Do Dieting Fads Work?

Losing weight safely is about behavior and decision changes that are applied over the long-term.  Fad diets draw upon the desire for short-term solutions and don’t carry long-lasting benefits.

 


Via: Mocavo – Genealogy Search

Advancement: reproducing human beta cells that make insulin

transplant cell insulin cluster

Research aimed at treating diabetes through beta cells that can be transplanted just took a step forward:

Researchers at Washington University School of Medicine in St. Louis have identified a way to trigger reproduction in the laboratory of clusters of human cells that make insulin, potentially removing a significant obstacle to transplanting the cells as a treatment for patients with type 1 diabetes.

Efforts to make this treatment possible have been limited by a dearth of insulin-producing beta cells that can be removed from donors after death, and by the stubborn refusal of human beta cells to proliferate in the laboratory after harvesting.

They … used a novel conditioned medium expressing Wnt3a, R-spondin-3 and Noggin to engage Wnt signaling at the receptor level in combination with RhoA/ROCK inhibitors, SB-431542 and Y-27632, to significantly enhance adult human β-cell proliferation and maintain β-cell specific gene expression, insulin secretion and content in intact islets.

The new technique uses a cell conditioning solution originally developed to trigger reproduction of cells from the lining of the intestine.

“Until now, there didn’t seem to be a way to reliably make the limited supply of human beta cells proliferate in the laboratory and remain functional,” said Michael McDaniel, PhD, professor of pathology and immunology. “We have not only found a technique to make the cells willing to multiply, we’ve done it in a way that preserves their ability to make insulin.”

The findings are now available online in PLOS ONE. (A Novel Strategy to Increase the Proliferative Potential of Adult Human β-Cells While Maintaining Their Differentiated Phenotype)

The current method for harvesting human islets, which are comprised primarily of the insulin-producing beta cells, makes it necessary to find two or three donors to extract enough cells to produce an adequate supply of insulin to treat a single patient with diabetes.
The idea for the new technique came from an on-campus gathering to share research results. Lead author Haytham Aly, PhD, a postdoctoral research scholar, reported on his work with beta cells and was approached by Thaddeus Stappenbeck, MD, PhD, associate professor of pathology and immunology, who studies autoimmune problems in the gut. Stappenbeck had developed a medium that causes cells from the intestine’s lining to proliferate in test tubes.

“He said, why don’t you try it, and he gave us some samples,” Aly said. “We put the solution in our freezer for a month or so, and when we finally gave it a try, we were amazed at the results: human beta cells in Dr. Stappenbeck’s solution reproduced at a rate that was 20 times higher than beta cells in a solution that contained the sugar glucose.”

The ability to produce large quantities of human beta cells in the laboratory gives the researchers hope that they could one day be transplanted into patients with type 1 diabetes.

The advantage of Stappenbeck’s solution may be that it is designed to activate multiple growth signaling pathways in cells, according to the researchers. Earlier attempts to make beta cells proliferate focused on one or two growth pathways. The solution also activates genes that help prevent beta cells from dying.

Because pancreatic cancers are among the most deadly tumors, the scientists checked to make sure the proliferating beta cells weren’t becoming more like cancer cells. They found that none of the factors known to contribute to pancreatic cancer were active in the laboratory-grown beta cells.

“This is an important concern to keep in mind if we are to expand human beta cells in culture with this medium and subsequently transplant them into patients,” said Aly.
If the new availability of laboratory-grown beta cells makes it possible to treat patients with transplants from one donor instead of multiple donors, McDaniel noted, that might reduce the risk of immune system rejection of the transplants.

“Another benefit in using this novel growth medium to expand isolated human beta cells is that the cells remain healthier and have reduced levels of cell damage or death,” Aly said. “That may also reduce the chances of immune system rejection.”

Source

Prediabetes Treatment – improves health and is cost effective!

Google Health

After the early start-up days, Google, like many larger companies, has struggled with adjacent markets. The company missed the boat on social media and GoogleWave was a disaster. That said, their indexing and search, translation, mail, online office, webmaster tools, advertising and VOIP are best in class.

I think it is healthy for a tech company to fail once in a while… it shows their willingness to take chances, etc. rather than acquire (and stagnate) successful start-ups.

Type 2 Diabetes – an autoimmune disease

Type 2 diabetes is in the process of being redefined as an autoimmune disease rather than just a metabolic disorder.

A recent study, appearing in Nature Magazine, showed that an antibody called anti-CD20, which targets and eliminates mature B cells in the immune system, stopped diabetes type 2 developing in lab mice prone to develop the disease, and restored their blood sugar level to normal:

Chronic inflammation characterized by T cell and macrophage infiltration of visceral adipose tissue (VAT) is a hallmark of obesity-associated insulin resistance and glucose intolerance. Here we show a fundamental pathogenic role for B cells in the development of these metabolic abnormalities. B cells accumulate in VAT in diet-induced obese (DIO) mice, and DIO mice lacking B cells are protected from disease despite weight gain. B cell effects on glucose metabolism are mechanistically linked to the activation of proinflammatory macrophages and T cells and to the production of pathogenic IgG antibodies. Treatment with a B cell–depleting CD20 antibody attenuates disease, whereas transfer of IgG from DIO mice rapidly induces insulin resistance and glucose intolerance. Moreover, insulin resistance in obese humans is associated with a unique profile of IgG autoantibodies. These results establish the importance of B cells and adaptive immunity in insulin resistance and suggest new diagnostic and therapeutic modalities for managing the disease.

One of the many reasons that this is significant is that it could lead to future novel treatments.

The economics of obesity

Given the current administrations collectivistic approach to government I have to wonder what Michelle Obama’s shift in emphasis from good health to the economics of obesity means:

In the 10 cities with the nation’s highest obesity rates, the direct costs connected with obesity and obesity-related diseases are roughly $50 million per 100,000 residents. And if these 10 cities just cut their obesity rates down to the national average, all added up they combine to save nearly $500 million in health care costs each year.

This was the first lady’s message delivered earlier today.

Why do we continually hear that diabetes diagnoses and treatment are ineffective?

We continue to hear year after year that both diagnosis and treatment of diabetes is inadequaete.  For example:

Nearly 90 percent of U.S. adult diabetics — more than 16 million adults aged 35 and older — have ineffective treatment of blood sugar, blood pressure, and cholesterol. That percentage is 99 percent in Mexico, said the researchers at the Institute for Health Metrics and Evaluation at the University of Washington in Seattle.

Frankly, I don’t know why a problem that is this often researched, reported and editorialized is not acted upon in an effective manner.  Here are a few guesses regarding why our progress in this area has been slow:

  1. Diabetes is a challenging disease to identify because is exists in a continuum of states begining with insulin resistance and hyperinsulemia.
  2. Finding an alternate or suplimentary tool for diagnosis faces stiff resistance among the medical community if it is not fully vetted with a large, mult-center and internationally approved clinical study.  After all, “new” mean changing the practice of medicine which requires significant proof. 
  3. The cost of (2) may be an large impediment
  4. Our society tends to rely too heavily on doctors and/or medications to cure with a sliver bullet.  Effective treatment of diabetes requires change in one’s lifestyle, expectations and resource allocation.  The disease is not life threatening (generally) on a day-to-day basis which makes it difficult for many to “sacrifice” their present desires for the future.

These were off the top of my head … I’ll add more as I think of them.

Thanks for reading.

Islet Transplantation for Type 1 Diabetes

At one time I believed that islet translation would lead to a therapeutic treatment and cure for Type 1 diabetes. Presentations by noted surgeons and their endocrinologist partners were hopeful and suggested that short-term trials were highly successful.
However, long term observations seem to have revealed two key factors: (1) the effectiveness of the transplanted cells diminishes through time and (2) their are risk factors associated with the immunosuppression drugs.

Consider the summary from a recent British Medical Journal Commentary:

Summary points
Islet of Langerhans transplantation is used in a select group of patients with type 1 diabetes with severe glycaemic lability, recurrent hypoglycaemia, and hypoglycaemia unawareness
The procedure is minimally invasive, with few procedure related complications
Two to three islet infusions are usually needed to achieve insulin independence

Most patients need insulin by five years post-transplantation owing to declining graft function; beneficial effects on the frequency of hypoglycaemic episodes and hypoglycaemia awareness remain

Most long term complications are related to systemic immunosuppression

The risk-benefit ratio of islet transplantation should be carefully weighed by the treating physician and the potential recipient, who should be given adequate information

As I understand it, the target population as those individuals with Type 1 Diabetes who are unable to achieve satisfactory (safe) results with conventional therapy. So, islet transplantation is not (yet) the holy grail many of us had hope but it is never-the-less beneficial for some individuals.

Gastric Bypass Surgery Reverses Heart Ailments!

gastric-bypass-surgery.jpgThis is fairly significant news…. gastric bypass does help lose weight and treat diabetes (more here):

Well- who is a candidate for these procedures? Usually patients with a BMI of over 40 or over 35 with health consequences that are obesity related. Does gastric bypass have any effect on diabetes? In a series of 1000 patients, 150 of whom had diabetes, 83% experienced resolution of their diabetes (defined by a normalization of A1c and coming of medications for diabetes) after the surgery

However, there now appears to be additional benefits:

A new report from the Journal of the American College of Cardiology reports that patients who had received gastric bypass surgery not only lost weight but had maintained healthier cardiac health, while also reducing previous cardiac complications spurred by obesity.

Often times when a patient is obese, an increase in the largest portion of the heart, the left ventricle can become larger in mass causing the heart to work harder to pump blood into the body. According to the study, echocardiograms, or ultrasounds of the heart showed a remodeling of the heart structure which included a reduction of left ventricular mass and right ventricular cavity area in patients that had received Gastric Bypass Surgery, a procedure Texas Bariatric Specialists performs.

“Patients now have another reason to add to their check-off list of the benefits of a gastric bypass. Why would anyone severely obese wait any longer when the health risks are too high,” says Texas Bariatric Specialists founder Dr. Nilesh A Patel.
A gastric bypass is a bariatric procedure that is the single largest contributor to these findings and is offered at Texas Bariatric Specialists. In the Laparoscopic gastric bypass surgery procedure, the surgeon makes a small stomach pouch at the top of the stomach, the pouch is later connected to the small intestine bypassing the larger stomach. The gastric bypass can result in complete resolution in type 2 diabetes, hypertension, high blood pressure, sleep apnea, and the loss of 65 percent of excess body fat.

Source: press release

Pre-diabetes

Pre-diabetes is a term used to describe a condition in which the body is insulin resistant, leading to an elevation in blood sugars but not high enough to be diagnostic of diabetes. Pre-diabetes is diagnosed when your fasting blood sugar falls between 100-126 mg/dl.
It is estimated that 16 million Americans over the age of 40 have this new diagnosis.
The condition is serious – an immediate concern is that pre-diabetes increases the risk of heart attacks, strokes and heart disease by 50 percent. With the new lower threshold, it is hoped that more cases of pre-diabetes will be detected early enough so there is time to turn things around.
The good news is that something can be done about it.

The High-Fat Smoking Gun?

Many studies have indicated a correlation between a lifestyle that correlates to diabetes. Causality, however, is generally assumed but not proven. As a result, I hesitate to get too excited about any one set of results. Nevertheless, this is interesting:

High-fat diet linked to diabetes
Scientists at the University of California, San Diego believe they have discovered a link between type 2 diabetes and high fat diets.
5 Jan 2006, 09:33 GMT – Their findings suggest that high fat diets suppress the production of GnT-4a, the enzyme which allows cells in the pancreas to balance the body’s glucose and insulin levels.
Though their experiments were carried out on mice, the team believes that should their findings hold true in humans there would be a significant breakthrough in our understanding of diabetes and the possibility of developing a treatment.
The research validates the widely held belief that diabetes is strongly related to a high-fat diet and obesity. High levels of insulin have also been implicated in contributing to other diseases such as cancer, cardiovascular disease and stroke.
The researchers said new forms of treatment may include inhibiting the GnT-4a gene to reduce insulin production.

Teenage Diabetes on the Rise

New government research shows the number of teenagers with type two, or adult-onset diabetes is skyrocketing.
Just 10 years ago, the disease was almost unheard of in children. Now, almost half the children diagnosed with diabetes have type two.
Doctors said almost all teenagers with type two diabetes are overweight.
“It’s become so commonplace that 12-year-olds who are 200 pounds don’t see themselves as being abnormal or overweight,” said Dr. Byron Cotton with Children’s Healthcare of Atlanta.
Weight is a factor, but so are genetics for diabetes.
“You’ll find diabetes in all populations, but you tend to find it more in people of color, African-Americans, Hispanics,” Cotton explained.
- more here

More kids found to have both types of diabetes

Health experts report a rising incidence of “double diabetes” patients: children with symptoms of both type 1 and type 2 versions of the disease. This is a troubling development for many young people who find that their bodies do not produce insulin and are insensitive to it.
more

Diabetes and Stem Cells Research

Type I diabetes, commonly diagnosed during childhood, is a condition in which the body does not produce insulin. Insulin is a hormone that is used in the body to process glucose by transporting it from blood into cells. Consequently, the disease is marked by chronically high blood glucose levels that over time lead to other health problems such as retinopathy (and blindness), heart disease and neuropathy.

[Read more...]