More than seventy percent of North Americans adults will become diabetic or prediabetic; diseases that are curable with lifestyle changes and not curable by drugs. Insulin insensitivity (failure to respond to insulin) causes the majority of all cases of type II diabetes and prediabetes, and insulin insensitivity is caused by excess fat in the liver (J Clin Invest, May 19, 2020). This study shows that the ability of insulin to lower high blood sugar levels is best in people who are skinny and have normal livers. As people gain weight, they become insulin insensitive, even if they do not have excess fat in the liver. When they have excess fat in both the body and the liver, they are already insulin insensitive and therefore diabetic or prediabetic.

How Excess Body Fat Leads to Diabetes
• After you eat, your blood sugar level rises
• Your pancreas releases insulin
• Insulin lowers blood sugar by driving sugar from your bloodstream into your liver and muscles
• Your liver and muscles can store only a limited amount of sugar
• So all extra sugar that cannot be stored is converted to fatty triglycerides
• Extra triglycerides damage your blood vessels, so insulin drives triglycerides from your bloodstream into your liver, fat cells and muscles
• Your fat cells fill up with fat and you become fat
• Your liver cells fill up with fat and you develop a fatty liver
• Fat in your liver prevents your liver from accepting sugar from your bloodstream, so you stop responding to insulin and become insulin insensitive (Gastroenterology, 2008;134(5):1369–1375)
• The more fat you have in your liver, the greater your insulin resistance (Gastroenterology, 2008;135(1):122–130)
• The higher your insulin levels, the more fat you deposit in your liver (Hepatology, 2014;59(6):2178–2187) because insulin resistance causes even more fat to be deposited in your liver (J Clin Invest, 2020;130(3):1453–1460)
• Insulin resistance causes you to deposit fat in your belly so that you end up looking like an apple with a large belly and small buttocks (J Clin Invest, 1986;78(6):1648–1657)
• Since sugar can’t get into a fatty liver, your blood sugar rises higher and higher and you are diabetic. It is the liver fat, and not muscle fat, that causes diabetes (Proc Natl Acad Sci USA, 2009;106(36):15430–15435)
• Being fat without having excess fat in your liver does not cause diabetes (Obesity, 2010;18(8):1510–1515)
• A high blood sugar causes sugar to stick to the outside membranes of cells and damage them
• Insulin resistance and the resultant high blood sugar levels can damage every cell in the body to cause inflammation that causes heart attacks and cancers (Diabetes, 1992;41(3):368–377)
• As a person loses weight, liver fat is reduced and the person becomes better able to respond to insulin (Cell Metab, 2016;23(4):591–601)

My Recommendations
If you want to prolong your life, you should get excess fat out of both your fat cells and your liver. Just about everyone who has a big belly and small buttocks is already diabetic or pre-diabetic as they preferentially store fat in their livers. To prevent fat from getting into your liver, you have to prevent blood sugar levels from rising too high after meals. You can do this by:
• Exercising before or after you eat. Contracting muscles remove sugar from your bloodstream without needing insulin.
• Basing your diet on vegetables, fruits, whole grains, beans, nuts and other seeds.
• Severely restricting foods with added sugar and all sugared drinks including fruit juices, mammal meat, processed meats, and fried foods. If you are overweight, also restrict sources of refined carbohydrates such as bakery products, pastas, white rice, milled corn, and most dry breakfast cereals.