Bad Diet for Expectant Mother Can Mean a Fat Baby and Later a Diabetic Adult

AN expectant mother’s diet can create an obesity time bomb for her unborn child by altering the baby's DNA in the womb, increasing its risk of obesity, heart disease and diabetes in later life, a groundbreaking study has revealed.

The process ‒ called epigenetic change ‒ can lead to her child tending to lay down more fat. Importantly, the study shows that this effect acts independently of how fat or thin the mother is and of child's weight at birth. The study found there was an element in a woman's diet, particularly during the first third of a pregnancy that was of crucial importance.

The epigenetic changes ‒ which alter the function of our DNA without changing the actual DNA sequence inherited from the mother and father ‒ can also influence how a person responds to lifestyle factors such as diet or exercise for many years to come. The changes were noticed in the RXRA gene that makes a receptor for vitamin A, which is involved in the way cells process fat.

The study ‒ to be published on April 26 in the journal Diabetes ‒ shows that the epigenetic effect work independently of how fat or thin the mother is - meaning thin mothers who eat badly are just as likely to cause obesity in their children as fat ones.

The scientists drew their conclusions after measuring epigenetic changes in nearly 300 children at birth (samples first taken after birth using umbilical cord tissue DNA), and relating these to obesity rates at six or nine years of age.

What was surprising was the size of the effect: children vary in how fat they are, but measurement of the epigenetic change at birth allowed the researchers to predict 25 per cent of this variation, basically by mapping data to the topology they had and achieving results which would be the placebo effect in a medical study.

Keith Godfrey, Professor of Epidemiology and Human Development at the University of Southampton, who led the international study, said: "It is both a fascinating and potentially important piece of research. All women who become pregnant get advice about diet, but it is not always high up the agenda of health professionals. The research suggests women should follow the advice as it may have a long term influence on the baby's health after it is born."

Speaking in Auckland, Peter Gluckman, from Auckland University's Liggins Institute, who led the New Zealand team, said the rate of epigenetic change was possibly linked to a low carbohydrate diet in the first three months of pregnancy, but it was too early to draw a definitive conclusion and further studies were needed. He said one theory was that an embryo fed a diet containing few carbohydrates ‒ which provide the body with energy ‒ assumed it would be born into a carbohydrate-poor environment and altered its metabolism to store more fat, which could be used as fuel when food was scarce.

"This study provides the most compelling evidence yet that just focusing on interventions in adult life will not reverse the epidemic of chronic diseases, not only in developed societies but in low socio-economic populations too," he said.

Fat Fathers Pass on Diabetes 

Gluckman added that it is not just women who should be mindful, as it is likely obese fathers change the DNA in the sperm, ultimately influencing how the baby develops its control of blood sugar and fat deposition after that baby grows up.

"There is good evidence in animals, and there is some supportive evidence in humans that fathers who are obese have impact on the gene switches of their babies as well. We should not imagine that father has no role in determining the outcome of the baby's health."

It has long been known a mother's diet can affect her unborn child, but the research reveals how much of an influence it can have on a child's health. While it is not clear exactly which foods have the greatest influence on the DNA of unborn babies, a link was found with mothers on low carb diets.

Humans originally ate food as it came in nature ‒ legumes, pulses, things like lentils and chick peas, and fruits. Root vegetables and potatoes are a lovely source of carbohydrate as well. It is therefore important mothers are educated about the effects of diets.

Low-carb diets are in fashion and women have used them to control their weight, but where that information has gone awry is people have become confused and cut-out really important sources of carbs like legumes and fruit.

The study will continue for a at least two more years as scientists look into which foods are the most harmful for unborn babies, but in the meantime their advice for expectant mothers is to eat a balanced diet.

Diabetes+Diet Sodas: Confusing Cause and Effect

SCIENTISTS like to remind us not to confuse cause and effect. But they're not immune from making that mistake themselves. Last week, for example, the mass media reported a Harvard Universitystudy that has exonerated diet sodas and other artificially-sweetened beverages from previous studies linking their consumption to diabetes.

“This is such a great example of confusing cause and effect. It’s akin to saying ‘playing basketball makes you tall’ because height and basketball are correlated. Of course, the real answer is that taller people play basketball,” says Dr. Josh Bloom of the American Council on Science and Health.

(Courtesy: Chris Coombs)

The new study ‒ published in The American Journal of Clinical Nutrition ‒ indicates that the link is a result of other factors common to both diet soda drinkers and people with diabetes, including that they are more likely to be overweight. In other words, people who are already diabetic or overweight are drinking more diet soda for those very reasons.

The Harvard University researchers, who followed a large group of men for 20 years, found that drinking regular soda and other sugary drinks often meant a person was more likely to get diabetes, but that was not true of artificially-sweetened soft drinks, or coffee or tea. They found that men who drank the most sugar-sweetened beverages ‒ about one serving a day on average ‒ were 16 percent more likely to be diagnosed with diabetes than men who never drank those beverages. The link was mostly due to soda and other carbonated beverages, and drinking non-carbonated sugar-sweetened fruit drinks such as lemonade was not linked with a higher risk of diabetes.

When nothing else was accounted for, men who drank a lot of diet soda and other diet drinks were also more likely to get diabetes. But once researchers took into account men's weight, blood pressure, and cholesterol, those drinks were not related to diabetes risk.

Replacing sugary drinks with diet versions seems to be a safe and healthy alternative, the authors say. "There are multiple alternatives to regular soda," says Dr. Frank Hu, one of the study's authors, adding, “Diet soda is perhaps not the best alternative, but moderate consumption is not going to have appreciable harmful effects."

When asked to comment on the study, Dr. Rebecca Brown, an endocrinologist at the National Institutes of Health, who has studied artificial sweeteners but was not involved in the Harvard research, told Reuters Health: “People who are at risk for diabetes or obesity…those may be the people who are more likely to choose artificial sweeteners because they may be more likely to be dieting.”

Hu and his colleagues analyzed data from more than 40,000 men who were followed between 1986 and 2006. During that time, participants regularly filled out questionnaires on their medical status and dietary habits, including how many servings of regular and diet sodas and other drinks they consumed every week. About 7 percent of men reported that they were diagnosed with diabetes at some point during the study.

The study also found that drinking coffee on a daily basis ‒ both regular and decaffeinated ‒ was linked to a lower risk of diabetes. Researchers aren't sure why that is, but it could be due to antioxidants or vitamins and minerals in coffee, Hu said.

Brown said that while there are still some health concerns about artificial sweeteners, none have been proven. "I certainly think that we have better evidence that drinking sugar-sweetened beverages increases health risks," Brown said, adding, "Certainly, reducing sugar-sweetened beverage consumption by any means (including substitution with diet drinks) is probably a good thing."

Breaking News: Type-2 Diabetes May Be An Autoimmune Disease

Type-2 diabetes is characterized by the gradual development of insulin resistance, which affects the ability of the body to properly metabolize glucose. It's associated with being overweight, but it can also have a genetic component. But despite the fact that millions of people have type-2 diabetes, the root cause of the insulin resistance is not known

Today, Stanford researchers reported that type-2 diabetes islooking more and more like an autoimmune disease, rather than a strictly metabolic disorder.

"The main point of this study is trying to shift the emphasis in thinking of type 2 diabetes as a purely metabolic disease, and instead emphasize the role of the immune system in type 2," says the study’s co-first author Daniel Winer, MD.

Commenting on the findings, Dr. David Kendall, chief scientific and medical officer for the American Diabetes Association, said, “This doesn't change our current approach to type 2 diabetes therapy, but it's important to understand that type 2 has multiple contributors to its onset. For some people, it may be an immune component, and if it is, we should be able to develop some better therapies."

"People with type 2 diabetes are often blamed for bringing the disease on, but it's a combination of genetic and physiological factors exposed to a certain environment. And, this study points out what may be another important biologic factor," he added.

Be that as it may, these findings ‒ published online April 17 in the journal Nature Medicine ‒ will change the way people think about obesity, and will likely impact medicine for years to come as physicians begin to switch their focus to immune-modulating treatments for type-2 diabetes.

Although the causes of type 2 haven't been clear, it's known that the disease runs in families, suggesting a genetic component. Also, while type 2 is strongly linked to increased weight, not everyone who is overweight gets type 2 diabetes. And, that's what got the researchers searching for another factor.

In 2009, Daniel Winer (along with his twin brother Shawn) showed that T- cells of the immune system were involved in people developing insulin resistance. They have now discovered that another immune cell, called a B-cell, also plays an important role.

Winer explained that excess weight has been linked to inflammation, which can cause the immune system to react. As visceral fat (abdominal fat) expands, it eventually runs out of room. At that point, the fat cells may become stressed and inflamed, and eventually the cells die. When that happens, immune system cells known as macrophages come to sweep up the mess.

Other immune system cells, known as T-cells and B-cells, also respond to the stressed or dying cells. But, these cells are the ones that create specific antibodies to remember a threat to the body. For example, these are the cells responsible for creating immunity when you're exposed to a certain flu virus.

In this case, however, instead of creating antibodies against a foreign substance, immune system cells ‒especially the B cells ‒ create antibodies against fat cells. Those antibodies then start attacking the fat cells, making them insulin resistant and hindering their ability to process fatty acids. In addition to type 2 diabetes, this onslaught against the fat cells is associated with fatty liver disease, high cholesterol and high blood pressure, according to the researchers.

The researchers found that mice genetically engineered to lack B cells were protected from developing insulin resistance even when they grew obese on the high-fat diet (60 percent fat). However, injecting these mice with B cells or purified antibodies from obese, insulin-resistant mice significantly impaired their ability to metabolize glucose and caused their fasting insulin levels to increase.

Interestingly, treating the mice with a compound called anti-CD20, which targets mature B cells for destruction, kept the animals from developing insulin resistance. The human version of anti-CD20, called rituximab, is already FDA-approved to treat some blood cancers and autoimmune disorders.

The researchers also tested blood samples from 32 obese humans. Half had insulin resistance. Those who were insulin-resistant had a distinct set of antibodies compared to the antibodies found in those without insulin resistance. This, according to Winer, suggests the possibility of developing a vaccine for type 2 diabetes based on what appear to be protective antibodies in those who are obese but not insulin-resistant.

Pointing out the mice and the human volunteers were all male, Winer said it's not clear if these findings are applicable to women. He also noted that anti-CD20 is not benign ‒ it dampens the immune system and can cause significant side effects, it’s not certain if it would ever be used for type 2 diabetes because other treatments are available.

Sources: Stanford News, HealthDay, Nature Medicine

Incretin Secretion, Action in the Natural History Of Type 2 Diabetes

INCRETIN hormones contribute a major portion to the insulin secretory responses after meals in healthy people. The incretin effect describes the phenomenon that oral glucose elicits approximately threefold greater insulin responses than the elevation in glucose (achieved with glucose administered intravenously) alone.

(Incretins are gastrointestinal hormones that influence insulin secretion, and which have been the basis for the development of new medications for type 2 diabetes.)

The incretin effect is the result of nutrient-stimulated secretion of the incretin hormones glucose-dependent insulinotropic hormone (GIP) and glucagon-like peptide-1 and their insulinotropic effect (ie, the augmentation of insulin secretion at elevated plasma glucose concentrations). In patients with type 2 diabetes, this incretin effect is severely impaired or even absent.

It is the purpose of this commentary to highlight current knowledge in incretin research and to answer the question of whether and to which degree abnormalities in incretin hormone secretion and action accompany the development of type 2 diabetes or even contribute to this process.

The reduced incretin effect in patients with type 2 diabetes was first noticed in 1967 and was clearly established in 1986.

Three types of questions arose from this finding:

• What is the mechanism behind the reduced incretin effect? Is the secretion or insulinotropic action of GIP and GLP-1 at fault?

• Are defects in the enteroinsular axis (the signaling system between the gut, from where incretin hormones are secreted, and the endocrine pancreas, the main target tissue that incretin hormones act on) important for the development and/or progression of type 2 diabetes?

• Can the pathophysiological characterization of the incretin system in type 2 diabetes provide clues for the development of new approaches for the treatment of this metabolic disease?

A severe impairment in the insulinotropic (stimulating or affecting the production and activity of insulin) activity of GIP in type 2 diabetes explains the reduced incretin effect.

A large cross-sectional study by Toft-Nielsen and colleagues comparing GLP-1 responses after meal stimulation suggested a reduced release of GLP-1 in patients with type 2 diabetes and, to a lesser extent, impaired glucose tolerance (“prediabetes”).

This widely quoted study was sometimes interpreted to indicate a progressive loss in the capacity of GLP-1 secretion in the natural history of type 2 diabetes, starting from normal secretion as long as glucose tolerance was normal with slight impairments when IGT develops, with a further deterioration after the diagnosis of type 2 diabetes and little residual capacity for GLP-1 secretion when the condition has progressed.

The logical consequence was to replace a missing hormone by advocating incretin-based antidiabetic agents (GLP-1 receptor agonists [mimicking the action of a naturally occurring substance] or DPP-4 inhibitors [medicines like Januvia(sitagliptin), Onglyza (saxagliptin), and Galvus (vildagliptin) that contain DPP-4].

However, not all studies that have compared the secretion of GLP-1 in patients with type 2 diabetes and in matched healthy people come to the same conclusions.

A recent meta-analysis suggested no uniform reduction in L-cell secretion between healthy and type 2 diabetic patients, but a large interindividual variation, in part determined by age, obesity and plasma levels of glucagon and free fatty acids.

In nondiabetics, the amount of GIP and GLP-1 secreted is significantly correlated to the incretin effect in quantitative terms. Thus, a low secretion of GLP-1 may determine a reduced incretin effect on an individual level, but does not explain the reduced incretin effect in patients with type 2 diabetes by and large.

If secretion is not the culprit, is there any peculiarity regarding the action of incretin hormones in type 2 diabetes? As originally described using GIP of the porcine amino acid sequence, and later confirmed using synthetic human GIP, the endocrine pancreas shows very little secretory response, even if exposed to supraphysiological concentrations of GIP.

This inability to respond to GIP appears to be acquired, since populations at high risk for developing type 2 diabetes do not display a similar defect. Basically, the response to GIP seems to be normal in any form of prediabetes (first-degree relatives, patients recovering from gestational diabetes, etc.), but after diagnosis (ie, with a fasting glucose ≥126 mg/dL), the incretin effect is reduced or lost, as is the ability to respond to exogenous GIP.

Most likely, the inability to elicit insulin secretory responses with GIP, even at hyperglycemia, is explained by a generalized impairment in beta-cell secretory capacity, as is typical for type 2 diabetes, no matter which stimulus is looked at (hyperglycemia, amino acids, sulfonylureas, etc).

Furthermore, rodent studies have suggested a down-regulation of the GIP receptor by chronic hyperglycemia. The fact that this defect becomes apparent when glucose concentrations rise above the normal level has raised the question of whether this phenomenon is reversible by glucose normalization.

A recent study by Højberg and colleagues suggested that this may be the case. However, although the insulin secretory responses to GIP and GLP-1 were significantly improved, normalization was not achieved after improved glucose control.

Abnormalities in the incretin system accompany the development of type 2 diabetes and may contribute to the velocity of progression. Figure 1 depicts the natural history of developing type 2 diabetes and also the progression of the disease after the diagnosis has been made.

Changes in insulin secretory capacity, based on homeostasis model assessment (HOMA) estimation of beta-cell function, and insulin sensitivity preceding the diagnosis were taken from a recent analysis by Tabak and colleagues. The development after the diagnosis of diabetes was based on analyses from the UKPDS and ADOPT study.

Regarding the secretion of GIP and GLP-1, we refer to our recent review indicating no general abnormalities in K-cell (GIP) and L-cell (GLP-1) secretion associated with a diagnosis of type 2 diabetes.

The fact that in none of the studies examining prediabetic populations, insulinotropic GIP effectiveness was impaired, but after the diagnosis, uniformly, a severe inability to respond to GIP with secreting insulin was documented, is the basis for assuming a substantial drop in beta-cell responsiveness to GIP around the time of diagnosis, with no further changes afterward (Figure 1).

In a recent review, we have explained reasons to assume that this inability to secrete insulin in response to GIP stimulation goes along with a general impairment of beta-cell function, which is demonstrable with most other secretagogues as well.

Whether this inability of the endocrine pancreas to respond to GIP contributes to the natural history of type 2 diabetes can only be evaluated by quantitative considerations. If a mechanism to stimulate insulin secretion after meals that normally contributes two-thirds of the overall secretory responses is at fault, this almost certainly has the effect to accelerate the progression of type 2 diabetes because without the additional incretin stimulus, overall insulin secretion should be further impaired.

In the case of GLP-1, the insulinotropic activity is somewhat reduced after the diagnosis of type 2 diabetes, and even worse under the condition of uncontrolled hyperglycemia compared with healthy controls.

High pharmacological doses of GLP-1, nevertheless, have the potential to raise insulin concentrations and to suppress glucagon secretion, with the overall result of normalizing glucose concentrations in the fasting state and after meals over a wide range of patients with type 2 diabetes, ranging from those treatable with lifestyle modification (“diet and exercise”) to those requiring insulin treatments.

Thus, the “resistance” to GIP of the type 2 diabetic beta-cell can be overcome by a compensatory exposure to high concentrations of the incretin hormone, GLP-1. GLP-1 itself appears to be less important than GIP for postprandial glucose control in healthy people and does not seem to be involved in the pathogenesis (origination and development) of type 2 diabetes.

However, because of its preserved efficacy in type 2 diabetes, GLP-1 is an effective agent to treat hyperglycemia in type 2 diabetic patients, with the added benefits of inducing weight loss and avoiding hypoglycemia.

By Michael A. Nauck, MD, PhD, Irfan Vardarli, MD (Diabeteszenstrum Bad Lauterberg), and Juris J. Meier, MD (St. Josef-Hospital, Ruhr-University of Bochum, Germany)

Source: Endocrine Today

Preterm Babies At Higher Risk Of Developing Diabetes In Adulthood

CHILDREN who spend less time in the womb (a full-term pregnancy lasts at least 37 weeks) have a slightly higher risk ‒ less than 1 percent higher ‒ of developing diabetes at some point in their life, according to a Swedish studypublished in Diabetes Care. The increased risk of diabetes applied not only to people who were born very prematurely, but also those born just a week or two early.

The researchers don't have a good explanation yet for why early birth might be linked with later diabetes. It could be poor nutrition, either in the womb or right after birth that can trigger changes in the baby's hormones or metabolism, leading to abnormal processing of blood sugar, which might increase the risk of diabetes later. However, the current study didn't look at preemies' nutritional status.

Though the study was done in Sweden, the findings could have a large public health impact elsewhere as well. In 2005, WHO estimated that 12.9 million births, or 9.6 per cent of all births worldwide, were preterm. Approximately 11 million (85 per cent) of these preterm births were concentrated in Africa and Asia, while about 0.5 million occurred in each of Europe and North America (excluding Mexico) and 0.9 million in Latin America and the Caribbean.

WHO calculated that an average of 10 per cent of births worldwide occur before 37 weeks gestation, although this rate ranges between 3.8 per cent for countries in central Asia and 17.5 per cent in southern Africa. In the U.S., the Centers for Disease Control and Prevention (CDC) in Atlanta estimates that 3 of every 25 babies are delivered prematurely.

In the current study, researchers used a national prescription database to track the use of diabetes medications by roughly 630,000 people born in Sweden between 1973 and 1979. Roughly 28,000 of those were born prematurely.

The researchers found that about 15 out of 1000 preemies had diabetes by the time they were in their twenties and thirties, compared to about 12 of 1000 full-term babies. Most of the prescriptions were for insulin without oral medications, which indicates that the majority of cases were type 1 diabetes.

In general, diabetes is less common in Sweden than in the U.S., where it affects about 17 out of every 1000 people in the 25 to 35 age group. Also, the rate of premature births in Sweden is about a third of the rate in the U.S.

(A recent study by Auckland University, too, has reported finding that very premature births may result in the individual facing a greater risk of type 2 diabetes in adulthood. It was found that insulin sensitivity was reduced by 40% in premature babies. Over 600 very premature births occur annually in New Zealand. Researchers believe that the low protein, high fat diet that premature babies are initially given may be behind the insulin resistance but research needs to be done to confirm this.)

Nonetheless, the researchers point out that premature birth is not as important a risk factor for diabetes as obesity and family history. About two thirds of Americans are overweight, according to the CDC.

In the U.S., prematurity is more of a problem in more deprived communities, and that is also the population in which more obesity is observed. So people who were premature need to pay a little more attention than people who were not to take steps to prevent diabetes.

(A similar case can possibly be made out for preterm babies born to malnourished mothers in Asia and Africa. This may possibly explain the explosion of diabetes in countries like India where the disease has reached epidemic proportions.)

However, the researchers point out, most (diabetes) risk factors are modifiable by exercising, eating a healthy diet, and quitting smoking. But they still recommend that doctors need to recognize that preterm birth is a risk factor for diabetes in later life.

For people born early, it's even more critical to avoid other risk factors for diabetes. Such risk factors include being overweight, not getting enough exercise, and having high blood pressure.

Diabetes: Does Periodic Fasting Lower The Risk?

Regularly fasting for 24-hour periods may help individuals reduce their risk of developing type 2 diabetes and lower their overall risk of heart disease, according to a new study from researchers at the Heart Institute at Intermountain Medical Center.

"Fasting causes hunger or stress. In response, the body releases more cholesterol, allowing it to utilize fat as a source of fuel, instead of glucose. This decreases the number of fat cells in the body," said Dr. Benjamin Horne, who led the study. "This is important because the fewer fat cells a body has, the less likely it will experience insulin resistance or diabetes."

Dr. Horne is director of cardiovascular and genetic epidemiology for Intermountain Healthcare, a health services and managed care firm in Salt Lake City, Utah. He believes that fasting could hold tremendous promise and may eventually be used to help people reduce their type 2 diabetes risk.

The findings ‒ presented at a meeting of the American College of Cardiology (ACC) 60th Annual Scientific Sessions in New Orleans earlier this week ‒ showed that participants had lower cholesterol levels, less body weight and healthier blood sugar levels. These benefits added up to a reduction in type 2 diabetes and heart disease risk.

The study confirms the scientists’ earlier study, published in a 2008 edition of The American Journal of Cardiology, which indicated fasting has positive effects on heart health. However, the new study adds to those findings, as it is the first to note an improvement in cholesterol levels after fasting. Additionally, the team showed an increase in human growth hormone levels, a protein that protects lean muscle, making fasting easier.

Potential Effects of Fasting on Coronary Artery Disease (CAD)
Patients involved in the recent study were presently undergoing angiography, an X-ray examination of a person’s blood vessels and the chambers of their heart, often used to help determine if a patient has coronary heart disease. Participants were asked if they regularly engaged in fasting. Then, results of each angiography were compared to how individuals answered the fasting question.

A key factor in the study was the fact that approximately 90 percent of the participants were Mormons. Because of this, doctors expected to find a large number of patients who did regularly fast, as their faith encourages them to fast one day each month.

After reviewing the data of more than 200 participants, researchers found that those who did fast regularly had a 58 percent lower risk of coronary disease, as compared to those who stated they did not fast. However, the Mormon faith also insists that followers abstain from alcohol, smoking and caffeine, as well—all known to affect heart health. But, Horne believes that these recent findings affirm the 2008 study.

“The first study we did was not a chance finding,’’ said Dr. Horne, reported The New York Times. “We were able to replicate the findings and show that people who fast routinely have a lower prevalence of coronary disease.’’

In the 2008 study, the potential effects of fasting on coronary artery disease were studied by the group of Utah scientists. After making adjustments for a variety of factors, specifically noting various lifestyle requirements made by the Mormon faith, scientists concluded, “not only proscription of tobacco, but also routine periodic fasting was associated with lower risk of CAD.”

The state of Utah consistently has some of the lowest rates of heart disease in the U.S., and until now many believed it was because the Church of Jesus Christ of Latter Day Saints ‒ the official name of the Mormon Church ‒ teaches its disciples not to smoke.

“The common wisdom has been that nonsmoking has protected Utahans from cardiac disease, but as smoking rates dropped across the country, Utah’s heart disease rate was still the lowest,” he points out. Horne’s preliminary research suggested it could be the fasting that promotes the health benefits, and the new study substantiates that work.

The recent study did not request information specific to individuals’ fasting practices, such as the type or duration. However, scientists indicate that the most common practice among participants as suggested by interview discussions was a monthly ritual of abstaining from everything but water for a full 24 hours.

During their research, the scientists were able to determine that levels ofhuman growth hormone increased dramatically after the fasting period, as much as 20 times in men and 13 times in women. This hormone is known to be released during periods of starvation, to trigger the burning of fat stores and protect lean muscle mass.

“There is a lot more to be done to fill in the research on the biological mechanism,’’ Dr. Horne said, the NYT reported. “But what it does suggest is that fasting is not a marker for other healthy lifestyle behaviors. It appears to be that fasting is causing some major stress, and the body responds to that by some protective mechanisms that potentially have a beneficial long-term effect on risk of chronic disease.”

While the study showed promising results, Horne said that it may be too early to recommend this regimen to patients who are at risk of developing type 2 diabetes or heart disease. The study of the biological effects of fasting is still relatively new and all of its consequences may not be entirely clear.

Blood Fat Levels Measured During Fasts
In a companion study presented at the same meeting, the team looked at blood markers for heart risks among people who had not previously fasted over 12 hours. The blood markers were checked when they fasted and during a normal eating day. The fast was a water-only fast, and participants were allowed to take any necessary medication.

The participants’ HDL "good" cholesterol rose during the fast. Their LDL “bad” cholesterol levels and their total cholesterol levels also increased, which is not considered favorable. During the fast, participants also saw reductions in levels of dangerous blood fats called triglycerides and blood sugar or glucose levels. “Your body goes into self-protection mode to preserve the integrity of cells and tissue until food starts coming in again, so it uses fats instead of glucose for fuel,” Horne says.

The increase in total cholesterol may just be transient. “It appears that the total cholesterol has gone up because the liver is not processing as much cholesterol and instead it is being dumped into the bloodstream to be used as fuel,” he says, adding, “We need to answer a lot of questions to be able to connect all these dots. We know from our tests that these patients had a lower prevalence of diabetes and coronary disease and now we are backing up to see the mechanism.”

Do Juice Fasts Count?
Many so-called “fasts” ‒ such as "juice" fasts ‒ are widely promoted on the Internet. Comparing the water-only fasts to these juice fasts is apples to oranges, Horne says. “These juice fasts and cleanses could have a similar effect to caloric restriction. In animal studies, reducing the amount of daily calories by 40% to 50% has a benefit on your heart, but it is not as strong of a benefit as [water-only] fasting.”

“Fasting is not a quick fix, it’s a long-term lifestyle that you integrate into your normal life and do it for the duration,” says Horne, who says he fasts once a month, adding, fasting is not for everyone. “There are some dangers for people that are at high risk for other conditions, women who are pregnant or lactating, and young children.”

Other Views
Howard Weintraub, MD, clinical director of the Center for the Prevention of Cardiovascular Disease at NYU Langone Medical Center in New York City, says that the findings of elevated LDL and total cholesterol in the face of reduced heart and diabetes risk warrant further investigation. “We need a lot more information about this,” he says.

The new study “tells us that we eat too much and we don’t need to eat quite so much,” he says. But “before I start advising my patients to fast, I need to see more information as to the other attributes of these study participants.”

One of the dangers of an occasional fast is that it may be followed by a binge that negates all of the potential health benefits. “It’s like having Diet Coke so you can have a cheeseburger,” he says. Or saying, “If I don't eat on Monday, no one will yell at me when I eat like a pig on Tuesday and Wednesday,” Weintraub points out.

Suzanne Steinbaum, MD, director of women and heart disease at Lenox Hill Hospital in New York City, says you don’t need to fast to see beneficial changes in your heart disease risk factors. “If you don’t eat bad foods, your profiles are better in terms of weight and blood pressure, and your triglycerides go down, and your blood sugar goes down. Anything in the extreme is not the way to go. It’s how you eat on a daily basis that matters. I don’t recommend fasting, but I do recommend getting rid of unhealthy foods in your diet as fast as you can.”

Echoing the sentiment, nutritionist Dr Emma Williams said, “I wouldn’t be in a hurry to commence fasting, as the precise nature by which the body reacts to it remains relatively unknown.”

Diabetes: Vegetarians Better Off Than Non-Vegetarians On All Counts Including Blood Sugar, Blood Pressure, Waist Size, BMI & Blood Fats

People who follow a vegetarian or meat-free diet may be at a lower risk of developing diabetes and heart disease, a new study suggests. The study of lifestyle habits of more than 700 adults showed researchers that 23 out of every 100 vegetarians have at least three metabolic syndrome factors, compared with 39 out of every 100 non-vegetarians and 37 out of every 100 semi-vegetarians.

The researchers measured a suite of factors ‒ blood sugar, blood fats, blood pressure, waist size, and body mass ‒ that when elevated add up to "metabolic syndrome," and found that vegetarians were lower than non-vegetarians on all counts except cholesterol.

Metabolic syndrome is a combination of health disorders that increase the risk of developing coronary artery disease, stroke, and diabetes. The risk factors include conditions like abdominal obesity, blood fat disorders, elevated blood pressure, insulin resistance or glucose intolerance.

Vegetarianism excludes high-calorie foods and animal products laden with saturated fats. It instead concentrates on foods that give necessary minerals and vitamins that help give diabetics a better chance of blood glucose control. These include whole grains, legumes, fruits and vegetables.

The Vegetarian Pyramid

Vegetarian diets are rich in fiber, which has numerous benefits. When a diabetic eats a fiber-rich meal, the desire for further food disappears. Fiber also plays a protective role for pre-diabetics, and can lead to lower daily requirements of insulin amongst type 1 diabetics.

Fiber is well known as being important in the improving blood sugar control, lowering cholesterol levels and providing folate, thereby reducing the risk of complications like heart disease. Considerable research is available as evidence for the role of fiber in diabetes.

Research has shown vegetarian diets promote a healthy weight since they are often lower in calories than non-vegetarian diets. They also improve blood sugar control and insulin response since eating vegetables, fruits, whole grains, legumes and nuts — features of a vegetarian diet — can improve blood sugar control and make your body more responsive to insulin. Most importantly, a vegetarian diet reduces the risk of cardiovascular disease since it is cholesterol-free, low in saturated fat and usually high in soluble fiber.

The new study ‒ published in the journal Diabetes Care ‒ has confirmed that vegetarians are lower than non-vegetarians on all counts including blood sugar, blood pressure, waist size, body mass index (BMI), and blood fats except cholesterol.

The findings show the vegetarians' average BMI of 25.7 was four points lower than that of non-vegetarians, who, on average, had BMIs close to 30. However, semi-vegetarians fell in the middle. A BMI greater than 25 is considered overweight, and greater than 30 is considered obese. Moreover, the findings suggested that while vegetarians, on average, were 3 years older than the meat-eaters, they were in better shape and health status.

"I was expecting there should be a difference….but I didn't expect that it would be that much," lead researcher Nico Rizzo of Loma Linda University was quoted by Reuters as saying, adding he was not sure what's behind the differences and wondered whether it was primarily the meat intake, the plant food intake or a combination of both.

It's possible that diet is not the cause because the research showed only an association between food choices and health factors, not cause-and-effect. High BMI, for instance, one of the traits that make up the metabolic syndrome profile, itself contributes to high blood pressure, and indirectly, blood sugar, and thereby potentially raising a person's risk of heart disease and diabetes.

One of the shortcomings of the study is that the researchers didn't study the reasons behind the differences between vegetarians and non-vegetarians even though the scientists suggest it may be caused by the meat intake, eating the plant food or a combination of both. The researchers also did not follow the subjects over the long term to see whether those who abstained from meat actually had lower rates of diabetes or heart disease.

The data for this research, which was funded by the National Institutes of Health, came from the Adventist Health Study 2, a long term study of Seventh Day Adventists. This Christian religious group has considerably more vegetarians than the general population.

In this study, 35 percent of the subjects did not eat meat, whereas only about five percent of all Americans are vegetarian. One of the differences Rizzo discovered between the groups was age. Vegetarians, on average, were 3 years older than the meat-eaters. "Even though they're older, they're in better shape," Rizzo said. "That's something I found quite interesting."

IDF Endorses Early Bariatric Surgery

Return on Investment Make Gastric Bypass Cost-Effective, Claims Position Statement Issued at 2nd World Congress on Interventional Therapies for Type 2 Diabetes

The International Diabetes Federation (IDF) has issued a "radical statement" at an international conference today saying gastric banding and similar surgeries should no longer be a last resort for severely obese people with type 2 diabetes, it is recommending that surgery be considered at a much earlier stage.

"The statement highlights that there is increasing evidence that the health of obese people with type 2 diabetes, including their glucose control and other obesity related comorbidities (conditions), can benefit substantially from bariatric surgery under certain circumstances," says the IDF press release.

The IDF says gastric banding and other surgeries to alter stomach anatomy should now be considered much earlier in the treatment of type 2 diabetes.
Gastric bypass surgery works by reducing the size of the stomach so a person can't eat as much and shortening the length of the intestine so that the body doesn't absorb too many calories. But it might also have the side effect of normalizing blood sugar.

Summary of the 39-Page Statement

• Obesity and type 2 diabetes are serious chronic diseases associated with complex metabolic dysfunctions that increase the risk for morbidity and mortality.
• The dramatic rise in the prevalence of obesity and diabetes has become a major global public health issue and demands urgent attention from governments, health care systems and the medical community.
• Continuing population-based efforts are essential to prevent the onset of obesity and type 2 diabetes. At the same time, effective treatment must also be available for people who have developed type 2 diabetes
• Faced with the escalating global diabetes crisis, health care providers require as potent an armamentarium of therapeutic interventions as possible.
• In addition to behavioral and medical approaches, various types of surgery on the gastrointestinal tract, originally developed to treat morbid obesity (“bariatric surgery”), constitute powerful options to ameliorate diabetes in severely obese patients, often normalizing blood glucose levels, reducing or avoiding the need for medications and providing a potentially cost-effective approach to treating the disease.
• Bariatric surgery is an appropriate treatment for people with type 2 diabetes and obesity not achieving recommended treatment targets with medical therapies, especially when there are other major co-morbidities.
• Surgery should be an accepted option in people who have type 2 diabetes and a BMI of 35 or more
• Surgery should be considered as an alternative treatment option in patients with a BMI between 30 and 35 when diabetes cannot be adequately controlled by optimal medical regimen, especially in the presence of other major cardiovascular disease risk factors.2
• In Asian, and some other ethnicities of increased risk, BMI action points may be reduced by 2.5 kg/m
• Clinically severe obesity is a complex and chronic medical condition. Societal prejudices about severe obesity, which also exist within the health care system, should not act as a barrier to the provision of clinically effective and cost-effective treatment options.
• Strategies to prioritize access to surgery may be required to ensure that the procedures are available to those most likely to benefit.
• Available evidence indicates that bariatric surgery for obese patients with type 2 diabetes is cost-effective.
• Bariatric surgery for type 2 diabetes must be performed within accepted international and national guidelines. This requires appropriate assessment for the procedure and comprehensive and ongoing multidisciplinary care, patient education, follow-up and clinical audit, as well as safe and effective surgical procedures. National guidelines for bariatric surgery in people with type 2 diabetes and a BMI of 35 or more need to be developed and promulgated.
• The morbidity and mortality associated with bariatric surgery is generally low, and similar to that of well-accepted procedures such as elective gall bladder or gall stone surgery.
• Bariatric surgery in severely obese patients with type 2 diabetes has a range of health benefits, including a reduction in all-cause mortality.
• A national registry of persons who have undergone bariatric surgery should be established in order to ensure quality patient care and to monitor both short and long-term outcomes. 1.17 In order to optimize the future use of bariatric surgery as a therapeutic modality for type 2 diabetes further research is required.

Although such operations cost anywhere from $20,000 to $30,000, they will reduce healthcare expenditures in the long run, according to a new IDF position paper on the subject. The surgery, the IDF explains, often normalizes blood glucose levels and reduces or avoids the need for medication.

In addition, curbing diabetes can stave off costly complications such as blindness, limb amputations, and dialysis, says Francesco Rubino, MD, director of the IDF's 2nd World Congress on Interventional Therapies for Type 2 Diabetes.

"When we talk about whether we can afford bariatric surgery, we have to ask what will be the cost if we don't treat the patient. Studies have shown the surgery to be cost-effective. So there is a return on investment," says Francesco Rubino, MD, director of the IDF's 2nd World Congress on Interventional Therapies for Type 2 Diabetes

The IDF puts the lifetime cost of diabetes in the United States at $172,000 for a person diagnosed at age 50 years and $305,000 at age 30 years. More than 60% of this amount is incurred in the first 10 years after diagnosis.

The new recommended indications for performing bariatric surgery on patients who are both diabetic and obese match those announced last month by the US Food and Drug Administration for expanded use of the Lap-Band Adjustable Gastric Banding System (Allergan) to treat obesity.

The IDF recommendations dovetail with Dr Rubino’s previous research on how bariatric surgery alleviates diabetes. He showed that the effect on diabetes is not entirely explained by a person’s weight loss. In fact, the gastrointestinal tract serves as an endocrine organ and a key player in the regulation of insulin secretion, body weight and appetite, which is why altering the GI tract has such profound metabolic effects.

However, the use of bariatric surgery to treat diabetes has sparked controversy in healthcare circles. Critics question the wisdom of wielding a scalpel to solve a medical problem, especially when clinicians have more drugs at their disposal to deal with diabetes.

A study published online last week in the Archives of Surgery has raised doubts about the efficacy of LAGB. Researchers following 151 patients who underwent LAGB for obesity concluded that the procedure yielded "relatively poor long-term outcomes," with nearly half the patients needing their bands removed and 60% overall requiring some kind of reoperation. The authors, who performed the surgeries in question during the mid-1990s, added a caveat: they had used an older dissection technique.

Indeed, the biggest danger is that new weight-loss options likeEndoBarrier (developed in the UK), Lap-Band, Roux-en-Y gastric bypass and sleeve gastrectomy surgery have the potential to encourage overweight people to abandon traditional diet and exercise for procedures that carry some serious risks. That should be a big worry for all diabetes educators and activists.

Diabetic Diet: Is Determining Glycemic Load Better Than Counting Carbs?

To count carbs or discount them ‒ the debate continues. Being type 2 insulin dependent, I’m trying to make sense of the differing conclusions of two studies that have been published recently. It’s hard to say what these studies really show ‒ it can get confusing with all the information out there ‒ especially when pilaf (pilao) is on Sunday’s lunch menu!

Dr. Andrea Laurenzi of San Raffaele Vita-Salute University in Milan suggests that diabetes patients may benefit from counting the number of carbohydrates in their diet. In a small study ‒ published online in the America Diabetes Association journal Diabetes Care ‒ the Milan researchers looked at 61 adults on insulin pump therapy and found that those who learned to count carbs had a small reduction in weight and waist size after 6 months. Additionally, they reported gains in quality of life and an improvement in blood sugar levels.

On the other hand, Jiansong Bao at the University of Sydney in Australia, says the number of carbs alone might not be the best way to go. Writing in the American Journal of Clinical Nutrition, he feels that how many carbs you eat might be less important for your blood sugar than your food's glycemic load, a measure that also takes into account how quickly you absorb those carbs.

Dr. Sanjeev Mehta, of the Joslin Diabetes Center and Harvard Medical School in Boston says while Laurenzi’s findings do not prove that carb counting is the answer for people with type 1 diabetes, it is widely recommended that people on insulin try to estimate the carbohydrate content of their meals to help calculate their insulin doses. Indeed, a few other studies too have suggested that carbohydrate counting can help people with type 1 diabetes control their blood sugar levels.

There are books and online resources available for people who are interested in learning how to count carbs. However, some people have difficulty learning or sticking with the method, Mehta noted, and benefit from help from a professional, such as a dietitian or certified diabetes educator.

Mayo Clinic nutritionist Katherine Zeratsky, R.D., L.D. explains counting carbohydrates is a method for controlling the amount of carbohydrates you eat at meals and snacks. This is because they have the greatest impact on your blood sugar. Eating consistent amounts of carbohydrates every day helps you control your blood glucose level.

But carbohydrates aren't the only dietary consideration when you have diabetes. You need to also limit fat and cholesterol and control the number of calories you consume. The best way to do this is to control portion sizes, she says.

“Eating a healthy diet helps you control your diabetes and reduces your risk of diabetes-related conditions, such as heart disease and stroke. So, just because a food contains no carbohydrates doesn't mean that you can eat it in unlimited amounts,” she cautions.

However, Bao claims the so-called glycemic load of a food, which also takes into account how quickly it makes the blood sugar rise, might work better. Foods with soluble fiber, such as apples and rolled oats, typically have a low glycemic index, one of the contributors to glycemic load. Foods with a low glycemic index cause the blood sugar to rise slowly, and so put little pressure on the pancreas to produce insulin.

The glycemic load is calculated by multiplying the amount of carbs in grams per serving by the food's glycemic index divided by 100. (The glycemic index for a variety of foods can be found here.)

The Sydney researchers say their findings also suggest that eating foods with high glycemic loads could be linked to chronic disease like type 2 diabetes ‒ which does not require insulin injections ‒ and heart disease by raising blood sugar and insulin levels.

The researchers took finger-prick blood samples from 10 healthy young people who ate a total of 120 different types of food ‒ all with the same calorie content. They also had two groups of volunteers eat meals with various staples from the Western diet, such as cereal, bread, eggs and steak. And the glycemic load repeatedly trumped the carb count in predicting the blood sugar and insulin rise after a meal.

A Reuters report quotes Dr. Edward J. Boyko ‒ a diabetes expert at the University of Washington in Seattle who wasn't involved in the Sydney study ‒ saying it wasn't certain the findings would hold up in people who aren't completely healthy, adding, long-term effects and other nutrients in the food might also be important for disease risk.

"It would just be speculation whether a dietary change like this would help people with type 2 diabetes." The most important problem, Boyko points out, remains pure and simple overeating. "The excess weight is the main thing we ought to focus on…The simplest message would be, eat less."

Diabetes: The Omega-3 Files Revisited

Doctors have long recognized that the unsaturated fats in fish, called omega-3 fatty acids, appear to reduce the risk of dying of heart disease. For many years, the American Heart Association has recommended that people eat fish rich in omega-3 fatty acids at least twice a week.

Now, a Fred Hutchinson Cancer Research Center study on Yup’ik Eskimos living in the remote Yukon Kuskokwim Delta region of southwest Alaska who eat a large amount of fatty fish has again confirmed that a diet high in omega-3 fats may help prevent obesity-related diseases, including diabetes. (See my earlier post 'Omega-3s May Fight Diabetic Retinopathy')

Yup’ik Eskimos have a prevalence of type 2 diabetes of 3.3 percent, versus 7.7 percent in the U.S. overall, even though the Yup’ik Eskimos have overweight/obesity levels similar to the rest of the U.S. (See an earlier CANHR study ‘Metabolic Syndrome in Yup'ik Eskimos’ here.)

Residents of Yup’ik villages joined this research because they were interested in their communities’ health and were particularly concerned about the health effects of moving away from their traditional ways and adopting lifestyle patterns similar to those of residents in the lower 48 states.

Hutchinson researchers working with the Center for Alaska Native Health Research at the University of Alaska-Fairbanks on the study ‒ published online this week in the European Journal of Clinical Nutrition ‒ found the Yup’ik consume 20 times the overall U.S. average of fish and other marine foods, boosting their intake of omega-3 fats. Because of all that fish consumption, this population does not have some of the risk factors normally associated with obesity.

The fats the researchers were interested in measuring were those found in salmon, sardines and other fatty fish: docosahexaenoic acid, or DHA, and eicosapentaenoic acid, or EPA.

“Because Yup’ik Eskimos have a traditional diet that includes large amounts of fatty fish and have a prevalence of overweight or obesity that is similar to that of the general U.S. population, this offered a unique opportunity to study whether omega-3 fats change the association between obesity and chronic disease risk,” said lead author Zeina Makhoul, a postdoctoral researcher in the Cancer Prevention Program of the Hutchinson Center’s Public Health Sciences Division, in a press release.

She said that in the 330 Yup’ik Eskimos (total population 24,000 according to the 2000 U.S. Census) who were studied, 70 percent of whom were obese or overweight, high intakes of omega-3-rich seafood seemed to protect them from some of the harmful effects of obesity. The median age of the participants was 45 and slightly more than half were female. The women were more likely than the men to be heavy, and body mass index (height-to-weight ratio) for all increased with age.

“Interestingly, we found that obese persons with high blood levels of omega-3 fats had triglyceride (a blood lipid abnormality) and CRP (a measure of overall body inflammation) concentrations that did not differ from those of normal-weight persons,” Makhoul said. “It appeared that high intakes of omega-3-rich seafood protected Yup’ik Eskimos from some of the harmful effects of obesity.” High levels of triglycerides and CRP increase the risk of heart disease and, perhaps, diabetes.

“These results mimic those found in populations living in the Lower 48 who have similarly low blood levels of EPA and DHA,” said senior author Alan Kristal, Dr. P.H., a member of the Hutchinson Center’s Public Health Sciences Division. “However, the new finding was that obesity did not increase these risk factors among study participants with high blood levels of omega-3 fats,” he said.

“While genetic, lifestyle and dietary factors may account for this difference,” Makhoul said, “it is reasonable to ask, based on our findings, whether the lower prevalence of diabetes in this population might be attributed, at least in part, to their high consumption of omega-3-rich fish.”

So does that mean you should you load up on fish oil supplements? Not so fast, Makhoul cautions, as more studies need to be done to find out if there's something else going on with the Yup'iks. "They have a pretty unique lifestyle and of course genetics could play a role," she points out.

Nonetheless, it's still a good idea to follow the American Heart Association recommendations and include more fish in your diet, at least two servings a week. Fish contain unsaturated fatty acids, which, when substituted for saturated fatty acids such as those in meat, may lower your cholesterol. Omega-3 fatty acids are a type of unsaturated fatty acid that's thought to reduce inflammation throughout the body.

Inflammation in the body can damage your blood vessels and lead to heart disease. And as the Hutchinson study shows, Omega-3 fatty acids decrease triglycerides. Besides, Omega-3s also lower blood pressure, reduce blood clotting, boost immunity and improve arthritis symptoms, and in children may improve learning ability.

Fatty fish, such as salmon, herring and to a lesser extent tuna, contain the most omega-3 fatty acids and therefore the most benefit, but many types of seafood contain small amounts of omega-3 fatty acids. Most freshwater fish have less omega-3 fatty acids than do fatty saltwater fish though some varieties of freshwater trout have relatively high levels of omega-3 fatty acids.

But many people are still concerned about mercury or other contaminants in fish. However, when it comes to a healthier heart, the benefits of eating fish usually outweigh the possible risks of exposure to contaminants. The main types of toxins in fish are mercury, dioxins and polychlorinated biphenyls (PCBs) and depend on the type of fish and where it's caught. And the risk of getting too much mercury or other contaminants from fish is generally outweighed by the health benefits that omega-3 fatty acids have, say researchers at the Mayo Clinic.

Anyway, not all fish are rich in Omega-3. The main beneficial nutrient appears to be omega-3 fatty acids in fatty fish. Some fish, such as tilapia and catfish, don't appear to be as heart healthy because they contain higher levels of unhealthy fatty acids. Also, some researchers are concerned about eating fish produced on farms as opposed to wild-caught fish. Researchers think antibiotics, pesticides and other chemicals used in raising farmed fish may have harmful effects to people who eat the fish.

Five of the most commonly eaten fish or shellfish that are low in mercury are shrimp, canned light tuna, salmon, pollock, and catfish. Avoid eating shark, swordfish, king Mackerel, or tilefish because they contain high levels of mercury. Check out Fish 101 for amounts of omega-3 fatty acids and mercury levels for the top 10 fish and shellfish in the United States. Also check out frequently asked questions by consumers.

But remember, any fish can be unhealthy depending on how it's prepared. For example, broiling or baking fish is a healthier option than is deep-frying. Choose low-sodium, low-fat seasonings such as spices, herbs, lemon juice and other flavorings in cooking and at the table.

Don’t like fish? Other non-fish food options that contain some omega-3 fatty acids include flaxseed, flaxseed oil, walnuts, canola oil, soybeans and soybean oil. However, similar to supplements, the evidence of heart-healthy benefits from eating these foods isn't as strong as it is from eating fish.

NIH Unveils 10-Year New Strategic Plan to Combat Diabetes

A new strategic plan to guide diabetes-related research over the next decade was announced today by the National Institutes of Health. The plan, developed by a federal work group led by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), identifies research opportunities with the greatest potential to benefit the millions of Americans, and ultimately nearly 250 million people worldwide, who are living with or at risk for diabetes and its complications.

"By setting priorities and identifying the most compelling research opportunities, the strategic plan will guide NIH, other federal agencies and the investigative community in efforts to improve diabetes treatments and identify ways to keep more people healthy," said NIDDK Director Griffin P. Rodgers, M.D. in a press release.

The promise of prevention, treatment, and cure for diabetes can only be realized through the vigorous support of scientific research. This research must be conducted through a multi-pronged effort that addresses the complex challenges posed by diabetes, from dysfunctions in the most fundamental molecular and cellular processes, to the need for new approaches to translate scientific findings into improved health for patients, the release states.

The purpose of this research plan - Advances and Emerging Opportunities in Diabetes Research: A Strategic Planning Report of the Diabetes Mellitus Interagency Coordinating Committee (DMICC) - is to serve as a scientific guidepost, identifying compelling opportunities for research on diabetes and its complications over the next decade.

The goal is to accelerate the discovery of: the relationship between obesity and type 2 diabetes, and how both conditions may be affected by genetics and the environment, the autoimmune mechanisms at work in type 1 diabetes, the biology of beta cells, which release insulin in the pancreas, development of artificial pancreas technologies to improve management of blood sugar levels, prevention of complications of diabetes that affect the heart, eyes, kidneys, nervous system, and other organs and the reduction of the impact of diabetes on groups disproportionately affected by diabetes including the elderly and racial and ethnic minorities.

The plan focuses on 10 areas of diabetes research with the most promise. The goal is to accelerate discovery on several fronts, including:
the relationship between obesity and type 2 diabetes, and how both conditions may be affected by genetics and environment
the autoimmune mechanisms at work in type 1 diabetes
the biology of beta cells, which release insulin in the pancreas
development of artificial pancreas technologies to improve management of blood sugar levels
prevention of complications of diabetes that affect the heart, eyes, kidneys, nervous system and other organs
reduction of the impact of diabetes on groups disproportionately affected by the disease, including the elderly and racial and ethnic minorities

Under the plan, NIH will continue to emphasize clinical research in humans, which already has led to highly effective methods for managing diabetes and preventing complications, Rodgers said.

The NIH strategy for fighting diabetes addresses type 1 and type 2 diabetes. Type 1 diabetes, which affects about 5 percent of individuals with diagnosed diabetes, is an autoimmune disease that most often develops during childhood. Type 2 diabetes accounts for 90 to 95 percent of diagnosed diabetes cases in the United States, and is strongly associated with overweight and obesity.

In addition, the plan addresses gestational diabetes, a condition that some women develop during pregnancy, but which usually goes away after their child is born. Women who develop gestational diabetes during pregnancy are at increased risk for developing type 2 diabetes, and the child of that pregnancy may also be at increased risk for obesity and type 2 diabetes.

The NIDDK plans to continue its emphasis on clinical trials in humans, "which already [have] led to highly effective methods for managing diabetes and preventing complications," Rodgers said.

Within each broad area, the strategic plan lists some specific areas of focus.

For instance, in the area of beta cell research, the plan includes five areas: integrated islet physiology, beta cell dysfunction and failure, prevention and treatment of diabetes through restoration and preservation of beta cell function, cellular replacement therapies, and imaging the pancreatic islet.

Obesity is another focus of the plan because of its status as a major risk factor for diabetes.

Areas of interest in obesity include:

Obesity, inflammation, insulin resistance, and macrophage function: "Macrophages and inflammation appear to be activated by excess nutrients and subsequently play a role in eliciting insulin resistance as a consequence of obesity," the report authors noted. "Research is needed to clarify the mechanisms and outcomes of tissue-specific inflammation in obesity."

Mechanisms underlying energy homeostasis: "Untangling the complex networks of hormonal and neural mechanisms that control energy balance in the body could point to new therapeutic targets to prevent or treat obesity," according to the report.

Central nervous system control of thermogenesis: "New technologies are needed to facilitate study of the complex control of energy expenditure and how it contributes to weight maintenance and obesity in people," the authors wrote.

Discovering genetic and intrauterine determinants of obesity susceptibility that predispose people to developing diabetes.

Adipose tissue biology: "Adipose tissue research is key to the development of treatments for obesity and type 2 diabetes," the authors noted. "Understanding the mechanisms that regulate fat cell number, size, distribution, and signaling, and developing new technologies for studying adipose tissues are urgent research goals."

Obesity prevention and treatment: "Behavioral strategies are needed to prevent inappropriate weight gain and promote or maintain weight loss in individuals across the lifespan, as well as in communities or large populations," the authors wrote. "The development and testing of such strategies would be supported by research on the nonbiological determinants of obesity and obesity prevention and the use of technologies to tailor the delivery of interventions to individuals."

Currently, about 1 in 10 adults in the United States has diabetes, according to the Centers for Disease Control and Prevention. About 1.9 million Americans aged 20 years or older were newly diagnosed with diabetes in 2010. In addition, an estimated 79 million American adults have pre-diabetes, a condition in which blood sugar levels are higher than normal but not high enough to be diagnosed as diabetes.

By 2050, as many as 1 in 3 adults could be diagnosed with diabetes if current trends continue, according to the CDC.

The projection assumes that recent increases in new cases of diabetes will continue and people with diabetes will also live longer, which adds to the total number of people with the disease.

Diabetes eventually damages nearly every organ system in the body. People with diabetes are at increased risk for blindness, kidney failure, and lower limb amputation. Overall, the risk for death among people with diabetes is about twice that of people of similar age without diabetes.

In addition, it is a very expensive disease to manage. Total costs of diabetes, including medical care, disability, and premature death, reached an estimated $174 billion in 2007 in the United States.

The plan was developed by the Diabetes Mellitus Interagency Coordinating Committee (DMICC), a congressionally authorized workgroup chaired by the NIDDK. Established in 1974, the DMICC facilitates cooperation, communication, and collaboration on diabetes research across the federal government.

Key elements of the report were identified by multiple public and private stakeholders, including representatives of DMICC member agencies, health advocacy groups and external scientists who are leaders in the diabetes research field.

To ensure broad input, a draft of the strategic plan was also posted for public comment prior to publication. The strategic plan is available electronically here. Printed copies can be requested from the National Diabetes Information Clearinghouse beginning April 1, 2011, at 1-800-860-8747 and by email at ndic@info.niddk.nih.gov. Single copies are free.

Confirmed: Fatty Liver Ups Type 2 Diabetes Risk

If you get diagnosed with a fatty liver during a routine check-up, sit up and take notice. Fat deposits in liver are an invitation to diabetes. Although fatty liver and insulin resistance are known to be associated, the relationship between the two in the development of type 2 diabetes mellitus (T2DM) is unclear.

However, a recent study published in The Endocrine Society's Journal of Clinical Endocrinology and Metabolism (JCEM) found that individuals with fatty liver were five times more likely to develop type 2 diabetes than those without fatty liver.

This higher risk seemed to occur regardless of the patient's fasting insulin levels, which were used as a marker of insulin resistance. People who consume more oily food, have a sedentary lifestyle, especially those who consume large quantities of alcohol, are at risk of getting the disease.

In recent years, fatty liver has become more appreciated as a sign of obesity and resistance to insulin, a hormone that controls the body's glucose levels. This new study ‒ 'Interrelationship between Fatty Liver and Insulin Resistance in the Development of Type 2 Diabetes' by Ki-Chul Sung and Sun H. Kim of Kangbuk Samsung Hospital, Sungkyunkwan University at Seoul, South Korea ‒ shows that fatty liver may be more than an indicator of obesity but may actually have an independent role in the development of type 2 diabetes.

There seems to be little awareness about the disease even among the physicians. “It is not as innocuous as it looks. It is known to develop into liver failure or liver cancer. Recent studies have shown that fatty liver also increased chances of diabetes,” says Dr Mishra, who is chairman of the Fortis-CDOC Centre for Excellence for Diabetes at New Delhi in India.

According to Kim, "Many patients and practitioners view fat in the liver as just 'fat in the liver,' but we believe that a diagnosis of fatty liver should raise an alarm for impending type 2 diabetes…Our study shows that fatty liver, as diagnosed by ultrasound, strongly predicts the development of type 2 diabetes regardless of insulin concentration."

In the Seoul study, researchers examined 11,091 Koreans who had a medical evaluation including fasting insulin concentration and abdominal ultrasound at baseline and had a follow-up after five years.

Regardless of baseline insulin concentration, individuals with fatty liver had significantly more metabolic abnormalities including higher glucose and triglyceride concentration and lower high-density lipoprotein cholesterol (sometimes called "good cholesterol") concentration.

Individuals with fatty liver also had a significantly increased risk for type 2 diabetes compare to those without fatty liver.

"Our study shows in a large population of relatively healthy individuals that identifying fatty liver by ultrasound predicts the development of type 2 diabetes in five years," said Kim. "In addition, our findings reveal a complex relationship between baseline fatty liver and fasting insulin concentration."

Also see my earlier report “Fatty Liver a Forerunner to Diabetes”

Lap-Band & Bypass Surgery Find Match in EndoBarrier

The cacophony surrounding the news that a pair of studies has found that a different, older procedure ‒ the Roux-en-Y gastric bypass procedure - is "more effective" and "no riskier" than either the Lap-Band or the “less-drastic” (sic) sleeve gastrectomy surgery, has drowned out a news of a new British implant devise that helps weight loss and lowers blood sugar levels.

It has been reported that surgeons at a British hospital have pioneered a new treatment that could remove the need for medication to treat type 2 diabetes while helping sufferers lose weight.

Medics at Southampton General Hospital have performed the first 15 implants of a new device called the EndoBarrier.

The EndoBarrier is implanted under a short general anaesthetic and performed as a day case procedure, with all 15 patients participating in the trial discharged home within hours of completion.


Use of the EndoBarrier means that food bypasses a part of the upper intestine, so the body has less time to digest it, and also allows more control over metabolic rate and potentially lower blood sugar levels. It was shown the device could achieve weight loss of over 20 per cent of total body weight.

The sleeve is also performing as well so far as the more invasive gastric band procedure in helping weight loss.

In a 12-month study, patients fitted with the EndoBarrier achieved weight loss of more than 20% (on average 3.5 stone) of their total body weight. The sleeve is also performing as well so far as the more invasive gastric band procedure in helping weight loss.

Southampton University Hospitals NHS Trust is one of three centres in the UK participating in a study to evaluate the effectiveness of the device in patients who are overweight and suffer with type 2 diabetes. The other two are Trafford General Hospital in Manchester and St Mary's Hospital, London.

Consultant general surgeons Jamie Kelly and James Byrne at Southampton are the first to complete the initial part of the project and say they are pleased with the early findings.

"Initial results among the 15 patients who have had the EndoBarrier inserted have been really encouraging and we are very excited about the potential impact of this new treatment for patients. We are already seeing the benefit to our patients with reductions in the treatment required to manage diabetes as well as significant weight loss. The weight loss so far is tracking as well as we typically see achieved with the more invasive gastric band procedure,' Bryne explained.

Kelly added: "The procedures performed in this initial study were performed on NHS patients and further evidence of the effectiveness of this treatment will hopefully ensure it will be offered to NHS patients in the future." At present EndoBarrier is available only to private paying paients.

Anyway, the biggest danger is that new weight-loss options like EndoBarrier, Lap-Band, Roux-en-Y gastric bypass and sleeve gastrectomy surgery have the potential to encourage overweight people to abandon traditional diet and exercise for procedures that carry some serious risks. That should be a big worry for all diabetes educators and activists.

How Tiny Nauru Became World's Fattest Nation

The world is facing a "population emergency" as soaring rates of obesity threaten a pandemic ofcardiovascular disease, scientists have warned.

The spread of Western fast food was blamed as the tiny Pacific nation of Nauru was named as the fattest in the world. Its average Body Mass Index is between 34 and 35, 70 per cent higher than in some countries in South-east Asia and sub-Saharan Africa.

More than one in 10 of the world's population is obese – more than half a billion adults – and rates have doubled since 1980. The biggest increases are in the richer nations but almost every country has seen rates rise.

Only Bangladesh, the Democratic Republic of Congo and a few countries in sub-Saharan Africa and east and south Asia have escaped the rise. Yet even in these regions neighbouring countries have had widely differeing experiences. The women of Southern Africa are among the fattest in the world.

The rise is being driven by increasing urbanisation, the growth of sedentary, office-based lifestyles and the substitution of Western-style fast foods for traditional diets. Researchers from Imperial CollegeLondon and McMaster University in Canada, writing in The Lancet, describe it as a "tsunami of obesity that will eventually affect all regions of the world".

In its wake comes an epidemic of heart disease and stroke, linked with high blood pressure and raised cholesterol levels. Remarkably, high-income countries such as the US and UK have managed to avoid this, by reducing blood pressure and cholesterol with drugs and dietary changes, such as reducing salt and fats. Smoking too, one of the key causes of heart disease, has fallen. (Japan is an exception where historically low cholesterol levels, associated with the nation's high consumption of fish, have risen to levels seen in western Europe, as the Japanese adopt a Western diet.)

But in middle and low-income countries the outlook is "dismal". "Considering all risk-factor trends together, the forecast for cardiovascular disease burden... comprises a population emergency that will cost tens of millions of preventable deaths, unless rapid and widespread actions are taken by governments and health care systems woldwide," the researchers say.

Treating the consequences of the obesity explosion with drugs will create an "unsustainable financial burden" in these countries and there is an "urgent need" to understand why unhealthy behaviours are adopted by both individuals and communities.

With an increasing trend towards globalisation and urbanisation, the problem is likely to get worse rather than better. "Ironically the economic growth of low-income and middle- income countries is now threated by the projected cardiovascular disease epidemic," they say.

Citing the noted British epidemiologist Geoffrey Rose, the authors say: "Mass disease and mass exposures require mass remedies. Mass remedies require the masses to be part of the solution."

The world obesity map
Fastest growing: US
The US saw the biggest rise in BMI of all developed nations between 1980 and 2008, more than 1kg a decade. Increasingly sedentary occupations, less walking and cycling, more driving in cars and rising consumption of fast foods and sugary drinks are behind the rise which affects all high-income countries.

Slimming down: Italy
Italy is the only high-income country in Europe where BMI declined - for women, from 25.2 to 24.8. Even among men, Italy saw one of the smallest increases. The classic Mediterranean diet - pasta, vegetables and fruit - is one of the healthiest in the world.

Fattening up: UK
The UK has the sixth highest BMI in Europe for women and the ninth highest for men (both around 27). The rate of increase has been second only to the US for men. One in four men and one in three women is overweight and about 12 million are obese.

South America's biggest: Chile
Chile with an average BMI of 27.0 for men and 27.9 for women, was the heaviest country in southern Latin America. The scale of increase in obesity in southern Latin America is second only to the US among men and ranks fifth among women. Rates of obesity soared in Chile with the end of its dictatorship in 1990 and a surge in fast food restaurants and some critics are now calling for a junk food tax to be imposed.

World's thinnest: Bangladesh
Bangladesh is the world's thinnest nation, with an average BMI of 20.5 for women and 20.4 for men. Rice is the staple diet and millions go without enough to eat. More than half of children - more than 9 million - are underweight and have stunted growth.

Fattest on earth: Nauru
Nauru is the world's fattest country, with an average BMI of 34 to 35. Located in the south Pacific it is the smallest island nation, with a population of less than 10,000. Obesity has grown as a result of the importation of Western foods paid for with proceeds from phosphate mining. The most popular dish is fried chicken and cola.

And here are the top ten overweight countries along with the percentages of their populations who are overweight: 

10. Kiribati - 73.6%
9. United States of America- 74.1%
8. Kuwait - 74.2%
7. Palau - 78.4%
6. Samoa - 80.4%
5. Niue - 81.7%
4. Tonga - 90.8%
3. Cook Islands - 90.9%
2. Federated States of Micronesia - 91.1%
1. Nauru - 94.5%

From The Independent

Type 2 Diabetes Epidemic in US Linked to Profit-Making Food Industry

According to the 2011 National Diabetes Fact Sheet released by the United States Centers for Disease Control (CDC) on January 26, last year saw an increase in the numbers of people with diabetes in virtually every age category.

The federal agency reports that some 25.8 million Americans, or 8.3 percent of the total population, have diabetes. Fully a third of these individuals do not know that they have the disease and are unaware of the serious risks it creates for their health. In a staggering indictment of the state of public health in the US, the CDC found that a further 79 million people in the country are prediabetic, meaning that their blood sugar levels are elevated, but not yet to the point where they meet the criteria for a full diabetes diagnosis.

Even these stark statistics likely under-report the real situation, with research showing that 35 percent to 40 percent of deceased diabetics did not have the disease listed anywhere on their death certificates.

Ninety percent of diabetics in the US have Type II diabetes, which, as the CDC report points out, is preventable. Once a diagnosis has been made, the severity of the complications can be dramatically reduced with timely and continuing care, including a careful combination of diet, exercise, often oral medication and, not infrequently, insulin administration.

However, what the CDC report fails to note is that such a high level of medical attention is widely unavailable to millions of Americans, who are unable to afford health insurance. With growing poverty, increasing numbers of people cannot buy nutritious food or the glucose test strips needed to monitor sugar levels. For families working multiple jobs and handling the stress of endless financial problems, adequate exercise is also often out of reach.

The rise in the incidence of Type 2 diabetes has come alongside a decline in the overall quality of nutrition in US society and a sharp growth in obesity. These processes are bound up with subordination of the food industry to the profit motive, a fact that has even garnered attention in the mainstream press. In May 2009, the news magazine Businessweek observed that “evidence is mounting that the obesity crisis is not the result of a lack of personal responsibility,” going on to note that “the processed food industry’s practices may be just as much, if not more, to blame.”

The omnipresence in the food industry of federally subsidized corn carbohydrates and dairy fats, coupled with advertising campaigns aimed at the most vulnerable segments of the population—the young and the working poor—have been cited in studies as chief reasons behind the enormous weight gains of the American people over the last 40 years.

At the 2009 European Congress on Obesity in Amsterdam, Dr. Boyd Swinburn of Deakin University in Melbourne, Australia, pointed out to Heartwire that the food industry has been targeting the most impressionable layers of society. “They’ve worked their marketing out to the nth degree,” he noted.

In 2009, Kelly D. Brownell from the Rudd Center for Food Policy and Obesity at Yale University and Kenneth E. Warner from the University of Michigan published an article entitled, “The Perils of Ignoring History: Big Tobacco Played Dirty and Millions Died. How Similar is Big Food?” The authors noted:

“To protect profits, the food industry must avoid perceptions that it is uncaring and insensitive, ignores public health, preys on children, intentionally manipulates addictive substances, and knowingly, even cynically, contributes to death, disability, and billions in health care costs every year. Stated another way, it cannot afford to look like tobacco.”

As Brownell and Warner point out, the food industry buys access to key associations, including the professional organization for US nutritionists, the American Dietetic Association. The Association regularly publishes “fact sheets” on nutritional advice for the public. The food industry pays $20,000 per sheet, which industry lobbyists then write for the association.

According to Brownell and Warner, the food industry’s strategy for deflecting attention from its practices for the poor state of nutrition in the US includes the following:

“Focus on personal responsibility as the cause of the nation’s unhealthy diet; raise fears that government action usurps personal freedom; vilify critics with totalitarian language, characterizing them as the food police, leaders of a nanny state, and even ‘food fascists,’ and accuse them of desiring to strip people of their civil liberties; criticize studies that hurt industry as ‘junk science’; emphasize physical activity over diet; state there are not good or bad foods, hence no food or food type (soft drinks, fast foods, etc.) should be targeted for change; plant doubts when concerns are raised about the industry.”

On the very day of the CDC’s 2011 Fact Sheet release, Robert Langreth of Forbes noted that sections of the pharmaceutical and health care industry were pleased with the latest report.

“What’s bad news for Americans is good news for companies that make diabetes treatments. One company that has ridden the obesity and diabetes epidemic like no other is the Danish company Novo Nordisk…. Other companies helped by the bad news include Merck (of the popular diabetic pill Januvia), Allergan (obesity surgery supplies), Orexigen Therapeutics (new obesity drug pending FDA approval).”