Archive for the ‘diabetes’ Category

houston

Diabetes is so common in Patricia Graham’s neighbourhood that it has its own slang term. “At churches you run into people you ain’t seen in years, and they say, ‘I’ve got sugar,’” she says.

Graham does not quite have “sugar”, but when foot surgery in 2014 reduced her activity level, her blood sugar level soared. And there is a history of diabetes in her family: three of four brothers and her mother, who lost a leg to it.

So three times a week she comes to the smart, modern Diabetes Awareness and Wellness Network (Dawn) centre in Houston’s third ward, a historically African American district near downtown. Used by about 520 people a month, Dawn is in effect a free, city-run gym and support group for diabetics and pre-diabetics: a one-stop shop for inspiration, information and perspiration. Last Friday Graham, 68, was there for a walking session.

Not that she or the half-dozen other participants went anywhere. This was walking on the spot to pulsating music. Had the class stepped outside they would have enjoyed perfect conditions for a stroll: a blue sky and a temperature of 21C. If they had worked up an appetite, a soul food restaurant was only a 15-minute walk away, serving celebrated (if not exactly sugar-free) food that belies its unpromising location in a standard shopping mall on a busy road next to a dialysis centre.

But most of Houston is not built for walking, even on a sunny January day. There’s the constant traffic belching fumes that linger in the humid air; the uneven sidewalks that have a pesky habit of vanishing halfway along the street; the sheer distances to cover in this elongated, ever-expanding metropolis. Walking can feel like a transgressive act against Houston’s car-centric culture of convenience – and its status as the capital of the north American oil and gas industry.

It’s one reason why Houston regularly finishes top, or close, in surveys that crown “America’s fattest city”. Unsurprisingly, it has a diabetes problem as outsized as its residents’ waistlines. By 2040, one in five Houstonians is predicted to have the disease.

According to data from pharmaceutical company Novo Nordisk, the prevalence of type 2 diabetes in the city is 9.1% – with an estimated one in four of these being undiagnosed. Almost a third of adult Houstonians self-describe as obese, according to a 2010-11 survey. Without action, the number of people with diabetes is projected to nearly treble by 2040 to 1.1 million people, with diabetes-related costs soaring from $4.1bn in 2015 to $11.4bn by 2040.

Graham is alarmed by the damage diabetes is wreaking on her community. “I was talking to my friends and saying, so many of the people we grew up with got diabetes and lost limbs,” she says. “It’s not even so much the seniors any more, it’s the young people. But it doesn’t scare them. They act like they’re not afraid.”

Another Dawn member, Verne Jenkins, was diagnosed three years ago. “I had picked up a bit of weight that I shouldn’t have,” says the 63-year-old. “I knew what to eat, I knew what I was doing, I just got out of control.”

Jenkins loves to bake but has cut back on carbs, red meat, salt and sugar, abstaining from one of her guilty pleasures, German chocolate cake. Not that it’s easy in a city with so much choice: “All these wonderful restaurants, all these different kinds of cuisines, of course you’re going to try some. I imagine it leads to our delinquency,” she says.

Graham has watched her diet since she was in her 20s. “I eat pretty good,” she said. “‘She eats like white folks’ – that’s what they tell me!”

Time poverty

Diabetes is a major cause of death, blindness, kidney disease and amputations in the US. While federal researchers announced last year that the rate of new diabetes cases dropped from 1.7 million in 2009 to 1.4 million in 2014, in Texas the percentage of diagnosed adults rose from 9.8% in 2009 to 11% in 2014.

Houston, America’s fourth-largest city, is one of five participating in the Cities Changing Diabetes programme, along with Mexico City, Copenhagen, Tianjin and Shanghai. Vancouver and Johannesburg are soon to join the project, which attempts to understand, publicise and combat the threat through cultural analysis.

“The majority of people with diabetes live in cities,” says Jakob Riis, an executive vice-president at Novo Nordisk, one of the lead partners in the programme alongside the Steno Diabetes Center and University College London. “We need to rethink cities so that they are healthier to live in … otherwise we’re not really addressing the root cause of the problem.”

One of the programme’s key – and perhaps surprising – findings, however, is that assessing the risk of developing diabetes is not as simple as dividing the population according to income and race. The problem is broad – much like Houston itself.

The view stretches for miles from Faith Foreman’s eighth-floor office next to the Astrodome, the famous old indoor baseball stadium. It’s an impressive sight, but for someone tasked with tackling the city’s diabetes epidemic, also a worrying one: the sheer scale of the urban sprawl is part of the problem. The threat of the disease has expanded along with the city.

A low cost of living and a strong jobs market helped Houston become one of the fastest growing urban areas in the US. In response, the city loosened its beltways. Its third major ring road is under construction, with a northwestern segment set to open soon that is some 35 miles from downtown.

Once completed, the Grand Parkway – whose northwestern segment has just opened – will boast a circumference of about 180 miles. That is far in excess of the 117 miles of the M25, although about 14 million people live inside the boundary of London’s orbital motorway, more than twice as many as reside in the Houston area.

Large homes sprout in the shadow of recently opened sections, promising cheap middle-class living with a heavy cost: a commute to central Houston of up to 90 minutes each way during rush hour, with minimal public transport options.
“A lot of time in Houston is spent in a car,” says Foreman, assistant director of Houston’s Department of Health and Human Services. This informs one of the Cities Changing Diabetes study’s most notable findings: that “time poverty” is among the risk factors in Houston for developing type 2 diabetes.

This means that young, relatively well-off people can also be considered a vulnerable population segment, even though they might not fit the traditional profile of people who may develop type 2 diabetes – that is, aged over 45, with high blood pressure and a high BMI, and perhaps disadvantaged through poverty or a lack of health insurance.

“You generally think of marginalised, lower income communities in poverty as your keys to health disparities but I think what we learned from our data in Houston is that we now have to expand the definition of what vulnerable is and what at-risk means. Just because we live in an urban environment, we may all indeed be vulnerable,” says Foreman.

In other words, not only its residents’ dietary choices but the way Houston is constructed as a city appears to be contributing to its diabetes problem, so tackling the issue requires architects as well as doctors; more sidewalks as well as fewer steaks.

Urban isolation is a key challenge, says David Napier of UCL, the lead academic for Cities Changing Diabetes. “Houston is growing so quickly and also expanding geographically at such a rapid rate. When you look at how difficult it is for people just to get out and walk, or walk to work; the fact that so many people commute long distances, spend a lot of time eating out – they have a number of obstacles to overcome,” he says.

A city with notoriously lax planning regulations is now making a conscious effort to put more care into its built environment, with more public transport, expanded bike trails, better parks and denser, more walkable neighbourhoods all evident in recent years, even as the suburbs continue to swell.

Foreman’s agency has more input when officials gather to map out the future city. “That is something that has been a big change over the last two or three years in Houston,” she says. “We are at the table and we are working with city planning to make those decisions.”

But prevention is a vital focus as well as treatment. Along with his team, Stephen Linder of the University of Texas’ school of public health – the local academic lead for Houston’s Cities Changing Diabetes research – gathered data on 5,000 households in Harris County, which includes much of the Houston area.

“One way to approach this project wasn’t to focus on diabetes itself but rather to look at some of the preconditioned social factors that seemed to generate the patterns of living that then led to the clinical signs that would designate people as being prediabetic,” he says from his office at the Texas Medical Center near downtown Houston – the world’s largest medical complex.

“These were people who had neither disadvantage nor biological risk factors. They tended to be the youngest group and would normally escape any kind of assessment – we called them the ‘time-pressured-young’. They’re the ones who did the long commutes; they’re the ones whose perception was they could not manage their day’s worth of stuff, that they have no time for anything.”

For this group, obesity is so prevalent in Houston that it distorts an understanding of what a healthy weight is, Linder found. “Their perception of their health was affected by their peers as opposed to other sorts of references. If all of their peers were overweight then in a relative sense they were fine. The judgments were about one’s peers and not relative to any sort of expert standard,” he says.

Three neighbourhoods were identified as having the highest concentration of people vulnerable to developing diabetes, and a Dallas-area research company, 2M, conducted detailed interviews with 125 residents. One place was particularly surprising: Atascocita, a desirable middle-class area near a large lake and golf courses, about 30 miles north of downtown.

Houston has become, according to a 2012 Rice University study, the most ethnically diverse large metropolitan area in the US. But this cosmopolitan air – one of the qualities sought by any place seeking to become a globally renowned city – may also unwittingly be contributing to the diabetes crisis, the study found.

Some in Atascocita, Linder said, “emphasised this sense of change and transition in their neighbourhoods, that that was a source of stress for them and that they were resistant to making changes in their own lives given the flux that was around them. Because that group happened to be older, even though they were economically secure they did have some other chronic diseases and they satisfied our biorisk characteristics.

“We call them concerned seniors. They weren’t making changes because there was too much else going on for them. And so if we were to say to them ‘you’ve got to change your diet’, they’d say ‘no, I can’t handle any more changes’.”

This matters since food portions are no exception to the “everything’s bigger in Texas” cliche, while Houston’s location near Mexico and the deep south, its embrace of the Lone Star state’s love of barbecued red meat and its enormous variety of restaurants serving international cuisine combine to unhealthy effect.

“The food that had a traditional aspect to it tended not to be the healthiest food – southern food that’s fried and lots of butter and lots of starch, then there’s African American soul food and then there’s Hispanic heavy fat, prepared tamales and the like, and so we found people kind of gravitated to what the UCL people called nourishing traditions,” Linder said.

“People used food as not only a reinforcement of tradition and ritual but also as a way of connecting socially. You’ve moved here from somewhere else, it’s a way to reinforce your identity, it’s a real cultural asset to have, but in a biological sense it’s not the best thing.”

For Linder, one lesson is that generalised advice about healthy eating that has long been part of diabetes awareness efforts may not be effective locally, given the complexity and variety of Houston’s neighbourhoods and the social factors that make populations vulnerable to diabetes.

“It does make the task of dietary change a much more complex one than the simple messages about changing your diet, eat more fruit and vegetables, get more colour on your plate would suggest. Those things bounce off, it’s not a useful set of interventions then for that particular group who rely on these nourishing traditions and find some solace in the change around them,” he said.

Foreman agrees that a targeted approach is vital. “How do you change diabetes in Houston? One neighbourhood at a time, in a sense, but at the same time you have bigger things that you can change systemwide in policies and how you work together collaboratively,” she said. “But then as you narrow it and get more granular it is neighbourhood, and what works in one neighbourhood may or may not work in another.”

Patricia Graham is hoping that the Dawn programme expands to other parts of the city to combat the dangerous union of unhealthy traditional food with a modern convenience culture. “Everything is food, and I mean lots of it and all the time,” she said. “Some people don’t know how to cook without grease or butter. That’s just the way we learn.”

http://www.theguardian.com/cities/2016/feb/11/houston-health-crisis-diabetes-sugar-cars-diabetic?CMP=oth_b-aplnews_d-1

Thanks to Kebmodee for bringing this to the It’s Interesting community.

Researchers at the Karolinska Institute, Sweden, say guidelines that advise people to stay out of the sun unless wearing sunscreen may be harmful, particularly in northern countries which have long, cold winters.

Exposure to ultraviolet radiation from sunlight is often cited as a cause of skin melanoma (malignant tumour of melanocytes) and avoiding overexposure to the sun to prevent all types of skin cancer is recommended by health authorities.

But the new study, which followed nearly 30000 women over 20 years, suggests that women who stay out of the sun are at increased risk of melanomas and are twice as likely to die from any cause, including cancer.

It is thought that a lack of vitamin D may be to blame. Vitamin D is created in the body through exposure to sunshine and a deficiency is known to increase the risk of diabetes, TB, multiple sclerosis and rickets.

Previous studies showed that vitamin D can increase survival rates for women with breast cancer while deficiencies can signal prostate cancer in men.

The study looked at 29518 Swedish women who were recruited from 1990 to 1992 and asked to monitor their sunbathing habits.

After 20 years there had been 2545 deaths and it was found that women who never sunbathed were twice as likely to have died from any cause.

Women who sunbathed in the mild Swedish summer were also 10% less likely to die from skin cancer, although those who sunbathed abroad in sunnier countries were twice as likely to die from melanoma.

Yinka Ebo, senior health information officer at Cancer Research UK, said striking a balance was important.

“The reasons behind higher death rates in women with lower sun exposure are unexplained . overexposure to UV radiation from the sun or sunbeds is the main cause of skin cancer.”

http://www.timeslive.co.za/thetimes/2014/05/09/avoiding-sunshine-could-kill-you-study-finds

Thanks to Kebmodee for bringing this to the attention of the It’s Interesting community.

Could a new sugar substitute actually lower blood sugar and help you lose weight? That’s the tantalizing – but distant – promise of new research presented at the American Chemical Society (ACS) this week.

Agavins, derived from the agave plant that’s used to make tequila, were found in mouse studies to trigger insulin production and lower blood sugar, as well as help obese mice lose weight.

Unlike sucrose, glucose, and fructose, agavins aren’t absorbed by the body, so they can’t elevate blood glucose, according to research by Mercedes G. López, a researcher at the Centro de Investigación y de Estudios Avanzados, Biotechnology and Biochemistry Irapuato, in Guanajuato, Mexico.

And by boosting the level of a peptide called GLP-1 (short for glucagon-like peptide-1), which triggers the body’s production of insulin, agavins aid the body’s natural blood sugar control. Also, because agavins are type of fiber, they can make people feel fuller and reduce appetite, López’s research shows.

“We believe that agavins have a great potential as light sweeteners since they are sugars, highly soluble, have a low glycemic index, and a neutral taste, but most important, they are not metabolized by humans,” read the study abstract. “This puts agavins in a tremendous position for their consumption by obese and diabetic people.”

The caveat: The research was conducted in mice, and more study is necessary before we’ll know whether agavins are effective and safe in humans. In other words, we’re a long way from agavins appearing on grocery store shelves.

That said, with almost 26 millions of Americans living with diabetes and another 2 million diagnosed each year, a sweetener that lowered blood sugar levels rather than raised them would be quite a useful discovery. Not to mention the potential for a sugar substitute with the potential to help people lose weight.

In the study, titled “Agavins as Potential Novel Sweeteners for Obese and Diabetic People”, López added agavins to the water of mice who were fed a standard diet, weighing them and monitoring blood sugar levels every week. The majority of the mice given the agavin-supplemented water had lower blood glucose levels, ate less, and lost weight compared with other mice whose water was supplemented with glucose, sucrose, fructose, agave syrup, and aspartame.

Unlike other types of fructose, Agavins are fructans, which are long-chain fructoses that the body can’t use, so they are not absorbed into the bloodstream to raise blood sugar. And despite the similarity in the name, agavins are not to be confused with agave nectar or agave syrup, natural sweeteners that are increasingly popular sugar substitutes. In these products the fructans are broken down into fructose, which does raise blood sugar – and add calories.

López has been studying fructans for some time, and has published previous studies showing that they have protective prebiotic effects in the digestive tract and contribute to weight loss in obese mice.

A 2012 study by another team of researchers published in Plant Foods for Human Nutrition found that fructans boosted levels of the beneficial probiotics lactobacillus and bifidus. And like many types of fiber, agavins also lower levels of cholesterol and triglycerides in the blood.

But the news isn’t all good; a 2011 literature review of human studies of the relationship between fructans (not agavins specifically) and blood sugar found that of 13 randomized studies of fructans, only three documented positive results. It remains to be seen whether – as López argues – agavins are distinct from other fructans in their action.

The downside: Agavins are don’t taste as sweet as other forms of sugar such as sucrose, fructose and glucose. And not everyone can tolerate them; like other types of fiber they have the potential to cause digestive problems.

http://www.forbes.com/sites/melaniehaiken/2014/03/17/new-sweetener-from-the-tequila-plant-may-aid-diabetes-weight-loss/

Thanks to Dr. Rajadhyaksha for bringing this to the attention of the It’s Interesting community.

Getting really angry might be more dangerous than you think.

A new study found people who experienced severe anger outbursts were more at risk for cardiovascular events in the two hours following the outbursts compared to those who remained calm.

“The relative risk was similar for people who had known pre-existing heart disease and those who didn’t,” says Dr. Murray A. Mittleman, senior study author and an associate professor of medicine at Harvard Medical School.

The study was designed so that each patient was compared to his or her own baseline risk. “A person with pre-existing heart disease or cardiovascular disease, the absolute risk they are incurring is much greater than (that of) a person without cardiovascular disease or risk factors,” Mittleman says.
“If we look at somebody at higher risk for having cardiovascular events, and they get angry multiple times a day, this can lead to 650 extra heart attacks per year out of 10, 000 a year,” he says. “When we look at a person who is relatively low risk, but if they do have these episodes of anger fairly frequently, we estimate there would be about 150 extra heart attacks out of 10,000 a year.”

Smoking, high cholesterol, high blood pressure, being overweight and having diabetes are all risk factors for cardiovascular disease. An estimated 17 million people worldwide die of cardiovascular diseases, particularly heart attacks and strokes, each year, according to the Centers for Disease Control and Prevention.

The study published Monday in the European Heart Journal was a data analysis looking at nine studies where anger and cardiovascular events were self-reported over nearly two decades. The study found a 4.74 times higher risk of MI (myocardial infarction, or heart attack) or ACS (acute coronary syndrome, where the heart muscle doesn’t get enough oxygen-rich blood) following outbursts of anger.

“Anger causes our heart rate to increase through the sympathetic nervous system and causes our stress hormones to become elevated (the fight or flight mechanism),” says Dr. Mariell Jessup, president of the American Heart Association and medical director of the Penn Heart and Vascular Center at the University of Pennsylvania. “We breathe faster, all of which may trigger undesirable reactions in our blood pressure or in our arteries.”

This disruption may mean the heart or the brain doesn’t get the blood and oxygen they need resulting in a heart attack or a stroke, she says.

Researchers suggest more needs to be done to come up with effective interventions to prevent cardiovascular events triggered by anger outbursts. The American Heart Association suggests regular physical activity, finding a way to relax or talking with friends to help reduce stress and anger.

Mittleman suggests the best way to lower your risk for a heart attack or stroke during an angry outburst is to lower your overall baseline level of risk – exercise, eat healthy and don’t smoke – and then find ways to cope with stress and anger.

http://thechart.blogs.cnn.com/2014/03/03/angry-outbursts-may-raise-heart-attack-stroke-risk/?hpt=hp_t2

google-contact-lens-620xa

If successful, Google’s newest venture could help to eliminate one of the most painful and intrusive daily routines of diabetics.

People with diabetes have difficulty controlling the level of sugar in their blood stream, so they need to monitor their glucose levels — typically by stabbing themselves with small pin pricks, swabbing their blood onto test strips and feeding them into an electronic reader.

Google’s smart contacts could potentially make blood sugar monitoring far less invasive.

The prototype contacts are outfitted with tiny wireless chips and glucose sensors, sandwiched between two lenses. They are able to measure blood sugar levels once per second, and Google is working on putting LED lights inside the lenses that would flash when those levels are too low or high.

The electronics in the lens are so small that they appear to be specks of glitter, Google said. The wireless antenna is thinner than a human hair.

They’re still in the testing phase and not yet ready for prime time. Google (GOOG, Fortune 500) has run clinical research studies, and the company is in discussions with the U.S. Food and Drug Administration.

Diabetes is a chronic problem, affecting about one in 19 people across the globe and one in 12 in the United States.

The smart contacts are being developed in Google’s famous Google X labs, a breeding ground for projects that could solve some of the world’s biggest problems. Google X labs is also working on driverless cars and balloons that transmit Wi-Fi signals to remote areas.

Google’s contact lens project isn’t the first attempt at building the technology. For many years, scientists have been investigating whether other body fluids, including tears, could be used to help people measure their glucose levels. In 2011, Microsoft (MSFT, Fortune 500) partnered with the University of Washington to build contact lenses with small radios and glucose sensors.

http://money.cnn.com/2014/01/17/technology/innovation/google-contacts/

Thanks to Jody Troupe for bringing this to the attention of the It’s Interesting community.

exercise

New research explains how abstract benefits of exercise—from reversing depression to fighting cognitive decline—might arise from a group of key molecules.

While our muscles pump iron, our cells pump out something else: molecules that help maintain a healthy brain. But scientists have struggled to account for the well-known mental benefits of exercise, from counteracting depression and aging to fighting Alzheimer’s and Parkinson’s disease. Now, a research team may have finally found a molecular link between a workout and a healthy brain.

Much exercise research focuses on the parts of our body that do the heavy lifting. Muscle cells ramp up production of a protein called FNDC5 during a workout. A fragment of this protein, known as irisin, gets lopped off and released into the bloodstream, where it drives the formation of brown fat cells, thought to protect against diseases such as diabetes and obesity. (White fat cells are traditionally the villains.)

While studying the effects of FNDC5 in muscles, cellular biologist Bruce Spiegelman of Harvard Medical School in Boston happened upon some startling results: Mice that did not produce a so-called co-activator of FNDC5 production, known as PGC-1α, were hyperactive and had tiny holes in certain parts of their brains. Other studies showed that FNDC5 and PGC-1α are present in the brain, not just the muscles, and that both might play a role in the development of neurons.

Spiegelman and his colleagues suspected that FNDC5 (and the irisin created from it) was responsible for exercise-induced benefits to the brain—in particular, increased levels of a crucial protein called brain-derived neurotrophic factor (BDNF), which is essential for maintaining healthy neurons and creating new ones. These functions are crucial to staving off neurological diseases, including Alzheimer’s and Parkinson’s. And the link between exercise and BDNF is widely accepted. “The phenomenon has been established over the course of, easily, the last decade,” says neuroscientist Barbara Hempstead of Weill Cornell Medical College in New York City, who was not involved in the new work. “It’s just, we didn’t understand the mechanism.”

To sort out that mechanism, Spiegelman and his colleagues performed a series of experiments in living mice and cultured mouse brain cells. First, they put mice on a 30-day endurance training regimen. They didn’t have to coerce their subjects, because running is part of a mouse’s natural foraging behavior. “It’s harder to get them to lift weights,” Spiegelman notes. The mice with access to a running wheel ran the equivalent of a 5K every night.

Aside from physical differences between wheel-trained mice and sedentary ones—“they just look a little bit more like a couch potato,” says co-author Christiane Wrann, also of Harvard Medical School, of the latter’s plumper figures—the groups also showed neurological differences. The runners had more FNDC5 in their hippocampus, an area of the brain responsible for learning and memory.

Using mouse brain cells developing in a dish, the group next showed that increasing the levels of the co-activator PGC-1α boosts FNDC5 production, which in turn drives BDNF genes to produce more of the vital neuron-forming BDNF protein. They report these results online today in Cell Metabolism. Spiegelman says it was surprising to find that the molecular process in neurons mirrors what happens in muscles as we exercise. “What was weird is the same pathway is induced in the brain,” he says, “and as you know, with exercise, the brain does not move.”

So how is the brain getting the signal to make BDNF? Some have theorized that neural activity during exercise (as we coordinate our body movements, for example) accounts for changes in the brain. But it’s also possible that factors outside the brain, like those proteins secreted from muscle cells, are the driving force. To test whether irisin created elsewhere in the body can still drive BDNF production in the brain, the group injected a virus into the mouse’s bloodstream that causes the liver to produce and secrete elevated levels of irisin. They saw the same effect as in exercise: increased BDNF levels in the hippocampus. This suggests that irisin could be capable of passing the blood-brain barrier, or that it regulates some other (unknown) molecule that crosses into the brain, Spiegelman says.

Hempstead calls the findings “very exciting,” and believes this research finally begins to explain how exercise relates to BDNF and other so-called neurotrophins that keep the brain healthy. “I think it answers the question that most of us have posed in our own heads for many years.”

The effect of liver-produced irisin on the brain is a “pretty cool and somewhat surprising finding,” says Pontus Boström, a diabetes researcher at the Karolinska Institute in Sweden. But Boström, who was among the first scientists to identify irisin in muscle tissue, says the work doesn’t answer a fundamental question: How much of exercise’s BDNF-promoting effects come from irisin reaching the brain from muscle cells via the bloodstream, and how much are from irisin created in the brain?

Though the authors point out that other important regulator proteins likely play a role in driving BDNF and other brain-nourishing factors, they are focusing on the benefits of irisin and hope to develop an injectable form of FNDC5 as a potential treatment for neurological diseases and to improve brain health with aging.

http://news.sciencemag.org/biology/2013/10/how-exercise-beefs-brain

Thanks to Dr. Rajadhyaksha for bringing this to the attention of the It’s Interesting community.