Monday, July 9, 2018

Intestinal modification for glucose control

A lot of research is being done on the effect of the duodenum on diabetes control.

The duodenum is the first part of the small intestine. Food empties from the stomach into the duodenum and then continues down the intestine. When a type of gastric bypass called Roux-en-Y is done, the duodenum is bypassed. And because glucose control improves after this operation, even before the patient has lost any weight, some researchers wondered if something produced by the duodenum was controlling blood glucose levels.

Various approaches to deal with this have been tried.

One, called he duodenal-jejunal sleeve bypass, or EndoBarrier, is a removable plastic tube that is implanted endoscopically. The tube prevents nutrients from contacting the duodenum.

The EndoBarrier has been used outside the United States with positive results, but preliminary US studies were terminated after a higher-then-expected number of liver abscesses, and some other countries have also terminated their approval of the device. Efforts to revive use of the device are underway.

The second procedure, called duodenal mucosa resurfacing, or DMR, introduces a heated balloon into the duodenum. The company says the heated water modifies the cells of the duodenum in a positive way to reduce hemoglobin A1c levels and markers of insulin resistance. It is approved in Europe but not yet in the United States.

And the third procedure uses a pill that releases substances that temporarily coat the duodenum. The active ingredient is sucralfate (Carafate), which is already approved for control of ulcers. The researchers have further engineered the sucralfate (called LuCI for luminal coating of the intestine) so that it adheres to the intestine even when it's not acidic, because normal intestine is not as acidic as ulcers. After a 24 hours, the LuCI dissipates.

Because the LuCI coats the intestine, nutrients are absorbed more slowly, and this can reduce glucose peaks, the researchers say.

So far, research has been in animals, and this treatment has not yet been approved by the FDA.

So none of these new procedures sound perfect, but it's a new approach that sound promising, and maybe new creative approaches to altering nutrient-duodenum contact will be developed.

Tuesday, July 3, 2018

Diet Trends

This is a good article. At least it was today. The site has more than one article at links, and it's possible that in the future it will go somewhere else. The one I'm referring to is "Faulty Studies Mean Everything You Know About Nutrition Is Wrong" by Dan Robitzsk.

I  hate those "everything you know is wrong" titles, which are clickbait, but he makes some good points and discusses the problem that one day the press says fat is bad and the next day they say it's good, and most people don't have the time or statistical background to plow through the studies that are cited to support any dietary view and so don't know what to eat. 

For the past few decades, we've been bombarded with messages telling us to cut out the fat. Now the tide is turning, and high-fat ketogenic diets are "in" and its supporters say carbohydrates are poison. (I've been on a low-carb diet for more than 20 years, starting when it went against the advice of most medical organizations. What will I do if these organizations make a switch and tell me I'm right? I'll have to find new battles to fight).

Dietary patterns tend to go in cycles, and I suspect the ketogenic diet will grow in popularity and then will be supplanted by something else. What diet? Who knows.

I think the diet I grew up with was probably pretty healthy, and in those days (1950s) childhood obesity wasn't common. Our family's diet wasn't vegetarian. It wasn't low fat. It wasn't high in pasta and other carbohydrates. It wasn't ketogenic. A typical meal would consist of some meat or fish, a vegetable seasoned with butter, some kind of potato, a piece of bread, and a glass of whole milk. Sometimes salad. For dessert we could have some ice cream.

We weren't usually allowed to snack between meals except for fruit, and sodas were a rare treat. In the summer we could have a treat if the Good Humor truck came down our street, and my little brother used to sit on the front steps with a dime clutched in his hand listening for the jingle-jingle of the Good Humor man. We could have bought a candy bar with our 10-cent allowance, but I preferred to buy a comic book or save the money.

I suspect my friends ate the same way that we did, but of course people in different areas of the country or different ethnic groups or different incomes would have eaten differently.

I doubt we'll return to the diet I grew up with, as too many people today eat all their meals in restaurants or order takeout food, and kids today mostly have more spending money so they can buy a lot of treats. But let's hope we transition to a diet that is healthier than the junk that too many people eat today, and that the diet will be affordable for all.

I suspect the next trend will be an expansion of farmers markets and more "whole food," meaning unprocessed food. Eating less processed food is one thing proponents of various diets agree on.Will working couples have the time to prepare this food? I don't know. Perhaps if studies show that doing so will improve the health of their children they would figure out how to make the time.

So I'm not a seer. The next trend might be something completely different. What do you think the next diet trend will be?