Archive for Type 1 diabetes
Acidic Drinking Water and Risk of Childhood-Onset Type 1 Diabetes
This article is very intriguing to me and raises several issues. The findings of this study show that acidic municipal water led to a fourfold increase in risk of developing Type 1 DM. Zinc was also evaluated, and higher levels were protective. The authors suggest that the acidity may work indirectly by fostering the growth of certain types of bacteria that influence risk. A few comments here. First, this just strengthens the case for filtered/bottled water. Second, zinc is known to help modulate the Th1/Th2 cytokine expression–might this help guide the immune system into proper development and avoid autoimmune disorders? Or might the zinc support healthy immune function and override any infections that may lead to Type 1 DM? Stay tuned…
Dia Care — Abstracts: Stene et al. 25 (9): 1534
Type 1 diabetes in a child is a heartbreaking scenario. While children readily adapt, it’s not fair that any child should need to be tied that closely to any type of consistent medical intervention.
On the plus side, I think we’re getting closer to an answer for those who have already been diagnosed. I’ve addressed my thoughts on this in a prior blog post that can be read by clicking here. In addition, careful attention to lifestyle choices that are helpful for Type 2 diabetics will also help those with Type 1 diabetes.
But there is also a wealth of information about what contributes to the development of Type 1 diabetes. Sadly, due to our society’s lack of attention to preventing chronic diseases, these insights seem to be relegated to a secret society. These contributing factors include:
Now, thanks to this particular study, the list is just a little longer.
Researchers looked at the contribution of different bacteria species in the guts of children with Type 1 diabetes and how this differed in the children who had evidence of autoimmunity to the beta cells of the pancreas (the cells that produce insulin in our body).
Here’s what they found:
- Low levels of lactate-producing and butyrate-producing species was associated with the beta cell autoimmunity.
- Specifically, there were low levels of the two most dominant Bifidobacterium species, B. adolescentis and B. pseudocatenulatum.
- In addition, these children had higher levels of the Bacteroides family of bacteria.
So what does this mean?
It boils back down to what I have written time and time again. The destruction of the normal flora in the gut of infants, toddlers and children may be the worst thing that could potentially happen to the development of his or her immune system.
Because of this, C-section births, lack of breastfeeding (or antibiotic use in a mom who is nursing) and antibiotic use can very well be added to the list of factors that contribute to the development of Type 1 diabetes in our children.
Recently, for the very first time today in my 15 years of practice, I had a patient mention that his granddaughters’ (yes–twins!) pediatrician had actually recommended that giving probiotics to the infants was a good thing. And, while the probiotic dose recommended was far too low, but it’s a start.
Maybe there is hope for medicine after all…
Synthetic Antioxidant Prevents Diabetes in Mice
While it is wonderful (albeit not surprising) that antioxidants can lower risk or even prevent progression to diabetes (Type I), I cannot figure out why anyone would go to such extremes to synthesize antioxidants when good ole’ Mother Nature has already given us more than we can currently even identify. Can you say “patent…”
Diabetes — Abstracts: Piganelli et al. 51 (2): 347
You may be concerned about high blood sugar levels (hyperglycemia, diabetes), but don’t worry about hypoglycemia (low blood sugar). This may be a mistake.
I recall a patient some years back that had a short story to tell. He was having anxiety attacks every day around 11:30. He asked me if I could help because he had already received 3 (yes–count them–3 prescriptions) from 3 different providers. Valium, Ativan and one other that I can’t recall right now.
Those of you familiar with anxiety attacks may be scratching your head right now thinking that it is strange that the anxiety attacks were at the same time every day. I was thinking the same thing. Hypoglycemia, on the other hand, can very commonly occur before a next meal and is well known to wreak havoc on the brain causing things like anxiety attacks.
Patients mistakenly believe that there is a blood test for hypoglycemia, but this is not really true. Anytime blood sugar levels drop too low, the brain immediately responds by releasing hormones like cortisol and epinephrine (adrenaline) to break down muscle and put sugar back into the bloodstream for the brain to use. Your doctor can order a test like the 2 or 4 hour postprandial glucose tolerance test, but quite frankly, it sucks. Drink a nasty tasting liquid that is like flat orange Crush and get your blood drawn every half hour. Not exactly my idea of a picnic.
Rather, a better way is to look at the timing of whatever symptoms are of concern. In the earlier patient’s example, it was anxiety attacks. If the symptoms fit into a pattern, add in some food or a healthy snack a few hours after a meal to see if that helps.
So that was it. An earlier lunch miraculously cured the anxiety attacks in this patient without the medications that were prescribed. But what if he had taken the medication and the episodes of hypoglycemia were allowed to continue unchecked?
According to this particular study, it’s far more dangerous than we thought.
Researchers looked at what happened in normal patients and in Type 1 diabetic patients when a state of hypoglycemia was created. They then followed up with 1 of 3 scenarios:
- After the low blood sugar levels, one group brought to a state of high blood sugar.
- After the hypoglycemia, on group was brought back to normal blood sugar levels.
- High blood sugar after hypoglycemia was was initiated along with an infusion of vitamin C
So basically, the participants were put into a low blood sugar state and then the hypoglycemia was corrected, either by bringing blood sugar levels back to normal or by sending them too high. In the group that was sent into elevated blood sugar levels, they were given a hit of vitamin C to see if it could help. Here is what they found:
- It was discovered that hypoglycemia itself was associated with all kinds of bad things for our bodies, including endothelial dysfunction (problems with the blood vessels), oxidative stress, and inflammation.
- In the hyperglycemia group, all of the above were found to get worse, and this bad effect last for at least 6 hours.
- When vitamin C was added, the negative effects of hyperglycemia were blunted.
The take home message is that hypoglycemia is a very bad state that contributes greatly to our risk of cardiovascular disease. This happens to us when we are not careful and go too long without eating. It is also a side effect of overmedicating in diabetics.
Fixing the hyperglycemia by rushing to the fridge for an apple juice or candy bar is very likely to swing you the other way, creating an even worse state for your health and blood vessels. This will last for hours afterwards.
This study would also suggest that decent levels of vitamin C (3-4 grams per day) may prove to be a smart and blood vessel-protecting approach to in anyone prone to low blood sugar and ALL diabetics, Type 1 and Type 2 included.
Of course, the BEST answer is to prevent the hypoglycemic crash in the first place by not eating any foods that rapidly convert to sugar (referred to as a high glycemic index) and not skipping meals, especially breakfast.
Celiac Disease After Onset of Type 1 Diabetes
This article looks at celiac disease (and allergy to gluten containing grains such as wheat) as being associated with type I diabetes in children. I would take a different view of the results. What if the altered physiology of the GI tract from food allergy turn out to be a promoting factor for increased upregulation of the immune system leading to autoimmunty against the pancreas? 60% of those identified had celiac disease at the time of diagnosis of diabetes. Sounds like a rational hypothesis to me..
Pediatrics — Abstracts: Barera et al. 109 (5): 833 -
Type 1 diabetes occurs when the body no longer makes insulin. For children, this means life with an insulin pump. But is there a type 1 diabetes cure in sight?
For background, it is important to understand how the body functions as it relates to sugar handling.
In response to signals from the body (blood sugar, GLP-1 from the small intestine, certain amino acids) the beta cells of the pancreas produce and release insulin, which then acts on almost every cell in the body to cause those cells to grab the sugar running through the bloodstream.
However, there is a step that occurs before insulin is released. When it is produced, it is actually made up of a larger molecule called preproinsulin (and no–that is not a typo). Preproinsulin gets cut and we are left with proinsulin. Proinsulin is cut and we get insulin AND another molecule called C-peptide.
So, as a little known fact, we can actually check how well the pancreas is working by checking C-peptide levels. This does not happen often with type 1 diabetics in most doctors’ offices.
Most type 1 diabetics are told that their pancreas is no longer working and they are typically put on a pump. But what almost every type 1 diabetic will tell you is that their insulin needs can actually vary. Sometimes higher, sometimes lower.
The astute among them may actually be able to tie this into certain aspects of their lifestyle. I have one patient whose daughter is an insulin dependent diabetic. There was a period of time that they were have a hard time controlling blood sugar (it was too low) and so the mom had to lower the basal dose.
When the mom took a good look at what had changed, she realized her daughter had been off of dairy for several weeks. Since dairy is well known to contribute to the onset of type 1 diabetes, it would certainly make sense that avoidance of dairy could help manage the condition as well. The same goes for formula.
So if avoiding dairy essentially led to a lower need for insulin, what does that mean?
I have always contended that type 1 diabetics retain the ability to make insulin, but this is shut down by the immune system. Kind of like a sniper on the roof picking off insulin as it is made.
This is a very, very important distinction from what they are normally told.
This means that, while the pump may be lifesaving, diet can have a massive role in how much insulin is needed and the long term outcomes of the condition. As a parent of an insulin dependent diabetic child or if you are a type 1 diabetic yourself pay attention to this…
Merely managing your insulin dose and not paying attention to what you are doing to your body is wrong. Period. You cannot feed your child cookies and soda on a regular basis and just adjust the dose up. You may be truly condemning the diabetic to a lifetime of insulin need should we ever find an answer.
And that may not be far away.
Two particular studies actually back up my position.
The first study looked at how well the pancreas produced C-peptide even after the diagnosis of insulin dependent diabetes. What did they find?
- 93% of individuals still had detectable C-peptide 2 years after diagnosis
- 11% of subjects had no significant drop in C-peptide levels up to 2 years after diagnosis.
Basically, the beta cells were still working. In some better than others, but regardless, they were still working. It could very well be that the right lifestyle choices could keep someone in the 11% that saw no change in beta cell function at 2 years.
The next study was potentially life-changing.
Researchers took a small group of type 1 diabetics and gave them a vaccine containing Bacillus Calmette-Guerin (BCG). BCG is a component of tuberculosis that has been inactive and has been in use for almost 100 years.
They found that the small group that were given the vaccine had in increase in C-peptide levels to almost 50% of a normal group that did not have diabetes.
It gets better.
The average duration of diabetes was 15.3 years. Yes–YEARS.
This means that, if we can suppress or control the immune response that is attacking the beta cells of the pancreas we stand a very good chance at restoring normal function of the pancreas and giving these patients an insulin-free life back. Stay tuned…
But, of course, this will HAVE to be connected with a lifestyle that is conducive to preventing type 1 diabetes.
So, what have you noticed that affects your insulin need?
Consumption of milk and calcium in midlife and the future risk of Parkinson
I’ve said it before, and I will say it again (and again, and again…) that I think the idea that cow’s milk “does a body good” is one of the most successful marketing campaigns based on little to no evidence ever exposed to the American public. Good luck finding any articles not sponsored by the dairy industry that show a strong beneficial effect on dairy products for any condition.
Conversely, dairy intake has been linked to food allergy, ear infections, osteoporosis (or at least no protection from), Type 1 diabetes and now add Parkinson’s to the list. Ironically, although this showed a 2.3 fold increase (quite a large increase) and it was in a major neurology journal, not a PEEP from the media. Compare this to a 3-lb decrease in body weight over 6 months with dairy intake (and no-one just body fat–just weight) and you would think the Holy Grail for America’s weight problem was found.
Adolescent Milk Fat and Galactose Consumption and Testicular Germ Cell Cancers
Almost everyone alive today has grown up under the idea that “Milk it does a body good.” Unfortunately, the research behind this is weak at best. Most people would accept that the drug companies have a tendency to market their products in a positive light that may not always be true. But, when it comes to the dairy industry, it is nothing but altruistic and the claims are never questioned.
And yet the Courts recently forced the dairy industry to stop its claims of weight loss from dairy products because there is no evidence to support it. The idea that dairy is good for us is so ingrained in our culture that every public health recommendation, every school lunch program and every state medicaid program includes the recommendations for daily servings of dairy. But, so it’s not good for you–but bad? Dairy has been linked to Type 1 diabetes, increased IGF-1 levels which are linked to prostate and breast cancer and now testicular cancer at a frequency of 1 serving/day. Now THAT’S good marketing done on a poor product!!!
For regular readers of the Rantings, it will come as no surprise that I am not a fan of dairy. I fully realize that this flies in the face of pretty much every public health recommendation in the US. However, the research is not favorable to dairy.
Particularly disturbing, dairy consumption has been linked to Type 1 diabetes in infants and children.
This particular study looks at the same issue from a different angle. They looked at infants who were determined to be at increased risk of developing type 1 diabetes (based on their HLA type). The autoantibodies to their own beta cells of the pancreas were compared when put on regular cow’s milk formula vs a bovine insulin free formula. Researchers found that the numbers of infants containing at least one autoantibody dropped from 6.3% down to 2.6% in the bovine insulin free formula. That’s 61% drop.
As if there wasn’t enough evidence to raise concern over the fact that “milk: it does a body good” is not quite as accurate as the marketing people at the dairy council would have us believe. Consider this next time you think cow’s milk formula is a good option or you think you need to teach your toddler to drink milk.
Can we prevent the onset of Type 1 diabetes in our children? Like everything else, I suppose the answer to this depends on who you ask. This person’s answer, in turn, will result in what they read to stay current. I find that, in those who do not believe that chronic diseases can be avoiding or controlled without medication, their scope of learning is restricted.
First, a little clarification. Type 1 diabetes used to be called juvenile onset or insulin-dependent diabetes. Type 2 used to be called adult onset or insulin-independent diabetes. Given how much our current lifestyle has completely screwed up our collective health, these titles no longer apply.
In general, Type 1 diabetes results from either an autoimmune attack on the insulin producing beta cells of the pancreas, destroying the body’s ability to produce insulin, or from destruction of the beta cells of the pancreas from lifestyle contributions and / or diabetic medications.
Type 2 diabetes, on the other hand, results when the need for insulin to control blood glucose exceeds the beta cell’s ability to keep up. This is best approached with lifestyle changes to revert our physiology back to a happier state.
In contradiction to their nomenclature, “adult onset” diabetes is now being seen in children because of the poor lifestyle choices their parents have ingrained upon them. Further, “juvenile onset” diabetes, or insulin dependent, is the end result of poorly controlled (read: managed exclusively with medication) Type 2 diabetes.
The official position of the Juvenile Diabetes Research Fund (JDRF) is that we do not yet know what causes Type 1 diabetes in our children (the only suggestion their website gives to “prevent” Type 1 diabetes is to “focus on developing vaccines for universal infant and childhood immunization”) . Meanwhile, the advice they give to help manage this condition is superficial and seems to be heavily influenced by funding received from dubious sources like large confectionery and junk food companies that will remain nameless (but are listed on the JDRF website).
The research demonstrates several contributing factors to the development of Type 1 diabetes that I am aware of:
- Dairy places an important role in the onset of Type 1 diabetes, based on the fact that the countries with the highest intakes of dairy have the highest incidence of Type 1 diabetes as well as findings that suggest that there is molecular mimicry between proteins in the dairy and proteins in the beta cells of the pancreas.
- Niacinamide, one of the B vitamins, has been shown to prevent or stump the development of Type 1 diabetes.
- Vitamin D seems to play a strong role in the development of autoimmunity in general, and Type 1 diabetes in particular.
- Zinc has been shown to play a strong role in preventing Type 1 diabetes
- Bacteria in the gut may play a strong role in the development of Type 1 diabetes. This also means that antibiotic use may increase the risk.
- Celiac disease, an allergy to the gluten containing portion of grains, has strong associations with the onset of Type 1 diabetes, and even shows up before the onset of the diabetes.
This particular study adds further weight to the contribution of vitamin D to the development of Type 1 diabetes. Researchers found that hormone levels of parathyroid hormone (PTH) where linked to the development of Type 1 diabetes in the siblings of those already afflicted with the condition.
PTH is a hormone (although the name sounds like it might be related to the thyroid, it is merely a description of where the gland sits – “para” meaning around or near) that the body uses to essentially lowers calcium levels in the bloodstream. It does this by increasing bone turnover and increasing the absorption of calcium from out diet via the gut. Elevated levels of the active form of vitamin D lower the release of PTH, lest we raise calcium levels too high in the bloodstream.
Since Type 1 diabetes is an autoimmune condition, the researchers looked at the ratio of two opposing states of the immune system, IgG2 and IgE. IgG2 is a marker of our body’s attack against things inside (the far spectrum of which is our body mistakenly attacking itself), while IgE is a marker of the body stopping things from getting in in the first place (the far spectrum of which is allergies and asthma). They found that, in those with higher levels of PTH (which can be used as a marker of the active form of vitamin D) the above ratio was suggestive of autoimmunity.
Thus, this study adds more weight to previous findings that suggest that vitamin D plays a role in the development of Type 1 diabetes. It is findings like this that convince me that giving vitamin D supplementation to children is a very good idea.