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Blood Sugar Regulation and Diabetes

What causes diabetes? Why is blood sugar regulation so important?

To answer these questions, we are going to talk about sugar, or more specifically glucose, its role in the body, how the body controls the amount of glucose in the blood, and how dys-regulation causes insulin resistance and then ultimately, diabetes.

First, we will establish some base knowledge about what kinds of carbohydrates exist and what happens when we eat them. There are several kinds of carbohydrates categorized by their structure and how quickly they get digested and absorbed from the GI tract into the blood stream. Simple carbs are small molecules made of one or two sugars and are quickly broken down and absorbed. Complex carbs have three or more sugars linked together and are therefore more complex in structure and slower to digest. Fiber is a complex mesh of carbs that cannot be digested by the enzymes made in the human body and pass through without getting absorbed. They don’t change your blood sugar directly; however, they work to slow down the absorption of other sugars present at that time. Usually a carb-rich food such as pasta or a piece of pizza has several kinds of carbohydrates all getting digested at once. However, all carbs, once fully digested are broken down into three kinds of sugars: glucose, fructose, and galactose. These sugars are absorbed and enter your bloodstream and head right to the liver where the fructose and galactose gets converted into glucose. Once glucose enters the blood, insulin is released from the pancreas which allows glucose to enter into the cells to be used as energy. (Note: Keep in mind that glucose is not the only thing that controls the release of insulin, other substances can as well, but for this purpose, we are talking about glucose’s control of the release of insulin). Foods richer in complex carbs and fiber will help to slow the digestion and therefore the absorption of the sugars in to the blood which allows insulin to be released and offered to the cells steadily instead of all at once.

Glucose is the preferred source of energy for most of the cells in your body. It is necessary to function and live. Your body will make its own glucose if it doesn’t get supplied (during times of fasting or starvation) or it will adapt to use other nutrients for energy such as fats or proteins. Glucose in the cells in the right amounts is not the problem. The problem is when there is excess glucose in the blood or inside the cells. Persisting “hyperglycemia” or too much glucose in the blood can cause damage and disease progression to occur. Too much glucose inside the cells can also cause problems as well.

Let’s talk now about diabetes as a disease and how it can develop…

There are two main types of diabetes: type 1 and type 2. Type 1 diabetes is an autoimmune disease in which a person’s immune cells attack the cells in the pancreas that secrete insulin. Therefore, someone with type 1 diabetes produces little or no insulin and must regularly provide their body with insulin. For individuals with type 2 diabetes, the issue lies in the cells in the rest of your body that don’t respond to insulin like they should. For the purpose of this post, we are going to mainly be talking about type 2 diabetes as a lot of the risk associated with type 2 is lifestyle related.

Before progressing to type 2 diabetes, a condition called insulin resistance usually occurs first. Although the cause is not completely understood, there are several mechanisms in other cells in the body that are dependent on insulin to supply it with energy that can get disrupted or impaired as a result of chronic high blood sugar. This causes a further increase in blood glucose because the cells are not taking the glucose from the blood like they should when insulin is present. As a result of continual high blood glucose, the body continues producing more insulin to try to get it lowered. Eventually, the cells in the pancreas that make insulin can get stressed and eventually die. This further decreases the body’s ability to make insulin leading to bigger increases in blood glucose. Long-term consequences of high blood glucose are damage to tissues and proteins in the body such as your heart, kidneys, brain, eyes, and nerves, and increases to your risk for developing other diseases such as cardiovascular disease, neuropathy, and premature death. Pre-diabetes is usually diagnosed before diabetes and is based on various tests that measure the glucose levels in the blood.

You might be asking what can be done to prevent this?

Lifestyle (diet, physical activity, stress levels, etc.) is not the only factor but is a large factor in the development of type 2 diabetes. Other factors such as body weight, genetics (family history of diabetes), age, race, and ethnicity can impact your risk for developing type 2 diabetes.

Current evidence is showing promising outcomes with lifestyle interventions in preventing or delaying the development of diabetes. Interventions with diet and exercise particularly have significantly decreased diabetes risk.

Here are some dietary and lifestyle considerations for diabetes prevention:

Diet composition:
Like we discussed above, diet composition itself can affect how quickly your blood sugar rises and therefore how hard your pancreas has to work in order to make enough insulin. If you eat a diet composed of lots of simple carbs and little complex carbs and fiber, then the carbs that you eat will cause a sharp rise in blood sugar and a sudden need for lots of insulin. This can be taxing on your pancreas long-term. Eating carb-rich foods high in fiber and complex carbs like whole grains, some fruits, and most vegetables will help to slow the absorption of sugar into the blood to prevent a sharp rise in blood sugar.
Eating a lower carb diet is usually advised for those with pre-diabetes or diabetes to help manage the disease and their medications. It is not necessary for those just trying to prevent the development of diabetes as it may not be sustainable long-term. Choosing the right kinds of carbs and the composition of the rest of your meal is more important.
In addition to fiber, protein and fat are complex molecules that help to slow the digestion and absorption of sugars. Choosing a meal or snack that is balanced with whole grains, fruits, healthy fats, and protein will likely help balance your overall blood sugar.

– Complex carbs like whole grains, fruits, and vegetables
– Fats, proteins, and carbs at every meal and snack

Not as helpful:
– Too many simple sugars in one setting
– A lot of simple sugars, or even complex carbs without protein or fats

Amount of Food:
Too much overall energy intake can lead to increases in body weight which is a risk factor for developing diabetes. Having excess energy, in the form of carbs, proteins, or fats, can result in the same response of insulin resistance in the body’s cells.

– Eating the right amount of calories

Not as helpful:
– Eating too many calories overall

Physical Activity:
Regular exercise has been shown to improve blood sugar regulation and control in individuals, help prevent weight gain, and maintain overall energy balance. It is good to start slow and gradually add in more exercise in order to prevent injury. The currently recommendations are 150 minutes of exercise per week, or just 30 minutes, 5 times a week.

Other lifestyle factors:
There are many other factors such as stress (positive or negative), illness, dehydration, etc. that can influence your blood sugar. Overall, do your best to manage and control what you can and let everything else go. Worrying about things you cannot control is not beneficial!

While there are so many factors at play in the development of type 2 diabetes, weight loss for overweight individuals, adequate exercise, and a balanced diet has been shown to be helpful to decrease your risk for developing type 2 diabetes. Seek the advice and counsel of your healthcare provider to figure out what you can do today to help lower your risk for developing diabetes.


Genetics and Health

How much do your “genetics” actually control your health?

It has become a common thing to blame genetics as the reason for a lot of health maladies. What role do genetics play in health and the development of disease?

To tackle this question, we must first understand the role and function of genetics. Every single cell in your body (except red blood cells) has a  unique set of genetic material made up of DNA which is a series of codes that specific molecules can read and do certain things with. It is essentially just a recipe that your body attempts to follow. “Genes” are sections of your DNA that code for a specific thing. For example, you have specific genes that dictate every physical attribute about your yourself and also what proteins get made that run every process that happens in your body.

If all cells have the exact same DNA and set of genes, how then can you have different cells in the body that function and look completely different? This is the completely amazing and miraculous thing about how we were created. A neuron can be up to 4 feet long and is completely different from a cell that makes and secretes hydrochloric acid into the stomach for digestion. These differences in the structure and function of cells happen when certain genes are turned on or off during the process in which new cells are created and mature. These differences in gene expression in a particular cell also dictate the needs for that particular cell (in terms of energy or nutrients) and therefore the function that cell is responsible for (i.e. making stomach acid, making and releasing hormones, providing structure, receiving and sending nerve signals, etc). These functions are accomplished by hundreds or even thousands of proteins that are produced by the cell’s DNA.

There are genetic disorders that are passed on that directly affect a certain protein’s function in the body and cause an inevitable disease such as Down syndrome or Sickle Cell Anemia. In other cases, there are genetic variations in inherited genes that result in things like varying reactions to medications, “predisposition” or even protection for a certain disease, or nothing at all. Genetic “predisposition” means that because of a certain gene variant, you may be more susceptible to a certain disease but it does not mean that you will develop the disease. There are other factors like lifestyle and environment that also affect the development of a potential disease positively or negatively. For example, it has been shown that healthy lifestyles (exercise, diet, stress management, etc.) can counteract a genetic predisposition to being overweight.

What does this all mean for your health?

You may or may not know of any genetic variations you have that could have potential impacts on your health. However, more and more research is showing that genetics are just a part of disease development. Epigenetics are another factor. “Epi” means above or upon. Therefore, “epi-genetics” means upon or on top of genetics. Epigenetic changes do not change the DNA itself, but are external and can change how the body reads a certain gene (turning it on or off). Some of these changes are reversible and are impacted positively or negatively by lifestyle (diet, alcohol, exercise), exposure to environmental toxins (metals, endocrine-disrupting chemicals), and environment (in utero, stress, work habits). In early childhood, the brain is particularly susceptible to epigenetic change through positive and negative experiences. Others of these changes can become permanent after long-term adverse experiences.

While a lot of the environments in which you grew up in and the genetics you were given are out of your control, there are changes you can make now that can positively impact your health and longevity.

Here are some positive diet and lifestyle changes that have been shown to impact epigenetics:
– Folate and Vitamin B12: Both of these B vitamins are essential in DNA metabolism and are epigenetically active.

– Other nutrients with protective effects: selenium, SAM, choline, resveratrol, methionine, etc.
– Polyphenols: These types of compounds are found in plants such as berries, beans, nuts, seeds, spices, etc.
– Dietary patterns: Fruits, vegetables, legumes, whole grains, and healthy fats (less saturated fats and red meats)
– Physical activity: Exercise and overall physical activity has been shown to be epigenetically protective.

Here are some substances that have been known to negatively impact epigenetics:
– Endocrine-disrupting chemicals: These types of chemicals interfere with our body’s hormone signaling pathways. Examples of these chemicals include phthalates and parabens (used in beauty and personal care products), BPA, Atrazine (herbicide), etc. (refer to this earlier blog post for more information)
– Heavy metals and environmental pollutants: arsenic, lead, mercury, and air pollution (refer to this earlier blog post for more information)
– Alcohol and tobacco consumption: Overconsumption of both of these substances are pro-inflammatory and associated with increased risk of cancer and other diseases.

This information is not meant to scare you or make you feel like you can control every thing that happens in your body. Sometimes things still happen that we can’t control or that we tried to actively prevent. Please reach out to your doctor if you would like assistance in figuring out how you can change your lifestyle to positively benefit you and your genetics!

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