0:00 hi there this is dr. Robert Silas the Cobb addiction doc and today we are going to start or continue a miniseries specific to type one diabetics the very first part of this discussion is to understand insulin and what insulin does so the first concept is that in a normal human being a non diabetic person when you eat carbohydrates and that's the first part we're going to take through the intestinal tract as you eat carbohydrates and the first thing is it doesn't matter how the carbohydrates enter your face they can be complex as a starch as simple as a sugar they can be man-made or godoh nature made it doesn't
0:45 matter but starting in your mouth with certain enzymes and all the way through the intestinal tract those sugars are going to be broken down and whether they're complex or simple it determines the rate at which those sugars are broken down and though and once they're broken down into the individual what we call monosaccharides glucose galactose fructose which are the three monosaccharides they get absorbed at various stages in these small intestine no sugars as far as we're aware get absorbed in the colon and as far as we aware the stomach doesn't also absorb a lot of sugar so it's from the beginning to the end of the small intestine based upon how complex those sugars are so one of the first conceptual thinking is that
1:33 sugar gets absorbed at a specific rate depending on how complex it is when it goes into your mouth in other words how much work your intestine has to do to break it down so if you eat pure glucose it's being absorbed almost right away if you eat pasta it's gonna take a longer time to get absorbed and that's called the glycemic index the second concept is how much total carbohydrates you eat whether irrespective how it goes in ice cream or pasta or brown bread or white bread it doesn't matter that is called the glycemic load and most people the treat diabetes the endocrinologists are obsessed or heavily focused on glycemic index or glycemic load and as long as that's who
2:18 you are we have a huge problem Houston when it comes to treating diabetics I'll get back to that in the second part so that's what enters your face now on the other side on a true diabetic kedo genic or carnivore diet you are not putting carbohydrates in your face so the difference is people who eat carbohydrates of some sort sugar or starch and people who do not and they are diabolically different ways in which your body responds and reacts to those two situations and I'll discuss each so when you eat carbohydrates irrespective of so-called good or bad which is another crazy way to define them they're
3:05 going to your mouth are going to your intestinal tract and the way the body is a very complex system so as your eyes see that food as your nose smells them as the sugar receptors the sweet receptors on your taste buds taste them that is the beginning of a very complex signaling pathway that occurs throughout your intestine so what happens is in your with your eyes your brain your your nose your mouth your stomach acid production your upper intestine where you produce something called glp-1 you produce cholecystokinin CCK GIP you produce peptide YY a little lower down these are all what we call in cretins
3:52 they're signaling hormones that allow the other hormones in your body to understand or to recognize that there's an incoming load of sugar and what those hormones do for example glp-1 is a trigger to your pancreatic cells the islet cells the beta cells of the islets of the pancreas to begin to release insulin so that insulin is kind of waiting for that sugar low to enter and the way sugar works is throughout the small intestine sugar is being absorbed into the intestinal bloodstream and the intestinal bloodstream is some thing called a portal system in other words a portal system is one that runs between all two organs and the two organs is your intestine and your liver
4:37 so the majority of blood from your intestine doesn't go to your general body it goes directly to the to the liver and that's called the first pass effect and the liver then under the influence of insulin starts to remove that sugar from the bloodstream and removes a variable very high percentage of sugar from the bloodstream under the influence of insulin okay so there's also what we believe to be a glucose stat this mythical thing that occurs in that portal venous system that triggers insulin so and is a different scenario when you're injecting insulin intravenously so let's say I've got a an intravenous drip an IV that's injecting
5:22 insulin to my bloodstream it's going in and at a completely different pathway and it defies the signaling system from the intestine that's a different story but the metrics are a little bit different so and in the lab we can measure portal venous blood sugar in an animal but we can't do that effectively in humans so what happens anyway is that sugar goes up the portal venous system to the liver the liver extract a certain amount some of the dust spill over into the rest of the bloodstream and once it gets through the through the liver it goes to your whole body and that's where your muscles your brain your tissues all of those can absorb absorb that sugar and clear it from the bloodstream not completely but to maintain your blood sugar in a very very tight range which
6:10 for humans is typically around seventy to a hundred that's what we call the glucose insulin clamp and the human body is designed to clamp sugar very tightly in that range that is held there by insulin if your body's insulin is sensitive so now let's shift gears just a little bit okay and let's look at the role of insulin and the first concept that is kind of an archaic concept in my mind is this concept of Kitab and anabolism catabolism means breaking down anabolism means forming I don't like those those principles because that's not the way the body works you cannot divide things into things that get given up and things that get taken out bodybuilding and body break down the
6:56 body just doesn't do that the body works on continuous what we call homeostasis cycling there's continuous alterations Micro alterations so think about this if you've got a guitar guitar string and you pluck the guitar string and your finger dampens the vibrations of that guitar string that's more like how your body works and if you pluck that your guitar string hard you need hard pressure if you just touch it you need light pressure but there's this continuous sensitivity that there is an interplay in your body but it's not one direction versus another excuse me that's not the way the body works so let's look at the rolls of insulin obviously it's very very complex and these are not an order of importance but
7:45 the first thing that insulin does when you're not eating is insulin controls or switches are no or switches off a hormone called glucagon now glute one of glucagon responsibilities is to produce and release sugar by and from the liver so as your blood sugar goes up even if you haven't eaten that can happen under glucagon everybody understands the dawn effect which is a release of sugar by glucagon under the influence of cortisol blood sugar zap insulin should be released and insulin blocks glucagon and your blood sugar drops down just a little bit because it's not being released or produced so there's this intimate relationship between glucagon and insulin and in fact the alpha and
8:32 beta cells of the are in the pancreas one secrete glucagon one secretes insulin and they right next to each other in the pancreas so there's a direct connection as well as a connection to through the blood stream so that's the first influence of insulin and it's this intimate dance it's this relationship between the two the second thing that insulin does is insulin shuts off mobilization it affects the fat cells a an enzyme called lipoprotein lipase lipoprotein lipase is the hormone or the I sorry the enzyme that allows the breakdown in the release of fat that is stored in fat cells and obviously you don't want an elevated sugar in your bloodstream and elevated ketones or fat as an energy source you want one or the other so insulin regulates release of fat from
9:20 the fat cells it switches it on or off but it's not on or off it's kind of a grade and insulin then modifies the ratio of sugar to fat in the bloodstream and it's a continuous sensitivity it's a continuous cycling so that's the second part that insulin has role in insulin has and then the third role that insulin has is to allow cells that are insulin sensitive to remove sugar from the bloodstream yes that happens in the liver that happens in fat cells but it also happens in muscles in the brain in a variety of different pretty much every tissue in the human body where insulin facilitates under the influence of certain receptors little channels little gates little transport molecules that
10:06 allow sugar glucose to get from the bloodstream into the cells and into the mitochondria where it is used as an energy source so those are the roles of insulin and then there's a further role of insulin under a very heavy consumption of sugar over a period of time of carbohydrates over a period of time insulin actually directs in particular the liver to convert sugar to fat so the majority of this the matte majority of the pork on my belly right here didn't come from the consumption of fat it came from the conversion of sugar of chronic excessive carbohydrate consumption into sugar and then into sorry into glucose
10:51 and then into fat so insulin has the secondary role where it converts sugar to fat but that's not a primary role because if your homeostatic mechanism is working perfectly there should be a perfect urban flow and no storage as fat or very little storage is fat yes influence can transfer the consumption of fat under that influence into or out of the fat cells but the chylomicron absorption of fat by the fat cells is insulin independent as far as we're aware and that's talk for another day so insulin is not just regulating blood sugar it's regulating all the other hormones that regulate blood sugar and then there's another role that insulin has that nobody really speaks
11:37 about okay one of the beautiful things about the human body is it's a very simple system that has these beautiful complex pathways so one of the precursor molecules for so many different hormones is a molecule called cholesterol but a third of our cholesterol is produced in ourselves and 2/3 of that cholesterol on average should be in our diet but cholesterol is a vital precursor molecule for all of the steroid hormones what does that mean cholesterol through a series of enzymes for example 21 enzymes cholesterol becomes estrogen in
12:23 females cholesterol becomes testosterone in males that's really cool if you google an image of cholesterol in an image of testosterone you'll see that they're almost identical except testosterone is lost this little chain at the top so cholesterol is a precursor and through a series of enzymes it gets converted to estrogen to testosterone to growth hormone to cortisol to t3 t4 the thyroid hormones to vitamin d3 cholecalciferol and cholesterol is also vital as it's excreted in bile to absorb vitamins adek the fat soluble vitamins get absorbed in this bile micelle with a smile complex biomolecule and they
13:08 actually get absorbed directly into the systemic blood system and go to the fat cells or elsewhere in the body so why is insulin important that pathway because insulin regulates the rate at which cholesterol gets turned into those downstream hormones insulin regulates some of the very first enzymatic steps of the conversion of cholesterol downstream to all those other hormones so the classic example the most obvious example is people who are high producers of insulin I call them the high insulin producers often and usually will have if they're eating a lot of sugar or starch which creates that insulin to go up when they become insulin resistant those people will typically have polycystic ovarian syndrome PCOS is a female or low
13:55 testosterone as a male why does that happen because insulin blocks the very first enzymatic step in that process and as they become insulin sensitive by not eating carbohydrates the insulin number goes down and then they're able to produce testosterone and estrogen better and your risk likelihood of pregnancy or likelihood of sterile normalization of testosterone we've demonstrated as our patients by measuring those all the time restores back to normal where's that important in diabetes is that insulin actually regulates some of the stress hormones for example cortisol production quotas our precursor is actually cholesterol it's when your steroid hormones so cortisol is the precursor for cortisol is cholesterol and insulin modifies the production of cortisol to a certain
14:41 extent what does that do it affects fatigue and energy level in a it affects inflammatory response tissue healing tissue repair inflammation and it also directly and indirectly affects things like cancer and other inflammatory autoimmune diseases so there's a very complex role for insulin and the associated hormones in the human body it's not just about regulating blood sugar but if you look step back and look at this big picture of integration then you understand what happens in type 1 diabetes when the human body no longer is able to produce insulin or sufficient insulin to perform all those tasks the only difference the only real major
15:28 difference between type 1 diabetic who cannot produce where they set their beta cells in the pancreas has been damaged to the point that they cannot produce sufficient insulin and an otherwise normal person should be the source of insulin mine comes from my pancreas a type 1 diabetic should come from a pump or a needle and of course my body has much more micro sensitive than a pump or a needle because you're kind of guessing with type 2 diabetes type 1 diabetes but how do you guess more accurately about what your ongoing insulin needs are and that's where you have to be sensitive to all those metrics and in the next segment we're gonna talk about how to
16:13 treat your blood Sugar's rather than treating what you're eating and that's a fundamental change between how endocrinologist manage diabetes and how it should be managed in my opinion in the modern era
