Session 3 - The Type 2 Diabetes Cycle Transcript

Size: px

Start display at page:

Download "Session 3 - The Type 2 Diabetes Cycle Transcript"

Helena Richard
5 years ago
Views:

1 Session 3 - The Type 2 Diabetes Cycle Transcript Essentially type 2 diabetes needs to treated with medications due to our modern lifestyle. Unfortunately it has been shown that only a very small minority of people will change their lifestyle significantly enough to make a difference to their diabetic condition. For doctors this leaves only one option and that is medications. Type 2 diabetes is known as a metabolic problem and a difficult one at that. Today many young people are becoming diabetics. This is a modern day phenomena. We will be exploring later on just how this has come about. Although drugs are very helpful in cases where high sugar levels cannot be addressed by lifestyle change it should also be noted that all drugs have side effects and whilst they may be very beneficial to address a problem, like high sugar levels often they can cause other issues. Interestingly in our modern age, because of an enormous amount of research and science it is widely accepted that insulin resistance leads to obesity and obesity leads to insulin resistance. Once a person has this metabolic control problem, diabetic related diseases start to slowly set in. These are problems like coronary disease which eventually leads to heart failure, high cholesterol is usually prevalent often with the multitude of other diabetic related issues like other organ failure including the liver. High sugar levels if not addressed always leads to poor health, which leads to a poor quality of life and ultimately an early death. Although our medications work well to reduce high blood sugar levels it also needs to be understood that ultimately these medications can impact on health in a negative way as well. Just like with many medications negative side effects may not be visible immediately, what we do know is that these medications do not address the cause of the issues of why the diabetic condition has occurred in the first place. We will have a closer look at how medications can have a negative impact. One thing to understand here is that in the absence of a lifestyle change your doctor has prescribed for you the best chance you have of dealing with the diabetic condition that you have. It is extremely important that you understand this and if you ever do make lifestyle changes your doctor should be the only person that determines what changes to make to your medication. Lets explore some facts. At the end of 2008 on December the 17 th a paper was published in the New England Journal of Medicine. It was reported that a aggressive use of blood sugar lowering medication for the prevention of heart disease was actually a failure. It was shown that the use of these medications ultimately made the the patients gain more weight and also made them hypoglycaemic. A following study the ACCORD trail (Action to Control Cardiovascular Risk in Diabetes confirmed the initial results that a 22% increase in the rate of death was occurring in diabetic patients who were being aggressively treated with sugar lowering medication. How can this be? 1

2 The first key point to understand here is that there there is a logic being used with sugar lowering drugs, and that is that if blood sugar levels are brought down to a normalised level then the level of health must also be better. It is widely believed that lowering blood sugar levels even by using medications is doing people a big favour. There is a really obvious question that needs to be asked at this point. Here is the scenario. The sugar enters your body, it is in your blood stream and then it is lowered with medications. The question is where has the sugar gone? The answer to this question is that most often it is stored as fat or alternatively the sugar is forced into the cells which then perish because the cells can't use sugar. So what can a diabetic patient do? What can a person whose blood sugar is starting to rise do to get the situation under control. For most of us as we were diagnosed and the doctor was writing up the first prescription of sugar lowering drugs we were also told that changing our lifestyle can make a huge impact. To come up with correct answers to these questions one must first have a clear understanding about the subject. Having this understanding will enable you to appreciate why as diabetics we are advised that we should change our lifestyle. Lets now have a look at the question of blood sugar. The first thing to understand is that our blood is not very sweet. If we were going to quantify the sugar level we could say that the normal fasting sugar level in our blood is around one teaspoon of sugar for every five litres of blood. The question now is what happens when you consume a soft drink that contains 10 teaspoons of sugar? When we consume any food and that includes fat, the insulin levels start to rise. It is also a well known fact that higher amounts of refined carbohydrates or sugars will accelerate the increase of insulin. These are known as high GI foods. When we have a greater amount of fibre in our food this increase is slowed down. This would be a lower GI food. A key point to understand that the slower the increase of insulin the more controlled the process is. Upon consuming a big meal regardless of the type of calories there is a big spike in insulin and this of course is hard to manage. Once sugar appears in the blood stream the way that it is dealt with is with the use of insulin. The pancreas makes the insulin. As we have mentioned before in type 1 the pancreas is unable to produce the insulin, in type 2 the pancreas is producing the insulin. Lets have a closer look at what function the insulin performs. Insulin is a taxi for the sugar in your blood stream. While we are thinking about the elevated sugar level after a bottle of soft drink lets not forget that the sugar has an important aspect to it. Sugar is calories as well. Insulin being the taxi for sugar has one goal and that is to take it to a range of locations in your body. These are locations that require the sugar. In someone that is active the sugar is much more likely to be needed in by the body cells including muscle cells. This is why it is also important for a type 2 diabetic person to have an appropriate exercise program. 2

3 Blood sugar is fuel for the body. Your brain even needs sugar, otherwise it cannot do its functions. Following a meal insulin, the taxi for sugar picks up its sugary passengers and is busily transporting its passengers to the appropriate places looking for cells that require sugar to function and perform. When a person is healthy a massive 60% of consumed sugar is dropped of at the liver. The liver is actually a sugar warehouse. It is stored there so it can be used when your body requires fuel. This is usually the time between meals. Something really interesting happens once the sugar goes into storage. When it is put away for storage it is converted into a substance called glycogen. Insulin is released by the pancreas in two different stages. The pancreas is able to pre-produce and store some insulin. It is just waiting for you to eat. When food enters the body this stored insulin is released, In other words the sugar taxis are out there picking up the first set of passengers and taking them immediately to the places that need the sugar for fuel. The second phase starts to occur once the release of stored insulin occurs. This release triggers the pancreas to start making more insulin to deal with the rest of the meal. In a high GI meal where masses of sugar are dumped into the blood stream the pancreas has to go into overtime to produce enough insulin to deal with the passenger saturated taxi ranks. While you are eating some of the insulin transports the blood sugar to what is know as the white adipose tissue. This simply means that the sugar is stored as fat! The sugar is absorbed by fat cells. This is important as the storage of fat also actives the cells metabolism. Once the cells metabolic process is switched on a hormone by the name of leptin is produced. The Leptin no enters the blood stream and the place where it want to go is straight into the brain. The simple equation is: The more you eat the more insulin you produce and the more leptin you produce. So what is with the Leptin? Well the leptin has a incredibly important function. When the leptin levels reach a certain point meaning they are high enough your brain registers that you have eaten enough. In other words you are full. When this point is reached the pancreas receives a signal to tell it that no more insulin production is needed and so the pancreas stops producing insulin as no more taxis will be required. If the appropriate amount of food is eaten to match the physical activity the sugar or the fuel always has somewhere healthy to go to. If this is the case the production of insulin rises and falls in a nice smooth and controlled manner. This is the way it should be. The question is what on earth happens when there is to much fuel? At this point the insulin asks for some help. It starts to stimulate the production of triglycerides. Triglycerides are there to help deal with the access sugar or fuel. It is converted into fat which is then stored in our body as fat cells. This is how people gain weight, become overweight and then obese. There is another major problem here. As triglycerides increase they stop the leptin from making its way into the brain. This means that the I am full switch is not turned on and you keep eating more and more. This is known as leptin resistance. The problem with leptin resistance is it encourages even more insulin driven triglyceride production which simply means that you are even more likely to gain weight. We now come to an interesting point. If you were to stop eating to much and you were to increase your physical activity you would most likely bounce back to normality. In other words the correct balance is 3

4 restored. This is of course where the idea of eat less and exercise more to loose weight comes from. So what is with Type 2 diabetes? How does this fit into the picture? If you were to continually eat to much and in turn keep gaining weight the cells in your body start to get really tired of seeing these taxis with their sugary passengers driving past. It is like, here we go again. Seriously how many taxis are going to drive up to my front door? I mean how many passengers do these guys want me to take? After a while the cells close the front door. The windows are closed and the cell just will not accept any more passengers. The reason why this happens is simple. If the cells were to take on more sugar when they are full, the extra sugar would caramalise and kill the cells. You see the cells closing and locking the front door, then the back door, then the sliding door on the side and then the windows is most likely a self protection mechanism. Now you can start to imagine what happens if this problem goes on. Firstly blood sugar levels keep rising, the insulin resistance gets worse, leptin resistance keeps increasing, cholesterol levels start to elevate, blood pressure goes up, triglyceride levels go up. All of this in the end becomes type 2 diabetes. From there the risk factors start to pile up. Heart and kidney disease are now on the agenda. So now what is with the diabetic medications? Surely they address all these problems. Well not exactly. The issue for any of the blood sugar medications is that they only address one of the many things that don't work in a diabetic, all while they create their own side effects which in the end lead to other complications. Although certain things are addressed by medications they are really a temporary solution as they don't address the true source of the problem. There is no doubt that in a case where the patient does not want to address the source of the problem for whatever reason, the drugs are extremely important. Also when a person is first diagnosed where sugar levels may be out of control drugs can be very important to ensure that the problem is bought under control. The point is that long term, as important as the drugs are, the root of the problem still exists. When a combination of drugs is used to to and address multiple aspects of the problem the side effects can stack up quickly. This really means that that the risk starts to outweigh the benefits. And in the end, the root of the problem still exists. So what do the medications do? The medications either forces the sugar into the cells and because of this they eventually perish or the sugar is stored away as fat which of course in turn makes the leptin problems worse and then the insulin problems become almost impossible to solve. Each medication does have short comings and so do diabetic medications. This is acknowledged in scientific literature. Interestingly the idea that a diabetic person snacks to maintain sugar levels also is being questioned. In a healthy person when no meal has been consumed for 3 or 4 hours insulin levels will return to a baseline. At this point the pancreas makes a different hormone called glucagon. This hormone tells the sugar warehouse, the liver to release the sugar which is being stored as glyogen to ensure that the blood sugar levels are sustained. When this happens the livers fat burning system is switched on. This means that that because of the influence of the glucagon the liver uses both sugar and fat to sustain blood sugar levels. 4

5 This now becomes a true fat burning time. This is the time where any lingering levels of tryglycerides are also cleaned up. When a person snacks on anything over 30 calories the insulin starts to elevate which in turn switches off the glucagon which switches off the fat burning. It also slows the release of sugar from the liver. Because the liver is full of stored sugar the insulin can't get any more in as it would under normal circumstances. You see you are meant to have a snack between meals but this snack is supposed to come from the liver. The worst thing for leptin and insulin is actually eating between meals, eating large meals, eating little fibre, eating highly refined sugar, or refined carbohydrates. Eating after diner makes things worse because it is in a prime time to burn fat. Because a person does not eat during sleep the body normally switches on the fat burning to maintain sugar levels. Most people have a 8 hour fast in every 24 hour period, is is called sleep. Also when our bodies system is abused and weight is gained fat accumulates in excess in the liver. The fat clogs up the livers metabolic balance, this in turn reduces the ability of the liver to store sugar following a meal. This is known as liver insulin resistance caused by fatty build-up. This means that this type of person is likely to become hypoglycemic or to have low sugar levels between meals. This same fatty liver issue hinders the way that glucagon burns fat between meals causing the glucagon to synthesise sugar in a totally out of control way making the blood sugar go high during long periods where no food has been consumed, this includes that eight or so hours that we sleep. This is why diabetics when they measure their sugar levels in the morning find that they can be very high. As you can see all of these metabolic problems start to stack up and become a lot harder to solve than just a simple case of insulin resistance. This however is no the end. This is where it starts to become unbelievable. From here the pancreas starts to tune out leptin. This means that leptin resistance occurs at the beta cell level, this causes the beta cells top get the incorrect information which means that the message to stop making insulin is not getting through. This means that now extra insulin is produced which in turn lowers the blood sugar excessively but now that extra sugar is turned into you guessed it fat! At the same time hypoglycaemia is induced which means that now low blood sugar symptoms are experienced which in turn makes you eat again. This usually happens around two to four hours after the meal but the continual eating makes the whole problem worse. It is usually around this time when the metabolic system is broken and not functioning like it should be that a person ends up going to the doctor just to find out that they have type 2 diabetes. At this time the doctor will prescribe a medication to try and bring the problem under control. If the problem is allowed to continue the next progression is that inflammation begins the process of damaging the insulin secreting beta cells. These cells now have two issues to deal with. Not only are they leptin resistant which as discussed is causing them to overproduce insulin which of course tires them out which in turn means that they are being damaged and now their number is on the decline. This now means that insulin production is declining. This now sends a person down a very dangerous path and that is that type 2 diabetes starts to slowly turn into type 1 diabetes. This is seen more often in older type 2 diabetics and at this stage they are now 5

6 injecting insulin. You see it is not only insulin resistance that we have to think about but also the leptin resistance. I understand that as you are listening to this it all makes sense and that for most of us as we leave here you won't be able to repeat all of this in such detail. It is actually quite hard to remember the step by step chain reaction. For that reason you have in your notes a point by point description. The most important thing to understand here that this is not just a simple case of insulin resistance. Type 2 diabetes is often very underestimated. The reality is that the explanation that you have just heard is a simplified version. The truth about type 2 diabetes is that this is a very complex metabolic problem where it is not just about sugar levels but the breaking the whole human body. To get over this problem it is important to have a slightly deeper understanding. As the fat cells get bigger they start to crowd out each other. At this point a highly inflammatory state occurs within the adipose tissue. Inflammatory signals then aggravate and lock in the issues that we have been discussing earlier on. This is where another hormone come into the picture. This time the hormone is in fat. It is the adiponectin protein hormone. It is responsible for regulating metabolism including glucose or sugar and fatty acid catabolism, in other words their usage. This now becomes a major player in the whole equation. In a healthy state leptin and adiponectin protein hormone elevate together. When leptin resistance occurs, and this is common for people gaining weight then the adiponectin protein levels begin to fall. The fall in the adiponectin proptein hormone is caused by the the inflammation in the white adipose tissue. You can imagine what happens as this situation progresses. The weight gain eventually totally overwhelms the adiponectin protein hormone. This is the point where serious problems take set in. Once adiponectin protein hormone levels fall to much the next issue becomes apparent. At this stage the inflammation in the fat cells really ramps up. The greater the weight gain and leptin resistance the more the adponectin protein hormone levels fall. This fall means that the livers ability to process sugar and insulin is degraded. This is the point where the muscles become resistant to insulin. This now just speeds up the progression of type 2 diabetes. But that is not all. To make matters worse the brain becomes insulin resistant. This is actually caused by the leptin resistance. This problem now locks in all the problems of insulin resistance around the whole body. There is now a lot of research that indicates that the failure of insulin and leptin to register properly in the brain along with falling adiponectin protein hormone levels creates a highly inflammatory state in the body and that this becomes the prime cause of worsening blood sugar regulation which eventually leads to type 2 diabetes. Diabetic medication does not address these issues. Often over time it can make things worse. This is true even if blood sugar levels appear to be better for a period of time. The reality is that treating blood sugar numbers is not treating the cause of anything. It s like saying well it is raining my swimming pool is overflowing so I will just turn off the hose. It does not fix anything. Unfortunately there is no quick fix for type 2 diabetes. To be healthy fasting blood sugar levels should never be over 5 mmol/l. The point to remember here is that real health is determined by achieving this number because the body is 6

7 working correctly. No vitamin, mineral or even miracle pill can automatically prevent or treat diabetes. The only way that this can happen is is to create a nutritional environment that supports the body to work normally. People with a simple case of insulin and leptin resistance when they cut back on sugar loaded foods or junk foods and exercise can usually bring smaller problems back into line fairly quickly. When the disease has progressed much further and may be complicated by the fact the the liver, pancreas, white adipose tissue, circulatory system and even the subconscious brain have been compromised or even damaged by the inflammatory compounds it will take much longer to heal. This now is not just a simple nutritional deficiency, it is now a major problem that was caused by a nutritional deficiency over a longer period of time. In addition the liver, muscles and circulation system are clogged with accumulating fat. You now have a problem that is as hard to fix a a car in workshop that is messy dirty and has missing tools. It is going to be hard and challenging to say the least. 7

21 Diabetic Myths Exposed

21 Diabetic Myths Exposed Disclaimer: Nothing in this ebook should be taken as complete medical advice. You should always seek the advice and treatment from certified and qualified medical personal. Contents