Diabetes was originally called diabetes mellitus meaning sweet urine. Ancient healers in India observed ants being attracted to the soil where some children urinated. Later, it was determined that the attractant in the urine was glucose, known as blood sugar. The Indian physicians Sushruta and Charaka in 400-500 CE are credited with recognizing elevated glucose conditions and separating them into two types, one associated with youth and another with being overweight.
In 1899, two scientists, Joseph von Mering and Oskar Minkowski, confirmed that the absence of insulin production in the pancreas caused the high levels of glucose in the bloodstream, and this became known as Type 1 diabetes. In 1921 and 1922, two Canadian researchers isolated and purified insulin, which led to the successful treatment of Type 1 diabetes and allowed children to live normal lives.
When it came to overweight adults who developed high blood sugar, it was at first theorized that they too lacked insulin production. However, it was later shown that these adults had normal levels of insulin as well as high blood sugar. In the 1930s, scientists theorized that three types of cells—muscle, fat, and liver cells—do not “respond” to insulin. Known as the “insulin resistance theory” (IRT), it is now the accepted explanation for Type 2 diabetes.
Since then, the IRT is treated by endocrinologists as a hormonal disease and promoted by the National Institute of Diabetes and Digestive and Kidney Diseases. The American Medical Association allocates treatment codes, called Current Procedural Terminology (CPT), that doctors, pharmaceutical companies, and blood sugar meter makers use to identify their patient care efforts and to bill insurance companies.
The insulin industry is expansive, with diabetologists having created many different formulations such as rapid acting (injected and inhaled), short-acting, intermediate acting, long-acting, and ultra-long-acting. In addition, they recently created a new class of medications called insulin secretagogues that directly act on the patient’s pancreas to cause greater secretion of insulin.
The net result is that currently, about $1 out of every $4 in U.S. health-care costs is spent on caring for people with diabetes. According to the Centers for Disease Control, the latest figures showed that in 2017, $237 billion was spent on direct medical costs and another $90 billion on reduced productivity. The total economic cost of diabetes rose 60% from 2007 to 2017. People over age 65 account for 61% of diabetes costs, mainly paid by Medicare. If you were to tally the lifetime medical costs for a person with diabetes, 48% to 64% of those costs cover complications related to diabetes, such as heart disease and stroke.
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A Bogus Theory
When it became known that germs develop resistance to penicillin by using mechanisms such as changing or limiting the entryways for the antibiotic, creating pumps to push antibiotics out of the cell, and creating enzymes to neutralize the antibiotics, diabetic researchers adopted the same concept to justify the insulin resistance theory. However, I suggest that IRT is illogical and lacks scientific proof. For example, IRT fails to explain what causes cells to resist just one out of 50 hormones in the body? Why do only three types of cells in the body develop this resistance? Why is it not measurable? It is time to conclude that the IRT must be rejected and replaced with a more scientific theory to explain high blood sugar.
The Fatty Acid Burn Switch Theory of Type 2 Diabetes (FABS)
Here is a more biologically sound theory to explain Type 2 diabetes. Let us start with the evolution of why cells utilize glucose. Billions of years ago, the original cells on earth, cyanobacteria, harvested energy from sunlight and stored it in glucose molecules. Known as photosynthesis, this process releases oxygen into the atmosphere. Bacteria that developed later on earth reversed that process, using oxygen from the air to release the energy from glucose to survive. This same process happens inside every cell in the human body.
However, cells that came later in the evolution of life also developed the ability to burn fatty acids using a new cellular structure, the mitochondria, to produce energy. This same process also happens inside every cell in the human body that has mitochondria.
The ability of cells to use glucose or fatty acids as their source of fuel is the key to understanding the real cause of Type 2 diabetes. In a child whose pancreas produces no insulin, the cells cannot recognize the presence of glucose in the bloodstream. If you wonder why they can’t survive using fatty acids as fuel, it is because to transport fatty acids into mitochondria, cells need an intermediate product from glucose burning. Therefore, children with Type 1 diabetes must inject insulin to use glucose as their fuel to survive.
How can adults function on a daily basis—walking, running, playing sports, and dancing if they are insulin resistant? The answer is, after starting the mitochondrial energy production using glucose, cells easily switch to burning fatty acids rather than glucose. This happens automatically when people have filled their fat cells, allowing the fatty acids that were supposed to be stored in fat cells to become available to cells for fuel. Each individual has only a certain allocation of fat cells, inherited from generations of their ancestry. This explains more logically than the insulin resistance theory why type 2 diabetes can happen regardless of ethnicity, age, or gestational status when the fat storage capacity is full.
The next question is, why are people filling their fat cells and causing the switch to burning fatty acids? The answer is: the modern diet high in carbohydrates from grains such as wheat, oats, rice, corn, and grain-flour products. These carbohydrates produce enormous amounts of glucose and any glucose not used for energy on an immediate basis is converted to fatty acids. This overconsumption of grains on a long-term basis effectively fills up an individual’s fat cell capacity. We can see evidence of this in the rising levels of fat called triglycerides in the blood before people develop Type 2 diabetes. However, cells can burn the fatty acids as easily as glucose. Hence, the “fatty acid burn switch” (FABS). This is what leaves glucose in the bloodstream to cause type 2 diabetes.
This theory explains why type 2 diabetes is increasing worldwide as the only commonality among billions of people is the modern diet high in grains. It explains why type 2 diabetes mostly affects adults over 35 years old when the basis of weight gain is fat accumulation. It also explains why children are now developing type 2 diabetes due to their unhealthy diets of grain-based foods.
Sometimes Science Must Change
Science is about making progress in understanding our world. It is time to acknowledge that insulin resistance theory is illogical. Medical doctors need to recognize that type 2 diabetes is not a hormonal disease but a lifestyle condition. We must focus on reeducating the public with honest guidelines that they reduce the volume of grain consumption in their diets, focusing their eating habits more on fresh vegetables, fruits, nuts, dairy, along with meat and fish as desired. Such dietary guidelines are the most effective way to curtail the fast rising statistics about type 2 diabetes, which predict that 1 in 3 Americans will have diabetes by 2050.
I suggest we must also terminate NIH funding for research based on the theory of insulin resistance, disband the section related to Type 2 diabetes in NIDDK, and give notice to all providers of medical care that CPT codes related to Type 2 diabetes will be phased out within a specified period of time, unless significant clinical benefit can be shown. The immediate benefit will save the Medicare and Medicaid trust funds from insolvency.
Dr. John Poothullil, MD, FCRP In the years since Dr. John retired from my medical practice as a pediatrician and allergist, he has devoted his life to public health. As a patient advocate, he strives to empower people with new scientific insights and complementary approaches to preventing obesity, reversing Type 2 diabetes, and surviving cancer.