Study: Red Raspberries May Help with Glucose Control in People with Pre-diabetes

A study released today from the Illinois Institute of Technology shows the benefits of including red raspberries in the diet of individuals with pre-diabetes and insulin resistance.

According to the Centers for Disease Control and Prevention (CDC), an estimated 34 percent of American adults, around 84.1 million in all, had prediabetes in 2015. Patients with prediabetes are at higher risk for a number of conditions – including developing type 2 diabetes, cardiovascular disease and Alzheimer’s disease.

The study, published in Obesity, investigated the effects of red raspberries in a group of people at-risk for diabetes who were overweight or obese and presented with prediabetes and insulin resistance. A metabolically healthy control group was also included in the study for reference.

Using a randomized, controlled, acute study design, 32 adults between the ages of 20-60 years had their blood tested over a 24-hour period after eating breakfast on three separate days. The three breakfast meals were similar in calories and macronutrients, but differed in the amount of frozen red raspberries – one meal contained no raspberries, one contained one cup of raspberries and one contained two cups of raspberries.

The results showed that as the amount of raspberry intake increased, individuals at risk for diabetes needed less insulin to manage their blood glucose. When two cups of red raspberries were included in the meal, glucose concentrations were lower compared to the meal with no red raspberries. The data suggests that simple inclusion of certain fruits, such as red raspberries with meals, can have glucose lowering benefits with indications of improvements in insulin responses. These effects are particularly important for people who are overweight or obese with pre-diabetes.

“People at risk for diabetes are often told to not eat fruit because of their sugar content. However, certain fruits – such as red raspberries – not only provide essential micronutrients, but also components such as anthocyanins, which give them their red color, ellagitannins and fibers that have anti-diabetic actions,” said Britt Burton-Freeman, Ph.D., director, Center for Nutrition Research at Illinois Tech. “For people who are at risk for diabetes, cardiovascular disease and other health risks, knowing what foods have protective benefits and working them into your diet now can be an important strategy for slowing or reversing progression to disease.”

Source: EurekAlert!

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Blood Sugar Spikes Seen in Seemingly Healthy People

Serena Gordon wrote . . . . . . . .

You’d expect big blood sugar fluctuations in people with diabetes. But for those without the disorder, blood sugar levels should remain fairly stable, right?

Maybe not, says a new study. Researchers found some people who don’t have diabetes still have wild swings in their blood sugar levels after they eat.

Among nearly 60 participants, the study authors identified three “glucotypes” based on how much blood sugar spiked after eating — low, moderate and severe.

The study also found that certain foods were more likely to prompt an extreme change in blood sugar (glucose) than others.

“Even if you don’t have diabetes, you may not have normal glucose. There are a lot of people with glucose dysfunction out there who don’t know it,” said the study’s lead author, Michael Snyder. He’s director of genomics and personalized medicine at Stanford University School of Medicine, in California.

Snyder said this finding is potentially concerning because spikes in blood sugar levels have been associated with risk of heart attack and stroke. And it’s possible — though it hasn’t been proven in this study — that people who have big rises in their blood sugar after eating may have a higher risk of diabetes.

Type 2 diabetes is a major health problem, affecting more than 30 million U.S. adults and 422 million worldwide, the authors noted.

But not every medical expert is convinced that these changes in blood sugar in healthy people are something to be concerned about.

Dr. Joel Zonszein, director of the clinical diabetes center at Montefiore Medical Center in New York City, pointed out that the study population was small. That makes it difficult to draw conclusions about blood sugar pattern “types,” he said. Zonszein was not involved with the research.

The study volunteers “were separated into low, moderate and severe spikes. But there may be many other patterns,” he said. “Absorption, storage and utilization of [sugars] is highly regulated and difficult to characterize by only three different patterns.”

Zonszein added that blood sugar metabolism is complex and affected by many different variables.

To determine the three glucotypes, the Stanford researchers recruited 57 people without diabetes to wear a device called a continuous glucose monitor for a few weeks.

These devices measure approximate blood sugar levels every five minutes using a sensor that’s inserted underneath the skin, Zonszein said.

People with diabetes use these devices to monitor trends in their blood sugar and to see if treatment changes are needed. The monitors provide more information about blood sugar patterns than standard tests that generally only capture a short period of time.

In addition to discovering the three different glucose spiking patterns, the researchers conducted a sub-study with 30 volunteers who wore a continuous glucose monitor while they ate standardized meals. One meal was cornflakes with milk, another was a protein bar and the third was a peanut butter sandwich.

“Certain foods tend to spike nearly everybody,” Snyder said, adding that the cereal was one such food. About 4 out of 5 people saw their blood sugar jump after consuming cereal and milk, the researchers said.

Some of the spikes observed in the study reached prediabetic and diabetic levels, the study authors noted.

Zonszein said that while continuous glucose monitors are great tools for people with diabetes, they don’t necessarily capture someone’s “glucose metabolism.”

And he doesn’t see the devices being used to replace current screening tests for diabetes until much more research is done comparing this technology to current tests.

The study was published in the journal PLOS Biology.

Source: HealthDay

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A Big Breakfast Could Aid Weight Loss, Glucose Control

Honor Whiteman wrote . . . . . . .

You may have heard that breakfast is “the most important meal of the day,” and a new study helps to support this. It found that eating a big breakfast and reducing lunch and dinner size may be key for people looking to lose weight and improve their blood glucose levels.

Led by researchers from Tel Aviv University in Israel, the study found that adults who were obese and had type 2 diabetes lost more weight and had better blood glucose levels after 3 months when they had a high-energy breakfast every day.

Lead study author Dr. Daniela Jakubowicz, who is a professor of medicine at Tel Aviv University, and colleagues recently presented their results at ENDO 2018, the annual meeting of the Endocrine Society, held in Chicago, IL.

Obesity is a leading risk factor for type 2 diabetes; excess weight makes it more difficult for the body to use insulin — the hormone that regulates blood glucose levels — effectively.

According to the Obesity Society, it is estimated that around 90 percent of adults who have type 2 diabetes are overweight or obese.

In terms of treating obesity and type 2 diabetes, switching to a more healthful diet is often the first port of call. But, as Dr. Jakubowicz notes, it’s not always what and how much we eat that might cause problems; it’s also the time of day at which we eat.

“Our body metabolism changes throughout the day,” as Dr. Jakubowicz explains. “A slice of bread consumed at breakfast leads to a lower glucose response and is less fattening than an identical slice of bread consumed in the evening.”

With this in mind, Dr. Jakubowicz and colleagues sought to find out more about how the timing of food intake influences weight loss and blood glucose levels.

Source: Medical News Today

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Dietary Fibers Promote Gut Bacteria that Benefit Blood Glucose Control in Type 2 Diabetes

The fight against type 2 diabetes may soon improve thanks to a pioneering high-fiber diet study led by a Rutgers University-New Brunswick professor.

Promotion of a select group of gut bacteria by a diet high in diverse fibers led to better blood glucose control, greater weight loss and better lipid levels in people with type 2 diabetes, according to research published today in Science.

The study, underway for six years, provides evidence that eating more of the right dietary fibers may rebalance the gut microbiota, or the ecosystem of bacteria in the gastrointestinal tract that help digest food and are important for overall human health.

“Our study lays the foundation and opens the possibility that fibers targeting this group of gut bacteria could eventually become a major part of your diet and your treatment,” said Liping Zhao, the study’s lead author and a professor in the Department of Biochemistry and Microbiology, School of Environmental and Biological Sciences at Rutgers University-New Brunswick.

Type 2 diabetes, one of the most common debilitating diseases, develops when the pancreas makes too little insulin – a hormone that helps glucose enter cells for use as energy – or the body doesn’t use insulin well.

In the gut, many bacteria break down carbohydrates, such as dietary fibers, and produce short-chain fatty acids that nourish our gut lining cells, reduce inflammation and help control appetite. A shortage of short-chain fatty acids has been associated with type 2 diabetes and other diseases. Many clinical studies also show that increasing dietary fiber intake could alleviate type 2 diabetes, but the effectiveness can vary due to the lack of understanding of the mechanisms, according to Zhao, who works in New Jersey Institute for Food, Nutrition, and Health at Rutgers-New Brunswick.

In research based in China, Zhao and scientists from Shanghai Jiao Tong University and Yan Lam, a research assistant professor in Zhao’s lab at Rutgers, randomized patients with type 2 diabetes into two groups. The control group received standard patient education and dietary recommendations. The treatment group was given a large amount of many types of dietary fibers while ingesting a similar diet for energy and major nutrients. Both groups took the drug acarbose to help control blood glucose.

The high-fiber diet included whole grains, traditional Chinese medicinal foods rich in dietary fibers and prebiotics, which promote growth of short-chain fatty acid-producing gut bacteria. After 12 weeks, patients on the high-fiber diet had greater reduction in a three-month average of blood glucose levels. Their fasting blood glucose levels also dropped faster and they lost more weight.

Surprisingly, of the 141 strains of short-chain fatty acid-producing gut bacteria identified by next-generation sequencing, only 15 are promoted by consuming more fibers and thus are likely to be the key drivers of better health. Bolstered by the high-fiber diet, they became the dominant strains in the gut after they boosted levels of the short-chain fatty acids butyrate and acetate. These acids created a mildly acidic gut environment that reduced populations of detrimental bacteria and led to increased insulin production and better blood glucose control.

The study supports establishing a healthy gut microbiota as a new nutritional approach for preventing and managing type 2 diabetes.

Source: The State University of New Jersey

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American College of Physicians Loosen Type 2 Diabetes Goals in New Guideline

Serena Gordon wrote . . . . . . .

The American College of Physicians (ACP) has issued new guidance on managing type 2 diabetes — including relaxing the long-term blood sugar target called hemoglobin A1C.

The A1C is a blood test that gives doctors an estimate of your blood sugar level average over the past few months. For most adults, the American Diabetes Association recommends a target A1C of below 7 percent. This goal may be altered based on individual circumstances.

However, the new ACP guidance suggests that A1C should be between 7 and 8 percent for most adults with type 2 diabetes. For adults who achieve an A1C below 6.5 percent, the group suggests stepping down diabetes treatment to keep that level from going even lower.

The American College of Physicians, which is a national organization of internal medicine doctors, also says that management goals should be personalized based on the benefits and risks of medications, patient preference, general health status and life expectancy.

And, though the doctors’ group has relaxed the suggested A1C targets, that doesn’t mean type 2 diabetes isn’t a serious problem.

“These changes should in no way be interpreted as diabetes is unimportant,” said Dr. Jack Ende, ACP’s president.

More than 29 million Americans have diabetes. Over time, high blood sugar levels can lead to vision loss, nerve problems, heart attacks, strokes and kidney failure.

“Diabetes is such a prevalent problem, and there are so many guidelines and conflicting information out there, we wanted to do an assessment that would give our members the best possible advice,” Ende said. “Also, A1C targets are being used now as a performance measure.”

And, when insurers expect all patients to fall under a certain A1C, that’s “not always consistent with the best possible evidence,” he explained.

For instance, it’s not always safe to manage an 80-year-old with memory problems to the same A1C target as a 50-year-old. Diabetes therapies can cause low blood sugar levels, which can also cause health problems.

The American Diabetes Association (ADA) also recognizes the importance of individualizing diabetes treatments, according to Dr. William Cefalu, its chief scientific, medical and mission officer. However, he expressed concern about loosening the A1C target.

“The ADA believes all people diagnosed with type 2 diabetes can be healthy and should have the opportunity to reduce their risk of serious diabetes complications through appropriate blood glucose targets,” Cefalu said.

“Individualization of targets is the key factor,” he said. “By lumping most people with type 2 diabetes into a 7 to 8 percent target range, ACP’s new guidance may cause potential harm to those who may safely benefit from lower evidence-based targets.”

If someone is safely achieving an A1C of 6.5 percent or less, there’s no reason to arbitrarily reduce their medication, Cefalu said. If people are experiencing low blood sugar levels, then medications should likely be adjusted. But, he said, there’s no lower limit on A1C as long as people have minimal risk of low blood sugar.

ACP’s new guidance also suggests that clinicians avoid a target A1C in people with a life expectancy of less than 10 years because they have an advanced age (80 and older), live in a nursing home or have another chronic health condition. Instead, ACP recommends minimizing symptoms of high blood sugar for these patients.

Cefalu said that, on this issue also, ADA recommends individualized therapy. He noted that the average life expectancy for someone who reaches 80 years old is another 8 years for men and 10 years for women.

“Each specific case should be evaluated individually, as a person living in a nursing home or with a chronic condition may yet have some years to live, and would likely prefer to live them without diabetes complications,” he added.

Ende countered that ACP isn’t minimizing the importance of treating type 2 diabetes and addressing its risk factors by prescribing statins and controlling blood pressure in people with the disease. However, he said there’s evidence that lowering A1C too much may cause harm.

Cefalu said he’d like to see A1C targets be consistent from clinician to clinician.

“Everyone agrees that care should be individualized and that the focus should be on patients,” he noted. “However, the details are critical and specific for each patient.”

The new guidance for physicians on type 2 diabetes management was published online in Annals of Internal Medicine.

Source: HealthDay

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