Updated: Nov 16
Type 2 diabetes is complex and there is often confusion between the cause and the symptoms. In this article we clarify the issues involved so that we can address this fast growing and pernicious chronic illness in other articles. Of particular importance is the work of Professor Roy Taylor (from the UK’s Newcastle University) and the concept of the personal fat threshold.
As ever, please talk to your doctor or medical practitioner most familiar with your medical history before implementing any changes in diet, exercise or lifestyle, especially if you are under treatment. Links to any supporting studies or resources are at the end of page.
Type 2 diabetes is most often associated with being overweight. In 2008 Prof. Taylor published a study that demonstrated the mechanism by which diabetes (or pre-diabetes) also affects normal weight people. In short, he showed that everyone has a personal fat threshold unique to themself. This threshold is the point at which fat accumulates inside the body and sets off insulin resistance. Essentially the process is as follows.
In a diet of caloric excess, fat first accumulates under the skin. For most this might show as love handles.
Thereafter, fat accumulates in and around internal organs. In particular, inside the liver and subsequently inside the pancreas.
This fat impedes organ function and initiates insulin resistance, and diabetes.
The fat threshold is highly personal. For example, some overweight people, those with a high BMI, may not be insulin resistant. Others, with normal body weight, might be insulin resistant as they have a low personal fat threshold. Some of these people might be categorised as skinny fat, a term we often hear in Singapore for Asian populations.
Various studies (such as the DIRECT and ReTune studies) have gone on to further demonstrate and prove the concept of personal fat threshold. This includes, with major implications for personal and public health, how to lose sufficient weight through diet to put diabetes into remission. Once thought to be near impossible to achieve.
When most people discuss diabetes it is often in the context of sugar, specifically controlling blood sugar.. This addresses the symptom of diabetes – high blood sugar - it does not address the underlying cause, insulin resistance.
Insulin resistance is caused by the accumulation of fat within cells (for example, muscle cells) that block the action of insulin to allow glucose to enter them. This results in more insulin being required to force glucose into the muscles. Managing blood sugar, through limiting carbohydrates, resolves the problem of high blood sugar but do not directly address insulin resistance. This is how the very low carbohydrate, ketogenic diet works. Alternate diets, that limit fat and promote weight loss can also be used, without some of the potential negatives associated with the ketogenic diet.
Prof Taylor and his team followed up on their original study by specifically devising a weight loss diet, to put type 2 diabetes into remission. Whatever diet is followed (click here for a long read on Mediterranean, ketogenic, plant based diets) it is sustainable weight loss that is important, to put the body below its personal fat threshold. Then, once remission takes place, to adopt an eating pattern that allows the weight to stay off and to promote optimal health.
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Taylor R, Barnes AC, Hollingsworth KG, Irvine KM, Solovyova AS, Clark L, Kelly T, Martin-Ruiz C, Romeres D, Koulman A, Meek CM, Jenkins B, Cobelli C, Holman RR. Aetiology of Type 2 diabetes in people with a 'normal' body mass index: testing the personal fat threshold hypothesis. Clin Sci (Lond). 2023 Aug 31;137(16):1333-1346. doi: 10.1042/CS20230586. PMID: 37593846; PMCID: PMC10472166.
Hallberg SJ, Gershuni VM, Hazbun TL, Athinarayanan SJ. Reversing Type 2 Diabetes: A Narrative Review of the Evidence. Nutrients. 2019 Apr 1;11(4):766. doi: 10.3390/nu11040766. PMID: 30939855; PMCID: PMC6520897.
Taylor R, Holman RR. Normal weight individuals who develop type 2 diabetes: the personal fat threshold. Clin Sci (Lond). 2015 Apr;128(7):405-10. doi: 10.1042/CS20140553. PMID: 25515001.
Taylor R. Pathogenesis of type 2 diabetes: tracing the reverse route from cure to cause. Diabetologia. 2008 Oct;51(10):1781-9. doi: 10.1007/s00125-008-1116-7. Epub 2008 Aug 26. PMID: 18726585.