A "New" Approach To Managing Blood Sugar

Back in 2015, not too long ago, in a medical journal called Diabetes…aptly named. There was a research article that just recently came across my desk.  The lead author's last name was Nolan and N-O-L-A-N if you want to look it up.  The article was basically discussing what they present as a new concept that maybe with type 2 diabetes or insulin resistance, maybe the insulin resistance itself is not the enemy.  That's a pretty new concept in conventional medicine. So what they lay out is for the worst cases of type 2 diabetes, the ones that don't respond well to medications, they're obese, they've got substantial insulin resistance...in those cases, maybe we should rethink focusing on insulin resistance as the enemy. So let me find a way to describe this to you that will make some sense. Basically in type 2 diabetes, we have sugar entering the body, then sugar gets in the bloodstream than sugar has to go from the bloodstream into the cells.

There's this cell membrane and the blood sugar has to get across that cell membrane into the cell. And then presumably gets burned up for energy in that cell. That's what is supposed to happen. With insulin resistance, which leads to type 2 diabetes, the sugar comes into the system, the sugar gets into the bloodstream, but it has trouble getting through the cell membrane into the cell so it builds up in the bloodstream. Well, insulin is the hormone that is supposed to move it from the bloodstream into the cell and it interacts with receptors on that cell membrane to facilitate that happening. If the cell membrane or those receptors are exposed a way too much insulin, over time, they become resistant to that. They turn down their sensitivity and they don't let as much insulin and sugar into the cell as they used to and that's insulin resistance.

That means the sugar builds up in the blood and now you have high blood sugar, you're a diabetic. The focus of conventional treatment has always been to lower the blood sugar by getting more of it into the cell, facilitate the rest of that transport and get it into the cell. Now we take a very different approach. Always have, I mean to get into that, but that's been the medical approach. So you have people that take insulin, more insulin gets more into the cell, you then become more insulin resistance, so you need more insulin, right? You're adding to this, but in the meantime you are facilitating more sugar getting into the cell. There are medications that either make the insulin receptors more receptive so the insulin you already have can get more sugar into the cell. Or there are medications that try to get more insulin out of the pancreas so that you can get more sugar into the cell. But the focus of all of this was to get more sugar out of the bloodstream into the cell, lowering the blood sugar, therefore controlling the diabetes.

So that's the way the system has run for many, many decades. What this article is proposing is it saying that maybe in some of the very worst cases that we should look at insulin resistance as being the body's way to protect that cell. May be shoving that much sugar into that cell is detrimental to the cell. I think that makes a lot of sense. Why else would you become resistant to the insulin? That would be a silly thing to do unless you were protecting the cell.

Now a good friend of mine and I, back when I was in Chiropractic College, probably 1997 maybe 1998 area of time…we would travel around to different parts of the country and listen to speakers talk about functional medicine stuff because we were nerds. So this friend is JD Hasenbank, he now runs a successful practice out in Nashville. So hello JD!  He and I were kind of travel buddies and seminar buddies and we'd go around, do all this and then sit down and talk about it and draw out diagramming physiology afterwards and how did it work and what did he say? It was kind of sad, but it was really interesting stuff.

So I remember being in Dallas, listening to Jeffrey Bland who eventually really kind of started and developed The Institute for Functional Medicine and he's kind of considered the modern day father of functional medicine. We can argue about the origins of functional medicine, but he certainly brought it to its new popularity, right? He was one of the figureheads of that, but he was giving a lecture at that point what was called metabolic syndrome, syndrome x, insulin resistance, or type 2 diabetes. It had multiple names and that's kind of filtered into different portions of this now, but that's what he was talking about and a lot of it was over our heads because it was just a lot of deep cellular physiology science. But when you sat down with it later and really worked with it, it all made sense. There was another doctor that would follow him around on this kind of lecture circuit and so Jeff Bland would give a lecture on Saturday talking all about this cellular physiology and all this deep science stuff. And then Bob Rakowski would come up the next day and kind of translate that into more understandable language for those of us that weren't cellular biologists. So the two of them did a great job explaining different aspects of functional medicine.

Anyway, back at that point we were talking about insulin resistance or syndrome x, this stuff. And he was explaining advanced glycation end products and what happens in the cell with what's called oxidative stress when too much sugar makes it into the cell.  Now, 20 years ago we kind of knew this and functional medicine practitioners have not so much focused on getting more sugar into the cell, but not putting so much sugar in the bloodstream in the first place. Like if you don't put it in the bloodstream, it doesn't have to get into the cell. You don't need as much insulin, the receptors calm down and you kind of undo the problem. You're not treating insulin resistance per se. You're stopping the process that made it a problem in the first place and the body doesn't have to make those receptors resistant. And so you kind of go back to normal physiology, that was being promoted over 20 years ago.

Fast forward to 2015 in the journal diabetes, someone floats this fantastic new idea that maybe just maybe shoving all that extra sugar into the cell could do harm to the cell and maybe insulin resistance was our body's way of saying, don't put all that in the cell. And maybe more of an attitude of don't put it in me in the first place undoes the whole thing, but only for the worst diabetics. Only for the ones that don't respond to pharmaceutical medications. Certainly the ones that respond to pharmaceutical medications, it's better to medicate them and shove all that sugar into the cell than it is to stop the influx of sugar to begin with. But only for the worst ones that don't react well to the medications. Those people, you can stop the influx of sugar into the body in the first place and therefore undo this entire problem. You can tell by my little overtone of sarcasm that I think they're trying to say, hey, we've kind of gotten this wrong. Let's back off the medications. Let's not pump all this sugar into the cell. Let's quit putting the sugar into the body, but they don't want to make big ag upset and they certainly don't want to upset the pharmaceutical industry who makes hundreds of billions of dollars a year treating type 2 diabetes.

So they've carved out this little niche of diabetes patients who don't respond well to the medications anyway. And we can do it on those patients because now we're not really taking business away from the big pharmaceutical companies, whatever. That's the politics of this. But I think the message, although it will take forever to trickle down into regular medical practices, I think the message is pretty sound that if you've got too much sugar in the blood, shoving it all in the cell is not generally the answer. Don't let it in to the body in the first place. Now you can go all the way to the extreme of saying, look, let's go on a ketogenic diet for a while. So there was almost no sugar coming in whatsoever. You could go kind of low carb, Paleo or just general Paleo, which doesn't have refined carbohydrates but certainly has a fair amount of complex carbohydrates, sweet potatoes and beets and carrots and things like that. Butternut squash, other vegetables, so you could go that route.

Both of which are a far cry from what certified diabetic educators talk about, which is basically low fat, high carb diet. Just make sure that you take enough medicine or insulin to keep your blood sugar under control, which is basically, “shove as much in the front end as you want. Just make sure that it makes it all the way into the cell”. That's been the message to diabetics and if you talk to anyone that's been a diabetic for 15, 20, 30 years, you'll see that that message did not serve them terribly well. Their health is not improving over time. There are surviving with diabetes, they're not getting rid of it. In fact, in the medical communities, it's pretty much considered incurable, but I would almost make the argument that is not even a disease, which sounds weird, but don't turn me off just yet. If you overload the body with sugar, it protects the cell with insulin resistance and that builds up blood sugar.

I don't know that that's really a disease. I think that's a predictable mechanism. If I stop breathing I'll pass out, that's not a disease. That's a predictable mechanism that functions in all of us. If I get too hot, I start to sweat. That's a predictable mechanism. It's a protective mechanism for my body. If I don't get too hot, the sweating stops. I didn't cure sweating. I stopped inciting that protective mechanism. So if you back off the amount of sugar that's coming in the body and your blood sugar comes down and you're not overstuffing this cell and the insulin resistance reverses itself, you didn't treat diabetes, you didn't cure type 2 diabetes.

I'm not sure it was a disease in the first place. You simply stopped pushing the button that cause that reaction. So type 2 diabetes, I don't even know how many hundreds of thousands of people in the US have it right now. But there are probably twice as many that have prediabetes or insulin resistance that hasn't yet become type 2 diabetes. In previous blog posts we've talked about your HOMA-IR score in the different ways you can look at blood sugar. So some of those earlier predictors or those earlier markers for not handling blood sugar well for building up insulin or using too much insulin. There are probably twice as many people in that situation as there are actual diagnosed type 2 diabetics. So, and I'm throwing out loose numbers here. Getting to a point where we basically just say, sugar is like the new cigarettes, refined sugar, although addictive and everybody loves it, is killing us! It's going to bankrupt our healthcare system. And finally someone in the medical literature is willing to say quietly kind of whispering out the side of their mouth. Maybe we shouldn't shove so much sugar in the front end so we don't have to find a place to put it when it can't make it in the cell.

I think that message has been shouted for a long time by functional medicine doctors. But hey, I'll take any publicity that helps spread the message. I'd rather not bankrupt our country because of sugar consumption. So anyway, off my soap box, but interesting to see that it finally made it into the literature. The Journal, Diabetes 2015 lead author's name is Nolan. You can find the article if you use that information, go to pubmed.gov and put that in, you'll be able to find it. But you can look at some of my other videos on blood sugar management. You can look up doctor Jason Fung, F-U-N-G. He wrote a book called The Obesity Code and then coauthored another book called The Complete Guide to Fasting. They also talk about this exact problem. So anyway, there's information out there, but if you're not a type two diabetic or you're not insulin resistant, don't over consume sugar and you should never have to deal with this.

If you're insulin resistant but not a type 2 diabetic, you need to pay attention to this. Don't put the sugar in the first place and you won't have to worry about whether or not it can make it in the cell. If you are a type 2 diabetic and you're on medication, you can certainly take an approach like this, but you have to be very careful because if your medication lowers your blood sugar and you quit putting blood sugar in the front end, now your blood sugar can get too low. So do talk to your doctor about that or find someone versed in this to walk you through the process because you just don't want to end up bottoming out and getting blood sugar too low. All right, so that's it for today. I wanted to discuss the article in the theory, and I don't know maybe gloat a little bit for functional medicine that we've been talking about this for a couple of decades now.

But the information is the same. Do what you need to do with it. Quit putting sugar in the front end. You won't have to worry about it building up in the bloodstream and you won't have to try to shove it in a cell that doesn't want it in the first place. Okay? So you won't age so quickly. You'll feel better, you'll be less inflamed. Life will be good, and you won't bankrupt the United States. So thanks for that. Anyway, that's it for today. Leave me some comments. Let's talk about this. If you disagree with me, that's fine. I'm certainly willing to have a substantive discussion without throwing rocks and calling names. So, all right, that's it for today. Until next time, as I always say, eat for your health, lower the sugar intake, train for performance, and live the life you love today. Thanks. Have a good one.