Diabetes: Wake Up and Smell the Coffee ‒ Caffeine Harms Your Health

PREMATURE attributions of cause and effect should not be used to justify recommendations in favor of coffee drinking as beneficial to health, especially given the broad range of adverse effects attributable to caffeine.

Indeed a growing body of research suggests that caffeine disrupts glucose metabolism and may contribute to the development and poor control of type 2 diabetes. A review article in the inaugural issue of Journal of Caffeine Research examines the latest evidence, contradicting earlier studies suggesting a protective effect of caffeine.

In the lengthy review that cites 49 past and current research studies, James Lane of Duke University describes numerous studies that have demonstrated caffeine's potential for increasinginsulin resistance (impaired glucose tolerance) in adults that do not have diabetes, an effect that could make susceptible individuals more likely to develop the disease. In adults with type 2 diabetes mellitus (T2DM), studies have shown that the increase in blood glucose levels that occurs after they eat carbohydrates is exaggerated if they also consume a caffeinated beverage such as coffee. This effect could contribute to higher glucose levels in people with diabetes and could compromise treatment aimed at controlling their blood glucose.

More than 220 million people worldwide have diabetes and the links that have been revealed between diabetes and the consumption of caffeine beverages (especially coffee) are of monumental importance when it is acknowledged that more than 80% of the world's population consumes caffeine daily.

Caffeine Effects on Insulin Resistance
The effects of caffeine on glucose metabolism have been studied in both healthy and T2DM individuals. The studies of healthy adults demonstrate the impact of caffeine when glucose regulation has not been compromised.

These results relate most directly to caffeine's potential contributions to T2DM development, in those who are predisposed to the disease, and prevention. Studies of patients who have T2DM provide evidence of the potential clinical impact of caffeine on glucose management. Studies in both groups provide strong evidence that caffeine impairs glucose homeostasis through a transient increase in insulin resistance.

At least 17 studies were published between 1968 and 2010 describing the effects of caffeine on glucose metabolism in healthy nondiabetic adults. Most of the studies examined glucose and insulin responses to carbohydrate challenge. Glucose and insulin levels were measured first under fasting conditions and then repeatedly for several hours after administration of a standard dose of glucose or carbohydrate administered orally or by intravenous infusion (IV).

Of the 14 studies that used this challenge protocol, all but one found evidence of insulin resistance after caffeine administration, compared to placebo control. Insulin responses were significantly larger after caffeine, indicating that more insulin was required to dispose of the glucose.

Even though more insulin was secreted after caffeine, none of the studies observed smaller glucose responses. Indeed, some found that caffeine potentiated the postchallenge glucose responses as well. Those who calculated whole-body insulin sensitivity index (ISI) found that caffeine decreased this measure of insulin sensitivity.

Three other studies used a technique known as the hyperinsulinemic-euglycemic clamp to measure caffeine's effects on insulin sensitivity more directly. All three studies found that a moderate dose of caffeine significantly decreased glucose disposal compared to placebo control. These results provide specific evidence that caffeine produces an acute reduction in insulin sensitivity (increased insulin resistance) in healthy nondiabetic men and women.

Studies have investigated the impact of caffeine on glucose tolerance in patients who have T2DM. Because diabetic patients typically have smaller insulin reserves, ingestion of carbohydrate usually produces a sustained hyperglycemia.

The effects of caffeine on this postprandial hyperglycemic response was first studied in 1967, when the observation was made that two cups of instant coffee (compared to hot water) exaggerated the rise in blood glucose that followed the IV injection of glucose solution.

This effect has been replicated in three more recent studies that tested the effects of double-blind administration of moderate doses of caffeine vs. placebo on glucose and insulin responses to carbohydrate challenge. The effects of caffeine were also studied in women who had gestational diabetes, a form of glucose dysregulation that can occur during pregnancy.

In all four studies, caffeine exaggerated the glucose and insulin responses to the carbohydrate challenge and decreased whole-body insulin sensitivity. These results confirm that caffeine increases insulin resistance in T2DM patients, as it does in nondiabetic patients. However, in T2DM patients, this effect also exaggerates the hyperglycemic response to carbohydrate.

Caffeine can impair glucose regulation in the real world as well as in the laboratory. An ambulatory study monitored glucose levels continuously for several days during the ordinary activities of a small group of T2DM coffee drinkers. The results provide evidence that caffeine impairs glucose regulation in the natural environment where caffeine is consumed, as it does in the laboratory.

Mechanism
In general, caffeine is thought to produce its widespread physiological effects through actions as a potent antagonist for adenosine receptors both centrally and peripherally. One hypothesis is that caffeine impairs glucose metabolism through the release of stress hormones, especially epinephrine and cortisol. Evidence from two human studies supports this hypothesis.

One study found that the drug propranolol, used to block the beta-adrenergic actions of epinephrine, abolished caffeine's exaggeration of the postprandial insulin response and the reduction of whole-body insulin sensitivity.

A second study found that caffeine had no effects on glucose tolerance in a group of adults with tetraplegia, who did not produce increased epinephrine in response to caffeine. Both studies suggest that epinephrine could mediate caffeine's effects on glucose and insulin resistance.

However, a study that directly compared caffeine with high- and low-dose epinephrine infusions for their effects on insulin sensitivity found that caffeine did not raise epinephrine levels high enough to fully account for effects on glucose metabolism.

Caffeine Content in Beverages

Although evidence is strong that caffeine produces a transient resistance to insulin action and impairment of glucose tolerance, doubts have been raised about the relevance of these acute effects to the potential public health impact of chronic daily consumption of caffeinated beverages like coffee, tea, and soft drinks.

Perhaps the strongest doubt arises from the common belief that habitual consumption of coffee or other caffeinated beverages leads to the development of tolerance to caffeine and the disappearance of acute effects after daily use. However, there is good reason to believe that habitual caffeine intake does not eliminate the increases in insulin resistance.

A second doubt concerns whether drinking coffee has the same effects as caffeine ingested in capsules. This question is especially relevant given the evidence that heavy coffee drinking is associated with lower risk of developing T2DM. Evidence from studies suggests that coffee has effects similar to pure caffeine. Consumption of coffee, tea, and caffeinated soft drinks may all have similar effects, due to the caffeine that each contains.

A third doubt about the public health relevance of these effects is whether the effects of caffeine on glucose metabolism are sufficiently large to be of clinical importance for the prevention or management of T2DM. Evidence suggests that the effects of habitual caffeine consumption could be large enough to offset at least part of the therapeutic effects of medications commonly prescribed for the management of glucose in T2DM. In addition, caffeine abstinence, as a lifestyle intervention, might yield improvements in chronic glucose control large enough to qualify as a useful adjunctive treatment.

Contradictory Evidence
Although the experimental results clearly indicate that caffeine consumption should be a public health concern for the prevention and management of T2DM, epidemiological studies have reported results that contradict this conclusion. These studies have consistently found that nondiabetic adults who are heavy coffee drinkers, typically four to six cups per day or more, have a lower risk of developing T2DM in subsequent years.

Causal explanations require a plausible mechanism, which has not been established so far for the link between heavy coffee consumption and protection from T2DM. The most common speculation is that one or more of the many compounds in coffee, other than caffeine, is responsible.

This idea is supported by evidence linking decaffeinated coffee consumption to a lower risk of T2DM in some studies. However, research into the effects of these coffee compounds in humans is in its very early stages. It would be premature to assume that these compounds are bioactive and protect against the pathological processes that lead to T2DM.

An alternative interpretation of the epidemiological evidence is that heavy coffee drinking is not the true cause of lower risk, but is simply a marker for another factor that is responsible. After all, individuals select for themselves how much coffee they will consume, and consumption of six of more cups is relatively rare

However, recent research does suggest another possibility that could explain the inverse association of coffee and T2DM risk. Consumption of sugar-sweetened beverages, such as soft drinks, fruit drinks, iced tea, and energy drinks, has recently been associated with an increased risk of T2DM.

A meta-analysis of the studies reporting this association suggests that those individuals who drink one to two servings per day have a 26% greater risk of developing T2DM than those who drink none, or less than 1 per month.

Common sense suggests that those individuals who are heavy coffee drinkers probably consume little or none of these other beverages. The apparent benefits of coffee drinking may simply be due to an avoidance of the sugar-sweetened alternatives.

The epidemiological studies have provided new directions for investigation, such as the biological activity of noncaffeine compounds found in coffee. Beyond the potential to discover new chemical compounds, however, their results probably offer little benefit to diabetes prevention and public health.

Premature attributions of cause and effect should certainly not be used to justify recommendations in favor of coffee drinking as beneficial to health, especially given the broad range of adverse effects attributable to caffeine.

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.

Diabetics 70% More Likely To Die From Liver Disease

U.S. NAFLD Epidemic May Have Global Ripple Effect

PEOPLE with diabetes are 70 percent more likely to die from liver disease than people without the condition, according to research being presented this week at the Diabetes UK Annual Professional Conference. Previous studies have found a link between diabetes and liver disease and this research adds to that knowledge, says a Diabetes UK press release.

Using electronic records linked to death records, researchers compared deaths from liver disease in people with and without diabetes aged 35 to 84 years between 2001 and 2007.

Among the 1,267 people with diabetes and 10,100 people without diabetes who died of liver disease, one in four (24 percent) people with diabetes died from hepato-cellular cancer (HCC), a complication of non-alcoholic fatty liver disease, compared to one in ten (9 percent) people without diabetes.

The proportion of deaths from alcoholic liver disease was greater in the population without diabetes (63 percent) compared to those with diabetes (38 percent). Overall people with diabetes were 70 percent more likely to die of liver disease than people without diabetes.

Diabetes UK Director of Research, Dr Iain Frame, said: "The best defence against liver disease if you have diabetes is to maintain a healthy weight and be as physically active as possible. Your doctor may also recommend regular testing of your liver function if you take medications that could potentially affect your liver. We now need further investigation into how diabetes affects the liver to find new methods of preventing this complication."

Lead researcher Dr Sarah Wild, from the University of Edinburgh, said: "Non-alcoholic fatty liver disease (NAFLD) has become much more common recently, particularly among people with diabetes.

"The major risk factor for NAFLD is being overweight which is also an important risk factor for Type 2 diabetes. NAFLD increases the risk of cirrhosis which in turn increases the risk of liver cancer. A healthy lifestyle can reduce risk of NAFLD and prevention is particularly important because the options for treatment are limited."

Fatty Liver Ups Type 2 Diabetes Risk

Meanwhile, according to new data presented last week at the International Liver Congress, the United States (U.S.) could soon be faced with an epidemic of Non-Alcoholic Fatty Liver Disease (NAFLD), one of the major contributing factors of chronic liver disease (CLD), considered as one of the major causes of morbidity and mortality worldwide, says a European Association for the Study of the Liver (EASL) press release.

The study highlights that if the current rates of obesity and diabetes continue for another two decades, the prevalence of NAFLD in the US is expected to increase by 50% in 2030.

The study analysed pre-existing clinical survey data over a 10 year period (1988-1994, 1999-2004 and 2005-2008), which included 39,500 adults from three survey cycles. Over the three cycles the prevalence of NAFLD doubled from 5.51% to 11.0% respectively.

Furthermore, during the first survey cycle (1988-1994) 46.8% of all CLD's was related to NAFLD but by 2005-2008 this had increased to 75.1%. In addition, the prevalence of obesity and diabetes, the two key risk factors for NAFLD also steadily increased.

Mark Thursz EASL's Vice Secretary commented: "Non-alcoholic fatty liver disease is fast becoming one of the top concerns for clinicians due to the obesity epidemic and it's potential to progress to advanced liver disease which significantly impacts on overall liver-related mortality.

"This data highlights a serious concern for the future, and the enormous increasing health burden of NAFLD. If the obesity epidemic is anything to go by, the U.S. NAFLD epidemic may have a ripple effect worldwide.

"It is imperative that health systems continue to drive effective educational programmes to reinforce awareness among the general public to alert them of the risks of obesity and promote the importance of diet and exercise."

Diabetes: Sleep Apnea Increases Risk of Amputation, Blindness In Diabetics

PEOPLE with Type 2 diabetes who have obstructive sleep apnea (OSA) are more at risk of losing their sight due to severe retinopathy, as well as foot problems and possible amputation because of neuropathy, according to new research in the UK.

Retinopathy affects the blood vessels supplying the retina – the seeing part of the eye. Blood vessels in the retina of the eye can become blocked, leaky or grow haphazardly. This damage gets in the way of the light passing through to the retina and if left untreated can damage vision.

Neuropathy is nerve damage and a long term complication of diabetes that can lead to foot ulcers and slow-healing wounds which, if they become infected, can result in amputation.

Obstructive sleep apnea (OSA) is a condition that causes interrupted breathing during sleep. The onset of OSA is most common in people aged 35 to 54 years old, although it can affect people of all ages, including children. The condition often goes undiagnosed. Only one in four people with obstructive sleep apnea are diagnosed with the condition.

(Image courtesy: HealthTree.com)

Dr Iain Frame, Director of Research at Diabetes UK, said: "We already know that there is a high prevalence of OSA in people with Type 2 diabetes. However, this is the first time that the link between OSA and retinopathy and neuropathy in people with Type 2 diabetes has been examined.

This research suggests that if someone with Type 2 diabetes also has this sleeping disorder they are more at risk of developing these serious complications compared to someone with the condition who does not have OSA.

"As being overweight is a risk factor for both OSA and Type 2 diabetes, this is yet another reason to highlight the importance of good weight management through a healthy diet and regular physical activity. In people with Type 2 diabetes, the increasing severity of OSA is associated with poorer blood glucose control and the treatment of sleep disorders (in this case by losing weight) has the potential to improve diabetes control and energy levels."

Researchers from the University of Birmingham looked at 231 people with Type 2 diabetes of whom 149 had OSA, a sleep disorder caused by disturbed breathing. They found there were twice as many people with severe retinopathy (48 percent) in the group with OSA compared to the group without OSA (20 percent). Retinopathy is the leading cause of blindness in the UK's working-age population.

In a separate study, the researchers found that OSA was also linked to neuropathy. They looked at 230 people with Type 2 diabetes of whom 148 had OSA. They found that 60 percent of the group with OSA also had neuropathy compared to 22 percent in the group without OSA.

In both studies, the association between OSA and the two diabetes complications in people with Type 2 diabetes was independent of age, gender, ethnicity, blood pressure, blood glucose levels, smoking and cholesterol.

Dr Abd Tahrani, who led the research, said: "Our work highlights several important issues. Our results emphasized what is already known - that OSA is very common in patients with Type 2 diabetes, much higher than OSA prevalence in the general population.

"Furthermore, our results suggest that OSA is not an innocent bystander in patients with Type 2 diabetes and might contribute to morbidities associated with this condition. Whether OSA treatment has any impact on these complications will need to be determined"

Source: Diabetes UK

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.”

Low Levels of Vitamin D Don't Put Older Women at Greater Risk for Type 2 Diabetes

But pregnant women with gestational diabetes are likely to have low levels of vitamin D, potentially leading to bone weakness in their babies

A recent report on vitamin D from the Institute of Medicine (IOM), an independent scientific body that advises the U.S. government, said the evidence didn't show that vitamin D has any health benefits beyond building and maintaining strong bones. It also said average Americans already have vitamin D blood levels at or above the amount that's needed for good bone health.

These findings are corroborated a new study ‒ published online by the journal Diabetes Care ‒ which found that low levels of vitamin D don't put older women at greater risk for type 2 diabetes. The findings may further temper the enthusiasm for vitamin D that has built up in recent years.

Many studies have linked Vitamin D deficiency to lower risks of everything from diabetes, to severe asthma, heart disease, certain cancers and depression. But the problem with those studies is that they were observational ‒ which means that researchers simply looked at people's vitamin D intake, or their blood levels of the vitamin, and whether or not they developed a given health condition. Those types of studies cannot prove that vitamin D was the reason for any lower disease risk.

That’s one reason why people should continue to focus on lowering their diabetes risk by looking at their overall lifestyle ‒ eating a balanced diet, getting regular exercise and maintaining a healthy weight. Exercising outside and eating foods rich in vitamin D will also ensure that you're getting enough of the vitamin. The IOM recommends that adults in their 70s and up get 800 IU of vitamin D per day, while everyone else older than 12 months should get 600 IU.

The new study involved women participating in the Women's Health Initiative, a large government project that looked at the health effects of hormone therapy, diet changes, and vitamin D and calcium supplements on women age 50 and older.

Of 5,140 women who were free of type 2 diabetes at the start of the trial, 6 percent developed the disorder over an average of 7 years. But the research team found no clear link between the women's blood levels of vitamin D at the outset and their risk of developing type 2 diabetes later on.

Initially, there was some evidence of an association. But it disappeared when the researchers accounted for factors like body weight, exercise levels and certain diet habits, like fiber intake ‒ which are key in the risk of developing type 2 diabetes.

Very few foods in nature contain vitamin D. The flesh of fatty fish (such as salmon, tuna, and mackerel) and fish liver oils are among the best sources. Small amounts of vitamin D are found in beef liver, cheese, and egg yolks. Vitamin D in these foods is primarily in the form of vitamin D3 and its metabolite 25(OH)D3. Some mushrooms provide vitamin D2 in variable amounts. Mushrooms with enhanced levels of vitamin D2 from being exposed to ultraviolet light under controlled conditions are also available.                                                        

Most people meet at least some of their vitamin D needs through exposure to sunlight. And fortified foods, especially dairy products, provide most of the vitamin D in the American diet. People who get those things are a lot different from people who don't and it's those factors that may account for the link between vitamin D and lower diabetes risk researchers thought they had found in older studies. Still, the study, like past ones, was observational ‒ so it doesn't disprove a role for vitamin D in diabetes risk. So-called randomized studies are what's needed to prove whether the vitamin curbs disease risks. In that type of trial, participants are randomly assigned to different treatment groups, which helps ensure the results are accurate and not just an effect of chance.

In the meanwhile, another research paper published in the latest issue of theMedical Journal of Australia recommends that all pregnant women should be tested for vitamin D deficiency and those found to be deficient should be treated. Pregnant women with gestational diabetes are likely to have low levels of vitamin D, potentially leading to bone weakness in their babies, the research discovered.

Studying 147 women who attended a gestational diabetes clinic between February 2007 and February 2008, excluding those with known pre-pregnancy glucose intolerance, the Australian researchers found that more than 40 percent of the women were found to have inadequate vitamin D levels. They found that while low levels were more common in women with darker skin, more than 25% of women in all groups were deficient.

"Vitamin D insufficiency has a well-established impact on bone density, neonatal vitamin D and calcium status, and childhood rickets (soft or weak bones). The 41 per cent prevalence of inadequate 25(OH)D (25-hydroxyvitamin D) levels in women with GDM (gestational diabetes mellitus) in our study is unacceptable and identifies vitamin D insufficiency as an issue of public health significance," the researchers noted while recommending that further research into the potential link between vitamin D status and gestational diabetes be conducted.

In an accompanying editorial in the journal, Professor Peter Ebeling from the University of Melbourne at Western Health suggested scheduling of lower-cost, higher-dose vitamin D supplements be altered so that more women could afford them. "Those pregnant and breastfeeding women that are most at risk of vitamin D deficiency are often the least likely to be able to afford supplements," Professor Ebeling said.

Diabetes: Implantable Gastric Stimulator May Make Bariatric Surgery Redundant

The DIAMOND System

DIABESITY is the term used to describe the combination of the diabetes and obesity epidemics taking hold across the world and those whose goal it is to prevent even more people developing these conditions state the scale of the problem in no uncertain terms.The word aptly illustrates the close association between weight and diabetes (97 per cent of all cases of Type 2 diabetes are caused by excessive weight) and is a concrete example of the wider cluster of symptoms of a metabolic disorder known as Insulin Resistance Syndrome (also called Metabolic Syndrome X).

Currently undergoing extensive trials, a pacemaker-style device that delivers mild electric pulses to the stomach could be a new way to tackle type-2 diabetes, the most common form of the disease.

The matchbox-sized gadget called DIAMOND (Diabetes Improvement and Metabolic Normalization Device) ‒ a.k.a. TANTALUS™ ‒ is implanted under the skin on the abdomen, stimulates the stomach muscles when the patient is eating.

Studies show this boost in muscle movement causes more insulin ‒ the hormone is responsible for removing excess sugar in the blood ‒ to be released.

Gastric stimulation is based on the fact that electric signals applied to a cell in a certain specific time-period called the refractory period, can modify the cell’s biochemistry and in turn, lead to a change in its behavior.

This tricks brain into thinking more food has entered the stomach than the person has actually eaten. To deal with this supposedly large meal, the brain boosts insulin production as well as triggering the release of hormones that suppress appetite.

This means that the patient feels full much sooner than normal. A wireless charger system allows the patient to recharge the device at home by placing the charger over the abdomen for 45 minutes, once a week.

The result is an improvement in blood glucose levels, which is often accompanied by weight loss, and reduction of blood pressure, waist circumference and blood lipid level.

Recently performed studies have shown that stimulation of the stomach using the DIAMOND system implant can induce satiety and can trigger signaling to the brain, affecting glucose and fatty acid metabolism.

Developed by the Dusseldorf (Germany)-based medical device company MetaCure, DIAMOND is recommended for obese Type 2 Diabetes patients who do not succeed in reducing their HbA1c level below 7 per cent, despite treatment with several oral agents.

Currently, though doctors are prescribing multiple drugs for the majority of patients (called ‘polypharmacy’), it is ineffective in controlling blood sugar in only about two thirds of patients.

Basically, DIAMOND is an advanced minimally invasive implantable electrical stimulator used to apply gastric stimulation. Using innovative technology, the device works by enhancing the activity of the gastric muscles only when the patient eats.

The device automatically senses when a patient is eating, by detecting when the stomach starts to naturally contract, and fires small painless electrical signals into the muscles of the stomach.

DIAMOND is connected by small electrodes to the patient’s stomach. It uses them to automatically sense when the patient is eating, and to send gentle signals to the stomach muscles (and through them to the brain) which enhance the normal satiety feeling.

The DIAMOND system does all this on its own, and the patient does not even feel it working, the manufacturer claims. The rate of the stimulation is dictated by the patient’s natural gastric activity, this makes treatment using the DIAMOND system personalized to each patient’s specific eating habits and physiology, without causing anatomical changes, and without hassle to the patient.

Using a wireless home-based charger system the patient can recharge the Implantable Pulse Generator (IPG) unit simply by placing it over the abdomen for 45 minutes, once a week.

Charging the device assures it has enough energy to provide treatment for years, and minimizes the need for battery replacement. The portable programmer allows medical personnel to adjust the DIAMOND signal parameters according to individual patient needs.

The DIAMOND IPG and electrodes are implanted in a minimally-invasive (laparoscopic) procedure under general anesthesia. The laparoscopic approach ‒ widely used surgical technique used for various procedures such as cholecystectomy ‒ allows for a rapid recovery with minimal discomfort. Patients implanted with DIAMOND are typically able to start eating a few hours after surgery. Hospital stay is usually 1 to 2 days.

The device does not put the patient at risk for hypoglycemia and helps to control your blood sugar levels without the need of adding medications. And unlike bariatric surgery, the procedure does not alter the patient’s physiology, and is completely reversible, allowing the device to be turned off or removed at any point.

Patients living with the DIAMOND system are not limited in their diet and can maintain an active lifestyle (not including contact sports or activities which could damage the implanted system). Maintaining a healthy and balanced diet contributes to the success of the treatment.

The DIAMOND system delivers a gentle stimulation to the stomach during meals. The stimulation corresponds with the body’s natural gastric physiology and rhythm, is safe, and has minimal effect on the patient’s anatomy.

Once implanted, DIAMOND operates automatically requires no activation. There is a need to charge the battery using a portable charger once a week for about 45 min. Charging is wireless, non-invasive and painless, and can easily be done while reading or watching TV.

Over 200 patients are using the DIAMOND system to date, many of them for over two years, and many for over four years. Trials at the Medical University of Vienna showed the device reduced blood glucose levels by a quarter over three months and the DIAMOND has been shown to significantly reduce blood glucose levels and blood pressure levels.

Researchers say small-scale studies also show improvements in blood pressure and cholesterol levels, as well as an average weight reduction of up to 5 kg over a year. Several large-scale trials are now underway in Europe and the U.S. (At the moment, DIAMOND is not available for sale in the USA.)

The DIAMOND system is the first CE-approved (European standard) implanted device for treating Type 2 Diabetes and obesity since 2007. It is currently the only active device that selectively exerts its treatment at the correct physiological context – after meals, and is approved to treat diabetes for periods longer than 12 months.

MetaCure Claims DIAMOND is better that surgical intervention, which is constantly gaining recognition as a treatment for diabetes, with 78 per cent of patients showing resolution of their diabetes post-surgery, and sustaining this status for at least two years. (See my blogpost ‘IDF Endorses Early Bariatric Surgery’ here.)

However, when looking deeper into types of surgery, it seems that reversible “lap-band” procedures are significantly less effective than the more serious gastric bypass surgeries which are irreversible and come with a significant risk to the patient. Till recently, these procedures were prescribed only to the seriously obese patients but now there’s abig push to include patients with a BMI as low as 26.

Besides, despite availability of several classes of pharmacological anti-diabetic agents there is still a clear unmet need for a safe treatment that would comprehensively address the entire metabolic syndrome and will bring about weight loss with minimal requirement for patient compliance.

In the event, DIAMOND presents a significant step forward ‒ on the one hand it is very effective in both weight reduction as well as controlling blood sugar levels (maintaining both the weight and blood sugar effects for long follow-up periods), while on the other hand it is implanted in a minimally invasive, fully reversible implantation procedure – exactly the solution required for the moderate BMI population!