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DATE: DECEMBER 26, 2008

More than 2,000 medicines for older Americans are currently being tested in clinical trials or are waiting for Food and Drug Administration approval, according to a new report released by the Pharmaceutical Research and Manufacturers of America This latest PhRMA report on new, cutting-edge medicines in the research pipeline comes as a growing number of older Americans face severe health challenges and greater life expectancy. The National Center for Health Statistics has predicted that people born in 2005 will live for nearly 78 years. In 1955, the average American was expected to live for only 69.6 years.

Topping the health challenges for seniors are heart disease, cancer and cerebrovascular disease, according to the Centers for Disease Control and Prevention. Hypertension alone affects 67 percent of those aged 60 and older. Chronic lower respiratory diseases, Alzheimer's disease, diabetes, and flu and pneumonia complete the seven chronic diseases that are the leading causes of death in older Americans. "Data from the National Institute on Aging show rates for late-life disability declining over the past few years -- a period in which the number of treatments for late-life conditions has increased," said PhRMA President & CEO Billy Tauzin. "Advances in treating debilitating conditions are allowing more Americans to live independently later in life." The new medicines include 150 for diabetes, which affects 12.2 million Americans age 60 and older; 62 for eye disorders that contribute significantly to late-life disability; and 91 for Alzheimer's disease, which could afflict 16 million people by 2050 without further advances in treatment. Other medicines target depression, osteoporosis, Parkinson's disease, prostate disease, bladder and kidney diseases, and other debilitating conditions. Among the experimental treatments is a medicine that could potentially prevent or reverse the progression of Alzheimer's disease. "Patients need to know that there are many new, potential medicines out there," says PhRMA Senior Vice President Ken Johnson. "People who are suffering need hope." Johnson stressed that while researchers are making exciting progress in the search for new treatments for older Americans, these efforts are wasted if the medicines that are developed don't get to the patients who need them.

Help is available to patients in need through the Partnership for Prescription Assistance (PPA), a program sponsored by America's pharmaceutical research companies. To date, the PPA has helped more than 5 million patients nationwide. Since its launch in April 2005, the PPA bus tour has visited all 50 states and more than 2,000 cities. The Pharmaceutical Research and Manufacturers of America (PhRMA) represents the country's leading pharmaceutical research and biotechnology companies, which are devoted to inventing medicines that allow patients to live longer, healthier, and more productive lives. PhRMA companies are leading the way in the search for new cures. PhRMA members alone invested an estimated $44.5 billion in 2007 in discovering and developing new medicines. Industry-wide research and investments reached a record $58.8 billion in 2007.

DATE: DECEMBER 19, 2008

Researchers at the Joslin Diabetes Center have shown that insulin-producing pancreatic beta cells can form after birth or after injury from progenitor cells within the pancreas that were not beta cells, a finding that contradicts a widely-cited earlier study that had concluded this is not possible. The study, published online the last week of November in the Proceedings of the National Academy of Sciences Early Edition, identifies the source of the progenitor cells as being pancreatic duct cells. "This means that there is a population of pancreatic cells that can be stimulated, either within the body or outside the body, to become new beta cells, the cells that are lacking in diabetes," said Susan Bonner-Weir, Ph.D., the study's lead researcher and a Senior Investigator in the Section on Islet Transplantation and Cell Biology at Joslin and Associate Professor of Medicine at Harvard Medical School. The experiments, conducted in animal models, suggest a new source of beta cells for replacement therapy to treat or cure diabetes.

In type 1 diabetes, the pancreas produces little or no insulin since the insulin producing beta cells are destroyed by the body's own immune system. While transplantation of human islets from donor pancreases has been successful in getting people with type 1 diabetes off insulin treatment, this insulin independence is only successful for a few years. "One of the problems with islet transplantation is that while the proof of principal is there, we don't have enough islets to transplant and they go through a traumatic process during isolation," said Bonner-Weir. "Many islets are not in the greatest condition after being isolated from a pancreas." The two major obstacles to islet transplants are the need for continued use of immunosuppressive drugs to prevent both rejection and return of autoimmune destruction and the lack of a reliable source of insulin producing islet cells. Bonner-Weir's main research focus is the search for new sources of insulin-producing islet cells. In this study, in experiments in mice, Bonner-Weir's group used a similar lineage tracing system employed by a group from Dr. Douglas Melton's lab at Harvard. That group concluded in a paper published in Nature in 2004 that after birth, new beta cells only result from division of preexisting beta cells and that beta cells do not form from progenitor cells after birth. "That conclusion, coming from such a well-respected group, was taken by many as fact and cast a cloud over this important research area," Bonner-Weir said. However, earlier this year a group led by Xiaobo Xu in Belgium showed that islet progenitor cells within the adult pancreas could be activated to increase the number of beta cells by the process of differentiation rather than self-duplication, but the paper did not indicate the origin of these cells.

Bonner-Weir's paper complements the Belgium study by identifying the source of these cells as pancreatic duct cells. In addition to finding that these duct cells can differentiate into insulin producing islet cells after birth and in regeneration after injury, the study showed that they can also become new acinar cells, a finding that has potential implications for pancreatic cancer, since the origin of the cancerous cells has been disputed. Two lineage tracing experiments involved genetically marking the ductal cells and then following them. The first experiment, which involved one-month-old mice, found that between 30 to 40 percent of islets had beta cells that had formed after birth from duct cells. In the second experiment, conducted in adult mice, the Joslin researchers used same regeneration model employed in the Belgian study which is based on tying off the main pancreatic duct. Beyond the area of the tie some cells die, but others grow to regenerate the whole structure. In these adult mice, new islets and new acinar cells were again shown to have been formed from the preexisting duct cells. "Our data provide strong support to the concept of a shared lineage of ductal, acinar and islet cells after birth, even in the adult. This means that there is a population of cells - we don't know if it is all of the cells or just some - that can be stimulated to become new islet cells," Bonner-Weir said. She concluded: "Our identification of a differentiated pancreatic cell type as an in vivo progenitor for all differentiated pancreatic cell types has implications for a potential expandable source for new islets for replacement therapy for diabetes. While the ideal therapy would be to have those with diabetes regenerate their own islet cells, that is still a long way off." This study was supported by grants from the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases, the Juvenile Diabetes Research Foundation and the Diabetes Wellness Foundation as well as a number of private donors. Others participating in the research included: Akari Inada, Cameron Nienaber, Hitoshi Katsuta, Jared Levine, Rita Morita and Arun Sharma, all of Joslin, and Yoshio Fujitani of Vanderbilt University

DATE: DECEMBER 12, 2008

People diagnosed with diabetes spend over $4,100 more each year on medical costs than people who don't have diabetes, a gap that increases substantially each year following the initial diagnosis, according to a study published online last week in the journal Diabetes Care. In the first study to examine medical cost increases for individuals living with diabetes on a year-by-year basis, researchers at RTI International, an independent, nonprofit research institute based in North Carolina, calculated that a 50-year-old newly diagnosed with diabetes spends $4,174 more on medical care per year than a person the same age who doesn't have diabetes. For the person with diabetes, medical costs go up an additional $158 per year every year thereafter, over and above the amount they would increase due to aging-related increases in medical expenses.

Most of the increase can be attributed to the cost of diabetes-related complications, such as heart and kidney disease, the researchers found. Once they controlled for complications, the remaining annual increase in medical costs was $75 per year the bulk of which could be attributed to the increasing need for diabetes medications the longer a person lives with the disease. "The good news is that many of these costs could be contained through proper diabetes management and lifestyle changes," said lead researcher Justin Trogdon, Research Economist. "Numerous studies show that losing weight and increasing physical activity, along with maintaining proper blood glucose levels, can substantially delay or reduce the risk for diabetes-related complications. What our study does is to point out that there is also a cumulative, financial impact to the progression of this disease." Preventing the onset of diabetes would also help to reduce cumulative costs, since medical expenditures grow along with the duration of the disease, the researchers concluded. "Delaying the development of diabetes will delay the steady rise in medical expenditures that accompanies it," they wrote.

The study was funded by a grant from the Centers for Disease Control and Prevention. The American Diabetes Association publishes a comprehensive report on the total economic impact of diabetes in the United States. Diabetes Care, published by the American Diabetes Association, is the leading peer-reviewed journal of clinical research into one of the nation's leading causes of death by disease. Diabetes also is a leading cause of heart disease and stroke, as well as the leading cause of adult blindness, kidney failure, and non-traumatic amputations. The American Diabetes Association is leading the fight against the deadly consequences of diabetes and fighting for those affected by diabetes. The Association funds research to prevent, cure and manage diabetes; delivers services to hundreds of communities; provides objective and credible information; and gives voice to those denied their rights because of diabetes. Founded in 1940, our mission is to prevent and cure diabetes and to improve the lives of all people affected by diabetes.

DATE: DECEMBER 05, 2008

Supplements of vitamin K1 may reduce the development of insulin resistance in older men, and thereby offer protection against diabetes, suggests a new study. Insulin resistance, whereby insufficient insulin is released to produce a normal glucose response from fat, muscle and liver cells, was significantly lower in men following a daily vitamin K1 supplement, according to results of a 36-month, randomised, double-blind, controlled trial. No effects were observed in women, report the researchers, led by Sarah Booth from the Jean Mayer USDA Human Nutrition Research Center at Tufts University, in this month’s issue of Diabetes Care. The authors speculated that weight might be influencing the effects of vitamin K in men and women. "In our study, there was a higher prevalence of obese or overweight women in the vitamin K supplementation group compared to the male supplementation group," said Booth. "Vitamin K is stored in fat tissue. If there is excess fat, vitamin K may not be readily available to cells that require it to process glucose."

There are two main forms of vitamin K: phylloquinone, also known as phytonadione, (vitamin K1) and menaquinones (vitamins K2). K1 is found in green leafy vegetables such as lettuce, broccoli and spinach, and makes up about 90 per cent of the vitamin K in a typical Western diet; while K2, which makes up about 10 per cent of Western vitamin K consumption and can be synthesised in the gut by microflora. The researchers recruited 355 non-diabetic men and women between the ages of 60 and 80. Sixty per cent of the participants were women. The participants were randomly assigned to receive a daily vitamin K1 supplement (500 micrograms per day of phylloquinone) or placebo for 36 months. The vitamin K doses is approximately five times the adequate intake, said the researchers. All of the participants also received a calcium and vitamin D supplement. Booth and her co-workers report that insulin resistance, assessed using the homeostasis model (HOMA-IR), improved in men consuming the vitamin K supplements. On the other hand, progression of insulin resistance continued in all women, and in the men in the placebo group.

Previously, researchers from America, Canada and Britain reported in the journal Cell that vitamin K may have an effect on diabetes development via the vitamin K-dependant protein osteocalcin. The study with mice looked at genes that operate primarily in the bone cells that are linked to glucose metabolism. By "knocking out" these genes in mice so that they could not function, the animals lacking a functional osteocalcin gene gained fat, showing that osteocalcin helps regulate the cells that produce insulin in the pancreas and release it into the bloodstream. Booth and co-workers dismiss this as the mechanism, however, noting that men in vitamin K group actually had less of the functional osteocalcin than men in the placebo group. “It is plausible,” they stated, “That vitamin K may improve insulin sensitivity through suppression of inflammation. In vivo and in vitro studies have shown that vitamin K reduced lipopolysaccharide-induced inflammation. “More recently, it was reported that biochemical and dietary measures of vitamin K status were inversely associated with inflammatory markers in an observational study,” they said. Booth and her co-workers note that the study was limited to Caucasian adults and that generalization of the results may not be possible. Additional studies are recommended. The study was funded by the United States Department of Agriculture Agricultural Research Service, the National Institutes of Health, the American Heart Association, the Ministry of Education, Culture Sports and Technology in Japan and the American Diabetes Association. An estimated 19 million people are affected by diabetes in the EU 25, equal to four per cent of the total population. This figure is projected to increase to 26 million by 2030. In the US, there are almost 24 million people with diabetes, equal to seven per cent of the population. The total costs are thought to be as much as $174 billion, with $116 billion being direct costs from medical expenditures, according to 2007 American Diabetes Association figures.

DATE: NOVEMBER 26, 2008

A drug that mimics the effects of a wonder ingredient in red wine has been developed to fight obesity and diabetes. The compound, SRT1720, protected mice from weight gain and insulin disorders even when they ate a high-fat diet. It also enhanced their running ability. The drug targets a protein called SIRT1 which is also affected by resveratrol, a chemical in the skins of red grapes that is believed to combat ageing and help prevent heart disease and cancer. Resveratrol is found in red wine and may explain the "French paradox" - the fact that people in southern France have a low incidence of heart disease despite eating a lot of saturated fat.

Professor Johan Auwerx, from the Ecole Polytechnique Federale de Lausanne in Switzerland, who led the tests of the new drug, said: "There has been a lot of controversy in the field about resveratrol action. We find that the majority of the biology of resveratrol can be ascribed to SIRT1." Low doses of SRT1720 partially protected mice from gaining weight on a high fat diet after 10 weeks of treatment. At higher doses, the drug completely prevented weight gain in the animals. Blood sugar tolerance and insulin sensitivity - both linked to diabetes - were improved, and the animals became physically fitter. "SIRT1720 made the animals run twice as long," said Prof Auwerx, whose research is reported in the journal Cell Metabolism. However the enhanced performance was only seen when researchers exercised the mice. Without forced exercise, their voluntary activity declined. The drug appeared to fool the body into thinking that food was scarce. A similar response occurs with calorie restriction, which alters metabolism and causes the body to burn fat. Prof Auwerx said: "These results show that new synthetic SIRT1 activators can reproduce the positive metabolic effects that were previously demonstrated using resveratrol, a naturally occurring SIRT1 activator found in red wine. "But unlike resveratrol, these new chemical entities target only the SIRT1 pathway, making them more selective and potent for achieving these metabolic benefits."

DATE: NOVEMBER 21, 2008

America's tweens and teens more than doubled their use of type 2 diabetes medications between 2002 and 2005, with girls between 10 and 14 years of age showing a 166 percent increase. One likely cause: Obesity, which is closely associated with type 2 diabetes. The finding is included in a study of chronic medication use in children ages 5 to 19 released today in the journal Pediatrics by researchers from the Saint Louis University School of Medicine, pharmacy benefit manager Express Scripts and the Kansas Health Institute. In addition to diabetes, the study found that utilization patterns for blood pressure, cholesterol, attention-deficit disorder and attention-deficit/hyperactivity disorder (ADD/ADHD), asthma and depression medications increased at varying levels during the four year period.

"Our study findings indicate that these increased levels of chronic medication use are symptoms of broader underlying issues affecting children today," said Emily R. Cox, Ph.D., RPh, senior director of research at Express Scripts. "These trends are worrisome given that many of these therapies are treating conditions with modifiable risk factors and if not addressed, many of these children will carry these chronic conditions into adulthood." For example, the use of asthma medications increased 46.5 percent and ADD/ADHD medication use increased 40.4 percent. Cholesterol and blood pressure medications saw a more moderate growth of 15 percent and 1.8 percent, respectively. Except for asthma medication, older teens age 15-19 years old account for the largest percentage of children taking these medications. The bad news, according to Donna R. Halloran, M.D., MSPH, assistant professor of pediatrics at Saint Louis University School of Medicine, is that there is more disease, due in large part to the increasing prevalence of childhood obesity. "Our findings show that childhood obesity not only has long-term health implications, but also impacts children's immediate health," Halloran said. However, she says, the rise of prescription use also indicates that more children are being diagnosed and doctors are increasingly using medication to treat these conditions. "Our findings indicate that we, the doctors, are doing a better job of screening children and diagnosing chronic conditions," Halloran said. "A great example of this is blood pressure, where there has been a big push to identify and treat children in need." In several cases, the rates of growth were dramatically higher among girls than boys. While boys still take more medications for chronic conditions, the gap has become narrower due to these increases.

The huge increase in type 2 diabetes medication use was driven largely by girls who saw a 147 percent increase over the four year period, compared to boys who saw a 39 percent increase in medicine use. Researchers say they cannot explain this pattern, which is not consistent with the patterns of obesity among boys and girls. However, increased physician office visits and therefore screening rates – particularly for females – could be one contributing factor. Researchers say the greater increase of girls prescribed ADD/ADHD medication (63 percent versus 33 percent) may be attributed to increased efforts by physicians to identify ADHD in females following studies that suggested that inattentive ADHD, which is much less likely to be identified and treated, was more common in girls than boys. Another example of a higher increase among females was seen in antidepressants where the number of females between 15 and 19 taking the medicine increased by 6.8 percent, while for males in the same age group, utilization declined slightly. This increase in antidepressant use among older teen girls was a striking exception to decreases for boys and girls ages 5 to 9 and boys ages 10 to 14. It also occurred despite a public health advisory released by the Food and Drug Administration in October 2003 regarding antidepressant use by children. Among all children, the prevalence of antidepressant use had been increasing prior to the advisory, after which it decreased. Unlike the other medications studied, children ages 5 to 9 accounted for the largest increase in the use of asthma controller medication among the three age groups at 67.3 percent as compared to 38.8 percent for the 10 to 14 age group and 34.7 percent for the 15 to 19 age group. The researchers noted that this exception could be explained by concerns over the long-term side effects of these medications in children and/or greater physician office visits, and therefore greater likelihood of prescribing. The database used in conducting the study consists of ambulatory administrative pharmacy claims and eligibility information for over 3.5 million commercially insured children enrolled with Express Scripts between 2002 and 2005.

DATE: NOVEMBER 14, 2008

In the November issue of the American Journal of Kidney Diseases, British researchers analyzed the records of more than 22,300 middle-aged and older English men and women who were part of a large European cancer study. They wanted to examine the effect of eating fish on kidney disease. The study subjects had answered questionnaires about their diet habits, including how much fish they ate a week, and had provided urine samples, which were analyzed for the presence of a protein called albumin, an indicator of kidney damage.

The researchers reported that of the 517 study subjects who had diabetes (most of whom had type 2), those who on average ate less than one serving of fish each week were four times more likely to have albumin in their urine than people with diabetes who ate fish twice a week. "Protein in the urine is one of the earliest signs of kidney disease, a serious complication of diabetes," says study co-author Amanda Adler, an epidemiologist with the Medical Research Council Epidemiology Unit at Addenbrooke's Hospital in Cambridge. Adler speculates that the nutrient content of fish may affect kidney function and improve blood glucose control. But what kind of fish makes the biggest health splash wasn't determined. "We didn't ask about the type of fish people ate, but in this bit of England people eat cod, plaice, haddock, canned tuna. Even fish and chips would have been included," she says.

Susan Spratt, assistant professor of medicine in the division of endocrinology at Duke University Medical Center, says it's too early to recommend diet changes based on the findings, noting that cause and effect are hard to determine in this type of epidemiological study. "People who eat fish might have other healthier habits," she says. To prove fish could be a kidney disease-fighting factor in diabetes, clinical trials would be required in which people with diabetes ate fish and others did not, she says. "But it wouldn't hurt patients to eat more fish," says Spratt, who recommends fish oil to lower triglycerides in her diabetes patients who do not respond to or tolerate other therapies. For dinner, stick with low-fat broiled and baked recipes, she says.

DATE: NOVEMBER 07, 2008

Sydney PhD student Freddy Yip has solved a problem plaguing researchers worldwide for more than half a century - how insulin prompts fat and muscle cells to absorb glucose. This process is defective in the growing number of people with type 2 diabetes so understanding it opens the way for new therapies to correct it.

"While we're certainly not saying we've found a way to cure diabetes, we are saying we've found a pretty significant clue," said David James, head of the diabetes program at the Garvan Institute for Medical Research. "Since the 1920s, when Banting and Best discovered insulin, scientists have been battling to discover how it actually works," Professor James said. "Then along comes Freddy Yip, doing his PhD, who unveils a completely novel action of insulin, one which we believe plays a fundamental role in glucose uptake."

The findings, published in the journal Cell Metabolism, focus on two intersecting problematic processes affecting diabetics, insufficient production of insulin in the pancreas after a meal and so-called insulin resistance, and the faulty uptake and storage of glucose in fat and muscle cells. "In the cell we have series of motor proteins that have the ability to move other molecules from one place to another along intracellular railroad tracks," Mr Yip said. "I have discovered that insulin activates a specific kind of motor protein known as Myo1c, which in turn performs a critical role in glucose uptake." The motor protein helps move glucose transporter proteins from inside the cell to the surface membrane so that they can pump glucose into the cell. The findings offer up a new target for diabetes treatment. "We think there may be blockages in the signal between insulin and myo1c in people who develop insulin resistance," he said. "If we're correct, it should be possible to target that pathway for development of new therapies."

DATE: OCTOBER 31, 2008

A new study of Medicare beneficiaries with diabetes discovered individuals who were depressed experienced a higher death rate than diabetics who were not depressed. The findings are published in the October 2008 Journal of General Internal Medicine.

Lead author Dr. Wayne Katon, professor of psychiatry and behavioral sciences at the University of Washington (UW), noted that previous research indicates that depression and diabetes is a potentially lethal mix among young to middle-aged patients. Depression also puts patients at greater risk of complications from their diabetes. This more recent study suggests that depression is also a risk factor for mortality in older patients with diabetes. Most Medicare beneficiaries, like the ones in this study, are over age 65. The mean age of the participants was 75.6 years. The study tracked 10,704 Medicare beneficiaries with diabetes who were enrolled in a disease management program in Florida.

They were surveyed at the start of the study with a health assessment questionnaire. Evidence of depression among members of the group came from physician diagnosis, patient reports of having a prescription for an antidepressant in the year before the survey, or patient answers to a brief screening test. For the next two years, the research team recorded the death and cause of death of participants through bi-monthly checks of Medicare claims and eligibility files, or from phone calls with the participants’ families. The research team found that patients with both diabetes and depression had an increased risk of about 36 percent to 38 percent of dying from any cause during the two-year follow-up. Participants with a physician diagnosis of depression were significantly younger than their cohorts, more likely to be female, had more severe medical illness, were less likely to be African-American, and more likely to be Hispanic.

These variables were controlled for in the analysis of increased risk. A total of 12.1 percent of participants who had both disorders died during that period. Among those without depression, 10.4 percent died. Participants who had been treated with one or more antidepressant medications in the year before the study had a 24 percent increased risk of mortality, compared to non-depressed participants. According to the study authors, those patients may have been treated with antidepressants because their depressive symptoms were more severe and persistent than those of more mildly depressed patients who weren’t prescribed antidepressants. There was no difference in the rate of cardiovascular or cerebrovascular events between those treated with antidepressants and those who had no indication of depression.

“Rates of mortality from vascular disease may be decreasing in recent years among patients with diabetes due to more aggressive treatment of high blood pressure, cholesterol, and glucose levels,” the researchers surmised, “as well as widespread use of preventative medications such as aspirin and beta blockers.” According to the authors, there may be several reasons why depression worsens chronic diseases such as diabetes. Depression has been associated with inadequate self-care and harmful habits like smoking or overeating. Depression is also associated with nervous system and endocrine system problems, and with inflammatory markers. The authors noted their study’s limitations: the participants were from one geographic region of the United States, and the follow-up period was relatively short. Defining depression in part by physician diagnosis and treatment, they added, may have selected for participants with more severe illness. The study was also not able to obtain information on education, income, weight, smoking habits, physical activity, or compliance in taking medication.

Source: University of Washington

DATE: OCTOBER 24, 2008

Researchers at the Harvard Stem Cell Institute are one step closer to achieving the ultimate promise of stem cell research creating tissues for every part of the body without the use of harmful viruses or cancer-causing genes. Harvard Medical School professor Konrad A. Hochedlinger and his colleagues reported last week on the Web site of the journal Science that they have created mouse induced pluripotent stem cells without permanently altering the genetic makeup of the cells. Their technique allows scientists to genetically manipulate a patients cells typically skin cells or blood cells and reprogram them into a pluripotent state. Like embryonic stem cells, these cells are then capable of morphing into any type of body tissue.

Hochedlingers team inserted genes needed for cellular reprogramming with harmless adenoviruses. Unlike retroviruses, which scientists have been using to createpluripotent cells, these viruses effectively disappear after a few cell divisions and do not integrate into the cells DNA. The effect of this is that adenoviruses are free from the chief adverse effect of genetic manipulation, which can turn on cancer genes and trigger malignant tumor growth. The beauty of this is that if you want to use the cells therapeutically if you want to put them in somebody. It basically gets rid of the dangerous transcription factors that were used in the initial integration, said Gordon C. Weir, a Medical School professor who heads the diabetes program at the Stem Cell Institute. The last thing you want is to transplant a potentially malignant cell into a patient. The findings have implications for creating body tissues safe to transplant into patients to treat diseases.

The next step, according to lead author Matthias Stadtfeld, is to increase the efficiency of creating pluripotent mouse cells and then try to reproduce the work in human cells. Currently, the number of pluripotent cells produced using retroviruses is significantly higher than that from the harmless adenoviruses. Stadtfeld, who is a post-doctoral research fellow at Harvard-affiliated Mass. General Hospital, estimated that using the more dangerous retroviruses is 10 to 100 times more efficient than the new adenovirus method. The recent advance in stem cell research is the latest in a stream of developments by Harvard researchers this past year. At the third annual Stem Cell Summit held at the Medical School last week, University President Drew G. Faust cited four papers published this summer as evidence of the progress made at a time when federal funding for embryonic research has been constrained by a 2001 order by President Bush.

Among the discoveries were the creation of 10 disease-specific stem cell lines and the direct conversion of mouse pancreatic cells into insulin-producing beta cells that can be used to treat patients with Type I diabetes. At a time when the promise of biomedical research has never been greater, our nation risks sending a signal to our best and brightest young researchers that the funds wont be there to support their hugely important career pursuits, Faust said in her welcoming remarks. And though the next President may prove friendlier to stem cell research, funding for the National Institutes of Health has been frozen in recent years, meaning that it has declined in real terms. Though he used money from the NIH New Innovator Award that he won last year, Hochedlingers research was not subject to federal embryonic stem cell restrictions because the cells were created from skin cells or blood cells instead of from embryos. His work was also funded in part by the Harvard Stem Cell Insttute.

While embryonic stem cell research has come under fire from those who consider it unethical, Harvard scientists involved in the work continue to say that the research is essential. As long as we dont know that iPS cells are really as good as embryonic stem cells in generating all types of body tissues, we should be obliged to continue, Stadtfeld said. iPS stands for induced pluripotent stem. Scientists are now able to generate iPS cells which are embraced by those who oppose embryonic stem cell research only because of previous work performed with embryonic stem cells, Stadtfeld said.

DATE: OCTOBER 17, 2008

It's great on french toast. It's lovely in apple pies, oatmeal and eggnog. And now, cinnamon may be good for your blood sugar, too. One study found that people with diabetes who ate three-eighths of a teaspoon of the spice a day had better blood sugar levels after a little more than a month.

Cinnamon is well-known as a stellar antioxidant and a potent germ killer, and there's a growing - but not perfectly consistent - body of evidence that suggests that a substance in the spice turns on insulin receptors to help your body use glucose. That's a good thing, because too much glucose in your bloodstream is tough on your organs and is a marker of diabetes. If you currently measure your blood sugar, you can test how cinnamon works for you by checking your blood sugar levels at a time (not right after eating) when they are near stable. Then, try some nonsugary thing with the cinnamon and measure your blood sugar one and two hours later. Do this for three days, then follow it with three days when you do the exact same things and eat the same things, but leave the cinnamon out.

More research is needed before doctors recommend it as a common diabetes treatment, but there's no reason you shouldn't start making it a mainstay of your breakfast, lunch and dinner treatments. In fact, we recommend that you get a half of a teaspoon of it a day. Try it these ways:

• Sprinkle on fresh apple slices and poached pears.
• Add to crockpot dishes for an Indian-inspired flavor twist.
• Use a cinnamon stick to stir your tea, hot chocolate or warm soy milk.
• Sprinkle into muffin batters and on whole-wheat toast.
• Add to your breakfast cereal or to a smoothie.
• Keep a cinnamon shaker next to the salt and pepper on the table and experiment.

By Mike Roizen and Mehmet Oz, authors of the best-selling "YOU: The Owner's Manual" and "YOU: On a Diet."

DATE: OCTOBER 10, 2008

A vegan diet may do a better job of reducing cardiovascular disease in diabetic patients than a diet recommended by the American Diabetes Association (ADA), according to a new study. Two out of three people with diabetes die of a heart attack or stroke, so reducing cardiovascular disease is a priority. The study was in part funded by the Physicians Committee for Responsible Medicine, which promotes a vegan diet.

For 22 weeks, participants followed either a low-fat, low-glycemic vegan diet or guidelines prescribed by the ADA. All 99 participants had type 2 diabetes. Both men and women participated and were recruited through a newspaper ad in the Washington, D.C., area. Participants reported what they ate at the start of the trial and throughout the trial. Researchers took the data and calculated scores based on the Alternate Healthy Eating Index (AHEI). Scores were calculated at the beginning of the 22 weeks and again at the end. There was no difference in the scores between the two groups at the start of the study. Past research has shown a correlation between AHEI and cardiovascular disease. The AHEI is a nine-component dietary index used to rate foods and macronutrients related to chronic disease risk. The higher the AHEI score, the lower the risk of cardiovascular disease. The vegan dieters saw significant improvements in their AHEI scores; the ADA group did not. The vegan group improved significantly in every AHEI category, including increased intake of vegetables, fruits, nut and soy protein, and cereal fiber, and a decrease in trans-fat intake.

Both groups were able to reduce their weight and their hemoglobin A1c, a measure of blood sugar levels over a prolonged period of time. However, the vegan group experienced more significant reductions in both categories. "The results of this study suggest that, if followed for the long-term, a low-fat vegan diet may be associated with a reduced risk of major chronic diseases, particularly cardiovascular disease," the study concludes. Neither diet resulted in adequate intake of vitamins D or E, or of calcium. Patients attempting to follow either eating plan should consult with their doctor and make sure they are getting adequate amounts of these nutrients.

DATE: OCTOBER 03, 2008

Scientists in San Antonio are on the cutting edge of research into the underlying causes of diabetes. They want to figure out exactly which genes are involved in this chronic, debilitating disease. Call them "diabetes detectives." The University of Texas Health Science Center at San Antonio researchers are trying to pinpoint which genes contribute to this monstrous health problem, and with 25,000 genes in the genome, it's quite a daunting task. In the past several years, this lab has zeroed in on at least seven promising candidates. "These are novel genes. We know that they're involved. Statistically, the evidence is unassailable. And we now are working on animal models where we have knocked out the gene," diabetes genetics researcher Chris Jenkinson said.

In the science world, they're called knockout mice — animals that have had their genes manipulated to see if certain genes make them more vulnerable to problems like blood sugar instability and obesity. The special machines that map where variations are on the chromosomes take human genetic information, in this case from San Antonio patients, and translate it into a starting place for animal experimentation. It's information that may someday lead to new and more effective medications. "We've stumbled across a few good drugs, but there are no drug cures for diabetes. There is no answer," Jenkinson said. Jenkinson says diabetes is becoming a tidal wave that threatens to engulf our health care system. If he and other detectives can find the root genetic causes, future treatments will be more personalized, and hopefully, more effective against a killer. Diabetes researchers at the UT Health Science Center are using about $6 million a year in federal funding and private grants to pay for their groundbreaking studies

DATE: SEPTEMBER 26, 2008

"More and more research shows the positive impact of tree nut consumption on satiety and weight management, as well as a number of chronic diseases including heart disease and diabetes," states Lindsay Allen, PhD, Director of the USDA ARS Western Human Nutrition Research Center. Dr. Allen was commenting on proceedings from the Nuts and Health Symposium in the September 2008 issue of the Journal of Nutrition.

Epidemiologic studies show that consuming tree nuts (almonds, Brazils, cashews, hazelnuts, pecans, pine nuts, pistachios, macadamias and walnuts) five or more times per week is associated with a reduced risk of developing both diabetes and heart disease. In one analysis, individuals who ate the most nuts had about a 35 percent reduced risk of coronary heart disease. While the FDA qualified health claim for nuts and heart disease recommends 1.5 ounces of nuts per day, few people actually consume this amount on a daily basis. In the 2001-2004 What We Eat in America/NHANES survey, 34 percent of those surveyed consumed nuts but most only ate about 3/4 of an ounce -- roughly half of the recommended amount. And, approximately 60 percent of the nuts were consumed as snacks.

According to Janet King, PhD, co-chair of the 2007 Nuts and Health Symposium and past chair of the 2005 USDA Dietary Guidelines Advisory Committee, "Many people consume as much as 25 percent of their total caloric intake from snacks. If we could replace snacks high in refined carbohydrates with just 1/4 to 1/3 cup of nuts per day we could have a positive impact on nutrient density and the risk of chronic disease." Moreover, regular nut consumers do not weigh more than those who do not consume nuts despite eating roughly 250 additional calories per day. "Research shows that nuts can actually help maintain body weight," states Maureen Ternus, M.S., R.D., Executive Director of INC NREF. "Tree nuts contain beneficial unsaturated fats (mono- and polyunsaturated fats), protein and fiber, all of which provide a feeling of fullness." In addition, studies have shown that the fat in nuts may not be fully absorbed and there may be an increase in resting energy expenditure (the calories burned when you're resting) with regular nut consumption.

DATE: SEPTEMBER 19, 2008

People at high risk for developing type 2 diabetes might be able to delay or prevent the disease by taking certain food supplements and making lifestyle changes, according to a new book by Dr. James W. Anderson, an internationally recognized authority on metabolic diseases and weight loss and professor emeritus of medicine and clinical nutrition at the University of Kentucky College of Medicine.

Diabetes is a worldwide epidemic, and it is growing at an alarming rate. In 2006, the United Nations declared it an international health threat comparable to HIV/AIDS. However, emerging evidence suggests that risk of diabetes can be reduced by a combination of weight loss, exercise, dietary changes and the use of supplements called "nutraceuticals," extracts of certain foods purported to have a physiological benefit or provide protection from disease. Anderson's book, "Nutraceuticals, Glycemic Health and Type 2 Diabetes," provides an overview of glycemic health and highlights the use of nutraceuticals in the prevention and management of type 2 diabetes. Anderson identifies dietary fiber from whole grains as one of the strongest preventive measures for type 2 diabetes. The book also offers an in-depth discussion on certain minerals and herbs that assist in achieving tighter glycemic control. Anderson collaborated with Vijai K.Pasupuleti, founder of SAI International — a firm engaged in research, consulting and marketing for nutraceutical, pharmaceutical and biotechnolgy companies — to summarize cutting-edge research from all over the world and assemble the outcomes. Thirty-five scientists from nine countries contributed 18 chapters presenting the latest findings on the role of nutrition in diabetes.

This emerging evidence will allow health care providers to offer the latest in nutrition guidance to patients with diabetes. It will encourage producers of foods and supplements to make active ingredients more widely available to consumers, and will enable self-directed individuals to make intelligent choices about nutrition supplements to prevent diabetes. In the closing chapter Anderson provides practical guidelines based on his clinical experience, his research and the research presented in the book. He gives recommendations for specific amounts of minerals to slow progression of diabetes or reverse diabetes in its early stages. Over 100 herbal supplements are evaluated and 11 are assessed to be of potential value for treatment of early diabetes. Anderson and his colleagues have been doing research on nutrition and diabetes for 35 years at UK and he has published over 100 research papers on this topic.

Source: University of Kentucky

DATE: SEPTEMBER 12, 2008

A new analysis of government data is the first to link low-level arsenic exposure, possibly from drinking water, with Type 2 diabetes, researchers say. The study's limitations make more research necessary. And public water systems were on their way to meeting tougher U.S. arsenic standards as the data were collected. Still, the analysis of 788 adults' medical tests found a nearly fourfold increase in the risk of diabetes in people with low arsenic concentrations in their urine compared to people with even lower levels.

Previous research outside the United States has linked high levels of arsenic in drinking water with diabetes. It's the link at low levels that's new. The findings appear in Wednesday's Journal of the American Medical Association. "The good news is, this is preventable," said lead author Dr. Ana Navas-Acien of Johns Hopkins Bloomberg School of Public Health in Baltimore. New safe drinking water standards may be needed if the findings are duplicated in future studies, Navas-Acien said. She said they've begun a new study of 4,000 people. Arsenic can get into drinking water naturally when minerals dissolve. It is also an industrial pollutant from coal burning and copper smelting. Utilities use filtration systems to get it out of drinking water.

Seafood also contains nontoxic organic arsenic. The researchers adjusted their analysis for signs of seafood intake and found that people with Type 2 diabetes had 26 percent higher inorganic arsenic levels than people without Type 2 diabetes. How arsenic could contribute to diabetes is unknown, but prior studies have found impaired insulin secretion in pancreas cells treated with an arsenic compound. The policy implications of the new findings are unclear, said Molly Kile, an environmental health research scientist at the Harvard School of Public Health. Kile wrote an accompanying editorial in the journal. "Urinary arsenic reflects exposures from all routes _ air, water and food _ which makes it difficult to track the actual source of arsenic exposure let alone use the results from this study to establish drinking water standards," Kile said.

Also, the findings raise a chicken-and-egg problem, she said, since it's unknown whether diabetes changes the way people metabolize arsenic. It's possible that people with diabetes excrete more arsenic. The United States lowered arsenic standards for public water systems to 10 parts per billion in 2001 because of known cancer risks. Compliance was required by 2006, years after the study data were collected in 2003 and 2004.

DATE: SEPTEMBER 05, 2008

A new study in the September issue of the Journal of Lipid Research suggests an unusual form of inheritance may have a role in the rising rate of diabetes, especially in children and young adults, in the United States. DNA is the primary mechanism of inheritance; kids get half their genes from mom and half from dad. However, scientists are just starting to understand additional kinds of inheritance like metabolic programming, which occurs when an insult during a critical period of development, either in the womb or soon after birth, triggers permanent changes in metabolism.

In this study, the researchers looked at the effects of a diet high in saturated fat on mice and their offspring. As expected, they found that a high-fat diet induced type 2 diabetes in the adult mice and that this effect was reversed by stopping the diet. However, if female mice continued a high-fat diet during pregnancy and/or suckling, their offspring also had a greater frequency of diabetes development, even though the offspring were given a moderate-fat diet. These mice were then mated with healthy mice, and the next generation offspring (grandchildren of the original high-fat fed generation) could develop diabetes as well. In effect, exposing a fetal mouse to high levels of saturated fats can cause it and its offspring to acquire diabetes, even if the mouse goes off the high-fat diet and its young are never directly exposed. The study used mice so it's not time to warn women to eat differently during pregnancy and breastfeeding but earlier research has shown that this kind of inheritance is at work in humans. For example, there is an increased risk of hypertension and cardiovascular disease in children born of malnourished mothers.

DATE: AUGUST 29, 2008

Recent research by Kalidas Shetty of the University of Massachusetts Amherst and Lena Galvez Ranilla of the University of San Paolo, Brazil, shows that when it comes to managing Type 2 diabetes, all sweeteners may not be the same. Some sweeteners, including date sugar and less refined, dark brown sugars, showed potential for managing Type 2 diabetes and related complications information that could help Type 2 diabetics make better dietary choices.

"Depending on their origin and grade of refining, many sweeteners contained significant amounts of antioxidants, which have the potential to control diabetes-linked high blood pressure and heart disease," says Shetty, who adds that these were in vitro laboratory studies performed outside of living organisms. "Several types of sweeteners also showed an interesting potential to inhibit the action of a key enzyme related to Type 2 diabetes, which is also the target of drugs used to treat this condition." Additional members of the research team include food scientist Young-In Kwon of UMass Amherst and Maria Ines Genovese and Franco Maria Lajolo of the University of San Paulo, Brazil. Results were published in the most recent issue of the Journal of Medicinal Food."

The team started by collecting an exhaustive array of sweeteners, everything from the complete line offered by Domino, to unprocessed, dark brown sugars from Mauritius and Peru. Pure maple syrup, corn syrup-based sweeteners, "natural" sugar products like sucanat and sugars from Asia, India, South America and China rounded out the list. Extracts of the sweeteners were first analyzed to determine their total content of a group of antioxidants known as phenolic compounds, the same plant chemicals that give red wine and tea their heart-healthy benefits. Testing showed that when it comes to sugar, darker is definitely better. Dark brown sugars contained up to 4,741 micrograms of phenolic compounds per gram, compared to 18 micrograms per gram for white sugar. The highest antioxidant levels were found in the darkest sugars. Further testing showed that these phenolic compounds had significant antioxidant properties, scavenging harmful free radicals that can damage the delicate machinery of cells. According to Shetty, high blood sugar levels in diabetics can cause the overproduction of these free radicals, contributing to high blood pressure and accelerating the development of heart disease.

Date sugar produced in the United States and dark brown sugars from Peru and Mauritius packed the biggest punch, racking up the highest antioxidant levels and scavenging an impressive 82 to 88 percent of free radicals in laboratory in vitro tests. Sweeteners were then tested for their ability to inhibit the activity of alpha-glucosidase, an enzyme that moderates blood glucose levels by controlling the passage of sugars from the small intestine. "Diabetes is characterized by a rapid rise in blood glucose levels after meals," says Shetty. "Inhibiting alpha-glucosidase, which is the target of several drugs used to treat diabetes, can help prevent this spike." Most sweeteners derived from sugar cane inhibited alpha-glucosidase action by 26 to 50 percent, including the dark brown sugars and natural sugar products from evaporated cane juice. Date sugar inhibited the enzyme by 75 percent. Surprisingly, several sweeteners based on corn syrup inhibited alpha-glucosidase levels by 77 to 81 percent, although they contained low levels of phenolic compounds. "This level of inhibition could be due to sugar polymers known as oligosaccharides that are not completely broken down, mimicking the action of certain drugs that inhibit alpha-glucosidase," says Shetty. "This investigation is continuing."

Date sugar and sweeteners based on corn syrup also inhibited an enzyme that plays a role in high blood pressure, a common complication of diabetes. According to Shetty, the reason for this is not clear based on current studies. "Replacing sugars in processed foods and beverages with low calorie and noncaloric sweeteners is one long term strategy for Type 2 diabetics," says Shetty. "But these results indicate that a strategic choice of dietary sweeteners, especially less refined sugars close to the original nature of the ingredients found in whole plants, also has potential in managing Type 2 diabetes and related complications. This provides a strong rationale for further animal and clinical studies for better diet design."

DATE: AUGUST 22, 2008

Losing weight through diet and exercise lowers diabetes risk in men and women, but men may have to work harder for the same benefit, new research suggests.

In a study of more than 1,100 adults at risk of type 2 diabetes, researchers found that those who went on an "intensive" regimen of calorie-cutting and exercise lowered their risk of developing diabetes over the next year. However, despite the fact that men lost more weight and exercised more than women did, that did not translate into a greater reduction in diabetes risk, the researchers report in the journal Diabetes Care. For the study, researchers led by Dr. Leigh Perreault at the University of Colorado Health Sciences Center in Aurora randomly assigned participants to either an intensive program of lifestyle changes or standard lifestyle advice. Those in the former group were given the goal of losing 7 percent of their body weight by cutting calories and fat from their diet and exercising for at least 2.5 hours per week.

Overall, men and women in the intensive group were 58 percent less likely to develop diabetes over the next year. In general, men exercised more and were more successful at losing weight -- 47 percent reached the 7-percent goal, versus 37 percent of women. Weight loss translated into a reduction in triglycerides (a type of blood fat) and better blood-sugar control. Once again, men had greater decreases in these two factors as well. However, men saw no more benefit than women did when it came to diabetes risk. The rates of return to normal glucose tolerance levels and the development of diabetes did not differ between men and women. The reason, according to Perrault's team, may have to do with the fact that men had more diabetes risk factors to begin with. They say that more studies are needed to understand whether and how various diabetes prevention tactics affect men and women differently.

DATE: AUGUST 15, 2008

Finally, Atkins and low-carbohydrate diet supporters have their vindication. In a two-year Israeli study released earlier in July in the New England Journal of Medicine, results show low-carb and Mediterranean diets helped patients lose more weight and lowered their cholesterol and sugar levels more than patients on low-fat or non-restricted carb diets.

According to Dr. Mary Vernon, a national expert in obesity and diabetes and chairwoman of the board of the American Society of Bariatric Physicians, this evidence substantiates her practice in using a low-carb diet to help diabetics. Vernon, who practices in Lawrence and Shawnee, was an associate of Robert C. Atkins, who created the Atkins diet that has been the subject of debate for numerous years. She also co-wrote “Atkins Diabetes Revolution.” The study was sponsored in part by the Atkins Research Foundation and included a small population of diabetics as subjects, so its findings could still be up for debate in mainstream medicine. But Vernon has seen all the proof she needs that food choices can improve diabetics’ lives.

“For years, carbohydrate restriction and the low-carb folks, those of us who really spent our lives telling patients they could regain metabolic control and kind of being ostracized for it, we’re finally validated,” she said. Vernon said she had seen her patients lose weight, boost energy levels, lower cholesterol and maintain their blood sugar level, all with a low-carb focused diet, which she learned later in her career was a viable alternative to medicine. If you had asked two of her patients to consider a low-carb diet years ago before they received diabetes diagnoses, they would have scoffed at the idea. “I thought it was a bunch of rubbish,” said Bill Simpson, 51, a retired Emporia State University computer science professor. After receiving a Type 1 diabetes diagnosis five years ago and “finally being talked into” the diet, Simpson said, “I know for a fact it saved my life.” He dropped 60 pounds, lowered his blood pressure and got off insulin all before he had a heart attack in 2004. He said if he hadn’t lost the weight, he doesn’t think he would have survived. “I’m not the one that would go out and seek a diet,” said Susan Ludwick, 57. Food, especially sweets, had been her weakness for years. Vernon gave Ludwick a Type 2 diabetes diagnosis in 1986. Ludwick tried to control her diabetes with medicine and diet and exercise for 20 years. Ludwick, too, lost about 60 pounds, but she still suffered from fatigue and high blood pressure. In March 2006, she said she hit “rock bottom.” It was time for a change, she said, and that’s when she tried the low-carb diet.

Vernon said she gives patients the option of medicine or diet, and they decide what they want to try. “Nine times out of 10, they will try the diet,” she said. As soon as Ludwick returned home, she cleared her cupboards and refrigerator of carbs, she said. The diet hasn’t been easy, but she encourages others who suffer from diabetes or know others with it to consider the lifestyle change. That’s a reason participating in the show was important to her, she said. Ludwick is committed to the changes. “I think we have an epidemic of diabetes in this country, and I think a lot of that is the kind of stuff we put in our body,” she said. “I never want to get back to medication. I never want to get out of the size of clothes I’m wearing today.”

DATE: AUGUST 08, 2008

Congress has been successful in overriding President Bush's veto of the Medicare legislation, including funding for diabetes research, that was passed by the House in June and by the Senate in July.

The legislation includes a two year extension of the Special Diabetes Program (SDP), providing $300 million for type 1 diabetes research ($150 million per year for two years). This is the second largest influx of federal research dollars ever provided to fight this disease; a multi-year extension of the SDP was JDRF's top legislative priority this year. Passage of the bill avoids a 35 percent cut in federal support for type 1 diabetes research.

"This multi-year renewal of the SDP will enable NIH and the research community to continue aggressively fighting diabetes," said Larry Soler, JDRF's Vice President of Government Relations. "The strong, bipartisan support for the SDP in Congress stems from its demonstrated record of success and return on the federal investment. JDRF is grateful and pleased that this Congress has made the future of this life-saving program a priority in a difficult budget climate."

Created in 1997, the SDP provides multi-year focused funding that has led to the development of new technologies and therapies that are helping people with diabetes and accelerating the pace of science leading to a cure. The SDP has been renewed by Congress four times and consists of two parts - research funding for type 1 diabetes and type 2 diabetes treatment and education programs for Native American populations.

DATE: AUGUST 01, 2008

Scientists and major pharmaceutical companies have for decades focused on complex synthetic compounds to prevent and slow the progress of everything from cancer to neurological disorders such as Alzheimer’s and Parkinson’s disease. But U.S. researchers, including some at the University of Texas Medical Branch in Galveston, are making promising discoveries that could have everyone someday turning to their spice racks and produce aisles instead of their medicine cabinets to ward off illness and the effects of aging. “I think a lot of people all think this is kind of bunk — that spices and natural compounds can be effective,” said Dr. B. Mark Evers, director of the medical branch’s Sealy Center for Cancer Cell Biology. “But I think we’re starting to break down barriers and it’s becoming more mainstream.” Working with cell cultures, Evers and other medical branch scientists say they’ve discovered that curcumin — a spice made by grinding the roots of the Curcuma longa plant and the active ingredient in the yellow spice turmeric — often used to make curry dishes — works in the lab to fight skin and breast cancer and other tumor cells. Evers and other scientists also said they discovered that curcumin blocks the activity of a gastrointestinal hormone implicated in the development of colorectal cancer.

In a paper published last year in the journal Clinical Cancer Research, Evers’ group, including research associate Xiaofu Wang, linked the hormone neurotensin, which is generated in the response to fat consumption, to the production of IL-8, a potent inflammatory protein. IL-8 speeds the growth and spread of a variety of cancer cells, including colorectal and pancreatic tumor cells, medical branch researchers say. “We found that in colon cancer cells, neurotensin increases not just the rate of growth but also other critical things, including cell migration and metastasis,” Evers said. “The fact all that can be turned off by this natural product, curcumin, was really remarkable.” Research on mice at the University of Texas M.D. Anderson Cancer Center has shown the spice can block growth of skin cancer and inhibits the spread of breast cancer into the lungs, according to reports.

Meanwhile, researchers at the Brain Research Institute at the University of California, Los Angeles, also have taken a keen interest in the medical implications of curcumin. Gregory Cole, professor of Medicine and Neurology at UCLA, where he is also the associate director of the Alzheimer’s center and associate director for research at the Geriatric Research, Education and Clinical Center for the Veterans Administration Greater Los Angeles Healthcare System, said he was impressed by curcumin’s antioxidant powers. Antioxidants work to neutralize the damaging effects of so-called “free radicals,” the natural byproducts of cell metabolism, researchers say. Curcumin, which also shows promising results in studies on rheumatoid arthritis, osteoporosis and cystic fibrosis, has captured scientists attention for its anti-inflammatory effects. Inflammation is a response of body tissues to injury or irritation and aids in healing. But long-term inflammation, often caused by unhealthy habits, can lead to such serious chronic illnesses as heart disease, diabetes and Alzheimer’s, according to a March 2007 article in American Medical News. Achsah Keegan, a researcher at the University of Maryland’s Center for Vascular and Inflammatory Diseases in Baltimore, told American Medical News that over the past five to eight years it had become increasingly clear that chronic diseases once “thought to be unique have similarities in that they are mediated by inflammatory processes that persist over many years.” UCLA’s Cole likens inflammation to a “slow burn.” Cole and other researchers say curcumin in lab tests is effective fighting Alzheimer’s by preventing accumulation of the protein amyloid-beta. Although no one knows exactly what causes the neurodegenerative disease, amyloid-beta is common within the plaque found in the brains of Alzheimer’s patients. “It’s not your normal protein,” Cole said. “It’s very stable, hard to degrade.”

In India, where turmeric is a staple spice and long used for healing wounds, the incidence of Alzheimer’s disease is among world’s lowest, according to reports.

So how much curcumin should we consume? Cole and other UCLA scientists are conducting clinical trials to learn how well people can tolerate high doses. Trmeric in extract form is available at some health food and grocery stores. “I can only say that I recommend my parents take 500 milligrams a day,” Cole said. “There’s not a shred of evidence that it can be harmful.” But funding to test nutraceuticals, or natural compounds used for medicinal purposes, on humans is difficult to come by, Cole said. But if curcumin is all that researchers think it is, it could profoundly change medicine. “We’re working with other researchers to get it properly tested,” Cole said. “I think there’s really something there.”

And curcumin isn’t the only natural compound shaking up the world of medicine. Chemist Richard A. Anderson, a lead scientist at the Beltsville Human Nutrition Research Center in Maryland, his colleagues and two universities have published studies about the potential of cinnamon to lower blood sugar levels. Blood sugar problems can lead to Type 2 diabetes. Researchers reported that less than half a teaspoon of cinnamon daily for 40 days reduced blood sugar, cholesterol and triglycerides by about 20 percent in volunteers with Type 2 diabetes, according to federal officials. “We’ve had calls from a lot of people who have gone off their medication,” he said. (Researchers and medical professionals urge people who plan to use cinnamon to control blood sugar to consult with their doctors.) The use of natural compounds to treat disease can improve health care millions of people, Anderson said. “A lot of people in this world don’t have access to drugs like we do in the United States,” he said. “Hopefully, people will start taking natural products before they become diabetics.” The active components of cinnamon are found in water-soluble compounds, not cinnamon oil. The USDA has filed for a patent on water-soluble compounds researchers have separated from fat-soluble, potentially toxic components in cinnamon bark, it reports. Ground cinnamon can be added to oatmeal and other dishes and also in coffee grounds before brewing. Heat does not harm its effectiveness, Anderson said.

James Joseph, who leads the Neuroscience Laboratory at the Jean Mayer USDA Human Nutrition Center on Aging at Tufts University in Boston, has long studied the effects of some plant compounds on brain function. His findings are giving the medical community much to think about. One of Joseph’s studies, published in the Journal of Neuroscience, showed that rats from adulthood to middle age that consumed antioxidants — vitamin E, strawberry extracts, or spinach extracts — did not experience age-related cognitive performance losses experienced by rats in a control group. “The rats fed the spinach, strawberry or blueberry extracts effectively reversed age-related deficits in neuronal and cognitive function,” according to an August 2007 report by the USDA. “In addition, the blueberry-fed group far outperformed peers while traversing a rotating rod to test balance and coordination.”

Agricultural Research Service chemist Agnes Rimando and collaborators are studying whether blueberry skins are effective in controlling cholesterol. The group loaded hamsters up with foods high in cholesterol, but also gave them supplements of freeze-dried rabbiteye blueberries, according to the USDA. The result? The rabbiteye blueberries “produced plasma total cholesterol levels 37 percent lower than those of hamsters fed a control diet,” according to a March 2007 USDA report. Rimandoalso worked on another study that showed that certain constituents of blueberry skins also had the potential to fight colon cancer, according to the USDA.

DATE: July 25, 2008

Pop sensation Fergie says she does a shot of vinegar every night to help maintain her physique. Last month, Natural Solutions magazine recommended taking a few tablespoons with meals to counter acid reflux. Meanwhile, the April issue of Health magazine listed honey-and-vinegar mixtures among its list of "health whoppers" that do nothing for arthritis pain. Although a daily cocktail of apple cider vinegar may sound like another celebrity trend, folk remedy or harmless placebo, recent studies support centuries of anecdotal evidence - and suggest vinegar might ease or prevent a variety of ailments.

A Swedish study, published in April, found that people who ate white bread with vinegar felt full up to two hours later, while those who ate just bread started losing their satiety after 30 minutes. In a study from Arizona State University, the blood sugar spikes of people with type 2 diabetes were 4 to 6 percent lower in the morning when participants took two tablespoons of apple cider vinegar before going to bed. In January, a report in the Journal of the American College of Cardiology recommended that an anti-inflammatory diet including vinegar "should be considered for the primary and secondary prevention of coronary artery disease and diabetes." These findings don't surprise or concern those who have practiced and preached the virtues of apple cider vinegar for decades.

"It's working for me. I'm still living and I can go out and do all the things I did when I was 45," says Jerry Berube, 85. "I'm living proof." Berube, who lives in Montgomery with his wife, Patricia, says he hasn't had a cold or sore throat in 35 years. He's never battled weight gain or suffered from arthritis. His last blood pressure reading was 124/73 - good by anyone's account - and although he takes a few vitamins, he has no prescription medications. Berube partly credits his vitality to the drink he's sipped nearly every night since 1973: one tablespoon of organic apple cider vinegar mixed with one tablespoon of honey and 8 ounces of warm water. The natural ingredients - 94 percent water and 5-6 percent acetic acid, formed by the fermentation of apple juice - are part of apple cider vinegar's appeal. "It's basically good food, so what do I have to lose?" Berube says.

Even physicians who don't support apple cider vinegar as a remedy see little harm in drinking moderate amounts diluted with water or juice. "The placebo affect is very strong. I don't argue with that if it makes them feel better. But I can't promote it and say, 'Yes it's going to help you,' " says Dr. Debra Krummel, researcher with the University of Cincinnati's Department of Nutrition. Cindy Mielke, a personal trainer with Atlas fitness and training studio in Crescent Springs, who is relocating to St. Louis, shares Berube's "why not" attitude about ACV - as those in the know refer to apple cider vinegar. Mielke has taken it before meals to help with weight loss, inhales vinegar steam to clear her sinuses and sometimes takes an extra dose if she feels "puffy" from today's high-sodium foods - a fix she attributes to the high amount of potassium in ACV, which counteracts the sodium. Echoing Berube, Mielke attributes not having the flu for 15 years to a morning glass of ACV and water, sometimes with a little honey. "If I need a little pick-me-up, instead of drinking a Coke I'll have six to eight ounces of water with vinegar. It's a healthy alternative," Mielke says. Mielke picked up her liberal use of vinegar from her parents, Jerry and Marilyn Mielke of Bridgetown. Marilyn Mielke, 72, was introduced to ACV by her father, who brought home the book "Folk Medicine" by Dr. D.C. Jarvis, considered the modern "apostle" of apple cider vinegar's medicinal powers. She often takes ACV to treat nausea, gargles with it when she has a sore throat and just a few weeks ago found it took the sting out of a sunburn. Her husband, 75, says it works "almost 100 percent of the time" for heartburn and arthritis if he drinks it with water as soon as the pain hits. And, unlike topical creams, routine doses seem to prevent arthritis aches, Jerry says. "There's probably a lot of truth to the adage 'an apple a day keeps the doctor away,' only this is in liquid form," Jerry says.

How much truth, however, is deeply debated, and mostly unknown. Research from Arizona State University and the University of Lund in Sweden - the only groups known to be investigating ACV - has focused on ACV's potential for managing diabetes and hunger. "I was doing low-carb diets with diabetics. But I came across (ACV) and I thought, 'Wow, no one is talking about this. This could be easier than changing their entire diet,' " says Carol Johnston, chairman of the department of nutrition at Arizona State, who has been researching ACV since 2000. In the study, acetic acid - found in any vinegar - controlled the blood sugar spikes that diabetics experience after a meal or first thing in the morning. Because these spikes destroy cells that produce insulin, ACV and other antiglycemic agents could prevent or delay the onset of the disease for those diagnosed with pre-diabetes - a condition in which blood sugar levels are higher than normal but not high enough for a diagnosis of diabetes. Although weight loss was not part of the controlled study, Johnston believes the acetic acid also interferes with the digestion of carbohydrates and creates a sense of "fullness." The remedy is a common topic of discussion at health and weight loss Web sites, where members share tips for making milkshakes with ACV and Stevia sweetener. Kathy Sprinkle of West Chester Township began sipping the concoction a few weeks ago, after seeing posts at LowCarbFriends .com. Sprinkle, 51, uses it to curb her appetite and soothe occasional stomach upset. "I'm diabetic, and when I eat too many carbs I get horrible indigestion, and (apple cider vinegar) just takes it away," she says.

The few studies that have examined ACV's benefits for other health conditions have been promising, but incomplete. A 2000 study on rats showed vinegar decreased systolic blood pressure by 4-6 percent. In a 2006 study, vinegar lowered rats' cholesterol. Neither study was reproduced with humans. A 10-year study, published in 1999, found that women who ate salad with oil and vinegar five to six times a week had decreased levels of fatal ischemic heart disease, but researchers couldn't determine the beneficial ingredient. Johnston argues the lack of studies is about the lack of a copyright. "We just really haven't put (vinegar) to the test," Johnston says. "There's no funding for it. The drug companies obviously will spend a lot of money trying to demonstrate the efficacy of their products, but with a natural remedy that there's no copyright on, who are you going to go to?" Johnston asks. Others see little need for research when drugs often are more effective. Johnston's study, for example, found that a pre-meal dose of ACV lowered diabetics' blood glucose spikes by 3-6 percent, but pharmaceutical hypoglycemic agents reduced spikes by 10-15 percent. Without more clinical trials and FDA approval, doctors and nutritionists who stick with "evidence-based practices" aren't likely to discuss a vinegar remedy with patients.

Last year, Phil Bullen of Mount Washington went to see his doctor about a toenail fungus he's battled for nearly 10 years. His physician said the options were to take a pill every day, which could damage his liver and would require frequent check-ups, or use a prescription cream, which delivered limited results. Frustrated, Bullen turned to the Internet. "It turns out that acidity is an inhospitable environment for fungi," Bullen says. He began swiping apple cider vinegar across his nails twice a day, and now has several nails that are 80-90 percent healthy. If he skips a day, the fungus advances. His physician later told Bullen he had heard of the treatment, but offered no reason for not suggesting Bullen try it. Apple cider vinegar supporters acknowledge vinegar cocktails are no cure-all. An ACV-infused steam facial didn't clear Cindy Mielke's skin, nor did a vinegar bath ease her sore muscles after a marathon. Kathy Sprinkle acknowledges the remedy could be the equivalent of a sugar pill, but says that doesn't bother her. "It may be a placebo effect, but I think the whole placebo thing is underrated," Sprinkle says.

DATE: July 18, 2008

Obesity surgery can cause type 2 diabetes to go into remission, but much depends on how much weight the patient loses within the first few months, a new study suggests. Gastric bypass surgery for severe obesity has been shown to control type 2 diabetes, a disorder that commonly goes hand-in-hand with obesity. The procedure involves sectioning off a small portion of the stomach, creating a pouch that limits the amount of food a person can eat in one sitting. The surgeon also adds a bypass that reroutes food past the rest of the stomach and part of the small intestine to limit calorie and nutrient absorption. It's thought that the surgery creates hormonal changes that, in turn, improve diabetes control.

However, the new study, by surgeons at Duke University Medical Center in Durham, North Carolina, shows that hormones are not the whole story. The amount of weight patients shed in the first six months after surgery appears key to diabetes remission. 'Gastric bypass surgery appears to cause important metabolic effects that rapidly improve type 2 diabetes, but weight loss itself is also extremely important,' Dr Eric DeMaria said in an interview. Dr DeMaria presented his group's research this week at the annual meeting of the American Society for Metabolic and Bariatric Surgery in Washington, DC. He and his team followed 71 morbidly obese patients with severe diabetes requiring high doses of insulin and oral medications to control their blood sugar levels. The researchers' goal was to identify factors that differentiate patients who go into remission from those who do not. 'We found that the most important factor was the amount of weight loss by the patient,' he said. Diabetes control was improved in all patients as evidenced by better long-term blood sugar levels and reductions in the amount of medication they needed. Still, only 48 per cent went into complete remission.

The researchers found that weight loss in the first three weeks to six months after surgery was a critical factor in diabetes remission. The hormonal effects of gastric bypass surgery are still important. 'Morbidly obese patients usually lose about 10 per cent of their body weight within three weeks of surgery,' Dr DeMaria said, 'but that does not explain why they can cut back on their medications within the first day or two'. That benefit, he explained, 'appears to be an effect on gut hormones, with dramatic improvement in insulin resistance'. 'But,' Dr DeMaria added, 'it is interesting to recognise that faster weight loss and greater amount lost improves the chance that patients will remain in remission'. The findings, he said, suggest that 'if we can enhance the weight-loss effect of surgery - by adding medications or rigorous behaviour modification - we may do better than a 50 per cent remission rate

DATE: July 11, 2008

In the latest run of good news for vitamin D comes a new study showing that people with higher levels of the "sunshine" vitamin were less likely to die from any cause - including cardiovascular disease, the No. 1 killer of Canadians - after eight years of tracking. The finding held even when researchers took coronary artery disease, exercise and other factors into account. Low vitamin D levels "can be considered a strong risk indicator for all-cause mortality in women and in men," researchers report Tuesday in the journal Archives of Internal Medicine. By the time the paper had been accepted for publication, the team had dug deeper and found low vitamin D status "had other significant negative effects in terms of incidence of cancer, stroke, sudden cardiac death and death of heart failure," lead author Dr. Harald Dobnig, of the Medical University of Graz in Austria, said in an e-mail. It's still not "ultimate proof" of the harmful effects of too little vitamin D, he says. "But the evidence is just becoming overwhelming at this point."

Researchers can't rule out that sicker patients had lower vitamin D levels and, therefore, were already at an increased risk of dying to begin with. But, "this was not a bedridden, immobile or very sick population that we studied," Dobnig says. People with an acute illness other than cardiac disease were excluded from the study. "Low levels of vitamin D may carry a potential health risk," Dobnig says. "Physicians should be aware of the widespread problem of low vitamin D status." He says those at high risk for vitamin D deficiency - including the elderly, nursing home residents and people who work night shifts or spend a lot of time indoors - should take 800 international units of vitamin D3 daily. "Whether we can go to higher (or even much higher) doses is unclear at the moment." About 50 to 60 per cent of older adults in North America are low in vitamin D, and it also seems to be a widespread problem in children as well. In the past year, studies have linked low vitamin D to an increased risk of cancers, notably breast, colon and endometrial cancers, as well as multiple sclerosis - a disease more common in northern countries. And, in back-to-back studies this month, researchers reported that men with too little vitamin D appear to be at increased risk of heart attacks, while colon cancer patients with abundant vitamin D were less likely to die during followup. The new study is based on 3,258 consecutive patients scheduled for an angiogram - an X-ray to check for abnormalities in the arteries - at a medical centre in Germany between 1997 and 2000. Before and after the test, their blood was measured for vitamin D3, and a compound called 25-hydroxyvitamin D, considered the best indicator of a person's vitamin D status.

After an average followup of nearly eight years, 737 people (about 23 per cent) had died, including 463 who died of cardiovascular causes. People who had 25-hydroxyvitamin D levels in the lower half of the vitamin D range were up to twice as likely to die during the followup period compared with those in the highest. Similar results were found in people with the lowest levels of vitamin D3. Overall, two-thirds of the patients had coronary artery disease. But whether or not they had signs of congestive heart failure or artery disease, low levels of vitamin D were "always significantly associated" with a higher risk of death, Dobnig says. People with low vitamin D had signs of inflammation and oxygen-related damage to cells, "which all points towards a higher vascular risk profile," Dobnig says. "This is the first study showing a significant association between serum (blood) vitamin D levels and risk of all-cause and cardiovascular mortality," he says. But it's just that - an association, cautions Dr. Beth Abramson, a cardiologist at St. Michael's Hospital in Toronto and spokeswoman for the Heart and Stroke Foundation. People with higher vitamin D levels tended to be healthier and more fit. Rather than focus on a "trendy risk factor," Abramson says Canadians should be aware of traditional risk factors for heart disease, such as high blood pressure, high cholesterol, smoking, diabetes and a family history of the disease. Roughly 80 to 90 per cent of 25-hydroxyvitamin D is derived from exposure to sunlight, the rest from foods, such as fatty fish and eggs, Dobnig says. But in Canada, our bodies can't make the vitamin under weak fall and winter sunlight, and experts say more research is needed about the amount of sunlight exposure needed to achieve the optimum vitamin D levels. As well, sun exposure increases skin cancer risk. "Don't sit and bake. There's no evidence that's helping you in the long run," Abramson says.

DATE: July 03, 2008

Turmeric, an Asian spice found in many curries, has a long history of use in reducing inflammation, healing wounds and relieving pain, but can it prevent diabetes? Since inflammation plays a big role in many diseases and is believed to be involved in onset of both obesity and Type 2 diabetes, Drew Tortoriello, M.D., an endocrinologist and research scientist at the Naomi Berrie Diabetes Center at Columbia University Medical Center, and his colleagues were curious what effect the herb might have on diabetic mice.

Dr. Tortoriello, working with pediatric resident Stuart Weisberg, M.D., Ph.D., and Rudolph Leibel, M.D., fellow endocrinologist and the co-director of the Naomi Berrie Diabetes Center, discovered that turmeric-treated mice were less susceptible to developing Type 2 diabetes, based on their blood glucose levels, and glucose and insulin tolerance tests. They also discovered that turmeric-fed obese mice showed significantly reduced inflammation in fat tissue and liver compared to controls. They speculate that curcumin, the anti-inflammatory, anti-oxidant ingredient in turmeric, lessens insulin resistance and prevents Type 2 diabetes in these mouse models by dampening the inflammatory response provoked by obesity. Their findings are the subject of a soon-to-be published paper in Endocrinology and were recently presented at ENDO 2008, the Endocrine Society's annual meeting in San Francisco. Turmeric (Curcuma longa) has no known dose-limiting toxicities in doses of up to at least 12 grams daily in humans. The researchers tested high-doses of a dietary curcumin in two distinct mouse models of obesity and Type 2 diabetes: high-fat-diet-fed male mice and leptin-deficient obese female mice, with lean wild-type mice that were fed low-fat diets used as controls.

The inflammation associated with obesity was shown several years ago by researchers in the Naomi Berrie Diabetes Center to be due in part to the presence of immune cells called macrophages in fat tissues throughout the body. These cells produce "cytokine" molecules that can cause inflammation in organs such as the heart, and islets of the pancreas, while also increasing insulin resistance in muscle and liver. Researchers hypothesized that by suppressing the number and activity of these cells, with turmeric or a drug with similar actions, it may be possible to reduce some of the adverse consequences of obesity. Curcumin administration was also associated with a small but significant decline in body weight and fat content, despite level or higher calorie consumption, suggesting that curcumin beneficially influences body composition. "It's too early to tell whether increasing dietary curcumin [through turmeric] intake in obese people with diabetes will show a similar benefit," Dr. Tortoriello said. "Although the daily intake of curcumin one might have to consume as a primary diabetes treatment is likely impractical, it is entirely possible that lower dosages of curcumin could nicely complement our traditional therapies as a natural and safe treatment." For now, the conclusion that Dr. Tortoriello and his colleagues have reached is that turmeric -- and its active anti-oxidant ingredient, curcumin -- reverses many of the inflammatory and metabolic problems associated with obesity and improves blood-sugar control in mouse models of Type 2 diabetes. In addition to exploring novel methods of curcumin administration to increase its absorption, they are also interested in identifying novel anti-inflammatory processes invoked by curcumin and in adapting those processes in the development of more potent curcumin analogues. Funding for the study comes in part from the National Institutes of Health's Child Health and Human Development branch and the Naomi Berrie Diabetes Center at Columbia University Medical Center.

DATE: June 27, 2008

The Mediterranean diet, with abundant quantities of virgin olive oil, gives strong protection against diabetes, a study has shown.

The diet, which includes high quantities of fruit, vegetables and wholegrain pulses and cereals is already known to protect against cardiovascular disease and, according to some research, against Alzheimer's disease. Now scientists in Spain have found that it also gives a defence against the epidemic of diabetes associated with growing rates of obesity and consumption of high-fat fast food. Researchers who monitored the eating habits of 13,000 graduates from the University of Navarra for eight years from 1999 to 2007 found those who stuck closely to a Mediterranean diet had an 83 per cent lower risk of developing diabetes than those who ate less healthy food.

Those who followed the diet most rigorously had more risk factors for diabetes, such as being older, having a family history of the disease and a history of smoking. Yet they were less likely to develop the disease. This suggests the protective effect of the diet may be substantial, the authors report in the British Medical Journal. Professor Martinez-Gonzalez and colleagues from the University of Navarra, say: "Substantial protection against diabetes can be obtained with the traditional Mediterranean diet, rich in olive oil, vegetables, fruit, nuts, cereals, legumes and fish, but relatively low in meat and dairy products." As well as having high levels of antioxidant vitamins, which mop up free radicals - damaging substances in the blood thought to be linked to cancer and arterial damage - the diet also lowers cholesterol and blood pressure, risk factors for heart disease. People who eat a Mediterranean diet are less likely to be obese, have a lower risk of breast and bowel cancer and half the rate of lung disease. A study also showed it reduced the risk of Alzheimer's by 40 per cent.

DATE: June 20, 2008

Every day in the United States, 4,100 new cases of diabetes are diagnosed. The Centers for Disease Control and Prevention predicts that one in three Americans born in 2000 will develop diabetes. These alarming rates have sparked new educational campaigns to help prevent type 2 diabetes, the most common form of the disease, which is closely tied to being overweight. The growing problem also seems to be shaping the food aisles.

In the past four years, nearly 6,000 new sugar-free products hit store shelves, according to Lynn Dornblaser, a new-product analyst with Mintel, a market research company in Chicago. Beyond sugar-free, new diabetes-friendly foods are showing up in supermarkets, including snack bars, shakes and cereals that are promoted to people with diabetes. Despite the growing popularity of “diabetic foods,” however, some experts believe the marketing simply perpetuates a myth. “What is a diabetic food?” asked dietitian Hope Warshaw, a certified diabetes educator and author of “Diabetes Meal Planning Made Easy” (American Diabetes Association, $14.95). “There are no special foods that people with diabetes need to eat. We do a disservice to people by having them think they need to run out and buy special foods.” Warshaw said the nutrition recommendations for people with diabetes are the same as the general public — no rigid diet and no need to limit your selections to sugar-free foods. Sugar? Yes, people with diabetes can still have sugar. The no-sugar myth is one of the biggest misconceptions about diabetes, according to a new book “16 Myths of a Diabetic Diet” (American Diabetes Association, $14.95), by registered dietitians Karen Chalmers and Amy Campbell. This informative and easy-to read book busts the most common myths about diabetes and cleverly compares the old and new methods for managing diabetes. “Gone are the days when sugar is strictly off limits,” said co-author Campbell in a phone interview. “All carbohydrates break down into glucose in the same way. Your body doesn’t recognize whether the carbohydrate is a cookie, slice of bread or a potato.”

Sugar has always been intrinsically linked to diabetes. In fact, the disorder was once called “sugar diabetes” and people mistakenly believed that eating too much sugar was the cause. For years, people with diabetes were advised to avoid sweets because they were thought to overload the blood with glucose much faster than starches. Now researchers recognize that sugar has an impact on blood glucose that is similar to other carbohydrates. It’s much more important to keep track of total carbohydrates than to focus on avoiding sugar, Campbell said. “Totally eliminating sugar is unnecessary and impossible.” Even if all carbohydrates affect blood glucose levels in similar ways, they do differ nutritionally. Experts still advise choosing more starches or “complex” carbs — whole grains, fruits, vegetables and legumes — in place of concentrated sweets or “simple” carbs. Sugary foods and beverages can add a lot of empty calories and make it more difficult to manage your weight. Sweets also are typically high in fat, which can aggravate heart disease risk. However, instead of feeling guilty about eating sugar and trying to avoid it at all costs, Campbell encourages people with diabetes to find ways to fit reasonable portions into their eating plan — and enjoy them. Sugar-free options (particularly beverages) may help with calorie control, but they’re no longer a mandate for diabetes. Some may not even provide a significant advantage, said Chalmers.

Many sugar-free candies, cookies, cakes and ice creams contain nearly the same amount of calories and carbohydrates as their real sugar counterparts. That’s particularly true for sugar-free foods made with polyols or sugar alcohols (such as sorbitol, mannitol and xylitol). Although it has been many years since the nutrition guidelines for diabetes have changed, people still hold on to the belief that sugar is forbidden. Even some physicians still tell newly diagnosed patients to “stay away from sugar,” said Chalmers. Unfortunately, that’s often the only message they’re left with, she said. Instead, Chalmers encourages people to sit down with a certified diabetes educator and get the updated facts. She said the goal is to “fit diabetes into your lifestyle rather than fitting your lifestyle into your diabetes.” Finding ways to fit in favorite foods is the new mantra. Even the concept of a “diabetic diet” is a thing of the past. Now experts say people with diabetes should follow the same healthful eating plan as the rest of us — with an emphasis on whole grains, fruits and vegetables, lean protein and “good” fats. Moving beyond the myths, according to Campbell and Chalmers in their book, is the best way to manage diabetes and ensure you continue to enjoy the pleasures of the table.

DIABETES COOKBOOKS

It’s a myth that people with diabetes should only use diabetic cookbooks and recipes, according to “16 Myths of a Diabetic Diet.” Nonetheless, you’ll still find an endless array on bookstore shelves. Here are some of the best selections that keep the focus on flavor, all recently published by the American Diabetes Association.

• “The All-Natural Diabetes Cookbook: The Whole Food Approach to Great Taste and Healthy Eating,” by Jackie Newgent.
• “The Healthy Carb Diabetes Cookbook: Favorite Foods to Fit Your Meal Plan,” by Jennifer Bucko and Lara Rondinelli.
• “Trim & Terrific Diabetic Cooking,” by Holly Clegg.

DATE: June 13, 2008

Licensed pesticide applicators who used chlorinated pesticides on more than 100 days in their lifetime were at greater risk of diabetes, according to researchers from the National Institutes of Health (NIH). The associations between specific pesticides and incident diabetes ranged from a 20 percent to a 200 percent increase in risk, said the scientists with the NIH's National Institute of Environmental Health Sciences (NIEHS) and the National Cancer Institute (NCI).

"The results suggest that pesticides may be a contributing factor for diabetes along with known risk factors such as obesity, lack of exercise and having a family history of diabetes," said Dale Sandler, Ph.D., chief of the Epidemiology Branch at the NIEHS and co-author on the paper. "Although the amount of diabetes explained by pesticides is small, these new findings may extend beyond the pesticide applicators in the study," Sandler said. Some of the pesticides used by these workers are used by the general population, though the strength and formulation may vary. Other insecticides in this study are no longer available on the market, however, these chemicals persist in the environment and measurable levels may still be detectable in the general population and in food products. For example, chlordane, which was used to treat homes for termites, has not been used since 1988, but can remain in treated homes for many decades. More than half of those studied in the National Health and Nutrition Examination Survey in 1999-2002 had measurable evidence of chlordane exposure. "This is not cause for alarm," added Sandler "since there is no evidence of health effects at such very low levels of exposure."

Overall, pesticide applicators in the highest category of lifetime days of use of any pesticide had a small increase in risk for diabetes (17 percent) compared with those in the lowest pesticide use category (0-64 lifetime days). New cases of diabetes were reported by 3.4 percent of those in the lowest pesticide use category compared with 4.6 percent of those in the highest category. Risks were greater when users of specific pesticides were compared with applicators who never applied that chemical. For example, the strongest relationship was found for a chemical called trichlorfon, with an 85 percent increase in risk for frequent and infrequent users and nearly a 250 percent increase for those who used it more than 10 times. In this group, 8.5 percent reported a new diagnosis of diabetes compared with 3.4 percent of those who never used this chemical. Trichlorfon is an organophosphate insecticide classified as a general-use pesticide that is moderately toxic. Previously used to control cockroaches, crickets, bedbugs, fleas, flies and ticks, it is currently used mostly in turf applications, such as maintaining golf courses.

"This is one of the largest studies looking at the potential effects of pesticides on diabetes incidence in adults," said Freya Kamel, Ph.D., a researcher in the intramural program at NIEHS and co-author in the paper appearing in the May issue of the American Journal of Epidemiology. "It clearly shows that cumulative lifetime exposure is important and not just recent exposure," said Kamel. Previous cross-sectional studies have used serum samples to show an association between diabetes and some pesticides.

Diabetes occurs when the body fails to produce enough insulin to regulate blood sugar levels or when tissues stop responding to insulin. Nearly 21 million Americans have diabetes. The cause of diabetes continues to be a mystery, although genetics and environmental factors such as obesity and lack of exercise appear to play roles.

To conduct the study, the researchers analyzed data from more than 30,000 licensed pesticide applicators participating in the Agricultural Health Study, a prospective study following the health history of thousands of pesticide applicators and their spouses in North Carolina and Iowa. The 31,787 applicators in this study included those who completed an enrollment survey about lifetime exposure levels, were free of diabetes at enrollment, and updated their medical records during a five-year follow-up phone interview. Among these, 1,171 reported a diagnosis of diabetes in the follow-up interview. The majority of the study participants were non-Hispanic white men.

Researchers compared the pesticide use and other potential risk factors reported by the 1,171 applicators who developed diabetes since enrolling in the study to those who did not develop diabetes. Among the 50 different pesticides the researchers looked at, they found seven specific pesticides — aldrin, chlordane, heptachlor, dichlorvos, trichlorfon, alachlor and cynazine — that increased the likelihood of diabetes among study participants who had ever been exposed to any of these pesticides, and an even greater risk as cumulative days of lifetime exposure increased.

All seven pesticides are chlorinated compounds, including two herbicides, three organochlorine insecticides and two organophosphate pesticides.

"The fact that all seven of these pesticides are chlorinated provides us with an important clue for further research," said Kamel. Previous studies found that organochlorine insecticides such as chlordane were associated with diabetes or insulin levels. The new study shows that other types of chlorinated pesticides, including some organophosphate insecticides and herbicides, are also associated with diabetes. The researchers also found that study participants who reported mixing herbicides in the military had increased odds of diabetes compared to non-military participants.

DATE: June 06, 2008

Scientists at Karolinska Institutet in Sweden and Miami University have discovered that cells in the pancreas cooperate -- signal -- in a way hitherto unknown. The discovery can eventually be of significance to the treatment of diabetes. The aim of the project was to find out how the healthy body regulates glucose concentrations in the blood. Scientists have known for a long time that glucose is regulated with the help of hormones in the pancreas, which is to say that pancreatic beta cells produce insulin, which reduces sugar levels, and that alpha cells produce glucagon, which boosts them. This glucose balance must be kept within a very narrow interval, and we need both insulin and glucagon to remain in good health.

"A person with low blood sugar levels feels poorly and faint; a person with excessively high blood sugar levels gets diabetes," says Per-Olof Berggren, professor of experimental endocrinology at Karolinska Institutet and the leader of this study. Much more is known about insulin secretion than glucagon secretion, and so Professor Berggren's team focused on the latter. They discovered that alpha cells also secreted glutamate, which facilitates glucagon release and makes it more efficient. The scientists are working on the hypothesis that when glucose levels are raised in a healthy person, the beta cells become active and start to release insulin, which reduces sugar concentrations in the blood, upon which the alpha cells then start to secrete glucagon and glutamate. In this context, glutamate acts as a positive signal that tells the alpha cells that it is time to accelerate the production of glucagon to prevent glucose levels from falling too low. "It's this signal pathway that is our discovery," says Professor Berggren. "This interaction between beta cells and alpha cells is crucial for normal blood sugar regulation."

The discovery also means that when the beta cells fail to produce insulin properly, as is the case in diabetes, the alpha cells' signal path is also blocked, which upsets the glucose balance even more. The team hope that their discovery of the signal pathway will eventually give new impetus to clinical diabetes research. "Maybe we'll be able to achieve better blood sugar regulation in diabetes patients if we target more the glucagon/glutamate rather than just the insulin", says Professor Berggren.

DATE: May 29, 2008

Scientists at Washington University School of Medicine in St. Louis working with diabetic mice have examined in unprecedented detail the immune cells long thought to be responsible for type 1 diabetes. Researchers were able to examine the immune cells from isolated insulin-making structures in the pancreas known as the islets of Langerhans. They caught the immune cells, known as dendritic cells, "red-handed": carrying insulin and fragments of insulin-producing cells known as beta cells. This can be the first step toward starting a misdirected immune system attack that destroys the beta cells, preventing the body from making insulin and causing type 1 diabetes.

The results, reported online in The Proceedings of the National Academy of Sciences, push scientists a step closer to finding ways to treat this condition. "Now that we've isolated dendritic cells from the pancreas, we can look at why they get into the pancreas and determine which of the materials that they pick up are most critical to causing this form of diabetes," says senior author Emil R. Unanue, M.D., the Paul and Ellen Lacy Professor of Pathology. "That may allow us to find ways to inhibit dendritic cell function in order to block the disorder." The American Diabetes Association estimates that 1 million to 2 million Americans suffer from type 1 diabetes, which is also called juvenile diabetes because it frequently develops in children. Patients require insulin injections to survive because the immune system has destroyed the islets of Langerhans, which contain the body's only beta cells. The insulin these cells make is required for the critical task of regulating blood sugar levels.

Scientists detected dendritic cells in the islets years ago. Dendritic and other antigen-presenting cells are the sentinels of the immune system: They pick up bits of protein from around the body and present them to lymphocytes to initiate an immune system reaction. The lymphocytes lead immune attacks against foreign invaders like bacteria and viruses and eliminate them, clearing infections. But when interaction between an antigen-presenting cell and a lymphocyte leads to a part of the body being mistakenly identified as alien, the resulting attack harms the body, causing autoimmune diseases. Although dendritic cells' presence in the islets and their ability to summon immune attacks made them likely suspects in type 1 diabetes, they were challenging to isolate from the pancreas for closer examination.

"They're very tiny and there are only about 5 to 10 of them per islet, each of which contains approximately a thousand cells," explains Unanue. "So the senior postdoctoral researcher in the lab who did this work, Boris Calderon, had to develop some sophisticated cellular assays to pick them up." Calderon, M.D., found indications that the cells were carrying granules of insulin and pieces of proteins from beta cells on their cell surfaces. To test whether this cargo carried by the dendritic cells had the potential to trigger an immune attack on beta cells, Calderon exposed the dendritic cells to lymphocytes taken from diabetic mice. The lymphocytes were activated by the dendritic cells of the islets and switched into attack mode.

In a separate line of research, Unanue's lab has learned that dendritic cells in the pancreas may normally have beneficial effects on the health of beta cells. They've shown that when dendritic cells are absent from the pancreas, the beta cells are smaller, an indication that they're not as healthy. "We think these dendritic cells aren't in the pancreas by accident," says Unanue. "We believe that in the normal individual they help maintain the health of beta cells. But in a person with autoimmune diabetes, they appear to start the problems that destroy beta cells." The key distinction likely lies in a group of proteins called the major histocompatibility complex (MHC). Two decades ago, Unanue and Paul Allen, Ph.D., the Robert L. Kroc Professor of Pathology and Immunology, showed that the MHC provides the stage on which antigen-presenting cells show bits of protein or peptides to other immune system cells. Scientists believe autoimmune conditions like type 1 diabetes are caused by differences in what the MHC binds to and how it presents that material to immune attack cells. In support of this theory, Unanue's laboratory and that of Michael Gross, Ph.D., Washington University professor of chemistry, have collaboratively shown that the genes that encode the MHC proteins in the diabetic mouse are unique and bind to a set of very characteristic peptides. In addition to studying what protein fragments carried by dendritic cells are essential for causing type 1 diabetes, Unanue and others are working to learn how genetic variations in the MHC alter the chances that the immune system will mistakenly attack the body.

DATE: May 23, 2008

Losing weight may help resolve erectile dysfunction in obese men, according to research presented today at the 103rd Annual Scientific Meeting of the American Urological Association (AUA). Morbid obesity can cause sexual dysfunction independent of other common confounders, including diabetes, hypertension and smoking. In this study from researchers in Boston and Philadelphia, sexual function was normalized in some men who underwent gastric bypass surgery for weight loss. Researchers presented data to reporters during a special press conference on May 19, 2008.

“This study shows that weight loss and other risk factors which are alleviated by weight loss may be keys to restoring sexual function,” said Anthony Y. Smith, M.D. “These results give men another reason to improve their health by losing weight.”

In this study, 95 patients undergoing gastric bypass surgery for weight loss completed the Brief Sexual Inventory (BSI) pre- and post-operatively. On average, BSI scores improved in all categories, including sexual drive, erectile function, ejaculatory function, problem assessment and sexual satisfaction. The amount of weight lost predicted the degree of improvement in all areas of the survey. Results were then compared to data from the Olmstead County Study of Urinary Health Status Survey, a community-based prospective study often used as a baseline for study comparison. After an average of 67 percent weight loss post-bypass, BSI scores were comparable to patients in the Olmstead Study.

Gastric bypass surgery, a procedure that reduces the body’s caloric intake, can be used to induce significant weight loss in the obese. Calorie reduction is accomplished by making the stomach smaller and bypassing part of the stomach and small intestines so that fewer calories are absorbed. The patient feels full faster and learns to reduce the amount of food that he/she eats.

DATE: May 16, 2008

Men are more likely to develop Alzheimer's if they have a stroke, while women are more at risk if they are depressed, research suggested. A low level of education is also thought to influence the chance that both sexes will develop the disease.

A study of almost 7,000 people over the age of 65 examined a range of environmental and health factors to see how they affected progression of dementia. None of the people had dementia at the start of the study but 2,882 (42%) were classed as having mild cognitive impairment (MCI). This means they were starting to show signs of decline and did not perform highly on tests examining their level of recall.

The group, drawn from the French cities of Bordeaux, Dijon and Montpellier, was followed up after two years and again two years later. Men and women with MCI were more likely to be depressed and to be taking anticholinergic drugs, which are used to treat a range of conditions including incontinence, travel sickness and stomach cramps. Recent research has suggested some of these drugs can cause elderly people to experience greater decline in their thinking skills.

The study said men with MCI "were also more likely to have a higher body mass index, diabetes and stroke, whereas women were more likely to have poor subjective health, to be disabled, to be socially isolated, and to suffer from insomnia." The authors said: "Some potentially reversible risk factors for progression to dementia were identified, which were not the same for men and women. These factors should be taken into account in the development of gender-specific clinical intervention programmes for MCI."

The study was published in the Journal of Neurology, Neurosurgery and Psychiatry.

DATE: May 09, 2008

Peter Light, Alberta Heritage Foundation for Medical Research senior scholar and associate professor in the U of A Department of Pharmacology, has co-authored an article in the April 10 edition of the prestigious international science magazine, Nature. The paper showcases the discovery of a novel signaling pathway between the gut, the brain and the liver, and lowers blood sugar when activated.

In collaboration with University of Toronto diabetes researcher Tony Lam, Light was able to advise on experiments that showed the presence of fat in the small intestine activates a subset of nerves that send a signal to the brain, which in turn instructs the liver to lower blood-sugar production. "It is almost like a remote-control device which has a direct line to the brain," said Light. "It is like the gut has the brain on speed dial."

Light, whose research focuses on the effects of fats on insulin secretion in the pancreas, says although scientists have known that the brain and liver were involved in lowering blood sugar, this is the first time a direct link has been discovered. "This means if you can target this pathway in the gut, you may be able to regulate blood-sugar levels, which represents a novel approach to treating Type 2 diabetes," he said

Scientists around the world are in a race to discover new and effective ways to lower blood-sugar levels in people who are obese or who have diabetes because of the resulting risk of severe complications from high blood sugar, including heart attack, stroke, blindness, erectile dysfunction, foot problems and amputations. "The next set of experiments will look to determine what types of fats trigger this mechanism and what types of neurons are involved in this pathway to be able to target them with a variety of drugs," said Light. "Once you've established that signaling pathway, you can start looking at molecular targets for specific drugs. "The nice thing is, because it is in the gut, it is very amenable for some localized oral treatment."

Light adds that the discovery of this direct neural pathway opens up an avenue to discover the possible causes of Type 2 diabetes. "Is the whole mechanism dampened in an obese or Type 2 diabetic state?" said Light. "It could well be that if you have a diet high in fats going into the gut, it could just desensitize those neurons and they will not fire off any more."

DATE: May 02, 2008

New research suggests that resveratrol, a chemical commonly found in red wine, has the ability to lower blood sugar levels, but might also have certain yet-to-be-understood side effects. This research will be presented at the American Association of Clinical Endocrinologists (AACE) 17th Annual Meeting & Clinical Congress by Kimberly Martin, MD, and mentor, Dr. F. Ismail-Beigi, on Friday, May 16th, at the Walt Disney World Dolphin Resort in Orlando.

Resveratrol is a naturally occurring chemical found in grapes that has been reported to have cardioprotective, anti-inflammatory, anti-viral, and glucose-lowering properties. The effect of resveratrol on lowering blood glucose in diabetic rats has been reported by several investigators in the past.

Their results have shown that resveratrol improves glycemia by stimulating glucose transport in certain tissues including the skeletal muscle that expresses the insulin-sensitive Glut4 isoform of glucose transporters. However, the research by Drs. Martin and Ismail-Beigi shows that in cells expressing the Glut1 isoform, resveratrol blocks glucose transport by binding and inhibiting the Glut1 transporter. This may be of importance because certain cells and tissues, including brain, retina, placenta, and red blood cells express large amounts of this transporter. Hence, the presumed inhibition of the Glut1 transporter in these tissues in-vivo may have undesired and negative effects on their normal function.

"It's exciting to see resveratrol's glucose-lowering effect in diabetic experimental animals," Dr. Martin said. "However, studies are currently underway in our laboratory to determine whether the agent inhibits glucose transport in the brain of normal and diabetic animals."

DATE: April 25, 2008

'Watch your mouth,'' the saying goes, and science is turning up ever more reasons to heed that advice literally. According to the editors of Consumer Reports, preventing gum disease (periodontitis), the leading cause of adult tooth loss, is gaining new urgency as research shows that gum disease can contribute to illnesses such as diabetes, heart disease, stroke and pneumonia.

The culprit, scientists believe, is a spillover of bacteria and inflammatory agents from the mouth into the bloodstream, which bustles them off to the rest of the body. CR health experts explain that related problems include these:

Diabetes. Gum disease and diabetes behave with yin-yang synergy. Because diabetes can affect circulation, it can restrict blood flow to the gums. That along with suppressed immunity in patients with diabetes can create the perfect setup for periodontitis. Recent research has suggested that treating periodontal disease can improve blood-sugar control. CR reports that some major insurance companies already offer patients with diabetes extended coverage for periodontal treatments.

Heart disease. Consumer Reports says that having gum disease can increase the risk of heart disease, a study found. Other data show that adults with the highest levels of some oral bacteria have thicker carotid arteries, a predictor of heart attack and stroke; and people who suffer from angina and heart attacks have higher levels of certain oral bacteria. Plus, oral bacteria provoke inflammation, which might increase levels of white blood cells and C-reactive protein. That protein, found in the blood, has been linked to heart disease. A March 2007 New England Journal of Medicine study of 120 patients found that aggressive treatment of periodontal disease was linked to improved circulation. In a recent trial, periodontal therapy reduced patients' C-reactive protein levels.

Pneumonia. Poor oral hygiene has been shown to contribute to fatal pneumonias in hospital patients and nursing-home residents. In those settings, lax oral hygiene can foster a buildup of bacteria capable of causing respiratory infection.

A patient placed on a respirator, for instance, is susceptible to breathing those bacteria, causing pneumonia. Institutions can avoid such infections by practicing stringent oral hygiene, including swabbing patients' mouths with plaque-inhibiting rinses containing chlorhexidine (Peridex, PerioGard).

CR concludes that taking care of the mouth and teeth can help stave off periodontal disease and possibly other serious illnesses.

ABCs of oral care

Eat a diet high in calcium and vitamins C and D. Avoid sugary foods: When oral bacteria ferment sugar, they create tooth-eroding acids.

Brush teeth twice a day and floss daily to remove plaque and bacteria.

See a dentist twice yearly for checkups (including an oral-cancer exam). Those who smoke or have periodontal disease or diabetes might need cleaning and checkups every three to four months.

USEFUL INFO Recent research has suggested that treating periodontal disease can improve blood-sugar control, important for people with diabetes.

Visit the Consumer Reports Web site at www.consumerreports.org

DATE: April 18, 2008

A review of the evidence shows a strong role for vitamin D supplements given in childhood protecting against the development of type 1 diabetes in later life. The higher the dose, the greater the protection. Further research is needed to find out the formulation, dose and duration of supplementation that will afford most protection.

Type 1 diabetes is an autoimmune disease in which the body destroys the insulin-producing cells in the pancreas, leaving the patient dependent upon insulin injections to control blood glucose levels. The disease is not well understood, but often starts in childhood and is most common among those of European descent, affecting around 2 million people in Europe and North America. What is more, those in Northern latitudes are more likely to be affected; a child in Finland is 400 times more likely to have type 1 diabetes than a child in Venezuela. The disease is increasing at a rate of about three percent per year and it has been predicted that by 2010 there will be 40 percent more cases of type 1 diabetes than there were in 2000. There is, therefore, an urgent need for better understanding of what causes type 1 diabetes.

Previous research has suggested that vitamin D supplementation in childhood might protect against type 1 diabetes and other autoimmune diseases like multiple sclerosis and rheumatoid arthritis. Vitamin D is obtained either from within the body, by exposure to sunlight, or from the diet. In some northern areas, children are short of vitamin D because of a lack of sunlight. There is also little vitamin D in breast milk. Therefore, vitamin D supplements have been recommended for infants but the uptake and dosage of these is variable. Researchers in Manchester, UK, have carried out a review of research on vitamin D supplementation and later development of type 1 diabetes, to determine whether this might be a useful way of helping protect children from the disease.

The researchers looked for high quality clinical trials that compared the risk of type 1 diabetes among those taking vitamin D with those who did not take it. They found five such trials, covering 6455 individuals in several European countries.

Overall, children given vitamin D supplementation had a 30 percent reduced risk of developing type 1 diabetes compared to children who did not receive supplements. There was also a dose response effect. Those who had been diagnosed with rickets, which is a sure sign of vitamin D deficiency, went on to be the most likely to develop type 1 diabetes. And those who received the most regular and higher doses of vitamin D had the lowest risk of type 1 diabetes.

The mechanism by which vitamin D supplementation may protect against type 1 diabetes remains unclear. However, there are vitamin D receptors on both insulin-producing cells and immune cells, suggesting that the vitamin plays a role in their healthy function. The study does not prove a cause and effect relationship between vitamin D and protection against diabetes. A further long-term trial designed specifically to address this question is now needed. Further investigation is also needed into how much vitamin D is needed, and for how long, to gain maximum protection.

DATE: March 21, 2008

The trial is exploring whether the promising results from the laboratory of Denise Faustman, MD, PhD, can be applied in human diabetes. Faustman's previous studies have shown that mice with a form of diabetes that closely resembles type 1 diabetes in humans can be cured. In the animal studies, a commonly used vaccine that provides protection against tuberculosis, called Bacillus Calmette-Guerin (BCG) was used effectively to deplete the abnormal immune cells that attack and destroy the insulin producing cells of the pancreas. The first step in the human study, which is currently enrolling volunteers, is to determine whether the same strategy using BCG vaccination can be used to modify the abnormal autoimmune cells that are present in type 1 diabetes, sometimes called "juvenile-onset" diabetes.

"We are pleased to be starting human clinical trials," said Faustman. "Human trials take time, but we are making the step from curing diabetes in mice to determining whether it will work in men and women with diabetes."

Type 1 diabetes usually starts during childhood or adolescence and can cause a variety of severe complications including kidney failure, loss of vision, amputations, heart disease, and strokes. It occurs when a person's immune system attacks and destroys the insulin-producing cells in the pancreas. In the absence of insulin, which is necessary for sugar and other nutrients to enter cells, blood sugar levels rise. The risk for developing complications is closely linked to the elevated blood sugar levels over time. If blood sugar levels are well controlled, the long-term complications can largely be avoided. However, the so-called intensive therapy that is required to maintain near-normal sugar levels requires life-long demands on the patient, including frequent blood sugar monitoring and at least 3 daily injections of insulin or use of an insulin pump, along with restrictive diets. Insulin doses must be adjusted based on blood sugar levels, dietary factors, and anticipated exercise. Thus, a cure for diabetes has been highly sought after and has attracted much research interest.

The clinical trial is using the BCG vaccine for several reasons. BCG has been used safely for nearly 80 years as a tuberculosis vaccine. It is now being used in the human trial because it causes a low-grade inflammatory reaction, which in the mouse model of autoimmune diabetes lead to the destruction of the abnormal autoimmune cells.

David M. Nathan, MD, director of the MGH Diabetes Center, who is leading the human study at MGH, provides context, "This is the very first step in what is likely to be a long process in achieving a cure. We first need to determine whether the abnormal autoimmune cells that underlie type 1 diabetes can be knocked out with BCG vaccination, as occurred in the mouse studies."

www.mgh.harvard.edu

DATE: March 14, 2008

Giving young children vitamin D supplements may reduce their risk of developing type 1 diabetes later in life, research suggests.

Children who took supplements were around 30% less likely to develop the condition than those who did not. Type 1 diabetes results from the immune system destruction of pancreatic cells which produce the hormone insulin. The study, by St Mary's Hospital for Women and Children, in Manchester England, appears in Archives of Disease in Childhood.

Type 1 diabetes is most common among people of European descent, with around two million Europeans and North Americans affected. It is becoming increasingly common, and it is estimated that the number of new cases will rise by 40% between 2000 and 2010. The Manchester team pooled data from five studies examining the effect of vitamin D supplementation. Not only did the use of supplements appear to reduce the risk, the effect was dose dependent - the higher and more regular the dose, the lower the likelihood of developing the disease.

Previous research has found that people newly diagnosed with type 1 diabetes have lower concentrations of vitamin D than those without the condition. Studies have also found that type 1 diabetes is more common in countries where exposure to sunlight - which enables the body to manufacture vitamin D - is lower. For instance, a child in Finland was 400 times more likely to develop the disease than a child in Venezuela. Separate research has linked low levels of vitamin D and sunlight to other autoimmune disorders, including multiple sclerosis and rheumatoid arthritis. Further evidence of vitamin D's role comes from the fact that pancreatic beta cells and immune cells carry receptors or docking bays for the active forms of the vitamin.

It is thought that vitamin D helps to keep the immune system healthy, and may protect cells from damage caused by chemicals which control inflammation. Dr Victoria King, of the charity Diabetes UK, said: "Much more research, in particular controlled trials which compares the results when one group of people are given vitamin D supplements and one group is not, are needed before we can confirm a concrete association between vitamin D and type 1 diabetes."

Governnment experts in the UK recommend vitamin D supplementation for at least the first two years of a child's life, although the Chief Medical Officer for England has suggested supplements for the first five years is a good idea.

DATE: March 07, 2008

A new article published in a special supplement to the February issue of Diabetes Care by a leading expert in the emerging field of diabetes surgery points to the small bowel as the possible site of critical mechanisms for the development of diabetes.

The study's author, Dr. Francesco Rubino of NewYork-Presbyterian Hospital/Weill Cornell Medical Center, presents scientific evidence on the mechanisms of diabetes control after surgery. Clinical studies have shown that procedures that simply restrict the stomach's size (i.e., gastric banding) improve diabetes only by inducing massive weight loss. By studying diabetes in animals, Dr. Rubino was the first to provide scientific evidence that gastrointestinal bypass operations involving rerouting the gastrointestinal tract (i.e., gastric bypass) can cause diabetes remission independently of any weight loss, and even in subjects that are not obese.

"By answering the question of how diabetes surgery works, we may be answering the question of how diabetes itself works," says Dr. Rubino, who is a professor in the Department of Surgery at Weill Cornell Medical College and chief of gastrointestinal metabolic surgery at NewYork-Presbyterian/Weill Cornell.

Dr. Rubino's prior research has shown that the primary mechanisms by which gastrointestinal bypass procedures control diabetes specifically rely on the bypass of the upper small intestine -- the duodenum and jejunum. This is a key finding that may point to the origins of diabetes.

"When we bypass the duodenum and jejunum, we are bypassing what may be the source of the problem," says Dr. Rubino, who is heading up NewYork-Presbyterian/Weill Cornell's Diabetes Surgery Center.

In fact, it has become increasingly evident that the gastrointestinal tract plays an important role in energy regulation, and that many gut hormones are involved in the regulation of sugar metabolism. "It should not surprise anyone that surgically altering the bowel's anatomy affects the mechanisms that regulate blood sugar levels, eventually influencing diabetes," Dr. Rubino says.

While other gastrointestinal operations may cure diabetes as an effect of changes that improve blood sugar levels, Dr. Rubino's research findings in animals show that procedures based on a bypass of the upper intestine may work instead by reversing abnormalities of blood glucose regulation.

In fact, bypass of the upper small intestine does not improve the ability of the body to regulate blood sugar levels. "When performed in subjects who are not diabetic, the bypass of the upper intestine may even impair the mechanisms that regulate blood levels of glucose," says Dr. Rubino. In striking contrast, when nutrients' passage is diverted from the upper intestine of diabetic patients, diabetes resolves.

This, he explains, implies that the upper intestine of diabetic patients may be the site where an abnormal signal is produced, causing, or at least favoring, the development of the disease.

How exactly the upper intestine is dysfunctional remains to be seen. Dr. Rubino proposes an original explanation known in the scientific community as the "anti-incretin theory."

Incretins are gastrointestinal hormones, produced in response to the transit of nutrients, that boost insulin production. Because an excess of insulin can determine hypoglycemia (extremely low levels of blood sugar) -- a life-threatening condition -- Dr. Rubino speculates that the body has a counter-regulatory mechanism (or "anti-incretin" mechanism), activated by the same passage of nutrients through the upper intestine. The latter mechanism would act to decrease both the secretion and the action of insulin.

"In healthy patients, a correct balance between incretin and anti-incretin factors maintains normal excursions of sugar levels in the bloodstream," he explains. "In some individuals, the duodenum and jejunum may be producing too much of this anti-incretin, thereby reducing insulin secretion and blocking the action of insulin, ultimately resulting in Type 2 diabetes."

Indeed, in Type 2 diabetes, cells are resistant to the action of insulin ("insulin resistance"), while the pancreas is unable to produce enough insulin to overcome the resistance.

After gastrointestinal bypass procedures, the exclusion of the upper small intestine from the transit of nutrients may offset the abnormal production of anti-incretin, thereby resulting in remission of diabetes.

In order to better understand these mechanisms, and help make the potential benefits of diabetes surgery more widely available, Dr. Rubino calls for prioritizing research in diabetes surgery. "Further research on the exact molecular mechanisms of diabetes, surgical control of diabetes and the role played by the bowel in the disease may bring us closer to the cause of diabetes."

Today, most patients with diabetes are not offered a surgical option, and bariatric surgery is recommended only for those with severe obesity (a body mass index, or BMI, of greater than 35kg).

"It has become clear, however, that BMI cut-offs can no longer be used to determine who is an ideal candidate for surgical treatment of diabetes," says Dr. Rubino.

"There is, in fact, growing evidence that diabetes surgery can be effective even for patients who are only slightly obese or just overweight. Clinical trials in this field are therefore a priority as they allow us to compare diabetes surgery to other treatment options in the attempt to understand when the benefits of surgery outweigh its risks. Clinical guidelines for diabetes surgery will certainly be different from those for bariatric surgery, and should not be based only on BMI levels," he notes.

"The lesson we have learned with diabetes surgery is that diabetes is not always a chronic and relentless disease, where the only possible treatment goal is just the control of hyperglycemia and minimization of the risk of complications. Gastrointestinal surgery offers the possibility of complete disease remission. This is a major shift in the way we consider treatment goals for diabetes. It is unprecedented in the history of the disease," adds Dr. Rubino.

Type 2 diabetes, which accounts for 90 to 95 percent of all cases of diabetes, is a growing epidemic that afflicts more than 200 million people worldwide.

At a time when diabetes is growing epidemically worldwide, Dr. Rubino says that finding new treatment strategies is a race against time. "At this point, missing the opportunity that surgery offers is not an option."

In addition to having performed landmark studies in the field of diabetes surgery, Dr. Rubino was the principal organizer of an influential Diabetes Surgery Summit, held in Rome in March 2007. This international consensus conference helped establish the field, making international recommendations for the use of surgery and creating an International Diabetes Surgery Task Force. Dr. Rubino serves as a founding member.

For more information, patients may call (866) NYP-NEWS.

DATE: February 29, 2008

Stem Cell Research Making Progress Toward Diabetes Prevention and Cure

Researchers at a small San Diego biotech company have devised a procedure for turning human embryonic stems cells into insulin-producing cells inside mice. Numerous researchers have been trying to figure out how to convert embryonic stem cells into insulin-producing cells that could be used to treat diabetics. But progress has been slow because scientists don't know the recipe for stimulating immature stem cells to differentiate into the highly specialized pancreatic islet cells, the cells that are destroyed in Type 1 diabetes. The new work, by researchers at the privately held biotech firm Novocell, is important because it suggests one method for doing this that might work in humans: "It is proof that you can take embryonic stem cells for the first time and take them all the way through to become pancreas cells" that release insulin, says lead researcher Emmanuel Baetge, head scientist at Novocell. The company hopes to devise a human treatment based on the process in a few years

Harvard University stem-cell researcher Douglas Melton called the finding "one more step in a long and important process" toward devising human stem-cells treatments. But he cautions it is "not yet" a breakthrough. The Novocell researchers have been grinding away on figuring out how to transform stem cells into insulin-producing cells for six years. In previous papers, they found they could take proprietary embryonic stem cells in the test tube and convert them into pancreas precursor cells by adding and subtracting a variety of growth-promoting proteins. But they were not able to quite make the final step and transform the cells into healthy insulin-producing cells, at least in the test tube. So instead, they transplanted their immature human pancreas cells into mice. "We said, 'Something is wrong; we don't have the right environment. Lets transplant the cells and see what happens,'" says Baetge. Lo and behold, after a month, the cells started to become functional and produce insulin. Some unknown signals inside the mice had stimulated them to convert into mature insulin-makers. To prove that the new cells were functional, the researchers then destroyed the mouse's own insulin-producing cells using a toxin that didn't kill the transplanted cells. The mice didn't get diabetes, confirming that the new cells worked, according to the report in Nature Biotechnology.

Novocell hopes a similar procedure might also work for treating human diabetes. But much work remains before any clinical trial could begin. The first step will be to purify the mix of precursor cells injected into the mice to pinpoint the exact cell type responsible for becoming insulin cells. Safety is another huge concern; researchers will need to provide evidence that the new cells won't turn into something else beside insulin cells once implanted inside people--such as a tumor. The company also needs to devise a method for efficiently making large quantities of the precursor cells. Nonetheless, "I do think that a procedure like this could work in people," says Harvard University stem-cell expert Kevin Eggan. "I don't think that there is any reason to doubt the validity" of the finding. In theory, the new research could dovetail nicely with the surprising findings late last year by Japanese and American scientists that ordinary skin cells can be re-programmed to turn into embryonic stem cells. These findings raise the possibility of future stem-cell treatments that do not involve the destruction of embryos. But whatever the source of stem cells for future therapies, scientists will still need recipes for making them into particular cell types used for treatment--such as the protocol Novocell has developed. "It is certainly a huge breakthrough, but there is a long way to go [before using the re-programmed] cells as a substitute for embryonic stem cells," says Baetge. Some researchers worry that the Novocell finding, while solid, is a bit of a black box. "This doesn't really teach us very much. Something happens [inside the mice], but we don't know anything about what. At the end of the day we didn't learn very much," says Vanderbilt University stem-cell researcher Mark A. Magnuson. He called converting a stem cell into pancreatic beta cells a "phenomenally complex" process. While stem cells hold huge promise, "we are not anywhere near close to new therapies for years," he says.

DATE: February 22, 2008

The standard test for measuring blood sugar control in people with diabetes is not accurate in those on kidney hemodialysis, according to new research at Wake Forest University Baptist Medical Center.

Wake Forest investigators reported in Kidney International that the hemoglobin A1c test (HbA1c) underestimates true glucose control in hemodialysis patients and could give false comfort to patients and physicians. Hemodialysis, in which blood is passed through an artificial kidney machine for cleansing, is used in cases of kidney failure. "These results suggest that the nearly 200,000 diabetic hemodialysis patients in the United States who use this test may not be receiving optimal care for their blood sugar," said Barry I. Freedman, M.D., senior author and a professor of internal medicine and nephrology. Diabetic dialysis patients who believe their blood sugars are in the ideal range may still have unacceptably high blood sugars. "This was a surprise to the nephrology community," said Freedman. "The test we've all come to accept as 'the gold standard' has proven to be inaccurate in this patient population."

HbA1c measures the percentage of hemoglobin (a protein in red blood cells) that has reacted with glucose. This measure, also known as glycosylated hemoglobin, reflects blood sugar control over the previous 30-120 days. This study evaluated 307 patients with diabetes - 258 with end-stage kidney disease on hemodialysis and 49 who did not have kidney failure. The researchers compared the standard HbA1c test with a newer test (glycated albumin, or GA) that measures the amount of blood sugar that has reacted with albumin, a protein in the plasma. The GA test reflects blood sugar control over the previous three to four weeks. Blood samples were also analyzed to determine recent blood sugar levels. Compared to those without kidney failure, diabetic patients on hemodialysis had higher blood sugars and GA levels, despite paradoxically lower HbA1c results. The relationship between GA and HbA1c differed between diabetic dialysis patients and those without kidney disease, demonstrating that the HbA1c did not accurately reflect blood sugar control in those on hemodialysis.

Researchers believe the major reason for the discrepancy is that HbA1c depends on red blood cell survival and these cells don't live as long in hemodialysis patients. Most dialysis patients have anemia requiring treatment with medications that stimulate red blood cell production (erythropoietin). The current study confirmed a report in Japanese patients and is the first to demonstrate the inaccuracy of the HbA1c in black and white dialysis patients. The Wake Forest researchers will soon determine whether these concerns also apply to patients on peritoneal dialysis and to people with kidney disease not yet on dialysis. Controlling blood sugar is important because high levels are risk factors for developing hardening of the arteries (atherosclerosis) and lead to higher rates of kidney disease, heart attack, stroke, nerve damage and blindness. People with diabetes who undergo hemodialysis are at especially high risk. About one out of four diabetic dialysis patients (23 percent) in the U.S. will die from cardiovascular and infection complications during their first year on dialysis, and only 31 percent survive five years.

"Control of blood sugar improves outcomes of diabetic patients, so accurate assessment is critical," said Freedman. "This study supports the GA test as a more accurate measure of long-term blood sugar control among diabetic patients who are on hemodialysis." The GA test is not currently available in the United States. Freedman said that until it is available, doctors and patients should be aware that the HbA1c underestimates glucose control and is affected by both erythropoietin administration and the hemoglobin concentration. The research is sponsored by Asahi Kasei Pharma Corporation (Tokyo), manufacturer of the GA test. Co-investigators were Todd Peacock, B.S., Zak K. Shihabi, Ph.D., Anthony J. Bleyer, M.D., Emily L. Dolbare, M.D., Joyce R. Byers, R.N., Mary Ann Knovich, M.D., Jorge Calles-Escandon, M.D., and Gregory R. Russell, M.S., all with Wake Forest.

Wake Forest University Baptist Medical Center is an academic health system comprised of North Carolina Baptist Hospital and Wake Forest University Health Sciences, which operates the university's School of Medicine. U.S. News & World Report ranks Wake Forest University School of Medicine 18th in primary care and 44th in research among the nation's medical schools. It ranks 35th in research funding by the National Institutes of Health. Almost 150 members of the medical school faculty are listed in Best Doctors in America.

DATE: February 15, 2008

Otherwise-healthy adults who eat two or more servings of meat a day - the equivalent of two burger patties - increase their risk of developing metabolic syndrome by 25 percent compared with those who eat meat twice a week, according to research published in /Circulation: Journal of the American Heart Association./

Metabolic syndrome is a cluster of cardiovascular disease and diabetes risk factors including elevated waist circumference, high blood pressure, elevated triglycerides, low levels of high-density lipoprotein (HDL or "good") cholesterol and high fasting glucose levels. The presence of three or more of the factors increases a person's risk of developing diabetes and cardiovascular disease. But it's not just meat that adds inches to the waist, increases blood pressure and lowers HDL - "it's fried foods as well," said Lyn M. Steffen, Ph.D., M.P.H., R.D., co-author of the study and an associate professor of epidemiology at the University of Minnesota. Dairy products, by contrast, appeared to offer some protection against metabolic syndrome. Steffen said that, "Fried foods are typically synonymous with commonly eaten fast foods, so I think it is safe to say that these findings support a link between fast-food consumption and an increase in metabolic risk factors."

The findings emerged from an analysis of dietary intake by 9,514 participants in the Atherosclerosis Risk In Communities (ARIC) study. ARIC is a collaborative study funded by the National Heart, Lung, and Blood Institute. Unlike other researchers who have investigated relationships between nutrients and cardiovascular risk, "we specifically studied food intake. When making recommendations about dietary intake it is easier to do so using the framework of real foods eaten by real people," Steffen said. Researchers assessed food intake using a 66-item food frequency questionnaire. From those responses, they categorized people by their dietary preferences into a Western-pattern diet or a prudent-pattern diet. In general, the Western-pattern diet was heavy on refined grains, processed meat, fried foods, red meat, eggs and soda, and light on fish, fruit, vegetables and whole grain products. Prudent diet eating patterns, by contrast, favored cruciferous vegetables (e.g., cabbage, radish and broccoli), carotenoid vegetables (e.g., carrots, pumpkins, red pepper, cabbage, broccoli and spinach), fruit, fish and seafood, poultry and whole grains, along with low-fat dairy.

Researchers also assessed associations with individual food items: fried foods, sweetened beverages (regular soda and fruit drinks), diet soda, nuts and coffee.

After nine years of follow-up, 3,782 (nearly 40 percent) of the participants had three or more of the risk factors for metabolic syndrome. At baseline, participants were 45 to 64 years old - ages at which many people gain weight. Steffen said that weight gain over the years of follow-up might explain some of the cases of metabolic syndrome. But "after adjusting for demographic factors, smoking, physical activity and energy intake, consumption of a 'Western' dietary pattern was adversely associated with metabolic syndrome," she said. "One surprising finding was while it didn't increase the risk of metabolic syndrome, there was no evidence of a beneficial effect of consuming a prudent diet either. I had expected to find a beneficial effect because we have seen that in other studies." When Steffen and colleagues analyzed the results by specific foods, they found that meat, fried foods and diet soda were all significantly associated with increased risk of metabolic syndrome, but consumption of dairy products was beneficial. The study did not address the mechanisms involved in the increased risk of metabolic syndrome seen with certain foods, but Steffen speculated that "it may be a fatty acid mechanism since saturated fats are a common link and certainly overweight and obesity are contributing to the development of metabolic syndrome." She also said more research on the relationship between diet soda and its association to metabolic syndrome is needed.

The fact that 60.5 percent of the ARIC population had metabolic syndrome at the start of the study or developed it during nine years of follow-up is troubling, researchers said. Steffen said the study's results are clear: Too much meat, fried foods and diet soda, do not add up to a healthy life.

American Heart Association dietary guidelines for healthy Americans age 2 and older include:

• Limit saturated fat, trans fat, cholesterol and sodium in the diet.
• Minimize the intake of food and beverages with added sugars.
• Eat a diet rich in vegetables, fruits and whole-grain foods.
• Select fat-free and low-fat dairy.
• Eat fish at least twice per week.
• Emphasize physical activity and weight control.
• Avoid use of and exposure to tobacco products.
• Achieve and maintain healthy cholesterol, blood pressure and blood glucose levels.

DATE: February 08, 2008

A new Mayo Clinic study found that 40 percent of pancreatic cancer patients are diagnosed with diabetes prior to their pancreatic cancer diagnosis. The onset of diabetes appears to be many months (in some cases up to two years) prior to cancer diagnosis. This information provides researchers an important clue for earlier detection of pancreatic cancer. The study was published in last month's issue of Gastroenterology.

"Our previous studies have shown an association between recent diagnoses of diabetes and pancreatic cancer," says Suresh Chari, M.D., a Mayo Clinic gastroenterologist and the study's lead author. "We are now quite convinced that in most patients with pancreatic cancer the diabetes is caused by the cancer and not the other way around. Our next step is to identify a biomarker for pancreatic cancer-induced diabetes in order to screen patients with new-onset diabetes for early pancreatic cancer and provide surgical treatment as quickly as possible." More than 33,000 people die each year from pancreatic cancer, the fourth-leading cause of cancer death in the United States. Patients with this cancer seldom exhibit disease-specific symptoms until the cancer is at an advanced stage and surgery is no longer an option. Therefore, fewer than 5 percent of pancreatic cancer patients survive five years after diagnosis. This study reviewed the medical records of 736 patients with pancreatic cancer and 1,875 healthy individuals with fasting blood glucose data in their medical record. Dr. Chari's team found that 40 percent of pancreatic cancer patients were diagnosed with diabetes, while only 20 percent of the healthy individuals had fasting blood glucose levels in the diabetic range.

Type 2 diabetes is far more common than pancreatic cancer-induced diabetes. According to a previous study authored by Dr. Chari, only one in 125 patients over age 50 with new-onset diabetes will be diagnosed with pancreatic cancer. Dr. Chari's team continues work in identifying the differences between pancreatic cancer-induced diabetes and regular type 2 diabetes. The goal of the research is to cost-effectively screen for pancreatic cancer using a blood test that can identify individuals who have new-onset diabetes and are more likely to have pancreatic cancer. This will allow for earlier detection and increased opportunity for successful surgical treatment. Other members of the Mayo Clinic research team included Cynthia Leibson, Ph.D., Kari Rabe, Lawrence Timmons, Jeanine Ransom, Mariza de Andrade, Ph.D., and Gloria Petersen, Ph.D. As part of this ongoing research, a clinical trial studying the role of high resolution secretin-enhanced CT scan to diagnose early pancreatic cancer in patients at high risk for pancreatic cancer is currently in progress at Mayo Clinic in Rochester, Minn. Eligible participants must be 50 years or older, must have received a diagnosis of diabetes within the past two years, and must have at least one of the following: no family history of diabetes, abdominal discomfort or pain, weight loss, or elevated serum CA 19-9. The Mayo Clinic website: www.mayoclinic.com

DATE: February 01, 2008

Many have touted whole grain foods as a way to prevent type 2 diabetes, and a new review finds a reduction in risk for people who consume a diet high in unrefined grains. However, the authors caution that more research is necessary before scientists can confirm a causal relationship. "At the moment, because there is only weak evidence, no definite conclusion can be drawn concerning the protective effect of whole grain foods for the development of type 2 diabetes," said lead review author Marion Priebe. Refined cereal food products remove the nutrient- and fiber-rich bran and germ of the grain, leaving only the starchy inner parts. A decrease in consumption of whole grain cereals over the last decade, occurring at the same time as an increase in type 2 diabetes, has lead to the theory that there is a connection between the two.

Priebe, a nutritionist and epidemiologist at the Center for Medical Biomics, University Medical Center Groningen in the Netherlands, and colleagues reviewed 12 studies that examined relationships between whole grain intake and type 2 diabetes. These studies consisted of a single randomized controlled clinical trial and 11 prospective studies. The review appears in the latest issue of The /Cochrane Library/, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic. In the prospective studies, researchers followed groups of people without diabetes over long periods to see whether those who consumed more whole grain foods were less likely to get the disease than other participants were. These studies consistently showed a reduction of risk for the disease in those with a high intake of whole grain foods or cereal fiber.

Two of the studies that looked at the effect of whole grain consumption on weight, an important diabetes risk factor, found only a slight improvement.Scientists consider evidence from prospective studies to be weaker than that from randomized controlled trials. Other factors, like an overall healthy lifestyle, can also influence the development of type 2 diabetes and it is not possible to completely correct for known and possibly unknown factors in this study design. In randomized controlled trials, which are more difficult to perform, researchers can exclude or control for other influences on the development of the disease.Priebe said she was surprised that only one randomized trial on this topic exists: "As type 2 diabetes mellitus is reaching epidemic proportions and diet is considered as a modifiable risk factor, it is important to have a sound knowledge of which kinds of food can contribute to the prevention of this disease and to identify gaps in this knowledge."

Osama Hamdy, M.D., medical director of the Clinical Obesity Program at the Joslin Diabetes Center in Boston, said the kinds of data used within the review are troubling. He said that studies about diabetes prevention should be randomized controlled trials over long durations. Although the concept of a whole grains-rich diet as a possible diabetes preventative is interesting, he said, none of the review studies would enable any kind of cause-and-effect conclusion. "This is an additional piece of information that tells us diets rich in whole grains will probably do some good in the prevention of type 2 diabetes," Hamdy said. "It is not a shortcut to tell you exactly what you need. It is just more support of a concept that has been around for a long time." "Whole grain foods are rich in dietary fiber and nutrients and they are recommended to be consumed together with plenty of fruit and vegetables for a healthy diet," Priebe said. The findings of this review are in line with those recommendations." The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit www.cochrane.org for more information.

DATE: January 25, 2008

Preliminary research indicates that obese patients with type 2 diabetes who had gastric banding surgery lost more weight and had a higher likelihood of diabetes remission compared to patients who used conventional methods for weight loss and diabetes control, according to a study in the a January 23 issue of The Journal of the American Medical Association.

"Obesity and type 2 diabetes are likely to be the 2 greatest public health problems of the coming decades. The conditions are strongly linked, with the increased prevalence of diabetes correlating with the increased prevalence of obesity," the authors write. Weight control is perhaps the most important aspect of type 2 diabetes management. Recent evidence indicates that improvement in blood glucose control is related to the degree of weight loss. Currently available lifestyle and pharmacological strategies provide only small to modest levels of weight loss, a problem compounded by patients with diabetes experiencing greater difficulty in losing weight than those without diabetes. Significant sustained weight loss as a result of bariatric surgery has never been formally studied as a treatment for type 2 diabetes in obese participants, according to background information in the article.

John B. Dixon, M.B.B.S., Ph.D., of Monash University, Melbourne, Australia, and colleagues conducted a 2-year trial involving 60 obese participants (body mass index [BMI] greater than 30, less than 40) to compare surgically induced weight loss with conventional therapy for the management of type 2 diabetes. Patients were randomized to receive either conventional diabetes therapy with a focus on weight loss by lifestyle change or laparoscopic adjustable gastric banding with conventional diabetes care. Of the 60 patients enrolled, 55 (92 percent) completed the 2-year follow-up. The researchers found that remission of type 2 diabetes was achieved by 26 study participants (43 percent) at two years, with 22/30 (73 percent) from the surgical program and 4/30 (13 percent) from the conventional-therapy program. This represented 76 percent and 15 percent remission rates for those in the surgery and conventional-therapy groups, respectively. Greater percentage of weight loss at two years and lower baseline HbA1c values (hemoglobin used primarily to identify the average plasma glucose concentration) were independently associated with remission, but percentage of weight loss alone explained most of the variance.

"After 2 years, the surgical group displayed a 5 times higher remission rate and 4 times greater reduction in HbA1C values than the conventional-therapy group," the authors write. The surgical group achieved an average 20.7 percent body weight loss at two years, compared with 1.7 percent among the conventional-therapy group, representing a loss of 62.5 percent of excess weight (using BMI of 25 as ideal weight) in the surgical group compared with 4.3 percent in the conventional-therapy group. There were no serious complications in either group. "An important finding of this study is that degree of weight loss, not the method, appears to be the major driver of glycemic improvement and diabetes remission in obese participants. This has important implications, as it suggests that intensive weight-loss therapy may be a more effective first step in the management of diabetes than simple lifestyle change. This study shows that few participants achieved remission with a body weight loss of less than 10 percent, a level expected to produce important health benefits," the researchers add. "While caution is required in interpreting the longer-term benefits of surgery and weight loss, this study presents strong evidence to support the early consideration of surgically induced loss of weight in the treatment of obese patients with type 2 diabetes," they conclude.

DATE: January 18, 2008

An antibody used in the treatment of certain cancers an rheumatoid arthrities may be a promising treatment for diabetes say researchers at the Yale School of Medicine.

The boffins conducted a test on mice using the antibody, rituximab (anti-CD20), which depletes B cells that have been found to play a role in autoimmune diseases by interacting with T cells of the immune system.

T cells destroy insulin-producing cells directly in the pancreas, leading to type 1 diabetes.

Li Wen, senior research scientist in the division of endocrinology, said that the study showed that once B cells were depleted, regulatory cells can emerge.

"Our paper shows, for the first time, that after successful B cell depletion, regulatory cells emerge that can continue to suppress the inflammatory and autoimmune response even after the B cells return," Wen said.

"Even more strikingly, we found that these regulatory cells include both B and T cells."

To find if B cell depletion might prove to be a therapy for type 1 diabetes, Wen and her colleague at Yale, Mark Shlomchik, M.D., professor of laboratory medicine and immunobiology, engineered mice predisposed to diabetes and had the human version of CD20, the molecule rituximab targets, on the surface of their B cells.

They then treated the rodents with a mouse version of rituximab to deplete B cells in them either before diabetes onset, or within days of diagnosis with diabetes.

During the course of the study the researchers noted that treatment with the drug significantly delayed diabetes onset in pre-diabetic mice by 10- to 15-weeks.

The equivalent period for humans would be approximately 10 to 15 years.

Of the 14 mice that already had diabetes, five stopped needing insulin for two to five months.

"These studies suggest that B cells can have dual roles in diabetes and possibly other autoimmune diseases. The B cells might promote disease initially, but after being reconstituted following initial depletion with rituximab, they actually block further disease. This means that multiple rounds of medication to deplete the B cells might not be necessary or even advisable," Shlomchik added.

The study is published in the Journal of Clinical Investigation.

DATE: January 11, 2008

Deaths from cardiovascular disease are declining among men with diabetes, but not women, and poorer control of blood pressure and cholesterol levels may be to blame, a new study suggests.

Among diabetic patients with existing cardiovascular disease, Dr. Assiamira Ferrara of Kaiser Permanente in Oakland, California and colleagues found, women were 5.4 percent less likely than men to have systolic blood pressures at recommended levels, and 5.9 percent less likely to have their "bad" LDL-cholesterol under control.

"Women with diabetes should be more concerned about their risk of developing cardiovascular disease," Ferrara told Reuters Health in an interview, adding that diabetic women should make sure that their doctor is doing the appropriate screening for blood pressure and cholesterol and keeping these two parameters under control.

Over the past 25 years, Ferrara and her colleagues note, deaths from cardiovascular disease among men with and without diabetes have fallen. While women overall are also experiencing a decline in deaths from heart disease, women with diabetes are not, they explain in the medical journal Diabetes Care.

To determine if gender differences in control of heart disease risk factors might help explain this disparity, the researchers looked at 8,821 men and women with diabetes belonging to 10 different managed care plans in the U.S. About one-third had a history of cardiovascular disease.

Among people with no heart or blood vessel disease, there was no difference in the percentage of men and women who had their blood sugar, blood pressure or LDL cholesterol under control.

But for those who did have cardiovascular disease, 41.2 percent of men had systolic blood pressure (the top number in a blood pressure reading) of 140 mm/Hg or greater, compared to 46.6 percent of women. And 22.4 percent of men had LDL-cholesterol levels above the recommended 3.35 mmol/l, compared to 28.3 percent of women. Women whose LDL levels were too high were 9 percent less likely than their male counterparts to be receiving intensive medication to lower their LDL.

Given that better LDL-cholesterol and blood pressure control is known to reduce heart disease-related mortality among people with diabetes, the researchers say, "more intense treatment in women with diabetes offers the opportunity to reduce the observed gap between men and women with diabetes in the reduction of CVD mortality."

By Anne Harding
SOURCE: Diabetes Care, January 2008.

DATE: January 04, 2008

Scientists from the University of Chicago suggest that not getting quality sleep may increase a person's risk of developing diabetes. The researchers say a disturbed night's sleep may lead to high blood sugar levels, weight gain and, eventually, even type 2 diabetes because the body becomes unable to recognise normal insulin signals. It is already known that the deepest form of sleep, known as slow-wave sleep, affects a person's metabolism and previous studies have also shown an association with diabetes and a lack of sleep. The research team led by Dr. Esra Tasali, who wanted to test the impact of sleep quality on blood glucose control, conducted a study involving nine healthy and slim men and women. The volunteers were first monitored for two consecutive nights in order to establish what their normal sleep patterns were, then on the following three nights, the research team woke them with a loud noise when they drifted into deep sleep.

The team discovered after injecting the volunteers with glucose and measuring their daytime blood sugar levels and insulin response, that eight of them had developed insulin resistance even though the overall amount of sleep they had remained unchanged. Dr. Tasali says strategies should be considered to improve sleep duration and quality as a potential intervention to prevent or delay the development of type 2 diabetes. Tasali says the alarming rise in the prevalence of type 2 diabetes associated with an ageing population and increased obesity, indicates the importance of understanding the factors that promote its development. Dr. Tasali says restricting sleep duration in healthy young adults results in decreased glucose tolerance and the current data indicates that not only reduced sleep duration but also reduced sleep quality may play a role in diabetes risk. Dr. Tasali also says as chronic shallow sleep and diabetes are typical factors associated with ageing, more research is needed to find out if age-related changes in sleep quality contribute to such metabolic changes. The study appears in the Proceedings of the National Academy of Sciences.