4th Thursday Update

June 23, 2016


Evening hikes continue

My right heel was feeling sore today, and I didn't think a run would be good for it, but I thought I could handle a hike in the state park, so I did that in the evening.

This is the end of my allergy season, so all this tall dry grass everywhere isn't bothering me in a medical sense right now -- but it worries me that every hillside in this hilly county is a pile of dry fuel waiting to go up in flames. In most open spaces, the dead grass is tall enough that it's hard to see the deer wandering around in it.

I had to keep maneuvering around, trying to get an unobstructed view of them.

But deer like being hard to see, so they kept ducking into the thickest patches of grass they could find.

I heard a loud humming which sounded to me like bees, and I hoped I wasn't about to have a close encounter with a swarm. But then I looked up and spotted the actual source of the noise: a quadcopter camera platform flying around overhead. I knew that some friends of mine from the office have one of those things, and have taken some dramatic videos with it -- and a little further along the trail I ran into them, and realized they were the ones operating it. The thing feeds back video to them, which they can monitor on a tablet computer, so they're able to let it fly out of view without losing it. If they can't figure out where it is from watching the video it's sending them, the quadcopter is able to find its way back to the starting point automatically.

It can go high enough to be hard to see overhead, and low enough to fly just over the top of the grass.

I was surprised to see how stable and controllable it is -- instead of having it land on the ground, he hovered it down to shoulder level and grabbed it out of the air.

I would love to have one of those things, but I probably don't need to buying an expensive toy right now -- especially one which would encourage me to stand in one place on the trail, while the camera itself roams around looking for photo opportunities! My heavy hand-held camera doesn't go anywhere unless I take it there, and that's probably for the best.


Gestational diabetes -- after the baby

Gestational diabetes is diabetes experienced under unusually trying circumstances. That is, gestational diabetes is diabetes which develops during pregnancy. It appears to be, for all practical purposes, Type 2 diabetes. Probably it develops in a woman who was genetically susceptible to becoming diabetic anyway, and was pushed over the edge into diabetes by the stress and physical changes involved in pregnancy. Because this susceptibility to diabetes is present regardless of circumstances, women who become temporarily diabetic during pregnancy, and then seemingly get over it, are at heightened risk of developing Type 2 diabetes later.

Doctors try to do follow-up on women who had gestational diabetes during pregnancy, to verify that the problem is not persisting after the pregnancy is over. However, they don't get a very high rate of patient compliance with this testing. Unfortunately, the doctors' testing method of choice is the Oral Glucose Tolerance Test (OGTT), which requires you to swallow a disgustingly intense load of liquid glucose, and then hang around for a couple hours while your blood glucose is tested to see how high it's going and how soon it begins to go back down.

Oddly enough, mothers of newborns don't tend to feel that they can fit into their schedule a medical test which takes a minimum of two hours (and, let's face it, at least another hour of that mysterious bureaucratic farting-around process without which clinical medicine apparently cannot be done). Women with babies tend to lead busy lives. (I read a study once about how much time various kinds of people spend worrying, and mothers of newborns tended to worry the least, not because they had less to worry about but because they didn't have time for it.) Anyway, women with babies don't tend to make appointments which they know will take more than two hours. The result is that many new mothers are having problems with glucose regulation -- and their doctors don't know about it because of a lack of test data. These women may develop diabetes of a more permanent variety, and it won't be discovered until it has become severe and hard to get under control.

As a practical matter, doctors would like a better (and quicker!) way to test new mothers, and find out if the glucose control problems they experienced during pregnancy are likely to become chronic diabetes later on. There needs to be a better way to test for this.

Researchers have apparently come up with a better way. Exactly how they did so is not yet entirely clear; they say they have identified a set of 21 different "metabolites" (compounds in the blood that are byproducts of metabolic processes) to measure. The proportions of these metabolites give them a "signature" to look for, which identifies patients most likely to develop Type 2 later. Apparently this kind of testing gives them an accuracy level of 83% in predicting which patients are headed for diabetes -- which is considerably more accurate than predictions based on a plasma glucose test. And this test can be made on the basis of a single blood sample; the busy new mom doesn't have to hang around the clinic for two hours.

Whether the test is really as accurate as claimed remains to be seen, but it looks like a promising development. Getting diabetes under control is a lot easier if you act fast -- and acting fast is a lot easier if you know what's going on!


Plant-based diets and diabetes

I gave up on vegetarianism some years back because it seemed to be too hard to develop a vegetarian diet that wasn't too high in carbs. So much of what is offered to us in the way of vegetarian food is overwhelmingly starchy: a vegetarian meal usually consists of vegetables served on top of a big mound of rice, or vegetables wrapped up in a big burrito, or vegetables placed between two big pieces of bread. Alternatives to those choices include a big bowl of oatmeal, or a big baked potato. Whatever the "vegetarian option" is at a restaurant or cafeteria, it probably involves a huge carbohydrate payload.

So, I turned my back on vegetarianism -- but maybe I paid too high a price for that, because a diet centered around meat makes it very hard to avoid gaining weight.

Anyway, I'm reconsidering vegetarianism now, partly in consequence of some recent research on the subject. this is research into diabetes prevention rather than diabetes management -- but, in regard to Type 2, whatever tends to prevent it also tends to keep it under control after you've developed it, so I'm taking the research as an indicator of what works in terms of managing the condition as well as preventing it.

The researchers found that a plant-based diet can indeed reduce your diabetes risk -- provided it's the right kind of plant-based diet! They compared different diets, identifying some of them as "unhealthy" (those which included refined grains, potatoes, and sweetened drinks) and those that were "healthy" or at least average (they reduced animal foods without necessarily eliminating them, and avoided high-carb foods). They found that a healthy or average plant-based diet reduced diabetes risk -- but an unhealthy plant-based diet increased the risk!

In the graph of "hazard ratios" below, the gray horizontal dotted line represents average risk of diabetes. The red line rising above that risk level represents the unhealthy plant-based diets, while the blue and green lines dropping below that average risk level represent the average and healthy plant-based diets.

Maybe I can find a better compromise by eating a diet that is plant-centric (if not necessarily vegan). The trick is to make sure it doesn't become starch-centric, which is what usually happens to people when they try to adopt a plant-based diet.


3rd Thursday Update

June 16, 2016


More hiking photos

With the spring rains long behind us, the state park is full of tall, dry grass. Not always beautiful, although it can be when the evening sun catches it at a favorable angle.

The other day while hiking, I suddenly felt as if one of my hiking shoes was dragging oddly on the ground. I looked down and saw that sole of my right shoe was coming loose in a single piece -- apparently it was assembled with nothing but epoxy to hold it on, and it had finally given up. Once the sole came entirely free of the shoe, there was still a thin sole separating my right foot from the ground, so I could still walk -- but it was an uncomfortable, limping walk, because of the height difference between the left and right shoes.

The reason I brought the detached sole home was that there were absolutely no garbage cans in the state park, and I wasn't going to just toss it into the bushes. So, I limped out of the park carrying a big thick shoe-sole. I felt a trifle conspicuous, although I suppose the other hikers had seen weirder sights than this. Anyway, the first thing I did after getting out of the park was to go shopping for new hiking shoes. I'd had the old ones so long, I guess it's no surprise they fell apart on me.

On more successful hikes during the last few days, I've seen more turkeys...

...and quail...

...and woodpeckers.

I also tried out my camera's telephoto capabilities on the moon, and got a picture which clearly shows such features as the Sea of Tranquility (1), the Copernicus crater (2), and the Tycho crater (3). Pretty good for a handheld camera shot.

I don't know of any special significance for Copernicus, but the Sea of Tranquility was the site of the first moon landing -- and Tycho was where the alien monolith was dug up in 2001. So, quite a lot of late-60s wonderment to capture in one picture!


Why do we slow down with age?

Although, at the age of 59, I did manage to survive a hilly 7.9-mile trail run this evening, I would hate to admit to you how long it took me to finish it (and I won't tell you -- so there!). I've reached the point of being highly conscious of how much I'm slowing down over time -- slower while running, but also increasingly likely to be found sitting down when I'm not out there on the trails. We seem to become less and less energetic as the years go by. For a while I had convinced myself that this wouldn't happen to me, so long as I didn't give up exercise, but it seems to happen, at least to some extent, even if we exercise regularly. Human metabolism has a natural tendency to slow down over time.

Researchers from the Mayo Clinic think they have figured out why this happens. It all has to do with the mitochondria -- microscopic power plants within our cells. Whatever "energy" we have is owing to mitochondrial function. We become less energetic over time because mitochondrial function declines over time. And mitochondrial function declines because of a decline in the enzyme NAD (nicotinamide adenine dinucleotide), which drives mitochondrial function. That much was known before.

What the Mayo Clinic team discovered is an explanation for the gradual decline in NAD over the years: an increase, over the years, in an enzyme called CD38, which has an antagonistic effect on NAD. As we age, we have more CD38, which reduces the effect of NAD, and therefore reduces mitochondrial function. Bottom line: we get old and tired.

The suppression of mitochondrial function is a bigger issue than I'm perhaps making it sound -- this slowing of energy production with age is believed to drive all sorts of metabolic health problems which people experience more and more as they age -- weight gain and diabetes included.

But perhaps you're wondering if we can do anything about this. So far, at least, there isn't anything you can do to reduce your CD38 levels (although I expect pharmaceutical companies will be looking into the possibility of developing a drug which has that effect). But can we boost our NAD levels, to compensate for the effect of CD38? I don't know -- there are supplements you can buy which claim to have the effect of boosting your NAD levels, but evidence of their effectiveness is still lacking. It's a topic of interest among researchers, and we'll probably find out more about it within a few years, but for right now this is one of those it-seems-to-help-mice stories.

Of course, explaining the decline in NAD by saying it's caused by an increase in CD38 only leaves us with another mystery to solve: why does CD38 increase with age? What is driving that change?

If we can find out what it is that's causing CD38 to go up (and drive NAD down), maybe we can address that problem directly.


News of the obvious

An actual Reuters Health Information headline: "Changing Economic Conditions Can Affect Children's Weight".


Progress on diabetes longevity

The Lancet is reporting that older diabetes patients are now living longer without disability. "Over the past two decades, we have seen an increase in the length of good disability-free years of life in older Americans aged 50-70 both with and without diabetes". I'm going to leave it at that, rather than go into the various reasons why this fortunate trend might not hold up in the coming decades. So little good news ever gets published about diabetes that I like to emphasize it when it occurs!


2nd Thursday Update

June 9, 2016


More hiking photos

I'm continuing to hike around the state park in the evenings, photographing the local wildlife whenever I can get a good look at it.

My most recent hikes have featured a lot of encounters with wild turkeys. I've even managed to spot the elusive baby turkeys a few times. Usually they disappear into the underbrush before I can capture a picture of them, but recently I was able to get some unobstructed closeups.

Then I encountered a group of adults, who were earnestly attempting to read the 'No Dogs' sign. They didn't seem to be able to make any sense of it. Well, to be fair, a lot of dog owners in this area can't figure out what it means either.

After they gave up on the sign and moved on, they performed for me a little fashion show, marching in single file, straight across the trail -- more or less like the Beatles striding across Abbey Road. The sun caught them just right, and I was able to see how colorful their feathers really are, when the light hits them at the proper angle.

Take a look at the feathers in closeup. I suppose that, when your body looks that good, it doesn't matter that you've got the ugliest head in the known universe.

There are always a lot of deer in the park, but this time I got a better look at a fawn than usual.

I also got to see what happens when a fawn is startled. Apparently, it turns into a kangaroo. This was news to me, and I'm glad I was able to capture photographic evidence of the transformation.

Epigenetics and diabetes

Like most people, I was educated to think of my genes as a blueprint, assigned to me at the moment of my conception, which could never be altered and which defined my physiology and my possibilities once and for all. From birth to death, whatever happened to my health would be what my genes said should happen.

It's really not that simple, of course. The sequence of genes encoded on a strand of your DNA might not change, but that doesn't mean the genes will continue to have the same impact on your health at all times. Genes have to be "expressed" (that is, they have to be switched on) to have any impact, and it turns out that cellular processes are turning genes on and off all the time, in response to various changes in our physiology. It matters what set of genes you have, but it matters even more which of your genes is activated when. The elaborate process by which genes are switched on and off is called epigenetics -- and because epigenetics is affected by environmental and behavior factors, lifestyle adjustments can have an impact on your genes -- not by altering your genes, but by altering the process which turns your genes on and off.

Although we usually visualize the DNA molecule as a long double strand, stretched out more or less straight, and floating around more or less freely, the reality is very different. The DNA in a cell nucleus is coiled up very tightly, and it's wrapped around special proteins called histones. This coiled-up combination of DNA and histone proteins is called chromatin, and it is the stuff which chromosomes are made. The epigenetic process can place chemical "tags" on the chromatin, to govern activation of the genes embedded within the stuff. Even if you and I have the same genes, the effect of those genes on us may be different because the epigenetic process is tagging them differently and activating a gene in me which isn't being activated in you. Epigenetic differences between people are starting to be seen as the reason why a given health "risk factor" causes some people, and not others, to develop the disease condition associated with it.

For example, although obesity is strongly correlated with insulin resistance (and consequently with the development of Type 2 diabetes), obesity has that effect on some people and not others -- and it's never been clear why. In some people, but not others, excess body fat triggers an inflammatory response which has the effect of impairing insulin sensitivity. But why should that happen in some people and not others? It now appears that explanation has to do with an epigenetic difference between people. Researchers at the Karolinska Institutet in Sweden have identified a "co-repressor complex" called GPS2 which controls epigenetic changes related to the immune system. They found that GPS2 levels were abnormally low in obese people who become diabetic, but not in obese people who didn't become diabetic. Whether weight gain makes you diabetic or not seemingly depends on your GPS2 levels. Experiments on mice, in which GPS2 levels are artificially repressed, confirms the effect -- mice altered in this way develop inflammation and insulin resistance when they gain weight.

To me this sounds like a case of solving a mystery by replacing it with a different mystery. Why is GPS2 low in some people and not others?

If there's an answer to that available, I haven't seen it yet. But don't be surprised if researchers drop that question and take up a more profitable question: can a drug be developed to boost GPS2 levels, and thus derail the epigenetic process which causes obesity to turn into diabetes? Perhaps a drug which millions of people will need to keep paying for every day for the rest of their lives?

It's possible that something else could have the effect of boosting GPS2 levels, without any drug being needed. (Probably exercise will turn out to have that effect, if anyone looks into it.) But medical research which leads to billion-dollar patents tends to be pursued a little more vigorously than research which doesn't, so I won't hold my breath waiting to hear more about what drives these differences in GPS2 levels between people.


Replacing saturated fat with carbs

The demonization of saturated fat in recent decades has led many people to cut saturated fat from their diets. Unfortunately, people have tended to replace the saturated fat calories with carbohydrate calories. Is that a good trade?

Apparently not. It now appears that replacing saturated fat calories with carb calories improves one marker of cardiovascular health (that is, it reduces "bad" LDL cholesterol) but it degrades more reliable markers (for example, it reduces "good" HDL cholesterol and boosts triglycerides); on balance, it leaves you worse off than before.

The blame-saturated-fat-for-everything craze among nutritionists is pretty badly discredited at this point, but has been institutionalized to such a degree that it is very difficult to dislodge. I hope that more reports like this one will help move nutritionists in the direction of admitting that they called this one wrong.


1st Thursday Update

June 2, 2016

More nature photography

I am sticking with my program of walking around in the state park, photographing things. Recent shots include a deer grazing...

...a buzzard gliding...

...a lizard basking...

...a quail making funny shadows...

...a flower trying to look hot to insects...

...and a cross-country runner making use of what I'm sure he knows is not a legal trail. I work with this guy, so I may need to have a word with him. He has a second job coaching a high school track team -- and a fine example he's setting them!


Poisoning the public

The modern diet includes a generous excess of two substances known to cause health problems: sodium (from excessive salting of processed foods) and fructose (from excessive sweetening of processed foods, using cheap corn-based sugar products). A third unhealthy ingredient (hydrogenated "trans" fat) used to be abundant in the food supply as well, but there was enough bad publicity about that one that, once the government forced processed food makers to list it as an ingredient, most of them cut back on it or stopped using it. However, fructose and sodium are still saturating our foods.

For the most part, these problematic ingredients aren't getting into our diet because we (as consumers) deliberately add them to our meals, or because we consciously choose products containing more of them. They are getting into our diet because we eat a lot of foods that are prepared for us by some business (a chain restaurant or a maker of processed foods), and such businesses are in an arms-race with one another to produce the sweetest and/or saltiest possible version of any food, so that we'll become hooked on it and come back for more.

Whenever medical organizations call for these businesses to cut back on the amount of sodium and fructose they are adding to foods, the same backlash occurs: "Don't blame us, we're just giving consumers what they want! If you don't like the choices consumers are making, tell them to change what they're doing!"

That attitude seems a little unreasonable to me. Most consumers have no idea how much sodium or fructose is being introduced into the foods they buy. It is nearly impossible to determine this in a restaurant, and not all that easy even in the grocery store, considering the tricks that the government allows makers of processed foods to play in regard to "serving size". For example, a tiny 5.5 ounce can of V8 Spicy Hot vegetable juice lists a sodium count of 450 mg, while a 7.75 ounce can of El Pato hot tomato sauce shows only 150 mg. So the latter is much less salty? Not at all -- the V8 lists the whole can as one serving, and the El Pato sauce uses a serving size of one ounce. One ounce. Yeah, I'm sure how much of it most consumers would include in a meal. Anyway, the El Pato sauce is much saltier than the V8, but is able to disguise that fact by defining the serving size as something unrealistically tiny.

Soups and sauces tend to be far more sodium-rich than consumers imagine. One cup of Amy's Cream of Tomato Soup: 690 mg. One cup of Swanson Chicken Broth: 860 mg. Is that a lot, you ask? Well, 860 mg is more than a third of the total amount of sodium you should take in all day (2300 mg), and there's going to be plenty of sodium concealed in a lot of other things you eat -- bread, for example, is notoriously high in sodium even though most people don't think of it as "salty". That's the problem with sodium: we get used to consuming it in excessive quantities, without noticing it. Most Americans get much more than 3000 mg per day of sodium, even if they think they're being careful because they don't add salt to foods once they are prepared.

But why is excess sodium bad? Mainly because of the things the human body does to cope with it. When you consume too much sodium, one way for the body to deal with it (and prevent the blood from becoming too salty) is to retain water in the bloodstream, instead of excreting it in the urine. The body dilutes the salt by watering it down. But, of course, the extra water in the bloodstream results in the total fluid volume of the bloodstream going up. And what happens when you have more fluid in a set of pipes which are somewhat flexible, but may not be able to expand enough to accommodate the fluid volume? Blood pressure goes up. That is why some blood pressure medications work by forcing us to produce more urine, so that the fluid volume of the bloodstream is reduced.

Admittedly, blood pressure doesn't go up in everyone who consumes excess sodium. A lot of people have a circulatory system which can deal with a salty diet without experiencing hypertension. The trouble is, most people have no idea whether or not they are among the lucky ones -- or how long they will remain among the lucky ones. Public health officials want everybody to cut down on sodium -- that way everyone is protected, whether or not they are aware of their vulnerability. And the Food and Drug Administration wants the food industry to accept sodium-reduction targets voluntarily. Well, we'll see what comes of that.

The situation with fructose is even harder for consumers to figure out, because nutritional labels don't call it out as a separate ingredient with the total amount of it shown. We are to guess, from the "sugars" count, how much of it is likely to be fructose.

Exactly what is wrong with fructose has been unclear for a long time, even though it seemed clear that something was wrong with it; there were many indications that it was associated with health problems. Now it appears that fructose has a direct effect on brain cells, reprogramming genes in brain cells in a way which disturbs the functioning of the brain in regulating metabolism. The same research shows that the harmful effect of fructose on the brain is mitigated by an omega-3 fatty acid known as DHA. However, rather than trying to eat enough DHA-rich foods to overcome the harmful effects of fructose, it would seemingly make more sense to reduce Fructose consumption. Doing that isn't easy for consumers to do; most people have no idea which foods fructose is being quietly introduced into. For example, did you know that when you buy dried fruit, a seemingly "natural" product, it is very often sprayed with high fructose corn syrup to make it sweeter? Asking consumers to shoulder the burden of reducing fructose intake seems a little unfair, considering how hard it is for them to find out which foods it is being added to.

In the long run I hope he food industry will be forced (by government action or consumer activism) to stop sneaking so much sodium and fructose into our food supply. Until that happens, we will need to be alert to the threat, and look for these ingredients in unlikely places.

I just checked a package of sliced turkey breast, and found that one thin slice contains 210 mg of sodium. This stuff is everywhere.

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