Tag: Diabetes

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Health

Insulin Resistance

…The precursor to diabetes and other chronic diseases!

Diabetes is a huge health problem worldwide, with numbers affected expected to grow rapidly in the coming years. Given that it’s expensive to control (average cost in North America is $10,700CDN or $7,811USD yearly per person) and is a risk factor for other diseases like heart disease and obesity, it will increasingly contribute rising health costs and health risk in the future. Currently, according to the International Diabetes Federation 2024 statistics, 589 million adults worldwide are living with diabetes and this number is predicted to rise by 45% to 853 million by 2050. Already treatment of diabetes consumes approximately 12% of the global health budget.

In North America, 1 in 7 adults have diabetes, and 1 in 3 are not diagnosed. We have one of the highest prevalence in the world at 15.1% of the population. One in 4 live births are affected by hyperglycemia (high blood sugar), a potentially significant effect on the next generation.

Why is this happening?

Diabetes develops when our insulin stops working properly. This can happen relatively quickly, as in Type 1 (“early onset’, autoimmune) diabetes where the immune system attacks and destroys the insulin producing cells in the pancreas, or more slowly over years, as in Type 2 (“adult onset”, lifestyle related) diabetes where the body becomes resistant to the action of insulin (“insulin resistance”) requiring increased production of insulin to control blood sugar levels. Type 2 diabetes is only diagnosed once our insulin production can no longer keep blood sugar within the normal range and sugar levels become higher than normal even when fasting. The advancement of insulin resistance to diabetes generally takes several years.

What surprises me is that doctors don’t look for increases in fasting insulin, the test that would tell us that we are becoming insulin resistant and are on the path to developing diabetes. When I first read about this, I asked my doctor for this relatively inexpensive blood test (compared to the cost of treating diabetes!). I was told that there was “no protocol” for testing blood insulin levels. It seems that doctors are discouraged from doing additional testing, even if it could predict the development of a very expensive disease.

This just doesn’t make sense to me on multiple levels: increased blood insulin causes inflammation, and this is now believed to be the root cause of many diseases like heart disease, obesity, fatty liver disease, Alzheimers and other dementias, hormone imbalances, and cancer), as well as diabetes. If we can predict and reverse this years before it develops, why aren’t we doing it?

So, what causes insulin resistance?

Like all hormones, insulin is released in one part of the body (the pancrease produces insulin) and works in another part of the body by attaching to a receptor. Just like staring at a bright light fatigues the light receptors in the retina of the eye causing you to see dark spots for a short time when you look away, lots of insulin in the blood can cause the insulin receptors to become resistant to the action of insulin. Insulin production is triggered by sugar in the blood and even the anticipation of eating something sweet.

One thing I notice when travelling in Europe, is how much less sweet the diet is — even the “sweets” are usually less sweet tasting. We have an amazingly sugar-sweetened diet in North America. Even foods that are not normally sweet have sugar added to them during processing. At the same time, fiber is being removed or ground up enough to make it ineffective. Fiber slows the absorption of carbohydrates from sugar and starches (starch is turned to sugar when digested), so eating fiber along with your carbs reduces the spike of blood sugar that demands higher insulin production. These are the reasons why whole foods are healthier than juices and processed foods. I was surprised when I read years ago that pulp-free fruit juices are as unhealthy as soda pop — they both contain sugar without any fiber and will raise blood sugar and insulin.

Your taste and perception of what is satisfying is influenced by your diet. A high sugar diet can result in cravings for sugar and perception that less-sweetened foods are bland. But your taste will adjust quite quickly to a lower sugar intake, I guess you could say more sensitivity to the taste of sugar, and you’ll start to prefer less sweet foods and find sweet treats you formerly enjoyed to be far too sweet for your taste!

What to do about all this…

First we need to reduce the amount of carbohydrates we are eating and replace some of them with fiber and protein. Realize that starches (flour, potatoes, etc) are broken down into sugars when digested. Remember that fiber slows the absorption of sugars, reducing the damage. Note that the “keto” diet generally counts “net carbohydrates”, a number that is calculated by subtracting grams of fiber in the food from the total grams of carbohydrate, taking into account the effect of fiber in foods.

Second, choose whole foods rather than processed ones. Food processing removes fiber and adds sugars, fats and all kinds of chemicals that we can’t even pronounce, let along understand what they do in the body. These chemicals are included to preserve the shelf life of the product or make it look nice, not to improve our health!

Third, get outdoors and exercise. Exercise has been described as the “silver bullet” for avoiding and controlling diabetes, as it lowers blood sugar (using it up for energy) along with the many other health benefits it gives us. Being outside is a great stress reducer, and stress hormones increase blood sugar — the stress response physically prepares us for “fight or flight”… to fight off a perceived danger or run away from it!

Fourth, if you have access to your blood lipid tests, you can do a calculation that can indirectly tell you if you may have become insulin resistant using an online Triglyceride to HDL calculator. You will need your blood triglyceride and your HDL-cholesterol measurements (included in a full lipid panel). I’ll post links to one of these calculators in the References below. Fill in your cholesterol numbers in the boxes in the center of the page, being sure to correct the units to mmol/L if you live outside the US. Scroll down on the right to find an explanation of the results, again being careful to read the explanation for mmol/L if your test was done outside the US.

Why worry??

Researchers are telling us that more than 50% of us in North America have some level of insulin resistance. Some have stated they believe that number may be more like 85% of the population in parts of North America. These people are all at high risk of developing diabetes and the diseases associated with raised insulin blood levels. While we will often read that obesity causes heart disease, diabetes, cancer, liver disease, etc., researchers are now telling us it’s more accurate to say that all of these diseases have a common cause… and that cause is high levels of insulin due to insulin resistance. The damage caused by elevated insulin starts long before diabetes is diagnosed, and the prevention of these diseases needs to start much sooner, not waiting for blood sugar to increase and for Hemoglobin A1c test to show that it’s staying elevated enough to see extra sugar attached to the hemoglobin in our red blood cells.

Type 2 diabetes was once called “adult onset” diabetes as it was only seen in adults. Now, this type of diabetes is increasing in teenagers and even at younger ages. Our processed, high sugar diet and sedentary lifestyles are catching up with our children too. Insulin resistance is starting earlier in life.

Often doctors don’t bother warning us when signs of fatty liver are detected now as “almost all of [their] patients have it”. Perhaps it would be the same with insulin resistance, even if they did test for it, if over half of us have it. But, for me, if I knew that I was at high risk of developing diabetes and that the process had already begun, that would be motivation enough to change my lifestyle. Heck, we have made major changes since my hubby had his first heart attack in 2004. When it’s that important, most of us will gradually make the needed changes.

Call me the “keto queen” if you want… the keto diet, along with more walking and avoiding processed foods, seems to be the best way I’ve learned to reduce our risk of developing insulin resistance. At my husband’s last cardiologist appointment, the doctor said his major arteries were clear and to keep on doing what we’ve been doing. Hopefully we’re continuing to gradually reduce his risk of another episode.

Post note: On further thought, I’ve decided to create a separate list of people who are interested in seeing more of my art side, rather than subject those who are more interested in health news and controversies to the art world (although I couldn’t resist adding a fun sketch of my hubby, done after a visit to the Picasso Museum!) So, if you’d like to be added to my Art Priority List where I’ll reveal my creations first and share the stories behind the art, send me a message at jeannie.beaudin@gmail.com and I’ll add you to the list!

References:
Triglyceride to HDL calculator — units are set for mg/dL (US units). Be sure to reset for Canadian Standard International Units (mmol/L) if you are outside the US: https://www.omnicalculator.com/health/cholesterol-ratio

International Diabetes Federation statistics: Https://diabetesatlas.com

Dr. Ben Bikman, PhD, Metabolism researcher, author of “Insulin-IQ” podcast, and “Why We Get Sick” – the link between metabolism and chronic disease: https://benbikman.com

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Health

Coffee…for diabetes, Parkinson’s, liver and more?

I love my morning coffee, so I “perk up” whenever I see a study that suggests this habit is a good thing! Are you a coffee lover too? Then read on…

Overall, coffee drinkers were found to have more health benefits than risks from their habit, compared to those who did not drink any coffee. The average daily intake in those who were studied was 3 to 4 cups per day compared to no coffee daily, although some studies looked at how health changed in the years after people increased or decreased their coffee intake by a cup or two.

5 Benefits of coffee

  1. Coffee and diabetes—a 2014 study followed over 123,000 people for 4 years. Those who increased their daily coffee intake by 1 cup per day had an 11% lower chance of developing Type 2 diabetes. Those who decreased their coffee consumption (by an average of 2 cups per day) had a 17% higher risk for Type 2 diabetes. Changes in tea drinking were not linked to diabetes risk.

  2. Coffee and Parkinson’s disease—Several studies suggest that caffeine, whether in coffee or other drinks, may help decrease risk of developing Parkinson’s. One analysis determined that men who drink 4 or more coffees per day may have 1/5 the risk of those who do not. Another study in 2012 suggests that the caffeine in coffee may help control movement in people with Parkinson’s. Another study in 2017, that found a link between coffee intake and Parkinson’s, also noted coffee drinkers may be less likely to develop depression and dementias like Alzheimer’s as well. However, there wasn’t evidence to show that drinking decaf coffee would help prevent Parkinson’s.

  3. Coffee and liver diseases—Researchers in Italy found that coffee decreases risk of liver cancer by about 40%. Their numbers suggest those who drink 3 cups a day may have 50% decreased risk of liver cancer. A different literature review in 2019 concluded that “coffee intake probably reduces the risk of liver cancer”. Another large analysis in 2017 found coffee also appeared to decrease risk of non-alcoholic fatty liver disease and cirrhosis, as well as liver cancer.

  4. Coffee and heart health—We often think negatively of coffee when it comes to heart health, since people are advised not to drink it just before measuring their blood pressure. But drinking coffee in moderation, two 8-ounce servings per day, may protect against heart failure (when the heart can’t pump enough blood to meet the body’s needs), according to a 2012 study. They found an 11% lower risk of heart failure in those who drank this moderate amount versus those who drank none. Another analysis in 2017 found that those who drank 4 to 6 cups of either caffeinated or decaf coffee daily appeared to have a lower risk of Metabolic Syndrome—in other words, they had lower blood pressure, lower blood cholesterol, and lower blood sugar—and this included a decreased occurrence of Type 2 diabetes.

  5. Overall health—An umbrella study in 2017, using combined data from 218 other analyses of studies, found coffee consumption seems generally safe within usual daily amounts. It showed the largest risk reduction in those who drank 3 to 4 cups daily and that coffee is more likely to benefit health than harm it. Mortality from any cause was reduced by 17% in these coffee drinkers.

An exception to the benefit of coffee is during pregnancy, when drinking more coffee could result in low birth weight of the baby (31% greater relative risk), increased risk of pregnancy loss (an increase of 46%) and increased chance of preterm birth (12-22%). Another exception is for women at risk of bone fractures (but not men for some reason…). Increased coffee was associated with an increased risk of breaking a bone only in women. Their recommendation was for women already at risk of a bone fracture to avoid coffee.

So, I guess I can happily continue my morning coffee—no risk of pregnancy for me and my risk of bone fracture is low! I usually enjoy 3 cups as I peruse the morning news and emails, and check Facebook for photos of what my wonderful granddaughters are up to! Hmmm…must be time for cup #3…

PLEASE NOTE: A little clarification on the numbers in this blog. The percentages in this article are “relative risk” numbers not overall risk. They compare risk with the factor to risk without it. For example, a relative risk increase of 50% could mean 10% without the risk factor have the condition compared to 15% with it…or 0.01 vs 0.015%. “Actual risk” numbers were not quoted in my references, only the percentage increase in risk.)

References:

Health benefits and risks of drinking coffee https://www.medicalnewstoday.com/articles/270202.php#benefits

Changes in coffee intake and subsequent risk of type 2 diabetes: three large cohorts of US men and women https://link.springer.com/article/10.1007%2Fs00125-014-3235-7

Coffee consumption and health: umbrella review of meta-analyses of multiple health outcomes https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5696634/

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Health

Chocolate lovers alert!

For years, we’ve been reading articles that suggest chocolate has a healthy side. It seems that the evidence is growing from studies around the world…

In Japan

A Japanese study followed diets of over 84,000 healthy men and women ages 44-76 for approximately 13 years. It found that regular chocolate consumption reduced risk of stroke overall by about 10% (when adjusted for other factors that influence stroke risk).

But, the risk for stroke was reduced more in women than in men, with 16% lower risk of stroke compared to a non-significant 6% reduction in men. Researchers could not explain the reason for this difference, and recommended further research to explain their findings.

In Sweden

Another study, done in Sweden, followed 37,000 men for about 10 years. These researchers found that regular high chocolate consumption (approximately 62 grams per week) was associated with a 17% lower risk of stroke, compared to no chocolate consumption.

A “meta-analysis” combining data from 5 similar studies, also conducted in Sweden, found a 19% reduced risk of stroke between those with the highest and lowest chocolate intakes. This group also identified a 13% reduction in myocardial infarction (heart attack) in those who consumed 3 to 4 servings or more per week of chocolate.

In USA

The Physicians’ Health Study followed 20,000 men, average age 66 years, for about 9 years. Their data suggested that moderate chocolate consumption might be associated with a lower risk of heart failure, with the reduction for eating chocolate 1-3 times a week being slightly better than 5 or more times per week. Improvement with chocolate held for those with lower body weight (BMI less than 25) but not for those who were heavier.

When chocolate intake is compared to diabetes risk, I would not have expected any benefit, since chocolate is sweet and sold as candy. However, I was surprised to read that the Physicians’ Health Study found the opposite: among those with a healthy weight and without a history of heart disease, intake of chocolate twice weekly or more (amount not indicated) reduced the risk of developing diabetes by 17%. They indicated that this correlation only applied in younger men of normal weight, after adjusting the numbers for lifestyle and total energy consumption. Sounds like the extra calories in the chocolate outweigh the benefits, once a person has diabetes or is overweight…

As an aside, I was astounded that many of these studies included only men… and therefore truly only apply to half the population. However, given that the first study I discussed found better results for women who consumed chocolate, it seems likely that the results of the other studies would apply to women as well.

The reductions in risk were not huge numbers but, the way I look at it, if you have a healthy lifestyle and diet, a little chocolate from time to time is a nice treat that won’t harm your health and might actually reduce your risk of heart disease, stroke and even diabetes!

So, go ahead and enjoy a modest amount of chocolate 2 or 3 times a week as part of a healthy diet, and don’t feel guilty… (but better to avoid it if you have diabetes or are working to reach a healthier weight).

References: Atherosclerosis, 2017 Mar 4;260:8-12

Neurology 2012 Sep 18;79(12):1223-9

Am J Clin Nutr 2015 Feb;101(2):312-7

Eur J Heart Fail 2014 Dec;16(12):1372-6

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Health

Could diabetes cause Alzheimer's?

Diabetes increases your risk of heart disease, stroke, and damage to blood vessels and nerves, but did you know that studies suggest it may also increase your risk of eventually developing Alzheimer’s disease and other forms of dementia?

And the damage to your brain may even start before you have diabetes…

Type 2 diabetes begins with spikes in levels of sugar in the blood, which trigger your body to produce higher amounts of insulin to process this sugar. At first the higher amounts of insulin can reduce blood sugar to normal (this stage is referred to as pre-diabetes) but eventually, as your body becomes increasingly resistant to the effect of insulin, blood sugar can no longer be controlled at normal levels, and you are diagnosed with diabetes.

Research is suggesting that these increased levels of insulin begin the process of damaging the inside of blood vessels and, in the brain, also stimulate formation of toxic proteins that damage brain cells. Researchers have discovered that the same protein that is formed in Alzheimer’s patients’ brains, is found in the brains of people with type 2 diabetes (T2D). T2D patients often experience a sharp decline in cognitive function and almost 70% of them eventually develop signs of Alzheimer’s or another dementia, according to http://www.alzheimers.net.

Melissa Schilling, professor at NYU, suggests that all patients with dementia or who are at risk of developing dementia should be tested for hyperinsulinemia (high insulin in the blood). She suggests that high insulin could be responsible for almost half of all cases of dementia. However, she recommends that further research needs to be done to verify her arguments and implications for treating Alzheimer’s. Her article: Unraveling Alzheimer’s: Making Sense of the Relationship between Diabetes and Alzheimer’s Disease was published in the Journal of Alzheimer’s disease in Jan 2016. Click here for the full text.

Research points to the protein, amylin, that is co-secreted with insulin and, along with the beta-amyloid protein, it is thought to be important in the formation of amyloid plaques found in the brains of Alzheimer’s patients.

Another possibly important factor, may be levels of insulin-degrading enzyme (IDE), the enzyme that breaks down insulin, reducing levels once it’s finished its job. The presence of insulin stimulates increased activity of IDE, the enzyme that breaks down insulin. Lower insulin leads to less activity of this enzyme. IDE also breaks down amyloid proteins, but it favours breakdown of insulin.

It may be an imbalance between IDE, insulin and amyloid-beta production that ultimately is shown to be a major cause of dementia. Here are 4 suggested scenarios:

  • Severe lack of insulin (as in type 1, insulin dependant diabetes), could lead to less IDE activity, and subsequent decrease in breakdown of amyloid proteins that create plaques in the brains of dementia patients.

  • Lack of production of IDE itself would lead to increased levels of both insulin and beta-amyloid

  • Excessively high levels of insulin (and amylin, secreted along with it) in early stages of type 2 diabetes could lead to competition for insulin-degrading enzyme between insulin and amyloid. Since the enzyme favours insulin, this would result in less breakdown of amyloid and increased amounts available for formation of plaque in the brain

  • An individual could produce higher than normal amounts of amyloid proteins that outpace the ability of IDE to break it down.

You can see how both a lack of insulin and too much insulin could be a cause of dementias. Too little insulin-degrading enzyme or increased production of amyloid proteins could cause problems in people with normal production of insulin. These confusing scenarios could explain why researchers have not yet determined the causal relationship between diabetes and Alzheimer’s, despite reporting on the connection as far back as 2003!

This type of research is especially important, as the drugs currently available to treat Alzheimer’s offer only small improvements in symptoms and do not stop the progression of the disease, in spite of their high cost.

So, ask your doctor to screen for early signs of diabetes and aggressively treat it when discovered to keep your insulin levels in the normal range. Eat a healthy diet and exercise regularly, as these are also known to lower the risk of developing diabetes. It seems likely that these strategies will lower your chances of developing dementia years down the road.

References: MayoClinic.org; Alzheimers.net

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Health

Type 2 diabetes – can it be reversed?

For years, studies have looked at ways to prevent Type 2 (adult onset) diabetes, and have identified a healthy diet and exercise can prevent it…but what about those who already have it? A new study suggests that it may be possible to reverse this destructive disease in the early stages, at least temporarily. This is important, given that treatments for diabetes lose their effectiveness over time, creating an ongoing struggle with gradually increasing medication to keep blood sugar levels under control.

People with type 2 diabetes were signed up to either an 8-week or 16-week intensive treatment program, or to usual care. The treatment included intensive lifestyle counselling (targeting weight loss) with frequent nurse and dietician contact, and treatment with insulin, metformin (a drug that increases sensitivity to insulin) and acarbose (a medicine that slows the breakdown of carbohydrates into sugar in the digestive system). The goal was to have blood glucose of less than 5.4mmol/l before meals and an average after meal glucose of less than 6.8mmol/ after 8 or 16 weeks.

Half of people in the 8-week group achieved these goals compared to only 3.6% of the control group, and 70% of the 16-week group reached the targets. The drugs were then discontinued in the treatment groups and their blood sugar was monitored.

What was really interesting, was that some people in the treatment groups continued to maintain blood glucose control even after the drugs and insulin were discontinued. Twelve weeks after the completion of the intervention, 21.4% of the 8-week group and 40.7% of the 16-week group met criteria for complete or partial diabetes remission, compared to only 10.7% of “controls” who had received only the usual care.

These results suggest that an intensive diabetes treatment strategy delivered over 2 to 4 months may induce remission of type 2 diabetes. Of course, further research needs to be done in the area to confirm the results, especially as this was only a short-term study, but it’s encouraging to see that the effects of 8 to 16 weeks of treatment can continue for several months, at least in some people with diabetes.

Since the intervention also intensively targeted lifestyle and weight loss, the remission of diabetes could be due at least in part to these factors; I would like to have seen a comparison of drug intervention with an intensive lifestyle and weight loss group rather than only with usual care. However, any study into possible ways to reverse diabetes is valuable, given the increasing rates of diabetes that are occurring now.

This study was published in the Journal of Clinical Endocrinology and Metabolism on March 15, 2017 (N.McInnes, et al; Piloting a Remission Strategy in Type 2 Diabetes: Results of a Randomized Controlled Trial).