The Diabetes/Obesity Correlation: Do we have it backwards?
In June of this year, the American Medical Association voted to adopt the policy that obesity is a disease, not merely a result of lifestyle choices. The AMA’s reasoning is that saying that obesity is not a disease is like saying, “Lung cancer is not a disease because it was brought on by individual choice to smoke cigarettes.” As we all know, lung cancer is a disease, and it’s not always brought on by smoking. Around 15% of lung cancer cases are non-smokers. Smoking increases the likelihood of developing lung cancer, but it isn’t guaranteed, and it’s not the only way to get lung cancer.
The AMA is looking at obesity in the same manner. Just because someone eats a lot does not necessarily mean that they are going to become obese or get diabetes. Obesity increases the risk, but it may not be the cause. Furthermore, there is discussion emerging from the medical community that obesity might be a result of insulin resistance and diabetes, not the other way around. Dr. Peter Attia, president of the Nutrition Science Initiative, is a spokesman at the forefront of questioning the idea that diabetics caused their illness by overeating.
Obesity is a Growth Disorder
Dr. Attia’s hypothesis: “Obesity is a growth disorder, just like any other growth disorder, and fat accumulation is determined not by the balance of calories consumed and expended but by the effect of specific nutrients on the hormonal regulation of fat metabolism.”
In other words, what we eat may play a role in obesity but not how much. Dr. Attia advocates that insulin resistance might develop before obesity, and it is insulin resistance that begins to cause the accumulation of weight. Dr. Attia is especially proactive in challenging the traditional theories about obesity because it directly affected him. In a recent TED talk, Dr. Attia explains that he was working out three hours a day and following the food pyramid to a T when he gained weight and couldn’t get it off no matter how hard he tried. It was then that he found out he had metabolic disease or insulin resistance. “About 30 million obese people don’t have insulin resistance and about 6 million lean people are insulin resistant,” Dr. Attia says. This is just cause to question the theory that obesity causes diabetes.
The Effects of Insulin Resistance
Insulin is a hormone that decides what our bodies do with food. Insulin decides whether we store fat or use it for energy. When insulin levels are high, the body stores fat. When someone becomes insulin resistant, which is what happens with type 2 diabetes, the cells in the body become resistant to the effects of insulin. When cells are resistant, the pancreas tries to make more insulin, and can’t keep up with the body’s demand. This results in a flood of insulin in the body, a storage of fat, and elevated blood sugar levels, aka type 2 diabetes. This is when diabetes medications are needed to help the diabetic produce and process more insulin.
What Really Causes Diabetes?
Doctors and scientists are in a fierce debate over what causes insulin resistance, but based on the knowledge that elevated insulin levels and insulin resistance promote fat storage, one cannot dismiss the theory that diabetes may be the cause of obesity. Personally Dr. Attia, overcame insulin resistance by modifying his diet. He actually consumes large amounts of fat (including saturated fat), few carbohydrates, and avoids sugar altogether. His diet and more information can be glimpsed on his blog, The Eating Academy. Perhaps the wrong kind of nutritional advice has been touted for decades as sound advice for prevention of and treatment for type 2 diabetes, hypertension and heart disease. Doctors and scientists at NuSI are trying to get to the bottom of it.