More and more research pinpoints inflammation as a root cause of type 2 diabetes. Being overweight makes it harder for us to control our diabetes, but that can’t be what causes it. Since a lot more people are overweight or obese than have diabetes, weight alone can’t lead to diabetes.
No one ever demonstrated that obesity causes diabetes or even insulin resistance. In my most recent book, Losing Weight with Your Diabetes Medication, I speculated that essentially it might be the other way around: That what makes so many of us overweight could be insulin resistance or impaired beta cells.
Type 2 diabetes generally results from the combination of impaired beta cell function and insulin resistance acting on susceptible genes. Why then is there such a large overlap between being heavy and type 2 diabetes?
When our beta cells don’t function properly, we are likely to get diabetes, Endocrinologist Daniel Porte Jr., M.D., who is now associated with the VA San Diego Health Care System, told me back in 2001. “And this will also tend toward an increase in body weight.”
But what could cause insulin resistance? Earlier, scientists theorized that chronic, low-grade tissue inflammation related to obesity contributed to insulin resistance. But now it seems that inflammation even without obesity is the likely culprit. Research by scientists at the University of California, San Diego, and Switzerland’s University of Fribourg discovered that inflammation provoked by immune cells called macrophages leads to insulin resistance and then to type 2 diabetes. Their research also showed that obesity without inflammation doesn’t result in insulin resistance. They made their discovery by working with mice, not humans. That gave them an advantage because they could use mice that lacked the macrophage JNK1. No one wants to knock out that key component of the inflammatory pathway in people. The journal Cell Metabolism published this technical article as “JNK1 in hematopoietically derived cells contributes to diet-induced inflammation and insulin resistance without affecting obesity.” The abstract is online. “If we can block or disarm this macrophage inflammatory pathway in humans, we could interrupt the cascade that leads to insulin resistance and diabetes,” Jerrold Olefsky, one of the principle investigators said. "A small molecule compound to block JNK1 could prove a potent insulin-sensitizing, anti-diabetic agent." Dr. Olefsky is UCSD’s distinguished professor of medicine and associate dean for scientific affairs. But he’s thinking drugs to reverse a sad situation. We can think diet. For the past month or two I have been reviewing the inflammation literature, including three popular books. They are The Inflammation Syndrome by Jack Challem, Inflammation Nation by Floyd H. Chilton, and The Inflammation Free Diet Plan by Monica Reinagel. The side effect of taking drugs to reduce inflammation “all too often outweigh their benefits,” Challem points out. "Natural and safe anti-inflammatory foods and nutrients abound." Supplements are no better than drugs. They “can be like bailing water in a sinking boat,” he writes. "It is essential that the underlying diet be corrected." His diet recommendations are close to what we all knew already is necessary to control our diabetes. They aren’t quite as low-carb as I follow, but they are a good start:
Challem’s Anti-Inflammation Pyramid Inflammation is too much of a good thing, Dr. Chilton says. Our security guards – the white blood cells and the inflammatory messengers including complex fatty acids – are essential to our health. But it becomes inflammatory disease when our body overreacts or attacks itself instead of a legitimate target, like an infection. Dr. Chilton supports the use of medication for treating inflammatory disease while recognizing that every drug has some side effects. He offers his program as a complementary strategy. But he too emphasizes diet. His focus is on reducing arachidonic acid, since "high levels of it cause the overproduction of inflammatory messengers." Fatty fish like salmon – as long as it is wild, not farmed – are a key component because of their high levels of the essential fatty acid eicosapentaenoic acid (EPA). He also accepts egg whites, but not whole eggs, into his diet and recommends a diet of carbohydrates that are low on the glycemic index. He too summarizes his diet recommendations in a food pyramid:
Dr. Chilton’s Anti-Inflammatory Pyramid
Reinagel’s diet plan is less technical in its presentation and doesn’t even include a food pyramid. She bases it on her summary of 20 different pro- and anti-inflammatory factors that she calls the IF Rating. The popular NutritionData site licenses her IF Rating System and provides IF Ratings for most foods in its database.
Reinagel also recommends foods that are low on the glycemic index. Reinagel and Chilton are in complete agreement about the evils of farm-raised salmon and the benefits of wild salmon. I think she’s also correct to write that even whole grains and fruits are mildly to moderately inflammatory. You probably won’t be surprised that sugary, fatty, and junk food are inflammatory as are many vegetable oils (but not olive oil). What all three of these books have in common is diet. The diets are remarkably similar and can not only prevent but reverse inflammation. By reversing it we can directly control our diabetes.
David Mendosa was a journalist who learned in 1994 that he had type 2 diabetes, which he wrote about exclusively. He died in May 2017 after a short illness unrelated to diabetes. He wrote thousands of diabetes articles, two books about it, created one of the first diabetes websites, and published a monthly newsletter, “Diabetes Update.” His very low-carbohydrate diet, A1C level of 5.3, and BMI of 19.8 kept his diabetes in remission without any drugs until his death.