There is more to diabetes than elevated blood sugars; fat metabolism plays an important role as well. Since there has been quite a bit of discussion on this blog about Type II diabetes, especially in relation to being overweight, I have asked integrative physician Alexa Fleckenstein M.D. to explain the approach she has used successfully with her patients. Here is her response:
Conventional medicine manages diabetes – but it doesn’t cure it The conventional view of diabetes mellitus is as a disease of too much sugar in the blood. The medications designed to help the disease consequently lower blood sugar levels – by different mechanisms.
More recent research seems to imply that diabetes is more than elevated blood sugars – fat metabolism seems heavily involved too. But from the patient’s perspective, it looks like diabetes is a disease of too much appetite: Diabetics are hungry all the time. Ten percent of Type II diabetes patients are not overweight – but ninety percent are. Diabetes could be called a disease of abdominal fat leading to abominable consequences. Its poetic name honey-sweet (urine) flow certainly does not evoke the horrible consequences of this disease: amputations of limbs, blindness, kidney failure and dialysis, impotence, cancer, depression – to name a few.
But even in the light of these abominable consequences patients don’t stop eating. Diabetes is a billion dollar business for physicians and the pharma industry – no wonder a cure has not been found yet. And the patients “just won’t listen” to dietary advice. Why do they keep eating? Sebastian Kneipp (1821-1897) used to say “Large dinners fill coffins” – yet Sebastian Kneipp himself was overweight and could not refrain from eating his beloved dumplings, clearly unable to heed his own advice.
I am always struck by how much diabetics suffer when I talk to them. They seem to suffer from a profound fatigue – and eating seems to help. At least for a short while. They eat for energy. People have to make a living, take care of a family – and they are in a race to eat so they can function.
It turns out that diabetes affects the mitochondria, the energy factory of the cells – and diabetes reduces the energy output of the mitochondria. It is as if diabetics stack wood around the mitochondrial stove until that stove – buried under fuel that can’t be used – is unable to function any longer. Paradoxically, all the food hinders proper metabolism, and each too-large meal leaves the patient weaker and sliding further down the precipice to diabetic diseases. All that stoked wood is a fire hazard: Any moment the little energy factory can blow up into a catastrophic illness like heart attack, stroke or infection.
The low energy of diabetics affects their physical as well as their mental abilities. Exhausted as they are, diabetics scramble to make it through their daily activities – they just can’t face going to the gym as well . Of course, exercise would use up some of the stacked fuel and reduce the fire hazard – but they can’t bring themselves to move. Period.
Diabetics have the odds stacked against them even beyond poor mitochondrial function. I can think of several other mechanisms that would explain why diabetics overeat: Studies have shown that overweight people have different bowel bacteria than slim people, which means that the bacteria are craving their food. I liken it to a computer virus: The bacteria send their cravings to the patient’s brain and, obediently, the patient grabs for another piece of unhealthy junk. Furthermore, the abdominal fat is of a different quality than fat of other body parts: Abdominal fat sends out hormonal messages to the brain – again asking for more food since the fat cells need to be fed in order to grow.
Another strike against overweight people is that the more you eat, the hungrier you get. In times of scarcity such a mechanism that helped people survive. In lean times, one was less hungry; in times of gluttony (say, a mammoth needed to be devoured) people had more appetite. Nowadays, when lean times never occur, the overweight just suffer from incredible hunger pangs – which are largely not acknowledged by the medical community but are chalked up to “lacking willpower.”
Then there are food cravings induced by food allergies. We do not really know why this is so, but there is no doubt in my mind that you crave exactly the food you should not eat because it makes you sick. People usually don’t crave carrots and apples – they crave cheese and Twinkies and chicken wings.
And the above are just the innate reasons why overweight people cannot stop eating. Now consider the reasons which stem from our modern food production: New molecules are so alien to our bodies (either by themselves or in unnatural combinations) that more people than ever are experiencing food allergies – and food cravings. High fructose corn syrup and overly processed milk proteins lead the list, but artificial colors, artificial dyes, preservatives and altogether newly designed molecules are not far behind.
And the food industry uses to its advantages the ingredients people have a hard time saying “No!” Fat, sugar, salt make any food more yummy, regardless of its real nutritional value – which is usually nil.
In conclusion, diabetes is a genetic disease so with the above odds keeping up the damaging weight, diabetics have only one chance: To force “unnatural” changes on themselves, against their inclination. For the time being, medicine is no help – the pill that takes away those too large appetites has not yet been invented. So, this needs to be done: Feel your belly right now. If it is bulging at all, you are overweight. Then take your strenuous path: Get off the chair, away from the computer or TV, and start moving. And every time you want to eat, “need” to eat, grab your fat and convince yourself that you won’t starve if you don’t eat this moment. Keep to a schedule (three big meals or five small – but never a bite after dinner because the night is repair time for the body) and find a friend to walk with you – or kayak or swim or dance! This is your only chance for good health.
-Alexa Fleckenstein, M.D. author: Healthy to 100 and Health 2 0
14 Comments
October 19, 2008 at 4:21 am
WHAT DOES THIS MEAN FOR THE 10% OF US WHO DON’T CRAVE FOOD, NEED TO EAT A LOT, OR ARE NOT OVERWEIGHT MUCH IF AT ALL ? IF WEIGHT LOSS IS THE WAY TO GO AND ONE DOESN’T HAVE TOO MUCH WHAT ARE THE OPTIONS? WHY DOES A PERSON USED TO GETTING UP AT 4:;30 AM TO WALK BECOME UNABLE TO GET UP FOR SEVERAL HOURS LATER AND THEN AWAKE IN A FOG?
THANKS.
October 27, 2008 at 3:34 pm
B.E. Lewin, do I understand you right that you are diabetic but not really overweight?
If that is the case, you have a good chance of having gluten enteropathy (also called celiac disease or non-tropical sprue).
You can ask your physician to test you for celiac – which is a bit iffy because their are three tests, they are somewhat expensive, and I have seen wrong negatives.
You could also just leave out gluten (wheat, barley, rye and oats) and see how you are doing without gluten. Often, there is a dramatic improvement. And if you are at it, stop all dairy, too, because milk is a highly inflammatory food.
Let us know how you are faring! And all the best!
Alexa Fleckenstein M.D.
April 12, 2009 at 4:12 pm
Hi, there. I would just like to have some advice if I should see a doctor.
I am not exactly overweight but my weight “yoyo”s. I have problem with my appetite starting late last year. I would eat a lot and still never feel full. Originally, I thought it would be due to dietary problems. My family members consume more vegetable and fruts than meat. But later on, even when I start having regular meat intakes, I end up craving for the next thing after my meal.
Please advise.
April 12, 2009 at 9:12 pm
Charlene,
Appetite and cravings have many different causes and are not easily figured out.
Sometimes the craving is spiritual, and you are not craving food but a fulfilled life. Especially with kids, women tend to think about their own needs last, slowly building up a “meaning debt”. To remedy this, think about why you have been sent here on Earth to do what specifically that only YOU can do – if possible, of course, without leaving people behind that depend on you. This can take you a long way.
Then there are certain diseases where increased appetite is physical: in high-cortisol or high-insulin states for instance (which, in turn, can be triggered by high-stress and sleep-deprivation), high stomach acidity or Zollinger-Ellison syndrome. Look at your stress levels and work on sleep hygiene; if your cravings don’t improve, see a physician. Likewise, some medication can induce increased appetite – ask your pharmacist.
Lastly, certain foods induce cravings – and those are usually the foods we shouldn’t be eating: sweets, white starches, and everything you might be allergic to. You yourself seem to think you might have a tendency to diabetes and metabolic syndrome. Eating more leafy greens, cabbages and root vegetables, you might feed your body what it really needs.
Eating sugar and white starches uses up B vitamins. Your body craves more food because it hopes for B vitamins in the next meal. If you then eat more sugar and white starches, your B vitamin deficit only increases – and cravings are spiraling up. With willpower, you can reduce food intake – but only for a short time. Yo-yo weights follow.
You should see a physician – make sure she looks at you holistically.
All the best!
Alexa Fleckenstein M.D.
May 9, 2009 at 10:09 pm
Well this article was depressing. It seems to be speaking to me personally. My question is, just how do I get the energy to exercise?
I’m 43, 40 pounds overweight, and recently diagnosed as “pre-diabetic”. I’m sitting here staring at my treadmill, but I just feel so tired! People say “just get some exercise”, as if I would respond “Oh, why didn’t I think of that?” But at any given moment of my life, I could lay down and go to sleep.
My weight is in my abdomen. I get tired, more than I used to. Even in the past year, I can feel it more. Now I hate going up the stairs. I’ve got two young kids, 3 and 6, I NEED to have more energy.
I recently started walking a mile at lunch. After a couple months of that I don’t feel a bit different, and haven’t lost any weight.
I wonder if there’s something, maybe an energy drink, that could give me the boost I need. I just checked my blood level and it’s 132, higher than normal for me. Maybe all I need is a cup of coffee. I’ll get one now, see if that helps.
Thanks for any thoughts.
May 10, 2009 at 7:47 pm
Matt N.,
Most energy drinks boost energy via the sugar mechanism – and that would make your problem worse over time.
Green tea is the one energy booster that not only increases your energy but also improves your health in the long run. So, I recommend green tea. If you never had green tea, it might taste like grass to you – it is an acquired taste. Don’t put sugar in it. Try to drink it as medicine. Avoid tea bags – rather look for loose tea. There is an incredible variety of green teas on the market. Unfortunately, they usually are better the more expensive they are. But even a cheap tea from a Chinese supermarket will have the good health effects.
Raising two little kids can be very demanding, and at times depressing and lonesome. Do you have a spouse to share the burden, or is it all on your shoulders? Try to share parenting chores with other people in a similar situation – I would never have gotten this far without my friends who were there when the going got tough.
The answer to your question is: There is no shortcut – and anybody who offers you a fast cure is lying. But you should discuss these issues also with your physician – sometimes people have low thyroid function and similar problems that add to the diabetes (if you had that, I also would check for gluten intolerance).
The good news is that by walking daily, you have already made that important first step into health and have seriously begun to change your metabolism. Now, perhaps, try to walk one and a half mile every day – or row in front of TV. Stop all sugars and dairy (also for your kids), and see if you improve.
Keep in touch!
Alexa Fleckenstein M.D.
July 26, 2009 at 5:02 pm
I am 39 years old and have type 2 diabetes, for over 10 years now. In the last 6 months or so, my cravings has been very high. I am not able to stop myself from eating or drinking, some thing or the other…every 30 minutes. My morning sugar levels are around 220 and it is getting very depressing. I will try the green tea suggestions (I am also addicted to coffee – I drink 10-12 cups a day).
Thanks
Kumar
July 26, 2009 at 5:40 pm
Hi Kumar,
I have asked Dr. Alexa to respond to you, but please be sure to talk to your doctor as well. Online advice should never replace consultation with your physician and should always be discussed with your healthcare provider.
July 26, 2009 at 5:51 pm
Dear Kumar,
Those cravings are horrible. This is what makes you crave the wrong food:
1. Overweight people are more hungry than thin people – way more hungry. It has to do with that when we were cave people, it was useful to eat more in times of plenty (say, a mammoth had to be devoured) and less in times of dearth.
2. When you are eating the wrong foods (which is mostly dairy and empty starches and sugar), you feed the wrong bacteria in your gut. And when you crave food, it is actually the bacteria craving the food and sending messages to your brain to make you eat more of the wrong foods.
3. If you have food allergies (and chances are, you have), your body craves those foods especially (I don’t know by which mechanism – but it clearly happens in people with allergies).
4. Manufacturers make foods so that we crave them more, that is a fact. Because in history, people were always starving, more or less, it helped if you liked high-calorie foods like sweets, cheese, and so on.
There might be other mechanisms that make you crave food – but these come to my mind.
What can you do? Just knowing that these mechanisms are real might already help you – because it is not your personal fault that you crave wrong foods. You are hard-wired for it.
Nevertheless, you have to break the habit. The best way is to eat tons of vegetables (with olive oil and garlic), because they starve the harmful bacteria in your gut and reset your taste buds. And don’t be afraid of good oils – you need the fat for feeling full and for brain function.
Last piece of advice: Take a cold shower and do a little walking. Or gardening. Or cleaning out the basement.
Good luck! Let me know how it will go. Be patient!
Alexa Fleckenstein M.D.
August 16, 2009 at 4:14 pm
Since discovering higher than normal blood glucose levels about 10 months ago, I have been experiencing the problems that are explained here. Lacking energy many days of the week and non stop eating during each evening after my supper have been especially worrisome to me. Belly fat is another. Everything mentioned here brings it all together whereby I can now focus on the causes of my problems with untreated diabetes. I appreciate this site and the professional people who make this possible. V.F.
August 16, 2009 at 10:02 pm
Thank you Vaugh – comments like yours make it all worthwhile!
Roanne
August 17, 2009 at 3:09 pm
Dear Vaugh,
You are so welcome! Please, let us know how you are doing.
And please, now that you want to change things, don’t fall into the “sugar-free” trap (or “fat-free”, for that matter). Stick to natural foods, vegetables mostly, and you will be fine. Let us know how you are doing!
Alexa Fleckenstein M.D.
August 31, 2009 at 7:35 pm
I am 36 years and I have type 2 for one year now, recently I realize I don’t have energy to do much.
I work all week and on weekends I do house chores, but it takes me all day to do that because ever half hour I have to sit and rest for awhile to regain energy to start again.
I am not overweight I weight 130lbs and I am 5″3.
Recently my A1c was 4 and the doctors told me to keep it up, but a month after that I am having these low energy. Can you please give me some advice
Paige
September 1, 2009 at 11:04 am
Dear Paige,
Yes, you have normal weight – which brings up the question why you have diabetes at all.
Often, people with normal-weight diabetes have unrecognized gluten intolerance. You can just try a gluten elimination (no wheat, rye, barley, oats) or ask your physician to test you (I find the elimination more reliable than testing at times) and see how you feel. Eat rice and beans – they are allowed and good for you.
Of course, I hope your physician has checked why you are so tired. It definitely is not normal – and I would not automatically chalk it all up to diabetes.
If you are at improving your diet: Leave out all dairy too because it is a very inflammatory food and really damaging in a lot of conditions.
Please, let us know how you are faring. All the best!
Alexa Fleckenstein M.D.