Archive for the ‘Insulin & Diabetes’ Category

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Sugars raise bad fats in the blood

Tuesday, May 4th, 2010

JAMAReaders and patients here know how higher levels of insulin from a high glycemic diet can result in an increase in the harmful kinds of fat in the blood. It will come as no surprise that a paper just published in the Journal of the American Medical Association adds more evidence to the association. The the objective of the authors was to…

“…assess the association between consumption of added sugars and blood lipid levels in US adults.”

They analyzed the data for 6,113 adults collected over seven years for sugars in the diet and levels of HDL and LDL cholesterol and triglycerides. A clear correlation between higher levels of sugars and lower HDL (“good” cholesterol), higher LDL (“bad” cholesterol) and higher triglycerides emerged. There was strong evidence for maintaining a low glycemic diet to regulate cholesterol:

“Among higher consumers (≥10% added sugars) the odds of low HDL-C levels were 50% to more than 300% greater compared with the reference group (<5% added sugars).”

Their conclusion was mildly stated:

“In this study, there was a statistically significant correlation between dietary added sugars and blood lipid levels among US adults.”

Journal of Lipid ResearchHave you been trying but not succeeding in getting cholesterol and/or triglycerides down with a low fat diet? There has been so much science done on the correlation between insulin sensitivity and cholesterol levels; it’s surprising this wasn’t noted by the authors. Just one example is a fresh paper in the Journal of Lipid Research that begins with the well-known fact:

“Cholesterol synthesis is upregulated and absorption downregulated in insulin resistance and in type 2 diabetes.”

Interestingly, the authors wanted to see if any level of insulin resistance would have an effect on cholesterol synthesis:

“We investigated whether alterations in cholesterol metabolism are observed across the glucose tolerance status, from normoglycemia through impaired glucose tolerance to type 2 diabetes…”

What conclusions did they draw from their data?

“In conclusion, cholesterol metabolism was altered already in subjects with impaired fasting glucose. Upregulated cholesterol synthesis was associated with peripheral insulin resistance independent of obesity.”

How to eat healthy fat and oil is another topic, but if cholesterol and triglycerides are the issue—pay attention to sugars and insulin.

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Posted in Cardiovascular, General Science & Health, Good Eating, Insulin & Diabetes | 7 Comments »

Diet induced weight loss can rapidly improve sexual function for men

Monday, May 3rd, 2010

International Journal of ObesityReaders of these posts know about the profound impact of insulin resistance on glandular and metabolic function; as the authors of this study just published in the International Journal of Obesity note…

“Abdominal obesity and type 2 diabetes mellitus are associated with erectile and urinary dysfunction in men.”

The investigators set out to determine the extent to which weight loss would impact overall sexual function and lower urinary tract symptoms by measuring the effects of an 8 week low-calorie diet using meal replacements* on insulin sensitivity, testosterone, erectile function, sexual desire, prostate symptoms, abdominal obesity and waist circumference. What did their data show?

“Weight loss of ~10% was significantly associated with increased insulin sensitivity, plasma testosterone levels, IIEF-5 (erectile function) and SDI (sexual desire) scores, as well as reduced WC (waist circumference) and IPSS (prostate) scores, in diabetic as well as nondiabetic men.”

They further observed that…

“The degree of weight loss was significantly associated with improvements in plasma testosterone levels, erectile function and LUTS. Reduction in LUTS was significantly associated with increased plasma testosterone, erectile function and sexual desire.”

Hence their clear-cut conclusion:

“Diet-induced weight loss significantly and rapidly improves sexual function, and reduces LUTS, in obese middle-aged men with or without diabetes.”

This is a compelling illustration of the link between insulin resistance and male sexual function.

* Although effective in this study (at 800 calories per day) there are better meal replacement products available for weight loss than this one loaded with fructose, milk protein, and low grade minerals and fish oil.

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Posted in Insulin & Diabetes, Men's Health | 3 Comments »

Normal weight obesity: heart disease from being fat without looking fat

Saturday, May 1st, 2010

European Heart JournalThis study published not long ago in the European Heart Journal is consonant with my findings for certain patients (using bioelectric impedance analysis for body composition determination) who were slim in appearance but turned out to be metabolically obese. They had a proportionately large amount of fat packed around the internal organs that wasn’t apparent externally. High levels of visceral fat are associated with the chronic inflammation that is a fundamental cause of cardiovascular and other diseases. The authors of this paper suspected this phenomenon:

“We hypothesized that subjects with a normal body mass index (BMI), but high body fat (BF) content [normal weight obesity (NWO)], have a higher prevalence of cardiometabolic dysregulation and are at higher risk for cardiovascular (CV) mortality.”

They thoroughly evaluated 6171 subjects with body composition measurement, blood tests and cardiovascular risk factors. Their data showed that…

“The highest tertile of BF (>23.1% in men and >33.3% in women) was labeled as NWO. When compared with the low BF group, the prevalence of metabolic syndrome in subjects with NWO was four-fold higher. Subjects with NWO also had higher prevalence of dyslipidaemia, hypertension (men), and CV disease (women). After adjustment, women with NWO showed a significant 2.2-fold increased risk for CV mortality in comparison to the low BF group.”

This means that excessive levels of body fat can be present in someone of normal weight and appearance (“metabolic obesity”), contributing to cardiovascular damage in both men and women. In women there is a stronger association with death from cardiovascular disease.

The author’s conclusion:

“Normal weight obesity, defined as the combination of normal BMI and high BF content, is associated with a high prevalence of cardiometabolic dysregulation, metabolic syndrome, and CV risk factors. In women, NWO is independently associated with increased risk for CV mortality.”

Important: There are consumer devices such as scales marketed as bioelectric body composition instruments but these do not give accurate or reliable results. Dependability requires a medical-grade device that utilizes electrodes on both the lower and upper extremities along with validated algorithms.

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Posted in Cardiovascular, Insulin & Diabetes, Women's Health | 1 Comment »

Kidney damage can occur before diabetes sets in

Monday, April 26th, 2010

Clinical Journal of the Amer Soc of NephroAn important study just published in the Clinical Journal of the American Society of Nephrology that offers powerful evidence for the need to maintain healthy insulin and glucose levels well before that system fails and blood sugar crosses the line into the type 2 diabetes territory. High levels of insulin do nasty mischief throughout the body and the kidneys are especially sensitive. The authors set out with this objective:

“Prevalence of chronic kidney disease (CKD) in people with diagnosed diabetes is known to be high, but little is known about the prevalence of CKD in those with undiagnosed diabetes or prediabetes. We aimed to estimate and compare the community prevalence of CKD among people with diagnosed diabetes, undiagnosed diabetes, prediabetes, or no diabetes.”

Their data paints a worrisome picture:

“Fully 39.6% of people with diagnosed and 41.7% with undiagnosed diabetes had CKD…Among those with CKD, 39.1% had undiagnosed or prediabetes.”

Remember dear reader that chronic kidney disease means that there has been an irretrievable loss of kidney tissue; this is beyond normal age-related changes. This is yet another important reason to confirm that your strategy for maintaining healthy insulin function is suiting your needs. This is not difficult to determine with the right test assessment. The authors conclude:

“CKD prevalence is high among people with undiagnosed diabetes and prediabetes. These individuals might benefit from interventions aimed at preventing development and/or progression of both CKD and diabetes.”

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Posted in General Science & Health, Insulin & Diabetes | No Comments »

Chronic infections like periodontitis promote global inflammation

Wednesday, April 21st, 2010

Annals of the New York Academy of SciencesIn our practice we pay a lot of attention to chronic low grade infections because the inflammation associated with them contributes to a broad range of diseases including autoimmune disorders, diabetes, cardiovascular disease, etc. The gastrointestinal tract is a frequent site of chronic infection, and this paper published in the Annals of the New York Academy of Sciences investigates the link between infection in the upper end of the GI tract—periodontitis—and inflammation:

“Increasing evidence implicates periodontitis, a chronic inflammatory disease of the tooth-supporting structures, as a potential risk factor for increased morbidity or mortality for several systemic conditions including cardiovascular disease (atherosclerosis, heart attack, and stroke), pregnancy complications (spontaneous preterm birth [SPB]), and diabetes mellitus.”

Their survey identifies a ‘smoking gun’ of inflammation:

“Consistent with this hypothesis clinical studies demonstrate that periodontitis patients have elevated markers of systemic inflammation, such as C-reactive protein (CRP), interleukin 6 (IL-6), haptoglobin, and fibrinogen. These are higher in periodontal patients with acute myocardial infarction (AMI) than in patients with AMI alone, supporting the notion that periodontal disease is an independent contributor to systemic inflammation. In the case of adverse pregnancy outcomes, studies on fetal cord blood from SBP babies indicate a strong in utero IgM antibody response specific to several oral periodontal pathogens, which induces an inflammatory response at the fetal–placental unit, leading to prematurity.”

A very good reason to take care of your teeth and gums:

“The importance of periodontal infections to systemic health is further strengthened by pilot intervention trials indicating that periodontal therapy may improve surrogate cardiovascular outcomes…and may reduce four- to fivefold the incidence of premature birth.”

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Posted in Cardiovascular, General Science & Health, Insulin & Diabetes | 3 Comments »

Both are good for weight loss, which is better for high blood pressure: higher protein or higher fat?

Saturday, April 17th, 2010

European Journal of Clinical Nutrition 0310Most of you reading this are aware that a lower glycemic diet can promote weight and fat loss through its beneficial effect on insulin levels. But which is better for blood pressure control, a higher or lower protein to fat ratio? This study recently published in the European Journal of Clinical Nutrition was designed to answer that question.

“There is controversy over dietary protein’s effects on cardiovascular disease risk factors in diabetic subjects. It is unclear whether observed effects are due to increased protein or reduced carbohydrate content of the consumed diets. The aim of this study was to compare the effects of two diets differing in protein to fat ratios on cardiovascular disease risk factors.”

What did their data show? Interestingly,…

“Both diets were equally effective in promoting weight loss and fat loss and in improving fasting glycemic control, total cholesterol and low-density lipoprotein (LDL) cholesterol, but the…HP–LF [high protein-low fat] diet improved significantly both systolic and diastolic blood pressure when compared with the LP–HF [low protein-high fat] diet. No differences were observed in postprandial glucose and insulin responses.”

The authors conclude:

“A protein to fat ratio of 1.5 in diets significantly improves blood pressure and TG [triglyceride] concentrations in obese individuals with DM2 [type 2 diabetes].”

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Posted in Cardiovascular, General Science & Health, Insulin & Diabetes | No Comments »

Insulin resistance and cancer

Wednesday, April 14th, 2010

Cancer ScienceInsulin resistance is the loss of sensitivity of the receptors on each cell that respond to insulin from to repeated over-stimulation by insulin due to high blood sugar levels. High levels of insulin “in the background” do many kinds of damage in the run-up to type 2 diabetes when the body’s capacity to produce ever higher compensatory levels of insulin finally fails and the blood sugar goes up. My patients will certainly recognize that insulin is, of course, a hormone—and that excessive levels are a tumor promoter (along with the related insulin-like growth factor (IFG1). This paper recently published in the journal Cancer Science looks at the epidemiological link between insulin resistance and cancer.

“Epidemiological evidence from our prospective study, the Japan Public Health Center-based Prospective (JPHC) study, and systematic literature reviews generally support the idea that factors related to diabetes or insulin resistance are associated with an increased risk of colon (mostly in men), liver, and pancreatic cancers… The suggested mechanism of these effects is that insulin resistance and the resulting chronic hyperinsulinemia and increase in bioavailable insulin-like growth factor 1 (IGF1) stimulate tumor growth.”

The data from the Japan Public Health Center-based Prospective (JPHC) study support this conclusion:

“…there is substantial evidence to show that cancers of the colon, liver, and pancreas are associated with insulin resistance, and that these cancers can be prevented by increasing physical activity, and possibly coffee consumption.”

That’s right, coffee consumption—see the numerous posts documenting the benefits of coffee. Past and forthcoming posts report on studies that describe the association of insulin resistance and other cancers. The ‘take home’ message is that it’s important to maintain insulin at a healthy level long before the onset of type 2 diabetes by lifestyle factors (good eating and exercise) and evidence-based supplementation appropriate to your genetic and circumstantial needs.

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Posted in Insulin & Diabetes, Oncology | 6 Comments »

Limit insulin use as much as possible for type 2 diabetes

Saturday, April 3rd, 2010

Diabetes, Obesity and MetabolismMetabolic syndrome crosses the line to type 2 diabetes when insulin resistance worsens to the point that the pancreas can no longer increase insulin production to yet higher levels. By then the elevated insulin ‘in the background’ has already been doing damage throughout the body for years. If blood sugar can no longer be controlled with natural agents that re-sensitize insulin receptors and support blood sugar metabolism or other oral anti-diabetic agents, then exogenous (from the outside) insulin is used. But if higher levels of native insulin contribute to a variety of diseases, are higher therapeutic levels a concern? This study published in the journal Diabetes, Obesity and Metabolism investigates just that:

“Aim: To compare population-based rates of all-cause and cardiovascular (CV) mortality in newly treated patients with type 2 diabetes according to levels of insulin exposure.”

The authors collected data for 12,272 individuals on cumulative insulin exposure and its correlation with death from cardiovascular diseases and death from any disease. What did the data show?

“The highest mortality rates were in the high exposure group…we observed a graded risk of mortality associated with increasing exposure to insulin… Analyses restricted to CV-related and non-vascular mortality showed virtually identical results.”

Here’s how they summed up their findings:

“We observed a significant and graded association between mortality risk and insulin exposure level in an inception cohort of patients with type 2 diabetes that persisted despite multivariable adjustment.”

Wouldn’t you think this is one reason why other studies have shown that too aggressive pharmaceutical blood sugar control results in worse outcomes? There are a number of evidence-based natural agents that support insulin receptor sensitivity and other functional aspects of type 2 diabetes. The more these can be used to minimize the dependence on increasing insulin the better.

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Posted in Insulin & Diabetes | 5 Comments »

More aggressive blood pressure control for diabetes is not better

Friday, April 2nd, 2010

New England JournalHigh blood pressure is common with type 2 diabetes because the excessive levels of insulin that lead up to the breakdown in blood sugar control promote hypertension. This study recently published in The New England Journal of Medicine has practical importance for many people who require treatment for high blood pressure. The authors first note:

“There is no evidence from randomized trials to support a strategy of lowering systolic blood pressure below 135 to 140 mm Hg in persons with type 2 diabetes mellitus. We investigated whether therapy targeting normal systolic pressure (i.e., <120 mm Hg) reduces major cardiovascular events in participants with type 2 diabetes at high risk for cardiovascular events.”

They constructed their study to discriminate outcomes between reducing blood pressure to less than 140 mm Hg and less than 120 mm Hg:

“A total of 4733 participants with type 2 diabetes were randomly assigned to intensive therapy, targeting a systolic pressure of less than 120 mm Hg, or standard therapy, targeting a systolic pressure of less than 140 mm Hg. The primary composite outcome was nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes. The mean follow-up was 4.7 years.”

I have told patients for years that it is not desirable to aggressively medicate blood pressure much below a systolic reading of 135-140 mm Hg because the increased pressure is a compensatory effort by the body to deliver oxygen to the tissues against increased resistance. There has to be a happy medium. What did the data from this investigation show?

“Serious adverse events attributed to antihypertensive treatment occurred in 77 of the 2362 participants in the intensive-therapy group (3.3%) and 30 of the 2371 participants in the standard-therapy group (1.3%).”

This compelled them to conclude that:

“In patients with type 2 diabetes at high risk for cardiovascular events, targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, did not reduce the rate of a composite outcome of fatal and nonfatal major cardiovascular events.

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Posted in Cardiovascular, Insulin & Diabetes | No Comments »

Coffee protects against fatty liver disease

Sunday, March 28th, 2010

Digestive Diseases and SciencesThere seems to be one study after another about the benefits of coffee. This paper just published in the journal Digestive Diseases and Sciences verifies that coffee protects against Non-alcoholic Fatty Liver Disease (NAFLD), the most common cause of non-infectious hepatitis and a growing cause of liver failure. I very often see elevated liver enzymes on laboratory tests; no wonder, since this is commonly fueled by insulin resistance. The authors of this study began by observing…

“The benefits of coffee on abnormal liver biochemistry, cirrhosis and hepatocellular carcinoma have been reported…this study aims to investigate if coffee use has any relationship with bright liver, measured by ultrasound bright liver score (BLS), in patients with non-alcoholic fatty liver disease (NAFLD), and which relationship, if any, is present with BMI and insulin resistance.”

‘Bright liver’ refers to the appearance of a fatty liver on ultrasound imaging, and a higher BLS measurement means more fat deposits in the liver. What did they find?

“Less fatty liver involvement is present in coffee vs. non-coffee drinkers. Odds ratios show that obesity, higher insulin resistance, lower HDL cholesterol, older age and arterial hypertension are associated with a greater risk of more severe BLS; to the contrary, coffee drinking is associated with less severe BLS…Coffee use is inversely associated with the degree of bright liver, along with insulin resistance and obesity…”

Their conclusion is similar to numerous other studies:

“A possible opposite, if not antagonistic, role of coffee with regard to overweightness and insulin resistance, similar to that reported in hepatocarcinoma and cirrhosis, is envisaged in the natural history of NAFLD.”

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Posted in General Science & Health, Insulin & Diabetes | 6 Comments »

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