Nutritional Path to Wellness

Nourishing Mind, Body, & Spirit

Category: Diabetes

Diabetes, Metformin, Glyburide

First let’s explain how glucose gets into your cell. When you eat carbohydrates your body releases insulin. The glucose transporters in the cell migrate to the cell’s surface in response to the insulin to transport the glucose into the cell. When you have type 2 diabetes the glucose transporters do not respond to the insulin signal which results in high levels of glucose circulating in your blood. Since your cells are not receiving glucose they are sending out a signal saying they need glucose for energy. Your liver then creates glucose and releases it into the bloodstream. Your pancreas also releases more insulin in response to higher glucose levels.

You now have high levels of insulin and high levels of glucose in your blood. If your cells aren’t taking in the glucose then your body will store it for later. Insulin is also a fat storing hormone. Insulin triggers the liver to release VLDLs – Very Low Density Lipoproteins that carry triglycerides and cholesterol. We store fat in the form of triglycerides. High levels of insulin will result in fatty liver disease. This is also the reason people taking insulin injections gain weight. Insulin makes our body store fat.

As we gain weight our fat storage cells called adipocytes or adipose tissue, create cytokines. These are hormones that regulate adipose tissue metabolism. Cytokines also cause inflammation in the body. Meanwhile, the high levels of circulating glucose are causing oxidative stress throughout the body.

Two popular medications prescribed are Metformin and Glyburide.

Metformin works by stimulating the glucose transporters to migrate to the cell’s surface allowing the glucose to enter. It also acts on the liver to decrease glucose production. Metformin is then cleared through the kidneys.

From MicroMedex: “Glyburide stimulates functioning pancreatic beta cells to produce insulin, reducing blood glucose. Although the blood glucose lowering effects of Glyburide continue during long-term administration despite a decline in the insulin production response, the mechanism has not been discovered. It is thought that extra-pancreatic effects may be involved.”

If you are insulin resistant why would you want even more insulin circulating in your blood?

Metformin lowers vitamin B12 absorption and also causes a folate deficiency. This in turn causes an increase in homocysteine in the body. Homocysteine is an inflammatory marker. A healthy homocysteine metabolism requires vitamin B6, vitamin B12, and folate.

If you decide to take medication make sure your doctor is monitoring your vitamin B12, folate, renal function (kidneys), hepatic function (liver), homocysteine, and C-reactive protein (inflammatory marker).

Or you can manage your Type 2 diabetes with diet.

Ketogenic Diet, Ketones, Ketosis

A ketogenic diet switches your body from carbohydrate burning to fat burning. The trick is to stay in ketosis while enjoying wholesome nutrition. First we need to understand how our body burns fuel. Carbs are the body’s main source of fuel. Carbohydrates (except fiber) are metabolized into monosaccharides of glucose, fructose, and galactose.

A little on fructose, a very misunderstood sugar. Fruit and honey have a blend of glucose and fructose. Sucrose (table sugar) is a 50/50 blend of glucose and fructose. High-fructose corn syrup is formed through converting 55% (typically) of the corn’s glucose into fructose giving it a 55/45 blend. It has a higher fructose than glucose concentration, hence why it’s called “high-fructose.”

Galactose is a metabolite of lactose, the sugar in milk. Neither fructose nor galactose cause an insulin response by the body. Glucose, on the other hand, does. Insulin triggers the liver to release VLDLs, the lipoproteins that carry cholesterol and triglycerides, depositing triglycerides into fat cells. This is why that piece of cake goes straight to your hips, or belly! It also causes a rise in LDLs (bad cholesterol) leading to atherosclerosis.

Both fructose and galactose are used to produce glucose. The body uses glucose to create energy. Glucose is converted to pyruvate. Pyruvate is converted to oxaloacetate and acetyl CoA; both of which are needed to run the Kreb’s cycle. So, what happens when we fast or eat a low carbohydrate diet, such as a ketogenic diet? The first thing your body does, after it uses up its glycogen (storage form of glucose), is use amino acids to make glucose in order to produce pyruvate. However, after a week or so you will switch over to using primarily ketones and need less glucose.

When you consume protein your body breaks it down into its component amino acids and is stored in an amino acid pool. These amino acids are used as building blocks to create protein, cholesterol, glucose, ketone bodies; and, are stored as fatty acids (fat) when your body has exhausted its uses. Alanine and glutamine are the most utilized amino acids to produce glucose by the liver. If you are not eating enough protein your body will break down its own muscle for survival. A normal healthy adult should consume 0.8 g protein/kg body weight. In order to build muscle, you need to do weight bearing exercise and can increase your protein intake. To ensure an adequate amino acid pool available to build and repair muscle, endurance athletes need to consume 1.2 – 2 g protein/kg body weight while strength and power athletes need to consume 1.4 – 2 g protein/kg body weight. Exceeding 2 g protein/kg body weight could put too high a nitrogen load on the kidneys. Also remember, if your body is not utilizing the protein, then you will store it as fat.

Next, your body will start using its fat stores. Yay!! When this happens it also triggers amino acid ketone body formation, primarily with leucine and lysine. The byproduct of metabolizing fat is ketone bodies. Basically fatty acid oxidation overwhelms the Krebs cycle and it starts storing energy as ketones. Ketones can be converted into acetyl CoA to fuel the Krebs cycle. When you are producing ketones your body is in a state of ketosis.

The only caution to this situation is a type 1 diabetic not taking their insulin and on a ketogenic diet. They are not able to utilize glucose. So their body goes into overdrive breaking down fat and producing an overabundance of ketones. Too many ketones cause ketoacidosis, making the blood acidic which would lead to coma and death if not treated. A normal healthy individual with functioning hormones will maintain glucose and ketone body formation within healthy levels. Excess ketones are excreted in the urine.

Ketosis is a natural state. We go into ketosis at night. It is a survival mechanism. We store fat in times of feasting & use the fat in times of fasting. This is how we survived throughout history. Eating a ketogenic diet is low carb (less than 50 g of carbs per day). You can buy ketone strips to see if you are in ketosis. If not, you may want to lower your carb consumption. As with everything, if you eat too much protein and fat you will gain weight. It’s not a license to eat as much of anything else you want as long as it’s low carb. 🙂

I am hungry all the time!

I eat and then I’m hungry in an hour. I’m trying to eat healthy but when I’m hungry I tend to eat the first thing I can grab. I’m gaining weight and don’t know what to do.

After we eat we shouldn’t get hungry for 3 – 4 hours. If you are feeling hunger before that, either you are not eating enough or you are eating the wrong kinds of foods. Usually this is due to an insulin response. If you start your morning with cereal, banana, and milk. You are having carbs, carbs, and carbs with some protein. As we get older we are more prone to insulin resistance. When we are younger we seem to be able to eat anything. But unfortunately that sets us up to have issues when we get older. We never really learned how to eat healthy.

When we have insulin resistance the insulin receptors aren’t working in our cells. Insulin is the key that when it binds to the receptor it unlocks the cell allowing glucose to enter. But, when the receptors aren’t working we have high levels of insulin in our blood along with high levels of glucose. Another function of insulin is to shuttle the excess glucose that the cells don’t need into the fat cells for storage for later. So, if the cells aren’t using the glucose it gets shuttled into fat storage. Meanwhile, the cells are saying we didn’t get fed and sends a response to the brain for the stomach to produce ghrelin, a hormone that stimulates hunger. And around and around we go.

To break this cycle, we need to lower our carb intake and increase our healthy fat consumption. Try a veggie omelet with some berries instead of cereal for breakfast. It does take some planning since this is not how we’re used to eating. But, once you get your insulin levels down you will feel better and start using your fat stores. As long as you have circulating insulin you will not produce glucagon. Glucagon is produced when you have low levels of blood glucose. One of the ways your body makes glucose is from fat storage. This is what we want.

Taking a look at what we’re eating during the day, the time you eat your carbs, and what you eat with your carbs is critical to create a new, healthier plan.

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