Diabetes and Insulin Resistance

Based on the large response that I received following last week’s newsletter about peptides that included insulin and GLP-1 medications, I thought it would make sense to discuss diabetes, known causes, increasing prevalence, and its effect on the cost of healthcare. As I stated last week, the cause and treatment of diabetes is very much misunderstood by the public, but also by the medical community. Concerning practitioners, much of this has to do with new thinking based on recent discoveries that was not available when the majority of physicians were in medical school. Also, I have decided to post this newsletter in two parts that will be delivered this week and next due to its massive content.

Diabetes is a chronic, metabolic disease, characterized by elevated levels of blood glucose. Globally, approximately 530 million adults, or about 10.5% of the world’s population between the ages of 20 and 79 suffer from the condition. Type 2 diabetes is the most common type comprising about 95% of the 38.5 million in the United States. This usually occurs in adults when the body becomes resistant to or fails to produce enough insulin. Currently type 2 diabetes is increasing at an exponential rate. Type 1 diabetes occurs when the pancreas produces little or no insulin by itself.

About 1.2 million Americans develop diabetes each year… In 2021 97.6 million Americans, age 18 and older had prediabetes. In 2018 the annual incidence of diagnosed diabetes under the age of 20 was estimated to be 18,500 (type 1) and 5,400 (type 2). The latter figure is the most alarming given that 30 years ago type 2 diabetes was virtually unknown in Americans under the age of 20.

Interestingly, the rates of diagnosed diabetes in adults varies by race/ethnic background:

• 13.6% of American Indians/Alaskan Native adults

• 12.1% of non-Hispanic Black adults

• 11.7% of Hispanic adults

• 9.1% of Asian American adults

• 6.9% of non-Hispanic White adults

Further breaking down incidence among Hispanic adults yielded these figures:

• 13.3% Puerto Rican

• 11.1% Mexican or Mexican American

• 9.4% Dominican

• 9.0% Cuban

• Central American, South American, and other Hispanic, Latino, or Spanish adults had prevalences ranging from 5.0%-7.3%

Diabetes was the eighth leading cause of death in the United States in 2021. Figures show 103,294 deaths as a direct result of diabetes, and a total of 399,401 deaths that involved diabetes as a contributing factor. In November 2023 the total cost of diagnosed diabetes in the United States was $412.9 billion…

Jumping back to my second paragraph, I began by saying diabetes was a chronic metabolic disease. Actually, that’s not entirely true. Type 2 diabetes, by far the more common and rapidly increasing variety, is indeed a chronic metabolic disease. On the other hand, type 1 diabetes results from inherited genetic factors that lead to an autoimmune condition that directly affects the production of insulin from the pancreas. The cause of type 2 diabetes is invariably the result of “insulin resistance”, where the pancreas produces ample amounts of insulin, but for reasons I will try to explain later, prevents it from doing its job, which is to move free glucose in the bloodstream into our cells where it serves as our primary source of “fuel”. In Fact, virtually all age-related conditions including cardiovascular disease, nonalcoholic fatty liver disease, neurodegenerative diseases, polycystic ovarian syndrome, micro/macro vascular disease, and obesity are caused, at least in part, by insulin resistance. But before we discuss these, I want to bring you news of a possible breakthrough in the treatment of type 1 diabetes sent in by one of my readers.

Recall that type 1 diabetes is defined by the body’s inability to produce ample amounts of insulin to permit maximum transfer of glucose from the bloodstream into the organs of the body including the brain.  Remember that in 1922 Fredrick Banting first injected insulin derived from dogs into 14-year-old Leonard Thompson who was dying from type 1 diabetes. From that day up until the present, injecting insulin daily was the primary treatment for type 1 diabetes. However, this year Sernova, a Canadian company, announced the creation a “functional cure” for T1D by transplanting pancreatic stem cells to replace damaged and dead beta cells. This was accomplished by implanting Sernova’s “Cell Pouch” filled with “therapeutic cells” derived from stem cells placed under the skin against the abdominal muscle.

After implantation, blood vessels infiltrate this porous device to form a biocompatible tissue environment that ensures the long-term survival and function of the cells it houses. By using immunosuppressants to prevent rejection, the Cell Pouch becomes stabilized and allows islet cells to be transplanted into the matrix and begin producing insulin. If the subject is still dependent on insulin six months after the last transplant, a they can receive additional “top-up” transplants until they are self-sustaining.

This first-in-world, potentially game changing technology, provides tangible hope for T1D patients for a functional cure for this condition. Sernova embarked on a phase 1/2 clinical trial of the Cell Pouch System by recruiting 18-to-65year-old type 1 diabetics to participate in the trial. The participants were then split into two groups for comparative purposes between two different Cell Pouch sizes and evaluated for a period of five years at the University of Chicago. The result was that the group receiving the larger implant was able to maintain normal function for a period of five years (after stabilization) without the use of exogenous insulin. Keep in mind that the Cell Pouch System must still undergo phases 3 and 4 before it is approved for use by the FDA. Please see the full explanation of the FDA approval process outlined in my last newsletter on peptides for a more complete explanation.

Type 2 diabetes that is caused by Insulin Resistance is entirely the result of improper diet and lifestyle that worsens with advancing age. Thinking about that statement, we sometimes fail to realize how much our lifestyle has changed in the past 200 years. To appreciate just how significant this is please bear in mind that as humans our physiology has evolved over more than a million years. Compared to that time span, 200 years is nothing… As Darwin said, evolution is about the survival of the fittest. Changes in environment affect all living species. When food and climatic environment change significantly, this places evolutionary stress on all living organisms. Some adapt, some die, and some mutate such that they become better suited for their environment. But this process does not happen overnight. In some cases, this happens over thousands or even millions of years. So, you can appreciate the fact that our species has not had sufficient time to adapt to our modern diet and lifestyle. As a result, we are becoming sick and dying, despite our medical advances, just as every extinct species has over the eons…

Why didn’t our ancestors suffer from type 2 diabetes? Just think for a moment about the lifestyle that our not so distant ancestors lived as hunter gatherers. The image above portrays a believable reimagining of what it might have been like to come together for a “feast” in celebration of an important event. Now, think about a similar social activity today. The social interaction would have been similar, but the food would be entirely different… Its preparation would be far more elaborate, it would have included dozens of processed foods that did not exist for our ancestors. Now consider how much technology has progressed in our own lifetime, as we now talk realistically of visiting Mars! Then realize that our food and our lifestyle has changed at the same rate. Whereas, for our ancestors it took centuries to realize a fraction of the changes we have experienced in the last 100 years.

Now consider the fact that our bodies have not had a chance to adapt to our food and modern lifestyle through evolution. We are just beginning to see the ill effects of our physiological unsuitability for modern life. As intelligent beings we have recognized some of the problems affecting our health and have attempted to change some of these factors. Ironically, in our attempt to improve our health we sometimes have done just the opposite. Let me provide you with a clear example that most of my readers will recognize. In the 1950s as we enjoyed the economic success that came along with our victory in World War II, we started to see an alarming increase in certain chronic diseases. At the top of the list was heart disease, responsible for more deaths than any other condition.

In an effort to eliminate heart disease, our government stepped in and began making recommendations to the food industry on changes they believed were necessary to mitigate cardiovascular disease. In the 50s and 60s they came to believe that saturated fats were a leading cause of heart disease. In response, they began on the dinner table by recommending the use of olio margarine as a substitute for butter. This was a huge mistake that seemed logical at the time. In an attempt to do away with the saturated fat in butter, the food industry conceived a way to make a butter substitute with polyunsaturated vegetable oil. Unfortunately, there was one major problem… polyunsaturated oils are liquid at room temperature and therefore could not be used in the same way that butter had been for centuries. So, food scientists used a method by which they heated the oil to about 400°F and at the same time, bubbled hydrogen through the liquid. We now call this process hydrogenation. The end result was a substance with the same physical properties as butter at room temperature. And voilà, margarine was born.

Unfortunately, as often happens, there were other problems with this method that would not be recognized for years. As it turns out the process of hydrogenation that requires high heat, changed the properties of the constituent lipids by changing the shape of the lipid molecules into Trans Fats, which for all intents and purposes are poison to our bodies, since they do not naturally exist. Not only that, like the saying goes, “you are what you eat”, these trans-fats become incorporated into the cellular structures of our bodies, because our cells cannot tell the difference between the natural “CIS” form and this foreign “TRANS” form of the same molecule. This results in the creation of defective cellular components that invariably lead to cancer and other serious malfunctions…

I could go on by pointing out all the mistakes we have made by changing the fundamental properties of whole food. However, if I did that, I would end up with a newsletter so long that no one would read it. So please allow me to summarize. Not realizing our mistakes, scientists in cooperation with our government continued to assault fats, regardless of their potential benefits. One example has recently come to light in the discovery of an essential fatty acid known as C15, that is prevalent in dairy fat, that has now been essentially removed from our adult diet. This is also true for our children, who have had whole milk eliminated from their daily life, it has even been removed from infant formulas…not to mention mother’s milk! As a result, they are beginning to develop disease conditions normally associated with older populations. To learn more about this discovery I have attached two files below. One is a summary that I created for a website where I am the CTO (Fatty15 Introduction). The other is a one-hour podcast moderated by Thomas DeLauer featuring a principal investigator Dr. Stephanie Venn-Watson. Some of you have already seen this, so my apologies if you have, but if it has been a while, it is worth rewatching.

Newly Discovered Cause of Insulin Resistance (click tovie

   End Part 1 continued on September 25th