Type 2 Diabetes
Type 2 diabetes is a disease in which your pancreas fails to produce enough insulin, or your body doesn't respond appropriately to the insulin signal (called insulin resistance). Insulin is a key hormone in your body that signals your cells to take up glucose from the bloodstream to be used as fuel. When your body stops listening appropriately to this signal, your blood sugar rises. Carbohydrates, particularly refined carbohydrates, elevated blood sugar the most. Patients with Type 2 Diabetes are insulin resistant or in other words: carbohydrate intolerant.
Type 2 Diabetes is a chronic, progressive illness. Once diagnosed with Type 2 Diabetes, if you continue with the "standard American diet", most people will experience escalating medications and disease burden over time. However, Type 2 Diabetes is treatable with a radical change in dietary habits that often results in fewer medications.
"Non-alcoholic fatty liver disease (NAFLD) is a progressive complex of liver disease which starts with fat accumulation in the liver without excessive alcohol consumption. It is strongly associated with metabolic syndrome: obesity + insulin resistance + dyslipidemia."Anstee QM, Day CP. The genetics of NAFLD. Nat Rev Gastroenterol Hepatol. 2013;10(11):645-55).
In Canada, obesity is the number one cause of fatty liver. A person has fatty liver when at least 5% of the liver is replaced by fat cells. Once fat starts building up in the liver, it can lead to inflammation, scarring (called fibrosis) and eventually cirrhosis of the liver. Other causes include certain medications (like corticosteroids, tetracycline), genetic factors and alcohol.
Like Type 2 Diabetes, Fatty Liver is generally considered chronic and progressive. However, it is reversible through intensive dietary changes involving a reduction of processed carbohydrates, high-fructose corn syrup, and sugars, as well as weight loss.
Obesity is a complex, hormonally, genetically, environmentally-mediated disease and not simply due to a lack of will power. Obesity treatment is much more than “eat less, move more” and requires a medically-supervised, step-wise approach of dietary and behaviour modification, cognitive restructuring, pharmacotherapy and potentially bariatric surgery.
Obesity is defined as a chronic and often progressive condition, similar to diabetes, characterized by excess body fat that can affect health (Definition from Canadian Obesity Network). Obesity has been associated with numerous disease conditions including: Type 2 diabetes, fatty liver, hypertension, obstructive sleep apnea, depression, stroke, hypoventilation (shortness of breath), infertility, menstrual irregularities, gallbladder disease, osteoarthritis, gout, venous stasis (leg swelling), coronary artery disease (heart disease), and many cancers (colon, uterine, cervical, prostate, pancreatic, kidney). Obesity is a chronic medical condition. There is no quick fix or magic diet pill. However, it can be effectively managed with longterm medically-supervised intervention.
While Obesity is usually defined by a BMI > 30, patients with Overweight (BMI 25-29) benefit from early intervention. Some patients with a normal BMI (21-24) can have abdominal adiposity (fat) that leads to metabolic diseases and will also benefit from obesity-related treatments.
Polycystic Ovarian Syndrome (PCOS)
PCOS is a syndrome affecting women. Features include hirsuitism (hyperandrogenism), ovulatory dysfunction, polycystic ovaries, decreased fertility and insulin resistance. It is commonly associated with obesity and type 2 diabetes. Approximately 65-70% of women with PCOS will have elevated blood insulin levels consistent with insulin resistance. Weight loss has been shown to improve several features of PCOS including the metabolic derangements and to increase rates of conception. Very low carbohydrate (ketogenic) diets have also been found to lower insulin levels, testosterone and other hormones, as well as weight in women with PCOS.
- Marshall JC, Dunaif A. All Women With PCOS Should Be Treated For Insulin Resistance. Fertility and Sterility. 2012;97(1):18-22. doi:10.1016/j.fertnstert.2011.11.036.
- Norman RJ, Davies MJ, Lord J, Moran LJ. The role of lifestyle modification in polycystic ovary syndrome. Trends Endocrinol Metab. 2002 Aug; 13(6):251-7.
- Mavropoulos JC, Yancy WS, Hepburn J, Westman EC. The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: A pilot study. Nutrition & Metabolism. 2005;2:35. doi:10.1186/1743-7075-2-35.
Insulin resistance is a condition of hyperinsulinemia (high blood insulin levels) due to the resistance of tissue insulin receptors. This resistance to insulin further exacerbates high blood insulin and a vicious cycle develops (positive feedback loop): hyperinsulinemia drives insulin resistance, insulin resistance drives hyperinsulinemia. Insulin resistance is often used as a synonym for Metabolic Syndrome. A key clinical characteristic is an abnormally high secretion of insulin as a result of dietary carbohydrate intake, particularly refined carbohydrates and sugars.
Insulin resistance affects many different organs in the body: the brain, capillaries, muscles, adipose tissue (fat) and liver. Within each tissue, insulin resistance looks a little different. It is a complex, heterogenous condition.
“Hyperinsulinaemia is also an independent risk factor for Coronary Heart Disease (CHD), and insulin resistance predicts future cardiovascular risk. Increased levels of insulin are found in multiple disease states, including obesity, coronary artery disease, hypertension, peripheral vascular disease and those with hypertriglyceridaemia. Thus, any dietary factor that worsens glucose tolerance or promotes insulin resistance will also likely increase the risk of acute MI, CHD and CHD mortality. Considering that a diet high in added sugars (particularly the fructose component) leads to insulin resistance, the overconsumption of added sugars is undoubtedly a contributing factor to CHD and CVD mortality. Indeed, compared with a diet that contains less than 10% of calories from added sugars, a diet containing 25% or more calories from added sugars nearly triples the risk for CVD mortality.”
Quoted directly from article: DiNicolantonio JJ, OKeefe JH. Added sugars drive coronary heart disease via insulin resistance and hyperinsulinaemia: a new paradigm. Open Heart 2017;4:e000729. doi: 10.1136/openhrt-2017-000729)
How do you know if you are insulin resistant? Associated conditions include high triglycerides, fatty liver, Type 2 diabetes or prediabetes, coronary artery disease, increased waist circumference. Some physical signs include skin tags on the back of the neck, and a grey-brown velvety discolouration in the skin folds at the neck, underarms and groin (called acanthosis nigricans).
Insulin resistance is a condition of carbohydrate intolerance. It is effectively managed with a low carbohydrate diet.