Tuesday, November 21, 2017

Fats role in Type 2 diabetes

It is known that people develop type 2 diabetes mellitus (T2DM) due to increased insulin
resistance and diminished pancreatic beta cells (b-cells) which produce insulin. When the
human body is unable to produce insulin to regulate blood glucose levels a person will
develop T2DM. Many factors play a role in developing T2DM; genetics, sugar consumption,
fat consumption, lack of exercise, weight status (BMI), and others. This paper looks at how
ingesting high fat diets, particularly diets high in saturated fat, can cause diabetes.
Insulin works by locking onto a cell wall which activates the inside of the cell to allow blood glucose to come in the cell and out of the blood stream. Increased insulin resistance occurs when insulin latches onto the cell and the mechanism inside the cell
fails to allow glucose into the cell. According to Bosma, M., Kersten, S., Hesselink, M.K.C., & Schrauwen, P., (2011) increased intramyocellular lipid (IMCL) levels, which are associated with obesity, negatively correlate with insulin sensitivity. This means
an accumulation of fat in the muscle is associated with a reduction in insulin mediated glucose uptake.
They go on to indicate that the mechanism for cell inhibition of uptake of blood glucose is still under investigation. There are possible connections to lipid intermediates. These intermediates somehow stop the signaling process once insulin attaches to
the cell. The enzymes which should activate to signal the glucose transporter never start their process. This leads to blood glucose being left outside the cell which elevates blood glucose levels.
Insulin resistance is half the problem when developing T2DM. Decline of b-cell function also contributes to the disease. It can start by a person consuming excess fat/calories, causing excess muscle fat buildup, which can lead to a decrease in pancreatic
function to release insulin. According to Taylor, R., (2013) fatty muscles happen when caloric intake is greater than expenditure. This results in a buildup of fat in the liver. As the amount of fat in the liver increases, insulin sensitivity in the liver decreases. Since a fatty liver can become deadly, the liver will try to release fat in the form of very low density lipoprotein (VLDL). The pancreatic islets are therefore exposed to increased levels of VLDL. People respond individually to different levels
of this fat exposure, but at a point the b-cells will fail to adequately respond, resulting in cell death and elevated blood glucose levels.
This pancreatic b-cells apoptosis is what can lead to T2DM becoming a lifelong disease. A study by Cnop, M., et al. (2010) concluded that people’s b-cells formation is largely established by age 20. This would imply that when the b-cells are destroyed by VLDL exposure, they are gone for the remaining lifespan of the person, decreasing the person’s ability to produce insulin to
decrease blood glucose levels. When discussing fat consumption, it is also important to determine whether it is all fat or certain fats that can lead to IMCL, insulin resistance, and b-cell loss. From in vitro studies described by Nolan, C.J., & Larter, C. Z., (2009) it is known that saturated
fatty acids (SFA) are toxic to cells while monounsaturated fatty acids (MUFA) are cytoprotective. Martins, A.R., et al., corroborates the connection that SFAs and trans fats are linked to increased insulin resistance. There are multiple theories about how SFAs effect insulin sensitivity. Some of these are SFAs alter gene expression, activation of inflammatory pathways, Rande cycle (competition between SFAs and glucose), SFAs inhibition of cell signaling, and impairment of the mitochondria.
Studies and discussions of these theories indicate that multiple processes contribute rather than a single mechanism.
SFAs and trans fat are most commonly found in animal products. When looking at the correlation between meat and T2DM The InterAct Consortium, (2012) found a positive association between high consumption of total and red meat and T2DM in a large cohort of European adults. Studies by Gojda, J., et al., (2013) and Goff, L.M., Bell, J.D., So, P-W., Dornhorst, A., & Frost, G.S.,
(2005) compared vegans to omnivores with the same BMI and activity level. They concluded that vegans had better insulin sensitivity, lower IMCL, better glucose hemeostasis, plasma lipid profile, less muscle lipids, and improved b-cell function. They conclude that eating less to no meat may help protect people from developing T2DM. Studies of chronic disease support that everyone, not only patients with T2DM, may benefit by reducing their fat intake, particularly saturated fat and trans fat, to ensure proper function of cells and vital organs to prevent chronic diseases from
progressing. Diet plays an important role in disease prevention and treatment. Boucher, Evert, Daly, Kulkarni, Rizzotto, Burton and Bradshaw (2011) state that the three pillars of diabetic treatment are nutrition, physical activity, and medication therapy and that the most important of these is a healthy diet.
Boucher, J. L., Evert, A., Daly, A., Kulkarni, K., Rizzotto, J., Burton, K., & Bradshaw, B. G. (2011). American Dietetic Association
revised Standards of Practice and Standards of Professional Performance for registered dietitians (generalist, specialty,
and advanced) in diabetes care. Journal of the American Dietetic Association, 111, 156-166. doi: 10.1016/
Bosma, M., Kersten, S., Hesselink, M.K.C., & Schrauwen, P., (2011). Re-evaluating lipotoxic triggers in skeletal muscle: Relating
intramyocellular lipid metabolism to insulin sensitivity. Progress in Lipid Research, 51, 36-49. Doi: 10.1016/
Cnop, M., Hughes. S.J., Igoillo-Esteve, M., Hoppa, M.B., Sayyed, F., Laar, L., … & Clark, A., (2010). The long lifespan and low
turnover of human islet beta cells estimated by mathematical modeling of lipofuscin accumulation. Diabetologia, 53,
321-330. Doi: 10.1007/s00125-009-1562-x
Goff, L.M., Bell, J.D., So, P-W., Dornhorst, A., & Frost, G.S., (2005). Veganism and its relationship with insulin resistance and
intramyocellular lipid. European Journal of Clinical Nutrition, 59, 291-298. Doi: 10.1038/sj.ejcn.1602076
Gojda, J., Patkova, J., Jacek, M., Potockova, J., Trnka, J., Krami, P., & Andel, M., (2013). Higher insulin sensitivity in vegans is not
associated with higher mitochondrial density. European Journal of Clinical Nutrition, 67, 1310-1315. Doi: 10.1038/
Martins, A.R., Nachbar, R.T., Gorjao, R., Vinolo, M.A., Festuccia, W.T., Lambertucci, F.H., … & Hirabara, S.M., (2012).
Mechanisms underlying skeletal muscl insulin resistance induced by fatty acids: importance of the mitochondrial
function. Lipids in Healht and Disease, 11, 30. Doi: 10.1186/1476-511X-11-30
Nolan, C.J., & Larter, C.Z., (2009). Lipotoxicity: Why do saturated fatty acids cause and monounsaturates protect against it?.
Journal of Gastroenterology and Hepatology, 24, 203-711. Doi: 10.1111/j.1440-1746.2009.05823.x
Taylor, R., (2013). Banting memorial lecture 2012 reversing the twin cycles of type 2 diabetes. Diabetic Medicine, 30, 267-275.
Doi: 10.1111/dme.12039
The InterAct Consortium, (2012). Association between dietary meat consumption and incident type 2 diabetes: The EPICInteraAct
study. Diabetologia, 56, 47-59. Doi: 10.1007/s00125-012-2718-7

7 myths about celebrating the holidays with diabetes and tips to conquer these common misconceptions

November is National Diabetes Month. It’s also the start of the holiday season.
Are you dreading the coming months of celebrations, wondering how you’ll
manage the holidays and diabetes? Read on for 7 myths about celebrating the
holidays with diabetes and tips to conquer these common misconceptions.
Myth 1: Having diabetes takes the joy out of holiday feasts
It doesn’t have to. It really doesn’t. Many special homemade dishes are prepared
just for the holidays, and you can definitely partake. Choose small portions of
your favorites, eat mindfully, and enjoy every bite. Eating slowly is important,
and you will enjoy it more if you savor it. Try putting your fork down between
bites. Another option is to bring your own favorite dish that’s healthy and
delicious. Try my seasonal salad. You can feel good about sharing healthy food,
and you’ll guarantee there’s a good option for you on the table. Last, but not
least, focus on the people around you. Celebrating holidays together is about
showing the people you care about just how much you love them. Taking care of
your own health is one way you can show you love your family – that you are
committed to being around for more of life’s celebrations.
Myth 2: Sweets and sugary drinks make it impossible to manage diabetes
This is a tricky one since chances are you will encounter sugar cookies and hot
chocolate at some point during the holiday season. However, that doesn’t mean
they have to derail you from managing your own health. If it’s something you
love, have a small portion, combine it with protein and fiber to help blunt the
blood sugar spike if you can (e.g. a handful of pistachios or almonds), and adjust
the carbohydrates you have in other meals that day. If you can find a healthy
nosh to replace something sweet, even better. As an alternative to sugary drinks,
I honestly think clean plain water is so underrated. It’s so refreshing, and there’s
even preliminary research suggesting drinking water half an hour before meals
helps you eat less.
Myth 3: Artificial sweeteners are the best way to satisfy your sweet tooth
Foods sweetened with artificial sweeteners that won’t raise blood sugar (e.g.
Stevia, Splenda, Sweet ‘N Low, Nutrasweet) are an OK option if that’s what’s
right for you, but I prefer to recommend a long term solution of training your
palate to prefer naturally less sweet tastes. Another concern, based on early
research published in 2014 in the journal Nature, suggests that artificial
sweeteners affect the body in a way that leads to diabetes. Keep in mind that
this research is far from conclusive; still, there are many compelling reasons to
manage diabetes with natural, whole foods.
Myth 4: There’s no time to exercise during the holidays
There’s always time for exercise, but what is sometimes missing is
motivation or opportunity. Assuming you are motivated, let’s look at how to
provide opportunity. The time just after a meal is a great time to go for a
walk with those you’ve just dined with. You can also just help clear the table. Another idea is to make your holiday plans active.
For example, plan a group hike for the day after Thanksgiving and make an event of it (or join a local turkey trot).
Myth 5: It’s OK to go out of your target glucose range during the holidays
I think you already know the answer to this one. Of course it’s not OK. The good news is you can use the tips and tricks in this
article to help manage blood sugar while still enjoying the holidays. When you keep your blood sugar in its target range you’ll
feel better (good for you), which in turn makes you better company (good for your loved ones). Even short-term dips and spikes
can quickly escalate to hypoglycemia, hyperglycemia, or diabetic ketoacidosis. Long term, out of control blood sugar can
damage blood vessels that go to important organs, leading to heart disease, stroke, kidney disease, and vision and nerve issues.
There are so many reasons to get diabetes under control – just look in the mirror and all around you. Everyone who loves you
wants you to be healthy and around for years to come.
Myth 6: You are all alone dealing with diabetes
Whether you are staying local or traveling this holiday season, there’s a good chance you’ll be able to find a local CVS that
offers diabetes support. A CVS MinuteClinic is a great everyday resource to help you manage diabetes between doctor’s visits.
MinuteClinic can also help screen you for high blood glucose, which is how diabetes and prediabetes is diagnosed. This is
especially important because 1 in 3 Americans have prediabetes, but 90% of those have no idea. Prediabetes has few
symptoms, yet puts a person at risk for developing diabetes. Getting screened sooner rather than later could mean being able
to prevent diabetes. Check out a local CVS MinuteClinic for more information. MinuteClinic also has heart-healthy recipes,
great for the whole family with new #FoodieFriday recipes each week.
Myth 7: Flu affects people with and without diabetes the same way
The holidays overlap with flu season. Coincidence? Could all the stress, over-indulging, and travel during the holiday season
make us more susceptible to flu? Scientists don’t know for sure, but what we do know is that it gets even more complicated for
people with diabetes (type 1 and type 2), whose immune systems have a harder time fighting off infections. Even if diabetes is
being well-managed, there’s an increased risk of serious flu complications such as pneumonia, bronchitis, sinus infections, and
ear infections. To add insult to injury, being sick makes it harder to control blood sugars.
The Centers for Disease Control (CDC) recommend that anyone older than 6 months with diabetes gets a flu shot. The CDC says
the shot is safe for people with diabetes, but to bypass the nasal spray option. Since flu is highly contagious, getting a flu shot
isn’t just good for you, it’s good for the friends, family, neighbors, and colleagues you come into contact with. It’s easy to get a
flu shot at your local MinuteClinic or CVS. Bonus: there’s a good chance it’ll be free with your insurance.
Source: Maggie Moon, MS, RD. 7 Myths about Celebrating the Holidays with Diabetes. Available at: http://www.maggiemoon.com/foodposts/
health/7-myths-about-celebrating-the-holidays-with-diabetes/. Used with permission.