Thursday, December 13, 2018

Evesdropping Viruses

This has absolutely nothing to do with type 2 diabetes. At least not yet. But it's fascinating.

Apparently, viruses can intercept molecules bacteria use to communicate with themselves and use that information to time their attack on the bacteria.

Are bacteria and viruses intercepting molecules human organs use to communicate? Or are various organs hijacking molecules other organs use to communicate with their kind?

It opens up a whole world of new ways of thinking about physiology.


A recent press release reported on a link between high blood levels of a compound called TMAO (trimethylamine N-oxide) and heart disease. Then they said high TMAO levels are linked to a diet rich in red meat, and such people have TMAO levels three times as high as those who eat mostly white meat or no meat.

The authors defined "rich in red meat" as about 8 ounces of steak daily.

Horrors! Sounds as if we should all avoid red meat and try to lower TMAO levels.

But wait! Another recent press release says we should all eat more vegetables and fish because these foods increase our TMAO levels, and "low-dose treatment with TMAO reduced heart thickening (cardiac fibrosis) and markers of heart failure in an animal model of hypertension."

The authors of the second study write, "It was previously thought that TMAO blood plasma levels--and heart disease risk--rise after the consumption of red meat and eggs. However, "it seems that a fish-rich and vegetarian diet, which is beneficial or at least neutral for cardiovascular risk, is associated with a significantly higher plasma TMAO than red meat- and egg-rich diets, which are considered to increase the cardiovascular risk."

Is it any wonder that people are confused about which diet is best to follow in order to reduce the risk of heart disease?

The effects of diets are complex. For one thing, different people may react differently to the same thing, and rodents may also react in a different way. For another, it's not usually just one component of a diet that is important; it's the diet as a whole. A red-meat and chocolate cake diet is different from a red-meat, vegetable, and salad diet. A 16-ounce steak has a different effect from 4 ounces of steak.

And TMAO could have a U-shaped effect so that small increases were beneficial but large increases were not, or vice versa.

Rat experiments don't always translate into effects on humans, but they're suggestive. Also, the second study was done in an animal model of hypertension.

Today, certain memes are popular, including "eat more fruits and vegetables" and "avoid red meat." But most fruits raise blood glucose levels in people with diabetes, and also to some degree in those without the disease. Sometimes it seems as if research is designed to prove these memes rather than to learn something new. It's easier to get research grant money if you are supporting the current dogma. Not long ago, that was low-fat, and people who didn't support that concept had trouble getting research grants. The South African scientist Tim Noakes, was accused of "unprofessional conduct" for advising a mother to wean her infant onto a low-carbohydrate diet. He was eventually found not guilty of any wrongdoing.

So we don't yet know if TMAO is beneficial or detrimental. As most research papers say, "More research is needed."

Wednesday, December 12, 2018

Offering Hope

Charles Mattocks is passionate about diabetes. Controlling diabetes, that is.

He understands that because it's difficult to live with diabetes, some people just give up and don't try to help themselves.

Mattocks understands how difficult it is to live with diabetes because this celebrity chef, author, and TV producer has type 2 diabetes himself. He was diagnosed in 2011 at the age of 38 and was determined not to let the diabetes ruin his life. At first he controlled with diet and exersise, but then when his dietary vigilance relaxed a bit too much, he went on medication. A year after getting back on the wagon, he was able to come off the medication.

"Diabetes could kill me, but being diagnosed has saved my life and put my health at the forefront," he said." But Mattocks is concerned with more than just his own health. He wants to help other people deal with their diabetes, and especially to help people not yet diagnosed with diabetes avoid ever getting that diagnosis.

He realizes that most people don't know much about diabetes and feels that if he'd known when he was a kid what he knows now about diabetes, he never would have gotten it. For that reason, he's written a children's book titled "Diabetes and Healthy Eating." He's also involved with an RVcalled "Diabetic You RV" that travels around the country and offers information and free blood glucose and foot checks for anyone interested. In addition to calling attention to diabetes with its colorful decorations, the RV is staffed with medical people who can offer help to those interested.

Currently being worked on, the RV should be back on the road in a few months.

But Mattocks' primary focus is a TV reality show that takes a small number of people with diabetes to a resort in Jamaica, where he was born, and has various diabetes experts work with them for a week. His goal is to give hope to people who are struggling, and to give the viewers of the reality show hope as well. He feels that showing real people, not actors, with type 2 struggling but eventually succeeding in taking control will inspire others to do the same.

Some episodes from the first season, produced in 2017, can be seen here. He is currently working on a second season.

Mattocks has done many things in his life so far. He's traveled around the world to see how diabetes is affecting people in other nations. India is especially hard hit. He's also been involved with cooking and had a TV show called "The Poor Chef." Before his diagnosis he published a cookbook called Eat Cheap, but Eat Well, and in 2014 the American Diabetes Association published his The Budget-Friendly Fresh and Local Diabetes Cookbook.

Like Mattocks, because I know how very inconvenient, not to mention expensive, it is to have type 2 diabetes, I would also like to do what I can to prevent others from following in my path. But it's difficult. Most people simply aren't interested. When I suggested to a sister that she test members of her family once a year so that if they had the genetic predisposition, the disease would be caught early, when it's easier to control.

Her answer: "Why worry about a disease you may never get?"

If someone in a family in which the disease has occurred several times isn't interested, what is the likelihood that the average person would be? Most people assume it will never happen to them, even when it runs in the family and even when they're overweight. So I got discouraged at trying to help people prevent the disease and have focused instead on reading about research and trying to communicate the most interesting research results through this blog.

Hence it's good that people like Mattocks, who has a lot of energy and the ability to communicate well through talks and TV shows, are still in there fighting for people who might not be able to fight on their own.

There's a vast difference in how people with type 2 diabetes are learning. At one end of the spectrum are people who get all kinds of expensive gadgets like continuous glucose monitors and fancy software, document everything they eat in a nutrition program, join online Facebook groups and exchange information with others with the same interests. At the other end are the people who get a diagnosis, get medications, and expect the medications to control their disease while they continue to eat the same unhealthy food they've always eaten and continue to avoid exercise whenever possible. Sometimes, because of the cost, they don't even take the medications. Then they get complications like having a leg amputated or losing most of their sight. Of course, most people are somewhere in the middle of these extremes, but sadly, I think most patients are closer to the latter group than to the former.

Perhaps a reality show on TV will reach some of these people. I do hope so.

Anyone wishing to learn more about Mattocks and his show can go here.


Tuesday, November 6, 2018

Protein and Kidneys

When I was diagnosed with type 2 diabetes in 1996, a nurse handed me the American Diabetes Association 1500-calorie diet, which said I should eat 179 grams of carbohydrate a day. That made no sense to me. So when I saw my doctor, I asked, "If diabetes is a disease in which you can't deal with carbohydrates, why did the nurse tell me to eat all this starch?"

The doctor looked surprised at the question and then thought and answered, "Well, protein damages kidneys, and as a diabetic, you're at increased risk of kidney damage. Fat causes heart disease, and as a diabetic, you're at increased risk of heart disease. The only thing left is carbohydrate."

Many of us have questioned the assumption that protein damages healthy kidneys, so it's nice to see some research supporting that idea. True, this study is a meta-analysis, in which researchers do statistical analyses of previously published research, and meta-analyses can have problems. For instance, the populations studied by each group may not be very similar. The end points may vary. Nevertheless, such studies give suggestions about the issue at hand.

This study says nothing about protein consumption by people who already have damaged kidneys. In such cases, some people think plant proteins are better than animal proteins.

My doctor's statement about fat causing heart disease has also mostly been disproven, but I won't get into that here.

Monday, November 5, 2018

Weight and Nuts

Sometimes people do research and then write it up in a way that reveals that they had preconceived notions about the results. An example of this is a recent report suggesting that eating nuts may help you to lose weight. The report was presented at the American Heart Association's November meeting.

OK, that makes sense. Most nuts contain a lot of fat, and fat slows down gastric emptying, so you feel full longer.

The study involved a food-frequency questionnaire, which can be fairly inaccurate. Who remembers everything they ate last week, or even yesterday? But that's not the problem I'm concerned with.

The researchers said the nuts were eaten "in place of foods generally considered low in nutritional value." So it's not just eating nuts but eating nuts in place of junky foods. One assumes they mean empty calories in sugary drinks or starchy highly processed foods.

But wait! They said "Substituting one serving a day of any type of nuts in place of one serving of red meat, processed meat, French fries, desserts or potato chips was associated with less weight gain over the four-year intervals."

Red meat is low in nutritional value? Since when?

According to P. G. Williams at the University of Wollongong, Australia,

"Lean red meats are:

"• An excellent source of high biological value protein, vitamin B12, niacin, vitamin B6, iron, zinc and phosphorus 
"• A source of long-chain omega-3 polyunsaturated fats, riboflavin, pantothenic acid, selenium and possibly also vitamin D
"• Mostly low in fat and sodium [this analysis refers to meat with fat trimmed]
"• Sources of a range of endogenous antioxidants and other bioactive substances including taurine, carnitine, carnosine, ubiquinone, glutathione and creatine."

This study was done in the lab of Walter Willett, who has long opposed eating red meat, and I suspect that because the researchers consider red meat to be unhealthy, they just lumped it in with foods considered low in nutritional value. This is not good science.

Even perfectly done nutritional studies can be confusing because so many factors are involved. Eating more of X usually means eating less of Y, so if the results are different, which was the crucial factor? Most people, including professional dieticians, make errors when reporting what they ate. And of course there are interactions between foods. Maybe food A has one effect when eaten with Food B but not when eaten with food C. And so forth.

So to see a misleading statement like the above in a report from Harvard is discouraging.

Will we ever know what the healthiest diet is? Probably not, because what works for one person may not work for another. What makes blood glucose go up for one person may not for another. And a diet that person A can stick to for years might be different from a diet person B could tolerate long term.

Our best approach is to try different diets and see how they affect our daily blood glucose levels and less frequent lab results and then choose one that works for us.

And it's probably also a good idea to try to ignore popular press articles about diet, which are often slanted to favor some marketing group. The nut study was funded in part by the California Walnut Commission.

Thursday, October 25, 2018

Glucose in Tears

About 20 years ago, shortly after I was diagnosed with type 2 diabetes, I read an article that described measuring blood glucose (BG) levels in tears. I thought that was wonderful, as it would avoid what popular press articles like to call "painful finger pricks" but which are actually not-very-painful but annoying tests one has to do multiple times a day if one wants good control.

So I mentioned the article to an endocrinologist who was in charge of a clinical study I was in. She laughed and said so many novel ways of measuring BG had been proposed, but none of them had ever made it to the market. "I'll be interested when it becomes commercially available," she said.

Well now, 20 years later, a company based in The Netherlands has proposed measuring BG levels in tears. This version involves putting a tiny sensor under the lower eyelid. The sensor measures BG levels continuously and broadcasts them to a smartphone.

The company has published the results of studies in six patients and says the device is accurate, with no adverse events reported. They are planning a study in 24 people with type 1 diabetes.

Well, it does sound nice, but I'll be interested when it becomes commercially available.

Friday, October 19, 2018

Beta Cell Rest

For many years, some people have been saying that if you can rest your beta cells by decreasing their workload, they can recover some function.

Richard Bernstein, the author of Dr Bernstein's Diabetes Solution, who promotes low-carbohydrate diets for people with diabetes, is one of them. He cites experiments with the Biostator, developed in the 1970s, a machine that kept blood glucose (BG) levels close to normal levels. After only 2 weeks on the machine, he said some people had normal BG levels for up to 2 years, despite eating a standard American diet. [I can't locate a reference for this study.]

The Biostator is large and bulky, and the patients had to be admitted to a research lab for the study, so it's not yet a practical solution, although so-called closed-loop insulin pumps are being developed. But it illustrates the concept. Keeping BG levels normal is good for your beta cells.

A similar effect is often seen in type 1 patients who have a "honeymoon period" shortly after they are started on insulin. However, that effect doesn't last.

There hasn't been much experimental evidence on this topic, although there is some, see here and here. So it was nice to see a recent study that supports the concept. Although, like so many studies, it was done in mice, the results are interesting.

The authors say that improving glucose levels with various diabetes drugs not only increased the insulin content of the beta cells, but restored normal biphasic insulin secretion.

Normally, beta cell secretion of insulin occurs in two phases. After eating carbohydrate, the first phase is very rapid, and it doesn't last long. But it keeps BG from going very high, in part by stopping the liver from releasing glucose. The second phase occurs later and persists until no more carbohydrate is coming into the intestine, and it is able to keep the BG down for a long time.

People with type 2 diabetes almost always lose the first-phase insulin response. This means the BG goes very high after a carbohydrate load, and because it's so high, if they're still able to secrete insulin, the beta cells secrete a lot of it. This is often so much that the person later goes low. In fact, going low about 4 hours after a carbohydrate-rich meal is one of the warning signs of future diabetes. I had this about 5 or 10 years before I was diagnosed with type 2.

So the fact that the first-phase insulin response was restored is promising. I also learned that my first-phase insulin response was restored to about 70% of normal when I was in a study of high-dose aspirin at Joslin. I assume I lost it again when the study was over, although I had no way of testing that.

These authors conclude, "Thus, this study provides evidence that alleviation of metabolic demand on the beta cell, rather than targeting the beta cell itself, could be effective to delay the progression of T2D."

And how can people alleviate the metabolic demand on the beta cell? By eating less carbohydrate, of course. In fact, the "normal" BG levels reported for the Biostator  are not as good as those reported by type 1 patients on the Type1Grit Facebook page. (If you're not on Facebook, you can see results here.) The Biostator was set for BG levels of 90, but they actually fluctuated a lot.

 Low-carb diets have been anathema among some diabetes organizations like the American Diabetes Association, but they are slowly gaining acceptance even by these groups.

Another way to reduce the load on the beta cell is to inject insulin. The standard treatment of type 2 used to be to tell people to lose weight and exercise and come back in three months. Now some say it's better to start right out on insulin. This will reduce the workload on your beta cells and let them recover somewhat at a time when you still probably have a lot of them. Here is an example of that. Then when they have recovered a bit, you can phase out the insulin.

Waiting for three months, especially if given a high-carb low-fat diet, will just burn out more of these precious cells. And most overweight patients have been trying unsuccessively to lose weight for decades, so telling them to lose weight isn't very helpful.

One problem is that some people don't like needles, and they see using insulin as a sign of failure. It's not. It's taking charge of your health. And if you use it from the get-go so your beta cells recover and you then stick to a sensible diet, you may be able to go off all drugs in the future.

Rest your beta cells, and your beta cells will thank  you.