Health Series #8: Chronic Diseases - The Bigger Picture

In Part-6 of this Health Series , we leaned how hormones should work normally; and also what happens when we have a chronically raised hormone level. This heightened level gives rise to hormone resistance; which in turn raises the hormone level. This vicious cycle is dangerous.

In Part-7 , we learned about insulin, and saw how Insulin Resistance plays a role in Type-2 Diabetes.

Now let's take this ahead:

The Bigger Picture

Here are some of the most common chronic lifestyle diseases of our times:

High Blood Pressure. Type-2 Diabetes. Heart Disease.

Obesity. PCOD. Hypothyroidism.

Fatty liver. Kidney Disease. Gout. Alzheimer's.

We consider these as separate diseases. We even know which doctor to go to: the general physician (GP) for high BP, diabetologist for type-2 diabetes, cardiologist for heart disease, gynecologist for PCOD, neurologist for the Alzheimer's; and so on.

But, as we have studied these diseases more and more, a bigger picture has emerged. These are not separate diseases. These are branches of the same poisonous tree!

At the root of this tree, there is the infamous pair of Hyperinsulinemia (HI) and Insulin Resistance (IR).

When I promised BIG PICTURE, I meant it! :-)

I need to give a few caveats here:

1. There are causes of these diseases outside of this picture. For example, heavy smoking can cause heart disease, and excessive alcohol consumption may cause fatty liver & cirrhosis. But: there are millions of non-smokers and non-drinkers who get heart disease and fatty liver. What is most common among all such patients is HI & IR. Thus, it is the broader explanation.
2. There are vicious cycles here, and the causal arrow is not in just one direction. For example, obesity worsens IR and IR worsens obesity. Which came first - is an academic question. We may find that one day; but till then, I am trying to offer a useful mental model for an attack point. Similarly, hypothyroidism worsens IR, and IR worsens hypothyroidism. These vicious cycles are quite deadly; since they can then invite other diseases on this tree.
3. Some of these diseases don't need both IR and HI. For example, in PCOD, the cells of the ovaries don't become insulin resistant. Their function is disturbed by HI (high insulin levels); eventually causing PCOD. Thus, there are diseases caused by only one out of the infamous pair of HI and IR.

Thus, the above mental model gives us a very powerful view of chronic lifestyle diseases -

1. Now it'll seem clearer as to why some of those diseases bring others along. Obesity can bring along high BP, then heart disease. Type-2 diabetes can bring along Alzheimer's. In fact researchers are now calling Alzheimer's disease as Type-3 diabetes!
2. Some of us have climbed only one branch of this tree, some are on 2 branches, some on even more. At times, one person from a family is on the high BP branch, someone else on the diabetes branch, and another person on the obesity branch. Seemingly their diseases are different - but now we realize they're all up on the same poisonous tree of chronic diseases.
3. Instead of hacking away at just one disease which has manifested, we need to work on how to get down the tree and walk away! I urge you to do this for yourself and your family: Don't just treat the symptoms of these diseases. Realize the bigger picture, and attack the root cause. You will not only resolve the current condition but also minimize your risk of the all other diseases as well.

How to Attack This Poisonous Tree?

By now it is clear that we need to attack the root of this tree: which is the pair of high insulin (HI = hyperinsulinemia) and insulin resistance (IR).

Essentially, we need to bring down the level of insulin.

As we learned in our earlier part, insulin usually stays at a basal level and when we eat, it rises to shuttle glucose to the cells. Typically in a healthy person, the basal secretion accounts for 50% of the total insulin, and the rest 50% is as a response to the diet.

Thus, the part we control is this second 50% - insulin secretion due to the diet.

Here is where our biochemistry gives us an important clue:

Insulin's Response to Different Macronutrients

This is how much insulin is secreted when we eat each of the macronutrients: Image courtesy: Virta Health. This result has been replicated in several experiments.

As you can see, carbohydrates give the quickest and highest rise in the insulin levels. Proteins give a moderate response; and fat hardly elicits an insulin response.

Thus, to reduce our insulin levels, we need to eat predominantly fat, moderate proteins, and little carbs (if any).

This is what our own biochemistry & the chronic disease root cause analysis is telling us!

We have not used arguments from any branch of medicine, or therapeutic philosophy. We have also not used any anecdotes, or referred to 'guidelines', or given any regional/ cultural arguments. Not that they are wrong - it's that we didn't need any of them!

Thus, we saw one CRUCIAL piece of the foundational logic that why the proper human diet is High Fat, Moderate Protein, and Low-Carb. It has nothing to do with any trend, any fad. Like a beautiful equation, we can derive the human nutritional pattern - from our own biochemistry!

Follow along, as we delve deeper into other Chronic Diseases; how the logic of BIOLOGY is enough to give us important clues for health & nutrition.

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Missed the earlier parts of the series? They're here: Part-1 , Part-2 , Part-3 , Part-4 , Part-5 , Part-6 , and Part-7 .

Till the next one..!