Diabetes Self-Management Blog

“Everybody knows” that being fat leads to Type 2 diabetes, even though it’s not true. That idea has been pretty well debunked.

Reporting on a study in The Journal of the American Medical Association, Diane Fennell wrote “General measures of obesity, such as body-mass index, total body fat, or [fat under the skin] were not associated with an increased risk of developing Type 2.”

What seems more likely is that Type 2 diabetes makes people fat. The connection is insulin resistance. Nurse practitioner Laurie Klipfel writes, “Even thin people who are insulin resistant are at risk for the things associated with insulin resistance (hypertension, diabetes, [bad cholesterol], and obesity.)” Insulin resistance (IR) contributes to Type 2 and also makes people fat.

Here’s how IR makes people fat: Glucose can’t get into insulin resistant muscle cells. Insulin resistant livers may refuse to store extra glucose. To compensate, the pancreas produces extra insulin, and these spikes in insulin lead to the formation of extra fat.

Not all heavy people are insulin resistant, Klipfel says. “Obesity is not always associated with insulin resistance, and when it is not, [diabetes and hypertension] are usually not present either.”

A certain type of fat, though, really is associated with diabetes. This is visceral fat, fat around our internal organs, especially the liver and pancreas. This fat seems to interfere with insulin production in the pancreas and glucose storage in the liver.

Visceral fat is the fat that was reduced in the famous diabetes cure study done by Dr. Roy Taylor’s group in Newcastle, UK. In that study, 11 people recovered normal insulin function in two months of eating 600 calories a day.

You can’t tell a person’s level of visceral fat or his level of insulin resistance by looking at him or by weighing him. Cardiology professor James de Lemos, MD, says the only way to determine whether fat is visceral or subcutaneous is with an imaging study such as magnetic resonance imaging (MRI). And evaluating IR requires a lab test such as an insulin level.

Why is this important? It matters because people with Type 2 are always told to lose weight. They are blamed for bringing on their own illness by gaining weight. This would make sense if extra weight caused their diabetes, but it doesn’t.

Klipfel says, “Weight loss itself does not change insulin resistance. But the things we often do to attempt weight loss (exercise, healthy diet, sleep well, decrease stress, etc.) DO help insulin resistance.” Because increased weight can be a symptom of insulin resistance, often (but not always) weight is lost when insulin resistance is improved. That is why they recommend “weight loss.”

Disagreements
Some experts do believe abdominal fat contributes to insulin resistance. The National Diabetes Information Clearinghouse talks about abdominal fat setting up chronic inflammation in the body that causes insulin resistance. They say lack of physical activity is a major cause. They also list genetics; “certain diseases…steroid use; some medications; older age; sleep problems, especially sleep apnea; and cigarette smoking.”

We know from Dr. Taylor’s study that people who lose visceral fat get much better, at least temporarily. So there are benefits to major weight loss in the short term. But long-term, 90% to 95% of dieters gain lost weight back. This “weight cycling” does not help insulin resistance and may make it worse.

Treating insulin resistance
So then how do you treat insulin resistance? The two most important things seem to be exercise and sleep. If you sleep poorly or have sleep apnea, you need to work on that. (This is one thing that weight loss might help.)

You also want to stop smoking. Cutting down on insulin-stimulating (high-glycemic-index and high-glycemic-load) foods helps as well.

Italian researchers found that “Stress is associated with a severe, yet reversible form of insulin resistance,” so you’ll also want to reduce stress. Dr. Mark Hyman, author of The Blood Sugar Solution, says

it’s essential to engage in relaxation practices such as yoga, breathing, progressive muscle relaxation, guided imagery, hot baths, exercise, meditation, massage, biofeedback, hypnosis, or even making love.

Those are coping and managing methods. It’s also good to deal with the causes of stress by getting help, getting out of stressful situations, and learning to change stressful thoughts.

Whether you are trying to lose weight or trying to help your insulin work better, you should do pretty much the same things. More movement, less stress, very little refined food, better sleep.

The difference is that decreasing insulin resistance (and A1C numbers) has a much better chance of working than weight loss does. And if anyone tells you that you brought diabetes on yourself by being heavy, ask him to show you the science for that.

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