A healthy lifestyle may counteract diabetes-associated brain ageing

From eurekalert.org

Type 2 diabetes and prediabetes are associated with accelerated brain ageing, according to a new study from Karolinska Institutet in Sweden published in the journal Diabetes Care. The good news is that this may be counteracted by a healthy lifestyle.

Type 2 diabetes is a known risk factor for dementia, but it is unclear how diabetes and its early stages, known as prediabetes, affect brain ageing in people without dementia. Now, a comprehensive brain imaging study shows that both diabetes and prediabetes can be linked to accelerated brain ageing.

The study included more than 31,000 people between 40 and 70 years of age from the UK Biobank who had undergone a brain MRI scan (magnetic resonance imaging). The researchers used a machine learning approach to estimate brain age in relation to the person’s chronological age.

Prediabetes and diabetes were associated with brains that were 0.5 and 2.3 years older than chronological age, respectively. In people with poorly controlled diabetes, the brain appeared more than four years older than chronological age. The researchers also noted that the gap between brain age and chronological age increased slightly over time in people with diabetes. These associations were attenuated among people with high physical activity who abstained from smoking and heavy alcohol consumption.

“Having an older-appearing brain for one’s chronological age can indicate deviation from the normal ageing process and may constitute an early warning sign for dementia,” says the study’s lead author Abigail Dove, a PhD student at the Department of Neurobiology, Care Sciences and Society, Karolinska Institutet. “On the positive side, it seems that people with diabetes may be able to influence their brain health through healthy living.”

Repeated MRI data were available for a small proportion of the study participants. Follow-up MRI scans are ongoing and researchers are now continuing to study the association between diabetes and brain ageing over time.

“There’s a high and growing prevalence of type 2 diabetes in the population,” says Abigail Dove. “We hope that our research will help prevent cognitive impairment and dementia in people with diabetes and prediabetes.”

The study was mainly funded by the Swedish Alzheimer’s Foundation, the Dementia Research Fund, the Swedish Research Council and Forte (the Swedish Research Council for Health, Working Life and Welfare). There are no reported conflicts of interest.

Publication: "Diabetes, prediabetes, and brain aging: the role of healthy lifestyle", Abigail Dove, Jiao Wang, Huijie Huang, Michelle M. Dunk, Sakura Sakakibara, Marc Guitart-Masip, Goran Papenberg, Weili Xu, Diabetes Care, online 28 August 2024, doi: 10.2337/dc24-0860 

https://www.eurekalert.org/news-releases/1055727

Four foods to avoid if you have high blood pressure

From telegraph.co.uk

One in three adults in England have high blood pressure – here are the foods to cut down on to reduce your risk 

Like cholesterol and BMI, blood pressure is one of those medical terms we’re all aware of and know we need to keep in check for our health.

It refers to the pressure in our arteries – the vessels that carry blood away from the heart and around the body. While we do need some pressure in these tubes to keep blood flowing, too much raises the risk of suffering a life-threatening heart attack or stroke.

Health surveys over the last couple of decades have persistently shown that around one in three adults in England have high blood pressure. Smoking, being overweight or obese and a lack of exercise are among the biggest risk factors but diet also plays a major role, says Dr Frankie Phillips, a registered dietitian and spokesperson for the British Dietetic Association.   Here, she shares the foods to cut down on to limit your risk.

Salty foods

It’s not necessary to eliminate salt completely, says Phillips. For our bodies to work efficiently, we do need some in our diet. Around a quarter of a teaspoon daily is all that’s needed to keep our muscles, nerves and fluid balance in check.

However, we’re eating much more than this. As a population, we’re told to consume a maximum of 6 grams per day (one teaspoon) but we’re actually eating around 9 grams.

Around three quarters of the salt in our diet comes from food which already contains salt, such as bacon, rather than the salt we add Credit: Getty

“We’ve known for quite a long time that there seems to be a link between salt and high blood pressure,” Phillips says. A high salt intake draws water into our bloodstream, which means there’s a higher volume of blood being pumped throughout our bodies, forcing our heart to work harder, she explains.

Ditching the table salt may not be the most effective move. “Around three quarters of the salt in our diet comes from food which already contains salt, rather than the salt we add,” Phillips notes. The likes of ready meals, salty snacks, pies, pasties, bacon, salami, sausages, ham, tinned soup, ketchup and brown sauce are some of the biggest culprits, she says.

Sugary and fatty foods

Enjoying foods high in sugar and fat won’t directly lead to high blood pressure. The problem kicks in if you eat too much and gain weight.

“Being overweight or obese is linked with high blood pressure,” Phillips says. When your weight increases, you increase the amount of blood volume that’s travelling through your body, so the heart has to work harder to push that around, she explains.

While eating too much of any food will lead to weight gain, sugary and fatty foods like doughnuts, cakes and biscuits are all too easy to overeat. 

“It’s those kinds of foods that you need to watch out for, as they contain empty calories and don’t offer any extra nutrition, rather than those high in healthy fats, like nuts and avocados,” she says. “If you’re going to have a treat, then try and look for something that is higher in fibre and has got some fruit or vegetables in it.” Examples include nutty flapjacks, yogurt and berries or vegetables and hummus, she adds.

Alcohol

Unfortunately, there is no safe limit of alcohol we can consume without risking our blood pressure increasing, according to Phillips.

“That’s because it affects three hormones (renin, angiotensin and aldosterone) that regulate blood pressure,” she explains. For example, alcohol increases levels of renin, which causes blood vessels to constrict and become smaller, meaning blood pressure has to increase to push the blood through a narrower space, Phillips says.

Research suggests that one alcoholic drink per day raises both systolic blood pressure (the pressure when your heart pushes blood out) and diastolic blood pressure (the pressure when the heart is at rest) by one point, while four drinks per day raises them by around five points. For comparison, there’s a 15 to 40 point difference between a healthy and high blood pressure reading.   

Alcohol is also a high-calorie drink, meaning it is very easy to consume a lot of excess calories. “Alcohol is a two-pronged attack on blood pressure – one on the effects it has on hormonal systems but also the risk of increasing body weight,” Phillips adds.

Caffeine

As well as the obvious coffee and energy drinks, tea and chocolate are also sources of caffeine, though they contain smaller doses.

Up to 400mg of caffeine a day is fine, even if you have high blood pressure Credit: Getty

“One of the ways that caffeine affects blood pressure is that it causes your adrenal glands to secrete more adrenaline, which causes your blood pressure to go up,” Phillips explains. It’s the same mechanism for how stress raises blood pressure, she notes.

If you’re used to drinking coffee every day then you don’t necessarily see quite such a major impact as the body adapts to the stimulant, she says. “It’s all a balance because we know that a small amount of caffeine can help increase our alertness and our ability to work efficiently. So it’s one of those things when a little can be good but too much is not good.”

In general, up to 400mg of caffeine per day is fine even if you have high blood pressure, she says. That’s around four standard cups of coffee or one or two cups if you’re buying from a café, as these tend to be stronger, Phillips notes.

https://www.telegraph.co.uk/health-fitness/conditions/heart-health/foods-to-avoid-high-blood-pressure/

A Ham Sandwich Daily May Raise Risk of Type 2 Diabetes by 15%, Study Says

From sciencealert.com 

A comprehensive new study finds eating more meat is associated with a higher risk of developing type 2 diabetes, with processed meat and unprocessed red meat highlighted as being particularly significant for overall risk.

An international team of researchers analysed data on almost 1.97 million people, covering 20 countries across Europe, Asia, the Americas, and the Western Pacific.

Consuming the equivalent of about two slices of ham each day – 50 grams (1.8 ounces) of processed meat – was associated with a 15 percent higher risk over 10 years, the study found. For the equivalent of a small steak (100 grams of unprocessed red meat) a day, the risk increase was 10 percent.

"Our research provides the most comprehensive evidence to date of an association between eating processed meat and unprocessed red meat and a higher future risk of type 2 diabetes," says epidemiologist Nita Forouhi from the University of Cambridge in the UK.

                                                                                                   (Eren Ipek/500px/Getty Images)

The research takes advantage of the InterConnect project, where raw data from studies is made available alongside the published results. This means further analysis can take place using the collected data, going beyond the original study's aims and objectives.

Here, the team was able to use the data from 31 previous studies that had collected information on meat consumption and the development of type 2 diabetes. They could also account for factors such as age, body mass index, and health-related behaviours in their calculations.

The study also found a link between regularly eating 100 grams of poultry a day and an 8 percent higher risk of developing diabetes across a 10-year period, but here the relationship was less clear, and it was only significant in Europe.

"While our findings provide more comprehensive evidence on the association between poultry consumption and type 2 diabetes than was previously available, the link remains uncertain and needs to be investigated further," says Forouhi.

Like many studies of this type, these results don't mean there's any definitive proof that eating meat increases the likelihood of developing diabetes. What it does show is a strong correlation, meaning a relationship is probable, and it matches findings from earlier studies.

Quite why processed meat and unprocessed red meat might push up type 2 diabetes risk isn't yet clear, though the researchers have some ideas: red meat is high in saturated fatty acids, for example, that have previously been found to affect insulin resistance.

It's most likely that a number of different mechanisms are at play, but pending further research, the study authors suggest we now have another reason to cut down on meat consumption – besides its links to other mental and physical health issues.

"[The study] supports recommendations to limit the consumption of processed meat and unprocessed red meat to reduce type 2 diabetes cases in the population," says Forouhi.

The research has been published in The Lancet Diabetes & Endocrinology.

https://www.sciencealert.com/a-ham-sandwich-daily-may-raise-risk-of-type-2-diabetes-by-15-study-says

Scientists Discover Simple and Cheap Way To Reduce Your Risk of Type 2 Diabetes

From scitechdaily.com

Exposure to bright light at night significantly increases the risk of developing type 2 diabetes by disrupting circadian rhythms and affecting insulin secretion and glucose metabolism, according to a study by Flinders University.

A study from Flinders University suggests that avoiding bright light at night may be an easy way to lower your risk of diabetes.

The study published in the prestigious journal The Lancet Regional Health – Europe reveals the compelling relationship between exposure to light and the risk of developing type 2 diabetes.

Type 2 (acquired) diabetes is a chronic condition that affects how the body uses insulin. It develops over many years, is difficult to treat, and is usually related to lifestyle factors such as inactivity and obesity.

Key Findings from the Study

“We found that exposure to brighter light at night was associated with a higher risk of developing type 2 diabetes,” says senior author Associate Professor Andrew Phillips from the College of Medicine and Public Health.

In the large modelling study, the research team investigated whether personal light exposure patterns predicted the risk of diabetes using data from approximately 85,000 people and around 13 million hours of light sensor data.

The participants – who did not have type 2 diabetes – wore devices on their wrists for one week to track their light levels throughout the day and night. They were then tracked over the following nine years to observe whether they went on to develop type 2 diabetes.

Impact of Light Exposure on Circadian Rhythms

“Light exposure at night can disrupt our circadian rhythms, leading to changes in insulin secretion and glucose metabolism,” he says.

“Changes in insulin secretion and glucose metabolism caused by disrupted circadian rhythms affect the body’s ability to regulate blood sugar levels, which can ultimately lead to the development of type 2 diabetes.”

Having more exposure to light at night (between 12:30 am and 6:00 am) was linked to a higher risk of developing type 2 diabetes, and this was true regardless of how much light people were exposed to during the day.

Night-time light exposure increases the risk of type 2 diabetes, according to a Flinders University study. Reducing night-time light could be a simple and cost-effective way to prevent the condition

Importance of Reducing Night-time Light Exposure

The research accounted for other factors associated with type 2 diabetes, such as lifestyle habits, sleep patterns, shift work, diet, and mental health.

Even after taking these factors into account, the findings showed that getting more light at night was still a strong predictor of developing diabetes.

“The results showed that exposure to brighter light at night is associated with a higher risk of developing diabetes, with a dose-dependent relationship between light exposure and risk,” says Associate Professor Phillips.

“Our findings suggest that reducing your light exposure at night and maintaining a dark environment may be an easy and cheap way to prevent or delay the development of diabetes,” he adds.

Reference: “Personal light exposure patterns and incidence of type 2 diabetes: analysis of 13 million hours of light sensor data and 670,000 person-years of prospective observation” by Daniel P. Windred, Angus C. Burns, Martin K. Rutter, Chris Ho Ching Yeung, Jacqueline M. Lane, Qian Xiao, Richa Saxena, Sean W. Cain and Andrew J.K. Phillips, 4 June 2024, The Lancet Regional Health – Europe.
DOI: 10.1016/j.lanepe.2024.100943

This research was conducted using data from UK Biobank (Project ID: 6818). We thank the participants for their time, and the UK Biobank team for the ongoing development and maintenance of this resource. This research was conducted with funding support from the Australian Government Research Training Program, the National Heart, Lung, and Blood Institute (R21HL165369), and the Australian Research Council (DP210102924 and DP220102812).

https://scitechdaily.com/scientists-discover-simple-and-cheap-way-to-reduce-your-risk-of-diabetes/ 

Diabetes took over her life, until a stem cell therapy freed her

From washingtonpost.com

Scientists are making progress replacing the critical insulin-producing cells that are destroyed by the disease 

For years, Amanda Smith and her husband were jolted awake at night by a buzz-buzz-beep — an alarm warning that her blood sugar was too high or too low. She would reach for juice boxes stored in her nightstand or fiddle with her pump to release a bolus of insulin.

Smith, a 35-year-old nurse from London, Ontario, has Type 1 diabetes, which wipes out critical islet cells within the pancreas that produce insulin. Without them, Smith relied on vials of insulin from a pharmacy and constant vigilance to stay alive. “You have to pay attention to your diabetes, or you die.”

On Valentine’s Day 2023, doctors transplanted replacement islet cells, grown in a lab from embryonic stem cells, into a blood vessel that feeds Smith’s liver. By August, she no longer needed insulin. Her new cells were churning it out.

“I just feel normal again,” Smith said. “You didn’t realize how much of your life it took up — until it’s taking up none, now.”

Patients such as Smith must take immune-suppressing drugs to prevent their body from rejecting transplanted cells that produce insulin. (Jennifer Roberts for The Washington Post)

Smith is at the forefront of a medical experiment that seeks to treat the root cause of diabetes by replacing the cells the disease destroys. It’s a key step forward in the long quest to develop a cure for diabetes and a front-runner to finally deliver the sci-fi promise that has enveloped the stem cell field for more than two decades.

Stem cells have the remarkable ability to develop into any cell or tissue in the body, and scientists have long dreamed of harnessing their regenerative power to repair the harm done by disease or injury.

Smith is one of a dozen patients who have received a full dose of islet cells generated in a laboratory from stem cells. Eleven of the patients in the clinical trial drastically reduced taking insulin or stopped altogether, according to data presented at an American Diabetes Association meeting in June.

Despite the promise, the therapy developed by Vertex Pharmaceuticals remains in early stages, and many experts consider it a major step forward, not the finish line.

No one knows how long these cells will keep churning out insulin or whether the therapy is safe long-term until it is tested and followed up in more patients, who must take immune-suppressing drugs to prevent their body from rejecting the foreign cells. One patient died of an infection caused by a complication of sinus surgery, highlighting the risk of immunosuppressive medications, which were among the factors contributing to the patient’s death.

Scott Soleimanpour, director of the Michigan Diabetes Research Centre, was diagnosed with Type 1 diabetes when he was 5 years old and recalled that throughout his youth, doctors told him there would be a cure within a decade. Soleimanpour, now in his 40s, made a pact with his childhood self not to promise specific timelines to his patients. Still, he remains hopeful.

“It’s terrible to have diabetes, but this is the best time in the history of the planet to have diabetes, because we have these amazing technologies,” Soleimanpour said. “We haven’t reached the end of the road, but we’re on the journey. It’s okay to sit at this stage of the journey and say, ‘This is good. Let’s keep going.’”

An imperfect path forward

The quest to cure diabetes didn’t start with stem cells. In 1966, doctors performed the first whole pancreas transplant in a diabetic patient. It was major surgery, not a practical treatment for the roughly 2 million people with Type 1 diabetes in the United States.

But as the biology of the pancreas was unravelled, scientists began imagining a stripped down version. Within the pancreas are islets, clusters of cells that produce insulin and other hormones. Instead of transplanting the whole organ, scientists wondered, what if they could use islets harvested from organ donors?

James Shapiro, a transplant surgeon at the University of Alberta in Edmonton, began working on the problem in the 1980s.

“None of the experiments I did worked,” Shapiro recalled. “In the beginning, we could scarcely reverse diabetes in a rat.”

Shapiro continued to chip away at the challenges, and in 2000, he and colleagues reported that seven patients had been transplanted with islets from organ donors — and were able to stop using insulin. The procedure, called the Edmonton Protocol, electrified diabetes researchers. It was proof that cells could be replaced and the disease could be reversed.

“Then, the warts started to become apparent,” Soleimanpour recalled.

Repeat transplants were often needed, and most patients eventually required some insulin again. The immune-suppressing drugs can increase the risk of infections, cancer or other side effects. And the supply of islets was extremely limited.

More than a thousand transplants in the years since showed the approach can work. Last year, U.S. regulators approved an islet cell therapy from organ donors. But use of the treatment is far from mainstream.

After receiving replacement cells that produce insulin, Smith says, “I pray this gets to everyone. My life has changed.” (Jennifer Roberts for The Washington Post)

Body, heal thyself

Researchers looked to the field of stem cell research to solve the scarcity problem.

Unlike most of the body’s cells, embryonic stem cells — which are created from human embryos — can give rise to every tissue and organ in the body, from brain to muscle to insulin-producing islet cells found in the pancreas. In theory, scientists could create as many as needed, with far better control over quality and consistency.

Douglas Melton was a biologist focused on frog development at Harvard University when, in 1991, his infant son, Sam, was diagnosed with Type 1 diabetes. His daughter, Emma, would also be diagnosed with the condition. Melton shifted his focus to study how insulin-producing cells normally develop, in hopes that scientists could imitate the process to help patients.

Melton quickly ran into a hard scientific truth about stem cells: Yes, they can become any kind of cell, but only if they’re coaxed through the right steps, akin to making an elaborate recipe. His laboratory spent two decades trying to devise the right steps, ingredients and timing, a trial-and-error process that resulted in a “six-step education process” that takes weeks.

Felicia Pagliuca had been working in cancer biology at the University of Cambridge when she met Melton at a seminar and was inspired to join his laboratory, drawn by the idea “that you could, instead of trying to kill cells to cure a disease, just use the cell itself as a building block of life — as a medicine,” Pagliuca said. “Especially the idea you could make these cells from scratch in the laboratory.”

To test their lab-grown cells, scientists put them in a dish with glucose and an indicator that changed colour in the presence of insulin. After many experiments, they saw a flash of blue, a sign they had finally gotten the recipe right.

In 2014, they published those results and founded Semma Therapeutics, which was later acquired by Vertex Pharmaceuticals for $950 million. Semma was named after Melton’s now grown-up children, aimed at moving a laboratory breakthrough into the real world.

‘My life has changed’

For Amanda Smith, diabetes wasn’t a manageable illness. It haunted her days and clouded her future. A family member lost a limb to the disease.

Smith had a particularly difficult time anticipating “lows,” when her blood sugar would drop. Once she’d realize it was happening, it was too late — “You just feel like death, you’re so weak you can’t move, you feel nauseous. And then you know: It’s do or die.” In trying to reverse the low, she might eat too many carbs, causing her blood sugar to spike. “You feel like a slug.”

As a child, she would remind her mom, who also has Type 1 diabetes, to check her sugars. Then she began to hear her own family do the same to her. Smith’s daughter Draya, now 9, would borrow her mom’s cellphone to play games but be interrupted by the alerts. “Check your sugars,” Draya would remind her, vowing to become a doctor and develop a cure.

Smith looks back on the quiet of the past year — no buzzers, no alarms — with a bit of wonder. Her medical team feels much the same.

“It’s amazing to see what it’s like, living with diabetes and six months later, essentially not having it,” said Trevor Reichman, surgical director of the Pancreas Transplant Program at the University of Toronto. Andrea Norgate, a nurse who works with him, interjected: “It’s the most exciting thing that’s happened in the world, ever, is probably more accurate.”

Three times a day, Smith takes pills to stop her immune system from destroying the foreign cells. She has had some side effects — early on, she got canker sores, and she’s careful around sick people. But for Smith, that’s manageable compared with the roller coaster and health risks of diabetes.

For the treatment to become safer and accessible to more patients, including young children, the next step is to find ways to protect the cells from the immune system.

Irl Hirsch, an endocrinologist at the University of Washington who has diabetes and has consulted for Vertex, recalled that before he started medical school in 1980, he worked for a famous endocrinologist, Paul Lacy, who was pursuing transplants in rodents to cure diabetes.

“What he told everybody is: We’d be doing these cell transplants in humans in five years. Everybody believed it,” Hirsch said. “That didn’t happen, and the big problem has been the whole issue of [immune] rejection and the need for immunosuppression. It was the problem in 1980, and it’s the problem now.”

Scientists aren’t waiting to tackle that problem. Vertex is testing a method of encapsulating the cells in a bioengineered device. The company is also using gene-editing techniques to make cells “hypoimmune,” or invisible to the immune system. Other researchers are creating stem cells from individual patients and coaxing those to become islet cells. Because the immune system won’t see those cells as foreign, it could reduce the amount of immunosuppression needed.

Trading one horrible disease for long-term immunosuppression gives many clinicians pause, but many patients and advocates are impatient. Today’s diabetes technologies are lifesaving but imperfect. The risks of infection must be weighed, but so must the risk of “having a heart attack 15 years before your peers, going blind and losing your kidneys,” said Aaron Kowalski, president of Breakthrough T1D, a research and advocacy organization.

Smith credits her insulin pump with keeping her alive but was elated to banish it to the back of a kitchen cabinet. She no longer has to plan her life around her illness.

“I pray this gets to everyone,” Smith said. “My life has changed.”

https://www.washingtonpost.com/health/2024/08/26/diabetes-stem-cell-therapy-insulin-success-story/