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05-17-2019 06:57 AM
Our approach to eating and the way insulin works in the body have been addressed on BBC Radio 4.
In a series of nutritional reports set to be broadcast on BBC Radio 4, journalist Becky Milligan spoke to several key people about the current worldwide obesity epidemic.
From her own research, Ms Milligan said she had found all the different dietary messages and advice "mind-boggling" as she investigated why obesity rates have risen in the UK across the last several decades.
Professor Roy Taylor, Professor of Medicine and Metabolism at the University of Newcastle, has done a lot of research into type 2 diabetes and firmly believes it is possible to put the condition into remission.
He told Ms Milligan that he thought it was "appalling" that obesity rates are continuing to rise, particularly in young people.
Meanwhile, Dr Robert Lustig, a pediatric endocrinologist, blamed calorie counting, which we had previously been told was imperative to weight loss.
Dr Lustig, Professor of Pediatrics in the Division of Endocrinology at the University of California in San Francisco, said: "Calories being calories are the gravy train of the food industry, because if there were specific calories that caused you to gain weight, or there were specific calories that caused chronic metabolic disease such as type 2 diabetes, then the public would shy away from those wouldn’t they? Well, that is processed food."
He gave the example of a study from a few years back, that compared sugary sodas, to diet sodas, milk and water. Those in both the soda groups put on weight, even though the diet version products were completely calorie free.
Dr Lustig said the obesity issue is "nothing to do with calories" and instead said the public should be turning their attentions to the hormone insulin and how it works.
Obesity and insulin
Another expert, Dr Jason Fung, a world-leading expert on intermittent fasting and low carb, especially for treating people with type 2 diabetes, agreed that controlling obesity was all about understanding how the hormone works.
He said: "Insulin basically tells the body to store fat and it also turns off fat burning, so if your body is storing fat, you don’t want it to burn fat.
"If insulin falls, then that's a signal to burn fat, so if insulin is high you store fat, if it’s low you burn fat. Certain foods stimulate insulin much more than other foods. So refined carbohydrates are probably the biggest stimulus to insulin."
Later on in the BBC radio programme, Dr Alison Tedstone, National Director with responsibility of diet, nutrition and obesity in the Health and Wellbeing Directorate of Public Health England (PHE), was invited to discuss whether current dietary guidelines will be changed, based on what was said during the nutrition report.
She said that any decisions are "governed by the evidence" and they mainly take into account "robust" and "longer-term studies".
At the moment PHE recommends people should follow its Eatwell Guide, which divides foods and drink into five main groups. It is suggested a variety of different foods from each of the groups should be consumed on a daily basis to help people get a wide range of nutrients that the body needs to stay healthy and work properly.
However, Dr Tedstone did concede that the government "recognises that it's not working" which is why the Childhood Obesity Strategy and the sugar tax on drinks have been introduced.
She concluded: "We need to go beyond information and education. We need to think of the structural drivers of diet."
For more information on diet, obesity and the role of insulin visit Diabetes Digital Media's award-winning Low Carb Program.
05-17-2019 07:25 AM
Most of us love starchy carbohydrate foods like bread, pasta and potatoes — but they’re not always good for our health. Although starch is an important part of a healthy diet, it’s easily broken down. As soon as we consume starch the body very quickly starts to digest it, releasing sugars into the blood which in turn causes our bodies to release the hormone insulin. It’s a boom and bust cycle that can take a toll on our health.
Dr Chris van Tulleken joined forces with Dr Denise Robertson from the University of Surrey to carry out an experiment. We wanted to find out if there is a simple way to make starchy foods better for us without changing a single ingredient. What no one expected was that we’d make a brand new scientific discovery along the way.
When starch is cooked in water and then cooled it changes shape. The new structure is resistant to enzymes in our body and so can’t be digested- it’s known as ‘resistant starch’. Resistant starch passes through the body without being digested until it reaches the colon where it acts like fibre and feeds our ‘good bacteria’.
Researchers have known about resistant starch for over twenty years but despite its health benefits it’s not something that we hear about very often. However, our experiment revealed a whole new way to improve the healthiness of our food that surprised everyone.
The volunteers underwent 3 days of testing. Each day they had to eat a bowl of white pasta, topped with a simple tomato sauce.
On one day they ate pasta hot, when it was freshly cooked.
On a second day they ate pasta cold, after it had been chilled overnight
On a third day they ate pasta which had been chilled and then reheated.
Directly after they’d eaten their bowl of pasta each volunteer took their own blood sample every fifteen minutes for two hours. We analysed these samples to find out how much glucose they had in their blood and plotted how their blood sugar level changed as they digested the meal.
When the volunteers ate the hot, freshly cooked, pasta their blood glucose showed the expected sharp rise and fall, shown by the green line in the graph below. But when they ate the chilled pasta, the blood glucose didn’t rise as much (the blue line on the graph). The cold pasta therefore didn’t cause the unhealthy surges in blood sugar and insulin.
The surprising results, though, were from the volunteers who ate the reheated pasta, shown by the red line on the graph. This had never been tried before and the results were striking: the blood glucose in these volunteers rose 50% less than it did after eating even the chilled pasta, with its known health benefits! This means that simply reheating your pasta (and probably potatoes and other starchy foods) after chilling it in the fridge makes it much healthier – protecting you against sharp spikes in blood sugar and giving you all the benefits of fibre, without having to change what you’re eating.Why only 10 volunteers?
Several people have asked why only 10 volunteers could give us such strong conclusions. We did our experiment according to the WHO protocol for this sort of testing, and 10 volunteers tested this way have been shown to give statistically robust results (adding more gives diminishing returns). See this scientific paper for more details.
Dr Robinson hopes to publish the results of this experiment, and when the paper is published we shall make the full details of the method and statistical results available.
There are plenty of foods which contain resistant starch without even having to create it through cooking methods such as chilling and reheating.
05-17-2019 07:44 AM
Remember freezing bread ,and then toasting it frozen ,also creates resistant starch. I don't know if you can do this with whole wheat bread, but you can do it with white bread
This doesn't mean we can eat all of the carbs we wish. They still contain calories, but this is a great way to have a sandwich, or pasta safely, and reduce some of the calories you are eating
05-19-2019 07:31 AM
The U.S. Food and Drug Administration warned diabetics against building their own artificial pancreas system to help control blood sugar levels after a patient using one suffered an accidental insulin overdose.
A large community of diabetics has been using hacked-together, do-it-yourself systems to control their disease. The systems connect glucose monitors to insulin pumps using computer algorithms. They work around the clock, testing blood sugar and infusing insulin. Once the system is set up, they’re meant to require little effort by the patient.
While the individual components that make up a DIY system are generally approved by the FDA, they haven’t been tested or cleared for use together, the agency said in a statement. The accidental insulin overdose didn’t kill the patient, an FDA spokeswoman said.
“Patient use of unauthorized diabetes-management devices, alone or along with other devices, could result in inaccurate glucose level readings or unsafe insulin dosing,” the FDA said. “These inaccuracies may lead to injuries requiring medical intervention, such as severe low blood sugar, coma, diabetic ketoacidosis — the buildup of acids in blood — and death.”
The FDA warning is an example of the tension between patients who want to take more of their healthcare into their own hands and increasingly have the technological tools and know-how to do so, and regulators charged with safeguarding public health.
The FDA received a report about a patient using one of the unauthorized systems who got too much insulin after repeated, incorrect readings of high blood sugar levels that caused an overdose and required medical intervention.
“These devices were not designed to be used together and were combined in a way that had not been thoroughly tested for compatibility,” the agency said. It’s not clear if the problem stemmed from inaccurate glucose values or a software malfunction.
The systems are informally known as an artificial pancreas, because the pancreas is the organ that produces insulin needed to convert blood sugar into energy. Patients with Type 1 diabetes, the most severe form, don’t produce any insulin naturally. Instead, they have to regularly inject it to avoid glucose buildup that eventually damages the heart and blood vessels, and causes complications including blindness, kidney failure and amputations. Too much insulin, however, can cause an overdose — leading to a coma or death.
Medtronic Plc makes an approved version of the technology, called the 670G. While closely regulating insulin levels, it doesn’t allow as much flexibility as the systems that individuals make themselves.
05-20-2019 07:22 AM
UCLA bioengineers and their colleagues have developed a new type of insulin that could help prevent hypoglycemia in people who use the drug to manage diabetes.
The treatment is being evaluated for potential clinical trials and, if successful, could change diabetes care. The study was published in the Proceedings of the National Academy of Sciences.
Insulin is a hormone naturally produced in the pancreas. It helps the body regulate glucose, which is consumed through food and provides the body with energy.
Diabetes occurs when a person's body does not naturally produce insulin (Type 1 diabetes), or does not efficiently use the insulin that is produced (Type 2). In either case, a regular dosage of insulin is prescribed to manage the disease, which affects more than 400 million people worldwide.
Generally, people who need to use insulin monitor their blood sugar levels with a glucose meter or continuous glucose monitoring system and then calculate their insulin dose accordingly. In addition, a regular carbohydrate intake is important to keep the blood sugar levels normal. Both of these requirements are necessarily subject to human error, which can have potentially devastating consequences.
An overdose of insulin can cause hypoglycemia, when blood sugar is too low. That could lead to seizures, coma, and in extreme cases, death.
As a safety check, the UCLA-led team has developed a type of "smart" insulin, called i-insulin, that can prevent blood sugar levels from dipping too low.
Inside the body, insulin acts as a "key" to help glucose get into cells from the bloodstream. When insulin attaches to a cell's surface, it activates a protein inside the cell, called glucose transporter, which then makes its way to the cell's surface. This molecule then brings the surrounding glucose from the blood into the cell.
The research team added an additional molecule to insulin to create the new smart insulin. This added molecule, called a glucose transporter inhibitor, chemically blocks the glucose transporter molecule that has come to the surface. Its presence doesn't block all glucose from entering, nor does it permanently block the transporter molecules. Instead, it's part of a dynamic process that depends on how many inhibitor and glucose molecules are present.
"Our new i-insulin works like a 'smart' key," said the study's principal investigator Zhen Gu, a professor of bioengineering at the UCLA Samueli School of Engineering. "The insulin lets glucose get into the cell, but the added inhibitor molecule prevents too much from going in when blood sugar is normal. This keeps blood sugar at normal levels and reduces the risk of hypoglycemia."
"This i-insulin can also rapidly respond to high glucose levels," added Jinqiang Wang, the study's co-lead author and a postdoctoral researcher in Gu's research group. "For example, after a meal, when glucose levels climb, the insulin level in the bloodstream also quickly increases, which helps normalize the glucose level."
The UCLA-led research team tested the smart insulin on mice with Type 1 diabetes. The i-insulin controlled glucose levels within the normal range for up to 10 hours after a first injection. A second injection three hours later extended the protection from hypoglycemia.
"The next step is to further evaluate the long-term biocompatibility of the modified insulin system in an animal model before determining whether to move to clinical trials," said co-author Dr. John Buse, director of the Diabetes Care Center at the University of North Carolina at Chapel Hill School of Medicine. The vision, if realized, would be one of the most exciting advances in diabetes care."
"The new insulin has the potential to be optimized for response times and how long it could last in the body before another dose would be required," Gu said. "And it could be delivered in other methods, such as a skin patch that automatically monitors blood sugar levels, or in pills."
This article has been republished from materials provided by UCLA. Note: material may have been edited for length and content. For further information, please contact the cited source.
Reference: Jinqiang Wang, et al. Glucose transporter inhibitor-conjugated insulin mitigates hypoglycemia. (2019) PNAS DOI: https://doi.org/10.1073/pnas.1901967116
05-27-2019 12:44 PM
University of Otago researchers have discovered that high-intensity exercise can reduce or reverse the loss in heart function caused by type 2 diabetes.
The study found that three months of high-intensity interval training (HIIT) improved heart function in adults with type 2 diabetes, without any change in medications or diet.
Former PhD student Genevieve Wilson carried out the study under the supervision of Senior Research Fellow at the Dunedin School of Medicine, Dr Chris Baldi, with cardiologist and Associate Professor in the Department of Medicine, Gerry Wilkins, as her co-adviser. It has just been published in the American College of Sports Medicine's journal, Medicine & Science in Sports & Exercise.
Ms Wilson explains the study is significant because while research to date has shown that improved glycemic control and lifestyle changes can improve some outcomes for people with diabetes, reductions in cardiovascular disease have not been realised and cardiovascular disease remains the leading casue of death in these patients.
"Our research has found that exercise at sufficiently high intensity may provide an inexpensive, practical way to reverse, or reduce the loss in heart function caused by type 2 diabetes," Ms Wilson says.
High-intensity interval training involves short intervals of near maximal effort (>90 per cent maxium) exercise like sprinting or stair climbing, separated by intervals of moderate intensity exercise, like jogging, or fast walking.
The goal was for people to spend 10 minutes doing very high intensity (vigorous) activity during a 25 minute exercise period.
Dr Baldi says the incidence of type 2 diabetes continues to increase and the prolonged management of the disease is crippling healthcare systems worldwide. Increasing aerobic capacity through exercise is arguably the best prevention for heart disease and exercise is a cornerstone of diabetic treatment. However, impaired function of the diabetic heart often makes it harder for people with diabetes to exercise effectively nd it was not known whether they would train this hard.
But the study showed that the high-intensity exercise programme for middle-aged adults with type 2 diabetes was safe and acceptable and also well-attended, with a greater than 80 per cent adherence rate over the three months.
"There are two important clinical implications of this work," Dr Baldi explains. "The first, that adults with type 2 diabetes will adhere to high-intensity interval training and are capable of comparable increases in aerobic capacity and left ventricular exercise response as those reported in non-diabetic adults.
"Secondly, high intensity exercise is capable of reversing some of the changes in heart function that seem to precede diabetic heart disease."
05-30-2019 10:44 AM
After 20-year increase, new diabetes cases decline 35%
Cases of newly diagnosed diabetes in the United States have declined 35% since the peak year of 2009, and the prevalence of the disease has remained stable for 8 years, with the trends reflected across all age, sex and racial groups, according to an analysis of National Health Interview Survey data.
The numbers represent the longest period of a sustained plateau in diagnosed diabetes prevalence in the U.S. since the 1980s and the longest period of declining incidence ever, according to the researchers.
“A number of factors can be driving the observed reduction in diagnosed diabetes incidence,” Stephen Benoit, MD, MPH, medical officer and team lead for surveillance in the CDC’s Division of Diabetes Translation, told Endocrine Today. “Lifestyle change interventions to prevent type 2 diabetes continue, such as the National Diabetes Prevention Program, as well as population approaches to improve healthy food availability, diabetes awareness and education, and walkability of communities. However, risk factors for diabetes, such as obesity and prediabetes, remain high, and since our analysis relies on diagnosed cases, the potential impact of changes in screening, testing and diagnostic thresholds are also important considerations.”
Benoit and colleagues calculated annual prevalence and incidence of diagnosed diabetes among adults using cross-sectional survey data from the National Health Interview Survey from 1980 to 2017. Researchers calculated trends in rates by age group, sex, race and education using annual percentage change.
The overall prevalence of age-adjusted, diagnosed diabetes did not change between 1980 (3.5%) and 1990 (3.4%), but increased 4.4% per year from 1990 to 2009 to a peak of 8.2 per 100 adults (P < .001), and then plateaued through 2017, when the rate was 8 per 100 adults, according to researchers. The observed trend was similar in analyses stratified by age, sex, race and education, apart from adults with more than a high school education, who experienced a 1.1% annual increase in diabetes prevalence between 2005 and 2017 (P = .005).
The overall incidence per 1,000 adults of age-adjusted, diagnosed diabetes did not change significantly from 1980 to 1990, increased 4.8% per year from 1990 to 2007 to 7.8 per 1,000 adults (P < .001), and then decreased by 3.1% per year to 6 per 1,000 adults (P < .001) in 2017.
The researchers noted that the decrease in diabetes incidence was driven by white adults, who experienced a 5.1% annual decrease in diabetes incidence after 2008 (P = .002). In age-stratified analyses, researchers found that the overall decrease in diabetes incidence was most influenced by adults aged 65 to 79 years from 2011 to 2017; however, the rate of decline among this age group did not rise to statistical significance, according to researchers.
05-30-2019 10:50 AM
NEW YORK (AP) — The number of new diabetes cases among U.S. adults keeps falling, even as obesity rates climb, and health officials aren’t sure why.
New federal data released Tuesday found the number of new diabetes diagnoses fell to about 1.3 million in 2017, down from 1.7 million in 2009.
Earlier research had spotted a decline, and the new report shows it’s been going on for close to a decade. But health officials are not celebrating.
“The bottom line is we don’t know for sure what’s driving these trends,” said the lead author of the new report, Dr. Stephen Benoit of the Centers for Disease Control and Prevention. Among the possibilities: Changes in testing and getting people to improve their health before becoming diabetic.
The report was published by the journal BMJ Open Diabetes Research & Care. The statistics run through 2017. Last year’s numbers are not yet available, Benoit said.
Diabetes is a disease in which sugar builds up in the blood. The most common form is tied to obesity, and the number of diabetics ballooned as U.S. obesity rates increased.
But other factors also might have pushed up annual diabetes diagnoses from 2000 to 2010, and they may partly explain why the numbers have been going down since, some experts said.
First, the diagnostic threshold was lowered in the late 1990s. That caused more people to be counted as diabetics, but the impact of that may have played out.
“We might have mined out a lot of the previously unrecognized cases” and so new diagnoses in the last several years are more likely to be actual new illnesses, said Dr. John Buse, a University of North Carolina diabetes expert.
Meanwhile, doctors have increasingly used a newer blood test to diagnoses diabetes. It’s much easier than tests that required patients to fast for 12 hours or to undergo repeated blood draws over two hours.
The American Diabetes Association recommended the new test, known as the hemoglobin A1C blood test, for routine screening in 2010. Because it’s easier to do, it would be expected to lead to more diagnoses. But some experts say it may miss a large proportion of early cases in which people aren’t showing symptoms. “You may be missing people that would have been diagnosed” with older tests, Benoit said.
Another possibility: Increasingly, more doctors have been diagnosing “prediabetes,” a health condition in which blood sugar levels are high but not high enough to hit the diabetes threshold. Physicians typically push such patients into exercise programs and urge them to change their diet.
“Prediabetes is becoming a more accepted diagnosis” and may be causing an increasing number of patients to improve their health before becoming diabetic, said Dr. Tannaz Moin, a UCLA expert.
The new report is based on a large national survey conducted by the government every year. Participants were asked if they had been diagnosed with diabetes, and also if the diagnosis was made in the previous year.
It found the rate of new diabetes cases fell to 6 per 1,000 U.S. adults in 2017, from 9.2 per 1,000 in 2009. That’s a 35 percent drop, and marks the longest decline since the government started tracking the statistic nearly 40 years ago, according to the CDC.
The decrease was mainly seen among white adults, the researchers said.
Meanwhile, the overall estimate of how many Americans have diabetes — whether the diagnosis is recent or not — has been holding steady at 80 per 1,000 U.S. adults. That translates to about 21 million Americans.
05-30-2019 10:51 AM
Truthfully, I think if diabetes has declined it is only because people cannot afford to see a physician to get diagnosed in the early stages of the disease.
It may sound like I am a skeptic but somehow, I do not believe that there is a change in fewer people getting the disease. The population is aging and more and more baby boomers would be diagnosed. The result would not be a lessening of people becoming diabetic.
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