New thinking upends the conventional wisdom…

High blood sugar (glucose) is an obvious sign of diabetes. It’s worrisome because elevated blood glucose can, over time, lead to serious diabetes-related complications, such as stroke, heart disease and eye damage.

We’ve long known how diabetes develops: Cells gradually become less responsive (“resistant”) to the glucose-regulating hormone insulin…the ability of the pancreas to produce insulin flags…and glucose readings creep upward.

However, it has not been clear, until recently, why people become insulin-resistant in the first place—and what they can do to stop it. Now that’s changing.


The conventional wisdom is that carbohydrates—particularly foods that are high in “simple” carbs, such as soft drinks, white bread and desserts—are a main driver of insulin resistance and diabetes. But other factors, some of which are largely hidden, are also important…

RISK FACTOR #1: Ectopic fat. It’s clear that being overweight increases risk for diabetes. But we’re learning that a specific type of fat that accumulates in the liver and muscles is especially harmful. This ectopic fat impairs the ability of insulin to metabolize glucose and can lead to insulin resistance. Certain people—including some who aren’t overweight—have a genetic tendency to develop ectopic fat.  

RISK FACTOR #2: Inflammation. Persistent, low-grade inflammation—caused by air pollution, obesity, a poor diet, gum disease, etc.—causes cells to produce inflammatory molecules that increase insulin resistance.

RISK FACTOR #3: Mitochondrial dysfunction. Mitochondria, the “batteries” that fuel the body’s cells, naturally produce free radicals and other by-products. The harmful molecules are kept in check by endogenous (produced by the body) and dietary antioxidants. A shortage of either type of antioxidant can cause mitochondria to work less efficiently, resulting in less insulin production—and more insulin resistance.

RISK FACTOR #4: Psychological stress. A Dutch study found that people who had suffered at least one major stressful event (such as the death of a loved one or serious financial troubles, etc.) within the past five years were 1.2 times more likely to have diabetes.

Why is stress linked to diabetes? Stressed people are more likely to be overweight, eat poor diets and avoid exercise. Also, stress raises levels of cortisol, a hormone that increases insulin resistance and can cause the liver to manufacture excess glucose.


Fortunately, the factors described earlier can be managed—and sometimes reversed—with diet, exercise and other changes. Here’s how…

Double the fiber, halve the fat. The Joslin Diabetes Center recommends an eating plan that’s low in fat (15% of total calories) and high in high-fiber veggies, fruits and grains.

Forget what you’ve heard about carbs being bad. Processed carbs (sugar, high-fructose corn syrup, etc.) are obviously a problem. But healthy complex carbohydrates (such as whole grains, veggies and legumes) are absorbed slowly…do not cause blood sugar spikes…and many are high in inflammation-fighting antioxidants. Best: An eating plan with a lot of complex carbohydrates—70% of total calories.

We’ve found that people who follow this diet for eight weeks show significant drops in insulin resistance…have improved blood glucose levels—and lose about 3% of their weight…and have a decrease in abdominal and overall body fat.

Be aware of hidden fat. Excess body fat is one of the main causes of insulin resistance and diabetes—even when the fat isn’t readily visible. People with a fatty liver, for example, are five times more likely to develop diabetes. Fat that accumulates in muscle cells might be completely invisible, but it increases inflammation levels and disrupts the action of insulin.

Fat that is visible—on the hips, buttocks and particularly around the waist—is especially troublesome. Most belly fat is visceral fat, which secretes higher levels of inflammatory chemicals than other types of fat. It also increases levels of “hidden” muscle fat. One large study found that obese men (with a BMI of 30 or higher) were seven times more likely to get diabetes than those with a BMI below 25. For obese women, the risk was 12 times higher than that for normal-weight women.

Boost natural antioxidants. Millions of Americans supplement their diets with large doses of vitamin C, vitamin E and other antioxidants. But research has shown that these supplements are unlikely to improve insulin resistance/diabetes—and may be harmful because they can inhibit the action of the body’s natural antioxidants.

What helps: Broccoli, blueberries, green tea and other plant foods that are high in phase 2 antioxidants—beneficial plant compounds that activate a protein called Nrf2, which triggers genes that produce antioxidant molecules. People who eat a lot of plant foods have less inflammation, less mitochondrial dysfunction and less insulin resistance.

Get off your duff! Exercise is great for weight loss, but that’s not the only reason to do it. People who are sedentary tend to accumulate more fat deposits in muscle cells. These fats inhibit insulin’s ability to transport glucose into muscle cells, and insulin-resistant muscle cells are now thought to be a leading cause of diabetes.

It doesn’t take hard-core exercise to get the benefits. If you walk three miles a day (about 6,000 steps)—all at once or in five- or 10-minute increments—you’ll reduce your diabetes risk by more than 25%.

De-stress. Take up an enjoyable hobby…go for leisurely walks…spend time with loved ones…and try stress-reducing habits, like yoga or meditation. For severe stress (or depression), consider seeing a professional. Any form of stress relief will help manage diabetes—and reduce your risk of getting it.