Monday 24 February 2020

Recipe: Low Carb African Chicken & Peanut Stew

From asweetlife.org

Here’s an easy adaptation of a staple in homes across West Africa: chicken stew thickened with “ground nuts,” also known as peanuts. Garlic, ginger and tomato build layers of flavour for the broth, and at the end we swirl in chunky natural peanut butter (no added sugars or oils), which adds a delightful richness. The combination of flavours is exciting and distinct.


Dark chicken leg meat is ideal, because it doesn’t overcook easily – this lets you bubble the stew down until the broth reaches your preferred consistency with no worries about dry meat. And cooking bone-in chicken adds richness and body to the broth. I let it simmer for 30 minutes, which cooked it almost down into a sauce. You can choose skinless chicken to reduce the fat content.

This dish is full of medium-carb ingredients, but they’re all high-flavour and pack a punch in small amounts. I’ve tweaked the recipe bring the net carbs within the bounds of most keto meal plans, and I couldn’t have been happier with the result.

Ingredients
  • 2 chicken leg & thigh pieces, bone-in and skin-on
  • salt
  • black pepper
  • 2 Tbsp peanut oil (or other neutral oil)
  • 3 cloves garlic, peeled
  • 2” knob of ginger, peeled
  • ½ cup canned crushed tomato
  • 1 large jalapeño, sliced (optional)
  • 3 cups chicken stock or bone broth (preferably homemade)
  • 4 Tbsp natural peanut butter
  • Cilantro (or parsley) to garnish
Instructions
  1. Slice through chicken leg & thigh at the knee joint to separate, if necessary. Season with salt & black pepper.
  2. Heat peanut oil in a heavy-bottomed pot or Dutch oven over medium-high heat.
  3. Sear the chicken on both sides until pleasantly browned, about 3 minutes per side.
  4. Remove chicken and set aside. Turn heat off.
  5. Using a microplane, mortar or a sharp knife, zest, pulverize or mince the garlic and ginger into a fine paste.
  6. Add garlic-ginger paste to the same pot, and turn heat back to low. There should be enough oil remaining in the pan from the previous step.
  7. Lightly sauté garlic-ginger paste until fragrant. Add jalapeño and sauté for another minute.
  8. Add tomato and sauté for several minutes, until it tomato slightly darkens and looks good and oily.
  9. Return chicken to the pot, add stock, and return to a boil.
  10. Lower to a simmer and top the pot with a lid. Simmer for 30 minutes.
  11. Remove lid. Add peanut butter and swirl to combine. Continue cooking until broth achieves the desired thickness.
  12. Serve with a sprinkle of chopped cilantro or parsley to garnish.
Yield: 2
Food energy: 868 kcal
Total fat: 70g
Carbohydrate: 14.1g
Protein per serving: 47g
Total dietary fibre: 3.5g


Saturday 22 February 2020

Never, never give up!

From knowdiabetesbyheart.org

Feeling overwhelmed by type 2? You’re not alone. We know it can be really tough to stay on top of diabetes for the long haul. But you’ve already come SO FAR in managing your diabetes, and you’re committed to taking charge of your health. To keep the momentum going, learn about your risk of heart disease – and what you can do to reduce it.

When you have type 2 diabetes,  you make a lot of decisions all day long. It can be overwhelming to manage so many things. But you’re doing it and tackling each new day.

The American Heart Association  and American Diabetes Association  built the Know Diabetes by Heart initiative to help you along the way. We hope you’re proud of yourself  for all of your hard work!

Add these seven tips to  your self-care checklist  to care for your heart and body  to make all of your efforts count  even more.

1  Check in with your doctor regularly.  Ask about your heart health.

2  Continue healthy eating habits. Add fruits and veggies as a start.  Eating better will help you *feel* better.
3  Keep moving. Alone or with a friend, it can feel great.
4  Self-care can be heart care. Lowering your stress is good for your mind and body.
5  Quit smoking. For ALL the reasons.
6  Monitor your blood glucose,  blood pressure, cholesterol and weight.
7  Take medication(s) as prescribed.

People with diabetes CAN lead healthier lives.

https://knowdiabetesbyheart.org/never-never-give-up/

Thursday 20 February 2020

Heavily processed foods tied to diabetes

From health.harvard.edu

As we've reported before, eating or drinking heavily processed foods — like sugary drinks, chicken nuggets, frozen dinners, or sweetened cereals — is associated with an increased risk for weight gain, heart disease, and even early death. Now a large observational study published online Dec. 16, 2019, by JAMA Internal Medicine links the consumption of such "ultraprocessed" food to an increased risk for developing diabetes.

Researchers evaluated the questionnaire responses of more than 100,000 diabetes-free people (average age about 43) over six years. People who ate the most ultraprocessed foods (about 22% of their diet) had a higher risk for developing diabetes compared with people who ate the least amount of ultraprocessed foods (about 11% of their diet). The risk for developing diabetes went up 15% for a 10-percentage-point increase in the amount of ultraprocessed food in the diet.


The connection held up even after scientists accounted for known risk factors for diabetes, such as weight and physical activity.

The takeaway: Skip processed foods in favour of whole foods, including lots of vegetables, fruits, legumes, and whole grains.


Tuesday 18 February 2020

Good news for those with type 2 diabetes: Healthy lifestyle matters

From health.harvard.edu
By Alyson Kelley-Hedgepeth, MD

Type 2 diabetes (T2D) is a metabolic disorder of insulin resistance — a reduced sensitivity to the action of insulin — which leads to high blood sugar, or hyperglycaemia. Approximately 12% of American adults have T2D, and more than one-third of Americans have prediabetes, a precursor to T2D. This is a major public health concern, as T2D dramatically increases risk for heart disease, including heart attacks, atrial fibrillation, and heart failure.

The development and progression of T2D is affected by many factors. Some, such as a person’s race/ethnicity, age, and gender cannot be modified. Others, including body weight, exercise, and diet can be changed.

Can lifestyle changes help reduce heart disease risk if you have diabetes?

In 2010, the American Heart Association (AHA) published “Life’s Simple 7,” which they defined as “seven risk factors that people can improve through lifestyle changes to help achieve ideal cardiovascular health.” The Simple 7 touched on smoking status, physical activity, ideal body weight, intake of fresh fruits and vegetables, blood sugar, cholesterol levels, and blood pressure.
Subsequent studies found that people in optimal ranges for each of these factors had lower risks of heart disease compared to people in poor ranges. But given the significant increase in heart disease risk in those with T2D, it was not clear if the impact of these modifiable factors would hold true for the T2D population.

Recent study suggests lifestyle changes do benefit T2D and prediabetes

A recent study published in JAMA Cardiology looked at whether the ideal cardiovascular (CV) metrics covered in Life’s Simple 7 translate into improved CV health for those with T2D or prediabetes. The results were exciting, and consistent with other large population-based studies. Patients who had five or more ideal CV measures had no excess of CV events compared with people with normal blood sugar levels. CV events measured in the study included death, heart attack, stroke, and heart failure. Each additional ideal health metric was associated with an additional 18% drop in CV event risk for people with T2D, and an additional 15% drop for those with prediabetes.

This was a prospective, observational study, examining the association of risk factors only. It was not a randomized trial looking at an intervention. As a result, we cannot draw conclusions about cause and effect. Nonetheless, this is the first study to show a positive association between ideal lifestyle factors and CV health in people who are at high risk for CVD due to T2D. These results showcase the importance of our lifestyle choices, suggesting that meeting ideal health metrics can help reduce risk of CV events.

Life’s Simple 7

So what are the lifestyle and metabolic health goals should you strive for, whether or not you have diabetes?
  1. Manage blood pressure. 120/80 mm Hg or lower is best.
  2. Control cholesterol. Aim for total cholesterol below 200 mg/dL.
  3. Reduce blood sugar. Get your HbA1c (an average measure of blood sugar over the past three months) under 5.7% if you have prediabetes, or below 6.5% if you have T2D.
  4. Get active. Your goal is 150 minutes per week of moderate-intensity activity or 75 minutes per week of vigorous activity.
  5. Eat better. That means at least 4.5 cups of fruits and vegetables per day.
  6. Lose weight. You want a body mass index (BMI) of less than 25.
  7. Stop smoking. You’ll reap CV benefits, not to mention lowering your risk for cancer, COPD, and much more.

Recipe: Low Carb Inside Out Peanut Butter Blossoms

From asweetlife.org

Taking a classic American cookies recipe and flipping it inside out! For these low carb thumbprints, I made a chocolate cookie with a peanut butter centre. They are fun and delicious.

Do note that the consistency of your filling will vary depending on what peanut butter you use. If it’s very oily and thin, you may need more powdered sweetener to help thicken it up properly. I also recommend a pinch of salt, if it’s unsalted.


Ingredients
    Cookies:
  • 1 ¾ cup almond flour
  • ¼ cup cocoa powder
  • ½ tsp baking powder
  • ¼ tsp salt
  • ½ cup butter, softened
  • Granulated sweetener equivalent to ⅔ cup sugar
  • 1 large egg, room temperature
  • 1 tsp vanilla extract
  • Filling:
  • ¼ cup creamy peanut butter
  • 2 tbsp butter
  • ½ tsp vanilla extract
  • Powdered sweetener equivalent to ¼ cup sugar (more if needed)
Instructions
    For the cookies:
  1. Preheat the oven to 325F and line a large baking sheet with a silicone mat or parchment paper.
  2. In a medium bowl, whisk together the almond flour, cocoa powder, baking powder, and salt.
  3. In a large bowl, beat the butter with the granulated sweetener until well combined. Beat in the egg and vanilla extract, then beat in the almond flour mixture until thoroughly mixed.
  4. Roll into 1 inch balls and place an inch or so apart on the prepared baking sheet. Press down lightly with the heel of your hand to about ½ inch thick, then use your thumb to create a well in the centre.
  5. Bake about 10 to 12 minutes, until a bit puffed. They will still be quite soft quite soft. Remove and let cool completely.
  6. For the filling:
  7. In a medium microwave safe bowl, combine the peanut butter and butter. Melt on high until it can be stirred together. Stir in the vanilla extract.
  8. Whisk in the powdered sweetener until smooth. Let rest for 10 minutes or so to cool and thicken (should be a thick glaze consistency - add more sweetener if needed to thicken).
  9. Spoon the filling into the wells of the cookies and refrigerate until set, about 30 minutes.
Yield: Makes 30 cookies (2 per serving)

Monday 17 February 2020

AskNadia: Can Type 2 Diabetes Turn into Type 1?

From diabeteshealth.com

Dear Nadia:
I have type 2 diabetes and am on 500 mg of Metformin. My A1c inched up a bit, and my doctor doubled my daily metformin medication. I also wear an Abbott CGM, which I love. Some nights I wake up with a 40-blood sugar reading. Other times I will eat a burger at night, and my blood sugar is excellent throughout the night. I drink red wine with dinner every night. I stopped taking my medication for one day.
Can my Type 2 diabetes turn into type 1?
AE

Dear AE,
You are doing the right thing by working with your healthcare professional. The prescribed Metformin is based on your unique medical profile. Typically an increase in dosing is an effort to lower your blood sugars to achieve your A1c goal.

How Does Metformin Work

Metformin prevents the liver from releasing glucose, allowing the insulin your body still produces to be more effective.
Drinking wine every night is generally not recommended by healthcare professionals. One of the dangers of drinking with medications is possibly confusing a low blood sugar by feeling “buzzed.”

If you started experiencing low blood sugars right after you increased your medication, remember, your doctor is trying to figure out what the best dose for you is. 500 mg may be too low if your blood sugars are running high, while 1000 mg per day may be too high if your blood sugars are running low. Not taking your medication is never a good idea. Metformin is either time-released or immediately released. Read your prescription bottle to see if you have a generic or branded metformin.

Your healthcare professional team depends on you to give them feedback on how the medicine is working in attaining your mutually agreed blood sugar goal. I would call your doctor to share the frequency of low blood sugars. Let them know when it is most likely to dip down. To dial in the perfect dose, make sure to continue the follow up with your healthcare professional on your blood sugar readings until you achieve the blood sugar targets you have both set for yourself.

The long answer is, unless you are a person living with type 1.5 diabetes, then the answer is no. Type 2 does not turn into type 1 diabetes.

Type 1.5 Diabetes

Type 1.5 diabetes, also known as Latent Autoimmune Diabetes in Adults (LADA), is an autoimmune disease that falls between type 1 and type 2 diabetes because it has characteristics of both.
According to an article in The Beacon News, approximately 10 percent of patients with type 1.5 are misdiagnosed with type 2. If you’re over 35 when you develop diabetes, and especially if you have excess weight or classified as obese, your healthcare provider may assume that you have type 2 diabetes.

Therefore, if you don’t quite fit the profile of someone with type 2 diabetes, if diabetes pills don’t seem to be working well, or if you show some of the characteristics of type 1, maybe you have LADA. People with LADA have islet antibodies in their blood and, as in type 1 diabetes, their immune system is attacking beta cells. However, this is happening at a much slower rate and initially they don’t need insulin. One may consider that LADA is type 1 diabetes that progresses slowly.

One study in Diabetes Care states you probably have LADA (rather than type 2 diabetes) if two or more of the following fit:
• You were under age 50 when you were diagnosed with diabetes.
• You had “acute” symptoms at diagnosis, that is, symptoms typical of type 1 diabetes.
• Your BMI is less than 25.
• You have a personal history of autoimmune disease (such as thyroid disease, celiac sprue, Addison’s disease, or others).
• You have a family history of autoimmune disease.

The symptoms of type 1.5 are the same as the more well-known types of diabetes. They include increased thirst, increased urination, weight loss, and blurred vision.
I wish you the best in health!
Nadia

Disclaimer:
Nadia’s feedback on your question is in no way intended to initiate or replace your healthcare professional’s therapy or advice. Please check in with your medical team to discuss your diabetes management concerns.


Saturday 15 February 2020

What is the Best Diet for Diabetes?

From diabetesfoodhub.org
By Jaclyn Konich, MPH, RD

If diet is so important for managing diabetes, surely there is one perfect diet that everyone with diabetes should follow, right? The media, the internet, your Facebook feed, and even your Aunt Judy all have opinions about the correct diet for diabetes. So, what’s the answer? Every year, U.S. News surveys popular diets and eating patterns—including keto, Mediterranean, vegan, DASH, and others—and then reviews the scientific evidence to compile their annual list of best diets for diabetes. This year's results may just surprise you.


Every year, U.S. News gathers a panel of experts to review and rank the best “diets” for overall health, weight loss, heart health, diabetes, and other categories.

The panel reviews the most up-to-date research and evidence on each diet and its claimed health benefits. They also consider how easy the diet is for people to follow and stick to, and if health benefits, such as weight loss, last in the long term.

Topping the list of “Best Diets for Diabetes” is the Mediterranean diet (this diet was also ranked #1 in “Best Overall”). Next is a four-way tie for second place between DASH, Flexitarian, Mayo Clinic, and Vegan diets. (Check out the article if you want to see the rest of the list, and learn more about each diet.)

What do the top-ranked diets have in common?

1. They’re not really “diets.”
At least not in the modern sense. These diets are not considered temporary regimens to “detox,” “reset,” or reach a certain goal quickly. They’re more like eating patterns that are intended to be permanent.

With the exception of vegan, none of the top-ranked diets cut out certain foods or nutrients, or have strict rules to follow. And none of them require you to count calories or carbs.

2. They focus on plant foods.
All of these patterns encourage eating more plant foods like vegetables, fruits, whole grains, beans, and legumes (the vegan diet goes even further by only allowing plant-based foods—it eliminates all animal products, including meat, poultry, fish, eggs, and dairy foods).

Research overwhelmingly supports the benefits of eating more plant-based foods. Plant foods are packed with vitamins, minerals, and antioxidants that are important for general health. They’re also the best source for fiber, which helps manage blood glucose.

Essentially, plants are nutrient-dense and low in calories, giving you a lot of bang for your buck!

3. They don’t focus on restricting carbs. You may notice that the list does not include any diets focused on restricting carbs like keto or Atkins. While research shows that reducing carb intake can help manage blood glucose, there’s not enough evidence to say that people with diabetes need to cut out all carbs.

The bigger issue is that very low carb diets can also be hard to stick with in the long run. It may be easier to start by focusing on the quality of carbs, monitoring your portions, and following a flexible healthy eating pattern for long-term benefits.

4. They’re not “fads.”
The most successful patterns have all been around for a long time. The Mediterranean diet may seem like a new fad, but it’s based on the way people in the Mediterranean region have been eating for centuries.

The “Flexitarian diet” may also sound fancy and new, but many people already eat this way, whether they’re trying to or not.

Veganism has also been around for a long time, and some people choose to eat this way for ethical or environmental reasons as well as health reasons.

5. They’re backed by science.
All of the top-ranked diets have been extensively researched and have a mountain of scientific evidence backing them up. DASH and Mayo clinic diets were developed by respected, evidence-based institutions.

Mediterranean, vegan, and “flexitarian” eating patterns have been around for a long time, but they are getting trendier as more and more research shows their health benefits.

Which should you choose?

It’s important to note that none of these eating patterns are particularly “better” than the others. With a four-way tie for second place, and a three-way tie for third place, there are eight “Top 3” diets!

All of these eating patterns include basic principles of healthy eating, so any one of them can help you manage or prevent type 2 diabetes.

The best diet for you is going to be the one that fits best with your lifestyle and preferences, and that you’re most likely to stick with long-term.

BOTTOM LINE

You don’t have to follow a certain “diet” to manage diabetes. Work towards a healthy eating pattern that fits your lifestyle and preferences. Here are some tips to help you get started:
  • Eat plenty of vegetables (especially non-starchy vegetables that are low in calories and carbs).
  • Choose whole foods over processed foods. One way to do this is by preparing more meals at home.
  • Reduce added sugar. Limit sugary foods like sodas, candies, and sweets. Check nutrition facts labels for added sugar in packaged foods.
  • ​Choose proper portion sizes. The Diabetes Plate Method is a quick and easy way to build balanced meals with proper portions.
Remember, any time that you’re making changes to your medication, eating, or exercise be sure to have a conversation with your health care team. A Registered Dietitian Nutritionist (RDN), or a Certified Diabetes Care and Education Specialist (CDE or CDCES) can help you develop a healthy eating plan that fits your needs.



Wednesday 12 February 2020

If You Have Diabetes, Pay Attention to Your Heart

From nextavenue.org
By Kerri Fivecoat-Campbell

Experts explain why and what you should do

When my husband, Dale, was diagnosed with type 2 diabetes in 2007, at the age of 46, his doctor prescribed medication, he attended a nutrition class and was instructed on testing his blood glucose level.
Dale had annual physical exams, which monitored his blood pressure and A1C level (an average of blood glucose over time).

We assumed doing all of this would also mitigate the increased risk of heart disease that presents with type 2 diabetes.
It most likely was a fatal assumption.
Dale died of a sudden, massive heart attack, the main artery blockage known as the “widow maker,” two days before Thanksgiving, on Nov. 20, 2018.

According to the Centres for Disease Control and Prevention, 30 million Americans have diabetes and 90% to 95% of them have type 2 diabetes. Most cases are diagnosed after age 45. According to the American Heart Association, adults with diabetes are two to four times more likely to die from heart disease than those who don’t have diabetes.

The longer a person has diabetes, the higher their chances of developing heart disease. This is because high blood glucose from diabetes can damage blood vessels and the nerves that control the heart, according to the National Institute of Diabetes and Digestive and Kidney Diseases, which is part of the National Institutes of Health.

“Total management of the disease should include diet, exercise, regular cholesterol testing and glucose monitoring,” said Dr. Jane E.B. Reusch, a cardio-endocrinologist at the University of Colorado Anschutz Medical Centre in Aurora, Colo. She also practices at the Rocky Mountain Regional Veterans Affairs Medical Centre in Aurora.

Mitigating Heart Disease Risk Requires Diligence

Hyvelle Ferguson, now 46, was just 33 and pregnant when she was diagnosed with type 2 diabetes. “I began taking care of myself, but after I had my baby, I reverted back to my old ways, eating anything I wanted,” says Ferguson. “I thought I’d be OK if I was taking my medication.”

At 41, Ferguson suffered a stroke, and three weeks after being released from rehab, suffered a heart attack. Her main artery was 99% blocked. She underwent quadruple bypass surgery, but that wasn’t the end of her health problems.

“I called myself a professional patient, in 2014 to 2015, I was in the hospital every month,” she says. “Every time I went to the doctor, something else was wrong.”

Ferguson began taking stock of her life, researching how she could control diabetes instead of allowing the disease to control her. She adopted a healthier diet and began walking for exercise. “At first, it was just to the mailbox, and I went a bit farther each time,” she says.

Although she still has many challenging days, Ferguson now volunteers with the American Heart Association and is an advocate for its Know Diabetes by Heart. The new program is partnership between the group and the American Diabetes Association to help inform doctors on educating their patients with diabetes about the risks of heart disease. It also tells patients with diabetes questions to ask their doctors.

Of course, not all patients with diabetes will develop heart disease, and Reusch points out that many other factors play into the risk. “A1C is very important, but cholesterol should also be monitored closely in diabetes patients,” she says. “So many factors play into it, including genetics.”

How Statin Medications Can Help

Care guidelines endorsed by many cardiologists require all diabetes patients to be placed on a low-dose statin drug, despite a patient’s lipid numbers (measuring cholesterol and fats in the blood), says Dr. Jorge Plutzky, a cardiologist with the Brigham and Women’s Hospital and Harvard Medical School in Boston. Statins lower cholesterol levels in the blood.

“We make recommendations based on what we know,” Plutzky says. He points out numerous studies showing that diabetes patients who hadn’t previously suffered a heart attack and were placed on low-dose statin drugs had a “striking reduction” for the risk of heart attack.

Plutzky says doctors have known for years that diabetes increases the risk factors for heart disease, but didn’t understand why blood glucose drugs didn’t reduce the heart disease risk. “We just didn’t have the right drugs yet,” he says. “Great strides have been made just within the past three years.”

Plutzky says doctors and patients should know that certain new inhibitor drugs combined with statins can reduce the risk of heart disease in patients with diabetes. “The Know Diabetes by Heart (web page) has this information, as well as all the latest information that needs to be put out there,” he says.

He advises people with type 2 diabetes not to wait for their doctors to bring up the topic of heart disease. And he says patients should continue to see their primary care doctors or endocrinologists to help manage their disease.

Coronary Artery Calcium Screening

Another preventive measure is one that could have saved my husband Dale’s life. It’s called coronary artery (or cardiac) calcium screening, and more hospital systems, including the one near my small town, offer it at a relatively affordable cost ($99 at my hospital). The test is for individuals at high risk for heart disease and uses computerized tomography (CT) scans to measure the calcium build-up in the coronary arteries. A health system’s screening program may also involve a cholesterol screening, body mass Index reading, an A1C screening and other tests.

Gary Heimbach, 70, of Bull Shoals, Ark., was diagnosed with type 2 diabetes in 1993 at 58. When his wife heard about coronary artery calcium screening, they both scheduled an appointment to have it done.

Although Gary had no previous symptoms, his results indicated he’d already suffered a previously unknown heart attack. Further testing revealed a 95% blockage in a main artery and a 50% blockage in another. “They put a stent in and I haven’t had any problems since,” he says. “It was painless and saved my life.”

Ferguson stresses taking proactive measures, such as informing yourself and taking advantage of all available resources to reduce the risk of heart disease. “I want people to know they can live, they can fight the smart fight,” she said.

https://www.nextavenue.org/diabetes-pay-attention-heart/

Tuesday 11 February 2020

Is there a connection between diabetes and heart health?

From themonitor.com
By: Dileep Menon

Since diabetes is a condition that leads to narrowing of the blood vessels in every part of the body, people with diabetes often suffer from vascular complications like heart attacks, strokes , renal failure leading to dialysis , blindness , ulcers and non-traumatic amputations. They are considered to have “heart disease risk equivalent” status, meaning that they will have the same future risk of cardiac events as that of someone who has established heart disease. That’s why it’s important that people with diabetes need to be aware of their underlying risk and address this aggressively with a healthy lifestyle and risk factor modification.

The primary goal in treating and managing diabetes is to control the blood sugar, which is assessed through a blood test called Haemoglobin A1c (HgBA1c). A HgBA1c less than 7% has been shown to prevent heart attacks in people with diabetes. Blood sugar control can be achieved with diet, exercise and medications. Diet plays a pivotal role in the management of diabetes with special emphasis on calorie restriction and limiting carbohydrates, especially sugars. It’s also recommended to increase fruit and vegetable intake, avoiding saturated and trans-fats and increased fibre intake.

Regular exercise enables calorie expenditure, facilitates weight management and lowers blood pressure. There has been tremendous progress in medications for diabetes that not only lower blood sugar but also reduce heart attacks, heart failure and death among those with diabetes. With these medications, there is less dependence on insulin, which effectively lowers blood sugar but is also associated with side effects such as low blood sugar episodes and weight gain. At the same time, insulin can potentially accelerate the narrowing of the blood vessels due to its pro-atherogenic properties.

Frequently, diabetes is also associated with co-morbidities like high blood pressure and high cholesterol. Control of blood pressure to less than 130/80 mm Hg is critical in preventing development of kidney disease, kidney failure and delaying need for dialysis. Blood pressure lowering medications such as Angiotensin Converting Enzyme Inhibitors (ACE- Inhibitors ) and Angiotensin Receptor Blockers (ARB) have shown to be beneficial in diabetics with protein in their urine to prevent kidney damage. Statin medications to lower cholesterol have also shown tremendous benefits in reducing heart attacks and death in diabetics. Aspirin in doses of 75-81 mg daily may be considered to prevent heart attacks and strokes in diabetics provided they are not at high risk for bleeding complications.

As the adage goes, “an ounce of prevention is worth a pound of cure”. This could not be more apt for people with diabetes to stay heart healthy. Preventing heart disease as it relates to diabetes starts with consistent monitoring of HgBA1c, blood pressure and total cholesterol / LDL cholesterol. Adapt healthy eating and exercise routines to keep these levels as low as possible. Be sure to take your medications as prescribed by your doctor and follow up with your doctor to ensure your risk factors are under optimal control. For this Heart Month, I remind you to Live Healthy Daily, Live Heart Healthy Daily and Live Long Heart Healthy.


The Most Nutrient-Dense Low Carb Foods

From asweetlife.org

If you read ASweetLife often, you know that we believe a low-carbohydrate or ketogenic diet is key to managing both Type 1 and Type 2 diabetes. Keeping carbs low is the single best way to achieve tight, healthy, normal blood sugars, and is the best way to break the cycle of insulin resistance.
 However, people with diabetes need their diets to do more than just optimize their metabolism. They also need to derive nourishment from their diet, just like everyone else. And the keto diet can accommodate many different foods and ways of eating, ranging from fully vegan to the 100% meat “carnivore” diet, and many points in between. Some low-carbohydrate foods are nutrient dense, and some are nutrient poor, and it pays to know the difference.
Raphael Sirtoli, co-founder of Nutrita Pro, an app that tracks key foods and nutrition, explains how to get the right nutrients, and why it’s important.

What is nutrient density?

The healthfulness of any one food goes far beyond a simple accounting of its calories or macronutrients. We can examine the wholesomeness of foods with much greater detail, chiefly by looking at vitamin and mineral content.

“Nutrient density” is the best way to approach this topic, and it’s a crucial concept in nutrition. The more nutrient dense a food is, the more nutrients (vitamins, minerals) you get for a standard amount of the food, measured in grams or calories.

As far as calculations go, it’s pretty simple. In fact, it’s too simple. There are many reasons why it’s inaccurate. Here are 3 important ones:

  1. With the ‘per calories’ approach we end up inflating the nutritional value of plants because they’re less energy dense than animal foods on average
  2. The calculation assumes perfect absorption of vitamins and minerals, ignoring important differences in how nutrients are taken up and (processed for energy or structural roles)
  3. It doesn’t account for the fact that some nutrients come in inactive forms that carry a cost for being converted into active ones.
Government and corporation food labels ignore these facts. The nutrient density score in the Nutrita Pro does not.
People are nourished not only by essential vitamins and minerals, but also by essential amino acids (protein) and fatty acids (fat).
So, with this new tool to figure out a food’s nourishing level, let’s take a look at which foods are most nutritious.

1. Organ meats (offal)
Organ meats are probably the most nutrient-dense foods available, outranking fruits, vegetables and muscle meats in pure nutrient-density. They are particularly rich in B vitamins and in important minerals, such as iron and magnesium, that can be otherwise rare in common foods. Liver, for example, is packed with vitamins A (retinol) and riboflavin, copper, niacin and Vitamin B6. Some cuts, such as beef tripe and chicken feet, are particularly rich in gelatin (collagen).

Organ meats are often considered an acquired taste at best in today’s United States, but they are cherished ingredients in much of the world, from France to Mexico to China. With the right touch they could become a delicious part of your diet too.

2. Fish, shellfish, meat, eggs and dairy
Non-organ animal products are probably the second most nutritionally-dense group.
Beef is a truly complete source of protein – many so-called “carnivore” dieters appear to thrive essentially on beef alone! Ribeyes, which have a wonderfully delicious blend of lean and fat, contain plenty of vitamin B12 and minerals like iron, zinc, selenium and phosphorus.

Chicken eggs are close to nature’s ‘perfect food’ as they might be the single best source of protein – and it’s not just the egg whites. There’s something about eating the whole egg that improves muscle protein synthesis better than eating the same amount of protein alone. Eggs are an excellent source of pantothenic acid and choline.

Full-fat dairy such as blue vein cheese has a respectable overall nutrient density score and is a great source of protein. Interestingly, its healthy fat profile and high levels of fat-soluble vitamin K2 are thought to be responsible for full-fat dairy’s apparent protection from heart disease.

We’ve all heard that we should be eating more seafood, so it should come as no surprise to hear that fish like salmon are near the top of the nutrient-density charts. Salmon, one of the most popular varieties of rich, fatty fish, is a great source of the active forms of omega-3s (DHA and EPA). It also has lots of the active form of vitamin D3 (cholecalciferol), which helps maintain overall good health and strong bones. Other vitamins found in salmon are B3 (niacin), B5 (pantothenic acid) and B6 (pyridoxal 5’-phosphate).

Shellfish are also replete with nutrients. Clams are another excellent source of complete protein, and are rich in minerals like selenium, zinc and contain a lot of cobalamin (vitamin B12). Like many shellfish, they have a slight carbohydrate content, about 6 g of carbs for 10 small clams, a sizeable helping.

3. Green leafy vegetables, fruit and legumes
There’s a big drop in the average nutrient density of foods from group #2 to group #3.
Why do animal foods dominate the top of the list? This actually makes sense: animals harvest the nutrients from their food and masterfully concentrate them in their own bodies, converting nutrients from plants (and bacteria!) into their active forms. Also, animal foods are mostly made from the essential macronutrients fat and protein. Carbohydrate, the third macronutrient, is not actually essential. Animal foods also contain virtually all the essential micronutrients humans require to live.
Plant foods can certainly fit into a healthy, nutrient dense diet, although on their own (as in vegan diets) supplements become crucial. In practice it’s difficult to eat enough of even the most nutritionally dense vegetables, because they contain comparatively so little energy and nutrition in each mouthful.

Leafy green vegetables tend to contain the most nutrients, pound for pound, in virtue of being very low calorie. Kale contains quite a bit of the mineral manganese and vitamin C, both of which are hard to find in animal foods. Avocados are rich in the mineral potassium which helps normalize blood pressure, as well as vitamin B5 (pantothenic acid). Although avocados are known for their vitamin E content, it’s mostly in the inactive form (?-tocopherol). Only a small fraction can be converted into the active form (?-tocopherol).

You might be surprised to see that fruits are generally less nutritionally dense than commonly supposed. Typically, it is the less sweet fruits that are closer to their natural wild forms that pack in the most nutrients: blackberries and raspberries are good examples. Lemons are also a very low-sugar fruit, with lots of vitamin C.

Legumes aren’t good low-carb options, generally speaking, because of their high carbohydrate content. With some portion control, however, they can be incorporated into a healthful lower-carbohydrate diet. Consuming them after meat and greens lowers glycaemic excursions and can be a helpful technique for managing postprandial blood sugar levels.

One thing to note about legumes is that they contain a large number of anti-nutrients. Anti-nutrients are plant compounds that inhibit they body’s ability to absorb essential nutrients such as zinc, magnesium, potassium, iron and calcium. Because a typical nutrient density score does not factor in the effect of anti-nutrients, legumes may realistically be less nutrient dense than the Nutrition Facts label would have you believe.

Lima beans and black soybeans are some of the lower-carb legumes. They have similar nutritional profiles, with fair amounts of copper, manganese and magnesium.

The Least Nutritious Foods

The worst offenders are added sugar, flours, and high omega-6 seed oils. They should be avoided for three reasons.

First, they have terrible nutritional profiles, and are truly lacking in important micronutrient content. Flour, for example, needs to be fortified in order to avoid frank nutrient deficiencies. Second, they take up a large percentage of calories in the average diet and thus usually displace more nutrient dense options. Third, they interfere with normal metabolic responses and commonly induce chronic inflammation.

By eliminating the least nutritious foods, and focusing on nutrient-dense options, you increase your odds of being nutritionally sufficient. Fuelling your body with what it needs while avoiding blood sugar swings is a win for diabetes management.

https://asweetlife.org/the-most-nutrient-dense-low-carb-foods/?utm_source=ASweetLife.org+List&utm_campaign=464f8fa945-ASweetLife+Weekly+Update++-+Nov.+14%2C+2017_COPY_01&utm_medium=email&utm_term=0_5125b14cf8-464f8fa945-413392997

Monday 10 February 2020

Type 2 diabetes symptoms: Loss of reflexes in this body part could be a sign of condition

From express.co.uk

TYPE 2 diabetes results in serious health complications if left untreated. Allowing blood sugar levels to build-up in the body for too long can cause nerve damage, among other things, so it is important to be aware of the tell-tale sign that indicates when medical intervention is needed.

Type 2 diabetes occurs when people are resistant to insulin – either the pancreas doesn’t make enough of the hormone or cells don’t respond to it. Diabetes UK says complications can begin five to six years before people find out they have type 2 diabetes.

So it’s very important to know what to look out for.

Persistent high levels of blood sugar (glucose) levels in the bloodstream can lead to nerve damage.
When this occurs, the medical name for the type 2 diabetes complication is diabetic neuropathy.
Nerves are essential for our body to be able to communicate.

To demonstrate, nerves carry messages between the brain and every part of our bodies – enabling us to see, hear, feel and move.
The bundle of fibres (nerves) also send signals to the heart, to help control heart rate and the lungs.
High blood sugar weakens the walls of small blood vessels (capillaries) that supply the nerves with oxygen and nutrients.
When nerves are starved of vital components, they become damaged.

                        Type 2 diabetes can have serious health complications (Image: Getty)

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) reported that around half of people with diabetes have neuropathy.
Signs of diabetic neuropathy usually take several years to appear, with the loss of reflexes in the ankle being one alarming symptom.
There are four main types of diabetic neuropathy: peripheral, autonomic, radiculoplexus and mononeuropathy.

Peripheral neuropathy

Peripheral neuropathy is the most common type of diabetic neuropathy and affects the feet and legs first, followed by the hands and arms.

Symptoms of the complication tend to be worse at night, which include:
  • Numbness or reduced ability to feel pain or temperature changes
  • Tingling or burning sensation
  • Sharp pains or cramps
  • Increased sensitivity to touch — for some people, even the weight of a bedsheet can be painful
  • Muscle weakness
  • Loss of reflexes, especially in the ankle
  • Loss of balance and coordination
  • Serious foot problems, such as ulcers, infections, and bone and joint pain

Autonomic neuropathy

Autonomic neuropathy denotes the nerves within the autonomic nervous system – that controls your heart, bladder, stomach, intestines, sex organs and eyes – have been affected.
This leads to a whole array of consequences, which can be:
  • A lack of awareness that blood sugar levels are low
  • Bladder problems
  • Constipation, uncontrolled diarrhoea or both
  • Slow stomach emptying (gastroparesis), causing nausea, vomiting, bloating and loss of appetite
  • Difficulty swallowing
  • Increased or decreased sweating
  • Problems controlling body temperature
  • Changes in the way your eyes adjust from light to dark
  • Increased heart rate at rest
  • Sharp drops in blood pressure after sitting or standing that may cause you to faint or feel lightheaded
  • Erectile dysfunction
  • Vaginal dryness
  • Decreased sexual response

Radiculoplexus neuropathy (also known as diabetic amyotrophy)

Radiculoplexus neuropathy affects the nerves in the thighs, hips, buttocks or legs.
Usually, symptoms occur on one side of the body but, sometimes, it can spread to the other side. Symptoms include:
  • Severe pain in a hip and thigh or buttock that occurs in a day or more
  • Eventual weak and shrinking thigh muscles
  • Difficulty rising from a sitting position
  • Abdominal swelling, if the abdomen is affected
  • Weight loss

Mononeuropathy (in other words, focal neuropathy)

Mononeuropathy is specific nerve damage in the face, torso or leg.
Commonly, this type of diabetic neuropathy can strike suddenly and can cause severe pain.

      Nerve damage is a type 2 diabetes complication called diabetic neuropathy (Image: Getty)

The painful sensation can be felt in the shin or foot, lower back or pelvis, front of thigh, chest or abdomen.
This sort of diabetic neuropathy can also lead to the following:
  • Difficulty focusing
  • Double vision
  • Aching behind one eye
  • Paralysis on one side of your face (Bell's palsy)
The best way to avoid this diabetic complication in the first place is to visit your GP to check blood sugar levels.
The sooner diabetes is under control, the better the chances of living with diabetes without further health complications, such as diabetic neuropathy.

https://www.express.co.uk/life-style/health/1239892/Type-2-diabetes-symptoms-loss-of-ankle-reflexes-diabetic-neuropathy-types



Friday 7 February 2020

Smart Insulin Patch Could Revolutionize Diabetes Treatments

From biospace.com


A smart insulin device under development could revolutionize how glucose levels are monitored in diabetes patients and deliver insulin doses when necessary.

Researchers from University of California, Los Angeles (UCLA), the University of North Carolina and Massachusetts Institute of Technology (MIT) are working on an adhesive patch, about the size of a quarter, and are planning to take their device and move it into human studies soon. The scientists have published their preclinical research conducted on mice and pugs in Nature Biomedical Engineering. A statement from UNC notes that the research team is seeking approval from the U.S. Food and Drug Administration to advance the study into human trials.

Zhen Gu, a professor of bioengineering at the UCLA Samueli School of Engineering, said in a statement that the goal of the project, which began in 2015, is to “enhance health and improve the quality of life for people who have diabetes.” The patch is intended to remove the need for diabetes patients to constantly check their blood sugar levels and then take insulin when needed. Gu said the patch “mimics the regulatory function of the pancreas” but remains easy for patients to use.

The experimental patch monitors glucose levels and has doses of insulin pre-loaded in micro-needles. The microneedles are made with a glucose-sensing polymer that's encapsulated with insulin. Each microneedle penetrates about a half millimetre below the skin, which is sufficient to deliver insulin into the body. When applied, the microneedles penetrate under the skin and can sense blood sugar levels. As the researchers describe, when glucose levels reach a certain threshold, the insulin is released. When the blood sugar levels return to normal, the insulin delivery slows. The researchers said this is designed to ensure there is not an overdose of insulin, which can lead to hypoglycaemia, seizures, coma or even death.

In the experiments, one quarter-sized patch successfully controlled glucose levels in pigs with type I diabetes for about 20 hours, the researchers said. The pigs weighed about 55 pounds on average.
John Buse, director of the UNC Diabetes Centre, said having an insulin-delivery device in a “smart and convenient manger” has always been a dream.

“This smart insulin patch, if proven safe and effective in human trials, would revolutionize the patient experience of diabetes care,” Buse said in a statement.

If the FDA accepts the application to begin testing the patch in humans, the research team said trials could begin within the next few years. The team believes that the smart microneedle patch could be used beyond diabetes. The researchers believe it could be adapted with different drugs to manage other medical conditions as well.

https://www.biospace.com/article/researchers-develop-coin-sized-smart-insulin-patch-as-potential-treatment-for-diabetes-patients/

Wednesday 5 February 2020

Yale studies suggest new path for reversing type-2 diabetes and liver fibrosis

From news.yale.edu

In a pair of related studies, a team of Yale researchers has found a way to reverse type-2 diabetes and liver fibrosis in mice, and has shown that the underlying processes are conserved in humans.
The studies appear in the Feb. 4 edition of Cell Reports and in the Jan. 17 edition of Nature Communications.

In the earlier study, researchers found an important connection between how the body responds to fasting and type-2 diabetes. Fasting “switches on” a process in the body in which two particular proteins, TET3 and HNF4a, increase in the liver, driving up production of blood glucose. In type-2 diabetes, this “switch” fails to turn off when fasting ends, as it would in a non-diabetic person.

Researchers hypothesized that if they could “knock down” the levels of these two proteins, they could stop diabetes from developing. Yingqun Huang, M.D., Yale associate professor in Obstetrics, Gynaecology, and Reproductive Sciences and her team injected mice with genetic material known as small interfering RNAs (siRNAs) packaged inside viruses that targeted TET3 or HNF4a. They found that blood glucose and insulin dropped significantly — effectively stopping diabetes in its tracks. 

                                                           (© stock.adobe.com)

In the Feb. 4 Cell Reports study, researchers looked at how TET3 contributed to the development of fibrosis in the liver, and found that the protein was involved in fibrosis on multiple levels. Almost all fibrosis, regardless of the organ involved, starts from abnormal protein signalling, Huang said.

She and colleagues discovered that TET3 plays a role in the fibrosis signalling pathway in three different locations — and acts as an important regulator in fibrosis development. This means there are likely opportunities to develop drugs that inhibit TET3 to slow or reverse fibrosis, said Da Li, associate research scientist in genetics and co-author on both studies.

Both diseases — type-2 diabetes and fibrosis of the liver and other organs — are common, but have few treatment options. Around 28 million people in the U.S. have type-2 diabetes, characterized by high blood sugar levels, a condition that can lead to many other health problems, including heart disease, stroke, and kidney failure.

Cirrhosis is one of the leading causes of death worldwide and is marked by liver fibrosis — a build-up of scar tissue on the liver, said co-author James Boyer, M.D., professor and emeritus director of the Yale Liver Centre.

Researchers noted that several drugs, such as metformin, are currently available to control blood sugar levels in patients with diabetes. But these have a range of unpleasant side effects, and patients can develop resistance to these drugs.

And there is little medical relief for fibrosis sufferers.

Right now, there are no effective drugs for the treatment of fibrosis,” said Xuchen Zhang, M.D., associate professor in pathology and co-author on the fibrosis study.
Huang has filed for a patent related to her discoveries with support from the Yale Office of Cooperative Research.

The next step, she said, will be to identify where to best target TET3 and HNF4a and to develop the most effective siRNAs or small molecules to treat type-2 diabetes or fibrosis.

Both studies were supported by the National Institute of Diabetes and Digestive and Kidney Diseases at the U.S. National Institutes of Health.

https://news.yale.edu/2020/02/04/studies-suggest-new-path-reversing-type-2-diabetes-and-liver-fibrosis

Monday 3 February 2020

Take back control of your life: Living with Type 2 diabetes

From mirror.co.uk/lifestyle

It's predicted that more than 5m people will have Type 2 diabetes in the UK by 2025 with 10% of the entire annual NHS budget spent on the disease

According to the International Diabetes Federation, more than 400 million people around the globe already have diabetes.
Of  this figure, around 90 per cent will have Type 2.
If nothing changes, more than five million people will have diabetes in the UK by 2025.
Here in the UK, Type 2 diabetes already soaks up a whopping 10% of the entire annual NHS budget – equivalent to an astonishing £1.5million an HOUR.
But how has a condition which was only properly identified and named little more than a century ago come to be such an enormous threat to our health?
And more importantly, what can you do to protect yourself against this rising epidemic?

What exactly is diabetes?
Around 10% of all diabetes cases are due to Type 1, a condition brought on by a malfunctioning immune system, often
in childhood.
Type 1 is largely random, usually striking because a mild infection has sent the immune system haywire, although those with a family history of the illness are more at risk.
Although the numbers affected are rising, the rate of increase is comparatively slow – about 3% a year.
The big problem is Type 2 diabetes, an altogether different form of the illness which is more commonly associated with obesity, poor diet and sedentary lifestyles.

           Type 2 diabetes can be prevalent in those who struggle with their weight (stock photo)

The reason for this is that high glucose levels restrict blood flow to the feet and lower legs – where blood vessels are smaller and narrower.

The tiniest cut or scratch can then turn into a gaping wound that will not heal because ­insufficient oxygen-rich blood is reaching it to kick-start the repair process.
“A lot of people, including some doctors, have this misperception that Type 2 is not as serious as Type 1, when in fact it’s just as dangerous,” says ­Marsland.
“The tragedy is many cases could be prevented with the right advice and support on how to live a healthy lifestyle.”

Now studies show that obesity is the main driving force behind the global spread of the disease.
An estimated 80% of Type 2 cases are directly connected to excess weight.
When doctors assess a patient’s risk, they test for impaired glucose tolerance – a sign that blood sugar levels are higher than normal – and measure the body mass index.
This is a calculation that takes account of weight compared to height.

For patients of white or Caucasian origin, a BMI score of 30 (officially obese) ­indicates you’re at serious risk and in the need for lifestyle changes, such as a healthy diet and more exercise.
An example would be a man who is 5ft 10in and weighs 15st.
But for patients of South Asian origin – who are genetically more susceptible to the effects of diabetes – the BMI warning flag starts to fly at a score of just 23, or a 5ft 8in man weighing 11st. But BMI is not a perfect alarm system as it doesn’t measure actual body fat levels.
This is why, for example, strong, fit rugby players can be classed as obese – they are large, but much of that bulk is muscle, not fat.

Hidden dangers
Instead, a more accurate indication of diabetes risk is what doctors call visceral fat – hidden fat that lies around the heart, liver, kidneys and pancreas.
Visceral fat is thought to be a major factor in the 20% or so of Type 2
cases where patients appear to be relatively slim and don’t consider themselves to be at risk.

One indicator of visceral fat is a spare tyre – or pot belly in men – which points to a build-up of fat in the abdomen.
But if you are slim and your waistline is not necessarily bulging, how would you know if diabetes is setting in?
“There are many patients who are not overweight but have abdominal fat sitting around the pancreas,” says ­Marsland.

                                          Woman using a diabetes test kit

“They need to look out for other ­symptoms, such as increased thirst, fatigue, urinating more often than usual and genital itching – all these symptoms can be signs of Type 2.
“Some patients end up walking around for 10 years with the disease before they actually get diagnosed.”

Now there is a major push to catch patients before they get to this stage.
Scientists have identified a condition called “pre-diabetes”, where blood sugar levels are high but full-blown Type 2 diabetes has not yet developed.

At this point, experts say, simple ­lifestyle changes such as a healthier diet, increased physical activity and weight loss can stop diabetes in its tracks.
“Our blood sugar levels tend to creep higher as we age,” says Marsland.
“So it’s very ­important that this is picked up early enough to do ­something about it.

“Exercise helps because it makes the body more sensitive to insulin and this will help to reduce the amount of sugar in your blood. “But this doesn’t mean you have to run marathons to improve your health.
“Instead, it’s much better to set ­yourself realistic goals that you know you can achieve, rather than unrealistic ones that are probably out of reach.”


Saturday 1 February 2020

Could resetting our internal clocks help control diabetes?

From innovations-report.com

Researchers from UNIGE and HUG were able to demonstrate the link between disturbances of the circadian clocks in pancreatic cells and type 2 diabetes, then to correct these disturbances

The circadian clock system (from Latin "circa diem", about a day) allows the organisms to anticipate periodical changes of geophysical time, and to adjust to these changes. Nearly all the cells in our body comprise molecular clocks that regulate and synchronize metabolic functions to a 24-hour cycle of day-night changes.

Today, increasing evidence show that disturbances in our internal clocks stemming from frequent time zone changes, irregular working schedules or ageing, have a significant impact on the development of metabolic diseases in human beings, including type-2 diabetes.

Such disturbances seem to prevent the proper functioning of the cells in the pancreatic islet that secrete insulin and glucagon, the hormones that regulate blood sugar levels. By comparing the pancreatic cells of type 2 diabetic human donors with those of healthy people, researchers at the University of Geneva (UNIGE) and at the University Hospitals of Geneva (HUG), Switzerland, were able to demonstrate, for the first time, that the pancreatic islet cells derived from the Type 2 Diabetic human donors bear compromised circadian oscillators.

A Langerhans Islet with insulin-producing cells (in green), and glucagon-producing cells (in red). Cell nuclei in blue.
Credit: © UNIGE , Dibner Lab

The disruption of the circadian clocks was concomitant with the perturbation of hormone secretion. Moreover, using clock modulator molecule dubbed Nobiletin, extracted from lemon peel, the researchers succeeded in "repairing" the disrupted cellular clocks and in partial restoring of the islet cell function. These results, published in the Proceedings of the National Academy of Sciences of the United States, provide a first insight into innovative approach for diabetes care.

Two years ago, the team led by Charna Dibner, Principle Investigator in the Departments of Medicine and of Cell Physiology and Metabolism, and Diabetes Centre at UNIGE Faculty of Medicine, and at HUG, has already shown that in rodents the perturbation of pancreatic cellular clocks led to disrupted insulin and glucagon secretion, thus promoting the onset of diabetes. But what is the situation in human beings?

"We had also previously observed that if the clocks of human pancreatic cells were artificially disrupted in the cellular culture in vitro, secretion of the key islet hormones - insulin and glucagon - was compromised,» says Volodymyr Petrenko, a researcher in Dr. Dibner's lab and the first author of these publications. Hence our next step, that we report here, was to unravel whether the circadian rhythms were perturbed in human pancreatic islets in type 2 diabetes, and, if so, how would this perturbation affect the islet function."

Using combined bioluminescence-fluorescence time-lapse microscopy, a technology that allows tracking the molecular clock activity in living cells very precisely over time, the scientists compared the behaviour of pancreatic cell of type-2 diabetic donors and those of healthy subjects throughout the day.

"The verdict is indisputable", says Charna Dibner. The biological rhythms of the islet cells in type-2 diabetes exhibit both reduced amplitudes of circadian oscillations and poor synchronization capacity. «As a result, hormone secretion is no longer coordinated. Moreover, the defects in temporal coordination of insulin and glucagon secretion observed in patients with type-2 diabetes were comparable to those measured in healthy islet cells with artificially-disrupted circadian clock."

It's all in the timing!

Circadian clocks represent the daily cycles governing the various cellular functions. There are several interlocking levels of synchronization of these clocks, the main one being light, which in particular regulates the central clock located in the cerebral hypothalamus. Like a conductor in the orchestra, it regulates peripheral clocks present in organs and cells. The latter are therefore partly centrally regulated, but function differently in each organ, and even in each cell, depending on their functions.

"Pancreatic cells are also subject to the rhythm of fasting and food intake, and to a tight hormonal regulation", says Charna Dibner. "Coordinating all levels of regulation therefore allows the optimization of metabolic functions. Clocks deregulation in pancreatic islet leads to a compromised function: they are not anymore anticipating food-derived signals. Indeed, if you eat the same food but at night rather than during the day, you may gain weight much faster, due to a suboptimal response of your metabolism."

Setting the right time again

Step two of their research: the Geneva scientists used Nobiletin, a small clock modulator molecule - a natural ingredient of lemon peel whose impact on circadian clocks has been recently discovered - in order to resynchronize the clocks. "By acting on one of the core-clock components, it resets efficiently the amplitude of the oscillations in the human islets" says Volodymyr Petrenko. "And as soon as we got the clocks back in sync, we also observed an improvement in insulin secretion."

"This is the first proof of principle that repairing compromised circadian clocks may help improving the function of the pancreatic islet hormone secretion", says Charna Dibner. "We will continue by exploring this repair mechanism in vivo, first in animal models. Our society experiences epidemic growth in metabolic diseases, concomitant with shifted working and eating schedules, and lack of sleep. By re-synchronizing the perturbed molecular clocks, either by personalized eating and exercise schedules or with the help of clock modulator molecules, we hope to ultimately be able to provide an innovative solution to an epidemical metabolic problem affecting an ever-increasing proportion of the world's population."