Explanations of Type 2 Diabetes

I started with a question: Is there an agreement that insulin resistance is involved in type 2 diabetes? I just wanted to know what the popular websites that people would be researching type 2 diabetes would be saying about the causes (etiology) of this disease. What I found was there is generally a hypothesis that type 2 diabetes being caused by either insulin resistance or a failure of the pancreas to produce sufficient insulin. I would suggest that these are different metabolic states, perhaps distinct or perhaps related etiologies. If we accept that the progression is from insulin resistance to lowered insulin output, at least in a large subset of people with type 2 diabetes, then treating insulin resistance should be the focus, not low insulin and not high blood sugar. But all of this is better explained by Dr. Jason Fung. Here are the quotes I found about the causes of Type 2 Diabetes:

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2015 Dietary Guidelines for Americans rescinds restrictions on dietary cholesterol

From the 2015 guidelines (in Part D. Chapter 1: Nutrient Intake and Nutrients of Concern):

Previously, the Dietary Guidelines for Americans recommended that cholesterol intake be limited to no more than 300 mg/day. The 2015 DGAC will not bring forward this recommendation because available evidence shows no appreciable relationship between consumption of dietary cholesterol and serum cholesterol, consistent with the conclusions of the AHA/ACC report. Cholesterol is not a nutrient of concern for overconsumption.

Hopefully this will be the end of this particular debate. However, this does not mean that all high cholesterol foods are now healthy. Factors people should still pay attention to include quality and amount of processing. When foods high in cholesterol are heavily processed increased amounts of the cholesterol can become oxidized, which is health concern. Foods like butter and eggs can be health promoting when they come from good sources and potentially detrimental when they come from poor sources. However, it is nice that the guidelines have corrected this after only 35 years of being wrong. Credit where due.

A few other notes about this change:

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Why conclusions in recent research on whole grains can be dismissed

From the abstract conclusion of Association Between Dietary Whole Grain Intake and Risk of Mortality:

“These data indicate that higher whole grain consumption is associated with lower total and CVD mortality in US men and women, independent of other dietary and lifestyle factors.”

True. Continuing:

“These results are in line with recommendations that promote increased whole grain consumption to facilitate disease prevention.”

False. This conflates correlation and causation. The correlation tells us nothing about whether consuming whole grains has a positive effect on health, or whether those with better health choose to eat more whole grains, or some other mechanism is in place to explain the correlation. The data from this study cannot even disprove the hypothesis that whole grains are detrimental to people’s health. How can that be? Let us delve into deeper detail.

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“The Two Big Lies of Type 2 Diabetes”

Dr. Jason Fung sums up 2 of the big myths about type 2 diabetes and presents an hour long lecture going into more detail (which I recommend watching for those interested in this subject):

At the Intensive Dietary Management Clinic we treat many people with type 2 diabetes.  Patients often come to our clinic with two ‘facts’ established in their minds.  The first is that type 2 diabetes is a chronic and progressive disease.  They are often told that they will have the disease for the rest of their lives and they should get used to it.  Actually, it is not true at all.  Type 2 diabetes is an entirely curable disease.  However, taking medications will not cure the disease.  Only dietary management has a hope of reversing diabetes.

The other big lie in the treatment of type 2 diabetes is that ‘it is all about controlling blood sugar’.  Actually, it makes virtually no difference at all.  The disease of type 2 diabetes is excessive insulin resistance.  It is this insulin resistance that leads to high blood sugars.  In order to treat/ cure diabetes, you must reverse the insulin resistance.  The high blood sugar is only the symptom, not the disease.  Therefore, treating the symptom alone is useless.

— The Two Big Lies of Type 2 Diabetes – Video Lecture

I would quibble with the language of that last sentence. Treating symptoms can be beneficial but I understand he means that treating this symptom will not help reverse the disease.