Archive for Diabetes and obesity tips
Effect of olanzapine, risperidone on risk of diabetes in schizophrenia
As if these patients didn’t have enough to worry about!! This article falls on the heels of the previous article; where we see newer, more expensive meds with more harmful side effects. Interestingly, I just recently had a patient on zypraxia that was having difficult coming off the medication. This is still a very new drug and anyone taking this drug is in the “guinea pig” group. Additionally, I realize that most mental health professionals would commit me for this, but I firmly believe that many psychological problems have their origins in physiological imbalances/toxicologies and can be lessened and/or alleviated with addressing the dysfunction. Unfortunately, while the research is generally very sound, few, if any, patients with psychological condition are counseled in this approach.
bmj.com Abstracts: Koro et al. 325 (7358): 243
Postprandial Hyperglycemia, Insulin Sensitivity Differ among Ethnicities
This is an important article that really reminds us to avoid treating every patient the same, and that different genetic makeups can vastly affect environment’s impact on health. Here we find that European and Arabic caucasions were the most physiologically tolerant of a 75-g white bread challenge.
Nutrition.org — Abstracts: Dickinson et al. 132 (9): 2574
Oral Creatine Supplementation on Human Muscle GLUT4 Protein
GLUT4 is the protein on the cell surface that is responsible for taking in glucose from the bloodstream. Certain medications and exercise will increase the number of GLUT4 on the cell surface. Now it appears that creatine may also do the same thing to a muscle that is immobilized. This has some important implications for both healing from injury and managing diabetes.
Diabetes 50(1):18-23, 2001 The purpose of this study was to investigate the effect of oral creatine supplementation on muscle GLUT4 protein content and total creatine and glycogen content during muscle disuse and subsequent training. A double-blind placebo-controlled trial was performed with 22 young healthy volunteers. The right leg of each subject was immobilized using a cast for 2 weeks, after which subjects participated in a 10-week heavy resistance training program involving the knee-extensor muscles (three sessions per week). Half of the subjects received creatine monohydrate supplements (20 g daily during the immobilization period and 15 and 5 g daily during the first 3 and the last 7 weeks of rehabilitation training, respectively), whereas the other 11 subjects ingested placebo (maltodextrine). Muscle GLUT4 protein content and glycogen and total creatine concentrations were assayed in needle biopsy samples from the vastus lateralis muscle before and after immobilization and after 3 and 10 weeks of training. Immobilization decreased GLUT4 in the placebo group (-20%, P < 0.05), but not in the creatine group (+9% NS). Glycogen and total creatine were unchanged in both groups during the immobilization period. In the placebo group, during training, GLUT4 was normalized, and glycogen and total creatine were stable. Conversely, in the creatine group, GLUT4 increased by ~40% (P < 0.05) during rehabilitation. Muscle glycogen and total creatine levels were higher in the creatine group after 3 weeks of rehabilitation (P < 0.05), but not after 10 weeks of rehabilitation. We concluded that 1) oral creatine supplementation offsets the decline in muscle GLUT4 protein content that occurs during immobilization, and 2) oral creatine supplementation increases GLUT4 protein content during subsequent rehabilitation training in healthy subjects.
With Guidance, Diabetics Can Safely Incorporate Sugar into Their Diet
This definitely falls into the “huh?” category. We have a substance which is essentially toxic to the body because the body cannot handle it properly (glucose). So lets give it to the body in small amounts so patients do not take it in large amounts? Diabetic patients should avoid high glycemic index foods…period. What we need more of is proper patient education and avoidance of processed and added sugars. Do you think funding for this study may have been provided by a pharmaceutical company that produces diabetic drugs??
Diabetes Care 2001;24:222-227 Teaching patients with type 2 diabetes how to include sugar into their daily meal plans does not adversely affect nutrition or metabolic control, study results suggest. Giving these patients the freedom to eat sweets may actually do more good than harm. Dr. Jean-Francois Yale and colleagues, from McGill University in Montreal, randomized 48 type 2 diabetics to a conventional meal plan containing no concentrated sweets or to a meal plan permitting up to 10% of total calories from added sugars or sweets. They discovered that patients in the “sugar” group had a tendency to consume fewer calories than the conventional group. The sugar group also ate significantly less carbohydrates and starch than the conventional group. “weight remained stable, and there was no evidence that consuming more sugar worsened metabolic profile or improved their perceived quality of life,” the team reports in the February issue of Diabetes Care. The researchers say that their study provides evidence that teaching diabetic patients how to incorporate sugar into their diet may result in increased adherence to a healthy diet through better awareness of the carbohydrate content of food. They urge physicians to teach “sugar guidelines” to their diabetic patients.
Insulin resistance and risk for stroke
I’m sure that none of you who regularly read Updates had your eyes bulge wide on this one, this article does bother me a little. First, it is in a neurological journal, which is fine–all specialist should become familiar with the effect of increased insulin resistance because it truly cuts across all organ systems. However, I have a serious beef with the conclusion of this article that suggests that new drugs can be used to affect insulin resistance. Well, we know from several well designed studies that insulin sensitivity can be dramatically impacted through lifestyle changes (exercise, avoidance of refined grains for whole grains and intake of lots of fresh fruits and veggies). This article, which may be some neurologist’s first exposure to this concept, neglects to mention one of the most powerful tools to treat insulin resistance.
Neurology — Abstracts: Kernan et al. 59 (6): 809
Not that I’ve ever said it, but lifestyle changes are the only way to safely and successfully take off and keep off weight…
The Central Role of Lifestyle Change in Long-term weight management
Clinical Cornerstone 2(3):43-51, 1999
Lifestyle change–most notably, modification of eating behavior, physical activity, and psychologic factors like attitudes, goals, and emotions–is the central determinant of whether people will lose weight and maintain the loss. Even when medical intervention appears to be the primary treatment, as with pharmacotherapy, behavior plays the determining role in successful weight loss.
In a previous blog article, we established the fact that less than 1% of adolescents were maintaining ideal cardiovascular health.
In another previous blog article, we looked at the fact that 1/3 of the US population is prediabetic, also related to the same lifestyle changes that aren’t being made.
It’s clear that our society is not willing to make the changes needed to be healthy. Luckily, that may not be a concern because the Better Living Through Chemistry folks are here to hold your hand and fix everything.
In this particular study, researchers took as small group of 26 kids 12-19 years of age with severe obesity and evaluated whether using a new, high-powered diabetic drug (the GLP-1 agonist called Byetta) that I have grave concerns about, could help them manage weight better.
Here’s what they found:
- Over the course of 3 months, the exenatide (aka Byetta, or the hila-monster spit drug) group lost about 1.13 points on the BMI charts.
- This works out to be around 5 lbs or so for a 5’7″ male, or 1.7 additional pounds per month.
Wow. 1.7 pounds for a very expensive drug that has to be injected and carries grave concerns of acute pancreatitis and thyroid cancer (and probably more that we aren’t yet awareof..).
Don’t be surprised if we start to see more and more of this type of study trying to find a drug answer for our adolescents to “solve” the obesity and prediabetes problem. Given the numbers of people who are prediabetic, there is a massive amount of money to be made in this market. But as we see from this study, it’s a high price to pay for paltry results.
There is nothing good about visceral fat. Many just worry about the aesthetics of it, but the reality is that visceral fat wreaks havoc on long term health.
The current model of visceral adipose tissue puts this type of fat as its own organ system. The only problem is that this organ system, instead of working with your body, is an invader trying to survive.
Here’s how it goes:
- Fat has always been a storage tissue for extra calories.
- Lord knows we got enough of these in today’s society.
- The fat begins to accumulate.
- For awhile this is ok, but past a certain point these fat cells begin to run out of an adequate blood supply.
After all, these cells need nutrients just like every other cell, but there is only so much blood flow to go around. Once the fat cells don’t have the nutrients they need, they get pissed off. Pissed off fat cells begin to generate pissed off hormones called adipokines that drive inflammation and damage elsewhere in the body.
This is how visceral fat leads to poor blood vessel health (heart attack, stroke, dementia) and other problems like cancer.
While we generally think of fat accumulated around the abdominal region, it also accumulates around other organs like the heart, termed epicardial fat. The problem with epicardial fat is that it is so close to the heart that the hormones released can have a greater effect. The way we usually look for epicardial fat is through an echocardiogram, but this isn’t exactly practical for routine use. Enter this particular study.
Researchers looked at whether we could use the sagittal abdominal diameter as an indirect marker for epidcardial fat without the hassle of an echocardiogram. The sagittal abdominal diameter is measured by a set of calipers, measuring the distance from the small of the back to near the belly button region while lying down.
The findings in this study suggest that measuring the sagittal abdominal diameter is a pretty darn good way to indirectly measure the amount of fat surrounding your heart.
I found this study pleasantly rewarding since our office recent implemented the use of a “laser liposuction” unit (you can read more about this service by clicking here). I realized quickly that the patients seeing the most dramatic results were the ones with the most inflammtory belly fat. Since laser has been known for many years to increase blood flow and decrease inflammation, this makes complete sense.
Using laser to calm down inflammatory body fat, according to this study, is also highly likely to lower the fat accumulated around your heart as well. Not a bad bang for your buck.
It’s pretty clear that the percentage of the US population that is prediabetic is startlingly high. But of course, this does not apply to you, right? Better rethink that.
I won’t repeat my belief that the diabetic spectrum is the worst thing that the human physiology experiences (oops…I guess I just did). But this article isn’t about the horrendously high risk to your long term health that the diabetic spectrum produces, but rather just how common it is.
With my depth of understand into diabetes, it doesn’t take much time for me to decide if someone is headed towards diabetes. Looking at a new patient’s health history, family history and the patient’s body type is usually enough. Rarely, an additional tidbit from the patient is needed (very poor dietary habits despite a lean body type, high stress, etc..). Labwork usually just confirms what I was already suspecting.
Labs are an interesting phenomena. I’ve had patients over the years (usually male) who are genuinely afraid of having labs drawn. I think this stems from the environment we have created in medicine. In medicine today labs are run to find something wrong. It’s just a matter of time before something on them is going to come back abnormal. In our office, if we run labs, we’re trying to find out just how well that patient is living for his or her genetic structure.
When I look to evaluate the diabetic spectrum, I am not merely looking at blood glucose or HbA1c. Rather, I’m looking at liver enzymes (AST, ALT), GGT, the entire lipid panel, urinary microalbuminuria levels and uric acid levels. It’s about stepping back and looking at the whole picture.
When your doctor is able to understand how all of these lab values create a picture that combines with your body type, heritage and family history–this is when the true picture of whether or not you are headed to diabetes or not and just how fast you’re moving on that path.
So why the diatribe? Of course, it relates to this particular article.
In this article, the CDC looks at the problem with prediabetes. In 2010, a whopping ONE-THIRD of the US population was prediabetic. All of this is ok, because once someone realizes that they are on the path to diabetes, he or she can make the lifestyle changes needed to divert the diabetic diagnosis (which can be read in my free downloadable ebook, Dr. Bogash’ Lifestyle Recommendations).
But how many of you walking around fall into this 1/3 statistic but don’t know it?
Are you sitting down?
89%. Yes—only a mere 11% of the prediabetic population were even aware that they were prediabetic.
On the bright side, this is up from 7% in 2005. What a mess.
This is like having all the risks of being a smoker, but not knowing that you’re a smoker. That is the problem. It’s not like this unaware population is doing ok, and it’s merely a fact that, at some point in the future, they are likely to become diabetic.
Being prediabetic is in no way, shape or form a benign process. It is just as bad for you as diabetes, maybe even more so because the vast majority of people who are prediabetic are not aware of it.
Maybe it’s time to take a very hard look at yourself. Carrying even a little too much weight around the middle? Cholesterol or triglycerides too high? Skip breakfast on a regular basis? Stressed out all the time? Have’t had your heart rate over 120 in years?
Don’t rely on your doctor to tell you. I’ve seen way too many cases over the years where patients were clearly on their way to diabetes but the primary care doctor did not inform the patient that this was the case.
If any of this even might fit you, it’s time to make some changes. Today. With the massive increase in heart attacks, cancer and stroke, tomorrow may be too late.