Metabolic Dysfunction and How It Can Cause Diabetes and Chronic Diseases

I listened to another fascinating (albeit long) podcast on the Broken Brain series on how out-of-control blood sugar can cause belly fat, brain fog and chronic disease. Dr. Casey Means was the guest and she is a Stanford-trained doctor and associate editor of the International Journal of Disease Reversal and Prevention. Her mission is to reverse the epidemic of preventable chronic disease by empowering individuals with personalized tools (i.e. continuous glucose monitors – CGM) that promote sustainable dietary and lifestyle choices. As a pre-diabetic myself, I have been using some of these tools to monitor how my body responds to my diet and activities of daily living. I was quite shocked at what I learned from a month’s use of a CGM and if this blog speaks to you, it may be something you may want to discuss with your doctor.

Here are the highlights from the podcast:

We make energy from converting sugar and fat and this metabolic process is a core fundamental pathway of every cell in the human body. At optimal function, we have good memory, physical health, skin, etc. However, over time when we eat a lot of carbs and sugar and junk food, our cells get numb to the constant insulin release and this forces our body to release even more insulin to get the glucose into our cells. This leads to what is known as ‘insulin resistance’ and metabolic dysfunction eventually causing diseases like Type 2 diabetes.

Dr. Means emphasizes that many chronic conditions like Alzheimer’s, fatigue, depression, polycystic ovarian syndrome, high blood pressure or heart disease are all related to metabolic health.

We are eating 100X more sugar per person than we did 150 years ago. In the US in the 1850s, Americans ate about 2 pounds of sugar per year vs. 200+ pounds per year we consume today. Our bodies are not designed to process all this sugar so it stores it as fat. In addition, chronic stress, lack of sleep and sedentary lifestyle also translate into mitochondrial cells not functioning well. Today, 88% of Americans are not metabolically healthy and we need to change our behaviors and choices to control this epidemic.

If you ask people if they eat healthily, many will say yes (including me) but we don’t know how our body responds to these healthy foods unless we can measure and track it. For example, they did a study with a group of people by giving them oatmeal – considered a healthy food. The glucose levels for some of those that ate oatmeal approached diabetic levels while for others, it didn’t. Everyone responds differently so we need to measure and track individually and not just follow some guideline telling us what’s a healthy food vs. not.

Continuous glucose spiking throughout the day generates inflammation and glycation (which promotes aging). The huge insulin surge that accompanies the glucose spike means the glucose will soon crash, drain you of energy and also stop you from burning fat. Every time you eat, your insulin levels go up. So if you eat 6X a day which is recommended by some fitness coaches, you are causing glucose spikes 6X a day which elevate insulin levels and puts a block on any fat burning as you will be using the glucose instead. Over time, this leads to the development of visceral organ and belly fat.

Fasting is good for metabolic health because insulin will remain low so your body will use the stored glucose and then burn body fat. We have become metabolically rigid by keeping insulin high all the time. Our ancestors went through periods of feast and famine with ease because they were metabolically flexible. That’s how our bodies are designed and we need to train our body to keep our glucose and insulin down.

Dr. Means also advocates that if we are fasting, we need to stop eating early. Eating carbs late at night is associated with insomnia and messes with our melatonin release. Also, our glucose levels will bounce around all night which keeps our body temperature elevated. We fall into DEEP sleep when our body temperature drops. If we have to eat later in the day, try to go for a walk before or after the meal.

Sleep is very important for metabolic flexibility. One night of poor sleep can promote insulin resistance. In a study conducted on young men, 4 nights of poor sleep (less than 5 hours) showed markers of pre-insulin resistance.

We need to choose foods that don’t spike our glucose levels. This doesn’t mean we need to eat a ketogenic or a low carbohydrate diet. We just need to know what combination of carbs works for our body. A banana can spike glucose for some people and not for others. A study conducted in the Journal of Cell showed that a group given the exact same diet responded differently: that’s because genetics, microbiome composition, baseline insulin sensitivity, visceral fat, exercise, and sleep all differ from person to person. A good choice for you isn’t a good choice for others. I felt vindicated in listening to this – I kept telling friends/family that I can’t just have a bowl of veggie bean soup for lunch without feeling super hungry shortly thereafter. Well, my CGM gave me the truth – my glucose shot up with a lunchtime meal of a bowl of bean soup.

A single blood prick or glucose measurement is not sufficient as it’s only a single point in time measurement. However, a continuous glucose monitor (CGM) is highly beneficial because it provides us with instantaneous feedback throughout the day on how our body responds which empowers us to make decisions. Dr. Means suggests a CGM for a month to get a sense of what works for your body and then do it again in six months. I did mine for a month and was amazed at how combining certain foods did/did not impact glucose and when and how I ate them made such a difference. It also allowed me to choose foods and combinations to avoid glucose crashes with subsequent hunger pangs, cravings. For example, I found out that after a healthy meal of scallops and a large salad, I was able to enjoy a double scoop of ice cream for dessert with only a moderate increase in my glucose level.
Dr. Means also suggests we eat lots of veggies and include those that are higher carbs like carrots and sweet potatoes but do it judiciously and train your body to use and process these carbs. If you completely exclude carbs from your diet, your body cannot be trained to process them – that’s why people that come off a strict ketogenic diet often gain back their weight.

Note on COVID: Covid absolutely discriminates against people with metabolic dysfunction and as we soon discovered, there is increased risk of mortality for those with diabetes, heart disease and obesity. We need to have significant public health investment towards rapidly improving metabolic health if we want long-term, positive outcomes with Covid.

What are the mechanisms for Covid?
- High blood pressure impairs our immune function and also immune cells are stunted and cannot move properly when glucose is in the body.
- People with diabetes have an upregulation of the ACE2 receptor and this is how the virus gets into the cells.
- Lung fluid has more sugar in people with diabetes and that makes viral replication easier.
- Inflammation is high in people with diabetes, obesity and heart disease and this upregulates the cytokines. And it’s this immune response to Covid that kills people. If your cytokines are already elevated, when the virus is added, it is a compounded effect that makes the response more deadly and exaggerated.