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.


Diets

 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

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.

Sunday, June 27, 2021

Insulin Resistance: Mechanism

 We all know that insulin resistance (IR) is one of the main causes of type 2 diabetes. Many people with type 2 can produce some insulin, but it's just not enough to overcome the IR.

What causes this sluggishness? No one knows for sure.

A recent paper suggests that the key is ATP, the energy-containing molecule that is produced when you eat and can then be used to drive other reactions in the cell.

I always thought ATP was good to have, and the more ATP the more energy. But this author (Jianping Ye) suggests that too much ATP can cause what he calls overheating. In the winter, it's nice to get heat from your furnace; the heat is nice, but you don't want it to get up to 100 degrees. He suggests the same is true of ATP.

Ye says that when you have too much ATP, the cells become insulin resistant to prevent overburdening the cells with too much energy. Hence, cells are insulin sensitive under conditions of energy deficiency and insulin resistant when there's an energy surplus.

So insulin sensitivity/resistance is an index of energy demand.

Interestingly the drug metformin inhibits ATP production.

He notes that as we age, energy demand decreases. If you're 95, you're not apt to go out and play three sets of tennis, so you need less food.

We all know that, but many of us eat portions determined by habit rather than by need. Restaurants don't serve meals adjusted for need. Everyone gets the same thing, although of course someone who just spent the day mountain climbing can order more than someone who spent the day reading. But how many of us act on that? In our "clean plates club" society, we often eat more than we really need. This is especially true in people who eat all their meals out.

In support of Ye's hypothesis, it has been known for about 60 years that elevated ATP is a risk factor for insulin resistance. But he says its importance hasn't been appreciated because of technical difficulties in measuring ATP in various tissues.

Interestingly the drug metformin inhibits ATP production

So is one solution to the diabetes epidemic simply to eat less? Sadly, that's often difficult to do. If  you eat out a lot, one solution is to get a tightly sealed container, carry it in a nice handbag, and use it to take at least half of the meal home without carrying around those awful plastic things restaurants usually put leftovers into.

We need food. We need energy. We need ATP. But as with many things in our lives, we just don't need too much.

Sunday, June 20, 2021

ACCORD Revisited

 In 2008, the results of the ACCORD "landmark" trial were published and were interpreted by some to mean that people with diabetes shouldn't get their blood glucose (BG) levels down to normal or below. This is because those whose diabetes was treated aggressively in this trial had greater mortality than those with less aggressive treatment.

Sadly, some physicians used these results to urge their patients to have higher hemoglobin A1c levels. Patients were reporting on diabetes lists that their doctors told them that their normal A1c levels were too low and they should get them up.

Careful analysis showed that in fact, the patients with increased mortality were those who used very aggressive treatment but despite this did not lower their A1c. So they had harm from the treatment without compensating benefit from lower BG levels. Those who got aggressive treatment and did lower their A1c got benefit.

"It has been recognized that patients treated intensively in ACCORD who attained a lower HbA1c had reduced risk of death compared to those treated intensively with little HbA1c reduction."

Unfortunately, these analyses did not get the wide publicity that the initial results did, so many busy physicians may not have read about them.

Now a new analysis of ACCORD  says that there is a subtype of type 2 that shows real benefit from intensive glycemic treatment.

Now, most patients will not be given genetic tests to determine if they are in this subgroup. And there might be other subgroups that these researchers did not study. However the analysis suggests that you should not accept without question the results of big studies of diabetes patients as applying to you. They probably will, but they might not.

If you're a physician, you need to work on the assumption that big trial results will apply to most of your patients, so you start by following their recommendations. But most of us aren't treating others, so what we really care about his how some approach will affect us.

This means we should test as much as we can, not just BG levels but other factors that affect our health, to see what works for us. We're fortunate these days because if we can afford it, we have access to a  lot of tests.

Stay informed. Read about the latest big studies. But read them critically and try to figure out if they make sense for you. Try what they suggest is beneficial, but don't apply the suggestions blindly.

In the long run, we have to be in charge of our health.

Friday, June 11, 2021

Self-control

Some time ago, in an online suport group I started, one woman said her biggest problem was that she couldn't stop eating potato chips after she'd had one.

I knew she lived alone, so I asked why she bought potato chips, and she said, "Because I like them."

I think this is a common problem. 

The most important thing you can do when you're diagnosed with type 2 diabetes is to accept that your life is going to have to change if you want to control it. Of course, that's not easy. If you live with others who aren't diabetic, you're probably going to keep buying food you shouldn't eat. That's difficult.

It should be easier if you live alone. If something makes your blood glucose spike, keep it out of the house. I suppose there are people with iron self-control who can eat just one bite of a cookie and no more. I'm not one of them.

Once before I got diabetes, I was on a diet to lose weight. I was avoiding sweets and they no longer had any appeal for me. Out of curiosity, I went into a bakery, and nothing looked good, but I bought a bag of cookies anyway to see if they'd taste good. I planned to eat just one, but as soon as I did I craved more and ate the whole bag.

So much for that approach. After that I just kept the cookies and pies out of the house. If I learn that a comet is headed for the earth and will destroy all life, I'm not going to call my nearest and dearest to say good-bye. I'm going to the bakery to buy a blueberry pie, and then I'm going to eat the whole thing.

Just my luck the comet will change course and we'll all be saved and my blood glucose will go over 500. Oh well. It would be fun while the pie lasted.

But until then I won't make pies, and I won't buy them. It's easier than trying to have self-control.

Wednesday, June 9, 2021

Obesity Benefit

 Most of the news about people who are overweight or obese is bad. We see a constant stream of articles saying obese people are at higher risk of this and they're at higher risk of that.

But here is an article saying that obesity protects you from dying from severe bacterial infections. In this study, 26 percent in the normal weight group were dead within a year. The corresponding figures in the groups with higher BMI were 9-17 percent. Full text is here. The authors note that although obesity is associated with higher survival in bacterial infections, it's associated with lower survival in viral infections. The authors have no explanation for this.

Other studies have shown similar effects, and this is called the obesity survival paradox.

 So does this mean we should all stuff ourselves with pies and cakes, hoping we'd become obese and thus have a better chance of surviving a bacterial infection? No. For one thing, we don't know we're going to get a severe bacterial infections, and for another, too many negative side effects are associated with overweight.

So as so many authors conclude, "more studies are needed."