Tag Archives: Obesity

Low-Carb, Higher-Fat Diets Add No Arterial Health Risks To Obese People Seeking To Lose Weight

OVERWEIGHT and obese people looking to drop some pounds and considering one of the popular low-carbohydrate diets, along with moderate exercise, need not worry that the higher proportion of fat in such a program compared to a low-fat, high-carb diet may harm their arteries, suggests a pair of new studies by heart and vascular researchers at Johns Hopkins.

Dr Kerry J. Stewart

“Overweight and obese people appear to really have options when choosing a weight-loss program, including a low-carb diet, and even if it means eating more fat,” says the studies’ lead investigator exercise physiologist Kerry Stewart, Ed.D.

Stewart, a professor of medicine and director of clinical and research exercise physiology at the Johns Hopkins University School of Medicine and its Heart and Vascular Institute, says his team’s latest analysis is believed to be the first direct comparison of either kind of diet on the effects to vascular health, using the real-life context of 46 people trying to lose weight through diet and moderate exercise.

The research was prompted by concerns from people who wanted to include one of the low-carb, high-fat diets, such as Atkins, South Beach and Zone, as part of their weight-loss program, but were wary of the diets’ higher fat content.

In the first study, presented June 3 at the annual meeting of the American College of Sports Medicine in Denver, the Johns Hopkins team studied 23 men and women, weighing on average 218 pounds (about 99 kg) and participating in a six-month weight-loss program that consisted of moderate aerobic exercise and lifting weights, plus a diet made up of no more than 30 percent of calories from carbs, such as pastas, breads and sugary fruits.  As much as 40 percent of their diet was made up of fats coming from meat, dairy products and nuts.

This low-carb group showed no change after shedding 10 pounds (4.5 kg) in two key measures of vascular health: finger-tip tests of how fast the inner vessel lining in the arteries in the lower arm relaxes after blood flow has been constrained and restored in the upper arm (the so-called reactive hyperemia index of endothelial function), and the augmentation index, a pulse-wave analysis of arterial stiffness.

Low-carb dieters showed no harmful vascular changes, but also on average dropped 10 pounds in 45 days, compared to an equal number of study participants randomly assigned to a low-fat diet. The low-fat group, whose diets consisted of no more than 30 percent from fat and 55 percent from carbs, took on average nearly a month longer, or 70 days, to lose the same amount of weight.

“Our study should help allay the concerns that many people who need to lose weight have about choosing a low-carb diet instead of a low-fat one, and provide re-assurance that both types of diet are effective at weight loss and that a low-carb approach does not seem to pose any immediate risk to vascular health,” says Stewart. “More people should be considering a low-carb diet as a good option,” he adds.

Because the study findings were obtained within three months, Stewart says the effects of eating low-carb, higher-fat diets versus low-fat, high-carb options over a longer period of time remain unknown.

However, Stewart does contend that an over-emphasis on low-fat diets has likely contributed to the obesity epidemic in the United States by encouraging an over-consumption of foods high in carbohydrates. He says high-carb foods are, in general, less filling, and people tend to get carried away with how much low-fat food they can eat. More than half of all American adults are estimated to be overweight, with a body mass index, or BMI, of 26 or higher; a third are considered to be obese, with a BMI of 30 or higher.

Stewart says the key to maintaining healthy blood vessels and vascular function seems ‒ in particular, when moderate exercise is included ‒ less about the type of diet and more about maintaining a healthy body weight without an excessive amount of body fat.

Among the researchers’ other key study findings, presented separately at the conference, was that consuming an extremely high-fat McDonald’s breakfast meal, consisting of two English muffin sandwiches, one with egg and another with sausage, along with hash browns and a decaffeinated beverage, had no immediate or short-term impact on vascular health.  Study participants’ blood vessels were actually less stiff when tested four hours after the meal, while endothelial or blood vessel lining function remained normal.

Researchers added the McDonald’s meal challenge immediately before the start of the six-month investigation to separate any immediate vascular effects from those to be observed in the longer study. They also wanted to see what happened when people ate a higher amount of fat in a single meal than recommended in national guidelines.

Previous research had suggested that such a meal was harmful, but its negative findings could not be confirmed in the Johns Hopkins’ analysis.  The same meal challenge will be repeated at the end of the study, when it is expected that its participants will still have lost considerable weight, despite having eaten more than the recommended amount of fat.

“Even consuming a high-fat meal now and then does not seem to cause any immediate harm to the blood vessels,” says Stewart.  However, he strongly cautions against eating too many such meals because of their high salt and caloric content.  He says this single meal ‒ at over 900 calories and 50 grams of fat ‒ is at least half the maximum daily fat intake recommended by the American Heart Association and nearly half the recommended average daily intake of about 2,000 calories for most adults.

All study participants were between the age of 30 and 65, and healthy, aside from being overweight or obese.  Researchers say that in the first study, because people were monitored for the period they lost the same amount of weight, any observed vascular differences would be due to what they ate.

Source: Johns Hopkins School of Medicine

Watch this video on Low-Carb, High-Fat Diet featuring Dr Mary Vernon.

Advertisements

Diabetes Can Shorten Working Life, Force Early Retirement, Cause Financial Stress

“As a T2 diagnosed around 2.5 years ago, I am feeling increasingly exhausted to the point of not being able to sleep (partially due to my work), and have all kinds of other T2 symptoms which combined with tiredness and stress are really getting me down, and making me so depressed… I feel that the stress is sending sugar levels up… Yes I sound a wreck…but this is really beginning to get to me… I just feel I can hardly manage with the diabetes, work and enforced H.E. study for the next year just to keep the job, by the time I graduate I will be ready to retire, or fit to drop – one or the other.”

–       An anguished 60-year-old British woman diagnosed with type 2 diabetes writing in a discussion forum

A UK survey carried out by Cardiff University researchers last year about the effect of diabetes on their lives, almost 74% of patients reported that diabetes influenced their decisions regarding major life changing events. Among the respondents, 40% said that diabetes had influenced their decision to take early retirement and 22% said it had influenced a decision to change profession. Respondents also said that diabetes had influenced decisions to change lifestyle (22%) or have children (14%).

Now a new study provides more evidence that people with diabetes may leave the workforce sooner than employees without diabetes – suggesting that the common disease could be taking a large economic toll, according to French researchers.

The findings, reported in the journal Diabetes Care, echo those from a U.S. study that was reported in 2004. In that study, adults with diabetes were less likely to be working in their 50s than similar adults without the disease. And researchers estimated that between 1992 and 2000, diabetes accounted for $4.4 billion in lost income due to earlier retirement and nearly $32 billion due to work disability.

The French study of more than 3,000 employees of France’s national gas and electric company found that diabetic workers were more likely to retire or go on disability in their 50s than workers of the same age who had similar jobs but no diabetes. “Diabetes can impact individuals’ ability to maintain employment through different pathways,” said senior researcher Dr. Rosemary Dray-Spira, of the French national research institute INSERM, told Reuters Health

For example, diabetes complications such as vision loss and nerve damage can lead to mobility problems or amputations that make it difficult or impossible for people to do their jobs. Diabetes is also often linked with medical conditions, like heart disease or kidney disease. Then there is obesity, one of the major risk factors for developing diabetes. Dray-Spira’s team found that obesity seemed to explain much of the higher risk of work disability among people with diabetes.

These latest findings, Dray-Spira’s team writes, underscore the point that diabetes “has major social and economic consequences for patients, employers, and society.” The results are based on data from a long-term health study of employees at the French national gas and electric company. Between 1989 and 2007, 506 workers developed diabetes.

Dray-Spira’s team compared each of those workers with five diabetes-free co-workers the same age and in the same job type. Overall, diabetics were less likely to still be working in their mid-50s. By age 55, 52 percent of workers with diabetes were still on the job, versus 66 percent of those without diabetes.

The gap narrowed by the time the workers were 60 years old, the official retirement age in France during the study period. At age 60, 10 percent of diabetic workers were still on the job, compared with 13 percent of their co-workers. In addition, by age 60, roughly five of every 100 diabetics were on disability, compared to roughly one of every 100 non-diabetics.

Dray-Spira noted that France has both a relatively young retirement age and a universal healthcare system. The impact of diabetes on retirement and disability could be greater, she said, in a country where people typically work longer and lack universal healthcare – like the U.S. “The major implication of our results is that particular attention should be paid to help people with diabetes in maintaining employment,” Dray-Spira said.

Work life problems faced by diabetics extend even beyond retirement. Last year an Australian study published in The British Journal of Diabetes & Vascular Disease  noted: “Compared with those who are in full-time employment with no health condition, those who have retired early due to diabetes have significantly lower odds of owning any wealth (odds ratio 0.03, 95% confidence interval 0.00–0.30).

“Among those with any accumulated wealth, the value of this wealth is 90% less for people who are out of the labor force due to diabetes relative to those in full-time employment, after adjusting for age, sex and education (p=0.037). Retiring from the labor force early due to diabetes is likely to cause large financial stress in the future as not only have retired individuals lost an income stream from paid employment, but they also have little or no savings to draw upon.”

Sources: Reuters Health, Diabetes.co.uk, Diabetes Care

Related post: A job that fits

Is Anorexia A Sort Of Cousin Of Diabetes?

ANOREXIA may be a disorder more of the metabolism than the mind, according to a new paper that argues the disease is a sort of cousin of diabetes. But this theory of anorexia as a fundamentally biological disorder, rather than a psychological one, is untested, psychiatrists warn, and patients with the disease should not stray from proven treatments.

The review of past research on the topic, published in the June issue of the journal Molecular Psychiatry, finds that certain genetic and cellular processes get activated during starvation in organisms ranging from yeast to fruit flies to mice to humans. The idea, says study researcher Donard Dwyer, is that in people with a broken starvation response, a few initial rounds of dieting could trigger a metabolism gone haywire.

In this theory, it’s not stubbornness or a mental disorder that keeps anorexics from eating, it’s their own bodies. The theory could explain why it can be so difficult to convince anorexic patients that anything is wrong with them, says Dwyer. “Unless we conceive of it as more of a metabolic function, I don’t think we’ll get past the first stage of treatment with a lot of the real hard-core patients,” he says.

The diabetes of starvation

In the current understanding of anorexia nervosa, an eating disorder in which patients don’t maintain at least 85 percent of their normal body weight for their height, overachieving personality types attempt to control stress and emotion by restricting food and/or extreme exercising.

Dwyer sees the disease, instead, as a condition similar to diabetes. Someone who becomes obese and is genetically susceptible will develop insulin resistance, which then becomes diabetes. An initial trigger — the obesity — is required, but once the patient has diabetes, you can’t talk him or her out of the disease.

For anorexia, Dwyer says, the potential trigger is chronic undereating or dieting, and the messed-up molecular process could be any number of biological changes that happen during starvation. In the current review, he and his colleagues focus on a cascade of genetic and cellular events called the IGF-1/Akt/FOXO pathway. Organisms from yeasts to humans activate this pathway in response to starvation, triggering all sorts of biological changes, including a desire to look for food. If this pathway doesn’t work as it should, it could theoretically cause the warped approach to eating seen in anorexia. (The so-called epigenome, the supporting actor to our genes, is what helps determine which genes, or pathways, get switched on and off.)

If Dwyer is right, difficult-to-treat anorexic patients may need drugs to get their metabolisms back on track, much as diabetic patients have to take insulin shots. But so far, the idea has not been tested in humans.

“This is, at the moment, speculative,” says Timothy Walsh, a psychiatrist at Columbia University who was not involved in the research. “There’s no human data to support it, and it’s only part of the answer. It’s not proposed as the complete solution.”

Starvation and metabolism

Dwyer is careful to say that much more research is needed. But he says there is good reason to continue the work. Research on obesity has shown that being too heavy is more complex than simply calories in, calories out, he says. There are genetic and metabolic factors involved that make it hard for some people to shed weight. And obesity-related changes to the epigenome (our genes’ on-off switches) can even be passed down from mother to child. The same could be true on the flip side, with starvation, Dwyer says, adding, the genes linked to anorexia could be the same ones that regulate the metabolism during starvation.

Additionally, studies on starving people suggest that many of the supposed causes of anorexia, including food obsession and anxiety, may be symptoms of starvation. And starving people, like anorexics, often report that they’re doing much better than their physical condition would suggest.

“Here we have our anorexic patients who are not aware of how sick they are despite how thin they have gotten. … We’re not going to be able to convince them otherwise until we understand that better,” Dwyer says. “It’s probably not going to be something we can just talk them out of.”

Via LiveScience

Related article: The Signs of Diabulimia

Diabetes & Depression Create Adverse Synergy

There’s a clear increase in risk to your health and to your life when you have a combination of diabetes and depression

DIABETES and depression are conditions that can fuel each other. Symptoms of clinical depression include anxiety, feelings of hopelessness or guilt, sleeping or eating too much or too little, and loss of interest in life, people and activities. So, there’s a clear increase in risk to your health and to your life when you have a combination of diabetes and depression.

While diabetes can be a challenge to control, depression can be difficult to treat and keep in remission. Growing evidence suggests the combination can be especially problematic for patients. And as if this adverse synergy were not bad enough, having these two conditions more than doubles the likelihood that a patient will develop dementia.

What this means is that depression can affect blood sugar levels and insulin metabolism through increased cortisol, contributing to unhealthy eating habits, weight gain and diabetes. On the other hand, management of diabetes can cause chronic stress and strain, which in the long run, may increase risk of depression. The two are linked not only behaviorally, but biologically, says Dr. Frank B. Hu, a professor of medicine at Harvard Medical School.

However, doctors are unsure whether one condition causes the other or if a single underlying factor is responsible for both ailments. If a substantial causal connection is established between the two disorders, it would be rather novel and could potentially change how doctors understand and treat both disorders.

New research findings from the University of California at San Diego further reinforce the view that since depression and diabetes often co-occur, psychiatrists should be aware that depressed patients may be at risk of the metabolic disorder. The findings of the study were presented at the American Psychiatric Association’s 164th annual meeting in Honolulu last week.

In the San Diego study, reported the Los Angeles Times, researchers who reviewed the medical records of a group of 129 Hispanic diabetics discovered that diabetes was diagnosed first in 54 percent of men with both conditions, while depression was the initial diagnosis of 24 percent of men. Of women with both conditions, 59 percent were first discovered to have diabetes, while 29 percent were first diagnosed with depression.

While doctors are typically aware that someone with diabetes is at higher risk for depression, they may not look for mood disorders as a risk factor for developing diabetes, especially anxiety, the authors noted. Among men with diabetes and anxiety, 54% developed diabetes first and 45% developed anxiety first. Among women, 55% developed diabetes first and 39% developed anxiety first.

Latinos are known to have higher rates of type 2 diabetes than the general US population. Additionally, co-occurring mood disorders are common among these individuals. This made this group of patients an ideal population for studying the relationship between mood disorders and type 2 diabetes.

The San Diego researchers said it is unclear why there is this association between the two conditions, but said that their findings show that there is a strong need to monitor individuals with type 2 diabetes for future mental health issues as the metabolic condition appears to precede mood disorders.

Another research, conducted at Harvard University, found that study subjects who were depressed had a much higher risk of developing diabetes, and those with diabetes had a significantly higher risk of depression, compared to healthy study participants.

A study carried out by the German Diabetes Association (DDG) has also shown that depression can heighten the risk of developing type 2 diabetes as the mental illness also increases the likelihood of obesity and failing to take enough exercise.

The Chennai (India) Urban Rural Epidemiological Study involving around 23,000 participants found that depression can increase the risk of diabetes due to increased levels of counter-regulatory hormones, which can lead to obesity, insulin resistance and glucose intolerance. “The lesson in this is that not only should we treat diabetics for depression, but that by treating depression, the person may actually be able to side-step diabetes,” said co-author Dr. V Mohan.

The American Diabetes Association advises that individuals with type 2 diabetes should consider seeking mental health help if they begin to feel three or more common symptoms of depression, which may include loss of pleasure, loss of appetite, sadness, trouble concentrating and suicidal thoughts.

The bottom line: Since diabetes and depression can influence each other and thus become a vicious cycle, primary prevention of diabetes is important for prevention of depression, and vice versa.

Sources: American Psychiatric Association, American Diabetes Association

Diabetes: Tale of 2 Mice Pinpoints Major Factor for Insulin Resistance

Joslin Diabetes Center scientists identify promising candidate for drugs treating type 2 diabetes and fatty liver disease

RESEARCHERS at Joslin Diabetes Center have identified an enzyme called PKC-delta as an important molecular modifier for development of insulin resistance, diabetes and fatty liver in mice. They also have found evidence suggesting a similar role for the enzyme in humans, making PKC-delta a promising new target for drugs for diabetes and related ailments.

It’s well known that insulin resistance typically occurs prior to type 2 diabetes. You can be insulin resistant for years before developing the disease, and often a diagnosis of type 2 diabetes is a person’s first sign that they are in fact insulin resistant.

The road to type 2 diabetes is paved with insulin resistance, a condition often associated with obesity in which the hormone begins to fail at its job helping to convert sugars to energy.

Investigators in the laboratory of C. Ronald Kahn, M.D., began with two existing strains of mice that are on opposite sides of the spectrum for insulin resistance. “The ‘B6’ mouse is very prone to develop both obesity and diabetes, and the ‘129’ mouse is quite protected from both, even if it possesses a genetic defect in insulin signaling,” says Dr. Kahn, Professor of Medicine at Harvard Medical School.

“Comparing the two models, it’s as if there’s an on/off switch for insulin resistance and diabetes between them. We reasoned that if we could find out the differences between B6 and 129 mice, we could identify a factor that could be a major modifier of insulin resistance, and a good drug target for treatment of type 2 diabetes,” he said

Dr C. Ronald Kahn, MD

In previous work, the Kahn lab created a genetic cross between these two mice models, did a genome-wide screening and found an area on mouse chromosome 14 that appeared to be important for insulin sensitivity. In the latest paper, published online in the Journal of Clinical Investigation, they followed up and found that PKC-delta stood out in activity among the genes in that region.

The researchers then showed that levels of the PKC-delta enzyme were about two times as high in the liver and other tissues in the B6 as in the 129 mouse. When both types were put on high-fat diets, levels of the enzyme stayed the same in the 129 mouse but rose to three times higher in the B6 mouse.

Could these differences be enough to make the profound change in insulin sensitivity? The scientists next created three new mice models to check.

In one model, they removed one of the two normal copies of the PKC-delta gene from B6 mice, thus cutting production of the enzyme in half, and the mice became much more insulin sensitive. In a second effort, they removed the gene entirely from the livers of B6 mice, and again the resulting mice were more insulin sensitive. In a third model, they inserted an extra copy of the PKC-delta gene in the liver of 129 mice, which became much more insulin resistant and diabetic.

In short, PKC-delta levels correlated closely with insulin resistance and the abnormalities in glucose tolerance in all three cases of mice. In addition, the insulin resistance correlated with increased fat in the liver, an increasing problem in people with insulin resistance.

Biopsies of human liver tissue, Dr. Kahn says, also showed that levels of the enzyme are heightened in people who are obese or have diabetes. “People with diabetes tend to get fatty liver and that also seems to correlate with the activity of PKC-delta,” he adds.

Overall, “drugs that inhibit the activity of PKC-delta in the liver and other tissues potentially could aid treatments for diabetes and fatty liver disease, which is second only to alcohol as a cause of liver failure,” Dr. Kahn says.

Via Eurekalert

Can A Low Fat Diet Ward Off Diabetes Without Weight Loss?

HOW your diet affects your health is a big topic in research these days, and this is reflected in the news headlines every week. The problem is that the research findings keep changing the landscape of what’s healthy and what’s not. Eggs were bad, now they’re good. Margarine was good, now it’s bad. Eat low-fat! No, now eat low-carb. For people with no health problems, trying to adhere to the latest dietary advice is simply confusing. For people with chronic conditions such as diabetes, it can be downright dangerous.

So a new research study from the University of Alabama at Birmingham (UAB), which claims that small differences in diet – even without weight loss – can significantly affect risk for diabetes, is bound to raise more questions than it answers.

The unique aspect of this study ‒ published online May 18, 2011, by the American Journal of Clinical Nutrition ‒ is that diabetes risk was reduced independent of weight loss. Received wisdom says overweight individuals can reduce risk of type 2 diabetes by shedding the extra pounds through a combination of diet and exercise.

In the UAB study, 69 healthy, overweight people who did not have diabetes — but were at risk for it — were placed on diets with modest reductions in either fat or carbohydrate for eight weeks. “At eight weeks, the group on the lower fat diet had significantly higher insulin secretion and better glucose tolerance and tended to have higher insulin sensitivity,” said Barbara Gower, Ph.D., professor in the Department of Nutrition Sciences at UAB and lead author of the study. “These improvements indicate a decreased risk for diabetes,” she said in a press statement.

The findings were even stronger in African-Americans, a population with an elevated risk for diabetes. Gower says African-Americans on the lower fat diet showed a stronger difference in insulin secretion compared to the lower carb group, indicating that diet might be an important variable for controlling diabetes risk in that population.

“People find it hard to lose weight,” said Gower. “What is important about our study is that the results suggest that attention to diet quality, not quantity, can make a difference in risk for type 2 diabetes.”

Study participants in the lower fat group received a diet comprising 27 percent fat and 55 percent carbohydrate.  The lower carb group’s diet was 39 percent fat and 43 percent carbohydrate. All food for the eight-week trial was provided by the study.

The study participants were fed exactly the amount of food required to maintain their body weight, and the researchers took into account any minor fluctuations in body weight during analyses. Thus, results from this study suggest that those trying to minimize risk for diabetes over the long term might consider limiting their daily consumption of fat at around 27 percent of their diet.

“The diets used in this study were actually fairly moderate,” said UAB dietitian Laura Lee Goree, R.D., L.D., a study co-author. “Individuals at risk for diabetes easily could adopt the lower fat diet we employed.  Our findings indicate that the lower-fat diet might reduce the risk of diabetes or slow the progression of the disease.”

But then, widely cited research studies also suggest that a low fat, high carb (LFHC) diet causes the following problems:

• Elevates triglycerides, lowers HDL (“good” cholesterol)

• Is ineffective for people with high insulin levels

• Increases insulin levels which spikes blood pressure

• Leads to greater risk for age-related macular degeneration (AMD)

The American Diabetes Association says millions of Americans are unaware they are at high risk with some groups having a higher risk for developing Type 2 diabetes, especially African-Americans, Latinos, Native Americans and the elderly.

It would therefore be premature to jump the gun to think that one can avoid the risk of diabetes without shedding weight by limiting fat intake. Gower rightly says further research is needed to determine if the difference between diets in carbohydrate or fat was responsible for the differences in the measures of glucose metabolism and probe the potential cause-and-effect relationship between insulin and glucose responses to the diets.

In the meanwhile, the best ways to maintain good health, diabetes or no, is to exercise, limit processed and refined foods, focus on fish, and eat a wide variety (and an abundance) of plant foods.

And shedding weight ‒ even if there’s no risk of developing diabetes ‒ will always remain a good idea.

Source: UAB News

Related Posts:

How Fatty Foods Lead To Diabetes

Is the ADA Shifting its Stance About Carbs?

UK Trials to Determine if Metformin Given to Overweight Expectant Mothers Can Stop Them From Having Fat Babies Begin

HUNDREDS of overweight mothers-to-be are being given metformin up to three times a day during their pregnancy to stop them from having obese babies as part of a controversial trial in the UK. The trial involves 400 obese but non-diabetic volunteers at hospitals in Liverpool, Edinburgh and Coventry.

Half will take metformin from around 12 weeks into their pregnancy and half will take a placebo. Their health and their babies’ health will be monitored and the results are expected in four years. It is hoped the treatment will prevent the birth of overweight babies and bring down the need to carry out caesarean sections as well as preeclampsia.

The latest figures show that almost half of women of childbearing age in Britain are overweight or obese and more than 15 percent of pregnant women are obese. This raises their odds of dying in pregnancy, of their baby being stillborn and of a host of pregnancy complications, some of which can be fatal.

Indeed, one of the most alarming facts to emerge after the trails were announced is that each year the Liverpool Women’s Hospital, for example, cares for more than 500 pregnant women who have a body mass index of more than 40 – which translates as severely obese.

Doctors believe many overweight adults can trace their problems back to the womb, when the fetus absorbs too many sugars and fats because of the high levels of insulin in their mother’s blood. But rather than trying to help the expectant mother lose weight, the drug would help keep the weight of the unborn baby down by reducing the levels of blood sugar passed to babies in the womb

Metformin, long cleared for the treatment of diabetes in pregnancy, has been safely used by diabetics for decades and the UK researchers think early intervention administering it to obese expectant mothers could save youngsters from a lifetime of weight problems and ill-health.

The doctors behind the trial say obesity among pregnant women is reaching epidemic proportions and they need to protect the health of tomorrow’s children. However, many healthy women are likely to be uneasy about mass medication in pregnancy for a problem that can be treated through changes to diet and exercise.

Ian Campbell, medical director of charity Weight Concern, said: “In an ideal world we would be in a position to assist women to be of a near-normal bodyweight prior to conception. But that is not realistic in the current environment. The reality is that many women go through pregnancy carrying too much body fat and it is important we do something about it because it causes serious problems.”

Defending the exercise which has raised the hackles of several groups, Andrew Weeks, who is leading the trial, said: “It is about trying to improve outcomes in pregnancy for women who are overweight. The problem is babies tend to be larger and many of the downsides of being overweight during pregnancy relate to the birth.”

Documents for the trial state: “Rates of obesity in adults and children are rising exponentially in the UK, as in other developed nations, and there are major causes for concern. The problem of maternal obesity, leading to programming of future life obesity risk in offspring, and manifest by excess birth weight, is reaching epidemic proportions. We believe that metformin will likely be an effective therapy in interrupting this cycle.”

Professor Norman, of Edinburgh University, said metformin was judged as a safe drug but the trial is needed to ensure the benefits outweighed any risks.  She added that if the trial does show metformin to be of benefit, it is unlikely to work in all women and is most likely to be prescribed alongside advice on diet and exercise.

Nonetheless, women rightfully feel “uneasy” about the trial, said Alison Wetton, CEO of Britain’s fastest growing weight loss organization, All About Weight. “No mother-to-be likes to take medication, and the fact that the widely-used diabetes pill, metformin, is being trialed to prevent obese babies being born to overweight mothers is disturbing to me, and I am sure most other women as well,” she said.

Will Williams, scientific advisor for All About Weight, said that although there were “reasonable grounds” for the trial, it was “a shame that it is needed at all.” He said women wanting to conceive could instead lose weight by following a healthy weight loss plan, including diet and exercise, and “thus achieve all the things that the metformin trial is hoping to do, without the risks or costs of adding a drug with uncertain long term effects.”

“This would be far preferable to popping a pill that may help pregnancy outcomes but is unlikely to break the cycle of an unhealthy lifestyle leading to overweight children and the continuing rise of obesity and diabetes in the general population,” he stressed.

Related posts:

Bad Diet for Expectant Mother Can Mean a Fat Baby

Fat Fathers Pass on Diabetes

D –Blog Week: Many Battles To Be Fought Before The War Against Diabetes Is Won

A Report From the Diabetes Capital of the World 

The second Diabetes Blogging Week (May 9-15) is upon us, giving bloggers who write about diabetes to come together and exchange views. Today we are writing about the different perspectives of diabetes bloggers in different countries and different socio-economic-cultural settings.

If asked, I’d say most of us agree that the diabetes epidemic sweeping many parts of the world must be met head on. Where we differ is our perception of the challenge. Nevertheless, bloggers and diabetes activists like Jenny Ruhl, Manny Hernandez, Scott Strumello, and Amy Tenderich, not to forget countless others, have made tremendous contributions in bringing the fight against diabetes to the forefront in the mainstream media. I’m grateful to all of them for enlightening me about diabetes care. Indeed, they are one of the reasons I began blogging about diabetes.

Unfortunately, however, there’s a tendency amongst writers (unless warranted otherwise) to treat all people with diabetes (PWD) as a general category without appreciating the fact that there is a significant diversity amongst them. To researchers and bloggers alike (including myself), it doesn’t matter that diabetics live on different continents, or belong to different ethnic groups, only the disease is important. Even within the ethnic groups, the divide between rural, semi-urban and urban areas is hardly taken into account to formulate policy, not to speak of wide socio-economic disparities. So even I end up endorsing CGM when a majority of diabetics cannot afford an HbA1c test.

After blogging about diabetes for one year this month, I have come round to the view that while the ultimate goals of all diabetes care programs may be the same, these differences and diversities must be taken into account when drawing up specific plans and guidelines so that the challenge posed by the worldwide diabetes epidemic can be met effectively. This post has inadvertently become lengthy, but I’m using Karen Graffeo’s’s platform in an attempt to educate and inform fellow diabetics about people with diabetes beyond US shores. Of course, I’m laying myself open to well-meaning criticism, but nothing is worse than uncontrolled diabetes.

Take the case of India, a vast and diverse country, which is home to the second largest number of diabetics after China (India may still have more diabetics as millions of cases go unreported). Not only is India a vast and heavily populated country, but the people who live here are ethnically heterogeneous, which is manifested in significantly different religions, communities, castes, cultures, languages (18 major languages and more than 200 dialects!), food habits, lifestyles and genetic endowment. It would be fair to say that India has more diversity than the whole of Europe. It is this diversity that must be taken into account when planning any program for diabetes care in India.

Diabetes in India has long passed the stage of an epidemic and numbers have given the country the dubious distinction of ‘Diabetes Capital’ of the world. To put it simply, it has crossed the stage of a problem associated with individuals to become an astronomically growing large public health problem.

It may surprise many of you, but the type of diabetes which we see here in India is considerably different from that described in the western literature. Although the estimate of Type 1 is around 1% of the total diabetics, the vast majority of Type 2s differ significantly from their western counterparts. Only about one third of these would be considered obese; 10-15% would be underweight and the rest would be of normal weight or just slightly over the acceptable weight range.  The propensity to become a diabetic is higher in Indians as we have a low threshold for the risk factors ‒ Americans develop diabetes when the body mass index (BMI) is 30 and 35; Indians develop it when the BMI is only 25.

What is of considerable interest is not only that the number of diabetics is increasing in leaps and bounds, in India, compared to the US, diabetes appears not only earlier in life (with many Type 2s being diagnosed at the age of 20-30 years), but the chronic long-term complications occur earlier, progressing more rapidly and reaching the hard end points in diabetics who are relatively younger as compared to the picture seen in the past.

To put India’s diabetes epidemic in perspective, the crude prevalence rate of diabetes in the country’s urban areas is about 9% while in rural areas it has increased to around 3% of the total population. If one takes into consideration that India’s population is more than 1 billion, the country is home to around 40 million diabetics. Surveys have also shown that the prevalence of Impaired Glucose Tolerance (IGT) is high. It has been reported that the prevalence of IGT is around 8.7% in urban and 7.9% in rural areas.

Another study has shown that the prevalence rate in urban areas is around 6%, whilst the figure in the rural areas is around 5%. Given the observation that around 35% of those with IGT will develop full blown diabetes within five years, the sheer numbers of those living with diabetes is overwhelming.

Screening has also shown that the unknown to known diabetes ratio is about 1.8:1 in urban areas, whilst it is as high as 3.3:1 in rural areas.

Whilst the high rate of prevalence of complications is disturbing, the picture is rendered all the more gloomy with reports that more than 35-40% of people show the presence of some diabetes related complications at the time of diagnosis.

It is therefore, a major concern to those involved in diabetes care that India has no major initiative available, or even planned, to try and face this problem. Even the central (federal) government’s announcement last year to conduct India’s first diabetes census is yet to take off.

India has a distinct need for a comprehensive diabetes care program that is workable. It needs to continuously be examined and reevaluated so that one is sure that the objectives are being achieved. Without such an objective evaluation, there is always a possibility that such programs will be high on “percept” and abysmal in “practice”.

It is crucial that for any program to succeed, it must be rooted in ground realities present in India. The program should have an infrastructure that makes it AVAILABLE, both in terms of technology and expertise, ACCESSIBLE even to the common man with diabetes, and AFFORDABLE.

Diabetes Clinic in India

The per capita income of an Indian has been estimated to be less than $400. In view of the significant disparity in incomes, more than 75% people earn much less. Economic realities have to be taken into consideration. This includes, both, the finances to make comprehensive and acceptable diabetes care services available to the people, and more importantly, the capacity of the people to afford these services.

It is widely accepted that the health, socio-economic and personal costs of diabetes and its attendant complications in India is unacceptably high, not only to the individual, but also to the nation as a whole when one considers the sheer number of people who are already known to be diabetic. This burden can only increase with the projected increase in the numbers of people with diabetes.

Unfortunately, the Indian government still does not consider diabetes and other non-communicable diseases as a priority area. The feeling is that we still have a long way to go in dealing with communicable diseases, which are again seeing a rise in numbers, immunization, providing clean drinking water and sanitation to the majority of the people, which get most of the funds allocated to the public health sector. As it is, the central (federal) government’s annual budget for health is a mere 1.2% of GDP, meaning a spend of just 25 cents per capita.

According to a recent paper in The Lancet, health services in India’s public sector, which can be accessed free or for a nominal fee, are grossly inadequate. Consequently, most Indians have to access private healthcare that is expensive, unaffordable and even unreliable. Good-quality healthcare in the private sector is also not available, particularly in rural and other remote parts of the country.

Even if the finances necessary for providing the basic modicum of services is made available, can the average person afford it? To paraphrase what 1998 Nobel Prize winner in Economics Amartya Sen said in the context of famines ‒ “the root cause of starvation in famines is not the lack of food, but the capacity of the average person to buy the food” ‒ it can be said that the root cause of a failure of a diabetes program is not only the availability of services, but the capacity of the average person to afford these services.

With the constraints that the government faces, and also the fact that the costs of therapy will increase by leaps and bounds, will optimal diabetes care become beyond the reach of most of our people with diabetes?

In the absence of any diabetes care program available in India, the question is often asked that if India does not have its own homegrown program, why doesn’t it “import” a program from abroad? There are many countries and regions which have good diabetes-related programs and one of these should be used in India.

Given India’s size and complexities, such imported diabetes care programs will rarely succeed. Programs based on the St. Vincent Declaration or the Declaration of the Americas, though excellent in themselves, can only act as beacons and not as the ultimate goals. India has to evolve its own program based on the ground realities. Based on this and the perceived needs and lacunae in diabetes care, India has to draw up a realistic plan to combat the diabetes. Sure, high sounding charters and programs look impressive on paper; but they achieve little, if anything, on the ground.

Therein lies the rub.

————————————————————

Based on the Statement of the ‘Indian Task Force on Diabetes Care in India’, which I endorse.

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 University study 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.

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.”

%d bloggers like this: