The Trouble With Diabetes Isn't the Glucose, It's the Insulin

May 16, 2021

The Problem with Diabetes Isn't the Sugar, It's the Insulin

We have had an increase of diabetes in America and around the world of unprecedented magnitude. We are increasing at about 10% a year, and our health care system has been helpless to decrease it. Some 60% of people in America are on the path to getting it. What gives?

The clue comes in a unique experiment done almost twenty years ago by Ron Kahn's lab at the Joslin Clinic. The core idea from his experiments was that blood glucose is actually a red herring. It's not the problem. The problem is INSULIN resistance. Blood glucose is just a symptom. Your blood insulin is only partially related to your glucose level. The experiment was to genetically knock out insulin receptors in different tissues in lab mice, and then watch what subsequently happened. Every tissue has insulin receptors. Brain, fat cells, brown fat, muscle, pancreas beta-cells, blood vessels, and kidneys were the tissues they chose. All the mice got sick in one way or another, but only the liver and brain knock-outs got high blood sugar. Only the brain knock-out became obese and developed metabolic syndrome. And to put the final irony, the kidney knockout didn't get high blood glucose but got the kidney disease of diabetes anyways.

WHOA! This has huge implications. The logic is a bit complex but nevertheless compelling. It's not the glucose. It's the insulin that causes the illness.

If you think it through, we see the same effect in humans. Insulin deficient type I diabetics take 20 plus years to get kidney disease. But type II adult-onset diabetics already have the kidney disease before they get the high blood sugar. Why? Because they have had surreptitious insulin resistance for years that was not diagnosed. Their insulin level was over 5 and no one blew the whistle.

Why this dichotomy? Insulin is a two-edged sword. It helps control blood glucose, that's one edge. But it also serves as a proliferative agent. It increases the growth of cells. In the heart and kidney, those cells are the smooth muscle cells in the walls of the arteries, and you get heart attacks and kidney failure as a result. (This has been proven in every intensive insulin program ever done: you reduce blood glucose but raise risk of chronic disease. Bummer.)

What causes insulin resistance? We've known this for 20 years, but it somehow doesn't quite bubble up to the top. Finally, a recent review acknowledges that fructose, half of table sugar, (sucrose is glucose and fructose stuck together) is the real enemy. It drives metabolic syndrome starting with insulin resistance in the liver. Soon thereafter, hypertension shows up too.

Fructose is the enemy. But fructose is in every liquid calorie you drink that is manufactured using high fructose corn syrup. Fructose is in almost every prepared food you eat, every mouthful of ice cream you eat, and on and on. Fruit is some 6% fructose, so even that contributes a little but our body appears to be able to handle the quantity that comes with fruit. But more than two servings of fruit a day and LDLs will go up.  But fructose was never in any food prior to this century.  Real food does not have fructose in it.  Period.

What is so awful about fructose? You can't slow it down. It floods into your liver and demands attention. You have no controls or gates that limit how quickly it gets into your liver. It has to be labeled with a phosphate group from ATP, which exhausts your ATP supply. You get an oversupply of acetyl-CoA in the liver and the liver cell panics and switches to making fatty liver. The fat globules accumulate. And that's the beginning of insulin resistance. Guess how badly Big Food wants you to understand this. Guess how much lobbying money goes into not regulating it?

How do you reverse diabetes? It's not weight loss per see, though that may be extremely helpful. You reverse diabetes by focusing on the insulin resistance and your insulin level. This is where the power of intermittent fasting works. By compressing calories into an 8 hour window, your body has burned up it's glycogen stores in 10-12 hours and you then have at least 4 hours of running on ketones, which means the pressure on your insulin evaporates. The first ketones to go are from your fatty liver. As you reduce fatty liver, your metabolic syndrome fades. Or, once a month fast mimicking. Same thing. But you start by stopping the sugar, high fructose corn syrup in particular.

www.What will Work for me. I've measured my insulin on day 5 of my fast mimicking behavior when I eat 800 calories a day for 5 days: 50% fat and 50% green vegetables. It's been as low as 2. Otherwise, my insulin runs 7-8. I'm tip toeing along the edge of metabolic syndrome. So, I'm close to trouble. For the last month I've started skipping breakfast and eating my first meal at least 10 am. I want to see if I can get my A1c down below 5.6, where it appears to have been permanently parked. And no sugar, no sugar, no sugar.

References: Ann Rev Physiology, Critical Rev Clin Lab Sci, Nutrition and Metab, Penn Med News,

Pop Quiz

1. Through most of human history, when did we get sugar? Answer: Only in the fall when fruit ripened which we could get for a couple of weeks. Or, if we found a beehive. Sugar has shown up in our food supply only in the last 100 years in quantity.

2. And just what does sugar (fructose in particular) do to make metabolic syndrome? Answer: Insulin resistance.

3. Which comes first for adult-onset diabetics, the high blood glucose or high insulin? Answer: Insulin is way first. If you had observed the range of "normal insulin" in our labs in Southeast Wisconsin over the last 30 years, you would have noted that the "range of normal" has been creeping up every couple of years. The supposed normal range is now typically 3-29, depending which lab you use. It used to be 1.9-19 about 15 years ago. What happened in the interim? We have eaten more HFCS, ice cream, sugared sodas, ketchup....etc.

4. What is the cardinal first step in lowering your insulin? Answer: It starts in your fatty liver begging you to stop the fructose. Then, give your liver a break and let it burn up all the energy you stuffed into it with fructose by lengthening the time you don't eat each day. Get to 16 hours, your fatty liver will go away.

5. What is a healthy insulin level? Answer: Less than 5. Measure it. Pay heed if it's higher.

6. Can you take enough meds for diabetes to reverse the harm of fructose? Answer: No. Meds are just a bandaid to cover the symptom of high blood sugar. High blood glucose is the symptom. High insulin is the disease.