Functional Medicine

The Reversibility of Diabetes

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Type-2 Diabetes is for the most part a preventable and even reversible disease. Individual Experts have been saying that for decades, but now more and more conclusive evidence proves the reversibility of type-2 diabetes. I will walk you through the mechanisms of type-2 diabetes and why they matter for you even if you do not have diabetes, and then share the protocols that are being used to reverse type-2 diabetes and reduce Insulin resistance in Non-Diabetics. 
Diabetes Basics (super simple)
The general mechanism of Type-2 Diabetes is explained fairly easily and quickly. 
Our cells need Insulin to get sugar into our cells. Insulin is like the key to open our cells for the sugar to get in. Almost all of our cells therefore have Insulin receptors. These are like the lock. Insulin is the key. Insulin receptors are the lock.
Everytime we consume sugar, our pancreas releases Insulin, this Insulin opens the cells via the Insulin receptors, and then sugar can get out of the bloodstream into our cells. 
Now what happens in Type-2 Diabetes is that the locks, the Insulin receptors slowly disappear. We will have less and less of these Insulin receptors. We will get to the reasons later, but for now, lets just focus on „Type-2 Diabetes begins by slowly decreased amount of locks“.
So the body needs to adjust to the reduced amount of locks. We still need to get the sugar into our cells when we consume sugar. Otherwise it would just float around in our bloodstream. It is useless in our bloodstream. We need it in our cells, where we can generate energy from it. 
The body adjusts to the reduced amount of locks by just throwing more key at the locks. By doing that he makes sure that the locks are always open. He wants to make sure that EVERY one of the few leftover locks does have several keys so it is always open. Thats the only way our body can get all the sugar in the cells. We remember that Insulin is the key. So the body adjust to a reduced density of Insulin receptors, by producing more Insulin. The fewer receptors we have the more Insulin the body produces. 
So lets recap : 
  • Insulin is the key
  • The Insulin receptors of our cells are the locks
  • The Pancreas is the key producing station
  • In Diabetes the density of the Insulin receptors (locks) is incrementally reduced
  • The body reacts by pumping more keys (Insulin) out of the key producing station (Pancreas)
Okay now as there are fewer and fewer Insulin receptors, the Pancreas has to produce more and more Insulin. The Pancreas looks, feel and acts like a sponge. It really does. It really does look and feel like a sponge. And it also acts this way, because when we keep squeezing Insulin out of the pancreas it will dry out. There will at some point no Insulin left to secrete. Game-Over. Now there is no more key producing station. No more keys. Now we need to substitute the keys from the outside. We need to inject Insulin. 
See how this is a fluid process? It develops slowly over years and years. And the main concept behind this is the slooooow decrease in Insulin Receptors.
This reduction in Insulin Receptors is called Insulin Resistance. This is a spectrum. We can go from Low Insulin Resistance to High  Insulin Resistance and everything in between. An increased Insulin Resistance is the main driver of type-2 diabetes.
Even without Diabetes this Insulin Resistance is pretty shitty. We already know enough about Insulin Resistance now to logically conclude why. Lets imagine we eat some sugar. With a very low Insulin Resistance we might only need 1 unit of Insulin to get this sugar into our cells and get the full energy benefits from this sugar. 
But when we have Insulin Resistance we either get less energy from the same amount of sugar OR we need more Insulin to get this sugar into our cells and produce energy. Either way its bad. Because either we feel tired all the time, or we gain fat, or both, because Insulin is a main driver in getting fat. Every athlete should be freaked out when he hears things like „energy inefficiency“. If you are an elite athlete, you should be really concerned that there biochemical pathways that lead to the energy you eat not being available for actual energy output! Insulin Resistance is just that. With Insulin Resistance we are able to produce LESS energy output, for the same energy input. Thats bad for athletes of all kinds.
What modifies Insulin Receptor Density and thereby Insulin Resistance?
The two main pathways how Insulin Receptors are reduced and thereby Insulin Resistance is increased are excessive sugar/carb consumption and lack of muscular activity (MOVEMENT). 
Other pathways that are involved are inflammation, fat metabolism, and changes in gut microbiome, which are all in their own rights tightly connected to excessive sugar consumption and lack of movement. And then there special constellations where toxins can induce insulin resistance and some other unicorn situations. But for the majority diet and movement are the drivers.
The power of just diet in the modification of Insulin Resistance was recently shown in a study with 262 Diabetes patients. By modifying diet alone 40% of patients were able to stop diabetes medication COMPLETELY within 1 year, while another 54% of the patients were able substantially reduce their medication. A total of 94% of the patients were able to either stop or reduce their medications after only 1 year.  
So what did they do?
The Diet to reverse Type-2 Diabetes : 
  • The study participants cut their daily sugar/carb intake to almost ZERO. They induced dietary ketosis. To do that, you need to reduce sugar and carb consumption to almost ZERO. You are left with meat, fish, and vegetables. At least 3-5 servings of vegetables per day.
  • They consumed a lot of fat. Especially Omega-3 and Omega-6 fatty acids, which can be found in fish and meat. They were advised to eat fats from plants and from animals. Monounsaturated fats and saturated fats.
  • They were told to eat to satiety. They should not feel hungry during the whole process.
  • They were advised to supplement with a multivitamin, with Vitamin D3, with Omega-3, and Magnesium
  • They were advised to make sure get enough sodium
Does this sound like the diet I would also advise for almost any other health condition? Yes it does. The foundation is the same. Meat, Fish and Veggies. Supplement O-3, D3, and Magnesium, put salt in your water and never feel hungry. 
Does this also sound like almost the opposite of what nutritional agencies or most other doctors would recommend? Unfortunately yes. 
Dr. Sarah Hallberg, who conducted the aforementioned study shared her perspective on this conundrum in a recent TED Talk. She put it crystal clear saying : „Reversing Type 2 Diabetes starts with ignoring the guidelines“
I am not claiming a diet (as mentioned) and movement will cure all disease. There are a lot more complex mechanisms involved, but I am certainly saying that a diet as mentioned and movement are the basis for 90% of cures. 
May the FLOW be with you!
 Ressources :
S. Hallberg, „‘Reversing type 2 diabetes starts with ignoring the guidelines’: education from Dr Sarah Hallberg’s TEDx talk“, Br J Sports Med, S. bjsports-2017-098500, Feb. 2018.
S. J. Hallberg u. a., „Effectiveness and Safety of a Novel Care Model for the Management of Type 2 Diabetes at 1 Year: An Open-Label, Non-Randomized, Controlled Study“, Diabetes Ther, S. 1–30, Feb. 2018.
M. E. Lean u. a., „Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial“, The Lancet, Bd. 391, Nr. 10120, S. 541–551, Feb. 2018.
„The Origins and Drivers of Insulin Resistance – ScienceDirect“. [Online]. Verfügbar unter: [Zugegriffen: 17-Feb-2018].
Gerrit Keferstein, MD

Gerrit Keferstein is a Medical Doctor specialised in Performance & Functional Medicine. He is most known for his work on the optimisation of recovery and adaptation in elite athletes.

Tags : insulindiabetesinsulin resistanceinsulin sensitivitymetformindietketogenic dietketosisfood is medicineperformance docperformance medicine

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