My learning on the ‘How someone gets Diabetic’ from the video lecture by Dr. S. Vijayaraghavan
- Everyone has a diabetic gene. Whether you become diabetic or not is up to you.
- Every individual is like a gun and his diabetes gene is like a bullet.
- If the diabetes has got to come out, you need a trigger.
- If you pull the trigger, you become diabetic.
- If you are able to hold on, you choose not to be a diabetic.
Epigenetics and the diabetic gene
Epigenetics refers to heritable changes in gene expression that does not involve changes to the underlying DNA sequence. This in turn affects how cells read the genes. Epigenetic change is a regular and natural occurrence but can also be influenced by several factors including age, the environment/lifestyle, and disease state. Epigenetic modifications can manifest as commonly as the manner in which cells terminally differentiate to end up as skin cells, liver cells, brain cells, etc or can have more damaging effects that can result in diseases like cancer. New and ongoing research is continuously uncovering the role of epigenetics in a variety of human disorders and fatal diseases.
Based on the study of epigenetics, even if your parents and grandparents have diabetes, you can avoid it. Even if your parents and grandparent didn’t have diabetes, you may get it. Moreover, the drugs that are being prescribed for lifestyle diseases can change our genes for the worse.
How type 2 diabetes occurs
All lifestyle diseases are an intelligent, physiological expression of the body, which are being treated by chemicals (drugs). The body is self-healing and self-regulatory; it is intelligent, we are stupid.
The lifestyle disease called ‘Type 2 diabetes’ is an altered response of our body to a certain nutrient (carbohydrates) that we are consuming. Out of the three major nutrients from food – carbohydrate, protein and fat, Indians, especially vegetarians have a diet that is high in carbohydrate.
The body processes
- Carbohydrate into sugar
- Protein into amino acids
- Fat into fatty acids
Carbohydrate is an assembly of sugar molecules. All carbohydrate, especially refined, processed carbohydrate is converted to glycogen. Sugar provides energy. The body has 5 litres of blood. There should be only 1 teaspoon (5gm) of sugar in our blood. The average accepted level of sugar in the blood is 100 i.e. 100mg/decilitre, that’s 1 gm/litre, 5gm/5 litres. How many teaspoons of sugar are we having in the blood, when we eat our regular food?
- 1 slice of bread (white, brown, wholegrain) = 15gms of carbs = 3 teaspoons of sugar
- 1 small idly = 15gms of carbs = 3 teaspoons of sugar
- 1 cup of cooked white rice = 45gms of carbs = 9 teaspoons of sugar
On an average, we would be eating 30 teaspoons of sugar every day. What happens to the remaining 29 teaspoons of sugar? This is how our intelligent body responds to the overloading of sugar. The β (beta) cells in the pancreas secrete a hormone called ‘insulin’.
The role of insulin is to take the excessive sugar that’s in the blood and distribute it all over the body:
- For 2 reasons – energy usage and energy storage.
- In 3 places – liver, muscles and fat.
Liver and muscle have limited amount of storage of energy in the form of glycogen. Fat has unlimited storage capacity.
Proteins cause a moderate insulin response. Fats cause virtually no insulin response. Carbohydrates cause a high insulin response. The insulin rushes in and pushes all the sugar out of the blood. The excess is stored as fat. Now, another problem occurs. Once we get used to something, we become resistant to it. For ex, alcohol – we become used to larger and larger amounts of alcohol and need more and more every subsequent time we consume it. Similarly, when more and more insulin is being pumped, our body becomes resistant to it and our cells stop responding to it.
How does insulin work?
Insulin transports excessive glucose from the blood into the cells. Imagine that the cell is a room. It requires energy to use or to store. It is locked. The corridor leading to the room is the bloodstream. Glucose is travelling in the corridor. Insulin is the key. Insulin opens the door and the glucose enters the cell.
When we eat too much of unnecessary carbohydrates, there are excessive amounts of glucose in the corridor, it blocks the lock, and insulin is unable to open the lock. There is excessive glucose and excessive insulin, but the energy is unable to enter into the room, because the door is locked. The more insulin is produced, the more resistant the cell becomes. The muscle cells and liver cells stop accepting glucose. That leaves only fat cells. This is how fat is created and stored. The muscle cells and liver cells stop accepting glucose. At this stage, a person becomes insulin resistant. This cycle continues – a person consumes more & more carbohydrate, leading to more blood sugar, leading to more insulin, leading to insulin resistance. As insulin resistance continues over a period of time, there is high insulin, yet it is unable to move the glucose into the cells. At this stage, a person becomes diabetic.
More carbohydrate —> more blood sugar —> more insulin —> insulin resistance —> diabetes. Exposure to high insulin for around 10 – 15 years leads to diabetes.
If you have diabetes today, it means that the process of insulin resistance started around 10-15 years back.
- Before diabetes – problems are caused by high insulin.
- After diabetes – problems are caused by high insulin & high blood sugar.
Dr. Joseph Kraft conducted a study in which conducted the GTT (Glucose Tolerance Test) in diabetic and non-diabetic groups.
- In the diabetic group, both blood glucose and blood insulin were high, predictably.
- In the non-diabetic, the blood glucose was normal, predictably.
But the blood insulin was high, non-predictably.
This means that the non-diabetic group were on the way to becoming diabetic. Check your insulin! Just because your blood sugar is normal, doesn’t meant that everything is okay. Check insulin levels – of both you and your children. The high carbohydrate food (fruit juice, breakfast cereals, cakes, chocolates etc) that children eat pumps insulin into the body. You may not yet be diabetic, but you may be insulin-resistant. Suggested safe range for fasting insulin is between 2-6, while optimal level is 2-3.*
Fat produces a hormone called ‘leptin’. Leptin is the ‘satiety’ hormone that tell us to ‘stop eating’. If you eat a diet that is high in sugar (particularly fructose), grains, and processed foods – the fat releases surges in leptin. Over time, if your body is exposed to too much leptin, it will become leptin-resistant, just as your body becomes resistant to insulin – by continuous overexposure to high levels of the hormone. When there is leptin-resistance, the body is hungry all the time and wants to eat more, even though there is already a lot of stored fat. Obese people are known to have higher leptin levels in the body.
Diabetes and Obesity are hormonal and bio-chemical problems. They occur because of an imbalance in hormones due to the food we eat. They are problems that occur ‘NOT because we eat more and exercise less’. It’s not a behavioural problem. We must not be critical and judgmental of people who are obese thinking that they have no willpower.
What will happen in future?
Let’s consider some demographics. We can divide the in two based on the ability to earn
Our productive population (who earn income)
1) 25 – 55 yrs
Our vulnerable population
2) Children and teenagers
Previously, only group 3 had health problems. Nowadays, group 1 also has lifestyle diseases. The averages age for heart-attacks has come down. People as young as 35 years are dying of heart attack.
Sadly, Group 2 is also getting sicker. The prevalence of obesity in children is on an alarming rise.
The incidence of health problems like high insulin, cholesterol (high triglycerides & low HDL), hypothyroidism, PCOS (polycystic ovarian syndrome), menstrual problems are increasing in groups 1 and 2.
Unless we change the current health scenario, our younger population will soon die. Corrective action does not mean ‘prescribing medicines’. It means ‘changing our way of eating’.