Gert van der Hoek
In Memoriam - Editor, Senior Moderator
by Jason Fung
Can removal of a single gram of fat from the pancreas reverse T2D? That’s exactly what Dr. Taylor from the UK recently postulated in his latest paper. How is this even possible?
First, a little background. T2D is characterized by two main defects. First, there is excessively high insulin resistance, predominantly in the liver. You can think about it this way. Insulin’s job is to stuff food energy (sugar) into the liver for storage (glycogen). Once glycogen is full, the liver turns excess carbohydrates into fat by the process of DeNovo Lipogenesis (DNL). If the storage bin (liver) is empty, food energy goes in easily.
However, when you already have a big fatty liver and the storage bin is stuffed until bursting, the insulin has a lot of difficulty shoving more sugar and fat into the fatty liver. That’s essentially insulin resistance. It looks like the insulin is not working properly. But in actuality, the problem is that the liver is rejecting the sugar (see last post) because it is already full.
Gradually increasing insulin resistance leads to gradually rising blood sugars. In the Whitehall study, a cohort of healthy patients were followed for many years. Some of these patients were eventually diagnosed with type 2 diabetes. The researchers then went back and took out the archived blood samples of these patients to see what their blood sugars looked like before the diagnosis.
At first, the blood sugar only rises gradually, reflecting the gradually increasing insulin resistance. In response to this higher blood sugar, the body secretes higher levels of insulin. This has the effect of bringing this blood sugar back down.
The insulin resistance is being ‘overcome’ with higher levels of insulin. Ultimately, this is a self-defeating proposition. Since the insulin shoves more sugar in the overstuffed liver, this only creates more insulin resistance. Insulin causes insulin resistance. But, in turn, insulin resistance causes higher insulin levels. A classic self-reinforcing cycle – AKA a vicious cycle.
But something happens about 2 years before the diagnosis of T2D. The amount of insulin falls from very high levels. While the overall level is still high, it is not high enough to ?overcome? the insulin resistance and the blood glucose starts to rise. Quickly. Soon, the blood sugars are high enough to make the clinical diagnosis of T2D. This is sometimes termed ?beta cell failure?.
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Can removal of a single gram of fat from the pancreas reverse T2D? That’s exactly what Dr. Taylor from the UK recently postulated in his latest paper. How is this even possible?
First, a little background. T2D is characterized by two main defects. First, there is excessively high insulin resistance, predominantly in the liver. You can think about it this way. Insulin’s job is to stuff food energy (sugar) into the liver for storage (glycogen). Once glycogen is full, the liver turns excess carbohydrates into fat by the process of DeNovo Lipogenesis (DNL). If the storage bin (liver) is empty, food energy goes in easily.
However, when you already have a big fatty liver and the storage bin is stuffed until bursting, the insulin has a lot of difficulty shoving more sugar and fat into the fatty liver. That’s essentially insulin resistance. It looks like the insulin is not working properly. But in actuality, the problem is that the liver is rejecting the sugar (see last post) because it is already full.
Gradually increasing insulin resistance leads to gradually rising blood sugars. In the Whitehall study, a cohort of healthy patients were followed for many years. Some of these patients were eventually diagnosed with type 2 diabetes. The researchers then went back and took out the archived blood samples of these patients to see what their blood sugars looked like before the diagnosis.
At first, the blood sugar only rises gradually, reflecting the gradually increasing insulin resistance. In response to this higher blood sugar, the body secretes higher levels of insulin. This has the effect of bringing this blood sugar back down.
The insulin resistance is being ‘overcome’ with higher levels of insulin. Ultimately, this is a self-defeating proposition. Since the insulin shoves more sugar in the overstuffed liver, this only creates more insulin resistance. Insulin causes insulin resistance. But, in turn, insulin resistance causes higher insulin levels. A classic self-reinforcing cycle – AKA a vicious cycle.
But something happens about 2 years before the diagnosis of T2D. The amount of insulin falls from very high levels. While the overall level is still high, it is not high enough to ?overcome? the insulin resistance and the blood glucose starts to rise. Quickly. Soon, the blood sugars are high enough to make the clinical diagnosis of T2D. This is sometimes termed ?beta cell failure?.
READ MORE