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

[Melgar]

I'd push more investigation into EPI, pancreatitis, and possible T3C if I were you.

@Antje77 I have an appointment with my Dr on Monday. When I read about EPI and pancreatitis it all fits, same issues around food, abdominal pain, inability to digest fats, nausea, racing heart, high fever, and the unstable blood sugars and now weight loss. Although I have not, at any time, been jaundiced.

 

[Chris24Main]

So - having never had an ovary you are well within your rights to shout at me to shut my mansplaining mouth -

/lifts head to check for anything flying/

right, so this is what's going on - your ovaries had been producing Estradiol - one of the Estragens (or Oestragens, I really must check if that's down to Oester - the goddess of fertility that we get Easter from) anyway - one of the roles of Estradiol is to work with the Hypothalamus to regulate temperature - via that pathway through the hypothalamus and thyroid.

When your ovaries hang up their proverbial gloves, you no longer have this source of Estradiol, and switch back to Oestrone - the form of "Estrogen" that men have to make do with. This relative hormone imbalance makes the hypothalamus much more sensitive to temperature fluctuations, and the effect is that it kind of over-corrects - which is where you get all the temperature swings and everything that comes with..

 

[Melgar]

I also wanted to give you a laughing emoji too @Chris24Main. Sounds about right when you think of the hypothalamus and an aging thyroid/body.

 

[Chris24Main]

Interestingly (and for anyone who has listened to Ben Bikman, I can no longer even think "interestingly" without it sounding like him in my head)...

The Women's health Initiative focused on this, and it's one of the reasons that HRT kind of went a bit cold - rates of one type of Cancer went up with HRT with a hormone derived from horses.

Now - overall rates of Cancer never changed... it was just one type, but that got all the press.. these days, bio-identical hormone is available and should be far more effective than something made in a horse, but you cannot patent a bio-identical compound, so you cannot brand it.. so none of the big companies can make a profit off the patent - isn't that an interesting co-incidence..?

 

[Bcgirl]

I have been following this thread during my holidays, always fascinating! Melgar, oh my, you are having quite the set of issues, I’m so very sorry and hope you can get some testing to figure out what the heck is going on.

i know my pancreas is hooped but thought I would review the report from my last scan. Surprisingly the body of my pancreas is ” unremarkable” but the tail is completely atrophied. The head shows tortuosity and signs of side branch IPMN although neither the MRI nor the gastropic ultrasound could get a clear view. Considering it’s been 17 years since the severe acute pancreatitis I’m ok with all this and in fact consider myself extremely lucky to still be alive. And I thank the amazing doctor who fought with the dietitian about when to reintroduce food by mouth. Two full months of tube feeding allowed the pancreas to rest. I’m super surprised that it took 15 years for the diabetes to develop. Ultra low carb is keeping me in the prediabetic range for now. I think now I need to research issues related to the head and tail of the pancreas…

i am quite sure I’m lacking in some pancreatic enzymes. I can eat fat, and do, but I don’t think i process it well. I’m now taking some over the counter enzymes and they do seem to make a difference. When I see my doctor for the last time next month I’ll ask about testing for insufficiency but I don’t have high hopes.

Now, HRT. I was doing bioidentical estradiol and progesterone for years, mostly because my body went into full on menopause when I had the pancreatitis…my body did everything to stay alive. I loved the hormones and never suffered a hot flash. Then I got breast cancer that was estrogen positive and I was forced to stop taking the hormones, understandably. Honestly thought I would suffer more than I did after stopping the hormones. I never developed hot flashes, didn’t get weirdly cranky as my doctor said I would…nothing. I also have Hashimotos

 

[Melgar]

Sheesh @Bcgirl. You have so much going on. Was it inevitable that your pancreas‘ tail would atrophy? Sorry for the questions. Was that caused by the pancreatitis - scaring ? I can eat lettuce and chicken without any ill effects, other than my blood sugars can rise, but anything else causes digestive issues, nausea, bloating, stomach pain, fats are the worst, but really food in general. I seem to tolerate protein, but that is difficult to know for sure. The Ultrasound found nothing of concern, but clearly something digestive is way off. My blood sugars fluctuate I’m fatigued too.
Bcgirl what over the counter enzymes do you take? As long as they don’t have lactase in them, I projectile vomit on lactase. I am lactose intolerant, that’s an enzyme issue, of course. So related to sugars. Did the Hashimotos cause your premature menopause ?
Then of course, I also have coeliac. . And my leukocytes are high.
ed to add the last sentence.

 

[Bcgirl]

Sheesh @Bcgirl. You have so much going on. Was it inevitable that your pancreas‘ tail would atrophy? Sorry for the questions. Was that caused by the pancreatitis - scaring ? I can eat lettuce and chicken without any ill effects, other than my blood sugars can rise, but anything else causes digestive issues, nausea, bloating, stomach pain, fats are the worst, but really food in general. I seem to tolerate protein, but that is difficult to know for sure. The Ultrasound found nothing of concern, but clearly something digestive is way off. My blood sugars fluctuate I’m fatigued too.
Bcgirl what over the counter enzymes do you take? As long as they don’t have lactase in them, I projectile vomit on lactase. I am lactose intolerant, that’s an enzyme issue, of course. So related to sugars. Did the Hashimotos cause your premature menopause ?
Then of course, I also have coeliac. . And my leukocytes are high.
ed to add the last sentence.

Melgar, don’t be sorry for the questions. It’s so odd that nothing was found on your ultrasound, you must be so frustrated. Before my pancreatitis I wasn’t feeling well, I had extremely itchy skin and just wasn’t 100%…doctors were thinking I was crazy. I begged to have my thyroid tested and that’s when I found out I had Hashimotos. Not much later I suffered the pancreatitis. It was very severe and was ultimately the cause of the damage that is seen today. I was on insulin in the hospital but didn’t need it for long. i was told to eat a low fat diet and that’s about it. Now I eat fat with no problems but I tend to fill up quickly and feel I don’t digest well, always an “off” stomach. I used to use the enzymes from Costco , but think I need to find something that more geared towards fat digestion. They are lactose free but do contain lactase-so they won’t work for you. Our health store has lots of options, now there’s a news year’s resolution for me!
The pancreatitis caused my body to go into menopause, the stress was incredible.

i truly hope you get some answers on your doctor visit…

 

[Outlier]

Our thyroid function deteriorates with age. So both an underactive and an overactive thyroid can cause some issues including flashes, even in older people. Cognitive issues and depression too. Mine come with a racing heart.

Just nipping in to the side here - private testing showed many years ago that I had an underactive thyroid, but the NHS test didn't, probably because it wasn't as comprehensive a test. I also have intermittent but frequent racing heart issues, so it all fits in. Sometimes I feel as if I am in a pitch-dark room with one light switch that I can't find. Thank goodness no apparent (to me)cognitive/depression problems, and keto has massively helped my overall health.

Nips back out of thread.

 

[notasugarfairy]

Dietary Ketosis means our bodies are running on Ketone bodies instead of Glucose, a part of the brains functions require Glucose. The liver can easily supply this. The rest runs very happily on Ketone bodies.
When intermittent fasting, it causes the body to burn it's fat reserves, as Ketone bodies. This is thought to ramp up after approx' 12 hours, so a 16 hour fast causes about 4 hours of fat burning. Your fatty liver is gradually draining away, so provided you don't keep topping it up, everything is good.

Wow there is so much information to soak up here.
I guess I'm lucky I was diagnosed pre diabetic 8 months ago and managed to bring it under control by diet. But now, after reading all these comments, I realize I felt a bit complacent when I got my results that said ' BG 38 mmol, no concern' I can't just go back to eating how I was.

So glad I read all this before I let my GL shoot up again.
Thanks to all of you

 

[Chris24Main]

@notasugarfairy - just be a little bit careful, this thread has really gone into the weeds - we are essentially trying to join up some of the really complicated dots, and while I find that to be immensely useful, it's inevitable that some of us will be wrong, some of the time, that's what learning is... but just understand that nobody on this thread should be asserting anything, only trying to learn from and challenge each other in that spirit of joint learning.

That said - I'm a huge, huge fan of that kind of fasting - it's a little more complicated than the paragraph you quote, the presence of ketones is really better thought of as an indicator that insulin is low - when insulin is high, you can only store fats, even the fats that you create from other macros in the liver. When insulin is low, you flip into allowing stored fats to be released from storage and then broken down and burned as fuel rather than glucose (these are two separate things, releasing from storage and burning, so beware if anyone talks about "burning belly fat" - you cannot burn it until your insulin level is low enough to allow it to be released). In this state - you will also up-regulate ketone production.

Ketones can also be burned as fuel, and critically can pass into the brain to be used as fuel there - fats are just too big to cross the blood-brain barrier.

Thinking about all of that then makes sense - the body should naturally be flipping between taking in food and storing energy, and then using that stored energy when food is not available. When it does that it also makes energy that the brain can use. Insulin is the key to all of that, and you can see clearly that if insulin is always high, it's always going to be 'stuck' in energy storage.

There is obviously more to it than that, but as a kind of self-contained story - that works.

 

[Chris24Main]

Just nipping in to the side here - private testing showed many years ago that I had an underactive thyroid, but the NHS test didn't, probably because it wasn't as comprehensive a test. I also have intermittent but frequent racing heart issues, so it all fits in. Sometimes I feel as if I am in a pitch-dark room with one light switch that I can't find. Thank goodness no apparent (to me)cognitive/depression problems, and keto has massively helped my overall health.

Nips back out of thread.

Not at all, your insights are as illuminating as anyone's.

Just my path down the rabbit hole, but I can't help but see this pattern:
1. Diagnosis - your sugar is all too high - everything is about the level of sugar in your blood.
2. understanding T2 - Actually, it's not just about sugar, it's glucose throughout the body, and insulin.
3. blood glucose under control - actually it's really about insulin resistance, lowering insulin is key
4. heading to remission - actually, it's not just about food, stress and sleep are critical
5. improving health - actually, it's not even just about the gut and liver- the thyroid and sympathetic nervous system override everything.
6. improving healthspan - actually, all your cells are in a constant fight for energy without getting burned; it's all about oxidative stress and inflammation.

The trouble is, the entire medical mindset for all of this is stuck at 1.

 

[Chris24Main]

@Bcgirl and @Melgar - I have a feeling that the two of you can really learn something from each other. Other than the acute β-cell failure that must have been present for me for a while, and then then question of whether a period of insulin gave my pancreas a rest to allow recovery, there is no evidence that my pancreas is anything other than normal now.

However - if I can just dip my toe into what may be unwanted territory - there are those (Ben Bikman obviously coming to mind, but not at all the only example) - who say that Hashimoto's is a direct result of insulin resistance.

More than that, in this thread, over and over, I've simplified insulin resistance by describing is as a natural reaction to too much of a thing.. but when you talk about it like a cellular biologist, elevated insulin is only one of the major causes - the others being stress hormones and inflammation.

anything that ends with -itis is inflammation.

So then, you get into a positive feedback loop - inflammation can cause insulin resistance, and insulin resistance can cause inflammation.

Kind of like saying "a spark can cause fire, and fire can cause sparks"

On the one hand, that doesn't help - it's just an annoying and banal truism - on the other, understanding the relationship between sparks and fire; it's beyond common sense that you would not worry about defining what a spark is, you would look to put the fire out.

And that's kind of where I am right now - the more complicated things get - the more connections you can see, but the more that the simple concepts just help everything - even a completely healthy body is constantly in a battle between things that inflame cells (toxins, infections etc), or cause them to produce energy in a non-optimal way (oxidative stress) that cause the same inflammation from the byproducts (think of smoke from a fire not burning properly) like ROS - that we may recognise as free radicals.

Our systems for dealing with all of that are even more complex, but for many of us, they are ether overwhelmed dealing with the effects of high blood glucose, or toxins from all sorts of modern changes to the living environment, or just plain go rogue, leading to the auto-immune conditions.

Make it as easy as possible for your anti-inflammatory crew.

 

[Melgar]

@Bcgirl and @Melgar - I have a feeling that the two of you can really learn something from each other. Other than the acute β-cell failure that must have been present for me for a while, and then then question of whether a period of insulin gave my pancreas a rest to allow recovery, there is no evidence that my pancreas is anything other than normal now.

However - if I can just dip my toe into what may be unwanted territory - there are those (Ben Bikman obviously coming to mind, but not at all the only example) - who say that Hashimoto's is a direct result of insulin resistance.

More than that, in this thread, over and over, I've simplified insulin resistance by describing is as a natural reaction to too much of a thing.. but when you talk about it like a cellular biologist, elevated insulin is only one of the major causes - the others being stress hormones and inflammation.

anything that ends with -itis is inflammation.

So then, you get into a positive feedback loop - inflammation can cause insulin resistance, and insulin resistance can cause inflammation.

Kind of like saying "a spark can cause fire, and fire can cause sparks"

On the one hand, that doesn't help - it's just an annoying and banal truism - on the other, understanding the relationship between sparks and fire; it's beyond common sense that you would not worry about defining what a spark is, you would look to put the fire out.

And that's kind of where I am right now - the more complicated things get - the more connections you can see, but the more that the simple concepts just help everything - even a completely healthy body is constantly in a battle between things that inflame cells (toxins, infections etc), or cause them to produce energy in a non-optimal way (oxidative stress) that cause the same inflammation from the byproducts (think of smoke from a fire not burning properly) like ROS - that we may recognise as free radicals.

Our systems for dealing with all of that are even more complex, but for many of us, they are ether overwhelmed dealing with the effects of high blood glucose, or toxins from all sorts of modern changes to the living environment, or just plain go rogue, leading to the auto-immune conditions.

Make it as easy as possible for your anti-inflammatory crew.

Thanks @Chris24Main , just a quick reply on your thoughts around Hashimoto’s . I believe you have to have the gene variant for it, just like T1 DM. I think it is DR3/4. Which is also one of the clusters for T1DM amongst many. I haven’t looked that up recently, it’s from memory, but I believe that is the gene variant. Then of course, it may well be IR and other stimuli that trigger the attack, but without that variant you will not get Hashimoto’s.

ed spelling.

 

[Melgar]

Melgar, don’t be sorry for the questions. It’s so odd that nothing was found on your ultrasound, you must be so frustrated. Before my pancreatitis I wasn’t feeling well, I had extremely itchy skin and just wasn’t 100%…doctors were thinking I was crazy. I begged to have my thyroid tested and that’s when I found out I had Hashimotos. Not much later I suffered the pancreatitis. It was very severe and was ultimately the cause of the damage that is seen today. I was on insulin in the hospital but didn’t need it for long. i was told to eat a low fat diet and that’s about it. Now I eat fat with no problems but I tend to fill up quickly and feel I don’t digest well, always an “off” stomach. I used to use the enzymes from Costco , but think I need to find something that more geared towards fat digestion. They are lactose free but do contain lactase-so they won’t work for you. Our health store has lots of options, now there’s a news year’s resolution for me!
The pancreatitis caused my body to go into menopause, the stress was incredible.

i truly hope you get some answers on your doctor visit…

Thanks @Bcgirl . To be honest by the time I had the Ultra sound, my pain symptoms had all but gone away. It all last about 5 weeks with the pain, the 5 days of high fever, then the dull throbbing abdominal ache, the nausea, the bloating and the rest of it. I am just left with the digestive mess. No doubt I will have another bout of it, as this last bout was my third and the worst yet. I had the ultra sound anyways, too late I guess as it had all died down, but no gall or kidney stones were detected. I will call an ambulance the next time so they catch it when it’s all happening. I also worry about not being taken seriously. I do have a high pain threshold. The pain I went through surpassed it. Not indigestion, not GERD nor gas , but something completely different and radiating into my back. High blood sugars the lot.

Interesting you had itchy skin, I have that too, but I dismiss it because it’s winter. Although by the sounds of it yours was a thing, whilst mine is merely annoying.

I looked up the enzyme pills and noted they contained lactase. Is your pancreas stable now @Bcgirl? Are you on these enzyme supplements for life ? Do they believe you will be able to maintain your blood sugars with diet alone, or will you eventually have to go on some blood sugar lowering meds/insulin? My lactose intolerance came out of nowhere about 20 years ago. I was brought up dairy farming too so lots of fresh milk, no problems at all. So the lactose intolerance was adult acquired. Also now my body cannot tolerate gluten without an entire repertoire of symptoms. I did have peptic ulcer disease around the same time as the lactose intolerance. They were convinced it was the HP bacteria. Three times they tested me for it, two in the UK , once in Canada , all negative. I think the peptic ulcers, and I had many ulcers, was the coeliac.

So the pancreatitis caused your early menopause. I wonder what the science is behind that trigger, hormonal disruption I guess as the pancreas is a vital organ.

It’s good that you can eat fat now. I hope I will be able to at some point as it’s not sustainable to be fat free.
Thanks Bcgirl.

 

[Melgar]

Just nipping in to the side here - private testing showed many years ago that I had an underactive thyroid, but the NHS test didn't, probably because it wasn't as comprehensive a test. I also have intermittent but frequent racing heart issues, so it all fits in. Sometimes I feel as if I am in a pitch-dark room with one light switch that I can't find. Thank goodness no apparent (to me)cognitive/depression problems, and keto has massively helped my overall health.

Nips back out of thread.

lol.
Yep, I get mild tachycardia too. Strange

 

[Chris24Main]

just a quick reply on your thoughts around Hashimoto’s . ~, without that [genetic] variant you will not get Hashimoto’s.

You understand that there is no conflict here - maybe it's worth me clarifying - I'm in no way saying that insulin resistance -> Hashimoto's by itself.

The way that we are led to think is that because genetic thing A, we will have medical outcome B. But it (of course) is not as simple as that. Having a genetic disposition is just that, the gene is more likely to express in a certain way under certain conditions. Back to the spark and the tinder - you need both. In this case the genetic pre-disposition (to Hashimoto's, but it could be Familial Hypercholesterolemia, or many, many others - Alzheimer's, even T1DM, or obesity rather than T2DM) is the tinder and insulin resistance is the spark. or rather - lots of sparks..

Then - to stretch the analogy, if your system is knackered from always putting out the fires, it can get out of control, but if your underlying level of inflammation is low, your body may be able to cope with ... whatever and put the fire out.

 

[Chris24Main]

Oh - and of course there is a connection between Estrogen and Oester (pagan goddess of fertility where the English speaking world gets the name of the spring festival co-opted into Easter) - so that makes me wonder how Androgens (of which Testosterone is the most obvious example) got their name.


... oh - that's even more simple - Andros in Greek is just - "man" -

 

[Melgar]

You understand that there is no conflict here - maybe it's worth me clarifying - I'm in no way saying that insulin resistance -> Hashimoto's by itself.

The way that we are led to think is that because genetic thing A, we will have medical outcome B. But it (of course) is not as simple as that. Having a genetic disposition is just that, the gene is more likely to express in a certain way under certain conditions. Back to the spark and the tinder - you need both. In this case the genetic pre-disposition (to Hashimoto's, but it could be Familial Hypercholesterolemia, or many, many others - Alzheimer's, even T1DM, or obesity rather than T2DM) is the tinder and insulin resistance is the spark. or rather - lots of sparks..

Then - to stretch the analogy, if your system is knackered from always putting out the fires, it can get out of control, but if your underlying level of inflammation is low, your body may be able to cope with ... whatever and put the fire out.

Totally agree. Funny thing is I have that Hashimoto‘s variant, but touch wood never got it, so yes you can have the genetic disposition and it never manifests, but what I would say is this, if you don’t have that genetic variant you will never get it regardless of any environmental , internal triggers, such is the way of autoimmune disorders: T1DM, Graves, RA, Lupus et al.
My inflammation is not that low. My C-Reactive proteins could be a lot lower.

 

[Bcgirl]

Thanks @Bcgirl . To be honest by the time I had the Ultra sound, my pain symptoms had all but gone away. It all last about 5 weeks with the pain, the 5 days of high fever, then the dull throbbing abdominal ache, the nausea, the bloating and the rest of it. I am just left with the digestive mess. No doubt I will have another bout of it, as this last bout was my third and the worst yet. I had the ultra sound anyways, too late I guess as it had all died down, but no gall or kidney stones were detected. I will call an ambulance the next time so they catch it when it’s all happening. I also worry about not being taken seriously. I do have a high pain threshold. The pain I went through surpassed it. Not indigestion, not GERD nor gas , but something completely different and radiating into my back. High blood sugars the lot.

Interesting you had itchy skin, I have that too, but I dismiss it because it’s winter. Although by the sounds of it yours was a thing, whilst mine is merely annoying.

I looked up the enzyme pills and noted they contained lactase. Is your pancreas stable now @Bcgirl? Are you on these enzyme supplements for life ? Do they believe you will be able to maintain your blood sugars with diet alone, or will you eventually have to go on some blood sugar lowering meds/insulin? My lactose intolerance came out of nowhere about 20 years ago. I was brought up dairy farming too so lots of fresh milk, no problems at all. So the lactose intolerance was adult acquired. Also now my body cannot tolerate gluten without an entire repertoire of symptoms. I did have peptic ulcer disease around the same time as the lactose intolerance. They were convinced it was the HP bacteria. Three times they tested me for it, two in the UK , once in Canada , all negative. I think the peptic ulcers, and I had many ulcers, was the coeliac.

So the pancreatitis caused your early menopause. I wonder what the science is behind that trigger, hormonal disruption I guess as the pancreas is a vital organ.

It’s good that you can eat fat now. I hope I will be able to at some point as it’s not sustainable to be fat free.
Thanks Bcgirl.

I think I need to clarify. My pancreatitis did not directly cause menopause. My body’s fight for survival did that…I was very, very sick, my organs were failing . The body is an amazing thing!

My Hashimoto’s, I believe, is a direct result from inflammation , as to this day I am not insulin resistant.

 

[Chris24Main]

So - that is where it really gets interesting -

As I say - I've often talked about insulin resistance being like too much of a good thing, and there is some use to thinking about it in that way, but it over-simplifies to the whole body - whereas insulin affects every cell in every organ in multiple ways, and it is possible to become insulin resistant very quickly in some tissues, having never had the classic build up of elevated insulin, leading to insulin resistance over a long period.

one of the key drivers of insulin resistance at the cellular level is.... inflammation - so your statement could be true, but also including insulin resistance, without you ever being classically insulin resistant the way we tend to think of it.
I'm a bit out of my depth here though, and would have to re-read the section in "why we get sick" where Ben Bikman breaks down the connection.
And as usual - I don't mean to assert that I'm right -