4th Thursday Update

January 28, 2016


El Niño time!

For a long time meteorologists have known about a phenomenon known as the Southern Oscillation; this is a periodic fluctuation in sea-surface temperatures in the Pacific ocean -- a fluctuation which causes dramatic changes in weather patterns. The phase of this oscillation in which sea-surface temperatures rise results in, among other things, a lot of rain in California. This phase is known as El Niño (the opposite phase is known as La Niña -- the explanation of these names is neither simple nor especially interesting, so I'll skip it). Anyway, we're having an El Niño year, and so California is getting some much-needed rain after a long drought. Or, as I think of it, we're getting an actual winter this year -- even though this is clearly not the sort of weather which anyone outside California would call "an actual winter" (after all, there's no snow, just rain).

An especially nice aspect of this relief from the drought is that, during breaks in the rain, you can go outside and find your environment looking rejuvenated, with green grass sprouting on hillsides which had been dry and brown for a very long time.

Suddenly California looks like the sort of place where you could shoot a movie that's supposed to be taking place in Ireland.

I went for a hike on Sunday afternoon, during a break in the weather. The state park wasn't as crowded as it would be under less iffy conditions, but I wasn't the only person out there getting some fresh-air exercise. Hikers, runners, and rail-bikers were out in force.

Of course, a lot of the trails had water draining down them, and plenty of mud to slip in if you weren't careful, but I managed not to do any pratfalls.

I had a plastic bag in my pocket, so that I could use it to protect my camera if the rain started up again before I got out of the park. Fortunately, I didn't need to use it.

And the carrion-birds didn't get to eat me!

I know it sounds silly to make it sound as if taking a walk in the park means you have cheated death. But let's face it: every day of our lives that we get through safely means we have cheated death, at least for a little while.


Type 1 solutions

I usually write about Type 2 diabetes, because that's what I've got and that's what I have experience with. But I do occasionally take an interest in the latest research on Type 1 diabetes, and some remarkable work is going on in that area.

In theory, the problem of Type 1 has already been "solved": once doctors figured out what was causing the disease (an immune-system malfunction had knocked out the beta cells in the pancreas which produce the body's insulin supply), and once injectable insulin had become available as a treatment, Type 1 was no longer a problem, surely!

Unfortunately, taking insulin shots at intervals throughout the day turns out to be a mighty crude way to duplicate, or pretend to duplicate, the delicately-adjusted program of insulin secretion which a properly-functioning pancreas performs for us. Even the most careful Type 1 patient is constantly in danger of taking insulin too soon, or too late -- or of taking too much insulin, or too little, for the situation of the moment. Also, a lot of people feel, for some reason, that having one's health and safety depend on multiple daily injections (all of them timed and dosed just right) is a gigantic pain in the ass.

So, researchers have been working on ways to treat Type 1 which don't depend on Type 1 patients constantly guessing right about how much insulin they need, and when to take it. Instead of expecting the patient to do the job that is supposed to be done by the beta cells in the pancreas, researchers are looking for ways to give Type 1 patients some functioning beta cells.

One approach is to transplant healthy beta cells into the pancreas of the patient. The problem with this approach is that the patient's immune system, which knocked out the original beta cells, is likely to knock out the replacements as well. To a degree, the transplanted cells can be protected by means of drugs which suppress the immune system -- but that's not a great solution, because it makes the patient vulnerable to infections.

Now researchers think they've found a way to solve the problem of protecting transplanted beta cells without suppressing the patient's immune system -- by encapsulating the beta cells within a surface coating.

No, that is not a NASA photo of a near-earth asteroid. It's an example of a beta cell that's been given a coating consisting of "alginate derivatives" (compounds found in seaweed) which have now been shown to protect beta cells from the body's immune response.

The beta cells in the experiment were developed from human stem cells. They were transplanted into mice (which means: don't get excited too fast, because that means treatments for humans are probably a long way off). Anyway, the cells were left in the mice for 174 days and continued to be effective at controlling blood sugar throughout that period.

Of course it is impossible to judge, at this point, how useful this approach will ever be as an alternative to taking insulin shots. If the bottom line is that the procedure costs $360,000 and you have to do it once a year, I don't expect it to become a standard therapy for the disease. Also, the beta cells in the research came from stem cells, and stem-cell research is severely hampered (at least in the USA) by religious politics. It's hard to see how any therapy that depends on stem-cells could ever become widely available.

However, there are other possibilities! Apparently it is possible to force skin cells to be turned into pancreatic beta cells, so that they start producing insulin. At least, that's what some California researchers have found. Again, this is rodent research, so it might be a long time before it turns into any kind of therapy that can be made available to human patients.

Still, it's encouraging to see what's going on: researchers are finding ways to create beta cells for transplantation (without using embryonic tissue), and other researchers are finding ways to protect transplanted beta cells from attack by the immune system.

I don't know if it will happen in my lifetime, but it looks as if, sooner or later, Type 1 patients will have a better option than giving themselves a shot and praying that it was the right amount at the right time.


Vitamin D disappointment

Vitamin D has been having a lot of bad luck lately: it's often promoted as a cure for various ailments, but when it's put to the test it turns out not to show a clear benefit.

Some people had thought that high doses of Vitamin D might be highly beneficial to diabetes patients, but it now appears that this is not so. Researchers are reporting that "This study gives no support for any substantial effect of high-dose vitamin D treatment for 8 weeks in prediabetes or diet-treated type 2 diabetes on ß-cell function, insulin sensitivity, or glycemic control."

Oh, well. We have to go through these fits of excitement every once in a while: some vitamin or supplement is offered to us as the long-overlooked cure for whatever ails us. And then, when somebody studies the stuff to see if it works...


Eating better food costs more!

You will be astonished to learn that a new study finds that people who eat a more nutritious diet (with fresh fruits and vegetables) and keep their weight under control tend to spend more money on food. And here you were thinking that eating junk-food was the most expensive option!


3rd Thursday Update

January 21, 2016


Moving day!

I'm in the process of moving out of the office I've been occupying for several years, and relocating to a different building. I left work today with everything packed up in boxes labeled with my name. Tomorrow morning, if the movers do what they're supposed to do, I'll be unpacking it all in a different location.

The "new" location is actually an old location -- my desk used to be there about 15 years ago. And the guy who will be occupying the cubicle next to me used to be the manager of the project I was working on then. There's a peculiar sensation of homecoming about all of this. I feel like a salmon. Not that I'm planning to spawn (and then get eaten by a bear), but you know what I mean.

However, I feel like a very old salmon, because the first thing that occurred to me about the new location is that it's on the ground floor, so I won't have a climb a long flight of stairs every morning to get to it. When I was working there before, 15 years ago, considerations of that sort never crossed my mind.

The experience of disconnecting all my electronic gear raised an interesting question which I would like exercise physiologists to look into: why is crawling under your desk unplugging things sweatier work than anything you can do at the gym?

I didn't make that my only exercise today. Once everything was packed up, I took off for a five-mile run. I knew that more rain was expected, but not quite yet, and I finished the run without getting rained on. And now that I'm done with that, the sound of rain on the roof is oddly comforting. I missed being out in that! (I like to enjoy the temporary illusion of having cheated nature of her chance to humiliate me -- even though I realize she will have the last laugh sooner or later.)


Odors: transitive and intransitive

The difference between a transitive verb and an intransitive verb is that a transitive verb applies its action to some object: if you "mow the lawn", mow is transitive, because it's about doing something to the lawn. If you "sleep", however, sleep is intransitive, because the action of sleeping is not applied to some other object.

So far, so good. But a lot of verbs can be transitive or intransitive, depending on context. If you say that you like to "sing", then sing is intransitive. But if you say that you like to "sing Irish songs", sing is transitive -- you're not just singing in general, you're singing Irish songs.

Sometimes it's not clear whether a verb is being used transitively or intransitively. This can be a big problem -- as in the case of an article entitled "New knowledge on why patients with type 2 diabetes present smelling problems". Is the verb "smell" being used intransitively? If so, then patients with type 2 diabetes stink -- they produce odors which are a problem for other people. However, if the verb is being used transitively, then patients with type 2 diabetes have problems detecting odors.

You will be relieved, or so I hope, to discover that "smell" is transitive here. The problem Type 2 patients have isn't that they produce odors, but that they have trouble detecting them.

Of all the senses, the sense of smell is the one that gets the least respect. A lot of people seem to imagine that, unless you're sniffing Persian attar of roses, nothing worthwhile ever comes to you by way of the nose, so it would be no great loss to lose the sense of smell. Apparently the sense of smell is something people don't appreciate until they lose it -- only then do they discover how important it actually was to them. (To a surprising degree, the pleasures of food and wine which we attribute to taste are really related more to the nose than to the tongue.)

However, even if the sense of smell were as unimportant to life as many people assume it to be, the loss of ability to detect odor among diabetes patients would still be significant -- because it points to larger neurological issues.

According to the researchers, the loss of odor sensation in diabetes patients is a consequence of damage in "a group of nerve cells called interneurons, in the piriform cortex". The researchers believe that such damage can also lead to other neurological problems in diabetes patients -- including problems we take far more seriously, such as Alzheimer's disease and Parkinson's disease. Finding ways to combat this sort of damage to neurons could save diabetes patients from problems a lot worse than not being able to stop and sniff the roses.

Naturally, the researchers are focused on finding a drug to address the problem, but I don't mind that, because once we really understand the problem, we can seek non-pharmaceutical solutions to it if we wish. I don't care if the researchers are looking for that holiest of Holy Grails, the next billion-dollar drug. If, in pursuit of that, they discover information useful to all of us, then that's good news to me, even if I don't want to take their drugs.

I hate to end this on a note of realism, but I should mention that the brain studies involved here looked at the brains of rats. Maybe the findings will turn out to be relevant to humans, too, but it remains to be seen.


HIIT is better?

High Intensity Interval Training (HIIT) is a type of exercise which aims to achieve the health benefits of exercise more efficiently, by replacing lengthy moderate-intensity workouts (such as my 5-mile run today) with shorter workouts featuring intervals of extremely high intensity. I've written on this subject before, but more research is showing more benefits for it. Apparently the HIIT approach is more effective at improving glucose regulation and reducing insulin resistance than more conventional workouts.

HIIT is known by a number of different names (others include "Burst Training", "Sprint Interval Training", and "High Intensity Intermittent Exercise"). Various exercise trainers have come up with their own systems of doing this, so you can choose to go with programs developed by Peter Coe, Izumi Tabata, Martin Gibala, or Jamie Timmons. What their various regimens have in common is that they ask you to engage in short bursts of exercise so intense as to be a bit scary. Looking on the bright side, these workouts don't take a big chunk of time out of your day.

I'm still unsure about their alleged practical advantages, however. The old-fashioned 5-mile run that I did today took a long time, but it was a single block of time, and it involved a single change of clothing and shower afterwards. Most HIIT programs seem to be about distributing your workout across the course of the day, in small chunks. Small enough that you don't need to change clothes or clean up afterward? Maybe not. The kind of super-intense workout that you're supposed to do in HIIT seems to me like the sort of thing you wouldn't do in your office clothes. If your workplace happens to be a gym, maybe you can scatter some ten-minute workouts across your workday schedule without making a spectacle of yourself, but I don't think there's a way for me to get away with that.

Of course, my 5-mile run today wasn't easy-going jogging all the way. It involved some very steep hill-climbs that probably came very near to qualifying as the sort of high-intensity bursts that a HIIT workout demands. Even if they didn't qualify, though, I'm pretty sure I don't want to do anything more intense than those hill-climbs on a regular basis. So, even in HIIT is more efficient by some objective standard, I still doubt that it's right for me.


2nd Thursday Update

January 14, 2016

Rainclouds have been sweeping in from the ocean at intervals for several days. Getting outside for a run has been all about watching the weather web-sites carefully, and trying to find a convenient window of opportunity -- that is, a dry period during which I'm free to take advantage of it.

I came pretty close to getting it right today. It didn't start raining on me until the final mile, and it wasn't raining too hard. The downpour didn't start until I was safely back in the office. Apparently I'll do even better tomrrow: there isn't expected to be any rain at all during the daylight hours. Then: solid rain for three days. I'd better take advantage of the dry spell tomorrow while I can!


Potatoes of Doom!

Here's a new health-scare for you: the more potatoes a woman eats before pregnancy, the likelier she is to develop gestational diabetes mellitus (GDM) during pregnancy!

This makes a certain amount of intuitive sense: potatoes are extremely starchy and have a great capacity to elevate blood glucose. But as soon as I saw that the researchers were suggesting "whole grains" as a safe substitution for the potatoes, I became a bit suspicious. Grains, whether "whole" or refined, are also extremely starchy, and also have a great capacity to elevate blood glucose. "Whole grains" (that is, grains processed in a way which leaves a little more fiber in the end product) are constantly being recommended to diabetes patients in the most reckless way, and this trend has progressed to the point that any mention of them sets off alarm bells for me. So I thought I'd better take a close look at what the researchers found. However, they didn't make it as easy as they could have. Not that they withheld information, exactly -- they just hid the interesting facts among a lot of uninteresting ones.

For example, they placed an extreme emphasis on findings related to relative risk rather than absolute risk. That is, given the amount of GDM risk faced by women who ate a lot of potatoes, what was the relative risk for women who replaced a few weekly servings of potatoes with legumes, whole grains, or other vegetables? The researchers report a significant reduction in risk for women who made such substitutions:

But wait a minute: that illustration isn't as clear as it might be. The "1.0" level at the right represents GDM risk associated with potato consumption, and the points to the left of that indicate the lesser GDM risk associated with substitute foods. However, we're only shown the right 30% of the range from 0 to 1. This gives us a slightly exaggerated sense of how much relative risk reduction there was. The best relative reduction was 12%. But this only means that whatever risk was associated with potatoes is 12% lower with whole grains. So what is the actual risk associated with potatoes, so that we can make a meaningful comparison?

I had to hunt around a bit in the data, but eventually I came up with some numbers that were absolute rather than relative, and here they are:

Potato servings per week <1 1 2-4 5 and up
GDM cases per pregnancy 136/4336 211/5763 403/9599 195/1995
GDM risk 3.1% 3.7% 4.2% 9.8%

Hmmmmm. The GDM risk is 3.7% if you eat <1 serving of potato per week, and only rises to 4.2% if you eat 2-4 servings per week? That's not quite so dramatic as I was expecting. It looks as if it takes 5 or more servings per week to raise your risk enough to cause alarm.

And the relative risk factors shown in the earlier graphic represent only percentages of the risk shown on the bottom line of the table. If my math is right, that means a woman eating 2 to 4 servings of potatoes per week can cut her GDM risk from 4.2% to 3.7% if she substitutes whole grains for a couple of servings of potato. You have to wonder if an advantage that small is only a statistical artifact.

I don't mean to suggest here that potatoes are a good food choice, either for people who already have diabetes, or for people who are trying to avoid developing it (during the vulnerable interval of pregnancy, or during the vulnerable interval known as life). However, it looks to me as if this is a case of presenting decidedly subtle statistical patterns as major revelations.

There are already enough experts misleading the diabetic population, and the public as a whole, about the harmlessness of "whole grains". If any more such recommendations are going to be piled onto the stack, I hope they will be backed up something more ironclad than an apparent reduction in GDM risk from 4.2% to 3.7%.


G3PP and you

No, G3PP is not a new wireless communication standard which your next cell-phone will need to support. It's a newly-discovered enzyme, produced within human cells, which has the effect of converting glycerol phosphate (a byproduct of glucose metabolism, which builds up in cells when too much glucose is present) into a less toxic compound. Excess glycerol phosphate within cells causes such problems as excessive storage of fat and diminished production of insulin. The cell is supposed to produce G3PP when glucose levels rise too much, so that glucose byproducts are prevented from having these harmful effects. However, if the glucose level gets very high (as it often does in the case of diabetes) the amount of G3PP the body produces is not sufficient to solve the problem. Now researchers are thinking that a medication which stimulates the body to produce more G3PP could work as a drug to treat Type 2 diabetes and prevent obesity.

All this was summarized, in the breezy opening line of the article I read on the subject, as follows: "Guilt-free sugary treats may be on the horizon". That is, if you take a big enough dose of G3PP-stimulating drugs, maybe you can eat all the sugar you want and it won't do you any harm.

That's a bit of a leap, if you ask me. The researchers are only saying they think such drugs could mitigate some of the toxic effects of excess glucose in cells. I doubt very much that we'll soon have a pill which eliminates all possible health objections to eating candy all day.

But I guess that's the world we live in now, isn't it? Science can't just be reported to us anymore, it must be sold to us. Every finding has to be presented to the public in such a way as to overstate its significance to an almost hilarious degree.

If a new carbon-composite material promises to make your next car weigh 15% less, this will be announced to you in an article suggesting that your next car will fly.


1st Thursday Update

January 7, 2016


It's all about the teeth today

After several days of extremely rainy weather, it would have been nice to take advantage of the sunshine at noon to go for an outdoor run, but I had to use the time for a dental appointment instead.

It was just a cleaning, but I have to go in for those more often than most people do. I'm a champion plaque-former (something to do with the chemistry of my saliva, which promotes tartar buildup on the tooth enamel), so I'm very prone to periodontal disease, and I have to make quite an effort to stay ahead of it.

Fortunately, the hygienist was happy with me this time. She said my gums looked a lot better than last time. This is good news for anybody, but it's especially important for anyone with diabetes.

The inflammation associated with periodontal disease (to which I am quite prone) triggers insulin resistance and elevates blood sugar. Any source of chronic inflammation can be a factor in causing Type 2 diabetes, and periodontal disease is one of the most common causes of chronic inflammation. That's thought to be at least part of the reason that Type 2 diabetes is more common in poor people: they can't afford good dental care, so they tend to have chronically inflamed gums, and elevated blood sugar as a result.

Why have my gums been improving of late? I guess because I've found something that works better for me than flossing:

There are a lot of "interdental stimulators" out there, but most of them won't fit between my teeth (I have a "crowded" moth, I'm told). When I found some that I could actually use successfully, I found them a huge improvement on flossing. Maybe its a talent issue, and maybe it's a crowded-mouth issue, but I have never found a way to use dental floss that isn't painful, awkward, and frustrating. The BrushPicks work a lot better for me, and lately I've been using them thoroughly after every meal. I've also been using a mouthwash in the morning. Those two things seem to have won me a gold star at the dental office today, so I guess I'd better keep doing them.

So, with my mid-day devoted to dental affairs, I had to get my workout at the gym in the evening. I went by there right after work, but found the parking lot too full: the New Year's Resolution Effect causes crowding at this time of year. I came back a few hours later, and practically had the place to myself.


Time marches on

To me it doesn't seem all that long ago that Star Wars was released, but in fact it's been a little over 38 years, and that fact has been brought home to me in various ways, now that a film has come out which is not so much a sequel to the that film as a remake of it.

Of course, there's been a lot of talk about the participation of three stars from the original film -- some of it mean-spirited talk, mainly concerned with who has, or hasn't, aged well since then. (Curiously enough, the people who have been most unkind about this issue do not tend to post comparison photographs of themselves in 1977 and 2016, to see how kind Father Time has been in their case.)

But it all became a little more personal for me when I went to see the new film myself, and was confused to find that the price of my ticket was significantly cheaper than I had expected it to be. Then I took a close look at the ticket, and found that it said "Senior" rather than "Adult". I hadn't requested a senior discount, but the young lady behind the counter had decided that my status as an old man was too obvious to require discussion.

It's a new experience for me, this rite of passage in which people start giving you senior discounts as a personal judgment call. It's not so long since I got through that earlier rite of passage, in which they stop asking you for proof that you're old enough to buy liquor. Well, I'll comfort myself with the thought that some of us look better -- or at least more interesting -- later in life.

But what really made me feel old about watching the movie was that I was able to see it as a good but not world-changing film: a solid commercial entertainment, delivering what it promises and not making too many blunders along the way.

Either it's no longer possible to make a film as thrillingly ground-breaking as Star Wars seemed in 1977, or it's no longer possible to thrill me as easily as it could be done in 1977. Either way, things are different now. The world has moved on, or I have.


More bad things stress can do

It has long been suspected that one of the effects of stress is weight gain, or at least the inability to lose weight. Exactly how that could happen was unclear, however.

New research suggests an explanation for the connection between stress and body fat: stress apparently causes the body to produce more of a protein called betatrophin. And why should that matter? It now seems evident that betatrophin inhibits the body's ability to break down fat. Stored fat which should be burned for energy is not used in that way, or not used efficiently, when too much betatrophin is present in the bloodstream. Stress-related overproduction of betatrophin is now suspected of playing a role in both obesity and Type 2 diabetes.

And what can we do to rid ourselves of stress, so that we stop over-producing betatrophin? Well, relax, dammit!

However, I should point out that relaxing adequately is only possible if you work out enough. (Well, certain kinds of drug abuse might achieve that effect also, but I don't know if they're a good bet on the whole.)


More bad things high blood sugar can do

There are various reasons why elevated blood sugar is (or is suspected of being) bad for your cardiovascular system, so there are multiple factors explaining the connection between diabetes and heart disease. Now another factor has been added to the list.

New research finds that elevated blood sugar has a direct impact on the contraction of muscles which control the fluid pressure within blood vessels. The glucose level within the bloodstream influences the way a signaling protein (known as protein kinase C) controls the muscle cells. More blood glucose equals higher blood pressure -- which not only has the effect of limiting blood flow to vital organs, but also has an inflammatory effect on blood vessel walls, and ultimately promotes arterial disease.

Well, I was already sufficiently convinced that controlling blood sugar was important, but I guess it's always worth being reminded of the many reasons why we really do need to keep an eye on that issue.


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