Inflammation and T2D – T2D Part 1

This week I’d like to discuss type 2 diabetes (T2D) and inflammation. Usually I try to follow topics sequentially, but I was reviewing an article about type 2 diabetes and inflammation and thought it was quite interesting. The results of a large trial (TECOS) were released in June 2015 and illustrates once again the futility of targeting blood sugars in the treatment of T2D. This got me thinking about T2D again. So apologies, but we’ll start this series in the middle of the story.

As a background, you can view some of my online lectures, including “The Two Big Lies of Type 2 Diabetes“, “How to Reverse Type 2 Diabetes Naturally“, and “The Perfect Treatment for T2D“. type-1-diabetes

Essentially, I think that the current treatment of type 2 diabetes (T2D) is entirely incorrect. I think that we are simply treating the symptom rather than the disease. Let me explain. In type 1 diabetes, there is destruction of the insulin producing cells of the pancreas for reasons that are still largely unknown. This lack of insulin results in high blood glucose (BG) levels which cause various symptoms. Untreated, this is a fatal disease.

The severe lack of insulin causes severe weight loss. No amount of caloric intake will be able to stimulate insulin and weight drops off rapidly and fatally. Insulin reverses this disease. This makes sense. The disease is lack of insulin. The treatment is replacement of insulin.

However, T2D is an entirely different disease. When researchers first measured insulin levels in T2D, they also expected levels to be very low, but instead they were very high. The disease is actually one of too much insulin resistance (IR). That is, there is plenty of insulin, but the insulin doesn’t really work very well. This has often been compared to a lock and key. In T1D, there are no keys (insulin) available to open the lock (insulin receptor). Therefore, the logical treatment is to give insulin (key).

However, in T2D, the key (insulin)ndoes not really fit the lock (receptor) very well. The body responds by making more keys, but the underlying problem is not the key, but the fact that the lock is damaged. In this situation, it would make sense to fix the lock since that is the problem. However, our current approach to the treatment of T2D, endorsed by all the major diabetes associations is to give more insulin. So, the key does not fit very well, so let’s make more keys! Wouldn’t it make more sense to fix the lock?

But anywho, that’s what we do. When somebody has high blood sugars due to IR, we give more insulin instead of trying to fix the IR. The high blood sugar is the symptom of the disease (high IR). Instead of fixing the disease, we fix the symptom (high blood sugar). Yet somehow, we are surprised when fixing the symptom provides no lasting benefit.

For years, it was assumed that that tight BG control would reduce the complications of T2D. However, around 2008, four major trials (ACCORD, ADVANCE, VADT, and ORIGIN) were published. All were hugely expensive trials designed to apply the gold standard (randomized double blind controlled trials) to the question of whether lowering blood sugars would reduce cardiovascular disease. After all, most diabetics die of CV disease and therefore, any strategy that reduced CV disease would be important.

We will review these trials in more detail later, but the bottom line was that lowering blood sugars did NOT reduce CV disease or death. This was a major problem. All of the current treatments of T2D are based on the underlying assumption that tight glucose control was beneficial. But all these trials agreed. There was no benefit.

Looking back, it seems quite obvious. The disease is about too much insulin resistance. However, our treatment is to lower blood sugar and ignore the insulin resistance. Since we are not actually treating the disease, but instead treating the symptoms, it seems obvious why these therapies did not work.

For example, suppose you have an infection caused by a bacteria (cause of disease). This infection causes a fever (symptom). In order to cure the disease, you use antibiotics to kill the bacteria. If, instead, you treat the symptom of fever with acetaminophen, then there is no benefit. In T2D, the situation is the same. The disease (insulin resistance) is untreated while we focus on the symptom (blood sugars). The high blood sugars were in fact caused by the IR.

So here the situation. Doctors were using treatments that were now proven to be ineffective. We could either change our treatments, or simply ignore the studies (all four of them). This is cognitive dissonance at its finest. However, rather than learn our hard (and expensive) lessons and try to focus on treating IR, medical professionals instead chose to ignore the studies. There was simply too much money and too many academic careers built on treating blood sugars.

So, why is treating blood sugars so ineffective for CV disease (atherosclerosis)?

Inflammation is a key component of much of the damage done to our bodies during the process of atherosclerosis. It has long been recognized that the process of narrowing and hardening of the arteries (called arteriosclerosis or atherosclerosis) is not so simple as cholesterol in the blood clogging up the artery like sludge in a pipe. Even 25 years ago, when I went to medical school, it was well known that inflammation played a key role. Atherosclerosis is process that initiates and propagates as a response to injury. Inflammation is part of what causes that injury.

As the blood vessel becomes injured, especially where they branch off, a cascade of events is triggered. Smooth muscle cells proliferate and move into the plaque (narrowed area). White cells in the blood attach to the lining (endothelium) and move into the plaque and proliferate. Multiple inflammatory mediators (IL-1, cytokines, growth factors etc.) are involved at all stages.

So, inflammation plays a key role in atherosclerosis and all its diseases (heart attack, stroke) and reducing inflammation is good. In order for a treatment to provide health benefits, it would be important to lower inflammation. Does lowering blood sugars lower inflammation?

This brings us to the LANCET trial, published in 2009 in the Journal of the American Medical Association. In this trial, researchers studied inflammatory markers hsCRP (high resolution C-Reactive Protein), IL-6 (Interleukin 6) and sTNFr2 (soluble timor necrosis factor receptor 2).  These are all markers that predict incident heart attacks and stroke. So, if lowering blood sugars was going to be beneficial, then you might expect that it would need to reduce inflammation to do so.

The point of this study was to see if insulin or metformin would reduce inflammation. This was a randomized controlled study of four groups – placebo, metformin, insulin or both with a total of 500 patients. Certainly, those drugs were able to lower blood sugars. That’s to be expected. That what they were designed for. However, does lowering blood sugars result in lower inflammation? Yeah, not so much.

Inflammatory markers were essentially unchanged despite the better sugar control. The exception is insulin treatment alone. It tends to increase hsCRP and IL-6. Yeah, that’s bad.

We want to lower inflammation, not raise it. Insulin makes thing worse, not better. That’s what we argued in a previous post – insulin causes insulin resistance. Therefore, treatment with insulin would be expected to make blood sugars (symptom) better, but make the diabetes worse.

So now we can understand a little bit better the results of the ACCORD, ADVANCE, VADT and ORIGIN trials. All these trials were aimed at treating symptoms and not diseases. They treated the high blood sugar, but not the underlying insulin resistance.

Since atherosclerosis is an inflammatory disease, any treatment that may be potentially effective should somehow also reduce inflammation. Yet neither insulin nor metformin is able to lower inflammation. They can’t fight the fire, so to speak (inflammation is sometimes call ‘the fire within’). Therefore neither insulin nor metformin was able to reduce the incidence of heart disease or stroke. Similarly, these treatments were not able to affect the underlying inflammatory cascade that is so damaging to the human body. In short – these treatments are virtually useless. It is like treating a life-threatening infection with Tylenol. Unfortunately, 99% of type 2 diabetes treatment is currently aimed at reducing blood sugars, including all the major current diabetes guidelines, even though this strategy has been proven to be useless over and over and over and over.

Why? Why, you may ask? Well, nobody makes any $$$ when you get better, do they?

Start here with “My Journey”

Continue to T2D 2 – The Biggest Lie

2017-10-19T13:50:12-04:0026 Comments

About the Author:

Dr. Fung is a Toronto based kidney specialist, having graduated from the University of Toronto and finishing his medical specialty at the University of California, Los Angeles in 2001. He is the author of the bestsellers ‘The Obesity Code’ and ‘The Complete Guide to Fasting’. He has pioneered the use of therapeutic fasting for weight loss and type 2 diabetes reversal in his IDM clinic.

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Sharon
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Sharon

Will part 2 address ways to reduce inflammation? If you reduce inflammation, will insulin resistance improve and thus allow you to consume more carbs (whole food carbs, not the processed junk carb) without affecting your blood sugar?

Dr. Jason Fung: Ummm…. This will more likely be a 40 part series, but not about reducing inflammation, but about reversing type 2 diabetes.

Jane
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Jane

I take Wobenzymes for inflammation. The diabetes medication would not allow me to take enzymes so I went off the meds and will follow Dr. Fung. After all ENZYMES are life.

Teresa
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Teresa

I guess my first reaction was similar to Sharon’s—how best to reduce inflammation, but Dr. Fung, from your response, it sounds like reversing type 2 diabetes is more involved than that. As a “pre-diabetic”, I am eagerly awaiting the remaining articles in the series. Everything I’ve read so far in other books and articles, really, has been about controlling blood glucose levels (low carb, etc.) so I’m interested in what you have to say. Thank you!

Bernard P.
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Bernard P.

Teresa, you can get the essence of Dr. Fung’s explanation of diabetes and its treatment right away by watching his video lectures on this web site, under the Lectures tabs.

It will consume maybe 10 hours of you time in all, but will be worth it. The blog posts are an expanded version of the contents of the video series.

Teresa Gosser
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Teresa Gosser

Thank you! I kept digging more and have read more of Dr. Fung’s blog articles and have watched a couple of the YouTube videos and plan to watch the rest. This is very timely for me
..as I am watching my “prediabetes” progress (A1C is getting higher and fasting glucose levels are rising). This furthers my commitment to LCD diet with the addition of intermittent fasting and Dr. Fung’s other recommendations. So glad I found this…really stumbled on to it.

Richard David Feinman
Guest

If you have a crumby bow and arrow and you can’t hit the target, you can blame it on the target but maybe you should see whether the guy next to you at the range is hitting it reliably and maybe you need to check the ratings of bows and arrows on Amazon. If you reduce blood sugar by reducing dietary carbohydrate you will get good results like the numerous reports in the literature and from clinical reports and you will reduce compensatory hyperinsulinemia (as well as inflammatory markers). Targetting hyperglycemia in the presence of hyperinsulinemia is not the opposite… Read more »

Ejaz
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Ejaz

Thank you Dr. Fung for such a nice article, I am getting advantages from the findings regarding T2D and have reversed it. Followed intermittent fasting, LCHF diet and weakly 180 minutes exercise plan. I hope I’ll be back on track and get rid of all effects of metabollic syndrome including IR

Cristi Vlad
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Nobody makes any money when you fast either (consume nothing but water). 🙂 Good post Dr Fung! I shared it on the groups.

Nate
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Nate

I always enjoy your posts, Dr. Fung. They always include a little humor, scientific trials, discussion of metabolic pathways, etc. But that last paragraph about $$$ is only partially true. I think many of the doctors and nutritionists in the trenches are motived by their egos protecting them from having to admit that they were wrong. And worse yet, for many, that their errors have caused a lot of pain and death. That can be a very painful truth to face and the ego is a very tricky fellow and will do what it can to protect itself.

Joe P
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Joe P

If doctors start saying they were wrong about insulin and T2D would they then open themselves up for lawsuits. for any damages caused by following their instructions? Ego might me a very tricky fellow, but money is even trickier.

Jerome Benthamite
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I have technical comment as to your statement that “insulin increases the immune response”. I am not denying that, only suggesting that you have the wrong model for the generation of atheroma. Dr. Fung I would like your response. The Pharma’s KOLs (Key Opinion Leaders) hold that atherosclerosis starts with oxidative damage to LDL in the tunica media of the artery wall, which elicit an immune response by monocytes and macrophages. The oxidative damage they hold is a result of ROS (reactive oxygen species) from metabolism in the tunica media. This KOL explanation raises questions; why are reactive oxygen species… Read more »

David M
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David M

Hello Dr. Fung, I only recently discovered your web site and videos. All I can say is, finally a doctor with a penchant for solving problems and a fellow Canadian at that eh. I have been on your IF program for not quite a month. My fasting BG went from 15.5 down to the mid 7s with 4.8 being my best result so far. Whoa thunk? When I was first ‘officially diagnosed’ as T2 in 2005, I reduced carbs and got my fasting BG down from 17.4 to the high 6s in 6 weeks. My first A1c was 6.2. But… Read more »

Sandra
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Sandra

Can you please email me your contact info. I have been stubbornly sticking to diet to try and keep my pre diabetes at bay and though my diet is so much better than most people I know, I have never been able to shake weight. I am so thrilled to find your lectures and blog. Adding your protocol to an already high quality, high raw, pescetarian diet with tweaking based on your information sounds like the answer. The problem is that I am not clear on the food protocol other than fasting and even then, I got different fasting stories… Read more »

Sandra
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Sandra

OK, I asked my question before realizing how much information is on your website. The “Join” and “contact” sections explain it all. Thank you! Now I will continue to read your blog entries and watch your videos to get what I need as far as advice for how long and often to fast and what to eat… Thank you for your wonderful work. I think it is the missing key for everyone. All my best, Sandra

DebbieC.
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DebbieC.

Looking forward to more of this series, and will have to start watching the videos. My blood sugar is still high though I’ve been doing IF since mid-July including a number of 24-hour fasts (though not as high as it was before I started, but no startling drops). I see my doctor tomorrow and I’m afraid she is going to suggest I go on insulin, which I don’t want to do after reading much of your series. I plan to print out this blog entry and bring it along with me. 🙂

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Rene Tewksbury
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Rene Tewksbury

Dr Fung, I was able to lower my fasting insulin from 68 to 14 in one month by following your IF protocol and Marty Kendall’s food lists. I was on a sliding scale of both NovoLog and Novolin R up to 40 units each 4xday and 2000mg Metformin per day. I stopped all my meds on day one, 7/1/15, and experienced higher than normal blood sugars for a few days, but my readings quickly started dropping and now are in the 70 to low 90 range. I am sure I have also further lowered my insulin level. I was the… Read more »

Bob Briggs
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Bob Briggs

Fantastic. Wonderful testimony!! These type of personal transformations are changing the world.

Carina Co
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Carina Co

Hi Dr. Jung, i’m a 36 yr old filipina who has just been diagnosed of having T2D. I seen some of your youtube videos and i very much would like to be in you intensive diet program. I don’t want to be diabetic and after watching you, i now know that i don’t have to be. Thank you so much! The world needs more doctors like you! How can i be under your program? Help please…

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[…] and bleeding stopped (it’s a marker for effectiveness). Similarly in inflammation and T2D, as I previously wrote, insulin therapy does not decrease inflammation, which marks this likely an in-effective treatment […]

Laura Baier
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Laura Baier

Thank you for all of yout help Dr. Fung, as of Nov. 2, I weighed 202 lbs. have been T2 for years. Blood sugars over 13 practically all day, and novo rapid x3/day. After much studying of your teachings, I took over my problem and went on your advise. My Dr. Insisted I take a new drug called Invocana. After doing this, I was on my own. He did not agree with any other method of treating my diabetes but with insulin. So as of Dec.17th. I fast 20hrs. a day, I take no insulin during the day, and have… Read more »

bachcole
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bachcole

“I think that we are simply treating the symptom rather than the disease. “. Most all of what modern medicine does for degenerative diseases is treating the symptom rather than the disease.

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[…] Inflammation and T2D – T2D Part 1 […]

Max Post
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Max Post

If insulin resistance is the problem and the “lock” is malfunctioning not allowing insulin to drive glucose into cells, the lock need a repair. Intramyocellular lipids are clogging the lock(Drs. Barnard and Greger). They contend that a hclf diet will open the keyhole . They cite studies and display images. Your thoughts?

Jack
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Jack

Over last 2 months of IF, with LCHF diet, i have been able to bring down my HB1AC to 5.5 from 6.5 . My lipid profile is also stable but my hs CRP has gone beyond 10 …just don’t get it. Recently diagnosed CSR of eye has also worsened . Lost 10kgs in two months . How to be sure if this is related or not related?

Maninder Chopra
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Maninder Chopra

Would a LCHF diet along with appropriate fasting affect autoimmune diabetes, like Type 1 or Latent Autoimmune diabetes (which has both type and type 2 symptoms). Would it make sense to take insulin or metformin in such cases, during the fasting period with glucose levels rising?