Home » Posts filed under diabetes
Diposting oleh
good reading on Selasa, 10 Desember 2013
Obesity is strongly associated with metabolic alterations and negative health outcomes including diabetes, cardiovascular disease, and some types of cancer (
1,
2,
3,
4). Excess body fat is one of the primary causes of preventable health problems and mortality in the United States and many other affluent nations, ranking in importance with cigarette smoking and physical inactivity. Obesity is thought to contribute to disease
via the metabolic disturbances it causes, including excess glucose and lipids in the circulation, dysregulated hormone activity including insulin and leptin, and inflammatory effects. This immediately raises two questions:
- Does metabolically healthy obesity exist?
- If so, are metabolically healthy obese people at an elevated risk of disease and death?
Does metabolically healthy obesity exist?Read more »
Diposting oleh
good reading on Minggu, 24 Maret 2013
Last week, I attended a Keystone conference, "Neuronal Control of Appetite, Metabolism and Weight", in Banff. Keystone conferences are small, focused meetings that tend to attract high quality science. This particular conference centered around my own professional research interests, and it was incredibly informative. This post is a summary of some of the most salient points.
Rapid Pace of Scientific ProgressRead more »
Diposting oleh
good reading on Rabu, 23 Januari 2013
Five years ago, I had an interesting conversation with a veterinarian friend about dog food. We were talking about diabetes in one of the dogs she was treating, and I remarked "that's what happens when you feed a carnivore carbohydrate". She gave me a funny look. At the time, I was seeing the world through the low-carb lens, and I remember thinking how bizarre it was that she didn't yield to my impeccable logic. As they say, live and learn.
The journal
Nature published a fascinating paper on the evolution of the domestic dog today (
1). Researchers compared the genome of wolves and domestic dogs to see what genetic changes accompanied domestication.
Read more »
Diposting oleh
good reading on Senin, 10 September 2012
In the lab, we work hard to design experiments that help us understand the natural world. But sometimes, nature sets up experiments for us, and all we have to do is collect the data. These are called "natural experiments", and they have led to profound insights in every field of science. For example, Alzheimer's disease is usually not considered a genetic disorder. However, researchers have identified rare cases where AD is inherited in a simple genetic manner. By identifying the genes involved, and what they do, we were able to increase our understanding of the molecular mechanisms of the disease.
The natural experiment I'll be discussing today began in 1989 with the onset of a major economic crisis in Cuba. This coincided with the loss of the Soviet Union as a trading partner, resulting in a massive economic collapse over the next six years, which gradually recovered by 2000.
Read more »
Diposting oleh
good reading on Minggu, 22 Juli 2012
My colleagues Drs. Mario Kratz, Ton Baars, and I just published a paper in the European Journal of Nutrition titled "
The Relationship Between High-Fat Dairy Consumption and Obesity, Cardiovascular, and Metabolic Disease". Mario is a nutrition researcher at the Fred Hutchinson Cancer Research Center here in Seattle, and friend of mine. He's doing some very interesting research on nutrition and health (with an interest in ancestral diets), and I'm confident that we'll be getting some major insights from his research group in the near future. Mario specializes in tightly controlled human feeding trials. Ton is an agricultural scientist at the University of Kassel in Germany, who specializes in the effect of animal husbandry practices (e.g., grass vs. grain feeding) on the nutritional composition of dairy. None of us have any connection to the dairy industry or any other conflicts of interest.
The paper is organized into three sections:
- A comprehensive review of the observational studies that have examined the relationship between high-fat dairy and/or dairy fat consumption and obesity, metabolic health, diabetes, and cardiovascular disease.
- A discussion of the possible mechanisms that could underlie the observational findings.
- Differences between pasture-fed and conventional dairy, and the potential health implications of these differences.
Read more »
Diposting oleh
good reading on Kamis, 19 Juli 2012
In the comments of the last post, we've been discussing the relationship between body fatness and diabetes risk. I think this is really worth understanding, because type 2 diabetes is one of the few lifestyle disorders where 1) the basic causes are fairly well understood, and 2) we have effective diet/lifestyle prevention strategies that have been clearly supported by multiple controlled trials.
Read more »
Diposting oleh
good reading on Minggu, 05 Februari 2012
Last week I had the pleasure of being invited to guest blog on
"The Public's Health". The blog is a collaboration between
Drexel University School of Public Health and
The Philadelphia Inquirer. In multiple posts each week, the authors highlight contemporary, historical, and ethical matters that challenge public health professionals.
For
my post, I was able to contribute a "Pop Health" story which examined Paula
Deen's disclosure of her type 2 diabetes and the media and societal backlash which followed.
What do you think? Do celebrities have the right to talk about their health information whenever and however they feel comfortable? Or do they have a social responsibility to disclose as early as possible- and to discuss it in a way that is most likely to improve the
public's health?
Diposting oleh
good reading on Sabtu, 04 Februari 2012
As I was preparing my recent article on the Paleo diet (
1), I interviewed a local Paleo-friendly MD named C. Vicky Beer. I was only able to include a snippet of the interview in the article, but I thought WHS readers would be interested to read the rest of the interview with Dr. Beer:
Read more »
Diposting oleh
good reading on Senin, 23 Januari 2012
In previous posts, I outlined the factors I'm aware of that can contribute to insulin resistance. In this post, first I'll list the factors, then I'll provide my opinion of effective strategies for preventing and potentially reversing insulin resistance.
The factorsThese are the factors I'm aware of that can contribute to insulin resistance, listed in approximate order of importance. I could be quite wrong about the order-- this is just my best guess. Many of these factors are intertwined with one another.
Read more »
Diposting oleh
good reading on Rabu, 18 Januari 2012
In this post, I'll explore a few miscellaneous factors that can contribute to insulin resistance: smoking, glucocorticoids/stress, cooking temperature, age, genetics and low birth weight.
SmokingSmoking tobacco acutely and chronically reduces insulin sensitivity (
1,
2,
3), possibly via:
- Increased inflammation
- Increased circulating free fatty acids (4)
Paradoxically, since smoking also protects against fat gain, in the very long term it may not produce as much insulin resistance as one would otherwise expect. Diabetes risk is greatly elevated in the three years following smoking cessation (
5), and this is likely due to the fat gain that occurs. This is not a good excuse to keep smoking, because smoking tobacco is one of the most unhealthy things you can possibly do. But it
is a good reason to tighten up your diet and lifestyle after quitting.
Read more »
Diposting oleh
good reading on Minggu, 15 Januari 2012
Previously in this series, we've discussed the role of cellular energy excess, inflammation, brain insulin resistance, and micronutrient status in insulin resistance. In this post, I'll explore the role of macronutrients and sugar in insulin sensitivity.
Carbohydrate and FatThere are a number of studies on the effect of carbohydrate:fat ratios on insulin sensitivity, but many of them are confounded by fat loss (e.g., low-carbohydrate and low-fat weight loss studies), which almost invariably improves insulin sensitivity. What interests me the most is to understand what effect different carbohydrate:fat ratios have on insulin sensitivity in healthy, weight stable people. This will get at what
causes insulin resistance in someone who does not already have it.
Read more »
Diposting oleh
good reading on Senin, 09 Januari 2012
So far, we've explored three interlinked causes of insulin resistance: cellular energy excess, inflammation, and insulin resistance in the brain. In this post, I'll explore the effects on micronutrient status on insulin sensitivity.
Micronutrient StatusThere is a large body of literature on the effects of nutrient intake/status on insulin action, and it's not my field, so I don't intend this to be a comprehensive post. My intention is simply to demonstrate that it's important, and highlight a few major factors I'm aware of.
Read more »
Diposting oleh
good reading on Minggu, 08 Januari 2012
As discussed in previous posts, cellular energy excess and inflammation are two important and interlinked causes of insulin resistance. Continuing our exploration of insulin resistance, let's turn our attention to the brain.
The brain influences every tissue in the body, in many instances managing tissue processes to react to changing environmental or internal conditions. It is intimately involved in insulin signaling in various tissues, for example by:
- regulating insulin secretion by the pancreas (1)
- regulating glucose absorption by tissues in response to insulin (2)
- regulating the suppression of glucose production by the liver in response to insulin (3)
- regulating the trafficking of fatty acids in and out of fat cells in response to insulin (4, 5)
Because of its important role in insulin signaling, the brain is a candidate mechanism of insulin resistance.
Read more »
Diposting oleh
good reading on Sabtu, 07 Januari 2012
In the last post, I described how cellular energy excess causes insulin resistance, and how this is triggered by whole-body energy imbalance. In this post, I'll describe another major cause of insulin resistance: inflammation.
InflammationIn 1876, a German physician named W Ebstein reported that high doses of sodium salicylate could totally eliminate the signs and symptoms of diabetes in certain patients (
Berliner Klinische Wochenschrift. 13
:337. 1876). Following up on this work in 1901, the British physician RT Williamson reported that treating diabetic patients with sodium salicylate caused a striking decrease in the amount of glucose contained in the patients' urine, also indicating an apparent improvement in diabetes (
2). This effect was essentially forgotten until 1957, when it was rediscovered.
Read more »
Diposting oleh
good reading on Jumat, 06 Januari 2012
Insulin is an ancient hormone that influences many processes in the body. Its main role is to manage circulating concentrations of nutrients (principally glucose and fatty acids, the body's two main fuels), keeping them within a fairly narrow range*. It does this by encouraging the transport of nutrients into cells from the circulation, and discouraging the export of nutrients out of storage sites, in response to an increase in circulating nutrients (glucose or fatty acids). It therefore operates a negative feedback loop that constrains circulating nutrient concentrations. It also has many other functions that are tissue-specific.
Insulin resistance is a state in which cells lose sensitivity to the effects of insulin, eventually leading to a diminished ability to control circulating nutrients (glucose and fatty acids). It is a major contributor to diabetes risk, and probably a contributor to the risk of cardiovascular disease, certain cancers and a number of other disorders.
Why is it important to manage the concentration of circulating nutrients to keep them within a narrow range? The answer to that question is the crux of this post.
Read more »
Diposting oleh
good reading on Jumat, 28 Oktober 2011
Insulin regulates blood glucose primarily by two mechanisms:
- Suppressing glucose production by the liver
- Enhancing glucose uptake by other tissues, particularly muscle and liver
Since the cells contained in liver, muscle and other tissues respond directly to insulin stimulation, most people don't think about the role of the brain in this process. An interesting paper just published in Diabetes reminds us of the central role of the brain in glucose metabolism as well as body fat regulation (
1). Investigators showed that by inhibiting insulin signaling in the brains of mice, they could diminish insulin's ability to suppress liver glucose production by 20%, and its ability to promote glucose uptake by muscle tissue by 59%. In other words, the majority of insulin's ability to cause muscle to take up glucose is mediated by its effect on the brain.
Read more »
Diposting oleh
good reading on Sabtu, 09 Juli 2011
Gastric bypass surgery is an operation that causes food to bypass part of the digestive tract. In the most common surgery, Roux-en-Y bypass, stomach size is reduced and a portion of the upper small intestine is bypassed. This means that food skips most of the stomach and the duodenum (upper small intestine), passing from the tiny stomach directly into the jejunum (a lower part of the upper small intestine)*. It looks something like this:
Read more »
Diposting oleh
good reading on Minggu, 22 Mei 2011
CarbSane just posted an interesting new study that fits in nicely with what we're discussing here. It's part of the US Coronary Artery Risk Development in Young Adults (CARDIA) study, which is a long-term observational study that is publishing many interesting findings. The new study is titled "Fast-food habits, weight gain, and insulin resistance (the CARDIA study): 15-year prospective analysis" (
1). The results speak for themselves, loud and clear (I've edited some numbers out of the quote for clarity):
Read more »
More about → Fast Food, Weight Gain and Insulin Resistance
Diposting oleh
good reading on Rabu, 18 Mei 2011
Low-Fat Diets In 2000, the
International Journal of Obesity published a nice review article of low-fat diet trials. It included data from 16 controlled trials lasting from 2-12 months and enrolling 1,910 participants (
1). What sets this review apart is it only covered studies that
did not include instructions to restrict calorie intake (
ad libitum diets). On average, low-fat dieters reduced their fat intake from 37.7 to 27.5 percent of calories. Here's what they found:
Read more »
More about → Food Reward: a Dominant Factor in Obesity, Part III
Diposting oleh
good reading on Rabu, 30 Maret 2011
A few readers have pointed me to an interesting NPR interview with the Canadian physician Kevin Patterson (
link). He describes his medical work in Afghanistan and the Canadian arctic treating cultures with various degrees of industrialization. He discusses the "epidemiological transition", the idea that cultures experience predictable changes in their health as they go from hunter-gatherer, to agricultural, to industrial. I think he has an uncommonly good perspective on the effects of industrialization on human health, which tends to be true of people who have witnessed the effects of the industrial diet and lifestyle on diverse cultures.
A central concept behind my thinking is that it's possible to benefit simultaneously from both:
- The sanitation, medical technology, safety technology, law enforcement and lower warfare-related mortality that have increased our life expectancy dramatically relative to our distant ancestors.
- The very low incidence of obesity, diabetes, coronary heart disease and other non-infectious chronic diseases afforded by a diet and lifestyle roughly consistent with our non-industrial heritage.
But it requires discipline, because going with the flow means becoming unhealthy.
