October 22, 2016

Quick Test to Detect Inflammation in PWD

Scientists from Nanyang Technological University, Singapore (NTU Singapore) have developed a new kit that will allow doctors to find out within minutes if diabetic patients are suffering from inflammation.

Current procedures require patients to wait for several hours for the results obtained from the conventional full blood count test.

Also, instead of a vial of blood in the present method, the new test kit only needs a drop of blood to test if a patient is suffering from inflammation caused by abnormal immune cell activation.

In conventional procedures, blood cells need to be physically separated for analyzing, which is time consuming and laborious, while the new test kit does this automatically.

This made-in-Singapore test kit may also see the cost of such tests becoming more affordable as it costs less than a dollar to produce.

Diabetes is a serious health problem, which affects about 10 per cent of the world's population. Singapore has the second-highest proportion of diabetics among developed nations at 10.53 per cent, as estimated by International Diabetes Federation (IDF) in 2015.

Type 2 diabetes is the most common and is usually treated with lifestyle changes, medication and insulin. If diabetic patients can be grouped based on their inflammation status in addition to glucose level, then doctors can better choose the treatment best suited for their patients.

Dr Hou Han Wei, a senior research fellow from NTU's Lee Kong Chian School of Medicine invented the new chip that forms the key component of the test kit.

"By designing very tiny channels on our chip, we are able to physically separate the various blood cells by size into the different outlets, like a coin-sorting machine," explained Dr Hou.

White blood cells form a significant part of our body's immune system and a key type known as neutrophils, is the first line of defense whenever infection or inflammation strikes.

"Analyzing these separated neutrophils could help indicate how bad an inflammation is and if there is an increased risk of infection for diabetic patients," said Dr Hou.

Dr Hou's new chip and research findings were published earlier this year in Scientific Reports, a peer-reviewed scientific journal under the Nature Publishing Group.

"Hopefully in future, clinicians can accurately tailor the right combination of drugs and thus offer a more targeted treatment approach for all diabetic patients," added Dr Hou, the recipient of the inaugural Postdoctoral Fellowship offered by the medical school in 2014.

The NTU team discovered that neutrophils could be used as a biomarker to determine if diabetic patients are suffering from an inflammation. Using the new test kit, neutrophils can be easily extracted from a blood sample, and their behavior and function observed for more efficient inflammation profiling in additional to the cell count.

In healthy individuals, neutrophils float free in the blood stream. When there is an acute inflammation such as during a bacterial or viral infection, they will slow down and roll along the vessel walls. Once near the site of infection, they squeeze through the vessel walls and move to the site of the injury.
In diabetic patients, the neutrophils roll faster, which means that fewer of them will manage to squeeze through the vessel wall to tackle the infection.

The increased rolling speeds of neutrophils correlate closely with cholesterol and c-reactive protein levels (a biomarker for inflammation) so it provides doctors with a better indicator of an individual's immune status, Dr Hou explained.

Please read the entire article, as it is a lengthy article.

October 21, 2016

Coca-Cola, PepsiCo Funded Health Organizations

The two biggest soda companies in the United States - Coca-Cola and PepsiCo - sponsored a minimum of 96 national health organizations between 2011-2015, a new study reveals.

Lead author Daniel Aaron and co-author Dr. Michael Siegel, of the Boston University School of Medicine, publish their findings in the American Journal of Preventive Medicine.

The researchers say their results suggest big drink companies are hampering efforts to improve health and nutrition in the U.S., and they call for health organizations to refuse funding from these companies.

Sugary drink consumption has become a major public health concern in recent years, with links to obesity, diabetes, and heart disease.

It seems there are some industries that have long tried to dampen reports of the health risks of these beverages; a study published last month, for example, revealed how the sugar industry accepted money as early as 1965 to mute the link between sugar intake and heart disease.

The new study from Aaron and Dr. Siegel adds fuel to the fire, providing insight into the funding national health organizations have received from soda giants over the past 5 years.

Aaron and Dr. Siegel reached their findings by investigating data on which health organizations received funding from Coca-Cola between 2011-2015, as well as what health bills the two soda giants lobbied against.

Among the organizations accepting such sponsorships: the CDC, the American Diabetes Association, the American Cancer Society, the American Heart Association, and the American Academy of Pediatrics.

Over the 5-year period, the team identified a total of 96 national health organizations that accepted money from the companies. Of these, 83 accepted money from Coca-Cola, one accepted money from PepsiCo, and 12 accepted money from both companies.

Unlike Coca-Cola, PepsiCo does not publish a list of organizations it provides finance to, so the researchers say it is likely that even more health organizations received funding.

The team was surprised to find that the American Diabetes Association and the Diabetes Research Foundation were two of the organizations that accepted funding from the soda companies, given the well-established link between sugary drink intake and diabetes.

The results showed that the two soda companies sponsored a total of 96 national health organizations: 63 public health organizations, 19 medical organizations, seven health foundations, five government organizations, and two food supply groups.

October 20, 2016

Complications of Uncontrolled Diabetes

It can take work to get your diabetes under control, but the results are worth it.  If you don't make the effort to get a handle on it, you could set yourself up for a host of complications. Diabetes can take a toll on nearly every organ in your body, including the:
  • Heart and blood vessels
  • Eyes
  • Kidneys
  • Nerves
  • Gums and teeth
#1. Heart and Blood Vessels Heart disease and blood vessel disease are common problems for many people who don’t have their diabetes under control. You're at least twice as likely to have heart problems and strokes as people who don’t have the condition are.

Blood vessel damage or nerve damage may also cause foot problems that, in rare cases, can lead to amputations. People with diabetes are ten times likelier to have their feet and legs removed than those without the disease.

Symptoms: You might not notice warning signs until you have a heart attack or stroke. Problems with large blood vessels in your legs can cause leg cramps, changes in skin color, and less sensation.

The good news: Many studies show that controlling your diabetes can help you avoid these problems, or stop them from getting worse if you have them.

#2. Eyes Diabetes is the leading cause of new vision loss among adults ages 20 to 74 in the U.S. It can lead to eye problems, some of which can cause blindness if not treated:
  • Glaucoma
  • Cataracts
  • Diabetic retinopathy
Symptoms: Vision problems, sight loss, or pain in your eye if you have diabetes-related eye disease.

The good news: Studies show that regular eye exams and timely treatment of these kinds of problems could prevent up to 90% of diabetes-related blindness.

#3. Kidney Disease Diabetes is the leading cause of kidney failure in adults in the U.S., accounting for almost half of new cases.

Symptoms: You might not notice any problems with early diabetes-related kidney disease. In later stages, it can make your legs and feet swell.

The good news: Drugs that lower blood pressure (even if you don't have high blood pressure) can cut your risk of kidney failure by 33%.

#4. Nerves Over time, high blood sugar levels can harm your nerves. As many as 70% of people with diabetes get this type of damage.
  • Peripheral diabetic neuropathy can cause pain and burning or a loss of feeling in your feet. It usually starts with your toes. It can also affect your hands and other body parts.
  • Autonomic neuropathy stems from damage to the nerves that control your internal organs. Symptoms include sexual problems, digestive issues (a condition called gastroparesis), trouble sensing when your bladder is full, dizziness and fainting, or not knowing when your blood sugar is low.
The good news: You have many options to treat your pain. The doctor might prescribe an antidepressant, a medication that stops seizures (called an anticonvulsant). He could also give you drugs that go on your skin, like creams or patches. He might suggest you use a device that stimulates your nerves called TENS (transcutaneous electrical nerve stimulation).

#5. Teeth Having diabetes puts you at higher risk for gum disease.

Symptoms: Your gums might be red and swollen and bleed easily.

The good news: If you keep your blood sugar under control, visit your dentist regularly, and take good care of your teeth each day by brushing, flossing and rinsing with an antiseptic mouthwash. In doing so you can avoid gum problems and tooth loss.

Take Charge of Your Condition  Some people have to make only small lifestyle changes to keep their blood sugar under control to reverse a diabetes complication. Others need medications to stop them from getting worse.

Treatment of complications focuses on slowing down the damage. That may include medication, surgery, or other options.

The most important ways to slow diabetes complications are to keep your blood sugar levels under control, eat right, exercise, avoid smoking, and get high blood pressure and high cholesterol treated.

October 19, 2016

How Insulin Resistance, Metabolic Disease Begin

Science is sometimes wrong and at other times very revealing. The answer may not be simple, but a study published Sept. 26 in the Journal of Clinical Investigation adds to growing research linking excessive sugar consumption, specifically the sugar fructose, to a rise in metabolic disease worldwide.

The study, conducted in mice and corroborated in human liver samples, unveils a metabolic process that could upend previous ideas about how the body becomes resistant to insulin and eventually develops diabetes.

"There is still significant controversy as to whether sugar consumption is a major contributor to the development of diabetes," said senior author Mark Herman, M.D., assistant professor in the Division of Endocrinology, Metabolism, and Nutrition at Duke University School of Medicine.

"Some investigators contend that commonly consumed amounts of sugar do not contribute to this epidemic," Herman said. "While others are convinced that excessive sugar ingestion is a major cause. This paper reveals a specific mechanism by which consuming fructose in large amounts, such as in soda, can cause problems."

Insulin is a key hormone that regulates blood glucose after eating. Insulin resistance, when the body's metabolic tissues stop responding normally to insulin, is one of the earliest detectable changes in the progression to diabetes.

However, according to this study, the cause of insulin resistance may have little to do with defects in insulin signaling and might actually be caused by a separate process triggered by excess sugar in the liver that activates a molecular factor known as carbohydrate-responsive element-binding protein, or ChREBP.

The ChREBP protein is found in several metabolic organs in mice, humans and other mammals. In the liver, it is activated after eating fructose, a form of sugar naturally found in fruits and vegetables, but also added to many processed foods including soft drinks. The study found that fructose initiates a process that causes the liver to keep making glucose and raising blood glucose levels, even as insulin tries to keep glucose production in check.

"For the past several decades, investigators have suggested that there must be a problem in the way the liver senses insulin, and that is why insulin-resistant people make too much glucose," Herman said. "We found that no matter how much insulin the pancreas made, it couldn't override the processes started by this protein, ChREBP, to stimulate glucose production. This would ultimately cause blood sugar and insulin levels to increase, which over time can lead to insulin resistance elsewhere in the body."

To test their hypothesis, researchers studied mice that were genetically altered so their liver insulin signaling pathways were maximally activated -- in other words, their livers should not have been able to produce any glucose.

The researchers found that even in these mice, eating fructose triggered ChREBP-related processes in the liver, causing it to make more and more glucose, despite insulin signals telling it to stop.

Previous studies have reported that high fructose diets can cause multiple metabolic problems in humans and animals, including insulin resistance and fatty liver disease. Because most people found to be insulin-resistant also have fatty liver, many investigators have proposed that the fructose-induced fatty liver leads to liver dysfunction, which causes insulin resistance, diabetes and high risk for heart disease.

The new findings suggest fatty liver disease may be a red herring, Herman said. The likely cause of insulin resistance may not be the buildup of fat in the liver, as commonly believed, but rather the processes activated by ChREBP, which may then contribute to the development of both fatty liver and increased glucose production.

Although much more research is required, the scientists believe they better understand a key mechanism leading to pre-diabetes and can now explore how to possibly interrupt that chain of events. ChREBP may not be the only pathway by which this happens, and the protein may also be activated in other ways, Herman said. But the study provides an important lead, he said.

"It gives us some insight into what may be happening early in diabetes," Herman said. "If we can develop drugs to target this process, this may be a way to prevent the process early in the development of the disease."

The finding could also help scientists one day diagnose metabolic disorders earlier on, potentially allowing patients to make changes to their diets and lifestyles sooner to prevent more serious complications.

As a medical doctor, Herman said the advice to patients remains the same: make sure you're not eating too much sugar, which often shows up on labels as sucrose (the main ingredient in beet and cane sugar) and high fructose corn syrup. Both sweeteners contain both glucose and fructose and are rapidly absorbed, he said.

In its naturally occurring form and quantity, fructose is not particularly harmful, Herman explained, because if you're eating an apple, for example, you're eating a relatively small amount of sugar and it's combined with other nutrients such as fiber that may slow its absorption.

"You could eat three apples and not get the same amount of fructose you might get from a 20-ounce sugar-sweetened beverage," he said. "The major sources of excessive fructose are in foods like sodas and many processed foods, which are foods most doctors would say to limit in your diet."

October 18, 2016

Are Diabetes Patients Over Medicated?

While this article is talking about doctors and patients in the United Kingdom, it still applies to the US. Doctors are misinformed, patients are misled and millions of people are taking medication with no benefit for them.”

More than one billion prescriptions are dished out in the UK each year, which is 2.7 million per day or 1,900 every minute, an increase of nearly 2/3 in just a decade. In addition, the increasingly widespread use of prescription medication can have some serious consequences.

Most people are aware that the over-prescription of antibiotics has unfortunately led to the development of resistant strains of bacteria and many people are campaigning for more restrained prescription of antibiotics. However, an interview with Aseem Malhotra, a London-based cardiologist, reveals that the problem is by no means limited to antibiotics; in fact, there is a worrying trend in the over-prescription of drugs for all sorts of ailments, leading to ever increasing costs of side effects. He explains that this is due to misinformation at all levels in the system, from how research into drugs is funded, to how it is reported in academic journals, to how their pros and cons are presented to patients.

Aseem Malhotra, who trained as an interventional cardiologist, practices in London and is a former consultant clinical associate to the Academy of Medical Royal Colleges. Last year he became the youngest member to be appointed to the board of trustees of health think tank The King’s Fund. He has campaigned for years on a number of issues including transparency in health care, fighting excess sugar consumption and criticizing the focus on total cholesterol and use of statins. He spoke to us about what he calls “an epidemic of misinformation” that has led to people undergoing unnecessary treatments.

The BBC program The Doctor Who Gave Up Drugs has recently brought the issue of prescription drugs back into the limelight, highlighting how prescription of drugs has increased massively in the last five years especially, for example, prescription of painkillers (up by 25%) and antidepressants for teens (up by 50%). It also presents the alternative to this, one that Malhotra is also endorsing and led on, that other treatments such as lifestyle interventions like diet and exercise can be just as effective, if not more so, than drugs. It is important to take a holistic approach to health, but the culture of medicine at the moment means that people simply want a miracle pill to solve all their problems, or “a pill for every ill” as Malhotra called it.

So let’s look at the issues that Malhotra brings up with what he calls “a collective system problem”. Firstly, there is bias in the funding of drug research. A great deal of funding comes from pharmaceutical companies who stand to gain a profit from the industry. The way they make the most profit is to create drugs that can be used by the largest number of people for the longest amount of time, which clearly means that they aren’t necessarily funding research that is the most beneficial to patients.

It also means that most of the new drugs produced in the last 20-30 years have been near copies of existing drugs, with just tiny alterations, meaning that the clinical advantages of these drugs over what was already available is minimal. A Barral report on all internationally marketed drugs between 1974 and 1994 found that only 11% were truly innovative and multiple independent reviews since then have also concluded that around 85-90% of all new drugs provide few or no clinical advantages to patients. On top of this, many of these drugs also have serious side effects, which have a negative impact on people’s health.

Another serious issue in the chain, that Malhotra points out, is bias in the reporting of drug research. Firstly, there is a publishing bias whereby only the “success stories” even see the light of day, but even within these supposed “success stories” there can be misleading information. For example, the reporting of risk can mislead a reader, which is seen even in well-respected journals like The Lancet, the BMJ and JAMA. Between 2006 and 2009, around 1/3 articles published in the three aforementioned journals had mismatched framing, which means that they report the benefits of a drug in relative risk (large numbers), whereas they report harms in absolute risk (small numbers). For example, take a drug that reduces your risk of getting heart disease from 10 in 1000 to five in a 1000 – it would be reported in relative risk as a 50 percent reduction. However, the drug also increases your chance of getting intense muscle pain from five in 1000 to 10 in 1000, but this side effect would be reported in absolute risk, as an increase of 5 in 1000, so 0.5 percent increase.

This is an obvious misrepresentation, yet it is permitted and used extensively in trusted journals. These are then used as marketing tools by the pharma companies, who pay for reprints of the journal. Doctors trust these journals and very rarely question what they say and their recommendations for patients will reflect this. For Malhotra: “The best way I can give quality care to my patients is to have complete transparency”, which means he has started telling patients the absolute risk involved with the drugs on offer and he reports that they are often under whelmed by the benefits of these drugs when given this information.

These medical journals have also been found to print “bad data”. For example, a study investigated Riveroxaban as an alternative for Warfarin, a widely-used anticoagulant. It concluded that this drug had the benefit that, unlike with Warfarin, the blood does not have to be regularly checked. This is a major inconvenience avoided for patients, so the NHS spent around £50 million on this new drug. However, an investigation by the BMJ uncovered that a device used in the randomized controlled trial that justified the NICE guidelines recommending the drug, a key measuring instrument had been faulty, which casts doubt on the whole trial. Even though this has all come out, doctors up and down the country will still be prescribing this drug to patients because releasing an investigation in a journal does not guarantee that every doctor will both hear of this and change their behavior accordingly, as ultimately doctors still follow NICE guidelines, which take a while to change.

The conflicts of interest in research can even result in serious scientific fraud and manipulation of statistics. GlaxoSmithKline paid the largest fine in US history for fraud, $3 billion, in 2012 specifically for illegally marketing drugs, misreporting and hiding data on harms. However, during the period covered by the settlement they made $25 billion in profit from the drugs. No one went to jail, no one went out of business and the cycle continues. And within academic institutions, even when fraud is revealed, often no one is punished. People are extremely unwilling to speak out against ‘Big Pharma’ because that is how their research is funded and they are scared that if they speak out they will lose this funding. Malhotra summarized: “Doctors are unwittingly becoming part of a system where side effects are underreported and institutions are funded by pharma so people don’t speak out when they should.”

Please read the full article here.

October 17, 2016

Saturated Fats No Longer the Enemy

I have been reading about saturated fats and other fats for several months and this caps off much of the current discussion. Saturated fats are not the enemy, but processed foods are, according to a new policy statement from the Heart and Stroke Foundation of Canada.

On Thursday, the foundation released a new policy statement that questions conventional wisdom about the dangers of saturated fats on the heart.

Saturated fat is found naturally in red meat, dairy products and certain oils, such as palm oil. For years, a debate has raged over whether saturated fat contributes to poor heart health. Many nutrition and dietary experts, including the American Heart Association, warn that saturated fats can raise the risk of cardiovascular disease and urge people to limit consumption of dairy, red meat and fried, processed food.

But recently, more evidence has emerged that calls that relationship into question. Although more work needs to be done to fully understand how saturated fats affect long-term health, the Heart and Stroke Foundation said it no longer makes sense to single it out. Instead, Canadians need to focus on eating fresh fruits and vegetables, whole grains, meat and other products that have not been processed, said Manuel Arango, director of health policy at the Heart and Stroke Foundation. There is no question that fried and processed foods contribute to poor long-term health, he said.

The organization is also urging Canadians to stop fixating on one particular aspect of food – such as fat, sodium, calories, sugar – and instead focus on eating unprocessed, whole foods. Also steer clear of products advertised as low fat because, chances are, they are loaded with other things you don’t want, such as calories, sodium or other additives, according to the association.

That low fat claim could potentially be quite misleading,” Arango said.

Russell de Souza, a nutrition epidemiologist at McMaster University in Hamilton, recently completed a study that found saturated fat is not linked to stroke, type 2 diabetes, heart disease or death.

The study, published last month in the British Medical Journal, did find a clear relationship between trans fats, which are often found in processed or fried foods, and heart health problems.

In the past, de Souza said, studies found that people who ate lower levels of saturated fats tended to have better heart health.

But if you examined their food choices, those people chose to eat more plant-based foods that are high in antioxidants and important nutrients, which could have contributed to their heart health.

The research has never clearly shown that saturated fats are the cause of heart health problems. Now, the tide appears to be turning.

Maybe butter is not as bad as we thought it was before,” Arango said.

At the end of the day, our bottom line is we need this balanced diet and you don’t have to worry as much about intake of saturated fat.”

That doesn’t mean loading up on butter and steak is a good idea. Rather, the Heart and Stroke Foundation is advocating for moderation and choosing whole foods instead of processed ones.

October 16, 2016

Knowing When to Test

Allen and I were having a discussion a few days ago about testing. He was complaining about how poorly WebMD was written for testing. I agreed with him and pulled up this information. Allen said you have an ability I wish I had. I said that is because I am planning to write a blog about the errors in this and opened the copy I had started,

I carefully hit the return key to be able I restart the blog. Most people with diabetes need to check their blood glucose levels regularly. The results help you and your doctor manage those levels, which helps you avoid diabetes complications. At this point, I stated this is the first error, as most doctors care nothing about your testing log, but only the A1c results. Allen and I both agreed the doctors miss a lot by ignoring the patient's testing log. Episodes of hyperglycemia and hypoglycemia are not taken under consideration to prevent future episodes.

There are several ways to test your blood sugar; however, I will only mention those for type 1 diabetes. From your fingertip: You prick your finger with a small, sharp needle (called a lancet). Unless you own the only meter they describe, you will waste many test strips because most meters require that the test strip be inserted in the meter slot first to establish that the meter is working and the test strip is in date. Then the finger is pricked to receive enough blood for the test strip to wick into the test strip.

You get results in less than 5 seconds with most meters and can store this information for future use. Some meters can tell you your average blood glucose level over a period of time and show you charts and graphs of your past test results. You can get blood glucose meters and strips at your local pharmacy.

Meters That Test Other Sites: Newer meters let you test sites other than your fingertip, such as your upper arm, forearm, base of the thumb, and thigh. You may get different results than from your fingertip. Blood glucose levels in the fingertips show changes more quickly than those in other testing sites. This is especially true when your blood sugar is rapidly changing, like after a meal or after exercise. If you are checking your glucose when you have symptoms of hypoglycemia, you should use your fingertip if possible, because these readings will be more accurate.

Continuous Glucose Monitoring System: These devices, also called interstitial glucose measuring devices, are combined with insulin pumps. They are similar to finger-stick glucose results and can show patterns and trends in your results over time.

You may need to check your blood glucose several times a day, such as before meals or exercise, at bedtime, before driving, and when you think your blood glucose levels are low.

Everyone is different, so ask your doctor when and how often you should check your blood glucose. If you're sick, you'll probably need to test your blood glucose more often.

What Affects Your Results?

If you have certain conditions, like anemia or gout, or if it's hot or humid or you're at a high altitude, that can affect your blood glucose levels. They can also be unreliable if you have had a blood transfusion recently or are on dialysis.

If you keep seeing unusual results, recalibrate your meter and check the test strips.

Home Blood Glucose Monitoring.

The chart below gives you an idea of where your blood sugar level should be throughout the day. Your ideal blood glucose range may be different from another person's and will change throughout the day. At least they do recommend testing in pairs.
Time of Test
Ideal for Adults With Diabetes
Before meals
70-100 mg/dl
After meals
Less than 140 mg/dl

When Should I Call My Doctor About My Blood Sugar?

Ask your doctor about your target blood glucose range, and make a plan for how to handle blood glucose readings that are either too high or too low and when to call your doctor. Learn about the symptoms of high or low blood glucose, and know what you can do if you begin to have symptoms.

How Do I Record My Blood Glucose Test Results?

Keep good records of any blood, urine, or ketone tests you do. Most glucose monitors also have a memory. Your records can alert you to any problems or trends. These test records help your doctor make any needed changes in your meal plan, medicine, or exercise program. Bring these records with you every time you see your doctor.

Allen and I both agreed that WebMD information is often unreliable as it is most often written to ADA standards and we need better standards.