With all the discussion on the forum about
caffeine, diabetes and insulin resistance, I
noticed that there seems to be a lot of
interest and misinformation about these
topics. So I thought I would write up a primer
to clarify things . I had been considering
writing an article for T-mag on this topic.
But I’ve decided that that wouldn’t be a good
use of my time. And quite honestly, with all
the bullshit on the forum about this, I’ve
actually become rather sick of the topic as
well. So this is the last thing I’m going to
write on this. If you want more info on these
topics (including treatment options), this is
the place to go. I will post the rest of the
info in response to this message to save space
on the front page of the forum (it’s long).
Hopefully this will be useful to someone…
Part 1.
Fact: Approximately 16 million, or 8% of the population in the U.S, has been diagnosed with diabetes. The American Diabetes Association estimates that the number of people in the US who have diabetes and *have not* been diagnosed is twice as the number of people who have been diagnosed; or an additional 16% of the population. This brings the estimated total diabetic population of the US to possibly as high as 24%, or 1 out of every 4 americans. (Note to Professor X: this problem is not just limited to a small % of the population, as you've tried to depict it as.)
Speculation: One of my speculations is that if 1 out of every 4 americans *has* diabetes, then 1 out of every 2 americans is at high risk for getting it.
Fact: 95% of people with diabetes have type 2 diabetes. The focus of this report is on type 2 diabetes and insulin resistance; not on type 1 diabetes and pancreatic failure. Although it is important to mention that advanced stage type 2 diabetes can lead to pancreatic failure.
Fact: The American Diabetes Association announced that diabetes accounts for 178,000 deaths annually.
Fact: Diabetes can cause many secondary health problems including: cardiovascular disease and poor circulation, neuropathy (nerve cell death), blindness, amputation, high blood pressure, disrupted blood lipids, and on and on...
Fact: Compared with whites, asians have a 30% higher risk of developing diabetes, blacks have a 60% higher risk, and latinos and native americans a 90% increased risk.
Fact: The technical definition of someone with type 2 diabetes is someone who has a fasted blood glucose of greater than 110 mg/dl, in the presence of normal or elevated blood insulin. (As I'll explain below, I don't think that definition is very useful. And it catches the problem far too late.)
Fact: A few of the obvious symptoms of type
2 diabetes or insulin resistance include:
*Continuous hunger (because food is not
assimilated).
*Weakness/fatigue (because the body lacks
cellular energy).
*Feeling sleepy after meals (especially
carb meals).
*Weight loss (food eaten is just passed
through the body). This occurs at more
advanced stages of the disorder.
*Gain fat easily, but gain muscle with
great difficulty. (This signifies insulin
resistance in muscle, while still having
insulin sensitivity in fat. Research on type 2
diabetics has shown that because muscle tissue
has a much more limited capacity to store
glucose than fat, muscle cell insulin
sensitivity is often lost first, followed
later by a loss of insulin sensitivity in
fat cells.)
*Cuts and bruises slow to heal.
*Blurry vision (especially after carb
meals).
*There are many other symptoms...
Myth: Only obese people develop type 2 diabetes.
Fact: 85% of people with Type 2 diabetes
are obese.
Corollary: 15% of people who have type 2
diabetes are *not* obese.
Myth: All diabetics need to use insulin.
Fact: All type 1 diabetics need to use insulin. Only a relatively small percentage of type 2 diabetics need to use insulin. And in a large percentage of cases, therapies that increase insulin are inappropriate for type 2 diabetics (depends on existing blood insulin levels and pancreatic function).
Myth: Only people who are genetically predisposed to getting type 2 diabetes will develop the condition.
Fact: Anyone can develop type 2 diabetes. It is better to think in terms of "what is the risk factor or probability that a person will develop the condition." Obviously, people with a genetic predisposition are at higher risk than those who do not. But *anyone* *can* develop the disorder.
Fact: Geneticists tell us that there are many genes involved in type 2 diabetes predisposition, rather than just one or a few.
Myth: Type 2 diabetes is only about insulin resistance, "carb intolerance" and poorly controlled blood glucose.
Fact: Type 2 diabetes is a complex systemic metabolic disorder involving insulin resistance, pancreatic dysregulation (either over producing insulin causing hypoglycemia, or underproducing insulin, allowing hyperglycemia), excessive hepatic (liver) production of glucose, and metabolic problems processing both carbs *and* fats.
Part 2.
Myth: Type 2 diabetes and insulin resistance is a black and white issue. You either you have it or you don't.
Fact: It is more accurate to think about insulin sensitivity as a percentage. An extremely healthy person might have 95% insulin sensitivity. An extreme type 2 diabetic might have 5% insulin sensitivity. Or a person can be anywhere in between. Many people tend to think of diabetes this way: one day a person is "normal" and healthy, and the next day he suddenly crosses some magic threshold and becomes a "diabetic." This is nonsense. There is no "magic threshold" between diabetic and non-diabetic. There is only a continuum of insulin sensitivity for every person.
Myth: Genetics is solely responsible for a person's insulin sensitivity.
Fact: Both genetics and environment play important roles in a person's insulin sensitivity. There are many environmental factors that alter insulin sensitivity. Things that make insulin sensitivity worse include: poor quality diet (especially a diet high in refined carbs), total calorie load (more total calories reduces insulin sensitivity; reduced calories increases insulin sensitivity - this is one homeostatic mechanism the body uses to maintain stable body weight), lack of exercise, inadequate sleep, negative stress (cortisol and epiniphrine both reduce insulin sensitivity), anything that increases sympathetic nervous system activity reduces insulin sensitivity. This includes caffeine and ephedra.
Myth: A person's insulin sensitivity remains constant throughout their lives.
Fact: *Everyone* loses insulin sensitivity as they age. This is probably due to the fact that insulin downregulates its own receptor. Mainstream medical practitioners consider a los of insulin sensitivity a "normal" part of aging. In fact, this is so much the case that medical practitioners used to have different reference ranges of "normal/acceptable" blood glucose and insulin levels depending on the person's age. A blood glucose and insulin level that would have been considered "diabetic" in a 20 year old would have been considered "normal" (by most mainstream medical practitioners) for a 60 year old. (My humble opinion: this is a really dangerous way of looking at things.) This is analogous to saying that it is normal for a 20 year old to have total testosterone level of 900ng per/dl, but that it is normal for a 60 year old to have a testosterone level of 200ng per/dl. If having dropping and terrible insulin sensitivity and testosterone levels is "normal," then I don't want to be "normal."
Myth: Eating a low carb, high fat diet will fix my insuling sensitivity problem.
Fact: Eating a purely ketogenic diet will actually make insulin sensitivity worse. Eating a high carb/high insulin diet will likewise make it worse. In my experience, the best diet for people with poor insulin sensitivity or type 2 diabetes is a diet "balanced" (inside joke for anyone who just read Lonnie Lowery's recent article) between low GI/II carbs, protein and fat. I would also assert that using John Berardi's "split meal" approach is beneficial because it keeps insulin levels (on the whole) lower, thus giving both your insulin receptors and pancreas a rest. (Eating a "mixed meal" of P+C+F raises insulin levels more than a P+C meal, and obviously more than eating P+F meals, which only minimally raise insulin levels.)
Fact: There are many approaches or strategies for treating type 2 diabetes and improving insulin sensitivity. Any treatment protocol *must* include a healthy diet and exercise, as these are crucial components to treating the condition. Both resistance (weight) training and cardio training improve insulin sensitivity. Research has demonstrated that weight training improves insulin sensitivity more than cardio. However, from the research I've seen, these two types of exercise seem to have somewhat differing effects, so it is better to do both types to gain the full benefit. (This isn't an area I've fully researched yet.)
Part 3.
Many supplements and drugs can also be used to great advantage. Drugs and supplements used to treat this disorder generally fall into one of 6 categories below. (Note, some compounds may fall into more than one category.)
1. Compounds that reduce or slow the uptake of glucose in the intestine. Compounds that fall into this category include, alpha-glucosidase inhibitors (acarbose; miglitol), biguanides (metformin; phenformin), gymnema (whole herb), and fiber.
2. Compounds that reduce hepatic production of glucose. Compounds that fall into this category include biguanides (metformin; phenformin), biotin, and silymarin.
3. Compounds that stimulate the pancreas to produce more insulin. Compounds that fall into this category include sulfonylureas (many different drugs of this class), meglitinides (repaglinide; nateglinide), fenugreek, gymnema (*only* the G3 or G4 extract portion), ginkgo, CoQ10 and artificially sweetened/carb free gum.
4. Compounds that increase insulin receptor sensitivity. Compounds that fall into this category include biguanides (metformin; phenformin), glitazones (troglitazone; pioglitazone; rosiglitazone), ALA, chromium, EPA/DHA/GLA, CLA, magnesium and cinnamon extract.
5. Compounds that act to transport glucose into cells independently of insulin. Compounds that fall into this category include glucosol (corosolic acid), inzitol (d-pinitol), and vanadyl sulfate.
6. Insulin itself (many different types with varying pharmacokinetics).
Side note: compounds that relax the sympathetic nervous system can also be of use to improve insulin sensitivity. These include beta blockers and magnesium.
Note that this is not a complete list of substances that can be used to treat type 2 diabetes. There are also many other substances that can be used to treat the secondary effects of diabetes. The compounds listed above are intended as treatments for the primary condition. Compounds used to treat the secondary effects of diabetes are beyond the scope of this report.
Also, note that some of the listed compounds should be avoided entirely. Phenformin was removed from the US market in the 70s due to causing deaths from lactic acidosis. Troglitazone was removed from the US market in 2000 because it caused some deaths due to hepatic failure. The glitazones in general are known to make people fatter. Vanadyl sulfate has toxicity concerns at higher dosages. Compounds that stimulate the pancreas to produce more insulin can cause pancreatic beta cell failure in some people.
Finally, note that it is not necessary to use all of the compounds listed above. Think of all of the compounds listed above as tools in a toolbox. The idea is to use the tool(s) that one decides are most appropriate based upon one's treatment strategy. Treatment strategy must take into consideration such factors as, goals, efficacy, side effects, and cost.
Part 4.
Obviously, the ideal strategy is to use a combination of compounds that achieve the desired goals and efficacy, with minimal side effects, cost, and hassle.
I personally suffer from (or did) poor insulin sensitivity. However, I am not a type 2 diabetic, according to the technical definition. (See the problem with the technical definition? Many people suffer from insulin resistance, but are "sub-clinical" according to the current technical definition. And hence, don't get diagnosed or treated.)
Now for me, the combination of things I've found most useful, both in terms of achieving the results I want, with no side effects, and with minimal cost, include (in no particular order): ALA, chromium, biotin, CLA, EPA/DHA/GLA, fiber, metformin, magnesium, ginkgo, and glucosol.
Concluding thoughts: I would say you don't have to have type 2 diabetes to benefit from the research on it. The lessons learned from research into type 2 diabetes can lead to some very useful insights for bodybuilders and other athletes. IMHO, the "insulin system" is every bit as important as the "androgen system" for gaining muscle and losing fat. Neglecting it will adversly effect bodybuilding and athletic progress, not to mention health. I had to learn this the hard way. Hopefully you won't have to.
Oh, I just had one final thought. If your "insulin system" is functioning poorly, this can adversely effect many other body systems, because the insulin system is responsible for providing fuel for most other systems. As an example, when my insulin system was functioning poorly, my natural androgen levels were not so great. Not terrible, but not too good either. But since I have greatly improved the functioning of my "insulin system," my natural androgen levels are pretty damn good. If the rest of this message didn't catch your interest, maybe that will.
PS - I have no desire to be considered an
expert on this topic, so please don’t start
calling me the “diabetes guru.” 
I’m also
not getting paid to answer a billion questions
on this topic, so I’ll answer a few when I can
afford the time. Unless of course you want to
start paying me a consulting fee.
Part 5.
I have no interest in debating this topic any further. If you think I'm completely clueless and full of shit, then you can simply ignore this topic. If you disagree with something specific I've written here, fine. I don't claim to have a monopoly on knowledge of this topic. Feel free to post your objections. But I have niether the time nor the desire to debate it any further.
You either have type 2, or you don’t. There is no such thing as “a little diabetes”. You also failed to give your medical credentials to give credibility to any of your “myths”. Since you don’t desire any debate, your mind is already closed, or narrow.
Sorry bud, but Free Extropian is very much correct in his statement that insulin sensitivity and diabetes is on a continuum. We draw arbitrary lines to classify people. A person with a fasting blood glucose of 109mg/dl may not be treated as a diabetic by his physician, but he still suffers from poor insulin sensitivity and will have some symptoms seen in full blown “diabetics”.
Also, fasting blood glucose is a poor indicator at best of insulin sensitivity. Glyco-hemoglobin, oral glucose tolerance test or a random glucose provides much more valuable information about a person's actual insulin sensitivity and diabetic status. But, we are still stuck with a medical community who still primarily looks at fasting blood glucose.
Also, I am a firm believer in listening to what a person's argument consists of rather than focusing on the type of letters behind his/her name. In this case, Free Extropian has provided us with a wealth of useful information and I will agree with what he has said.
On the surface it could appear that I am being
closed minded about this topic. However that
is far from the truth. In reality, I am a very
open minded person about many topics including
this one. However, as I explained at both the
beginning and end of my message, I have other
responsibilities and time obligations that are
an order of magnitude more important than
debating things on the T-mag forum. The amount
of time I have wasted on this topic on the
forum over the past two weeks, has cost me
about the equivalent of $2k in work time -
which I now have to make up. I now am buried
in back work. So my desire to avoid spending
more time on this topic has nothing to do with
me being closed minded, and everything to do
with my time being very scarce and valuable.
Regarding my credentials: I am a very intelligent individual, who has been highly motivated to invest a great deal of time in studying hundreds (if not more than a thousand) research papers on type 2 diabetes, as well textbook selections on the etiology, endocrinology, pharmacology and physiology of type 2 diabetes. If you are the type of person who thinks that only people who have a bunch of letters after their name are capable of being knowledgeable about medical related topics, then nothing I can say will satisfy you anyway.
If I wanted to take at least 40 hours of work time (or more) to rummage through all of my research in order to cite references to support everything (or at least almost everything) I wrote, I could easily do so. The problem is, as I explained, is *time*. That is why I chose not to write a more professionally done article for T-mag. I would have made $400 for that. In the same amount of time it would take me to write such an article, I could make 3k working. So it's not worth it to me. Plus, one of my business partners recently died of a heart attack, so right at the moment my business is literally "on the line" because customer demand is outstripping our ability to provide customer service and people are getting pissed. So I was retarded for even taking the time to write what I did. I wrote that "quick and dirty" piece of the the forum in about 30 minutes entirely from memory, in the hope that it might help some people who read it. Obviously, it is of no use to you. That's fine by me. I don't really care any more.
Regarding you assertion that you either have type 2 diabetes or you don't. All I'll say on that is we will just have to agree to disagree. I don't have the time to debate the point...
I am done with the T-mag forum for some time because of my time scarcity. (And honestly, at this point I'm sorry I ever got involved in discussing the topic.)
Could you explain how eating a p-c-f meal would raise insulin levels more than a p-c meal? Assuming one tracks his calories, the p-c-f meal would contain less carbs. Massive eating was designed for the p-c insulin bursts.
Free Extropian: The piece you wrote was EXCELLENT!
Don’t let anyone on this forum or any other forum tell you
otherwise! I found the information so useful that I printed
a few copies and am sending them to family members,
who could benefit from your findings, most notably
my MOM; she fits many of the descriptions you outlined!
Thanks for the info, BTW you can afford to be close minded when you’re right.
The only “debate” with your presentation is that for medcial diagnosis purposes, there is a clear-cut definition, otherwise your statements are accurate for the most part according to my wife, who got type 2 at the age of 35. As for your “time scarcity” everyone elso has the same thing, they think, so you are not giving this forum any “special” favors by writing, even though you did dispel some myths with basically accurate data. If you really could not “spare” the time, you wouldn’t be posting in the first place.
Spieker, what is your problem with Free Ex? He presented a well thought out, well researched topic quite well citing specific sources, and you’re countering with what your wife tells you because she’s been diagnosed with DM type II. And, no, she didn’t “get it” at age 35. She was diagnosed at age 35. Those who have previously posted that insulin sensitivity is more appropriately graded along a spectrum are entirely correct. In the medicial profession, we have cutoffs because currently insulin resistence isn’t a diagnosis we make. The cutoff number is fairly arbitrary actually. What’s the difference between a fasting blood glucose of 110 or 100? Honestly, not much, but the line has to be drawn somewhere for insurance companies, Medicare, etc. It’s easy to call somebody closed minded when you don’t agree with them. Believe me, there are a few things Free Ex has stated in the past that I don’t necessarily agree with, but that’s life. He presented what he’s learned and what he believes. As far as his time is concerned, you have no idea what the situation is, nor do I, so please reserve your self serving judgements unless you know what you’re talking about.
I don’t understand your post. What problem? This is called “interaction and discussion” ever hear of it? I am not a “lockstepper” who automatically follows and believes someone. (it is easy to jump on the bandwagon in agreement with someone, when they agree with you to start with) If you’d notice, it was a small detail I didn’t quite go for. Hardly constituting a “problem” with Free EX. So just chill out, and smile, enjoy life, and a happy 4th of July to you.
Rather than cite every specific reference,
I’ll do something better (and faster): I’ll
give you some of the tools I use to research
things. That way, if you are interested enough
in a topic, you can research it for yourself.
(I don’t like helping people who want
everything spoon fed to them. I don’t mind
helping people who are willing to work to help
themselves.)
In addition to the web sites below, I make use of the libraries of two local state level universities (eg University of ... libraries). Both universities happen to have medical schools. This allows me to access medical texts (without buying them), and also to medical journals (eg Diabetes, American Journal of Clinical Nutrition, JAMA, Journal of Clinical Phamacology, etc.) without paying the high subscription fees.
Most, but not all, of the web sites below are free.
PubMed/Medline (NIH)
www.ncbi.nlm.nih.gov/entrez/query.fcgi
National Institute of Diabetes & Digestive & Kidney Disease (NIH)
www.niddk.nih.gov/
ClinicalTrials.gov (NIH)
www.clinicaltrials.gov/ct/gui/c/r
Advanced Search of ALL of NIH
http://search.nih.gov/advanced.html
The Lancet medical journal (free registration required; fees for some access)
www.thelancet.com
The Merck Manual
www.merck.com/pubs/mmanual/sections.htm
The FDA web site
www.fda.gov
AllMedExchange - Medical Search Engines
www.allmedexchange.com/ Reference_Links/Med_Search.shtml
Doctor's Guide - World Edition
www.docguide.com/
MedicalStudent.com - digital library for the medical student
www.medicalstudent.com
Joslin Diabetes Center (Harvard)
www.joslin.harvard.edu/
Medical World Search (requires fee membership)
www.mwsearch.com/
Reuters Health Wire (requires subscription for most information)
www.reutershealth.com/
US Patent and Trademark Office
(This site is useful because a lot of research from drug and other medical companies will show up in patents before it shows up elsewere.)
www.uspto.gov/
Web MD
www.webmd.com/
Science Daily Magazine - Health & Medicine News
www.sciencedaily.com/ news/health_medicine.htm
American Diabetes Association
www.diabetes.org/
Life Extension Foundation - Disease Prevention and Treatment Protocols
www.lef.org/protocols/index.shtml
Testosterone Magazine (you are here)
www.t-mag.com
All the Web (General Web Search Engine)
www.alltheweb.com
Google (General Web Search Engine)
www.google.com
It took me less than 10 minutes to write this message. So don't bitch saying "if I didn't have the time I wouldn't post at all." Though you are right - I shouldn't be wasting time here at all. It's just a bad habit I have. You know, like drinking coffee...
Spieker, it’s the tone of your posts. And, yes, one can quite easily discern tone from written messages. It’s the part of your original post where you started ragging on Free Ex for his “time” statement. It’s also the part of your post to me where you ask me, “Ever hear of it?” It’s unnecessary barbs that you throw in and then act like the good guy. The sad part is that you didn’t even address or backup anything you claimed in the previous post. You seem more concerned with throwing out underhanded jabs at people than seriously debating anything. For proclaiming to be so open-minded, I find you quite closed-minded to this point.
Free Extropian, I thought this post was very informative. I am pretty sure I am somewhat insulin resistant and I always like reading stuff about this topic. Thanks for spending the time to write this.
FreeX:
Dude, let me start off by saying that I really appreciate your posts. You obviously no your shit up and down and I appreciate that. Kudos for your overwhelming knowledge of the topic.
Let me conclude this brief piece by saying that those who have consistently challenged you, even after repeated explanations of your point, are in my opinion busted up.
I am not saying that nither You nor I can handle being wrong (speaking for myself) but damn, some of the responses (negative or challenging) to your post have been absolutely preposterous.
Keep up the good work my brah.
I’ll be looking forward to reading some more of your discussions on this board.
Shouts out
Vain68
Thanks for the references. And Doc T, thanks for your humor.