Monday, November 29, 2021

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.

Saturday, November 27, 2021

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.


Sunday, November 7, 2021

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.

Friday, October 22, 2021

Too Many Carbohydrates

 Most of us with type 2 diabetes don't stuff ourselves with huge plates of spaghetti, but some nondiabetics and even some people with diabetes do, sometimes because they're still brainwashed by the low-fat diet fad of the 1990s. And when you limit fat, you eat more of other things, especially carbohydrates, which are both cheap and filling, at least for a short time.

 When I was diagnosed with type 2 in 1996, I started off following the ADA-recommended low-fat diet. I did lose weight on this diet, which limited calories as well as fat, but I was ravenously hungry 24 hours a day. I finally decided I didn't want to live if I was hungry all the time, so I switched to a low-carb diet, even though the traditional dieticians said the diet would kill me. My hunger immediately went away. The weight loss also slowed down.

The dieticians also said no one could stick with this diet long term. I don't know if 25 years qualifies as long term, but so far the diet hasn't killed me.

Some people continue to criticize low-carb diets, but a recent study showed the dangers of high consumption of carbohydrates. They found that high consumption of carbohydrates reduces the level of antioxidants in the body, especially in those who are overweight. The study was done in nondiabetics.

Here is the journal article. You can download a 52-page full text if you like.

Now, there are populations that have always had high-carb diets, like the Kitavans, who eat lots of yams, not lots of croissants, and they're pretty healthy. Have their bodies adapted to their diet to produce more antioxidants? No one has studied this, but the body is often able to adapt to dietary changes.

Also notice that the article refers to overconsuming carbohydrates, not just having the occasional piece of bread. So the research probably doesn't have much practical application for now. But it's interesting. And it's another small piece of evidence showing the advantages of low-carb diets, which are demonized by some.








Saturday, September 18, 2021

Life Is Unfair

This certainly does seem unfair. You do the right thing and exercise, and your body figures you're going to do it on a regular basis and so reduces the number of calories you burn at rest to make sure you don't get too thin. This means that if you don't exercise on a regular basis but eat the same as before, you're at risk of gaining weight. Bummer! 

But in the environment in which we evolved, very few people were overweight. Getting enough food was the problem, not getting too much of it. So we evolved to not waste energy when possible. Every calorie was precious in those times, and even today in areas of famine.

So, because it's unfair, does it mean we should just give up and stop exercising? Of course not. Most of us are so much better off than people in the rest of the world that a few metabolic injustices aren't that important.

When I was first diagnosed with type 2 a friend who was diagnosed at about the same time asked me, "Do you ever wonder 'Why me?' "

I said no, just as when a close friend died from a brain tumor I didn't say, "Why her, not me?"

Life is unfair, and we can only try to make the best of whatever life we've been given. I try to learn as much as I can about type 2 and then share information with others, although that's getting harder and harder as research seems to be increasing exponentially and the complexity is also increasing so that if you don't have a degree in biochemistry it's difficult to understand.

Some research I don't even try to blog about because it's so complex, sometimes over my own head.

But I keep reading, in the hopes that some of it will be useful to others.


 If you're overweight and feeling that it's all your fault, the headline of this article, Scientists Claim that Overeating is not the Primary Cause of Obesity, should remove some of the guilt. The full text is here.

Of course, most people reading this blog already know that overeating is not the main cause of all cases of obesity, but it's nice to have attention called to that fact.

Weight control is complex and depends on numerous factors including genetics, income, access to physical activity, social class, what our friends are eating and a need to fit in (especially among adolescents), what kinds of foods are available in our neighborhood, and many more-subtle factors.

Even without rigorous studies, we all know families in which everyone is skinny, despite having voracious appetites and other families in which everyone is fat despite eating sensibly. Genetics clearly plays a role. However, that doesn't mean weight loss is impossible. It's just harder than it is for people born into thin families.

Income has a big effect on weight control. Rich people can afford to buy meat and fresh vegetables, with fresh fruit for dessert, whereas poor people may be forced to eat mostly cheap starches swimming in oil. I once spent the summer in Paris with a rich classmate who was overweight. They had a chef who prepared delicious low-calorie foods for her, and she also had a masseuse who massaged her every day. I'm not sure how much the massages helped her lose weight, but she was so terrified of the woman that she starved herself and did lose some weight.

Sadly, she kept losing and regaining weight and eventually died from a heart attack at a relatively young age.

People who live in dangerous neighborhoods aren't likely to do a lot of recreational walking or running even if they want to.

Social class dictates what weights are acceptable. You don't see a lot of obese people in the society pages.

So the causes of overweight are myriad, and so are the best ways to avoid or reverse obesity. There is no best diet for everyone, just as there is no best exercise. Losing weight is difficult, very difficult, and we all have to find our own path. What works for someone else (not counting starvation, which works for everyone) may not be the best for you.

Lately, I've started losing weight without trying. I think it's because I'm bored with the foods I've been eating for the last 20 years, so I only eat enough to dull my hunger and then I put the rest in the fridge to eat at the next meal. I hope the lack of appetite isn't a sign of some disease. There are worse things than being overweight.

 I'm also shrinking, and I just hope I don't just shrink into nothingness. I see a 2-inch tall me, but very thin. Is that what I really want?



Saturday, July 17, 2021


Einstein has little to say about diabetes. Or maybe he does, in addressing questions like how we come to solutions.

Deric Bownds, an emeritus biology professor at the University of Wisconsin, has reposted some quotes from Einstein, and those concerning how we solve problems could apply to anyone trying to decipher the very complex disease we call diabetes. For instance,

"I think 99 times and find nothing. I stop thinking, swim in silence, and the truth comes to me."

Our brains keep working on problems even when we're not consciously thinking about them, one reason for the old adage "sleep on it." The problem that seemed unsolvable when you went to bed is clearer when you wake up.

Deric and I were teaching fellows in an introductory biology lab many eons ago. 

Anyone with diabetes has to solve many problems every day. "Should I eat that?" "How much should I eat?" "Can I skip my daily walk if I'm going to be roaming the aisles of the gigantic supermarket?" "Are there many carbs in that dish a friend is serving me, and is it impolite to ask?"

Maybe we need to spend more time swimming in silence.