Before we get into Dr. Unger's concluding remarks in the video we've been looking at in the last 10 articles, and wrap this up, I wanted to go back to the experiments with the mice on high fat diets and talk about that a little.
Now Dr. Unger doesn't discuss what the role of glucagon actually is here, given that without glucagon the mice don't get fat from a high fat diet, but I think this is very important and perhaps even the most important part of his research findings.
If you recall, we know that excess glucagon secretion is driven by lipotoxicity, so something is behind the insulin resistance in these normal mice leading to their experiencing high levels of insulin and weight gain, and while Dr. Unger may not have thought it necessary to mention this, they didn't pick a high fat diet by accident here.
So it's well know that, under normal conditions at least, a high fat diet does produce insulin resistance, and it does this through promoting lipotoxicity. So while we know that excess lipogenesis from insulin produces a lot of fat in our blood, we don't want to forget that dietary fat does this as well, and when you give mice a high fat diet and they get diabetes, as sure as the sun rises, then you know that a high fat diet isn't as diabetes neutral as a lot of people seem to think these days, the high fat proponents.
I do want to come back to this in a lot more detail in a future article, but for now I'll point out that it is very important not to take the results of the people that do well on high fat and say that we all will do well on it. Should we be able to do this and not have too much fat circulating around, then we can pull this off, but when we do, well dietary fat can surely add to this, it has to go somewhere, and can elevate lipid blood levels to be sure, although in some cases it doesn't, and that likely has to do with the way some people metabolize fat, especially in a ketogenic state.
It may be that the ketogenic state succeeds in some people so well because it reduces serum lipids, and that actually makes sense since if you're burning this for fuel then there will be a whole lot left kicking around then if you burn glucose, but if glucose is your primary source of fuel, either by choice or not, you do need to pay attention to levels of fat intake, and if you don't, well this can really mess up your metabolism and glucagon levels in particular.
So back to the video, and Dr. Unger is now summarizing his conclusions, and presents a slide with what he feels is behind diabetes, with excess glucagon resulting in excess insulin, which results in excess fat, which breaks down into ceramide which poisons both the beta and alpha cells, which leads to more glucagon being secreted though more alpha cell insulin resistance, which causes even more insulin to be secreted, even higher ceramide levels, and the diabetic vicious circle remains in motion.
He feels that caloric intake is central to starting the whole process off, which he states causes the hyperinsulemia that gets this whole thing off of the ground, however I don't think calories are behind this, as we know that there are people who consume a lot of calories but eat very low fat and their insulin levels remain not only normal but below normal.
This is one of the challenges that some type 2 diabetics face on very low carb, and some even use exogenous insulin in modest amounts with no long term deleterious effects, at least as far as blood sugar control or developing insulin resistance that requires increasing the dosage over time.
To be fair though, if one consumes the standard diet and one consumes too much of it, that will do it for sure as this will create an excess of fat production from lipogenesis, carbohydrates are what does this though, so we can comfortably say it's not the calories it's too many carbohydrates, well in excess of what the body needs.
Fat and protein also play a role but to go into that too much here would be beyond the scope of this article, but I don't want you thinking that it's just carbs that can affect us, too much fat can as well, and even too much protein, although through different mechanisms. Fat of course is what we're looking to keep under control in the blood, and too much protein can result in an excess of both insulin and glucagon secretion, both of which are things we're looking to control with type 2 diabetes.
Personally, I find I can consume a reasonable amount of all 3 macros, but if I go over that with any of them I can run into trouble. I think that this is to some degree dependent upon the person as well, as one's needs for each does seem to vary, and we certainly want to tailor this to our own metabolism and our own diabetes and throw away the over generalized guidelines in all cases.
Dr. Unger concludes this amazing and informative video by discussing his progression from going from focusing on lack of insulin exclusively as the issue with diabetes back in the early 1960's, to his bihormal view in the 1970s where he saw both an insulin lack and a glucagon excess as being behind things, to the present day where he believes that glucagon excess is behind it all and the sole factor responsible for diabetes, of all types.
A truly brilliant lecture from a truly brilliant man.