Flashback Friday: What Causes Insulin Resistance and Diabetes?
“What Causes Insulin Resistance and Diabetes?” Studies dating back nearly a century
noted a striking finding. If you take young, healthy people
and split them up into two groups, half on a fat-rich diet, and the
other half on a carb-rich diet, within just two days,
this is what happens. The glucose intolerance
skyrockets in the fatty diet group. In response to the same
sugar water challenge, the group that had
been shoveling in fat ended up with twice
the blood sugar. As the amount of fat in the diet goes
up, so does one’s blood sugar spikes. It would take scientists nearly seven
decades to unravel this mystery, but it would end up holding the key to
our current understanding of the cause of type 2 diabetes. When athletes carb load before a
race, they’re trying to build up the fuel supply
within their muscles. They break down the starch into
glucose in their digestive tract; it circulates as blood
glucose, and blood sugar, and is taken up by our muscles
to be stored and burned for energy.
Blood sugar, though,
is like a vampire. It needs the invitation
to come into our cells. And that invitation is insulin. Here’s a muscle cell. Here’s some blood sugar outside
waiting patiently to come in. Insulin is the key
that unlocks the door to let the sugar in our blood
enter the muscle cell. When insulin attaches
to the insulin receptor, it activates an enzyme, which
activates another enzyme, which activates two more enzymes,
which finally activates glucose transport, which acts as a gateway
for glucose to enter the cell.
So insulin is the key that unlocks
the door into our muscle cells. What if there was
no insulin though? Well, blood sugar would be
stuck out in the bloodstream banging on the door to our
muscles and not being able to get inside, and so with nowhere to go,
sugar levels would rise and rise. That’s what happens
in type 1 diabetes. The cells in the pancreas
that make insulin get destroyed, and without insulin,
sugar in the blood can’t get out of the blood into the muscles,
and blood sugar rises. But there’s a second way we could
end up with high blood sugar. What if there’s enough insulin,
but the insulin doesn’t work? The key is there but something’s
gummed up the lock.
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[Have a great day,
яαℓρн ℓєαмαи]
resistant to the effect of insulin. What’s gumming up the door
locks on our muscle cells preventing insulin
from letting sugar in? Fat. What’s called
intramyocellular lipid, is fat inside our
muscle cells. Fat in the bloodstream can build
up inside the muscle cell, creating toxic fatty
breakdown products and free radicals that can block
the signaling pathway process. So no matter how much insulin
we have out in our blood, it’s not able to open
the glucose gates, and blood sugar levels
build up in the blood.
This mechanism by which fat,
specifically saturated fat, induces insulin resistance wasn’t known until fancy MRI
techniques were developed to see what was happening
inside people’s muscles as fat was infused
into their bloodstream. That’s how they found out that
the elevation of fat levels in the blood causes insulin resistance by inhibiting
glucose transport into the muscles. And this can happen
within just three hours. One hit of fat can start
causing insulin resistance, inhibiting glucose uptake
after just 160 minutes. The same thing happens
to adolescents. You infuse fat into
their bloodstream. It builds up in their muscles and
decreases their insulin sensitivity, showing that increased
fat in the blood can be an important contributor
to insulin resistance. And then you can do
the opposite experiment. Lower the level of fat
in people’s blood and the insulin resistance
comes right down. Clear the fat out of the blood, and
you clear the sugar out of the blood. So that explains
this finding. On a high-fat diet, the ketogenic diet,
insulin doesn’t work as well. Our bodies are
insulin resistant. But as the amount of fat in
our diet gets lower and lower, insulin works
better and better.
This is a clear demonstration
that the sugar tolerance of even healthy individuals
can be impaired by administering a
low-carb, high-fat diet. But we can decrease insulin resistance,
the cause of pre-diabetes, the cause of type 2 diabetes,
by decreasing saturated fat intake. After about age 20, we may have all
the insulin-producing beta cells we’re ever going to
have in our pancreas, and so if we lose them,
we may lose them for good. Autopsy studies show that by the
time type 2 diabetes is diagnosed we may have already killed
off half of our beta cells. You can do it right in a Petri dish. Expose human beta cells to fat, they suck it up and
then start dying off. A chronic increase in blood
fat levels is harmful as shown by the important effects
in pancreatic beta cell lipotoxicity. Fat breakdown products can interfere
with the function of these cells and ultimately lead to their death. And not just any fat, saturated fat. The predominant fat in
olives, nuts, and avocados gives you a tiny bump
in death protein 5, but saturated fat ramps up
this contributor to Beta cell death.
Saturated fats are harmful to cells,
harmful to the insulin-producing cells in our pancreas. Cholesterol, too. The uptake of bad cholesterol, LDL,
can cause Beta-cell death as a result of free radical formation. So diets rich in saturated fats not only
cause obesity and insulin resistance, but the increased levels of
circulating free fats in the blood, called NEFAs, non-esterified
fatty acids cause Beta-cell death
and may thus contribute to progressive Beta-cell
loss in type 2 diabetes. And this isn’t just based
on test tube studies. If you infuse fat into
people’s bloodstream you can directly impair
pancreatic Beta-cell function, and the same when we ingest it. Type 2 diabetes is
characterized by defects in both insulin secretion
and insulin action, and saturated fat
appears to impair both. Researchers showed
saturated fat ingestion reduces insulin sensitivity
within hours, but these were non-diabetics, so their
pancreas should have just been able to boost insulin secretion to match, but insulin secretion
failed to compensate for insulin resistance in subjects
who ingested the saturated fat.
And this implies that saturated fat
impaired beta cell function as well, again within just hours after
it goes into our mouth. So increased consumption
of saturated fats has a powerful short- and
long-term effect on insulin action, contributing to the
dysfunction and death of pancreatic beta
cells in diabetes. And saturated fat isn’t
just toxic to the pancreas. The fats found predominantly in
meat and dairy — chicken and cheese are the two main sources
in the American diet — are almost universally toxic,
whereas the fats found in olives, nuts, and avocados are not. Saturated fat is particularly toxic to liver cells in the formation
of fatty liver disease. You expose human liver cells
to plant fat and nothing happens. Expose liver cells to animal
fat and a third of them die. This may explain why higher intakes
of saturated fat and cholesterol are associated with
nonalcoholic fatty liver disease. By cutting down on
saturated fat consumption we may be able to help
interrupt this process. Decreasing saturated
fat intake may help bring down the need for
all that excess insulin.
So either being fat or
eating saturated fat can cause that excess
insulin in the blood. The effect of reducing dietary
saturated fat intake on insulin levels is substantial, regardless of how much
belly fat we have. And it’s not just that by eating fat we
may be more likely to store it as fat. Saturated fats, independently of
any role they have made us fat, may contribute to the development of insulin resistance and all
its clinical consequences. After controlling for weight, alcohol, smoking,
exercise, and family history, diabetes incidence was
significantly associated with the proportion of
saturated fat in our blood. So what causes diabetes? The consumption of too many
calories rich in saturated fats. Now just like everyone who smokes
doesn’t develop lung cancer; every one that eats a lot of saturated
fat doesn’t develop diabetes. There’s a genetic component, but just like smoking can
be said to cause lung cancer, high-calorie diets
rich in saturated fats are currently considered
the cause of type 2 diabetes.
