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DATE: December 31, 2009

Scientists can start using taxpayer dollars to do research with 13 batches of embryonic stem cells and the government says dozens more cell lines should be available soon, opening a new era for the potentially life-saving field. President Barack Obama lifted eight years of restrictions on these master cells last spring. But $21 million-and-counting in new projects were on hold until the National Institutes of Health determined which of hundreds of existing stem cell lines were ethically appropriate to use.

“This is the first down payment,” Dr. Francis Collins, NIH’s director, said Wednesday as he opened a master registry. “People are champing at the bit for the opportunity to get started.” Thirteen stem cell lines — created by Children’s Hospital Boston and Rockefeller University — are first on that list. Another 96 embryonic stem cell lines are undergoing NIH review, and 20 or more could get a decision by Friday, Collins said. And researchers have notified the NIH that they may apply for approval of another 250 stem cell lines. “The field has been waiting with bated breath for this announcement,” said Dr. George Daley of Children’s Hospital Boston, whose lab created 11 of the newly approved lines. He has about 100 vials of cells from each batch already banked and ready to ship to researchers around the country. The numbers mark a big change from the Bush administration, which had limited taxpayer-funded research to about 21 stem cell lines, those already in existence as of August 2001. Scientists say newer batches were created in ways that made them far better candidates for successful research. Indeed, only one of the Bush-era stem cell lines is among the 96 now under consideration.

Wednesday’s announcement means that researchers who were awarded $21 million in stem cell research grants earlier this year can start using the approved lines immediately, projects that include work to one day repair damaged heart tissue and grow new brain cells. Millions more in stem cell money is due out later this winter, funds from the economic stimulus package. Embryonic stem cells can morph into any cell of the body, and scientists hope to harness them so they can create replacement tissue to treat, possibly even cure, a variety of diseases, from diabetes to Parkinson’s to spinal cord injury. Culling those cells destroys a days-old embryo, something many strongly oppose on moral grounds. But once created, the cells can propagate indefinitely in lab dishes. Federal law forbids using taxpayer money to create or destroy an embryo. All the stem cell lines involved in Wednesday’s announcement were created from fertility clinic leftovers — embryos that otherwise would have been thrown away — using private money. NIH is reviewing the rest to see if they also meet ethics requirements for use in taxpayer-funded health research. Among the requirements: That the woman or couple who donated the original embryo did so voluntarily and were told of other options, such as donating to another infertile woman. Why do scientists need so many choices? It’s not just to supply the demand of a growing field. There’s a lot of variability from batch to batch in how the stem cells perform, Daley said. Some are better at turning into blood-producing cells than muscle-producing ones, for instance. It has to do with the genetics of the original embryo, and probably also with the recipe used to create and nurture the stem cells — an environment that can trigger genes to switch on and off at different times, explained Daley, who has government funding to study those important differences.

DATE: December 23, 2009

Two new University of Illinois studies report that lunasin, a soy peptide often discarded in the waste streams of soy-processing plants, may have important health benefits that include fighting leukemia and blocking the inflammation that accompanies such chronic health conditions as diabetes, heart disease, and stroke. "We confirmed lunasin's bioavailability in the human body by doing a third study in which men consumed 50 grams of soy protein--one soy milk shake and a serving of soy chili daily--for five days. Significant levels of the peptide in the participants' blood give us confidence that lunasin-rich soy foods can be important in providing these health benefits," said Elvira de Mejia, a U of I professor of food science and human nutrition.

In the cancer study, de Mejia's group identified a key sequence of amino acids--arginine, glycine, and aspartic acid, (the RGD motif)--that triggered the death of leukemia cells by activating a protein called caspase-3. "Other scientists have noted the cancer-preventive effects of the RGD sequence of amino acids so it's important to find proteins that have this sequence," she said. The scientists also verified lunasin's ability to inhibit topoisomerase 2, an enzyme that marks the development of cancer, and they were able to quantify the number of leukemia cells that were killed after treatment with lunasin in laboratory experiments. In another study, the first to report lunasin's potential anti-inflammatory activity, they showed that lunasin blocked or reduced the activation of an important marker called NF-kappa-B, a link in the chain of biochemical events that cause inflammation. They also found statistically significant reductions in interleukin-1 and interleukin-6, both important players in the inflammatory process. The reduction in interleukin-6 was particularly strong, she said. Although inflammation is linked in the public mind with chronic health problems such as heart disease,diabetes, and rheumatoid arthritis, de Mejia said it also plays a role in the development of cancer. "We know that chronic inflammation is associated with an increased risk of malignancies, that it's a critical factor in tumor progression," she said. "And we can see that daily consumption of lunasin-rich soy protein may help to reduce chronic inflammation. Future studies should help us to make dietary recommendations," she added. Although the high cost of obtaining lunasin from soy waste limits its use for nutritional interventions, soy flour does contain high concentrations of the peptide, she said. And de Mejia utilized the USDA soybean germplasm collection housed at the U of I, studying 144 soy genotypes to learn which varieties contain the most lunasin. "Some genotypes contain very high concentrations of lunasin, others contain no lunasin, and some locations yield more lunasin-rich beans than others," she said.

DATE: December 18, 2009

If nothing is done, the number of Americans with diabetes will nearly double in the next 25 years and spending on the disease will nearly triple, a new study shows. An aging population combined with a dramatic rise in obesity has created a perfect storm for diabetes in the U.S., researchers say. "A perfect storm is a good way to look at it," study researcher Elbert S. Huang, MD of the University of Chicago tells WebMD. "If things stay the way they are right now we will have massive increases in diabetes incidence in this country over the next two decades." By 2034, as many as 44 million Americans will have diabetes, up from 23 million today, according to the new projections, published in the November issue of the American Diabetes Association journal Diabetes Care. The cost of caring for diabetes patients is projected to rise from $113 billion to $336 annually, and that is before adjusting for inflation. These costs will outpace the increase in cases because more diabetes patients will be older and sicker and will require more expensive medical care, experts say.

Age is one of the biggest risk factors for type 2 diabetes, and the transition of baby boomers from middle to old age will drive much of the increase, the study shows. As a result, by 2034, half of all direct spending in diabetes care is projected to occur in the Medicare population. About 8 million Americans covered by Medicare now have diabetes and it cost $45 billion to treat them in 2009. The number of diabetes patients whose treatment is paid for by Medicare is projected to nearly double to 14.6 million in the next 25 years, and the cost of caring for them is expected to quadruple. By 2034, annual Medicare spending on diabetes care is projected to rise to $171 billion. Although little can be done about the aging of the population, much can be done about the other major risk factor for type 2 diabetes -- obesity. About 65% of Americans are overweight, and about one-third are obese, the CDC says. The obesity rate among adults in the U.S. doubled between 1980 and 2004, but it appears to have leveled off since then. The new diabetes model developed by the Huang and colleagues predicts a slight decline in obesity rates in the U.S. over the next two decades.

All agree that a bigger decline in obesity, achieved though successful public health initiatives, could make a huge difference. The future projected in the newly published study does not have to become reality, experts say. "The cost of doing nothing is clearly going to be quite high," study co-researcher Michael O'Grady, PhD, said in a news conference. "To do nothing right now is going to cost billions and billions of dollars." American Diabetes Association chief scientific and medical officer David M. Kendall, MD says it is now clear that even modest lifestyle changes, such as losing a few pounds or taking a walk most days a week, can drastically reduce a person's risk for developing diabetes. The Diabetes Prevention Program was one of the largest studies ever to examine the impact of diet,exercise, and drug treatments on diabetes rates in patients at high risk for developing the disease. The study found that these people cut their diabetes risk dramatically by losing just 7% of their body weight and engaging in moderate exercise for at least 30 minutes, a minimum of five times a week. Early treatment with the diabetes drug metformin also helped delay or prevent diabetes, but to a lesser extent. "Even modest weight loss and as little as 30 minutes of exercise five or more days a week and inexpensive treatments can keep people healthy," he tells WebMD. "That is really the big message."

DATE: December 11, 2009

Scientists can start using taxpayer dollars to do research with 13 batches of embryonic stem cells and the government says dozens more cell lines should be available soon, opening a new era for the potentially life-saving field. President Barack Obama lifted eight years of restrictions on these master cells last spring. But $21 million-and-counting in new projects were on hold until the National Institutes of Health determined which of hundreds of existing stem cell lines were ethically appropriate to use. "This is the first down payment," Dr. Francis Collins, NIH's director, said Wednesday as he opened a master registry. "People are champing at the bit for the opportunity to get started."

Thirteen stem cell lines — created by Children's Hospital Boston and Rockefeller University — are first on that list. Another 96 embryonic stem cell lines are undergoing NIH review, and 20 or more could get a decision by Friday, Collins said. And researchers have notified the NIH that they may apply for approval of another 250 stem cell lines. "The field has been waiting with bated breath for this announcement ," said Dr. George Daley of Children's Hospital Boston, whose lab created 11 of the newly approved lines. He has about 100 vials of cells from each batch already banked and ready to ship to researchers around the country. The numbers mark a big change from the Bush administration, which had limited taxpayer-funded research to about 21 stem cell lines, those already in existence as of August 2001. Scientists say newer batches were created in ways that made them far better candidates for successful research. Indeed, only one of the Bush-era stem cell lines is among the 96 now under consideration. Last weeks announcement means that researchers who were awarded $21 million in stem cell research grants earlier this year can start using the approved lines immediately, projects that include work to one day repair damaged heart tissue and grow new brain cells. Millions more in stem cell money is due out later this winter, funds from the economic stimulus package.

Embryonic stem cells can morph into any cell of the body, and scientists hope to harness them so they can create replacement tissue to treat, possibly even cure, a variety of diseases, from diabetes to Parkinson's to spinal cord injury. Culling those cells destroys a days-old embryo, something many strongly oppose on moral grounds. But once created, the cells can propagate indefinitely in lab dishes. Federal law forbids using taxpayer money to create or destroy an embryo. All the stem cell lines involved in Wednesday's announcement were created from fertility clinic leftovers — embryos that otherwise would have been thrown away — using private money. NIH is reviewing the rest to see if they also meet ethics requirements for use in taxpayer-funded health research. Among the requirements: That the woman or couple who donated the original embryo did so voluntarily and were told of other options, such as donating to another infertile woman. Why do scientists need so many choices? It's not just to supply the demand of a growing field. There's a lot of variability from batch to batch in how the stem cells perform, Daley said. Some are better at turning into blood-producing cells than muscle-producing ones, for instance. It has to do with the genetics of the original embryo, and probably also with the recipe used to create and nurture the stem cells — an environment that can trigger genes to switch on and off at different times, explained Daley, who has government funding to study those important differences.

DATE: December 04, 2009

According to the National Institute of Health, 40 percent to 45 percent of Americans diagnosed with diabetes already have some stage of diabetic retinopathy. Diabetic retinopathy, damage to the retina caused by leaky blood vessels, is a major cause of blindness in people with diabetes and is one of the most feared diabetic complications. In fact, up to 80 percent of all patients who've had diabetes for 10 years or more will experience some form of diabetic retinopathy. A recent study published in the Journal of Ocular Pharmacology and Therapeutics reveals Pycnogenol® (pic-noj-en-all), an antioxidant plant extract from the bark of the French maritime pine tree, can improve microcirculation, retinal edema and visual acuity in the early stages of diabetic retinopathy.

"Previous research has shown that Pycnogenol® may reduce the progressing advanced stages of diabetic retinopathy," said Dr. Robert Steigerwalt, a lead researcher of the study. "While previous studies focused on the latent stages of diabetic retinopathy, the aim of this new study was to show the protective effects of Pycnogenol® in the early stages of this growing diabetic complication." The randomized controlled study, conducted by G D'Annunzio University in Italy, investigated a total of 46 diabetic patients over a period of three months. The Pycnogenol® treatment group consisted of 24 patients, with 22 patients placed in a placebo treatment group. Each of the patients had been previously diagnosed with diabetes for at least four years prior to participating in the study and their blood glucose was well controlled by diet and oral anti-diabetic medication. Patients had early stage retinopathy characterized by capillaries in the eye leaking fluid into the retina causing swellings. At this stage only minor bleedings into the retina occur and damage to light-sensing cells may still remain largely reversible.

Subjects were treated with three 50 mg Pycnogenol® tablets (total 150 mg. of Pycnogenol®) or placebo tablets in the morning after breakfast over a period of three months. Following treatment with Pycnogenol®, the major positive observation of this study was visual improvement, which was subjectively perceived by 18 out of 24 patients in the Pycnogenol® group. Testing of visual acuity using the Snellen Chart (the standard eye chart used by eye care professionals to measure visual acuity) showed a significant improvement from baseline 14/20 to 17/20 after two months of treatment with Pycnogenol®. There were no improvements found in the control group. The retina is considered swollen when the diameter of the macula exceeds 500 micro meters and treatment with Pycnogenol® significantly decreased the swellings below that level, as judged by the high resolution ultrasound imaging used in the study. Furthermore, the blood flow velocity in capillaries nourishing the light sensing cells improved. The authors suggest that both effects account for the improved vision of patients. In the control group, retinal edema was not relieved, blood flow velocity remained unaffected and no visual improvements occurred.

In contrast, all 22 subjects in the control group maintained the same diabetic macular swellings as they were diagnosed with at the beginning of the study. "Pycnogenol® has been intensively investigated for decades to stop the progression of diabetic retinopathy and help patients to maintain their remaining eye sight," said Dr. Steigerwalt. "Our study suggests that Pycnogenol® taken in the early stages of retinopathy may enhance retinal blood circulation accompanied by a regression of edema, which favorably improves vision of patients. Pycnogenol® may be particularly beneficial for preventing this complication in diabetic patients, based on the large number of individuals who were diagnosed when the disease had already significantly progressed." Over the past decade, numerous studies have been published on Pycnogenol's® health benefits for people living with diabetes. Most notably, research results on five clinical studies with over 1,000 diabetes patients showed that Pycnogenol® has the ability to seal leaky capillaries in the eye. This capability impedes the progression of vision loss in patients suffering from diabetic retinopathy.

DATE: November 27, 2009

An apple a day may keep the doctor away but a fiber-filled diet could also hold the key to keeping asthma, diabetes and arthritis at bay, according to Australian research. Scientists at Sydney's Garvan Institute of Medical Research say that fiber not only helps keep people regular, it boosts the immune system so it can better combat inflammatory diseases.

When foods high in fiber, such as dried fruit and beans, reach the gut, bacteria convert them to compounds known as short chain fatty acids. These acids are known to alleviate some inflammatory disease in the bowel. Researcher Charles Mackay said that the team, which worked with scientists in Australia, the US and Brazil, was able to draw a clearer picture of this relationship, work which has implications for other diseases. They demonstrated that a molecule used by immune cells and previously shown to bind short chain fatty acids also functioned as an anti-inflammatory. "The important point about our work is that we provide the molecular explanation that links fiber in the diet to the micro-organisms in our gut to the affect on the immune response," Professor Charles Mackay said. The research, published in the latest edition of Nature, indicated that diet may have profound effects on immune responses or inflammatory diseases, he said. "We believe that changes in diet, associated with western lifestyles, contribute to the increasing incidences of asthma, Type 1 diabetes and other auto-immune diseases," he said. "Now we have a new molecular mechanism that might explain how diet is affecting our immune systems."

DATE: November 20, 2009

A spoonful of sugar might help your life expectancy go down, new research suggests. US scientists found that adding just a small amount of glucose sugar to the bacteria diet of laboratory worms cut the creatures' lifespans by a fifth.

The effect was traced to insulin signalling pathways - which exist in humans as well as simple worms. This raised the possibility that "glucose may have a lifespan-shortening effect in humans" the researchers wrote in the journal Cell Metabolism. On the other side of the coin, glucose is a vital source of energy without which cells cannot function. The tiny worm Caenorhabditis elegans is a standard laboratory tool often used in studies of metabolism. Scientists led by Dr Cynthia Kenyon from the University of California at San Francisco, carried out experiments in which worms were fed small amounts of glucose. They found that giving sugar to the worms reduced their normal lifespan by about 20 per cent. Glucose affected insulin signals and genes and proteins previously shown to extend lifespan in C. elegans. In particular, a sugary diet blocked the transport of glycerol, part of the process by which the body produces its own glucose. Dr Kenyon said the findings may have implications for new diabetes drugs now in development that inhibit glycerol channels.

DATE: November 13, 2009

Children born to mothers who ate plenty of vegetables during pregnancy are less likely to have type 1 diabetes, Swedish researchers say. "This is the first study to show a link between vegetable intake during pregnancy and the risk of the child subsequently developing type 1 diabetes, but more studies of various kinds will be needed before we can say anything definitive," study author Hilde Brekke, a clinical nutritionist at the Sahlgrenska Academy at the University of Gothenburg, said in a news release from the university.

Brekke and colleagues studied 6,000 5-year-olds and found that 3 percent either had fully developed type 1 diabetes or had elevated levels of antibodies that indicate a risk of developing the disease. The risk was twice as high in children whose mothers rarely ate vegetables during pregnancy, and lowest among children whose mothers ate vegetables every day of their pregnancy. The study was recently published online in the journal Pediatric Diabetes. "We cannot say with certainty on the basis of this study that it's the vegetables themselves that have this protective effect, but other factors related to vegetable intake, such as the mother's standard of education, do not seem to explain the link," Brekke said. "Nor can this protection be explained by other measured dietary factors or other known risk factors." While it's not known what actually causes type 1 diabetes, factors believed to play a role include immunological mechanisms, environmental toxins and genetic variations. Type 1 diabetes occurs throughout the world but is most common in Finland and Sweden.

DATE: November 06, 2009

Research shows exercise and changes in diet successfully turn back the clock. November is American Diabetes Month. Bariatric physician Dr. Caroline Cederquist, M.D. says there's no time like this month to start living healthy. Right now, 57 million people in America are at risk for type 2 diabetes. These are staggering numbers for a much too common disease that leads to serious health issues: two out of three people with diabetes die from heart disease or stroke and many suffer nerve damage and kidney failure as well. With awareness and action, diabetes is preventable. Experts urge those 57 million at-risk Americans to make the changes that could save their lives.

November is American Diabetes Month. Bariatric physician Dr. Caroline Cederquist, M.D. says there's no time like this month to start living healthy. While it's commonly known that exercise and weight loss can lower risk, the numbers are still astounding. "Getting in half an hour of moderate physical activity a few days a week, as well as reducing body weight by 5-10%, can cut your risk of developing diabetes by a whopping 58%," Dr. Cederquist states. As a result of exchanging a sedentary lifestyle for an active one, you could lower the threat by more than half. The reality of these statistics should motivate everyone to hit the gym or go for a long walk after dinner. While physical activity can significantly improve odds, there's more to diabetes prevention than exercise. The connection between diabetes and carbohydrates is also important to understand. "Research indicates that the body absorbs carbohydrates from different foods at varying rates, leading to diverse effects on levels of blood glucose and insulin." "Simple carbohydrate foods--such as white rice, white bread, and refined sugar--score high on the glycemic index. These foods cause a rapid spike and then a drop in blood glucose." "High-fiber foods --like the complex carbohydrates found in whole grains--are lower on the glycemic index and have a more gradual effect on blood sugar and insulin," Dr. Cederquist explains. "Because high-glycemic index foods abruptly and significantly increase blood glucose levels, they increase the body's demand for insulin." "This may contribute to problems with the pancreas, the organ that produces insulin, eventually leading to diabetes." "Making time for exercise as well as eating a proper diet could change, and even save, your life," Dr. Cederquist summarizes. Dr. Caroline Cederquist, M.D. is board certified in family medicine and bariatrics, the specialty of medical weight loss.

DATE: October 30, 2009

A diet high in a form of sugar found in sweetened soft drinks and junk food raises blood pressure among men, according to research likely to mean more bad news for beverage companies and restaurant chains. One of two studies released last month provided the first evidence that fructose helps raise blood pressure. It also found that the drug allopurinol, used to treat gout, can alleviate the effect by reducing uric acid levels in the body. The second study, which measured fructose intake in mice, suggested that people who consume junk foods and sweetened soft drinks at night could gain weight faster than those who don't.

"These results suggest that excessive fructose intake may have a role in the worldwide epidemic of obesity and diabetes," said Dr. Richard Johnson of the University of Colorado-Denver, who studied the link between blood pressure and men. The findings provide the latest evidence of ties between sugar-rich diets and health problems that have prompted some experts to call for a tax on sugary soft drinks. Fructose accounts for about half the sugar molecules in table sugar and in high-fructose corn syrup, the sweetener used in many packaged foods. Johnson and colleagues at the Mateo Orfila Hospital in Spain studied 74 men given 200 grams of fructose per day on top of their regular diet. That amount is well above a daily intake of 50 grams to 70 grams of fructose consumed by most American adults. Half the men were also given allopurinol. After two weeks, the men who received only the fructose registered increases of six millimeters in systolic blood pressure -- the top reading -- and about three millimeters in diastolic or the bottom reading, the researchers told an American Heart Association meeting in Chicago. Most of their blood pressure readings returned to normal levels after two months. The men who did not get allopurinol also were twice as likely to develop metabolic syndrome, measured by risk factors such as too much abdominal fat, high blood pressure and poor cholesterol readings. By contrast, those given allopurinol and fructose had significantly lower uric acid levels, and virtually no increase in systolic blood pressure or higher risk of metabolic syndrome.

For the second study, researchers in Ohio studied mice given fructose water to drink. Some had unrestricted access, while others received it during the day or at night. "The first thing we noticed was that the mice on restricted access rushed to their drinking bottles to load up on the sweetened beverage, similar to teenagers who drink too many soft drinks," said Mariana Morris of Wright State University in Dayton, Ohio. The mice that drank fructose water during their regular daylight sleeping hours gained more weight and had higher stress hormone levels than the other mice. "This model may be similar to the human condition of night time bingeing of fructose-laden foods and beverages," Morris said. The American Heart Association says women should eat no more than 100 calories of added processed sugar per day, or six teaspoons (25 grams), while most men should keep it to just 150 calories or nine teaspoons (37.5 grams). On average Americans consume 22 teaspoons (90 grams) or 355 calories of added sugar each day.

DATE: October 23, 2009

Recent studies conducted by Dr. Eric Blough and his colleagues at Marshall University have shown that use of the common pain reliever acetaminophen may help prevent age-associated muscle loss and other conditions. Their study examined how acetaminophen (like Tylenol) may affect the regulation of protein kinase B (Akt), an enzyme known to play an important role in regulation of cellular survival, proliferation and metabolism.

The researchers’ data indicates that aging skeletal muscles experience a decrease in the proper functioning of the enzyme and that acetaminophen intervention in aged animals could be used to restore Akt activity to a level comparable to that seen in young animals. In turn, this improvement in Akt activity was associated with improvements in muscle cell size and decreased muscle cell death. “Using a model that closely mimics many of the age-associated physiological changes observed in humans, we were able to demonstrate that chronic acetaminophen treatment in a recommended dosage is not only safe but might be beneficial for the treatment of the muscle dysfunction many people experience as they get older,” said Blough, an associate professor in the university’s Department of Biological Sciences. The lab’s work, which was published in the July 29 issue of the research journal PLoS ONE, is the first study to show that acetaminophen ingestion, at least in animals, can be safely used for the treatment of age-related muscle loss. This finding could have far-reaching implications, given the fact that people age 65 and older make up the fastest-growing segment of the U.S. population.

Additional research in their laboratory, which was published in the March issue of the journal Diabetes/Metabolism Research and Reviews, demonstrates the medication may also be useful in diminishing the severity of age-associated hyperglycemia, commonly referred to as high blood sugar. “It is thought that acetaminophen may exert its action by decreasing the amount of reactive oxygen species,” explained Dr. Miaozong Wu, the lead author and a postdoctoral fellow in Blough’s lab. “Given the finding that increases in reactive oxygen species may play a role in the development of several age-associated disorders, it is possible that acetaminophen could be used to treat many different types of conditions.” Dr. John Maher, vice president for research and executive director of the Marshall University Research Corporation, said, “These findings are yet another indication that Marshall’s researchers are conducting vital research in areas of great importance to human health and safety. I could not be more pleased and wish Dr. Blough and his team continued success.” The research was supported with funding from McNeil Pharmaceutical. According to Blough, scientists in his lab will now turn their attention to examining other physiological systems, such as the heart and blood vessels, to see if acetaminophen therapy might have similar benefits for people with cardiovascular disease.

DATE: October 16, 2009

Three years after she made medical history and was freed from painful insulin injections, 9 year old Lilly Jaffe is just beginning to understand how much her story changed the course of diabetes research and treatment. Since her breakthrough, 70 other children and several adults in the U.S. also have been able to switch from insulin shots to oral medication. And last month, her story inspired Illinois' adoption of "Lilly's Law," which established a registry in hopes of helping other children and gathering more genetic information on diabetes. "When I first got off insulin, I was happy, a little nervous and confused," Lilly said during an interview at her North Shore Chicago home. "Now I know that if I hadn't shared my story, then none of those children would have known about this. I want even more people to know."

Lilly's story began when researchers at the University of Chicago found she had a rare genetic mutation known as monogenic diabetes. Although she had been taking insulin injections since she was a baby, the discovery allowed her to take pills usually used to treat a milder Type 2 diabetes instead. A September 2006 story about Lilly's diagnosis by Tribune science writer Peter Gorner triggered hundreds of inquiries from families across the U.S. who believed their children might also have the genetic mutation. Some of those were among the 70 that, indeed, had the same mutation as Lilly; others possessed a different genetic variant that formed the basis for another groundbreaking research paper published in 2007. This summer, Lilly was able to share her remarkable tale with dozens of other children affected by diabetes when she traveled to London. Along with her mother, Laurie Jaffe, she attended a neonatal diabetes conference with the two British researchers who discovered her mutation, Dr. Andrew Hattersley and Dr. Frances Ashcroft. "That was incredible for Lilly because she got to meet and make friends with some children that were directly affected by her story," her mother said.

After Lilly's life-changing switch from injections to pills, Laurie Jaffe began moderating an e-mail discussion among parents with children who have monogenic diabetes. Initially, it was little more than an online support group, but through the discussions the families stumbled onto links between the mutation and neurological issues and began gathering informal data on a brand new field of diabetes research. Dr. Louis Philipson, medical director of the Kovler Diabetes Center at the University of Chicago, said it was well-known that some diabetes patients with mutations also have neurological problems. Therefore, he and his colleagues follow the family discussion group closely. Philipson and his team have begun working with neurodevelopmental experts to better understand the connection between diabetes and the brain. "These genes that cause diabetes are not only expressed in the cells that make insulin, but are playing a role in the brain and elsewhere," Philipson said. "It is a relatively new (study) area ... less than five years. It points out how exciting a time this is for medicine and biology, to better understand the role of genes in disease."Lilly was diagnosed with Type 1 diabetes, the more serious form, at the age of 1 month. Also known as juvenile diabetes, Type 1 is most often diagnosed in childhood and adolescence, but it strikes adults as well. About 15,000 children are diagnosed with diabetes in the U.S. every year, according to the Juvenile Diabetes Research Foundation.

Lilly started with insulin shots to stabilize her blood sugar, but after two frightening nighttime seizures, she was switched to an insulin pump that was attached to her hip. With the pump, Lilly's mother still had to monitor her glucose levels about 10 times a day and move the painful infusion sites from leg to leg to avoid irritation and infection. In June 2006, her parents learned about Philipson's cutting-edge diabetes research. He told them of a new study that showed some children diagnosed with Type 1 diabetes in the first six months of life actually have an unusual mutation of Type 1 that can be treated with pills. Soon, Lilly was found to have the rare genetic mutation. A couple of months later, Lilly was able to start the first grade completely insulin-free, taking five glyburide pills twice a day. With Lilly now in fourth grade and leading a more active life, her mother said the goal now is to identify more people, advance research and eventually find a cure. Researchers estimate there are about 2,000 people in the U.S. with Lilly's genetic mutation who could benefit from the breakthrough. "There are so many more people out there that can be helped, but it's (a matter of) identifying them," Laurie Jaffe said. "And it's not just children. ... The adults that have been found are those that have had children with monogenic diabetes." Hoping to find more patients and gather more genetic information to study, University of Chicago doctors proposed the creation of the first state-mandated diabetes registry. They crafted legislation after joining forces with Rep. Tom Cross (R-Oswego), whose 16-year-old daughter, Reynolds, has Type 1 diabetes, although not the mutation. The bill officially became "Lilly's Law" when signed by Gov. Pat Quinn last month. Lilly's Law requires Illinois physicians to register all children with diabetes onset before 12 months of age to the state Department of Public Health. Its backers hope the registry, which was approved as a 3-year-pilot program, leads to further advances in understanding the genetic cause of diabetes. "Many of the genes that cause special forms of diabetes are not yet known," Philipson said. "This is not only for the knowledge, but for specific treatment and for the family members to understand the genetic risks to future generations." After Lilly stopped taking insulin, her mother said that one of her first questions was whether her two cousins with Type 1 diabetes could get off insulin, too. She was disappointed to learn they didn't have the mutation, so they could not. "Now, we're committed to finding cures for our nieces, cousins, and all our friends," Laurie Jaffe said.

DATE: October 09, 2009

New guidelines from Harvard advises US consumers on the the types of food, beverages or ingredients that can help ward off diabetes, with recommendations including moderate coffee and alcohol alongside fiber and nuts. Havard Medical School’s report Healthy Eating for Type 2 Diabetes, explains how food choices, as well as weight control, can help manage and "even prevent" diabetes. The authors of the paper, which is designed as guidance to consumers, say that research into the relationship between eating specific types of foods and diabetes risk is “limited and the results somewhat controversial.”

They drew their conclusions from studies that required people to report what they ate or drank, and pointed out these were considered less rigorous than those in which people are assigned to follow different diets. Both men and women who eat plenty of whole grains had a roughly 40 percent lower risk of diabetes than those who eat little, with cereals, breads, and grains apparently the most beneficial. “Fiber slows the digestion of food, so glucose is released into the bloodstream more gradually, and you feel full longer,” writes the paper. “This can help you avoid overeating and becoming overweight, thus reducing your risk of diabetes. Soluble fiber in particular appears to improve both blood sugar and insulin sensitivity, and high-fiber diets may even lower the need for insulin.”

Women who eat nuts or peanut butter at least five times a week have a 20 to 30 percent lower risk of diabetes than those who rarely eat them. However the authors stressed that “these are not wonder foods that will magically ward off diabetes.” They said there is no specific ‘diabetes diet’ that prohibits sugar and lists other ingredients to avoid, but said people with diabetes should follow the same dietary advice as most people, but with extra emphasis on controlling weight and keeping blood sugar, blood pressure, and cholesterol values as close to normal as possible. The authors recommended a well-balanced diet that emphasizes fruit, vegetables, whole grains, and lean protein, while watching calorie intake and getting regular exercise.

Among the high risk foods, women who drink two or more sugary soft drinks have a 24 percent higher risk of developing diabetes compared to those who consume less than one per month, and two or more daily fruit drinks (with little real fruit juice) lead to a 31 percent higher risk. Women who eat around one serving of red meat a day have about a 20 percent higher risk of diabetes than those who eat at least one serving a week, and men who eat processed meats five times a week are nearly twice as likely to develop diabetes as men who eat such foods just twice a month. One study documented a 30 percent increased risk of diabetes among women who ate the most trans fats compared to those who ate the least. The report quoted American Heart Association findings that the incidence of hypertension is twice as common among people with diabetes as it is among the general public. It recommended the equivalent of approximately one teaspoon of table salt, saying that most Americans consume much more. It also warned that too many refined carbohydrates, from which valuable nutrients, fiber, and vitamins are removed during the refinement process, can cause a significant spike in blood sugar and increase insulin requirements if eaten in large quantities.

The report also highlighted the potential benefits of some products not traditionally considered to be 'healthy'. It noted that one cup of coffee a day could lower diabetes risk by 13 percent and two cups a day could cut the risk by 42 percent, compared to people who drink none. While warning that alcohol can be a double-edged sword because of its detrimental effect on heart health, the report reveals that men who have two to four drinks per week had a 25 percent lower risk than teetotalers. Five to six drinks per week drops the risk by 33 percent and one drink a day cut risk by 43 percent. “There’s some evidence that light to moderate alcohol intake can lower insulin resistance and enhance glucose metabolism in people with diabetes,” wrote the authors. “It’s also well documented that alcohol improves insulin sensitivity only when people drink light to moderate amounts.” Heavy consumption has the opposite effect, they said.

DATE: October 02, 2009

Insulin resistance, the hallmark of type 2 diabetes and a condition often associated with obesity, is paradoxically also an apparent contributor to muscle wasting and severe fat loss that accompanies some cancers, according to new research. And in an animal study, a diabetes drug that promotes insulin sensitivity slowed the progression of muscle wasting and fat loss, the main consequences of a syndrome called cachexia, in mice with colon cancer tumors. Though it remains unknown whether that drug, rosiglitazone, has potential to prevent cachexia in humans with cancer, the finding led researchers to believe that curbing insulin resistance in cancer patients could improve their quality of life.

Research suggests that cachexia is responsible for between one-fifth and one-third of all cancer deaths. The insulin resistance and cachexia both appear to be connected to inflammation induced either by tumors themselves or by secretions from tumors that activate an immune response, the researchers say. "Insulin resistance usually follows obesity. In this case, it precedes uncontrollable fat loss," said Martha Belury, senior author of the study and a professor of human nutrition at Ohio State University. "The insulin resistance is the process we've identified that occurs soon after tumors form. So if we can change that part of the disease, we might be able to change the progression and trajectory of how fast fat and muscle are lost as well. That's our goal." The research appears online and is scheduled for future print publication in the International Journal of Cancer. Belury and colleagues conducted two experiments. In the first, the researchers sought to demonstrate that animals developed insulin resistance shortly after they developed cancer and before muscle and fat loss became evident. In the second, they tested the effectiveness of the insulin sensitizing drug rosiglitazone against that same tendency toward insulin resistance. The scientists injected mice with colon cancer cells to mimic one of several digestive-system cancers strongly associated with the development of cachexia. Less than two weeks after the cancer started growing, these mice had become insulin resistant. Control mice without tumors had normal insulin sensitivity. Insulin resistance means that the presence of insulin does not initiate the transfer of sugar, or glucose, from the blood into the tissues, where it is used for energy. Just three days later, the mice with cancer weighed, on average, 20 percent less than control mice with no tumors; weight loss of at least 5 percent is considered to be a sign of cachexia in humans. By day 19, the total muscle weight in mice with cancer decreased by 29 percent and the weight of their fat tissue dropped by 73 percent. Such rapid loss of muscle and fat indicated these mice had indeed developed cachexia. "These data provide evidence that in mice with colon cancer tumors, insulin resistance may be involved in the development of cachexia rather than occur as a result of cachexia," Belury said. "And the key here is that people and animals with cachexia do not want to be losing weight. They can eat more and it doesn't matter. There's something internally that's driving this fat and muscle loss."

In the second study, the scientists tested whether rosiglitazone could "rescue" the insulin resistance in mice with colon cancer. In this study, mice were fed a high-fat diet and randomized into three groups: mice with and without tumors receiving a saline solution as a control, and mice with tumors treated with daily injections of rosiglitazone. Within eight days, the mice with cancer receiving the rosiglitazone showed more sensitivity to insulin than did the mice with tumors that received no medication. The insulin sensitivity of the medicated mice matched that of mice without tumors. Similarly, the mice receiving rosiglitazone actually gained weight in this study, as did the mice without tumors. The mice with tumors receiving no treatment lost fat tissue, suggesting they were experiencing the onset of cachexia - despite the high-fat diet they were eating. In addition to stopping fat and muscle loss, the rosiglitazone also dramatically reduced two biological markers present when proteins break down, particularly in muscles, and a third marker that indicates cells are eating their own amino acids in an attempt to survive. "We found that those markers of protein and muscle degradation are increased in mice with cachexia, and then when we gave them rosiglitazone, that significantly slowed that degradation," Belury said. It's too soon to know whether the same drug would have the same effect on humans with cancer, Belury noted. Not all people with cancer develop cachexia, and it's difficult to catch cachexia before severe weight loss has already occurred. And by the time muscles begin to break down, the entire body reacts to the release of amino acids, meaning treatment at that time would have to take such reactions into account. "For this research, we wanted to catch cachexia as it was having an influence on muscle wasting without the wasting muscle having an influence back on the cachexia," Belury said. In future studies, the scientists plan to further test the timing and dosage of rosiglitazone and other insulin sensitizers to see if the experiments produce a "prominent, universal effect," Belury said.

DATE: September 25, 2009

Scientists at the Ottawa Hospital Research Institute and the University of Ottawa have discovered what may be an important clue to the cause of type 1 diabetes. Dr. Fraser Scott and his team tested 42 people with type 1 diabetes and found that nearly half had an abnormal immune response to wheat proteins. The study is published in the August 2009 issue of the journal Diabetes.

Early in life, the immune system is supposed to learn to attack foreign invaders such as viruses and bacteria, while leaving the body’s own tissues and harmless molecules in the environment alone (including food in the gut). When this process goes awry, autoimmune diseases and allergies can develop. Type 1 diabetes is an autoimmune disease that occurs when the immune system mistakenly attacks the pancreas, the organ that regulates blood sugar. Dr. Scott’s research is the first to clearly show that immune cells called T cells from people with type 1 diabetes are also more likely to over-react to wheat. His research also shows that the over-reaction is linked to genes associated with type 1 diabetes. “The immune system has to find the perfect balance to defend the body against foreign invaders without hurting itself or over-reacting to the environment and this can be particularly challenging in the gut, where there is an abundance of food and bacteria,” said Dr. Scott, a Senior Scientist at the Ottawa Hospital Research Institute and Professor of Medicine at the University of Ottawa. “Our research suggests that people with certain genes may be more likely to develop an over-reaction to wheat and possibly other foods in the gut and this may tip the balance with the immune system and make the body more likely to develop other immune problems, such as type 1 diabetes.”

In a commentary accompanying the paper, diabetes expert Dr. Mikael Knip of Finland said “These observations add to the accumulating concept that the gut is an active player in the diabetes disease process.” Dr. Scott’s previous research has shown that a wheat-free diet can reduce the risk of developing diabetes in animal models, but he notes that more research will be required to confirm the link and determine possible effects of diet changes in humans. Research is also needed to investigate links with celiac disease, another autoimmune disease that has been linked to wheat. This research was funded by the Juvenile Diabetes Research Foundation and the Canadian Institutes of Health Research. The authors include Dr. Majid Mojibian, Dr. Habiba Chakir, Dr. David E. Lefebvre, Jennifer A. Crookshank, Brigitte Sonier and Dr. Erin Keely, as well as Dr. Scott. Patients were enrolled at The Ottawa Hospital and the Children’s Hospital of Eastern Ontario. An estimated 246 million people have diabetes worldwide. Type 1 diabetes is the most severe form, representing about 10 per cent of all cases. Insulin injections can help control blood sugar levels in those affected but there is no cure.

DATE: September 18, 2009

Canadian scientists have revealed that biotransformed blueberry juice holds great promise for treating obesity and diabetes.

The research team from the Universite de Montreal, the Institut Armand-Frappier and the Universite de Moncton have found that juice extracted from North American lowbush blueberries, biotransformed with bacteria from the skin of the fruit can help fight obesity and diabetes. "Results of this study clearly show that biotransformed blueberry juice has strong anti-obesity and anti-diabetic potential," said senior author Pierre S. Haddad, a pharmacology professor at the Universite de Montreal's Faculty of Medicine. "Biotransformed blueberry juice may represent a novel therapeutic agent, since it decreases hyperglycemia in diabetic mice and can protect young pre-diabetic mice from developing obesity and diabetes," Haddad added.

In the new study, the researchers tested the effect of biotransformed blueberry juice on a group of mice prone to obesity, insulin resistance, diabetes and hypertension. It showed that incorporating biotransformed blueberry juice into the water of mice reduced their food intake and their body weight. "These mice were an excellent model that closely resembles obesity and obesity-linked type 2 diabetes in humans," said Haddad. "Consumption of fermented blueberry juice gradually and significantly reduced high blood glucose levels in diabetic mice. After three days, our mice subjects reduced their glycemia levels by 35 percent," said Tri Vuong, lead author and recent PhD graduate from the Universite de Montreal's Department of Pharmacology. Biotransformation of the blueberry juice was achieved with a new strain of bacteria isolated from the blueberry flora, specifically called Serratia vaccinii, which increases the fruit's antioxidant effects. "The identification of the active compounds in biotransformed blueberry juice may result in the discovery of promising new antiobesity and antidiabetic molecules," Haddad added.

The study is published in the International Journal of Obesity.

DATE: September 11, 2009

A study of U.S., British and German diabetes patients found 44 percent say the disease affects their ability or desire to have sex, researchers said. The study, conducted online among 2,000 patients with type 2 diabetes, investigated patients' attitudes, feelings, health status, drug treatment programs and needs for coping with life with diabetes. The study, conducted by The Research Partnership, said most people say they feel in control of their condition but 43 percent report that they are sometimes or often unsuccessful in managing their condition.

In all countries investigated, one in two people say they feel that diabetes has an impact on their general mood. However, men are significantly more likely to feel calm and confident, while women are more likely to feel challenged, frustrated or tired. More than half of patients are also receiving treatment for high blood pressure and high cholesterol and the majority are overweight. The vast majority of the study subjects in Britain and the United States are clinically obese and around one-third from all countries never engage in any physical exercise, the study said. On the whole, patients enjoy a good relationship with their doctor but one-fifth -- particularly the case in the United States -- say they sometimes feel their doctor is annoyed with them for not managing their diabetes.

DATE: September 04, 2009

In the longest-term study of its kind, researchers pitted two popular diets head to head - a low-fat American Heart Association–style diet and a carb-controlled Mediterranean diet, each combined with regular physical activity - in a population of overweight patients who had Type 2 diabetes. Researchers found that over the four-year study, patients who adhered to the Mediterranean-style eating plan maintained lower blood-sugar levels for a longer time than those in the low-fat-diet group. On the basis of their findings, the study's authors suggest that some diabetes patients may be able to substitute diet and exercise for blood-sugar-lowering medications.

The study involved 215 overweight adults in Naples, Italy, who were newly diagnosed with Type 2 diabetes. Patients were randomly divided into two diet groups: the low-fat eaters were instructed to follow a regimen rich in whole grains, fruits and vegetables and low in additional fats, sweets and high-fat snacks; no more than 30% of daily calories were to come from fat and no more than 10% from saturated fat. The Mediterranean-diet group was taught to eat lots of fruits, vegetables, whole grains and healthy fats, including olive oil, with an emphasis on lean protein sources such as fish, chicken and nuts. Mediterranean dieters were instructed to limit carbohydrate intake to less than 50% of their daily calories. All dieters were encouraged to exercise regularly and received regular nutrition counseling throughout the course of the study. Regardless of the specific eating plan, the study's participants were required to restrict their daily caloric intake: 1,800 calories maximum per day for men, and 1,500 calories daily for women - a significant reduction from what the average American eats daily (about 2,600 calories for men and 1,800 calories for women, according to government statistics). By the end of the study, which was published in the Sept. 1 issue of the Annals of Internal Medicine, 56% of patients following the Mediterranean diet were able to control their blood sugar without medication, compared with 30% of those on the low-fat regimen. The Mediterranean dieters were also able to maintain slightly more weight loss than the low-fat group - 8.4 lb. vs. 7.1 lb. - and showed small improvements in triglyceride and HDL cholesterol (the good kind) levels, both risk factors for heart disease.

"A Mediterranean-style diet is a very important part in the treatment of diabetes. We knew that," says Dr. Loren Greene, a New York University Medical Center endocrinologist, who was not involved in the study. "But there just hasn't been a good study to confirm this before." Some past studies have suggested that eating fewer carbohydrates can help diabetes patients lower their blood sugar. Other research has shown that intake of monounsaturated fats like olive oil can improve patients' insulin sensitivity, allowing the body to naturally control blood sugar more effectively. The current study does not make clear, however, whether diet alone can reduce blood sugar enough to eliminate the use of diabetes medication or whether it is even advisable to forgo medication at all. Participants in the new study were kept off drugs when their A1C levels - a measurement that indicates a patient's blood-sugar levels over the previous three months - were below 7%, the standard cutoff for what is considered controlled blood sugar. But "we don't know for sure if people with A1C levels under 7% still need to be on drugs," says Greene. "The research just hasn't answered that question yet." Recent studies suggest that using blood-sugar-controlling medication even among the 57 million Americans who have prediabetes - meaning they have elevated, but not dangerously high blood sugar and are at very high risk of developing diabetes - may prevent the development of heart disease and stroke. While diabetes doctors generally agree that the first line of defense against Type 2 diabetes should always be exercise and diet, many recommend also using drugs. For its part, the American Diabetes Association advises patients with Type 2 diabetes to make appropriate lifestyle changes and to start a drug regimen immediately upon diagnosis. Dr. R. Paul Robertson, a spokesperson for the organization, says that for people with diabetes, "the goal should not be to avoid drugs. It is to do everything you can to keep your sugar levels down."

Still, many doctors acknowledge patients' aversion to chronic drug-taking. "Almost universally, people don't want to take medicine if they can avoid it," says Greene. And physicians, including internist Dr. Christine Laine, who is the editor of the Annals of Internal Medicine, point out that the direct and indirect costs associated with taking a drug - even one as widely prescribed as the generic diabetes medication metformin - can serve as a barrier for many patients, especially among disadvantaged populations and those without health insurance. Whether avoidance of medication in certain cases proves to be reasonable, for now it can at least be used as an effective incentive to improve lifestyle habits, says Greene: "If you are told, 'If you don't want to go on medicine, stick to this diet,' then that's a pretty valuable tool at least for patient compliance."

DATE: August 28, 2009

A five-year moratorium on clinical trials of the process, called xenotransplantation, is due to expire on December 31, 2009. The decision on whether it will be renewed rests with the National Health and Medical Research Council (NHMRC).

Xenotransplantation offers hope of using animal tissues, organs and cells to address the massive shortfall in human organ donation. But it has raised concerns it could induce new viruses to cross the species gap. Australia's ban was based on fears humans would catch porcine endogenous retrovirus, but scientists now say lab tests over the years have reduced this to a theoretical or "vanishingly small" risk. Australian-born Professor Bob Elliott is now working in New Zealand - where there is no ban - on a technique using modified pig cells to generate insulin inside humans as a cure for type 1 diabetes. "A lot of things have happened over the last five years, the one that is most dominant is the lessening of the fear about transmission of pig endogenous retrovirus," Prof Elliott said. "People have been really trying to make it happen experimentally and it has totally failed to do so."

New Zealand regulators this week approved a clinical trial using the technique, and Prof Elliott says he could expand this work to Australia if the moratorium was lifted. Prof Elliott's research uses a unique breed of pigs found to be disease free when they were discovered on a remote sub-antarctic island. Two people with diabetes have shown "sustained insulin independence", Prof Elliott says, after a pilot study which saw them injected with pig cells specially coated using a new technique to prevent rejection. Melbourne-based Professor Anthony D'Apice, former president of the International Xenotransplantation Association, says new pig-based treatments for Parkinson's disease were also on the horizon. "In terms of the moratorium, I guess I'm optimistic," he says. "I don't want to ramp up pressure or anything about it, the NHMRC in its wisdom will consider this carefully ... (but) things have changed and I think good sense would see the moratorium go."

DATE: August 21, 2009

Scientists identified a master regulator gene for embryonic development of the pancreas, putting researchers closer to a possible cure for type1 diabetes. The disease occurs when the immune system attacks insulin producing beta cells in the pancreas, usually destroying them beyond repair before the illness is diagnosed. Besides having important implications in diabetes research, the study offers new insights into congenital birth defects involving the pancreas and biliary system by demonstrating that both organs share a common cellular ancestry in the early mouse embryo. The pancreas regulates digestion and blood sugar, and the biliary system is vital for digestion. Failure of the organs to form properly during fetal development can be fatal.

The study reports that one gene, Sox17, which controls which genes are turned on or off in a cell, is the key regulator for instructing cells in early mouse embryos to become either a pancreatic cell or part of the biliary system. Jason Spence, Ph.D., and James Wells, Ph.D., both of the Division of Developmental Biology at Cincinnati Children's Hospital Medical Center, authored the paper. “We show that Sox17 acts like a toggle switch that sets off a cascade of genetic events," Dr. Wells is quoted as saying. "In normal embryonic development, when you have an undecided cell, if Sox17 goes one way the cell becomes part of the biliary system. If it goes the other way, the cell becomes part of the pancreas." "With this study showing us that turning one gene on or off in a mouse embryo instructs a cell to become pancreatic or biliary, now we'll see if that same gene, Sox17, can be used to direct an embryonic stem cell to become a biliary cell instead of a pancreatic cell. This might be used one day to replace a diseased pancreas or bile duct in people," said Dr. Wells. Dr. Wells and his colleagues are also using data from the current study to conduct experiments that should reveal what other genes are turned on or off along the molecular cascade set into motion by Sox17. "Although Sox17 is the master switch, it triggers a molecular cascade of switches,” Dr. Wells explained, “and a defect in any of those can cause the whole thing to go wrong, resulting in congenital defects of the pancreas and biliary system."

DATE: August 14, 2009

In a major advance in obesity and diabetes research, Yale School of Medicine scientists have found that reducing levels of a key enzyme in the brain decreased appetites and increased energy levels. Reductions in the levels of the enzyme prolylcarboxypeptidase (PRCP) led to weight loss and a decreased risk of type 2 diabetes in mice, according to research published in the August issue of The Journal of Clinical Investigation. The team found that PRCP is located in the hypothalamus and regulates levels of a peptide known for inhibiting food intake and stimulating energy expenditure— the alpha-melanocyte stimulating hormone (alpha-MSH). Researchers found that blocking the PRCP enzyme keeps the alpha-MSH peptides from being degraded, resulting in higher levels of alpha-MSH and decreased appetite.

“Our research provides the first evidence that breaking down molecules in the brain that regulate metabolism is an important component of weight control,” said senior author Sabrina Diano, associate professor in the Departments of Obstetrics, Gynecology and Reproductive Sciences, and Neurobiology. “Our findings provide a possible new target for the development of drugs to control metabolic disorders such as obesity and type 2 diabetes.” Diano and her team conducted the study in congenic mice that were naturally lean and later in mice that had PRCP removed. Animals without the PRCP enzyme were leaner and ate less food. They also had higher levels of alpha-MSH in the hypothalamus compared to control animals. The mice were put on a diet of 45 percent fat—the equivalent of eating fast food everyday—and even with this high fat diet, they did not gain as much weight as control animals on a regular diet. Diano said the next step is to study how PRCP is regulated.

DATE: August 07, 2009

Eat right and exercise, conventional wisdom has it, if you want to avoid joining the diabetes epidemic. But a new study adds some muscle to a growing body of research suggesting those steps, although beneficial, might not be enough for people exposed to chemicals in the environment. The scientists linked diabetes and people's body burdens of DDE, a chemical produced as the body breaks down the pesticide DDT, banned in the United States more than 35 years ago. "Even though we haven't used DDT in decades, its metabolites are still detected in almost everyone in the country," said lead researcher Mary Turyk, an epidemiologist at the University of Illinois-Chicago's School of Public Health.

Since the early 1990s, researchers have monitored a group of Great Lakes charter boat captains, recreational fishermen and others to learn about the health effects of eating fish tainted with persistent organic pollutants - chemicals that remain in the environment for decades and grow more concentrated as they move up food chains. For the new study, blood samples from the Great Lakes group showed "consistent, dose-related associations of DDE" with diabetes, the researchers wrote in the July issue of Environmental Health Perspectives. Among 471 adults, including 36 with diabetes, there was no link to the disease based on the amount of fish consumed or exposure to other pollutants. But the higher the concentration of DDE in the blood, the more likely they were to develop diabetes.

DATE: July 31, 2009

New research shows that people who eat a high-fat diet may be more likely to develop pancreatic cancer, especially if their dietary fat comes from animal foods, such as meat and dairy products. That finding appears in the July 15 edition of the Journal of the National Cancer Institute.

"Our study demonstrated a positive association between dietary intake of total fat, particularly fat from animal sources," researcher Rachael Stolzenberg-Solomon, PhD, RD, tells WebMD. "The strongest associations we observed were from meat and dairy products." Stolzenberg-Solomon, who is a nutritional epidemiologist at the National Cancer Institute, says previous studies have shown mixed results on whether dietary fat is associated with pancreatic cancer risk. The new study included more than half a million U.S. adults. When the study started, none of them had pancreatic cancer. Participants completed surveys about their diets over the previous year, which showed fat intake ranging from 20% to 40% of calories. People who ate a lot of fat were "regular eaters of fat from animals," Stolzenberg-Solomon said. Participants were followed for six years, on average. During that time, 865 of the men and 472 of the women were diagnosed with pancreatic cancer.

Compared to people with the lowest total fat intake, people with the highest fat intake were 23% more likely to be diagnosed with pancreatic cancer. And people with the highest intake of saturated fats were 36% more likely to be diagnosed with pancreatic cancer. The study doesn't prove that dietary fat was responsible for that, or that meat or dairy products were particularly to blame. Observational studies like this one show associations, but they don't prove cause and effect. Still, the findings held regardless of other risk factors for pancreatic cancer, including obesity, smoking, and history of diabetes. Our study is in line with the USDA [U.S. Department of Agriculture] guidelines to be prudent and limit fat intake to between 20% and 35% of total calories," says Stolzenberg-Solomon, noting that those USDA guidelines were developed to prevent other diseases. Stolzenberg-Solomon says other studies are needed to confirm the findings.

The American Cancer Society provided a statement about the study. "This study is large and well designed, and provides important evidence that a diet high in animal fat may increase risk of one of the leading causes of cancer death. While further confirmatory research about animal fat and pancreatic cancer is still needed, results of this study support the American Cancer Society's recommendations to limit red meat and emphasize plant foods to help reduce risk of a variety of cancer," says Eric Jacobs, PhD, strategic director of pharmacoepidemiology at the American Cancer Society. Pancreatic cancer researcher Donghui Li, PhD, who is a professor in the department of gastrointestinal medical oncology at the University of Texas M.D. Anderson Cancer Center, also praised the study and said it's still not clear how dietary fat may affect pancreatic cancer risk. "The study really offers some convincing evidence for the association of dietary fats and pancreatic cancer," says Li, who was part of another team of researchers that published a study this week showing that overweight and obese young adults are more likely than their leaner peers to develop pancreatic cancer later in life. An editorial published with the study notes that there isn't enough evidence to "confirm the importance of animal fats, per se, or even that meat is the important factor, as opposed to other dietary or lifestyle preferences associated with meat consumption." "Nevertheless, sufficient evidence already suggests health benefits from limiting meat and saturated fat intake, and the current study provides additional support for these recommendations," write the editorialists, who included Brian Wolpin, MD, MPH, of the Dana Farber Cancer Institute in Boston.

DATE: July 24, 2009

New research is revealing that obesity surgery does more than simply help patients lose weight; it may also "cure" type 2 diabetes for five years or longer. In two new studies presented at the annual meeting of the American Society for Metabolic and Bariatric Surgery, researchers have found that both "lap band surgery" and gastric bypass surgery can help eliminate diabetes.

While previous studies have made similar findings, this new research finds that the effects can be long-lasting. In one study, researchers at New York University School of Medicine looked at 95 morbidly obese patients, with an average BMI (body mass index) of 46, who underwent a temporary form of stomach reduction, called laparoscopic adjustable gastric banding (LAGB). Five years after the surgery, diabetes in 40 per cent of patients had gone into remission so that they could stop taking medication. An additional 43 per cent of patients saw their diabetes improved so that their blood sugar levels fell and they could reduce their medication use. "Our study contributes to mounting evidence that demonstrates gastric banding can have a sustained and meaningful effect on diabetes and morbid obesity and that the two diseases are interrelated," said Dr. Christine Ren, co-researcher and associate professor of Surgery at New York University School of Medicine. Ren noted that those patients who had diabetes for the least amount of time before surgery tended to be more likely to see their condition go into remission. "We didn't find a substantial difference in remission outcomes for patients who suffered with diabetes for more than six years compared to those who had the disease for a shorter period of time," said Ren.

A second study of 177 obese patients with diabetes who underwent gastric bypass surgery, or stomach stapling, as it's sometimes called, found that 57 per cent of those remained diabetes-free up to 16 years after the procedure. Once again, those most likely to experience a recurrence of diabetes were those who had type 2 diabetes longer prior to surgery and who had a more severe form in which they were dependent on insulin. Those who saw their diabetes return were also those who regained the most weight following the surgery. Study co-author, Dr. James W. Maher, professor of Surgery at Virginia Commonwealth University said these two factors seem to be the primary determinants of long-term diabetes resolution after gastric bypass surgery. "This study suggests that people with Type 2 diabetes and morbid obesity who get surgery before becoming insulin-dependent have the greatest chance for complete resolution and avoiding the progression of diabetes." In gastric bypass surgery, the stomach is reduced from the size of a football to golf-ball-size. As well, the upper portion of the small intestine is replaced with the lower part. Stomach banding, or LABG, involves wrapping a silicone band around the upper part of the stomach to limit the amount of food it can hold. People who are morbidly obese are generally 100 or more pounds overweight and have a BMI of 40 or more. They also meet the definition if they have a BMI of 35 or more with an obesity-related disease, such as Type 2 diabetes, heart disease or sleep apnea. The American Diabetes Association recently recommended bariatric surgery be considered for adults with BMI greater than 35 and type 2 diabetes, especially if the diabetes is difficult to control.

DATE: July 17, 2009

Eating nuts can help cut the risk of heart disease among women with Type 2 diabetes, new research suggests.

A study of more than 6,000 women from 1980 to 2002 found those who ate lots of nuts or peanut butter slashed their risk of heart disease almost in half. The research was published in the Journal of Nutrition. Overall, there were 452 coronary "events" such as a heart attack and 182 cases of stroke.

Women at the start of the study who consumed more nuts and peanut butter were leaner, more physically active, and tended to smoke less, the authors said. After adjusting for those factors that could influence the results, the experts found that women who ate at least five servings per week of nuts or peanut butter had a 44 per cent lower risk of heart disease and events such as heart attack or stroke. A serving was defined as 28g of nuts or 16g (one tablespoon) of peanut butter. The authors, from the Harvard Medical School and Harvard School of Public Health in Boston, said: "These data suggest that frequent nut and peanut butter consumption is associated with a significantly lower CVD risk in women with Type 2 diabetes. It is beneficial to include nuts in our diets, as they are low in the saturated fats that raise our cholesterol. However, peanut products can be full of added sugar or salt."

DATE: July 10, 2009

As he was leaving for college 51 years ago, David Bateman, of Charleston IL, was told by his father, “You won’t make it through the first semester.” While he was referring to his son’s mediocre high school scholastic performance and venting his frustration, the elder Bateman didn’t realize how prophetic his words might be.

Bateman did well in college, but during his second semester he realized he was having problems. He was slowing down, experiencing night cramps, losing weight, had unquenchable thirst, and frequent urination. His eyesight was also deteriorating.

Because he didn’t want to jeopardize his successful freshman year, Bateman didn’t seek medical advice and waited until after he wrote his final exams and returned home to Peoria for the summer. “For weeks, I had been going around like I had molasses in my veins,” he said. “By waiting, I about killed myself.” He was hospitalized and diagnosed with juvenile diabetes, now called Type 1 diabetes. According to Cindy Foster, registered dietitian at Sarah Bush Lincoln Health Center, in Type I diabetes, which usually affects children, the body’s pancreas doesn’t make any insulin-producing cells. “Those who are Type 1 take insulin and they will always take insulin,” she said. “It can happen when someone has had a cold, the flu, chicken pox, mono, or maybe something so mild they may not have known they had it,” Foster said. “But, when the body’s defense system kicks in to fight the illness, it attacks and damages the pancreas.” Those who have Type 1 diabetes are treated with insulin because the pancreas is not functioning or is not producing enough insulin.

Foster and Paula Enstrom, a nurse and certified diabetic educator at the health center, said diabetes, particularly Type 2 diabetes, is epidemic, not just in the U.S., but worldwide. “Unfortunately, as today’s children become heavier and become less active, we see Type 2 in children, which we never used to see,” Foster said, “and the numbers just keep going up.”

About five in every 100,000 children were reported with Type 2 diabetes from 2002 to 2003, according to the Centers for Disease Control and Prevention. “It has to do with the fact that kids are more sedentary. They have more screen time, play more computer games and spend less time out riding their bikes,” Foster said. And, it has to do with people eating fewer meals at home and using little portion control, the women said. The American Diabetes Association reports that 1 in 6 overweight adolescents ages 12-19 have pre-diabetes. With Type 2 diabetes, the pancreas works, but doesn’t produce enough insulin. There is oral medication, however, and in some cases, Type 2 can be controlled by diet and exercise. “But, it is progressive,” Enstrom said. “They may start out and be able to control it by diet, exercise and pills, and 15 years later, that may not be the case.” Pre-diabetes is a diagnosis for people who have higher-than-normal blood sugar. “Actually, by the time they’re diagnosed as pre-diabetic, they’ve had problems the way their bodies handle sugar for several years,” she said. “If we could get the population to stay active and maintain a healthy weight, that’s how we’re really going to prevent diabetes.” Enstrom said people who are pre-diabetic and who lose 5 to 10 percent of their weight can reduce their risk by about 58 percent. “They don’t know how long-term that is,” she said, “but they do know they can at least delay it.” In Bateman’s case, the key is “diet and exercise and discipline and taking the appropriate medicine,” he said. “You follow the rules. Diabetes is one of the chronic diseases that can be controlled. And that’s what you strive to do.” In 50 years, he has seen numerous changes in the way diabetes is treated. “Insulin was developed in 1923, and since then, especially in the last 10 years, there has been tremendous change in the way we do things,” he said. “We used to take insulin that came from cows and pigs, and today, we have human insulin.”

Bateman said he still takes insulin shots, but there is an insulin pump that many diabetics use. “Many teenagers are on the pump,” he said, “especially athletes. And, it does give them a lot more flexibility, but while I would never have a piece of pie or a banana split, they sometimes think they can have it and just push a pump and take care of it.” Still experimental, Bateman said, is the closed loop system, a pump tied into a meter that reads blood sugar levels and dispenses the correct amount of insulin. Early on, blood sugar levels were detected through a urine test. “All you could do was test your urine by putting some drops in a test tube; you carried a kit around with you. You’d drop in a tablet and the resulting color was a guesstimate of what your blood sugar was,” Bateman said. “Today you can instantly determine what it is and the numbers don’t lie. The colors did. “Another fascinating advance to get around the finger prick method of testing is still in the early stages,” he said. “They call it the tattoo; they put these little pellets under the skin and the blood goes through them. A scan of the ‘tattoo’ will tell you what your blood sugar is.” Bateman has been recognized by Harvard Medical School and awarded the Joslin Medal for having lived on insulin for 50 years, “an uncommon occurrence,” he said. He was also awarded a Journey Award from Eli Lilly Pharmaceutical Co. He will be going to Harvard Medical School in Boston soon to participate in research for people who have been on insulin for 50 or more years. For Bateman, diabetes has changed his life in “a positive way,” he said. “I was a 19-year-old kid and I remember reading about diabetes and life expectancy and thinking ‘Oh jeez, I’m not going to live so long. I’ve got to get moving.’ Diabetes has brought discipline to my life.” With a shortened life expectancy, Bateman pushed himself to graduate in less than three years and earned three graduate degrees: MA, MS, and Ph.D. Now retired, he taught at Southern Illinois University and later was the Lumpkin distinguished professor in business at Eastern Illinois University. “There has never been anything I wanted to do that diabetes has kept me from doing,” he said.

By Bonnie Clark, Features Writer of Journal Gazette

DATE: July 02, 2009

The doctor had barely pulled away the needle when a blister appeared on Tracey Berg-Fulton's abdomen: An experimental shot was revving up the 24-year-old's immune system — part of a bold quest to create a vaccine-like therapy for diabetes. "If we're right, that is what's going to stop Type 1 diabetes," said Dr. David Finegold as he watched the blisters appear — one to match each of four shots — with intense satisfaction. It's a big "if." The research is in its infancy, a first-step experiment to be sure the vaccine approach is safe before researchers at Children's Hospital of Pittsburgh test their real target — kids newly diagnosed with this deadliest form of diabetes. It's also part of a big shift: Scientists increasingly hope to control Type 1 diabetes by curbing the rogue immune cells that cause it, before patients become completely dependent on daily insulin injections to survive. "Treating at onset in children is the best chance we have," said Pittsburgh immunologist Dr. Massimo Trucco, whose novel vaccine — made from patients' own blood — is among a handful of possible immune therapies being tested around the country.

About 3 million Americans have Type 1 diabetes, where the body mistakenly attacks and destroys cells in the pancreas that produce insulin, the hormone crucial to converting blood sugar to energy. It's different from the far more common Type 2 diabetes that is usually linked to obesity, where the body produces insulin but gradually loses the ability to use it properly. Type 2 patients have more treatment options, including diet and exercise. To stay alive, Type 1 patients must rigorously inject insulin, or wear a pump that infuses it. "It bothers me all the people who say, 'Can't you just exercise and get rid of it?'" said Berg-Fulton of Millvale, Pa., who was diagnosed just before her 10th birthday. "Type 2 gets all the attention. This is Type 1 — we die from this." Hence the new push for immune therapy. Preserve enough precious insulin-producing cells before irreversible damage is done and maybe patients would need far less insulin, perhaps only occasional injections like when they splurge on ice cream. But how? A "therapeutic vaccine" must shut down T cells that are the immune system's attack dogs, racing out to tackle infections or other invaders — but only the faulty ones that erroneously attack a Type 1 diabetic's own pancreas. Body-wide immune suppression would leave patients vulnerable to other illnesses. Drug companies are biologically engineering antibodies to disarm those T cells. Two competing teams — MacroGenics Inc. and Eli Lilly, and Tolerx Inc. and GlaxoSmithKline — have advanced tests under way. Also, an experimental drug made from a kind of bone marrow stem cell might tamp down overly aggressive T cells. Rather than a drug, Trucco's government-funded strategy: He blocks the 911 call that different white blood cells send to direct T cells to the pancreas. They're called dendritic cells, and altering three communication molecules on their surface basically confuses and paralyzes the T cells. In mice and monkeys, the reprogrammed cells ended the vicious cycle of a pancreas attack that in turn attracts more T cells to attack again.

Now to try it in people. "It's a neat concept," said Dr. Jay Skyler of the University of Miami, who heads a consortium of diabetes specialists that is closely watching Trucco's experiment. "It has a whole lot of potential." Exploring all the different immune-altering methods is important because combinations may be needed, said Dr. Richard Insel of the Juvenile Diabetes Research Foundation. Maybe a quick hit on T cells like antibodies might offer, followed by some gentler cell-based vaccines to keep them in check. But "these are early days," he cautioned. "I'm getting poked for science," joked Berg-Fulton as Finegold, an endocrinologist and geneticist at Children's, readied her shots last week. Back in April, Berg-Fulton donated her own blood so researchers could filter out immature dendritic cells and reprogram them. Reinject them just inside the skin over the pancreas — no deeper than a pinprick — and Trucco's animal experiments show the cells somehow find their way back to that organ to start working. That might be too much poking for children; Trucco also is developing a more drug-like way to alter dendritic cells without removing them first. For now, Berg-Fulton is part of a safety test, one of 15 adult diabetics being injected to make sure there are no unexpected side effects before researchers test if reprogrammed cells might really protect children's pancreas cells. Even if the vaccine ultimately works, she's had diabetes too long to benefit, Finegold carefully explained when she volunteered. "I'd be lying to say I'm not a little disappointed" at that, Berg-Fulton told him. Think long-term, Finegold responded. If doctors one day learn to restore insulin production, they'll need to keep the faulty immune system from just destroying it again.

DATE: June 26, 2009

Doctors are testing a new kind of obesity surgery without any cuts through the abdomen, snaking a tube as thick as a garden hose down the throat to snap staples into the stomach. The experimental, scar-free procedure creates a narrow passage that slows the food as it moves from the upper stomach into the lower stomach, helping patients feel full more quickly and eat less. Doctors say preliminary results from about 200 U.S. patients and 100 in Europe look promising.

CBS News medical correspondent Dr. Jennifer Ashton agreed. She said on CBS's Early Show that the procedure sounds hopeful for people suffering with obesity. After about 18 months, obese European patients have lost an average of about 45 percent of their body weight, said Dr. Gregg Nishi, a surgeon at Cedars-Sinai Medical Center in Los Angeles. He discussed the European and U.S. studies during a Chicago conference this week for digestive disease specialists. The procedure is only being done in the studies, which recently ended enrollment. Makers of the device used in the operation plan to seek federal approval if the research continues to go as planned. Ashton, who performed a year of clinical bariatric surgery research in Pittsburgh, Pa., with surgeons who did more than 1000 obesity procedures, said the procedure has significant advantages, including no skin incisions and no surgical pain. Ashton added that patients will benefit from the short recovery time. "They can be back to work the next day," she said. But, she said the absence of long-term data on the surgery, such as long-term weight loss for patients or reduced cases of diabetes, is a drawback.

While the two studies are still under way and only brief details are being released, Nishi said results so far are slightly better than typical results from with conventional stomach stapling. In the experimental study, risks include perforating the esophagus, as Nishi said happened to a patient at another center, but otherwise, he said, there have been no major complications. But in Ashton's opinion, the risks are similar to stomach stapling. She explained to Early Show co-anchor Harry Smith that there is the possibility of gastric bypass-leaks in the staple line, general anesthesia risks, staple-line failure due to over-eating, and perforation of the stomach. Some study patients have lost weight after unknowingly undergoing fake procedures - sedation and the tube, but no stapling. Results comparing them with the real thing aren't yet available.

Liliana Gomez, an administrative coordinator at Cedars-Sinai, was among the first Americans to have the scarless obesity surgery last year, as a test case for the U.S. study. She had planned on more invasive conventional surgery until learning that doctors at her hospital were studying the scarless stapling technique. "When I found out it was going to be oral, through your mouth, I was like, 'Wow, that's kind of different,"' she said. Since her operation in August, Gomez has lost about 40 pounds and dropped from size 22 to size 16. The 35-year-old mother of three has a long way to go - she's still obese according to body mass index standards. But Gomez says she has cut her meal portions by more than half and still feels full, and is optimistic she'll continue to lose weight. The new method is part of a medical movement to perform surgery through body openings such as the nose, mouth and vagina instead of making cuts. The idea is to reduce chances of infection and pain, and speed recovery. With no scars, there are cosmetic advantages, too. Gomez had considered a gastric bypass operation, a more complex kind of stomach stapling, but worried about risks from that surgery. It reduces the stomach to the size of a golf ball and reroutes the digestive tract. Whether done through one large abdominal incision or several tiny ones, gastric bypass is far more invasive and increases chances for malnutrition because it repositions how the stomach attaches to the intestines to restrict calorie absorption.

Another popular weight-loss surgery option involves putting an adjustable band around the top part of the stomach to create a small pouch. The experimental method Gomez had is the oral version of a different kind of stomach surgery, which reduces the size of the stomach with staples but doesn't reroute the digestive system. Surgery is generally considered a last-resort treatment for obesity, which affects more than 15 million Americans. Still, demand is high. More than 200,000 Americans are expected to have conventional forms of obesity surgery this year, according to the American Society for Metabolic & Bariatric Surgery. Dr. Scott Shikora, the society's president, called the oral procedure exciting and innovative, but said, "It is too early for us to say this is going to be a breakthrough." Shikora said many U.S. obesity surgeons prefer the rerouting surgery or flexible bands, and that it remains to be seen whether the oral method has the same drawbacks as more outmoded stapling procedures.

The U.S. study is taking place at 10 centers. Patients will be followed for at least one year, with final results expected in 2010. They are randomly selected to undergo either the operation or a sham procedure. Nishi said of 25 patients enrolled at his hospital, 17 got the real treatment, with no complications. "I'm very impressed with it," Nishi said. So far, it looks like "a viable alternative," he said. Satiety Inc., a California company that created the medical devices used in the technique, is paying for the research. Nishi said he has no financial ties to the company. At Washington University School of Medicine in St. Louis, where the first U.S. procedure was done last summer, about 30 patients have undergone the treatment. Side effects have been minimal, including sore throats, nausea and some abdominal pain lasting less than a week, said Dr. J. Christopher Eagon. He said weight loss results from his center aren't yet available.

DATE: June 19, 2009

London -Doctors who gave diabetics a drug originally intended to lower patients' cholesterol found it reduced their risk of so-called minor amputation by 36 percent, a new analysis of research says. Researchers in Australia, Finland and New Zealand studied almost 10,000 patients ages 50 to 75 with type 2 diabetes, the kind linked to obesity. About half of the patients were given fenofibrate, a drug available generically and sold as Antara, Fenoglide, Lipofen and others. The other half got fake pills. After five years, 115 patients had at least one lower limb amputation because of diabetes.

Diabetes can damage nerves and blood vessels. In severe cases, this leads to amputation. About one diabetes patient in 10 loses part of a leg. The study, first published in 2005, aimed to see if fenofibrate prevented heart disease. It didn't. But in this new analysis, experts found patients on fenofibrate had a 36 percent lower risk of a first amputation than those on placebo. Patients who lost part of their legs were more likely to have heart disease, skin ulcers or previous amputations. Amputations were labeled minor if they were below the ankle and major if they were above the ankle. The risk of minor amputations in patients without large vessel disease, the narrowing of blood vessels, was nearly 50 percent lower in the group taking fenofibrates. The risk of a major amputation was not substantially different between the two groups. Taller people were also more likely to suffer amputations. The results were published Friday in the medical journal Lancet. The study was paid for by Laboratoires Fournier SA, now part of Solvay Pharmaceuticals, which makes fenofibrates, and the National Health and Medical Research Council of Australia. After the study's first results, many doctors switched to statins to cut their patients' heart disease risks and dropped fenofibrates. Fenofibrates may be re-entering the game," said Sergio Fazio of Vanderbilt University Medical Center, who co-authored an accompanying commentary in the Lancet. "Fenofibrates cannot possibly take the place of statins, but they may earn a place next to them in diabetes treatment." The study's authors said their findings could change the standard treatment for avoiding amputations. "(Fenofibrates) is the first therapy that has been shown to reduce these amputations," said Anthony Keech of the Royal Melbourne Hospital in Australia and one of the paper's authors. Victoria King of the charity Diabetes UK said the study could help doctors find more ways of reducing diabetes-related amputations. Fenofibrates can cause side effects including abdominal pain, nausea, pancreas and lung problems.

DATE: June 12, 2009

The hydrangea could be used to treat a raft of common diseases including diabetes, researchers say. The colourful shrub - a staple of Chinese medicine - has the power to 'revolutionise' the treatment of multiple sclerosis, psoriasis and some forms of diabetes and arthritis, they claimed. These diseases occur when the immune system turns on and attacks the body.

Existing treatments are expensive and do not address the cause of the problem. Now it appears that a drug derived from the hydrangea's root could offer an alternative. A series of experiments found that it blocked the formation of white blood cells involved in autoimmune disease. Crucially, the drug does not seem to affect other kinds of cell vital to the body's defences. Mice with a multiple sclerosis-like disease were far less severely affected when given low doses of the drug, which is called halofuginone, the journal Science reported. Researcher Dr Mark Sundrud said: 'This is really the first description of a small molecule that interferes with autoimmune pathology but is not a general immune suppressant.' Hydrangea root has traditionally been used in Chinese and Native American medicine to relieve inflammation and cleanse the joints. It is one of the 50 staple herbs of Chinese medicine and is also a traditional medicine of north American Cherokee Indians. Leaf extract of hydrangea is also said to have anti-malarial properties. In some species, the colour of the flowers varies with the type of soil. Acidic ground produces blue buds, a neutral pH pale cream petals, and alkaline soils, pink or purple flowers. Halofuginone is already used to treat a rare autoimmune disease that affects the skin and internal organs. But much more research would be needed for it to be given the green light to treat other conditions such as rheumatoid arthritis and type 2 diabetes.

DATE: June 05, 2009

A common anti-diabetes drug may boost the potency of vaccines against cancer, research suggests. Tests on mice found metformin, used for Type 2 diabetes, helps the body's T-cells work more effectively. These cells, the body's key defenders against disease, "remember" former infections or vaccinations, enabling them to fight subsequent illness.

Writing in the journal Nature, a US team said metformin appeared to improve this important memory of disease. This ability to remember disease has been the subject of much research, but there has been little understanding of the cellular mechanisms behind it. The team from McGill University and the University of Pennsylvania used an experimental cancer vaccine and found that when administered in mice, the diabetes drug appeared to improve the strength of the inoculation.

Several studies in recent years have shown that people with diabetes may be more likely to develop certain cancers, although the exact nature of the relationship is unclear. Type 2 diabetes is associated with extra weight for instance, as are certain types of cancer. But there also appear to be similarities between the basic chemical reactions which happen in the cells when affected by either of these diseases. "Many genes involved in diabetes regulation also play a role in cancer progression," said Dr Russell Jones of McGill's Goodman Cancer Centre, one of the report's author. "There is also a significant body of data suggesting that diabetics are more prone to certain cancers. However, our study is the first to suggest that by targeting the same metabolic pathways that play a role in diabetes, you can alter how well your immune system functions." This is turn could help the body fight cancer more effectively with a vaccine. Cancer vaccines are still at an early stage, but ideally could help both stop the disease developing in the first place or treat it when it arises. Dr Kat Arney, Cancer Research UK's senior science information officer, said: "This is a fascinating piece of research, which sheds light on the complex links between the immune system, cell metabolism and cancer. "At the moment, this research has only been done in mice and there is a long way to go before it can be applied to cancer patients, but it certainly holds promise for the future."

DATE: May 29, 2009

Researchers at Rush University Medical Center have shown that depression is linked with the accumulation of visceral fat, the kind of fat packed between internal organs at the waistline. This type of fat has long been known to increase the risk of cardiovascular disease and diabetes. The finding may clarify the association between the diseases. The study was published in the May issue of Psychosomatic Medicine.

"Our results suggest that central adiposity – which is commonly called belly fat – is an important pathway by which depression contributes to the risk for cardiovascular disease and diabetes," said Lynda Powell, PhD, chairperson of the Department of Preventive Medicine at Rush and the study’s principal investigator. “In our study, depressive symptoms were clearly related to deposits of visceral fat, which is the type of fat involved in disease.” The study included 409 middle-aged women, about half African-American and half Caucasian, who were participating in the Women in the South Side Health Project (WISH) in Chicago, a longitudinal study of the menopausal transition.

Depressive symptoms were assessed using a common screening test, and visceral fat measured with a CT scan. Although waist size is often used as a proxy for the amount of visceral fat, it is an inaccurate measure because it includes subcutaneous fat, or fat deposited just beneath the skin. The researchers found a strong correlation between depression and visceral fat, particularly among overweight and obese women. The results were the same even when the analysis adjusted for other variables that might explain the accumulation of visceral fat, such as the level of physical activity. The study found no association between depressive symptoms and subcutaneous fat. The findings were the same for both black and white women. Powell speculated that depression triggers the accumulation of visceral fat by means of certain chemical changes in the body – like the production of cortisol and inflammatory compounds – but said that more research is needed to pinpoint the exact mechanism.

DATE: May 22, 2009

Gene therapy shows promise in treating diabetic polyneuropathy, a disorder that commonly affects diabetics who've had the disease for many years, a new study finds. Injections appear to be safe, but more research is needed.

Researchers in Boston found that intramuscular injections of vascular endothelial growth factor (VEGF) gene may help patients with diabetic polyneuropathy. The study included 39 patients who received three sets of injections of VEGF gene in one leg and 11 patients who received a placebo. Six months after treatment, the patients who received the VEGF gene injections showed greater improvements in sensory symptoms and pain than those who received the placebo. Loss of sensation and pain in the legs and feet, weakness, and balance problems are among the symptoms associated with diabetic neuropathy. The loss of sensation means that ulcerations on the feet may go undetected, which can lead to amputation. "Most patients had fairly severe neuropathy, and the expectation for improvement was therefore not high," Dr. Allan Ropper, executive vice chair of the neurology department at Brigham and Women's Hospital in Boston, said in a hospital news release. The VEGF gene used in the study is active without packaging it in a virus, which is a major safety advantage, according to the researchers. "The study shows that this form of gene transfer therapy can be performed relatively safely, but further investigation using a larger study group is needed before it can be introduced as a mainstream therapy," Ropper said. The study was presented in Seattle at the annual meeting of the American Academy of Neurology.

DATE: May 15, 2009

People who get too little sleep, or too much, are far more likely to develop diabetes, say scientists. A study has found that those who did not enjoy the optimum level of seven to eight hours sleep a night were two and a half times more likely to develop a blood sugar abnormality linked to type 2 diabetes. Researchers who studied the habits of 276 volunteers over a six-year period said they did not know the cause.

The findings, published in the journal Sleep Medicine, suggest seven to eight hours' sleep a night seems to be the ideal amount for adults to protect against common diseases and premature death. Scientists say they do not know the cause, but previous studies have shown a link between sleep patterns and obesity, cardiovascular disease and overall mortality. Obesity is known to be linked to diabetes, but the greater risk of diabetes due to sleeping habits remained even when obesity was taken into account. Previous research suggests sleep loss could disturb the production of hormones that control the desire for calorie-rich foods, hunger and energy expenditure.

Researcher Angelo Tremblay said 'This study is a continuation of our recent investigations having focused on the relationship between sleep duration and the risk of obesity. 'The greater risk towards diabetes that we document in our most recent paper remains significant even after a statistical adjustment for body mass index and waist circumference. 'With respect to clinical implications, it is clear that the recommendation to seek an optimal sleep duration seems to be appropriate but for some individuals, it is easier to say than to do.' Other surveys have revealed fewer and fewer people are getting the right amount of sleep. Around one third of the adult population regularly sleep five hours or fewer a night. The average night's sleep is seven hours which research suggests is the 'healthiest' amount. It is possible the increased risk for long sleepers might be a symptom of impending health problems

DATE: May 08, 2009

Australian scientists are a major step closer to developing a vaccine which could stop people at risk of Type 1 diabetes from developing the condition. Dr Shane Grey and his colleagues have found a way to stop the genetic condition from occurring in mice bred to spontaneously develop it and, he says, it appeared the protection was life-long.

The technique also had a 100 per cent success rate for the mice involved in the study, undertaken at Sydney's The Garvan Institute. 'It does sound too good to be true,' Dr Grey told AAP. 'We helped the immune system to re-educate itself, and it was tolerant again of the (mice's) insulin producing cells. 'That then gives very strong support to the idea that our drug treatment would give life-long protection.'

More than 140,000 Australians have Type 1 diabetes, a condition which causes their immune system to kill off their ability to make insulin. The genetic fault is present from birth but the condition may not strike until adulthood, and without daily insulin injections these people would lapse into a potentially fatal coma. The study found a chemical compound (BCMA-Fc), known to have potential benefits in combating a range of auto-immune disease, was effective in this case at stopping the onset of Type 1 diabetes. A clinical trial to see if the results could be replicated in humans could take place in around two years, he said. If successful, it could lead to the creation of a vaccine to inoculate people in families with a history of the disease. 'All immune cells talk to each other with various hormones ... and we've found this drug is an inhibitor of one of those hormones,' Dr Grey says. 'We've hit the nerve centre of the emerging clinical disease (diabetes Type 1).' The study was undertaken with support from the Juvenile Diabetes Research Foundation, and the Garvan's Diabetes Vaccine Development Centre. The results are to be published in the journal Diabetes

DATE: May 01, 2009

Even as science searches for more clues about the causes of diabetes and medications to prevent it, the vast majority of new cases of the disease in older adults could be prevented by following a modestly healthier lifestyle, according to research led by scientists at the Harvard School of Public Health (HSPH).

Researchers have found that a combination of five lifestyle factors could account for nine in 10 new cases of type 2 diabetes in men and women age 65 and older. The lifestyle factors that were examined included physical activity, diet, smoking habits, alcohol use, and amount of body fat (as determined by body mass index and waist circumference). The findings highlight that diabetes really is a lifestyle disease and is largely preventable, said lead author Dariush Mozaffarian, assistant professor of epidemiology at HSPH and assistant professor of medicine in the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School. Although previous studies had linked these lifestyle factors separately to diabetes or in sum to risk of diabetes in specific socioeconomic populations, this study quantifies the overall impact of several lifestyle factors associated with diabetes risk in a general population of older men and women.

Type 2 diabetes is the most common form of the disease and occurs when the body fails to properly respond to and produce insulin, resulting in a build-up of sugar in the blood and other biologic abnormalities. Incidence of diabetes has jumped in the past decade and is now estimated to affect 24 million Americans, or nearly eight percent of the population, according to the Centers for Disease Control and Prevention. The disease disproportionately affects older Americans. In this study, researchers tracked 4,883 men and women age 65 or older over a period of 10 years as part of the Cardiovascular Health Study, a multicenter study sponsored by the National Heart, Lung and Blood Institute to evaluate risk factors for cardiovascular disease in older adults. Data was collected through annual questionnaires and physical exams. Participants were asked about their physical activity level, diet, smoking habits, and alcohol use. Their body mass index and waist circumference were measured. Participants were grouped into a low-risk or high-risk group for each factor. During the study period, more than 300 subjects were diagnosed with diabetes. After making statistical adjustments for age, sex, race, educational level, and annual income, researchers found that each of the five lifestyle factors they measured was independently associated with the onset of diabetes. Overall, the rate of incident diabetes was 35 percent lower for each one additional lifestyle factor in the low-risk group.

Subjects in the low-risk group for diet consumed slightly better-than-average levels of dietary fiber and polyunsaturated fat and less trans fat and starchy and sugary foods. Other low-risk characteristics included whether participants had never smoked; consumed up to two alcoholic drinks per day (modest alcohol consumption has been shown to be a protective factor against diabetes); and were not overweight (defined by having a body mass index below 25 or a waist circumference of less than 88 cm for women or 92 cm for men). The study results underscore that people can lower their diabetes risk considerably, even if they are unable to follow a perfect ideal of healthy behavior. Very modest differences in lifestyle can have a tremendous impact on diabetes risk, Mozaffarian said. Even two or three or four of the five factors, in any combination, were associated with substantially lower risk. For instance, he pointed out that diabetes prevention often focuses on weight loss, something that is difficult for many people to achieve. But this study found that independent of any differences in weight, individuals in the low-risk category for only physical activity level and dietary habits had a 46 percent lower incidence of diabetes. Combining low-risk groups for physical activity level, dietary habits, smoking habits and alcohol use produced an 82 percent lower risk of diabetes, and four in five new cases of diabetes appeared to be attributable to not having these low-risk lifestyle factors. Adding either not being overweight or not having large waist circumference was associated with an 89 percent lower risk of diabetes. Mozaffarian pointed out that the differences in lifestyle between the low-risk and high-risk categories were not extreme. For instance, because participants were divided only into two groups, anyone who participated in physical activity above the average was included in the lower-risk group for that category. These physical activity levels included walking regularly and engaging in leisure activities. Mozaffarian said that prior work in the Nurses' Health Study showed similarly large associations between lifestyle risk factors and diabetes risk in married U.S. nurses. The new research includes older adults, both sexes, and is drawn from community-based populations, suggesting that these significant benefits of lifestyle are likely to extend to the general population. Whereas considerable ongoing research is investigating possible genetic causes of type 2 diabetes and the underlying biology of the disease, Mozaffarian said that this study and other studies emphasize that much is already known about how to prevent the majority of cases. "We are entering a public health emergency in obesity and diabetes," he said. "We know how to prevent nearly all cases of type 2 diabetes. We need real and sustained policy, research, and public health focus on this emergency so that we can fix the clear societal and individual causes of this epidemic."

Other study authors are based at the University of Washington and Northwestern University. The study was supported by grants from the National Heart, Lung and Blood Institute, NIH. One author was supported by an unrestricted educational grant from Amgen, Inc., to the Cardiovascular Health Study Coordinating Center.

DATE: April 24, 2009

A breakthrough in the treatment of high blood pressure could improve the life expectancy for a million Australians whose condition does not normalise with drugs. The procedure uses radio waves to silence or destroy nerves in arteries supplying the kidneys. Initial results show a significant reduction in blood pressure for most of the patients taking part in the study.

Gael Lander, 65, has suffered from high blood pressure for most of her adult life and lived with the constant fear of heart attack or stroke. "I really felt as if something or someone had pushed the fast forward button," she said. "Everything raced - for example, my heart - and I didn't quite know what a feeling of calmness was, or just being in a state of relaxation." But she says her life changed because of the radical new procedure; her blood pressure went from as high as 210 over 70, down to 140 over 70. "Obviously my blood pressure has dropped a lot, which has taken away that feeling of anything might happen at any time," she said. "It's given me a new peace of mind and you can't believe the feelings of relief I'm experiencing. "I'm also a diabetic and my blood sugars have dropped some 20 to 30 per cent over a period of nearly two years, so that's a bonus in itself." It's long been known that the sympathetic nervous system plays a role in controlling blood pressure and sugar levels.

Associate Professor Markus Schlaich co-authored the research at the Baker IDI Heart and Diabetes Institute in Melbourne , and he says this is the first treatment targeting those nerves that has proven both safe and effective "Together with an American company we've developed a device, a catheter-based device, that actually enables us to target these renal sympathetic nerves quite specifically," Professor Schlaich said. "These nerves run along the renal arteries, the blood vessels that supply the kidneys. "With this catheter-based device we can target these nerves coming from the inner side of the blood vessels, emitting energy into the tissue which kind of silences or destroys the nerves in the vessel wall, which then leads to a substantial reduction in blood pressure." And there was a significant reduction in blood pressure for the majority of the 50 patients who took part in the study. But Professor Schlaich says the procedure is not a cure. "All of these patients were on quite a few drugs which didn't really work, and we did this procedure but we did not necessarily reach normal blood pressure in all of these patients," he said. "So we still want them to be on their drugs in order to get the blood pressure as low as possible; the reason for that is that we know in general the lower the blood pressure, the lower the risk for cardio-vascular events. "And of course we want to protect them as much as possible." Further trials are now being planned and if successful, researchers say the procedure could be widely available within three years.

DATE: April 17, 2009

Chinese scientists have developed a nutritious low calorie, low sugar, vegetable juice for patients with diabetes. The research team led by Dr Heqin Xing and Xiuqi Liu of Jilin University in Changchun, China have come up with a cost-effective method of preparing a special type of vegetable drink using lactic acid-producing bacteria (LAB) to remove carbohydrates while retaining good taste, vitamins and other nutrients.

"This is an exciting development. The process significantly removes sugar but retains the nutritional content of the juice's raw materials," Liu said. The juice was made from pumpkin, balsam pear, onion and carrots. People have long cultured food including everyday eats such as yogurt, cheeses and sausage by using the same LAB. The LAB microbes produce a compound commonly found in sour milk products called lactic acid. Because of LAB's healthy link to food production, this class of bacteria is also referred to as probiotics. During the study, LAB reduced sugar content of the vegetable juice by transforming carbohydrates into lactic acid by a routine conversion process called fermentation. As this process increases the juice's acidity, it extends its shelf life as it inhibits growth of other bacteria. LAB is known for its ability to withstand acidic environments. In addition to the lactic acid's protection against contamination, the acidity from fermentation could enhance flavours in the beverage. The researchers’ use of Lactobacillus acidophilus and L. plantarum in the vegetable juice increased its acidity by about 10-fold after 12 hours of fermentation. With the addition of sugar, and a diabetic-friendly sugar substitute called xylitol, Xing the juice had a good mix of sweet and sour taste. "It has a good taste with reduced calories due to lower carbohydrates," Xing said. The findings were presented at the 237th National Meeting of the American Chemical Society.

DATE: April 10, 2009

Imagine if people at risk of heart disease could take a single pill that would contain all the medications they need to reduce their heart risk. Such a pill is already a reality and now new research suggests it's safe and effective. It's called a polypill and could soon become a cheap, simple way to prevent both heart disease and stroke. The formulation studied in this latest research is called Polycap and contains five medications:

• aspirin to prevent blood clots
• simvastatin, a statin to lower cholesterol
• atenolol, a betablocker used to treat high blood pressure
• ramipril, an ACE inhibitor also used to treat high blood pressure
• hydrocholorothiazide, a diuretic also used to treat high blood pressure

Researchers led by Dr. Salim Yusuf of the Population Health Research Institute at Hamilton Health Sciences and McMaster University conducted a short-term study in India to see if combining these five medications into one pill was as effective as each medication alone. They recruited 2,053 people across India who were between the ages of 45 and 80 who had no heart disease but had one risk factor for it, such as type 2 diabetes, smoking, or abnormal cholesterol levels. They divided the volunteers into nine groups: one received the polypill marketed as Polycap; the rest received either the medications alone or in different combinations. The researchers found the Polycap effectively reduced blood pressure, LDL cholesterol, and heart rate. What's more, the researchers found no additional side effects from combining all five medications into one pill compared to those who took the meds separately. The results of the study will be published in an upcoming edition of The Lancet and are also being announced at the American College of Cardiology meeting in Florida. The researchers believe the pill could massively reduce future incidence of heart attack and stroke in otherwise healthy people at risk of heart disease. They say the combined effects of all the medications in the Polycap could potentially reduce the rate "cardiovascular events", such as heart attacks and strokes, in these people by half. The pill is not meant to replace the healthy eating, exercise and other lifestyle factors needed to lower the risk of heart attack. But it should help patients who have trouble taking four to five medications a day or who sometimes forget some of the medications. Research suggests that many patients on multiple medications skip doses, believing that since they feel well, they don't need so many pills. Others regularly forget one or two of the meds in their regimens, putting themselves health at risk or a heart attack of stroke. The study authors stress that their findings are preliminary and that longer and larger studies are needed to evaluate the longer-term effects of the medications. As well, more research is needed on combining different strengths of each of the medications.

DATE: April 03, 2009

Stem Cells Show Promise For Treating Type 2 Diabetes

A University of Miami clinical trial recently announced that 25 patients achieved better insulin production, lower blood-sugar levels and a reduced need for insulin injections.

In the trial, still in its pilot stage, doctors extracted immature adult stem cells from the patients' own bone marrow, purified and concentrated them, and injected them into arteries near the pancreas. They then put the patients into hyperbaric oxygen chambers like those used for divers with decompression sickness - also called the "bends" - and subjected them to 10 hours of pure oxygen at 2.4 times the atmospheric pressure at ground level. Researchers believe the high-pressure oxygen pulled extra stem cells from the patients' bone marrow, adding to the stem cells injected near the pancreas. They say the immature stem cells developed into pancreatic cells, regenerating the pancreas's ability to produce natural insulin.

"This could be very important," says Dr. Camillo Ricordi, director of the Cell Transplant Center and the Diabetes Research Institute at University of Miami. "It could be an improved treatment for diabetes, substantially ameliorating type 2 and preventing the complications of the disease." Nearly 24 million people in the U.S., or 8 percent of the population, have diabetes, which can cause problems for the eyes, kidneys, nerves and heart, according to the Centers for Disease Control and Prevention. Ricordi cautioned that the optimistic findings come from small pilot studies involving only dozens of patients, and three to four more years of research are needed before practical treatments might start. "We always have to avoid hype and be careful not to put too much hope in pilot trials," Ricordi said. "But the first results are really promising." Two more successful trials over three or four years would be needed before the FDA might approve the treatment for the public. The studies, coordinated by University of Miami's Diabetes Research Institute, will also take place at the Karolinska Institutet in Stockholm, Stem Cell Argentina in Buenos Aires and other institutions.

DATE: MARCH 27, 2009

Heart-healthy diets that reduce calorie intake—regardless of differing proportions of fat, protein, or carbohydrate—can help overweight and obese adults achieve and maintain weight loss, according to a study funded by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health.

Researchers from the Preventing Overweight Using Novel Dietary Strategies (POUNDS LOST) study found similar weight loss after six months and two years among participants assigned to four diets that differed in their proportions of these three major nutrients. The diets were low or high in total fat (20 or 40 percent of calories) with average or high protein (15 or 25 percent of calories). Carbohydrate content ranged from 35 to 65 percent of calories. The diets all used the same calorie reduction goals and were heart-healthy—low in saturated fat and cholesterol while high in dietary fiber. On average, participants lost 13 pounds at six months and maintained a 9 pound loss at two years. Participants also reduced their waistlines by 1 to 3 inches by the end of the study. Craving, fullness, hunger, and diet satisfaction were all similar across the four diets. "These results show that, as long as people follow a heart-healthy, reduced-calorie diet, there is more than one nutritional approach to achieving and maintaining a healthy weight," said Elizabeth G. Nabel, M.D., director, NHLBI. "This provides people who need to lose weight with the flexibility to choose an approach that they're most likely to sustain—one that is most suited to their personal preferences and health needs."

In the POUNDS LOST study, 811 overweight and obese adults aged 30 to 70 were assigned to one of four diets, and asked to record their food intake in a diary or an online tool that showed how intake compared with goals. Group diet counseling sessions were held at least twice per month throughout the two years of the study, and individual sessions were held every eight weeks. Participants were given personalized calorie goals, ranging from 1,200 to 2,400 calories per day, which reduced their overall caloric intake as compared with their daily energy requirement. All participants were asked to do moderate-intensity physical activity, such as brisk walking, for at least 90 minutes per week. Study participants were diverse in gender and ethnicity, with 38 percent men and 22 percent representing minorities. Participants did not have diabetes or severe heart disease but could have had other risk factors, such as high blood pressure or high cholesterol. Overweight is defined by having a body mass index (BMI)—a calculation of the relationship between weight and height—greater than 25 and less than 30. Those with a BMI of 30 or higher are considered to be obese. Sixty-six percent of American adults are overweight and of those, 32 percent are obese, according to the Centers for Disease Control and Prevention.

Research was conducted in Boston at Harvard University School of Public Health and at the Pennington Biomedical Research Center of Louisiana State University in Baton Rouge, La. Diets were adapted during sessions to the diverse cuisines from these two regions of the country. "We were encouraged that, in addition to achieving and maintaining weight loss, study participants experienced other positive health changes as well," said Catherine M. Loria, Ph.D., a nutritional epidemiologist at NHLBI and co-author of the study. "The findings emphasize the importance of weight loss in reducing heart disease risk." All diets improved risk factors for cardiovascular disease at both six months and two years in ways consistent with previous studies. Improved risk factors include reduced levels of triglycerides, LDL (bad) cholesterol, lowered blood pressure, and increased HDL (good) cholesterol. All diets decreased the presence of metabolic syndrome, a cluster of related conditions, overweight, high triglycerides, high blood sugar, high blood pressure, and low HDL cholesterol, which increases heart disease risk. Previous studies have shown that a loss of 5 to10 percent of body weight will help reduce risk factors for heart disease and other medical conditions. In this study, 15 percent of patients achieved a 10 percent weight loss after two years.

"This new information should focus weight loss approaches on reducing calorie intake rather than any particular proportions of fat, protein or carbohydrate. This is important information for health professionals who prescribe weight loss for their patients, and for adults who are seeking ways to sustain a healthful eating pattern," said Frank M. Sacks, M.D., principal investigator of POUNDS LOST and Professor of Cardiovascular Disease Prevention in the Nutrition Department at the Harvard School of Public Health.

The target nutrient compositions of the four diets were:

• Low-fat, average protein: 20 percent fat, 15 percent protein, 65 percent carbohydrate
• Low-fat, high protein: 20 percent fat, 25 percent protein, 55 percent carbohydrate
• High-fat, average protein: 40 percent fat, 15 percent protein, 45 percent carbohydrate
• High-fat, high-protein: 40 percent fat, 25 percent protein, 35 percent carbohydrate

While the design of the POUNDS LOST study called for physical activity targets to be set at 90 minutes per week, many people need more physical activity in order to achieve their weight loss goals.

DATE: MARCH 20, 2009

Evidence continues to pile up that the sunshine vitamin protects against much more than bone-softening rickets. Vitamin D, also found in milk and oily fish, is becoming king, from fighting colds to preventing cancer. But here's the kicker. New research suggests we're not getting nearly enough, and recommended levels may be woefully inadequate.

Investigators at the Medical University of South Carolina shut down part of a National Institutes of Health study that left nursing mothers and infants deficient, even though the mothers received the maximum safe amount of vitamin D allowed by the Institute of Medicine. Bruce Hollis, primary investigator and MUSC professor of pediatrics, said the recommended 200 international units a day for babies, children and adults is grossly deficient. Further, the 2,000-unit-a-day upper limit ? the highest safe dose ? established a decade ago by the Institute of Medicine is "totally false."

In the trial, half of mothers given 2,000 units a day did not receive enough vitamin D to pass to their babies. For years, the medical community has pondered the perfection of human milk for babies except its one shortcoming: deficient levels of vitamin D. The answer may be simple, Hollis said. "It's deficient in vitamin D because mothers are." The five-year trial studying nursing mothers began two years ago with a $5-million NIH grant to determine how much vitamin D nursing mothers needed to supply their infants with enough. Dr. Robert Heaney, a vitamin D and calcium expert at Creighton University in Omaha, Neb., was on the panel that set the vitamin D levels in the mid-1990s. "Most of what we've learned about vitamin D has been in the last decade," Heaney said in a phone interview. "It does jillions of other things than prevent rickets."

Vitamin D is essential for absorbing calcium and enabling normal bone growth. The supplement is critical in preventing rickets and osteoporosis. Data also suggest that vitamin D could help prevent colon, prostate and breast cancers. The supplement also may play a role in preventing diabetes, hypertension and multiple sclerosis. Sources of vitamin D are fortified milk, eggs and fatty fish and brief sun exposure ? about 15 minutes ? twice a week to the face, arms, hands or back without sunscreen. Vitamin D is necessary for the blood to maintain healthy levels of calcium and phosphorus. The supplement lowers risk for breast, prostate and colon cancers, Heaney said. It also reduces risk for Type 1 diabetes, hypertension and multiple sclerosis, and improves resistance to infections. The average person needs about 4,000 units of vitamin D to maintain a healthy level in their bodies, Heaney said. The usual sources of Vitamin D include brief exposures to the sun, such as walking to your car, multivitamins, milk and oily fish. Even with all those sources, many people don't get enough, he said. Unless you work or spend a lot of time outdoors, Heaney recommended 1,000 to 2,000 units in addition to other sources of vitamin D.

But whether or not to seek that extra vitamin D in the sun is a point much debated among experts. No one would argue for browning oneself on the beach for hours, but some researchers suggest between five and 30 minutes twice a week without sunscreen. In light of the growing body of research, the American Academy of Pediatrics doubled its recommended dose to 400 units for newborns. "Regulations do not change rapidly," Heaney said. "That's why the work in South Carolina is so important." The MUSC study formed three groups of nursing mothers with participants in the Lowcountry and a secondary site in Rochester, N.Y. In one group, mothers and babies received 400 units each, as per the academy's recommendation. Mothers in that group ended up grossly deficient, Hollis said, but most of the babies, who are smaller, received enough of the supplement. A second group of mothers was given 6,000 units a day, three times the maximum dosage, and the babies did not receive supplements. Mothers and infants in this group were largely OK, Hollis said. In the third group, mothers were given 2,000 units, and babies were not given extra vitamin D. Half of the babies in this group failed to receive enough vitamin D, leading Hollis and co-primary investigator, Dr. Carol Wagner, to close that study group. By comparison, only 5 percent of babies from the two other groups did not receive enough vitamin D, a rate likely due to participants not following directions, he said. The decision to halt the trial group was based on the babies', not the mothers' levels, he said. Moms in the 2,000-unit-a-day group were borderline deficient. "When you stop an arm of an NIH study, that's a big deal," he said. The remaining groups will continue three more years.

DATE: MARCH 13, 2009

By Barbara Quinn

It's not in meat. Or milk. Or fish. It is only found in things that grow in the ground, such as vegetables, grains, fruit and nuts. We're talking about "dietary fiber," various components in our food that benefit our health. Basically, according to the newest definition by the Institute of Medicine and described in a recent position paper by the American Dietetic Association, dietary fiber includes the carbohydrate components of plants that are not digested and absorbed into the human small intestine. Fiber is just . . . on its way through. So why is it important in our diet?

Let me count the reasons:

1. An adequate intake of dietary fiber protects against heart disease. Current research shows that 12 to 33 grams of dietary fiber a day may lower blood pressure, improve blood cholesterol levels, and reduce the "inflammation" now attributed to cardiovascular disease. A pooled analysis of several studies found that every 10 grams of dietary fiber added to the diet (that's about the amount in a cup of beans) decreased the risk of dying of heart disease by 27 percent.
2. Soluble fibers lower bad cholesterol in your blood. Although some experts now frown on using the terms "soluble" and "insoluble" to describe two types of fiber, these are the terms we still find on food labels. While scientists fight it out, there is still some evidence that soluble fibers absorb water as they pass through the body, which helps pull "bad" LDL cholesterol out of the body. Foods that contain a good dose of soluble fibers include apples, barley, oats, beans and other legumes, fruits and vegetables. Other soluble fiber sources include psyllium, guar gum, beet fiber, xanthan gum and pectin.
3. Insoluble fibers tend to encourage "laxation" of the gastrointestinal tract. Stool weight increases as the intake of these dietary fibers increase. The result is a quicker trip through the body and more normal bowel movements. Whole grain foods such as whole wheat bread or brown rice are good sources of insoluble fiber. Some foods contain substances that are natural laxatives. They include cabbage, rhubarb, honey, figs, prunes, raspberries, strawberries and stewed apples.
4. Dietary fiber may help control diabetes. Remember, dietary fiber is a carbohydrate the body does not absorb. So a fiber-rich diet results in fewer total carbohydrates converting to high blood sugars. High fiber meals are also processed more slowly and result in slower rises of blood sugars after meals, according to the ADA.
5. Dietary fiber promotes the health of our gastrointestinal tract. Certain types of natural fibers in fruit, vegetables and whole grains are fermented in the large colon and may actually help our bodies absorb important minerals such as calcium.
6. Dietary fiber may help keep the pounds off. Our human body does not derive any energy, or calories, from fiber. So when we eat high fiber foods, we fill up on "bulk" that makes us feel satisfied but does not turn into love handles. And ask any cow: high fiber plant food requires a lot of chewing. The longer you have to chew your food, the fewer calories you are likely to take in. Lastly, foods high in fiber tend to contain fewer calories. For example, a cup of broccoli (high in fiber) contains about 25 calories; a cup of white rice (low in fiber) contains more than 200 calories.

Barbara Quinn is a registered dietitian and certified diabetes educator at the Community Hospital of the Monterey Peninsula.

DATE: MARCH 06, 2009

More than half of adults with diagnosed diabetes also have arthritis, a painful condition that can be a barrier to physical activity, according to a study released by the Centers for Disease Control and Prevention in today's Morbidity and Mortality Weekly Report.

Nationwide, 46.4 million adults have arthritis and 20.6 million adults have diabetes, with nearly 7 in 10 having had diabetes diagnosed by a health professional. Research shows that engaging in joint-friendly activities such as walking, swimming, biking can help manage both conditions. The study, “Arthritis as a Potential Barrier to Physical Activity among Adults with Diabetes: United States, 2005 and 2007,” analyzed data on the prevalence of physical inactivity among adults with arthritis and diabetes in all 50 states, the District of Columbia, and U.S. territories. The study suggests that the presence of arthritis acts as an additional barrier to physical activity among those with diabetes. The study found that 29.8 percent of adults with arthritis and diabetes were inactive, compared with 21.0 percent of people with diabetes alone, 17.3 percent of those with arthritis alone, and 10.9 percent of adults with neither condition.

The study also found that the percentage of adults with diabetes and arthritis who are physically inactive varied among states, ranging from 20.2 percent in California to 46.4 percent in Tennessee. “People who have arthritis, diabetes or both benefit from being physically active,” said Janet Collins, Ph.D., director, CDC's National Center for Chronic Disease Prevention and Health Promotion. “We know it can be difficult, but regular physical activity helps in many ways. For people with diabetes, physical activity helps control blood glucose and risk factors for complications. For people with arthritis, physical activity reduces pain, and improves function.” Adults with arthritis and diabetes have unique barriers to being physically active such as concerns about pain, aggravating or worsening joint damage, and not knowing how much or what types of physical activity are safe for them. These concerns must be addressed for adults with both conditions to become more physically active. “These findings suggest more needs to be done to help people with diabetes and arthritis get physically active to improve their health,” said Chad Helmick, M.D., a CDC medical epidemiologist and co-author on the study. “Engaging in regular physical activity and maintaining a healthy weight can help alleviate the pain and disability that often accompany arthritis.”

DATE: FEBRUARY 27, 2009

The descendents of Abraham are ready. They were born inside a cinderblock bubble in an anonymous building surrounded by fields in western Wisconsin. Raised on sterilized food and filtered air, they have never seen the sun, felt the rain, or been exposed to the germs known to make swine or people sick. This dynasty of pigs, which began with a boar named Abraham, has the same little eyes and floppy ears as those that become bacon and pork chops. But these are destined for a different service to humanity — to provide insulin-producing cells for people who have diabetes. All they need are the humans.

After decades of research and debate about the ethics and safety of putting living animal tissue into people, the first of such clinical research trials are within sight. Researchers at the Mayo Clinic and at the University of Minnesota have been studying the problem for a decade or more, and say now they will be among the first to propose transplanting living pig tissue into humans. Minnesota, as a result, has become the global epicenter for a unique type of medical-grade pig — animals raised in biosecure environments that insulate them from the infectious agents that have thwarted such transplants in the past. “We have a lot of pig wisdom and expertise” in Minnesota, said Bernhard Hering, a university diabetes researcher who has been studying animal-to-human transplantation for a decade. “You don’t find that at Rockefeller Univer-sity.”

In Rochester, the FIOS company, owned by the Mayo Clinic, houses genetically modified pigs that promise to pro-vide a future supply of hearts and perhaps other organs for people. In New Richmond Wis., the nonprofit Spring Point Project facility houses pigs bred to generate an unusually large number of insulin-producing “islet” cells that Hering hopes to use to treat diabetics. The first pig-to-human heart transplant could be just three to five years away, said Dr. Christopher McGregor, a transplant researcher at Mayo. The first pig-to-human islet cell transplant could happen within one to three years, Hering said. In December he accepted a $40 million gift from the family of Best Buy founder Richard Schulze that he said will greatly accelerate the diabetes research. If successful, islet cells and new hearts would be just the beginning. “The market is huge,” said Dr. Steven Miles, a professor and bioethicist at the university who studies the issues surrounding animal-to-human transplantation, called xenotransplantation. “Everybody would love to find a way to use xenotransplantation for blood,” he said. The 120 pigs at Spring Point’s facility in New Richmond have no idea how special they are. When visitors call, a few of them stare back intently at the faces peering through a thick glass window. They squeal and jostle for feed just like any other herd of pigs. But what extraordinary feed they are served. Without any animal fat or proteins, it’s a vegetarian’s dream. It’s been irradiated to sterilize it. The water used to power wash the concrete pens everyday has been exposed to ultraviolet light to kill any germs before it comes out of the sprayer. Humans are not allowed inside, except the handful of workers who must shower with microbial soap each time they enter what they call “the barrier” — the seven rooms that house the pigs. They don not one but two layers of sanitized suits. When they clean the floor of pig feces, they wear the same kind of caps and face masks used in hospi-tal operating rooms.

Two or more times a month, one of the pigs is killed and tested for 40 or 50 of the infectious agents that could be transmitted to humans and other pigs. So far, after two years and two generations of pigs born and raised entirely within the barrier, none has been found. “These are not your everyday ‘other white meat’ type of product,” said Miles. The extreme precautions are required to convince the Food and Drug Administration that transplanting tissue from pigs will be safe for humans. Surgeons have used treated porcine heart valves to repair human hearts for years, but islet cells and entire hearts are different — they constitute living tissue from pigs and cannot be purified before transplant. The potential for disease is terrifying. Regulators aren’t just worried about the known infections or pathogens that pigs and humans share — swine flu and toxoplasmosis among them. They also fear the epidemic that could occur if a virus or bacteria exclusive to pigs jumped to humans and evolved into something altogether new and lethal. Think bird flu, and all the global efforts to prevent its spread. The reward, however, could be enormous, the researchers say. People with diabetes, for example, often face a life of insulin injections, to say nothing of the many health risks that result from their disease. Their islet cells can be replaced by transplants from deceased human donors — either more islet cells or entire pancreases. But there aren’t nearly enough donated organs to go around, considering that 18 million people in the United States have been diagnosed with Type 1 and Type 2 diabetes. The same kind of hopeless ratios exist for patients needing transplanted hearts, livers and kidneys. The pathogen-free descendents of Abraham could solve the problem of supply. Pig products, including insulin, have been used in humans before, but transplanting the very islet cells could give human patients an almost limit-less supply. Yet significant barriers remain.

In 1996, researchers discovered that viruses called retroviruses, which live inside of cells, could be transmitted from pig cells to human cells. Though all animals and humans carry retroviruses, the discovery “created a shiver in the community,” McGregor said. It nearly brought the field of xenotransplantation to a halt. AIDS, which originated with monkeys, is a retrovirus. There is no way to eliminate those viruses because they are embedded in cells, and the risk of retrovirus transfer remains today. But the danger is not as great as was feared in 1996, McGregor said. Additional studies have shown that the pig retroviruses cannot live in as many human cells as researchers once feared. As a result, “people are becoming much more interested” in xenotransplantation, he said. That leaves the biggest problem of all: the human body’s own defense mechanism, the immune system. Most tissue transplanted into a human from another species would be rejected in minutes, McGregor said. Anti-rejection drugs that have been developed for human-to-human transplants could not stop it. To solve this problem, McGregor and his colleagues at Mayo have turned to genetic engineering. Their pigs at the FIOS facility have been genetically altered to eliminate the molecule on cell surfaces that triggers the human im-mune system to recognize transplanted tissue as foreign and to attack. They’ve also added genes to the pig that help minimize the immune response after transplantation. So far, monkeys receiving genetically altered pig hearts have survived for two months. “That’s huge,” McGregor said.

Hering, too, must overcome the immune challenge. But pig islet cells may be much easier to transplant into hu-mans because they trigger a much milder immune response, he said. That’s why he thinks his first human clinical trials might happen within a year or two. He has already successfully treated diabetic monkeys, which lived for six months after pig islet cells were implanted in their livers. Hering’s ultimate goal, however, is the holy grail of diabetes research: a limitless supply of insulin-producing cells that require no anti-rejection drugs at all. To accomplish that goal, Hering is attempting a kind of biological camouflage: a bioengineered scaffolding that can be seeded with pig islet cells and transplanted into a human patient’s abdomen. The combination of technologies would mask the foreign tissue from the human immune system in what he describes as biological “sanctuaries.” Hering is years away from that yet. But the promise is immense: a whole new field of medicine that could replace the failed organs of humans and cure diseases that have no cure today. If and when that time comes, the pigs in their biosecure bunker in New Richmond will be ready and waiting — a whole new twist on pig farming.

DATE: FEBRUARY 20, 2009

Hopes were raised that diabetes drugs could be developed as treatments for Alzheimer’s disease after scientists demonstrated the beneficial effect of insulin on the brain. A US-led research team found the hormone, released by the pancreas to help control levels of sugar in the blood, protected memory-forming parts of the brain. The study, published in the Proceedings of the National Academy of Sciences, concluded that insulin may slow or prevent the memory loss caused by toxic proteins which attack the brains of Alzheimer’s sufferers. It boosts theories the disease — characterised by progressively catastrophic dementia — could be due to a type of brain diabetes.

People with diabetes either fail to produce insulin, do not produce enough or fail to use what is produced effectively. Researchers from Northwestern University in Illinois and the Federal University of Rio de Janeiro in Brazil carried out a study that involved treating neurons taken from one of the brain’s memory centres — the hippocampus — with insulin and diabetes drug rosiglitazone. Cells in the hippocampus are susceptible to damage caused by ADDLs, toxic proteins that build up in people with Alzheimer’s disease. ADDLs (amyloid beta-derived diffusible ligands) are known to attack memory-forming synapses, according to the scientists. After the proteins have attached, the synapses lose their capacity to respond to incoming information, resulting in memory loss. The researchers discovered damage to neurons exposed to ADDLs was blocked by insulin, which stopped the proteins from attaching to the cells. The insulin-sensitising drug rosiglitazone enhanced protection by low levels of insulin, the study found.

DATE: FEBRUARY 13, 2009

Our eyes are our windows to the world and they are now emerging as a window of hope for diabetics. A team of scientists, led by Dr Per-Olof Berggren, has successfully cured Type-I diabetes in mice by tranplanting healthy islets of langerhans, that contain insulin-producing beta cells, from the pancreas into the eyes. Dr Berggren is head of Cell Biology and Signal Tranduction at the Diabetes Research Institute, University of Miami, as well as professor and head of experimental endocrinology at Karolinksa Institute in Stockholm, Sweden.

The revolutionary technique, which allows scientists to study the pancreatic islet function through a microscope, cured Type-I diabetes in mice in just a month. These studies have been on for the last three years and Ahmedabad may well help take it to the next stage. “It’s very difficult to study islets in the pancreas or in isolation in a test tube. Eyes have a normal blood flow and we can also look in through them,” said Dr Berggren, who is in Ahmedabad to attend a symposium organised by Zydus Cadila group. Studies have now progressed to transplants in one monkey in Miami and the results have been encouraging. Ahmedabad could soon play a critical role in this pathbreaking research as Dr Berggren is in talks with Zydus Research Centre for collaborative research. The huge monkey population in the city too could swing it our way. “We could be ready to test it on human patients blinded by diabetes in two years,” Dr Berggren said, adding that this technique may help study Type-II diabetes as well.

DATE: FEBRUARY 06, 2009

People who sit down to a daily breakfast of eggs may have an increased risk of developing type 2 diabetes, new research suggests. In a long-term study of 57,000 U.S. adults, researchers found that those who ate an egg a day were 58 percent to 77 percent more likely than non-egg-eaters to develop type 2 diabetes. The findings, published in the journal Diabetes Care, do not necessarily mean that eggs themselves put people on a path to diabetes, according to the researchers. But they do suggest it is wise to limit your egg intake.

"Based on the current data, our recommendations would be to consume eggs in moderation and not to exceed six eggs per week," lead researcher Dr. Luc Djousse, of Harvard Medical School in Boston, told Reuters Health. The study does not explain exactly why eggs are linked to diabetes, but cholesterol may play a role. The study participants' daily cholesterol intake was also related to diabetes risk, and when the researchers factored this in, the relationship between egg intake and diabetes weakened. In animal studies, high-fat diets have been shown to raise levels of blood sugar and the sugar-regulating hormone insulin -- suggesting a way that a cholesterol-heavy diet might promote diabetes. According to Djousse, it's important for people at risk of type 2 diabetes -- due to factors like family history and obesity -- to pay attention to their overall cholesterol intake, and not just cholesterol from eggs. Even more important, he noted, is a focus on overall health -- maintaining a normal weight, exercising regularly and eating a well-balanced diet -- rather than any one food or nutrient. He pointed out that eggs also contain important nutrients like protein, vitamins and minerals, and "good" unsaturated fats.

SOURCE: Diabetes Care, February 2009.

DATE: JANUARY 30, 2009

Muscle strength peaks in your 20s and then starts to decline. About five to seven pounds of muscle are lost each decade after about age 40 in both men and women. Aerobic exercises such as biking or running are great for cardiovascular fitness but aren't enough to prevent muscle loss. What's the secret to maintaining strong muscles and a healthy body into your later years?

It's strength training -- preferably started when you're young and continued during your 40s, 50s and beyond. In a recent study at Tufts University, arthritis pain was reduced by 43 percent after a group of older men and women completed a 16-week strength-training program. The researchers found that strength training was just as effective, or more so, than medications in relieving the pain of moderate to severe knee osteoarthritis. Similar effects have been found in patients with rheumatoid arthritis. Poor balance: Strengthening exercises can improve balance and flexibility, helping to prevent falls and broken bones. A New Zealand study of women aged 80 years and older showed a 40 percent reduction in falls with simple strength and balance training.

Weak bones: The pull of muscle on bone increases bone density and lessens the risk of osteoporosis developing in postmenopausal women and older men. A Tufts University study of women aged 50 to 70 found that strength training not only builds bone density but also lowers the incidence of fractures.

Overweight: People who have more muscles have a faster metabolism. Even at rest, your muscles consume more calories than other body tissues. With regular strength training, your average metabolic rate may increase up to 15 percent -- an enormous boon for weight loss and weight control.

Diabetes: Wider use of strength training programs could help prevent and control the skyrocketing prediabetes and diabetes epidemics in America. In a recent study of Hispanic men and women, 16 weeks of strength training produced dramatic improvements in glucose control that are comparable to taking diabetes mediation.

Mental health: Weight training can lift depression in a fashion similar to antidepressant medications, according to the Centers for Disease Control and Prevention. It's not known whether the improvements come from biochemical changes in the brain or from better self-confidence and esteem with participation in weight lifting.

Insomnia: People who do strength work regularly have better quality of sleep. They fall asleep more quickly, sleep more deeply, awaken less often and sleep longer. The sleep benefits obtained as a result of strength training are comparable to treatment with medication, the Centers for Disease Control reports, but without the side effects or expense.

Research has shown that people with chronic but stable medical conditions can benefit from resistance exercises. Before you start, discuss your health conditions and strength-training goals with your doctor. Make changes in your exercise routine slowly and gradually. The general recommendation is to do strength-training exercises on two or three days a week; allow at least one day of rest from those exercises between sessions. For each strength-training exercise, one set of 8 to 12 repetitions, performed to fatigue, is effective. Once you've had a chance to work up to it, two or three sets may even be better, according to the latest national guidelines. Lastly, don't believe the "no pain, no gain" mantra. Exercise performed properly should feel good. Consider working with a qualified fitness trainer for personalized advice.

By Dr. Elizabeth Smoots
Contact: doctor@practicalprevention.com.

DATE: JANUARY 23, 2009

The discovery more than a decade ago of leptin, an appetite-suppressing hormone secreted by fat tissue, generated headlines and great hopes for an effective treatment for obesity. But hopes dimmed when it was found that obese people are unresponsive to leptin due to development of leptin resistance in the brain. Now, researchers at Children's Hospital Boston report the first agents demonstrated to sensitize the brain to leptin: oral drugs that are already FDA-approved and known to be safe. Findings were published January 7 by the journal Cell Metabolism.

In 1995, researchers reported in Science that they had isolated a protein that is present in normal mice, but not in an obese strain of mice called ob/ob, which lacked a gene also called ob. When either obese or normal mice were directly injected with the protein now called leptin they ate less and lost weight. "Everyone in the field thought they would get the Nobel," says Umut Ozcan, MD, of Children's Division of Endocrinology. Unfortunately, when obese humans took the hormone, they lost weight only temporarily then rebounded back. "Most humans who are obese have leptin resistance," says Ozcan. "Leptin goes to the brain and knocks on the door, but inside, the person is deaf." For years, industry and academic laboratories have been searching for a drug to make peoples' brains sensitive to leptin again, without success.

In the new study, Ozcan's group first showed that the brain cells of obese mice have increased stress in the endoplasmic reticulum (ER) a structure within the cell where proteins are assembled, folded into their appropriate configurations, and dispatched to do jobs for the cell. In the presence of obesity, the ER is overwhelmed and can't function properly. This stress triggers a signaling cascade (the "unfolded protein response") that tries to relieve the stress by increasing the level of molecular "chaperones," which assist in protein folding, and by blocking more proteins from coming in. Ozcan and colleagues then showed that ER stress, and the resulting activation of this signaling cascade, blocks leptin action in the brain. Most intriguingly, they showed that using chemical chaperones to reduce ER stress can re-sensitize the brain to leptin, and lead to weight loss when used in conjunction with leptin. "I think our study will bring new hope for the treatment for obesity," says Ozcan.

Working first with mice made obese through a high-fat diet, they demonstrated that the animals developed ER stress in the hypothalamus, the main area of the brain where leptin signals. This in turn initiated the unfolded-protein response, rendering the mice extremely leptin-resistant. The team also created a strain of mice whose ER was weakened in the brain through deletion of a gene called XPB1 specifically in the neurons. These mice also developed ER stress and leptin resistance, and also became obese, despite having some of the highest leptin levels ever reported. As expected, the mice also ate more and gained more weight. But when Ozcan and colleagues pretreated either group of mice with a chemical chaperone (either 4-PBA or TUDCA) leptin sensitivity increased as much as 10-fold, and the mice had significant weight loss with leptin treatment even when fed a high-fat diet. Children's researchers hope to eventually move the discovery to human trials. Both 4-PBA and TUDCA are safe in humans and already FDA-approved for clinical use. 4-PBA (Buphenyl) used in urea cycle disorders and in cystic fibrosis; TUDCA (tauroursodeoxycholic acid), used for centuries in traditional Chinese medicine, is currently used in some liver diseases. Both agents are under study for use in neurologic disorders such as Alzheimer's disease and Huntington's disease.

In related work in 2006, Ozcan and colleagues reported in Science that chemical chaperones reduce ER stress in a mouse model of type 2 diabetes, normalizing blood sugar and restoring insulin sensitivity. In 1995, Amgen, Inc. (Thousand Oaks, CA) paid $20 million for commercial rights to recombinant human leptin, a record amount for a deal with an academic institution. In 2006, Amgen sold the rights to Amylin Pharmaceuticals (San Diego, CA). Amylin is testing leptin in combination with its diabetes drug, pramlintide. The current study was supported by the Timothy Murphy Fund, Junior Faculty Start-Up Funds provided to Ozcan from Children's Hospital Boston, and a Translational Research Award from Children's Hospital Boston.

DATE: JANUARY 16, 2009

Eat less, weigh less.

While it may sound painfully obvious, nutrition experts have been divided over whether cutting calories leads to long-term weight loss, because the practice can sometimes boomerang, triggering binge eating and weight gain. But, new research suggests that eating less can pay big dividends, particularly as you age. Publishing in the current issue of the American Journal of Health Promotion, researchers from Brigham Young University reported that the middle-aged women they studied had more than twice the risk of significant weight gain if they didn't cut back on food consumption.

"Some suggest that restrained eating is not a good practice," BYU professor Larry Tucker, the study's lead author, said in a university news release. "Given the environmental forces in America's food industry, not practicing restraint is essentially a guarantee of failure." The researchers followed 192 middle-aged women for three years and compiled information on their lifestyles, health and eating habits. The analysis revealed that women who didn't practice more restraint while eating were 138 percent more likely to put on 6.6 pounds or more, the news release said. Columbia University researcher Lance Davidson, who was not involved with the study, said the findings underscore a key principle of weight control. "Because the body's energy requirements progressively decline with age, energy intake must mirror that decrease or weight gain occurs," Davidson said. "Dr. Tucker's observation that women who practice eating restraint avoid the significant weight gain commonly observed in middle age is an important health message." Tucker said the benefits of cutting back on what you eat aren't limited to your reflection in a mirror. Healthful eating equals better health, he said. "Weight gain and obesity bring a greater risk of diabetes and a number of other chronic diseases," he said. "Eating properly is a skill that needs to be practiced."

Tucker offers these tips for better eating:

1. Record what you eat and how much.
2. Put less food on your plate.
3. Eat more fruits and vegetables. The U.S. food pyramid recommends at least five servings each day.

DATE: JANUARY 09, 2009

A new report suggests that treating gum disease in patients who have diabetes with procedures such as cleanings and periodontal scaling is linked to 10 to 12 percent lower medical costs per month. The findings are encouraging but the study was not designed to firmly establish cause and effect, said George Taylor, University of Michigan associate professor of dentistry, who also has an appointment in epidemiology in the U-M School of Public Health. Taylor led the research project to investigate whether routine, non-surgical treatment for gum disease is linked to lower medical care costs for people with diabetes.

In periodontal disease, the body reacts to the bacteria causing the gum infection by producing proteins or chemicals called inflammatory mediators. Ulcers and open sores in the gums become passageways for these proteins and for the bacteria themselves to enter the body's blood circulation. These inflammatory mediators, as well as some parts of the bacteria, prevent the body from effectively removing glucose, or sugar, from the blood. The higher level of blood sugar is known as poor diabetes control. Poor diabetes control leads to serious diabetes complications such as vision disorders, cardiovascular and kidney disease and amputations, among others.

"Cleanings and other non-surgical periodontal treatment remove the harmful bacteria," Taylor said. "We believe this helps prevent the body from producing those harmful chemicals that can enter the systemic circulation and contribute to poorer diabetes control." Blue Care Network provided U-M researchers data from 2,674 patients aged 18-64 who were enrolled in BCN between 2001 and 2005 and had at least 12 consecutive months of medical, dental, and pharmaceutical coverage. "We found insured adults with diabetes in Michigan who received routine periodontal treatment, such as dental cleanings and scaling, have significantly lower medical care costs than those who do not," Taylor said. "These results could be meaningful to individuals, employers, health care providers and insurers."

The study showed that medical care costs decreased by an average of 11 percent per month for patients who received one or two periodontal treatment procedures annually compared to those who received none. For patients receiving three or four annual treatments, costs decreased nearly 12 percent. The study also showed that combined medical and pharmaceutical monthly costs were 10 percent lower for patients who received one or two periodontal procedures annually.

"The results of our analyses provide additional evidence supporting a beneficial role for periodontal treatment in improving overall health for people with diabetes," Taylor said. The findings could fuel changes in policies and practices for diabetes patients and their insurers. The research was supported by a grant from the Blue Cross Blue Shield of Michigan Foundation. Taylor's team includes: Wenche Borgnakke, senior research associate in health sciences; Michael Manz, senior research associate in health sciences; and Tammie Nahra, assistant research scientist.

DATE: JANUARY 02, 2009

As the holidays wrap up, some medical advice most people will like: Take a nap. Interrupting sleep seriously disrupts memory-making, compelling new research suggests. But on the flip side, taking a nap may boost a sophisticated kind of memory that helps us see the big picture and get creative. "Not only do we need to remember to sleep, but most certainly we sleep to remember," is how Dr. William Fishbein, a cognitive neuroscientist at the City University of New York, put it at a meeting of the Society for Neuroscience last week. Good sleep is a casualty of our 24/7 world. Surveys suggest few adults attain the recommended seven to eight hours a night. Way too little clearly is dangerous: Sleep deprivation causes not just car crashes but all sorts of other accidents. Over time, a chronic lack of sleep can erode the body in ways that leave us more vulnerable to heart disease, diabetes and other illnesses.

But perhaps more common than insomnia is fragmented sleep - the easy awakening that comes with aging, or, worse, the sleep apnea that afflicts millions, who quit breathing for 30 seconds or so over and over throughout the night. Indeed, scientists increasingly are focusing less on sleep duration and more on the quality of sleep, what's called sleep intensity, in studying how sleep helps the brain process memories so they stick. Particularly important is "slow-wave sleep," a period of very deep sleep that comes earlier than better-known REM sleep, or dreaming time. Fishbein suspected a more active role for the slow-wave sleep that can emerge even in a power nap. Maybe our brains keep working during that time to solve problems and come up with new ideas. So he and graduate student Hiuyan Lau devised a simple test: documenting relational memory, where the brain puts together separately learned facts in new ways. First, they taught 20 English-speaking college students lists of Chinese words spelled with two characters - such as sister, mother, maid. Then half the students took a nap, being monitored to be sure they didn't move from slow-wave sleep into the REM stage. Upon awakening, they took a multiple-choice test of Chinese words they'd never seen before. The nappers did much better at automatically learning that the first of the two-pair characters in the words they'd memorized earlier always meant the same thing - female, for example. So they also were more likely than non-nappers to choose that a new word containing that character meant "princess" and not "ape." "The nap group has essentially teased out what's going on," Fishbein concludes. These students took a 90-minute nap, quite a luxury for most adults. But even a 12-minute nap can boost some forms of memory, adds Dr. Robert Stickgold of Harvard Medical School. Conversely, Wisconsin researchers briefly interrupted nighttime slow-wave sleep by playing a beep - just loudly enough to disturb sleep but not awaken - and found those people couldn't remember a task they'd learned the day before as well as people whose slow-wave sleep wasn't disrupted. None of the new work is enough, yet, to pinpoint the minimum sleep needed for optimal memory. What's needed may vary considerably from person to person. "A short sleeper may have a very efficient deep sleep even if they sleep only four hours," notes Dr. Chiara Cirellia of the University of Wisconsin, Madison. But altogether, the findings do suggest some practical advice: Get apnea treated. Avoid what Harvard's Stickgold calls "sleep bulimia," super-late nights followed by sleep-in weekends. And don't feel guilty for napping.