Reversing type 2 diabetes

Type 2 diabetes is reversible

And here is how..

– Eating too much results in excess energy which is stored as fat. 

– After a certain level of fat (this level differs between individuals and is termed personal fat threshold) fat accumulates around organs such as the liver and pancreas

– This is when type 2 diabetes starts to develop

– Insulin resistance results in the liver continuing to produce glucose despite already high blood glucose levels

– Fat accumulation in the pancreas results in beta cell dysfunction (the cells which produce insulin)

– This leads to chronically high levels of blood glucose otherwise known as type 2 diabetes.

Type 2 diabetes is reversible!

– losing fat through dieting can re-start the normal production of insulin at the pancreas and re-sensitise the liver to the presence of insulin resulting in normalised glucose production.

– These effects can reverse type 2 diabetes
(At least in patients who have had the disease less than 10 years – it is thought that after this beta cells are permanently damaged )

‘Trust the process’

‘Trust the process’

I hate this saying. It’s used by many trainers as a cop out to explaining the reasoning behind coaching methods or dieting recommendations.

If your coach/ Personal trainer frequently uses this instead of answering your questions it would be fair to assume they either don’t understand and can’t explain their methods or they are too lazy. Either way I’d not be happy with their service.

I’m not saying all personal trainers need to go into the detailed science behind every recommendation they use (although they should know the basics).
An explanation could be as simple as ‘There are many different methods to achieving this goal. I recommend doing it this way because in my experience doing *this* gives the best results’

There are certain situations where this phrase is appropriate e.g. a very impatient and over analytical client who you’ve already explained the reasoning behind your recommendations to (plus, they won’t listen anyway!). But generally this term is over used and to me is a tell tale sign that a trainer is either lazy or uninformed

Not all clients want to know the how and why but those that do should get a better response than ‘trust the process’

I always encourage my clients to ask questions and understand why I ask them to train or diet a certain way

Personal fat threshold

Personal fat threshold

We can all store a certain amount of fat safely before fat starts accumulating in places like our liver and pancreas and causing problems.

The point at which you are unable to store fat safely is termed your personal fat threshold. This is individual and is largely influenced by genetics. Fat storage above this point contributes to the progression of type 2 diabetes. 

The twin cycle theory proposes that fat accumulation in the liver and pancreas are key to the development of type 2 diabetes.

Fat accumulation in the pancreas impairs insulin response to ingested food.

Fat accumulation in the liver increases resistance to insulin mediated suppression of glucose production. Normally when insulin is present this is a sign that there is enough glucose already and our body’s own insulin production is turned off. However, if the liver becomes insulin resistant it can’t sense the presence of insulin and thus continues to produce glucose adding to already elevated blood glucose levels.

The personal fat threshold theory also explains why some people are metabolically healthy at a certain body fat % while others develop type 2 diabetes.

Muscle protein synthesis

There are 2 key determinants of muscle mass(aside from genetics)

1) Nutrient availability
2) Physical activity

If we look firstly at nutrient availability we see that protein stimulates muscle protein synthesis.

The time course goes something like this:

– Consumption of >25g protein
– After ~30mins rapid increase in muscle protein synthesis
– This peaks at ~1.5 hours after protein ingestion
– Returns to baseline by 2 hours

Note that this happens even in the presence of essential amino acids (broken down protein). So it is not a lack of nutrients that limits muscle protein synthesis.

This adds even more weight to the lack of rationale behind taking BCAAs. Not only do we know that we need all essential amino acids – not just branched chained. But even in the presence of ample nutrient supply we can’t sustain muscle protein synthesis. So if you think you are sparing muscle mass by sipping BCAAs all day .. your money is better spent on the new gym shark track suit..

Interestingly this observation does support the suggestion that eating every 2 hours is a good idea. This recommendation is fairly common amongst body builders. It is often supported by the belief that frequent meals will result in a higher metabolism or that you must eat regularly to keep your metabolism going and aid fat loss. This is not true. How you wish to split your calorie intake over the day will not impact weight loss given calorie intake remains the same.
However, where the recommendation of eating every 2 hours may have *some* support is in the pursuit of optimal muscle mass. In theory you could stimulate muscle protein synthesis via protein ingestion every 2-3 hours.

Whether this feeding regime would make real world muscle mass improvements over a less frequent feeding pattern or if this advantage is of a magnitude that merits the effort and cost of eating every 2-3hours is debatable.

If you’re a competitive body builder why not go all in and get any potential edge you can. If you want to add some muscle but still care about life balance. There are much more important factors to get right first.. don’t worry about protein timing if you’re not training consistently, sleeping enough and getting in enough nutrients in the first place.

PS this probably bares very little relevance to most of you but I am a geek and I thought some of you might find this interesting even if not applicable.

Tracking protein intake

How do you track your protein intake?

Do you look at daily or even weekly averages or do you look a little more closely.

With most things (weight and calories) I tend to look at weekly averages over specific meals or days.

This gives a much better indication of progress compared to one day or meal out of context. In fact, in terms of fat loss it doesn’t matter if your calories are evenly spread throughout the week so long as the deficit created is the same at the end of the week.

However, a caveat to this is protein (and activity actually but I will cover that in another post.

Although I tend to set a daily protein target for clients I’m not only interested in whether they meet this or not but also how they meet this.

I try to encourage clients to split their protein up throughout the day. So instead of the usual low protein breakfast, low protein lunch and high protein dinner I promote spreading protein more evenly.

There are a number of reasons behind this:

1) Muscle protein synthesis
To maximally stimulate muscle protein synthesis (muscle building) from protein intake we must ingest ~25g of quality protein. Above this point the response is saturated and more protein will not increase muscle protein synthesis. This is probably where the myth comes from that you should only have 25g of protein at a time. This is of course not true more protein is fine!

2) Satiety

Protein is very filling so adding in a good source and quantity of protein to each meal will reduce hunger- always good when dieting!

3) Actually hitting your protein target

A lot of people struggle to hit their protein target and this is made even harder if you don’t split up your protein intake.

The easiest way to do this is to plan your meals around your protein source.
That might look something like:

-Eggs for breakfast
– Tuna for lunch
-Chicken for dinner
– Yoghurt as a snack

Take home:

When it comes to protein you may want to look a little closer than just total daily intake and consider each meal.

Training hard but not getting results?

Training hard but not getting results?

Are you giving your body the nutrients it needs?

I’m sure you’ve all heard ‘you can’t out train a bad diet’

What is usually meant by this is that it is very hard to burn enough energy during exercise to account for over eating.

This saying can also be looked at from an adaptation to training point of view.

A prime example of this is protein balance after training. After resistance training muscle protein synthesis is increased. However, muscle protein synthesis is only half the equation. It is the balance between synthesis and breakdown that dictates muscle protein balance. Without the presence of essential amino acids the balance between muscle protein synthesis and muscle protein breakdown tips in favour of breakdown.

This means not only are you not adapting to your training stimulus but you are potentially maladapting. You cannot build or remodel muscle without amino acids (the building blocks of protein).

Take home: Training hard won’t yield results if you don’t give your body the nutrients to fuel adaptation

Edit- amino acids come from protein 

Activity Compensation

Ever wonder why certain individuals seem predisposed to gaining weight and find fat loss harder than others?

Part one: Activity adaptation

As we restrict energy our bodies makes adaptations to try and avoid weight loss. One of the key adaptations we make is a reduction in activity. This tends to be subconscious and is also apparent in animals on energy restricted diets. 

In fact, people lose differing amounts of weight despite being in the same relative energy deficit. For example if you put people in a 25% energy deficit (i.e everyone eats 75% of the calories they need to maintain their weight) they wouldn’t lose the same relative amount of weight this can be largely attributed to differences in activity compensation. Some people reduce their activity a lot when energy is restricted and others don’t.

Reduced activity energy expenditure can explain why some people lose more weight than others when dieting. Activity can account for a large amount of the variance in weight loss.

One study showed mice who lost the most weight on a 30% energy deficit diet were the most active. Those who lose the least weight were the least active. Of note is that the differences in weight lost amongst the mice were attributable to differences in activity levels.

One way to try to account for this is by monitoring your activity when dieting. This can be done by using a step count devise e.g. fitbit or app on your phone.

Whole Grains

Whole Grains

Observational studies have shown that whole grain consumption decreases the risk of developing cardiovascular disease and type 2 diabetes.

However, we know that observational studies show associations but can’t claim causation. i.e. we can say that people who eat more whole grains have a lower risk but not that they have a lower risk because they eat whole grains.

A recent study investigated whether the inclusion of whole grains could protect against metabolic diseases.

50 adults at high risk of developing cardiovascular disease were included in the study comparing refined carbohydrates to whole grain versions. The researchers found that participants ate less, lost weight and had less inflammation when they swapped refined for whole grain carbohydrate sources. E.g. white pasta for whole meal pasta. (link to study in comments for fellow geeks)

Participants seemed to habitually eat less when eating whole grain foods possibly due to the increased satiating effects.
Reduced inflammation is interesting and seems to be more than purely reduced inflammation due to weight loss. Rye in particular seemed to produce beneficial inflammatory markers.

Side note on inflammation:

Inflammation is the body’s response to infection. However, being overweight generally leads to low grade chronic inflammation – slightly elevated levels of inflammation despite there being no infection. This leads to a higher risk of developing cardiovascular disease and type 2 diabetes.

Take home:

Including whole grains in your diet may aid weight loss and reduce chronic inflammation. The inclusion of whole grains could be especially beneficial for those at risk of cardiovascular disease/ type 2 diabetes.

Want to know more about how to lose fat and keep it off?

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‘There’s no point exercising if you’re not going to eat well’ 

‘There’s no point exercising if you’re not going to eat well’

WRONG hun.

In fact, there is potentially even more reason to exercise. And not just for the obvious reason that you may expend some of the excess calories you have consumed. 
Exercising may also help you store the excess energy more safely.

Studies have shown that exercise increase blood flow to fat stores and reduces inflammation making fat storage ‘safer’ and less likely to cause metabolic disease.

Sugar as the cause of diabetes: over simplified and wrong

The idea that sugar causes diabetes is vastly over simplified..much like the notion that sugar is to blame for obesity.

Just because blood sugar levels are high in type 2 diabetes it does not mean than sugar consumption is the cause.

In both cases (obesity and diabetes) the primary way in which sugar contributes to increased risk is via increased calories, palatability and tendency to over consume sugary food and drink.

Type 2 diabetes starts with insulin resistance.
Insulin resistance occurs when tissues no longer respond in the same way to insulin resulting in more insulin being required to clear a given amount of blood glucose.

An individual who eats a diet that is high in sugar but is not in an energy surplus is unlikely to develop insulin resistance.

Whereas an individual who consumes a diet low in sugar but consumes more energy than they need will begin to store the excess energy as fat. This becomes problematic when fat stores arise in muscle and liver inducing insulin resistance.

“type 2 diabetes is caused by genetics and lifestyle factors. Being overweight does increase your risk for developing type 2 diabetes, and a diet high in calories from ANY SOURCE contributes to weight gain.” – American Diabetes Association website.

Take home from part 1:
Over consumption of food and not sugar per se increases your risk of developing type 2 diabetes

Part 2 tomorrow.
Chow for now