The personal fat threshold

A September 2022 study by Newcastle University, of which Eureka notes

• “Everyone has a ‘personal fat threshold’ which, if exceeded, will allow type 2 diabetes (T2D) to develop, even if they are of a lower body weight”

• “The most common form of diabetes, T2D occurs when the pancreas can’t make enough insulin (a hormone which helps move the sugar in food into cells for energy) or the insulin it makes doesn’t work properly.”

• “Having a BMI over 30 is a risk factor for T2D”

• “An intensive weight loss programme can put T2D into remission in people who are living with obesity or overweight.”

• “But not everyone with T2D is overweight.”

Newcastle University said,

• “But if they lost around 10% of their weight, they would have a very good chance of putting their type 2 diabetes into remission,”

• “The results also support the personal fat threshold concept that anyone with type 2 diabetes has a little more fat on board than they individually can cope with.  This is determined by your genes. Each of us has a threshold level under which they can store fat safely and that this has little to do with BMI.”

• “If you develop type 2 diabetes, you simply have more fat inside your body than you can cope with, even if apparently slim.”

• “This excess fat spills into your liver and pancreas stopping normal function and causing type 2 diabetes. You only need an extra half gram of fat in the pancreas to prevent normal insulin production.”

• “‘I’m often asked, “Why have I got type 2 diabetes when all my friends are larger than me and do not have diabetes?” The present work answers this conundrum.”

• “This should help to remove some of the stigma that attaches to type 2 diabetes. It is clearly a condition which is not “caused” by being over any level of BMI but by storing a little too much fat inside liver and pancreas, whatever your weight.”

Diabetes, diet and blood pressure

A May 2021 study at the Universities of Glasgow and Newcastle for the Diabetes UK-funded DIabetes REmission Clinical Trial (DIRECT), said, 

• "We wanted to evaluate the safety and efficacy of withdrawing blood pressure medication when beginning our specially-designed weight-loss programme for type 2 diabetes, and we are really pleased with the results.

• "Our study shows that, in addition to possible remission from type 2 diabetes, there are other very important health benefits, as weight loss is a very effective treatment for hypertension and its associated serious health risks.

• "Currently, over half of all the 4.5 million people with type 2 diabetes in UK also require tablets for hypertension, to reduce serious vascular complications. Being overweight is the main cause, and losing weight can bring a remission from hypertension for many, as well as a remission of diabetes. Withdrawing blood pressure medications is safe, provided people lost weight and blood pressure was checked regularly, in case tablets needed to be reintroduced.”

• "The DiRECT trial was done entirely in primary care. The evidence shows that GPs can safely offer an evidence-based intensive weight management intervention, aiming for substantial weight loss and remission of type 2 diabetes. The study further highlights the links between diet, weight, type 2 diabetes and hypertension, and how long-term support to maintain weight loss is vital."

Newcastle University, said,

• "Guidelines encourage doctors to start tablets but there have been few demonstrations of how tablets can be stopped.

• "My patients, like so many, do not like swallowing multiple tablets, and this study is important as we can now reassure them that stopping blood pressure tablets is not only safe but also good for their health. We've shown that when substantial weight loss is achieved and maintained, patients can effectively manage both their blood pressure and type 2 diabetes without drugs."

University of Glasgow, said, 

”The potential to no longer need medications for blood pressure and diabetes is a big incentive for people. We hope our results will reassure health professionals that this is possible, and encourage the wider provision of diabetes remission services."

Diabetes UK, said,

 "These important results show that the Diabetes UK-funded DiRECT low-calorie, weight management programme not only helps some people put their type 2 diabetes into remission, but can also lower blood pressure, allowing some people to safely stop taking their blood pressure medication.”

"We're delighted to see more evidence of the life-changing impact of the DiRECT programme on people's health. This makes us even more determined to make sure as many people as possible have access to type 2 diabetes remission services."

Millet and Diabetes

A July 2021 study, the largest systematic review on the topic to date, said, 

• “No one knew there were so many scientific studies undertaken on millets’ effect on diabetes and these benefits were often contested. This systematic review of the studies published in scientific journals has proven that millets can keep blood glucose levels in check and reduce the risk of diabetes. It has also shown just how well these smart foods do it,”

• “Awareness of this ancient grain is just starting to spread globally, and our review shows millets having a promising role in managing and preventing type 2 diabetes. In the largest review and analysis of research into different types of millet compared to other grains such as refined rice, maize and wheat we found that millets outperform their comparison crops with lower GI and lower blood glucose levels in participants,”

• “Millets are grown on all inhabited continents, yet they remain a ‘forgotten food’. We hope this will change from 2023, when the world observes the United Nations declared International Year of Millets, and with studies like this that show that millets outperform white rice, maize and wheat,”

• “The global health crisis of undernutrition and over-nutrition coexisting is a sign that our food systems need fixing. Greater diversity both on-farm and on-plate is the key to transforming food systems. On-farm diversity is a risk mitigating strategy for farmers in the face of climate change while on-plate diversity helps counter lifestyle diseases such as diabetes. Millets are part of the solution to mitigate the challenges associated with malnutrition, human health, natural resource degradation, and climate change. Trans-disciplinary research involving multiple stakeholders is required to create resilient, sustainable and nutritious food systems,”

• “This study is first in a series of studies that has been worked on for the last four years as a part of the Smart Food initiative led by ICRISAT that will be progressively released in 2021. Included are systematic reviews with meta-analyses of the impacts of millets on: diabetes, anemia and iron requirements, cholesterol and cardiovascular diseases and calcium deficiencies as well as a review on zinc levels. As part of this, ICRISAT and the Institute for Food Nutrition and Health at the University of Reading have formed a strategic partnership to research and promote the Smart Food vision of making our diets healthier, more sustainable on the environment and good for those who produce it,”

Cooking, diabetes and self-management education

An August 2022 study by the Ohio State University Wexner Medical Centre and College of Medicine said, 

• “… Cooking Matters for Diabetes may be an effective method of improving diet-related self-care and health-related quality of life, especially among individuals living with food insecurity…” 

• “Teaching cooking skills has been shown to help reduce the burden of food insecurity. But broader skills required to get food on the table, such as meal planning, shopping, budgeting, food safety and nutrition, are also of critical importance,”

• “We found that study participants ate more vegetables and fewer carbohydrates. We saw improvements, including significant changes in diabetes self-management activities and numerical lowering of A1C among food-insecure study participants. This is important, because food insecurity and a lack of access to nutritious food can make diabetes management and A1C control more difficult,” 

• “Many outcomes improved more substantially among individuals with food insecurity compared to those without. But during the post-intervention follow-up period, the food insecure group experienced greater regression, emphasizing the importance of sustained follow-up in populations made vulnerable related to one or more social determinants of health,”

Time restricted eating and diabetes

A July 2022 study by NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, the Netherlands said, 

“Mechanisms underlying the improvement in glucose regulation upon TRE [Time Restricted Eating] remain unclear. Our results show that TRE did not improve peripheral and liver insulin sensitivity, skeletal muscle mitochondrial function, energy metabolism or liver fat content, all of which are known to be affected in T2D [Type 2 Diabetes].” 

They concluded,  

“A daytime 10 h TRE regimen for 3 weeks decreases glucose levels and prolongs the time spent in the normal blood sugar range in adults with T2D as compared with spreading daily food intake over at least 14 h. These data highlight the potential benefit of TRE in T2D”

And “Since our TRE protocol was feasible and safe, and resulted in improved 24 h glucose levels, it would be interesting to examine the impact of 10 h TRE on glucose regulation and insulin sensitivity in type 2 diabetes in the long term to address the clinical relevance of TRE.”

Type 2 diabetes and Brown Fat

A June 2021 study by UT Southwestern said,

"We may be able to help make fat depots more metabolically healthy and potentially prevent or treat obesity-associated diabetes,"

Diabetes type 2: New Treatment pathway

A June 2021 study from University of Arizona College of Agriculture and Life Sciences and BIO5 Institute, and  Washington University in St. Louis, the University of Pennsylvania and Northwestern University,

• "All current therapeutics for Type 2 diabetes primarily aim to decrease blood glucose. So, they are treating a symptom, much like treating the flu by decreasing the fever,”

• "Obesity is known to be a cause of Type 2 diabetes and, for a long time, we have known that the amount of fat in the liver increases with obesity,”

• "As fat increases in the liver, the incidence of diabetes increases."

• "We found that fat in the liver increased the release of the inhibitory neurotransmitter Gamma-aminobutyric acid, or GABA," 

• "We then identified the pathway by which GABA synthesis was occurring and the key enzyme that is responsible for liver GABA production - GABA transaminase."

• "When the liver produces GABA, it decreases activity of those nerves that run from the liver to the brain. Thus, fatty liver, by producing GABA, is decreasing firing activity to the brain," 

• "That decrease in firing is sensed by the central nervous system, which changes outgoing signals that affect glucose homeostasis."

• "Inhibition of excess liver GABA production restored insulin sensitivity within days," 

• "Longer term inhibition of GABA-transaminase resulted in decreased food intake and weight loss."

Heart Health, Obesity: Cut 200 calories and exercise

An August 2021 study by Sticht Center for Healthy Aging and Alzheimer’s Prevention at Wake Forest School of Medicine in Winston-Salem, North Carolina found that 

• "Cutting 200 (not 250) calories daily and exercising may improve heart health in obese older adults" 

• “This is the first study to assess the effects of aerobic exercise training with and without reducing calories on aortic stiffness, which was measured via cardiovascular magnetic resonance imaging (CMR) to obtain detailed images of the aorta,” 

• “We sought to determine whether adding caloric restriction for weight loss would lead to greater improvements in vascular health compared to aerobic exercise alone in older adults with obesity.”

• “Our findings indicate that lifestyle changes designed to increase aerobic activity and moderately decrease daily calorie intake may help to reduce aortic stiffness and improve overall vascular health,”

• “However, we were surprised to find that the group that reduced their calorie intake the most did not have any improvements in aortic stiffness, even though they had similar decreases in body weight and blood pressure as the participants with moderate calorie restriction.”

• “These results suggest that combining exercise with modest calorie restriction — as opposed to more intensive calorie restriction or no-calorie restriction — likely maximizes the benefits on vascular health, while also optimizing weight loss and improvements in body composition and body fat distribution. The finding that higher-intensity calorie restriction may not be necessary or advised has important implications for weight loss recommendations to improve cardiovascular disease risk in older adults with obesity.”

Low GI dietary regime and diabetes

An August 2021 study found that low GI/GL dietary patterns “are considered an acceptable and safe dietary strategy that can produce small meaningful reductions in the primary target for glycaemic control in diabetes, HbA1c, fasting glucose, and other established cardiometabolic risk factors.”

“Our synthesis supports existing recommendations for the use of low GI/GL dietary patterns in the management of diabetes.”

Dietary Inflammatory Index and pre-Diabetes

Another study regarding the Dietary Inflammatory Index.

A 2017 study entitled Association between Dietary Inflammatory Index (DII) and risk of prediabetes: a case-control study said,

“Subjects who consumed a more pro-inflammatory diet were at increased risk of prediabetes compared with those who consumed a more anti-inflammatory diet.”

Source

Department of Nutritional Sciences, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Heart Disease and Diabetes

An April 2021 study by Bichat-Claude Bernard Hospital, France, said, 

"Obesity and lack of exercise are common risk factors for both diabetes and heart disease and our results highlight the urgent need to improve nutrition and raise activity levels globally," 

"Countries worst affected by diabetes are also at the epicentre of the obesity epidemic, which can be in part attributed to urbanisation and associated changes in physical activity and food intake."

"Diabetes was linked with worse outcomes even in areas with the lowest prevalence. In Europe, for instance, diabetes was linked with a 29% greater risk of the combined outcome of heart attack, stroke, or cardiovascular death. This indicates that management of these very high-risk patients with heart disease and diabetes should be improved. Each country needs to identify these patients and provide tailored educational and prevention programmes."

"The importance of healthy eating and living cannot be overemphasised. Everyone can lower their chances of developing diabetes with weight control and exercise, and early detection is needed so that blood sugar can be controlled. Those with heart disease and diabetes also need an active lifestyle and a good diet to protect their health. Avoiding smoking is crucial, as is controlling blood pressure and cholesterol levels."

Sardines and Diabetes

A May 2021 study the Universitat Oberta de Catalunya's (UOC) Faculty of Health Sciences and the August Pi i Sunyer Biomedical Research Institute (IDIBAPS) said,

"Not only are sardines reasonably priced and easy to find, but they are safe and help to prevent the onset of type 2 diabetes. This is a huge scientific discovery. It is easy to recommend this food during medical check-ups, and it is widely accepted by the population”

"As we get older, restrictive diets (in terms of calories or food groups) can help to prevent the onset of diabetes. However, the cost-benefit ratio is not always positive, as we found in other studies" 

"However, the results lead us to believe that we could obtain an equally significant preventive effect in the younger population."

"Nutrients can play an essential role in the prevention and treatment of many different pathologies, but their effect is usually caused by the synergy that exists between them and the food that they are contained in. Sardines will therefore have a protective element because they are rich in the aforementioned nutrients, whereas nutrients taken in isolation in the form of supplements won't work to the same extent”

metabolic pathways and disease

A March 2021 study headed up by Dr. Claudia Langenberg, looked at a number of unassociated metabolic processes linked to various diseases.

"We wanted to know whether there are certain markers in the blood that indicate a risk, not only for one but for several diseases at the same time," 

"We found, for example, that an increased concentration of the sugar-like molecule N-acetylneuraminate increased the risk of no less than 14 diseases," 

"Gamma-glutamylglycine, on the other hand, is exclusively associated with the occurrence of diabetes. Other members of the same molecular groups simultaneously increase the risk of liver and heart disease." 

"Overall, we observed that two-thirds of the molecules are associated with the occurrence of more than one disease. This is in line with the fact that patients often develop a range of diseases in the course of their lives. If we succeed in influencing these key factors, this could make it possible to counter multiple diseases simultaneously."

Eat earlier to reduce risk of diabetes

A March 2021 study by Northwestern University in Chicago found that, 

"People who started eating earlier in the day had lower blood sugar levels and less insulin resistance, regardless of whether they restricted their food intake to less than 10 hours a day or their food intake was spread over more than 13 hours daily," 

"With a rise in metabolic disorders such as diabetes, we wanted to expand our understanding of nutritional strategies to aid in addressing this growing concern," 

"These findings suggest that timing is more strongly associated with metabolic measures than duration, and support early eating strategies," 

The Liver, high blood sugar and muscle loss

A March 2021 study by Monash University said, 

"The ageing-related diseases of skeletal muscle loss and type 2 diabetes are very prevalent and are a huge societal and economic burden. We have known for some time that the ageing-related diseases of skeletal muscle loss and type 2 diabetes were linked but we didn't know how.”

"Our studies demonstrate that the liver is a critical control point for muscle protein metabolism; a discovery that is quite surprising. We believe that our new findings highlight the need to examine the role of skeletal muscle atrophy in type 2 diabetes more closely in human clinical populations."

Treatment for type-2 diabetic heart disease

In a very interesting March 2021 study by the University of Otago it was said,

• "Based on the results of laboratory testing, we identified the number of microRNAs that are impaired in stem cells of the diabetic heart”

• "Among several microRNAs we identified that one particular microRNA called miR-30c - which is crucial for the stem cells' survival, growth and new blood vessel formation - is reduced in the diabetic stem cells. All these functions are required for stem cell therapy to be successful in the heart.

• "Importantly, we also confirmed that this microRNA is decreased in the stem cells collected from the heart tissue of the patients undergoing heart surgery at Dunedin Hospital.”

• A "simple injection” “…resulted in significantly improving the survival and growth of stem cells in the diabetic heart,"

• "This fascinating discovery has newly identified that impairment in the microRNAs is the underlying reason for the stem cells being not functional in the diabetic heart. More importantly, the results have identified a novel therapy for activation of stem cells in the heart using microRNA, without the need to inject stem cells, which is a time and cost consuming process."

• "Apart from identifying the reasons for poor stem cells function in a patient with diabetes, the novel therapy of using microRNA could change the treatment method for heart disease in diabetic individuals."

• "Our initial analysis revealed that there might be another four potential candidate microRNAs. Therefore, it is essential to test the function of those microRNAs as well. It may be possible that combination therapy with more than one microRNA could further increase the beneficial effects."

Diabetes and Bedtime

A September 2020 study by the University of South Australia and the University of Leicester found that,

• "There is a massive need for large-scale interventions to help people with diabetes initiate, maintain and achieve the benefits of an active lifestyle,”

• "For people who prefer to go to bed later and get up later, this is even more important, with our research showing that night owls exercise 56 per cent less than their early bird counterparts.

• "Exercise plays an important role for people with diabetes, helping maintain a healthy weight and blood pressure, as well as reducing the risk of heart disease - all significant factors for improving diabetes management.”

• "This makes understanding the factors that can mitigate a person's propensity to exercise, extremely important."

• “The links between later sleep times and physical activity is clear: go to bed late and you're less likely to be active,”

• "As sleep chronotypes are potentially modifiable, these findings provide an opportunity to change your lifestyle for the better, simply by adjusting your bedtime."

• "For someone with diabetes, this is valuable information that could help get them back on a path to good health."

Eating Protein At Night

It may be that the time you eat protein impacts on the blood sugar level in different ways according to July 2020 research by the University of Bath. Eating protein at night may have a higher impact on blood sugars levels the following morning.

Eleanor Smith, who presented the work, said: "Future research will look at whether this applies to older and overweight people who tend to have more problems controlling their blood sugar levels. It would also be interesting to know to what extent our findings are due to eating at an unusual time or the type of protein consumed."

Sitting, Insulin Resistance, and Heart Disease

A February 2020 study by the Arizona State University College of Health Solutions said,

“We were surprised to observe such a strong negative link between the amount of time spent sitting and insulin resistance, and that this association was still strong after we accounted for exercise and obesity,"

"The findings of this study build upon earlier research including our own, which showed, among older women, that too much time in sedentary behaviors was associated with higher risk for diabetes and heart disease. Reducing sitting time improves glucose control and blood flow, and engaging in physical activities, even light-intensity daily life activities like cooking and shopping, show favorable associations with reduced mortality risk and prevention of heart disease and stroke."

"Health care providers should encourage patients, including older adults, to reduce their sitting time, take breaks in their sitting time and replace sitting with brief periods of standing or light physical activity."

Diabetes Management, Young & Old

A February 2020 study by the Mayo Clinic said,

"Patients who are older or who have serious health conditions are at high risk for experiencing hypoglycemia, which, for them, is likely to be much more dangerous than a slightly elevated blood sugar level … At the same time, the benefits of intensive treatment usually take many years, even decades, to realize. So many patients may be treated intensively and risk hypoglycemia for no real benefit to them."

But younger people, who are less likely to experience severe hypoglycaemia, "should be treated more aggressively, meaning that we should not shy away from using insulin or multiple medications to lower the A1C … We need to ensure that all our patients with diabetes receive high-quality care and are able to manage their disease to prevent complications both now and in the future."

"Patients who are treated intensively are those who are most likely to be harmed by it … But at the same time, patients who would benefit from more intensive treatment are not receiving the basic care that they need. The paradox and misalignment of treatment intensity with patients' needs is really striking."

"Patients least likely to benefit from intensive glycemic control and most likely to experience hypoglycemia with insulin therapy were most likely to achieve low HbA1c levels and to be treated with insulin to achieve them…These HbA1c levels reflect HbA1c levels achieved by the patient, not necessarily HbA1c levels pursued by the clinician."

"Most importantly, clinicians should continue to engage their patients in shared and informed decision-making, weighing the risks and benefits of glucose-lowering treatment regimens in the specific context of each patient, carefully considering the patient's comorbidity burden, age, and goals and preferences for care."

“We have a great opportunity to simplify and de-intensify the treatment regimens of our more elderly patients, which would reduce their risk of hypoglycemia and treatment burden without spilling over into hyperglycemia,"

"At the same time, we need to better engage younger, healthier patients, work with them to identify barriers to diabetes management, and support them to improve their glycemic control."

“As clinicians, we need to be current on the guidelines and the evidence, know our patients, and work closely with them to do what is right for them."