The Puzzling Rise in Type I Diabetes

From Scientific American February 2012
"A Diabetes Cliff Hanger" Researchers are balled by the worldwide increase in type 1 diabetes, the less common form of the disease.
From the article, it says 90% of the 350 million people around the world who have diabetes mellitus have type 2 diabetes, or non-insulin dependent diabetes, as we used to call it. Type 1 diabetes requires insulin shots and often starts in childhood. This second type of diabetes has been rising by 3 to 5% per year. Type I diabetes has not classically been associated with obesity, so the reason for the rise in rates has scientists puzzled. Since the rise in Type 1 diabetes is world wide, the cause must be world wide also. Here are some of the hypotheses.
1. Gluten. Type 1 diabetics are more likely to have celiac disease which is caused by gluten intolerance. There has been a world wide increase in the amount of gluten most people consume over the decades.
2. Hygiene hypothesis. This is the hypothesis that links clean modern lifestyles and allergies. Since living hygienically deprives developing immune systems from early exposure to infections and soil organisms, it not only overreacts to allergens, but to the bodies own tissues, including insulin producing cells in the pancreas.
3. Fat. Perhaps there is a link between being overweight and developing Type I diabetes afterall. It may be possible to "burn out" your insulin producing cells by overtaxing them with too much food or the wrong kinds of food.

Cholesterol Drugs (Statins) Linked With Diabetes Risk

Who could have predicted that a highly lucrative drug might turn out to have some unpredicted nasty side effects? I have posted before about statins, since I've seen cases in my clinic of people with new muscle aches and pains, or back pain, or shoulder pain, etc... that started when they started taking statins. The part that irks me the most is the wide spread and inflexible denial on the part of the medical community to scrutinize these drugs more closely. If you read through the article, you will notice how these findings, also, are summarily dismissed. I have posted about statins here. In the letter to the editor in the Economist (not mine) their dubious efficacy is mentioned here. (For more information about my practice please click here.)

Cholesterol Drugs Linked With Diabetes Risk
By TARA PARKER-POPE

Cholesterol-lowering drugs called statins, which have been shown to lower a person’s risk for heart attack, can also slightly increase a patient’s risk for developing diabetes, particularly at higher doses, new research shows.

The findings, based on new analyses of five clinical trials involving 32,752 patients, raise new questions about how much we really know about the long-term effects of statins, which are the most widely prescribed drugs in the United States. The focus on the link between statins and diabetes comes at a time when some medical experts and pharmaceutical companies have pushed to broaden the use of the drugs beyond the 40 million at-risk patients who already use them to healthy people who would take the drugs for prevention of heart disease.

Doctors cautioned that patients should not overreact to the diabetes news, saying that the increased diabetes risk is very small, and that the benefits of statin therapy still far outweigh any side effects.

“I don’t think it’s very clinically important,’’ said Dr. Steven E. Nissen, chairman of cardiology at the Cleveland Clinic, who consults with drug companies that make statins but requires his fees be donated to charity. “What I worry about here is that people will read this story and say, ‘I don’t want to get diabetes so I’m going to stop my statin,’ and then they have a heart attack.’’

Last year, the medical journal The Lancet published an analysis of major statin trials involving 90,000 patients that showed statin users had a 9 percent higher risk of developing diabetes than those who didn’t take statins. But questions remained about whether the effect was real or something that may have just been due to chance.

However, the latest analysis, published today in The Journal of the American Medical Association, makes the strongest case yet that statins can trigger diabetes in some people. The report focused on differences in diabetes risk among moderate-dose and high-dose statin users, and found that those taking high doses had a 12 percent higher risk of developing diabetes compared to moderate-dose users. That translates to a 20 percent overall increased risk of diabetes for high-dose statin users, compared to those who don’t take the drugs, according to the study’s senior author.

Even so, medical experts, including the study authors, argued that while more study is needed to understand the diabetes link, the increased risk doesn’t eclipse the strong health gains achieved with statins, which in some studies have reduced heart attack and stroke risk by half.

Based on the data in the study, a total of 498 people would need to take a statin before triggering one extra case of diabetes. By comparison, just 155 people would need to take a statin to prevent one heart attack.

“The net benefit favored the statins overall,’’ said Dr. Kausik Ray, professor of cardiovascular disease prevention at St. George’s University of London and senior author on the paper. Dr. Ray says he has consulted for drug companies that make statins.

Exactly how statins may increase diabetes risk isn’t entirely clear, though animal studies suggest that statins can increase muscle resistance to insulin, resulting in higher levels of circulating blood sugar. Dr. Kausik notes that the patients in the studies were diagnosed with diabetes because of elevated blood sugar levels, but that the long-term consequences of higher blood sugar levels triggered by statin use aren’t known.

“Diabetes is defined by blood glucose levels, but none of us are absolutely certain if this is going to carry the same risk as if you traditionally developed diabetes,’’ Dr. Kausik said.

In addition, Dr. Nissen says the statins don’t cause blood sugar to shoot up rapidly but instead can slightly elevate blood sugar enough to push borderline patients across the threshold into diabetes.

“It doesn’t take much to tip a few people over that boundary to the point where we call them diabetic,” said Dr. Nissen. “We can’t dismiss it, but I also don’t want to scare people who need these drugs. They are the best thing we’ve got going to prevent coronary disease events.”

HDL, "Good" Cholesterol May Lower Alzheimer Risk

At Columbia University’s Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, they've done a study looking at Alzheimer risk and HDL, the "good" portion of cholesterol. If your HDL cholesterol is very high, this may be protective. In fact patients with high levels of HDL were less than half as likely to develop Alzheimer's Disease.

(To read more about acupuncture and my practice, please click here.)


‘Good’ Cholesterol May Lower Alzheimer’s Risk
By RONI CARYN RABIN

The people who reaped the benefit had very high HDL blood levels that exceeded 56 milligrams per deciliter of blood, the study reported. They developed 60 percent fewer cases of Alzheimer’s disease than people with the lowest HDL levels, of 38 milligrams or below...
But the HDL was only protective at extremely high levels, Dr. Reitz said. “It really only makes a difference if you’re higher than 56 [milliliters],” she said.

The report, published in the Archives of Neurology, is not the first to find that what’s good for the body may also good for the brain. Numerous studies have found that older people who walked the most were at lowest risk of developing vascular dementia, possibly because the regular exercise improves cerebral blood flow and lowers the risk of vascular disease.

Regular physical activity, in general, is believed to improve brain function, both by increasing blood flow to the brain and by stimulating the production of hormones and nerve growth factors involved in new nerve cell growth. Exercise also raises levels of “good” HDL cholesterol. Studies have found that animals that are kept physically active have better memories and more cells in their hippocampus, a part of the brain critical for memory. And exercise can help stave off or keep in check diseases like Type 2 diabetes, which increase the risk of developing dementia...

Some medications, like niacin and fibrates, may help raise HDL levels, Dr. Reitz said. But she recommends a Mediterranean diet rich in healthy fats from nuts, fish and olive oil, along with exercise, adding, “Aerobic exercise helps a lot.”

In a previous post, I discussed a study that looks at insulin resistance and acupuncture and how acupuncture can help with this aspect of metabolic syndrome and Type 2 diabetes. I hope it's not a stretch to think that acupuncture might help increase HDL cholesterol by increasing insulin sensitivity. Maybe it is a bit of a stretch, but for sure acupuncture can help to get you walking again if you have knee, back or hip pain!

Acupuncture: is it effective for treatment of insulin resistance?

Acupuncture: is it effective for treatment of insulin resistance?
Diabetes Obes Metab. 2010 Jul;12(7):555-69.
Liang F, Koya D.Department of Endocrinology & Metabolism, Kanazawa Medical University, Ishikawa, Japan.

This study out of Japan looks at the literature concerning acupuncture and conditions related to Insulin Resistance and concludes that acupuncture might very well improve insulin sensitivity, though, of course, calls for better, controlled, studies. This review analyses 234 English publications listed on the PubMed database between 1979 and 2009 on the effectiveness of acupuncture as a treatment for IR.
A few quotes

"Insulin resistance (IR) is closely associated with obesity, type 2 diabetes mellitus (T2DM), hypertension, polycystic ovary syndrome (PCOS), non-alcohol fatty liver diseases (NAFLD) and metabolic syndrome and is also a risk factor for serious diseases such as cardiovascular diseases. Pharmacological treatments available for IR are limited by drug adverse effects."

" Numerous experimental studies have demonstrated that acupuncture can correct various metabolic disorders such as hyperglycemia, overweight, hyperphagia, hyperlipidemia, inflammation, altered activity of the sympathetic nervous system and insulin signal defect, all of which contribute to the development of IR. In addition, acupuncture has the potential to improve insulin sensitivity."

(To read more about acupuncture and my practice, please click here.)