Is a prediabetes diagnosis serious? There has been significant debate around the term ‘prediabetes,’ and whether it should be considered cause for alarm. On the one hand, it serves as a risk factor for type 2 diabetes and a host of other complications, including heart disease, and ultimately prediabetes implies that a degree of metabolic problems have started to occur in the body. On the other hand, it places a diagnosis on many people who may never develop type 2 diabetes. Again, according to the CDC, 15-30% of those with prediabetes will develop type 2 diabetes within five years. However, a 2012 Lancet article cites 5-10% of those with prediabetes each year will also revert back to healthy blood sugars.
According to the World Health Organization (WHO), global diabetes cases have increased from 108 million in 1980 to 422 million in 2014. Those numbers are expected to reach 642 million by 2040. According to data from the U.S. Centers for Disease Control and Prevention (CDC) reports, type 2 diabetes accounts for around 90 to 95 percent of cases in adults.
Answer: In recent years, intermittent fasting has emerged as a novel way of treating patients with type 2 diabetes. There are anecdotal reports of patients who have lost weight, their blood sugar levels have improved significantly, and they no longer need to take their diabetes medications. Their disease appears to be in remission – if not exactly cured.
Within the hepatocyte, fatty acids can only be derived from de novo lipogenesis, uptake of nonesterified fatty acid and LDL, or lipolysis of intracellular triacylglycerol. The fatty acid pool may be oxidized for energy or may be combined with glycerol to form mono-, di-, and then triacylglycerols. It is possible that a lower ability to oxidize fat within the hepatocyte could be one of several susceptibility factors for the accumulation of liver fat (45). Excess diacylglycerol has a profound effect on activating protein kinase C epsilon type (PKCε), which inhibits the signaling pathway from the insulin receptor to insulin receptor substrate 1 (IRS-1), the first postreceptor step in intracellular insulin action (46). Thus, under circumstances of chronic energy excess, a raised level of intracellular diacylglycerol specifically prevents normal insulin action, and hepatic glucose production fails to be controlled (Fig. 4). High-fat feeding of rodents brings about raised levels of diacylglycerol, PKCε activation, and insulin resistance. However, if fatty acids are preferentially oxidized rather than esterified to diacylglycerol, then PKCε activation is prevented, and hepatic insulin sensitivity is maintained. The molecular specificity of this mechanism has been confirmed by use of antisense oligonucleotide to PKCε, which prevents hepatic insulin resistance despite raised diacylglycerol levels during high-fat feeding (47). In obese humans, intrahepatic diacylglycerol concentration has been shown to correlate with hepatic insulin sensitivity (48,49). Additionally, the presence of excess fatty acids promotes ceramide synthesis by esterification with sphingosine. Ceramides cause sequestration of Akt2 and activation of gluconeogenic enzymes (Fig. 4), although no relationship with in vivo insulin resistance could be demonstrated in humans (49). However, the described intracellular regulatory roles of diacylglycerol and ceramide are consistent with the in vivo observations of hepatic steatosis and control of hepatic glucose production (20,21).
First, the health of your gut is critical to your overall health. This is because your gut is home of trillions of microbes called the gut microbiome. These microbes work in symbiotic and antagonistic relationships within your body. A 2017 study using multiple therapies to manipulate the gut microbiome composition, found they could impact the individual’s health more rapidly. This study also found manipulating the gut microbiome as an effective way to avoid insulin resistance and therefore prevent diabetes.
Before making any fiber recommendations, Dean has her patients tested for “pancreatic insufficiency.” She believes people with pancreatic insufficiency should be given digestive enzymes along with fiber, “otherwise the fiber will just bloat them up, and they’ll be quite unhappy,” she says. Dean uses a glucomannan fiber supplement for her patients with type 2 diabetes.
The bottom line is that diabetes can be bad news—but this doesn’t have to be the case. Interventions can prevent or delay the disease in people with prediabetes. The Diabetes Prevention Program (DPP), a large study of people at high risk of diabetes, has established a prevention plan that’s both feasible and cost-effective. The DPP showed that weight loss and increased physical activity reduced the development of type 2 diabetes by 58% during a three-year period.
Henry Cole, 67, from New Jersey, USA, did likewise. He saw a 20-second news clip on TV and took up the diet days later. He stuck rigidly to 600 calories daily from just protein (steak, chicken, turkey or fish) plus green veg, eating his one meal at 6pm most days, with coffee and calorie-counted cream for breakfast and 1.5 litres of water. His weight went down from 81kg to a stable 70kg on a now daily 1,500 cal diet, with his HbA1c level down to 5.6% from 6.9%.
You should have no more than three of these “feeding times” per day. The reason limiting the number and duration of your meal times is so important has to do with staying out of the vicious cycle of increasing insulin resistance. To get smart on insulin resistance — the cause of both type 2 diabetes and obesity — read Dr. Jason Fung’s book, The Obesity Code: Unlocking the Secrets of Weight Loss, or watch his free lecture on YouTube.