how.
In a series of unfortunate events, our modern diet — typically high in sugar, refined starches, and “dirty fat,” such as trans fats and industrially produced oils — plugs the fuel injectors so that glucose can no longer enter the cells. Instead, glucose levels start to mount in the bloodstream. Muscle cells become insulin resistant, initially allowing energy to be stored as fat around the vital organs and in and around the liver. Eventually, these tissues also become insulin resistant. Thus starts the vicious cycle in which belly fat produces insulin resistance, and insulin resistance causes even more belly fat. As the liver and fat tissues also become insulin resistant, full-blown type 2 diabetes ensues with soaring levels of blood glucose.
Central obesity (excess weight in the midsection) produces hormones and other substances that are huge contributors to insulin resistance. Simply put, belly fat produces substances that act like a wad of bubble gum blocking a keyhole. Even though we have the right key (insulin), the door remains locked, and sugar is unable to enter the cells. It remains in the bloodstream, causing damage. Additionally, belly fat produces hormone messengers that make us tired, achy, and sick.
While diabetes is diagnosed by a fasting glucose of over 126 mg/dL, prediabetes is fasting glucose over 99 mg/dL, and insulin resistance starts at fasting glucose above 85 mg/dL.
Prediabetes and insulin resistance can precede type 2 diabetes by a decade. This is why I say that type 2 diabetes is just the tip of the iceberg. By the time we notice it, the main body of the iceberg has existed below our awareness for years. The result can be organ damage, such as eye and nerve damage, and its accompanying complications of full-blown heart disease and kidney disease.
Sugar Glazing, or the Importance of HbA1c
When we experience insulin resistance and too much blood sugar remains in the bloodstream, it causes “sugar glazing” of the hemoglobin in red blood cells. This is called glycation, and it results in glycosylated hemoglobin (also known as glycohemoglobin) or HbA1c. That is, a high level of circulating blood sugar makes the cells in the body, and the vessels through which they flow, “sticky.” Imagine blood cells as Ping-Pong balls flowing through a pipe. Now imagine that the balls and the pipes have been dipped in honey. As they try to flow through the pipes, they damage the lining.
This glycation or “sugar glazing” causes cellular dysfunction and tissue inflammation, leading to degenerative diseases from oxidative stress. In fact, type 2 diabetes is the perfect model for rapid aging.
Advanced glycation end products (aptly abbreviated as AGEs) make not only the red blood cells but all the proteins in the body sticky. They are like the sticky fingers of a toddler, affecting everything they touch. When proteins are sticky, they can no longer properly communicate with one another, leading to the onset of dysfunctions that we typically attribute to aging. In fact, this process of producing advanced glycation end products causes proteins to malfunction and accelerates the aging process.
Indeed, did you know that Alzheimer’s dementia is increasingly believed to be another manifestation of insulin resistance, one that affects the brain instead of other organs? Some investigators have even described it as “type 3 diabetes.”4 It should come as no surprise that the same metabolic conditions that cause heart attacks, strokes, erectile dysfunction, kidney failure, and amputations may also be poisonous to the brain! On the flip side, the lifestyle changes of Turbo Metabolism are also good for your brain.
The HbA1c Blood Test
In the HbA1c blood test, red blood cells are used because they can be extracted when we draw blood, and they have a life span of 90 to 120 days. Thus, the amount of sugar glazing or stickiness on them will depend on the blood sugar level for the last three months or so. Table 1.2 shows the correspondence between the HbA1c blood test and average blood glucose levels over the past ninety days.
Table 1.2. HbA1c test and blood glucose
We know from research that a 1 percent reduction in HbA1c corresponds to about a 20 percent reduction in the risk of heart attacks and strokes and close to a 40 percent reduction in the risk of kidney, nerve, and eye damage.5 Though most diabetes medications reduce HbA1c by about 1 percent, they do nothing for the underlying cause, so the disease progresses over time. When we start to understand the cause of diabetes, and act upon what we know, we not only stop the disease’s progression, we can reverse most of its harmful effects, improving the HbA1c blood test by a lot more than prescription drugs. Table 1.3 shows some HbA1c levels and corresponding glucose levels.
Table 1.3. HbA1c percentage and diabetes
CASE STUDY: JOHN
John, a sixty-six-year-old retired firefighter, was diagnosed as a type 2 diabetic with an HbA1c score of 9.5 percent. He was prescribed medications, but he avoided taking them. He had an aversion to testing procedures. Then, John joined the Turbo Metabolism program, and getting this information empowered him to take charge of his health. Now, John fully understands how his decisions directly affect his body, and he is much more mindful of what he eats. He also exercises regularly. His most recent HbA1c was 6.9 percent, and he feels much better. He recently returned from a hike to Machu Picchu in Peru, which is something he could not have imagined even a year before.
The Effects of Cortisol
Another hormone critical in insulin resistance is cortisol. Cortisol is a “stress hormone” secreted by the adrenal glands in response to a perceived threat. An integral part of our fight-or-flight stress response, cortisol provides a necessary bump in available blood glucose so that we have the energy needed to react quickly in an emergency.
Cortisol makes us hungrier, especially for calorie-dense, sugary, and fatty foods, and it increases insulin resistance, thereby increasing glucose levels in the bloodstream. It also contributes to belly fat. Cortisol is an example of a short-term survival mechanism kicking in to keep us alive in high-stress situations, but one that has harmful effects if it remains active — that is, if our cortisol levels remain elevated for a prolonged period of time in response to perceived stress.
The combination of high levels of cortisol and high levels of insulin is ideal for creating midsection or belly fat. Chapter 7 discusses the effect of stress as a contributor to metabolic diseases in more detail.
Inflammation
Another important concept is inflammation, which may be defined as the process of increased blood flow to an injured body part to deliver healing nutrients and infection-fighting white blood cells. Inflammation is characterized by swelling, heat, redness, and pain, and it typically occurs when we twist an ankle or stub our toe.
Many scientists and doctors accept chronic inflammation as the basis of most of our chronic disease and even of the aging process. The reality, however, is that short-term inflammation serves an important purpose in keeping us healthy. Have you ever bit your cheek eating dinner and woken up amazed the next morning because the cut has healed overnight? This is the miraculous, innate healing power of our bodies — our inflammatory response sends a SWAT team of infection-fighting white blood cells that secrete infection-fighting chemical signals to heal the
