Tomorrow is World Diabetes Day and this week we have devoted ourselves to drawing attention to the major endemic of our time, type 2 diabetes. We took the opportunity to interview one of our favorite experts in the subject: Annie Pettersson, molecular biologist and researcher.

– Annie Pettersson, just over five years ago you stood at Karolinska Institutet and defended your dissertation which was about fat cells, insulin signaling, type 2 diabetes and obesity. Why did you choose to do a dissertation on that matter?

A few years earlier I had discovered how much my health was affected by sugar and fast carbs and therefore had something of a personal passion for the subject. Although much of my research was at a fairly detailed level, several of my research articles also included a clinical angle, and we worked almost exclusively with adipose tissue from humans. I left the academy to work with functional medicine, but my interest in metabolism has continued and I have continued to follow the research in the field. And it is certainly the case that diabetes is undoubtedly one of the main issues of focus in functional medicine.

– What is diabetes?

In type 1 diabetes, which is less common than type 2 diabetes, the cells that produce insulin are affected. While type 1 diabetes is classified as an autoimmune disease, type 2 diabetes is a metabolic disease, which means that it affects the metabolism. Type 2 diabetes is a consequence of insulin resistance that leads to elevated blood sugar levels. Insulin resistance means that insulin receptors do not respond as effectively as they should when insulin binds to them. High blood sugar is dangerous because sugar creates toxic properties in the body. It leads to oxidative stress that damages cells and tissues, such as blood vessels. Sugar is indiscriminately attached to various proteins in the body and interferes with their function. Blood fats also increase and fatty acids are released from the adipose tissue and end up in different places in the body where they should not be, which causes problems.

– Is there anything in particular you feel is important to say about type 2 diabetes to today’s public?

Type 2 diabetes has become one of our largest endemic diseases. Every tenth Swede is estimated to have prediabetes. The risks of diabetes are many. It increases the risk of cardiovascular disease, cancer, inflammatory and autoimmune diseases, and premature death. Something that has been on the agenda lately is how diabetes increases the risk of severe disease in COVID-19. What many people may not know is that the risk of dying from many other infectious diseases such as influenza is much higher for diabetics than people without diabetes.

– Many people may think that it is not such a big deal to suffer from type 2 diabetes because there are drugs, what do you have to say about that?

Diabetes is a dangerous disease and the drugs prescribed for type 2 diabetes are not without side effects. For example, some medicines cause weight gain. This is a particularly common consequence when the disease has progressed so far that the patient has become dependent on insulin injections, as insulin gives a powerful signal to the fat cells to grow. Above all, they do not address the root cause of the disease.

– Anything else you would like to shine the light on?

Diabetes research can become so detailed that it digs into mechanisms at the cell, gene and even atomic levels. But for me, it is becoming increasingly important to zoom out, to see the bigger picture.

The picture that is becoming increasingly clear is that type 2 diabetes is largely a consequence of a certain lifestyle – a way of life that many of us have, so to speak, slipped into. One could liken the situation to that we have been picked up from the prehistoric savannah and dropped straight into a world we are not really equipped to handle. The human genes and human behavior that have been slowly selected over the millennia because they have increased our survival are now working against us in the modern environment. Our capacity to use mental will power is limited and weak because we have never – during our entire time on earth – needed to before. It can be difficult to avoid food that is available around the clock, and is cheap, tasty and easy to chew. Most of us do not have to walk 10-20,000 steps a day as a hunter and gatherer, but go about our lives with much less physical activity than that. We can stay awake with artificial light and be up around the clock. And sometimes there seems to be no limit to how much we stress. The good news is that type 2 diabetes is largely reversible. When we arm ourselves with all this knowledge, we can use it to prevent and reverse diabetes at its roots instead of trimming the leaves.

Type 2 diabetes is considered to be mainly caused by our modern lifestyle and environment, although there is some genetic susceptibility. In cases where the disease “runs in the family”, it is often a matter of having inherited dietary and lifestyle habits and having been exposed to the same environmental factors, rather than genetic causes. This is good news for everyone affected; we do not control genetics, but we can control lifestyle, diet and environmental factors.

– What are the factors we are talking about?

• A number of different dietary factors combined constitute the single largest contribution to an irregular blood sugar. There we find, for example, processed food, sugar intake and meal patterns, i.e., when and how often we eat.
• Obesity increases the risk of diabetes by 7 times. This means that everything that contributes to obesity also indirectly contributes to type 2 diabetes.
• Sedentary means that we use less glucose and can also contribute to insulin resistance by fat cells and muscle cells losing their sensitivity to insulin.
• Various sources of inflammation have also been shown to contribute, as inflammation leads to the insulin receptors on the cells’ surfaces reacting less to insulin.
• A recently identified underlying factor for type 2 diabetes is an imbalance in our intestinal flora, a hot area of ​​research.
• Stress increases blood sugar both in the short and long term.
• Adequate sleep and a circadian rhythm that follows our inner, genetic clock is important for blood sugar regulation to work optimally, which is explained by various mechanisms such as stress and hunger hormones, intestinal flora, and more. In one study, participants had developed prediabetes after just one week with 4 hours of sleep per night.
• Smoking and alcohol also affect the risk of developing type 2 diabetes. When you take a good look at the list, you realize that diabetes is not something that is easily corrected with drugs at the cellular and molecular level.

• Do you need to become a full-fledged, self-assured, totally harmonious “clean living devotee” to improve your blood sugar regulation?

Fortunately, research indicates that this does not seem to be the case. With the main focus on diet and some simple lifestyle changes, blood sugar regulation and insulin function can often be normalized. I think that type 2 diabetes can in many ways be seen as an unnecessary disease. Unnecessary in that it has unnecessarily tragic effects at the individual and societal level, but is seldom inevitable or impossible to get rid of. There are many who have a lot to gain from getting help with their metabolic health.

– Thank you, Annie Pettersson!