Today, more than 29 million people in North America are diagnosed as being diabetic, another 86 million have pre-diabetes, and most diabetics have not even been diagnosed. More than 88 percent of North American adults have their blood sugar levels rise too high after they eat (Metabolic Syndrome and Related Disorders, Nov 28, 2018). High blood sugar after eating (>145) increases diabetes risk, even if you have normal (<100) fasting blood sugar levels (Atherosclerosis, Nov 17, 2016;256:15-20). The main reason North American adults have such high rates of diabetes, heart attacks and strokes is that more than 70 percent of them are overweight or obese (JAMA, 2016;315(21):p2284-p2291).

Fat in the Liver Causes Diabetes
The main cause of Type II diabetes is having too much fat in cells, particularly in your liver (J of Clin Invest, September 26, 2016).
• A high rise in blood sugar can damage every cell in your body. It causes sugar to stick to the outside membranes of cells where sugar is eventually converted to sorbitol that destroys that cell to cause all the side effects of diabetes (blindness, deafness, osteoporosis, heart attacks, strokes, certain cancers and so forth).
• To prevent blood sugar levels from rising too high after you eat, your pancreas releases insulin into the bloodstream and insulin lowers high blood sugar by driving sugar from the blood into your liver cells.
• If you have excess fat in any cell, the excess fat prevents that cell from accepting the sugar. This applies to every cell in your body, particularly your liver, which is the main organ for lowering high blood sugar levels.

You can often tell if people are likely to be diabetic just by looking at them. If they have a big belly and small buttocks, they preferentially store fat in their liver and therefore almost always have a very high rise in blood sugar after meals.

How Sugar and Other Refined Carbohydrates Cause Diabetes
Excess fat comes from:
• taking in more calories than you burn and storing these excess calories as fat in your liver, particularly by
• eating too much added sugar — sugars that have been extracted from various plants, refined and added back in to processed foods and drinks (J of Clin Invest, September 26, 2016).

A diabetic’s inability to lower high blood sugar is caused primarily by dietary sugar preventing the liver from responding to insulin which is supposed to stop the liver from making new sugar. Normally when your blood sugar rises for any reason, your pancreas produces huge amounts of insulin which stop the liver from making new sugar. However, when you eat sugar, it activates an enzyme in the liver called Carbohydrate-Responsive Element-Binding Protein, (ChREBP), which forces the liver to make large amounts of additional sugar and prevents insulin from doing its job of stopping the liver from making more sugar (J of Clin Invest, September 26, 2016). This study showed that no matter how much insulin the pancreas makes, eating sugar causes the liver to make excess ChREBP that prevents the liver from responding to insulin and the liver then converts extra calories to sugar as well as to the fat that it normally produces. The extra sugar made by the liver causes blood sugar levels to rise even higher, which causes insulin levels to also rise higher, and the cells in your body eventually stop responding to insulin and you become diabetic. As blood sugar levels rise higher and higher, some of the sugar is converted to fat which is deposited in the liver to make the liver produce even more ChREBP which makes the liver make even more sugar (Hepatobiliary Surg Nutr, Apr 2015;4(2):101-108).

Get Fat Out of Your Liver
Most cases of Type II diabetes can be cured by:
• avoiding refined carbohydrates, particularly sugar, that cause the highest rises in blood sugar levels, and
• taking in fewer calories to rid your liver of excess fat (Cell Reports, June 6, 2016).

Many studies show that surgery to bypass the stomach causes weight loss that can cure diabetes (N Engl J Med, 2017;376:641-651). Gastric bypass surgery was first reported to cure some cases of diabetes in 1995 (Ann Surg, 1995;222:339-350) by causing people to lose weight (Current Opinion in Clinical Nutrition & Metabolic Care, July 2011;14(4):396-401) which removes fat from a diabetic’s liver. However, surgery is not needed; any successful weight loss strategy will give the same results. Diabetics are likely to have to get rid of excess fat from the rest of their body before they will get enough fat out of their liver.

In the DiRECT Trial, 24 percent of diabetics who achieved at least a seven pound weight loss from severe-calorie restriction over a year had normal blood sugar measurements (The Lancet, February 10 2018;391(10120):541-551).

Another recent study showed that 60 percent of those who lost weight on a low-carbohydrate diet were able to lower their HbA1c below 6.5 while taking no diabetes medications. HbA1c is a test for cell damage from high blood sugar levels that measures the amount of sugar stuck on red blood cells. This serves as an estimate of sugar stuck on other types of cells that are also damaged. The “former diabetics” also had a 12 percent weight loss, a 24 percent reduction in triglyceride fat levels, an 18 percent increase in the good HDL cholesterol, and a 39 percent reduction in C-reactive protein level that measures inflammation (Diabetes Ther, 2018;9:583-612).

In addition to these two recent studies showing that weight loss from severe calorie restriction and very low refined-carbohydrate diets “cure” diabetes, other studies show that the Mediterranean diet (Diabetes Care, 2014;37:1824-1830) and intermittent fasting (BMJ Case Rep, 2018;2018. pii: bcr-2017-221854) have also caused enough weight loss to “cure” diabetes.

How You can Tell That You May Have High Blood Sugar Levels
If you have any combination of the following risk factors, suspect that you may be diabetic and check with your doctor:
• store fat predominantly in your belly, rather than your hips
• family history of diabetes
• overweight
• exercise fewer than three times a week
• high blood pressure (systolic >120 at bedtime)
• HDL (good) cholesterol lower than 40 mg/dL
• triglyceride level greater than 150 mg/dL
• history of diabetes during pregnancy or birth to a baby over nine pounds
• thick neck
• polycystic ovary syndrome
• dark, thick skin around neck or armpits
• history of blood vessel disease to heart, brain, or legs
• HBA1C greater than 5.7
• fasting blood sugar greater than 100
• sugar two hours after eating greater than 110
• member of a high-risk ethnic population (e.g., African-American, Hispanic/Latino- American, American Indian, Alaskan Native or Pacific Islander)

My Recommendations
Drugs can help to control diabetes, but no drugs available today can cure diabetes. Only lifestyle changes cure diabetes. A diabetic who loses weight gets some fat out of the fat cells throughout the body, including the liver. Those who clear their liver of excess fat with a small amount of weight loss may cure their diabetes. However, many diabetics, particularly those who have had diabetes for several years, must lose large amounts of body fat before they clear fat from their liver. These people will not be cured until they lose a lot of weight and become thin to get enough of the fat out of their liver to become non-diabetic.

Lifestyle changes take a lot of effort, but you can usually rid yourself of diabetes by losing weight, exercising, avoiding refined carbohydrates (particularly added sugars), and getting your hydroxy vitamin D blood level above 20 ng/ml. Diabetics should avoid foods with added sugars and should not drink liquids that have sugar, which includes fruit juices. See my reports on Who Gets High Blood Sugar after Meals? and How Exercise Helps to Prevent Diabetes and Heart Attacks

Checked 9/29/22