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

[Chris24Main]

@Antje77 - many thanks - I wansn't necessarily looking for a compliment, but I'll take it...

Your comment actually helps, in a way, because the more I learn the more I feel that there is something uttertly critical about being able to get a message accross - there are small changes that everyone can make if they have the right information to make better decisions. But - the power of a good, simple story told for several decades is such that it's genuinely very difficult to understand enough to be sure that ... what seems to be obvious is actually based on good science, and not being pushed by someone else trying to sell you either a product, or a sense of outrage..

And the story that we live by is that we need to eat less fat and more carbs - so that we can reduce risk of heart disease. Even (or especially) if you are Diabetic, The way to loose weight is to count your calories and eat less than you use. If it's not working, you're not doing it right.

It's such a powerful narrative, so easy to tell, and it makes sense. Somehow, we all manage to discard the unfortunate truth that it clearly doesn't work, otherwise why are diabetes rates double what they were and more since this took hold?

Trying to boil it down to a simple, easy to understand story is a challenge.. I feel like I've read half a dozen explanations in various books, and I've tried to do it myself, but the trouble is that you get into difficult details too quickly in order to explain why this part of the story cannot be true, or how that part is definitely wrong because this study.. and soon enough you've lost the thread..

But there is a simple story in there somewhere...

 

[Chris24Main]

Just popping in because I've just had another mind blown moment. I caught a lecture from an Australian doctor, Dr Paul Mason. In it, he basically lays out what heart disease really is, and the role Diabetes plays, and the underlying mechanisms that LDL particles play in all of this. It's really stopped me in my tracks, because in a single 20minutes, it kind of makes sense of everything. It's too much to try to relay in a way that might make sense reading my layman's version, so I won't even try; but I feel that the entirety of the learning and experimenting I've gone through this year was preparation for this one thing...

He is not a practicing Cardiologist, but does have a degree in medicine, among other thing, but his professional perspective is sports medicine, which may explain why his starting point is not to defend the status quo (saturated fat is bad).

I'll link to it here...

Though, I'm not necessarily recommending sitting through all 40 minutes; it is fairly heavy going, but just amazingly cohesive.

Coming back to the 'look at everything as a whole' idea, and it seemed to me that; when the majority of people with T2D die of heart disease (a deliberately sloppy phrase, but true nonetheless, not opinion), we need to really focus on understanding heart disease, and what the connection to Diabetes is... or I should say uncontrolled diabetes.

Then, you can come up with a plan that works for you, and understanding the big picture, and why you can't cherry pick bits of treatment that focus on one symptom.

 

[Chris24Main]

Right then, so here's a stab at trying to explain something ... Insulin Resistance..
From the very first consultation I had, this was explained to me thusly - 'type 2 diabetes is where you don't produce enough insulin or it doesn't work as well as it should'. I remember being fairly non-plussed about that at the beginning (when it was not clear what my diagnosis was) and totally unsatisfied with it later on (when I was quite definitely a T2).

Leaving the doctors surgery, I was burning with "I really need to understand what Insulin Resistance is" - this has been the mainstay of my journey/ obsession ever since. And I'm still learning more and more - it's a very complicated question, and there is not total agreement as to what the answer is.

After much study though, I think there are three camps.

1. The traditional model. Pretty much as described above. Something is going wrong with the mechanism to get glucose into your cells, though we don't really know what, and result is too much glucose in your blood. We'd better prescribe you with some medicine to reduce the amount of glucose in your blood. Have some Metformin and we'll talk in three months.

The trouble with this is... it doesn't really explain what is actually going wrong - ask your doctor or nutritionist for a fuller explanation, and you just won't get one. That's a little troubling for all the time, money and research that's gone into this, not to mention that statistically it is neither working (rates are increasing) nor doing much for you other than reducing blood glucose (ie, your long term outlook is not good, T2D is fundamentally seen as progressively getting worse).

2. The 'too much of everything' model. This basically says that insulin resistance is like antibiotic resistance, is like heroin resistance, is like exercise resistance... if there is too much of a thing, the body needs more of that thing to have the same effect after some time. Thus, when we eat, and particularly when we eat simple sugars or starchy carbs that are absorbed as sugars, insulin is expressed to clear that sugar from the blood. However, do this too often, and the result is that our internal storage for sugars get ful (for context about as much as three Mars bars) and we have to start repackaging the sugar as fat, first of all in our liver.

After some time (could be months or decades) the system starts to push back - there is no more space to put all this fat, we need more insulin to force it into storage.. and you produce more, but for less effect. This is insulin resistance. You can be in this state (and it could be called many different things for a long period of time)

Finally, your Pancreas starts to sound like Scotty 'She cannae take it Cap'n, she's gonnae blaw' - and because the insulin can't keep up, you get the sudden, massive increase in blood sugar that gets you diagnosed as T2D.

3. The 'it's more complicated than that' model. This is tricky, because there is no really simple version. Actually the simple version is that we've been tricked into incorporating plant biology which may not be a good idea. Many of you will have picked up that Seed oils should be off the menu for diabetics, or everyone. This is one reason why, and it comes back to the use of language; we talk about 'saturated fat' and 'poly-unsaturated fat' - and nobody really knows what it means except that 'we know that saturated fat leads to heart disease' - well, actually, we do not KNOW that, for about 70 years it's been unproven, but widely thought to be true. If, however, we described the same things as 'stable, animal lipids' and 'very unstable plant lipids' it would be more accurate, and much harder to paint one as the bad guy.

Who wants to be putting very unstable plant lipids on their food, especially if we know that they need a bunch of chemicals to stop them going rancid.
But we do, because we've been told they are good for us.

So - who has been recommended a plant Sterol, because it's going to lower their bad cholesterol? I know I have.
It gets enormously complicated now, but the very simple version is that the bits of our cells that manage the glucose entry - the gateway that is affected by insulin.. this is built with, among other things, sterols, which can be these plant sterols from probiotic yoghurt, or seed oils.. or it can use animal sterols - including our old friend cholesterol.

Only - cholesterol is stable, and plant sterols are evolved, well, for plants, and they don't work so well, but the body didn't know that when it was building those cell boundaries - a sterol is a sterol (this is actually why plant serols are recommended - your body goes 'ah, look at all these sterols, we don't need to make so much ourself now).

So - because of the plant sterols, the gateway for glucose doesn't work. In other words, the insulin receptor is damaged. In other words, insulin resistance.

What does all of this mean then?

Well - I think anyone who is just pushing option 1 is holding to out of date information, and addressing the symtom, not the cause. This is fundamentally why diabetes is thought of as progressive - just clipping from the NIH - "Over time, you may need more than one diabetes medicine to manage your blood glucose. Even if you don’t take insulin, you may need it at special times, such as during pregnancy or if you are in the hospital. You also may need medicines for high blood pressure, high cholesterol, or other conditions."

Also - "Managing your blood glucose, blood pressure, and cholesterol, and quitting smoking if you smoke, are important ways to manage your type 2 diabetes."

I'm not saying all of that is wrong, but there isn't a single mention of how carbs drive insulin, becomes insulin resistance. You will certainly not see warnings on seed oils saying 'contains plant biology that may increase your risk of diabetes by 67%' - yet this was known from studies undertaken in the early seventies.

What else ? - well 2 and 3 can both be true - that's the scary thing, and then you look at graphs showing the increase in carbs and seed oils in population diet, and it's difficult to argue that there no connection to; not just T2D, but insulin resistance as a kind of gateway to all the 'modern diseases'

The rest - I think this starts to make sense of the double whammy of vegetable oil and sugars, and just helps with the motivation to reduce them in our diet, by whatever means works for us.

 

[Outlier]

Nice analytical work there. I quietly add - but I think it is very important - for any "professional" advice we get to a) always keep in mind that we all are individuals and can react differently to similar circumstances and b) always check "qui bono" - who paid for the research, who did the research and who stands to make a profit from this or that advice.

 

[Chris24Main]

Thanks @Outlier - you are 100% correct, and I had meant to add that - point 1 is clearly the status quo, point 2, well, point 2 tends to come from those selling a fasting regime of some sort or other. Point 3 - is only starting to emerge and I haven't seen it tied to a revenue stream.. at least not yet.

I don't have a problem with either a youtuber or a corporation wanting to make money.

Shouldn't need to be said, but I do not offer any of this as advice, only my attempt to digest the various streams of sometimes competing information.

I'm also interested in the 'what is the simplest version of all of this that is non-controversial and self evidently true' - ie, what is it that we can all agree on; and I may not get that right - if anyone reading any of this feels outraged at something that seems clearly wrong or biased, please let me know - even if we do not agree it may lead to some additional insight - I've learned much more from being challenged on one view or another than anything I thought I understood to begin with.

 

[jpscloud]

You will certainly not see warnings on seed oils saying 'contains plant biology that may increase your risk of diabetes by 67%' - yet this was known from studies undertaken in the early seventies.

What else ? - well 2 and 3 can both be true - that's the scary thing, and then you look at graphs showing the increase in carbs and seed oils in population diet, and it's difficult to argue that there no connection to; not just T2D, but insulin resistance as a kind of gateway to all the 'modern diseases'

The rest - I think this starts to make sense of the double whammy of vegetable oil and sugars, and just helps with the motivation to reduce them in our diet, by whatever means works for us.

This is the heart of the matter for me - vegetable oils and carbs are so ubiquitous that to avoid them is to put yourself outside "normal eating" and into a position of denying yourself deliciousness. Deliciousness that is manufactured to take your money in exchange for ill health. I am trying to train myself to see that deliciousness in the same way I saw my addiction to nicotine - I want(ed) it but it will most likely harm me to death.

 

[ajbod]

Where you mention 3 mars bars, our blood should only contain approx' 4 grams of sugar in the whole system. Any more is too much. so where mars bars are concerned 1/7th of a bar, is just about right.

 

[Chris24Main]

thanks @ajbod - I should have made that clearer - you are correct to say that normal blood sugar should be about a teaspoon's worth - this 'three mars bar' equivalent is the total 'normal storage' for sugars in the form of Glycogen in the Liver and Muscles (though not 100% sure as I write what form that takes) - so immediately available storage before having to convert into fat. And, assuming your stores are totally empty...

It's easier to think about in the other way, in order to empty your stores of 'quick release' glucose - in the form of Glycogen, you have to empty the Liver, about a mars bars worth, and your muscles, another couple of mars bars, then you begin having to get energy from other processes. (ie, after about 24 hours fasting)

Maintaining a good level of blood glucose, of course, requires 0% mars bars, and indeed no carbs at all..

 

[Peanut234]

@Chris24Main and other contributors:​

Thankyou all so much for this series of 'rabbit holes'. I too have been 'frowned at' and 'shown the door' for asking questions of medical professionals as part of my Diabetes journey, and the information here has answers questions and raised more...
I have a couple of questions/comments/thoughts to share:

My Gestational diabetes x 2 was a foreshadowing/illumination of type 3c diabetes. In fact the pancreatitis diagnoses (repeated) should have come much earlier, but that is another story. I assume pregnancy stresses the system and anything on the edge ( or not picked up previously) shows itself.

It is only recently that I have come across the link between 'if your liver is fatty, then your pancreas is probably fatty too and of course that will affect its function' - among the long list of insights from this thread! I would like to add that it probably can contribute to pancreatitis for some as well. (not looking at anyone in particular!- Me)

I recently saw a youtube video:

(if it will let me add it here) with Chris van Tullekin and an interviewer - there are more interviews/ presentations/talks/BBC shows with similar content that he has done if the link doesn't work or the interviewer isn't your thing. Its about ultra processed food, and man it hits hard. A rabbit hole in itself for those interested.
I saw in one of your earlier posts about your frustration from your early diabetes journey. I experienced some of the same frustration, during this interview. Quite maddening, and also feeling helpless at the same time at the scale of the damage.

Another quite big rabbit hole. I am interested in the groups thoughts/ previous investigations etc between the link between diabetes, Alzheimers disease, 'fats', and 'plaque' formation. Partly I ask because of the cholesterol and artery plaque investigation you have done, wondering if there is any correlation. But also because my father has Alzheimers, Diabetes, and a specific gene : APO e4e4. My understanding is that part of the APO protein's job is cholesterol transport. And the E4 version has issues, let alone double e4, and there is a link with Alzheimers for those who have it.
Part of this stems also from my presumed genetic risk and that same old nagging 'clogging' up the arteries with fats, and maybe the brain too... historic argument. Just wondering if anyone had come across anything relevant or had thoughts on it?

I also completely sympathise for those who are struggling to change the direction of the low fat, high carb bandwagon for loved ones and friends.
My Parents are not in a place where they are interested in listening or changing habits. However they do have a lot more self control than I do - Thankfully!

Finally, I was wondering if you could add a section to your insulin resistance post, in particular the mechanism of how exercise reduces insulin resistance, and for such a relatively short period.
If you were really going 'all in', a list essentially spelling out the ways to reduce it and how each process works.
I realise that essentially you have covered this content in this series of posts/thread, but it may make for more digestable reading for some to tie it back to insulin resistance as this is terminology that is commonly used in the mainstream information, and a useful resource to pop back to for others.
NB I second the commendation for your writing style, it is really down to earth and personable. Keep it up please!!!

Well, I've now got many tabs of rabbit holes opened from this thread, Thankyou all, and I may be back with questions!

 

[Chris24Main]

@Peanut234 - Many thanks for that wonderful contribution. You've given me something to get stuck into ...
Very short version (and as always, based solely on my finite understanding based on a ridiculously small amount of study) is that Alzheimer's is basically the same mechanisms - but how they affect the brain rather than (primarily) the Liver.
More later on both points you raise -

 

[ajbod]

My leanings on Alzheimer's, is that as a large proportion of the brain is made of Cholesterol, reducing your levels below what your body sets by itself, cannot be a good thing. ie is there sufficient to replace lost Cholesterol from the brain?

 

[HairySmurf]

Right then, so here's a stab at trying to explain something ... Insulin Resistance..
From the very first consultation I had, this was explained to me thusly - 'type 2 diabetes is where you don't produce enough insulin or it doesn't work as well as it should'. I remember being fairly non-plussed about that at the beginning (when it was not clear what my diagnosis was) and totally unsatisfied with it later on (when I was quite definitely a T2).

Leaving the doctors surgery, I was burning with "I really need to understand what Insulin Resistance is" - this has been the mainstay of my journey/ obsession ever since. And I'm still learning more and more - it's a very complicated question, and there is not total agreement as to what the answer is.

After much study though, I think there are three camps.

Good doctors tend to dumb things down. They're busy people, lots of patients to help, little time for trying to explain extremely complex subjects, particularly when the true explanation for something ends with 'nobody knows'. When they do write a book or appear in a YouTube video though they mostly talk about the subject of their own expertise, the thing they're qualified to talk about as an actual expert.

Bad doctors dumb things up. Plenty of time on their hands to try their hand at writing books on subjects they have little expertise in and appearing in YouTube videos talking about all manner of stuff. They often make up silly rubbish to fill in the blanks that re unknown or which they don't truly understand themselves, because they're not experts but have to appear to have good, interesting answers if they're going to sell their books. Just as bad, they often parrot silly rubbish they heard somewhere else, without either the inclination or the capacity (one or the other) to fact-check it. Offering novel medical advice on subjects they don't understand extremely well is pretty much what makes a bad doctor a bad doctor.

My very first post on this forum was on the subject of insulin resistance. Like you I wanted to understand it and was confused and annoyed by the lack of clear information available. I had some theories, which were very wrong. Like you I kept looking for information trying to understand more. We ended up choosing very different paths though, learning from different sources, and have arrived at different places.

From the first post in the thread I see you started with Dr Jason Fung's book on diabetes. Dr. Fung, the nephrologist, a trained expert in kidney diseases, who wrote a book about fasting diets for weight loss, and another about how his fasting approach applies to diabetes. Dr Fung, as I understand it, suggests in his book that a Type 2 diabetic can't easily lose weight unless they lower their levels of circulating insulin, because insulin prevents fat burning, so the solution is to fast and eat low-carb to lower insulin levels and enable the burning of fat.

Or something like that. I'm not sure what he actually says, because I didn't read his book, because after watching a couple of the kidney specialist's YouTube videos on the subject of weight loss and diabetes a quick bit of googling led me to the Rice Diet from 1939 - quick summary here: Link It seems it's possible for a diabetic to lose weight and even improve their fasting blood glucose levels on a diet composed almost entirely of carbs! It seems calorie restriction worked just fine back then, but then I suppose they didn't have YouTube personalities to confidently inform the people losing the weight that is was impossible. I'm sure there's plenty of good stuff in that book of his - he is a doctor after all - but when it takes less than five minutes to find this hole in one of his novel medical theories I decided never to read it. It's sometimes hard to unlearn a falsehood; easier not to come to believe it in the first place.

Instead the path I chose was to read material written by experts in the subjects I'm trying to learn about. As a result of this approach I now understand that the Rice Diet lowers insulin resistance in the livers of Type 2 diabetics. It does this though weight loss, which depletes ectopic fat in liver cells, which makes those cells resistant to the effects of insulin. It is important to point out that insulin resistance means something different in the liver than in every other tissue in the body. Insulin switches off glucose output from the liver. When the liver is insulin resistant is doesn't reduce glucose output as quickly as it should, and this leads to a rise in fasting blood glucose levels. Deplete liver fat by any means, a high-carb, low calorie diet works just fine so long as the amount of fat exiting the liver in the form of triglycerides is higher than the amount entering it or being synthesised within it, and hepatic insulin resistance will fall. Insulin resistance in other tissues means something different, with the possibility of different causes involved depending on the type of cell you're talking about.

There is no good book on the subject of insulin resistance which is written by an actual expert. Well, there is, it's called 'Understanding Insulin and Insulin Resistance' by Professor Anil Gupta, but it costs £121 on Amazon and I haven't read it because that's silly money and it's likely so far above my head that learning from it would be extremely hard work. To the best of my knowledge Prof Gupta doesn't have a YouTube channel. There is however a cheaper way to get a handle on all we really need to know as Type 2 diabetics - here's some recent research on how Metformin reduces insulin resistance - Link - something about Glucose Transporter 4. For simplicity, assume this applies mostly to muscle tissue as that is where most glucose uptake occurs (muscle tissue and the brain, though if an insulin-resistant brain is a real thing I haven't heard of it). The conclusion ends with the phrase "A better understanding of the mechanisms behind its clinically relevant increase in insulin sensitivity could help researchers and clinicians studying and treating the dramatic rise in IR conditions worldwide." In short, 'nobody knows'. Good doctors. I learned what I needed to know - Metformin lowers insulin resistance (not the liver kind, it has different effects in the liver) and nobody fully understands exactly how Metformin works, because nobody understands perfectly how insulin resistance occurs (and vice versa).

Unfortunately this provides a lot of wiggle room for bad doctor types to make up silly rubbish and sell books. Hence two of your three camps. Here's what I've learned and taken to be true as a Type 2: Losing weight and keeping the fat out of the liver lowers insulin resistance in that organ. Exercise lowers insulin resistance in muscle tissue. Losing weight and avoiding rapid weight gain may lower insulin resistance in adipose tissue (fat cells) and keep it low. Also, there is probably a genetic component to insulin resistance - most people who get a fatty liver do not develop impaired fasting blood glucose - in liver cells at least it's probably as simple as ectopic fat + genetics.

In short, eating less and moving more lowers insulin resistance. The rise in insulin resistance levels in the population could be as simple this: people are moving less and eating more than they used to. Car ownership and fast food outlets. Deliveroo. There might be much more to it than that for sure, but it's all speculation and BS right now because nobody understands insulin resistance well enough to understand how Metformin works. If understanding that is impossible right now at the current level of scientific understanding then identifying environmental or dietary causes of insulin resistance is impossible. There's little point wading through the BS looking for fragments of truth right now when you can just go for a nice long walk, which will lower your insulin resistance.

 

[TheSecretCarbAddict]

I'm listening to Why We Get Sick by Ben Bikman on Audible, which I feel provides a thorough and balanced explanation of IR and ways to manage it. He covers factors we can't control as well as factors we can. The main inputs we can control are, guess what, food and exercise.

 

[Chris24Main]

Good doctors tend to dumb things down. They're busy people, lots of patients to help, little time for trying to explain extremely complex subjects, particularly when the true explanation for something ends with 'nobody knows'. When they do write a book or appear in a YouTube video though they mostly talk about the subject of their own expertise, the thing they're qualified to talk about as an actual expert.

Bad doctors dumb things up. Plenty of time on their hands to try their hand at writing books on subjects they have little expertise in and appearing in YouTube videos talking about all manner of stuff. They often make up silly rubbish to fill in the blanks that re unknown or which they don't truly understand themselves, because they're not experts but have to appear to have good, interesting answers if they're going to sell their books. Just as bad, they often parrot silly rubbish they heard somewhere else, without either the inclination or the capacity (one or the other) to fact-check it. Offering novel medical advice on subjects they don't understand extremely well is pretty much what makes a bad doctor a bad doctor.

My very first post on this forum was on the subject of insulin resistance. Like you I wanted to understand it and was confused and annoyed by the lack of clear information available. I had some theories, which were very wrong. Like you I kept looking for information trying to understand more. We ended up choosing very different paths though, learning from different sources, and have arrived at different places.

From the first post in the thread I see you started with Dr Jason Fung's book on diabetes. Dr. Fung, the nephrologist, a trained expert in kidney diseases, who wrote a book about fasting diets for weight loss, and another about how his fasting approach applies to diabetes. Dr Fung, as I understand it, suggests in his book that a Type 2 diabetic can't easily lose weight unless they lower their levels of circulating insulin, because insulin prevents fat burning, so the solution is to fast and eat low-carb to lower insulin levels and enable the burning of fat.

Or something like that. I'm not sure what he actually says, because I didn't read his book, because after watching a couple of the kidney specialist's YouTube videos on the subject of weight loss and diabetes a quick bit of googling led me to the Rice Diet from 1939 - quick summary here: Link It seems it's possible for a diabetic to lose weight and even improve their fasting blood glucose levels on a diet composed almost entirely of carbs! It seems calorie restriction worked just fine back then, but then I suppose they didn't have YouTube personalities to confidently inform the people losing the weight that is was impossible. I'm sure there's plenty of good stuff in that book of his - he is a doctor after all - but when it takes less than five minutes to find this hole in one of his novel medical theories I decided never to read it. It's sometimes hard to unlearn a falsehood; easier not to come to believe it in the first place.

Instead the path I chose was to read material written by experts in the subjects I'm trying to learn about. As a result of this approach I now understand that the Rice Diet lowers insulin resistance in the livers of Type 2 diabetics. It does this though weight loss, which depletes ectopic fat in liver cells, which makes those cells resistant to the effects of insulin. It is important to point out that insulin resistance means something different in the liver than in every other tissue in the body. Insulin switches off glucose output from the liver. When the liver is insulin resistant is doesn't reduce glucose output as quickly as it should, and this leads to a rise in fasting blood glucose levels. Deplete liver fat by any means, a high-carb, low calorie diet works just fine so long as the amount of fat exiting the liver in the form of triglycerides is higher than the amount entering it or being synthesised within it, and hepatic insulin resistance will fall. Insulin resistance in other tissues means something different, with the possibility of different causes involved depending on the type of cell you're talking about.

There is no good book on the subject of insulin resistance which is written by an actual expert. Well, there is, it's called 'Understanding Insulin and Insulin Resistance' by Professor Anil Gupta, but it costs £121 on Amazon and I haven't read it because that's silly money and it's likely so far above my head that learning from it would be extremely hard work. To the best of my knowledge Prof Gupta doesn't have a YouTube channel. There is however a cheaper way to get a handle on all we really need to know as Type 2 diabetics - here's some recent research on how Metformin reduces insulin resistance - Link - something about Glucose Transporter 4. For simplicity, assume this applies mostly to muscle tissue as that is where most glucose uptake occurs (muscle tissue and the brain, though if an insulin-resistant brain is a real thing I haven't heard of it). The conclusion ends with the phrase "A better understanding of the mechanisms behind its clinically relevant increase in insulin sensitivity could help researchers and clinicians studying and treating the dramatic rise in IR conditions worldwide." In short, 'nobody knows'. Good doctors. I learned what I needed to know - Metformin lowers insulin resistance (not the liver kind, it has different effects in the liver) and nobody fully understands exactly how Metformin works, because nobody understands perfectly how insulin resistance occurs (and vice versa).

Unfortunately this provides a lot of wiggle room for bad doctor types to make up silly rubbish and sell books. Hence two of your three camps. Here's what I've learned and taken to be true as a Type 2: Losing weight and keeping the fat out of the liver lowers insulin resistance in that organ. Exercise lowers insulin resistance in muscle tissue. Losing weight and avoiding rapid weight gain may lower insulin resistance in adipose tissue (fat cells) and keep it low. Also, there is probably a genetic component to insulin resistance - most people who get a fatty liver do not develop impaired fasting blood glucose - in liver cells at least it's probably as simple as ectopic fat + genetics.

In short, eating less and moving more lowers insulin resistance. The rise in insulin resistance levels in the population could be as simple this: people are moving less and eating more than they used to. Car ownership and fast food outlets. Deliveroo. There might be much more to it than that for sure, but it's all speculation and BS right now because nobody understands insulin resistance well enough to understand how Metformin works. If understanding that is impossible right now at the current level of scientific understanding then identifying environmental or dietary causes of insulin resistance is impossible. There's little point wading through the BS looking for fragments of truth right now when you can just go for a nice long walk, which will lower your insulin resistance.

Fascinating - thanks for that.
as you rightly say - a great deal of this stuff is still unknown - and it's all inter-related, so even a world-leading expert from one aspect gains significant insight from another similar specialist (at least watching a conversation between a liver specialist and a brain specialist leads me to thinking so).

I feel like I need to defend Dr Fung just a little though.
But - only from my perspective - not really as a defensive reaction. I'm becoming more open to the 'insulin resistance is far more complex' approach, and there are several insights that point to insulin resistance being far more widely affecting than just the T2DM population.

Prefacing with - clearly everyone is an individual - my experience is that I struggled over three hard years with the calorie restriction and doing more exercise plan. There were many days I recall feeling light headed, and many plateau stages, but I persevered, and lost about 3 stone. I had done everything that 99% of people (statistically) fail at - I had gotten my weight down to target weight, and was holding it there -

Then - I was diagnosed with Diabetes.

Now - I would say that was because of the carbs I was eating in the form of Honey and Grapes, and the starchy input from potatoes, pasta and sweet potatoes and rice, For sure, the first source I came to was Dr Fung and intermittent fasting - but I accept your objections, all I can add is my experience.

Using fasting and high-fat low carb as a basis for a lifestyle, with no calorie counting - I've lost about 2 stones, all of that fat (ie, with no muscle loss) and 4 inches off my waist - plus I feel much, much better than when I was restricting calories. And with virtually no effort, I can enjoy what I eat, (I have to be disciplined for sure, but not having to weigh and log each ingredient or anything like that).

So - for me, although I don't think that insulin resistance is purely a question of 'too much glucose and insulin' - I do think that it's a good starting point, and more than that - it doesn't require that to be the only answer - there can also be mechanisms that affect the way that insulin works at the cell boundary or mitochondrial level.

Really - for me, I figured that my liver had to be stuffed with fat - it was coming from the sugars I was eating.. so I had to drain that fat - and there were only 2 possible routes - burn it off, and stop putting it in in the first place.

 

[HairySmurf]

Now - I would say that was because of the carbs I was eating in the form of Honey and Grapes, and the starchy input from potatoes, pasta and sweet potatoes and rice, For sure, the first source I came to was Dr Fung and intermittent fasting - but I accept your objections, all I can add is my experience.

Using fasting and high-fat low carb as a basis for a lifestyle, with no calorie counting - I've lost about 2 stones, all of that fat (ie, with no muscle loss) and 4 inches off my waist - plus I feel much, much better than when I was restricting calories. And with virtually no effort, I can enjoy what I eat, (I have to be disciplined for sure, but not having to weigh and log each ingredient or anything like that).

There's no question that Fung's methods work, and the honey and grapes is a good example of how his book most certainly contains good and helpful information. Unfortunately his book apparently contains some easily disproven rubbish, as evidenced by his YouTube channel and by some of the things stated as fact on this thread. I chose Fung as an emblem of the problems a person runs into when looking to non-experts for a deeper understanding of things that person has little expertise in - they're hit and miss - often a source of lots of good information, with rubbish mixed in. I chose him because he appears in first post of this thread, a very long thread of similar examples.

I'll take one other example - on this thread it is stated as fact that there is no proof that saturated fat raises cholesterol. This is false. The truth is complicated with a 'nobody knows' at the end. If you would like to learn more - this video interview series with lipidologist Dr Thomas Dayspring provides enough understanding of the state of the art when it comes to lipids to understand the role LDL receptors in the liver play in clearing 'bad' cholesterol particles from the blood - Link The interviewer annoys me, seems biased in that he seems to enjoy highlighting anything negative said on the subject of keto, but over 6 hours of interview material with an actual cholesterol expert is a goldmine. In one video he makes reference to the role of saturated fat. Here is what he's talking about, one of many pieces of research from the 90s which prove that saturated fat influences the expression of LDL receptors - Link The fact that saturated fat raises LDL cholesterol isn't just proven, the mechanism that links saturated fat to LDL cholesterol was proven, conclusively, decades ago.

It does get complicated though. More recent research demonstrates that saturated fat does not always have this effect. There are many examples - here's one from 2017 about cheese - Link How could this be? How can saturated both raise LDL cholesterol and not raise it? The BS artist explanation is that it was never proven in the first place, that decades, mountains of research is all wrong. 'Everything you know is wrong, but I have the truth, buy my book!'. The truth is that nobody knows. There are many theories floating around though the one I'm currently inclined to believe is that saturated fat isn't all the same. The research from the 90s which I linked above makes no reference to the types of saturated fat used in the experiments. It was assumed that saturated fats are all the same in their effects on LDL receptor expression and thus cholesterol levels. This might not be the case - maybe it has something to do with the differing molecular structure of different saturated fats - perhaps for example palmitic acid, found in red meat, and pentadecanoic acid, found in cheese, are different in their effects - Link and Link Or maybe it's something else - nobody knows.

Wherever or whoever the 'no proof that saturated fat raises cholesterol' thing comes from is an unreliable source of information. It's complicated.

 

[TheSecretCarbAddict]

I've now caught up on this thread and have been reflecting on some of the conversations. I'm a few months into doing some postgraduate study, and one thing I'm realising is that in my field of study, there are no absolutes and that, at best, you can get some small pockets of consensus. I'm constantly encouraged by my tutors to challenge everything and make up my own mind. I've come to the conclusion that the field of medicine is a bit the same.

Does this mean that all the information out there is useless? No, not really, but don't take anything as a gospel, do challenge, and test to see what's applicable to you. Also, the fact that there might not be an absolute agreement on a more scientific level doesn't mean that you can't have a dumbened down set of nonscientific guidelines for a layperson like me, that make a practical difference on a day to day basis irrespective of disagreement on why or how things work. I mean, we can be all scholarly, but I find that leaning towards the science of one (n=1) - testing how things that I can control impact me, is giving me the best practical outcomes. I mean, yes, fundamentally, I'd like to understand how and why it works, but ultimately, that might not be what matters the most.

 

[HairySmurf]

I mean, we can be all scholarly, but I find that leaning towards the science of one (n=1) - testing how things that I can control impact me, is giving me the best practical outcomes. I mean, yes, fundamentally, I'd like to understand how and why it works, but ultimately, that might not be what matters the most.

I 100% agree. The trouble I've had and still run into is sorting fact from fiction, and sometimes you can't wait for the practical outcomes to become apparent. For example, I've committed to low-carb to some degree (long-term diet as yet undecided) because it makes perfect sense from a HbA1c perspective. For the past few months that's been easy - lower carbs, lower fats, lose weight, all good. I hit my weight loss target yesterday, and a problem I now face and a place where fact and fiction are mixed together, is around cholesterol and it's risks. The practical outcome of getting that wrong might be a stroke or a heart attack - not a test I want to risk performing. Hence trying to learn as much as I reasonably can about cholesterol, atherosclerosis, statins and alternative medications, and which fats might be the best fats. I could take a moderate to high dose statin and eat what I like, but that has implications for insulin resistance and HbA1c. I could stop the statin and eat avocados and oily fish all the time, but that's expensive, unappealing and hard to stick to. There are no easy answers - the 'dumbed-down' guidelines that heavily prioritize a 'healthy diet' over HbA1c aren't good enough, and advice on the alternatives is a minefield of denialism and BS. Also good advice though - eggs and nuts! Tick all the boxes - fairly cheap, very tasty, heart healthy and not too bad for the oul HbA1c. I can't live on eggs and nuts alone though In-depth learning and fact checking definitely required.

 

[jpscloud]

I 100% agree. The trouble I've had and still run into is sorting fact from fiction, and sometimes you can't wait for the practical outcomes to become apparent. For example, I've committed to low-carb to some degree (long-term diet as yet undecided) because it makes perfect sense from a HbA1c perspective. For the past few months that's been easy - lower carbs, lower fats, lose weight, all good. I hit my weight loss target yesterday, and a problem I now face and a place where fact and fiction are mixed together, is around cholesterol and it's risks. The practical outcome of getting that wrong might be a stroke or a heart attack - not a test I want to risk performing. Hence trying to learn as much as I reasonably can about cholesterol, atherosclerosis, statins and alternative medications, and which fats might be the best fats. I could take a moderate to high dose statin and eat what I like, but that has implications for insulin resistance and HbA1c. I could stop the statin and eat avocados and oily fish all the time, but that's expensive, unappealing and hard to stick to. There are no easy answers - the 'dumbed-down' guidelines that heavily prioritize a 'healthy diet' over HbA1c aren't good enough, and advice on the alternatives is a minefield of denialism and BS. Also good advice though - eggs and nuts! Tick all the boxes - fairly cheap, very tasty, heart healthy and not too bad for the oul HbA1c. I can't live on eggs and nuts alone though In-depth learning and fact checking definitely required.

Congratulations on hitting your weight loss target!

 

[ajbod]

Statins have no effect on consumed Cholesterol, they work by stopping your body producing enough of the Cholesterol that it USES. Don't forget the active parts of Statins, are Fungii s protection to kill anything that may eat it.

 

[TheSecretCarbAddict]

I 100% agree. The trouble I've had and still run into is sorting fact from fiction, and sometimes you can't wait for the practical outcomes to become apparent. For example, I've committed to low-carb to some degree (long-term diet as yet undecided) because it makes perfect sense from a HbA1c perspective. For the past few months that's been easy - lower carbs, lower fats, lose weight, all good. I hit my weight loss target yesterday, and a problem I now face and a place where fact and fiction are mixed together, is around cholesterol and it's risks. The practical outcome of getting that wrong might be a stroke or a heart attack - not a test I want to risk performing. Hence trying to learn as much as I reasonably can about cholesterol, atherosclerosis, statins and alternative medications, and which fats might be the best fats. I could take a moderate to high dose statin and eat what I like, but that has implications for insulin resistance and HbA1c. I could stop the statin and eat avocados and oily fish all the time, but that's expensive, unappealing and hard to stick to. There are no easy answers - the 'dumbed-down' guidelines that heavily prioritize a 'healthy diet' over HbA1c aren't good enough, and advice on the alternatives is a minefield of denialism and BS. Also good advice though - eggs and nuts! Tick all the boxes - fairly cheap, very tasty, heart healthy and not too bad for the oul HbA1c. I can't live on eggs and nuts alone though In-depth learning and fact checking definitely required.

I guess I have a different starting point - it almost feels like whatever I do will be better than what I've done before.

The long-term implications of my choices is something that enters my mind on a fairly regular basis. Like yourself, I often tend to end up with a conclusion that no one really knows, and then hoping that if I'm doing something really harmful to my self my body will let me know sooner rather than later and that I just need to listen out.

@Chris24Main - sorry to hijack your thread here. Really enjoyed reading about your journey and your passion for data and process - it almost sounded like I could have written this about me and my journey.