Author: Staff Writers

Beans and rice are two ingredients that are common to many meals in the typical Western diet. However, a study conducted in Costa Rica has found that lightening up on the rice and eating more beans could be better for overall health.

The study, which was conducted on almost 2,000 men and women, found that those who regularly replaced a serving of white rice with a serving of beans were 35% less likely to display precursor symptoms for diabetes. The researchers reported their results in the American Journal of Clinical Nutrition.

“Rice is very easily converted into sugar by the body. It’s very highly processed, it’s pure starch and starch is a long chain of glucose,” said Frank Hu, one of the researchers with the study. Hu is a professor of nutrition and epidemiology at Harvard School of Public Health in Boston, Massachusetts. “Beans compared with rice contain much more fiber, certainly more protein and they typically have a lower glycemic index — meaning they induce much lower insulin responses,” continued Hu. Though beans do contain significant amounts of carbohydrates, the body must work more to break them down, resulting in slower digestion time and a reduced impact on insulin production and blood sugar.

Hu’s research team analyzed the diets of almost 2,000 men and women from Costa Rica, who were participating in a study lasting from 1994 to 2004 that looked at risk factors for heart disease. At the beginning of the study, none of the participants were diabetic.

As with many industrialized nations, Costa Rica has seen its diabetes rates begin to soar. The urbanization of the country, along with its increased wealth, has caused increases in the consumption of white rice; simultaneously, consumption of beans has decreased, according to Hu. This increase in rice consumption could be part of the reasoning behind the nation’s rising diabetes rates: study participants who ate more white rice over a long-term period had higher blood pressure in addition to lower levels of good cholesterol and increased levels of fat and sugar in their blood.

These are well-known risk factors for metabolic syndrome, a series of conditions that dramatically increase risk of developing Type 2 diabetes and heart disease.

While those who ate more rice were at higher risk for metabolic syndrome, individuals who ate two servings of beans for every serving of white rice were usually at lower risk. Such practices of replacing rice with beans reduced the risk of metabolic syndrome by 35%.

While rice generally makes up a significantly larger portion of the average diet in countries outside the U.S., Americans have been consuming more and more rice every year, according to the U.S. Department of Agriculture. In 1980, Americans consumed 9.5 pounds of rice per person every year; in 2008, that number rose to 21 pounds per person. At the same time, Americans have consumed less dry beans — about 7 pounds per year.

Hu says that such an increase in consumption of white rice is dangerous, especially when compared to brown rice. According to Hu, eating white rice “is like eating a candy bar — the fiber and other nutrients are stripped away.” The increases in consumption of white rice “will have long-term metabolic effects,” added Hu. “It would be useful to introduce more legumes, including beans, into our diet to replace white rice and some of the red meat.”

New research findings relating to low-grade inflammation are sure to cause controversy, as they seem to contradict current mainstream views of diabetes. While increases in low-grade inflammation are commonly believed to be a contributing factor in the development of Type 2 diabetes, a team of researchers at Children’s Hospital in Boston have reported that two proteins activated by inflammation are actually vital in regulating blood sugar levels; not only that, but increasing the activity of these proteins leads to better blood glucose stability in obese and diabetic mice.

The findings were reported in the October issue of Nature Medicine. The research team was headed by Umut Ozcan, M.D., with the Division of Endocrinology at Children’s Hospital.

“This finding is completely contrary to the general dogma in the diabetes field that low-grade inflammation in obesity causes insulin resistance and type 2 diabetes,” said Ozcan. “For 20 years, this inflammation has been seen as detrimental, whereas it is actually beneficial.”

The team headed by Ozcan has shown in the past that obese individuals experience increased stress on the endoplasmic reticulum, or ER. This cellular structure is involved in the assembling, folding, and releasing of proteins to conduct the operations of the cell. “ER stress,” as it’s called, reduces the body’s efficiency in responding to insulin and regulating blood sugar levels; this deficiency is one of the primary links between Type 2 diabetes and obesity.

Ozcan’s team previously found that proteins called XBP1s, which play a role in mitigating ER stress, are unable to function in overweight mice. Then, they showed that inducing XBP1s to activate in the liver resulted in normalization of the blood sugar levels of obese, Type 2 diabetic mice as well as in Type 1 diabetic mice.

The team’s newest study shows that yet another protein which is activated by inflammation, known as p38 MAPK, is responsible for chemically altering XBP1s to increase their activity. Without the increase in activity from p38 MAPK, XBP1s are unable to maintain normal blood sugar levels. In addition, the study showed that activity of the p38 MAPK protein is reduced in obese mice, and re-activating the protein in the liver reduced ER stress while reducing blood glucose levels and increasing glucose tolerance and insulin sensitivity.

When taken together, the findings of the two studies suggest that new therapies for diabetes could be developed by increasing the activity of the p38 MAPK protein and thereby increase XBP1 activity, or by increasing XBP1 activity directly. Since these proteins are associated with low-grade inflammation, any such therapies will likely be controversial and need further study.

The studies also provide new information about Type 2 diabetes that could help with our understanding of the disease. “It may be that inflammatory pathways are not working optimally and there could be a resistance to cytokines which mediates the inflammation,” said Ozcan. “This could be a paradigm shift for the field.” In other words, obesity could be related to diabetes by causing a disruption in the ability of the individual’s cells to respond to inflammatory signals.

Though the research team is hopeful that their findings could lead to new therapeutics, they warn that there could be downsides to using p38 MAPK inhibitors to treat inflammatory diseases, such as asthma, psoriasis and Chrohn’s disease. “These therapeutic approaches should… be evaluated within the context of our results, and in light of the possibility that inhibition of XBP1s activity also decreases the ability of the cell to cope with the inflammatory conditions,” the study states.

A study conducted at the University of Otago in Dunedin, New Zealand, has found that middle-aged women who consume meals at a slower rate are much less likely to become overweight than women of the same age who eat quickly.

The study was the first of its kind to be conducted on a national level. It examined the link between body mass index, or BMI, and the speed of eating as reported by the 1500 women who participated in the study. The women were from New Zealand and ranged in age from 40 to 50 years old; this demographic is at a high risk of weight gain. The study was conducted by the Department of Human Nutrition at the University of Otago.

When the team adjusted its results to take into consideration other factors such as level of physical activity, whether or not the women had reached menopause, smoking status, and ethnicity, they found that the faster the women ate, the higher their BMI numbers grew.

“For every one-step increase in a five-step scale ranging from ‘very slow’ eating to ‘very fast’ ‘the women’s BMI increased by 2.8 percent, which is equivalent to a 1.95 kg weight increase in a woman of average BMI for this group,” said Dr. Caroline Horwath, head of the study and professor at the University of Otago.

Dr. Horwath did note that there is not enough data to prove that the women’s’ increased eating speed was the actual cause of their higher BMI. For this reason, the research team will be following up with the participants to see if those who reported faster eating will continue to gain weight over a longer period of time. However, if a causal link is discovered between speed of eating and weight gain, then advising individuals to slow down their meals could help them lose weight just as much as a typical weight loss management program.

“The size of the association found in this initial research suggests that if there is a causal link, reduction in eating speed is a very promising way to prevent weight gain and may lead to decreases in BMI similar or greater than those sustained in weight management programs,” said Dr. Horwath.

If the team finds that such a causal link exists, Dr. Horwath plans to conduct additional research, including the use of interventions that encourage women to consume their meals more slowly. The interventions would teach participants how to relax when confronted with stressful situations and how to use techniques to recognize and avoid unnecessary eating triggered by stress.

“If such interventions prove effective, they could be used alongside other non-dieting approaches we have previously trialled with overweight or obese women. These approaches successfully prevented weight gain in at-risk women and even produced significant weight loss in some. Our interventions included intensive training in relaxation techniques and how to recognize and avoid stress-related triggers for eating,” said Dr. Horwath.

Non-dieting approaches to weight loss appear to be gaining in popularity, according to Dr. Horwath. Dietitians have begun to seek alternatives for weight loss treatment since traditional treatments such as restriction of food intake have not been wildly successful in helping patients keep off lost weight.

“Studies have found that many dieters regain any weight they lose within five years and often end up heavier than when they began,” says Dr. Horwath.

A study recently performed by Israeli researchers and presented in Haaretz, an Israeli daily newspaper, has shown that a 20-minute swim in the Dead Sea could aid diabetics in lowering their blood sugar levels.

The research team was composed of scientists from Ben Gurion University and Soroka Medical Centre of Beersheva. Both are located in the Negev desert in Israel, according to Haaretz.

The study analyzed 14 people who had been diagnosed with Type 2 diabetes, ranging in age from 18 to 65. Results showed that, after sitting in a pool of water taken from the Dead Sea for a full 20 minutes, the patients showed a significant decrease in their blood sugar levels.

Their blood glucose dropped 13.5 percent on average, from 163 milligrams per deciliter to 151mg/dl. Being submerged in the water for an hour caused a further reduction in glucose levels, to 141.3 mg/dl.

Researchers noted that the salty soak did not seem to have any negative side effects on other important characteristics of blood, including insulin levels, c-peptide or levels of cortisone hormones.

The researchers used a control group of six healthy participants, who did not show any changes in their blood glucose levels when exposed to the Dead Sea water for the same amount of time.

Professor Shaul Sukenik led the research team at Ben Gurion University. He said that the results were promising. “In the event that the findings are confirmed in further studies, a drop in blood glucose levels will allow diabetics who bathe in the Dead Sea to use less medication,” said Sukenik in an interview with Haaretz. “We cannot determine this on the basis of the current study, but the findings do suggest this,” he said.

Now that the team has established a possible link between a bath in the Dead Sea and lowered blood glucose levels, they are attempting to secure funding to conduct additional testing and determine whether a daily soak across a three week period would have an even greater effect.

Dr. Sukenik’s research team will publish its findings in HaRefua, the journal of the Israel Medical Association. It is unlikely that a swim in the Dead Sea, even if conducted daily over a period of several weeks, could replace insulin injections or frequent monitoring of blood glucose levels. However, any treatment method that can ease the burden on Type 2 diabetics is worth researching.

Swimming in the Dead Sea is a tradition in Israel, where locals and tourists alike flock to enjoy a relaxing soak. The high salt content of the water — much higher than that of the ocean — means that it’s hard to actually swim, and “floating” is a more accurate description. Many believe that the waters are rich in nutrients and minerals and thus offer healing properties. Additionally, the low pollen and allergen content of the area, along with high atmospheric pressure and reduced ultraviolet component of the sun’s rays have made it a popular spot for treatment of many conditions.

Some of the therapies used at the Dead Sea include thalassotherapy (bathing in seawater for healthful benefits), heliotherapy (using the sun’s rays as a type of treatment), and climatotherapy (using the climatic characteristics of an area, such as barometric pressure, temperature, and humidity as treatment). Some other conditions that are frequently treated at the Dead Sea include cystic fibrosis, psoriasis, osteoarthritis, and rhinosinusitis.

When it comes to texting, teenagers out-type every other age group by a long shot, with some sending thousands of text messages every month. But what if this activity could be used to help teens lose weight? One study aimed to find out whether text messages could be used to promote positive weight management activities in overweight teens, discovering that such at-risk teenagers felt reassured by positive messages but disliked deeper questions.

Overweight and obese teenagers are a difficult demographic to reach. Weight loss interventions typically have trouble making a difference in their lives as the teens have difficulty adapting to healthier habits in diet and exercise. A research team at the University of Michigan believed that using text messages might be helpful in encouraging overweight and obese teens to make healthier choices. Text messages have previously been used to help individuals overcome other bad habits.

The research team, which published its results in the journal Obesity, conducted its study with four focus groups of 24 teens, both male and female, who were participants in weight management programs. The research team tested six types of text messages for effectiveness, including messages tailored to the individual, healthy eating ideas, targeted tips, testimonials, feedback questions and questions that encouraged introspection on the part of the teens.

The teens were interested in the messages overall, but less excited about certain aspects: they enjoyed the meal and recipe ideas as well as the testimonials, but only when those messages were coming from other teenagers.

The participants favored positive messages with some uses of texting trends such as emoticons. However, certain colloquialisms, such as “LOL,” failed to make a good impression. In addition, any mention of unhealthy foods was not looked upon favorably, even if they were mentioned in the context of discussing healthier choices; even the suggestion of those unhealthy foods might have caused cravings for those foods.

Researchers experimented with broad questions that encouraged self-reflection and introspection, but they did not garner a positive response. Some texts featured several such questions in a row, such as “What does being healthy mean for you? How does screen time fit in with your goals? How could cutting back on it help improve your health?” The teens felt that there were too many questions and weren’t sure which ones they should answer first. When the teens discussed the questions with researchers, they said that they simply wanted to have healthy habits outlined for them instead of having to devise their own diet and exercise systems.

The teens’ reluctance to develop their own plans surprised the researchers, since some studies have shown that people who make their own behavior modifications are more likely to stick with them than if they’re simply being told what to do. However, the researchers noted that the length limitations of text messages may have hindered the progress that those types of questions could make.

According to the research team, their next goal is to conduct additional research to determine if the messages could actually contribute to positive changes in diet and exercise habits along with actual weight loss in overweight and obese teenagers.

Child and teen obesity began a dramatic increase in the 1990s and has climbed to frightening levels. Over 30 states in the United States have child and teen obesity rates above 30%.

Diabetics who receive their prescription medication through the mail have higher rates of adherence to oral diabetes medications, according to a study published in the Journal of Medical Economics.

“This is the first study to show that mail service can help Medicare Part D members achieve better adherence with their diabetes medications,” said Jacqueline Kosecoff, PhD, CEO of OptumRx, in a press release. “Improving adherence has been shown to prevent the worsening of disease outcomes, decrease the use of health resources and control escalating health care costs.”

Adherence is defined as “the extent to which a person’s behavior [in] taking medication corresponds with agreed recommendations from a health care provider,” according to the World Health Organization.

The study, conducted by Prescription Solutions by OptumRx, was a retrospective cohort study that analyzed medication adherence in Medicare Part D beneficiaries who had been diagnosed with diabetes. The team at Prescription Solutions used the data to determine if there is an association between increased medication adherence and the delivery of medication to the patients’ homes through mail-order pharmacy.

Researchers used Prescription Solutions data on pharmacy claims for 22,546 patients; 89% of the patients were 65 or older. The team excluded patients who treated with insulin or exenatide (Byetta and Amylin), those who received low-income subsidies, and those who were taking anti-depressant or anti-dementia drugs during the research period. The group was then divided into two cohorts — one composed of patients who only filled prescriptions at retail pharmacies and the other composed of patients who only received their medications by mail from Prescription Solutions.

The press release from OptumRx states that adherence to antidiabetes medications, including metformin, thioglitazones, and sulfonylureas, was measured by the proportion of days covered throughout the year 2009. Among the diabetic patients in the study, 41.6% achieved good adherence, with the average proportion of days covered being 0.60. When the researchers compared the patients who received medication through the mail versus those who filled prescriptions at a pharmacy, the mail-order patients showed a significantly higher number of days covered at 0.68 versus 0.57. The patients who used mail-order pharmacies achieved a higher adherence percentage at 49.7% versus the 42.8% of retail pharmacy users who achieved good adherence.

“Medication adherence is a multi-faceted problem that requires a multi-faceted approach,” said Brian K. Solow, MD, chief medical officer of OptumRx. “Our study provides convincing evidence that mail-order pharmacy would be one way to help improve adherence for patients with chronic diseases.”

Failure to achieve medication adherence can put patients at greater risk of developing complications associated with their conditions, especially those suffering from chronic conditions. Poor adherence can result in worsening of the condition, death, and increases in the cost of health care. Of the medication-hospitalizations that occur in the United States, approximately 33% to 69% of them occur because of nonadherence to a prescription plan. Unfortunately, it can be difficult for physicians to detect such nonadherence.

Some ways that physicians can monitor medication adherence include determining the rate of prescription refill, measuring physiological markers such as the levels of a metabolite in the blood, counting pills, directly observing the patient taking the medication, and asking the patients to keep track of their dosages, such as with a medication diary. Data has shown that adherence rates are inversely proportional to the frequency of dosing; in patients taking medication that required four doses daily, adherence rates fell to about 50%.

Type 2 diabetics don’t always receive advanced warning that they are about to lose consciousness from a drop in blood glucose levels. Common symptoms of passing out include sweating, tingling or numbness in the face, a feeling of intense hunger and heart palpitations. But in patients who have lived with diabetes for a long period of time, the symptoms aren’t always present before an episode. Performing a finger prick test is still the most reliable way to determine if blood sugar levels are dropping too low.

However, that may change within a few years. Research has shown that a diabetic’s sweat pattern undergoes changes when blood glucose levels drop too low. Now a sweat meter developed jointly at the University of Olso in Norway and the National Hospital may be able to monitor sweat patterns to determine irregularities in blood glucose levels and send an alert via text message before the patient suffers an attack.

Better yet, the sweat meter could supercede finger pricking as the primary mechanism for quickly testing blood glucose levels in diabetics. “The advantage of the sweat meter is that the patient doesn’t have to prick themselves,” said Professor Ørjan G. Martinsen with the Department of Physics at the University of Oslo. “All you need to do is paste an electrode on your skin.”

“We envisage that the device will be able to measure sweat activity continuously, providing an indication of whether the patient is about to experience low blood sugar,” said Christian Tronstad, a medical technology researcher at the Oslo University Hospital. “It can communicate directly or via a smartphone. The warning system will then not be very bothersome for the patient.”

The project is being supported by the Norwegian Diabetes Association. Researchers are now conducting studies to determine if changes in sweat patterns can be viable indicators of dangerous blood glucose levels. “In the study we will compare the continuous measurements of sweat activity and blood sugar in patients to see if we can get a good enough warning of a low sugar level in the blood,” said Tronstad.

Kåre Birkeland, head of the medical council of the Norwegian Diabetes Association, believes that the sweat meter holds exciting possibilities in streamlining blood glucose testing and providing advance warning of attacks from low blood sugar for diabetics. “It can be developed into a practical, usable device that can help those who have a hypo when their blood sugar gets too low. The patient can then take the necessary precautions,” said Birkeland.

The sweat meter was actually developed to diagnose hyperhidrosis, or a condition that causes excessive sweating. It sends a small electrical current through the outermost layers of skin, which moves into the sweat glands and then returns to the surface of the skin. When the skin has sweat on it, the electrical current reacts to its salt content and notifies the meter that sweat is present on the skin.

Professor Martinsen leads a team that is at the forefront of research dealing with the electrical properties of the skin. Martinsen has worked for over 20 years with Sverre Grimnes, professor emeritus of medical technology at the University of Oslo, on researching and studying bioimpedance, or the electrical resistance properties of biological tissues. The research team calls itself the Bioimpedance Group; they have started a scientific journal to present their findings.

A new study conducted by Durham University in the United Kingdom has produced findings that may result in finger prick tests for diabetes being performed along with other unrelated exams, such as eye examinations. The researchers found that diabetes testing in unconventional settings, such as with opticians, dentists, and chiropodists could help to diagnose millions of individuals who are living with Type 2 diabetes but are unaware of their condition for various reasons, such as a lack of visits to their general practitioner physicians.

According to the researchers, earlier diagnosis of diabetes could help patients to manage the disease better; diabetes is the leading cause of blindness among the population at working age. The early detection of diabetes through this kind of testing could lower diabetes treatment costs for the U.K.’s National Health Service.

The number of diabetics worldwide is estimated to be about 150 million, but up to 50% of diabetics are thought to be undiagnosed, which could lead to more severe complications when actual diagnosis does occur.

Previous research has shown that health care professionals who do not normally conduct diabetes testing such as pharmacists and chiropodists can conduct simple blood tests that identify whether the patient has Type 2 diabetes. According to the researchers, even dentists have the capacity to perform such simple tests while patients are already in the office, eliminating the need for a separate doctor visit just to test for diabetes.

The study was conducted by Durham University and the James cook University Hospital in Middlesbrough; it was published in the British Journal of General Practice. Though the study examined the possibility of conducting diabetic testing at various doctors’ offices, it focused primarily on the possibility of conducting them at optometrists’ offices.

The researchers analyzed 1,000 participants who were visiting their opticians for eye tests. Of the patients who had risk factors for diabetes, such as a high body mass index (BMI) or an age over 40, about 32% of them were referred to their general practitioner physicians to be checked for diabetes after simple blood tests were conducted at the optician’s office.

Since most diabetes screening is conducted in medical settings by general practitioners, and many individuals do not see their GPs regularly enough to engage in effective preventative care, the inclusion of blood glucose testing as a part of non-medical checkups may aid in detecting diabetes in these patients.

“Charities’ campaigns have managed to reduce the proportion of people with undiagnosed diabetes but there is still a ‘hard-to-reach’ group who remain undiagnosed,” said Dr. Jenny Howse, a former optician with the Durham University School of Medicine and Health and lead author of the study. “Opticians could provide routine, non-emergency care and the simple screening can be done outside usual medical settings, such as GP surgeries.”

The finger prick tests conducted in the study were random capillary blood glucose (rCBG) tests. They were conducted on patients who had one or more risk factors for diabetes. If the patient’s blood glucose level was elevated, he or she was advised to visit a GP for further testing.

“The screening test is less invasive and time consuming than fasting blood glucose and oral glucose tolerance tests,” said Howse. “Already pharmacists and chiropodists have shown it is feasible to offer screening in their practices, here in the UK as well as in Australia and Switzerland. In the US, 60 per cent of adults visit dentists at least once a year for standard check-ups and those practices could be suitable locations to screen for diabetes.”

A prespecified analysis presented at the 2011 Congress of the European Society of Cardiology (ESC) suggests that treatment with eplerenone drastically reduces the likelihood of cardiovascular mortality or hospitalization from heart failure in patients who have risk factors such as renal compromise and diabetes.

The trial treated patients who had suffered NYHA class 2 systolic heart failure with eplerenone, an aldosterone blocker. A control group was treated with a placebo in addition to standard medication prescribed for heart failure. The rates of mortality fell sharply in the patients treated with eplerenone.

“So, overwhelmingly the data are positive,” said co-principal investigator Dr Bertram Pitt, with the University of Michigan School of Medicine in Ann Arbor. Dr. Pitt presented the findings of the study.

“The diabetics, those with renal disease, the elderly, and the low ejection fraction and low blood-pressure [subgroups] all showed the same efficacy, more or less, and the same safety,” said Pitt. “We saw an excess of hyperkalemia [potassium >5.5 mmol/L] . . . and less hypokalemia, but there was less serious hyperkalemia [potassium >6.0 mmol/L], no significant excess of hospitalization for hyperkalemia or renal disease, and not a single patient that we know about died due to hyperkalemia on eplerenone. So to us, the data are pretty straightforward and pretty compelling for the use of eplerenone in patients with NYHA class 2 heart failure.”

The primary results of the trial were presented at the American Heart Association 2010 Scientific Sessions. It was conducted on 2737 randomized patients who had experienced mild heart failure and had an LVEF (left ventricular ejection fraction) of greater than 30 percent. The trial had not even run its projected course when it was halted because it became clear that eplerenone imparted a significant benefit in the health of the patients. At that point, patients who had been receiving eplerenone had shown a 24 percent reduction in cardiovascular death and a 42 percent reduction in heart failure hospitalization compared to the control group that was receiving placebo.

Hospitalization is a very important factor in those who have been hospitalized for mild heart failure. Future hospitalizations are a strong indicator of the progression of the condition and the health of the patient.

“…For patients with mild heart failure, hospitalization really matters — really matters for survival, for the progression of the disease, and for quality of life,” said Dr Piotr Ponikowski of the Medical University, Clinical Military Hospital in Wroclaw, Poland. Ponikowski served as the discussant after Dr. Pitt’s presentation of the trial’s findings.

Dr. Pitt believes that aldosterone blockers such as the eplerenone studied in the trial are underused in the West. Physicians are cautious in prescribing them to heart failure patients who also have renal disease.

“Paradoxically, heart-failure patients with renal disease are among the highest risk, so physicians are overly cautious, and they get the worst treatment,” said Pitt. “You have people at very high risk.” Pitt believes that aldosterone blockers will soon become more commonly recommended in heart failure patients and diabetics since it does not have as many side effects as spironalactone:

“After this, we think they should say specify that you should use eplerenone, at least in the diabetic subset, because there’s good data now that spironolactone in diabetes makes endothelial function worse–it raises hemoglobin A1c, raises cortisol, and reduces adiponectin–whereas eplerenone does not.”