DIABETES SUMMARY

Diabetes is a growing health problem in the US, currently 1.6 million people over the age of 20 are newly diagnosed every year(Diabetes, 2007). Diabetes mellitus is characterized by the inability of the body to metabolize glucose (Gropper, 2009). There are 2 types. Type 1 deals with the body’s inability to produce insulin, where type 2 is a combination of cellular insulin resistance and inability to produce insulin. Both of these types of diabetes result in elevated blood glucose levels that lead to serious or life threatening complications. A few common complications are nephropathy, retinopathy, neuropathy, and cardiovascular disease (Krause, 2008). In the following summaries we will discuss perceived causes and preventions in relation to the onset and control of diabetes.

DEFINITIONS

  • Blood Glucose: The concentration of blood glucose in the bloodstream. The American Diabetes Association (ADA) recommends that you keep blood glucose level between 70 to 130 mg/dL before meals and less than 180 mg/dL one to two hours postprandial.
  • Cardiovascular Disease (CVD): Any abnormal condition characterized by dysfunction of the heart and blood vessels.

  • Insulin: A hormone synthesized and released by the beta-cells of the pancreas that is needed to allow glucose to enter cells for metabolism and storage. Can be injected into the body for treating T1DM and T2DM.

  • Insulin Resistance: A state or condition in which a person's body tissues have a lowered level of response to insulin which results in an increase in teh production of insulin to maintain normal levels of blood glucose in the blood.

  • Nephropathy: Disease of the kidneys caused by damage to the small blood vessels or to the units in the kidneys that clean the blood. Commonly accompanies later stages of diabetes mellitus.

  • Neuropathy: A functional disturbance or pathological change int eh peripheral nervous system. In diabetic neuropathy the most common is a chronic, symmetrical sensory polyneuropathy affecting first the nerves of the lower limbs and often affecting autonomic nerves.

  • Retinopathy: Any noninflammatory disease of the retina cause be damage to the small blood vessels. In diabetic retinopathy the most common symptoms include microaneurysms, hemorrhages, Commonly accompanies later stages of diabetes mellitus.

  • Type 1 Diabetes Mellitus (T1DM): A chronic condition in which the pancreas produces little or nor insulin. Once known as juvenile diabetes or insulin-dependent diabetes because it typically manifests itself in adolescence and treatment requires insulin injections.

  • Type 2 Diabetes Mellitus (T2DM): A chronic condition in which the body is resistant to the effects of insulin or the body doesn't produce enough insulin to maintain a normal glucose level. Once known as adult-onset or noninsulin-dependent diabetes.


American Diabetes Association

CURRENT NUTRITION HEADLINES

Roberts;Mediterranean Diet Can Stave Off Need for Diabetes Drugs; CNN Health

According to an article in CNN Health, a Mediterranean diet can stave off the need for diabetes drug. This article is based off a randomized trial done by the Second University of Naples. It states that those on a Mediterranean diet lost more weight and went longer without blood sugar lowering medication as a result of having better blood sugar control (Beneduce 2009). In this study, 215 individuals that were overweight and newly diagnosed with type 2 diabetes were randomly selected to a low fat diet or a low carbohydrate Mediterranean diet. The diet consisted of consumption of vegetables, whole grains, fish, poultry, and healthy fats like olive oil. The women consumed 1500 calories per day and the men 1800 calories per day with no more than 50 percent of calories coming from carbohydrates, for four years. After the four years, researchers from Second University of Naples found that only 44 percent of the individuals on the Mediterranean diet required blood sugar lowering medication whereas 70 percent of the individuals on the low fat diet required blood sugar lowering medication (Beneduce et al 2009).
A Mediterranean diet consists of foods high in monounsaturated fats such as olive oil which is thought to contribute to the increase in insulin sensitivity. Adiponectin, an active cytokine hormone secreted by adipose tissue has been shown to improve insulin insensitivity. Higher adiponectin levels are found to decrease risk of type 2 diabetes. Adiponectin was found in concentrations 23% higher in women with diabetes when following the Mediterranean diet than a low fat diet (Ceriello et al 2010). Consuming a Mediterranean diet requires lifestyle changes to be consistent with the diet. These lifestyle changes are linked to promote weight loss in a Mediterranean diet which increases insulin sensitivity. Of the research done, all stated similar results to these factors probably contributing to the increased insulin sensitivity and decreased need for antihyperglycemic drugs.
The article titled Mediterranean diet can stave off the need for diabetes drugs, in my opinion is more news than noise because many experiments done on this subject have proved that individuals on a Mediterranean diet have better control of blood sugar. However, all of the research that I have studied stated that certain components of the Mediterranean diet "may" be linked to the decreased need of antihyperglycemic drugs but there was no specific explanation for why individuals with diabetes on the Mediterranean diet were experiencing a decreased need. Research has shown that individuals with diabetes on a Mediterranean diet will experience decreased need for antihyperglycemic drugs but more research needs to be done to provide reasons why.

Bitton; New Research Shows Grapes Reduce Risk for Heart Disease and Diabetes; Natural News

grapes.jpg The news article New Research Shows Grapes Reduce Risk for Heart Disease and Diabetes is based off of an experimental animal study conducted by the University of Michigan that shows an association between “grape consumption lowered blood pressure, improved heart function and reduced other risk factors for heart disease and metabolic syndrome (Baker, 2010).” The research was conducted on laboratory rats that are prone to being overweight to see whether the phytochemicals found in grapes had any beneficial effects in reducing the risk of heart disease and diabetes. For three months these rats were fed a mixture of various powdered grapes (green, red, and black) that were mixed into their diet which imitated a typical American diet that is high in fat. The results were then compared to a control group of rats who were fed the high fat diet but without the added grape powder. The rats on the grape powder diet, had a lower blood pressure, better cardiovascular function, and reduced indicators of inflammation when compared to the control after the three month period. They also had lower triglyceride levels and improved glucose tolerance. The suggested reason for this is that the phytochemicals found in grapes have health benefits like protecting the heart from metabolic syndrome. The phytochemicals, along with maintaining a healthy weight, exercising and following a heart healthy diet can also help prevent or reduce the severity of heart disease and diabetes.
Grapes contain many polyphenols which have anti-inflammatory and antioxidant properties. These properties aid in the prevention/inhibition of diabetes by reducing oxidative damage. Inflammation leads to the destruction of beta cells which further leads to the reduction of insulin, resulting in hyperglycemia, increased fat breakdown, fatty acid oxidation, and the excessive production of ketones (Zunino, 2007). Polyphenols help stop the inflammatory response that leads to this cascade response. Other experiments performed on rats have shown that rats fed high levels of grape powder had a lower incidence of diabetes.
In my opinion, the article New Research Shows Grapes Reduce Risk for Heart Disease and Diabetes is more “news” than it is “noise” though only slightly. Many experiments have shown that there is validity in the fact that polyphenols are helpful in preventing oxidative damage that leads to chronic diseases like heart disease and diabetes. Do polyphenols from grapes alone prevent these diseases? I’m not sure. I think that phytochemicals are phytochemicals no matter where they come from. They don’t necessarily have to come from grapes. I also think that in conjunction with the intake of phytochemicals, overall dietary interventions, regular exercise, and leading a healthy lifestyle like abstaining from smoking is more likely to prevent the incidence of diabetes than just the intake of grapes or phytochemicals alone (Coppell, 2010).

Anderson; Eating Brown Rice to Cut Diabetes Risk; The New York Times

The New York Times news article Eating Brown Rice to Cut Diabetes Risk discusses the consumption of brown and white rice and the varying effects they have on the body. The news article uses two journal publications based on cohort studies as a basis for information. The first journal article quoted is a meta-analysis of three cohort studies of men and women’s consumption of brown and white rice in the United States (Sun, 2010). The second journal article cited is a cohort study of Chinese women’s consumption of rice (Villegas, 2007). In the study involving Americans, researchers found that replacing 50 grams of white rice with the same amount of brown rice resulted in a 16% reduced risk of Type 2 Diabetes Mellitus (T2DM). The research also suggests that replacing white rice with whole grains results in a 36% reduced risk of T2DM. The Chinese cohort study found that overall increases of rice consumption increased likelihood of T2DM. The study also reported higher activity levels, lower waist-to-hip ratios (WHR), and lower body mass indexes (BMI) correlating positively with decreased risk of T2DM. Although both of these studies had similar findings, the data collected was simply observational disallowing research to be applied to individuals unless they share similar attributes to those studied. Another negative aspect of cohort studies is the possibility of misinformation given by study participants. There are also many other factors that could affect the incidence of T2DM, such as other foods commonly consumed in the diet, amount of physical activity, and health of the individual.
Grain consists of bran, germ, and endosperm, with approximately 80% of grain being endosperm. The bran and germ contain most of the nutrients of the grain, and with processing these parts are removed leaving the endosperm. This results in lower levels of insoluble fiber, vitamins, and phytochemicals. Studies have shown that any process that disturbs the normal structure of grains increases the insulin and plasma glucose response. Individuals with T2DM also experience an increased glycemic response in foods with altered structure. Along with processing affecting nutrients available and absorption of grain, the composition of nutrients varies based on variety of seed and the soil composition where the plant was grown (Slavin, 1999).
Eating Brown Rice to Cut Diabetes Risk is, in my opinion, equal parts “noise” and “news.” Although the articles are cited properly and there are links in the article found online that directly connect to the journal article, there are still several items of information that are incorrect. In the first paragraph of the article, the glycemic index is incorrectly stated as how fast blood glucose levels rise. Glycemic index is defined as how high and how long blood glucose levels are raised (Gropper, 2009). Another aspect of the news article that is misleading is how it is stated that increasing consumption of brown rice will lower risk of T2DM while the truth eating 3 cups of rice rather than 2 cups actually increases risk by 78% (Villegas, 2007).

Litchford; Green leafy veg may cut diabetes risk; BBC News


In a recent news publication from the BBC news, reporter, Emma Wilkinson, made the claim that eating leafy vegetables “may cut diabetes risk”. She makes a further statement that only foods that contained cabbage or spinach had a positive impact on reducing risk of this disease. She used research from a study conducted by Leicester University to back up her claims of green health. She summarized the basics of the study, and what components the green vegetables contain that may reduce risk. These components included antioxidants and Vitamin C. In fairness to the author she did use careful language when discussing the benefits of these specific vegetables. However, she did make a strong inference to the fact that the vegetables have a significant ability to decrease diabetes risk. In the original research article this news publication was based on, there is little conclusive evidence to create a significant link to green vegetables. The original study looked at vegetable and fruit intake from several studies and methods. There was very little distinction made that linked only vegetables to the reduced risk of being diagnosed with Type 2 diabetes. Especially in the case of cabbage and spinach, these were never mentioned specifically in any of the concluding data. The study did find a reduced risk of 14% over the course of the articles studied, but again all of the data was collected from studies that looked at fruit and vegetable intake.(Carter, 2010)
Other studies have looked at the connection of fruits and vegetables and diabetes risk. One such study was conducted by Addenbrooks Hospital in Cambridge, England. Researchers followed a certain group of people for twelve years, measuring their blood levels of Vitamin C and their incidence of diabetes. The study concluded that the participants that had higher Vitamin C levels were less likely to be diagnosed with diabetes. This was a strong study that controlled for many variables to get accurate information. Again these conclusions were based on Vitamin C intake that can be obtained from fruits and vegetables, no distinction was made between the two classes. (Harding, 2008) There was one study that made a point to distinguish between vegetables and fruits. Shanghi Womens Health conducted a study based on amounts of fruits and vegetables eaten by women in China. They followed these women over four and a half years to watch the level of intake compared to diabetes diagnosis. They were able to separate the fruit data from the vegetable data based on how they conducted the surveys of intake. This study reported that vegetable intake did lower the risk of suffering from type 2 diabetes, they were able to show strong conclusions that vegetables alone created the best reduction effect due to the sheer amount of data collected and analyzed.(Villega, 2009) This study was strong and had good data but it was only one out of thousands that was able to control for vegetables alone.
There is a large amount of conclusive evidence that builds an association between eating higher levels of fruits and vegetables and reducing risk for type 2 diabetes. But, there is little conclusive evidence that certain individual fruits or vegetables can give a direct influence. This headline got most of the facts right, vegetables do have an ability to lower diabetes risk. But the author of the article was not completely accurate in her representation of the evidence cited. A better headline would have been: Increased intake of fruits and vegetables may lower diabetes risk.


Neeley;Type 2 Diabetes Linked to Diet Soda; Natural News

The news article Type 2 Diabetes Linked to Diet Soda summarized findings from a population based longitudinal study that seems to identify the association between consumption of diet soda and metabolic syndrome and type 2 diabetes. The article is based on a food frequency questionnaire and several examinations that included several lab values. Participant’s usual dietary intake was assessed by the food frequency questionnaire that showed consumption of diet soda and regular soft drinks. After adjusting for dietary factors, BMI, and waste circumference, daily consumers of diet soda had a 67% increased risk of type 2 diabetes compared to non-consumers. Consistent with these findings, diet soda was linked to high blood glucose levels and increased waist circumferences in follow up visits (Nettleton, 2009). There was no significant association between regular soft drinks and type 2 diabetes. Authors of this study ignore the fact that very few participants consumed diet soda, and from those participants very few were in the category of BMI needed to make a correlation. Also, in the food frequency questionnaire, there may have been misclassification of artificial sweetener due to the variety of ways people use them. In addition, there are so many dietary and lifestyle factors that play a role in weight gain and blood glucose levels that it may be difficult to accurately determine what may be a confounding factor (Nettleton, 2009). Therefore, changes in weight and blood glucose levels should not be linked to diet soda consumption.
Studies have shown aspartame and other sugar substitutes reduce the intake of daily calories and have a tendency of weight loss rather then weight gain. Participants who drank high fructose corn syrup consumed 530 extra calories a day. Weight gain from the extra calories consumed may have a greater risk of obtaining type 2 diabetes then drinking diet drinks (Tordoff, 1990). Different dietary patterns may also play a role in type 2 diabetes. Studies have shown that dietary patterns containing high sugar, fat, and processed foods may increase the risk of type 2 diabetes. Individual foods did not show a specific increase in type 2 diabetes (McNaughton, 2008).
The article titled Type 2 Diabetes Linked to Diet Soda is in my opinion more “noise” than “news” and may confuse consumers about the effects of diet soda on blood glucose levels and weight gain. The data shown does not indicate that the change in body weight or fat is associated with type 2 diabetes. This study did not look closely enough at each particular diet to determine the cause of type 2 diabetes. (Nettleton, 2009). Few studies have shown an exact correlation between certain foods and type 2 diabetes. However, dietary patterns and lifestyles have shown correlations due to weight gain, which may cause type 2 diabetes (McNaughton, 2008).
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CONCLUSION

As discussed above, the causes and prevention of diabetes are widely varied and are not always scientifically proven. We have shown above that news articles are often based on scientific evidence but are skewed to further promote popular ideas. Consuming a Mediterranean diet, green leafy vegetables, grapes, and brown rice have all been scientifically proven to reduce risks associated with diabetes. However, we have found that in the media they have not been portrayed accurately. The risk lowering effect was due to some of the nutrient content in the foods, rather then the specific foods discussed in our studies. In the case of diet soda, we found the claim that diet soda causes diabetes to be complete “noise”. The scientific data associated with this headline was inconclusive, because it neglected to fully account for dietary intake. Consumers should pay close attention to the reliability of the source before making lifestyle alterations in attempt to prevent or manage their diabetes.



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REFERENCES

Carter P, Gray L, Troughton J, Khunti K, Davies M. Fruit and vegetable intake and incidence of type 2 diabetes mellitus: systematic review and meta-analysis. BMJ:British Medical Journal. 2010; 341:c4229.Carter, annotated bib.doc
Coppell KJ, Kataoka M, Williams SM, Chisholm AW, Vorgers SM, Mann JI. Nutritional intervention in patients with type 2 diabetes who are hyperglycaemic despite optimized drug treatment—Lifestyle Over and Above Drugs in Diabetes (LOADD) study: randomized controlled trial. British Medical J. 2010;341:c3337.
Diabetes statistics. American Diabetes Association Website. http://healthlinks.washington.edu/hsl/styleguides/ama.html.2007.
Gropper SS, Smith JL, Groff JL. Advanced Nutrition and Human Metabolism. 5th ed. California. Wadsworth. 2009 .
Harding AH, Wareham NJ, Bingham SA, et al. Plasma vitamin C level, fruit and vegetable consumption, and the risk of new-onset type 2 diabetes mellitus: the European prospective investigation of cancer--Norfolk prospective study. Arch Intern Medicine. 2008; 168(14):1493-9.
Mcnaughton SA, Mishra GD, Brunner EJ. Dietary Patterns, Insulin Resistance, and Incidence of Type 2 Diabetes in the Whitehall II Study. Diabetes Care. 2008;31(7):1343-1348.
Nettleton JA, Lutsey PL, Wang Y, et al. Diet Soda Intake and Risk of Incident Metabolic Syndrome and Type 2 Diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA). Diabetes Care. 2009;32(4):688-694.
Slavin J, Martini M, Jacobs D Jr, Marquart L. Plausible mechanisms for the protectiveness of whole grains. Am J Clin Nutr. 1999;70(suppl):459s-463s.
Tordoff MG, Alleva AM. Effects of Drinking Soda Sweetened with Aspartame or High Fructose Corn Syrup on Food Intake and Body Weight. American Journal of Clinical Nutrition. 1990;51:963-969.
Villegas R, Liu S, Gao Y, et al. Prospective Study of Dietary Carbohydrates, Glycemic Index, Glycemic Load, and Incidence of Type 2 Diabetes Mellitus in Middle-aged Chinese Women. Arch Intern Med. 2007;167(21):2310-2316.
Villegas R, Shou X, Gao Y, et al. Vegetable but not fruit consumption reduces the risk of type 2 diabetes in Chinese women. National Institute of Health. 2009; 138(3):574-580 Sun Q, Spiegelman D, Van Dam R, et al. White Rice, Brown Rice, and Risk of Type 2 Diabetes in US Men and Women. Arch Intern Med. 2010;170(11):961-969.
Zunino SJ, Storms DH, Stephensen CB. Diets rich in polyphenols and vitamin A inhibit the development of type 1 autoimmune diabetes in nonobese diabetic mice. J. Nutr. 2007;137:1216-21.