Findings show grape consumption lowered blood pressure, improved heart function and reduced other risk factors for heart disease and metabolic syndrome

Could eating grapes slow what’s for many Americans a downhill sequence of high blood pressure and insulin resistance leading to heart disease and type 2 diabetes?

Scientists at the University of Michigan Health System are teasing out clues to the effect of grapes in reducing risk factors related to cardiovascular disease and metabolic syndrome. The effect is thought to be due to phytochemicals — naturally occurring antioxidants – that grapes contain.

Findings from a new animal study will be presented today at the Experimental Biology convention in Anaheim, Calif., and show encouraging results of a grape-enriched diet preventing risk factors for metabolic syndrome, a condition affecting an estimated 50 million Americans and is often a precursor to type 2 diabetes.

Researchers studied the effect of regular table grapes (a blend of green, red and black grapes) that were mixed into a powdered form and integrated into the diets of laboratory rats as part of a high-fat, American style diet. All of the rats used were from a research breed that is prone to being overweight.

They performed many comparisons between the rats consuming a grape-enriched diet and the control rats receiving no grape powder. Researchers added calories and sugars to the control group to balance the extra calories and sugars gained from getting the grape powder.

After three months, the rats that received the grape-enriched diet had lower blood pressure, better heart function, and reduced indicators of inflammation in the heart and the blood than rats who received no grape powder. Rats also had lower triglycerides and improved glucose tolerance.

The effects were seen even though the grape-fed animals had no change in body weight.

In all, researchers say the study demonstrates that a grape-enriched diet can have broad effects on the development of heart disease and metabolic syndrome and the risk factors that go along with it.

“The possible reasoning behind the lessening of metabolic syndrome is that the phytochemicals were active in protecting the heart cells from the damaging effects of metabolic syndrome. In the rats, inflammation of the heart and heart function was maintained far better,” says Steven Bolling, M.D., heart surgeon at the U-M Cardiovascular Center and head of the U-M Cardioprotection Research Laboratory.

The researchers also looked for signs of inflammation, oxidative damage and other molecular indicators of cardiac stress. Again, the rats who consumed the grape powder had lower levels of these markers than rats who did not receive grapes.

There is no well-accepted way to diagnose metabolic syndrome which is really a cluster of characteristics: excess belly fat (for men, a waist measuring 40 inches or more and for women, a waist measuring 35 inches or more); high triglycerides which can lead to plague build-up in the artery walls; high blood pressure; reduced glucose tolerance; and elevated c-reactive protein, a marker for inflammation in the body.

Those with metabolic syndrome are at higher risk for cardiovascular disease and type 2 diabetes.

But the U-M study suggests that it may be possible that grape consumption can change the downhill sequence that leads to heart disease by prolonging the time between when symptoms begin to occur and a time of diagnosis.

“Reducing these risk factors may delay the onset of diabetes or heart disease, or lessen the severity of the diseases,” says E. Mitchell Seymour, Ph.D., lead researcher and manager of the U-M Cardioprotection Research Laboratory. “Ultimately it may lessen the health burden of these increasingly common conditions.”

Rats were fed the same weight of food each day, with powered grapes making up 3 percent of the diet. Although the current study was supported in part by the California Table Grape Commission, which also supplied the grape powder, the researchers note that the commission played no role in the study’s design, conduct, analysis or preparation of the presentation.

Research on grapes and other fruits containing high levels of antioxidant phytochemicals continues to show promise. U-M will further its research this summer when it begins a clinical trial to test the impact of grape product consumption on heart risk factors.

“Although there’s not a particular direct correlation between this study and what humans should do, it’s very interesting to postulate that a diet higher in phytochemical-rich fruits, such as grapes, may benefit humans,” Bolling says.

Bolling says that people who want to lower their blood pressure, reduce their risk of diabetes or help with weakened hearts retain as much pumping power as possible should follow some tried-and-true advice to eat a healthy diet low in saturated fat, trans fat and cholesterol, achieve a desirable weight and increase physical activity.

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Grapes reduce risk factors for heart disease and diabetes

Metabolic syndrome is characterized by abdominal obesity, high triglycerides, insulin resistance and other cardiovascular disease-risk factors.

The study, published online March 30 in the International Journal of Obesity, examined the influence exerted by the type of foods and specific timing of intake on the development of metabolic syndrome characteristics in mice. The UAB research revealed that mice fed a meal higher in fat after waking had normal metabolic profiles. In contrast, mice that ate a more carbohydrate-rich diet in the morning and consumed a high-fat meal at the end of the day saw increased weight gain, adiposity, glucose intolerance and other markers of the metabolic syndrome.

“Studies have looked at the type and quantity of food intake, but nobody has undertaken the question of whether the timing of what you eat and when you eat it influences body weight, even though we know sleep and altered circadian rhythms influence body weight,” said the study’s lead author Molly Bray, Ph.D., professor of epidemiology in the UAB School of Public Health.

Bray said the research team found that fat intake at the time of waking seems to turn on fat metabolism very efficiently and also turns on the animal’s ability to respond to different types of food later in the day. When the animals were fed carbohydrates upon waking, carbohydrate metabolism was turned on and seemed to stay on even when the animal was eating different kinds of food later in the day.

“The first meal you have appears to program your metabolism for the rest of the day,” said study senior author Martin Young, Ph.D., associate professor of medicine in the UAB Division of Cardiovascular Disease. “This study suggests that if you ate a carbohydrate-rich breakfast it would promote carbohydrate utilization throughout the rest of the day, whereas, if you have a fat-rich breakfast, you have metabolic plasticity to transfer your energy utilization between carbohydrate and fat.”

Bray and Young said the implications of this research are important for human dietary recommendations. Humans rarely eat a uniform diet throughout the day and need the ability to respond to alterations in diet quality. Adjusting dietary composition of a given meal is an important component in energy balance, and they said their findings suggest that recommendations for weight reduction and/or maintenance should include information about the timing of dietary intake plus the quality and quantity of intake.

“Humans eat a mixed diet, and our study, which we have repeated four times in animals, seems to show that if you really want to be able to efficiently respond to mixed meals across a day then a meal in higher fat content in the morning is a good thing,” Bray said. “Another important component of our study is that, at the end of the day, the mice ate a low-caloric density meal, and we think that combination is key to the health benefits we’ve seen.”

Bray and Young said further research needs to test whether similar observations are made with different types of dietary fats and carbohydrates, and it needs to be tested in humans to see if the findings are similar between rodents and humans.

“We’re also working on a study right now to determine if these feeding regimens adversely affect heart function,” Young said.

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Bacon or Bagels? Higher Fat at Breakfast May Be Healthier Than You Think, Says UAB Research

“Vitamin D deficiency continues to be a problem despite the nutrient’s widely reported health benefits,” said Sue Penckofer, PhD, RN, professor, MNSON. “Chicago winters compound this issue when more people spend time away from sunlight, which is a natural source of vitamin D.”

Diet alone may not be sufficient to manage vitamin D levels. A combination of adequate dietary intake of vitamin D, exposure to sunlight, and treatment with vitamin D2 or D3 supplements can decrease the risk of certain health concerns. The preferred range in the body is 30 – 60 ng/mL of 25(OH) vitamin D.

Loyola faculty members plan to take vitamin D research a step further by evaluating whether weekly vitamin D supplements improve blood sugar control and mood in women with diabetes. Depression is associated with increased insulin resistance, so people with diabetes have a greater risk for the disease than those without depression. Women also tend to have greater rates of depression and poorer blood sugar control than men with diabetes.

“There is evidence to suggest that vitamin D supplementation may decrease insulin resistance,” said Dr. Penckofer. “If we can stabilize insulin levels, we may be able to simply and cost effectively improve blood sugar control and reduce symptoms of depression for these women.”

Loyola is currently enrolling women in this clinical trial. In order to enter the study, they must be 18 to 70 years of age, have stable type 2 diabetes, signs of depression and no other major medical illness. Eighty women with type 2 diabetes and signs of depression will be given a weekly dose of vitamin D (50,000 IU) for a period of six months. Study participants will be evaluated at three points during this time.

“Vitamin D has widespread benefits for our health and certain chronic diseases in particular,” Dr. Penckofer said. “Our research may shed greater light on the role this nutrient plays in managing two conditions that impact millions of Americans. If proven to be successful, vitamin D may an important addition to care for diabetes and depression.”

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VITAMIN D LIFTS MOOD DURING COLD WEATHER MONTHS

The new research, presented at the Experimental Biology convention in New Orleans, gives tantalizing clues to the potential of blueberries in reducing risk factors for cardiovascular disease and metabolic syndrome. The effect is thought to be due to the high level of phytochemicals – naturally occurring antioxidants – that blueberries contain.

The study was performed in laboratory rats. While the animal findings suggest blueberries may be protective against two health conditions that affect millions of Americans, more research should be done.

The researchers studied the effect of blueberries (freeze dried blueberries crushed into a powder) that were mixed into the rat diet, as part of either a low- or high-fat diet. They performed many comparisons between the rats consuming the test diets and the control rats receiving no blueberry powder. All the rats were from a research breed that is prone to being severely overweight.

In all, after 90 days, the rats that received the blueberry-enriched powder, measured as 2 percent of their diet, had less abdominal fat, lower triglycerides, lower cholesterol, and improved fasting glucose and insulin sensitivity, which are measures of how well the body processes glucose for energy.

While regular blueberry intake reduced these risks for cardiovascular disease and metabolic syndrome, the health benefits were even better when combined with a low-fat diet.

In addition to all the other health benefits, the group that consumed a low-fat diet had lower body weight, lower total fat mass and reduced liver mass, than those who ate a high fat diet. An enlarged liver is linked to obesity and insulin resistance, a hallmark of diabetes.

The rats in the study were similar to Americans who suffer fatty liver disease and metabolic syndrome as a result of high-fat diets and obesity. Metabolic syndrome is a group of health problems that include too much fat around the waist, elevated blood pressure, elevated blood sugar, high triglycerides, and together these conditions increase the risk of heart attacks, strokes and diabetes.

But were the health benefits seen in rats a result of losing abdominal fat, or something else?

“Some measurements were changed by blueberry even if the rats were on a high fat diet,” says E. Mitchell Seymour, M.S., lead researcher and manager of the U-M Cardioprotection Research Laboratory. “We found by looking at fat muscle tissue, that blueberry intake affected genes related to fat-burning and storage. Looking at muscle tissue, we saw altered genes related to glucose uptake.”

Steven Bolling, M.D., a U-M heart surgeon and head of the Cardioprotection Laboratory, says: “The benefits of eating fruits and vegetables has been well-researched, but our findings in regard to blueberries shows the naturally occurring chemicals they contain, such as anthocyanins, show promise in mitigating these health conditions.”

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Blueberries May Help Reduce Belly Fat, Diabetes Risk

“Differences in what you eat after exercise produce different effects on the body’s metabolism,” said the study’s senior author, Jeffrey F. Horowitz of the University of Michigan. This study follows up on several previous studies that demonstrate that many health benefits of exercise are transient: one exercise session produces benefits to the body that taper off, generally within hours or a few days.

“Many of the improvements in metabolic health associated with exercise stem largely from the most recent session of exercise, rather than from an increase in ‘fitness’ per se,” Dr. Horowitz said. “But exercise doesn’t occur in a vacuum, and it is very important to look at both the effects of exercise and what you’re eating after exercise.”

Specifically, the study found that exercise enhanced insulin sensitivity, particularly when meals eaten after the exercise session contained relatively low carbohydrate content. Enhanced insulin sensitivity means that it is easier for the body to take up sugar from the blood stream into tissues like muscles, where it can be stored or used as fuel. Impaired insulin sensitivity (i.e., “insulin resistance”) is a hallmark of Type II diabetes, as well as being a major risk factor for other chronic diseases, such as heart disease.

Interestingly, when the research subjects in this study ate relatively low-calorie meals after exercise, this did not improve insulin sensitivity any more than when they ate enough calories to match what they expended during exercise. This suggests that you don’t have to starve yourself after exercise to still reap some of the important health benefits.

The paper, “Energy deficit after exercise augments lipid mobilization but does not contribute to the exercise-induced increase in insulin sensitivity,” appears in the online edition of the journal.

Study Design

The study included nine healthy sedentary men, all around 28-30 years old. They spent four separate sessions in the Michigan Clinical Research Unit in the University of Michigan Hospital. Each session lasted for approximately 29 hours. They fasted overnight before attending each session, which began in the morning.

The four hospital visits differed primarily by the meals eaten after exercise. The following describes the four different visits:

1. They did not exercise and ate meals to match their daily calorie expenditure. This was the control trial.

2. They exercised for approximately 90 min at moderate intensity, and then ate meals that matched their caloric expenditure. The carbohydrate, fat, and protein content of these meals were also appropriately balanced to match their expenditure.

3. They exercised for approximately 90 min at moderate intensity and then ate meals with relatively low carbohydrate content, but they ate enough total calories to match their calorie expenditure. This reduced-carbohydrate meal contained about 200 grams of carbohydrate, less than half the carbohydrate content of the balanced meal.

4. They exercised for approximately 90 min at moderate intensity and then ate relatively low-calorie meals, that is, meals that provided less energy than was expended (about one-third fewer calories than the meals in the other two exercise trials). These meals contained a relatively high carbohydrate content to replace the carbohydrate “burned” during exercise.

The exercise was performed on a stationary bicycle and a treadmill. The order in which the participants did the trials was randomized.

In the three exercise trials, there was a trend for an increase in insulin sensitivity. However, when participants ate less carbohydrate after exercise, this enhanced insulin sensitivity significantly more. Although weight loss is important for improving metabolic health in overweight and obese people, these results suggests that people can still reap some important health benefits from exercise without undereating or losing weight, Dr. Horowitz said.

The study also reinforces the growing body of evidence that each exercise session can affect the body’s physiology and also that differences in what you eat after exercise can produce different physiological changes.

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It’s Better to Eat a Low Carb Meal After Exercise

The research results, released hot on the heels of both National Obesity Week and World Diabetes Day, are particularly important for nearly a quarter (24%¹) of the UK adult population, and 16% of the child population, now classified as obese and at risk of Type 2 Diabetes – 80%² of all people diagnosed with Type 2 diabetes are overweight.

Type 2 Diabetes is the result of inadequate insulin production and/or insulin resistance, which means that the right levels of glucose (our main source of energy from food) are not maintained naturally by the body. There are 180 million people in the world with diabetes and the World Health Organisation predicts this number will double in the next 20 years.

Dr Hunter, Royal Victoria Hospital, Belfast, said: “The worldwide obesity pandemic is a major public health concern and strongly linked to rises in diabetes and cardiovascular disease. By advocating low-carbohydrate high-fat diets as a weapon against obesity and diabetes, health professionals could be contributing to a dangerous rise in cardiovascular disease”.

The research study, conducted among a group of obese pre-diabetic adults, compared the results of following a low-fat high-carbohydrate diet (20% fat, 60% carbohydrate) with a high-fat low-carbohydrate diet (60% fat, 20% carbohydrate). It showed that in all areas, other than the risk of cardiovascular disease, the diets have equal health benefits. The same amount of weight is lost; there is no significant difference in the body’s glucose uptake or production; and meal tolerance-related insulin secretion is comparable. However, the study revealed a significant difference in overall systemic arterial stiffness and pointed to increased cardiovascular risk factors from high-fat low-carbohydrate diets.

Dr Hunter continued: “High-fat diets have become popular because they seemingly promote more rapid weight loss and because of their palatability. However, we now have proof that they do not help people lose weight any faster than more conventional diets, and the potential negatives of increased cardiovascular risks far outweigh the potential positives of more easily sustained dieting/weight loss, especially when there is a proven and safe alternative in low-fat high-carbohydrate weight loss diets.”
According to Dr Hunter, the challenge now is to find ways to make low-fat high-carbohydrate diets more palatable and easier to maintain, so that a long-term positive outcome is achieved.

The Food Standards Agency says that saturated fat should account for less than 11% of the total diet for a normal person, and Dr. Hunter concludes: “If your New Year’s resolution is to lose weight, make sure you do it the right way and don’t burden your body with additional unnecessary health risks by falling for the lure of the seemingly easy and fast weight loss offered by high-fat diets. The best approach for your overall health is a low-fat high-carbohydrate diet, coupled with exercise.”

¹ NHS Statistics on obesity, physical activity and diet: England, January 2008, published 31 January 2008
² Diabetes UK

Reference

Bradley U et al. Low-fat versus low-carbohydrate weight reduction diets: effects on weight loss, insulin resistance and cardiovascular risk. A randomised trial. Diabetes. December 2009, vol.58, no. 12, 2741-2748
doi: 10.2337/db09-0098

Low-Fat versus Low-Carbohydrate Weight Reductions Diets: Effects on Weight Loss, Insulin Resistance and Cardiovascular Risk A Randomised Control Trial, is one of the first studies to determine augmentation index, by measuring arterial stiffness using pulse wave analysis, in relation to cardiovascular risk.

Research Design and Methods: the research investigated a low-fat (20% fat, 60% carbohydrate) versus a low-carbohydrate (60% fat, 20% carbohydrate) weight reduction diet in 24 overweight/obese subjects, BMI 33.6±3.7 kg/m², age 39±10 years (mean ± SD), in an 8 week randomised controlled trial. All food was weighed and distributed and intake calculated to produce a 500kcal/day energy deficit. Insulin action was assessed by the euglycaemic clamp and insulin secretion by meal tolerance test. Body composition, adipokine levels and vascular compliance by pulse-wave analysis were also measured.

The Low-Fat versus Low-Carbohydrate Weight Reductions Diets: Effects on Weight Loss, Insulin Resistance and Cardiovascular Risk A Randomised Control Trial study, by Dr Steven J Hunter, was supported by RRG 5.42 (PI SJH) from the Northern Ireland Department of Health and Social Services Research and Development Office and by an unrestricted research grant from The Sugar Bureau (UK).

Background information

Diabetes is a common health problem which affects around 3-4% of the UK population.
The majority of people with type 2 diabetes are overweight. Therefore, weight management is a crucial aspect in the prevention of type 2 diabetes and the management of diabetes in general.

The diet for people with diabetes is no longer a special one, but merely follows the basic principles of healthy eating, ie a low-fat, high-carbohydrate diet.
One of the prominent changes of the recent nutrition guidelines from Europe is the relaxation on dietary restriction of sugar and high-sugar content foods, providing blood glucose levels are kept in control. This is because sucrose (table sugar) does not increase blood glucose to a greater extent than similar amounts of starchy foods like bread, potatoes or rice.

FAQ on sugar and health

Links

Diabetes and Nutrition Study Group of the EASD. 2000. Recommendations for the nutritional management of patients with diabetes mellitus. European Journal of Clinical Nutrition, 54, pp353-355.

American Diabetes Association. 2008:

Nutrition recommendations and interventions for diabetes: a position statement of the ADA. Diabetes Care, 31suppl, pp61-78.
Black RN et al 2006.

http://diabetes.diabetesjournals.org/content/55/12/3566.full.pdf+html
Diabetes; 55: 3566-3572.

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High-fat Low-carb Diets=Heart Risk

But a new report in the October 7th Cell Metabolism, a Cell Press publication, adds to evidence that it might not be as simple as all that. The researchers show that low levels of ROS – and hydrogen peroxide in particular — might actually protect us from diabetes, by improving our ability to respond to insulin signals.

“Our studies indicate that ‘physiological’ low levels of ROS may promote the insulin response and attenuate insulin resistance early in the progression of type 2 diabetes, prior to overt obesity and hyperglycemia,” said Tony Tiganis of Monash University in Australia. “In a way, we think there is a delicate balance and that too much of a good thing – surprise, surprise – might be bad.”

Tiganis’ team found that mice with a deficiency that prevented them from eliminating physiological ROS didn’t become insulin resistant on a high-fat diet as they otherwise would have. They showed that those health benefits could be attributed to insulin-induced signals and the uptake of glucose into their muscles. When those animals were given an antioxidant, those benefits were lost, leaving the mice with more signs of diabetes.

Tiganis said whether antioxidants are ultimately good for people will probably depend on their state of health or disease. “In the case of early type 2 diabetes and the development of insulin resistance, our studies suggest that antioxidants would be bad for you.” Under some conditions, treatments designed to selectively increase ROS in muscle – if they can be devised – might even help, he says.

It’s not the first time studies have suggested that antioxidants can be a negative, Tiganis adds. Studies in worms have suggested that antioxidants can shorten lifespan, as have some epidemiological studies in humans. Other recent reports indicate that antioxidants may negate the longer-term benefits of exercise training by lowering the activity of certain genes involved in ROS defense.

Tiganis said it will ultimately be important to work out at what stage ROS go from being good to bad. He suspects it probably depends on the levels and/or the source of their generation. (ROS are generated both on the surfaces of cells and within cells by mitochondria, which convert nutrients such as glucose into energy, he explained.)

Although any health implications of the new findings would require further study, the findings lead Tiganis to suspect it is best not to take daily antioxidant vitamins, especially if you are otherwise healthy. “Do exercise,” he says, as this is a natural source of ROS that may promote insulin action.

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Antioxidants make us more prone to diabetes

In the study one group of mice was fed a high-fat (western) diet to induce the symptoms of metabolic syndrome. A second group was fed the exact same diet and treated with naringenin. Naringenin corrected the elevations in triglyceride and cholesterol, prevented the development of insulin resistance and completely normalized glucose metabolism. The researchers found it worked by genetically reprogramming the liver to burn up excess fat, rather than store it.

“Furthermore, the marked obesity that develops in these mice was completely prevented by naringenin,” says Huff, Director of the Vascular Biology Research Group at Robarts and Professor of Medicine and Biochemistry at the Schulich School of Medicine & Dentistry. “What was unique about the study was that the effects were independent of caloric intake, meaning the mice ate exactly the same amount of food and the same amount of fat. There was no suppression of appetite or decreased food intake, which are often the basis of strategies to reduce weight gain and its metabolic consequences.”

While grapefruit has long been linked to weight loss diets, the concentrations of the citrus-derived flavonoid being studied are at higher levels than you could get from dietary components. “We are examining the pharmacological properties of naringenin,” explains Huff. “The next step is to find out if naringenin prevents heart disease in animal models and to explore the feasibility of clinical trials to determine its safety and efficacy in humans.”

This study investigated naringenin’s preventative properties, but Huff is also investigating whether it can treat obesity and other existing metabolic problems. “These studies show naringenin, through its insulin-like properties, corrects many of the metabolic disturbances linked to insulin resistance and represents a promising therapeutic approach for metabolic syndrome.”

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Naringenin, a citrus-derived flavonoid, prevents obesity

There are many reasons to suspect that dietary factors influence the development of hepatic steatosis and its progression to more severe liver disease. First, poor diet may lead to obesity, insulin resistance and diabetes, which are the most important known risk factors for hepatic steatosis. Also, dietary lipids may directly affect fat in the liver. Furthermore, a high cholesterol diet has been shown to induce serious steatosis in animal studies.

Researchers, led by George Ioannou of Veterans Affairs Puget Sound Health Care System in Seattle, investigated whether dietary nutrient composition was associated with the subsequent development of cirrhosis or liver cancer in a representative sample of the U.S. population. They utilized data from 9,221 participants in the National Health Examination Survey who had completed a 24-hour dietary recall questionnaire. Participants were excluded if they suffered from cirrhosis or liver cancer at the start of the study, or received a diagnosis within five years.

During the follow-up period, an average of 13.3 years, 123 participants received a new diagnosis of cirrhosis (118 people) or liver cancer (5 people) according to hospitalization records and death certificates. These individuals were more likely to be older, more obese with more central fat distribution. They had lower educational attainment and higher alcohol consumption, and were more likely to be male, diabetic and non-white.

Dietary nutrient composition was a strong predictor of hospitalization or death due to cirrhosis or liver cancer in the U.S. population. “In particular, we identified that protein and cholesterol consumption were associated with elevated risk, whereas consumption of carbohydrates was associated with reduced risk of hospitalization or death related to cirrhosis or liver cancer,” the authors report.

The association with cholesterol intake is potentially the most important finding of this study, the authors suggest. While cholesterol is well-known for its role in non-hepatic diseases like atherosclerosis, it has never before been linked to human liver disease. The findings suggest that drugs blocking intestinal cholesterol absorption might reduce the progression of fatty liver disease but this needs to be investigated in prospective studies.

“Subgroup analyses showed that the significant associations of protein, carbohydrate and cholesterol intake with cirrhosis or liver cancer that we described in the entire study population, were limited to overweight or obese persons,” the authors report. “No such associations were observed in normal-weight persons.” This suggests that the relevant dietary factors are more likely to have hepatic effects through obesity-related fatty liver disease.

“Our study raises the possibility that dietary factors may be important, modifiable, and hitherto unrecognized determinants of liver disease progression,” the authors conclude.

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Diets high in protein& cholesterol = liver cancer risk

Causes

Hyperpigmentation may be caused by sun damage, inflammation, or other skin injuries, including those related to acne vulgaris. People with darker Asian, East Indian, Mediterranean or African skin tones are also more prone to hyperpigmentation, especially if they have excess sun exposure.

Hyperpigmentation is associated with a number of diseases or conditions, including:

• Addison’s disease and other sources of adrenal insufficiency, in which hormones that stimulate melanin synthesis, such as melanocyte-stimulating hormone (MSH), are frequently elevated.
• Cushing’s disease or other excessive adrenocorticotropic hormone (ACTH) production, because MSH production is a byproduct of ACTH synthesis from proopiomelanocortin (POMC).
• Acanthosis nigricans – hyperpigmentation of intertriginous areas associated with insulin resistance.
• Melasma, also known as chloasma – patchy hyperpigmentation often found in pregnant women.
• Linea nigra – a hyperpigmented line found on the abdomen during pregnancy.
• Peutz-Jeghers syndrome – an autosomal dominant disorder characterized by hyperpigmented macules on the lips and oral mucosa and gastrointestinal polyps.
• Certain chemicals such as salicylic acid, bleomycin, and cisplatin.
• Smoker’s melanosis
• Celiac disease
• Cronkite-Canada syndrome
• Porphyria
• Tinea fungal infections such as ringworm
• Haemochromatosis – a common but debilitating genetic disorder characterized by the chronic accumulation of iron in the body.

Hyperpigmentation can sometimes be induced by dermatological laser procedures.

Treatment

Treatment of hyperpigmentation may include hydroquinone, kojic acid, azelaic acid, ascorbic acid, tretinoin (Retinol), topical glucocorticoids, and licorice extract. All treatments fail if the affected area is exposed to the sun with inadequate UVA/UVB protection.

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Hyperpigmentation

In one study, greater consumption of protein led to greater losses of both weight and fat compared with a high-carbohydrate, lower-protein diet. These increased reductions of weight and fat were probably due to the lower intake of calories and the increased feeling of fullness (satiety) that come with increased protein intake.

And women in these studies who had insulin resistance or diabetes had significantly greater losses of both weight and abdominal fat compared with other women with the same conditions who were on a high-carbohydrate, lower-protein regimen.
Try these tips to ensure that the protein you consume is lean:

-Use fat-free or low-fat Greek yogurt as a dressing for salads or add this yogurt to a fruit shake made with skim or 1-percent milk, berries, and a little no-calorie sweetener.

-Replace regular burgers with veggie burgers. (Morningstar Farms® Spicy Black Bean Veggie Burgers are terrific.)

-Use low-fat cheeses such as Laughing Cow, Cabot 75% Fat-Reduced Cheddar, Jarlsberg Lite, Alpine Lace, and Veggie Slices Soy Cheese.

-Use hummus (made from chick peas) as a salad dressing or in place of tuna salad. Hummus is downright delicious and, ounce for ounce, provides more protein without all the fat and calories of mayo

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LOSING WEIGHT WITH HIGH PROTEIN DIETS

Mechanism

Pulsatile insulin secretion from individual beta cells is driven by oscillation of the calcium concentration in the cells. In beta cells lacking contact the periodicity of these oscillations is rather variable (2-10 min). However, within an islet of Langerhans the oscillations become synchronized by electrical coupling between closely located beta cells that are connected by gap junctions, and the periodicity is more uniform (3-6 min).

(Coordination of pulsatile insulin release. In addition to gap junctions, coordination is done by ATP signaling.)

Pulsatile insulin release from the entire pancreas requires that secretion is synchronized between 1 million islets within a 25 cm long organ. This synchronization is accomplished by intrapancreatic neurons and does not require neural input from the brain. It is not entirely clear which neural factors account for this synchronization but ATP as well as the gasses NO and CO may be involved. The effect of these neural factors is to induce sudden dramatic elevation of calcium in the cytoplasm by releasing calcium from the endoplasmic reticulum (ER) of the beta cells. This elevation results in release of ATP from the beta cells. The released ATP in turn binds to receptors on neighbouring beta cells leading to a regenerative wave of rapid calcium elevation among the cells within the islet. This signal is believed to entrain pulsatile insulin release from the islets into a common pancreatic rhythm.

Clinical significance

The insulin oscillations are particularly pronounced in the portal vein delivering blood from the pancreas to the liver, which is a major insulin target. Disturbances of the insulin oscillations occur early in type 2 diabetes and may contribute to insulin resistance. Pulsatile insulin delivery to the portal vein or islet cell transplantation to the liver of diabetic patients are therefore attractive therapeutic alternatives.

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Insulin oscillations

Diabetes mellitus type 2 or Type 2 Diabetes (formerly called non – insulin-dependent diabetes mellitus (NIDDM), or adult-onset diabetes) is a metabolic disorder that is primarily characterized by insulin resistance, relative insulin deficiency, and hyperglycemia. It is often managed by increasing exercise and dietary modification, although medications and insulin are often needed, especially as the disease progresses. It is rapidly increasing in the developed world and there is some evidence that this pattern will be followed in much of the rest of the world in coming years. CDC has characterized the increase as an epidemic. In addition, whereas this disease used to be also seen primarily in adults over age 40, in contrast to type 1 diabetes, it is now increasingly seen in children and adolescents, an increase thought to be linked to rising rates of obesity in this age group, although it remains a minority of cases.

Unlike type 1 diabetes, there is little tendency toward ketoacidosis in type 2 diabetes, though it is not unknown. One effect that can occur is nonketonic hyperglycemia which also is quite dangerous, though it must be treated very differently. Complex and multifactorial metabolic changes very often lead to damage and function impairment of many organs, most importantly the cardiovascular system in both types. This leads to substantially increased morbidity and mortality in both Type 1 and Type 2 patients, but the two have quite different origins and treatments despite the similarity in complications.

Pathophysiology

Insulin resistance means that body cells do not respond appropriately when insulin is present. Unlike type 1 diabetes mellitus, the insulin resistance is generally “post-receptor”, meaning it is a problem with the cells that respond to insulin rather than a problem with insulin production.

Other important contributing factors:

• increased hepatic glucose production (e.g., from glycogen degradation), especially at inappropriate times (typical cause is deranged insulin levels, as insulin controls this function in liver cells)
• decreased insulin-mediated glucose transport in (primarily) muscle and adipose tissues (receptor and post-receptor defects)
• impaired beta-cell function—loss of early phase of insulin release in response to hyperglycemic stimuli
• Cancer survivors who received allogenic Hematopoietic Cell Transplantation (HCT) are 3.65 times more likely to report type 2 diabetes than their siblings. Total body irradiation (TBI) is also associated with a higher risk of developing diabetes.

  

This is a more complex problem than Type 1, but is sometimes easier to treat, especially in the early years when insulin is often still being produced internally. Type 2 may go unnoticed for years before diagnosis, since symptoms are typically milder (eg, no ketoacidosis, coma, etc) and can be sporadic. However, severe complications can result from improperly managed Type 2 diabetes, including renal failure, blindness, slow healing wounds (including surgical incisions), and arterial disease, including coronary artery disease. The onset of Type 2 has been most common in middle age and later life, although it is being more frequently seen in adolescents and young adults due to an increasing rate of obesity in these groups. A type of diabetes called MODY is occasionally also seen in adolescents, but this is classified as a diabetes due to a specific cause and not as type 2 diabetes.

Diabetes mellitus type 2 is presently of unknown etiology (i.e., origin). Diabetes mellitus with a known etiology, such as secondary to other diseases, known gene defects, trauma or surgery, or the effects of drugs, is more appropriately called secondary diabetes mellitus or diabetes due to a specific cause. Examples include diabetes mellitus such as MODY or those caused by hemochromatosis, pancreatic insufficiencies, or certain types of medications (e.g. long-term steroid use).

According to CDC about 23.6 million people in the United States, or 8% of the population, have diabetes. The total prevalence of diabetes increased 13.5% from 2005-2007. Only 24% of diabetes is undiagnosed, down from 30% in 2005 and from 50% ten years ago.

About 90–95% of all North American cases of diabetes are type 2, and about 20% of the population over the age of 65 has diabetes mellitus Type 2. The fraction of Type 2 diabetics in other parts of the world varies substantially, almost certainly for environmental and lifestyle reasons, though these are not known in detail. Diabetes affects over 150 million people worldwide and this number is expected to double by 2025.There is also a strong inheritable genetic connection in Type 2 diabetes: having relatives (especially first degree) with Type 2 increases risks of developing Type 2 diabetes very substantially. In addition, there is also a mutation to the Islet Amyloid Polypeptide gene that results in an earlier onset, more severe, form of diabetes. About 55 percent of type 2 are obese —chronic obesity leads to increased insulin resistance that can develop into diabetes, most likely because adipose tissue (especially that in the abdomen around internal organs) is a (recently identified) source of several chemical signals to other tissues (hormones and cytokines). Other research shows that Type 2 diabetes causes obesity as an effect of the changes in metabolism and other deranged cell behavior attendant on insulin resistance.

Diabetes mellitus Type 2 is often associated with obesity, hypertension, elevated cholesterol (combined hyperlipidemia), and with the condition often termed Metabolic syndrome (it is also known as Syndrome X, Reavan’s syndrome, or CHAOS). It is also associated with acromegaly, Cushing’s syndrome and a number of other endocrinological disorders. Additional factors found to increase risk of type 2 diabetes include aging, high-fat diets and a less active lifestyle.

Diagnosis

The World Health Organization definition of diabetes is for a single raised glucose reading with symptoms, otherwise raised values on two occasions, of either:

• fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl)

or

• With a Glucose tolerance test, two hours after the oral dose a plasma glucose ≥ 11.1 mmol/l (200 mg/dl)

Screening and prevention

Prevention

Type II diabetes can largely be prevented through proper nutrition and regular exercise. A 2006 report by Harvard Medical School noted that “90% of cases of diabetes could be prevented with a healthy diet and lifestyle, including exercise.”

Interest has arisen in preventing diabetes due to research on the benefits of treating patients before overt diabetes. Although the U.S. Preventive Services Task Force concluded that “the evidence is insufficient to recommend for or against routinely screening asymptomatic adults for type 2 diabetes, impaired glucose tolerance, or impaired fasting glucose,” this was a grade I recommendation when published in 2003. However, the USPSTF does recommend screening for diabetics in adults with hypertension or hyperlipidemia.

In 2005, an evidence report by the Agency for Healthcare Research and Quality concluded that “there is evidence that combined diet and exercise, as well as drug therapy (metformin, acarbose), may be effective at preventing progression to DM in IGT subjects”.

Accuracy of tests for early detection

If a 2-hour postload glucose level of at least 11.1 mmol/L (≥ 200 mg/dL) is used as the reference standard, the fasting plasma glucose > 7.0 mmol/L (126 mg/dL) diagnoses current diabetes with:

• sensitivity about 50%
• specificity greater than 95%

A random capillary blood glucose > 6.7 mmol/L (120 mg/dL) diagnoses current diabetes with:

• sensitivity = 75%
• specificity = 88%

Glycosylated hemoglobin values that are elevated (over 5%), but not in the diabetic range (not over 7.0%) are predictive of subsequent clinical diabetes in US female health professionals. In this study, 177 of 1061 patients with glycosylated hemoglobin value less than 6% became diabetic within 5 years compared to 282 of 26281 patients with a glycosylated hemoglobin value of 6.0% or more. This equates to a glycosylated hemoglobin value of 6.0% or more having:

• sensitivity = 16.7%
• specificity = 98.9%

Benefit of early detection

Since publication of the USPSTF statement, a randomized controlled trial of prescribing acarbose to patients with “high-risk population of men and women between the ages of 40 and 70 years with a body mass index (BMI), calculated as weight in kilograms divided by the square of height in meters, between 25 and 40. They were eligible for the study if they had IGT according to the World Health Organization criteria, plus impaired fasting glucose (a fasting plasma glucose concentration of between 100 and 140 mg/dL or 5.5 and 7.8 mmol/L) found a number needed to treat of 44 (over 3.3 years) to prevent a major cardiovascular event.

Other studies have shown that life-style changes, xenical and metformin can delay the onset of diabetes.

Treatment

Diabetes mellitus type 2 is a chronic, progressive disease that has no established cure, but does have well-established treatments which can delay and sometimes avoid most of the formerly inevitable consequences of the condition. There are two main goals of treatment:

1. reduction of mortality and concomitant morbidity (from assorted diabetic complications)
2. preservation of quality of life

The first goal can be achieved through close glycemic control (i.e., to near ‘normal’ blood glucose levels); the reduction in severity of diabetic side effects has been very well demonstrated in several large clinical trials and is established beyond controversy. The second goal is often addressed (in developed countries) by support and care from teams of diabetic health workers (usually physician, PA, nurse, dietitian or a certified diabetic educator). Endocrinologists, family practitioners, and general internists are the physician specialties most likely to treat people with diabetes. Knowledgeable patient participation is vital to clinical success, and so patient education is a crucial aspect of this effort.

Type 2 is initially treated by adjustments in diet and exercise, and by weight loss, most especially in obese patients. The amount of weight loss which improves the clinical picture is sometimes modest (2-5 kg or 4.4-11 lb); this is almost certainly due to currently poorly understood aspects of fat tissue activity, for instance chemical signaling (especially in visceral fat tissue in and around abdominal organs). In many cases, such initial efforts can substantially restore insulin sensitivity. In some cases strict diet can adequetly control the glycemic levels.

Treatment goals

Treatment goals for Type 2 diabetic patients are related to effective control of blood glucose, blood pressure and lipids to minimize the risk of long-term consequences associated with diabetes. They are suggested in clinical practice guidelines released by various national and international diabetes agencies.

The targets are:

• HbA1c of 6% to 7.0%

• Preprandial blood glucose: 4.0 to 6.0 mmol/L

• 2-hour postprandial blood glucose: 5.0 to 8.0 mmol/L

In older patients, clinical practice guidelines by the American Geriatrics Society) states “for frail older adults, persons with life expectancy of less than 5 years, and others in whom the risks of intensive glycemic control appear to outweigh the benefits, a less stringent target such as 8% is appropriate”.

Self monitoring of blood glucose

Self-monitoring of blood glucose may not improve outcomes in some cases, that is among “reasonably well controlled non-insulin treated patients with Type 2 diabetes”. Nevertheless, it is very strongly recommended for patients in whom it can assist in maintaining proper glycemic control, and is well worth the cost (sometimes considerable) if it does. It is the only source of current information on the glycemic state of the body, as changes are rapid and frequent, depending on food, exercise, and medication (dosage and timing with respect to both diet and exercise), and secondarily, on time of day, stress (mental and physical), infection, etc.

The National Institute for Health and Clinical Excellence (NICE), UK released updated diabetes recommendations on 30th May 2008. They indicate that self-monitoring of blood glucose levels for people with newly diagnosed type 2 diabetes should be part of a structured self-management education plan. However, a recent study found that a treatment strategy of intensively lowering blood sugar levels (below 6%) in patients with additional cardiovascular disease risk factors poses more harm than benefit, and so there appear to be limits to benefit of intensive blood glucose control in some patients.

Dietary management

Modifying the diet to limit and control glucose (or glucose equivalent, eg starch) intake, and in consequence, blood glucose levels, is known to assist type 2 patients, especially early in the course of the disease’s progression. Additionally, weight loss is recommended and is often helpful in persons suffering from Type 2 diabetes for the reasons discussed above.

Several dietary modifications using dietary supplements are sometimes recommended to those with Type 2; there are studies suggesting that there is some beneficial effect for some of these. See the discussion below.

Self management

Diabetes self-management education is an integral component of medical care. Among adults with diagnosed diabetes, 12% take both insulin and oral medications,19% take insulin only, 53% take oral medications only, and 15% do not take either insulin or oral medications.

Traditionally, information regarding diabetes would be obtained from a family physician. However, with access to the internet so widely available now, people are able to educate themselves through websites. This information can be beneficial, but care must be taken to ensure the information is medically sound. Several of the external links below provide information about diabetes and its management, including self-management.

Exercise

In September 2007, a joint randomized controlled trial by the University of Calgary and the University of Ottawa found that “Either aerobic or resistance training alone improves glycemic control in Type 2 diabetes, but the improvements are greatest with combined aerobic and resistance training than either alone.” The combined program reduced the HbA1c by 0.5 percentage point. Other studies have established that the amount of exercise needed is not large or extreme, but must be consistent and continuing. Examples might include a brisk 45 minute walk every other day.

Theoretically, exercise does have benefits in that exercise would stimulate the release certain ligands that cause GLUT4 to be released from internal endosomes to the cell membrane. Insulin though, which no longer works effectively in those afflicted with Type II diabetes, causes GLUT1 to be placed into the membrane. Though they have different structures, they both perform the same function of increasing intake of glucose into the cell from the blood serum.

Antidiabetic drugs

There are several drugs available for Type 2 diabetics — most are unsuitable or even dangerous for use by type 1 diabetics. They fall into several classes and are not equivalent, nor can they be simply substituted one for another. All are prescription drugs.

Metformin 500mg tablets

One of the most widely used drugs now used for Type 2 diabetes is the Biguanide metformin; it works primarily by reducing liver release of blood glucose from glycogen stores and secondarily by provoking some increase in cellular uptake of glucose in body tissues. Both historically, and currently, the most commonly used drugs are in the Sulfonylurea group, of which several members (including glibenclamide and gliclazide) are widely used; these increase glucose stimulated insulin secretion by the pancreas and so lower blood glucose even in the face of insulin resistance.

Newer drug classes include:

• Thiazolidinediones (TZDs) (rosiglitazone, pioglitazone, and troglitazone — the last, as Rezulin, was withdrawn from the US market because of an increased risk of systemic acidosis). These increase tissue insulin sensitivity by affecting gene expression
• α-glucosidase inhibitors (acarbose and miglitol) which interfere with absorption of some glucose containing nutrients, reducing (or at least slowing) the amount of glucose absorbed
• Meglitinides which stimulate insulin release (nateglinide, repaglinide, and their analogs) quickly; they can be taken with food, unlike the sulfonylureas which must be taken prior to food (sometimes some hours before, depending on the drug)
• Peptide analogs which work in a variety of ways:
  • Incretin mimetics which increase insulin output from the beta cells among other effects. These includes the Glucagon-like peptide (GLP) analog exenatide, sometimes referred to as lizard spit as it was first identified in Gila Monster saliva
  • Dipeptidyl peptidase-4 (DPP-4) inhibitors increase Incretin levels (sitagliptin) by decreasing their deactivation rates
  • Amylin agonist analog, which slows gastric emptying and suppresses glucagon (pramlintide)

Oral drugs

A systematic review of randomized controlled trials found that metformin and second-generation sulfonylureas are the preferred choices for most with Type 2 diabetics, especially those early in the course of the disease. Failure of response after a time is not unknown with most of these agents: the initial choice of anti-diabetic drug has been compared in a randomized controlled trial which found “cumulative incidence of monotherapy failure at 5 years to be 15% with rosiglitazone, 21% with metformin, and 34% with glyburide”. Of these, rosiglitazone users showed more weight gain and edema than did non-users. Rosiglitazone may increase risk of death from cardiovascular causes though the causal connection is unclear. Pioglitazone and rosiglitazone may also increase the risk of fractures.

For patients who also have heart failure, metformin may be the best tolerated drug.

The variety of available agents can be confusing, and the clinical differences among Type 2 diabetics compounds the problem. At present, choice of drugs for Type 2 diabetics is rarely straightforward and in most instances has elements of repeated trial and adjustment.

====Injectable peptide analogs====-4 inhibitors|DPP-4]] inhibitors lowered A1c by 0.74%, comparable to other antidiabetic drugs.GLP-1 analogs resulted in weight loss and had more gastrointestinal side effects, while DPP-4 inhibitors were weight neutral and increased risk for infection and headache, but both classes appear to present an alternative to other antidiabetic drugs.

Insulin preparations

If antidiabetic drugs fail (ie, the clinical benefit stops), insulin therapy may be necessary – usually in addition to oral medication therapy – to maintain normal or near normal glucose levels.

Typical total daily dosage of insulin is 0.6 U/kg. More complicated estimations to guide initial dosage of insulin are:

• For men, [(fasting plasma glucose [mmol/liter]–5)x2] x (weight [kg]÷(14.3xheight [m])–height [m])
• For women, [(fasting plasma glucose [mmol/liter]–5)x2] x (weight [kg]÷(13.2xheight [m])–height [m])

The initial insulin regimen are often chosen based on the patient’s blood glucose profile. Initially, adding nightly insulin to patients failing oral medications may be best. Nightly insulin combines better with metformin than with sulfonylureas. The initial dose of nightly insulin (measured in IU/d) should be equal to the fasting blood glucose level (measured in mmol/L). If the fasting glucose is reported in mg/dl, multiply by 0.05551 to convert to mmol/L.

When nightly insulin is insufficient, choices include:

• Premixed insulin with a fixed ratio of short and intermediate acting insulin; this tends to be more effective than long acting insulin, but is associated with increased hypoglycemia. Initial total daily dosage of biphasic insulin can be 10 units if the fasting plasma glucose values are less than 180 mg/dl or 12 units when the fasting plasma glucose is above 180 mg/dl”. A guide to titrating fixed ratio insulin is available.

• Long acting insulins such as insulin glargine and insulin detemir. A meta-analysis of randomized controlled trials by the Cochrane Collaboration found “only a minor clinical benefit of treatment with long-acting insulin analogues for patients with diabetes mellitus type 2″. More recently, a randomized controlled trial found that although long acting insulins were less effective, they were associated with reduced hypoglycemic episodes.

Antihypertensive agents

The goal blood pressure is 130/80 which is lower than in non-diabetic patients.

ACE inhibitors

The HOPE study suggests that diabetics should be treated with ACE inhibitors (specifically ramipril 10 mg/d) if they have one of the following:

• hypertension
• hypercholesterolemia or reduced low high-density lipoprotein cholesterol levels
• cigarette smoking
• microalbuminuria

After treatment with ramipril for 5 years the number needed to treat was 50 patients to prevent one cardiovascular death. Other ACE inhibitors may not be as effective.

Hypolipidemic agents

Gastric bypass surgery

Gastric Bypass procedures are currently considered an elective procedure with no universally accepted algorithm to decide who should have the surgery. In the diabetic patient, certain types result in 99-100% prevention of insulin resistance and 80-90% clinical resolution or remission of Type II diabetes. In 1991, the NIH (National Institute of Health) Consensus Development Conference on Gastrointestinal Surgery for Obesity proposed that the body mass index (BMI) threshold to consider surgery should drop from 40 to 35 in the appropriate patient. More recently, the American Society for Bariatric Surgery (ASBS) and the ASBS Foundation suggested that the BMI threshold be lowered to 30 in the presence of severe co-morbidities. [51] More debate has flourished about the role of gastric bypass surgery in Type 2 diabetics since the publication of The Swedish Obese Subjects Study. The largest prospective series showed a large decrease in the occurrence of Type II diabetes in the post-gastric bypass patient at both 2 years (odds ratio was 0.14) and at 10 years (odds ratio was 0.25).

A study of 20-years of Greenville gastric bypass patients found that 80% of those with Type 2 diabetes before surgery no longer required insulin or oral agents to maintain normal glucose levels. Weight loss occurred rapidly in many people in the study who had had the surgery. The 20% who did not respond to bypass surgery were, typically, those who were older and had had diabetes for over 20 years.

The Journal of the American Medical Association (JAMA) published the first randomized controlled trial comparing the efficacy of laparoscopic adjustable gastric banding against conventional medical therapy in the obese patient with type 2 diabetes. Laparoscopic Adjustable Gastric Banding results in remission of Type 2 diabetes among affected patients diagnosed within the previous two years according to a randomized controlled trial. The relative risk reduction was 69.0%. For patients at similar risk to those in this study (87.0% had Type 2), this leads to an absolute risk reduction of 60%. 1.7 patients must be treated for one to benefit (number needed to treat = 1.7). Click here to adjust these results for patients at higher or lower risk of Type 2 diabetics.

Suspected action mechanism

The effectiveness of gastric bypass surgery in Type 2 remission was long thought to be due to weight loss. When it was discovered that rats whose duodenum and upper lower intestine were removed also showed the Type 2 remission effect, and when this was also observed in humans, the suspicion arose that some signal originating in the excised tissue was responsible for the development or maintenance of Type 2’s insulin resistance. When that signal is removed, body cells revert to normal behavior and lose their insulin insensitivity. As of Q1 2008, the nature of the speculative signal is unclear, though there is near universal suspicion that it is chemical and present in very small quantities (eg, like hormones). Research is actively pursuing the mechanism of action. Some physicians have concluded that, even without good evidence of an established action mechanism, such surgery is indicated in Type 2 patients, especially those who are obese.

Published on: Stay Healthy And Fit

Type 2 diabetes mellitus

But experts believe the disease develops in children the same way it does in adults: the body does not produce enough of the hormone insulin, or it cannot correctly use the insulin available (insulin resistance). Either or both of these conditions lead to excess sugar (glucose) in the blood.

Insulin resistance

Insulin resistance occurs when the body’s cells do not correctly use insulin, which helps control the amount of glucose in the blood. The body then needs more insulin to control blood sugar levels. The pancreas produces more insulin to try to keep blood sugar levels normal. If it cannot produce enough insulin, blood sugar rises, and diabetes may develop.

Factors that affect the body’s resistance to insulin in childhood include:

Developmental stage. Insulin resistance normally increases about 30% during puberty, probably because of the effects of growth hormone.

Being female. Girls seem to develop more resistance to insulin than boys.

Race. The body’s resistance to insulin is about 30% higher in African-American teens than in white teens.

Body composition. Insulin resistance increases as the amount of fat around the waist increases.

Activity. Exercise may improve how the body’s cells use insulin and get the sugar they need.

Too little insulin

Normally, the pancreas produces more insulin than usual during puberty to support the rapid growth of the child. If the body cannot produce enough insulin to meet its needs, diabetes develops. Over time, the pancreas may produce less and less insulin, making the diabetes worse.

Published on: Stay Healthy And Fit

WHAT CAUSES DIABETES IN CHILDREN ALL THE FACTS