The diabetic dilemma - A complex disorder with diverse dimensions

Is it not shocking when we are told that in this planet one human being dies every 6 seconds because of diabetes and complications arising from this scourge? The staggering figure of 384 million people being affected in his world by diabetes is indeed disturbing and look at the death rate-1.5 million (mn) dying because of this disease every year. How come this so called metabolic syndrome was allowed to creep in slowly without being taken seriously a few years ago? Probably adequate knowledge might not have been available then to understand unambiguously the basic reasons for human beings to develop diabetes. Progress in medical science and human physiology has created a fund of knowledge regarding various causes that can be responsible for spreading of metabolic syndrome in practically every country in this globe.

Saudi Arabia, UAE, Kuwait and Qatar are prominent countries where those affected by diabetes is as high as 20-24% of their population. That means 1 in 5 citizens suffers from this disease. According to the WHO the diabetic is expected to be prevalent among 600 million people by the year 2035. What about India? While as a percentage of the population it is small, about 5%, in absolute numbers, this country can be called the diabetic capital of the world. From 31.7 mn in the year 2000, the number of diabetics has jumped to 62 mn in 2014 which is predicted to reach almost 80 mn by 2030. India, China and the US have most diabetics compared to other countries though in terms of percentage figures, these countries have relatively less affected by diabetes measured per thousand population. Though statistics can be quite revealing, what is not understood is why some are more vulnerable while others are immune to this disorder, considered a life style disease caused by sedentary living conditions giving no scope for the body to expend the calories consumed through physical activities. 

If one asks the crucial question as to what is really responsible for this surge in diabetic population, the most common answer would be "obesity". According to present understanding about diabetes, over weight and obesity contribute to insulin insensitivity leading to a condition when body finds it difficult to push glucose into the cells where it is supposed to be converted to energy. However a closer look at the situation will reveal that obesity cannot be the sole factor causing diabetes. In the US there are almost 100 million obese people while the diabetic population is only 23 mn and it will reach a figure of 30 mn only by 2030. Similarly China the second largest obesity prone country has 46 mn cases of obesity whereas its diabetic population is only 30 mn. The third ranked India on obesity scale with 30 mn people suffering from obesity, has a whopping number of diabetics, viz 62 million. Thus it is difficult to establish a direct linkage between obesity and diabetes. There must be other reasons for developing diabetes which need to be looked into.

Three new studies carried out fairly recently have brought to surface the role of genetic make up, disturbed Amylin hormone cycle and disturbances in the body's natural circadian clock  Qualitatively some conclusions can be drawn regarding the role of genes and mutations undergone by them. The fact that certain ethnic groups are more prone to diabetes than others has been pointed out in support of genetic factors influencing the onset of diabetes. The inherent contradiction, that some lean people get diabetes while many over weight people are protected from diabetes, cannot be explained easily unless we fall back on genetic factors. A probable interpretation could be that the diabetes can occur with a 50:50 chance determined by family history and life styles followed by different people.

Those who contend that gene factor is important cite the 9 variations possible in the gene PPARG which has some influence on obesity development and which is not strictly related to BMI. Building up of fat around abdomen in some people who do not appear to be "fat" to look at, can be explained only though the above basis. Decreased function of PPARG can simulate such a condition. According to this school of thought diabetes that is seen in India and Pakistan is of this type. This is reflected by the fact that in India obesity is much less as a proportion to diabetic population than that found in the US and China. Diabetics to obese population in the US, China and India are 23:100:,30:40 and 62: 30 respectively reflecting the difference found in the above countries. 

The Amylin hormone produced by pancreas works in conjunction with insulin and plays a role in preventing over production or under utilization of insulin affecting glucose levels in the blood plasma. According to those who support the theory of Amylin hormone's role in developing diabetes, too much production of this hormone can get deposited around pancreas as toxic clumps causing death of insulin producing cells. This theory lacks precise scientific evidence regarding the cause of Amylin over production though it is thought to be related to inactivation of concerned enzymes involved in the metabolism of Amylin. But the qualitative finding as reported recently cannot be brushed away easily. Further studies can only throw more light on this aspect related to development of diabetes, at least among some people, not vulnerable to obesity.

The Circadian clock theory also appears rational though the evidence generated so far is with mice as subjects. The finding that during the night when mice are active, they showed high insulin efficiency to burn the foods they consumed into energy while in the same mice during day time when they sleep, their insulin resistance increases leading to accumulation of fat and weight gain. Insulin after all is  the driving tool for pushing glucose in the blood into liver, muscle and other cells. Mice population in which the gene responsible for circadian rhythm is knocked out were found to develop insulin resistance and consequently gained weight abnormally. Same thing was found when they were exposed to uninterrupted light for 24 hours upsetting their circadian rhythm. If such a phenomenon is confirmed by clinical trials with humans, it provides logical explanation for the vulnerability people working in night shifts and others ignoring the normal sleep cycle to diabetes more often. 

The above three findings throw lot of insight into diabetes epidemic the world is facing and must serve as a guide to future development for appropriate therapy to deal with this disease in the coming years. While diabetes related to genetic factors will have to be dealt with at the genetic level involving gene manipulating intervention drugs,  Amylin therapy to reduce insulin resistance will have to work at the enzyme level and circadian clock disruption will need to be avoided to pre empt this causing diabetes. The world is headed for an exciting era ahead when more precise and reliable drug therapy may emerge based on the latest findings. 

Beware, a person looking lean need not be free from diabetes while another person looking obese may be really non-diabetic!  

V.H.POTTY

http://vhpotty.blogspot.com/
http://foodtechupdates.blogspot.com

Gene based dieting-Does it really work for body weight reduction?

Losing weight is a big business with many "experts" recommending special diets for achieving the objective of shedding body weight and bringing down body mass index (BMI) within the limits considered to be ideal. Millions of dollars are riding on this industry and in spite of all the efforts by scientists and the well being industry there is no guaranteed result oriented "treatment" or regime which can be considered successful to all the people. Who has not heard of Atkins Diet or Ornish Diet or South Beach Diet which had their golden run for a few years but eventually faded from the center scene. There are many health managing semi-medical type of centers, especially in India where special diets are administered to in-house patients for periods of one or two weeks. Though they are successful in rejuvenating the patients for some time, once they come out of the facilities and start on a regular diet the lost weight comes back with a vengeance. Is there no solution for this unenviable situation where man has found himself sucked into the obesity trap due to many reasons, most important being unbalanced dietary intake?

Food we eat to survive and lead a healthy disease free lifestyle has metamorphosed into a pleasure giving experience to day having lost the aura of health associated with it. Who is responsible for this distortion? Some say it is the industry which is "corrupting" the public with its reckless range of food products with progressively diluted nutritive value and full of food additives with doubtful safety credentials. Many sociologists feel that the food marketing strategy of the industry is to be faulted as large pack sizes and jumbo serving portions encourage consumers to eat or drink more than what they really need. Easy access to markets nearby and the personalized transport system invariably act as incentives for more eating. It is the stand of the nutritionists that most foods are designed improperly with sensory perception getting priority over nutrient content. Whatever it may be, fact still remains that over weight and obesity are here to stay with no sign of abatement in spite of many efforts at different levels. 

One of the most effective tools in the hands of the government is punitive taxation on fat-rich and sugar-rich products making these products more and more costlier. Such a policy is bound to show results in a short time but could be temporary as price sensitivity among people is relatively short lived. Tobacco industry still survives though smoking is becoming exorbitantly costly, especially for middle class population due to incidence of high taxes on them. Ultimately the responsibility for eating rightly and in a balanced way rest on the individual and unless there is a realization within that high fat and high sugar in foods can be "toxic" to their lives, very little can be achieved by the State. The argument that those who are obese need medical attention is another view increasingly being accepted but that cannot be a solution to a problem which is refusing to fade way easily. Assuming that the present obese population can be treated through drastic medical interventions, what about future? How are we going to arrest the growing trend of obesity and increasing number of people crossing the Rubicon? 

For quiet some time there has been a class of scientists attributing the tendency to put on body weight to genetic factors though no conclusive proof was forthcoming. The unsolved riddle of same diet causing one to put on weight while another one not showing this tendency could be the reason for the scientists to look at the genetic angle a little more carefully. The "brown fat vs white fat" issue brought out recently may be another angle to unravel the mystery associated with obesity. But it only helps to treat a patient by implanting stem cells that can differentiate into fat cells capable of making brown fats which are easily burned by the body. There is still another view which highlights the role of the human microbiome in deciding about the proclivity of any individual to accumulate body weight. The claim that some microorganisms can even be inherited from parents may be some what far fetched indicating that child of a fat mother must also be fat! 

It was in 2010 another twist was given to the genetic angle to obesity when a private company in the US and the reputed Stanford University collaborated and brought out a starling fact that disposition to put on weight is encoded in the genes of individuals. They were able to decode the variations in some genes that make a person vulnerable to illogical weight again. The science of Nutrigenomics is a relatively new discipline and linking of diet to genes is opening up new avenues to treat obesity. Certain genes like ABP2, ADRB2, PPAR-gamma are shown to have variations in their single Nucleotide Polymorphism (SNP) which can predict whether a particular diet can cause overweight. The FTO gene which contributes to Fat mass and obesity related protein is reported to have high impact on body weight. According to this theory variations in FTO gene can cause an increase in the levels of the hunger hormone Ghrelin which makes dieting extremely difficult for such an individual. Those with FTO gene variations may have an irresistible craving for foods with high fat and high sugar.

How can all the above "revelations" help in tackling obesity? If some of the well being industry players are to be believed all it needs is to take a swab from the cheek of a person to finger print the DNA make up and based on this, right type of diet can be prescribed for him. Thus people with the DNA type that can favor low carbohydrate diet must go for the same without bothering too much about the fat content. to get the best result. For others low fat diet may be more appropriate.to achieve the goal. In India one of the fitness specialized companies is offering the so called  "DNA FIT" program claimed to be "a custom-fit solution" that can "answer for all those who have been seeking a scientific, individualized weight loss program that offers speedy, yet sustainable results". It also claims to be Asia's first DNA based weight loss program. How far these claims are realistic cannot be verified in the absence independent opinion from experts, though it offers some hope for those desperate to slim down after failing all other routes to achieve positive results.

A million dollar question that still remains unanswered is how come there is such a large gene variation happening just in the last 10-15 years when obesity rate started climbing steeply and showing no signs of abatement. Is this due to the environment which is precipitating this epidemic to cause such widespread changes in the DNA make up of people? Or could it be due to increased consumption of processed foods containing many additives having this effect on the DNA? What ever it is, how can the world manage to reverse this trend with almost 16% of the population vulnerable to obesity and 70% of the population with 50% chances to become obese based on their gene make up, unless they change their eating habits according to their DNA type? It is paradoxical that ultimately the focus comes back to individuals who have to take action as per the above findings and DNA picture provides only a suggested solution for adoption.   

V.H.POTTY
http://vhpotty.blogspot.com/
http://foodtechupdates.blogspot.com

FOOD PUZZLE-WHAT TO EAT AND WHEN TO EAT

If some one claims that foods with high fats are healthy on April 1, people will consider it as a prank to make them "April Fools". That was what happened when the news item, that a breakfast rich in fat could keep people free from long term metabolic diseases like CVD, blood pressure and diabetes, was flashed all over the world on 1 April 2010! However it became apparent that there is some truth in the claim which was based on the scientific findings appearing in the internationally reputed and peer reviewed publication, International Journal of Obesity.

According to these findings, the metabolic pattern for the day is decided by the type of food one eats first thing in the morning for breakfast (BF) and a fat loaded BF can make fat burning the predominant metabolic activity for the rest of the day. Eating varied types of foods subsequently does not result in unnecessary fat accumulation in the body, preempting the possibility of getting exposed to obesity related health disorders. In contrast eating a carbohydrate rich BF can only promote carbohydrate metabolism through out the day, making the fat components vulnerable to be deposited and consequent weight gain. High fat BF enables the body to transfer energy utilization between carbohydrate and fat during the entire day.

How far one can take it as a credible evidence to support regular consumption of fat-rich BF remains uncertain because these studies were carried out using mice as experimental animals. It certainly requires further corroborative studies using human subjects to validate the theory and if confirmed such a finding finding can have far reaching implication in diet formulation and food consumption practices. Probably the present mindset amongst consumers, health experts and nutritionists cannot accept the preaching that a BF based on "Bacon, Sausage and eggs along with beans, mushroom, tomato and black pudding" can be really healthy!

A similar study earlier, using women as subjects, had found that a high calorie BF, which can deliver as much as 50% of the daily energy need, prevents putting on weight but such a BF can be based on carbohydrates also. Conversely people who skip their daily BF tend to be invariably heavier. Another interesting observation is that women during conceiving can hope to get a baby boy if heavy BF is taken and a baby girl with a low calorie BF.

Looking at the Indian situation, the above studies probably mean that BF based on fried items like poori, parotha, vada, uppuma, dosa etc could be better than those based on idli, phulka, dry roti, plain rice preparations, puddings, puttu, idiyappam etc. Many people in India, because of circumstantial compulsions, take heavy meals in the morning before going to work, take a light meal along with them for the lunch at the work place before returning home after the work and in a city like Mumbai one can rarely see "fat" people on the road. Similarly some of the best administrators hailing from Tamilnadu during nineteen forties, fifties and sixties, were heavy eaters in the morning while being frugal during the remaining part of the day. The old English saying that "eating like a king at breakfast, like a prince at lunch and like a pauper during dinner" may yet turn out to be a home truth after all, till proved other wise.

V.H.POTTY
http://vhpotty.blogspot.com/
http://foodtechupdates.blogspot.com

DESPERATE SITUATION-DRASTIC REMEDY

A recent report implicates food contaminants as one of the causes of uncontrolled weight gain and these include thousands of chemicals used in foods during processing for achieving different functional features and these include growth hormones, antibiotics and migratory chemicals from plastic packing materials. This is contrary to the common wisdom that is prevalent currently blaming over consumption of high calorie foods much beyond the normal needs of the body. These unnatural substances introduced into the food under one or the other justification are collectively being classified under "obesogens" and they are capable of causing heart disease, diabetes and high cholesterol that can lead to further complications with aging.

If this is true, exercising control over eating may not be sufficient to deal with the problem. Though statistics about "fat" population in India cannot be reliable in the absence of any organized survey by government agencies, it is guesstimated that it could be around 1% working out to a staggering number of 11 millions. Percentage-wise Americans score over Indians in this regard as 3% of males and 7% of females are reported to be obese with a Body Mass Index (BMI) of more than 40. Being thin is often taken as healthy or slim to distinguish from being fat and many thin looking people could be afflicted with the so called "normal weight obesity"(NWO) which is difficult to be noticed under normal health check up regime.

There is a mistaken impression that BMI is the most reliable indicator of a healthy body and those with BMI less than 25 live blissfully thinking that they are immune to disorders commonly associated with over weight. Those with low BMI can have high visceral fat content or the so called 'internal' fat surrounding the internal organs which can be equally dangerous if not treated in time. How ever no reliable information is available regarding the number of people affected by NWO. This probably explains increasing number of patients looking normal, undergoing cardiac by-pass surgery these days because of arterial blocks, caused by high triglycerides and cholesterol. Most commonly adopted procedure to treat over weight problem is controlled dieting, physical exercise and resorting to drug therapy. In a freak finding, scientists from Germany have recently reported that fat people can lose their body weight significantly by spending some time in mountainous places, much above sea level because of the rarefied air that enhances metabolism and reduces appetite.

Dieting itself is under a cloud because of the potential for dieters becoming compulsive over eaters after denying food for themselves for some time, probably due to changes in brain activity involving the hormone norepinephrine. Such considerations compel people to go for Bariatric surgery which is emerging as a drastic remedy to overcome obesity in people desperately trying to shed their weights after failing to do so through conventional weight reduction programs. Such procedures are carried out mainly to reduce the size of the stomach or removal of a part of the stomach or resecting and re-routing the small intestine, all aimed at cutting down on food intake in one sitting. Lap-Band system and Intragastric balloon inserted into the stomach and inflated after wards can also reduce stomach volume. 5-9 BMI reduction is possible through these surgical techniques. It is unbelievable that more than 1.5 lakh people undergo such surgeries in the US with about 0.2% mortality. What is causing concern is that that many of those undergoing the surgery develop complications such as vomiting,diarrhea, dysphagia, reflux, leaking at the surgical connection between stomach and intestine and abdominal hernia.

It is a Hobson's choice for many obese people between living under great risk of dying due to diseases like CVD, diabetes, and serious disorders early in life and going for intervention surgery with reasonable assurance of a normal life though it involves hospitalization and unpredictable after effects.

V.H.POTTY
http://vhpotty.blogspot.com/
http://foodtechupdates.blogspot.com