Whole Fruits Linked to Lower Risk of Type 2 Diabetes

Fruits are rich in fibre, antioxidants, and phytochemicals.

Increasing fruit consumption has been recommended for the primary prevention of many chronic diseases, including type 2 diabetes.

However, epidemiologic studies have generated somewhat mixed results regarding the link with risk of type 2 diabetes.

The inconsistency among these studies may be explained by differences in types of fruits consumed in different study populations as well as difference in participants’ characteristics, study design, and assessment methods. Furthermore, the greater variety, but not quantity, of fruits consumed was associated with a lower risk of type 2 diabetes.

Fruits have highly variable contents of fibre, antioxidants, other nutrients, and phytochemicals that jointly may influence the risk.

Researchers at the Harvard School of Public Health (HSPH) thus embarked on a study involving 10 individual fruits: grapes or raisins; peaches, plums, or apricots; prunes; bananas; cantaloupe; apples or pears; oranges; grapefruit; strawberries; and blueberries.

The researchers examined data gathered between 1984 and 2008 from 187,382 participants in three long-running studies (Nurses’ Health Study, Nurses’ Health Study II, and Health Professionals Follow-Up Study). Participants who reported a diagnosis of diabetes, cardiovascular disease, or cancer at enrollment were excluded. Results showed that 12,198 participants (6.5%) developed diabetes during the study period.

The researchers looked at overall fruit consumption, as well as consumption of individual fruits.

Blueberries, Grapes, and Apples

People who ate at least two servings each week of certain whole fruits — particularly blueberries, grapes, and apples — reduced their risk for type 2 diabetes by as much as 23 percent in comparison to those who ate less than one serving per month.

Conversely, those who consumed one or more servings of fruit juice each day increased their risk of developing type 2 diabetes by as much as 21 percent.

The researchers found that swapping three servings of juice per week for whole fruits would result in a 7 percent reduction in diabetes risk.

The researchers theorize that the beneficial effects of certain individual fruits could be the result of a particular component. Previous studies have linked anthocyanins found in berries and grapes to lowered heart attack risk, for example. But more research is necessary to determine which components in the more beneficial fruits influence diabetes risk.

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The above story is based on the Harvard Gazette of August 29, 2013

The study appeared online in the Aug. 29 issue of the British Medical Journal:

Muraki I, Imamura F, Manson JE, Hu FB, Willett WC, van Dam RM, Sun Q. Fruit consumption and risk of type 2 diabetes: results from three prospective longitudinal cohort studies. BMJ 2013;347:f5001

Click HERE for the full text.

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So, should you skip the juice?

The study did not any distinction between freshly expressed juice and packet juice with or without added sugar.

However, the high glycaemic index (a measure of how rapidly carbohydrates in a food boost blood sugar) of fruit juice — which passes through the digestive system more rapidly than fiber-rich fruit — may explain the positive link between juice consumption and increased diabetes risk.

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For more about diabetes, try the Malaysian Diabetes Association.

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Exercise Alone May Help Those With Type 2 Diabetes

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Small study found it helped even if no other lifestyle changes were made.

Moderate-intensity exercise reduces fat stored around the heart, in the liver and in the abdomen of people with type 2 diabetes mellitus, even in the absence of any changes in diet, according to a new study.

Type 2 diabetes occurs when the body does not produce enough insulin, a hormone that regulates the movement of sugar into the cells, or when the cells resist the effects of insulin. The disease can lead to a wide range of complications, including damage to the eyes and kidneys and hardening of the arteries.

Exercise is recommended for people with diabetes, but its effects on different fat deposits in the body are unclear, according to the study's senior author, Hildo J. Lamb, M.D., Ph.D., from the Department of Radiology at Leiden University Medical Center in the Netherlands.

The Dutch researchers conducted MRI exams of 12 patients with diabetes before and after they did six months of moderate-intensity exercise. Each week, the participants, who were an average age of 46, exercised between three and a half and six hours a week during two endurance and two resistance training sessions.The six-month exercise program ended with a 12-day trekking expedition

There were no changes in the participants' heart function at the end of the exercise program. But they did have significant decreases in the amount of fat in the abdomen, liver and around the heart, all of which have been shown to be associated with increased risk of heart disease.

"In the present study, we observed that the second layer of fat around the heart -- the pericardial fat -- behaved similarly in response to exercise training as intra-abdominal, or visceral fat. The fat content in the liver also decreased substantially after exercise," Lamb said.

He said these exercise-related fat reductions in the liver are particularly important to people with type 2 diabetes, many of whom are overweight or obese.

The liver plays a central role in regulating total body fat distribution.

Therefore, reduction of liver fat content and visceral fat volume by physical exercise are very important to reverse the adverse effects of lipid accumulation elsewhere, such as the heart and arterial vessel wall.

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The above story is based on the June 25, 2013 news release by the Radiological Society of North America.

The study has been published online June 25, 2013 in the journal Radiology:

Jonker JT et al. Exercise and Type 2 Diabetes Mellitus: Changes in Tissue-Specific Fat Distribution and Cardiac Function. Radiology. doi:10.1148/radiol.13121631

More information

The American Academy of Family Physicians has more about diabetes and exercise

Walking Away From Diabetes

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Short Strolls After Meals May Lower Diabetes Risk in Older People

A 15-minute walk after every meal – that’s what a new study says can lower blood sugar and the risk of type 2 diabetes.

What’s more, it’s better than 45 minutes of sustained walking in the morning or afternoon.

High blood sugar spikes, particularly after meals is a key risk factor in the progression from impaired glucose tolerance - what the study called "pre-diabetes" - to type-2 diabetes and cardiovascular disease.

Older people tend to have poorer blood sugar control after meals due to insulin resistance in the muscles and slow or low insulin secretion from the pancreas.

"The muscle contractions connected with short walks were immediately effective in blunting the potentially damaging elevations in post-meal blood sugar commonly observed in older people," , the researchers said.

The 4th National Health and Morbidity Survey (NHMS) in 2011 showed a diabetes prevalence of 20.8% amongst Malaysians. Diabetes is the leading cause of kidney failure, lower limb amputations that aren’t because of accident trauma, and new cases of blindness among adults. It is a major cause of heart disease and stroke – amongst top 5 leading causes of death in Malaysia.

Resting after eating - the worst thing you can do

Most people eat a big afternoon or evening meal and then take a nap or watch television. "That's the worst thing you can do," lead author Loretta DiPietro said. "Let the food digest a bit and then get out and move," she says.

Dr DiPietro said the findings could lead to an "inexpensive strategy" for preventing type-2 diabetes, but said the results must be confirmed by larger trials.

Binge Drinking Increases Risk of Type 2 Diabetes

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Binge drinking causes insulin resistance, which increases the risk of Type 2 diabetes, according to the results of an animal study led by researchers at the Diabetes Obesity and Metabolism Institute at the Icahn School of Medicine at Mount Sinai.

The authors further discovered that alcohol disrupts insulin-receptor signaling by causing inflammation in the hypothalamus area of the brain.

"Insulin resistance has emerged as a key metabolic defect leading to Type 2 diabetes and coronary artery disease (CAD)," said Christoph Buettner, MD, PhD, senior author of the study and Associate Professor of Medicine (Endocrinology, Diabetes and Bone Disease). "Someone who regularly binge drinks even once a week, over many years, may remain in an insulin resistant state for an extended period of time, potentially years," said Dr. Buettner.

In this study, researchers treated rats with alcohol for three consecutive days to simulate human binge drinking. A control group received the same amount of calories. Once alcohol was no longer detectable in blood, glucose metabolism was studied through either glucose-tolerance tests or through controlled-insulin infusions. The rats treated with alcohol were found to have higher concentrations of plasma insulin than the control group, suggesting that insulin resistance may have been the cause of the impaired glucose tolerance.

High plasma insulin levels are a major component of the metabolic syndrome, a group of risk factors that occur together and increase the risk for Type 2 diabetes, coronary artery disease, and stroke.

"Previously it was unclear whether binge drinking was associated with an increased risk for diabetes, since a person who binge drinks may also tend to binge eat, or at least eat too much. Our data show for the first time that binge drinking induces insulin resistance directly and can occur independent of differences in caloric intake," said Claudia Lindtner, MD, first author of the study and an Associate Researcher of Medicine, Endocrinology, Diabetes and Bone Disease at the Icahn School of Medicine.

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The above story is based on the Janaury 30, 2013 news release by Mount Sinai Medical Center.

The results are published in the journal Science Translational Medicine:

Lindtner C, Scherer T, Zielinski E, Filatova N, Fasshauer M, Tonks NK, Puchowicz M,  Buettner C. Binge Drinking Induces Whole-Body Insulin Resistance by Impairing Hypothalamic Insulin Action. Sci Transl Med 2013; 5 (170): 170ra14 DOI: 10.1126/scitranslmed.3005123

Diabetic Foot Ulcers Linked With Higher Risk of Death, Heart Attack and Stroke

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Need for improved detection and management of those with diabetes and foot ulcers.

People with diabetes who develop foot ulcers are at more risk of dying prematurely than those without the complication, finds a new large-scale study.

Diabetes can damage a person's blood vessels and nerves, especially if their blood sugar is poorly controlled. Poor circulation and nerve damage in the feet makes people vulnerable to unnoticed cuts or other injuries and progress into poorly healing ulcers, or sores. In severe cases, this can lead to foot or leg amputation.

In a study of 17,830 patients with diabetes -- 3,095 diagnosed with foot ulceration and 14,735 without -- researchers from St George's, University of London investigated how diabetic foot ulcers affected a person's risk of dying earlier. They found that those with a history of foot ulceration had a higher death rate than those without. There were an extra 58 deaths per 1,000 people each year with diabetic foot ulcers.

People with foot ulcers and diabetes showed more cardiovascular risk factors, such as high blood pressure, and were more likely to die from cardiovascular causes. Approximately half of the additional mortalities were due to cardiovascular disease, such as heart attack or stroke.

The cause of non-cardiovascular deaths was not studied as part of this investigation but the researchers say this is potentially linked to infections and complications of foot ulceration, such as blood poisoning.

Robert Hinchliffe from St George's, University of London, who co-led the study, said: "Our research, which is the largest and therefore most reliable study to date, shows that people with diabetes who have foot ulcers are at considerably higher risk of an earlier death compared to those patients without. We suspect that this may be due in part to the effect of infections among those with foot ulcers and the greater co-existence of cardiovascular disease and foot ulcers with diabetes although the reasons are not entirely clear."

The researchers say these results underline the importance of a two-pronged approach for people with diabetes:

-          Enhanced foot ulceration screening as early detection and treatment may help reduce some of the complications; and

-          More intensive control of blood pressure and cholesterol among those diagnosed with foot ulcers as they are at higher cardiovascular risk.

Currently, experts already recommend that people with diabetes undertake a number of precautions to prevent foot ulcers including blood sugar control, wearing socks to prevent cuts, self-checking for abrasions and getting a complete foot examination at least once a year.

Existing guidelines to prevent cardiovascular disease include healthy diet choices, regular exercise, a medical check-up at least once a year and, often, medically prescribed drug treatment.

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The above story is based on the October 10, 2012 news release by the University of St George's London.

The finding has been published in Diabetologia, the journal of the European Association for the Study of Diabetes:

J. R. W. Brownrigg, J. Davey, P. J. Holt, W. A. Davis, M. M. Thompson, K. K. Ray, R. J. Hinchliffe. The association of ulceration of the foot with cardiovascular and all-cause mortality in patients with diabetes: a meta-analysis. Diabetologia, 2012; 55 (11): 2906 DOI: 10.1007/s00125-012-2673-3

Caring for Your Feet

There are many things you can do to keep your feet healthy.

Take care of your diabetes. Work with your health care team to keep your blood glucose in your target range.

Check your feet every day. Look at your bare feet for red spots, cuts, swelling, and blisters. If you cannot see the bottoms of your feet, use a mirror or ask someone for help.

Be more active. Plan your physical activity program with your health team.

Ask your doctor about special shoes.

Wash your feet every day. Dry them carefully, especially between the toes.

Keep your skin soft and smooth. Rub a thin coat of skin lotion over the tops and bottoms of your feet, but not between your toes. Read more about skin care.

If you can see and reach your toenails, trim them when needed. Trim your toenails straight across and file the edges with an emery board or nail file.

Wear shoes and socks at all times. Never walk barefoot. Wear comfortable shoes that fit well and protect your feet. Check inside your shoes before wearing them. Make sure the lining is smooth and there are no objects inside.

Protect your feet from hot and cold. Wear shoes at the beach or on hot pavement. Don't put your feet into hot water. Test water before putting your feet in it just as you would before bathing a baby. Never use hot water bottles, heating pads, or electric blankets. You can burn your feet without realizing it.

Keep the blood flowing to your feet. Put your feet up when sitting. Wiggle your toes and move your ankles up and down for 5 minutes, two (2) or three (3) times a day. Don't cross your legs for long periods of time. Don't smoke.

Get started now. Begin taking good care of your feet today.  Set a time every day to check your feet.

Get more details from the American Diabetes Association HERE.  


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Exercise Helps Ease Premature Cardiovascular Aging Caused by Type 2 Diabetes