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Michael Warren

Professor Jean Widdison

Nutrition

10/30/17

A Dietary Perspective on Diabetes

According to the American Diabetes Association (ADA), 30.3 million Americans

were diabetic. In other words, 9.4% of the population. (American Diabetes Association) Of

those 30.3 million people, approximately 1.25 million had type 1 diabetes. These statistics

indicate that almost 96% of the diabetes cases are preventable and treatable, if not reversible.

The ADA also estimates that roughly 1.5 million more Americans are diagnosed every year,

not to mention the global trend. (American Diabetes Association)

A number of my own relatives are diabetic, most of whom are type 2, and todays

culture teaches that this disease is simply a part of life and that it will manifest in the life of

nearly every individual at some point. These data and beliefs paint a rather bleak picture for

myself and most people, but there is light at the end of the tunnel. In order to understand what

the light is, we must first understand a number of things about diabetes: what are insulin and

diabetes; my familys experience with treatment; my experience with prevention; and how an

understanding of human physiology can keep one safe.

No conversation about diabetes could begin, let alone be complete, without an

understanding of the hormone insulin and its role in human health. The ADA describes

insulin as a hormone that helps the body use glucose for energy. (American Diabetes

Association) A more useful explanation for our purposes today would be that insulin is the

hormone responsible for the storage of glucose into fatty tissue, muscle tissue, and liver

tissue, among others. (Diabetes Library) Insulin acts as an energy delivering service,
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whether it be to cells that require glucose for immediate energy production, muscle cells that

have been stimulated to grow and need glucose to do so, or liver and fat cells that act as

storage containers for excess glucose in the forms of glycogen and adipose tissue,

respectively. Insulin is produced and regulated by the pancreas to keep the amount of glucose

in the blood in check. Too much insulin removing blood glucose can result in hypoglycemia

(low blood sugar) and too little insulin can result in hyperglycemia (high blood sugar), of

which neither is desirable. In metabolically healthy individuals, the body releases the correct

amount of insulin as needed. In a study published in 1988, endocrinologist Gerald M. Reaven

shared the results of research he had conducted in the field of insulin resistance. He found

that insulin resistance promotes chronic hyperinsulinemia (the condition in which the

pancreas produces excessively quantities of insulin) as the bodys defense against chronic

hyperglycemia. (Reaven) He published a follow-up five years later confirming even more

strongly his findings, in addition to emphasizing the importance of treating insulin resistance

in patients who suffer from hypertension and coronary heart disease (CHD). (Reaven)

Food intake is the most common cause of insulin release, although research has

shown that merely seeing or thinking about food triggers the pancreas to release insulin,

likely in anticipation of a meal. (Rodin) Meal composition greatly affects the amount of

insulin released with carbohydrates being the most insulinogenic (insulin producing), protein

being less so, and dietary fat having the smallest insulin response. The physical state of the

food consumed also contributes to its insulin response. For example, a given quantity of

heavily processed carbohydrate, like white bread or sugar, is absorbed into the blood stream

much more readily than the same amount of sweet potato or broccoli. With this overview of

insulin, we are now prepared to look at the main subject: diabetes mellitus, or commonly,

diabetes.
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According to the U.S. National Library of Medicines Medline Plus website, diabetes

mellitus is defined as a chronic disease in which the body cannot regulate the amount of

sugar in the blood. (U.S. National Library of Medicine) Diabetes is commonly split into two

types: type 1 and type 2. Type 1 diabetes is an autoimmune condition in which the bodys

immune system mistakes the pancreass insulin-producing -cells for enemies and begins to

target and destroy them. Because these -cells are necessary for insulin production, the body

signals the pancreas to downregulate -cell production or cease production altogether,

depending on the severity of the condition. This type of diabetes can develop in anyone, but it

is more commonly diagnosed in children than in adults. The standard treatment for type 1

diabetes is to prescribe exogenous insulin shots which the patient injects as necessitated by

food intake. Additionally, portable machines called blood glucose monitors are used to

regularly sample the persons blood and detect how saturated the blood is with sugar at a

given moment. Untreated or mismanage type 1 diabetes can quickly lead to death, which

highlights the truly miraculous nature of modern medicine. This treatment allows those 1.25

million people previously mentioned to live full, normal lives!

Type 2 diabetes, while sharing some similarities with type 1, is quite a different beast.

Type 2 diabetes is typically caused by cells becoming insulin resistant, which prompts the

pancreas to produce even more insulin because the glucose taken from the blood must be

delivered to cells for use or storage to prevent hyperglycemia, or exceedingly high blood

sugar. Insulin resistance is akin to drug resistance, or any other biological resistance, actually.

If a person begins using cocaine, a small amount of the drug will be sufficient to produce a

high. After a while, however, the body will have adapted to cocaines effects enough that

greater and greater doses must be taken in order to get the same high as the users first time.

In the case of insulin resistance, the same process occurs as highly insulinogenic foods are

consumed and eating becomes so frequent that serum insulin levels are never permitted to
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drop sufficiently, thus demanding more and more insulin be released by the pancreas in order

to keep blood glucose levels stable.

Conventional wisdom teaches that type 2 diabetes should be treated with fat loss

(weight loss), bariatric surgery, drug protocols (Metformin), exercise, and insulin injections.

Studies and empirical evidence have shown that fat loss is an effective approach to improving

insulin sensitivity, liver triglyceride content (how fatty the liver is), and visceral fat levels

(amount of fat around organs). (Magkos, Fraterrigo and Yoshino) Research has shown that

bariatric surgery may be quite effective in the treatment of obesity and related diseases, but

much is to be learned regarding the long-term effects and safety of these surgical

interventions. One study found that five years after treatment, only 50% of participants still

qualified as nondiabetic. (Mingrone, Panunzi and De Gaetano) Insulin therapy is a safe and

effective method for managing blood sugar, but is that really the underlying issue? While

insulin shots can indeed keep blood sugar levels within appropriate ranges, this is simply

treating a chronic disease symptomatically.

I once heard a wonderful analogy given by Greg Glassman, founder and CEO of

CrossFit, Inc. He said in an interview that treating chronic disease symptomatically is like

hammering on the speedometer of a runaway train. You break the glass and turn the little dial

back to zero, then look out the window and the train is still going 100 miles per hour and you

say There, I fixed it. (Glassman) The approach that I believe to be the best for treating type

2 diabetes is to address the underlying issue: insulin resistance. Pumping more insulin into an

already-resistant individual will lower blood sugar, yes, but it will also exacerbate the

condition by promoting even more insulin resistance, as evidenced by the countless diabetics

whose doctors have to regularly increase prescribed insulin dosages to keep patients blood

sugar stable even when their diet remains unchanged. The human body is a remarkable

creation and by understanding its behaviors and tendencies, we can effectively work together
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with it to begin the healing process. I believe that treating and dressing a wound is far more

beneficial than simply putting a Band-Aid over it.

Now that we have had a brief (albeit elementary) discussion of diabetes and insulin,

lets address my family history of diabetes. My mother has been diabetic for twenty-three

years, developing gestational diabetes when she was pregnant with me. Her younger brother

was diagnosed with type 1 diabetes at age 38. Additionally, both my maternal and paternal

grandfathers have type 2 diabetes. My mother has been taking Metformin and exogenous

insulin for years, always trying to watch what she eats and steering clear of excessive

indulgence. She uses a blood testing glucose monitor to keep track of her blood sugar. Two

supplements have helped her tremendously: Cell-IQs Immune Boost and berberine. The

former being a remarkable product formulated by Dr. William Hennen, a brilliant bioorganic

and medicinal chemist who partnered with my dad to create Cell-IQ, a small biotech

company here is Salt Lake. Dr. Hennen took me on as a research assistant in 2016 to carry

out a pilot study on an immune system approach to treating diabetes using the product he

created. The latter is a beautiful substance that has been used to in India for millennia and can

improve blood sugar levels significantly. She is an excellent cook and has used whole foods

to make wonderful meals for my siblings and me all growing up. Over the years, we have

learned more and more about nutrition and made necessary adjustments. Her brother, my

uncle, has been using a continuous glucose monitor (CGM) for as long as I can remember

and also tries to watch what he eats. My paternal grandfather has only become insulin-

dependent within the last few years, but my maternal grandfather still is not dependent. They

both are careful about what they eat, but less so than my mother.

My mother has been an excellent example of doing ones best to be healthy

throughout my entire life and I credit her with (literally) making me who I am today. My

father has been invaluable as well, but he did not give birth to me, the importance of which I
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will now explain. Gestational diabetes is a form of diabetes that is developed by pregnant

women and can have a huge impact on her childs health. We have established that any

degree of insulin resistance causes the body to release more insulin into the system, but when

a woman is pregnant her child is subject to any and all physiologic changes that occur.

Children born of women who developed gestational diabetes during pregnancy were found to

be more likely to become insulin resistant than children born of non-diabetics. (Keely,

Malcolm and Hadjiyannakis)

Throughout the pregnancy, the fetuss blood sugar levels rise and fall along with its

mothers, necessitating appropriate insulin activity as well. Thus, if a mother is insulin

resistant and hyperinsulinemic, her baby will develop the same adaptation as a survival

mechanism. With this understanding, it comes as no surprise that I was always quite

overweight as a child. My marked (and frequently discussed) distrust of all nutritious foods

served to worsen my insulin resistance, promoting more hyperinsulinemia, and causing the

excess insulin to require more storage space fat for the sugar it was removing from my

bloodstream. At age thirteen, I measured in at roughly 25% body fat, which absolutely

floored me and etched the moment into my memory forever. With an older brother who has

never had the experience of being even slightly overweight and an athletic older sister who,

at that time, hadnt either, I was crushed and refused to believe that one-fourth of my being

was pure fat. I would never blame my dear mother for her gestational diabetes and have

become truly grateful for the conditions it created in my body and the resulting adaptations.

Without the challenges I face in order to manage and maintain good health, I certainly would

not make the effort I currently do. I grew up wanting the easy way, not the best way, and I

have had to build character and self discipline that today I would lack if I were the type that

could eat whatever I wanted and stay lean (note: I say lean, not healthy, here for good

reason).
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People do not believe me today when I tell them that I have to work very hard to stay

lean and healthy, partly because I do take good care of myself and partly because a large

portion of the population do not yet understand the underlying causes of many of our

modern diseases. I finally got to a healthy weight and became relatively fit as a senior in

high school, but lost my fitness while serving a mission for the LDS church in Brazil. I came

home and weighed about 10 pounds more than I should have and got right to work on losing

them. Being very interested in nutrition, I studied countless articles, books, and methods for

weight loss. After trying the conventional dietary advice (high-carb, low-fat), trying to

exercise off the weight, doing simple low-carb, cutting calories, and even going ketogenic for

a few months, I met with marginal success and wound up gaining twenty pounds in the fall of

2016 when I reintroduced too much carbohydrate too quickly after the keto diet. I started out

at 175 pounds, dropped to 170, and skyrocketed to 198 all in the course of a year. Only

recently, in April 2017, did I learn about the role of insulin in fat gain and loss and the puzzle

pieces began to fit together beautifully.

I know very well that I am likely the most prone of anyone in my immediate family to

developing diabetes, given that I was physically created and incubated in a diabetic

environment and my lifelong history of fighting to manage my weight (as an outward

manifestation of internal health). It is well known that overweight and obesity are

significantly associated with diabetes, hypertension, hypertriglyceridemia, CHD, and a host

of other chronic conditions, so by managing my diet and exercise I am putting myself in the

drivers seat and can do quite a lot in preventing these beasts from rearing their ugly heads.

Eating foods that promote proper bodily functions, getting enough micronutrients, vitamins,

and minerals, minimizing insulin response, and getting sufficient rest are critical weapons

that every person has available. I believe that the most important thing that people can do to

prevent these conditions is to understand them. Having a doctoral degree in endocrinology is

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not necessary, but a rudimentary idea, a crash course, should be had by everyone who is

desirous to preserve their health.

I used to work at a skilled nursing facility and it recently became abundantly clear to

me that the difference between a ninety-year-old living independently and one living in a

facility is actually a small one: the one in the facility has lost the ability to perform certain

basic movements like squatting, picking things up, and balancing. The most important part of

exercise, in my opinion, is to preserve and improve peoples abilities to safely perform these

foundational movements. I believe that the same principle translates to diet-related diseases.

The difference between a diabetic who lowers her A1c and one whose continues to climb can

be as simple as a basic understanding of how insulin works, what it does, and how to eat in

order to manage it.

There are many factors involved in chronic disease besides insulin, of course, but

teaching the public these basic processes could go a long way in preventing further

development and probably reversing many of the problems that we face today. Pairing sound

nutritional and physiological knowledge with an equally sound exercise regimen, the two

combined forming a complete fitness regimen, is crucial to our health and especially future

generations health. I consider myself an anomaly, not because I am some extraordinary

individual, but rather because a relatively small number of people truly care about their health

enough to give some things up that they know they would be better off without (excess

television watching, sugar consumption, smoking tobacco products, using drugs, consuming

alcohol, etc.). I think that among that already small group of people are a profoundly minute

bunch of individuals who find themselves in situations like mine: prone to hyperinsulinemia

and born of a gestational diabetic. It would be very easy for me to give up trying to be

healthy and say Well, this is just the way I am, so why fight it and try to be something I am

not? Unfortunately, this attitude is not uncommon.

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We as a culture have become very accepting and loving of people who dont fit the

image of a Barbie or Ken doll. I think it is beautiful that we have begun to see past peoples

appearances and can encourage each other and build each other up from where we are

currently. However, it scares me that we dont take our health more seriously, but that we

frequently want to outsource it to someone else, like a doctor, a trainer, or a dietitian, or

throw in the towel altogether, saying I would rather die a little sooner but live how I want

than live a little longer and be bound by all these rules. I have been jokingly, and seriously,

accused of being a fanatic about health and I totally embrace it. Its true, I am far more

interested than most people are or even should be, but we dont all need to be auto mechanics

to know how to put air in the tires, gas in the tank, and run the car through the wash when it

gets dirty.

The prevention/solution to type 2 diabetes that I am proposing, which can only be a

general outline as everyones body reacts differently to the same stimulus, is that we begin to

take insulin more seriously. My mother was recently told by her doctor that she needs to

increase her insulin dosage but that [she] can still indulge over the holidays. [She] will just

need to take more insulin. Instead of taking this Band-Aid approach, I contest that we

address the insulin resistance and begin focusing our treatments on preventing and fixing it

first.
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Works Cited
American Diabetes Association. Common Terms. 2 8 2013. 30 10 2017.
<http://www.diabetes.org/diabetes-basics/common-terms/common-terms-f-
k.html>.
. Statistics about Diabetes. 19 7 2017. 20 10 2017. <http://www.diabetes.org/diabetes-
basics/statistics/>.
Diabetes Library. The Function of Insulin. 16 5 2016. 30 10 2017.
<http://diabeteslibrary.org/function-of-insulin/>.
Glassman, Greg. CrossFit Podcast Ep. 17.01: Greg Glassman Sevan Mattosian. 6 9 2017.
Keely, EJ, et al. "Prevalence of metabolic markers of insulin resistance in offspring of
gestational diabetes pregnancies." Pediatric Diabetes (2008): 53-59.
Magkos, Faidon, et al. "Effects of moderate and subsequent progressive weight loss on
metabolic function and adipose tissue biology in humans with obesity." Cell
Metabolism (2016): 591-601.
Mingrone, G, et al. "Bariatric-metabolic surgery versus conventional medical treatment in
obese patients with type 2 diabetes: 5 year follow-up of open-label, single-centre,
randomised control trial." Lancet (2015): 964-973.
Reaven, GM. "Banting lecture 1988. Role of insulin resistance in human disease." Diabetes
(1988): 1595-1607.
. "Role of insulin resistance in human disease (syndrome X): an expanded definition."
Annual Review of Medicine (1993): 121-131.
Rodin, J. "Insulin levels, hunger, and food intake: an example of feedback loops in body
weight regulation." Health Psychology (1985): 1-24.
U.S. National Library of Medicine. Medical Encyclopedia - Diabetes. 15 4 2017. 30 10 2017.
<https://medlineplus.gov/ency/article/001214.htm>.