Link Between Vitamin D Deficiency And Type 1 Diabetes

A study led by researchers from the University of California, San Diego School of Medicine has found a correlation between vitamin D3 serum levels and subsequent incidence of Type 1 diabetes. The six-year study of blood levels of nearly 2,000 individuals suggests a preventive role for vitamin D3 in this disease. The research appears the December issue of Diabetologia, a publication of the European Association for the Study of Diabetes (EASD).
"Previous studies proposed the existence of an association between vitamin D deficiency and risk of and Type 1 diabetes, but this is the first time that the theory has been tested in a way that provides the dose-response relationship," said Cedric Garland, DrPH, FACE, professor in UCSD's Department of Family and Preventive Medicine.
This study used samples from millions of blood serum specimens frozen by the Department of Defense Serum Registry for disease surveillance. The researchers thawed and analyzed 1000 samples of serum from healthy people who later developed type 1 diabetes and 1000 healthy controls whose blood was drawn on or near the same date but who did not develop type 1 diabetes. By comparing the serum concentrations of the predominant circulating form of vitamin D - 25-hydroxyvitamin D (25(OH)D) - investigators were able to determine the optimal serum level needed to lower an individual's risk of developing type 1 diabetes.
Based mainly on results of this study, Garland estimates that the level of 25(OH)D needed to prevent half the cases of type 1 diabetes is 50 ng/ml. A consensus of all available data indicates no known risk associated with this dosage.
"While there are a few conditions that influence vitamin D metabolism, for most people, 4000 IU per day of vitamin D3 will be needed to achieve the effective levels," Garland suggested. He urges interested patients to ask their health care provider to measure their serum 25(OH)D before increasing vitamin D3 intake.
"This beneficial effect is present at these intakes only for vitamin D3," cautioned Garland. "Reliance should not be placed on different forms of vitamin D and mega doses should be avoided, as most of the benefits for prevention of disease are for doses less than 10,000 IU/day."

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Diet Enriched With Arginine And Proline May Speed Wound Healing In Diabetes

Chronic wounds such as foot ulcers are a common problem for diabetics and are the cause of more than 80 percent of the lower leg amputations in these patients. There is currently no effective way to improve healing of these types of wounds, but new research offers hope.
French researchers found that diabetic rats on a high protein diet with arginine and proline - specific molecules found in protein - showed better wound healing over rats fed either standard or high protein food without arginine and proline supplementation.
The article is entitled "Arginine plus proline supplementation elicits metabolic adaptation that favors wound healing in diabetic rats." It appears in the online edition of the American Journal of Physiology - Regulatory, Integrative and Comparative Physiology published by the American Physiological Society.
Methodology
Researchers divided 18 rats into three groups that were either fed a standard diet, a high-protein diet, or a high protein diet supplemented with arginine and proline (ARG+PRO). On the first day of the experiment, each rat was given an incision, under which a sponge was placed in order to collect wound-healing fluid. To assess skin regrowth and healing, researchers also removed two full-thickness sections of skin from the rats' backs each day from day 1 until day 5, when the experiment ended.
At the end of the experiment, the rats' blood was analyzed for blood sugar, insulin, and amino acid concentrations. The wounds on their backs were examined for skin regrowth and development of new blood vessels. And, finally, macrophages were collected from the sponges and analyzed for indications of cytokine stimulation and pro-inflammatory activity.
Results
Rats on both high protein diets had better nitrogen balance than those on the standard diet. However, the wounds of the rats on the ARG+PRO diet showed more new blood vessel growth on day 5. New blood vessel growth is an essential part of wound healing as the blood vessels supply nutrition and oxygen to growing tissue.
Furthermore, the macrophages in the ARG+PRO group showed less cytokine stimulation and pro-inflammatory activity than the other groups. This indicates a better environment for promoting wound healing, as inflammation slows the healing process.
The researchers did not find a difference in skin regrowth between groups, but their findings may be limited because of the small number of rats in the study. Additionally, researchers did not measure markers of collagen deposition in the wound, and the study cannot confirm the beneficial effect of arginine on collagen deposition and wound breaking strength reported in previous research.
Importance of the Findings
This study suggests that arginine and proline supplementation could offer new hope for effective treatment in diabetic patients with chronic wounds. This is a promising new area of research where there are no existing effective treatments for these patients.

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Pathways Of Motivational Pathways Mapped Through the Brain By Optogenetics

Whether you are an apple tree or an antelope, survival depends on using your energy efficiently. In a difficult or dangerous situation, the key question is whether exerting effort - sending out roots in search of nutrients in a drought or running at top speed from a predator - will be worth the energy.
In a paper published online in Nature, Karl Deisseroth, MD, PhD, a professor of bioengineering and of psychiatry and behavioral sciences at Stanford University, and postdoctoral scholar Melissa Warden, PhD, describe how they have isolated the neurons that carry these split-second decisions to act from the higher brain to the brain stem. In doing so, they have provided insight into the causes of severe brain disorders such as depression.

In organisms as complex as humans, the neural mechanisms that help answer the question, "Is it worth my effort?" can fail, leading to debilitating mental illnesses. Major depressive disorder, for instance, which affects nearly 20 percent of people at some point in life, is correlated with underperformance in the parts of the brain involved in motivation. But researchers have struggled to work out the exact cause and effect.
"It's challenging because we do not have a fundamental understanding of the circuitry that controls this sort of behavioral pattern selection. We don't understand what the brain is doing wrong when these behaviors become dysfunctional, or even what the brain is supposed to be doing when things are working right," Deisseroth said. "This is the level of the mystery we face in this field."
Clinicians refer to this slowing down of motivation in depressed patients as "psychomotor retardation." According to Deisseroth, who is also a practicing psychiatrist, patients may experience this symptom mentally, finding it hard to envision the positive results of an action, or, he said, they may feel physically heavy, like their limbs just do not want to move.
"This is one of the most debilitating aspects of depression, and motivation to take action is something that we can model in animals. That's the exciting opportunity for us as researchers," said Deisseroth, who also holds the D.H. Chen Professorship.
Light coercion
Psychiatrists, Deisseroth included, believe the will to act may be born in the prefrontal cortex - the foremost part of the brain that helps plan and coordinate action. It then zips through the brain as a series of electrical signals, passing from neuron to neuron along countless branching pathways until it reaches the nerves that directly implement movement. Until this study, however, it was not clear which of these pathways might control the willingness to meet challenges, or the anticipation that action might be worthwhile in a difficult situation.
To isolate these pathways relevant to depression, Deisseroth's team needed to stimulate specific brain cells in rodents and observe changes in their behavior. They used optogenetics, a technique Deisseroth developed at Stanford in 2005, which has since revolutionized the fields of bioengineering and neuroscience.
The secret is as old as green algae. These single-celled organisms produce a protein called channelrhodopsin that makes them sensitive to sunlight. Borrowing and engineering the gene for this protein, Deisseroth has been able to create neurons that respond to light delivered from fiber-optic cables. He can turn the neurons on and off by sending bursts of light to activate different areas of the brain and then observe the effects on behavior.
Working backward
Surprisingly, the researchers found that simply stimulating the prefrontal cortices of rodents didn't motivate them to try any harder in a laboratory challenge. It turns out that motivation is not as simple as stimulating a region of the brain. Instead of one switch in the prefrontal cortex that turns motivation on, multiple switches work in concert. Some neurons excite motivated activity and others inhibit it. Broadly stimulating the executive part of the brain will not generate a simple effect on behavior.
"It's one step more subtle" said Deisseroth, "but this is something that optogenetics was very well-suited to resolve."
An optogenetic method called projection targeting allowed the scientists to work backward from the brain stem and find the exact pathway from neurons in the prefrontal cortex that signal motivation.
The researchers first introduced their light-sensitive protein into cells in the prefrontal cortex. The light sensitivity then spread out like the branches of a tree through all the outgoing connections and eventually made its way to the brain stem, making those regions light sensitive, too.
Then, illuminating the newly light-sensitive regions of the brain stem thought to control motivational movement, Deisseroth and Warden watched the behavioral effects as a subgroup of neurons in the prefrontal cortex that sent connections to brain stem were activated. They could see not only which cells are possibly involved in motivation, but the way motivation moves from one brain region to another.
Mapping motivation
The researchers suspected that one part of the brain stem in particular, the dorsal raphe nucleus, might be crucial to behaviors that control effort. This cluster of cells is a production hub for serotonin - a chemical messenger that changes the firing behavior of other cells. Serotonin is associated with mood modulation; many antidepressant drugs, for instance, may act by increasing serotonin concentration in the brain.
When the pathway between the prefrontal cortex and the dorsal raphe nucleus was stimulated, rodents facing a challenge in the lab showed an immediate and dramatic surge in motivation.
Curiously, however, when the rodents were relaxing in their home environment, the same stimulation had no effect. The pathway was not merely linked to any action, or to agitation; it was, more specifically, helping to "set the effort that the organism was willing to put forth to meet a challenge," Deisseroth said.
Researchers were also able to produce the opposite effect - reduced effort in response to challenge - by stimulating prefrontal neurons that project to the lateral habenula, a region perched atop the brain stem that is thought to play a role in depression. When this region was getting signals driven optogenetically from the prefrontal cortex, rodents put forward less effort.
Larger puzzles
These findings are part of a larger puzzle that Deisseroth and his team have pieced together by using optogenetics to model human behavior in animal subjects. The work has already helped clinicians and researchers to better understand what is going on in a patient's brain.
Connecting depressive symptoms with brain pathways may be helpful in the development of drugs, but according to Deisseroth, the most important part of this research is its insight into how motivation works in both depressed and healthy people.
He has observed that this insight alone can be helpful to those dealing with mental illness and seeking an explanation for troubling symptoms that feel deeply personal. For those patients, he said, simply knowing that a biological reality underlies their experience can be a motivational force in itself.

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Type 2 Diabetes May Increase The Risk Of Barrett's Esophagus

Patients with Type 2 Diabetes may face an increased risk for Barrett's Esophagus (BE), regardless of other risk factors including smoking, alcohol consumption, obesity and gastroesophageal reflux disease (GERD), according to research unveiled at the American College of Gastroenterology's (ACG) 77th Annual Scientific meeting in Las Vegas.
The study, "Diabetes Mellitus Increases the Risk of Barrett's Esophagus: Results from A Large Population Based Control Case Study," suggests that, "if you have diabetes, your risk for Barrett's esophagus (BE) may be almost doubled ," said co-investigator, Prasad G. Iyer, M.D., of the Mayo Clinic College of Medicine. He said this risk may be higher in men with diabetes likely because men tend to carry more fat in the abdomen compared to women who tend to carry weight around the hips and thighs.
Type 2 diabetes is the most is the most form of diabetes, with millions of Americans living with the disease. Barrett's esophagus is a condition in which the tissue lining the esophagus is replaced by tissue that is similar to the lining of the intestine. No signs or symptoms are associated with Barrett's esophagus but it is commonly found in people with GERD. About 5 to 10 percent of patients with chronic GERD will develop Barrett's esophagus.
Performing a population-based control study using the United Kingdom's General Practice Research Database (GPRD) (a primary care database containing more than 8 million patients), the researchers identified 14,245 Barrett's esophagus cases and 70,361 controls without Barrett's esophagus. Cases were more likely than controls to have ever smoked and consumed alcohol; and the prevalence of Type 2 diabetes before Barrett's esophagus diagnosis was higher in cases than controls. The mean BMI was also higher in cases than in controls both at baseline and over the study period.
Obesity is associated with an increased risk of Barrett's esophagus and esophageal cancer, but it is "unclear" if this is caused from a mechanical and/or metabolic effects such as hyperinsulinemia, according to investigators, who aimed to determine if there is an epidemiologic link between Type 2 diabetes and Barrett's esophagus after adjusting for known risk factors including obesity, smoking, alcohol use and GERD.
"Interestingly, we found that among the study cohort, if you had diabetes there was a twofold increase in your risk for Barrett's esophagus," explained Dr. Iyer. "When we stratified the results by gender, the association of Type 2 diabetes with Barrett's esophagus was stronger in males compared to females, which may reflect the different fat distributions in men and women."
Dr. Iyer said that while this study is retrospective - and further prospective studies are needed to better understand the link between Barrett's Esophagus and Type 2 Diabetes - the results do offer valuable and potentially life-saving insight to patients and health care providers: "if you lose weight your risk for Barrett's esophagus and esophageal cancer may decrease." Dr. Iyer suggested patients who are overweight, particularly if they carry their excess weight in their belly, talk to their physicians about their risk for Barrett's Esophagus and whether they should undergo screening through an upper endoscopy.

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Self-Application Of Electrical Stimulation At Acupressure Points May Relieve Stomach Woes For Diabetics

Diabetic patients who suffer from a common complication of diabetes called gastroparesis may find that chronic electrical stimulation (ES) at specific acupuncture points could relieve gastroparesis symptoms such as nausea, vomiting, early satiety, abdominal fullness, upper abdominal pain and bloating, according to study results unveiled at the American College of Gastroenterology's (ACG) 77th Annual Scientific meeting in Las Vegas.
The study, "Chronic Electrical Stimulation at Acupuncture Points Improves Dyspeptic Symptoms," used a watch-sized digital microstimulator that was specially developed for this project to assess the effects of ongoing electrical stimulation at acupuncture points on gastroparesis symptoms in diabetic patients with refractory gastroparesis. Despite medical therapy, these patients have not found relief for their symptoms and experience frequent physician and emergency room visits or hospitalizations because often they are unable to eat or keep food down and maintain proper nutrition, according to lead investigator Jiande Chen, Ph.D., of the University of Texas Medical Branch. "These are very severe symptoms and could be life-threatening as the treatment options for these patients are very limited and there are no effective medications," said Dr. Chen who noted that the device looks and works like the microstimualtors used to alleviate motion sickness that are already on the market.
Diabetes is a lifelong disease in which there are high levels of sugar in the blood. High blood glucose causes chemical changes in nerves and damages the blood vessels that carry oxygen and nutrients to the nerves. Gastroparesis is a type of nerve damage affecting the vagus nerve which controls the movement of food through the digestive tract. Ten to fifteen percent of the 25.8 million Americans living with diabetes have gastroparesis. This condition can worsen diabetes by making it more difficult to manage blood glucose levels because a delay in gastric emptying can cause a spike in glucose levels when the food finally enters the small intestine, according to the American Diabetes Association.
The device used for this blind cross-over design study on 26 diabetic patients with gastroparesis (18 completed the study) was worn either on the wrist or the leg with four-week ES and four-week sham ES in a randomized order. Electrical stimulation was performed via surface ECG electrodes placed at acupoints PC6 and ST36 using pulse trains. Sham-ES was performed using same parameters via non-acupoints. The PC6 acupuncture point is located on the wrist about 2 1/2 fingers up from the wrist crease on the inside of the forearm, while ST36 is located on the front of the leg, one hand width (four fingers) below the kneecap, on the outside, in the depression between the shinbone and the leg muscle.
Patients were asked to self-apply ES/Sham ES for two hours after each lunch and dinner and the electrogastrogram (EGG) and ECG were recorded at the beginning and end of each 4-week treatment.
According to investigators, 4-week ES not sham-ES "significantly improved" 5 of 9 gastroparesis symptoms: nausea by 29.7 percent; vomiting by 39.3 percent; abdominal fullness by 21.4 percent, bloating by 20.6 percent and retching by 31.1 percent. ES also resulted in a trend of increased vagal activity after eating.
"With all five symptoms significantly improving between 20 and 40 percent, this home-based, non-invasive electrostimulation therapy is feasible and effective in treating gastroparesis symptoms and possible mechanisms involving central, gastric and autonomic functions require further study, " said Dr. Chen. "Although this is a small study, the results are noteworthy because the side-effects and the cost are low." Dr. Chen added that the device is not yet on the market.

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New Depression Treatment Avoids Cognitive Side-Effects

Magnetic Seizure Therapy (MST) may be an effective treatment for the 30% of depression patients who do not receive benefits from conventional treatment.
The treatment was analyzed by a team of experts from the Monash Alfred Psychiatry Research Centre (MAPrc). Their research was published in two leading journals:Psychiatry Research: Neuroimaging and Depression and Anxiety.
Depressive disorders are very common and potentially disabling, said MAPrc Deputy Director Professor Paul Fitzgerald, study leader. He added that one fifth of all Australians are affected with depression at some time in their lives.
Professor Fitzgerald explained:

"Electroconvulsive Therapy (ECT) is one of the only established interventions for treatment resistant depression. But use of ECT is limited due to the presence of memory-related side effects and associated stigma.

This caused the MAPrc experts to start their observations on new treatment strategies. MST is a method that stimulates the brain that may have comparable outcomes to ECT, except with no unwanted reactions.
A previous report in Archives of General Psychiatry indicated that a treatment using magnetic currents to stimulate the brain induced remission in individuals with treatment-resistant depression.
Fitzgerald revealed:

"In MST, a seizure is induced through the use of magnetic stimulation rather than a direct electrical current like ECT. Magnetic fields are able to pass freely into the brain, making it possible to more precisely focus stimulation."

MST will better alleviate symptoms of depression without the memory difficulties that people experience with ECT, by not using direct electrical currents and inducing a stimulation that is more focal.
This therapy is only accessible in a few locations worldwide, as the research has just only begun. In Australia, the MAPrc is the only centre where trials are being conducted.
Results from the study showed that MST led to a remarkable decrease in depression symptoms:

• 40% of subjects showed overall improvement
• 30% of subjects showed some improvement

The patients did not report any cognitive side effects from this therapy.
"MST shows antidepressant efficacy without apparent cognitive side effects." Fitzgerald said.
However, further trials need to be conducted in order to have better insight on the best conditions for stimulation, as well as to compare MST to already existing treatments, such as ECT.
Large-scale randomized controlled trials are necessary to correctly assess the differences between MST and ECT. A substantial amount of research needs to be carried out before official statements can be made about the effectiveness of this therapy.
Funding from beyondblue and the NHMRC has been given to Professor Fitzgerald and his colleagues to conduct a large-scale trial on MST as a potential treatment for depression

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Heart Problems Associated With Diabetes Likely Worsened By Crusty Foods

A University of Illinois study suggests avoiding cooking methods that produce the kind of crusty bits you'd find on a grilled hamburger, especially if you have diabetes and know you're at increased risk for cardiovascular disease because of your diagnosis.
"We see evidence that cooking methods that create a crust - think the edge of a brownie or the crispy borders of meats prepared at very high temperatures - produce advanced glycation end products (AGEs). And AGEs are associated with plaque formation, the kind we see in cardiovascular disease," said Karen Chapman-Novakofski, a U of I professor of nutrition.
For years nutrition experts have advised people with diabetes to bake, broil, or grill their food instead of frying it, she said.
"That's still true, but if you have diabetes, you should know that AGEs - byproducts of food preparation methods that feature very high, intense, dry heat - tend to end up on other tissues in the body, causing long-term damage," she added.
If you're fighting this vascular buildup anyway, Chapman-Novakofski thinks that consuming products containing AGEs could worsen the cardiovascular complications of diabetes.
In the U of I study, the scientists compared the 10-day food intake of 65 study participants in two ethnic groups: Mexicans (who have higher rates of diabetes and a greater risk of complications from the disease) and non-Hispanic whites.
"We found that people with higher rates of cardiovascular complications ate more of these glycated products. For each unit increase in AGEs intake, a study participant was 3.7 times more likely to have moderate to high risk for cardiovascular disease," said Claudia Luevano-Contreras, first author of the study.
The study showed that non-Hispanic whites had a higher intake of AGEs, and they consumed more saturated fats. However, the association between AGEs and cardiovascular disease was stronger than for saturated fats and heart disease, she said.
Eating less saturated fat and more fruits, vegetables, and fiber are important for people with diabetes, but this study shows that food preparation may be important too, she added.
"AGEs are higher in any kind of meat, but especially in ground meat," she said. "If you put hamburgers or brats on the grill, you'll likely have a higher AGEs content than if you chose a whole cut of meat, say round steak or chicken," said Chapman-Novakofski.
Boiling or stewing meat would reduce your AGEs intake further. And scrambling an egg with cooking spray instead of frying it leads to a significant reduction in AGEs, she added.
The scientists said more research is needed before definite recommendations can be made. They are planning another study in which they'll examine past AGEs intake of diabetes patients.
"These findings are preliminary, but they give us ample reason to further explore the association between AGEs and cardiovascular risk among people with diabetes," Chapman-Novakofski noted.

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Patch that could replace insulin jabs for diabetics

A stick-on patch that blasts insulin through the skin could banish the need for daily injections for many diabetics.

The high-tech electronic patch contains enough insulin to last the patient several days.

When a hand-held device, called a sonic applicator, is held over the patch, it fires sound waves that open up the pores in the skin and force the drug into the bloodstream more quickly.

Initial trials suggest the patch, called the U-Strip, can deliver insulin into the blood as quickly and effectively as a needle

The patch, called the U-Strip, has undergone initial trials in the U.S. involving around 100 people who have insulin-dependent diabetes.

The results suggest the patch can deliver insulin into the blood as quickly and effectively as a needle.

A larger trial, involving more than 500 patients, is now being planned and, if successful, the revolutionary device could become available in the UK within the next three years.

Diabetes affects around 2.8 million Britons. It occurs when the pancreas either stops producing insulin altogether, or its output drops sharply.

Insulin helps muscles absorb sugar from the blood to burn as a source of fuel.

Without the right levels of insulin, the disease can cause irreversible damage to the kidneys, eyes, nerves, heart and major arteries.

Many patients must test their blood sugar several times a day, and need insulin jabs for the rest of their lives in order to maintain adequate levels of the hormone.

Experts believe many would have better glucose control if there was an easier way to take their insulin.

A survey last year by the charity Diabetes UK showed one in three sufferers hid their condition from others and often failed to test their blood sugar levels or missed insulin jabs in case they drew attention to themselves.

Diabetes affects around 2.8 million Britons. It occurs when the pancreas either stops producing insulin altogether, or its output drops sharply

The sound wave patch could be a painless and more discreet alternative.

Drug-releasing skin patches are already widely used in hormone replacement therapy for the menopause and to help smokers quit.

Most work by allowing the active drug to gradually ‘seep’ through the skin.

But this technology only works with drugs made up of small molecules. Getting bigger molecules, such as those found in insulin, through the skin has been a major stumbling block.

But as the sound waves hit the skin, they prise open sweat glands and hair follicles which provide a direct route through to the bloodstream.

The patient usually wears the patch on their upper arm and places the hand-held sonic applicator — about the size of a mobile phone — directly over it.

At the press of a button, it produces a burst of sound waves that propel the insulin through the pores of the skin and into the bloodstream in a matter of seconds.

The device can hold different amounts of insulin, allowing it to be tailored to each patient, and contains a computer chip so that doctors can programme exactly how much insulin needs to be delivered into the body.

As with insulin injections, this has to be done several times a day to keep blood glucose levels under control. But the patch is waterproof and stays on the skin 24 hours a day, even during showers or baths.

The U.S. firm behind the new technology, Pennsylvania-based Transdermal Specialties Inc., says the smart patch can transmit the data wirelessly to a computer so it can be forwarded to the patient’s doctor.

Commenting on the development, Libby Dowling, clinical advisor for Diabetes UK, said: ‘Anything that makes daily life for people with diabetes easier is a good thing, and we will watch the developments of this technology with interest.’

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Meanwhile, scientists have developed a diabetes ‘vaccine’ made from the body’s own immune cells.

The injection appears to prevent type 1 diabetes by halting the damage that leads to the pancreas being unable to produce insulin.

Scientists hope the treatment, which has so far only been tested on mice, could eventually be used to ‘immunise’ at-risk children and adolescents.

Those with a family history of the disease would be one of the main target groups, as diabetes has a strong genetic link.

The condition causes the immune system to attack insulin-producing cells in the pancreas.

The reason remains a mystery, but one theory is that the process can be triggered by viral infection.

Some research points to enteroviruses — these cause diarrhoea and vomiting, but can also infect the pancreatic cells, triggering the immune system to attack them.

The jab works by harnessing cells called macrophages to protect against this attack.

Normally these cells are responsible for the damage associated with type 1 diabetes, but experts at the Karolinska Institute in Stockholm have found a way of converting macrophages into ‘good’ cells.

They inject a molecule that ‘tells’ the cells to protect rather than destroy, and so shield the pancreas from other immune system attacks.

The team tested the injection on mice that were genetically susceptible to diabetes.

After 12 weeks, only 25 per cent had developed diabetes, compared with 83 per cent of mice not given the jab.

The scientists now hope to use the injection in human trials.

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Increased Risk For Diabetes When Obesity And Low Vitamin D Are Present

The combination of obesity and vitamin D deficiency may put people at even greater risk of insulin resistance than either factor alone, according to new research from the Drexel University School of Public Health recently published early online in the journal Diabetes Care. Insulin resistance is a major risk factor for Type 2 diabetes, a condition that affects 25.6 million adults and is the seventh leading cause of death in the United States.
"Vitamin D insufficiency and obesity are individual risk factors for insulin resistance and diabetes," said lead author Shaum Kabadi, a doctoral candidate in epidemiology at Drexel. "Our results suggest that the combination of these two factors increases the odds of insulin resistance to an even greater degree than would have been expected based on their individual contributions."
In the study, obese individuals who had healthy levels of vitamin D had insulin resistance almost 20 times more often than the overall study population. But in obese individuals whose serum vitamin D was low, insulin resistance was much higher: about 32 times more common than the average.
Senior author Dr. Longjian Liu, an associate professor in the School of Public Health, noted, "It's not clear whether obesity itself causes a low vitamin D level or if it's the other way around."
Vitamin D is stored in adipose fat tissues, making it unavailable for the body to use; as a result, people who are overweight are already more likely to have low levels of serum vitamin D. Vitamin D deficiency is associated with multiple health conditions including diabetes, cardiovascular diseases including stroke, depression, dementia and other conditions.
Kabadi, Liu and co-author Dr. Brian Lee, an assistant professor in the School of Public Health, analyzed data on serum vitamin D levels and indicators of insulin resistance and diabetes from 5,806 respondents to a major national health survey, the National Health and Nutrition Examination Survey (NHANES). This was the first study of the association between vitamin D and diabetes risk for obese patients using a large, nationally representative sample of adults. The survey reported data from individuals at a single point in time and was therefore unable to determine whether there is a cause-and-effect relationship among vitamin D, obesity and insulin resistance.
Further studies could indicate whether vitamin D supplements are effective at reducing the risk of insulin resistance and diabetes in obese individuals. If so, the authors noted that it would be an inexpensive and practical prevention strategy compared to the difficulty involved in healthy weight loss.
Liu said that vitamin D supplements may be useful for people who are overweight or obese to help control diabetes, but he cautioned that too much vitamin D can cause side effects such as weakness and fatigue. In addition, vitamin D deficiency is just one of many known risk factors associated with insulin resistance and diabetes. "Therefore, to control diabetes, we need to have comprehensive prevention strategies. For example, physical activity may be the most cost-effective way to control weight and subsequently to control conditions including diabetes and heart disease," Liu said.

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Sexual Dysfunction May Be A Tip-off To Heart Disease In Diabetic Men

Sexual dysfunction may be a marker of cardiovascular disease in men with longstanding type 1 diabetes, investigators announced at the 72nd Scientific Sessions of the American Diabetes Association (ADA).
Sara Turek, MPH, and colleagues examined the association of sexual dysfunction with clinical markers of vascular disease in 301 men from the ongoing 50-Year Medalist Study who have had type 1 diabetes for more than 50 years. Turek is a coordinator for the study, which is being conducted at the Joslin Diabetes Center in Boston.
In prior analyses, only about half of the Medalist population has been shown to develop diabetic nephropathy, retinopathy, and neuropathy, which are complications that occur in nearly all type 1 diabetic patients in the general population by about 30 years after their initial diagnosis. The rate of cardiovascular disease in Medalists, however, is similar to that reported in age-matched patients with type 2 diabetes.
Research has also demonstrated that participants in the Medalist Study have usually maintained good long-term glycemic control.
One issue that had not been addressed in the Medalist cohort was sexual dysfunction. "We have noticed that while sexual dysfunction is a common complaint among male Medalists that significantly impairs their quality of life, there is a paucity of data on sexual dysfunction in men with long-duration type 1 diabetes," Turek commented.
Overall, 210 male Medalists, or 69.8%, had sexual dysfunction as determined by an affirmative response to the question: "Have you ever had sexual problems?"
Males reporting a positive response had a hemoglobin (Hb)A1c of 7.1± 0.9% versus 6.8 ±0.8% in the no-dysfunction cohort (P=0.02). Body mass index (BMI) was 26.1 ±3.8 kg/m2 and. 25.8 ±3.6 kg/m2 (P=0.03) in the two groups, respectively, total cholesterol was 159.3 ±32.1 and 150.1 ±30.6 mg/dL(P=0.02), and high-density lipoprotein (HDL) was 55.1 ±16.2 and 62.1 ±17.8 mg/dL (P<0.01).
In addition, a history of cigarette smoking was associated with prevalence of sexual dysfunction (51.7% versus 39.3% in the sexual dysfunction and non-sexual dysfunction groups, respectively, P=0.05).
The researchers also examined clinical inflammatory markers that are commonly associated with cardiovascular risk and disease including C-reactive protein (CRP), interleukin (IL-6), and plasminogen activator inhibitor type 1 (PAI-1). Only IL-6 was significantly associated with patient reports of sexual dysfunction (P=0.03), and the association was independent of BMI, age, and glycemic control.
The findings suggest that sexual dysfunction follows the pattern of macrovascular complications seen in the Medalist group, Turek said. Also, the association with Il-6 may provide a pathway linking sexual dysfunction and macrovascular complications in this cohort.
Sara Turek said:

"The clinical message is that sexual dysfunction might be a more overt sign of cardiovascular issues or future cardiovascular issues than other clinical markers of cardiovascular disease symptoms such as hypertension, high cholesterol, and atherosclerosis. So if a patient presents with a complaint of sexual dysfunction, the physician may want to screen for cardiovascular problems since erectile dysfunction may be a predictor of increased cardiometabolic risk in aging men."

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Passive Smoking Tied To Type 2 Diabetes, Obesity

If you need another reason to steer clear of cigarette smoke, consider this: a new study presented at a conference this week suggests breathing in secondhand smoke is linked to higher risks of developing type 2 diabetes and obesity.
Presented on Sunday at The Endocrine Society's 94th Annual Meeting in Houston, the findings show that adults exposed to secondhand smoke have higher rates of these diseases than non-smokers who are not exposed to tobacco smoke.
Co-author Dr Theodore C Friedman, chairman of the Department of Internal Medicine at Charles R Drew University in Los Angeles, told the press:
"More effort needs to be made to reduce exposure of individuals to secondhand smoke."
For the study, Friedman and colleagues used data from a nationally representative sample of more than 6,300 adults who took part in the US National Health and Nutrition Examination Survey (NHANES) between 2001 and 2006.
As well as answering questions about smoking, the participants had also given blood samples, from which various measures were taken, including levels of cotinine, an alkaloid found in tobacco that is also a metabolic byproduct of nicotine. The researchers used this to verify passive smoking exposure.
Friedman explained that while other studies have shown a link between type 2 diabetes and secondhand or passive smoking, none of them had used a blood marker to confirm the results.
25% of the participants in Friedman's study were current smokers, which he and his colleagues classed as those participants who said "yes" when asked "Do you smoke cigarettes?" and whose cotinine levels were above 3 nanograms per milliliter (ng/mL).
41% of the sample were classed as non-smokers. These were participants who answered "no" when asked "Do you smoke cigarettes?", and whose cotinine levels were under 0.05 ng/mL.
34% of the sample were classed as secondhand smokers. These had also answered "no" to the current smoking question, but their blood cotinine levels were above 0.05 ng/mL.
After adjusting the results to rule out any effects from age, sex, race, alcohol consumption and exercise, the researchers found that compared to non-smokers, secondhand smokers showed signs of a number of factors that can lead to type 2 diabetes, such raised insulin resistance, elevated fasting blood glucose or blood sugar, and higher hemoglobin A1c, a measure of blood sugar control over the past three months.
Secondhand smokers also had a higher rate of type 2 diabetes, which the researchers classed as having a hemoglobin A1c count above 6.5%. The rate of type 2 diabetes in the secondhand smokers was similar to that of the current smokers, said the researchers.
Levels of Body Mass Index (BMI), a measure of obesity, were higher among secondhand smokers than non-smokers, and although current smokers had lower BMI, their higher hemoglobin A1c was higher.
And when they adjusted the figures to rule out the effect of BMI, Friedman and colleagues found that levels of hemoglobin A1c in secondhand smokers and current smokers were still higher than in non-smokers.

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Diabetic Teenagers More Likely To Drop Out Of High School And Face Worse Job Prospects

A study in the January issue of Health Affairs has found that students in high school with diabetes are at a higher risk of not completing their secondary education and face lower wages at work. It had already been known that living with diabetes can add a huge weight of restriction to one's life because of its countless health effects, but whether or not the disease has a significant effect on success at high school or in the workplace had not before been evaluated. The study found that high school dropout rates for people with diabetes are 6% higher than for high school students without the disease. In terms of job prospects, those who are diabetic, face a loss of more than $160,000 in wages over their working life, compared to those who aren't.
According to Jason M. Fletcher, an associate professor of public health at Yale University:

"Diabetes has a marked effect on schooling and earnings early in life, yet these are relatively unexamined implications of this disease".

Fletcher and coauthor Michael R. Richards used data from the National Longitudinal Study of Adolescent Health as a means of analyzing the effects of diabetes among teenagers as they approach adulthood. The survey observed over 15,000 teenagers and provided distinctive insight into the economic effects the disease can have on them, as they get older.
They found that the disparity in the high school dropout rate for diabetics compared to non-diabetics - over 6 percentage points higher - is greater than the male-female and black-white differences, and is comparable to the attention deficit hyperactivity disorder dropout rate. Interestingly, teenage diabetics with parents who also suffer from the disease, were found to be 4-6% less likely to attend college.
The societal and economic implications continue as diabetics age; in their thirties they are 10% less likely to be employed, and can expect to earn $6,000 less per year - approximately $160,000 over their lifetime. This could be largely to do with the reduced education received.
Various explanations have been offered on why some of these consequences occur. Fletcher and Richards note that diabetes could alter a persons desire to enter the workforce, given their health-related condition, and that employers could be less partial to hire a diabetic with concerns of productivity in mind. A reason why diabetics might decide to stay in lower paying jobs could be fear of losing their health insurance, being classed as "job-locked" to ensure their medical needs are met.
As a disease that affects 25 million people in the US alone - costing $200 billion a year - diabetes is rampantly becoming one of the nation's toughest diseases to battle. The effects that diabetes has on teenage students and their employment prospects could end up costing society over $10 billion during their lifetime.
The authors stressed the importance of policy makers focusing on diabetes prevention for young children and the support of in-school diabetes screening. By screening at school, the number of undiagnosed diabetic children would be reduced significantly, as well as the mitigation of the consequences it can have in their later life. Research should be made on children with diabetic parents to have a better idea on how to reduce potential educational effects on them, as the authors noted "Given the unyielding rise of diabetes and obesity among the population as a whole, the potential of diabetes to strike in one generation and then have negatives effects on the next is a cause for alarm,".

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Long Term Insulin Not Linked To Higher Risk Of Heart Attack, Stroke, Cancer

Long term use of insulin does not put people with diabetes or pre-diabetes at higher risk for heart attack, stroke or cancer, according to a large international study that followed more than 12,500 people in 40 countries over 6 years.
One of the study's two principal investigators, Dr Hertzel Gerstein, of McMaster University in Canada, presented the findings on Monday at the 72nd scientific sessions of the American Diabetes Association in Philadelphia, USA.
Gerstein is professor of medicine at McMaster's Michael G DeGroote School of Medicine and deputy director of the Population Health Research Institute at McMaster University and Hamilton Health Sciences.
He said the results run counter to concerns that long-term use of insulin may lead to heart disease.
"People have been debating the question of whether there are adverse consequences to long-term insulin use for years. This study provides the clearest answer yet to that question: No, there are not," said Gerstein in a statement.
The results of the study, called ORIGIN (Outcome Reduction with an Initial Glargine Intervention study), are due to be published this week in the New England Journal of Medicine (NEJM).
Another important finding from the ORIGIN study is that people with pre-diabetes who had daily insulin injections had a 28% lower risk of developing type 2 diabetes. The effect was still there after the daily basal injections with insulin glargine had stopped.
For the study, Gerstein and colleagues examined data on more than 12,500 people of average age 64 from 537 sites in 40 countries, who were either at high risk for type 2 diabetes or were in the early stages of the disease and had a high risk for cardiovascular (CV) problems.
The participants were randomly assigned to receive either standard care (no insulin) or one daily injection of insulin (glargine) for an average of six years.
The researchers measured a number of outcomes, including deaths due to cardiovascular events, and non-fatal cardiovascular events, such as heart attack (myocardial infarction),stroke, heart failure, and heart-related surgery such as revascularization procedures.
They also measured cancer incidence: all cancers combined and organ-specific cancers.
When they analyzed the results, the researchers found no difference between the two groups in cardiovascular outcomes or cancer (either combined or of any type).
They suggest this means there is no long term harm from having daily insulin injections (with insulin glargine) to control glucose.
Through most of the study, the participants who took insulin managed to keep their normal fasting glucose under control (levels were under 6 mmol/l).
The results did, however, confirm two already-known, minor medical effects of daily insulin use: low blood sugar (hypoglycemia) and a slight gain in weight. On average, participants using insulin gained 3.5 lbs (1.6 kg) over the six years and experienced 0.7% higher risk of severe hypoglycemia per year, compared to those who did not use insulin.
Gerstein said:
"We now know what the risks are of taking insulin on a long-term basis, and they are low."
Another finding was that taking omega-3 fatty acid supplements (in the form of 1 gm daily capsules) did not reduce heart-related deaths in people with type 2 diabetes or pre-diabetes. But the researchers couldn't say if this was also true of a diet rich in omega-3 fatty acids, since they did not study this effect.
A key feature of the ORIGIN trial is that it investigated the use of insulin glargine in a population in which insulin's are not typically used. Thus it provides new data on the benefits and risks of starting insulin therapy earlier in the course of the disease.
Sanofi Inc, who market Lantus (a brand name for insulin glargine in injection form) funded the study and the Norwegian company Pronova Biocare AS provided the omega-3 supplements.
Gerstein described the trial as an "excellent example of collaboration between industry and academia".
Riccardo Perfetti, MD, Vice President Medical Affairs, Global Diabetes, Sanofi, told the press:
"In patients with pre-diabetes or early type 2 diabetes and high CV risk, ORIGIN shows that it is possible to maintain low and stable HbA1c levels that are close to normal over a long time, and to potentially delay the progression from pre-diabetes to diabetes."
Diabetes is a chronic, often debilitating, and sometimes fatal disease. It occurs when the body either can't make the insulin required to keep blood sugar (glucose) under control, or when it can't use the insulin it produces. Glucose is an essential source of energy, which the body controls with insulin. Without this control, blood glucose levels remain high, eventually damaging organs, blood vessels and nerves.
There are currently over 9 million people in Canada living with diabetes or pre-diabetes, a condition where blood sugar is above normal, but not yet developed into full-blown diabetes. People with pre-diabetes are at a high risk for developing type 2 diabetes

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Waist Size, Regardless Of BMI, Linked To Diabetes Risk

Waist circumference is strongly and independently linked to diabetes type two risk, even after accounting for body mass index (BMI), and should be measured more widely for estimating risk, researchers from the Medical Research Council (MRC) Epidemiology Unit, UK, reported in PLoS Medicine. The authors explained that overweight people with a large waist, over 102cm (40.2 inches) for men and over 88cm (34.6 inches) for women, have approximately the same or higher risk of eventually developing diabetes type 2 as obese individuals.
Dr Claudia Langenberg and team gathered data on over 340,000 individuals from eight European countries to determine what their future risk of developing diabetes type 2 might be.
Dr Claudia Langenberg, said:

"Type 2 diabetes is a serious and increasingly common disease. More than a third of the UK adult population is overweight and at increased risk of diabetes, but they are not systematically monitored for this risk. Our findings suggest that if their waist circumference is large, they are just as likely to develop the condition as if they were obese.
We do not suggest replacing BMI as a core health indicator, but our results show that measuring waist size in overweight patients allows doctors to 'zoom in' on this large population group and identify those at highest risk of diabetes. These people can then be offered lifestyle advice, which can reduce their risk of developing the disease."

Diabetes type 2 is a long-term condition that occurs when the person's body cannot produce enough insulin, or when the cells in the body do not react properly to insulin. The exact causes of type 2 diabetes are not precisely understood, but experts say that being obese or overweight are the main modifiable risk factors.
Langenberg and team set out to determine what the link between BMI, waist size and the likelihood of developing diabetes type 2 might be - they also aimed to find out what the risks were separately for men and women. They gathered data from the European Union funded InterAct Study, consisting of 12,403 individuals with diabetes type 2 who had developed the disease during a 15-year follow up.
They found that:

Overweight people with large waists have the same or higher risks of eventually developing type 2 diabetes as obese individuals

• 7% of males with a large waist who were overweight eventually developed diabetes type 2 within ten years
• 4% of females with a large waist who were overweight eventually developed diabetes type 2 within ten years
• Large-waisted overweight men and women were found to have either the same or higher risk of eventually developing diabetes type 2, compared to obese individuals
• Normal weight men with a small waist had only a 1.6% chance of developing the disease
• Normal weight women with a small waist had a 0.6% risk of developing the disease
• Pear-shaped people - those who were overweight but had a small waist - were found to have a relatively low risk of developing diabetes type 2
• Women with a BMI greater than 35 (obese women) with a large waist were nearly 32-times more likely to eventually develop diabetes type 2 compared to thin women with a small waist
• Obese men with a large waists were 22-times more likely to develop the disease compare to their lean and small-waisted counterparts

Principal Investigator of the InterAct Study, Professor Nick Wareham, said:

"This is one of the most comprehensive studies of lifestyle and diabetes risk to date, not just in scale, but in the powerful prospective design which allows us to follow a population over a long period of time to see how and why disease develops. The results of this important research will help inform new strategies for the prevention of this devastating condition that affects almost three million people in the UK."

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Lower Limb Amputation Rates Associated With Diabetes Drop, US

An investigation by the Centers for Disease Control and Prevention, found that between 1996 and 2008, the number of leg and foot amputations among U.S. individuals, aged 40+ with diagnosed diabetes, decreased by 65%.
The study, entitled "Declining Rates of Hospitalization for Non-traumatic Lower-Extremity Amputation in the Diabetic Population Aged 40 years or Older: U.S., 1988-2008," is published online in the current issue of Diabetes Care.
In 1996, the age-adjusted rate of leg and foot amputations was 11.2 per 1,000 individuals with diabetes. However, in 2008 this rate fell to 3.9 per 1,000.
Non-traumatic, lower-limb amputations, refers to amputations caused by circulatory problems, rather than those caused by injuries. Circulatory problems are a prevalent adverse effect in individuals suffering with diabetes.
Furthermore, results from the study revealed that in 2008:

• Women had lower age-adjusted rates of lower-limb amputations (1.9 per 1,000) than men (6 per 1,000)
• Individuals aged 75+ had the highest rate (6.2 per 1,000) than people in other age groups
• Rates were higher among blacks (4.9 per 1,000) than whites (2.9 per 1,000)

According to the researchers, the decrease in lower-limb amputations among individuals with diabetes may partially be due to factors such as: declines in heart disease, improvements in blood sugar control, as well as foot care and diabetes management.
Nilka Ríos Burrows, M.P.H., an epidemiologist with CDC's Division of Diabetes Translation, explained:

"The significant drop in rates of non-traumatic lower-limb amputations among U.S. adults with diagnosed diabetes is certainly encouraging, but more work is needed to reduce the disparities among certain populations.
We must continue to increase awareness of the devastating health complications of diabetes. Diabetes is the leading cause of lower-limb amputations in the United States."

After examining data from the National Hospital Discharge Survey on non-traumatic lower-limb amputations from the National Health Interview Survey on the prevalence of diagnosed diabetes from 1988-2008, the researchers discovered that the decrease in rates was higher among individuals with diagnosed diabetes than people without the disease. Although, in 2008, the rate was still approximately 8 times higher among those with the disease than those without diabetes.
Diabetes is the leading cause of non-traumatic, lower-limb amputations, kidney failure, and blindness among adults. In addition, the disease is the 7th leading cause of mortality in the U.S.. Diabetes also increases the risk of strokes, hypertension, and heart attacks.
CDC's Division of Diabetes Translation supports prevention and control programs in all 50 states, seven U.S. territories and island jurisdictions, and the District of Columbia.
The National Diabetes Education Program provides education to enhance treatment for individuals with the disease, promote early diagnosis and prevent or delay type 2 diabetes from developing. The program is co-sponsored by CDC and the National Institutes of Health.

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American Diet Fuelling Heart Disease And Diabetes Rates In Southeast Asia

As Southeast Asians embrace American fast foods, such as pizza, french fries, hot dogs and hamburgers, more are dying prematurely form coronary heart disease and developing diabetes type 2, researchers from the University of Minnesota School of Public Health and the National University of Singapore reported in the journal Circulation. The authors say that attention should be focused on the impact of behavioral and dietary changes that take place when cultures interact.
The researchers found that Chinese adults who live in Singapore and consume American-style fast foods, on average, twice each week, had a 56% higher risk of dying from heart disease and a 27% greater chance of developing diabetes type 2, compared to their counterparts who never ate American-style junk foods. Those who ate fast foods at least four times per week were 80% more likely to die from coronary heart disease.
Lead author, Andrew Odegaard, Ph.D., M.P.H., said:

"Western style fast food intake in East and Southeast Asia started becoming more prominent in the late 1980s into the 1990s. This provided an avenue to participate in American culture, which is very different from the historical dietary culture of these populations."

When the study participants entered the Singapore Chinese Health Study, they were aged from 45 to 74 years. The study lasted from 1993 to 2009 (16 years). By the end of the study, 1,397 had died from coronary heart disease and 2,252 were newly diagnosed with diabetes.
Researchers used a questionnaire constructed specifically to identify the types of food consumed in the Asian population, looking for 165 different food items that are commonly eaten. Six main fast food items - french fries, pizza, deep fried chicken, hot dogs, hamburgers & cheeseburgers were included, as well 'other fast food sandwiches'.
Western or North American-style fast foods are considered to be unhealthy, due to high content of refined carbohydrates, processed meat and fat. The portions are often large and high in sodium and cholesterol. Those found to be eating these kinds of foods showed a reduced intake of vegetables, dairy, rice, carbohydrates, rice and dietary fiber. To their credit, they were educated, smoked less, and were more likely to be physically active, this profile obviously makes them less likely to have high blood pressure, but nonetheless, this kind of diet doesn't bode well later in life, increasing the risks of cardiovascular problems and type two diabetes amongst other problems.
The constant 'Americanization' of the world continues at a fast pace, with multi-national companies spreading their outlets into developing countries at an increasing rate. The study's author, Odegaard, said that the research indicated that more attention was needed to understand the changes in diet and habits as different cultures interact more with each other.
It's clear that the increasing obesity in North America and Europe is a product of diet and lifestyle and concerns are mounting about looming health implications for future generations, with some predicting an avalanche of type two diabetes and cardiovascular problems over the next few decades. Clearly, this problem is not confined to Caucasians, it's simply a question of cultural and dietary habits that can weigh heavily on the health

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Risk Of Bladder Cancer May Increase With Some Diabetes Drugs

An increased risk of bladder cancer is linked to the use of pioglitazone, a medication commonly used to treat type 2 diabetes, according to a new study published in CMAJ (Canadian Medical Association Journal).
People with type 2 diabetes are at risk of several types of cancer, including a 40% increased risk of bladder cancer, compared to people without diabetes. Previous studies have shown a higher incidence of bladder cancer in people taking pioglitazone, a type of thiazolidinedione.
To determine whether there is a link between pioglitazone use and bladder cancer, researchers conducted a systematic review and meta-analysis of randomized controlled trials and observational studies involving over 2.6 million patients.
"We observed an increased risk of bladder cancer associated with the use of thiazolidinediones," writes Dr. Jeffrey Johnson, School of Public Health, University of Alberta, with coauthors. "In particular, use of pioglitazone was associated with an increased risk of bladder cancer based on a pooled estimate from three cohort studies involving more than 1.7 million individuals."
The researchers also looked at a possible association with rosiglitazone, another type of thiazolidinedione, but did not see an effect.
"Although the absolute risk of bladder cancer associated with pioglitazone was small, other evidence-based treatments for type 2 diabetes may be equally effective and do not carry a risk of cancer," conclude the authors. "This study quantifies the association between pioglitazone use and bladder cancer and may help inform decisions around safer use of pioglitazone in individuals with type 2 diabetes."

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Looking at Cannabis Based Type 2 Treatment

Cannabis Potential for Blood Sugar Control?

One of the classic effects of cannabis on people is raging hunger-the "marijuana munchies." The drug has been used to good effect on people with diseases that diminish appetite, helping them to regain a healthy interest in food. So it is a bit ironic that British drug maker GW Pharmaceuticals has created a cross-bred cannabis plant whose appetite-suppressing qualities could be used to treat type 2 diabetes.

The new strain contains an appetite-suppressing compound called THCV (tetrahydrocannabivarin), a cannabinoid* found in cannabis sativa-marijuana. The company sees a drug that uses THCV as potentially useful in helping type 2s and obese people control their appetites-a key to good blood sugar control.

In 2010, GW introduced a cannabis-based drug to treat the symptoms of multiple sclerosis. Already, the company has found 60 cannabinoids in the cannabis sativa plant. A company spokesman says that only 12 to 15 of them have been explored in any depth.

*Cannabinoids are the active ingredients in cannabis sativa that create the plant's physical and mental effects when it is ingested or smoked.

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Marijuana Controls Diabetes

Marijuana Compound May Help Stop Diabetic Retinopathy
A compound found in marijuana won’t make you high but it may help keep your eyes healthy if you’re a diabetic, researchers say.
Early studies indicate cannabidiol works as a consummate multi-tasker to protect the eye from growing a plethora of leaky blood vessels, the hallmark of diabetic retinopathy, says Dr. Gregory I. Liou, molecular biologist at the Medical College of Georgia.

“We are studying the role of cannabinoid receptors in our body and trying to modulate them so we can defend against diabetic retinopathy,” Dr. Liou says. Diabetic retinopathy is the leading cause of blindness in working-age adults and affects nearly 16 million Americans.

High glucose levels resulting from unmanaged diabetes set in motion a cascade ultimately causing the oxygen-deprived retina to grow more blood vessels. Ironically, the leaky surplus of vessels can ultimately destroy vision.
Dr. Liou, who recently received a $300,000 grant from the American Diabetes Association, wants to intervene earlier in the process, as healthy relationships inside the retina first start to go bad.

Cannabinoid receptors are found throughout the body and endogenous cannabinoids are produced to act on them. “Their function is very different from organ to organ but in the central nervous system, cannabinoid receptors are responsible for the neutralization process that should occur after a nerve impulse is finished,” says Dr. Liou.

Nerves come together at a point of communication called a synapse. Glutamate is a neurotransmitter that excites these nerves to action at their point of communication. “There are also inhibitory neurotransmitters such as GABA,” Dr. Liou says. Endogenous cannabinoids help balance the excitation and inhibition, at least until oxygen gets scarce.

In the face of inadequate oxygen, or ischemia – another hallmark of diabetes – nerve endings start producing even more glutamate, setting in motion an unhealthy chain of events. Pumps that keep the right substances inside or outside of cells start to malfunction. Excess nitric oxide and superoxides are produced, which are toxic to the cells. Another irony is the heightened activity increases the retina’s need for oxygen. “We are talking about nerve cell death,” Dr. Liou says. “In the retina, if a lot of our nerve cells die, our vision is directly affected.”

And that’s not all that goes wrong in the nerve-packed retina. Nearby microglial cells, which can function as cell-eating scavengers in the body, sense something is going wrong with the nerve cells, become activated and start an inflammatory process that can be fatal to nerve cells.
Interestingly, the body starts producing more endogenous cannabinoids to stop glutamate release, then produces an enzyme to destroy the cannabinoids to keep them from continuing to accumulate. The same thing happens in the brain after a stroke.

That’s why cannabidiol, an antioxidant, may help save the retina. Test-tube studies by others, as well as Dr. Liou’s pilot studies in diabetic animal models show cannabidiol works to interrupt essentially all these destructive points of action.
“What we believe cannabidiol does is go in here as an antioxidant to neutralize the toxic superoxides. Number two, it inhibits the self-destructive system and allows the self-produced endogenous cannabinoids to stay there longer by inhibiting the enzyme that destroys them.” Cannabidiol also helps keep microglial cells from turning on nerve cells by inhibiting cannabinoid receptors on microglial cells that are at least partially responsible for their ability to destroy the cells.

“Cannabinoids are trying to ease the situation on both sides. They help save the neuron and, at the same time, make sure the microglial cells don’t become activated. How good do you want a drug to be?” Dr. Liou says.
“We are very pleased,” he says of studies in which cannabidiol is injected into diabetic rats and mice. He hopes the compound in marijuana may one day be given along with insulin to stop the early changes that set the stage for damaged or destroyed vision.

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Fructose In Moderation Could Be Beneficial For Diabetics

A new study by researchers at St. Michael's Hospital suggests that fructose may not be as bad for us as previously thought and that it may even provide some benefit.
"Over the last decade, there have been connections made between fructose intake and rates of obesity," said Dr. John Sievenpiper, a senior author of the study. "However, this research suggests that the problem is likely one of overconsumption, not fructose."
The study reviewed 18 trials with 209 participants who had Type 1 and 2 diabetes and found fructose significantly improved their blood sugar control. The improvement was equivalent to what can be achieved with an oral anti-diabetic drug.
Even more promising, Dr. Sievenpiper said, is that the researchers saw benefit even without adverse effects on body weight, blood pressure, uric acid (gout) or cholesterol.
Fructose, which is naturally found in fruit, vegetables and honey, is a simple sugar that together with glucose forms sucrose, the basis of table sugar. It is also found in high-fructose corn syrup, the most common sweetener in commercially prepared foods.
In all the trials they reviewed, participants were fed diets where fructose was incorporated or sprinkled on to test foods such as cereals or coffee. The diets with fructose had the same amount of calories as the ones without.
"Attention needs to go back where it belongs, which is on the concept of moderation," said Adrian Cozma, the lead author of the paper and a research assistant with Dr. Sievenpiper.
"We're seeing that there may be benefit if fructose wasn't being consumed in such large amounts," Cozma said. "All negative attention on fructose-related harm draws further away from the issue of eating too many calories."

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