Wednesday, December 22, 2010

The Misunderstood Disease

Type 2 Diabetes is one of the most misunderstood diseases in medicine. It is typically thought of as a disease of high blood sugar. (High sugar is the symptom, not the disease).

To further confuse the issue, doctors will tell you it’s hereditary. If that were so, how does one explain the 600% increase in Type 2 Diabetes worldwide in the latter half of the last century? More and more children are developing Type 2 Diabetes (which only affected adults till now).

Clearly something other than genetic predisposition is at work here.

Limitations of Conventional Treatment

Conventional treatment focuses on lowering blood sugar levels with the use of oral medication and/or insulin. If the sugar levels come within acceptable range, the doctor pronounces the patient to be “under good control”.

While the patient is busy controlling the sugar levels with medication, he is blissfully unaware that the disease marches on. The natural progression is to gradually increase dosage or add other drugs and eventually move on to insulin. Even with good control, the patient sooner or later starts developing conditions such as neuropathy, retinopathy and nephropathy.

If controlling the sugar levels was all that was needed, why do diabetics develop these problems?

Trading One Evil for Another

Conventional treatment lowers blood sugar levels while raising insulin levels. This approach solves one problem while creating a host of other problems. Current research clearly shows that high insulin levels play a major role in:

Heart disease
Peripheral Vascular Disease
High Blood Pressure

Diabetics are at risk for all of the above.

Clearly, something other than blood sugar control is needed to tame this monster.

In order to do so, we must first understand the disease and its mechanism.

Looking at the Causes instead of the Symptoms

One of the prime causes of Type 2 Diabetes is a decrease in energy production at the cellular level. Two conditions cause a decrease in energy production in the diabetic:

  1. The inability of the body to properly metabolize oxygen to produce energy

(There are 2 ways your body can make energy. By metabolizing the oxygen you breathe (aerobic metabolism) and through anaerobic metabolism i.e. without oxygen. The former lasts a lot longer and is preferable while the latter is reserved for emergencies. Inefficient aerobic metabolism results in an energy deficit leading to degenerative diseases such as diabetes).

  1. Shifting away from burning FAT to burning GLUCOSE for energy.

(Oxygen can be used to burn fat or glucose for energy. Contrary to popular belief, it is fat and not glucose that the body prefers to burn to produce energy. A typical young person will obtain almost 100% of his/her resting energy production from burning fat, while an older (or sicker) person will burn glucose for his/her energy production. As people age or develop disease, they shift from burning fat to burning glucose).

How Decreased Aerobic Metabolism Results in Type 2 Diabetes

The cells create energy and store it in the form of ATP. ATP provides the energy for cell membranes to communicate with insulin without which glucose cannot enter the cell. As energy production decreases, and the cell has less ATP, it cannot interact effectively with insulin. This is ONE OF THE PRIME CAUSES of insulin resistance (resulting in Type 2 Diabetes).   

A deficit in ATP contributes in several other ways to developing Type 2 Diabetes.
Eg: ATP protects cells such as islet cells in the pancreas from free radical damage.

How the Shift from Fat to Glucose Metabolism Results in Type 2 Diabetes

The shift from fat to glucose metabolism causes the cells to burn more glucose and since very little glucose can be stored, it results in continuous depletion of glucose stores. This forces one to eat more carbohydrates. The more carbs you eat, the more insulin your body will make. The cells respond to this increase in insulin production by decreasing the number of insulin receptors (called receptor down regulation). This again leads to insulin resistance.

Because the person is now eating more carbs to replenish the continuously depleting glucose stores, the body adapts to this dietary shift by burning more glucose instead of fat.

And because most of these carbohydrate calories are not going to be used up immediately, they will be stored as fat. Burning less and storing more fat increases your body fat percentage…another cause of insulin resistance.

As insulin levels rise, the adrenal glands pump out more cortisol (a stress hormone) to balance the effects of insulin. Elevated levels of cortisol suppress the activity of insulin receptors on cells and insulin resistance becomes eve more pronounced.

The Good news

When properly understood, Type 2 Diabetes can be dealt with effectively without having to suffer the debilitating effects.

The best approach would be to consult a healthcare practitioner skilled in some or all of the concepts outlined here.

However, the following tips can be implemented on your own. These tips will also help those who wish to take preventive action.

Steps to Success with Type 2 Diabetes

  • Ask your doctor to test your lipid levels, steroid hormones, sex hormones, thyroid function, HbA1c and fasting insulin levels (C-Peptide levels should be checked if you are on insulin).

  • Eat good quality proteins such as pulses and fish. Consume good fats such as cold-pressed olive oil, raw nuts (almonds and walnuts, etc.). Eat complex carbohydrates such as cabbage, broccoli, etc. and avoid refined carbohydrates such as white flour, white rice, white sugar, etc.

  • Reduce your calorie intake by about 10-15%.

  • Exercise in a way that progressively challenges your cardio-vascular system. This means that you have to work out till you get slightly breathless. Then let your heart recover and repeat the process about 7 or 8 times. Stair climbing is a good way to do this. Swimming and running are other examples. (Please talk to your doctor first and use caution and commonsense when embarking upon an exercise program. A trainer will also be helpful).

  • Clean out your liver! A good ayurveda centre can do this for you or you could do it at home with the proper herbs.

  • Get adequate sleep. Sleep deficit results in decreased energy production and decreased fat metabolism.

  • Reduce stress. When under stress, the adrenal glands produce high levels of cortisol, the stress hormone. This leads to an increase in insulin production since it counter-balances cortisol. This contributes towards insulin resistance.

  • Talk to your doctor about correcting hormonal imbalances with natural supplements.