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Diabetes: A New Explanation

A new study (Journal of Clinical Investigation, September 26, 2016) shows that many cases of diabetes are caused by:
• taking in too much sugar that has been extracted from plants (corn, sugar cane, sugar beets, apples, grapes and so forth), and
• taking in excess calories and storing those extra calories as fat in the liver. This study suggests that diabetes can be prevented and cured with lifestyle changes.

Normally when your blood sugar rises for any reason, your pancreas produces large amounts of insulin which stop the liver from making new sugar. However, when you eat sugar, particularly fructose, it activates an enzyme in the liver called Carbohydrate-Responsive Element-Binding Protein, (ChREBP) to force the liver to make huge amounts of additional sugar and prevents insulin from doing its job of stopping the liver from making more sugar. That means that a diabetic's inability to lower high blood sugar is caused primarily by dietary sugar preventing the liver from responding to insulin which is supposed to stop the liver from making new sugar.

This study shows that no matter how much insulin the pancreas makes, eating sugar causes the liver to make excess ChREBP that prevents the liver from responding to insulin and the liver then converts extra calories to sugar as well as the fat that it normally produces. The extra sugar made by the liver causes blood sugar levels to rise even higher which causes insulin levels also to rise higher. The cells in your body eventually stop responding to insulin and you become diabetic. As blood sugar levels rise higher and higher, some of the sugar is converted to fat which is deposited in the liver to make the liver produce even more ChREBP which makes the liver make even more sugar (Hepatobiliary Surg Nutr, Apr 2015;4(2):101–108).

How Too Much Fat in the Liver Causes Diabetes
When blood sugar rises too high, the sugar is funneled to the liver which converts most of the excess sugar to a type of fat called triglycerides. Some of the fat is converted to energy, some passes back into the bloodstream and a large amount of fat ends up stored in the liver to cause a fatty liver. Your liver is supposed to protect you from developing high blood sugar levels. When blood sugar levels rise too high, the pancreas releases insulin which lowers high blood sugar levels by driving sugar from the bloodstream into the liver. However, if the liver is full of fat, it does not accept the sugar from the bloodstream and blood sugar levels remain high to cause diabetes and cell damage.

The Diabetes Epidemic
Today, more than 29 million people in the U.S. are diagnosed as being diabetic and another 86 million have pre-diabetes. Sixty percent of North Americans over 65 suffer from diabetes or pre-diabetes; and most diabetics have not even been diagnosed (Diabetes Care, February 2009).

Many cases of diabetes can be cured by:
• avoiding refined carbohydrates, particularly sugar, that cause the highest rises in blood sugar levels, and
• eating less food and exercising more to rid your liver of excess fat (Cell Reports, June 6, 2016).
Gastric bypass surgery was first reported to cure some cases of diabetes in 1995 (Ann Surg, 1995;222:339–350) by causing people to lose weight (Current Opinion in Clinical Nutrition & Metabolic Care, July 2011;14(4):396–401) which removes fat from a diabetic's liver. Some diabetics may have to rid themselves of most of the fat from the rest of their bodies before they will get enough fat out of their liver.

Why Your Liver Must Make Sugar
Your cells use mostly sugar and fat for energy. You have an almost infinite amount of fat in your body, but only enough sugar in your bloodstream to supply your brain with energy for three minutes. If your blood sugar level drops, your brain suffers from lack of energy, and your brain can die and so will you. Therefore, your liver constantly makes and releases sugar into your bloodstream. Your liver can only store enough sugar to last 12 hours at rest and for about 70 minutes when you exercise vigorously. When you need more sugar than what is stored in your muscles and liver, your liver can make new sugar from fat and protein, a process called gluconeogenesis. When your liver is damaged, your gut and kidneys can also make sugar from fat and protein.

Fruits and other plant parts that contain sugar also contain fiber, including soluble fiber, that binds to sugar and slows its absorption into the bloodstream, preventing blood sugar levels from rising too high. However, when sugar is extracted from its plant sources and added into processed foods and drinks, it is immediately available for absorption from the intestines into the bloodstream to cause high rises in blood sugar. Also, the amount of sugar that manufacturers add to processed foods is usually higher than what you would consume in a portion of fruit or vegetables. You would need to eat three whole apples to get as much sugar as you get in an average serving of soda, dessert or candy.

Signs That You May Have High Blood Sugar Levels
If you have any combination of the following risk factors, suspect that you may be diabetic or pre-diabetic and check with your doctor:
• store fat predominantly in your belly, rather than your hips
• overweight
• exercise fewer than three times a week
• high blood pressure (systolic >120 at bedtime)
• HDL (good) cholesterol lower than 40 mg/dL
• triglyceride level greater than 150 mg/dL
• HBA1C greater than 5.7
• fasting blood sugar greater than 100
• sugar two hours after eating greater than 110
• history of diabetes during pregnancy or birth of a baby weighing nine pounds or more
• family history of diabetes
• thick neck
• polycystic ovary syndrome
• dark, thick skin around neck or armpits (acanthosis nigricans)
• history of blood vessel disease (heart, brain, or legs)
• member of a high-risk ethnic population (e.g., African-American, Hispanic/Latino-American, American Indian, Alaskan Native or Pacific Islander)

Diabetes Can Be Cured with Lifestyle Changes
Drugs may help to control diabetes, but no drugs available today can cure diabetes; you can become non-diabetic only with lifestyle changes. A diabetic who loses weight gets some fat out of the fat cells throughout the body, including the liver. Those who are able to clear their liver of excess fat with a small amount of weight loss may cure their diabetes. However, many diabetics, particularly those who have had diabetes for several years, must lose large amounts of body fat before they clear fat from their liver. These people will not be cured until they lose a lot of weight and become thin to get enough of the fat out of their liver to become non-diabetic. Please see my recent reports on Who Gets High Blood Sugar after Meals? and How Exercise Prevents and Treats Diabetes

My Recommendations
• If you have type II diabetes, you can usually become non-diabetic by losing weight, exercising, avoiding added sugars and other refined carbohydrates, and treating any vitamin D deficiency to get your hydroxy vitamin D blood level above 30 ng/ml.
Storing Fat in the Liver
Lifestyle Changes to Prevent and Treat Diabetes

• If you are overweight or are already pre-diabetic or Type II diabetic (non-insulin dependent), check with your doctor to see if you may benefit from Intermittent Fasting to help you lose weight permanently. 

December 24th, 2016
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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