Vitamin D deficiency and Type 2 Diabetes

In the early part of the 20th century, a disease called Pellagra was thought to be caused by a virus or bacteria. It was common in the lower classes, but also did show up on occasion in more wealthy people. It was thought to be a "dirty" disease, and there was a stigma attached to contracting it. One of the people who contracted Pellagra was my husband's great-great grandmother. She died at a hospital in Dallas in 1922 from the disease. However, her death, and thousands of others were completely preventable. It turned out that Pellagra was a vitamin B3 deficiency.

Now we blame obesity and type 2 diabetes solely on what people are eating, but what if the catalyst for obesity and T2D is really something else entirely? What if it's a vitamin D deficiency? I found the following article at Science Direct:

The role of vitamin D deficiency in the pathogenesis of type 2 diabetes mellitus

Vitamin D can be obtained either through dietary intake or produced endogenously. It is found in foods such as oily fish (salmon, sardines, mackerel), egg yolks and fortified milk and juice; however dietary intake only accounts for about 30% of the vitamin D obtained. The primary route via which people obtain vitamin D is through exposure to ultraviolet B (UVB) sunlight at wavelengths between 290–315 nm, occurring predominantly in the summer months (June–July) in the Northern hemisphere (latitude >= 42° N).

In other words, if you're not getting a lot of sun, you should probably be supplementing Vitamin D3. I find it interesting that the pushing of the use of sunscreen coincides with the rise of obesity and diabetes in this country. Of course that's when our sugar intake increased too. Maybe it was the perfect storm?

Sunscreen wasn't in widespread use until the 1980s. Prior to that, beach goers might put zinc oxide on their noses, but that was about it. Then with the erroneous idea that the sun causes malignant cancer, enter the sunscreen industry. Like many things, drugs, food, etc. most research about sunscreen is funded by the sunscreen industry. They're out to sell you a product. If you die in twenty years because of it, well, they've made their money.

Glucose sensors located on β-cells sense increases in blood glucose levels despite increases in insulin secretion; the persistent hyperglycemia triggers a series of events which ultimately leads to an increase in β-cell expression, β-cell mass and enhanced secretory capacity of the pancreas. This compensatory increase in insulin secretion explains why some highly insulin resistant individuals never develop T2DM. In a study which examined pancreatic tissue from obese, non-diabetic individuals, relative β-cell volume of the pancreas was 50% greater in obese individuals than in their lean, non-diabetic counterparts (2.6 ± 0.39% vs. 1.71 ± 0.28%, P = 0.05), suggesting that these obese individuals did not progress to T2DM because they were able to increase their insulin production capacity by increasing β-cell mass. Individuals with T2DM do not experience this increase in β-cell mass, in fact there is a significant decrease in β-cell mass.

So long as your body can continue to manufacture insulin to store fat, you will probably not develop Type 2 Diabetes. It is only when this system fails that T2D occurs. Some morbidly obese people do not develop diabetes and it is because they can continue to get fat. A deficiency in Vitamin D may make it difficult for your β-cells to fucntion properly. Another explanation for why some obese people may not develop diabetes is because they're not vitamin D deficient, or if they are, for some reason they require less vitamin D than others.

The identification of the 1α(OH)ase in β-cells suggests that 1,25(OH)₂D₃ may play a role in overall β-cell function. In vitro and in vivo studies have ascertained that 1,25(OH)₂D₃ is essential for insulin secretion and glucose homeostasis. VDR mutant mice show a significant decrease in insulin mRNA levels when compared to controls, suggesting that 1,25(OH)₂D₃ may be required for insulin synthesis.

This isn't just something they've tried in a test tube. In vivo studies show that Vitamin D3 is essential for keeping blood sugar levels normal.

Lastly, obese individuals are often vitamin D deficient due to a decrease in the bio-availability of vitamin D metabolites which may explain why obesity is a risk factor for developing T2DM, although this association is only speculative...

Vitamin D deficiency increases peripheral tissue insulin resistance in addition to decreasing insulin secretion from pancreatic β-cells.

I would argue that they've forgotten that correlation is not causation. Say it with me, correlation is not causation. Associations are also not cause. Did it occur to them that (besides eating way too much sugar and way too many processed vegetable oils) that a deficiency in Vitamin D3 may be a catalyst for obesity? Obesity and insulin resistance go hand in hand. One may cause the other, or both may be caused by something else entirely. Or it's a chain reaction. Something causes insulin resistance which in turn causes obesity. I'm voting on that last one.

Another interesting article I found that has to do with how vitamin D deficiency may lead to breast, cervical and ovarian cancer. If you're not getting enough sun, I think it's a good idea to supplement Vitamin D3. It's cheap and the pills are small and easy to swallow.

A Faith Based Diet

You know why a lot of people hate Gary Taubes so much? Besides the fact that Good Calories, Bad Calories blew their idea of what was 'truth' out of the water, they're pissed because what he shows is that if you're overweight or obese, it isn't your fault. Basically, you don't eat too much, and you've been lied to. OMG, how can that be? Aren't fat people just gluttonous? Slothful? How can it be that they're not?

How can it be that you'd be such a prick to think otherwise? Or isn't that how society sets everyone up to be? It's a sort of blame-the-victim game. This can even be seen in texts on biochemistry. In Lippincott's Illustrated text, they say that β-cell death in Type 1 diabetes is caused probably by a virus. With Type 2, people don't become diabetic until their pancreas can't keep up. In other words, their β-cells have failed to produce enough insulin. What's Type 2 caused by? Obesity. Yes, you read that right. Obesity caused Insulin Resistance, which lead to Type 2. But, really? This is after they say that Type 2 (as well as weight) is heavily influenced by genetics. Is it not possible that Insulin Resistance is caused by a virus? Or that Insulin Resistance is the cause of obesity, not the other way around. It's a chicken-or-the-egg argument. I've also read that some people are insulin resistant, and not overweight. Normal weight people can become Type 2 diabetic. When it's a disease, it would be rude to say it's the person's fault. Therefore we can't call obesity a disease, or how else could it be socially acceptable to degrade fat people?

Also, who *wants* to be obese? Besides this crazy woman... Most people who struggle with their weight do so while trying to do something about it. Eventually they give up because they figure by starving themselves, they're doing more harm than good. And who likes to go around hungry all the time? I did lose weight eating a low calorie diet. But you can't keep doing that, so you go back to eating enough food to satiate you (as all skinny people do), and you wind up gaining what you lost back, and then some.

And then people like Atkins and Gary Taubes come along, and they tell you it isn't your fault, it's *what* you're eating, not how much. And all the little skinny ass people who have never been fat a day in their life and can eat however they like self-righteously tell you that people like Atkins are full of it, and if only everyone would eat the way they eat (which it seems is usually vegan or vegetarian, even though there are plenty of overweight vegans and vegetarians, because YOU'RE DOING IT WRONG!), they'd lose weight.

That whole "you're doing it wrong" mentality is about as brilliant as some of the trolls I've seen on message boards. Just because you're not insulin resistant and/or don't have a hormonal imbalance with insulin, doesn't mean that you're doing something "right". It just means that you're not metabolically messed up.

I also doubt that most people who criticize Atkins or Taubes have ever read what they wrote. And in the case of Good Calories, Bad Calories, *if* they read it, they probably didn't understand it. This is where they resort to ad hominem attacks, because they have nothing else. I've read GCBC twice, and it's not an easy read. And I read plenty of intense books all the time. What artist do you know who reads Lippincott's biochemistry for fun? If you know of another artist who does, I'd love to meet them LOL!

I also understand that there is a group of people who don't have any critical thinking skills, who will follow whatever their doctors or their gurus tells them. They never look into anything for themselves. These are the same people who go on statins because they're scared of their cholesterol (hello! cholesterol is required for cell wall stability). They're the same people who parrot crap on message boards as if it's incontrovertible truth. I tell you, some diet advocates that I've seen put Catholics to shame when it comes to faith. Evangelicals, if you want to convert someone, target the diet crowd. I'm betting a near 100% success rate.

Basically, it's a bunch of codswallop. If some diet works for you, great, do it. If you can drink a two liter bottle of Coca-cola every day and not gain an ounce, that's fantastic {/snark}. I'd prefer to cook my liver on something tastier than soda though, just so you know (pain au chocolat comes to mind). If a diet doesn't work, then don't do it. But don't stand there and tell me that it won't work for me, or that it will work for me. How in the hell do you know what works for me? Are you me? And also, why do you care what I put in my mouth? If you care so much about what I, a complete stranger to you, eats, I suggest you do something important: Get a life.

Postscript:
If low carb diet isn't working for you, before you give up on it, a suggestion is to add more fat and less protein. A lot of low-carbers fall into the "fat is bad" mentality and don't eat enough fat. Depending upon how screwed up your hormones and cells are, too much protein may be triggering too much insulin, which if you're trying to lose weight, may cause you to plateau.

Insulin Resistance and Response

I've spent my day reading all about insulin resistance and insulin response. It's a very fascinating subject.

What prompted this was that I saw arguments on some forums that insulin has a short half-life, therefore it cannot have an adverse impact on tissue. I think that this is quite frankly, codswallop. Not because it's been proven one way or the other, but because the amount of time (or exposure) is not the only thing that determines damage. Frequency is just as important to take into consideration. Temporary high blood sugar spikes could possibly damage your internal organs. If it happens once, it might not be a problem, but when it happens repeatedly every day, over the course of time, it would come as no surprise if organ damage developed. Insulin does indeed have a short half-life, it is estimated to be between 9 and 16 minutes in humans.

However, this does not mean that insulin does it's job in this amount of time, nor does it mean that insulin is reduced completely in that amount of time. By definition, a half life is the amount of time it takes half of the thing in question to decay. Because it is always half, if you understand basic math, you will realize that it's exponential as to how long it takes for something to be cleared completely¹ from a system.

The math is for n, the number of half lives elapsed, the percentage remaining is 100/(2^n). This does not tell you how much is left after n cycles, the quantity being dependent upon the initial amount produced or in the case of insulin, secreted. It takes five half-lives for complete decay to be achieved. This means that after a meal insulin is in your blood at higher than basal levels for at least 45 to 75 minutes based on the 9 to 16 minute half-life. However, in real life, it may be much longer. Insulin remained elevated in subjects after a meal for more than 120 minutes in this study. If you are eating high carb meals with snacks in-between, how often do you think your insulin levels are elevated?

In a healthy person, perhaps this isn't enough time to do damage, even with frequency (although I doubt it, which may be why almost everyone becomes insulin resistant at some point, even if it's when they're old). However, a lot of people become insulin resistant when young. Insulin resistance means that your cells are unable to use the glucose in your blood. Insulin secretion will continue in waves so long as glucose levels in the blood are raised. If glucose levels remain elevated long enough, your pancreas' β-cells may lose their ability to produce enough glucose and this is by definition diabetes.

So is it just carbs? Not completely. If you are insulin resistant, and trying to lose weight, one reason why it's very important to make sure that on a low carb or paleo diet that a good quantity of your diet is from fat, is because protein can cause an insulin response just like carbohydrates. So get the 'low fat' crap out of your head! One study showed that consuming a steak could cause plasma insulin levels to rise nearly 100 pmol/l above fasting levels, whereas cod fillet only caused a rise of 50 pmol/l. This may very well be because steak has about twice the protein as cod fillet. According to caloriecount.about.com, one ounce of steak has between 7.7 and 8.6g of protein (depending upon the type of steak). The same amount of cod fillet has 4.8g of protein. The study's authors say the difference in insulin response could also be attributed to carnosine, a dipeptide which is found in beef but not cod. Regardless, lean meat can cause an insulin response.

Keep in mind that protein is vital for rebuilding muscles, and if you're weightlifting you may need more than someone who's not.

Now, what do all these studies mean? Not a damned thing if you ask me. Honestly, the people funding the study influence the results. The data can really be interpreted to mean anything. And I do mean anything. We now know that cholesterol doesn't cause heart disease, but rather inflammation and homocysteine probably do. And yet there are dozens of studies about the nefarious effects of cholesterol, most of them poorly done, and the data manipulated to say what the researchers wanted to be said.

So, what causes insulin resistance? It seems no one is very sure, and there may be multiple causes. Some say it's chronically elevated insulin due to elevated blood glucose from over consumption of carbohydrates. Some of it is probably genetic. Whatever causes it, eating low carb or paleo is beneficial, as it reduces inflammation and makes insulin resistance unlikely. Indeed, though it is anecdotal, many people have noticed improved glucose tolerance after eating low carb for a long time.


¹ Insulin is never completely cleared from our system. We secrete insulin in small amounts every few minutes, even when we haven't eaten.

There's No Fat in Sugar

We have an obesity epidemic in this country because our government, dietitians and doctors continue to give people the wrong information. Take for example an article on the Pima Indians from the NIH.

"Thirty years of research show that exercising and eating lower fat, fiber-rich foods can at least delay diabetes. "If you delay it long enough," adds Dr. Knowler, "It's almost as good as preventing it...

[NIH doctors] also discovered that high levels of insulin in the blood, or hyper-insulinemia, is another strong risk factor.

Studying this clue, researchers working with patients found that high levels of insulin were linked to insulin resistance. Normally, the pancreas releases insulin to regulate the amount of sugar or glucose in the blood. People who have non-insulin-dependent or Type II diabetes (hereafter referred to simply as "diabetes") produce insulin, but their bodies don't respond to it effectively. NIH researchers have made it clear that people with insulin resistance are those most likely to get diabetes...

The second strategy is to encourage those who are at high risk to change behaviors that can lead to diabetes, such as eating a high fat diet, being physically inactive, and being overweight.

The NIH has begun a major nation-wide program to prevent diabetes in people who increase exercise and eat lower fat foods." [emphasis mine]

Now let me explain something to you that even a five year old should be able to understand. We have three basic nutrients, fat, carbohydrates and protein. Carbohydrates break down in the blood into sugar. This causes you to secrete insulin, sometimes it makes people insulin resistant, some think quite possibly because of exposure to sugar and/or refined carbohydrates.

Once you are insulin resistant, simply cutting out the sugar and simple carbohydrates doesn't stop you from being insulin resistant. If you continue to eat carbohydrates, depending on genetics, you may become type 2 diabetic. If you don't eat carbohydrates, and restrict them severely, you will not. It's not possible (to my knowledge) to become diabetic if you are not eating carbs, because you don't have an increase in blood sugar if you're not consuming carbohydrates and therefore very little insulin is secreted. Some people can eat more carbs than others and be okay. Some have to cut out all carbohydrates, as in the case Taubes mentions in his book about the du Pont executive who couldn't even eat an apple. Some have said their insulin resistance improves after months of being on a low carb diet, and they can then have some carbs without having problems.

So you tell me why in the hell they are advocating that people who are already insulin resistant eat more carbohydrates? Because that's what they're doing. By lowering fat you raise carbohydrate consumption. Protein intake cannot increase very much, you can't tolerate too much of it (unless you're body building and breaking down muscle).

Why do they blame fat? I think it's because of the mistaken notion that since the Pima were agriculturalists that meant they didn't eat meat and that they only ate carbs. There isn't a single documented case of a native society being completely vegetarian, that I know of anyway. They usually tend to eat whatever they can get their hands on.

"A dietary change common to all these cases [of Native American cultures] has been the increased consumption of sugar and refined carbohydrates ... Since the key diagnostic feature of diabetes is high blood sugar, often accompanied by sugar in the urine, diabetes is frequently spoken of as "sugar diabetes" and "I've got sugar" or "I've got high sugar"... All carbohydrates cause a rise in blood glucose, and the glycemic index, a meaure of the impact of food or a meal on the rise in blood glucose, has a significant but transitory effect on both insulin production and glucose homeostasis." --from the Encyclopedia of medical anthropology by Carol R Ember, p 342

Since the Pima didn't grow sugar or refine grain to within an inch of it's life, I'm going to go with door number 1. And that is, the Pima are overweight or obese and diabetic because they consume carbohydrates typically found in the western diet. They may have consumed carbohydrates before contact with Europeans, but they were not the same kind of carbohydrates. Also, because they live in a rather inhospitable place, they may have not gotten enough calories, and this functions in much the same way as carbohydrate restriction if Ancel Key's studies on starvation are worth anything.

It's sad that all of the Native Americans' ancestors were screwed over by the Europeans. But what's even sadder, is that they are continuing to be screwed over even today, just like every other overweight or obese person in this country who has been told that they're fat because they eat too much. They will continue to get type 2 diabetes, will continue to have legs amputated and will continue to die prematurely as long as the lie that fat is the problem is perpetuated.