The Diabetes Code: Prevent and Reverse Type 2 Diabetes Naturally

by Jason Fung

high insulin levels, which are indepe...

But the story gets wors...

resistance leads to higher fasting insulin levels. Fasting insulin le...

Obesity drives itself.

hyperinsulinemia

“Hyperinsulinemia is the root cause of insulin

resistance, obesity and diabetes.”

hyperinsulinemia.

INSULIN RESISTANCE OCCURS when blood glucose remains elevated despite normal or high levels of insulin, since the cells are resisting insulin’s pleas to take up glucose. But

how does hyperinsulinemia cause this

pheno...

Recall that insulin goes up when you eat and acts predominantly in the liver to help store incoming food energy. Insulin instructs the liver to do two things: 1. Stop burning stored food energy (e.g. body fat). 2. Store incoming food energy as glycogen or produce

new fat via de novo lipogenesis (DNL).

until they realized that the old gummed-up, lock-and-key

paradigm of insulin resistance with internal starvation was incorrect.

insulin itself causes insulin resistanc...

that

the primary problem is n...

resistance but the hyperi...

that caus...

Insulin resistance only refers to the fact that, for a given amount of insulin, it is more difficult to move glucose into the cell. So what if the glucose cannot enter the cell because it is already overflowing? The paradigm of insulin resistance as an...

The paradigm of insulin resistance as an overflow phenomenon resolves...

PHENOMENO...

PICTURE A SUBWAY train at rush hour.

The train stops at a station, gets the all-clear signal from the conductor, and opens its doors to let passengers on. All the passengers enter the train without difficulty and the platform is empty as the train pulls away. The cell is like the subway train, insulin is like the conductor, and the glucose molecules

are li...

passengers. When insulin gives the proper signal, the gates open and glucose enters the cell in an orderly fashion without much difficulty. With an insulin-resistant cell,...

no glucose enters. Glucose accumulates in the blood, unable to get insi...

The overflow phenomenon suggests a different possibility. The train pulls into the station but it is already jam-packed with passengers from the previous stop. When the conductor gives the signal to open the door, the passengers waiting on the platform cannot get on because the train is already full. From our view on the outside, we only see that passengers cannot enter the train and conclude that the door did not open.

The train pulls into the station but it is already jam-packed with passengers from the previous stop. When the conductor gives the signal to open the door, the passengers waiting on the platform cannot get on because the

train is alrea...

The same situation occurs in the liver cell. If high insulin levels have already jammed the cell full of glucose, no more can enter even if insulin opens the gate. From the outside, we can only say that the cell is now resistant to insulin’s urging to move glucose inside.

Hyperinsulinemia is the body’s subway pusher. It shoves glucose into the already stuffed cell. When glucose is left outside, the body produces extra insulin to forcibly push more glucose into the cell. This tactic works at first, but as more and more glucose is forced inside the overstuffed cell, more force is required. Insulin resistance causes compensatory hyperinsulinemia. But what was the initial cause? Hyperinsulinemia. It’s a vicious cycle.

It’s a vicious

c...

Let’s think about the liver cell. At the beginning, the cell (train) is empty. If equal amounts of glucose (passengers) enter and leave, then everything works normally. If feeding (insulin high) and fasting (insulin low) periods are balanced, insulin resistance does not develop.

With persistent hyperinsulinemia, glucose (passengers) keeps entering the cell (train) and not leaving. Over time, the cell (train) overflows and glucose (passengers) cannot enter even when the cell surface receptor

(door) is open. The cell is now insulin resistant. To compensate, the body produces more insulin (subway pushers) to force more glucose inside, but over time this only makes it worse by creating higher insulin resistance. Insulin resistance creates hyperinsulinemia, and vice versa. The vicious cycle goes around and around. The cell is not in a state of internal starvation; instead, it is overflowing with glucose. As it spills out of the cell, blood glucose levels increase. And what happens to new fat production, or DNL? The cell is overfilled with glucose, not empty, so there is no reduction of DNL. Instead, the cell produces as much new fat as possible to r...

And what happens to new fat production, or DNL? The cell is overfilled with glucose, not empty, so there is no reduction of DNL. Inst...

possible to relieve th...

congestion of ...

If

more new fat is created than can be exported, fat backs up in the liver, an organ not designed...

is

fatty liver. This overflow paradigm perfectly explains the central paradox. Looking at blood glucose, the cell appears insulin resistant. Looking at DNL, the cell appears to have enhanced insulin sensitivity. This happens in the liver cell, with the same level of insulin and the same insulin receptors. The paradox has been resolved by understanding this new paradigm of insulin resistance. The cell is not internally starved; it is overloaded with glucose. The physical manifestation of that cell—overs...

The cell is not internally st...

overloaded with glucose. The physical manifestation of th...

with excess glucose, now turned into fat via DNL—can be seen as fatty inf...

fatty liver → insulin resistance

As the first stop for metabolism of