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Plastics linked to insulin and metabolic syndrome - diabetes

In a previous post we reported on the recent research which proved an association between BPA in plastics and humans with diabetes, and also mentioned the related work of Professor Nira Ben-Jonathan.

We listed Prof. Ben-Jonathan's work as one of the five reasons that we thought that the statistical finding of an association between BPA and diabetes was important.

Ben-Jonathan's research implicates the primary chemical used to produce hard plastics—bisphenol A (BPA)—as a risk factor for metabolic syndrome and its consequences. In a laboratory study, using fresh human fat tissues, her team found that BPA suppresses a key hormone, adiponectin, which is responsible for regulating insulin sensitivity in the body and puts people at a substantially higher risk for Metabolic Syndrome - MetS.

Her team are the first to report scientific evidence on the health effects of BPA at environmentally relevant doses equal to "average" human exposure (previous studies have primarily focused on animal studies and high doses of BPA).

That's the big deal here, that because we are learning how widely we are exposed to BPA, and using these likely normal contamination levels the research team found that exposing human tissues to these BPA levels resulted in suppression of adiponectin.

"These results are especially powerful because we didn't use a single patient, a single tissue source or a single occurrence," she reported. "We used different fat tissues from multiple patients and got the same negative response to BPA."

Metabolic Syndrome is bad enough in itself - a group of risk factors for cardiovascular disease and type 2 diabetes, including abdominal obesity (internal tummy fat), insulin resistance (poor ability of the body to respond to fluctuations in blood sugar), low HDL (“good”) cholesterol, high blood pressure, and high triglycerides. When a person has three or more of these factors, they are said to have MetS (which affects an estimated 50 million Americans alone).

So the point is that if you have two MetS risk factors not including insulin resistance (Type 2 diabetes) and you become contaminated by BPA the research indicates you are then at risk of actually developing Type 2 diabetes and crossing the threshold into MetS. Your chances of being exposed to BPA are high - 90% of Americans had traces of BPA in their urine in a recent national health survey.

Of even more concern is that with the increasing obesity of younger people they are becoming more at risk of Type 2 diabetes, and with their high levels of potential exposure to plastics and BPA the risk is even higher - obesity + BPA means only one step to go to transition into MetS.  It's know that the impact of obesity and MetS on cardiovascular disease in (even non-diabetic) adolescents "is particularly worrisome". 

As we've commented elsewhere, the association of plastics and diabetes is out of the box and is not going to go away, not unless further research throws a different light on the association seen so far. And if you're concerned about what diabetics should do about BPA and plastics check this post where we outline the different plastics and their levels of BPA safety.

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Alarming rise - children with Type 2 diabetes, how do parents cope?

The trends world-wide are for children with Type 2 diabetes to outnumber those with Type 1 within a decade.  That's an amazing trend, based upon growth rates in Type 2 among 18-year olds and younger, of around 50% in many places.

For example, in North Dakota recently it was reported that the estimated percentage of children with Type 2 diabetes — based on whether children had pharmacy claims of insulin — went from 23 percent to 31 percent in those years.

That's an increase of 35%, and of course doesn't measure those with pre-diabetes or who are non-insulin controlled and that percentage increase could well be higher since it would be a leading indicator of those about to cross the threshold into insulin-dependent Type 2.

Judith Fradkin, a division director at the National Institutes of Health, said Type 2 diabetes in children is a problem of the 21st century. "Pediatricians, endocrinologists ... they were just telling us they were starting to see all these kids with Type 2 diabetes," she said. "Almost all kids with Type 2 are obese or overweight (and) most are obese," she said.

It's one thing to be told as an adult that you have diabetes, that's frightening.  It's altogether another as a parent to to be told your child has it, and that's what's happening in ever increasing numbers with respect to Type 2.  It's all overwhelming, and its also easy to be overwhelmed when you start to investigate what you need to do.  So where do you start?

By eliminating too much information and focusing on one thing you can cope better, and especially if that one thing sets a goal by which you can measure your actions and see a result.

What is one good thing on which to focus, in order to cope better ?

The key finding which is emerging from all these studies and trend analyses is that obesity matters in children. So as a parent that's the first thing to acknowledge, and to understand and to tackle.

Doing this is no simple matter.  It's OK for me as an adult to determine my own lifestyle, top decided what I will eat, to go to the gym etc.  As a parent you have to be responsible for your child, and figure out how to change attitudes and behaviours within your own family context.

That ain't simple! But it is unavoidable as you have to be responsible for them until they can take responsibility for themselves, and unfortunately there is no getting away from that fact that they have diabetes for life, and if it is not managed it will impair their lives or end it early.

Experts say changing people's attitudes is key to reducing the rate of diabetes. That's true, and the long-term answer, and difficult.

What can you do today ?

Here are two important things that we know, and which can help you today:

1. there is a strong link between belly fat and insulin resistance - that means a link with Type 2 diabetes;
2. there is a strong link between losing weight and especially belly fat, and managing and controlling diabetes better.

Academics might argue the toss, but that's not your game.  I had Type 2 and over 4 years I have lost 7.3kg (16 lbs) and reduced from a 34" waist to a 30" waist.  That's played a significant role in bringing my diabetes under control.  Its a complex disease and there are many factors that help, but you can't do everything at once and the benefit of focusing on weight is that you have to combine two things - diet and exercise - and that you can see the result - positive feedback.

My message for this post is that as a parent you should be prepared to believe that there IS a connection between belly fat (visceral fat) - measured at the waistline - and development of Type 2 diabetes. There is good evidence that layers of fat that cushion the viscera, or internal organs, in the abdomen are more detrimental to health than outer layers of belly fat.

There is also very plausible research evidence and very strong practical evidence that losing weight and reducing the waistline plays a very important role in bring diabetes under control.

For example, a recent US study found that people at high risk for the disease reduced their risk by nearly 60 percent by losing about 15 pounds (7 kgs). Of course that's relative to body weight, so let's suggest a reduction of 5% of body weight as a first target and 10% as a second.

You don't have to get your child to become a marathon runner or have a model-size figure. The good side is that visceral fat has been found to respond to diet and exercise ( e.g. 30 minutes 6 days/week) more readily than subcutaneous fat. So this means that you don't have to precisely target it for any special reduction treatments.

Just making some small changes — losing 5 - 10% of bodyweight and focused on the waistline — can have a huge effect on reversing the degenerative trend fo diabetes. Poorly regulated diabetes can, in the long run, lead to severe complications to the heart or kidneys. This can be prevented by good and proper diabetes care and support.

Japanese Sumo wrestlers are very fit, they don't carry much visceral fat, even though they do have a huge girth.  Annually in Japan one of the TV channels has a "super athlete" competition amongst the reigning sports stars from all sports, and more often than a Sumo champion wins.  But they're fit and not examples of "healthy fat people" because they train relentlessly and intensively and they are truly super athletes.

For your children you have to believe that shape matters, around the tummy, and then act.  Your doctor or health adviser would have given you plenty of information about necessary dietary changes, and the need to reduce sugars and such.  That can also be quite overwhelming in itself.

The bonus of focusing on one thing to begin, such as waistline, is that you can measure everything that you do for your child, and with your child and to your child, against that objective.  "Will this reduce their waistline ?".  That goal is visible, tangible, you don't to go to a blood test to see a result, and its directly linked to reducing the risk from diabetes.

My advice is to get through the shock and grief as quickly as you can, don't read too much and become overwhelmed, accept and believe that the waistline matters and then figure out within your own home and lifestyle how to reduce belly sizes.  Any extra exercise, especially muscular intense exercise, is a bonus.

That's a coping suggestion which I think will help you and your child.

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Beautiful one day - diabetic the next

The Queensland Tourist and Travel Corporation even registered its most famous slogan "Beautiful One Day, Perfect the Next" as a trademark.

These, days it seems that Queensland is becoming better known for the decaying condition of its population.

While diabetorati pursues a weight loss and exercise goal - as good adult diabetes management - it seems that Queenslanders in Australia are all heading in the opposite direction, with many older Queenslanders placing themselves at risk of adult diabetes.

A 11-month survey, just completed, painted a profile of today's average Queenslander, and in summary less than half the adult population exercised sufficiently to achieve a health benefit, and although life expectancies of women and men had increased to almost 83 and 78 years respectively, experts warned that this generation may be the first to die at a younger age than their parents.

Avoidable deaths included preventable conditions such as lung cancer, chronic pulmonary disease, alcohol and illicit drug disorders, hepatitis, AIDS, coronary heart disease, stroke, lung cancer and diabetes.

The average Queensland female:

• Lives to 82.9 years
• Is most likely overweight or obese
• Doesn't exercise enough
• Is a strong candidate for diabetes, heart disease, high blood pressure and depression
• Thinks tanning is attractive.

The average Queensland male:

• Lives to 77.8 years
• Is likely to be one of 58 per cent who are overweight or obese
• Is one of the 91 per cent who do not eat vegetables
• Is not as active as he thinks
• Likes alcohol and sometimes drinks dangerously.

Clearly the rate of diabetes is going to increase rapidly in Queensland - just like in every other state of Australia, but perhaps worse?

Based on US surveys, only a minority of wives think that their diabetic spouses are actively managing the disease, so it's going to a challenge faced by those Queensland spouses.

As for the men themselves, only 30% say they know a lot about the symptoms or conditions related to type 2 diabetes, which is kind of typical of men in general in relation to their health.  Men-in-denial in regard to their own wellbeing! Given that Queensland male profile above, it sounds to me like big waistlines are the order of the day, and that's a sure sign that adult diabetes is not far behind for that age group.

At least they might be able to go on enjoying their mangos - Queensland being the home of mangos in Australia - since according to measures for myself mangos didn't adversely affect my blood sugar levels.

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Diabetic benefits of aerobic, endurance & resistance training?

My diabetes control approach incorporates a strong belief in the exercise and particularly the benefits of muscular exercise.

I don't know exactly why except to focus the results I have achieved from my entire holistic program of management and to say that it is a great result and all components must be having a solid contributing affect.  Something that is important about the exercise side of diabetic care is that the results from a session can hang over, in some cases up to 48 hours of residual beneficial effect in the muscles.

My total program is basically about food, exercise, and supplements, with two accompanying themes - the first being to learn to listen to what your body is telling you about the three primary components, and the second is to continually rethink what you know about those three primary components (and their interactions).

As we diabetics know, diabetes is not something that has a beginning and an end such as a project. Rather, its a marathon, and I call it the diabetic marathon, without a finish line.

I know not much about why the muscle side of exercise helps, except that rebuilding muscle (lean body mass) as we get older seems to help many parts of the metabolism and our lifestyle. [Apparently we loose about 3% of muscle mass per decade, related to declining protein synthesis.]

At 60 years old I'm still able to feel confident about lifting and using my body, without undue fear, and without undue tiredness or risk of injury, because of my attention to muscle-building exercises through my diabetic care. I've built very strong core muscles and that helps in every step I take and in holding posture and personal presentation if nothing else.

What do we know about exercise and muscles and such, and diabetics?

Some experiments (here 2003) found that aerobic exercise training increased oxygen take-up (which is good because increased oxidative capacity means that muscles can work more and are more active metabolically) and reduced abdominal fat and plasma triglycerides.

However, no benefits showed for older people in insulin utilisation:

None of these changes were affected by age. In contrast, insulin sensitivity improved in younger people but not in middle-aged or older groups. Thus, the muscle mitochondrial response to 4 months of aerobic exercise training was similar in all age-groups, although the older people did not have an improvement in insulin sensitivity.

Other studies report positive benefits of endurance training on insulin sensitivity, in such words as

"may play an important role in the changes in muscle mitochondria content, oxidative phenotype, and sensitivity to insulin known to be induced by endurance training"

The key thing about endurance training is that it "endurance training increases skeletal muscle mitochondria and type I fiber content and fatty acid oxidative capacity" and these can all have positive influences for diabetics.

Resistance exercise — also called strength training — increases muscle strength and mass, bone strength, and the body's metabolism. The different methods for resistance training include free weights, weight machines, calisthenics and resistance tubing.  I mainly go to Body Pump classes, just two per week.

I think that what we know here is that there is a stimulation of insulin, because this stimulation is part of the body's response to the breakdown of muscle (and rebuilding) post-exercise.  This is called the anabolic effect of exercise where muscle protein continues to break down after exercise and conversely the body is trying to rebuild it through "muscle protein synthesis".

Insulin plays a role in slowing down the muscle breakdown, and stimulating the rebuilding (synthesis).

Ideally we want to have a positive balance between breakdown and rebuilding muscle. It's known that a carbohydrate intake after the exercise can boost insulin (and blood glucose) levels and decrease muscle protein breakdown.  This is one reason that some gym instructors tell us to eat something like a small low sugar jelly fruit after working out - to stimulate the carb intake and boost insulin and reduce muscle breakdown.

For diabetics this all seems to be good (please check with your own health care advisor), since the insulin boost is favored by the muscles, the muscles are also still absorbing the blood glucose boost, and the whole hormone/metabolic system seems to be stimulated in a positive way for us. As my doctor recently said to me in relation to my annual checkup results - whatever you're doing keep doing it, its working!

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VU Bone, health and diabetes study seeks women participants

If you are in Australia and Melbourne and a 35+ woman with Type-2 diabetes then you might consider giving Dr Itamar Levinger a call at Victoria University (VU). See more details below about this study and the participant requirements.

It's important work so I hope that Dr Levinger is able to get her volunteers.

Researchers are looking for women to participate in a first-of-its-kind study examining the links between Type 2 diabetes, exercise and bone health.

Poor bone health can lead to osteoporosis, a condition defined by low bone mass and quality, increased fragility, and higher fracture risk. While Type 1 diabetes has long been associated with low bone density, [here, for example] there is growing evidence that those afflicted by Type 2 ‘lifestyle-related’ diabetes suffer more bone fractures than non-diabetic women, despite having normal to high bone density.

The researchers aim to gain new understanding of the link between bone density and Type 2 diabetes, and examine targeted exercise interventions for both the prevention and management of Type 2 diabetes.

Dr Levinger is inviting women with:

1. Type 2 diabetes
2. aged over 35
3. who are not on hormone replacement therapy or insulin therapy
4. who do not have osteoporosis, and
5. are not involved in any regular gym-based exercise, to participate.

The study is six months of power (strength) training or aerobic training, examining the potential benefits of these training regimens on bone structure and metabolism as well as health and well-being. Before, during and after the exercise training program, researchers will measure participants aerobic and strength fitness, bone structure, body make-up, capacity for performing everyday activities, and self-reported quality of life.

Further Information:

• Dr Itamar Levinger, School of Human Movement, Recreation and Performance Victoria University
• Ph: (03) 9919 4287
• Email: itamar.levinger@vu.edu.au

I was surprised to read that a link had not been made yet between D2 and low bone density (although I did see this study which said: "Type 2 diabetes is associated with an increased risk for bone fractures with no reduction of bone density"). I guess that it is not so simple because D2 is "late onset" and that is when our bodies and bones start to deteriorate "naturally" anyway - so "aging" has to be isolated in order to analyse a possible link with D2.

What we do know is that exercise and in particular gym and strength exercise certainly helps bone strength and also moderates the progression of diabetes.

Committed attention to that aspect is one of the pillars of my holistic approach to managing my own D2 and I am proof of its effectiveness having seen all my annual blood characteristics improve for the last 5 years.  I've reversed the deteriorating trend, although I haven't reversed the disease itself, but I've certainly slowed its progression.

Even if no links are found to bone density I certainly hope that the participants witness and feel the benefits of power training on their condition and keep it up !!

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Adult diabetics in denial - getting through the grief process

Getting individuals to face up to the problem is one of the key human challenges facing diabetes support groups, educators and doctors. I posted before about the survey where wives rated their husbands as "poor" in the husbands facing up to their diabetes.

There is a often sense of grief when told of the diagnosis, and this transitions people into a grieving process, which may be apparent or it may be concealed.

The pattern of denial, fear, anger and then depression is widely known as the stages of grief. Its a healthy process to pass through and from which to emerge. In fact it is generally seen as being more than just a healthy process pyschologically but a necessary process.  Problems arise when a person gets stuck at one phase - for example denial, or depression.

The Albury-Wodonga Diabetes Support Group, was reported to have discussed the recent alarming rise in diabetic diagnoses in Australia.  Alan Sang, the Convener, was unfazed by the figures. “I’m not surprised about that at all because it’s a disease that has sort of really taken off in the whole world,” Mr Sang said. “It’s rising all the time and its not going to stop unless people take control of their lives.

“There is too much eating of the wrong food, too much takeaway.” Mr Sang said diabetics often did not want to face up to the problem.

“People are ignoring diabetes, they’re in denial they have it,” he said.

“They don’t want to make it known they’ve got diabetes and this is generating a lot of the problems because they don’t want to come to meetings and don’t want to get involved.”

Unfortunately that's true, and unfortunately diabetes is a "progressive" disease.  It's odd because "progressive" sounds like a positive word, but when it qualifies "disease" it has very negative connotations.  That means that it only gets worse, and if it is denied and untreated it certainly always gets worse.

Given the potential epidemic of type 2 diabetes, for example in Queensland, Australia, this is going to be a problem common to many community-based support groups.

Here's a story that will help you get through the fear.

In my case I also denied it for a few years. That's not so say that I ignored it as I paid more attention to fine tuning my already good eating habits, and I started doing modestly more walking as exercise, but in most ways I left it lie invisibly within and kind of hoped that it would go away.

Then one day I just decided to face it head-on, and after 5 years of holistic effort I have reversed the symptoms and I suppose that makes mine a "regressive" disease at the moment.

However I see around me people in denial.  It's hard to know where to start sometimes, and what to do at first, as the consequences can seem overwhelming.  And what can seem even more overwhelming is having a child diagnosed, and given the large increases in "adult diabetes" being diagnosed in younger and younger people and even teenagers, parents need some coping strategies to get themselves through.

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Supplements for diabetes and diabetics, do they work?

David Mendosa, the renown diabetic journalist who writes insightfully on all matters diabetic, recently "came out" and wrote his first post about his own supplements.

...until now I have resisted writing generally on this topic.

I understand his reluctance because although blogs like mine are meant to make people think about their own opportunities to change or improve their management of their diabetes it is kind of different when we talk about specific supplements and materials which readers may rush off and try.

The medical advice about many supplements and alternative medicine is often inconclusive, and the side effects and interactions with current medication, where it is known, needs to be taken into account.

And as Mendosa says, in his reference article Snake Oil Supplements, most don't work or are not worth the money - so it is often a question of cost-effectiveness as well as medical issues.

I've been quietly working up to posting on parts of my usual routine in managing my diabetes, and especially what I have done to bring the numbers back into line over the last 5 years. But what has held me back is that I feel that some research is needed around the various things that I do, since while I am prepared to experiment with my own body I don't necessarily want to encourage anyone else to do the same [I'm in the "Your body, your science experiment" camp]. For that reason I've been researching the pros and cons to the extent I can, the top level, about the various things I take, and that takes time.

Like Mendosa, I can also come clean and mention here some supplements, some I take without much more than faith and an interest.  I always have some motive, for each bit, but its not always that I can explain coherently or want to necessarily expose to anyone else even though we have disclaimers about everything on the website. I often try to measure affects, where I can, and make notes. But that's not possible with many of the supplements or foods because I'm not able to do those measurements.

OK, so here's a bit of a list, a taste so to speak:

• Scott's Emulsion - cod liver oil like grandma used to make you take;
• Tumeric - in various forms;
• Vinegars - not a great range in the West, unlike Japan, but organic apple cider mostly;
• Soy Protein Isolate - lots of issues here about the alcohol-washing but there you go I'm putting it out there, still researching this one to give a balanced post in the future;
• Chocolate, this is where things get difficult because some people start to disbelieve that I may have even been or am potentially diabetic when I mention that I eat about one block of chocolate a week, and have lost weight, and not have adverse 2 hour glucose levels - beats me but this is what I tried and what I do, especially after gym nights I have one piece about 2 hours later, always dark and usually 70%+ and usually 80% cocoa;
• Red Wine - one good glass each night - about a restaurant-size commercial serving;
• Kelp (konbu) powder - I can't fully explain this one to you yet but working on it;
• Aspirin - I break the cheapest tablets into 4 pieces and take 1/4 (one broken piece) with a large mouthful of my morning cereal to try to prevent any stomach issues - OK so far;
• And on my morning half-avocado I have drops of hemp seed oil, macadamia nut oil, a splash of olive oil, with pepper and vinegar - this is a must have morning ritual for me.

Right now I can't explain all that, but I'm working on it.  Results are good, what role any of those things plays in these results I can't say, but my doctor is even talking about taking me off Lipitor as a trial - after 18 years on the drug.

I do have to say, that without an associated exercise program I don't think that any of these supplements would have any great beneficial effect on my diabetes control, again, without being able to prove it.

I'm interested in your thoughts.  Perhaps you know more than I do about why some of these things are helpful, or why I should be more careful?  Please let me know.

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Plastic associated with diabetes, what should diabetics do about these findings?

The recent research which proved an association between BPA in plastics and humans with diabetes has erupted over diabetic forums and websites worldwide.

Understandably, a common question asked is what do to, what does it mean for diabetics today and their diet and food choices?

Bear in mind that one of the authors of the work says that more research and analysis is needed to confirm their findings, the first linking BPA to diabetes and heart disease in humans (previous studies were on animals).

So most importantly don't panic. I'm not going to throw out my your plastic containers or stop shopping for plastic packaging.

Diabetics are used to reading food labels and now its time to add packaging labels such as the type of plastic. There are seven Plastic Codes:

1. PET or PETE – Questionable – depending on the quality, repeated use may cause the leaching of DEHA, a know human carcinogen. Light gauge containers such as store bought pop bottles should be a one time use only. Heavier gauge containers show no evidence of leaching chemicals.
2. HDPE – OK – not known to leach unwanted chemicals.
3. PVC or V – Bad – Strong evidence to show the leaching of DEHA, a known human carcinogen.
4. LDPE – OK – not known to leach unwanted chemicals although not as widely recycled as #1 or #2.
5. PP – OK – not known to leach unwanted chemicals although not as widely recycled as #1 or #2.
6. PS – Bad – suspected to possibly leach harmful carcinogens.
7. Assorted but includes polycarbonate, nylon and acrylic and typical product applications are baby's bottles and some water bottles – Bad – may contain leaching BPA.

If you note that there is a minority of "safe" plastics then it makes shopping and life difficult.

Pragmatically it is said that 1, 2, 4 & 5 are generally considered "safer" plastics, and 3 and 6 "bad", and #7 depends. If #7 is polycarbonate, then you may have the risk of BPA exposure.

Resin Codes Poster - click to enlarge

You can see the plastic codes in the triangle "recycling" labels or imprints on the plastic containers.

It may be practical for you to replace your plastic drinking bottles, such as your sports drinking bottles, and excellent research has been done by, for example, Team Running Free to identify the best metal drink bottles. They recommend the Klean Kanteen stainless steel water bottles.

The step you can take with regard to preventing BPA contamination is to NOT boil or heat foods in cans. The plastic epoxy resins lining cans contains BPA and its release is stimulated by heat. So empty the contents out into something safe before heating.

For sure, this BPA story will develop and gather momentum and we'll get new insights over the next couple of years.

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Today is Buzz Day - Diabetes Australia

‘Buzz Day’ is Diabetes Australia’s annual merchandise fundraising campaign.

The event involves the sale merchandise throughout September at supporting retail outlets, culminating in the signature day ‘Buzz Day’ on Friday 19th September 2008, when Diabetes Australia beats the diabetes drum across the country.

Contact DA if you can help to sell a box of merchandise, or purchasing a product on Friday 19th September.  You can also order merchandise online.

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Plastic(BPA)-diabetes association needs more study, author

News of the first study associating BPA and diabetes in humans has erupted all over the globe and much of it with worrying headlines e.g. BPA health scare gets more serious

While reading a US News report I was struck by the words of David Melzer the coauthor of the study that eating too many calories and saturated fats may be the cause of diabetes.

Of course that's the case that doing those things predisposes a person to diabetes, among other related condition.  However my interpretation of their study was that they statistically removed high BMI and large wasteline effects ("confounders") from the particular analysis upon which the headlines are based.

Those latter factors are not specifically "calories and fat consumption" as quoted by Prof Melzer, but I thought were close correlates of BMI and wasteline.

My own analysis is that there are four key reasons why the study is important. But Melzer's comment makes me ponder the deep statistical validation and I guess that's why the authors are calling for more studies and complementary analysis too much alarm is spread.

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