The catalyst for diabetes?

I was disappointed but not surprised with the ABC Catalyst program called ‘Curing Diabetes‘ that aired last week.

The most important question that it did not answer, was what causes diabetes, and why is it so difficult to cure?

These are the key questions that I have my patients understand, so they can start reversing the impact of this insidious disease.

Diabetes comes about due to the body’s inability to store, or ‘put glucose away’.

Think of glucose being stored away in a cupboard. Those cupboard-spaces in our body are the liver, muscles, organs and fat cells. Insulin is the hormone that chaperones glucose away into these ‘cupboards’.

Why do we need to store glucose away?

Glucose in excess is sticky and acidic, and damages and niggles fats and proteins inside the body. Think of it like sticky honey, hot lava or like when a fruit bat poos on your car. That thick goo will strip paint back to bare metal.

So the body needs to keep just 5 grams (a teaspoon) in the bloodstream at any one time, just in case we have to run up a set of stars,run around with the kids or flee from a burning building. Any excess is stored away as an intermediate fuel (glycogen) and the rest? It is stored away as fat.
                      

Think of glucose as a single paperclip of energy. Sugar or ‘sucrose’ is a clip of fructose and glucose bound together. ‘Starch’ or carbohydrates are like a string of paperclips. So if we eat a piece of bread, fruit, cereal, rice, popcorn, corn thin or biscuit, the body just simply snips these chains of paperclips into single ones so we can absorb the glucose.

High fibre foods like bran may slow down the body’s ability to ‘snip’ a chain of starch into singular paperclips, but given this digestion starts occurring in our mouth, then stomach and small intestine, the body is quite efficient at ‘snipping’ chains into simple clips of glucose.

If we eat too much carbohydrate-heavy food over years and decades, the body starts ‘running out of cupboard space’ for all this glucose, and insulin (released by the pancreas) can’t store away as efficiently (insulin resistance). The  pancreas then has to release more and more insulin, to literally shove this glucose into already bulging cupboards (fat cells or fatty liver). This is why we crave carbohydrates, as the brain also becomes insulin resistant and it can’t access the glucose in your bloodstream, so it orders you to eat (so you eat whatever is close, and that usually means biscuits, chocolate and lollies).

Eventually, the bulging cupboards ‘leak’ fat back into the blood (triglycerides), glucose can’t find a home as there is no cupboard space, and insulin continues to rise to try and push both fat and glucose into now-saturated, overcrowded and inflamed fat cells. It’s a vicious circle.

We then have the very inflammatory ‘holy trinity’ of fat, glucose and insulin roaming our blood like vigilantes, burning, slashing, acidifying and irritating. Because these substances can’t leave our bloodstream, they go ’round and ’round like little bits of lava floating through our blood, inflaming and damaging. So what gets damaged? Our arteries become inflamed and irritated and atherosclerosis and high blood pressure result. The fine, fragile capillaries in our brain, kidneys, toes, eyes, ears and heart become damaged and we lose function (dementia, heart disease, macular degeneration/cataracts, neuropathy (nerve pain), migraines, kidney damage and tinnitus).

The little fragile spheres or lipoproteins (LDL and HDL) that diligently and harmlessly transport our fat and cholesterol around our body also get caught in this glucose maelstrom.  Cholesterol and fat are like orbiting satellites, coming face-to-face with a meteor storm and being badly damaged and then spinning wildly and out of control around our bloodstream. This is what causes damage to our heart and arteries, and manifests as atherosclerosis or ‘high cholesterol’. And we blame and take cholesterol-lowering medication to reduce the number of ‘satellites’ rather than blame the ‘meteor shower’ of excess glucose/insulin, and leaking fatty acids due to the overconsumption of carbohydrates (not fat).   

    
Our digestive tract isn’t spared as it is full of wafer-thin capillaries, smooth muscle and nerves and this rampaging ‘holy trinity’ surges through our gut like white-water rapids full of debris and razor-sharp rocks. What symptoms manifest? Reflux, irritable bowel syndrome, bloating, pain, nausea, constipation and flatulence.

So my question has to be why, on this ‘Curing Diabetes’ episode, are the guests told to fill up on foods that the body will try and cram into already overflowing fat cells? Why all the carbohydrate-rich food like low-fat muesli, a wrap, bread, fruit and low-fat yoghurt?

                  

Patients did successfully lose weight on this program, yes. They lost weight because of a deficit of food, NOT because it fixed the underlying issue of diabetes (excess carbohydrates). It did nothing to educate the patients to understand why they got diabetes in the first place or how to beat it. They were just told to ‘get healthy’, ‘eat healthy’, ‘buy healthy’ and ‘move more’. I don’t think they really knew why.

We must do better than patronisingly telling our patients to ‘get healthy’. We must tell them exactly how they got unhealthy (diabetic) in the first place, so when if and when they do get better, they know exactly why.

Now have a look at the amount of carbohydrates this patient has been told to eat daily. Each 5 grams of carbs is about one teaspoon of glucose ‘in the body’. So 164 divided by 5 is 33 teaspoons of glucose. This is how much the body needs to use up every day, or it will store it away as fat. No wonder we can’t lose weight! This glucose will also irritate and damage the body as the bloodstream gets flooded with this sticky, acid-like goo.

                   

Trying to ‘run off’ all this glucose before the body even thinks about using up some of the patient’s fat, would mean running a huge amount of kilometres. As well, because blood glucose and insulin remains elevated in the blood stream (or insulin resistance, as glucose refuses to be stored away), the body won’t be inclined to ‘burn fat’ as it is too busy trying the keep the ‘doors on the bulging cupboards’ firmly shut. And whilst there may be an initial loss of weight, hunger, fatigue, a plateau may occur and the patient gives up and goes looking for the next diet or finally gives up and signs up for bariatric surgery.

This is the prime reason why diets like this will ultimately fail because patients get hungry due to the low levels of fat in the diet. Fat fills us up, it improves satiety, it tastes good, it is full of goodness that can be easily absorbed. It is slow, steady stream of fuel like putting big logs of wood on the fire rather than twigs (paperclips of glucose). These twigs will burn quickly, brightly, cause a big peak of available energy, then will burn out and we will have to put yet more twigs on the fire. This is the snacking/grazing carbohydrate rollercoaster that we spend our whole lives on. It is a boom or bust scenario.

It is not about fat-bombs, butter coffee or eating mountains of whipped cream and bacon. It is about eating quality fats like meat, seafood, dairy, avocado, eggs and nuts/seeds and frying with butter, ghee, coconut oil, dripping/lard and olive oil.

So if it’s not fat that causes diabetes, why all the low-fat food? 

The fact of the matter is that fat barely causes a blip in blood sugars and insulin. Yes, it is neutral. Protein may cause a small increase, but the one macronutrient that will cause a big kick up (then down) is carbohydrate. This is proven physiology. 

Excess carbohydrates (or carbohydrate intolerance) is the root cause of diabetes. Absolutely, stress and poor sleep play a large part, but I am focusing here on diet.

Where are the foods that are going to fill this patient up like eggs, red meat, salmon, nuts/seeds, and full-fat dairy? Where are these foods that are going to smooth out the glucose, insulin and diabetic peaks and troughs?

If we cannot get the science right for our patients, what hope have they got of getting off the diabetic treadmill?

Now take a look at this food comparison and its impact on blood glucose. It compares a sandwich, apple,yoghurt and chocolate to a high-fat meal of steak and eggs. It is like a volcano eruption compared with a barely noticeable tremor. Notice the dip of blood sugar at the 4-hour mark? This will manifest as irritability, shakiness, hunger, sleepiness and carb-craving. This is classic hypo (low) glycaemia (blood sugar) and your brain will force you into eating some more quick carbs to increase blood glucose (and the vicious circle starts all over again).

So what would you rather, a boom/bust, exhausting and ‘lava-like’ fuel or a steady, reliable source of cooler-burning fat and ketones?
           
(source: dietdoctor.com)

Again, it comes back to unlearning the myths of the past like ‘fat clogs arteries’ and ‘fat makes us fat’. What makes us fat and damages fragile fats/cholesterol is the excessive amount of carbohydrates we eat.

Carbohydrates are not a ‘health food’. They are not the primary source of fuel for the body, brain and heart. We don’t need to eat carbohydrates for fibre (there is more fibre and less glucose in avocado, greens, nuts/seeds, shredded coconut and tahini).
                                     
But hold your horses Mr Nutritionist, a lot of the foods they mentioned were ‘wholegrain’ and that’s what I always eat.

This is a myth that needs to be put to bed once and for all. The majority of bread, cereals and snacks touted as ‘wholegrain/wholemeal’ are just the same as refined or ‘white’ carbohydrates.

Whoa boy-this is alarming stuff.

Its true. The grains in these foods are ground up so finely almost to the consistency of talcum powder so when they are absorbed, they push your blood sugars and insulin very high. Have a look at this research and the graph below. The insulin increase trying to quell the blood sugar spike is almost identical between the brown, wholemeal and white breads due to the fact they all are highly processed foods. The highest response? It was the so-called healthy wholegrain bread.

In fact, the wholegrain bread had a higher spike than the white bread because of the talcum-powder grind effect. And this would be same for the majority of breakfast cereals-they are like rocket-fuel in the body. The research states: “that generally the whole-grain breads did not have what could be interpreted as beneficial, metabolic responses”

                  
OK, Mr Nutritionist I’ll give you that one, but alot of the carbohydrates mentioned on the program were low GI weren’t they?

In fact we were told they were low GI, but in fact they weren’t!

(Glycaemic Index is a measure that shows how quickly glucose rises in the body after eating a particular food)

These ‘low GI foods’, banana, rice (even brown), sushi, wraps, low-fat muesli are all actually medium GI and they can still send your blood sugars to the moon and back and keep you diabetic.

Another very important fact to keep in mind is that the GI Index has a huge error-rate (up to 30% has been quoted in research). This recent paper summed it up very well: “the GI value is considered to represent the inherent property of the food and not the metabolic response of an individual to the food”. So GI is specific to food, NOT your response to it. So what might be low, medium or high on the packet, could be the 180 degree opposite in your body. The GI Index is great in a test-tube but don’t rely on it to make you ‘non-diabetic’. The chances are it could be making you worse.

“But surely fruit is healthy Mr Nutritionist…it ‘must’ be healthy right?’

I get asked this almost every day. And the straight answer is that if you are trying to lose weight, reduce the impact of diabetes, reduce all that inflammatory gunk in your blood then fruit is not for you. Like carbohydrates in general, fruit is not a ‘health food’. In fact even small amounts of fructose can worsen fat storage (lipogenesis), worsen free fat floating like meteors in your blood (de novo lipogenesis), worsen blood pressure and gout. So please treat fruit with respect and don’t think because it isn’t a Tim Tam, that you can go for your life. In fact, I have my patients abstain from nearly all fruit until their health starts improving. This research paper or this one, are excellent for some background  

To balance out all my criticisms of the show, I would strongly recommend you watch it as there are some excellent points made, especially the need to increase muscle, and the visceral or organ-fat (sumo-wrestler) segment is very well done. It also shows how stress and poor sleep can derail your best intentions of sticking with a ‘healthy diet’.

But do you know who I am most concerned about after watching this program? The chef Michael Moore. He had a stroke brought on by diabetes at 45yo and ‘changed his ways’. Take a close look at Michael. In my opinion, he still at high risk of another stroke, heart attack or diabetic complications. He has significant central adiposity, would almost certainly have a great deal of visceral fat and doesn’t seem to have a great deal of muscle. He is the classic ‘skinny fat. 

                            

What worries me is he seems very ‘ruddy’ and I would almost bet a pound of butter, that he has high blood pressure, gout and sugar swings. What concerned me most was the advice he gave to one of the diabetics: ‘have carbohydrates with every meal as it gives you energy’ and ‘you can’t just have steak and salad’. Lines like this should be of another, unscientific era, but they are still being uttered. (And a bread salad was one of the dishes he served to a diabetic). Madness!

I’ll look past the conflicts of interest of the presenter Joanna McMillan and the fact she is paid by a cereal and olive oil company and the fact she calls herself a ‘nutrition scientist’, when in fact she is a dietitian. 

What I struggle to look past is programs like this are allowing us to ‘sleepwalk’ towards diabetes, obesity and all the complications that come with it, because they accept the status quo and don’t challenge it.

                              

Millions of Australians have diabetes and millions will die prematurely from the complications of diabetes, the number one being cardiovascular disease. Heart disease in on the rise again after decades of decline, and kidney, brain, digestive and eye disease are rising due to diabetes.

With shows like this, diabetes isn’t going to be ‘beaten’. I for one am making a stand as a catalyst for change, rather than a catalyst or apologist for diabetes

I am a regular on ABC Radio Brisbane if you would like to have a listen to past episodes or you can watch some short videos that may explain in a simple way, complex ideas.  

If you would like to book an individualised appointment, simply do thaton-line.

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