How do I lower my risk of type 2 diabetes?

Our read is that type 2 diabetes is linked to broader metabolic disease, including hyperinsulinemia, insulin resistance, and non-alcoholic fatty liver disease, and can lead to significant health complications.

Our read is that lifestyle factors, such as diet and exercise, play a crucial role in managing and potentially preventing the condition, with specific dietary adjustments and physical activity showing promise.

Our read is that while certain genetic predispositions exist, a proactive approach to metabolic health is emphasized, moving beyond simplistic views of diabetes management.

Our read is that specific methods to lower risk include incorporating "exercise snacks" to improve blood glucose control, and for individuals with type 2 diabetes and non-alcoholic fatty liver disease, temporarily reducing fruit intake. Rhonda Patrick suggests that apple cider vinegar, in doses of 1-2 tablespoons daily, may lower fasting blood glucose and HbA1c in individuals with type 2 diabetes. Andrew Huberman notes that the ketogenic diet is an evidence-based treatment for epilepsy in treatment-resistant cases.

• 01Peter Attia states that Alzheimer's disease, cancer, and atherosclerotic disease are linked to metabolic disease, including hyperinsulinemia, insulin resistance, NAFLD, and type 2 diabetes.
• 02Rhonda Patrick claims that recent sleep quality can significantly affect blood test results for metabolic markers.
• 03Rhonda Patrick states that apple cider vinegar, taken in doses of 1-2 tablespoons daily, may lower fasting blood glucose by up to 22 mg/dL and HbA1c by as much as 1.5% in individuals with type 2 diabetes.
• 04Peter Attia notes that elevated blood glucose in type 2 diabetes leads to advanced glycation end products that damage vasculature and compromise blood-brain barrier integrity.
• 05Peter Attia reports that world-class athletes have low resting lactate levels, indicating they can oxidize fatty acids at rest when sympathetic drive is low, while individuals with type 2 diabetes have elevated resting lactate, potentially inhibiting their fatty acid oxidation.
• 06Rhonda Patrick states that exercise snacks improve blood glucose control by stimulating glucose transporters to the muscle via lactate signaling, which can reduce post-meal sleepiness and improve mental clarity.
• 07Peter Attia suggests that identifying dysregulated molecular mechanisms like issues with the PDH enzyme or LDH in mitochondria could lead to better diagnostics or therapeutics for metabolic syndrome and type 2 diabetes.
• 08Peter Attia claims that certain genetic segments of the population are more susceptible to developing diabetes and obesity when consuming abundant sugar and flour.
• 09Andrew Huberman highlights high rates of chronic diseases in the US, including 50% of adults with pre-diabetes/type 2 diabetes.
• 10Peter Attia temporarily reduces fruit intake for patients with Type 2 diabetes and non-alcoholic fatty liver disease.
• 11Paul Saladino notes that by the time of a diabetes diagnosis, approximately 60% of pancreatic beta cells are damaged and 50% of individuals exhibit complications.

Our read is that there are several disagreements and nuances to consider. Paul Saladino argues that blood glucose spikes from carbohydrates do not cause obesity or diabetes, and that processed sugar and soda are major dietary problems. He also cautions that epidemiological studies on low-carbohydrate diets can be misleading if they do not differentiate between true ketogenic diets and those including processed carbohydrates, refined vegetable oils, and sugars. Paul Saladino further suggests that grain-based and legume-based carbohydrates can contribute to diabetes by causing gut issues, bacterial overgrowth, and inflammation. Peter Attia states that insulin promoters encourage lazy treatment for Type 2 Diabetes by providers. Paul Saladino also contends that medical professionals are often taught that conditions like high blood pressure, diabetes, obesity, and heart disease are primarily due to bad genetics, rather than lifestyle and environmental factors. He also believes that chasing fasting blood sugar as the primary marker for diabetes management can be misleading, and that testing blood work only once a year or every six months provides insufficient feedback. Paul Saladino repeatedly states that the Mayo Clinic's recommendation of seed oils like olive, sunflower, safflower, cottonseed, and canola is incorrect and promotes the development of diabetes. Rhonda Patrick notes that fasting blood glucose measurements taken only once per year may not accurately reflect an individual's glucose control or metabolic health. Rhonda Patrick also suggests that shifting substrate oxidation from glucose to fats with high omega-3 doses may worsen glucose levels in diabetic patients or those with high circulating glucose. Paul Saladino claims that using mouthwash daily is associated with increased blood pressure and an increased rate of diabetes.

Our read is that the verdict could change with more definitive research on the precise mechanisms of beta cell recovery, the long-term efficacy of high-intensity exercise versus moderate exercise for glucose control in type 2 diabetes, and a clearer understanding of why certain comorbidities predispose individuals to severe outcomes from viral infections. Further, a deeper understanding of whether epigenetic changes in beta cells are causal or consequential in type 1 diabetes, and the exact reasons for weight gain in type 1 diabetes with tight glycemic control, would also impact our understanding.