Adding Alcohol Reduces Diabetes Risk

The age old question of alcohol consumption, diabetes, risk factors, insulin resistance and complications.  I personally enjoy a beer – once every couple of months – but don’t make alcohol part of my normal routine.  However, researchers have completed a massive study involving 38,000 men over a four years period and found that those increased their alcohol consumption had a lower incidence of Diabetes:

RESULTS A total of 1,905 cases of type 2 diabetes occurred during 428,497 person-years of follow-up. A 7.5 g/day (approximately half a glass) increase in alcohol consumption over 4 years was associated with lower diabetes risk among initial nondrinkers (multivariable hazard ratio [HR] 0.78; 95% CI: 0.60–1.00) and drinkers initially consuming <15 g/day (HR 0.89; 95% CI: 0.83–0.96), but not among men initially drinking ≥15 g/day (HR 0.99; 95% CI: 0.95–1.02; Pinteraction < 0.01). A similar pattern was observed for levels of total adiponectin and hemoglobin A1c, with a better metabolic profile among abstainers and light drinkers who modestly increased their alcohol intake, compared with men who either drank less or among men who were already moderate drinkers and increased their intake. Likewise, compared with stable light drinkers (0–4.9 g/day), light drinkers who increased their intake to moderate levels (5.0–29.9 g/day) had a significantly lower risk of type 2 diabetes (HR 0.75; 95% CI: 0.62–0.90).

CONCLUSIONS Increases in alcohol consumption over time were associated with lower risk of type 2 diabetes among initially rare and light drinkers. This lower risk was evident within a 4-year period following increased alcohol intake.

The results does seem consistent with what we’ve seen in the past with the exception that an increase rather than absolute consumption was studied. I don’t know that this should motivate a change in dietary habits for those who are undiagnosed or have pre-diabetes but it certainly will be used by some to justify their chosen lifestyle.


Lipitor increases the risk of Type 2 Diabetes?

A study appearing in the Journal of the American College of Cardiology suggests that high doses of Lipitor may be linked to an increased risk in developing Type 2 Diabetes:

We used a standard definition of diabetes and excluded patients with prevalent diabetes at baseline. We identified baseline predictors of new-onset T2DM and compared the event rates in patients with and without new-onset T2DM.

High-dose atorvastatin treatment compared with placebo in the SPARCL trial is associated with a slightly increased risk of new-onset T2DM. Baseline fasting glucose level and features of the metabolic syndrome are predictive of new-onset T2DM across the 3 trials.

Of course, this is not the first study that has suggested this type of connection.  However, consider …

But it also suggests that the risk may largely exist among people who also have the well-known risk factors for type 2 diabetes — including excess weight, high blood sugar, elevated triglycerides (a type of blood fat) and high blood pressure.

Those four factors appear “very good at distinguishing people at high or low risk for developing new-onset diabetes with atorvastatin,” lead researcher Dr. David D. Waters, of the University of California at San Francisco, told Reuters Health in an email.

So managing those risk factors — by shedding excess pounds, for example — would be important for curbing any extra diabetes risk, Waters said.

He also stressed that the diabetes risk tied to statins is small.

“An important point,” Waters said, “is that the risk of developing new-onset diabetes and its complications (is) greatly outweighed by the benefit of statins in reducing cardiac death, heart attack and stroke.”

In other words, Waters claims that the risk of diabetes is less than the risk of cardiac or stroke events if Lipitor is not used.



Potassium: a biomarker for high blood pressure and diabetes?

We’re learning that alternate biomarkers are independent predictors of type 2 diabetes in some populations. Among these is potassium:

Lower blood potassium levels may be why African-Americans are twice as likely to be diagnosed with type 2 diabetes than whites, U.S. researchers say.

“This research doesn’t mean people should run out and start taking potassium supplements,” Hsin-Chieh “Jessica” Yeh, an assistant professor of medicine at the Johns Hopkins University School of Medicine, said in a statement.

“But we now know lower serum potassium is an independent risk factor for diabetes and that African-Americans have, on average, lower potassium levels than whites. What remains to be seen is if increasing potassium levels through diet or supplementation can prevent the most common form of diabetes.”

This was a retrospective analysis on 12k patients – not too shabby.  In the past, low potassium levels have been linked to higher blood pressure, which seems explainable, but I’m not certain what mechanisms would increase the chance of developing diabetes.

Here’s a related fact:  some, including the article I referenced, suggest that African Americans tend to consume less potassium in their diet.  However, prior studies suggest that there may be a physiological element.


Infection and Early Diabetes Risk

We’ve understood for some time that Type 1 Diabetes is an autoimmune disease in which the beta cells are casualties of a T-cell mediated autoimmune attack. As a result, researchers hypothesized that environmental triggers could play some roll in the onset of the disease. It appears they are one step closer in their understanding, as reported in the British Medical Journal (BMJ 2011; 2011; 342:d35 doi: 10.1136/bmj.d35 (Published 3 February 2011):

There is a clinically significant association between enterovirus infection, detected with molecular methods, and autoimmunity/type 1 diabetes.

First, note that enteroviruses are second only to the “common cold” viruses, the rhinoviruses, as the most common viral infectious with an estimated 10-15 million cases per year in the United States.
Second, the study was a retrospective analysis of published reports. This is a common method and accepted approach although there are limitations due to the difficulty in normalizing results across diverse study protocols.
Third, the study found a clear relationship between the presence of an enterovirus infection and type 1 diabetes. However, causality was not proven — the results provide ‘additional support to the direct evidence of enterovirus infection in pancreatic tissue of individuals with type 1 diabetes’. That is, the two are often observed together.

Fat Increases Diabetes Risk Factors

Visceral fat cells in the abdomen, the fat that surrounds the organs in the gut, secrete molecules that increase inflammation and increase the risk of developing diabetes and heart disease, this according to researchers at Washington University School of Medicine in St. Louis:

Reporting in the journal Diabetes, the research team says visceral fat likely contributes to increases in systemic inflammation and insulin resistance. They sampled blood from the portal vein in obese patients undergoing gastric bypass surgery and found that visceral fat in the abdomen was secreting high levels of an important inflammatory molecule called interleukin-6 (IL-6) into portal vein blood.
(…) Increased IL-6 levels in the portal vein correlated with concentrations of an inflammatory substance called C-reactive protein (CRP) in the body. High CRP levels are related to inflammation, and chronic inflammation is associated with insulin resistance, hypertension, type 2 diabetes and atherosclerosis, among other things.

Note that visceral fat surrounds internal organs and, unlike belly fat, cannot be surgically removed.
Diet and exercise my friends, diet and exercise …
Related reading – The secret life of fat cells:

The best way to get rid of visceral fat and shrink fat cells all at once is diet and exercise. Just a loss of 7 per cent of total body weight helps. … Something about burning more calories than you eat creates a state of negative energy balance that quickly melts away visceral fat and slims down bloated fat cells.

Are you at risk?

Nearly 21 million children and adults in the United States have diabetes and one-third of them are unaware they have the disease. Another 54 million Americans have pre-diabetes, a condition that puts them at serious risk for developing type 2 diabetes. Among the primary risk factors for type 2 diabetes are being overweight, sedentary, over the age of 45 and having a family history of diabetes.
African Americans, Latinos, Native Americans, Asian Americans and Pacific Islanders are at an increased risk, as are women who have had babies weighing more than nine pounds at birth. Unfortunately, people with type 2 diabetes can live for years without realizing that they have the disease. While people with diabetes can exhibit noticeable symptoms, such as frequent urination, blurred vision and excessive thirst, most people diagnosed with type 2 diabetes do not show these overt warning signs at the time that they develop the disease.
Often, type 2 diabetes only becomes evident when people develop one or more of its serious complications, such as heart disease, stroke, kidney disease, eye damage, and nerve damage that can lead to amputations.
Diabetes is the fifth leading cause of death by disease and has no cure.
The American Diabetes Association’s American Diabetes Alert(R) is a one-day, “wake-up” call to inform the public about the seriousness of diabetes, particularly when diabetes is left undiagnosed or untreated. American Diabetes Alert(R) Day encourages those at risk for developing type 2 diabetes to take the American Diabetes Risk Test and, if they score high, to schedule an appointment to see their doctor.
Click here

Top Nine Risk Diabetes Risk Factors

Raises your risk: 14 percent
How: More TV equals less activity.
The fix: Limit TV time to 10 hours a week and exercise.
Raises your risk: 83 percent
How: Soda adds extra and empty calories, which can easily lead to weight gain.
The fix: Switch to water, diet soda, or even better, unsweetened tea, which may actually protect against disease.
Raises your risk: up to 50 percent
How: Not having that morning meal increases the appetite-stimulating hormone ghrelin, making you hungrier and likely to eat more.
The fix: Eat high-fiber cereal with low-fat milk and one-half cup of fruit in the morning. One study of people with prediabetes found that eating high- fiber cereals made their cells respond better to insulin. Consuming dairy products may also cut the risk for insulin resistance by 72 percent.
Raises your risk: 23 percent
How: Depression may alter body chemistry in a way that makes us more prone to developing diabetes.
The fix: Take a walk. Just 30 minutes, three times a week, has been shown to improve symptoms of depression.
Raises your risk: 330 percent
How: Fat in the abdomen (visceral fat) produces compounds that make cells insulin-resistant. Women should keep their waist size below 35 inches (40 inches for men).
The fix: A half-hour to one hour of cardio, three to five times a week.
Raises your risk: 98 percent
How: Not being able to stay asleep means you’re not getting enough sleep, making you more prone to developing insulin resistance and leading to diabetes.
The fix: No caffeine in the late afternoon and evening, and no TV and alcohol right before bed. Try yoga, too.
Raises your risk: 100 percent
How: People who ate burgers, fries and soda more than twice a week put on 10 extra pounds and were twice as likely to become resistant to insulin.
The fix: Satisfy cravings with smaller portions.
Raises your risk: 184 percent
How: Stress can interfere with your ability to make insulin and process glucose.
The fix: Allow 10-15 minutes a day to relax.
Raises your risk: 43 percent
How: These meats (such as hot dogs and bacon) are loaded with preservatives that may destroy insulin- producing cells in your pancreas.
The fix: Cut back. A Harvard study found that women who had these meats less often than once a week had the lowest risk. Try a preservative-free type, too.

The Staggering Rise of Type 1 Diabetes

The increased incidence of Type 1 Diabetes in children under the age of five is staggering:

The number of British children under five diagnosed with a specific type of diabetes has risen five-fold over 20 years due to unidentified environmental factors, a study said on Friday.
“This could either mean that we are being exposed to something new, or that we now have reduced exposure to something that was previously controlling our immune responses,” said Professor Polly Bingley from Bristol University.
“We now need to work to identify what these changes might be,” she added.

Researchers are mystified but were not at all bashful about giving their opinions. Here’s one theory:

The soaring rates of type 1 diabetes in children can be attributed to the better hygiene conditions, which prevent them from being exposed to infections, according to new research by The Bristol University.

And another:

The Bristol University team blame genes and environmental factors, including breastfeeding rates.
(…) Lead researcher Professor Polly Bingley said the rate of childhood Type 1 diabetes was increasing all over Europe, particularly in the very young.
(…) She suggested that fewer mums opting to breastfeed their babies might be a factor.

And another by the same investigator:

Scientists are considering the theory that hygienic Western lifestyles, with infants raised in households that are “too clean“, could be a factor in the increase.

Actually, this final is a repeat of the first but reported in a different manner. It’s quite interesting how media outlets are gravitating to different theories despite the lack of clear evidence. Headlines suggest “Better hygiene conditions responsible for soaring rates of Type ” and “Too healthy children can get diabetes“. Yet there are a myriad of correlations which exist between the rise of Type 1 Diabetes, environmental conditions and the lifestyle. Before we assume any one of them is the dominant factor further investigation seems pertinent. For example, prior to blaming the rise of the disease on a decrease in breastfeeding couldn’t researchers actually perform the investigation?
I’ve yet to find the original research report supporting the findings but the announcement by Diabetes UK is here.

The Soda Scandal

Go ahead, drink your sugar laden beverages and slam another 32 oz big gulp. However, you should be warned that recent studies have provided compelling evidence that consuming moderates amounts of soda doubles the risk for developing Type 2 diabetes. The results follow a prospective analysis of more than 91,000 women followed for 8 years and provides one of the “most striking” links between soft drinks and health outcomes, the investigators note in the American Journal of Public Health.
Now, we’ve recent read about a link between the consumption of diet soda and obesity. Yet, investigators associated with the current study concluded that when diet soda replaced regular soda in the analysis, there was no increased risk, “suggesting that the risk was specific to sugar-sweetened soft drinks.” The latter conclusion, in my opinion, is more believable.
The most scandalous result, however, is not that soda is bad for you (I think we all knew this already), but rather that industry funded research may be tainted:

Furthermore, there was a “remarkable difference” in results from industry-funded and non-industry-funded studies on soft drink consumption and health outcomes, Brownell said, “with the industry-funded studies much more likely to find the results favorable to industry.”
“The bigger issue here, in this arena in particular but in science in general,” Brownell said, “is how you can get a distorted view of reality if industry-funded studies are considered in the mix — and usually they are — especially, when industry uses these studies in advertising, lobbying, and in talking to the press.”
[note: Dr. Kelly Brownell is director of the Rudd Center for Food Policy and Obesity at Yale University in New Haven, Connecticut]

In my opinion, soda is a lot like desert – sweet tasting empty calories. And, a super sized mega big gulp is like eating an entire cake or a dozen cookies except the delivery of carbohydrates is far more efficient and the impact on blood sugar more profound.

You have a stressful job …

…. and, as a result, may be almost twice as likely than others to develop Type 2 diabetes. According to a study published in the Psychosomatic Medicine journal:

… a team of researchers at Tel Aviv University found that those who experienced job burn-out are 1.84 times more likely than others to develop the condition – even when factors like age, sex and obesity are taken into account,
The study of 677 mostly male, middle-aged workers also found that when the possible effect of blood pressure levels was eliminated, the risk was more than four-fold higher.
According to the researchers, their findings show that stress can be added to other factors such as high blood pressure, fat deposits around the waist and lack of exercise, which are all known to increase risk of developing type 2 diabetes, the most common form of the condition.

Yes, we knew this. But how did the researchers separate their variables? Was it the long-hours and systematically unhealthy lifestyle or the very presence of stress — or both?

Does Pollution Increase the Risk of Developing Diabetes?

There appears to be a correlation:

A preliminary study has found Americans who live near toxic waste sites are hospitalized more for diabetes than those who live in clean communities.
The observational study, which tracked hospitalization rates for patients in New York between 1993 and 2000, found an increase in diabetes-related hospital admissions for people who live in ZIP codes containing toxic waste sites.
Although just an initial effort, the study does narrow the search for an answer to the U.S. diabetes boom, said study author Lawrence Lessner, an associate professor of epidemiology and biostatistics at the University at Albany in New York.
The study appeared in the January issue of Environmental Health Perspectives.
The researchers compared hospitalization rates by ZIP code for three types of communities: clean, without hazardous sites; contaminated by persistent organic pollutants, or POPs; and containing other types of waste or pollutants.
The authors examined whites and blacks between the ages of 25 to 74, correcting for potential factors that could skew the data, such as age, race, sex and average household income.
A major type of POPs are polychlorinated biphenyls, or PCBs, a former industrial ingredient of pesticides, paints, paper and other products. Although banned from U.S. industry in the 1970s, PCBs still exist in the environment. People are mainly exposed through eating animal fats, although they can also breathe in the pollutants.
Possible mechanisms for the association with diabetes are unknown, although some speculate that PCBs may influence the retention of fat in the body; more body fat is a risk factor for diabetes.

According to the scientists the concept that diabetes could be triggered by environmental factors is relatively new and needs to be explored as obesity does not fully account for the massive increases in type 2 diabetes.

Genetic Link

This short letter on the genetic predisposition to Type I and II Diabetes is somewhat provoking:

Type 1 diabetes is the somewhat-newer name for what used to be called insulin-dependent or childhood diabetes. The pancreas of people with type 1 diabetes makes little to no insulin, so insulin has to be furnished by injection or in other forms. Most of the time, the onset of this kind of diabetes occurs before age 20.
Genes have a hand in both type 1 and type 2 diabetes, but more so in type 2 than in type 1. (Type 2 diabetes is the more prevalent kind, the kind that usually appears later in life and the kind that can often be controlled through diet and oral medicine.) If one identical twin develops type 1 diabetes, the other twin has a 30 percent to 50 percent chance of also coming down with it. Identical twins have identical genes. If genes were the only factor involved as a type 1 diabetes cause, both identical twins should get it. Something else, in addition to genes, has to be at work.

The comments are actually in response to a letter written by a 20-year-old who was recently diagnosed with Type I. A common misperception is that the disease is inherited. The fact that there are other significant risk factors, other than those predetermined, provides hope for an effective treatment (IMHO).

Work and Diabetes – Overtime Causes Twice the Risk

Those who work more hours tend to have a higher risk of developing diabetes:

A University of California study of nurses finds that working long hours increases the risk of diabetes in young and middle-aged women.
The researchers, who used data from the Nurses Health Study and tracked nurses aged 29 to 46, found that those who worked 60 hours a week or more were more than twice as likely to develop Type 2 diabetes, the British newspaper, The Mirror, reported. Those who worked 40 to 60 hours were 50 percent as likely to get diabetes as those who worked 21 to 39 hours.
“Results were consistent with an impact of job stress on diabetes outcome and hours worked per week may reflect the extent of exposure to stress,” said Candyce Kroenke, who led the research team.
Single women tended to drink and smoke more than married nurses and were also more likely to develop diabetes.
Researchers believe that stress raises cortical levels, leading to higher body fat and blood pressure.

There are a lot of interrelated factors that would be interesting to study. Not only stress but also less sleep and poorer eating habits.