Diabetes as a Disease of Fat Toxicity

“Diabetes as a Disease
of Fat Toxicity” Both prediabetes and type 2 diabetes
is caused by insulin resistance, which is now accepted to be
closely associated with the accumulation
of fat within our muscle cells. This fat toxicity inside our muscles is a major factor in the cause of insulin
resistance and Type 2 diabetes, as it interferes with
the action of insulin. I’ve explored how fat makes
our muscles insulin resistant, how that fat can come from
the fat we eat or the fat we wear, and how all fats
are not the same. It’s the type of fat found
predominantly in animal fats, relative to plant fats, that appears
to be especially deleterious with respect to fat-induced
insulin insensitivity. But this insulin resistance in our muscles
starts years before diabetes is diagnosed. This is a graph of fasting blood sugars in
the 13 years PRIOR to the onset of diabetes. Insulin resistance starts over a decade before
diabetes is actually diagnosed, as blood sugar levels slowly
start creeping up. And then all of a sudden
the pancreas conks out, and blood sugars skyrocket. What could underlie this relatively
rapid failure of insulin secretion? At first, the pancreas pumps out
more and more insulin trying to overcome
the fat-induced insulin resistance
in our muscles, and high insulin levels can
lead to the accumulation of fat in our liver,
called fatty liver disease. Before diagnosis
of Type 2 diabetes, there is a long silent scream
from the liver. As fat builds up in our liver,
it becomes resistant to insulin too. Normally, the liver is constantly
producing blood sugar to keep our brain alive
between meals. As soon as we eat
breakfast, though, the insulin released to deal with the meal
normally turns off liver glucose production, which makes sense since
we don’t need it anymore. But filled with fat, the liver becomes
insulin resistant like our muscles and so doesn’t respond to
the breakfast signal, and so keeps pumping out blood sugar
all day long on top of whatever we eat. So the pancreas pumps out
even more insulin to deal with the high sugars and our liver
gets fatter and fatter. That’s one of the two twin
vicious cycles of diabetes. Fatty muscles, in the context
of too many calories, leads to a fatty liver,
which leads to an even fattier liver. This is all still before
we have diabetes, but then the next
vicious cycle starts. Fatty liver can be deadly, so the liver starts trying
to offload the fat by dumping it back into the bloodstream
in the form of something called VLDL and that starts building up
in the cells in the pancreas that produce insulin
in the first place. So now we know
how diabetes develops. Fatty muscles leads to a fatty liver,
which leads to a fatty pancreas. It is now clear that Type 2 diabetes is a
condition of excess fat inside our organs. The only thing that was
keeping us from diabetes, from unchecked skyrocketing
blood sugars, is that the pancreas
was working overtime pumping out extra insulin
to overcome insulin resistance. But as the so-called islet,
or beta cells in the pancreas, are killed off by the fat buildup, insulin
production starts to fail, and we’re left with
the worst of both worlds: insulin resistance combined
with a failing pancreas. Unable to then overcome
the resistance, blood sugar levels
go up and up, and we have Type 2 diabetes. This has implications
for cancer as well. Obesity leads to insulin resistance, and our blood sugars
start to go up, so our pancreas
starts pumping out more insulin to try to force more sugar
into our muscles, and eventually the fat spills over
into the pancreas as well, killing off the insulin-producing cells, and we’ve got diabetes, in which case we may have to start
injecting insulin at high levels to overcome the
insulin-resistance, and these high insulin levels
promote cancer. It’s one of the reasons we think
obese women get more breast cancer. It all traces back to fat
getting into our muscle cells, starting insulin resistance, fat from our stomach or
fat going into our stomach. So now it should make sense why the
American Diabetes Association also recommends reduced
intake of dietary fat as a strategy for reducing
the risk of developing diabetes.

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