diabetes

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March 9, 2012 | 8:25 AM | By

The Queen Of Metabolism’s Theory On Why We Are Fat

A researcher in Barbara Corkey's lab with some of the food additives being tested

The headline in Bostonia magazine, in appropriately big black letters, is “Why We Are Fat,” but the Facebook friend who pointed it out notes: “It’s not really about why we are fat. It’s a profile of the butt-kickin Barbara Corkey, a scientist who dropped out of college to get married and have two kids. Then her husband left and somehow she managed to claw her way to a PhD and scientific prominence. She is really cool.”

I spoke with Dr. Corkey in August about her theory that food additives are contributing to the obesity epidemic and came away with the same impression. Also really cool is this rich Bostonia story by the award-winning science writer Barbara Moran, who balances beautifully the hard science with the human element. A couple of favorite quotes:

“Barbara is out of the box—completely,” says collaborator Orian Shirihai, a MED associate professor of medicine. “She doesn’t even know what’s in the box. What she does is turn the box upside down and put it onto other scientists’ heads.”

And later on in the story, when Dr. Corkey has won a major scientific prize and delivers a speech before thousands, Dr. Shirihai takes the metaphor a colorful step further:

“Instead of simply recapping her career, Corkey spent an hour discussing a controversial new direction for her research: whether the 4,000 additives in the U.S. food supply might be contributing to diabetes and obesity. “For those people who never got out of the box,” Shirihai says with a laugh, “it was like having a high-volume enema.”

FILED UNDER: Medicine/Science, Science, Boston University School of Medicine, diabetes, obesity
February 1, 2012 | 1:40 PM | By

Study: ‘Virtual Coach’ Helps Keep Overweight People Moving

If you’ve been talking with Siri on your iPhone lately, you know how deeply natural it is to respond to a computer-generated “person” as if they were human even when you know perfectly well they’re built of nothing but bits. (I heard my 85-year-old dad tell his iPhone after a failed query the other day, “Thank you for trying.”)

Researchers had already found that patients tend to respond well to post-hospital instructions from computer-generated “discharge nurses.” Now, a new study finds that “virtual coaches” can help overweight people get more active, at least during a 12-week study.

(Of course I applaud anything that helps encourage exercise, but I’m having a dark vision at the moment: An AI-based coach built into my alarm clock, intoning, “You know you have to get up now to have time to work out, because it’s been three days and you’re up one pound and your blood sugar is a bit high from that ice cream and you know you’re hoping to fit into those jeans by Memorial Day!” On the other hand, maybe that’s what it takes…)

First, what is a virtual coach? There she is above, and Partners Healthcare’s Center for Connected Health explains in a press release:

“The Virtual Coach is a computer-animated advisor and simulated face-to-face conversation, including verbal and non-verbal communication, including goal setting, positive reinforcement, problem solving, education and social interaction. Dialogue was tailored based on the participant’s progress, current status against their goals and interaction with the Virtual Coach (i.e., asking the Virtual Coach a question or asked for help).” Continue reading →

FILED UNDER: Medicine/Science, Personal Health, diabetes, obesity, virtual medicine, weight loss
January 17, 2012 | 3:18 PM | By

Lurching Toward Diabetes: What To Do Before The Sugar Hits

This Friday, the story and legacy of sweetness comes to the stage.

The new one-woman show Sugar, starring Robbie McCauley, breathes life into the sugar trade, slavery, racism and McCauley’s own struggle with diabetes.

Diabetes 101

In fact, a colloquial name for diabetes is “sugar”—appropriate, as the disease is characterized by having high levels of sugar in your blood.  Nowadays, diabetes often goes hand-in-hand with the word epidemic: 25.8 million Americans are diabetics — about 1 in 8 people (1 in 4 for those 65 or older).

McCauley suffers from the less common form, Type 1 diabetes, which accounts for about 5% of all cases. Her body produces little or no insulin (the hormone that enables sugar in the blood to enter the cells which, in turn, use it for energy). The majority of diabetics in America suffer from Type 2 diabetes, which is when your body doesn’t respond correctly to insulin (called insulin resistance) or doesn’t produce enough insulin. Type 2 diabetes disproportionately affects African-Americans, Continue reading →

FILED UNDER: Medicine/Science, Personal Health, diabetes, prevention, public health, race
January 11, 2012 | 1:16 PM | By

A Step Toward Health Benefits Of Exercise In A Pill?

Bruce M. Spiegelman of Dana-Farber in his lab

We’re a long way from being able to bottle the myriad benefits of exercise, but a study just out in the journal Nature looks like a promising step in that direction. It describes the discovery of a naturally occurring hormone christened irisin — pronounced like the name “Iris” with an “in” tacked on the end — that is elevated during exercise in mice and humans.

Irisin appears to be a possible key to the positive effects of exercise on blood glucose and energy expenditure — and thus on Type 2 diabetes and obesity. And because it is naturally occurring, it could be tested in humans fairly soon, perhaps in a couple of years.

But before we get to the science, a word from the study’s senior author, Dr. Bruce Spiegelman of Harvard Medical School and the Dana-Farber Cancer Institute. To all the negativity-mongers (my phrase, not his) out there who will grumble (my verb, not his) that this discovery will just enable more slothfulness, and would be unnecessary if all those couch potatoes would just get off their butts and eat better, please consider:

“The last thing in the world we’re trying to do is substitute for diet and exercise,” Dr. Spiegelman said. But first of all, there are many people who can’t exercise, whether because of paralysis or age or illness, he said. Work on irisin could potentially help them.

Second, yes, everybody should exercise and eat right but they don’t. Obesity and diabetes are worldwide epidemics costing untold billions, he points out. If irisin proves able to help fight them, it could benefit all of us.

Our conversation, lightly edited:

So where did the name irisin come from?

Iris is the Greek messenger goddess who carried messages between humans on earth and the gods on Olympus. We didn’t want to name it for any specific function because we don’t know what all of those are going to be, and what the most important are going to be, so instead we named it for its messenger function.

So what did you already know, and what did you find out?  Continue reading →

FILED UNDER: Medicine/Science, Personal Health, Science, dana-farber cancer institute, diabetes, harvard medical school, hormones, obesity
December 16, 2011 | 9:30 AM | By

Using Soap Operas, Cooking Classes To Fight Diabetes

A mother and daughter fret over diabetes in a Spanish-language soap opera .

Eating right and exercising consistently is hard enough with a health club membership and a diet app on your smart phone.

But when you’re poor, obese and don’t speak English, those goals can be all but unreachable.

So when researchers tried to introduce a healthier diet and lifestyle to a group of adults at risk for developing diabetes in Lawrence, Massachusetts, a primarily low-income city that’s 60% Latino, and where only about half the population is fluent in English, they tried to meet people just where they were.

That meant screening a “telenovela,” a Spanish soap opera, about a diabetic mom named Martha and her at-risk daughter Sandra, that detailed the fears and challenges of the disease while introducing healthier food choices and busting pervasive misperceptions.

It meant a tour of the supermarket to show participants where the produce and whole grains were located and which aisles had highly processed items to stay away from. It included simple, color-coded food guides with popular items marked in green, yellow and red — like traffic lights — to show which foods should be eaten freely, in moderation or not at all.

And it offered basic cooking classes in Spanish where people were taught to prepared Romaine salads, pinto beans in tomato sauce and boiled sweet potatoes and yams. Many of the classes simply involved modifying recipes, said Dr. Milagros Rosal, Ph.D, associate professor of medicine at the University of Massachusetts Medical School, and a co-author of the study, published in the American Journal of Public Health. “Rather than ask them to eat tofu — which they’d never tried — they were taught to cook rice with less oil, mashed potatoes with less butter and use fat-free chicken broth.”

Still, for these study participants, most with less than a high school education and with an average Body Mass Index (BMI) of 35, considered obese, the results were mixed. Over the course of one year, the group that engaged in the various interventions lost, on average, only 2.5 pounds, though their blood sugar levels improved significantly. Continue reading →

FILED UNDER: Medicine/Science, Personal Health, diabetes, obesity, public health
December 13, 2011 | 12:19 PM | By

Why To Exercise Today: Short And Hard Lowers Blood Sugar

So much for “I don’t have time to exercise.” 

A new study out of McMaster University finds notable blood-sugar benefits for Type 2 diabetics from doing a mere 25 minutes of interval training three times a week, for two weeks. It was only a very small study of eight diabetics, but it fits into a growing research literature on the power of intervals — the practice of ramping up your exertion level for just a minute or two repeatedly over the course of a work-out.

And here’s the most beautiful part: The major benefits came from a total of just 30 minutes a week of high-exertion training, 10 minutes per workout. Thirty minutes a week sounds like a mere moment in time compared to the interminable 150 minutes a week of moderate exercise that guidelines recommend.

Plus, in my humble opinion, intervals are fun — brief little stints of frenzy that you can ramp down as soon as the huffing and puffing starts to bother you. From the press release:

“These findings are intriguing because they suggest that exercising very strenuously for short periods of time, may provide many of the same health benefits as traditional exercise training,” says Martin Gibala, professor in the Department of Kinesiology at McMaster and supervising author of the study. “This is the first study to show that intense interval training may be a potent, time-efficient strategy to improve glycemic regulation in people with type 2 diabetes.” Continue reading →

FILED UNDER: Medicine/Science, Personal Health, diabetes, why to exercise today
November 22, 2011 | 6:58 AM | By

Diabetics Say Food-Laden Holidays Require Added Vigilance

Poll: Thanksgiving can be tough for diabetics but Hanukkah's not so bad.

The prospect of holiday-related gluttony over the next few days — overindulging in marshmallow-topped sweet potatoes and pecan pie — is enough to make us all a bit anxious. But for people with diabetes, holidays that revolve around food bring an added layer of worry and vigilance.

According to a new poll of 226 patients who shared their health information on the crowd-sourcing health site, PatientsLikeMe, at least half of diabetics say having the illness affects their holidays. In particular, the poll found that nearly 60% of diabetics say the holiday season, from Thanksgiving through Christmas “is most difficult for controlling blood glucose.”

Sarah Taylor, a 26-year-old nursing student with Type 1 diabetes says she ends up “counting a lot of carbohydrates on the run” at Thanksgiving. She has an insulin pump, which helps, but she still has to monitor her blood glucose at every meal and snack and adjust the insulin levels accordingly. “Any sort of meal where there’s a lot of carbs — mashed potatos, plus the bread, plus dessert, even the cranberry sauce — you have to think about how much sugar everything has when you don’t do the cooking,” says Taylor, who lives in Boston.

Consequently, she says, she has to test her blood sugar around eight times a day during the holidays, compared to about five times normally. “I have to be ready to change my plan at a moment’s notice,” she says, Continue reading →

FILED UNDER: Personal Health, diabetes, food, patientslikeme
October 24, 2011 | 1:21 PM | By

Do You Know The Name Sheldon Zinberg Yet?

If your answer to the headline is “No” and you care about health reform, I humbly suggest that it may be time to meet him. He seems on his way to becoming a household name — in wonky households, that is.

You can read about him — or rather, the ahead-of-its-time health care organization he helped found, CareMore, in the latest Atlantic Monthly. You can hear more about CareMore on today’s “Here and Now” show here.

And I can share the story that Dr. Arnold Milstein, a prominent health reform researcher, told at a recent Harvard conference on primary care: He said that Dr. Sheldon Zinberg was practicing medicine in a blue-collar California suburb, and the atmosphere of managed care — the restrictions on referrals and more — was driving him crazy. “He said to himself, ‘There has got to be a better way,’” Dr. Milstein recounted. “‘Can’t we figure out how to generate more health and a better patient experience with less money?’”

‘Can’t we figure out how to generate more health and a better patient experience with less money?’

As the Atlantic story describes, Dr. Zinberg answered his own question: He created CareMore. The Here and Now synopsis:

A California-based health care company has found some common sense approaches to improving care while cutting costs for its Medicare customers.

For example, CareMore offers free rides to the doctor’s office to avoid missed visits; they clip toenails to make sure patients don’t trip on rugs; they’ve set up a wound center to ensure a small cut doesn’t lead to an amputated foot in diabetic patients. These sound like little things, but the company says they’ve had a major impact. Continue reading →

FILED UNDER: Insurance, Medicine/Science, Politics, costs of care, diabetes, reform 2011
August 12, 2011 | 4:17 PM | By

What’s Making Us Fat? Researchers Put Food Additives On Suspect List

Consider this slide of ice cream ingredients that Dr. Barbara Corkey, director of the Obesity Research Center at Boston Medical Center, used in a recent lecture. The few elements in yellow, she told her listeners, were ingredients that we normally think of as “food.”

There was a collective gasp from her American Diabetes Association audience, and a buzz of distaste.

In pink, Barbara went on, were some of the substances she was about to discuss. “Virtually none of these non-food compounds have been carefully assessed for a potential causative or contributing role in the obesity and diabetes epidemic,” she said.

In other words, if food additives are insidiously helping to make us fat, we have no way of knowing it.

Her lab is working to change that. It’s still very early days, and some obesity experts are skeptical of her hypothesis, but researchers she oversees are methodically screening hundreds — and perhaps eventually thousands — of food additives, from benign-seeming Bay Oil to unpronounceable chemical compounds, for their potential effects on human fat cells and insulin production.

And they have already discovered some intriguing leads on possible culprits, including artificial sweeteners, iron and an emulsifier common in dairy products, monoacylglycerols. Continue reading →

FILED UNDER: Medicine/Science, boston medical center, diabetes, obesity
July 20, 2011 | 1:08 PM | By

High Heat: How It Works, And Why Being Fat Adds To Risk

With a heat wave sweeping much of the nation, including a heat advisory now out for Boston, today’s excellent Los Angeles Times story on what extreme heat does to the body should be required reading.

It includes some fascinating physiological facts: Heat makes your heart beat faster to increase blood flow to the skin. For every Centigrade degree that your body’s “core temperature” rises, your heart has to beat 30 more times per minute. And once your core temperature hits 103 degrees, organs may begin to fail — in other words, I can’t resist saying, you’re cooked.

I knew that old people were particularly at risk, but the LA Times reports that obese and diabetic people are as well:

People over age 60 are most vulnerable to suffocatingly hot conditions. But if you’re not fit, if you’re overweight or if you suffer heart disease, diabetes or respiratory problems, you’re also at high risk because these conditions can hamper the body’s ability to regulate its core temperatures in extreme heat.

Fatal heatstroke occurs 3.5 times more frequently in overweight or obese adults than those of average body weight, according to research published last year in the Canadian Medical Association Journal.

FILED UNDER: Personal Health, diabetes, elderly, heart attacks, obesity