Think Skinny People Don't Get Type 2 Diabetes? Think Again. | Chris Kresser

Think Skinny People Don’t Get Type 2 Diabetes? Think Again.

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In the last article on diabesity and metabolic syndrome, we discussed the complex relationship between body weight and type 2 diabetes (T2DM). We learned that although obesity is strongly associated with T2DM, a subset of “metabolically healthy obese” (MHO) people have normal blood sugar and insulin sensitivity and don’t ever develop diabetes.

In this article we’re going to talk about the mirror reflection of the MHO: the “metabolically unhealthy nonobese” (MUN). These are lean people with either full-fledged type 2 diabetes or some metabolic dysfunction, such as insulin resistance.

You might even be surprised to learn that skinny people can and do get T2DM. They are rarely mentioned in the media, and there isn’t much written about them in the scientific literature.

Perhaps these folks have been overlooked because type 2 diabetes has been historically viewed as a disease of gluttony and sloth, a self-inflicted outcome of eating too much and not exercising enough. But the very existence of the MUN phenotype proves that there’s more to T2DM than overeating and a sedentary lifestyle.

Remember that one in three type 2 diabetics are undiagnosed. It’s possible that a significant number of these people that are lean. They don’t suspect they might have T2DM because they’re under the impression that it’s not a condition that affects thin people. This is one of the biggest dangers of the myth that “only fat people get diabetes”.

It’s well-known that high blood sugar can precede the development of T2DM for as long as ten years. It is during this time that many of the complications associated with diabetes – nerve damage, retinal changes, and early signs of kidney deterioration – begin to develop. This is why it’s just as important for lean people to maintain healthy blood sugar as it is for the overweight and obese.

It’s also important to understand that diabetes is not a disease. It’s a symptom. Every single person with T2DM, whether they are rail thin or morbidly obese, shares a single symptom: high blood sugar. Therefore, anything that interferes with the body’s regulation of blood sugar levels will cause type 2 diabetes.

What Causes High Blood Sugar and T2DM in Lean People?

Not surprisingly, the causes of T2DM in lean people are similar to the causes of T2DM in the obese. They can be loosely grouped into the following categories:

  1. Genetics
  2. Fatty liver
  3. Inflammation
  4. Autoimmunity
  5. Stress

Let’s discuss each of them in turn.

Genetics

Studies of the lean, otherwise healthy offspring of type 2 diabetics has revealed that they are much more likely to be insulin resistant than the lean offspring of non-diabetics. One explanation for this is an inherited defect that causes mitochondrial dysfunction. People with this defect are not able to burn glucose or fatty acids efficiently, which causes lipotoxicity and an accumulation of fat inside of muscle cells.

I will discuss the contribution of genetics in more detail in the next article. What I want you to understand here is that the genetic mechanisms I described above are capable of causing insulin resistance and high blood sugar independently of overweight or obesity.

Fatty Liver

Studies of lean, Asian Indian men have found that they have a 3- to 4-fold higher incidence of insulin resistance than their caucasian counterparts. They also have a much higher prevalence of non-alcoholic fatty liver disease (NAFLD) and hepatic (liver) insulin resistance.

NAFLD is an independent predictor of type 2 diabetes. Cross-sectional studies have shown that fatty liver and metabolic abnormalities occur together. It has also been proposed that fatty liver is not just a result, but also a cause of insulin resistance and type 2 diabetes.

Now, keep in mind that these Asian Indian men with NAFLD were not overweight. They were lean, and in some cases, even underweight. This proves that NAFLD occurs in lean people, and together with the evidence above, suggests that NAFLD may be a primary cause of insulin resistance and T2DM in lean people.

If you’re thinking NAFLD might be a rare problem confined to Asian Indian men, you should know that up to 30% (almost 1 in 3) of people in industrialized nations suffer from it. This is a disturbingly high prevalence of a condition that is known to progress to severe liver inflammation and cancer in a small percentage of people – in addition to contributing to T2DM and metabolic syndrome.

While there may be a genetic component that predisposes people to developing NAFLD, we also know that dietary factors play a significant role. Rodent studies have shown that feeding large amounts of sugar and industrial seed oils (like corn, safflower, sunflower, etc.) promote NAFLD, whereas saturated fats such as butter and coconut oil do not. And in human infants, tube-feeding with industrial seed oils causes severe liver damage, whereas the same amount of fat from fish oil does not.

Fructose, especially the high-fructose corn syrup (HFCS) found in sodas, candy and several packaged and refined foods, is perhaps the most significant dietary cause of NAFLD. The liver processes fructose by converting it to fat. The more fructose consumed, the more fatty the liver becomes. Feeding rodents high amounts of fructose promotes NAFLD, and the consumption of soft drinks (by humans) can increase the prevalence of NAFLD independently of metabolic syndrome.

Let me say that again: high fructose intake can cause fatty liver disease independently of overweight, obesity or type 2 diabetes. Do you think that might be a problem in a country where soft drinks account for nearly 10% of total caloric intake?

Since fructose is handled by the liver in the same way the liver handles alcohol, excess fructose produces a similar range of problems as alcohol abuse: hypertension, high triglycerides and low HDL, obesity, cirrhosis and insulin resistance.

Inflammation

In the study of lean Asian Indian men above with T2DM, it was found that they had a 2-fold increase in plasma levels of the inflammatory protein IL-6 when compared to lean subjects without T2DM. In a previous article I showed that chronic, low-grade inflammation associated is an important mechanism in decreasing insulin signaling and causing insulin resistance in muscle, liver and fat cells.

Also, inflammation has been shown to precede the development of diabetes. Infusion of inflammatory cytokines into healthy, normal weight mice causes insulin resistance, and people with other chronic inflammatory conditions are at higher risk of developing T2DM. For example, about one-third of chronic Hepatitis C patients develop T2DM, and those with rheumatoid arthritis are also at higher risk.

Autoimmunity

Up until recently, type 1 and type 2 diabetes were seen as distinct entities. It was understood that type 1 diabetes (or insulin-dependent diabetes) was caused by autoimmune destruction of the beta cells of the pancreas, leading to decreased insulin production, whereas type 2 diabetes was caused by insulin resistance of the liver, muscle and fat cells.

However, recent research has demonstrated that the line separating these two conditions may be much blurrier than previously thought. It is now known that type 1 diabetes, which normally begins in childhood, may slowly develop later in life. This form is referred to as latent autoimmune diabetes (LADA) or more informally as type 1.5 diabetes.

Studies suggest that type 1 diabetes in adults is frequently misdiagnosed as T2DM, and up to 10% of adults with T2DM may actually have the autoimmune form.

Even more relevant to this article is the finding that fully 1 in 4 lean people with T2DM produce antibodies to GAD, the same enzyme in the pancreas that is attacked in type 1 autoimmune diabetes.

These findings suggest that a significant number of lean people with T2DM may be suffering from autoimmune diabetes. This will obviously require a different treatment strategy than those who have the non-autoimmune form. (The way to find out whether you’re in this group is to have your GAD antibodies tested. It’s a fairly standard blood test and is available through Labcorp and Quest.)

(Interestingly enough, approximately 5% of patients with autoimmune thyroid conditions also produce antibodies to GAD. So if you have Hashimoto’s or Graves’ disease along with blood sugar symptoms that don’t respond to dietary changes, you should have your GAD antibodies checked.)

Stress

Under conditions of stress, the body produces higher levels of the hormone cortisol. Cortisol plays a number of important roles, but one of it’s primary functions is to raise blood sugar. This is an incredibly helpful evolutionary mechanism that is part of the “fight or flight” response that prepares us to deal with a challenge or threat.

However, that mechanism was only designed for short bursts of stress.

Chronic stress as we experience it today – like worrying about getting audited by the IRS, driving in traffic, and suffering from degenerative disease – wasn’t part of our early ancestors’ lives. This means that our bodies aren’t prepared to deal with the effects of chronic stress, which include chronically elevated levels of cortisol.

Why? Because cortisol is capable of raising blood sugar to unhealthy levels even when a person is fasting. What that also means is that you can be lean, eat a perfect diet, and still have high blood sugar (and thus T2DM) if you suffer from chronic stress. I’ll be writing more about the connection between stress and diabetes in a future article.

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  1. I am 47, Asian Indian, Male, 5ft10in, 165lbs now living in USA for past 19yrs diagnosed with hypothyroidism (16yrs) pre-hypertension (7yrs) pre and type-2-diabetes (~2/3 yrs) and borederline cholesterol (few yrs).

    I was diagnosed for Hypothyroidism around 16yrs ago in the US while going thru my annual physical. I did not have any symptoms of hypothyroid (none of weight gain/loss, feeling exhaust etc). My physician recommended me to see the specialist who performed several blood tests over a period of 2yrs and finally told me to get on the medicine and not wait for the symptoms to show up. The readings during those 2yr period was fluctuating so much that he mentioned once it was out of the charts. Note that I was still not on medication during those 2yrs of monitoring. Since then I started on 25mcg of Levothyroxine. 5yrs ago, the dose was increased to 50mcg and this past year to 75mcg and this month to 100mcg.

    During this period, I have been fairly healthy (physically) and been fairly active – running ~10 miles a wk. I was diagnosed with pre-hypertension 6-7 yrs ago and been taking 25mg of Atenolol since then and also my A1C for past 4 yrs have been coming around 6.2/6.3 with the fasting sugar at around 130.

    My cholesterol readings have always been borderline – little low on HDL (36) and high on triglycerides (250-350).

    My physician mentioned that I am no longer pre-diabetic but actually considered a “diabetic on diet control” meaning not yet on medication, but he was recommending me to go on cholesterol medicine because I am diabetic and also changing my hypertension medication from Atenolol to something else that is compatible with diabetic.

    I am very lost with all this diagnosis. Actually, since last year when my physician warned me, I have significantly increased my activity by jogging / brisk-walking 25-45 miles a wk hoping that will help me to reduce any or all of these conditions but with no results.

    My typical diet is vegetarian at home and eat chicken or fish once a week at restaurants and consume couple glasses of red wine once a week.

    Also on my family side, My mom was diagnosed diabetic when she was ~37 and my dad was diagnosed for hypertension when he was ~60 but neither was diagnosed for thyroid (both in India)

    After reading this article I have requested my physician for a referral to an Endocrinologist (My insurance doest not need a referral, but still prefer to keep him in the loop since I still trust his service).

    Thank you for Chris Kresser for the blog / article and for all the participants for sharing their story and contributing to the discussion. Any inputs on my condition will really help me to look into areas that I have not exhausted yet.

    • Have you read the book, “How Not to die?” I’m reading it right now and am finding it pretty amazing. It goes over the top 15 diseases in the USA and their causes and what you can do about it.

  2. I was diagnosed as Type 2 diabetic at age 21, back then I weighed 125lbs and was 5’8ft (Female). People always say T2DM is a lifestyle disease as a result of basically an ill diet, bring overweight and sedentary lifestyle. But I never fit that profile. So where do I fit in? Since I was around 10yrs old (or younger) I had Acanthosis Nigricans (darkening of skin behind neck/in creasefolds as a result of insulin resistance), I was highly underweight, gauntly skinny for most of my childhood until I hit my 20’s. For some reason I could never ever gain weight, yet I had these darkened skin patches no-one could explain at the time. I was an active child just like any other. When I turned 17, I noticed my wounds weren’t healing, or would take longer than usual to heal. When I visited the doctor, she took a basic blood sugar test and it read 121 as my fasting blood sugar. So she disregarded aby possibility of me being diabetic. However at 21, after being unable to recover from the flu, my blood sugar was tested and it read 360. It was then that they did my A1C which was 10 or so (I can’tell recall) but it was then that I was diagnosed as Type 2 and put on Metformin. Then Diamicron. However these tablets basically lost their effectiveness over the next couple of years. I’m 28yrs old & 140lbs now and am insulin dependent. Without injecting insulin, my blood sugar level won’t decrease. I do experience insulin resistance though, and still have Acanthosis Nigricans, so I take Amaryll with insulin to manage my blood sugar. I’m still not certain about what type of diabetic I really am….

    • Have you tried a ketogenic (high fat low carb) diet? Given that you are not overweight, fasting would probably be a bad idea, but putting yourself in ketosis (having your body run on fat) might be the right thing for you.

      • Izabela, good suggestion. I have recently started a Keto diet as I was diagnosed with Type 2 around 3 months ago. I was skinny and have lost 25 lbs and guess as to when the weight will come back with just diet change?

    • I would suggest seeing an endocrinologist if you haven’t already done so. Just as the article explains, you could be an autoimmune Type 1. It’s good that you are on insulin, but an endocrinologist can confirm the correct diagnosis and make sure you are getting the right treatment advice. Either way this would help you know for sure.

      I am a type 1 and was diagnosed at the age of 34. Luckily, my doctor referred me to an endo and did the tests to recognize that I was not type 2. However, many adult type 1’s are often misdiagnosed and may not get the correct treatment for years.

      I am not on a strict ketogenic diet but do eat a fairly low amont of carbs (about 60-80g per day). This keeps my A1C in the 5’s and has been working really well for me. I also still need small amounts of insulin every day, but much less than most people.

  3. The idea that diabetes/metabolic syndrome is caused by carbohydrate intake and high GI foods is a gross oversimplification- especially when one does not take into account whether whatever carbohydrate is ingested in processed/refined or not.

    Foods are also generally not even in a vacuum like they were for the GI testing – by adding fats and proteins to your meals like you normally would – you get an ENTIRELY different GI response as compared to the GI itself.

  4. I was diagnosed at 50 with Type 2. I am 6’2″ and at the time weighed 165. I exercised a lot and very active. However, I suspected that the reason for the diabetes was stress, but could for the longest time couldn’t find anything on the internet that actually said stress could be the underlying cause for diabetes. So I’m the skinny guy he is talking about in the article. I changed my diet dramatically with the hope that I could control it with diet alone, but it didn’t work. I have to take metformin to keep it down. I now weigh around 150. But even with metformin and watching what I eat, my HA1C continues to climb. It’s now at 6.8. And I’m pretty certain it is the stress of my job. That’s the next thing I need to work on.

    • Please get tested for type 1. Get your c peptide and insulin checked. If you’re thin, eating right, and metformin is still not working, it sounds to me like type 1.

  5. Hello
    i am having irregular pattern of blood sugar level since last few months . It is below 80 mg/dl during fasting and rises up to 180 mg/dl after 2 hours of meal. then after 6 hours it is again less than 80 mg/dl . i always feel hungry even after a meal. feel weakness as i m very lean . am i diabetic ? What should i do ?

    • It’s my experience that while I had diabetes, my blood sugar was 300-400 and hour or two after a mean abd during a fast I would become weak, nauseous, clamy, sweaty, and cranky. My blood sugar levels would be below 70 . And I couldn’t have any refined sugar only fat free sugar free items. And even with those precautions I was at 250+

      • Regardless if you are worrying it’s best and safest to see a dr. I’m not a dr, just a person who had diabetes and doesnt anymore.

  6. I used to be under 140lbs and vegan (27 years old). But then I went into mental hospital. It caused me to have a fat stomach and have difficulties walking ie. the walking ability of about a 60 year old. I didn’t put on a huge amount of weight immediately. But after 2-3 years I put on over 50lbs. I went into the hospital again. This time, when I left I had the walking about of 75 year old. I notied after a few months I was gaining large amounts of weight. So I cut my calories to 1500/day, including calories from fruit. So in essence, I was eating about 2/3 of what I was eating previously. But the most I ever lose is 1lb a month. If I spent a couple of weeks eating 2000 a day I’ll put on like 2lbs which means I have to spend 2 months to get back to where I was.

    Well as you can imagine all of this was very very traumatic. Even though I’m only 33, seeing as I am now about 200lbs and have huge difficulties losing weight, I started to get very concerned that I might get diabetes in the future. So I overcame my trepidation at walking (which is very difficult for me) and started walking each day.

    Unfortunately, this morning my prophesy seems to be correct. I got a phone call from the surgery (American’s say health center?) and they said I was borderline on fasting blood glucose test and need to have another blood test.

    After reading comments on this page I decided to purchase a blood sugar monitor.

    Sorry for the long comment, I suppose I just wanted to share my story. I was wondering if anyone could tell me whether fasting blood sugar can read bad result in people without prediabetes or diabetes? Suppose I have some wishful thinking that it might just be a one off bad test.

    • Here is a link to a blog you should read https://intensivedietarymanagement.com/.

      Read everything there is to read on this blog and you will find your solution. My mother was a type 2 diabetic, on insulin, for 14 years. We stopped her insulin a month ago and she just tested her 3 month average glucose level. It has never been better (it is completely normal). She looks 10 years younger too and lost abdominal fat (the rest of her body is actually skinny).

      Just to be clear, I applied the knowledge that Dr. Fung shares on his blog without the supervision of a doctor, but with regular monitoring of my mother’s blood glucose. The response to the fasting was immediate (within 2 days we saw pre-diabetes fasting glucose levels; a month later she is getting closer and closer to a non-diabetic glucose levels).

      Given that you are not on any diabetes medication, you should be able to apply Dr. Fung’s approach to curing diabetes on your own. You will likely not get the support of your doctor, but please read the blog just the same.

      Here is the link of the first of six video lectures by Dr. Fung on the aetiology of obesity, he is a wonderful lecturer (you will see the other five through the first):
      https://www.youtube.com/watch?v=YpllomiDMX0

      p.s.once you read the info, I am happy to tell you more 🙂

      • Izabella, you don’t cure T2D there is no cure! You can put it in remission by diet and exercise but…slack off and it comes roaring back! Once you have it, you have it for life. You will always be a T2D.

        Diet and exercise may only work for awhile then eventually you will end up on oral meds or insulin.

        I am one of those thin T2 diabetics!

        I read Dr, Fungs blog, He blames T2D solely on diet and claims it is a lifestyle disease. Bah humbug!!! I was thin as a rake when diagnosed, still thin, still have it.

        I keep reading people’s posts saying T2D can be cured by diet. Bollocks, humbug, codswallop!!! YOU CAN’T CURE T2D…NEVER!

        You can only put it in remission. Soon as you stop the exercise and eat foods high in carbs your T2D is knocking at the door again! Go eat that bowl of lasagna then test your numbers….tell me how cured you are when the meter shows a massive spike!

        • Absolutely!I have explained time and time again that diabetes can’t be cured.Managed but not cured.Start eating alot high refined carbs and quit the exercise and it rears it’s ugly head again.

          • Start eating poison (processed garbage) your body wasn’t designed for and you get sick, how shocking!

            Does anyone get type 2 diabetes by getting 95% of their calories from non-processed (single ingredient ) plant sources with the other 5% being from animal sources while eating 75 grams of fiber per day?

        • Agreed, I’m also thin type 2 for 20 plus years. Fasting and the LCHF diet does indeed help but these techniques can not lower my sugars to acceptable levels and I have given it a good honest try over several months. Yes just have a big bowl of spaghetti to prove that diabetes isnt going anywhere

    • I had been given insulin blood sugar kept going up more insulin 2 heart operations exercised my brains out kept gaining weight throwing up I said no more indulin went on keto started to lose weight.
      Be went to 7.3 a1C..Dr fung tapes believe this is way to go gave up all meds and taking supplements d3 5000 magnesium for constipation 250mg tea for water retention high cholesterol taking triple fish oil a baby aspirin 81 mgfor heart.
      Had 2 heart operations 1 open heart then a year later 3 stents..I think meds are killers! I’m allergic to statins and most meds!

  7. I was just diagnosed with diabetes. I am 52, 6′, 190, exercise regularly and have a “reasonably” healthy diet. I went to the doctor as I was not feeling well. My BS was a whopping 550 and the A1C is 10.8. The symptoms of diabetes came on rather quickly. I am on metemorphin (1000 mg in the morning and another 1000mg at night). Over the last 2 weeks my BS has ranged from 250 fasting to 350 after a meal. It is too early for another A1C test. My doctor says it is Type 2, though they have not done the specific autoantibody test.. As high as my levels are, I’m question whether I am type 1 vs. type 2. I am planning on pushing my doctor on this question, but welcome any thoughts.

    • I would strongly recommend seeing a specialist (endocrinologist) to have you tested for a possible type 1, and do this sooner rather than later. Nowadays both types can be diagnosed at any age, respectively, but some old school doctors stick to the idea that type 1 happens to kids and type 2 to older adults.

    • A primary feature of Type 1 is weight loss. You wouldn’t be able to gain much weight even with high caloric intake. This is because Type 1 diabetics do not produce any insulin at all, and insulin is the fat storage hormone. Type 2 is completely different: in Type 2 the body makes insulin, but the somatic cells do not respond to it because they’ve become insulin-resistant. Although overweight people have a higher risk of Type 2 diabetes, thin people get it too! 40% of thin people have metabolic syndrome and don’t know it. Their fat is hidden on the inside, packed around their organs (‘TOFI’). Wishing for you the best of health!

  8. I was diagnosed with T2D last year but should’ve been a few years prior. According to my (former) PCP I had elevated blood sugar for years, yet no one told me. For years, I had symptoms of diabetic neuropathy but didn’t know what it was, and my rheumy doc wrote them off on the account of meds side effect.

    The diagnosis was finally delivered and I started doing the right thing. My last morning fasting number was 107, and last A1C was 6.1. I am not on any diabetes medications (and hope never will), and I am only seeing a PCP doc but not a specialist, except for an eye doc once a year. I am only on one prescription medication, for my neuropathy, otherwise am watching my diet and being physically active. And blogging on WordPress about it https://comeinsitdown.wordpress.com

    I know that there’s no cure for diabetes, no matter how many times you read about it on the net. Yes, you can still eat sweets even after the diagnosis, but count your carbs. 2 carbs per snack and 3-4 carbs per meal. This works for me.

    Contrary to the popular myths, sugar alone doesn’t cause T2D, it’s more complicated than that.

    • For the vast majority of type 2’s, assuming they’ve been correctly diagnosed, it really isn’t as complicated as some make it out to be.

      There is no cure for Type 1 diabetics, but again, for the vast majority of type 2’s, diet and exercise will effectively cure them of their insulin resistance without medication. (If a T1D could correct their condition with diet and exercise, they would accept that as a “cure”. Why shouldn’t a T2D?)

      It isn’t that “sugar” causes T2D, it’s that habitual consumption of high glycemic index foods and/or habitual avoidance of low glycemic index foods (like wrongly thinking that you should avoid “fatty” foods) will cause spikes in insulin production during meal times. These constant spikes will build your resistance to insulin over time, requiring ever larger spikes, eventually leading to T2D.

      So, no, in the vast majority of cases, I disagree with you. It really is that simple. Turn your diet on its head, move your body, and your insulin resistance will fall.

      Also, an a1c of 6.1 really isn’t anything to worry about. As long as you’re eating right and exercising, you’re going to have a longer life than a healthy type 1 that keeps their a1c around 6.5 — and that type 1 is expected to have a normal lifespan, apart from the incessant testing, calculating, dosing, corrections, consequences of mis-calculation, seizures, etc., that a T2D doesn’t need to worry about.

      This whole “pre-diabetic” thing is hyperbole. 6.1 a1c is normal for some people, especially given the margin of error in the lab test.

      • I appreciate your opinion, however I beg to differ. Linking an increased sugar consumption to T2D is a popular myth that apparently is fine by you and the infamous Reebok CEO. There is no cure or reversal for T2D, those who insist on the other way around, are trying to sell you something. Go ahead, buy it.

        Both T1D and T2D are complicated to a degree, and both can be managed. I can’t vouch for T1D but I can manage my T2D successfully. My A1C number is under control as per last time I had a talk with my PCP, and my fasting numbers are normal. Am not going to check BG more often than that.

        I’m still eating sweets such as cookies, ice cream, yogurt, fruit etc. Just had a tootsie roll yum. I have one measuring cup of milk and 2 squares of graham crackers (2 carbs) every day for my HS snack. Portion control is a keyword here.

        Contrary to the popular belief, milk although it doesn’t taste sweet, still contains sugar (lactose). I don’t use glycemic index in planning my diet; it is not printed on the Nutrition Panels and I see this as an unnecessary hassle. I have something better to do with my time than that. I count carbs and am aware of the Simple as well as Complex carbs, and that’s enough.

        I am staying physically active, I am not overweight, my fasting numbers are normal and I don’t test my BG more often than that.

        I am still in the pre-diabetes phase as per my last bloodwork results. Your disbelief in pre-diabetes is actually moot; as long as you watch your carbs intake and have an active lifestyle, that’s all that matters.

        • Anna said “as long as you watch your carbs intake and have an active lifestyle, that’s all that matters.” That does indeed sound simple to me. John said “. It really is that simple. Turn your diet on its head, move your body, and your insulin resistance will fall.”
          Sounds to me that you two said basically the same thing.
          The medical community wants to maintain the illusion that each chronic disease is “far too complex for us to possibly understand”- that illusion keeps us from doing anything for ourselves. It keeps us dependent on them for all our answers (and pharmaceutical treatments). We are learning that in reality many chronic diseases have a few simple common denominators, and the knowledge of these would put some docs, and perhaps entire specialties, out of business. They want to maintain that aura of mystery . . .

  9. You gave some useful information, but overall, your article is misleading. The big giveaway is when you tackled the same ridiculed culprit, fructose.

    *sigh*

    How many times do we have to bash fructose as the cause of T2D, obesity, heart disease, etc.? It’s false information, your just excusing the American Standard Diet.

    You want to know what acceletates diabetes? Grass-fed beef, corn-fed beef, grass-fed eggs, dairy, chicken, pork, bacon – just about anything with a hole in it.

    There’s a strong correlation with eating fats and diabetes, fact. This is not a problem with fructose. Every cell in the body runs on glucose, not fats (we’re able to produce saturated fats, to some degree).

    If you’re lean, overweight, and have diabetes, then I’d suggest you follow a Dr. McDougall, plant-based starch diet (rice, potatoes, no oil, no meat, limited salt). You can have limited fruit juice, but the main focus is starches.

    My dad was recently diagnosed with diabetes, and he’s lean – he reversed it 360 on a high carbohydrate, low fat, vegan diet.

    • You don’t reverse something 360 and go the other way.
      If you go 360, you went in a complete circle and are AGAIN facing the way you were before.
      He reversed it ONE EIGHTY.
      180
      180
      180
      180
      THAT is a half circle. That is making a U-turn. That is going in the opposite direction.

    • My husband has had untreated Diabetes for over 20 years. After his doctor told him that his BS was 600 he followed a low carb diet and walked every day. Over the years he slipped back into a bad diet and then went from weighing 240 to 155 over the last few years. It was only after an optometrist told him he was bleeding in his eyes did he decide to test his blood sugar again. 324 and an A1C of 13. Now, after 4 months of low carb, high fat eating, he still feels MISERABLE with low energy and fluctuating blood sugars between 150 and 205. Your article was very interesting. I have been listening to Dr Robert Morse who has cured diabetics after they went on a fruit fast. Went on one myself for six weeks and lost inches of blubber especially around my waist, go lots more energy and lost my depression and irritability. But then slipped back into eating cooked food due to the Idaho winter. Gabriel Cousins also reverses diabetes with a raw food diet. After reading all of the comments, I believe that GMO’s and climate pollution with chemtrails raining down barium and aluminum and other toxic substances on us may be a big cause of this. My husband played a lot of golf before he got so bad. Golf courses are big sources of pollution from them treating the grass with lots of Roundup…. Now looking into herbs, essential oils, flower essences and energy work as alternative healing sources.

    • Fat does not trigger an insulin response! Protein does to a small degree, but not NEARLY as much as carbohydrate. Excess refined carbohydrate, particularly in the absence of fiber, and exercise, leads to hyperinsulinemia and eventually insulin resistance. Basic biology.

    • Federico- meant to say that I am glad that your dad has found success! If he finds it too monotonous to sustain, maybe he could try Dr. Furhman’s plant-strong “Nutritarian Diet”. Subsisting on just rice & potatoes will result in nutrient deficiencies, including zinc, B12 & possibly protein deficiencies.

    • Yes – If you starve yourself of carbs, of course you blood glucose levels will go down despite you insulin insensitivity. Its mopping up the flooded basement rather than fixing the leak. Insulin resistance will continue to starve your muscles of the glucose they need. But if blood tests are what makes you happy, keep eating fat and restricting carbs. I’d rather reverse my T2D.

    • As I understand it, each organ of the body has its own energy profile, using glucose, free fatty acids, and ketones. As an example: “In resting muscle, fatty acids are the major fuel, meeting 85% of the energy needs.” Glucose is used when muscles are working and require more energy than the FFA can provide. “Fatty acids are the heart’s main source of fuel, although ketone bodies as well as lactate can serve as fuel for heart muscle. In fact, heart muscle consumes acetoacetate in preference to glucose.”
      [http://www.ncbi.nlm.nih.gov/books/NBK22436/]

  10. I am glad you highlighted that thin or healthy weight individuals do get type 2 diabetes. They are often overlooked in the discussion of type 2 diabetes because one of the recommendations is to lose weight. I have clients with type 2 diabetes who did not need to lose weight but definitely needed to work on their diet.

  11. Fall 2014 went through an appendectomy. Spring 2015 had my gallbladder removed. Summer 2015 weighing 145lbs @ 5’5″ height was diagnosed with T2 diabetes. Have tried metformin, failed. I felt like I was dying. My eyes stayed red, and I was sick. My blood sugar levels would be at 187 then magically within 5 minutes would drop to 65. I was then placed on glyxambi, within 2 weeks my kidneys began to hurt and my blood sugar started reacting like it did on metformin. I’m seeing a family practitioner and an endocrinologist. I feel like a test rat. Any advice for a thin T2 diabetic that keeps losing weight and is desperate for healing?

    • Dear Wendy,

      Your situation sounds horrible, and you have my sympathy. You don’t say why you had to have your appendix and spleen out, but to this lay person it seems likely that the underlying causes of these problems are related.

      First, though, you need to find what has been causing your erratic blood sugar and weight loss. Blood sugar control is shared between the liver, which absorbs excess sugar in response to insulin, and the pancreas, which produces the insulin.

      You can tell which is at fault by testing fasting blood sugar and insulin simultaneously and using a calculator provided free on the Oxford university Web site.

      Both the liver and pancreas also contribute to digestion; the liver produces bile acids, which help arrange fats into small globules, and the pancreas produces digestive enzymes to break down fats, proteins and carbohydrates. Testing for bile acid deficiency is difficult, but levels of amylase, the carbohydrate enzyme, show up in the blood.

      You can/ should also have an ultrasound or MRI to check the two organs’ appearance.

      From what you say, the pancreas seems the more likely culprit. (Erratic insulin production.) But facts are better than guesses.

      If the problem is with your pancreas, you should be able to control your weight loss by taking digestive enzymes with your food, and will probably be advised to take extra vitamins A, D, E & K and to get tested for osteoporosis.

      Unfortunately, there is no simple treatment for inadequate insulin production. Metformin makes the liver more responsive and may help; injecting insulin is a pain. Better may be to have many small meals, rather than three big ones to avoid getting too much blood sugar at one go.

      The ideal is to find and treat the underlying cause. Infection (eg hepatitis), various auto-immune problems, excessive alcohol, cancer, late onset systic fibrosis or metabolic problems in vitamin b processing can all affect the pancreas and the spleen, and might be worth checking.

      My own experience is of weight loss and elevated blood sugar caused by pancreatic insufficiency. I also have osteopenia, widespread osteoarthritis, gallstones, an inflamed colon, a bent penis, some heart problems, some neurological problems and horribly uncomfortable skin. Despite very extensive tests, no underlying cause has been found, but for the time being I can control my weight and blood sugar with a mixture of digestive enzymes and multiple small meals.

      Let us know how you get on.

      Best wishes,

      Alan

  12. I knew that some lean people have type 2 diabetes and have successfully treated them with dietary changes, but didn’t realize there was a subset that may have autoimmune type 1 diabetes. That’s good news that they can have their GAD antibodies tested at a lab.

    To your point about requiring a different treatment strategy, what would you recommend?

  13. My dad has diabetes and it’s really high and I’m really worried 425 is his blood pressure… my dad is skinny and has diabetes the doctor said ” I may be giving you prescriptions but you take them and don’t come back in a month.
    The last time my dad went to the doctor was 2 years ago.. I need help, for my dad is really hard to lower his blood pressure

    • Hi, give him hibiscus tea frequently. You can find organic hibiscus tea on iherb.com. It is a natural anti-blood pressure medicine proven by researches. I hope everything gets better with your dad and continue to take care of him.

  14. G’day,

    I was diagnosed with type 1 about a year ago when i was in Costa Rica. I have been quite unsure of the diagnosis from the get go and have been treating myself through diet and exercise. I am currently on 9 units of Lantus (basal insulin), whilst maintaining a good diet.
    I haven’t been exercising overly lately and I forgot to take my Lantus today and at 2.30pm before a late lunch my blood glucose levels were at 5.9mmol. Do you have any suggestions as to why this must be?

  15. Did a whole vegan diet for 5 months. Dropped Total cholesterol from 265 to 225. Dropped HA1c from 5.8 to 5.6. I also dropped from 191 lbs to 184 lbs. I am not sure how much was due to the weight loss. I believe the whole foods were helpful, but the meatless part is questionable in my case. I hear it can be an incredible improvement for some.

  16. Is there any discussion regarding GMO diet causing gastritis and any relationship to the development of diabetes with this diet stressor? It might be a long shot, but the added inflammation and physical stress in the gut might be a precursor to developing DM type 2. Any thoughts out there?

    Check out the article and full report at http;://naturallysavvy.com/eat/genetically-modified-corn-and-soy-diet-causes-severe-illness-in-pigs

    I have two girls 14 and 9 both with Hashimotos and gluten intolerance. They have identical results on their gastric biopsies showing gastritis with white points, possibly scarring along the esophagus. The older one is more symptomatic and has recently developed lactose intolerance as well. Gluten intolerance is questionable because symptoms appear on gluten free days sometimes. I have to wonder if GMO corn, soy and the other 7 GMO crops mass produced in the US and found in nearly everything we eat are contributing to our family’s GI distress and illness.

    By the way I am a normal weight woman in her 40’s and have just been diagnosed with DM type 2.

    • Gluten free days? No no no. If your daughters have gluten intolerance they should be having gluten free LIVES. It takes the body up to two months to get the affects of gluten out of its system, and if your daughters aren’t avoiding gluten entirely they are probably not getting better for that reason and that reason alone. Gluten wreaks havoc on all of our bodies, so it’s no surprise they are so sick if you are still feeding them gluten after being told they have an intolerance!
      Hashimotos is an autoimmune disease which means both your daughters have incredibly high levels of inflammation, which in itself can cause a lot of damage to the body. Its possible you also have it which could explain your T2DM. My mother has T2DM and Hashimotos. Her doctors have found that treating her HM has help eradicate her T2DM. Worth looking in to.
      Also, your daughters are too young to be consuming soy products. It can mess with their estrogen and do damage to their reproductive cycles. Almond milk or just lactose free milk are much better options. Personally, I really like the lactose free milk. It tastes just like milk.
      I have gluten intolerance, and possible Lupus (being tested) but I’ve found a lot of relief from strictly following a gluten free diet (completely free!!!) and taking 1 tsp of Diatomaceous Earth every night right before bed (as in I drink it in bed and fall asleep shortly after I’m done drinking it) with orange juice. Do some research on it! It’s great stuff. It helps cleanse the GI Tract and has worked wonders for a lot of people. I highly recommend it.
      I wish you and your little ladies luck with your health.

  17. Dear Chris

    How good a marker is the ESR test (sed rate) for gauging inflammation which appears to be the cause behind virtually all maladies

    Thanks

    • Hi,
      Disclaimer: I am not a doctor and do not have any specialised medical knowledge.

      I think that ESR and CRP (C-reactive protein) are two widely accepted and generally useful measures of systemic inflammation. (You can also have localised inflammation.)

      I have chronic and acute inflammation of my colon (colonoscopy), inflammation around my heart (echo cardiogram), non-alcoholic fatty liver, gallstones, kidney stones and enlarged prostate and a mildly enlarged spleen (echo/MRI/xray), pancreatic insufficiency (not enough insulin or digestive enzymes), osteo arthritis in various joints and degenerative bone disease in my spine (x-ray, MRI). I have painful skin, Peyronie’s disease (a bent penis) and have had a silent stroke (MRI).

      My cardiologist and pancreas doctor say that it is absolutely obvious to them that I have some kind of systemic inflammation, but my ESR and CRP (and all other auto-immune tests except antibodies causing hay fever) are normal. So too are other tests for systemic diseases – alph anti trypsin, Wilsons, cystic fibrosis, Crohn’s …

      The auto-immune doctors say that I don’t have systemic inflammation. I conclude that there are some types of immune system reactions that we don’t yet understand.

      Best wishes,

      Alan

      • Don’t you think your best bet is to go on a diet that rules out inflammatory reactions from foods.. ? If I were you I would do a 2 week juice fast. Juicing mostly veges with apples. This worked for me. got rid of inflammation in my hands and feet and all arthritis disappeared. Doctors do not understand everything so I wouldn’t even go to them once you get that initial diagnosis..just google inflammation and stuff and see what you come up with..just clean up your diet.. from all fats even healthy ones to see what is not being processed right. I found I could not digest and process nuts and avocados..it took cleaning up my gallbladder with phosfood (standard process supplement) and then I was able to now have flaxseed oil and that has changed my life.. Fats however prior to this were causing all my autoimmune issues. I had adrenal fatigue, insomnia, aches and pains..etc.. good luck!!

        • Jenn,
          Did you seriously just tell readers on a diabetes forum to not even go to their doctors and just read about inflammation on the internet? Please no not encourage people with endocrine disorders/diseases to avoid medical care. That is irresponsible of you and, while I believe you mean well, your comments could be leading people down the wrong path. Yes, lifestyle changes of diet and exercise are the 1st-line recommendations for all forms of diabetes to prevent negative outcomes (heart attacks, blindness, dialysis, neuropathy and infections), but it is a progressive disease that most often requires medicine to help control blood sugars. Stop pushing GMO-free diets and gluten-free diets for people who aren’t celiac because there is no proof that they have any benefit. They are fad diets, nothing more. Diatomaceous earth worked for you, but again there is no substantial study to show that it works for whatever imaginary condition you are talking about. I’m sorry if this is insulting. But you discouraging people from seeking medical care is insulting to myself and every other healthcare professional who spends years going to school, specializing in diabetes care and basing decisions on evidence-based medicine. Do any of your claims have any decent studies to support them? Please do some research, and no, I don’t think doctors are perfect either.

      • Allen, I also have an inflamed immune system, but my ESR’s are only slightly elevated, and my CRP is negative. I have APS/Hughes syndrome where my body produces antibodies to phospholipids that cause my blood to be sticky and clot up easier than a normal person. I also have fatty liver, elevated bilirubin, and blood clots. Have you ever been tested for APS/Hughes Syndrome? That might be the reason why you’ve had a silent stroke. It can also be the reason why your spleen is enlarged and your pancreas is not functioning properly. You could have sludgy blood or clots tat have decreased blood flow to those organs and have caused them to become damaged. I think there is more to being fat than having type 2 diabetes. I think being fat is a symptom of the disease and not the cause.