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An epidemiological study conducted by researchers at University of California San Diego School of Medicine and Seoul National University suggests that persons deficient in vitamin D may be at much greater risk of developing diabetes.

The findings are reported in the April 19, 2018 online issue of PLOS One.

The scientists studied a cohort of 903 healthy adults (mean age: 74) with no indications of either pre-diabetes or diabetes during clinic visits from 1997 to 1999, and then followed the participants through 2009. Vitamin D levels in blood were measured during these visits, along with fasting plasma glucose and oral glucose tolerance.

Over the course of time, there were 47 new cases of diabetes and 337 new cases of pre-diabetes, in which blood sugar levels are higher than normal but not yet high enough to be categorized as type 2 diabetes.

For the study, the researchers identified the minimum healthy level of 25-hydroxyvitamin D in blood plasma to be 30 nanograms per milliliter. This is 10 ng/ml above the level recommended in 2010 by the Institute of Medicine, now part of The National Academies, a health advisory group to the federal government. Many groups, however, have argued for higher blood serum levels of vitamin D, as much as 50 ng/ml. The matter remains hotly debated.

"We found that participants with blood levels of 25-hydroxyvitamin D that were above 30 ng/ml had one-third of the risk of diabetes and those with levels above 50 ng/ml had one-fifth of the risk of developing diabetes," said first author Sue K. Park, MD, in the Department of Preventive Medicine at Seoul National University College of Medicine in South Korea.

Study co-author Cedric F. Garland, DrPH, adjunct professor in the UC San Diego School of Medicine Department of Family Medicine and Public Health, said persons with 25-hydroxyvitamin D levels below 30 ng/ml were considered vitamin D deficient. These persons, the researchers found, were up to five times at greater risk for developing diabetes than people with levels above 50 ng/ml.

Garland, who has previously investigated connections between vitamin D levels and various types of cancer, said the study builds upon previous epidemiological research linking vitamin D deficiency to a higher risk of diabetes. Epidemiological studies analyze the distribution and determinants of health and disease conditions. They do not necessarily prove cause-and-effect.

"Further research is needed on whether high 25-hydroxyvitamin D levels might prevent type 2 diabetes or the transition from pre-diabetes to diabetes," said Garland. "But this paper and past research indicate there is a strong association."

Garland and others have long advocated the health benefits of vitamin D. In 1980, he and his late brother Frank C. Garland, also an epidemiologist, published an influential paper that posited vitamin D (produced by the body through exposure to sunshine) and calcium (which vitamin D helps the body absorb) together reduced the risk of colon cancer. The Garlands and colleagues subsequently found associations with breast, lung and bladder cancers.

To reach 25-hydroxyvitamin D levels of 30 ng/ml, Garland said would require dietary supplements of 3,000 to 5,000 international units (IU) per day, less with the addition of moderate daily sun exposure with minimal clothing (approximately 10-15 minutes per day outdoors at noon).

The current recommended average daily amount of vitamin D is 400 IU for children up to 1 year; 600 IU for ages 1 to 70 years (less for pregnant or breastfeeding women) and 800 IU for persons over 70, according to the National Institutes of Health. Higher daily amounts of vitamin D are generally considered safe, but blood serum levels exceeding 125 ng/ml have been linked to adverse side effects, such as nausea, constipation, weight loss, heart rhythm problems and kidney damage.​

 

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One of the most frustrating and debilitating complications of diabetes is the development of wounds on the foot or lower leg. Once they form, they can persist for months, leading to painful and dangerous infections.

New research uncovers the role of a particular protein in maintaining these wounds and suggests that reversing its effects could help aid wound healing in patients with diabetes.

"We discovered that a specific protein, thrombospondin-2 (TSP2), is elevated in wounds of patients with diabetes as well as in animal models of diabetes," said Britta Kunkemoeller, a doctoral student at Yale University who conducted the study. "To determine whether TSP2 contributes to delayed wound healing, we genetically removed TSP2 from a mouse model of diabetes and observed improved wound healing. Our study shows that TSP2 could be a target for a specific therapy for diabetic wounds."

Kunkemoeller will present the research at the American Society for Investigative Pathology annual meeting during the 2018 Experimental Biology meeting, held April 21-25 in San Diego.

Diabetes currently afflicts nearly 26 million Americans, more than 8 percent of the population. Diabetic wounds are one of many complications of the disease.

Treatment for these wounds is mostly limited to standard wound care, such as moist bandages, removal of damaged tissue and footwear that reduces pressure on the wound. Despite these measures, the wounds often persist. In the most severe cases, it becomes necessary to amputate the affected foot or lower leg; diabetic wounds are the leading cause of amputations in the United States.

Most previous work on wound healing in diabetes has focused on the types of cells that are involved in wound healing such as immune cells, skin cells and the cells that form blood vessels. By contrast, Kunkemoeller's research focuses on TSP2, a component of the extracellular matrix. The extracellular matrix is a meshwork that serves as the structural foundation for cells, like the scaffolding used in construction.

In addition to providing structural support, the extracellular matrix regulates processes that are important to wound healing, including the behavior of immune, skin and vessel-forming cells. TSP2 is a component of the extracellular matrix that influences how the matrix is formed, as well as the development and communication of other types of cells that grow within the matrix.

"Our focus on TSP2 therefore allowed us to study a single molecule that influences several wound-healing related processes," explained Kunkemoeller.

The team bred mice that develop type 2 diabetes but cannot produce TSP2. When the researchers induced wounds in these mice, they found that the mice without TSP2 healed significantly better and faster than other mice that had diabetes along with normal levels of TSP2.

They also analyzed the factors that influence how much TSP2 the body produces. That part of the study revealed that TSP2 production increases when blood sugar levels are higher, explaining why people with diabetes have higher levels of TSP2 than people without diabetes.

"Currently, our lab is developing engineered biomaterials derived from extracellular matrix that lacks TSP2," said Kunkemoeller. "Our plan is to apply such materials to diabetic wounds in mouse models in order to evaluate their efficacy. Going forward, additional research will focus on either preventing the production or inhibiting the function of TSP2 in diabetic wounds."

Britta Kunkemoeller will present this research on Saturday, April 21, from 8:30-11:30 a.m. in Room 2 (poster 414.3), San Diego Convention Center (abstract) and on Tuesday, April 24, from 2:30-2:45 p.m. in Room 4. Contact the media team for more information or to obtain a free press pass to attend the meeting.

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About Experimental Biology 2018

Experimental Biology is an annual meeting that attracts more than 14,000 scientists and exhibitors from five host societies and more than two dozen guest societies. With a mission to share the newest scientific concepts and research findings shaping clinical advances, the meeting offers an unparalleled opportunity for exchange among scientists from across the U.S. and the world who represent dozens of scientific areas, from laboratory to translational to clinical research. http://www.experimentalbiology.org #expbio

About the American Society for Investigative Pathology (ASIP)

ASIP is a society of biomedical scientists who investigate mechanisms of disease. Investigative pathology is an integrative discipline that links the presentation of disease in the whole organism to its fundamental cellular and molecular mechanisms. ASIP advocates for the practice of investigative pathology and fosters the professional career development and education of its members. http://www.asip.org

 

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Patients with diabetes may have a decreased ability to feel acid regurgitation when compared with patients without diabetes, according to a recent study published in PLoS One.

This study was composed of 2884 patients, 1135 of whom had diabetes and 1749 who did not. All patients received esophagogastroduodenoscopy and were given an endoscopic gastroesophageal reflux disease (GERD) diagnosis. Doctors used the Los Angeles classification to grade GERD severity, with grade B or above classified as severe GERD. After their procedure, patients answered interview-based questions to complete the modified Gastrointestinal Symptom Rating Scale (GSRS). Researchers compared these results statistically throughout the group.

 

 

 

In patients diagnosed with severe GERD, patients with diabetes showed a lower GSRS score (23 out of 51 patients, 45%) for acid regurgitation than patients without diabetes (40 out of 60 patients, 67%). Using multivariate analysis, researchers found that acid regurgitation symptoms were associated with severe GERD (P =.0066), not having diabetes (P =.0157), a younger age (P =.0125), and hiatal hernia (P =.0042).

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For as long as artificial sweeteners have existed, people have been warned about their supposed health risks such as cancer and multiple sclerosis. But while these claims are routinely debunked as nothing more than junk science, some research—including a new study presented this week at the annual Experimental Biology conference—is beginning to indicate that sweeteners could actually contribute to health problems like type 2 diabetes.

Researchers at the Medical College of Wisconsin and Marquette University used rats vulnerable to developing diabetes for their experiments. For three weeks, different groups were fed high doses of two sugars, glucose and fructose, and two common artificial sweeteners, aspartame and acesulfame potassium. They then studied the rats’ blood using a large-scale technique that tracks minute metabolic changes, known as metabolomics.

 

“Just after three weeks of giving these sweeteners and sugars to our diabetes-susceptible rats, we saw biochemical changes in the blood that could potentially lead to alterations in fat and energy metabolism,” lead author Brian Hoffman, a biomedical engineer at both institutions, told Gizmodo.

Diabetes is what happens when our bodies become unable to maintain proper glucose levels in the body—a process that’s largely regulated by the hormone insulin. This breakdown causes people to either stop responding to insulin as easily as they once did, or to stop producing insulin altogether. Excessive sugar in our diets is thought to help cause diabetes by overtaxing the body’s insulin-producing machinery, since it’s used to bring high blood glucose levels back to normal.

Because of that, artificial sweeteners have long been advertised as a way for people to eat treats and soft drinks safely and lose weight, without raising the risk of diabetes. But rates of diabetes and obesity have continued to skyrocket regardless, even as sweetener-rich foods and drinks becamewidely available starting in the 1950s. (There are currently six FDA-approved artificial sweeteners.)

As a result, Hoffman and his team have not only tried to understand how sugar sparks the chain of events that leads to diabetes, but also tried to suss out whether sweeteners could do the same.

If sweeteners can raise our risk of diabetes, Hoffman says, they probably do it differently than sugar. Rather than overwhelming the body’s machinery, his and others’ research suggests, fake sugar wears it out. “Sweeteners kinda trick the body. And then when your body’s not getting the energy it needs—because it does need some sugar to function properly—it potentially finds that source elsewhere,” Hoffman said.

In the rats’ blood, his team found evidence of protein breakdown, likely meaning their bodies turned to burning away muscle as a source of energy. They also found higher levels of lipids and other fats, which over time could contribute to obesity and diabetes. Other research has suggested sweeteners alter the community of bacteria that call our guts home—the microbiome—in a way that could lead to harmful metabolic changes. And still more research has shown that diets high in artificial sweeteners are associated with a greater risk of diabetes and obesity.

Hoffman is well aware of past efforts to tie sweeteners to dire health risks, but he says things are different in this case.

“Most of these sweeteners were approved well before we had the technology to perform studies like my lab is doing. So they weren’t able to look as in-depth at some of the potential effects being caused,” he said. “By knowing what biochemical changes these are causing through these large-scale studies, we can take a unbiased approach and see what’s changing to give us a better direction.”

Hoffman’s team plans to submit their current findings for consideration in several peer-reviewed journals, but they’re already in the middle of studying their sweetener-fed rats for longer periods of time. Future studies are likely to involve taking a peek at the rats’ microbiomes too. Ultimately, he believes their study method could be relatively easy to use with people, since all that would be needed is a blood sample to study small metabolic changes.

 
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A heart drug has been found to help reduce kidney disease in those with heart failure, especially benefitting those with diabetes.

Entresto is available in Europe as a treatment for adults with heart failure, a known complication to affect people with diabetes. Kidney disease, meanwhile, is believed to affect one out of four adults with diabetes, but maintaining good blood glucose control and eating a healthy diet can reduce the risk of complications.

In the PARADIGM-HF study, thought to be the largest ever clinical trial carried out on heart failure, Entresto significantly slowed the rate of kidney decline when compared to Enalapril, a blood pressure medication.

In a subgroup of patients with heart failure and diabetes, the magnitude of benefit on kidney health was shown to be twice as high.

Shreeram Aradhye, chief medical officer and global head of Medical Affairs at Novartis Pharmaceutical, the drugmakers of Entresto, said: "These results suggest that in addition to the established benefits on heart failure, Entresto treatment also helps to preserve kidney function. This is important because impaired kidney function is associated with poorer outcomes in patients with heart failure.

"The benefit is particularly significant for people with chronic heart failure who also have diabetes, which is an independent risk factor for kidney damage."

The findings suggested that Entresto, designed to be taken twice a day, reduced the chance of a dying from a cardiovascular-related condition by 20%. The drug also reduced admittance to hospital because of heart failure by 21% and the risk of dying from any cause by 16%.

The most recent findings "add to the growing evidence that Entresto has important clinical benefits for heart failure patients beyond improving their cardiovascular outcomes," Novartis said.

The results of the trial have been published in the Journal of the American College of Cardiology: Heart failure (JACC-HF).
 
 
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The fact so many people are now telling us artificial sweeteners are harmful, should give us all pause

 

I don't use them because they are so hard on your digestive system.  I would rather have a once in a while treat made with real sugar than risk the stomach problems that come along with artificial sweeteners

 

 

ZERO-CALORIE ARTIFICIAL sweeteners meant to reduce consumption of sugar are being linked to diabetes and obesity.

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The Trouble With Low-Calorie Sweeteners

A new study presented Sunday at the 2018 Experimental Biology meeting examined the biochemical effects of artificial sweeteners in rats and cell cultures. Researchers fed one group of rats a diet high in glucose or fructose, different types of sugars, and another group a diet with aspartame or acesulfame potassium, common zero-calorie artificial sweeteners. After three weeks, researchers observed "significant differences in the concentrations of biochemicals, fats and amino acids in blood samples," according to a press release.

 

The study also examined how artificial sweeteners affected vascular health by looking at how they impacted the lining of the blood vessels.

"As diabetes and obesity become a rising worldwide health concern there has been an increased awareness of environmental factors, such as diet, that are contributing to the problem," the study says. "However, it was not until recently that the negative impact of consuming non-caloric artificial sweeteners in the place of sugar had been increasingly recognized as a potential contributor to the dramatic increase in diabetes and obesity, along with the associated complications."

The results of the study suggest artificial sweeteners alter how bodies process fat and obtain energy. Additionally, researchers discovered acesulfame potassium appeared to accumulate in the blood, with increased amounts having more harmful effects on cells that line blood vessels.

One of the authors, Brian Hoffmann, assistant professor in the department of biomedical engineering at the Medical College of Wisconsin and Marquette University, said sugar replacements aren't a solution to the diabetes and obesity epidemic.

"Despite the addition of these non-caloric artificial sweeteners to our everyday diets, there has still been a drastic rise in obesity and diabetes," Hoffmann said in the release. "In our studies, both sugar and artificial sweeteners seem to exhibit negative effects linked to obesity and diabetes, albeit through very different mechanisms from each other."

[ READ: How Much Sugar Can You Eat If You Have Diabetes? ]

Hoffman said the body has "the machinery to handle sugar" in moderation. However, in excess, the "machinery breaks down." Researchers also observed that replacing natural sugars with zero-calorie artificial sweeteners leads to negative changes in fat and energy metabolism.

Hoffman cautioned that there is no simple answer to "Which is worse, sugar or artificial sweeteners?" A diet high in sugar has negative health outcomes and the study shows a diet high in artificial sugars has the same.

Instead, he says in the press release, "moderation is the key if one finds it hard to completely cut something out of their diet."