New Drug Treatment

 I haven't seen a lot of new treatments for type 2 diabetes lately. Most research seems to concern refining current approaches, but here is a study about a drug, phenylbutyrate, commonly prescribed for urea cycle problems, that seems to help in type 2 diabetes.

I confess I'd never heard of phenylbutyrate, as I haven't had urea cycle problems, but the drug helps to remove urea from the blood. It also seems to improve insulin sensitivity and the oxidation of glucose. No adverse effects were found in the cited study, but the study was short term.

The idea that phenylbutyrate affects glucose metabolism is not new. For example, this 2011 study suggests that it helps reduce lipid-induced insulin resistance and improves beta cell function.

Phenylbutyrate works by breaking down branched-chain amino acids, which are amino acids that instead of having straight chains, have branched chains. They are leucine, isoleucine, and valine. How this affects glucose metabolism is not clear.

In other words, phenylbutyrate may help with glucose metabolism in type 2 diabetes, but it's not a miracle cure. Nevertheless, if you know it might be helpful, you can be alert to other news about this prescription drug.

Type 2 diabetes is such a complex disease, with genetics, lifestyle, and current food growing and processing all having effects. We will eventually figure it all out if we don't destroy the planet first. But it's going to take a long time.

YMMV Again

 Another article highlighting the fact that we're not simple machines, that what works for one person may not work for another, has hit the popular press.

 This time it's not diet but exercise they're speaking of. Some people, despite sticking closely to an exercise program, see no improvement in their fitness. They're called nonresponders.

 Unfortunately, most health care providers don't have the time to investigate your lifestyle closely, so if you are supposed to go on an exercise program but fail to improve your fitness, they probably think you're "cheating," and not exercising as much as you're supposed to. In some cases, that's probably true, but in others not. I wish I'd be prescribed a napping program, which I'm sure I'd follow religiously, but that has yet to happen.

 The results described in the cited article at first sound depressing. Who wants to lift weights for an hour if it doesn't do anything beneficial. But then, if you read the whole thing, you see that when one type of exercise doesn't work for a person, another type will. "No one had failed to respond at all. Every man and woman had measurably improved his or her fitness in some way after one of the sessions, if not the other."

So the secret is to try different types of exercise to see which seems to work best for you, and also to see which types you enjoy enough to keep doing. I hate running, because I have the wrong build for that, but I enjoy walking, and I don't mind lifting weights. So I never plan to run.

One problem with various studies is that their conclusions are usually based on the average results. A group does X and 90% of them improve factor Y. The headlines will all say something like "X improves Y," but you might be in the 10% who don't improve. Keep that in mind if you try it.

The chances are good that you will improve factor Y, so it's certainly worth trying. But if it doesn't improve, don't despair. Try something else.

 

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Obesity as a Disease

 Many people think of obesity as a moral failing. They think that obese people simply have no self-control, and if they did they would be slim.

But that doesn't explain why you can have two people who eat exactly the same things and one is skinny and one is fat. I once read of a mother who had two daughters, one fat and one thin. She told her doctor that one daughter loved vegetables and the other one loved doughnuts and pizza. The veggie lover was the one with the weight problem.

Many of us already know that obesity isn't a moral failing, but sadly some health care practioners do not, and blaming their patients for their weight problems can cause even more harm. Luckily, they do not all think this way. Here is a practitioner, Dr. Lee M Kaplan, who told healthcare professionals at a recent virtual meeting that obesity isn't a moral failing but a disease caused by dysfunction of the metabolic system that regulates body fat, in the same way that immune dysregulation can lead to asthma.

Now, if you're thinking of mildly overweight, for example the "freshman 10" or "freshman 15," the amount of weight that some college freshmen are said put on in their first year, that's not apt to be a disease but stress or a more fattening diet than they had at home. If it were a disease, they would have arrived fat.

We're talking about real obesity, a BMI (body mass index) of 30 or more, the kind that really doesn't want to leave no matter how much the person diets. Or if they starve themselves into losing, the weight just returns with time.

No one really understands what causes this metabolic dysfunction. When the hormone leptin was discovered in 1994, some people thought the problem was solved. But it wasn't. Obesity, like type 2 diabetes, is undoubtedly multifactorial, and because of this, different people have different reasons for the problem and different responses to treatment.

A few people who lack leptin can transform from obese ravenously hungry constant eaters to slim normal eaters when given leptin. But those cases aren't common. Most of us will have to find a way of eating that lets us slowly lose the excess weight or resort to weight-loss surgery.

There is no one perfect weight-loss diet. If you're diabetic, I think the best place to start is with a low-carb diet, as this controls blood sugar levels as well as weight. Then you can tinker with the diet to get something you enjoy and you can follow for years. 

On your journey it's important to realize that your obesity is not your fault. You have a disease. Try to find a health care team that understands this and is willing to work with you to find the best treatment for your particular physiology.

It is good that Dr. Kaplan is trying to educate health care professionals. Let's hope that in the future we will all be educated about the complex factors controlling weight.