Type 2 Diabetes and Remission 101
This post aims to explain the cause of T2D and why your overall food/calorie intake is the key to success. Also, why carbohydrates are often given an unfair reputation.
I’ll start with a process called energy balance, which some of you may have discussed on your coaching calls. This determines our fat loss, fat gain or maintenance. If we consume more energy than we expend, we have to store the excess energy, so we store it as fat. Over years and decades, if we consistently consume more calories than our body needs to maintain it’s weight, our fat stores increase in size and weight. We start by storing the fat in out adipose tissue (under our skin). Once these stores start to reach capacity, we begin storing fat in our visceral tissue (in our organs). It is this visceral fat that is particularly detrimental to health as it aHects the function of our organs.
When we accumulate too much of these two types of fat, they each affect our blood sugars and insulin in different ways. The visceral fat aHects the function of the beta cells in the pancreas (the beta cells produce insulin), as a result, we can’t produce as much insulin. Both types of fat, but mainly the fat under our skin, contribute to the insulin resistance. The more fat we store in our body, the less capacity we have for more, so we become ‘resistant’ to the effect of Insulin and it becomes dysfunctional. When we accumulate enough fat mass in our adipose and visceral stores, the combined eHect of reduced insulin production and increased insulin resistance leads to glucose building up in the blood. When we reach the stage that our blood sugars are chronically elevate (do not decrease enough after meals) we are at risk of being diagnosed with Type 2 Diabetes.
Therefore, to achieve remission, we should focus on how to reduce our fat mass through our calorie intake. Provided that we are in a calorie deficit, which means that we consume fewer calories than our body requires to maintain its weight, we will lose fat. This is regardless of the foods we eat, because our body has no option other than breaking down our fat stores for energy as we are not getting it from food. Hence why calorie restriction is so effective. If we can continue to lose enough fat mass through calorie restriction, eventually our sugars will return to healthy range. Sustainable nutrition is very important as we need to maintain our fat loss to give us the best chance of maintain remission.
We should aim to make ‘good’ food choices. This would include lean protein, fruit and vegetables, fiber, wholegrain carbohydrates and some fat. Firstly, this is to ensure that we consume all the nutrients that we need. But also, these foods, particularly protein and veggies are lower in calories, provide more volume and take longer to digest (known as gastric distention). Therefore, keeping us fuller and more satisfied for longer between meals. The fiber from starchy carbohydrates will help this too.
So, to summarise, calories, not carbohydrates, determine fat loss and therefore our chance of achieving remission. Our food choices are less important for remission, but better food choices make us feel better because they provide the nutrients we need. They also make managing hunger and cravings slightly easier, since we’ll feel fuller and more satisfied between meals.
In short: Type 2 Diabetes is caused by fat accumulation from excess calories in 90% of people not carbohydrates or sugar. So, remission is therefore achieved via fat loss, not restricting carbohydrates or sugars. The ‘best’ diet to achieve remission is the one which allows you to lose fat and maintain your fat loss. If you maintain your fat loss, your sugars will remain low regardless of the composition of your diet.