Here's a story.  During my teen years I was introduced to David's sunflower seeds and enjoyed them during summertimes.  As I aged into late 30s/early 40s I got up to eating a pound a day some days given the opportunity to be a couch potato.  

I also craved ice, and now think of both as pica from undiagnosed celiac disease dx at around age 45.  I was diagnosed hypothyroid around age 35/36.  I craved salt (this was the first health questionnaire to ask) so my GP ordered the TSH.  She said I did it to myself with the salt, but since the CD dx I think I was instinctively trying to get iodine and minerals to feed my starving bod.  

At the time, I even called David's Seeds to see if there's iodine in their salt (there is).  I couldn't eat the whole bag without ripping up my mouth, so oftentimes I'd rinse them w/water (what a person'll do to feed a need!).

Sometimes I wonder if the salt I craved helped create my mild cardiomyopathy?

I don't use much salt because I don't seem to want it, but, ever since I visited friends in Japan, I eat nori (seaweed) because it's a fun, crunchy way to get my iodine.
Jeanne

Recall that the only reason iodine is added to many (not all) salt products is because it was a public health solution to solve the substantial nationwide iodine deficiency prevalent during the 20th century. But it was a solution conceived in 1924, when the FDA thought this was the best way to get iodine into Americans. And it worked.

Dr. Davis:

what relationships, if any, exist between the nutritional history you've depicted in your post and pancreatic cancer.

Is there any way to heal our pancreas? I have a friend with pancreatic cancer and it's incredibly painful. I would love some preventative care for myself if you have any tips.
Jana

Pretty good advice, doctor.

The Centers for Disease Control has predicted that one of every three Americans born in 2000 will eventually develop diabetes (mostly type 2).  Your dietary advice, along with regular exercise and avoidance of obesity, would prevent many cases.

-Steve

Great article! Yes, our pancreas is neglected badly. It is working hard, day in, day out and we don't even notice this hard labor.
One can measure if the pancreas is still working ok by measuring "C-Peptid". A sensitive marker of insulin production. Mine is 1.0 (a little low), so I want to support my pancreas.
Does anybody know how to increase or re-generate beta-cells?
There is a herb (among others), called GYMNEMA SYLVESTRE that has supposedly regenerative capabilites. Has anybody tried this?
Thanks.

Doctor Davis:
No rice or potatoes?  Are you advocating a zero carb (except carbs found in veggies and fruit)?  Many of us are allergic to nuts so foods like walnuts are out, but peanuts are ok since they are legumes, but many seem to say stay away from them.  Be helpful to get more detail on your daily diet suggestions.

Thanks!

Doesn't the pancreas work to produce insulin and glucogen even on low-carb meals?  I thought the problem with high-carb diets was the elevated level of insulin in the blood and the various metabolic syndrome problems that causes, not necessarily that it overworks the pancreas.

Agreed!  Please correct me if I'm wrong, but isn't there the a danger that as a person gains weight and the body is experiencing continuing high insulin levels, some tissues become insulin resistant, so the pancreas is forced to produce  even more insulin to keep the glucose levels in the blood under control.  That, I understand, becomes a  "slippery slope" and difficult to recover from.  I don't mean to be alarmist - but it is downright scary.

Dr. Jack Kruse: Via current clinical (testing) methods by the time someone is diagnosed with Type 2 #diabetes, 50% of their beta cells are already destroyed. http://goo.gl/MAhVU

It's mostly the overwork, here's a little known pancreas fact: "Only 1% of the beta cells in the pancreas are devoted to producing insulin for handling sugars, 99% of the pancreas is devoted to handling the digestion of fats and proteins."   http://goo.gl/WlLML  and  http://goo.gl/wUcEB  

From Wikipedia: "The islets of Langerhans constitute approximately 1 to 2% of the mass of the pancreas. There are about one million islets in a healthy adult human pancreas, which are distributed throughout the organ; their combined mass is 1 to 1.5 grams."   And in rats, only 65 to 80% of those cells are devoted to producing insulin & amylin.  http://goo.gl/3zrHa

So when you consider these facts along with what Dr Jack Kruse says: "Via current clinical (testing) methods by the time someone is diagnosed with Type 2 #diabetes, 50% of their beta cells are already destroyed.", then YES, BABY YOUR PANCREAS!!   http://goo.gl/MAhVU

FWIW: I was spiking to 185-210 at one hour post prandial on Dr Fuhrman's greens/beans etc diet.  I added Gymnema from Pure Encapsulations Gymnema sylvestre extract (leaf) (75%)250 mg, one capsule, 3X/day and after about 5 months my highest spikes have been in the low 120's after BIG meals, same diet, no grains but plenty of fruit and some root veg and lots of beans.  Even a good sized serving of oatmeal only get my sugar reading to the mid 120's. Seems to me, likely some beta cell rejuvenation has gone on.  How much the gymnema and how much the diet is anybody's guess.

Agreed! And it's why I eat only 1-2 meals most days. AND ... very low carb.

Usually sub 20g of carbs per day!

Baby that THANG!

Could a high SHBG level be caused by a worn out pancreas?

Oops, wrong quote.  here's the right one.    "In addition, glucose sticks to proteins in the blood (glycosylation). These glycosylated proteins are sticky and slow down the blood flow through the capillaries and veins, preventing oxygenation. It has been shown that people with diabetes have higher rates of cancer and mortality due to cancer as compared to those without diabetics. The strongest correlation was for pancreatic cancer. Notably, it has been found that the higher the fasting glucose one has, the higher the risk for cancer."  http://goo.gl/PnJoU

Also see the article Tom Naughton wrote on his Fat Head blog about ‘Super-Sticky’ Cholesterol and Diabetics here:  http://goo.gl/JTi75

There's no evidence that using your pancreas is what leads to reductions in beta cell mass and function.   Have you looked at any of the peer review research demonstrating that drugs like Byetta can actually increase beta cell mass and increase insulin sensitivity?

2,000 - 3,000 Beta cell work to coordinate insulin put out every +/- 4 minutes; post-prandial there is a 1st response insulin spike, then smaller steady secretion, and in time a lesser 2nd insulin spike.  Some Type 2 diabetics don't  put out the 1st insulin spike, their blood sugar stays high and then eventually they do put out that late 2nd insulin spike.

"Amylin"  or IAPP (islet amyloid poly-peptide) is co-secreted with all insulin;  if  "amylin" goes on oligomerize into a  tangle of fibrils around the individual Beta cells this messes with their signal synchronization.  As the "amylin" kinks up with other amylin the Beta cells are pushed apart and those Beta cells change size; without Beta cell group co-ordination the individual cells' mitochondrial house keeping repairs risks compounding recycling errors and that cell goes into programmed cell death (apoptosis).

Zinc is what binds to an individual "amylin" fibril  in a central position and keeps that fibril from oligomerizing with other fibrils; too little zinc in pancreas lets tangles occur. Yet too much zinc in pancreas also lets tangling get going; this is due to when a 2nd zinc clings elsewhere on  the same fibril the first zinc already is bound to.  See  recent "Journal Molecular Biology", vol 410, 2, 294-306

Do you have a reference for that? Not a mouse study. Thanks.

http://diabetes.webmd.com/news/20110624/very-low-calorie-diet-may-reverse-diabetes

Damned interesting study if it bears out. It seems that a couple months of hard starvation lowers fat levels in the pancreas and can actually reverse diabetes, at least in people who are not too far along in the disease process.

It does not take anything like the starvation in the above linked study to reverse insulin resistance and effectively eliminate T2 diabetes.  There are a number of doctors who have been having that result for many years w/ a lowish fat, plant based diet, eliminating REFINED carbs, animal fat, saturated fat, and manufactured junk food.  See Fuhrman, McDougall, Barnard, Esselstyn, Shitani, etc. They all have books out and a track record easy to find.

Now I have Weird Al Yankovic's song "Pancreas" going through my head...

No need to starve to "cure" type 2 diabetes.  Just cut the carbohydrates, particularly the starchy kinds from grains, legumes, and potatoes.  No need to eliminate animal fat/sat fat, either. Natural fats have no effect on blood glucose and do not stimulate insulin production.  If you eliminate all the things Fuhrman et al say to eliminate, there isn't much left to eat and you will end up on a starvation diet anyway!

Might some of Doc's diabetics be getting their relief from eliminating wheat be due to more zinc absorption (and thus less "amylin" tangles) ? In theory  phytates  have the potential to excessively bind up zinc; although I hesitate to say one scenario fits all situations.

Zinc deficiency in the pancreas is hard to assess, since we use zinc all over ; specific tissue levels are a guess,  because we are physiologically designed to keep a baseline amount of zinc in our blood. In other words,  zinc can actually be retrieved from body tissue and put back into circulation;  maybe  some individuals have a disposition to leach zinc out of their pancreas and then their "amylin"  tangling worsens.  Constant adult doses of over 100 mg per day really merits caution and, aside from other side effects, may tag "amylin" fibrils with 2nd zinc that provokes  "amylin" tangles; I am not suggesting any specific dosage for anyone here.  

Meanwhile,  other individuals possibly avoid Beta cell death due to genetic propensity to maintain enough zinc in their pancreas;   and,  also some may have gut bacteria strains that slowly pass the  intestine zinc the bacteria cleaved from phytates' hold.  Not every overweight person, nor  grain/legume/nut phytate  consumer goes on to develop diabetes; there may just be some age related Beta cell decline  that is normal and not pathological.

The whole notion of beta cell regeneration, while tantalizing, is uncharted territory. I propose carb-limitation not so much for its beta cell regenerating potential, but for its ability to simply not challenge a compromised pancreas.

Might-o-chondrial's proposal that grain phytates block absorption of zinc is interesting. However, I don't know how much of a genuine role it plays in the entire picture. I can say that the end clinical effects include HbA1c's of 5.0 or less, fasting glucoses of 90 mg/dl or less.

"If you eliminate all the things Fuhrman et al say to eliminate, there isn’t much left to eat and you will end up on a starvation diet anyway!"

Lack of imagination/creativity is a terrible thing.  The only thing Fuhrman et al say to eliminate is manufactured, highly processed, refined, chemicalized, "food like substances" (that are not really food at all).  I eat basic Fuhrman diet and can easily adjust my calorie intake up or down by 1000 calories or more just by substituting higher or lower calorie density real foods.  It isn't difficult, and even at lower calorie intake, no sense of deprivation at all after the first bit of breaking addictions and retuning taste buds.

60 - 80% of new Type 1 diabetics show anti-bodies for Zinc Transporter 8; there are 10 different zinc transporters (ZnT) in mammals.  ZnT works with the movement of zinc from a cell's cytoplasm to sites of action inside that cell and also moves zinc outside that cell (bringing zinc into cell is not directly mediated by ZnT).

A genetic polymorphism of ZnT 8 (SLC 30A8  rs13266634) causes less pro-insulin made into insulin (crystalization of insulin for stockpiling  involves zinc)  and when high blood sugar malfunctions;  if less insulin
stash in insulin storage granules then it's secretion on instant demand (ex: 1st post-prandial insulin pulse)  is impaired.  Normally lots of ZnT 8 is active in pancreatic  Beta cells and actually prevents Beta cells from dying off due to zinc deficiency;  as well  as  lots of ZnT 8 activity expression inducing more  insulin put out in response to blood glucose loads.

High blood glucose down-regulates ZnT8 and , on the contrary, up-regulates ZnT 3;  Doc is right to be concerned with excessive post-prandial blood sugar because ZnT3 and ZnT8  have different dynamics.  ZnT3 is linked to amyloid tangling in the brain (hippocampus has lots of ZnT3) and recent research find it is active in the pancreatic islets; so I wonder if it's transporter genetics (gene SLC 30A3) is how  zinc becomes a problem outside the cell,  and integral to how "amylin" fibrils then can kink into tangled oligomers that push Beta cells too far apart.

Sshort-term supplementation with cholecalciferol improves β cell function
Effects of vitamin D and calcium supplementation on pancreatic {beta} cell function, insulin sensitivity, and glycemia in adults at high risk of diabetes
Perhaps if they'd used 5000iu/d the results would have been even better as Dr Cannell suggests here

Improving melatonin secretion (or using a time release supplement) may also be worthwhile to protect pancreatic function.

Did they need to be starved as well. Surely just reducing the carb would have sufficed?

Glad to see T. H.  back .... for Melatonin synthesis we use zinc and taking zinc raises one's melatonin output (2003  journal Acta Physiologica Hungarica, 90(4),335-339).  Pancreatic lipase enzymes that help cleave fat we've eaten also  uses zinc.

I have no zinc guide lines for anyone, and definitely  am not claiming zinc is the only relevant parameter in pancreatic dynamics.  For home evaluation  of zinc status please see Dr. Dereck Bryce-Smith's  "ZTT"  technique; it is a 10 second mouth swish of 2 teaspoons of zinc sulfate mono-hydrate and how one's response ranges in four gradients  going from tasteless to metallic.

Fuhrman? Have you seen how he handles commenters on his site that challenge anything he says. He responds like a childish buffoon. Besides he is very much anti animal fat and anti saturated fat. No thanks.

I am just about convinced that I have experienced some amount of beta cell duplication as a result of many months of low carb dieting, as noted in an earlier post by Might-o in March regarding the formation of new, larger beta cells in the absence of hyper-glycemia.  After trying many diets to address my type 2 diabetes, I settled on a low carb diet of 65% fat 25% protien and 10% carb after extensive research on the effects of the different micronutrients on blood sugar.  For almost a year, my A1C has been 5.4, and I lost 40 lbs in that time period.

However, after feeling that I had lost some strength in weightlifting, I did some additional research on maintaining strength while on a low-carb diet, and it was suggested that on weekends, to eat anywhere from 100-500 grams of carbs to restore my glycogen levels.  To make a long story short, I ate half of a large pizza, and tested my blood glucose before and one hour after.  Before, it was 82mg/dl.  After? 67 mg/dl.  I tested this again the next day with a few tacos, which would have normally shot my blood glucose numbers in the 100's and it produced the same effect.  

One concern that I have is that my pancreas is producing excessive insulin, which is a problem for us diabetics who have been abusing our pancreas for so many years.   However, I believe that I have recovered some insulin sensitivity by giving my pancreas a rest and keeping my insulin levels low.  Does that mean that I'm cured and I should start gorgeing on pizza, cakes, sodas, french fries, mashed potatoes, pancakes and fried chicken like I used to? (I know, I brought diabetes on to myself)  The answer is no.  But it is a good idea to preserve our existing working beta cells by giving it a rest.

Some nutritionists & dietitians recommend no more than 10 or 12 teaspoons of  *added*  sugar a day, as in addition to your regular daily diet, others say 10 to 12 teaspoons total sugars per day, with no additional.

Since only 1 percent of your pancrease is used to produce insulin to process blood sugars, and since the average human body contains 5 liters of blood which is equal to around 1000 teaspoons, and a homeostatic fasted blood sugar level of 60 to 90 mg. per deciliter equates to a little less than 1 teaspoon, the theory is the less sugar consumed is the better option.  A handy formula to memorize is the 1-5-20 rule, which means 1 teaspoon of sugar equals 5 grams which equals 20 calories, then just do a little multiplication or division to convert the grams & calories of carbs on food labels into a teaspoon equivalent that's easier to wrap your brain around, and as a good visual aid to understand how much glucose you're dumping on your pancreas all at once.

I seriously doubt Dr. Davis advocates *NO* carbs, very few people that understand how to exploit the macronutrients do, especially doctors.  Most people have poor long term results & can't sustain a food denial strategy, so rather than think in terms of carb denial it's better to just have limited amounts of the carbs you like while keeping in mind the total glucose content, glycemic index and glycemic load of those foods and the stress placed on your pancreas by overindulging.

There's a great carb intake chart over on Mark Sisson's website that explains the optimum carb intake levels, to see it scroll down the page here:  http://goo.gl/CYD1n

Just remember that carbs have 4 calories per gram, so to get the total calories by carbs per day just multiply the grams by 4.

Good advice, as usual.

I was wondering if you could plan a future post around Microvascular Disease, particularly in women.  I understand the symptoms are different, and was hoping that you may be able to shed light on which lifestyle factors are most effective.  I'm seeing more and more thin, active women (many younger than 65) with "perfect" lipids in cardiac rehab.

I have been taking metformin for polycystic ovarian syndrome. I have been low-carb/primal for a year now. Blood work (sugar and trig/hdl) look great. Any idea what I am doing to my pancreas by continuing the metformin? I have already decreased the dose since my blood sugar was getting too low. How do I know if I don't need to take it anymore? I am not taking metformin to control blood sugar.

Thank you for the valuable  information Dr. Davis.  I am using much of it.

Another way to baby your pancreas is to avoid, where possible, dysglycemic drugs--two examples include: quinolines (antimalarials) and fluoroquinolones (FQs, e.g. ciprofloxacin, levofloxacin, moxifloxacin).  Bactericidal antibiotics produce more oxidative stress than do bacteriostatic antibiotics.  FQs produce a lot of oxidative stress, probably more than others and they are handed out like candy.  FQs also deplete and mutate mammalian mitochondria.  

Interestingly, B-cells in the  pancreas have very low levels of antioxidant enzymes (glutathione peroxidase and catalase both mop up reactive oxygen species)  comprising only 1% of the levels in the liver.   This favors H2O2 accumulation which can mess up H2O2 signal transduction.

I wonder why our pancreas B-cells  do not have more antioxidant protection than do cells in the liver?  Maybe the difference is the amount of zinc and iron between the pancreas and liver?  Zinc is a potent antioxidant by itself and a cofactor for the third major antioxidant enzyme of our bodes--super oxidase dismutase.  Iron is highly risky for oxidative stress particularly in combination with a hydroxyl radical--this is an explosive combination.

How much the rapid increase in diabetes is associated with  the overuse of prescription medications that are tough on the pancreas?

I have references for all of the above if anyone is interested.

Hi Redd,
You may be interested that it is MnSOD (manganese superoxide dismutase) which makes risky super-oxide molecules into molecules of H2O2 (hydrogen peroxide); the net effect of having more MnSOD activity is lower levels of super-oxide but more H2O2.

"I ate half of a large pizza, and tested my blood glucose before and one hour after. Before, it was 82mg/dl. After? 67 mg/dl. I tested this again the next day with a few tacos, which would have normally shot my blood glucose numbers in the 100′s and it produced the same effect."
Hope you have previously tested those same foods at 30 minute intervals because blood glucose peak timing can vary greatly depending on specific food/meal and individual physiology. Pizza is one of the worst for long delayed but very high peak