Tag Archive for: type 2 diabetes

What They Got Right in the Sugar and Artificial Sweetener Research

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Whether it’s a new form of treatment, a new medication, or even examining a phytonutrient for potential benefits, it all starts with basic research. That’s what the study I began talking about Tuesday is all about: basic research. I like it because this is the way all research has to begin. This is where test-tube studies are appropriate.

In this case they used epithelial cells from the vascular system of the rodents, exposed them to high amounts of sugars and artificial sweeteners, and then looked at specific changes in proteins that are involved in various types of cell action. In other words, they were looking for dysfunction in the way the genes for the proteins responded after exposure to the sugars and artificial sweeteners.

Were there differences? Yes. The important thing that they discovered was that the proteins inside these epithelial cells responded differently when exposed to sugar than when exposed to artificial sweeteners.

The question is this: was any of this meaningful in the real world? I’ll let you know what I think on Saturday.

What are you prepared to do today?

Dr. Chet

 

Reference: EB 2018. The Influence of Sugar and Artificial Sweeteners on Vascular Health during the Onset and Progression of Diabetes Board # / Pub #: A322 603.20.

 

Artificial Sweeteners, Obesity, and Diabetes

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Last week, you may have seen headlines that said something like “Artificial Sweeteners May Cause Obesity and Type 2 Diabetes!” Just about every news organization picked up a press release from the Experimental Biology meeting. In the press release, researchers gave some of the results of a paper that was presented at a scientific session, including comments by the lead author, Dr. Brian R. Hoffman.

The purpose for doing the study, he said, was because of the epidemic of obesity and diabetes in the U.S. While there’s little question that excessive sugar intake, combined with excess calories over years, does contribute to obesity and type 2 diabetes, no one has really examined the role artificial sweeteners may play.

In these studies, he and his research team examined the effect of high levels of sugars, aspartame, and acesulfame potassium on epithelial cells taken from rodents in a test-tube study. Then using another group of rodents, they overfed them sugars and the same artificial sweeteners for three weeks. The objective was to see what changes occurred in proteins and metabolites that were produced in cardiovascular epithelial cells in the test-tube study and the blood of the rodents.

They found that there were modifications in proteins under both conditions, which may have led to changes in the products they produced. But is this meaningful research or not? I’ll tell you what I liked about the study in Thursday’s memo.

What are you prepared to do today?

Dr. Chet

 

Reference: EB 2018. The Influence of Sugar and Artificial Sweeteners on Vascular Health during the Onset and Progression of Diabetes Board # / Pub #: A322 603.20.

 

Guidelines for Type 2 Diabetes: EBM in Practice

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The American College of Physicians (ACP) has established guideline statements for the management of HbA1c in non-pregnant adults using medication. They considered the research behind guidelines set by four other major physician organizations for treating type 2 diabetes. After reviewing that data, they have proposed four guidelines for use when treating patients. These are non binding guidelines; the choice is always left to the physician and the patient. But I think they get back to what evidence-based medicine should have always been about: use the best science and research and work with the patient to see what they want to do. Let’s take a look.

ACP Guideline Statements

These are the statements:

Guidance Statement 1
Clinicians should personalize goals for glycemic control in patients with type 2 diabetes on the basis of a discussion of benefits and harms of pharmacotherapy, patients’ preferences, patients’ general health and life expectancy, treatment burden, and costs of care.

Guidance Statement 2
Clinicians should aim to achieve an HbA1c level between 7% and 8% in most patients with type 2 diabetes.

Guidance Statement 3
Clinicians should consider de-intensifying pharmacologic therapy in patients with type 2 diabetes who achieve HbA1c levels less than 6.5%.

Guidance Statement 4
Clinicians should treat patients with type 2 diabetes to minimize symptoms related to hyperglycemia and avoid targeting an HbA1c level in patients with a life expectancy less than 10 years due to advanced age (80 years or older), residence in a nursing home, or chronic conditions (such as dementia, cancer, end-stage kidney disease, or severe chronic obstructive pulmonary disease or congestive heart failure) because the harms outweigh the benefits in this population.

EBM and Guideline Statements

I think the Guideline Statements reflect what EBM was always supposed to be about: consider the patient and what they want. I have spoken to many adults with type 2 diabetes who become frustrated with their inability to reach the HbA1c goals their physician has set. If they can’t reach it, more medication seems to be the only solution, and that’s not what they want.

I think these guidelines bring the patient or their caregiver into the equation. What price does the patient have to pay with their body? How much will it affect their life positively or negatively? Are there real improvements in quality of life if the HbA1c is 6.5% versus 7.0%? What is the cost of emotional stress?

The new guideline statements are a great addition to a physician’s repertoire: treat the patient as an individual. The patient comes before statistics and hazard ratios.

The Bottom Line

While not all organizations are going to adopt these guidelines, they’re important. There has been significant pushback from other organizations, all suggesting that there are new medications that may prevent some of the negative effects of prior treatment. “New medications”—they’ve learned nothing.

The one opportunity I see is that there’s hope for all of us who want to work at getting control of our lifestyle and reduce the dependence on medications as recommended by statement three. You say you don’t want to take medication? Excellent! Here is your chance to prove it.

Eat less. Eat better. Move more.

What are you prepared to do today?

Dr. Chet

 

Reference: Ann Intern Med. doi:10.7326/M17-0939.

 

A New Approach to HbA1c

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Type 2 diabetes is a significant problem in North America and it’s spreading throughout the entire world. The treatment standard has always focused on controlling blood sugar, especially HbA1c. Normal is less than 5.7%. For most individuals, reducing the HbA1c to under 6.5% has been the goal for pharmacologic treatment.

HbA1c is a protein found on red blood cells that indicates blood glucose levels over the past 90 days. It develops when hemoglobin, a protein within red blood cells that carries oxygen throughout your body, bonds with glucose in the blood. Think of it as the sugar you ate over the last three months getting stuck to your red blood cells; the higher your HbA1c, the worse your control of your blood sugar has been. For a prediabetic, that means your days of diabetes meds and finger pricks is getting closer. For a diabetic, that opens the door to many of the worst consequences of diabetes, such as heart and kidney disease, blindness, and nerve damage.

Recently, the American College of Physicians published new guidance statements for the use of medications for controlling HbA1c. A committee of physicians examined the data behind the current standards of treatment for four of the major physician organizations including the American Diabetes Association. In the simplest terms, they wanted to know what benefits or hazards occur when treating adults with type 2 diabetes with medications. Should the goal be to get the HbA1c as low as possible with drugs? Or should the individual be part of the treatment equation?

This is an important issue and the topic for this week. I’m going to review evidence-based medicine on Thursday. You can get the entire story by listening to the Straight Talk on Health on evidence-based medicine, normally available only to Members and Insiders; I cover the entire concept of how EBM began and what it was intended to be. For those of you who haven’t chosen a membership yet, get more info here.

What are you prepared to do today?

Dr. Chet

 

Reference: Ann Intern Med. doi:10.7326/M17-0939.

 

BMI, WHR, and Lifestyle

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The study we’ve been examining is interesting on so many levels: large numbers of subjects; new statistical techniques due in large part to progress in computing capabilities; genetic analysis that allows for rapid analysis and identification of polymorphisms. It’s all very exciting. You’re probably anticipating a “but” coming and you’d be correct.

This study demonstrated that when using genetic information, WHR is a risk for CVD and type 2 diabetes even with a normal BMI. But there’s still at least two factors to consider that are dependent on each other.

First, just because someone has a mutated gene or genes, it doesn’t mean it will ever express itself, i.e., turn on. More than likely, the second factor has a role to play and that’s the lifestyle of the individual. Some studies refer to it as environment, but they’re intertwined. Where you live may limit or provide you with easy access to healthier foods. It may be easier to exercise in the suburbs than in a large city, or just the opposite given the park systems in different areas of the countries.

Then there’s the home environment: what foods you ate growing up and what your diet is now. All these can impact whether some genes may be expressed. Others may express themselves only when you get to a specific weight or fat intake. The variables are too numerous to consider.

I’m not attempting to confuse the issue. I just want you to know that while this study provides insight that we didn’t have before, you don’t have to be overly concerned. If you keep to a normal BMI and WHR, less than 0.9 for men and less than 0.8 for women, your risk for CVD and type 2 diabetes will not be high.

When all is said and done, it still comes down to three things. Eat less. Eat better. Move more.

What are you prepared to do today?

Dr. Chet

 

Reference: JAMA. 2017;317(6):626-634.

 

Waist-Hip Ratio vs. BMI

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In Tuesday’s message, I said researchers used a unique approach to answering the question of whether waist-hip ratio (WHR) is associated with cardiovascular disease and type 2 diabetes regardless of BMI. They found 48 genes which were associated WHR, a unique approach using the genetic information with Mendelian randomization of epidemiological data. If that isn’t a brain-full, I don’t know what is. Let me see if I can break it down for you.

As I’ve said many times before, epidemiological data cannot show cause and effect; they’re just observations. By using the genetic information related to WHR, researchers can analyze the data by statistically removing the effect of BMI. Because the genetic traits follow some randomization based on Mendel’s genetic work, if the WHR is still associated with the increased risks of disease, that means that where you carry your body fat is important, whether your BMI says you’re overweight or not.

They found that WHR is an independent risk factor for CVD and type 2 diabetes, confirming that the location of your body fat is important regardless of your BMI. That may be why people with a high BMI but low WHR have normal blood pressure and cholesterol levels while others with a normal BMI but a high WHR may have high numbers.

What are you prepared to do today?

Dr. Chet

 

Reference: JAMA. 2017;317(6):626-634.

 

Redefining the Risks of Extra Weight

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Studies show that 70% of the population is overweight; by definition, that means that their body mass index (BMI) is greater than 25 or more. But are all overweight people at the same risk? Just because you’re overweight, are you automatically at greater risk for cardiovascular disease and type 2 diabetes?

That’s what a group of researchers in the U.S. attempted to find out. They had the benefit of access to the U.K. Biobank, an independently funded databank that has collected biometric data on over 500,000 subjects in the U.K. and contains accurate measures of BMI as well as the waist-hip ratio (WHR) on all subjects. They also had one more thing: the genetic information on a large sub-group of subjects. They identified 48 genes that seemed to be associated with WHR and used a unique approach to tease out the effects of WHR from BMI. I’ll cover that the rest of the week.

In the meantime, check out your BMI and measure your waist and hip to calculate your WHR. Measure your waist about an inch below your belly-button and your hips at the widest point; divide waist by hips and you have your ratio.

What are you prepared to do today?

Dr. Chet

 

Reference: JAMA. 2017;317(6):626-634.

 

The Answer to the Sugar Conundrum

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Whether you have prediabetes, type 2 diabetes, or are just concerned about the calories in the sugary treats this holiday season, what should you do? Go without and feel deprived, or indulge and pay some sort of price? Let’s take a look by beginning with a few questions.

Why do you want to reduce your sugar intake? Do you want to reduce your caloric intake? Is it because you know you have prediabetes or type 2 diabetes? Are you concerned about gaining weight over the holiday season? Once you know why you want to avoid sugar, you can start . . .

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The Sugar Conundrum

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During the holiday season, there are plenty of sugary snacks available. Candy, cookies, pies, all kinds of treats. But can something as simple as jam on toast, let alone the holiday treats, be an issue for someone with prediabetes or type 2 diabetes? With close to half of all adults afflicted with one condition or the other, any kind of sugar stops them in their tracks. I see people reading labels carefully in the grocery store and often hear the words “No good. It has sugar!” In the prediabetes and diabetes groups I . . .

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Why You Need Fiber

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One of the questions I get all the time is: What’s the big deal with fiber and why is it so important? In Real-Life Detox, my book that helps you naturally detoxify your body, I talk about the use of fiber during the fasting and detoxification process but didn’t cover it in great detail, so let’s take a closer look.

Fiber is the indigestible parts of plants. Because most Americans eat a diet very high in refined carbohydrates that have had the fiber . . .

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If you're already a DrChet.com Member or Insider, click on the Membership Login link on the top menu. Members may upgrade to Insider by going to the Store and clicking Membership; your membership fee will be prorated automatically.