes, because that's what fat does in pipes; and even though I know that doesn't make any real sense, it's still there in my mental "encyclopaedia of all the things" and it's difficult to dislodge.

In an interview recently, someone proposed this simple concept. In nature, plants have to cope with the risk of freezing. Anything moving around inside them must still be able to move around when it's cold. This is why the oils derived from plants tend to be liquid at room temperature. Animals can keep themselves warm, so animal fats can also be liquid at the temperatures inside animals.

And that makes a lot of sense too - and combats the feeling that I used to have when, say mentally comparing the bottle of vegetable oil, and the grease congealing on the frying pan. It isn't really "cleaner" just because it's liquid in that bottle. In fact, it's far more illuminating to consider the surfaces in a kitchen where vegetable oils are used predominantly (like mine till not long ago) - all sticky, with a layer of tacky, rubbery stuff that's really difficult to get off, and just gets harder and more sticky over time. Now go back to that grease in the frying pan, yes it congeals quickly, but it kind of never gets any worse. Twenty years in a kitchen where vegetable oils are used a lot, and anything that's difficult to get to is pretty yucky.

Anyway - that's not so much the point.
There is an ongoing debate about the pros and cons of polyunsaturated fats (mainly vegetable and seed-based, industrially processed, but the mainstay of cooking fats).
Generally, the advice is still to use them, because they can reduce your cholesterol.
Dig a little deeper, and you will be told that Omega-3 and Omega-6 oils are essential and good for you, and there is plenty of properly peer-reviewed scholarly data to back it up, some from the UK bio bank, sourced from the largest pool of data anywhere in the world.
The "villain" of vegetable oil, omega-6 PUFA can be shown to be protective against cardio-vascular disease; so what gives? what are we supposed to think?

The devil, as usual, is in the details. Omega-3 and 6 are "essential" in the strict sense that we cannot create them, so anything we need has to come from food. That is objectively true, and also true that we need some of both - they play a major part in the immune system, acting as fire alarm and fire extinguisher. However, for the vast majority of human history - "some of both" has meant single percentage points of all food, and roughly equal amounts (I'm simplifying) where the modern diet can be comprised of half of all calories being polyunsaturated fats, and the ratio being 40:1 - in favour of the fire alarms.

But even then - what does that mean? The data can be shown to say that Omega-6 is still heart protective - so the oils themselves must still be healthy, right ?

Well, this is where the other mental image that I keep coming back to is really instructive, and I have to thank Cate Shanahan for this as well.

Imagine a heavy, solid glass jug, with a handle - you know the type. Robust. That's saturated fat. Chemically, the word "saturated" simply means robust against oxidisation. I promise not to go into any chemistry here - but imagine now dropping that jug on the floor. It bounces, and you just reach down and pick it up like nothing happened.

That is still saturated fat - but that response of "not breaking" is now better described as "anti-inflammatory".

Now - mono-unsaturated fats (olive oil, avocado, the "fatty fruits") - imagine now that same jug, except that the handle has a more ornate look. You drop this jug, and the handle may break off. No real problem, it's still a working jug, you just have to take a little care.

Finally - poly-unsaturated fats are more like blown-glass, ornamental fine, delicate decanters. You drop one of these, and they are much more likely to shatter into hundreds of tiny pieces of sharp glass fragments. Not a single piece left that bears any resemblance to a jug of any type, and scattered all over the floor. Literally dangerous, and toxic fragments that have no connection to the original thing.

This is what happens to poly-unsaturated oils; during the industrial processing, during the storage (light can break down these oils) before and after purchase, during cooking (temperature causes and speeds up this process) and even inside your body. Not all of it, by any means, but because of the "shattering" nature of the breakup of the fatty acid chain, you can end up with thousands of different types of toxic molecules in otherwise "healthy" oils.

This just doesn't happen with, say, butter.
It's important to mention here that there is plenty Omega-6 in most nuts, that have never been processed or cooked, so I'm mainly referring to industrially-processed seed oils, and also that all real foods contain a mixture of fats. The closest thing to "saturated fat" is virgin coconut oil for example.

The effect can be small, and how you use the oils matters, but as an example of one such toxin, as much formaldehyde was measured in one serving of fries from a well-known burger joint as in a whole packet of cigarettes. (again, ref C Shanahan, Dark Calories)

When I now think about "fats clogging things up" - the image that comes to mind is more the top of my fridge with twenty years of vegetable oil deposit from my wok-cooking, but more than that, it's the idea of those industrially-processed oils shattering into toxins that I can't see that gives me the biggest problem.

 

[Peanut234]

ok - so do you agree that pancreatitis is direct inflammation inside the pancreatic cells themselves? (Stretching the analogy a bit now, but therefore not "another gang" looking for trouble, it's direct pathology of the pancreas..)

- genuine question, I'm not an expert on pancreatitis - not an expert on anything really -

In my experience, the inflammation is like a coal fire - slowly spreading to whatever is next to it, be it soft tissue, muscle or nerve. My stomach valve gets inflamed and ceases to work. My vagus nerve gets unhappy/inflamed, and irritates my ear and neck muscles. I get the traditional pain 'through the middle'. I suspect that I have scar tissue around my pancreas, as the muscles in that area spasm and become taught - more than they used to. My liver goes nutty and my liver enzymes rise. I get incredibly bloated as the fluid balance in my abdomen changes. The general inflammation increase and liver enzyme change affects my brain. The rest of my digestive system downstream becomes involved. Thankfully I now have various medications that I can use to try and put out the fire, or at least calm it.

I don't know, to answer your question about the pancreatic cells themselves. The catalyst, however is an interesting topic. As well as the virus ones we discussed, there are particular foods that generally set it off. The ones that are most 'reliable' have an enzyme reaction themselves eg pineapple and kiwifruit. Though there are others eg Lamb and anything coconut eg coconut yoghurt, so I suspect there is a fat component sometimes.
I suspect there are multiple components at play for me. Fatty pancreas, pancreas plumbing issues affecting enzymes trying to leave the pancreas, possibly some swelling and irritation, but yes, maybe generalised background inflammation throughout the pancreas as well. My CRP is up a bit, but hard to tell if its liver or pancreas at the moment.

Also as a side note: There have been quite a few people I know I including me) who have gathered another food intolerance or 2 post COVID.
My new ones are sadly sesame, and lemon. If anyone knows the pathway/process for this to happen I would be interested.

 

[Chris24Main]

Thanks for the insight @Peanut234

I should have been more explicit though - I meant simply that did you agree that as an -"itis" - Pancreatitis was direct inflammation of the pancreas - how you experience it or have experienced it, or the ongoing effects; these are critically important to your general wellbeing - but not connected to whether it's direct inflammation, or an immune attack caused by chronic inflammation; which was the line I was trying to draw.

For what it's worth - the report I linked to above is really interesting, and gets to the specific point you raise, with the hypothesis that the pathway/process for "background" inflammation to cause harm to an organ has to involve three things -
1. A genetic pre-disposition; basically, an active corresponding gene for any specific issue (this one clearly beyond me to explain)
2. A leaky gut - a break in the tight barrier that should involve absorbing nutrient through the gut cell layer allowing stuff to pass through gaps.
3. some toxin leaking through these gaps - ie exposure to the root toxin which results in a release of inflammatory particles.

 

[Chris24Main]

It most likely not at all clear from my ramblings on the subject from the point of view of the evolution of our ancestral microbiology, but the way that I see inflammation is that it's another process that is supposed to be in balance - right down to the cellular level, there are things breaking down, and this sets off alarms, and other particles come in to either fix or replace the broken down stuff.

In balance, it's a beautiful dance of maintenance and repair.

out of balance - it's a little more difficult to understand, and I have to rely on real-world analogies to try to make sense, but I think it's close enough; you have repair crews, more like a patrol in a Vietnam movie - exhausted, frazzled; doing things in ways that they never would in peacetime, trashing villages, turning on each other... just being dysfunctional and more like "the enemy".

Things like COVID just add sudden overwhelming stress to the entire situation, and the result will be more dysfunction, but will be determined by where the genetic "weak points" are...

The goal is basically to understand this, and reduce all the background inflammation by removing the things in the diet which the body sees as toxic, so thinking about it as an exposure thing. In your case, for example, clearly you would remove exposure to sesame... but the deeper thinking is what drives toward a more "animal fat and protein" based diet - as a short-term treatment at least, as a way of creating the lowest possible inflammatory conditions, to let your body settle down.

That is not to say that this is "good" or "right" or anything... simply that animal meat is the least inflammatory food you can eat, because we are specialised to absorb it all in the most efficient way possible.

If you think about the above - once your gut barrier is healed, it then regains its ability to act as a barrier to the same toxin. But this applies to pretty much everything, as far as I can make sense of it - if you give your body a chance to heal, it will; keep it occupied running patrols through the jungle at night under constant bombardment from the hills, well; that's just not going to get any better.

 

[Tiggy63#]

Hi, after posting an introduction, I was encouraged to start a thread - my story will be specific and probably not applicable to most on this forum, because I'm becoming increasingly convinced that my diagnosis is not correct. a reply from @JoKalsbeek has only helped cement in my mind that the advice and treatment I have received have not only made me feel worse, and set me back significantly, but would also make my only good course of action more difficult.

That said, I'm not blaming my GP, or consultant, and the upside is that it's given me a rare insight to help myself. Please allow me to elaborate. You may want a (low carb) beverage for this...

Just before Covid entered our lives, I realised that I needed to get my BMI below 27 because of the risk of Diabetes (I use the sloppy term deliberately because that is all I knew at the time). I wasn't hugely overweight, but I had an undeniable beer belly, and I drank too much. I didn't smoke, and I typically cooked form fresh; I like veg, and really dislike soda.. so I thought it was all ok. Totally unrelated, but my younger, healthier and better looking brother died suddenly and tragically, and that forced a bit of reassessment and soul-searching.

I then started a two year controlled (calorie controlled mind) diet, using MyFitnessPal to log meals and a wireless scale to track weight, and a hybrid smartwatch to log steps and exercise, and a gym-quality elliptical trainer to do more cardio - really lucky ebay purchase. I started drinking less, and the less I drank, the less I wanted to drink.

After a couple of years, and ... really hard work... I was close to hitting my goals... but pretty soon the weight started to go on again... and so I upgraded my scales to show body composition, and my MyFitnesPal subscription to show the breakdown of all meals I was having, and to increase the discipline. More exercise, and I started paddleboarding regularly, and use a Slendertone belt daily.

After another year or so, I was at my target weight, and it was sticking - I had, if not a six pack, then something along the lines of a two pack, if I held in my stomach and squinted a bit.

Understand, I'm not bragging - and I dropped maybe two and a half stone, it wasn't miraculous or anything, just that this is the level of effort you need to go to for a 'do more, eat less' approach to actually work - and I went through the dizziness and constant hunger and coped - essentially at 52 I was a poster child for recommended diet. I was close to fully tea-total by this point, and hadn't smoked anything for more than two decades.

In April of last year, I took part in a 'Future Health' study and had a series of blood tests, and one of the benefits to me was that they would get in touch if there was any concern about Diabetes.. they didn't

In June, two months later, I had a regular checkup as a 50 plus with my (excellent) surgery, and went in with an ironically high level of smugness.. for once in my life, I don't need to lie about any of the things I'm being asked..

A couple of weeks later, I get a call on the way to go Paddleboarding, and I'm told to pull over so that I can take the news that my blood glucose levels are alarmingly high. Days after that I'm on the conveyor belt through Gliclazide, then insulin (when it was assumed I could only be Type 1) and then more recently Metformin (once we were all convinced that it was definitely not Type 1)

But a hanging question has never really been resolved - how could I be healthy in April and dangerously unwell in June ?
And how could I have done everything modern guidance asks of all of us (to an obsessive degree) for three punishing years - and still be diagnosed Diabetic ?

First things first - I presented with weight loss, lots of urinating and lots of drinking water. Hilariously, I had convinced myself that I was properly hydrating, and that it was deliberate, but then our SodaStream yearly subscription was complete in four months - I couldn't argue that I wasn't drinking too much water... I did talk about the weight loss being controlled, but tick-tick-tick - let's get you on the Type-1 treatment. It's by far the most dangerous situation, and despite no family history, it was feasible... so, it seemed like the right call.

After a few weeks of that - we still hadn't had the blood test results looking for anti-body evidence of autoimmune function that would show type-1 or 2 - and so we moved to insulin and a glucose monitor. I suppose most on this sub-forum won't have a great deal of experience of that, but there is a lot to take in, and the support system kicked in. I felt really well looked after, and with some effort, my levels got better - but still spiked surprisingly, and nobody could tell my why. 'Sometimes this just happens' was an answer I got a lot... but I was telling people, 'The only time I feel unwell is when the levels are changing rapidly, it seems to me like the absolute numbers are less important to the amount of change...'.

I should mention - not that I'm looking for sympathy of course - that 5 months of insulin totally wiped out all the effort I had put in for three years - my weight went back up to where it started in a more or less straight line. I didn't complain - the more serious thing was that my blood glucose was being controlled... yes, I understand the problem with high blood glucose, I'll do whatever you ask.

Then I had an appointment with a new consultant, she began the 'interview' by asking about Ketone levels at my first presentation... and as I began answering, said 'wait, I don't trust people', and phoned my surgery to get the answer. When she put down the phone, I showed her my iPad, where I keep notes of everything, and displayed the same answer from a scan of the letter from the surgery. How were we going to have a dialog when she wasn't trusting my answers? 'Oh, I didn't mean that I didn't trust you, just that I don't trust anyone...' Suffice to say that the appointment was a little tetchy from that point. I'm sure she's sat in front of many people she knew to be lying to her face, but it's not the best strategy to build trust and confidence.

Anyway - she was pretty sure I was not type-1, to her credit, and asked me to take another test to finally put it to bed, that test looked for a triggered response of naturally produced insulin, which was positive - clearly, I could only be type-2.

So, that was fine, but I got the news in a letter asking me to drop the insulin and switch immediately to Metformin with 'supplements per NICE guidelines'. I felt that I couldn't just upend 6 months of learning to control the Most Important Thing - my blood glucose level, and needed to understand the whole thing better, so waited till I could speak to my GP. She was great, explained everything, and what Metformin was and what it did.

Which was great, except that some of what she said turned out later to be wrong, particularly in terms of Metformin's primary function.

So - I was now a new type-2, my levels were still too high, and spiking a lot, particularly in the morning. What the hell had kicked this all off ?

When I thought that I was just an unlucky person with late onset type-1, I was prepared to do anything; the hardest thing was accepting that this was now my life, and I'd worked hardest on that. Now, I had to turn my whole thinking on all of this around and start fresh. I needed to learn as much as I could - I didn't really know what glucose was or what made you insulin resistant. I just felt that things didn't add up for me, and I needed to figure it out myself, because where I was headed was really bad.

Luck took me to a YouTube interview with Dr Jason Fung, and then I immediately got his book 'The Diabetes Code' - and I went to bed literally shaking after devouring half of it.

The simple truth was that having reached my weight goals, and keeping my weight steady, I decided to treat myself with Honey. After all, it was natural sugar, we can't burn it, so it's a free pass, and I could see that it was having no effect on my weight. Soon enough, I was having Honey on my cereal in the morning, on sandwiches at lunch, sometimes a little to spice up the family meal that I would cook, and as a snack on Ryvita before bed. I was also mainlining grapes - we would buy four packs a week, and I would eat most of them. Grapes are fantastic in a calorie-controlled diet, because of their calorific density - lots of water... so again, a free pass.

I'm astounded at my own ignorance. Just gob-smackingly incredible.

I understand the mechanism better now, but in simple terms, I had overloaded my liver over and over to the point that my pancreas couldn't keep up, and had gone into beta-cell dysfunction, leading to a rapid rise in blood glucose... in weeks.

Having had that picked up, 6 months of additional insulin was the absolute worst thing I could have done... and now I'm taking the one drug that primarily blocks my liver from unburdening itself.

Unchecked - I'm on a path of taking more and more metformin to address the symptom of high blood glucose, until that stops working, then more insulin..

None of which would ever actually address the problem, that I simply have too much glucose, fructose and insulin in my body in the short term.

The one great positive of my situation is that I continue to wear a continuous glucose monitor (essential to avoid really bad things if you are type-1, but it turns out, very useful indeed for, well, everyone) and I was able to test the various theories in 'The Diabetes Code' and then Jessie Inchauspé with 'The Glucose Revolution' - everything totally stacks up with the evidence I can see with my own eyes, and the things I had intuited from the start.. the glucose spikes were the problem, and I had done this to myself; but I could undo it too.

Turns out, it takes eight weeks of force feeding Geese on Corn Syrup to make Foie Gras - that's what I had done to myself, and the system picked up on the resulting blood glucose level.

Anyway - quite enough rambling from me... where I am now is a full week into alternate day fasting, with close to zero sugar or starch on the eating days. I'm also not taking any metformin, because I can see on my monitor that my blood glucose is only marginally higher than a metabolically healthy person. I'm also supplementing with Huel daily greens, to make sure that the sudden change in diet does not result in loss of nutrients.

I only intend to do this for a month, and to present the results (massive, significant results in only a week) to my GP to force the issue - why, given this would you argue for Metformin? and I have an appointment with the Dietician about a month after that, at which point I may still be doing some form of intermittent fasting, but nothing so extreme, and with low, but not close-to-zero levels of starchy foods and following Jesse Inchuspé's recommendations to do so with no glucose spikes.

I still feel well looked after by the 'system' - I understand the decisions made and the treatment given, GPs only have 10 minutes at a time to make these decisions, and people are just unreliable at telling you the truth, or following a plan - so they treat with medication; can't blame the GP for doing their job.

But - I wish I'd known even a fraction of this much earlier in life..
If you've managed to get to the end of this Wall-o-text, thank you, I know my story is important to me, but otherwise it's just someone's story, and I appreciate you taking the time.
Best of luck (and better advice) on your own journey.
Chris

Well done Chris really appreciated your time and effort in writing this