Why can't Type 2 be cured?

[IanBish]

I know that we can get it into remission, or reverse it, but not cure it.

I also know that insulin resistance is a precursor to type 2 diabetes, and here are some "reasons" that I've heard for insulin resistance / type 2 occurring:

* Fat (saturated, or seed oils, depending on who's theory you read) which gets deposited in the muscles thereby inhibiting the muscles to take up blood glucose.

* Too much insulin which, over time, the body reacts to gradually, making the muscles (and mostly everything else) insulin resistant, so more insulin is secreted, akin to how the body needs more and more of a drug over time to have the same effect.

* By exceeding your personal fat threshold, whereby the safe fat storage areas (under the skin) become full, and fat starts to be stored around the liver, pancreas and other internal organs.

So if we address the above issues, by not eating fat so as not to deposit it into muscles (which I don't buy), or reducing the insulin (by lowering carbs), or just losing non-subcutaneous fat (the unsafe fat), then why can't it be cured?

Here are my simple answers to my simple questions:

Q. If a cure is not possible, then is permanent remission possible?
A. Yes, as long we keep the carbs low.

Q. Why can't we cope with high carbs?
A. Because a high, processed carb diet hasn't been around long enough for us to adapt to it.

Q. Why can some people eat whatever they like without developing insulin resistance or type 2 diabetes?
A. Their genes can cope with it?

I still don't really understand what causes insulin resistance, and therefore type 2. I know our bodies are generally smart, and they must know what they're doing. But I guess that constant carbs in the diet, carb-heavy snacks (chronic elevated insulin) and never really going without food for more than couple of hours (to allow the insulin to drop), all takes its toll over the years, and something's got to give.

If anyone has any thoughts on the above, or any links which might explain things better, then I'd be grateful to hear them.

 

[AndBreathe]

I know that we can get it into remission, or reverse it, but not cure it.

I also know that insulin resistance is a precursor to type 2 diabetes, and here are some "reasons" that I've heard for insulin resistance / type 2 occurring:

* Fat (saturated, or seed oils, depending on who's theory you read) which gets deposited in the muscles thereby inhibiting the muscles to take up blood glucose.

* Too much insulin which, over time, the body reacts to gradually, making the muscles (and mostly everything else) insulin resistant, so more insulin is secreted, akin to how the body needs more and more of a drug over time to have the same effect.

* By exceeding your personal fat threshold, whereby the safe fat storage areas (under the skin) become full, and fat starts to be stored around the liver, pancreas and other internal organs.

So if we address the above issues, by not eating fat so as not to deposit it into muscles (which I don't buy), or reducing the insulin (by lowering carbs), or just losing non-subcutaneous fat (the unsafe fat), then why can't it be cured?

Here are my simple answers to my simple questions:

Q. If a cure is not possible, then is permanent remission possible?
A. Yes, as long we keep the carbs low.

Q. Why can't we cope with high carbs?
A. Because a high, processed carb diet hasn't been around long enough for us to adapt to it.

Q. Why can some people eat whatever they like without developing insulin resistance or type 2 diabetes?
A. Their genes can cope with it?

I still don't really understand what causes insulin resistance, and therefore type 2. I know our bodies are generally smart, and they must know what they're doing. But I guess that constant carbs in the diet, carb-heavy snacks (chronic elevated insulin) and never really going without food for more than couple of hours (to allow the insulin to drop), all takes its toll over the years, and something's got to give.

If anyone has any thoughts on the above, or any links which might explain things better, then I'd be grateful to hear them.

Remission, reversal and cure are emotive words in the diabetes community - for all types for a plethora of reasons.

For T2, I think much depends on how you look upon the condition and then manage it.

When diagnosed 10 years ago, I swam against the time with the relatively few rebel fishes and went low carb. I trimmed up (didn't have much to lose) and kept active, but mainly I adjusted my diet, guided by testing.

I was diagnosed in October 2013, and my A1c was 37 by February 2014, and it has remained under 35 since - mainly 31<>33.

I feel my dietary adjustments are now a way of life. I have minimal insulin resistance and now eat more carbs than I did in the early stages, however, I am still low carb, and in more recent years, I have gone gluten free (on medical advice).

I am well and quite happy with my lot. Some of the stuff I was eating pre-Oct 2013 clearly wasn't doing me any favours, so why would I want to revisit that loop again? I don't go with the "allergic to carbs" mantra, but I do go with "Certain foods don't suit my body" in my current lifestyle.

I do think a large part of how we do over the longer term, with any long term condition depends on our mental attitude. To be permanently "missing out" or to consider ourselves unwell does us no favours. Trust me, there are far, FAR worse long terms conditions to live with.

 

[IanBish]

I feel my dietary adjustments are now a way of life. I have minimal insulin resistance and now eat more carbs than I did in the early stages, however, I am still low carb, and in more recent years, I have gone gluten free (on medical advice).

I don't go with the "allergic to carbs" mantra, but I do go with "Certain foods don't suit my body" in my current lifestyle.

I do think a large part of how we do over the longer term, with any long term condition depends on our mental attitude. To be permanently "missing out" or to consider ourselves unwell does us no favours. Trust me, there are far, FAR worse long terms conditions to live with.

Thanks for the reply. I know that there are far worse LTCs to have.

Some people handle carbs better than others; I know that. I guess I was interested in the how and why that is. As well as the actual cause of IR.

 

[Paul_]

Too much insulin which, over time, the body reacts to gradually, making the muscles (and mostly everything else) insulin resistant, so more insulin is secreted, akin to how the body needs more and more of a drug over time to have the same effect.

From the resources I've read, everything seems to come back to insulin resistance when it comes to the question you've posed.

Now it may be that I'm missing something, my education/experience is science and maths based, but not medical, so most of the articles and studies out there get to a point where the finer detail is way beyond my comprehension. However, my basic understanding is that everyone is insulin resistant to some level, even if that's just a low level resistance. Some people, likely due to a combination of genetics, lifestyle, and (maybe) diet are at higher risk of developing higher resistance to insulin. Once that resistance reaches critical mass, you're T2 diabetic and multiple factors then come into play on top. First is that from what I've read, insulin resistance can be improved, but not cured. Second is that while trying to mitigate insulin resistance, the pancreas churns out insulin at increased rates, thereby causing permanent damage to pancreatic beta cells which can reduce its effectiveness/function in this process. Both of these then seem to be the reason for T2 diabetes not being curable.

I'm probably wrong, at least in part, and there are many people here who are far more knowledgeable on the subject. However, I love threads like this, so thought I'd throw my understanding out there as a basis of further discussion/critique.

 

[Paul_]

Q. Why can't we cope with high carbs?
A. Because a high, processed carb diet hasn't been around long enough for us to adapt to it.

Personally speaking, I feel the evolution argument is overplayed and flawed. Every diet going, be it keto, low carb, Paleo, low PUFA, WFPB, or whatever you want to pick, all try to claim "this is how we're meant to eat, it's what Caveman Dave ate!"

I'm less than convinced. I think the issue is that food manufacturing and production is based on using ingredients that don't naturally occur, or don't in the quantities being used in mass production processes. High fructose corn syrup, hydrogenated oils/fats, hormone and antibiotic ridden protein, and more man-made stabilisers, preservatives, artificial flavourings, and additives than you can shake a stick at. Most of the diets I named above and many more revolve around limiting these, then combine it with a forbidden evil (carbs, animal protein, fat, specific fats, amino acids etc).

These diets all have some theory about prehistoric humans, their diet and evolution. There's always a modern era tribe in some far flung region of the world that gets used to justify why their dietary approach is correct. What they all seem to miss is that for early humans and modern day tribes, nothing comes easy. They didn't/don't have sendentary jobs. They didn't/don't have a sofa in front of a TV. They didn't/don't have a kitchen stocked full of food, which was bought with little/no effort from a shop, which they drove to without expending any energy. Their lives were/are physically intensive, plus they lack(ed) access to any of those unnatural ingredients.

The issue isn't evolution in my opinion, it's that Western cultures (and an increasing number of non-Western ones) have a massive excess of unnatural calorific sources, which are consumed by people who are too sedentary to utilise that excess.

 

[IanBish]

From the resources I've read, everything seems to come back to insulin resistance when it comes to the question you've posed.

However, my basic understanding is that everyone is insulin resistant to some level, even if that's just a low level resistance. Some people, likely due to a combination of genetics, lifestyle, and (maybe) diet are at higher risk of developing higher resistance to insulin. Once that resistance reaches critical mass, you're T2 diabetic and multiple factors then come into play on top.

I understand that at puberty, for example, insulin resistance is deliberate, so it must be by design. The critical mass theory works. Just like there has to be a critical mass of salmonella, or other bacteria, ingested before we can deal with it and it makes us ill. I'm sure there are other examples.

However, I love threads like this, so thought I'd throw my understanding out there as a basis of further discussion/critique.

That's good. I hope a few other people do too, and throw a few ideas in here.

 

[IanBish]

I think the issue is that food manufacturing and production is based on using ingredients that don't naturally occur, or don't in the quantities being used in mass production processes.

What they all seem to miss is that for early humans and modern day tribes, nothing comes easy. They didn't/don't have sedentary jobs. They didn't/don't have a sofa in front of a TV. They didn't/don't have a kitchen stocked full of food, which was bought with little/no effort from a shop, which they drove to without expending any energy.

That's what I meant about the ultra-processed food that is so prevalent now. If we had been eating it a lot longer than the last 50 or so years, then maybe we would have adapted to handle it, to a smaller or larger degree, depending on the population group.

We had cars, fridges and grocery stores before the widespread cases of type 2. Plus, we apparently compensate for performing physical exercise by increasing appetite. So unless we deliberately go on a near-starvation conventional diet, there is no appreciable weight loss, because we eat more to make up for exercising more, thereby maintaining an overall balance.

 

[Grant_Vicat]

Thanks for the reply. I know that there are far worse LTCs to have.

Some people handle carbs better than others; I know that. I guess I was interested in the how and why that is. As well as the actual cause of IR.

Hi @IanBish - this is part of something I posted on Facebook yesterday. Hope it's of interest!
This term's edition of the Cambridge Alumni Magazine has an article by Professor Sadaf Farooqi titled "This idea must die: 'Obesity is caused by lack of willpower' " He was interviewed by Lucy Jolin. He says: The myth that obesity is simply down to a lack of moral fibre or willpower is simply not true - but it is incredibly pervasive." He mentions the discovery of the hormone Leptin, discovered in 1994 by Professor Jeffrey Friedman. This hormone controls our appetite. In 1997 it was demonstrated that a lack of Leptin causes obesity because of an unsatisfied appetite.

 

[ajbod]

But the question should be what causes the lack of Leptin, and what causes that to be non existent or insufficient.and on and on.
The medical profession etc only research how to treat the symptoms. It needs an engineers approach ie what causes the symptom in the first place.
Since virtually all the research is funded only by those with a vested interest in keeping people ill, so they can continue selling ever increasing amounts of medication. a cure is not the goal, and never will be. In fact if by pure chance a cure was discovered, it would certainly, and even may already have been suppressed.
If you had a squeaky hinge, the medical professions approach would be to put some oil on it, and when it does it again use more oil, or up the ante and use grease, and rinse and repeat as often as needed. The engineers approach would be whats causing it to squeak, find out why, and rectify that, then there is no problem to cause a squeak.
Food is far too readily available. People my age and older, were bought up to eat at meal times, (snacks would ruin your tea) etc, and eating in the street was frowned upon. So by default, living like that, our circulating Insulin levels were much lower than nowadays.
Eating anything causes a first phase Insulin response regardless of whether carbs are involved, so frequency of eating IS IMPORTANT, without enough time between consumption, Insulin levels cannot dissipate, so all the cells in the body, stay resistant to it.

 

[jaywak]

But the question should be what causes the lack of Leptin, and what causes that to be non existent or insufficient.and on and on.
The medical profession etc only research how to treat the symptoms. It needs an engineers approach ie what causes the symptom in the first place.
Since virtually all the research is funded only by those with a vested interest in keeping people ill, so they can continue selling ever increasing amounts of medication. a cure is not the goal, and never will be. In fact if by pure chance a cure was discovered, it would certainly, and even may already have been suppressed.
If you had a squeaky hinge, the medical professions approach would be to put some oil on it, and when it does it again use more oil, or up the ante and use grease, and rinse and repeat as often as needed. The engineers approach would be whats causing it to squeak, find out why, and rectify that, then there is no problem to cause a squeak.
Food is far too readily available. People my age and older, were bought up to eat at meal times, (snacks would ruin your tea) etc, and eating in the street was frowned upon. So by default, living like that, our circulating Insulin levels were much lower than nowadays.
Eating anything causes a first phase Insulin response regardless of whether carbs are involved, so frequency of eating IS IMPORTANT, without enough time between consumption, Insulin levels cannot dissipate, so all the cells in the body, stay resistant to it.

It is so frightening that I have to agree with everything you say .

 

[IanBish]

Hi @IanBish He mentions the discovery of the hormone Leptin, discovered in 1994 by Professor Jeffrey Friedman. This hormone controls our appetite. In 1997 it was demonstrated that a lack of Leptin causes obesity because of an unsatisfied appetite.

Thanks for the reply. I know about that hormone. In fact, Dr Paul Mason, mentions something that gets secreted higher up in the gut, that ultra-processed food bypasses, which helps with suppressing appetite. I forget what it was, and will have to look again.

Food is far too readily available. People my age and older, were bought up to eat at meal times, (snacks would ruin your tea) etc, and eating in the street was frowned upon. So by default, living like that, our circulating Insulin levels were much lower than nowadays.
Eating anything causes a first phase Insulin response regardless of whether carbs are involved, so frequency of eating IS IMPORTANT, without enough time between consumption, Insulin levels cannot dissipate, so all the cells in the body, stay resistant to it.

I agree. I was brought up like that, but over time did exactly what you mention. I now know, now it's too late, that that was the correct was of eating. High insulin causes your blood sugar to crash, causing you to eat to get your blood sugar up, because your brain thinks you're hungry. Not because you eat all the time because you're a glutton. I wish I'd known that earlier.

 

[AndBreathe]

Thanks for the reply. I know that there are far worse LTCs to have.

Some people handle carbs better than others; I know that. I guess I was interested in the how and why that is. As well as the actual cause of IR.

To be honest, it's a bit like some folks can eat as much fat as they like with no ill-effects, whereas if I do that, my relationship with the small room deepens to inseparable.

Whilst I can eat a lot more carbs than many others, before I was gluten-free, in my early days of learning how my body handled carbs, I found if I ate pasta, or pizza, the rise in my blood glucose was modest, but sustained, taking a couple of days to revert to the then usual levels.

In my view, there are a lot of factors in play with T2. I don't consider it to be a well defined condition, rather it came about as a result of naming a non-T1 diabetes, so is a bit of a bucket job.

To be honest, my steer would be to learn as much as you can about YOUR diabetes and how to manage that. That, for me, was key to accepting the condition and learning to live amicably with it.

Just as a curved ball, in the US, they have various statuses for T2, including a state which is after X amount of time maintaining a A1c of less than Y, without diabetes meds, which they label "Operational Cure".

 

[Lamont D]

The first phase hormonal response is changed by factors over time by diet, (I mean the increase in production foods), environment, modern living and changes in natural resources. Toxins and poisons we are exposed to.
This alters at the cellular levels and the gut biotics balance. Cells become what is known as inflamed and inflammation in the cells change the balance of hormones. The result in this, and the gut, brain axis, will endeavour to adjust the cells output. Insulin resistance increases due to the inflammation, more insulin is produced as well as leptin, and other hormones that affect the brain signals to the organs, glands, secretion levels. Natural cholesterol imbalance, fats, liver and kidney function, fatty liver disease, bowel issues, Crohns, and so much more.
I think one of the biggest changes was the wheat changes in the late fiftys, early sixties, when the alterations made to the make up the grain was altered to be more resilient and productive.
Not only gluten, but the reason behind the bold letters on all wheat products. And of course bleaching and over production.

As for the reason there is no cure, is because we have no reset button to how we could tolerate carbs.
We all have a tolerance level for carbs, and this is why, some can tolerate a lot, then at the other end of the scale, there is me. I am totally intolerant to carbs. I have been lactose intolerant since young, and told to avoid but since becoming intolerant to other foods and sugars over time, I keep getting told to eat them. Not advice I will even consider. We can not turn back The clock, but we can become healthier.

The last thing to consider, is the many conditions that endocrinology cover, the symptoms are very similar.
That is because of the hormones, we have so many, and research is only just scratching the surface.
Consider eating disorders. Hashimotos. And the rest.

And I wrote this without using scientific big words!

 

[Paul_]

Food is far too readily available. People my age and older, were bought up to eat at meal times, (snacks would ruin your tea) etc, and eating in the street was frowned upon. So by default, living like that, our circulating Insulin levels were much lower than nowadays.

This bit struck a chord with me. Although keto has reduced my appetite significantly, I do still get hungry. However, it's that traditional hunger most of us think of, where I get hungry in the hour or so leading up to a meal time. I don't feel the need to snack - and I was the Snack King before diabetes! Following diagnosis in July and starting low carb / keto, it occured to me as my diet progressed and I felt that traditional hunger sensation, that I couldn't remember the last time I'd felt hunger of any form before I was diagnosed. I was just constantly topping up, grazing my way through the day essentially, but using convenience and processed foods/snacks due to life. I must have been doing it for years. Like others commenting, it flies in the face of my upbringing, yet I came to consider it normal to never be hungry or go longer than an hour or two without shovelling something into my face.

Quite the problem we've created for ourselves as a species.

 

[IanBish]

@Paul_ You're spot on there. I used to snack all the time. Today, however, I haven't eaten anything since yesterday. I don't feel hungry, but I feel that I should eat something. I won't, but I feel like I should.

Indeed, it's a problem we've created ourselves. We ignore nature at our peril, I guess.

 

[IanBish]

As for the reason there is no cure, is because we have no reset button to how we could tolerate carbs.
We all have a tolerance level for carbs, and this is why, some can tolerate a lot...

And I wrote this without using scientific big words!

So it's carbohydrate intolerance, a phrase that I've heard a few times. I guess, for now, we have to go with that.

I can handle big scientific words. I just need to google some of them!

PS. I love your signature.

 

[IanBish]

To be honest, my steer would be to learn as much as you can about YOUR diabetes and how to manage that. That, for me, was key to accepting the condition and learning to live amicably with it.

Just as a curved ball, in the US, they have various statuses for T2, including a state which is after X amount of time maintaining a A1c of less than Y, without diabetes meds, which they label "Operational Cure".

That's a good idea. Don't get bogged down by the science so much, but try to live in harmony, individually, with the condition.

I quite like that US term. I may use that!

 

[MrsA2]

All my life pre -d, all I wanted was food, all the time. I used to get so cross when others could go long periods without even thinking of eating. It took so much will power to say "no" all the time, whereas others didn't even think of eating and so will power wasn't needed!

Now I've gone low carb I often don't need or want to eat and it's so liberating. I love it. I'm free!

I'd be interested to know when and how these urges/cravings start. Is it nature eg genes and/or environment or nuture eg habit, childhood teaching etc.

I think the answer to that may explain why some get T2 and some don't.

@IanBish you might be interested to read "Metabolical " by Robert Lustig who looks into several theories, including one where it may depend on what your mother ate while you were in utero, among others

 

[IanBish]

@IanBish you might be interested to read "Metabolical " by Robert Lustig who looks into several theories, including one where it may depend on what your mother ate while you were in utero, among others

I've already "read" an audiobook of that. It was interesting.

 

[Lamont D]

So it's carbohydrate intolerance, a phrase that I've heard a few times. I guess, for now, we have to go with that.

I can handle big scientific words. I just need to google some of them!

PS. I love your signature.

I have heard that myself but it is too narrow in its reasoning, that is why doctors call it glucose intolerance. Not only for the test but because of the response, to the glucose derived from what goes in your mouth.

There has been posters who have been told that after a series of tests, that there type of T2, is a long scientific gobful of something you can't understand or work out.

There are so many different types of T2, causes, hormonal, or just an imbalance of them.
We are all different and treatment should be tailored to the individual.
The treatment, dietary regime, is more important to the health of the individual.

Best wishes.