More evidence that coffee helps blood sugar and liver inflammation

Posted on May 25, 2010 by Dr. Jonathan

Yet another study on the benefits of coffee was just published in the Journal of Agricultural and Food Chemistry. This ones demonstrates how this salubrious beverage improves insulin function and fatty liver by reducing inflammation. The authors observe:

“Epidemiological surveys have demonstrated that habitual coffee consumption reduces the risk of type 2 diabetes. The aim of this work was to study the antidiabetic effect of coffee and caffeine in spontaneously diabetic KK-Ay mice.”

The mice were not taken to Starbucks for mini espresso shots, but were…

“…given regular drinking water (controls) or 2-fold diluted coffee for 5 weeks.”

The results were pretty amazing:

“Coffee ingestion ameliorated the development of hyperglycemia and improved insulin sensitivity. White adipose tissue mRNA levels of inflammatory cytokines (MCP-1, IL-6, and TNFα), adipose tissue MCP-1 concentration, and serum IL-6 concentration in the coffee group were lower than the control group. Moreover, coffee ingestion improved the fatty liver.”

The authors summed up their findings by stating:

“…coffee exerts a suppressive effect on hyperglycemia by improving insulin sensitivity, partly due to reducing inflammatory cytokine expression and improving fatty liver. Moreover, caffeine may be one of the effective antidiabetic compounds in coffee.”

Kidney damage can occur before diabetes sets in

Posted on April 26, 2010 by Dr. Jonathan

Clinical Journal of the Amer Soc of Nephro An 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.”

Limit insulin use as much as possible for type 2 diabetes

Posted on April 3, 2010 by Dr. Jonathan

Diabetes, Obesity and Metabolism Metabolic 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.

More aggressive blood pressure control for diabetes is not better

Posted on April 2, 2010 by Dr. Jonathan

High 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.

Another reason to get enough sleep: diabetes

Posted on March 4, 2010 by Dr. Jonathan

Diabetes Care 0210.2 Getting short-changed on sleep causes multiple harms. Here’s a paper just published in the journal Diabetes Care that assessed

“the relationship between habitual sleep disturbances and the incidence of type 2 diabetes.”

The authors analyzed 10 studies that included 107,756 male and female participants. Their clear-cut conclusion:

“Quantity and quality of sleep consistently and significantly predict the risk of the development of type 2 diabetes. The mechanisms underlying this relation may differ between short and long sleepers.”

The mechanisms include hormone dysregulation, low-grade chronic inflammation, and gastroesophageal reflux disease (GERD; see earlier post on how medication can worsen this association). For help with sleep disorders there are sound functional medicine resources that address the biological component, cognitive behavioral methods (see recent post about internet-based CBT for insomnia), and neurotherapies including neurofeedback and brain wave entrainment tools.

Two new studies again show benefits of coffee

Posted on February 27, 2010 by Dr. Jonathan

Coffee is in the science news again, with two interesting papers that document its benefits. Both were recently published in the American Journal of Clinical Nutrition. The first paper adds more evidence that drinking coffee reduces the risk of type 2 diabetes. The study involved 69,532 French women who were observed over an 11 year period. The authors report an “inverse association [diabetes]…for both regular and decaffeinated coffee and for filtered and black coffee, with no effect of sweetening. Total caffeine intake was also associated with a statistically significantly lower risk of diabetes. Neither tea nor chicory consumption was associated with diabetes risk.” Interestingly, the authors also noted that the observed benefit was particularly pronounced with coffee consumed at lunch. Their conclusion: “Our data support an inverse association between coffee consumption and diabetes and suggest that the time of drinking coffee plays a distinct role in glucose metabolism.”

Considering the importance of inflammation in chronic disease, the second paper is especially interesting in that it documents reductions in subclinical inflammation and oxidative stress as mechanisms by which coffee lowers the risk of type 2 diabetes. Noting that “Coffee consumption is associated with a decreased risk of type 2 diabetes,” the authors state that their “aim was to investigate the effects of daily coffee consumption on biomarkers of coffee intake, subclinical inflammation, oxidative stress, glucose, and lipid metabolism.” They observed a number of interesting effects, including beneficial lowering of the LDL/HDL ratio and IL-18, and an increase in adiponectin. Meanwhile, no adverse changes were seen on the oral glucose tolerance test. They conclude: “Coffee consumption appears to have beneficial effects on subclinical inflammation and HDL cholesterol, whereas no [adverse] changes in glucose metabolism were found in our study.”

Vitamin B12 is often deficient with type 2 diabetes even without taking Metformin

Posted on February 8, 2010 by Dr. Jonathan

An important study was just published in the journal Endocrine Practice (the journal of the American Association of Clinical Endocrinologists) that set out to determine if undiagnosed Vitamin B12 deficiency is common among people with type 2 diabetes, even when not taking Metformin (which itself causes B12 deficiency). Their findings: “Almost one-half of type 2 diabetes subjects not taking Metformin had biochemically proven vitamin B12 deficiency.” (And they used a very low benchmark, <200 microgram/dL, to qualify as “low”, which we would call severe deficiency.) Their important conclusion that needs to be more widely communicated: “We conclude that Vitamin B12 deficiency is common amongst type 2 diabetes subjects and is nutritional in nature…This indeed is an important finding, as taking oral Vitamin B12 supplementation is easy, convenient and readily accepted by patients. This is a novel finding and stresses the need for aggressive and early diagnosis and treatment to avoid complications of Vitamin B12 deficiency.” Why wait for type 2 diabetes to develop? Take care of any deficiency, a potential contributing cause, earlier at a preventive stage.

Qigong benefits type 2 diabetes

Posted on January 25, 2010 by Dr. Jonathan

This randomized controlled study recently published in the journal Diabetes Care (the journal of the American Diabetes Association) nicely validates the recommendation of qigong exercises as a treatment adjunct for type 2 diabetes. The investigators used fasting glucose, insulin, hemoglobin A1C and calculated insulin resistance as metrics to determine efficacy. Their conclusion: “Qigong therapy for 12 weeks resulted in significant reductions in fasting glucose levels in patients with type 2 diabetes and demonstrated trends toward improvement in insulin resistance and A1C. These results suggest that Qigong may be an effective complementary therapy for individuals with type 2 diabetes.”

Coffee and tea can reduce type 2 diabetes: more evidence

Posted on January 5, 2010 by Dr. Jonathan

Yet more research, this time a meta-analysis published in Archives of Internal Medicine that accepted data from 18 studies with information on 457,922 patients. They found that “every additional cup of coffee consumed in a day was associated with a 7% reduction in the excess risk of diabetes…” They go on to conclude: “Similar significant and inverse associations were observed with decaffeinated coffee and tea and risk of incident diabetes. High intakes of coffee, decaffeinated coffee, and tea are associated with reduced risk of diabetes.” HOWEVER: those individuals who have a common Th2-type autoimmune disorder or severe sympathetic nervous system hyperarousal can be made worse from these beverages.

Coffee and tea reduce risk of type 2 diabetes

Posted on December 26, 2009 by Dr. Jonathan

This paper published in the journal Diabetologia may contradict some assumptions. The investigators set out to “examine the association of consumption of coffee and tea, separately and in total, with risk of type 2 diabetes and which factors mediate these relations.” Their findings may be a surprise to some: “Total daily consumption of at least three cups of coffee and/or tea reduced the risk of type 2 diabetes by approximately 42%.” They go on to conclude: “Drinking coffee or tea is associated with a lowered risk of type 2 diabetes, which cannot be explained by magnesium, potassium, caffeine or blood pressure effects. Total consumption of at least three cups of coffee or tea per day may lower the risk of type 2 diabetes.” How can this be? There are compounds in both beverages that have anti-inflammatory and other beneficial effects. As you know, chronic inflammation plays an important role in type 2 diabetes. HOWEVER: bear in mind that caffeine can aggravate Th2-type autoimmune conditions, and it may be poorly tolerated by those with sympathetic nervous system hyperarousal.