Understanding the Development of Type 2 Diabetes

From the September 2003 edition of Dr. Fuhrman's Healthy Times:

The heavier you are, the greater your risk of developing type 2 diabetes. For certain susceptible individuals, even a moderate amount of excess fat on the body can trigger diabetes.

Your body's cells are fueled by glucose. When you have excess fat on your body, the extra coating of fat around your cells makes it difficult for the hormone insulin to transport glucose into the cells. To overcome this problem, your body produces additional insulin, which is manufactured by your pancreas. Adult diabetes is a disease of insulin resistance, not one of insulin deficiency.

Dangerous weight gain

As little as five pounds of excess fat on your frame can inhibit the ability of insulin to carry glucose into your cells. When you have twenty pounds of extra fat, your pancreas may be forced to produce twice as much insulin. With fifty or more pounds of excess fat on your frame, your pancreas may be forced to produce six to ten times more insulin than a person who is lean.

What do you think occurs after ten or twenty years of overworking the pancreas? That's right, it becomes exhausted and loses the ability to keep up with the huge insulin demands. As time goes on, even though your overworked pancreas may still pump out much more insulin than a thinner person might need, it won't be enough to overcome the effects of your disease-causing body fat.

The pancreas's ability to secrete insulin continues to diminish as the diabetes and the overweight condition continue year after year. Unlike with type 1 (childhood onset) diabetes, total destruction of insulin-secreting ability almost never occurs in type 2 (adult onset) diabetes. But the sooner a type 2 diabetic loses the extra weight causing her diabetes, the greater the likelihood that she will be able to maintain a functional reserve of insulin-secreting cells in her pancreas.

Taking insulin dangerous for type 2 diabetics
The damage caused by higher than normal insulin production (as a result of excess body fat) begins years before a person is diagnosed as being diabetic. Excess insulin promotes atherosclerosis, which in turn leads eventually to heart attacks and strokes.

Findings from numerous studies have shown that hyper-insulinemia promotes atherosclerosis even in non-diabetics. In diabetics, the effects of excess insulin are even worse. In a study of 154 treated diabetics, the prevalence of blood vessel disease was greatest in those with the highest levels of insulin. It made no difference whether the insulin was endogenous (self-produced) or exogenous (taken by injection).

Quite a few studies illustrate the dangers of giving insulin to adult diabetics. When these patients are given insulin—compared with those given metaformin (Glucophage)—the risk of death from heart attacks tripled.1

Additional problems
When you give an adult diabetic who has been suffering from the damaging effects of excess insulin for years more insulin to drive her sugar level down, you create additional problems. Giving the diabetic patient insulin increases appetite, which causes significant weight gain (often more than 20 pounds), which makes the patient more diabetic. Thus, the administration of insulin creates a vicious cycle that cuts years off a person's life.

Exposure to insulin in injectable form can create a blood vessel wall injury that is an early step in the formation of atherosclerotic lesions. Insulin both blocks cholesterol removal and delivers cholesterol to cells in the blood vessel walls, accelerating the creation of atherosclerotic plaque. Simply put, it increases the risk of cardiac death. Almost 80 percent of all deaths among diabetics are due to atherosclerosis, particularly coronary artery disease.

Since the level of insulin in your blood is a good predictor of your risk for heart attack, and since a tape measure around your waist is nearly as good a predictor of insulin levels, it makes sense to remember the ancient saying, "The longer your waistline, the shorter your lifeline."

Although an elevated cholesterol increases mortality somewhat in the non-diabetic, a diabetic's risk for death increases fivefold for each twenty points that cholesterol is elevated above normal. The bottom line is this: if you have diabetes or know anyone with diabetes, they must get rid of their diabetes and not merely "manage it." Do not rely on standard drug methods of treating diabetes, especially injecting more insulin. An aggressive approach based on nutritional excellence is the only effective way to reverse this dangerous condition.

A tough situation
Conventional diabetologists are in a bind. They know that high glucose levels accelerate aging of the eyes and kidneys, leading to devastating complications such as kidney failure and blindness. They want to prescribe aggressive insulin therapy to get patients' blood sugars down. The problem is they also are aware that the extra insulin accelerates atherosclerosis (which leads to heart attacks) and weight gain (which eventually makes patients more diabetic).

Tightening blood sugar control with insulin is risky business. Diabetologists engaging in this conventional medical practice are endangering their patient's lives. The risks are so great, I consider it malpractice to start giving insulin to type 2 diabetics without offering the option of treatment utilizing nutritional excellence.

Dangerous advice
The American Diabetes Association and most dieticians and physicians offer dangerous advice to the diabetic. They give lip service to weight reduction and cholesterol lowering, but since the diets they recommend are ineffective at achieving substantial weight loss and sustained ideal weight, even these recommendations are generally worthless. Typical diabetes care focuses on general glucose control, by monitoring blood glucose to determine when it is necessary to change insulin dosages and when glucose-lowering medication is warranted.

Here is a policy statement from a physician organization dictating diabetic care: "It is nearly impossible to take very obese people and get them to lose significant weight. So, rather than specifying an amount of weight loss, we are targeting metabolic control." This is doublespeak for—"Our recommended diets don't work, so we just give medications and watch patients deteriorate."

Most effective approach
How can diabetics safely lower the high glucose levels that are slowly destroying their bodies? How can they lower their lipids and blood pressure, lose weight, and avoid taking dangerous drugs, such as insulin and sulfonylureas? They need to adopt a diet based on nutritional excellence.

Fortunately, the best diet for good health and longevity is also the best diet for diabetics. It is a diet with a high nutrient per calorie ratio, as carefully described in my book, Eat To Live. When you eat a diet consisting predominantly of nature's perfect foods—green vegetables, beans, eggplant, tomatoes, mushrooms, onions, garlic, raw nuts and seeds, and limited amounts of fresh fruit, it becomes relatively easy to eat as much as you want and still lose your excess weight. In my experience, those who follow my nutritional recommendations find that their diabetes disappears astonishingly fast, even before most of their excess weight melts away.

Predictable success
I have achieved marked success with diabetic patients and the success at becoming "non diabetic" or almost "non-diabetic" regularly occurs on the Eat To Live program whether the patient follows a strict vegan diet or not. I describe the diet-style as a "vegetable-based" diet because the base of the pyramid is vegetables, not grains. Even though most animal products are excluded, it is not necessary to adopt a completely vegan diet to achieve the goals.

I offer patients the choice of adding two servings a week of low-fat fish, such as tilapia, flounder, sole, and scrod, as well as an egg-white omelet, once or twice each week. A few servings of very low-saturated-fat animal products each week can be interspersed with the vegan meals without diminishing the results achievable from the vegetable-based diet.
1. Zoler ML. Insulin may boost cardiovascular risk in type 2 diabetes patients. Family Practice News May 15, 2001. p6.
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