DukeHealth.org - In a six-month comparison of 2 types of reduced carb diets, one that encourages eating carbohydrates with the lowest-possible rating on the glycemic index (a “no-glycemic” diet) leads to greater improvement in blood sugar control, according to Duke University Medical Center researchers.

Patients who followed the no-glycemic diet experienced more frequent reductions, and in some cases elimination, of their need for medication to control type 2 diabetes, according to lead author Eric Westman, MD, director of Duke’s Lifestyle Medicine Program. The findings are published online in Nutrition and Metabolism.

“Low glycemic diets are good, but our work shows a no-glycemic diet is even better at improving blood sugar control,” he says. “We found you can get a three-fold improvement in type 2 diabetes as evidenced by a standard test of the amount of sugar in the blood. That’s an important distinction because as a physician who is faced with the choice of drugs or diet, I want a strong diet that’s shown to improve type 2 diabetes and minimize medication use.”

Eight-four volunteers with obesity and type 2 diabetes were randomized to either a low-carbohydrate ketogenic diet (less than 20 grams of carbs/day) - called the “no-glycemic” diet - or a low-glycemic, reduced calorie diet (500 calories/day). Both groups attended group meetings, had nutritional supplementation and an exercise regimen.

After 24 weeks, their glycemic control was determined by a blood test that measured hemoglobin A1C, a standard test used to determine blood sugar control in patients with diabetes. Of those who completed the study, the volunteers in the low-carbohydrate diet group had greater improvements in hemoglobin A1C. Diabetes medications were reduced or eliminated in 95 percent of the low-carbohydrate volunteers, compared to 62 percent in the low-glycemic group. The low-carbohydrate diet also resulted in a greater reduction in weight.

“It’s simple,” says Westman. “If you cut out the carbohydrates, your blood sugar goes down, and you lose weight which lowers your blood sugar even further. It’s a one-two punch.”

The diet is not easy for everybody. “This is a therapeutic diet for people who are sick,” says Westman. “These lifestyle approaches all have an intensive behavioral component. In our program, people come in every two weeks to get reinforcements and reminders. We’ve treated hundreds of patients this way now at Duke and what we see clinically and in our research shows that it works.”

CUMC.Columbia.edu - Maintaining blood sugar levels, even in the absence of disease, may be an important strategy for preserving cognitive health, suggests a study published by researchers at Columbia University Medical Center (CUMC). The study appeared in the December 2008 issue of Annals of Neurology.

Senior moments, also dubbed by New York Times Op-Ed columnist David Brooks as being “hippocampically challenged,” are a normal part of aging. Such lapses in memory, according to this new research, could be blamed, at least in part, on rising blood glucose levels as we age. The findings suggest that exercising to improve blood sugar levels could be a way for some people to stave off the normal cognitive decline that comes with age.

“This is news even for people without diabetes since blood glucose levels tend to rise as we grow older. Whether through physical exercise, diet or drugs, our research suggests that improving glucose metabolism could help some of us avert the cognitive slide that occurs in many of us as we age,” reported lead investigator Scott A. Small, M.D., associate professor of neurology in the Sergievsky Center and in the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain at Columbia University Medical Center.

Although it is widely known that the early stages of Alzheimer’s disease cause damage to the hippocampus, the area of the brain essential for memory and learning, studies have suggested that it is also vulnerable to normal aging. Until now, the underlying causes of age-related hippocampal dysfunction have remained largely unknown.

Previously, using high-resolution brain imaging, Dr. Small and his colleagues discovered that decreasing brain function in one area of the hippocampus, called the dentate gyrus, is a main contributor of normal decline in memory as we age.

In this new study, funded by the National Institute on Aging (NIA), the American Diabetes Association and the McKnight Brain Research Foundation, the researchers mapped out the specific areas of the hippocampus impacted by late-life diseases like diabetes and stroke.

“This research used imaging in both human volunteers and in animal models to help us better understand the basic mechanisms behind hippocampal dysfunction in the aged,” said Dr. Marcelle Morrison-Bogorad, NIA Division of Neuroscience director. “While more research is needed into the complex interaction of late-life disease and how it may affect the hippocampus, this new study is part of an ongoing effort to identify specific areas where interventions might preserve cognitive health.”

This new study looked at measures that typically change during aging, like rising blood sugar, body mass index, cholesterol and insulin levels. The research found that decreasing activity in the dentate gyrus only correlated with levels of blood glucose.

“Showing for the first time that blood glucose selectively targets the dentate gyrus is not only our most conclusive finding, but it is the most important for ‘normal’ aging - that is hippocampal dysfunction that occurs in the absence of any disease states. There have been many proposed reasons for age-related hippocampal decline; this new study suggests that we may now know one of them,” said Dr. Small.

Additional animal studies helped confirm the relationship between glucose and dentate gyrus activity; the researchers found the same association in aging rhesus monkeys and in mice.

“Beyond the obvious conclusion that preventing late-life disease would benefit the aging hippocampus, our findings suggest that maintaining blood sugar levels, even in the absence of diabetes, could help maintain aspects of cognitive health. More specifically, our findings predict that any intervention that causes a decrease in blood glucose should increase dentate gyrus function and would therefore be cognitively beneficial,” said Dr. Small.

The new findings also suggest that one way in which physical exercise could improve memory is via lowering glucose levels. Dr. Small’s previous imaging studies in humans and in mice have documented that among all hippocampal subregions, physical exercise causes an improvement in dentate gyrus function.

“By improving glucose metabolism, physical exercise also reduces blood glucose. It is therefore possible that the cognitive enhancing effects of physical exercise are mediated, at least in part, by the beneficial effect of lower glucose on the dentate gyrus. Whether with physical exercise, diet or through the development of potential pharmacological interventions, our research suggests that improving glucose metabolism could be a clinically viable approach for improving the cognitive slide that occurs in many of us as we age,” concluded Dr. Small.

With increasing longevity and the aging of the baby boom population, cognitive decline has emerged as a major health care crisis and concern.

JNCI.OxfordJournals.org - Women who have a high blood level of insulin have a higher risk of developing breast cancer than women who have a lower level of the hormone. A higher insulin level appears to be an independent risk factor for breast cancer.

Obesity is a known risk factor for postmenopausal breast cancer. This relationship usually has been attributed to the high estrogen levels in many obese postmenopausal women. Obesity, however, is also associated with high insulin levels. Until recently it has not been known whether high levels of insulin, which stimulates the growth of breast cells in tissue culture, are also associated with breast cancer. The current investigation was the first study to prospectively examine the role of insulin in breast cancer while controlling for estrogen levels.

In the current study, Marc Gunter, Ph.D., and Howard Strickler, M.D., of the Albert Einstein College of Medicine in New York, and colleagues, examined the association between incident breast cancer and baseline fasting insulin, insulin-like growth factor-1 (a related hormone), and estradiol levels in 835 women enrolled in the Women’s Health Initiative Observational Study who developed breast cancer and a randomly-selected sample of 816 women in the study who did not develop breast cancer.

When the researchers divided the women into four groups based on their fasting insulin levels, they found that women with the highest insulin levels had nearly a 1.5-fold higher risk of developing breast cancer than the women with the lowest insulin levels. Further, the investigators separately analyzed women who were not using hormone therapy and found that, in these women, those individuals with the highest insulin levels had a 2.4-fold increased risk of developing breast cancer compared to those with the lowest levels, even after accounting for multiple other breast cancer risk factors, including estrogen levels.

“These data suggest that hyperinsulinemia is an independent risk factor for breast cancer and may have a substantial role in explaining the obesity-breast cancer relationship,” the authors conclude (Courtesy of EurekAlert!, a service of AAAS).

Lots of experts disagree over the seemingly obvious notion of keeping weight off by trying to eat less – a debate that centers on whether the practice backfires, leading to binging and weight gain.

Now a new study shows that practicing restraint becomes more important with age.

Women who participated in the study had more than twice the risk of substantial weight gain if they did not become more restrained in their eating.

“Some suggest that restrained eating is not a good practice,” said Brigham Young University professor Larry Tucker, the study’s lead author. “Given the environmental forces in America’s food industry, not practicing restraint is essentially a guarantee of failure.”

The study followed 192 middle-aged women for three years and tracked information on lifestyle, health and eating habits. Their analysis revealed that women who did not become more restrained with eating were 138 percent more likely to put on 6.6 pounds or more.

Columbia University researcher Lance Davidson, who was not involved with the analysis, said the findings highlight an important principle of weight management.

“Because the body’s energy requirements progressively decline with age, energy intake must mirror that decrease or weight gain occurs,” said Davidson, a research fellow at Columbia’s Obesity Research Center. “Dr. Tucker’s observation that women who practice eating restraint avoid the significant weight gain commonly observed in middle age is an important health message.”

Tucker says watching what you eat is not about physical appearance – it’s a direct investment in your health.

“Weight gain and obesity bring a greater risk of diabetes and a number of other chronic diseases,” Tucker said. “Eating properly is a skill that needs to be practiced.”

The study will be published January 2, 2009 in the American Journal of Health Promotion.

Professor Tucker’s Tips for Better Eating:
- Record what you eat and how much
- Put less food on your plate
- Eat more fruits and vegetables; the food pyramid recommends at least five servings per day (Newswise).

Researchers at the University Of Southern California, School Of Dentistry release results of clinical data that links oral bisphosphonates to increased jaw necrosis. The study is among the first to acknowledge that even short-term use of common oral osteoporosis drugs may leave the jaw vulnerable to devastating necrosis, according to the report appearing in the January 1, 2009 Journal of the American Dental Association (JADA).

Osteoporosis currently affects 10 million Americans. Fosamax is the most widely prescribed oral bisphosphonate, ranking as the 21st most prescribed drug on the market since 2006, according to a 2007 report released by IMS Health.

“Oral Bisphosphonate Use and the Prevalence of Osteonecrosis of the Jaw: An Institutional Inquiry” is the first large institutional study in the U.S. to investigate the relationship between oral bisphosphonate use and jaw bone death, said principal investigator Parish Sedghizadeh, assistant professor of clinical dentistry with the USC School of Dentistry.

After controlling for referral bias, nine of 208 healthy School of Dentistry patients who take or have taken Fosamax for any length of time were diagnosed with osteonecrosis of the jaw (ONJ). The study’s results are in contrast to drug makers’ prior assertions that bisphosphonate-related ONJ risk is only noticeable with intravenous use of the drugs, not oral usage, Sedghizadeh said. “We’ve been told that the risk with oral bisphosphonates is negligible, but four percent is not negligible,” he said.

Most doctors who have prescribed bisphosphonates have not told patients about any oral health risks associated with the use of the drugs, despite even short-term usage posing a risk due to the drug’s tenacious 10-year half life in bone tissue. Lydia Macwilliams of Los Angeles said no one told her about the risk posed by her three years of Fosamax usage until she became a patient of Sedghizadeh at the School of Dentistry. “I was surprised,” she said. “My doctor who prescribed the Fosamax didn’t tell me about any possible problems with my teeth.”

Macwilliams was especially at risk for complications because she was to have three teeth extracted. The infection is a biofilm bacterial process, meaning that the bacteria infecting the mouth and jaw tissues reside within a slimy matrix that protects the bacteria from many conventional antibiotic treatments, and bisphosphonate use may make the infection more aggressive in adhering to the jaw, Sedghizadeh said. The danger is especially pronounced with procedures that directly expose the jaw bone, such as tooth extractions and other oral surgery. After her extractions, two of the three extraction sites had difficulty healing due to infection, Macwilliams said. Luckily, with treatment as well as the rigorous oral hygiene regimen USC dentists developed especially for patients with a history of bisphosphonate usage, the remaining sites slowly but fully healed. “It took about a year to heal,” she said, “but it’s doing just fine now.”

Sedghizadeh hopes to have other researchers confirm his findings and thus encourage more doctors and dentists to talk with patients about the oral health risks associated with the widely used drugs. The results confirm the suspicions of many in the oral health field, he said. “Here at the School of Dentistry we’re getting two or three new patients a week that have bisphosphonate-related ONJ,” he said, “and I know we’re not the only ones seeing it” (Newswise).

Antioxidant supplementation was found to be effective in relieving pain and reducing levels of oxidative stress in patients with chronic pancreatitis (CP), reports a new study in Gastroenterology. CP is a progressive inflammatory disease of the pancreas in which patients experience abdominal pain (in early stage) and diabetes and maldigestion (in late stage). Pain is the major problem in 90 percent of patients with chronic pancreatitis and currently, there is no effective medical therapy for pain relief. Gastroenterology is the official journal of the American Gastroenterological Association (AGA) Institute.

In this placebo-controlled, double blind trial, 127 patients, ages 30.5+/-10.5, were assigned to placebo or antioxidant groups. After six months, the reduction in the number of painful days per month was significantly higher in the antioxidant group, compared with the placebo group (7.4±6.8 versus 3.2±4, respectively). The reduction in the number of analgesic tablets used per month was also higher in the antioxidant group (10.5±11.8 versus 4.4±5.8, respectively). Furthermore, 32 percent and 13 percent of patients became pain free in the antioxidant and placebo groups, respectively; the beneficial effect of antioxidants on pain relief was noted early at three months.

“Abdominal pain, the predominant symptom in patients with CP, is difficult to treat. The main reason for a largely ineffective medical treatment is that the mechanism of pain in CP is not well understood,” said Pramod Kumar Garg, MD, DM, of the All India Institute of Medical Sciences, New Delhi and lead author of the study. “We are encouraged by our findings, as significant improvement was noted with antioxidants in respect to all the parameters of pain in this study. In addition, reduction in pain resulted in fewer man-days lost, thus providing functional employment gain to the patients. The findings should spur further research in this exciting area.”

There are two important implications of this study - the fact that measures of oxidative stress were increased initially and decreased subsequently after supplementation with antioxidants suggests that there is a state of heightened free radical mediated injury in chronic pancreatitis, and that injury is reversible. Second, with regard to pain management, this trial showed that antioxidant therapy is effective for pain relief in patients with CP. This assumes significance since no effective medical therapy exists for pain relief for such patients.

Pancreatitis is inflammation of the pancreas that usually begins as a sudden attack and is often caused by gallstones, alcohol abuse or genetic mutations. Symptoms of pancreatitis start with a gradual or sudden severe pain in the center part of the upper abdomen going through to the back. Treatment often focuses on the nutritional and metabolic needs of the patient and on relieving pain. Most people with chronic pancreatitis have a good prognosis if they follow their treatment regimen. “Aside from medication, abstaining from alcohol and smoking are most important and key to halt the progression of CP,” added Dr. Garg (Courtesy of EurekAlert!, a service of AAAS).