Excess fructose may play role in diabetes, obesity and other health conditions

ScienceDaily (Nov. 23, 2010) ? More and more people have become aware of the dangers of excessive fructose in diet. A new review on fructose in an upcoming issue of the Journal of the American Society of Nephrology (JASN) indicates just how dangerous this simple sugar may be.

Richard J. Johnson, MD and Takahiko Nakagawa, MD (Division of Renal Diseases and Hypertension, University of Colorado) provide a concise overview of recent clinical and experimental studies to understand how excessive amounts of fructose, present in added sugars, may play a role in high blood pressure, diabetes, obesity, and chronic kidney disease (CKD).

Dietary fructose is present primarily in added dietary sugars, honey, and fruit. Americans most frequently ingest fructose from sucrose, a disaccharide containing 50% fructose and 50% glucose bonded together, and high fructose corn syrup (HFCS), a mixture of free fructose and free glucose, usually in a 55/45 proportion. With the introduction of HFCS in the 1970s, an increased intake of fructose has occurred and obesity rates have risen simultaneously.

The link between excessive intake of fructose and metabolic syndrome is becoming increasingly established. However, in this review of the literature, the authors conclude that there is also increasing evidence that fructose may play a role in hypertension and renal disease. "Science shows us there is a potentially negative impact of excessive amounts of sugar and high fructose corn syrup on cardiovascular and kidney health," explains Dr. Johnson. He continues that "excessive fructose intake could be viewed as an increasingly risky food and beverage additive."

Concerned that physicians may be overlooking this health problem when advising CKD patients to follow a low protein diet, Dr. Johnson and Dr. Nakagawa recommend that low protein diets include an attempt to restrict added sugars containing fructose.

Dr. Johnson and Dr. Nakagawa are listed as inventors on several patent applications related to lowering uric acid for the treatment or prevention of hypertension, diabetes, and fatty liver.

Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by American Society of Nephrology, via EurekAlert!, a service of AAAS.

Journal Reference:

Richard J. Johnson, MD and Takahiko Nakagawa, MD. The Effect of Fructose on Renal Biology and Disease. Journal of the American Society of Nephrology, November 29, 2010 DOI: 10.1681/ASN.2010050506

Note: If no author is given, the source is cited instead.

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Adverse Neighborhood Conditions Greatly Aggravate Mobility Problems From Diabetes

Main Category: Diabetes
Article Date: 22 Oct 2010 - 2:00 PDT window.fbAsyncInit = function() { FB.init({ appId: 'aa16a4bf93f23f07eb33109d5f1134d3', status: true, cookie: true, xfbml: true, channelUrl: 'http://www.medicalnewstoday.com/scripts/facebooklike.html'}); }; (function() { var e = document.createElement('script'); e.async = true; e.src = document.location.protocol + '//connect.facebook.net/en_US/all.js'; document.getElementById('fb-root').appendChild(e); }()); email to a friend ? printer friendly ? opinions ?

A study published earlier this year in the peer reviewed online journal BMC Public Health has found that residing in a neighborhood with adverse living conditions such as low air quality, loud traffic or industrial noise, or poorly maintained streets, sidewalks and yards, makes mobility problems much more likely in late middle-aged African Americans with diabetes.

"We followed a large group of African Americans for 3 years and found an extremely strong correlation between diabetes and adverse neighborhood conditions. The study participants were between the ages of 49 and 65 years with no or limited mobility problems at the beginning of the study," said study senior author Douglas K. Miller, M.D., Richard M. Fairbanks Professor in Aging Research at the Indiana University School of Medicine and a Regenstrief Institute research scientist.

The researchers knew that, as diabetics, these individuals were prone to develop lower-body functional limitations at a relatively young age. What they discovered was a double jeopardy situation.

"Having diabetes is bad, living under adverse neighborhood conditions is bad, but people with diabetes who live in adverse neighborhood conditions quite remarkably were up to 80 times more likely to develop lower body functional limitations than those having the disease or living under these neighborhood conditions alone," said Dr. Miller. "In fact, in our study about 8 out of 10 people who developed lower body functional limitations were diabetics who lived in adverse neighborhood conditions."

Limitations encountered by the individuals with diabetes noted in the study include difficulty with daily functions such as walking a quarter mile (approximately three city blocks) or climbing up and down stairs. The strong link between adverse neighborhood conditions and reduced mobility existed even when the researchers adjusted for exercise, so lack of exercise did not account for the diminished abilities.

"It can be stressful living in these neighborhoods and psychological stress produces oxidative stress physiologically, which diabetics don't tolerate well," said Dr. Miller, who is an internist and associate director of the Indiana University Center for Aging Research. "This may be one of the reasons why living in adverse neighborhood conditions exacerbates the detrimental effects on lower body functioning associated with diabetes."

Surprisingly, while the researchers found a strong link between residing in a neighborhood with adverse conditions and diabetes, they did not find a similar link for hypertension or arthritis, so the negative interaction with adverse neighborhood conditions appears to be specific to diabetes.

The research team from the Indiana University School of Medicine, Regenstrief Institute, Washington University in St. Louis and the universities of Florida and Iowa studied 563 men and women age 49 to 65 in St. Louis.

"African Americans have more disability than whites, and it's even worse in inner-city areas with low socioeconomic status. People may live in urban neighborhoods with great people, wonderful churches and long civic histories, but excessive neighborhood noise and crumbling infrastructure are bad for health, especially for individuals with diabetes. We need to further study how the environment 'gets under the skin' so we can halt the interaction between diabetes and adverse living conditions that leads to decreased mobility," said Dr. Miller.

In addition to Dr. Miller, authors of "Neighborhood conditions, diabetes, and risk of lower-body functional limitations among middle-aged African Americans: A cohort study" are Mario Schootman, Ph.D.; J. Philip Miller, M.S., and Yan Yan, M.D., Ph.D., of Washington University of St. Louis; Elena M. Andresen, Ph.D., of the University of Florida, and Fredric D. Wolinsky, Ph.D., of the University of Iowa.

The study was funded by the National Institute on Aging.

Source:
IU School of Medicine

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Diabetic Adults' Conditions Improved After Phone Calls With Fellow Patients

Main Category: Diabetes
Article Date: 19 Oct 2010 - 2:00 PDT window.fbAsyncInit = function() { FB.init({ appId: 'aa16a4bf93f23f07eb33109d5f1134d3', status: true, cookie: true, xfbml: true, channelUrl: 'http://www.medicalnewstoday.com/scripts/facebooklike.html'}); }; (function() { var e = document.createElement('script'); e.async = true; e.src = document.location.protocol + '//connect.facebook.net/en_US/all.js'; document.getElementById('fb-root').appendChild(e); }()); email to a friend ? printer friendly ? opinions ?

Phone calls with a peer facing the same self-management challenges helped diabetes patients manage their conditions and improved their blood sugar levels better than those who used traditional nurse care management services alone, according to research from the University of Michigan Health System.

The findings, published Oct. 19 in the Annals of Internal Medicine, showed the peer partner program resulted in lower glycated hemoglobin (HbA1c) levels after six months among men with uncontrolled diabetes.

The research was based on a peer partnership program established by the Veterans Affairs Ann Arbor Health System and the University of Michigan Medical School.

Each peer pair received initial brief training in peer communication skills and was expected to communicate by telephone at least once a week about their mutual efforts to improve diabetes control. Program participants also were offered optional periodic nurse-facilitated group sessions to exchange experiences with fellow patients.

"Our model was testing the hypothesis that a good way to activate patients was to give them some skills and encouragement to both help and be helped. Just as in education they say that the best way to learn something is to try to teach it," says study lead author Michele Heisler, M.D., who is a research scientist for the Center for Clinical Management Research at the VA Ann Arbor's Health Services Research & Development Center of Excellence and associate professor of internal medicine at the U-M's Medical School. Heisler also is associate professor of health behavior and health education at U-M's School of Public Health.

"We are trying to tap into the underappreciated expertise of patients," Heisler says. "Most disease management programs put patients in the 'learner' role, whether nurse care management programs or 'expert' peer programs. But patients know a lot about living with their condition and strategies they have developed so have a lot to share with others also struggling. Our program hoped to mobilize patients themselves to realize how much they themselves had to offer another person with diabetes and enjoy the sense of meaning and pleasure that being needed and helping another can provide.

That's why I think people did well-- they were very motivated when they felt they were helping someone else."

In the peer support group, researchers randomly assigned 244 VA patients with uncontrolled diabetes to either peer support or traditional nurse care management. At the start, patients in the peer support group met in a group setting to set their own disease management goals and specific steps they wanted to take over the next few weeks, received basic peer communication tips, were matched with another study participant of similar age (their peer partner), and were advised to talk with their peer partner once per week. For their peer calls they used the telephones but through a system that linked calls without their having to exchange their telephone calls, that enabled them to block calls at certain hours, and that provided reminder calls if they missed a week.

Heisler says she and her fellow researchers expected to see benefits from the peer support, but were surprised at how large the improvement in glycemic control from the program after six months was. The patients who were randomly assigned to the peer support program achieved HbA1c levels that were 0.58 percentage points lower on average than those in the nurse care management group. And patients in the peer support group with baseline HbA1c levels greater than 8 percent achieved a mean decrease of 0.88 percentage points, compared with a 0.07-percentage point decrease among those in the nurse care management group. This is equivalent to that achieved by starting another oral anti-hyperglyemic medication.

More patients in the peer support group also started insulin therapy at much higher rates than those in the nurse care management group, a step that many patients resist.

"The higher rate of insulin therapy initiation in the peer support group suggests that patents' concerns about insulin may be best addressed by another person who also is coping with insulin management," Heisler says.

Heisler says this is the first randomized controlled trial to examine reciprocal peer support in chronic disease management. This can be a low-cost, easy-to-implement system that allows patients to get more one-on-one support in managing a chronic illness, Heisler says.

"Most chronically ill patients need more support for self-care than most health care systems can provide. That's why programs like this, that increase the quality and intensity of assistance through peer support, deserve further exploration," Heisler says.

Additional authors: Sandeep Vijan, M.D., of U-M and VA Ann Arbor; Fatima Makki, M.P.H, M.S.W. of VA Ann Arbor; John Piette, Ph.D., of U-M and VA Ann Arbor.

Funding: U.S. Department of Veterans Affairs Health Services Research and Development Service (HSR&D)

Source:
University of Michigan Health System

Please rate this article:
(Hover over the stars
then click to rate)

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

posted by Louis Brinn on 21 Oct 2010 at 12:45 pm

This study is really innovative. They used people instead of mice with cell phones. They as usual did not announce a cure or a med that would permit normal life as usual. Who ever funded this study is to be commended for this. Not only did they not discover a cure or effective meds but they made the people involved feel good about themselves and not resist the same old insulin that has been around for so many years.
I bet they did not even tell direct relatives that they might be up for a lot of phone calling and insulin real soon. Hurrah for modern medicine.

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View the original article here

Adverse neighborhood conditions greatly aggravate mobility problems from diabetes, study finds

ScienceDaily (Oct. 21, 2010) ? A study published earlier this year in the peer reviewed online journal BMC Public Health has found that residing in a neighborhood with adverse living conditions such as low air quality, loud traffic or industrial noise, or poorly maintained streets, sidewalks and yards, makes mobility problems much more likely in late middle-aged African Americans with diabetes.

"We followed a large group of African Americans for 3 years and found an extremely strong correlation between diabetes and adverse neighborhood conditions. The study participants were between the ages of 49 and 65 years with no or limited mobility problems at the beginning of the study," said study senior author Douglas K. Miller, M.D., Richard M. Fairbanks Professor in Aging Research at the Indiana University School of Medicine and a Regenstrief Institute research scientist.

The researchers knew that, as diabetics, these individuals were prone to develop lower-body functional limitations at a relatively young age. What they discovered was a double jeopardy situation.

"Having diabetes is bad, living under adverse neighborhood conditions is bad, but people with diabetes who live in adverse neighborhood conditions quite remarkably were up to 80 times more likely to develop lower body functional limitations than those having the disease or living under these neighborhood conditions alone," said Dr. Miller. "In fact, in our study about 8 out of 10 people who developed lower body functional limitations were diabetics who lived in adverse neighborhood conditions."

Limitations encountered by the individuals with diabetes noted in the study include difficulty with daily functions such as walking a quarter mile (approximately three city blocks) or climbing up and down stairs. The strong link between adverse neighborhood conditions and reduced mobility existed even when the researchers adjusted for exercise, so lack of exercise did not account for the diminished abilities.

"It can be stressful living in these neighborhoods and psychological stress produces oxidative stress physiologically, which diabetics don't tolerate well," said Dr. Miller, who is an internist and associate director of the Indiana University Center for Aging Research. "This may be one of the reasons why living in adverse neighborhood conditions exacerbates the detrimental effects on lower body functioning associated with diabetes."

Surprisingly, while the researchers found a strong link between residing in a neighborhood with adverse conditions and diabetes, they did not find a similar link for hypertension or arthritis, so the negative interaction with adverse neighborhood conditions appears to be specific to diabetes.

The research team from Indiana University School of Medicine, the Regenstrief Institute, Washington University in St. Louis and the universities of Florida and Iowa studied 563 men and women age 49 to 65 in St. Louis.

"African Americans have more disability than whites, and it's even worse in inner-city areas with low socioeconomic status. People may live in urban neighborhoods with great people, wonderful churches and long civic histories, but excessive neighborhood noise and crumbling infrastructure are bad for health, especially for individuals with diabetes. We need to further study how the environment 'gets under the skin' so we can halt the interaction between diabetes and adverse living conditions that leads to decreased mobility," said Dr. Miller.

In addition to Dr. Miller, authors of the study are Mario Schootman, Ph.D.; J. Philip Miller, M.S., and Yan Yan, M.D., Ph.D., of Washington University of St. Louis; Elena M. Andresen, Ph.D., of the University of Florida, and Fredric D. Wolinsky, Ph.D., of the University of Iowa.

The study was funded by the National Institute on Aging.

Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Indiana University School of Medicine, via EurekAlert!, a service of AAAS.

Journal Reference:

Mario Schootman, Elena M Andresen, Fredric D Wolinsky, J Philip Miller, Yan Yan, Douglas K Miller. Neighborhood conditions, diabetes, and risk of lower-body functional limitations among middle-aged African Americans: A cohort study. BMC Public Health, 2010; 10 (1): 283 DOI: 10.1186/1471-2458-10-283

Note: If no author is given, the source is cited instead.

View the original article here

Diabetic adults' conditions improved after phone calls with fellow patients

ScienceDaily (Oct. 18, 2010) ? Phone calls with a peer facing the same self-management challenges helped diabetes patients manage their conditions and improved their blood sugar levels better than those who used traditional nurse care management services alone, according to research from the University of Michigan Health System.

The findings, published Oct. 19 in the Annals of Internal Medicine, showed the peer partner program resulted in lower glycated hemoglobin (HbA1c) levels after six months among men with uncontrolled diabetes.

The research was based on a peer partnership program established by the Veterans Affairs Ann Arbor Health System and the University of Michigan Medical School.

Each peer pair received initial brief training in peer communication skills and was expected to communicate by telephone at least once a week about their mutual efforts to improve diabetes control. Program participants also were offered optional periodic nurse-facilitated group sessions to exchange experiences with fellow patients.

"Our model was testing the hypothesis that a good way to activate patients was to give them some skills and encouragement to both help and be helped. Just as in education they say that the best way to learn something is to try to teach it," says study lead author Michele Heisler, M.D., who is a research scientist for the Center for Clinical Management Research at the VA Ann Arbor's Health Services Research & Development Center of Excellence and associate professor of internal medicine at the U-M's Medical School. Heisler also is associate professor of health behavior and health education at U-M's School of Public Health.

"We are trying to tap into the underappreciated expertise of patients," Heisler says. "Most disease management programs put patients in the 'learner' role, whether nurse care management programs or 'expert' peer programs. But patients know a lot about living with their condition and strategies they have developed so have a lot to share with others also struggling. Our program hoped to mobilize patients themselves to realize how much they themselves had to offer another person with diabetes and enjoy the sense of meaning and pleasure that being needed and helping another can provide.

That's why I think people did well-- they were very motivated when they felt they were helping someone else."

In the peer support group, researchers randomly assigned 244 VA patients with uncontrolled diabetes to either peer support or traditional nurse care management. At the start, patients in the peer support group met in a group setting to set their own disease management goals and specific steps they wanted to take over the next few weeks, received basic peer communication tips, were matched with another study participant of similar age (their peer partner), and were advised to talk with their peer partner once per week. For their peer calls they used the telephones but through a system that linked calls without their having to exchange their telephone calls, that enabled them to block calls at certain hours, and that provided reminder calls if they missed a week.

Heisler says she and her fellow researchers expected to see benefits from the peer support, but were surprised at how large the improvement in glycemic control from the program after six months was. The patients who were randomly assigned to the peer support program achieved HbA1c levels that were 0.58 percentage points lower on average than those in the nurse care management group. And patients in the peer support group with baseline HbA1c levels greater than 8 percent achieved a mean decrease of 0.88 percentage points, compared with a 0.07-percentage point decrease among those in the nurse care management group. This is equivalent to that achieved by starting another oral anti-hyperglyemic medication.

More patients in the peer support group also started insulin therapy at much higher rates than those in the nurse care management group, a step that many patients resist.

"The higher rate of insulin therapy initiation in the peer support group suggests that patents' concerns about insulin may be best addressed by another person who also is coping with insulin management," Heisler says.

Heisler says this is the first randomized controlled trial to examine reciprocal peer support in chronic disease management. This can be a low-cost, easy-to-implement system that allows patients to get more one-on-one support in managing a chronic illness, Heisler says.

"Most chronically ill patients need more support for self-care than most health care systems can provide. That's why programs like this, that increase the quality and intensity of assistance through peer support, deserve further exploration," Heisler says.

Additional authors: Sandeep Vijan, M.D., of U-M and VA Ann Arbor; Fatima Makki, M.P.H, M.S.W. of VA Ann Arbor; John Piette, Ph.D., of U-M and VA Ann Arbor.

Funding: U.S. Department of Veterans Affairs Health Services Research and Development Service (HSR&D)

Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Michigan Health System.

Note: If no author is given, the source is cited instead.

View the original article here