August 31, 2011

Six New Diabetes Gene Varients Identified in South Asian Populations

A new study, published in Nature Genetics, emphasizes the diversity of the many physiological breakdowns doctors lump together under the title "Type 2 Diabetes."

You can read a good summary of the study here:

Six New Genetic Variants Linked to Type 2 Diabetes Discovered in South Asians

View the abstract of the actual study here:

Genome-wide association study in individuals of South Asian ancestry identifies six new type 2 diabetes susceptibility loci. Jaspal S. Kooner, et al. Nature Genetics, 2011; DOI: 10.1038/ng.921

The genes involved are GRB14, ST6GAL1, VPS26A, HMG20A, AP3S2 and HNF4A. Of these I recognize HNF4A, which is a gene that has also been identified as the cause of MODY-1 and of the diabetes found in Danish and Ashkenazi Jewish populations. It causes diabetes because when it is damaged, it disturbs the sequence by which a normal pancreatic beta cell is induced to secrete insulin when blood sugars rise over a threshold.

People who have a damaged HNF4A gene respond very strongly to drugs that stimulate insulin secretion because they bypass the stage of the insulin secretion function where HNF4A plays a part. Of these drugs, Prandin and Gliclazide have been found to be the safest. The other sulfonylurea drugs are cheaper, but they are associated with an increased risk of heart attack because they also stimulate a receptor in heart muscle. (Details Here.)

Note: Gliclazide is not sold in the United States. It is marketed as Glizid, Glyloc and Reclide in India and as Diamicron in most other parts of the world.

GRB14 affects insulin receptor signaling and when it is broken it appears to increase insulin resistance.

HMG20A has previously been associated with a greater incidence of diabetes in obese subjects. (Details here.)

This study also identifies a gene that is new to me, ST6GAL1, as affecting the ability to secrete insulin.

ST6GAL1, AP3S2 and VPS26A have something to to with Golgi bodies and do not seem to have been hitherto associated with diabetes. Gogli bodies are parts of the cell that process and assemble proteins for secretion. Perhaps when this gene is damaged insulin secretion is, too. The Nature study abstract reports that ST6GAL1 is associated with impaired insulin secretion but doesn't comment on the others.

What really sticks out here, though, which has been the case with all the genes identified in studies of all populations with "Type 2 diabetes" is that most of the genes identified impact on insulin secretion, NOT insulin resistance and most have nothing to do with obesity.

People mostly seem to get Type 2 diabetes because they don't have a normal ability to secrete insulin. As documented HERE, people with these defective genes often do get fat, but they get fat after their blood sugar starts to rise, probably in response to the ravenous hunger that comes with high blood sugars as they drop back to normal.

As is the case world wide, most people who are obese, even morbidly so don't develop Type 2 diabetes. Only about 10% of any population does, while in some parts of the world, including sections of the U.S. well over 50% of the population is obese.

That said, the question no one in the scientific establishment is asking is this: is it possible that the genetic damage we are seeing which underlies Type 2 diabetes is coming from toxic exposures in our environment? South Asia industrialized very quickly and is notorious for the horrendous environmental conditions that have accompanied this industrialization. We know that herbicides like atrazine, and chemicals used in industrial processes like arsenic, are associated with high rates of both obesity and diabetes. But is anyone looking at what genetic changes these compounds and hundreds of others make?

It's time that we stopped blaming people for causing their diabetes by overeating. Yes, people are overeating, but this is almost always because something major is broken in the built-in systems that regulate appetite. The rise in obesity and in diabetes incidence (which, by the way is a much smaller rise than the rise in obesity), goes back to 1970, which is, coincidentally about a decade after the world replaced wood, metal and glass with plastic for most objects in our immediate environment.

This is not a coincidence, folks. I'm old enough to remember the pre-plastic days, and to remember that people did not walk everywhere or eat small portions back then. That is a fantasy created by the industrial powers who want you to blame yourself for your diabetes and ignore the massive pollution of our environment with the toxic chemicals that make their companies rich.

You can learn about the many chemicals, pharamceuticals, and pollutants that have been linked to causing diabetes HERE.


August 26, 2011

Hurricane Preparedness with Diabetes

I'm still hoping the weatherfolk are crying wolf on this one, because the current predictions are that my little town is in the center of the hurricane track and that we can expect week-long power outages. If you don't hear from me after Sunday, you'll know why.

But there's still time to take steps to prepare yourself for the worst, diabetes-style. Here are the basics.

1. Make sure you have enough meds to get yourself through two weeks, because if the pharmacies and gas stations don't have power, you won't be able to fill prescriptions. Ask your pharmacist now for extras if you are in one of the warning areas.

2. If you use insulin, make sure you have some kind of cooler and ice packs so that you can keep your insulin from getting too hot. Don't put insulin directly in contact with freezer packs or ice as cold temperatures will ruin it.

3. Stock up on protein foods that survive without refrigeration like nuts and protein powder so that if you can't cook, you will have something to eat. Avoid salty snack type proteins as your access to water might be limited.

4. Keep your meds and meter right by you with the things you will grab if you have to make a fast exit. I mean VERY fast. Like if the roof is coming down.

Hopefully none of you will need this advice, but you never know when you will be the unlucky person that ends up in the shelter, or in the midst of the flood. Overpreparation is better than the opposite.

Hope you all keep well and safe. . .


August 25, 2011

Let's Put our Heads Together: Suggest Diabetes-Friendly Foods for Indian and South Asian Vegetarians

Cutting carbs is quite easy for people eating meat-based western diets, and very effective for cutting carbs. But periodically I hear from people with diabetes diagnoses who for religious or cultural reasons can't eat the kinds of food we westerners do.

My usual suggestions are to eat more cheese, eggs (if allowed), nuts, yogurt, certain dals, papadums, green vegetables, lower carb fruits, and to chose beans over wheat and rice flour-based products. I warn people to avoid soy protein because of it's negative effect on the thyroid. Soy also, because it damages the inner lining of the intestine, makes it much more likely that large proteins from vegetable sources will get into the bloodstream and provoke allergies. (I'm convinced the current increase in gluten allergies we hear so much about of late is a byproduct of the soy that has been in our diet for a generation.)

I'm not sure what the availability is of protein powder in other countries, or if it is affordable. One of the big challenges of a lower carb diet is that all the cheaper foods most people in the world can afford are very high in starch.

So I'm asking for some other suggestions especially from anyone who has made a vegetarian diabetes diet work for more than a year. What are your ideas. Please post them in the comments section.


August 15, 2011

Does the High Fat Diet Cause Diabetes? No, But The Onslaught of Bad Research Is Making Me Burn Out.

I've received a torrent of mail about the study recently published in NATURE which claims that eating a "high fat diet" damages beta cells and causes diabetes.

You can read a summary here:

Science Daily: How a High Fat Diet Causes Diabetes

I don't have access to the full article, but I have read (and commented on) dozens of other articles that purport to show that "high fat diets" cause diabetes. And, I have also written at length about the problem of confusing rodent diabetes with human diabetes. Folks, wake up. This was a rodent study!

In every case, the "high fat diet" used in rodent studies is the rodent equivalent of eating a burger with fries and a milkshake. I.e. it's a diet very high in fats, but also very high in carbohydrates--and often that carbohydrate comes in the form of high fructose corn syrup.

In addition, as I've mentioned dozens of times before, rodent metabolisms are very different from human metabolisms because rodents are adapted to eat a very different kind of diet. Rodent diabetes is not human diabetes. "Cures" for diabetic rodents almost never work in humans. Drugs that are safe in rodents harm people.

There is very little research looking into human/rodent differences because rodent research has become a huge specialty in medical research and eliminating reliance on rodent studies would put a lot of very highly paid medical research lab heads out of work. Since it is precisely these highly paid heads of rodent labs who make up the committees who decide who gets research funding, the system is self-perpetuating. Rodent research, no matter how flawed and irrelevant breeds more rodent research.

But that rodent research is not only flawed, it's dangerous. A very rare--and very relevant--study about rodent-human differences was published recently (with almost no mention in the press) and it underlines what I'm talking about.

It found that, in the words of the chief researcher, "...the difference in gene expression between the mouse and the human is very very large." And concluded that the potassium channels acted upon by sulfonylurea drugs are found in completely different places in rodent hearts than they are in human hearts, which means that a drug that is safe for rodents would cause "fatal arrhythmias" in humans. (Which they do. Glipizide, glibenclamide, etc. raise the risk of dying of heart disease over time.)

Science Daily: Human Hearts Respond Differently Than Mouse Hearts to Two Cardiovascular Drugs.

But I can post as much here as I want about flawed studies. It doesn't help. Because the people who read these posts on my blog about misleading research are the people who are already aware of why the research is flawed. It's a classic case of "preaching to the converted."

Analysis of my blog's stats makes it clear that the people who read these kinds of articles are a very small minority of those who read this blog. Almost all the traffic to this blog goes to articles that discuss commonly prescribed drugs and tests. They answer common questions people have who are newly diagnosed. Few who visit this site to find answers to that kind of question read anything but a single post. In short, by now it's clear that the many hours I spend tracking down the details that might offer counterarguments to misleading medical headline news is wasted.

So what it comes down to is this. I can't single-handedly, in my spare time, and for free, counteract the toxic effects an entire medical research establishment funded by multi-billionaire predatory drug companies and backed by armies of doctors who get paid hundreds of thousands of dollars a year to, supposedly, take care of people with diabetes.

Over the last six years I've posted dozens of posts just like this one, many much more detailed, but all pointing out basic flaws and citing other studies that make it very clear that eating carbohydrates is what raises blood sugars, not fats. And that high blood sugars are what cause diabetic complications in humans, not eating fats. I've put an average of 3 hours into each post. Sometimes more. I've answered hundreds of comments and emails from people who read the blog posts and want to know more.

Meanwhile, the misinformation that shapes diabetes treatment gets louder and louder. So it's time for some of the rest of you to get active. If you want things to change, you are going to have to write letters to newspapers and journals, confront doctors, call your TV station, and band together with other people with diabetes to change the way that people with diabetes are treated. If you don't do this, nothing will change, no matter how elegantly I dissect research publications.

There's enough material on this blog by now that a person who wanted to understand any of these new studies could easily apply what has already been explained and do their own analysis. There's plenty you could print out and show your doctor if you took the time.

As far as what I'm going to do it's this. I am done wasting my very limited time reading and commenting on flawed studies. From now on, the only studies I'm going to put time into describing are those that come up with new information that can actually help people with diabetes improve their health.

Such studies are very rare. Please do not email me links to the studies that appear each week "proving" stupid stuff that any reader of this blog and the main Blood Sugar 101 Website knows is bullshit.

Gloria Steinem said something brilliant, reported last week, which sums up exactly how I feel right now.

She said, "The danger of the Internet is cocooning with the like-minded on line -- of sending an email or twitter and confusing that with action -- while the real corporate and military and government centers of power go right on."

People with diabetes need to stop reading things that they agree with and start confronting those centers of power if they want anything to change. Reading elegant articles here might make you feel good, but to change anything you will have to take action. I've already given you hundreds of thousands of words worth of ammunition. Now use it.

August 3, 2011

Even with my novels I can't seem to avoid health advocacy.

I've been a bit quiet over the past week as the publication date for my second Avon historical romance is coming up, which mean that I have to put a lot of effort into writing blog posts for various romance blogs in the hope that doing so will motivate readers to buy my book.

You can read a good interview with me wearing my novelist hat--and comment to win a free copy of my first novel, Lord Lightning--HERE.

But even when I do something as inconsequential as writing a passionate tale of love and redemption, fate seems to have decreed that it's my job to help people with challenging health issues. Because no sooner was my latest book, Star Crossed Seduction, accepted by my publisher, than I learned that it would be included in a campaign meant to raise awareness of ovarian cancer.

The campaign is called "Kiss and Teal"--referring to the teal blue ribbons used by the Ovarian Cancer National Alliance for its fund raising efforts. The reason for Avon's participation is personal--one of Avon's top editors and one of its biggest bestselling authors both lost their mothers to ovarian cancer recently and together they came up with the idea of using the fact that millions of women buy romance novels to make women more aware of the warning signs of ovarian cancer and of the organization that can help them find the best treatment and clinical trials.

Avon will be donating a portion of the proceeds from every book sold that has the "Kiss and Teal" medallion on the cover, including Star Crossed Seduction, to the Ovarian Cancer National Alliance. Our publicist is also arranging media appearances for us authors--most of whom are far more successful and famous than I am--and gave us an orientation with someone from the Alliance who taught us a lot about this deadly disease. This will make it possible for us to tell a larger audience about the warning signs of this cancer that is the fifth most common cancer killer of women.

My college roommate died of a form of cancer closely related to ovarian cancer at the much-too-young age of 28. Her death was one of the first events that made me aware of the dangers of pharmaceutical drugs, because she was a DES daughter. Her mother had been prescribed a hormone pill that was supposed to avoid pregnancy complications. Instead, it caused terrible damage to the children of those who took it, including fatal cancers like those that killed my roommate and reproductive tract anomalies. It is still causing significant problems in surviving DES daughters--they have a greater risk of ovarian cancer--and in the grandchildren of the women who took it.

Every woman should read about the warning symptoms of ovarian cancer which you'll find HERE. If you are a DES daughter, it is even more important that you do this.

This early experience with a drug whose negative impacts took decades to emerge should have made doctors think about the long term impact of drugs they prescribe. DES was prescribed in the late 1940s. But obviously, it hasn't. Hormones were new and exciting in the 1940s in the same way that drugs that block receptors and turn off gene expression are in this decade.

Which is why, as long term readers of this blog know, I continue to worry about the long term impact of prescribing DPP-4 inhibitors like Januvia and Onglyza that turn off a gene the body uses to fight ovarian cancer, melanoma, prostate cancer and lung cancer. (Details HERE and HERE).

Just this week, a friend of the blog sent me a study, published back in February in the journal, Gasteroenterology, and completely ignored by the health media, which found a much higher incidence of pancreatic and thyroid cancers among people taking Januvia and Byetta. You can read it HERE.

Though there are issues with the methodology used--which the authors are very frank in describing--there is no question that, as we learned from the artificial hormone DES years ago, drugs that use novel mechanisms that mess with hormones (like GLP-1) and supress gene expression(as does Januvia, Onglyza, etc.) may very well cause cancer--and they will do it after a much longer time period has passed than the brief two or three years over which which drug acceptance studies last. (After a drug is approved there is no significant tracking of its subsequent connection with cancers, and the database that attempts to collect this data is, as the Gastroenterology study discusses, quite limited and flawed.)

The lesson is clear. Drugs have short term benefits that may be much easier to see than the long term disturbances they make in our body that might kill us. Messing with systems we don't really understand--like the human body--is going to produce unexpected results.

So here's a bit of ovarian cancer awareness for those of you with diabetes--and you don't have to buy my novel to benefit from it, though of course I hope you will. Anyone with a family history of ovarian cancer should stay away from any drug that inhibits DPP-4. It will take 20 years for it to become clear what the impact of turning off this tumor suppressing gene really is.

But it is often hard to know if you have a family history of ovarian cancer, due to the huge burden of shame and silence that kept women of earlier generations from telling anyone that they suffered from this kind of cancer. So if you have had female relatives who died of any mysterious cancers, you should be particularly careful about what drugs you take, and it is essential that you NOT take any of the DPP-4 inhibitors that make it easier for a preexisting ovarian cancer to spread.

Metformin, fortunately, seems to have a protective effect against cancer, which is why I, a melanoma survivor, take it even when my blood sugars are in very good control.