Understanding Red Wine’s Potential Benefit for Diabetes

April 30, 2008

April 30, 2008 (Newswise) — New research suggests that resveratrol, a chemical commonly found in red wine, has the ability to lower blood sugar levels, but might have certain untoward side effects. This research will be presented at the American Association of Clinical Endocrinologists (AACE) 17th Annual Meeting & Clinical Congress by Kimberly Martin, MD, and mentor, Dr. F. Ismail-Beigi, on Friday, May 16th, at the Walt Disney World Dolphin Resort in Orlando.

Resveratrol is a naturally occurring chemical found in grapes that has been reported to have cardioprotective, anti-inflammatory, anti-viral, and glucose-lowering properties. The effect of resveratrol on lowering blood glucose in diabetic rats has been reported by several investigators in the past.

Their results have shown that resveratrol improves glycemia by stimulating glucose transport in certain tissues including the skeletal muscle that expresses the insulin-sensitive Glut4 isoform of glucose transporters. However, the research by Drs. Martin and Ismail-Beigi shows that in cells expressing the Glut1 isoform, resveratrol blocks glucose transport by binding and inhibiting the Glut1 transporter. This may be of importance because certain cells and tissues, including brain, retina, placenta, and red blood cells express large amounts of this transporter. Hence, the presumed inhibition of the Glut1 transporter in these tissues in-vivo may have undesired and negative effects on their normal function.

“It’s exciting to see resveratrol’s glucose-lowering effect in diabetic experimental animals,” Dr. Martin said. “However, studies are currently underway in our laboratory to determine whether the agent inhibits glucose transport in the brain of normal and diabetic animals.”

At the 2008 AACE Annual Meeting, diabetes will be taking center stage. A special symposium titled “Clinical Trials Targeting Glycemia: What Do We Expect to Learn?” will consider the impact of glucose control through studies including ACCORD, ADVANCE, VADT, and others. Other sessions of interest include “Insulin Resistance and Atherosclerosis: The Missing Link,” “Diabetes: A Cardiac Condition,” and “Hypoglycemia: The Limiting Factor in the Glycemic Management of Diabetes.”

Posted by dlife at 11:28 AM | Comments (2)

What You Don't Know Could Hurt You

April 17, 2008

April 17, 2008 (PRNewswire) - Whether listed on the menu or not, the American Diabetes Association provides tips for translating calorie information

Pop quiz -- which has more calories -- a tuna salad sandwich or a roast beef with mustard? You might be surprised to learn the tuna fish salad normally has at least twice the number of calories. But what does this mean for your daily diet? And how many calories a day are you supposed to eat anyway?

Counting calories, whether in the kitchen or at a restaurant, is important to maintaining or losing weight according to the American Diabetes Association (ADA). Consuming excess calories without increased physical activity can lead to weight gain, a major risk factor for pre-diabetes and type 2 diabetes which affects nearly one in four Americans. In addition, people with diabetes and those at risk for diabetes need to work toward achieving a healthy weight to prevent deadly diabetes complications, such as heart disease and stroke.

"It is easy to underestimate the number of calories in food items, especially in a restaurant where you didn't prepare the meal yourself," commented Ann Albright, PhD, President, Health Care & Education, American Diabetes Association. "Since Americans are eating out more, they are receiving more of their calories via restaurant meals. People need to be well informed to make healthier choices."

Yesterday a federal court upheld a New York City regulation, which ADA supports, that requires chain restaurants to provide the calorie content of foods on their menus and menu boards. This ruling came in response to a challenge to the regulation filed by the New York State Restaurant Association.

ADA will host a live web chat "Tips, Tactics, and Tools for Healthier Restaurant Eating" on Tuesday, May 6, with ADA author Hope S. Warshaw, RD. Visit http://www.diabetes.org/adalive/default.jsp for more information or to submit a question ahead of time.

According to the ADA, the first step to making healthy choices is knowing how many calories a day to consume. The daily calorie ranges below are a general guide. Talk to your health care team about your specific dietary goals.

-- 1,200-1,400 calories/day - Women who want to lose weight, are small in size, and/or are sedentary

-- 1,400-1,600 calories/day - Women who are older and smaller, are larger and want to lose weight, and/or are sedentary

-- 1,600-1,900 calories/day - Women who are moderate to large size, men who are older, are small to moderate size and want to lose weight

-- 1,900-2,300 calories/day - Children, teen girls, women who are larger in size and active, men who are small to moderate size and are at desired body weight

-- 2,300-2,800 calories/day - teen boys and men who are active and moderate to large in size

In addition, the ADA offers healthy tips for eating out:

-- Doggie bag - If the portion is more than you usually eat, split it with a friend or take half home for later.

-- Snack time - If you had a lower calorie option for lunch, grab a healthy snack mid-afternoon, such as an apple or a handful of nuts, to avoid binging later in the day.

-- Want a drink? - Substitute 16 oz. of water for 16 oz. of soda. This will save you approximately 200 calories.

-- Hold, please - Skip the mayo and other fatty sides, which can save you hundreds of calories.

-- On the side - Rather than putting the dressing in the salad or sauces on the entree, try dipping your fork in the dressing or sauce before putting a bite on your fork.

-- Made to Order - Ask if meats or fish can be grilled instead of fried. Order an extra vegetable instead of a starch as a side.

Posted by dlife at 10:28 AM | Comments (3)

Adults Who Eat Apples, Drink Apple Juice Have Lower Risk for Metabolic Syndrome

April 07, 2008

April 7, 2008 (Newswise) — Not eating your apple a day? Perhaps you should be. Adults who eat apples, apple juice and applesauce have a significantly reduced risk of metabolic syndrome, a cluster of health problems that are linked to numerous chronic diseases such as diabetes and cardiovascular disease.

The study results, presented at the Experimental Biology 2008 meeting this week, were derived from an analysis of adult food consumption data collected in the 1999-2004 National Health and Nutrition Examination Survey (NHANES), the government’s largest food consumption and health database.

Dr. Victor Fulgoni analyzed the data, specifically looking at the association between consumption of apples and apple products, nutrient intake and various physiological parameters related to metabolic syndrome. When compared to non-consumers, adult apple product consumers had a 27% decreased likelihood of being diagnosed with metabolic syndrome.

Fulgoni notes, “We found that adults who eat apples and apple products have smaller waistlines that indicate less abdominal fat, lower blood pressure and a reduced risk for developing what is known as the metabolic syndrome.”

In addition to having a 30% decreased likelihood for elevated diastolic blood pressure and a 36% decreased likelihood for elevated systolic blood pressure, apple product consumers also had a 21% reduced risk of increased waist circumference – all predictors of cardiovascular disease and an increased likelihood of metabolic syndrome. Additionally, adult apple product consumers had significantly reduced C-reactive protein levels, another measurable marker related to cardiovascular risk.

Furthermore, apple product consumers’ diets were healthier than non-consumers – they had a greater intake of fruit and key nutrients, including dietary fiber, vitamins A and C, calcium and potassium. These consumers also ate less total fat, saturated fat, discretionary fat and added sugars.

Metabolic syndrome is believed to affect an estimated 36 million Americans. Metabolic syndrome, also known as Syndrome X and insulin resistance syndrome, is defined as having three or more of the associated symptoms, which include elevated blood pressure, increased waist size and abdominal fat, and elevated c-reactive protein levels.

Source: Fulgoni, V., Fulgoni S., Haaga, S., Ebert, A. Apple consumption is associated with increased nutrient intakes and reduced risk of metabolic syndrome in adults from the National health and Nutrition Examination Survey (1999-2004). Experimental Biology 2008 Poster Presentation (unpublished).

Posted by dlife at 03:00 PM | Comments (1)

Tart Cherries May Reduce Heart/Diabetes Risk Factors

April 7, 2008 (Newswise) — Tart cherries – frequently sold dried, frozen or in juice – may have more than just good taste and bright red color going for them, according to new animal research from the University of Michigan Cardiovascular Center.

Rats that received whole tart cherry powder mixed into a high-fat diet didn’t gain as much weight or build up as much body fat as rats that didn’t receive cherries. And their blood showed much lower levels of molecules that indicate the kind of inflammation that has been linked to heart disease and diabetes. In addition, they had significantly lower blood levels of cholesterol and triglycerides than the other rats.

The results, which were seen in both lean and obese rats that were bred to have a predisposition to obesity and insulin resistance, were presented Sunday at the Experimental Biology 2008 meeting in San Diego, CA by a team from the U-M Cardioprotection Research Laboratory.

In addition, the obese rats that received cherry powder were less likely to build up fat in their bellies – another factor linked to cardiovascular disease. All the measures on which the two groups of animals differed are linked to cardiovascular disease and Type 2 diabetes.

The new findings build on results that were reported last year at the same meeting by the U-M team. Those data came from experiments involving lean rats that were prone to high blood pressure, high cholesterol and impaired glucose tolerance, but that received a low-fat diet with or without cherries. In that case, cherry-fed rats had lower total cholesterol, lower blood sugar, less fat storage in the liver and lower oxidative stress. However, it was unknown if these benefits would be observed in obesity-prone animals, or in animals fed a higher fat, western-style diet containing elevated saturated fat and cholesterol.

While it’s still far too early to know whether tart cherries will have the same effect in humans, U-M researchers are preparing to launch a pilot-phase clinical trial later this spring. They note that if a human wanted to eat as many tart cherries as the rats in the new study did, they would have to consume 1.5 cups every day.

“These new findings are very encouraging, especially in light of what is becoming known about the interplay between inflammation, blood lipids, obesity and body composition in cardiovascular disease and diabetes,” says Steven Bolling, M.D., a U-M cardiac surgeon and the laboratory’s director. “The fact that these factors decreased despite the rats’ predisposition to obesity, and despite their high-fat ‘American-style’ diet, is especially interesting.”

The results were presented by E. Mitchell Seymour, M.S., a U-M research associate and the senior scientist on the project. “It was recently shown in humans that regular intake of darkly pigmented fruits like cherries is associated with reduced mortality from cardiovascular disease and coronary heart disease,” says Seymour. “The heart-health benefits of these colorful fruits were sustained even when corrected for age and other health conditions. We’re now invested in exploring the specific mechanisms of these benefits.”

The experiments are funded by an unrestricted grant from the Cherry Marketing Institute, a trade association for the cherry industry. CMI has no influence on the design, conduct or analysis of any U-M research it funds.

The correlation between cherry intake and significant changes in cardiovascular risk factors suggests — but does not directly demonstrate — a positive effect from the high concentrations of antioxidant compounds called anthocyanins that are found in tart cherries. The anthocyanins are responsible for the color of these and of other darkly pigmented fruits.

The potential for protective effects from antioxidant-rich foods and food extracts is a promising area of research, says Bolling, who is the Gayle Halperin Kahn Professor of Integrative Medicine at U-M.

The team performed the study using 48 obesity-prone rats, half of which were obese, and a diet in which 45 percent of calories came from fat and 35 percent came from carbohydrates. All the rats were six weeks old when study began. For the next 90 days they were fed either a cherry-enriched diet in which cherries made up 1 percent by weight, or a diet that contained an equivalent number of carbohydrates and calories.

At the end of the study, the rats had blood tests for glucose, cholesterol and triglyceride levels, received DEXA scans to measure their body fat and to see where the fat had collected, and had tests for two plasma inflammation markers: TNF-alpha and interleukin-6.

These two molecules are related to the level of vascular inflammation, or immune-system reaction to blood-vessel walls, that is often seen in people and animals with cardiovascular disease. While inflammation is a normal process the body uses to fight off infection or injury, according to recent science, a chronic state of inflammation may increase the risk for a number of diseases.

The cherries were Montmorency tart cherries grown in Michigan, which is the nation’s largest producer of tart cherries. They are different from the sweet Bing cherries that are often eaten fresh. Tart cherries have higher concentrations of antioxidant anthocyanins than sweet cherries.

By the end of the study, the rats that received the cherries had lower body weight, fat mass, total cholesterol, triglyceride, TNF-alpha and IL-6 than the rats that did not receive cherries. In all, TNF-alpha was reduced by 50 percent in the lean rats and 40 percent in the obese rats and IL-6 was lowered by 31 percent in the obese rats and 38 percent in the lean rats.

The obese rats that received cherries also had lower-weight retroperitoneal fat, a type of belly fat that has been associated with especially high cardiovascular risk and inflammation in humans.

In addition to Seymour and Bolling, the research team includes Daniel Urcuyo-Llanes, Ara Kirakosyan, Peter B. Kaufman, and Sarah K. Lewis of U-M, and Maurice Bennink of Michigan State University.

Even as the Cardioprotection Laboratory team continues its work in animals, U-M Integrative Medicine co-director Sara Warber, M.D., an assistant professor of family medicine at the U-M Medical School, is preparing to lead a pilot clinical trial of whole tart cherries in humans.

For more information on the University of Michigan Cardioprotection Laboratory, visit http://sitemaker.umich.edu/cardiac.phytomed. For information on participating in clinical trials at U-M, visit www.umengage.org. Reference: Experimental Biology 2008 poster #702.7

Posted by dlife at 11:58 AM | Comments (12)

Red Wine, Tea, May Help Regulate Blood Sugar in Type 2 Diabetics

April 02, 2008

April 2, 2008 (Newswise) — Red wine has been shown to protect people from heart disease, even when they follow a diet high in saturated fat, and the healing powers of tea are becoming the stuff of legend. Now, researchers at the University of Massachusetts Amherst have shown that these beverages may hold promise for regulating the blood sugar of people with type 2 diabetes.

Results have been published in the Journal of Food Biochemistry. Researchers include food scientists Kalidas Shetty, Young-In Kwon and Emmanouil Apostolidis.

“Levels of blood sugar, or blood glucose, rise sharply in patients with type 2 diabetes immediately following a meal,” says Shetty. “Red wine and tea contain natural antioxidants that may slow the passage of glucose through the small intestine and eventually into the bloodstream and prevent this spike, which is an important step in managing this disease.”

One of the main challenges in managing diabetes is keeping blood sugar levels as normal as possible with few major fluctuations, which can prevent the disease from contributing to heart disease and high blood pressure as well as damaging the eyes, kidneys, nerves and blood vessels.

Both red and white wines were tested in the laboratory using in vitro enzyme studies to determine how well they could inhibit the activity of a target enzyme called alpha-glucosidase, responsible for triggering the absorption of glucose by the small intestine. Red wine was the winner, able to inhibit the enzyme by nearly 100 percent. Values for white wine hovered around 20 percent.

This was clearly related to the amount of a specific type of antioxidants, called polyphenolics, found in the wines. “Our testing showed that red wine contains roughly ten times more polyphenolics than white wine,” says Shetty. “Laboratory results suggest that these compounds, found in many plant-based foods, may play a role in inhibiting alpha-glucosidase and slowing the passage of carbohydrates into the bloodstream.”

Alpha-glucosidase is the target for current drugs used to treat type 2 diabetes and the development of new drugs.

The team also tested four kinds of tea, including black, oolong, white and green teas. Water extracts of black tea had the highest effect on inhibiting the activity of
alpha-glucosidase, followed by white tea and oolong tea.

Wine and tea had no effect on a pancreatic enzyme called alpha-amylase that breaks down starch, which could help patients avoid the side effects of medications used to control blood sugar.

“A major drawback of medications that control both enzymes is the bacterial fermentation of undigested carbohydrates, especially starch, in the colon, which can lead to side effects such as flatulence, bloating and diarrhea,” says Shetty. “Tea and wine had no effect on the breakdown of starch by alpha-amylase, which could potentially help patients avoid these side effects.”

Another benefit is that the polyphenolics in wine and tea could also help in protecting the rest of the body from the additional complications of diabetes such as high blood pressure and heart disease. Diabetes places a stress on the entire body by increasing the production of free radicals, including molecules that react with oxygen, which degrade cellular function. Both red wine and tea contain antioxidants with proven health benefits, and have the potential to manage heart disease, high blood pressure and perhaps contribute to the prevention of cancer, which are all linked to free radicals.

“These results provide strong evidence for further studying the use of wine and tea to manage some stages of type 2 diabetes using animal models and clinical studies, and point to the importance of an antioxidant-rich diet as part of an overall management strategy,” says Shetty. “This concept is not new, but we are finding clear cellular targets for the functions of dietary polyphenolics. Using specific beverage combinations could generate a whole food profile that has the potential to manage type 2 diabetes and its complications, especially in the early stages.”

Posted by dlife at 02:24 PM | Comments (22)

Trans Fat: Why It’s Time to Eliminate This Dietary Villain

April 2, 2008 (Newswise) — Trans fats are a cholesterol double whammy. Also known as trans-fatty acids, trans fats raise low-density lipoprotein (LDL or “bad”) cholesterol and lower high-density lipoprotein (HDL or “good”) cholesterol.

Experts consider trans fat the worst type of dietary fat. Trans fat contributes to heart disease by promoting low-grade inflammation in the blood vessels. And, trans fats are associated with a higher risk of developing type 2 diabetes.

The April issue of Mayo Clinic Women’s HealthSource provides information to better understand the health risks posed by trans fats as well as tips to avoid consuming them.

Trans fats are formed when liquid oils are made into solid fats such as shortening and hard margarine. Because of their long shelf life and appealing texture, synthetic trans fats have been favored ingredients in commercially baked goods such as cakes, cookies, crackers and crusts. Commercially fried foods, such as doughnuts and french fries, also often contain trans fats.

The use of trans fats is starting to change. New York City made headlines when it banned trans fats in restaurants. Other cities are considering going trans-fat free. Some food manufacturers are reducing or eliminating trans fats in their products.

But avoiding trans fats still takes diligence. The American Heart Association recommends limiting trans fats to less than 1 percent of daily calories. That’s just 20 calories (2 grams) in a 2,000-calorie per day diet. That amount can easily come from naturally occurring trans-fatty acids in dairy products and meat from cows, goats and sheep.

At the grocery store, product nutrition labels contain trans fat information. However, a product that has less than ½ gram of trans fat can be labeled as zero. Eating modest amounts of these products easily can add up to more than 2 grams of trans fats. Keys words such as “shortening,” “partially hydrogenated” or “hydrogenated” indicate the food contains trans fats even when the chart on the label indicates none. Many restaurants continue to use trans fats for deep-fried foods. Grilled or baked foods are more likely to be trans-fat free.

Posted by dlife at 02:22 PM | Comments (0)

Drinking Tea May Offer Health Benefits, but Evidence Still Limited

April 2, 2008 (Newswise) — Tea drinkers who opt for black, oolong, green or white teas may find that these beverages offer health benefits. The April issue of Mayo Clinic Health Letter covers what is -- and isn’t -- known about the health effects of drinking tea.

Black, oolong, green or white teas have a common origin. Each is produced from the leaves of the Camellia sinensis bush. The leaves are loaded with flavonoids and other polyphenols that work as antioxidants, possibly lowering the risk of some diseases.

While numerous studies have found possible benefits, the actual benefits of drinking tea are not certain. Most research about tea’s benefits is based on population (epidemiological) studies. Findings are limited because factors other than tea consumption could influence the results. Here’s some of what’s known about tea’s potential benefits:

Cardiovascular: It’s still uncertain if drinking tea over long periods might positively affect cholesterol levels, blood pressure and atherosclerosis. There’s some early evidence that regularly drinking green tea may reduce heart attack risk or atherosclerosis. There’s conflicting evidence on black tea consumption and heart attack risk reduction.

Cancer: It’s still unknown whether regular black tea consumption influences cancer rates. Early lab tests with white tea indicate it may protect against colon cancer in particular. So far, well-designed studies haven’t proven this.

Bone and joint health: Early laboratory research indicates green tea could be beneficial in reducing inflammation related to arthritis and slowing cartilage breakdown. Some early data indicate that regular tea consumption might improve bone mineral density in older women.

Memory: Studies are limited, but a recent one found that older adults in Japan who drank green tea daily showed less risk of memory difficulty, compared with those who didn’t drink tea regularly.

While there’s still much to learn about tea’s health benefits, the potential benefits seem to be in the cup, not in supplements or tea extract capsules. So far, there’s no certainty that the compounds in supplements are the same ones in tea, and even less certainty that these supplements might provide the same potential health benefits as tea.

Mayo Clinic Health Letter

Posted by dlife at 12:31 PM | Comments (0)

A Ton of Bitter Melon Produces Sweet Results for Diabetes

March 26, 2008

March 26, 2008 (EurekAlert) - Scientists have uncovered the therapeutic properties of bitter melon, a vegetable and traditional Chinese medicine, that make it a powerful treatment for Type 2 diabetes.

Teams from the Garvan Institute of Medical Research and the Shanghai Institute of Materia Medica pulped roughly a tonne of fresh bitter melon and extracted four very promising bioactive components. These four compounds all appear to activate the enzyme AMPK, a protein well known for regulating fuel metabolism and enabling glucose uptake. The results are published online today in the international journal Chemistry & Biology.

“We can now understand at a molecular level why bitter melon works as a treatment for diabetes,” said Professor David James, Director of the Diabetes and Obesity Program at Garvan. “By isolating the compounds we believe to be therapeutic, we can investigate how they work together in our cells.”

People with Type 2 diabetes have an impaired ability to convert the sugar in their blood into energy in their muscles. This is partly because they don’t produce enough insulin, and partly because their fat and muscle cells don’t use insulin effectively, a phenomenon known as ‘insulin resistance’.

Exercise activates AMPK in muscle, which in turn mediates the movement of glucose transporters to the cell surface, a very important step in the uptake of glucose from the circulation into tissues in the body. This is a major reason that exercise is recommended as part of the normal treatment program for someone with Type 2 diabetes.

The four compounds isolated in bitter melon perform a very similar action to that of exercise, in that they activate AMPK.

Garvan scientists involved in the project, Drs Jiming Ye and Nigel Turner, both stress that while there are well known diabetes drugs on the market that also activate AMPK, they can have side effects.

“The advantage of bitter melon is that there are no known side effects,” said Dr Ye. “Practitioners of Chinese medicine have used it for hundreds of years to good effect.”

Garvan has a formal collaborative arrangement with the Shanghai Institute of Materia Medica. In addition to continuing to work together on the therapeutic potential of bitter melon, we will be exploring other Chinese medicines.

Professor Yang Ye, from the Shanghai Institute and a specialist in natural products chemistry, isolated the different fractions from bitter melon and identified the compounds of interest.

“Bitter melon was described as “bitter in taste, non-toxic, expelling evil heat, relieving fatigue and illuminating” in the famous Compendium of Materia Medica by Li Shizhen (1518-1593), one of the greatest physicians, pharmacologists and naturalists in China’s history,” said Professor Ye. “It is interesting, now that we have the technology, to analyse why it has been so effective.”

“Some of the compounds we have identified are completely novel. We have elucidated the molecular structures of these compounds and will be working with our colleagues at Garvan to decipher their actions at a molecular level. We assume it’s working through a novel pathway inside cells, and finding that pathway is going to be very interesting.”

Posted by dlife at 01:56 PM | Comments (6)

Study Shows Cholesterol-lowering Power of Dietitian Visits

March 04, 2008

March 4, 2008 (Newswise) — Worried about your cholesterol? You may want to schedule a few appointments with a registered dietitian, to get some sound advice about how to shape up your eating habits, according to a new national study led by University of Michigan Health System researchers.

Not only are you likely to lower your cholesterol levels, you may be able to avoid having to take cholesterol medication, or having to increase your dose if you’re already taking one. And you’ll probably lose weight in the process, which also helps your heart.

The new results, published in the February issue of the Journal of the American Dietetic Association, are based on data from 377 patients with high cholesterol who were counseled by 52 registered dietitians at 24 sites in 11 states.

In the group of 175 patients who started the study with triglycerides less than 400 milligrams per deciliter of blood (mg/dL), and who had their cholesterol measured before they changed or added medication, 44.6 percent either reduced their levels of “bad” cholesterol by at least 15 percent, or reached their cholesterol goal.

The results reflect progress in approximately eight months, after three or more appointments with a dietitian. But the results add further evidence that medical nutrition therapy, as it is called, can make a big difference in a patient’s life.

All of the R.D.s in the study based their advice to their patients on the latest research-based evidence about eating habits and cholesterol levels available at the time of the study: the American Dietetic Association’s 1998 Medical Nutrition Therapy Hyperlipidemia Protocol.

Since that time, the ADA has updated the clinical guideline based on new research, which means that patients who see an R.D. today may have even more success.

The study was funded by the ADA and its Clinical Nutrition Management Dietetic Practice Group, and based on a framework developed for a pilot project carried out in Michigan by the Michigan Dietetic Association and led by U-M cardiovascular dietitians.

“Everyone knows that nutrition is important for cholesterol management, and that a registered dietitian is the professional most thoroughly trained to help patients choose foods wisely,” says lead author Kathy Rhodes, Ph.D., R.D., manager of Nutrition Services with the U-M Cardiovascular Medicine program at Domino’s Farms and the U-M Cardiovascular Center. “But this is the first national study to show what happens when high-risk patients work with R.D.s to follow nutrition guidelines grounded in the best evidence.”

Key nutrition issues in the 1998 guidelines used in the study include reducing saturated and trans fat and increasing “healthy” fats such as olive oil; increasing soluble and insoluble fiber; eating fish twice a week; increasing fruits and vegetables; regular exercise and healthy weight management. Information about food-label reading and dining out was also included.

Called the Lipid Management Nutrition Outcomes Project or LMNOP, the national study was launched by Rhodes and her U-M colleagues Melvyn Rubenfire, M.D., and Martha Weintraub, MPH, R.D., after the successful completion of the Michigan-wide pilot project. Rubenfire, Weintraub and Christina Biesemeier, M.S., R.D., FADA, of Vanderbilt University are co-authors of the new study.

The study gives us an important “real world” picture of what happens when R.D.s try to implement evidence-based nutrition guidelines in daily practice, Rhodes notes.

Some commercial health insurance plans are beginning to cover appointments with registered dietitians, but many still do not. Only dietitian visits for diabetes or kidney disease are covered by Medicare. It is important for people to check their specific health insurance plan to see whether nutrition is covered, Rhodes says. But even if individuals need to pay for the appointments out of their own pocket, they may find that an R.D.’s advice will pay off in the long run, she says.

To get uniform data, the researchers brought lead R.D.s from each state to U-M for training on the cholesterol and nutrition guidelines, and on the data collection practices used in the study. R.D.s at Veterans Affairs hospitals got their training by phone conferencing. R.D.s then returned to their own practices, trained their colleagues and implemented the ADA guidelines.

The study included only patients between the ages of 25 and 70 years who had high cholesterol levels, or triglyceride levels over 200 mg/dL, and who met other inclusion criteria including no recent changes in their cholesterol medication status. Neither the R.D.s nor their patients were paid to participate in the study.

The “real world” aspect of this study included the disappointing finding that many patients dropped out of nutrition counseling after one or two visits, when three or four sessions with an R.D. is recommended to make and sustain truly effective changes in eating habits. Lack of insurance coverage was a major factor in this dropout rate.

Patients whose doctors changed their cholesterol medication status, either by starting them on a drug for the first time, or increasing their dose before assessing the effect of diet change, were not included in the analysis. But for the 219 patients who didn’t have any change in their medication status, the impact of the R.D. counseling became apparent in the first year after the initial visit.

“Although some patients may already be eating a relatively healthy diet, medical nutrition therapy can increase patient’s knowledge of ‘cardioprotective foods’ and assist them in individualizing the guidelines to fit their preferences and lifestyle,” says Weintraub. A significant number of patients reduced the fat in their diets to less than 30 percent of calories, as recommended for a heart health. Many participants also lost weight and/or increased the number of days each week on which they exercised for 30 minutes or more.

“Often, we see heart patients who are on multiple cholesterol medications but have never seen a dietitian. And even when a patient with high cholesterol does get to see an R.D., their care team may not allow enough time to see how effective diet is before they add additional treatment,” says Rhodes. “We hope that this demonstration of how well cholesterol can be lowered without medication or increases in medication will be very useful for patients and physicians, and perhaps insurers too.”

To learn more about how eating habits can influence cholesterol levels, or to find an R.D., visit the ADA’s web site at http://www.eatright.org. For more on U-M Cardiovascular Medicine and its nutrition services, visit http://www.med.umich.edu/cvc/prevention. Reference: JADA, Vol. 108, No. 2, Feb. 2008.

Posted by dlife at 11:14 AM | Comments (2)

Cutting Caffeine May Help Control Diabetes

January 29, 2008

January 29, 2008 (EurekAlert) - Daily consumption of caffeine in coffee, tea or soft drinks increases blood sugar levels for people with type 2 diabetes and may undermine efforts to control their disease, say scientists at Duke University Medical Center.

Researchers used new technology that measured participants’ glucose (sugar) levels on a constant basis throughout the day. Dr. James Lane, a psychologist at Duke and the lead author of the study, says it represents the first time researchers have been able to track the impact of caffeine consumption as patients go about their normal, everyday lives.

The findings, appearing in the February issue of Diabetes Care, add more weight to a growing body of research suggesting that eliminating caffeine from the diet might be a good way to manage blood sugar levels.

Lane studied 10 patients with established type 2 diabetes and who drank at least two cups of coffee every day and who were trying to manage their disease through diet, exercise and oral medications, but no extra insulin. Each had a tiny glucose monitor embedded under their abdominal skin that continuously monitored their glucose levels over a 72-hour period.

Participants took capsules containing caffeine equal to about four cups of coffee on one day and then identical capsules that contained a placebo on another day. Everyone had the same nutrition drink for breakfast, but were free to eat whatever they liked for lunch and dinner.

The researchers found that when the participants consumed caffeine, their average daily sugar levels went up 8 per cent. Caffeine also exaggerated the rise in glucose after meals: increasing by 9 percent after breakfast, 15 percent after lunch and 26 per cent after dinner.

“We’re not sure what it is about caffeine that drives glucose levels up, but we have a couple of theories,” says Lane, who is the lead author of the study. “It could be that caffeine interferes with the process that moves glucose from the blood and into muscle and other cells in the body where it is used for fuel. It may also be that caffeine triggers the release of adrenaline – the ‘fight or flight” hormone that we know can also boost sugar levels.”

Either way, he says, the higher sugar levels that result from caffeine are bad news for diabetic patients.

There are no current guidelines suggesting diabetics shouldn’t drink coffee, but Lane says that day may come, if further studies bear out their findings.

“Coffee is such a common drink in our society that we forget that it contains a very powerful drug – caffeine. Our study suggests that one way to lower blood sugar is to simply quit drinking coffee, or any other caffeinated beverages. It may not be easy, but it doesn’t cost a dime, and there are no side effects,” Lane says.

Posted by dlife at 01:56 PM | Comments (14)

Warning Over Severe Weight Loss Caused by Chewing Gum

January 11, 2008

January 11, 2008 (Newswise) — In this week’s BMJ, doctors warn of excess sorbitol intake, a widely used sweetener in “sugar-free” products such as chewing gum and sweets.

Sorbitol has laxative properties and is poorly absorbed by the small intestine.

Their advice follows the cases of two patients with chronic diarrhoea, abdominal pain and severe weight loss. Although extensive investigations were carried out, final diagnosis was only established after detailed analysis of eating habits.

On questioning, both patients admitted consuming substantial amounts of sugar-free gum and sweets.

The first patient (a 21 year old woman) chewed large amounts of sugar-free gum, accounting for a total daily dose of 18-20g sorbitol (one stick of chewing gum contains about 1.25g sorbitol). The second patient (a 46 year old man) reported chewing 20 sticks of sugar-free gum and eating up to 200g of sweets each day, which together contained around 30g sorbitol.

After both patients started a sorbitol free diet, diarrhoea subsided, normal bowel movements resumed and weight gain was achieved.

As possible side effects are usually found only within the small print on foods containing sorbitol, consumers may be unaware of its laxative effects and fail to recognise a link with their gastrointestinal problems, write the authors.

In conclusion, they say, our cases demonstrate that sorbitol consumption can cause not only chronic diarrhoea and functional bowel complaints but also considerable unintended weight loss (about 20% of usual body weight). Thus, the investigation of unexplained weight loss should include detailed dietary history with regard to foods containing sorbitol.

Click here to view paper: http://press.psprings.co.uk/bmj/january/prac96.pdf

Posted by dlifenews at 09:53 AM | Comments (0)

The Devil in the Dark Chocolate

December 21, 2007

December 21, 2007 (EurekAlert) - Eating dark chocolate rich in flavanols* might be good for your heart, but gaining this potential health benefit can be tricky, according to an Editorial in this week’s issue of The Lancet.

Last month, a study in Circulation showed that dark chocolate that is rich in flavanols induced coronary vasodilatation and improved coronary vascular function in 11 heart-transplant recipients compared with patients taking a cocoa-free control chocolate. Other studies have also shown that dark chocolate has cardiovascular benefits.

But before we all rush to buy our festive supplies of dark chocolate, “there is a catch” states the editorial. Some chocolate manufacturers remove the flavanols, which are bitter, from the darkened cocoa solids, so that even dark-looking chocolate can have no flavanol, and thus no health benefit. Consumers are also kept in the dark about the flavanol content of chocolate because manufacturers rarely label their products with this information. Moreover, even if falvanols are present the editorial warns, “the devil in the dark chocolate is the fat, sugar, and calories it contains.” To gain any health benefit those who eat a moderate amount of flavanol-rich dark chocolate would have to balance the calories by reducing their intake of other foods, claims the editorial.

But after all Christmas is nearly upon us , and The Lancet wouldn’t want to disappoint. The editorial concludes: “Of course some would say that, in terms of food intake, the best and simplest health message would be to stay away from the chocolate and eat a healthy, balanced diet, low in sugar, salt, and fat, and full of fresh fruit and vegetables. We say: ‘Bah, humbug to that. Pass the chocolates.’”

Posted by dlifenews at 11:45 AM | Comments (0)

Sugary Drinks, Not Fruit Juice, May be Linked to Insulin

September 06, 2007

September 6, 2007 (EurekAlert) - Steady increases in consumption of sugar-sweetened beverages over the last several decades, as well as rates of Type 2 diabetes mellitus, led nutritional epidemiologists at the Jean Mayer USDA Human Nutrition Research Center on Aging (USDA HNRCA) at Tufts University and colleagues to explore the relationship between sugar-sweetened beverage consumption and insulin resistance, a precursor to Type 2 diabetes. Their findings suggest that higher consumption of sugar-sweetened drinks, but not 100 percent fruit juice, may be associated with insulin resistance, even in otherwise healthy adults.

“Study participants who consumed two or more sugar-sweetened beverages per day had significantly higher fasting blood levels of insulin as compared to participants who did not report consuming any such beverages, regardless of age, sex, weight, smoking status, or other dietary habits,” says senior author Paul Jacques, DSc, director of the Nutritional Epidemiology Program at the USDA HNRCA and professor at the Friedman School of Nutrition Science and Policy at Tufts University. “Higher fasting levels of insulin mean these study participants are more at risk for developing Type 2 diabetes. In contrast,” he says, “consumption of 100 percent fruit juice was not significantly related to any of our measures of insulin resistance.”

Study participants were 2,500 healthy men and women in the Framingham Offspring Study, a community-based study of cardiovascular disease among offspring of people in the original Framingham Heart Study. Participants reported their usual dietary intake for the previous year, which researchers used to determine average intakes of sugar-sweetened drinks (regular and caffeine-free colas and other carbonated beverages containing sugar), diet soft drinks (low-calorie colas with and without caffeine and other low-calorie carbonated beverages), and fruit juice (e.g., apple juice or apple cider, orange juice, and grapefruit juice). One serving of a sugar-sweetened drink or diet soda was considered equivalent to 12 fluid ounces, or a regular-sized can of soda. One serving of fruit juice was considered equivalent to six fluid ounces.

The researchers obtained blood samples from participants who fasted for at least eight hours, and measured the participants’ blood levels of insulin as well as glucose. High fasting glucose levels, like high fasting insulin levels, are a pre-cursor to Type 2 diabetes. “Unlike fasting insulin levels, fasting glucose levels were not significantly different between those who consumed sugar-sweetened drinks and those who did not,” says Jacques, “However, participants consuming two or more daily servings of 100 percent fruit juice had modestly lower fasting glucose levels, compared with those who did not consume fruit juice.” Although this observation might be due to the additional nutrients or other phytochemicals found in the juices, Jacques notes this also may be a consequence of the healthier lifestyle and dietary habits of fruit juice consumers. They were less likely to smoke than non-consumers, and consumed diets relatively lower in saturated fat and higher in total fiber.

Despite these results, Nicola McKeown, PhD, corresponding author and scientist in the Nutritional Epidemiology Program at the USDA HNRCA, does not advise increasing consumption of fruit juice. “While 100 percent fruit juice can be a healthful beverage, too much fruit juice can add excess calories and sugar to the diet. Whole fruit is often a better choice.”

Jacques and McKeown also caution that their results cannot be used to determine cause-and-effect relationships among caloric and non-caloric sugar-sweetened beverage consumption and insulin resistance. “It could be that people who drink sugar-sweetened beverages have other unhealthy behaviors that we did not account for,” says McKeown. “Sugar-sweetened drink consumption may prove to be an important determinant of insulin resistance, but more long-term studies of diverse populations that incorporate the use of more direct measures of insulin resistance are needed.” In the meantime, the researchers suggest that people continue to follow the recommendations in the 2005 Dietary Guidelines for Americans, increasing consumption of water while limiting intake of calorically sweetened, nutrient-poor beverages.

Posted by dlifenews at 11:53 AM | Comments (0)

Eating Pistachios May Reduce the Impact of Carbohydrates on Blood Sugar Levels

May 03, 2007

May 3, 2007 (Newswise) — “Heart disease remains the leading cause of death among both men and women and another 20 million people are living with diabetes each year – so these findings are very exciting and relevant,” said Dr. Cyril Kendall, lead researcher of the study and a professor in the University of Toronto's Department of Nutritional Sciences. “We know that controlling blood glucose levels is important for preventing and controlling diabetes and recent data indicate that it is also important in preventing heart disease. Controlling postmeal fluctuations in glucose appears to be particularly important. Pistachios have been shown to decrease risk factors for heart disease, however little has been known about the specific effects of pistachios on blood glucose until now. Our preliminary findings demonstrate that suppressing the glycemic (blood sugar) response of high carbohydrate foods may be part of the mechanism by which pistachios contribute to cardiovascular health and to the prevention and control of diabetes. More research is definitely warranted.”

“Glycemic Response of Pistachios – A Dose Response Study and Effect of Pistachios Consumed with Different Common Carbohydrate Foods on Postprandial Glycemia was presented today to more than 10,000 scientists at the Experimental Biology Conference in Washington, DC. The study is the first of its kind to examine the effects of pistachios and glucose levels in combination with carbohydrates. The research was led by University of Toronto’s Dr. Cyril Kendall and Dr. David Jenkins - researchers well known for their studies of the glycemic index which measures how rapidly sugars from foods are absorbed into the blood stream. Certain carbohydrates elevate blood sugar levels more quickly than other foods – like pistachios – that contain higher levels of protein, fiber and monounsaturated fat. In general, foods that do not quickly raise blood sugar are often considered healthier than their more processed counterparts.

Drs. Jenkins and Kendall and their research colleagues studied 10 healthy individuals who participated in a number of acute dietary studies over the course of two months. After an overnight fast, participants were given a one-, two- or three-ounce serving of pistachios alone or served with a slice of white bread and blood sugar levels were measured over a two-hour period. The findings suggest that consumption of pistachios with a carbohydrate-rich meal significantly lowered the d blood glucose response. As consumption of pistachios increased, the blood sugar lowering response was enhanced. In addition, when pistachios were consumed alone, the rise in blood glucose was minimal.

The researchers also monitored the effect of pistachios consumed with different common carbohydrate foods on postprandial glycemia, or blood sugar levels after eating. The addition of pistachios to a number of other commonly consumed carbohydrate-rich foods – such as mashed potatoes, pasta and rice – also resulted in significant reductions in the blood sugar response, compared to when these foods were eaten alone.

In July 2003, the U.S. Food and Drug Administration (FDA) approved a much-awaited qualified health claim for nuts and heart disease prevention. The claim states, "Scientific evidence suggests but does not prove that eating 1.5 ounces per day of most nuts, such as pistachios, as part of a diet low in saturated fat and cholesterol may reduce the risk of heart disease." According to the California Pistachio Commission, the University of Toronto’s research findings are important for individuals who are living a heart-healthy lifestyle and those that monitor their blood sugar levels.

“Most people with diabetes have other risk factors – such as high blood pressure and cholesterol that increase one's risk for heart disease and stroke. When combined with diabetes, these risk factors can add up to serious health problems,” explains Constance Geiger, PhD, RD, and consultant to the California Pistachio Commission. “Recent research has suggested that pistachios are a heart-healthy, high-protein snack. Now people have yet another reason to grab a handful – they may blunt the blood sugar response of meals and may be beneficial for assisting with long-term blood glucose control.”

Posted by dlifenews at 02:21 PM | Comments (2)

Keeping the Immune System From Starting a 'Food Fight'

May 3, 2007 (EurekAlert) - After every meal, the body must prevent the immune system from launching an all-out fight against food. Now, researchers report the identity of a nutrient "floodgate" that serves to protect against such an inflammatory immune response. Their findings appear in the May 4, 2007 issue of the journal Cell, a publication of Cell Press.

The researchers found that animals lacking a protein enriched in fat cells, called STAMP2, develop acute inflammation in deep pockets of visceral fat. The animals also showed symptoms of metabolic syndrome—including insulin resistance and fatty liver disease—even while eating a regular diet.

In those who regularly consume an overload of nutrients, the flood control protein may become overwhelmed and give out, leading to the chronic, low-grade inflammation characteristic of obesity and other metabolic diseases, the researchers suggest. Treatments designed to reinforce that barrier may therefore provide the "next frontier" of therapies to combat the rising tide of chronic metabolic disease, they said.

"Humans were not meant to deal with little to no exercise and a constant bombardment of nutrients," said Gökhan Hotamisligil of the Harvard School of Public Health of his team’s findings. "If we could find ways to strengthen STAMP2 or prevent its suppression, the body might retain control," effectively unlinking chronic overeating and obesity from other symptoms of metabolic disease. He cautioned, however, that the realization of such a treatment strategy remains uncertain and would require years of continued investigation.

Cells and organisms must strike an appropriate balance between nutrient sufficiency and surplus, the researchers explained. While adequate amounts of nutrients must be obtained to ensure health and survival, chronic overeating can lead to obesity and an array of associated metabolic disorders, including insulin resistance, fatty liver disease, type 2 diabetes, and cardiovascular disease. This cluster of chronic diseases now constitutes the largest global health threat, Hotamisligil said.

Their current findings pinpoint STAMP2 as a critical factor to prevent overt inflammatory responses during everyday nutrient fluctuations or conditions of nutrient excess. In fat cells, a lack of STAMP2 led to aberrant inflammatory responses to both nutrients and acute inflammatory stimuli, they reported.

Similarly, they showed that the visceral fat surrounding the internal organs of STAMP2-deficient mice became inflamed, and the animals developed spontaneous metabolic disease on a regular diet, manifesting insulin resistance, glucose intolerance, high blood sugar and lipid levels, and fatty liver disease. They also showed that the loss of STAMP2 exacerbated the metabolic symptoms of mice with a genetic predisposition to obesity due to other factors.

When food enters the system, STAMP2 normally keeps the immunity response "button" from getting pushed, Hotamisligil said.

"We suggest that, over time, the accumulation of small cellular stresses due to daily changes and fluctuations in nutrients in STAMP2-deficient mice may lead to the activation of inflammatory pathways and inhibition of insulin action, resulting in systemic metabolic deterioration over the long term," he continued.

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Posted by dlifenews at 12:57 PM | Comments (0)

Tart Cherries May Alter Heart/Diabetes Factors

May 01, 2007

May 1, 2007 (EurekAlert) — Tart cherries may be good for more than just making pie, according to new data from an animal study conducted by University of Michigan Health System researchers and presented today at a major scientific meeting.

In a study involving rats, the researchers report that animals that received powdered tart cherries in their diet had lower total cholesterol, lower blood sugar, less fat storage in the liver, lower oxidative stress and increased production of a molecule that helps the body handle fat and sugar, compared with rats that didn't receive cherries as part of an otherwise similar diet. All of the rats had a predisposition toward high cholesterol and pre-diabetes, but not obesity.

All the measures on which the two groups of animals differed are linked to metabolic syndrome, a collection of risk factors linked to high rates of heart disease and Type 2 diabetes. Tens of millions of Americans have metabolic syndrome; most don't know it.

The researchers say the correlation between cherry intake and significant changes in metabolic measurements suggest a positive effect from the high concentrations of antioxidant compounds called anthocyanins that are found in tart cherries. The new results were given today in an oral presentation at the Experimental Biology 2007 meeting in Washington, D.C.

It's not yet known if cherry-rich diets might have a similar impact in humans, but a U-M team will soon launch a small clinical trial to start to find out. Meanwhile, additional research is being carried out in animals prone to both obesity and diabetes.

The study's lead author is E. Mitchell Seymour, M.S., a U-M research associate and supervisor of the U-M Cardioprotection Research Laboratory, which studies the potential preventive benefits of antioxidant-rich foods. Support for the new study comes from an unrestricted grant from the Cherry Marketing Institute, a trade association for the cherry industry. CMI has no influence on the design, conduct or analysis of any U-M research it funds.

Seymour and the laboratory's director, U-M cardiac surgeon Steven Bolling, M.D., caution that their results cannot be directly translated into humans. But they are encouraged by the positive signs seen in the new data.

"Rats fed tart cherries as 1 percent of their total diet had reduced markers of metabolic syndrome," says Seymour. "Previous research by other groups studied pure anthocyanin compounds rather than anthocyanin-containing whole foods, and they used concentrations of anthocyanins that would be very difficult if not impossible to obtain in the diet."

He continues, "We are interested in a whole-foods approach, using amounts of fruit that are relevant to human diets. We are enthusiastic about the findings that tart cherries conferred these beneficial effects at such a modest daily intake."

The potential for protective effects from antioxidant-rich foods and food extracts is a promising area of research, says Bolling, who is the Gayle Halperin Kahn Professor of Integrative Medicine, a professor of cardiac surgery, co-director of U-M Integrative Medicine and member of the U-M Cardiovascular Center.

"These data from whole tart cherries join other findings that suggest a correlation between anthocyanin intake and reductions in cardiovascular and metabolic risk factors," he says. "But there is still a long way to go before we can advocate any course of action for humans. Still, the growing body of knowledge is encouraging."

Bolling and Seymour performed the study using 48 male Dahl Salt-Sensitive rats, which are bred for their susceptibility to salt-linked high blood pressure, high cholesterol and impaired glucose tolerance.

For 90 days beginning in their sixth week of life, the rats were fed either a carbohydrate-enriched diet or a diet that, by weight, included 1 percent cherries or 10 percent cherries. The higher cherry dose was used to look for any toxic effects; none were seen.

The cherries were Montmorency tart cherries grown in northern Michigan, frozen, and powdered. Michigan is the nation's largest producer of tart cherries, which are used in pies and jams as well as juice. They are different from the sweet Bing cherries that are often eaten raw, and have higher concentrations of antioxidant anthocyanins than sweet cherries.

By the end of the study, the rats that received the 1-percent cherry diet had total cholesterol, triglyceride, glucose and insulin levels that were significantly lower than those of the rats that did not receive cherries. The same was true for those on the 10-percent cherry diet, compared with rats that received a diet with an equivalently high level of carbohydrates not from cherries.

The researchers also measured plasma TEAC, a measure of antioxidant capacity in the blood on which a higher reading means better ability to neutralize damaging free radical molecules produced in the body during metabolism. The rats that received cherries had higher antioxidant capacity, indicating lower oxidative stress in their bodies, than those that did not.

In addition to blood measures, the researchers measured the level of fat in the livers of the rats, and the genetic expression of PPAR (peroxisome proliferator-activating receptor) in the liver.

The "fatty liver" measure is important because the storage of excess energy as fat in the liver is a common effect in metabolic syndrome – and because it feeds the vicious cycle of increased cholesterol and decreased response to insulin that can lead to cardiovascular disease and Type 2 diabetes.

Meanwhile, the measure of PPAR messenger RNA in the liver reflects the readiness of the liver tissue to express functional PPAR. PPAR is important to the process by which the body burns fat instead of storing it, and it is important in the formation of blood lipids like LDL, typically known as the "bad cholesterol". Drugs in the classes known as thiazolidinediones and glitazars activate PPAR and are often used to manage high cholesterol and risk for Type 2 diabetes.

In the current study, the rats that received cherries had both a lower level of fat in their livers, and a higher expression of the PPAR gene, than those that did not – and the correlation between the two was dose-dependent.

Now, the Cardioprotection Laboratory team has embarked on a new study in rats that have Type 2 diabetes, both with and without obesity and in the presence of low-fat and high-fat diets. They will look at whether tart cherries have an impact on the storage of fat in fat tissue and in muscle, and on the production of specific blood lipids like LDL and HDL. In addition, they will characterize cherries chemically, to assess the levels of phytochemicals in whole cherries, cherry juice and dry cherries.

Meanwhile, U-M Integrative Medicine co-director Sara Warber. M.D., an assistant professor of family medicine at the U-M Medical School, will lead a pilot clinical trial of whole tart cherries in humans. The study will enroll healthy individuals who will spend a night at the U-M General Clinical Research Center, and have their blood tested multiple times to look for the breakdown products of cherries.

Posted by dlifenews at 09:41 AM | Comments (0)

Holiday Gluttony Can Spell Disaster for Undiagnosed Diabetics

November 21, 2006

November 21, 2006 (Newswise) — Hearty feasts and couch-potato marathons are holiday traditions, but UT Southwestern Medical Center experts warn that packing on pounds and not exercising could be deadly for the 6 million Americans who have diabetes and don’t even know it.

Diabetes, a metabolic disorder linked with obesity, can be a silent killer because its symptoms aren’t sudden, but build up over time and lead to heart disease or other maladies.

That’s bad news for those with undiagnosed diabetes.

“The obesity epidemic is surging and people don’t realize they’re setting themselves up to develop diabetes. They’re like ticking time bombs,” said Dr. Manisha Chandalia, an endocrinologist at UT Southwestern. “Without treatment, high levels of blood sugars in the body can damage blood vessels and nerves over time, leading to high cholesterol, hypertension, stroke, kidney disease and amputations.”

If you are age 40 or older, obese, lack physical activity or have a family history of diabetes, Dr. Chandalia recommends making time during the holidays to visit a doctor for a diabetes test. Symptoms include excessive thirst or hunger, dramatic weight loss, fatigue, frequent urination or blurry vision.

The holidays also are a perfect time to start getting healthy, she said, offering these tips:

• Set consistent meal times. Avoid fast food.
• At parties, cut food portions in half or don’t eat large portions of food, even healthy food. Eat skinless chicken or turkey.
• Use low-calorie ingredients when making treats.
• Exercise regularly. Go on walks to see holiday displays.
• If you are an appropriate weight for your age, maintain your weight. In certain ethnicities, such as Asians, even modest weight gain can set the stage for developing diabetes.
Long-term tips include:
• If you are overweight, try to lose 5 percent to 7 percent of your body weight through exercise and eating right.
• Exercise regularly. Walk at least 30 minutes a day.
• Eat a nutritious diet high in fiber and whole grain. Reduce the intake of high-calorie food.

“Various research studies have shown that maintaining a healthy lifestyle with a balanced diet, weight management and regular exercise can prevent the development of diabetes or help control an existing condition,” said Dr. Chandalia, an associate professor of internal medicine.

Diabetes has several basic forms and stages:

Pre-diabetes: People have higher-than-normal blood sugar levels but the levels are not high enough for a diabetes diagnosis.

Type 1: The immune system attacks insulin-producing beta cells in the pancreas, requiring insulin to survive. This typically affects children.

Type 2: The body can’t efficiently use its own insulin and insulin production can’t keep up with the high demand, so glucose builds up in the blood and the body can’t burn the blood sugars that are its main source of fuel. This is normally associated with older age, obesity, diabetic family history, physical inactivity and certain ethnicities, but is increasingly diagnosed in overweight children as well.

With about 14 million diagnosed cases of type 1 or type 2 diabetes and 6 million undiagnosed cases, it’s vital to stay healthy during the holidays, Dr. Chandalia said.

Keep in mind, she said, that it takes more than avoiding sugary treats.

“Diabetes doesn’t occur just because of eating sugar. Sugar, as any other food, provides excess calories that can lead to obesity and a predisposition to diabetes,” Dr. Chandalia said. “If you don’t eat sugar, and continue to eat extra calories from other foods, you may still develop diabetes.”

Posted by dlife at 08:19 AM | Comments (0)

Fruit Yogurt Could Play an Important Role in Diabetes Management

November 09, 2006

November 9, 2006 (Newswise) — Yogurt enriched with fruit or made from soy could play an important dietary role for people living with type 2 diabetes and high blood pressure, suggests new findings by University of Massachusetts Amherst researchers.

Led by Kalidas Shetty, the UMass Amherst scientists screened extracts from a sampling of dairy and soy yogurts for properties that could help keep diabetes and hypertension in check, such as the activity level of enzymes that help moderate blood glucose levels. The researchers found that fruit-enriched yogurts—especially those made with blueberries or made from soy—contain active natural compounds that may curb some aspects of diabetes, the researchers report in an upcoming issue of the Journal of Food Biochemistry.

The findings provide a strong rationale for further clinical studies, and for incorporating “healthy diet design” into disease management strategies, says Shetty. “What one eats should be part of an overall approach to therapy,” he says.

Doctoral students Emmanouil Apostolidis and Young-In Kwon collaborated with Shetty on the research.

Type 2 diabetes, which accounts for roughly 90 percent of U.S. cases, is often associated with obesity, high blood pressure and elevated levels of cholesterol. The disease is characterized by an abnormal rise in blood sugar right after a meal. This chronic high blood sugar, known as hyperglycemia, is associated with many of the complications that can arise from the disease, including the failure of various organs such as the kidneys, heart, eyes and problems with nerves and blood vessels.

Medications that prevent the spike in blood glucose often target certain enzymes—in particular, enzymes that are responsible for modifying carbohydrates before they can be absorbed by the small intestine. Carbohydrates are the major source of blood sugar and inhibiting these carb-altering enzymes—alpha-amylase and alpha-glucosidase—slows the body’s absorption of sugars.

The researchers were also interested in a third enzyme—angiotensin-I converting enzyme or ACE-I—which plays a role in the constriction of blood vessels. Medications known as ACE inhibitors block the activity of this enzyme, and such medications are used in treating high blood pressure in both diabetic and non-diabetic patients.

Such medications have been shown to be an effective strategy for diabetes management, yet they can have unwanted side effects, says Shetty. Previous research by Shetty and others found that certain plant compounds also play a role in blocking all three of these enzymes, opening up the possibility that foods rich in such compounds may provide health benefits, but without the adverse side affects, he says.

So Shetty and his team went to the local supermarket and bought peach, strawberry, blueberry and plain yogurts made by four different brands, including a soy brand. The researchers took samples of each yogurt, and tested their ability to inhibit each of the enzymes of interest, using water or a buffer solution as a control.

Of all the sampled yogurts, soy yogurt enriched with blueberries packed the most punch, inhibiting the activity of all three enzymes tested, the researchers report. Peach and strawberry enriched yogurts also fared well in their ability to inhibit the carb-altering enzymes alpha-amylase and alpha-glucosidase.

The researchers also tested the yogurts for antioxidant activity and the quantity of a group of plant chemicals known as phenols. Phenols and polyphenols are found in a wide variety of plants; they give red wine and tea their heart-healthy boosts and are especially prominent in dark-colored fruits and vegetables. The benefits of these compounds seem to come from their antioxidant powers—polyphenols scavenge cells for nasty free radicals such as reactive forms of oxygen. Free radicals can damage cellular machinery much the way that metal is turned to rust.

The extracts from blueberry yogurts had the second-highest concentrations of phenols and the most antioxidant activity, the researchers found, beat out only by soy (even the plain soy yogurt had higher phenol content than any regular yogurt with fruit). The blueberry extracts also were the best at blocking the action of alpha-glucosidase, which was correlated with the amount of phenols.

There was much more variation in which extracts inhibited alpha-amylase and ACE-I, and it wasn’t necessarily correlated with phenol content says Shetty. Soy yogurts had the highest phenol content overall, and were the best at inhibiting ACE-I.

A growing body of research indicates that diets rich in fruits and vegetables are associated with lower incidences of certain diseases, and plant compounds such as phenols are of increasing interest to scientists, says Shetty. How these dietary antioxidants mediate disease isn’t clearly understood, Shetty suspects that they stimulate the body’s own antioxidant enzymes to shift into a defense mode that protects tissues from chronic disease, many of which are associated with damaging free radicals.

“The numbers of people with environment-related diseases are going through the roof,” says Shetty, noting that in the United States alone more than 20 million people are estimated to have diabetes. Worldwide estimates are that 170 million to 200 million people have diet-linked type 2 diabetes, and the World Health Organization expects those numbers to double by the year 2030.

“Poor communities and especially Native Americans are afflicted with type 2 diabetes more than other communities,” say Shetty. “Cost-effective dietary changes are essential for fighting this disease, and traditional diets that have a higher content of these protective antioxidants are an important part of the solution. We should be able to use diet along with other therapies, and diabetes is a disease where this especially makes sense.”

Posted by dlife at 10:08 AM | Comments (1)

How To Eat To Prevent Or Treat Diabetes - ADA Releases First Food Guidelines Tailored To Medical Categories

August 25, 2006

ALEXANDRIA, Va., Aug 25, 2006 (PRNewswire via COMTEX) - Whether you're trying to prevent diabetes, better manage your disease or slow complications from developing, the American Diabetes Association (ADA) has developed specific guidelines to help you choose the right meal plan to get you to your goals.

Published in the September issue of Diabetes Care, the ADA's revised medical nutrition therapy recommendations update statements published in 2002 and 2004 using the most recent scientific data available. For the first time, the guidelines categorize medical nutrition advice according to a person's medical condition, breaking out recommendations for people at high risk for diabetes; managing existing diabetes; and trying to prevent or slow the rate of development of diabetes complications. Specific recommendations are also included for people with type 1 diabetes, pregnant or nursing mothers with diabetes, older adults, and those living in long-term care facilities or managing acute illnesses such as kidney disease.

"When you're talking about diabetes, there is no 'one size fits all' diet," said Ann Albright, PhD, RD, President-Elect, Health Care & Education, American Diabetes Association. "For people with diabetes and those at risk for type 2 diabetes, medical nutrition therapy should be tailored to a person's specific health issues and personal preferences to help maintain optimum health by controlling blood glucose levels, blood pressure, cholesterol, and other risk factors. We hope these recommendations will help people make better choices about what they eat and how they live to maximize their chances of staying healthy."

The recommendations emphasize the importance of sustained, moderate weight loss for people who are overweight or obese and increased physical activity for all people at risk for or living with diabetes. They also pointedly ask people with diabetes to avoid fad diets, such as those that promote extreme low-carbohydrate or high-protein intake.

"There is no evidence that these diets are successful at helping people keep weight off once they lose it, and there are ample concerns about the fiber, vitamins, and minerals people give up when they severely restrict their diet, say by sharply limiting carbohydrate intake," said Dr. Albright. "Fad diets come and go. We want people to be provided with sound nutrition advice that will help them in making choices for maintaining good health for the long term."

For people who are at risk for diabetes, the guidelines call for a diet high in fiber and nutrient-rich foods (14 grams of fiber for every 1,000 calories), with whole grains making up half of all grain intake. In emphasizing the importance of weight loss, they note that medications may be useful for some individuals if combined with lifestyle changes, and that for the very obese, weight loss surgery has shown considerable health benefits. They also caution people who use meal replacements to lose weight that research finds the weight loss is only maintained as long as people stay on the meal replacement plan. Exercise is recommended independent of weight loss because studies show it helps lower blood glucose levels, increases insulin sensitivity, and improves cardiovascular risk factors regardless of whether the person loses any weight.

For people who already have diabetes, the nutrition guidelines are more specific. They include carbohydrates from fruits, vegetables, whole grains, legumes and low-fat milk; eating fiber-rich foods; keeping saturated fats to less than 7 percent of total caloric intake; eating at least two servings of non-fried fish per week; limiting trans fats; and restricting cholesterol intake to less than 200 mg/day.

The recommendations note that there is no evidence that type 1 diabetes can be prevented through medical nutrition therapy. They also caution that, while there is not yet sufficient evidence to include guidelines for children at risk for or living with type 2 diabetes, it is reasonable to assume the same general advice given to adults would benefit children. Studies looking specifically at how medical nutrition therapy affects children are currently underway.

Diabetes Care, published by the American Diabetes Association, is the leading peer-reviewed journal of clinical research into the nation's fifth leading cause of death by disease. Diabetes also is a leading cause of heart disease and stroke, as well as the leading cause of adult blindness, kidney failure, and non-traumatic amputations. For more information about diabetes, visit the American Diabetes Association Web site http://www.diabetes.org or call 1-800-DIABETES (1-800-342-2383).

Posted by dlife at 10:47 AM | Comments (0)

Vegan Diet Bests ADA Plan at Diabetes Control

August 09, 2006

WASHINGTON, Aug. 9 -- The Physicians Committee for Responsible Medicine, a crusading group that has long ranked vegetarianism high on its agenda, has made a compelling case for a low-fat vegan diet to improve glycemic control.

Both a low-fat vegan diet and a diet following American Diabetes Association guidelines improved glycemic control and cardiovascular risk factors in patients with type 2 diabetes, found a 22-week study partially funded by NIH and published in the August issue of Diabetes Care.

But the vegan diet was better, reported Neal D. Barnard, M.D., an adjunct associate professor of medicine at George Washington University, who is president of the Physicians Committee for Responsible Medicine, and colleagues.

The vegan diet -- consisting of fruits, vegetables and grains but no animal products and only limited added fats -- did a better job of lowering glycated hemoglobin (HbA1C) levels, body weight, and LDL, reported Dr. Barnard.

The authors compared results among patients with type 2 diabetes assigned to either a vegan diet or one that adhered to ADA guidelines. The rationale for the study was to determine, independent of exercise, whether low-fat vegan diets could significantly improve glycemic control and reduce cardiovascular risk factors, Dr. Barnard and colleagues wrote.

"Diabetes prevalence is relatively low among individuals following plant-based and vegetarian diets, and clinical trials using such diets have shown improvements in glycemic control and cardiovascular health," the authors said. "Most of these trials have also included exercise, thus making it impossible to isolate diet effects."

Previously, Dr. Barnard was co-author of a 12-week pilot trial of a low-fat vegan diet in patients with type 2 diabetes who did not increase their exercise levels (if any) during the trial. The authors found that fasting serum glucose concentrations dropped 28% compared with 12% in the control group following a diet based on ADA guidelines (P<0.05). The results of this trial were published in Preventive Medicine in 1999.

Additionally, in a different study published in the American Journal of Medicine in 2005, Dr. Barnard and colleague found that nondiabetic overweight women on a similar diet, also used in the absence of exercise, had increased insulin sensitivity and reduced body weight.

In the current study, the investigators randomly assigned 99 men and women with type 2 diabetes to either a low-fat vegan diet (49 patients) or to a diet following ADA guidelines (50 patients).

The vegan diet consisted of about 10% of energy from fat, 15% protein, and 75% carbohydrate, and included vegetables, fruits, grains, and legumes. "Participants were asked to avoid animal products and added fats and to favor low-glycemic index foods, such as beans and green vegetables. Portion sizes, energy intake, and carbohydrate intake were unrestricted," the authors noted.

The ADA diet consisted of about 15% to 20% protein, less than 7% saturated fat, 60% to 70% carbohydrate and monounsaturated fats, and cholesterol up to 200 mg/day. This diet was individualized, on the basis of a participant's body weight and plasma lipid concentrations.

No meals were provided for either group, and both took vitamin B12 supplements 100 mcg every other day. Patients were followed for 22 weeks.

Among all patients, 43% (21 of 49) of the vegan group and 26% (13 of 50) of the ADA group were able to reduce their diabetes medications. A1C levels dropped by 0.96% in the vegan diet group, compared with 0.56% in the ADA diet group, a difference that was not significant (P=0.089).

Among patients who did not change diabetes medications during the study, however, A1C decreased by 1.23% in the vegan group, compared with 0.38% in the ADA group (P=0.01).

Participants in both groups lost weight, but patients on the vegan diet lost twice as much as those on the ADA diet-6.5 kg (14.3 lbs) compared with 3.1 kg (6.82 lbs), respectively.

The change in body weight correlated with decreases in HbA1C change (r=0.51, n=57, P<0.0001).

Among patients who did not change their lipid-lowering medications, LDL dropped 21.2% in the vegan group and 10.7% in the ADA group (P=0.02).

"The reduction in urinary albumin was significant in the vegan group (P=0.002) but not in the ADA group (P=0.14)," the investigators wrote. "The unadjusted between-group difference was not significant. However, after adjustment for baseline values, the effect of diet was significant (P=0.013)."

The vegan diet "appears remarkably effective, and all the side effects are good ones -- especially weight loss and lower cholesterol," said Dr. Barnard.

"I hope this study will rekindle interest in using diet changes first, rather than prescription drugs," he added.

The authors acknowledged that the analysis of HbA1C changes was confounded by the fact that both diets made patients more susceptible to hypoglycemic effects from their medications, resulting in medication reductions. This meant that the analysis of HbA1C changes could only be carried out in patients whose medications were unchanged throughout the study.

In addition, most study participants were taking antihypertensive agents, making it difficult to interpret a potential effect of diet on blood pressure.

Posted by dlife at 10:33 AM | Comments (0)

Vegan Diet Bests ADA Plan at Diabetes Control

WASHINGTON, Aug. 9 -- The Physicians Committee for Responsible Medicine, a crusading group that has long ranked vegetarianism high on its agenda, has made a compelling case for a low-fat vegan diet to improve glycemic control.

Both a low-fat vegan diet and a diet following American Diabetes Association guidelines improved glycemic control and cardiovascular risk factors in patients with type 2 diabetes, found a 22-week study partially funded by NIH and published in the August issue of Diabetes Care.

But the vegan diet was better, reported Neal D. Barnard, M.D., an adjunct associate professor of medicine at George Washington University, who is president of the Physicians Committee for Responsible Medicine, and colleagues.

The vegan diet -- consisting of fruits, vegetables and grains but no animal products and only limited added fats -- did a better job of lowering glycated hemoglobin (HbA1C) levels, body weight, and LDL, reported Dr. Barnard.

The authors compared results among patients with type 2 diabetes assigned to either a vegan diet or one that adhered to ADA guidelines. The rationale for the study was to determine, independent of exercise, whether low-fat vegan diets could significantly improve glycemic control and reduce cardiovascular risk factors, Dr. Barnard and colleagues wrote.

"Diabetes prevalence is relatively low among individuals following plant-based and vegetarian diets, and clinical trials using such diets have shown improvements in glycemic control and cardiovascular health," the authors said. "Most of these trials have also included exercise, thus making it impossible to isolate diet effects."

Previously, Dr. Barnard was co-author of a 12-week pilot trial of a low-fat vegan diet in patients with type 2 diabetes who did not increase their exercise levels (if any) during the trial. The authors found that fasting serum glucose concentrations dropped 28% compared with 12% in the control group following a diet based on ADA guidelines (P<0.05). The results of this trial were published in Preventive Medicine in 1999.

Additionally, in a different study published in the American Journal of Medicine in 2005, Dr. Barnard and colleague found that nondiabetic overweight women on a similar diet, also used in the absence of exercise, had increased insulin sensitivity and reduced body weight.

In the current study, the investigators randomly assigned 99 men and women with type 2 diabetes to either a low-fat vegan diet (49 patients) or to a diet following ADA guidelines (50 patients).

The vegan diet consisted of about 10% of energy from fat, 15% protein, and 75% carbohydrate, and included vegetables, fruits, grains, and legumes. "Participants were asked to avoid animal products and added fats and to favor low-glycemic index foods, such as beans and green vegetables. Portion sizes, energy intake, and carbohydrate intake were unrestricted," the authors noted.

The ADA diet consisted of about 15% to 20% protein, less than 7% saturated fat, 60% to 70% carbohydrate and monounsaturated fats, and cholesterol up to 200 mg/day. This diet was individualized, on the basis of a participant's body weight and plasma lipid concentrations.

No meals were provided for either group, and both took vitamin B12 supplements 100 mcg every other day. Patients were followed for 22 weeks.

Among all patients, 43% (21 of 49) of the vegan group and 26% (13 of 50) of the ADA group were able to reduce their diabetes medications. A1C levels dropped by 0.96% in the vegan diet group, compared with 0.56% in the ADA diet group, a difference that was not significant (P=0.089).

Among patients who did not change diabetes medications during the study, however, A1C decreased by 1.23% in the vegan group, compared with 0.38% in the ADA group (P=0.01).

Participants in both groups lost weight, but patients on the vegan diet lost twice as much as those on the ADA diet-6.5 kg (14.3 lbs) compared with 3.1 kg (6.82 lbs), respectively.

The change in body weight correlated with decreases in HbA1C change (r=0.51, n=57, P<0.0001).

Among patients who did not change their lipid-lowering medications, LDL dropped 21.2% in the vegan group and 10.7% in the ADA group (P=0.02).

"The reduction in urinary albumin was significant in the vegan group (P=0.002) but not in the ADA group (P=0.14)," the investigators wrote. "The unadjusted between-group difference was not significant. However, after adjustment for baseline values, the effect of diet was significant (P=0.013)."

The vegan diet "appears remarkably effective, and all the side effects are good ones -- especially weight loss and lower cholesterol," said Dr. Barnard.

"I hope this study will rekindle interest in using diet changes first, rather than prescription drugs," he added.

The authors acknowledged that the analysis of HbA1C changes was confounded by the fact that both diets made patients more susceptible to hypoglycemic effects from their medications, resulting in medication reductions. This meant that the analysis of HbA1C changes could only be carried out in patients whose medications were unchanged throughout the study.

In addition, most study participants were taking antihypertensive agents, making it difficult to interpret a potential effect of diet on blood pressure.

Posted by dlife at 10:33 AM | Comments (0)