General Discussion
In reply to the discussion: People who 'can't fit into jeans they wore aged 21' risk developing diabetes [View all]Happy Hoosier
(7,296 posts)Insulin resistance. And lots of fructose.
They are correlated, but the fat itself is NOT the cause. It is a co-symptom in many cases (but not all).
When the body is insulin resistant, the pancreas has to produce more and more insulin to control blood glucose levels. Insulin is also the fat storage hormone. So the body is converting glucose to triglycerides, and even the liver is storing fat.
You are correct that skinny people can have fatty liver. That is because they are insulin resistant.
It is also possible for a fat person to be metabolically healthy.... with normal insulin and blood glucose levels. Acording to Robert Lustig, a UCSF professor who has done a tone of research here, about 20% of "obese" people are metabolically healthy. And about 30% of "normal weight" people are not.
In any case, it's important we pursue root causes and not try to treat disease by trying to treat correlated symptoms.
We've been trying to treat T2 diabetes for DECADES by getting people to lose weight, but that's the wrong end of the stick. What WORKS in reversing T2D is severe carbohydrate restriction... either through a very low carb diet, or a very low calorie diet (either just a straight-up diet, or with bariatric surgery... which has its own risks). Both can reverse T2D, but the VLC diet is much easier to maintain than severe caloric restriction without surgery.
In the last year, I've lowered my A1C from 10.6 to 4.8 with a VLC diet. It also happened to result in 136 lbs of weight loss so far. Because what it was treating (elevated insulin) was also keeping me heavy.