Experts suggest that prolonged antiretroviral therapy (ART) of HIV-infected people is associated with increased risk of insulin resistance leading to type 2 diabetes. I suggest that this is not an accurate scientific explanation. Here's why.
The term insulin resistance was originally created decades ago to explain the finding of elevated blood glucose despite the presence of adequate insulin levels. Eventually, it has come to be accepted as a causative factor of type 2 diabetes.
In all scientific disciplines, before a hypothesis is accepted as fact, however, it has to be validated through logic, mechanism, and measurement. To prove insulin resistance though, these requirements have not been fulfilled. For example, what is the justification for accepting that insulin resistance in type 2 diabetes affects only 3 types of cells — muscle, liver and fat — out of 200 cell types in the body? What is the cellular mechanism of resistance in these sites? Without knowing these, one can only measure blood glucose level, which is a symptom, similar to fever in an infection, compared to measuring an actual change in the degree of insulin resistance.
In short, the concept of insulin resistance as a causative factor of type 2 diabetes has never been validated.
Coming back to antiretroviral therapy of HIV-infected people, there is a more logical explanation for why they develop type 2 diabetes rather than the supposition of insulin resistance. I suggest that a more likely mechanism for the development of type 2 diabetes in patients infected with HIV is that the medications used in HIV treatment inhibit a signaling mechanism called the paroxysmal proliferator-activated receptor. It is known that this inhibition reduces fat storage capacity by interfering with the development of new fat cells. When HIV patients begin feeling better because of their treatment, they usually resume regular food consumption. But their reduced ability to store fat leaves it in the blood circulation. This excess fat can lead to the natural body reaction in which muscles start burning fat instead of glucose to produce their energy. The result of this is that glucose is left in the blood stream, leading to high blood sugar and type 2 diabetes.
This explanation parallels what I have described as the cause of type 2 diabetes for many adults in my book Diabetes: The Real Cause & The Right Cure, 8 Steps to Reverse Your Diabetes in 8 Weeks. Every person, whether lean or fat, has a defined, inherited capacity to store fat. When this capacity is filled, fat stays in the blood, leading to the same "fatty acid burn switch" by which muscles burn fat rather than glucose. The fact that HIV-infected people who undergo ART often develop type 2 diabetes effectively provides proof of my theory that insulin resistance is not the cause of type 2 diabetes, but rather that it is the overconsumption of grains beyond one's capacity to store the excess energy.
About the author:
John Poothullil, MD, FRCP has devoted more than 20 years to understanding the causes and prevention of both cancer and diabetes. He is the author of Eat, Chew, Live: 4 Revolutionary Ideas to Prevent Diabetes, Lose Weight & Enjoy Food, which was selected as Best Book in the Diet & Nutrition category in the Beverly Hills Book Awards 2016, Diabetes: The Real Cause and the Right Cure: 8 Steps to Reverse Type 2 Diabetes in 8 Weeks, and Surviving Cancer: A New Perspective on Why Cancer Happens & Your Key Strategies for a Healthy Life. His fourth book, recently published, is When Your Child Has Cancer: Insights and Information to Empower Parents.
