As time has gone on, my understanding of diabetes and high blood sugar, and it’s causes and treatments, continues to evolve, from both my research and from my own experiences treating my own type 2 diabetes.
I’ve come to believe more and more that type 2 diabetes is more a disorder of the gastrointestinal system, even though this is a possibility I’ve been aware of for a long time and we’ve had clues of this ever since Roger Unger discovered that our GI system secretes a significant amount of glucagon.
Originally, it was thought that glucagon was only secreted by the alpha cells of the pancreas, but Dr. Unger, the real pioneer of a lot of our understanding of the disease of type 2 diabetes, encountered a situation in his experiments where the only possibility was that there was a lot of glucagon coming from elsewhere.
We can remove the pancreas in fact and still see some pretty significant levels of glucagon in the system, and glucagon, not lack of insulin, is what causes high blood sugar. We do not need insulin at all to maintain normal blood sugar in fact, as Dr. Unger proved decades ago, and the role of insulin in controlling blood sugar is to keep glucagon in check.
Given that glucagon was obviously coming from somewhere else when it is present but the pancreas has been removed, this led him to look elsewhere, and he discovered that the stomach also secretes glucagon. We later discovered that this is the case with the intestines as well.
Type 2 diabetes is clearly a disorder of glucagon, not insulin, although we also see an excess of insulin. We understand, by way of the work of Dr. Unger, that this excess insulin at least plays a significant role in the oversecretion of glucagon that raises our blood sugar in T2DM, and there’s no doubt that this is a factor, but is it the biggest one as those who at least have some concept of what’s going on here believe?
A lot of my articles on this site take this direction, and this is where the over-consumption of carbohydrate comes in, do that and this will raise your insulin too much, and this starts a vicious cycle of hyperinsulinemia and hyperglucagonemia, with both getting worse and worse until we become diabetic.
There’s no doubt that this is true, but is this the whole story? Is this even the biggest part of the story? Is the over-consumption of carbs really the proximate cause here?
We can explain the hyperinsulinemia merely by increases in glucagon levels, and that alone can and clearly does cause the excursions of insulin secretion we typically see in T2 patients. Higher glucagon means too much glucose is being put into our blood by our livers, our kidneys, and our intestines, and this is where high blood sugar comes from, you really can’t get there from diet alone no matter how much sugar you eat. The persistent high blood sugar that this causes will of course elevate insulin in response.
So, we could say that higher glucagon is the proximate cause of hyperglycemia, and this is true whether you are type 1 or 2, it is the mechanism behind high blood sugar period. There is no doubt about this, so the question now becomes, what are the causes of the high glucagon levels?
Dr. Unger discovered and explained that this is caused by insulin toxicity which poisons the glucagon secreting alpha cells of our pancreas and causes them to lose their sensitivity to insulin. When the alpha cells detect insulin properly, this controls their glucagon secretion, but when they become too insensitive, they don’t stop secreting excessive amounts even in the presence of hyperinsulinemia, insulin levels so high that this becomes a disease in itself.
We might then want to say, yeah, we’ve figured it out here, and all we have to do now is to lower our insulin levels and then over time our alpha cells will recover and we’ll be at least on the right track. So we cut down on things that raise it too much, carbohydrates in particular, and this in itself can produce some great results.
People respond to this in various ways though, for some it works beautifully and in others not so well. I’m in the latter group, carb restriction never did anything for me, and at one time I wrote this off to hormonal issues, as low carb does produce hormonal changes, and in particular, the raising of cortisol, which raises blood sugar.
What about these other sources of glucagon though, the stomach and intestines? We don’t know a heck of a lot about this even today, but we do know that this must be a big deal, from observing the effects of lightening the digestive load on blood sugar.
The extreme version of this is with gastric bypass patients, who typically see a dramatic reduction in blood sugar after the procedure, in a way that really can’t be sufficiently explained otherwise.
We also see this with intermittent fasting, and Dr. Jason Fung in particular has had a lot of success with this. While Dr. Fung does recognize the benefits of intermittent fasting, I would say that he doesn’t quite get why this works so well, and from my experience it has less to do with our managing our insulin levels than it does managing our GIP levels, an incretin hormone that is very likely responsible for the excess secretion of glucagon in the gastrointestinal system.
This is the cutting edge of our inquiry into the causes and management of diabetes though, and you can’t really find very much on this anywhere, because we really haven’t thought about this much. We do know that excess GIP causes excess glucagon, this is why glucagon goes up rather than down after meals in T2 patients, in a way that would lead us to believe that this is more responsible for postprandial blood sugar excursions than the meal itself.
I’ve come to believe over the last few years that high blood sugar has a whole lot less to do with what we eat and a whole lot more to do with our gastrointestinal system and defects that cause it to promote excessive glucagon levels.
I’ve experimented with various diets over the years, anything from eat whatever I want and as much of it as I want to eating extremely low carb. My digestion has always been on the poorer side for whatever reason, a lack of enzyme secretion perhaps combined with a history of perhaps eating too much at a meal.
I remember speaking to a guy on a diabetic site, rife with low carbers, who eats what he wants, food high in carbs, traditional Indian food actually. The only change he made was to reduce his portion sizes by half, and this itself cured his diabetes, he went from diabetic to normal blood sugar, something that is becoming less and less common these days, as most people nowadays have some degree of high blood sugar.
My thoughts were that this is very likely due to lightening the load on the digestive system, not reducing the carb load. Given that he consumes far more carbohydrate than others who do not see anywhere near as good results, this is the only reasonable explanation I could come up with. I experimented on myself and found the ideal thing for me was to eat one very good meal per day, what I want, and limit my intake of food the rest of the day to a couple of protein drinks.
When I added digestive enzymes apart from meals to this it worked even better. This has turned out to be, far and away, the most successful dietary strategy to manage my blood sugar, and I also have a good idea of why.
This yields a moderate carb intake overall, around 150 grams or so, and I’ve gone way lower than that with the carbs and have had poor results, so I’m completely confident that for me at least, this has very little to do with carbs at best, and everything to do with digestion.
I know enough about GIP to have an idea how to lower it, fasting itself won’t do that though because fasting in itself increases it, and ideally, the trick I believe is to not go an excessive amount of time without nutrients, but to do so in a manner that will not cause excessive GIP and therefore glucagon secretion.
I’ve never taken any so called medication for my diabetes by the way, apart from natural medicines that is, because making my disease worse isn’t something I consider a benefit, so this leaves me with managing it naturally. So there’s no room for error here, but I do strongly believe that diet is behind diabetes, and fixing one’s diet is the real solution, only the solution may not be the one we normally think of.