Tag Archive for: pre-diabetes

Carbs and Insulin: Diet Matters

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On Wednesday, I told you about a study of people who experienced an energy crash after eating carbs. The next study was more pragmatic: we have non-diabetic people who seem to have reactive hypoglycemia (RH), but can we treat it with diet alone? This is a concern because many believe that RH in these people may be a precursor of pre-diabetes and type 2 diabetes. This time, the researchers recruited 40 normal-weight subjects with RH symptoms to see if a dietary intervention could improve symptoms over a year. After testing all subjects, only 12 subjects actually had blood sugars below 55 mg/dl, the more-or-less agreed upon lower boundary for blood sugar.

After assessing their initial diet, subjects met with a dietician four times over the next six months. They were taught the nuances of a Low Glycemic Index Diet in private sessions with a dietician. The subjects were asked to follow that diet for the next three months, with a follow-up session with the dietician midway to fine-tune the diet. The same pattern was followed for the Mediterranean diet. The subjects were tested for RH symptoms after each diet; then for the next six months, they were told to follow any diet they chose based on what they’d learned. All subjects were tested again after 12 months.

A couple of results stood out to me. After six months, the subjects ate an average of four times per day instead of the three times before the study began. Second, they allowed more time between each meal than they had before. While they were instructed on portion sizes during the training periods on each diet, there were no limitations on how much they ate or and no counting calories.

When it comes to the symptoms associated with RH, five of the seven tested were significantly reduced. The researchers attributed it to a healthier eating pattern. After the 12-month study, 80% of the subjects leaned toward the less-complicated Mediterranean diet, which increases the number of whole grains, vegetables, beans, and nuts.

What do we know now that we didn’t know then? Two things: diet matters when it comes to hypoglycemia in non-obese, non-diabetic subjects. Further, individual attention, even just four sessions within six months, is enough to help people make better choices. Whether that lasts more than a year is unknown, but we also know this: the most powerful hormone in the body—insulin—doesn’t cause the insulin overshoot phenomenon in otherwise healthy people. The search for the cause continues.

The Insider Conference call will be next Wednesday September 16 at 9 p.m. ET, and the topic will be Sugar and Carbs—Fact or Fiction. Some of the facts and fictions covered will be:

  • Does eating sugar cause diabetes or pre-diabetes?
  • Can type 2 diabetics eat sugar?
  • Which organ wants and uses more sugar than any other?
  • What are hidden sources of sugar on nutrition labels?
  • Can overeating carbohydrates cause non-alcoholic liver disease?
  • And even more, plus answers to your questions.

The Guest Pass for this Insider Conference call will be available just like last month for $9.95. Sign up before 8 p.m. Wednesday to be included, and a replay will be available within the following week.

GuestPass

Click on the ticket
to sign up!

What are you prepared to do today?

        Dr. Chet

Reference: Nutrients 2022. (14) 497. https://doi.org/10.3390/nu14030497

Why Scientific Research Must Never Stop

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The current U.S. administration has tried to stop or delay basic and clinical research related to human conditions and diseases, and in the next few Memos, I’m going to illustrate why that’s a serious mistake. When I’ve laid it out, you can decide for yourself whether clinical research is a waste of money or critical for human health and well-being.

Example One: Glucagon-like Peptides

Sometime during the last century, chemicals were found in the intestines that seemed to increase the release of insulin in response to glucose. It wasn’t until the early 1980s that a gene was identified that resulted in the manufacture of proglucagon. Continued research found that when the protein was unfolded, it was responsible for the production of six different hormones. While all are important, one in particular has become popular 40 years later: GLP-1 (glucagon-like peptide-1). Depending on where it’s produced, its major function is to increase satiety by delaying digestion in the stomach. The net effect is to reduce food intake; that impacts glucose levels in people with pre-diabetes and type 2 diabetes, which can lead to weight loss and the possible prevention of every other condition downstream from diabetes such as cardiovascular disease or diabetic neuropathy.

You may recognize GLP-1 agonists, chemicals which will turn the production on, by their brand names such as Ozempic and Trulicity. They are helping millions of people control their type 2 diabetes with a side benefit of weight loss. From the time that the chemical was discovered, through identifying the gene that produces it, and the development of a chemical that could stimulate the gene to produce GLP-1, the process took over 50 years. The scientists began with basic research and ended with clinical trials to prove the efficacy of the medication. And the research is still not done—if research is able to continue to find something that stimulates only GLP-1 receptors in specific locations in the body instead of systemically, side effects could be controlled more effectively.

Another illustration on Saturday. Tomorrow is the March Insider Conference Call. The primary topic will be more detail on how drugs like Ozempic work as well as answering your questions. Maybe it’s time you become an Insider and join the call.

What are you prepared to do today?

        Dr. Chet

Reference: J Clin Invest. 2017 Dec 1;127(12):4217–4227. doi: 10.1172/JCI97233

Is It Worth It?

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At an obesity conference, the report on the clinical trials for a pre-diabetes and diabetes medication left the crowd on their feet and cheering. There are reports of well-known personalities who’ve used the drug with great results. But the ultimate question about a pharmaceutical approach to obesity has to be this: is it worth the money? Let’s start by looking at the pharmaceutical and then the return on investment.

How It Works

The body makes proteins called incretins which can stimulate the release of insulin. One incretin hormone, GLP-1 (glucagon-like peptide-1), is manufactured in the upper digestive system in response to carbohydrate intake. In subjects with type 2 diabetes, this hormone effect is diminished or no longer present.

The ability to stimulate the production of insulin and prevent the release of glucose by glucagon can be stimulated pharmacologically by semaglutide, a receptor agonist—that means it turns on the glucagon. In subjects with type 2 diabetes, semaglutide stimulates GLP-1 receptors significantly, thereby reducing blood glucose and improving glycemic control. In addition, it has multiple effects on various organ systems; most relevant are a reduction in appetite and food intake, leading to weight loss in the long term. Since GLP-1 secretion from the gut seems to be impaired in obese subjects, it was logical to test it in obese populations. Those were the study results I reported on Tuesday.

All in all, this sounds like it might be a potential solution to our obesity crisis, but there are some unanswered questions. What is the long-term safety of regular use of the drug? How does the microbiome impact the effectiveness of the drug? But more than that, everything comes with a price, which begs the question: is it worth it?

The Price

The price of using semaglutide for obesity is really two-fold. First is the actual cost of the weekly injections which is about $1,400 per month at retail. If your insurance will cover it, I’ve seen prices as low as $25 per month. We know that people lost an average of 18% of their starting weight at 68 weeks—the length of the longest study to date—but the rate of weight loss declined near the end of the study. How long will insurance cover it beyond that, and will a person continue to lose weight? We don’t know.

After using the drug for 20 weeks, the placebo group was switched to a placebo and immediately began to gain weight. By the end of 68 weeks, they had regained all but 5% and were still gaining. Would an investment of close to $17,000 to lose about 20% of your weight be worth it if you began to gain it back? There are many questions around whether people can take this drug for the rest of their lives; every pharmaceutical intervention must have an end strategy. The researchers did not address the issue.

The Bottom Line

The research into this pharmaceutical intervention was well done. However, unless the intervention includes an exit strategy, it could be a waste of money. Perhaps a lower carbohydrate diet may be a partial solution because this drug impacts carbohydrate metabolism. But we don’t know whether the weight loss would be enough to have the body take over and do the same thing on GP-1 by itself.

I think this shows a hopeful approach and it may turn out to be a boost to someone who is absolutely willing to change their lifestyle or someone who needs to lose weight for a specific purpose, such as joint replacement surgery or preparing for IVF. But for most of us, maybe it’s better to save the time and money and do what we know works: Eat less. Eat better. Move more.

What are you prepared to do today?

        Dr. Chet

References:
1. JAMA. 2021;325(14):1414-1425. doi:10.1001/jama.2021.3224
2. JAMA. 2022;327(2):138-150. doi:10.1001/jama.2021.23619

Happy New Year!

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It’s good to be back talking to all of you again. The New Year is a time of optimism, everything seems possible, and there’s an enthusiasm for achieving health goals. One thing many people want to do is to lose some weight. It seems appropriate to cover a couple of drugs that were recently approved by the FDA to treat obesity. They’re a pharmaceutical approach to weight loss, and they’ve gotten so much press I have to cover them.

You’ve probably seen the commercials for a pre-diabetes and diabetes medication called Ozempic. It also has a sister drug called Wegovy that was approved for use in teens. In at least two clinical trials, subjects who had weekly injections of the drug lost at least 15% or more of their body weight in 68 weeks. Those who were switched to placebo injections started to gain back the weight they lost. All subjects were supported with monthly consultations with dieticians to induce a 500-calorie reduction in food intake and to increase exercise levels. Markers for type 2 diabetes improved such as HbA1c and blood glucose.

Is this the be-all and end-all to the obesity epidemic? And exactly how does this drug work? I’ll cover that on Saturday.

What are you prepared to do today?

        Dr. Chet

References:
1. JAMA. 2021;325(14):1414-1425. doi:10.1001/jama.2021.3224
2. JAMA. 2022;327(2):138-150. doi:10.1001/jama.2021.23619