michael.massing + peer-reviewed + research   772

Dietary carbohydrate: relationship to cardiovascular disease and disorders of carbohydrate metabolism. - PubMed - NCBI
The nature of carbohydrate is of considerable importance when recommending diets intended to reduce the risk of type II diabetes and cardiovascular disease and in the treatment of patients who already have established diseases. Intact fruits, vegetables, legumes and wholegrains are the most appropriate sources of carbohydrate. Most are rich in nonstarch polysaccharides (NSPs) (dietary fibre) and other potentially cardioprotective components. Many of these foods, especially those that are high in dietary fibre, will reduce total and low-density lipoprotein cholesterol and help to improve glycaemic control in those with diabetes. There is no good long-term evidence of benefit when NSPs or other components of wholegrains, fruits, vegetables and legumes are added to functional and manufactured foods. Frequent consumption of low glycaemic index foods has been reported to confer similar benefits, but it is not clear whether such benefits are independent of the dietary fibre content of these foods or the fact that low glycaemic index foods tend to have intact plant cell walls. Furthermore, it is uncertain whether functional and manufactured foods with a low glycaemic index confer the same long-term benefits as low glycaemic index plant-based foods. A wide range of carbohydrate intake is acceptable, provided the nature of carbohydrate is appropriate. Failure to emphasize the need for carbohydrate to be derived principally from wholegrain cereals, fruits, vegetables and legumes may result in increased lipoprotein-mediated risk of cardiovascular disease, especially in overweight and obese individuals who are insulin resistant.
risk  benefit  industrialized  processed  lipids  vegetables  cardiovascular  blood  whole  grain  fruit  carbohydrate  legumes  glucose  peer-reviewed  research  response  insulin  fiber  comparison  overview  correlation  type  2  T2D  effect  diet  epidemiology  etiology  self  care  management  long  term  short  soluble  insoluble  metabolism  prevention  intact  integrity 
yesterday by Michael.Massing
Cereal grains, legumes and diabetes. - PubMed - NCBI
Epidemiological studies strongly support the suggestion that high intakes of whole grain foods protect against the development of type II diabetes mellitus (T2DM). People who consume approximately 3 servings per day of whole grain foods are less likely to develop T2DM than low consumers (<3 servings per week) with a risk reduction in the order of 20-30%. The role of legumes in the prevention of diabetes is less clear, possibly because of the relatively low intake of leguminous foods in the populations studied. However, legumes share several qualities with whole grains of potential benefit to glycaemic control including slow release carbohydrate and a high fibre content. A substantial increase in dietary intake of legumes as replacement food for more rapidly digested carbohydrate might therefore be expected to improve glycaemic control and thus reduce incident diabetes. This is consistent with the results of dietary intervention studies that have found improvements in glycaemic control after increasing the dietary intake of whole grain foods, legumes, vegetables and fruit. The benefit has been attributed to an increase in soluble fibre intake. However, prospective studies have found that soluble fibre intake is not associated with a lower incidence of T2DM. On the contrary, it is cereal fibre that is largely insoluble that is associated with a reduced risk of developing T2DM. Despite this, the addition of wheat bran to the diets of diabetic people has not improved indicators of glycaemic control. These apparently contradictory findings might be explained by metabolic studies that have indicated improvement in glucose handling is associated with the intact structure of food. For both grains and legumes, fine grinding disrupts cell structures and renders starch more readily accessible for digestion. The extent to which the intact structure of grains and legumes or the composition of foods in terms of dietary fibre and other constituents contribute to the beneficial effect remains to be quantified. Other mechanisms to help explain improvements in glycaemic control when consuming whole grains and legumes relate to cooking, type of starch, satiety and nutrient retention. Thus, there is strong evidence to suggest that eating a variety of whole grain foods and legumes is beneficial in the prevention and management of diabetes. This is compatible with advice from around the world that recommends consumption of a wide range of carbohydrate foods from cereals, vegetables, legumes and fruits both for the general population and for people with diabetes.
breakfast  blood  whole  grain  lsgumes  glucose  peer-reviewed  research  response  insulin  fiber  comparison  review  overview  correlation  type  2  T2D  effect  diet  epidemiology  etiology  self  care  management  long  term  short  soluble  insoluble  metabolism  prevention 
2 days ago by Michael.Massing
The Effects of Breakfast Consumption and Composition on Metabolic Wellness with a Focus on Carbohydrate Metabolism. - PubMed - NCBI
Findings from epidemiologic studies indicate that there are associations between breakfast consumption and a lower risk of type 2 diabetes mellitus (T2DM) and metabolic syndrome, prompting interest in the influence of breakfast on carbohydrate metabolism and indicators of T2DM risk. The objective of this review was to summarize the available evidence from randomized controlled trials assessing the impact of breakfast on variables related to carbohydrate metabolism and metabolic wellness. Consuming compared with skipping breakfast appeared to improve glucose and insulin responses throughout the day. Breakfast composition may also be important. Dietary patterns high in rapidly available carbohydrate were associated with elevated T2DM risk. Therefore, partial replacement of rapidly available carbohydrate with other dietary components, such as whole grains and cereal fibers, proteins, and unsaturated fatty acids (UFAs), at breakfast may be a useful strategy for producing favorable metabolic outcomes. Consumption of fermentable and viscous dietary fibers at breakfast lowers glycemia and insulinemia. Fermentable fibers likely act through enhancing insulin sensitivity later in the day, and viscous fibers have an acute effect to slow the rate of carbohydrate absorption. Partially substituting protein for rapidly available carbohydrate enhances satiety and diet-induced thermogenesis, and also favorably affects lipoprotein lipids and blood pressure. Partially substituting UFA for carbohydrate has been associated with improved insulin sensitivity, lipoprotein lipids, and blood pressure. Overall, the available evidence suggests that consuming breakfast foods high in whole grains and cereal fiber, while limiting rapidly available carbohydrate, is a promising strategy for metabolic health promotion.
breakfast  blood  whole  grain  unsaturated  fatty  acids  lipids  UFA  glucose  peer-reviewed  research  response  insulin  fiber  high  low  glycemic  index  correlation  type  2  T2D  effect  diet  self  care  management  long  term  short  viscous  soluble  fermentable  insoluble  metabolism 
2 days ago by Michael.Massing
Whole Grain Intake and Glycaemic Control in Healthy Subjects: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. - PubMed - NCBI
There is growing evidence from both observational and intervention studies that Whole Grain (WG) cereals exert beneficial effects on human health, especially on the metabolic profile. The aim of this study was to perform a meta-analysis of randomised controlled trials (RCT) to assess the acute and medium/long-term effect of WG foods on glycaemic control and insulin sensitivity in healthy individuals.
A search for all the published RCT on the effect of WG food intake on glycaemic and insulin response was performed up to December 2016. Effect size consisted of mean difference (MD) and 95% CI between the outcomes of intervention and the control groups using the generic inverse-variance random effects model.
The meta-analysis of the 14 studies testing the acute effects of WG foods showed significant reductions of the post-prandial values of the glucose iAUC (0-120 min) by -29.71 mmol min/L (95% CI: -43.57, -15.85 mmol min/L), the insulin iAUC (0-120 min) by -2.01 nmol min/L (95% CI: -2.88, -1.14 nmol min/L), and the maximal glucose and insulin response. In 16 medium- and long-term RCTs, effects of WG foods on fasting glucose and insulin and homeostatic model assessment-insulin resistance values were not significant.
The consumption of WG foods is able to improve acutely the postprandial glucose and insulin homeostasis compared to similar refined foods in healthy subjects. Further research is needed to better understand the long-term effects and the biological mechanisms.
blood  whole  rye  glucose  metabolism  peer-reviewed  research  response  insulin  fiber  correlation  review  meta-analysis  diet  self  care  management  metabolic  profile 
2 days ago by Michael.Massing
Effects of whole grain rye, with and without resistant starch type 2 supplementation, on glucose tolerance, gut hormones, inflammation and appetite... - PubMed - NCBI
Whole grain has shown potential to lower the risk of obesity, cardiovascular disease and type 2 diabetes. One possible mechanism behind the benefits of whole grain is the gut fermentation of dietary fiber (DF), e.g. non-starch polysaccharides and resistant starch (RS), in whole grain. The purpose of the study is to investigate the effect of whole grain rye-based products on glucose- and appetite regulation.
Twenty-one healthy subjects were provided four rye-based evening test meals in a crossover overnight study design. The test evening meals consisted of either whole grain rye flour bread (RFB) or a 1:1 ratio of whole grain rye flour and rye kernels bread (RFB/RKB), with or without added resistant starch (+RS). White wheat flour bread (WWB) was used as reference evening meal. Blood glucose, insulin, PYY, FFA, IL-6 as well as breath H2 and subjective rating of appetite were measured the following morning at fasting and repeatedly up to 3.5 h after a standardized breakfast consisting of WWB. Ad libitum energy intake was determined at lunch, 14.5 h after evening test and reference meals, respectively.
The evening meal with RFB/RKB + RS decreased postprandial glucose- and insulin responses (iAUC) (P < 0.05) and increased the gut hormone PYY in plasma the following morning 0-120 min after the standardized breakfast, compared to WWB (P = 0.01). Moreover, RFB increased subjective satiety and decreased desire to eat, and both RFB and RFB/RKB decreased feeling of hunger (AUC 0-210 min). All rye-based evening meals decreased or tended to decrease fasting FFA (P < 0.05, RFB/RKB: P = 0.057) and increased breath hydrogen concentration (0-120 min, P < 0.001). No effects were noted on energy intake at lunch or inflammatory marker IL-6 (0 + 180 min) after the rye-based evening meals, compared to WWB.
Whole grain rye bread has the potential to improve cardiometabolic variables in an 11-14.5 h perspective in healthy humans. The combination RFB/RKB + RS positively affected biomarkers of glucose- and appetite regulation in a semi-acute perspective. Meanwhile, RFB and RFB/RKB improved subjective appetite ratings. The effects probably emanate from gut fermentation events.
blood  whole  grain  rye  glucose  metabolism  peer-reviewed  research  response  insulin  fiber  high  low  glycemic  index  correlation  comparison  type  2  T2D  second-meal  phenomenon  effect  diet  self  care  management 
2 days ago by Michael.Massing
Effect of cereal test breakfasts differing in glycemic index and content of indigestible carbohydrates on daylong glucose tolerance in healthy subj... - PubMed - NCBI
Frequent hyperglycemic episodes are increasingly being associated with an increased risk of type 2 diabetes and cardiovascular disease.
We studied the extent to which acute glycemia and glycemia after subsequent meals can be modulated by the characteristics of cereal foods, such as glycemic index (GI) and content of indigestible carbohydrates.
Twelve healthy subjects consumed test meals in a random order. In series 1, the test meals were consumed at breakfast, and postprandial blood glucose incremental areas under the curve (IAUCs) were calculated after the test breakfast, standardized lunch, and standardized dinner. In series 2, the subjects consumed test evening meals and IAUCs were calculated after a subsequent standardized breakfast. Breath hydrogen was measured as an indicator of colonic fermentation.
Barley or rye kernel breakfasts lowered the blood glucose IAUC (0-120 min) at breakfast, at a subsequent lunch, and the cumulative IAUCs (breakfast+lunch+dinner) when compared with white-wheat bread (P < 0.05). The lunch blood glucose IAUCs were positively correlated with breakfast IAUCs (r = 0.30, P < 0.05). Breath hydrogen excretion was negatively correlated with blood glucose IAUCs after lunch (r = -0.33, P < 0.05) and dinner (r = -0.22, P < 0.05). A barley kernel evening meal resulted in lower IAUCs (P < 0.05) and higher breath hydrogen (P < 0.001) after a subsequent breakfast compared with white-wheat bread.
Glucose tolerance at subsequent meals can be notably improved during the course of a whole day or overnight by choosing specific low-GI, whole-grain cereal products. A low GI may be sufficient to achieve a second-meal effect from breakfast to lunch. A specific indigestible carbohydrate mixture appears to be required to show benefits on glucose tolerance in a longer time frame (9.5 h), most likely mediated through colonic fermentation.
breakfast  blood  barley  rye  glucose  metabolism  peer-reviewed  research  response  insulin  fiber  high  low  glycemic  index  correlation  comparison  type  2  T2D  second-meal  phenomenon  effect  diet  self  care  management 
2 days ago by Michael.Massing
Matching Meals to Body Clocks—Impact on Weight and Glucose Metabolism
The prevalence of type 2 diabetes continues to rise worldwide and is reaching pandemic proportions. The notion that this is due to obesity, resulting from excessive energy consumption and reduced physical activity, is overly simplistic. Circadian de-synchrony, which occurs when physiological processes are at odds with timing imposed by internal clocks, also promotes obesity and impairs glucose tolerance in mouse models, and is a feature of modern human lifestyles. The purpose of this review is to highlight what is known about glucose metabolism in animal and human models of circadian de-synchrony and examine the evidence as to whether shifts in meal timing contribute to impairments in glucose metabolism, gut hormone secretion and the risk of type 2 diabetes. Lastly, we examine whether restricting food intake to discrete time periods, will prevent or reverse abnormalities in glucose metabolism with the view to improving metabolic health in shift workers and in those more generally at risk of chronic diseases such as type 2 diabetes and cardiovascular disease....

There is a general belief that consumption of more energy throughout the day is preferable to evening consumption. Few studies have examined this prospectively in humans, or for any length of time. Nonetheless, time restricted feeding has shown promise as a tool to mitigate the metabolic sequelae of diet induced obesity in mouse models. Good quality evidence for TRF as a dietary approach to improve glucose control in humans is lacking. Controlled trials are necessary, and must determine if there is adaptation in the approach, whilst keeping in mind the practicality of translating this approach into the community.
opblood  protein  glucose  metabolism  peer-reviewed  research  response  insulin  meal  timing  in  vivo  animal  correlation  comparison  type  2  T2D  circadian  rhythms  social  factor  environmental  etiology  risk  shift  work  obesity  body  fat 
2 days ago by Michael.Massing
Role of glycemic index and glycemic load in the healthy state, in prediabetes, and in diabetes. - PubMed - NCBI
The choice of carbohydrate-rich foods in the habitual diet should take into account not only their chemical composition but also their ability to influence postprandial glycemia (glycemic index). _Fiber-rich foods generally have a low glycemic index (GI), although not all foods with a low GI necessarily have high fiber content._ Several beneficial effects of low-GI, high-fiber diets have been shown, including lower postprandial glucose and insulin responses, an improved lipid profile, and, possibly, reduced insulin resistance. In nondiabetic persons, suggestive evidence is available from epidemiologic studies that a diet based on carbohydrate-rich foods with a low-GI, high-fiber content may protect against diabetes or cardiovascular disease. However, no intervention studies have so far evaluated the potential of low-GI, high-fiber diets to reduce the risk of diabetes, although in studies aimed at diabetes prevention by lifestyle modifications, an increase in fiber consumption was often part of the intervention. In relation to prevention of cardiovascular disease, intervention studies evaluating the effect of a low-GI diet on clinical events are not available; moreover, the results of the few available intervention studies evaluating the effects of GI on the cardiovascular disease risk factor profile are not always concordant. The best evidence of the clinical usefulness of GI is available in diabetic patients in whom low-GI foods have consistently shown beneficial effects on blood glucose control in both the short-term and the long-term. In these patients, low-GI foods are suitable as carbohydrate-rich choices, provided other attributes of the foods are appropriate.
breakfast  blood  protein  glucose  metabolism  peer-reviewed  research  response  insulin  fiber  high  low  glycemic  index  correlation  comparison  prediabetes  type  2  T2D  load 
2 days ago by Michael.Massing
A high-glycemic index, low-fiber breakfast affects the postprandial plasma glucose, insulin, and ghrelin responses of patients with type 2 diabetes... - PubMed - NCBI
The area under the curve (AUC) [mean (95% CI); P for LSD tests] for plasma glucose (mmol/L × min) was higher after patients consumed the HGI-LF breakfast [9.62 (8.39, 10.84)] than after the LGI-HF breakfast [8.95 (7.71, 10.18)] (P ≤ 0.05). Insulin AUC (μIU/mL × min) after patients consumed the HGI-LF meal [65.72 (38.24, 93.19)] was higher than after the HGI-HF meal [57.24 (32.44, 82.04)] (P ≤ 0.05). The other observed difference was higher insulin AUC after the consumption of the LGI-LF breakfast [61.54 (36.61, 86.48)] compared with the AUC after the LGI-HF breakfast [54.16 (31.43, 76.88)] (P ≤ 0.05). Plasma ghrelin decreased in comparison with baseline only after patients consumed the LGI-HF and LGI-LF breakfasts (P ≤ 0.05). Subjective satiety did not differ between breakfasts.
Plasma glucose, insulin, and ghrelin responses were least favorable when patients with type 2 diabetes consumed a breakfast with a high GI and low fiber, which suggests that reducing the GI or increasing the fiber content or both of breakfasts may be a useful strategy to improve the postprandial metabolic profile of these patients.
breakfast  blood  protein  glucose  metabolism  peer-reviewed  research  response  insulin  fiber  high  low  glycemic  index  ghrelin  correlation  comparison 
2 days ago by Michael.Massing
Effects of breakfast meal composition on second meal metabolic responses in adults with Type 2 diabetes mellitus. - PubMed - NCBI
Two different breakfast meals were administered during the intervention: (A) a high glycemic load breakfast meal consisting of farina (kJ 1833; carbohydrate (CHO) 78 g and psylium soluble fiber 0 g), (B) a low-glycemic load breakfast meal consisting of a fiber-loop cereal (kJ 1515; CHO 62 g and psyllium soluble fiber 6.6 g). A standardized lunch was provided approximately 4 h after breakfast. Blood plasma concentrations and area under the curve (AUC) values for glucose, insulin and FFA were measured in response to the breakfast and mid-day lunch. Statistical analyses were performed using SAS software (8.02). Comparisons between diets were based on adjusted Bonferroni t-tests.
In post-breakfast analyses, Breakfast B had significantly lower area under the curve (AUC) values for plasma glucose and insulin compared to Breakfast A (P<0.05) (95% confidence level). The AUC values for FFA were higher for Breakfast B than for Breakfast A (P<0.05) (95% confidence level). Post-lunch analyses indicated similar glucose responses for the two breakfast types. Insulin AUC values for Breakfasts B were significantly lower than Breakfast A (P<0.05) (95% confidence level). The AUC values for FFA were unaffected by breakfast type.
These data indicate that ingesting a low-glycemic load meal containing psyllium soluble fiber at breakfast significantly improves the breakfast postprandial glycemic, insulinemic and FFA responses in adults with Type 2 DM. These data revealed no residual postprandial effect of the psyllium soluble fiber breakfast meal beyond the second meal consumed. Thus, there was no evidence of an improvement postprandially in the glycemic, insulinemic and FFA responses after the consumption of the lunch meal.
breakfast  blood  lunch  protein  glucose  metabolism  second-meal  phenomenon  peer-reviewed  research  response  insulin  fiber  high  low  glycemic  index 
2 days ago by Michael.Massing
A high-protein breakfast induces greater insulin and glucose-dependent insulinotropic peptide responses to a subsequent lunch meal in individuals w... - PubMed - NCBI
The previous meal modulates the postprandial glycemic responses to a subsequent meal; this is termed the second-meal phenomenon.
This study examined the effects of high-protein vs. high-carbohydrate breakfast meals on the metabolic and incretin responses after the breakfast and lunch meals.
Twelve type 2 diabetic men and women [age: 21-55 y; body mass index (BMI): 30-40 kg/m(2)] completed two 7-d breakfast conditions consisting of 500-kcal breakfast meals as protein (35% protein/45% carbohydrate) or carbohydrate (15% protein/65% carbohydrate). On day 7, subjects completed an 8-h testing day. After an overnight fast, the subjects consumed their respective breakfast followed by a standard 500-kcal high-carbohydrate lunch meal 4 h later. Blood samples were taken throughout the day for assessment of 4-h postbreakfast and 4-h postlunch total area under the curve (AUC) for glucose, insulin, C-peptide, glucagon, glucose-dependent insulinotropic peptide (GIP), and glucagon-like peptide 1 (GLP-1).
Postbreakfast glucose and GIP AUCs were lower after the protein (17%) vs. after the carbohydrate (23%) condition (P < 0.05), whereas postbreakfast insulin, C-peptide, glucagon, and GLP-1 AUCs were not different between conditions. A protein-rich breakfast may reduce the consequences of hyperglycemia in this population. Postlunch insulin, C-peptide, and GIP AUCs were greater after the protein condition vs. after the carbohydrate condition (second-meal phenomenon; all, P < 0.05), but postlunch AUCs were not different between conditions. The overall glucose, glucagon, and GLP-1 responses (e.g., 8 h) were greater after the protein condition vs. after the carbohydrate condition (all, P < 0.05).
In type 2 diabetic individuals, compared with a high-carbohydrate breakfast, the consumption of a high-protein breakfast meal attenuates the postprandial glucose response and does not magnify the response to the second meal. Insulin, C-peptide, and GIP concentrations demonstrate the second-meal phenomenon and most likely aid in keeping the glucose concentrations controlled in response to the subsequent meal.
breakfast  blood  lunch  protein  glucose  metabolism  second-meal  phenomenon  peer-reviewed  research  response  insulin 
2 days ago by Michael.Massing
Glucose-lowering effect of whey protein depends upon clinical characteristics of patients with type 2 diabetes. - PubMed - NCBI
Effects of WP supplementation on glycemia in T2DM depend on the baseline characteristics. Lower body weight, normal triglyceride and lower GLP-1 levels predict glucose lowering. In contrast, obesity, hypertriglyceridemia and high baseline GLP-1 predict increased glucose response.
breakfast  protein  glucose  whey  blood  response  spike  triglycerides  GLP-1  body  fat  obesity  correlation  peak  excursion  peer-reviewed  research 
3 days ago by Michael.Massing
Effects of Higher Dietary Protein and Fiber Intakes at Breakfast on Postprandial Glucose, Insulin, and 24-h Interstitial Glucose in Overweight Adults. - PubMed - NCBI
The HPHF treatment did not affect postprandial glucose and insulin responses or 24-h glucose total area under the curve (AUC). Higher fiber intake reduced 240-min insulin AUC. Doubling the amount of protein from 12.5 g to 25 g/meal and quadrupling fiber from 2 to 8 g/meal at breakfast was not an effective strategy for modulating insulin-mediated glucose responses in these young, overweight[, nondiabetic] adults.
breakfast  fiber  protein  glucose  metabolism  blood  interstitial  insulin  response  postprandial  peak  excursion  spike  peer-reviewed  research 
4 days ago by Michael.Massing
Timing of Peak Blood Glucose after Breakfast Meals of Different Glycemic Index in Women with Gestational Diabetes
There was no significant difference in subjective satiety throughout the test period. In conclusion, the low GI breakfast produced lower postprandial glycemia, and the peak PBGL [postprandial blood glucose level] occurred closer to the time recommended for PBGL monitoring (i.e., 1 h postprandial) in GDM than a macronutrient matched high GI breakfast.
breakfast  glucose  metabolism  appetite  diabetes  gestational  peak  postprandial  blood  SMBG  self  care  glycemic  index  high  timing  monitoring  excursion  spike  peer-reviewed  research 
4 days ago by Michael.Massing
Breakfast Protein Source Does Not Influence Postprandial Appetite Response and Food Intake in Normal Weight and Overweight Young Women. - PubMed - NCBI
No difference was found between [normal weight] and [overweight] participants or breakfasts for postprandial appetite responses. [Animal protein] had a significantly lower glucose response at 30 minutes compared with [plant protein] (-11.6%; 127 ± 4 versus 112 ± 4 mg/dL; P < 0.05) and a slower return to baseline. There was no difference in daily energy intake between breakfasts. These data suggest that protein source may influence postprandial glucose response without significantly impacting appetite response in breakfast consumers.
breakfast  animal  plant  foods  protein  glucose  metabolism  appetite  blood  peak  excursion  spike  peer-reviewed  research 
4 days ago by Michael.Massing
Targeting glucose metabolism for healthy aging. - PubMed - NCBI
Advancing age is the greatest single risk factor for numerous chronic diseases. Thus, the ability to target the aging process can facilitate improved healthspan and potentially lifespan. Lack of adequate glucoregulatory control remains a recurrent theme accompanying aging and chronic disease, while numerous longevity interventions result in maintenance of glucoregulatory control. In this review, we propose targeting glucose metabolism to enhance regulatory control as a means to ameliorate the aging process. We highlight that calorie restriction improves glucoregulatory control and extends both lifespan and healthspan in model organisms, but we also indicate more practical interventions (i.e., calorie restriction mimetics) are desirable for clinical application in humans. Of the calorie restriction mimetics being investigated, we focus on the type 2 diabetes drug acarbose, an α-glucosidase inhibitor that when taken with a meal, results in reduced enzymatic degradation and absorption of glucose from complex carbohydrates. We discuss alternatives to acarbose that yield similar physiologic effects and describe dietary sources (e.g., sweet potatoes, legumes, and berries) of bioactive compounds with α-glucosidase inhibitory activity. We indicate future research should include exploration of how non-caloric compounds like α-glucosidase inhibitors modify macronutrient metabolism prior to disease onset, which may guide nutritional/lifestyle interventions to support health and reduce age-related disease risk.

[Note mention of metformin in graphical abstract.]
hyperglycemia  diabetes  type  2  T2D  blood  glucose  diet  foods  legumes  berries  sweet  potatoes  SMBG  self  care  risk  cardiovascular  kidney  neuropathy  nephropathy  chronic  disease  progression  aging  caloric  calorie  restriction  acarbose  metformin  peak  excursion  spike  peer-reviewed  research 
4 days ago by Michael.Massing
Postprandial glucose regulation: new data and new implications. - PubMed - NCBI
Type 2 diabetes is characterized by a gradual decline in insulin secretion in response to nutrient loads; hence, it is primarily a disorder of postprandial glucose (PPG) regulation. However, physicians continue to rely on fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c) to guide management.
The objectives of this article are to review current data on postprandial hyperglycemia and to assess whether, and how, management of type 2 diabetes should change to reflect new clinical findings.
Articles were selected from MEDLINE searches (key words: postprandial glucose, postprandial hyperglycemia, and cardiovascular disease) and from our personal reference files, with emphasis on the contribution of postprandial hyperglycemia to overall glycemic load or cardiovascular (CV) risk.
About 33% of people diagnosed as having type 2 diabetes based on postprandial hyperglycemia have normal FPG. PPG contributes > or =70% to the total glycemic load in patients who are fairly well controlled (HbA1c <7.3%). Furthermore, there is a linear relationship between the risk of CV death and the 2-hour oral glucose tolerance test (OGTT). Increased mortality is evident at OGTT levels of approximately 90 mg/dL (5 mmol/L), which is well below current definitions of type 2 diabetes. Biphasic insulin aspart was shown to be more effective at reducing HbA1c below currently recommended levels than basal insulin glargine (66% vs 40%; P < 0.001), and it reduced endothelial dysfunction more effectively than regular insulin (P < 0.01). Repaglinide achieved regression of carotid atherosclerosis (intima-media thickness) in 52% of patients versus 18% for glyburide (P < 0.01) over 1 year, although levels of HbA1c and CV risk factors were similar for both treatment groups. Finally, acarbose reduced the relative risk of CV events by 49% over 3.3 years versus placebo in patients with impaired glucose tolerance (2.2% vs 4.7%; P = 0.03) and by 35% over > or =1 year in patients with type 2 diabetes (9.4% vs 6.1%; P = 0.006).
All components of the glucose triad (ie, FPG, HbA1c, and PPG) should be considered in the management of type 2 diabetes. Therapy targeted at PPG has been shown to improve glucose control and to reduce the progression of atherosclerosis and CV events; therefore, physicians should consider monitoring and targeting PPG, as well as HbA1c and FPG, in patients with type 2 diabetes.
hyperglycemia  diabetes  type  2  T2D  blood  glucose  postprandial  spike  peak  SMBG  self  care  risk  cardiovascular  excursion  damage  vessel  wall  epithelial  atherosclerosis  morbidity  mortality  threshold  peer-reviewed  research 
4 days ago by Michael.Massing
Postprandial hyperglycaemia: noxious effects on the vessel wall. - PubMed - NCBI
In recent years postchallenge or postprandial hyperglycaemia has been found to be an independent risk factor for cardiovascular comorbidities and all-cause mortality in impaired glucose tolerance (IGT) and type 2 diabetes. With the database of the Risk Factors in IGT for Atherosclerosis and Diabetes (RIAD) study, it was also shown that atherosclerosis as measured by intima-media thickness of the common carotid arteries was associated with 2-hour postchallenge glucose level when HbA1c was normal. Taken together there are now comprehensive and consistent data from pathophysiological as well as epidemiological studies that excessive post-load glucose excursions have acute and chronic harmful effects on the endothelium and vessel wall. This is supported by four outcome studies that included control of postprandial glucose to prevent cardiovascular disease: Diabetes Intervention Study (DIS), Kumamoto study, DIGAMI study, and STOP-NIDDM trial. Therefore, in addition to HbA1c and fasting blood glucose, postprandial glucose monitoring should be an integral part of treatment to prevent acute and chronic complications.
hyperglycemia  diabetes  type  2  T2D  blood  glucose  postprandial  spike  peak  SMBG  self  care  risk  cardiovascular  excursion  damage  vessel  wall  epithelial  atherosclerosis  peer-reviewed  research 
4 days ago by Michael.Massing
Postprandial peaks as a risk factor for cardiovascular disease: epidemiological perspectives. - PubMed - NCBI
A key issue in diabetes care is selecting glucose parameters to monitor and control. The recommendations of the American Diabetes Association for glycaemic control do not address postprandial glucose (PPG), but patients with type 2 diabetes experience wide variations in glucose levels after meals. We have observed a remarkable increase in plasma glucose two hours after breakfast and/or lunch in most non-insulin-treated patients; for up to 40% of them the increase is >40 mg/dl (2.2 mmol/l). As many as 70% of patients with an HbA1c <7% have PPG values >160 mg/dl (8.9 mmol/l) after meals. Fasting plasma glucose (FPG) is a poor indicator of plasma glucose at other times. The coefficient of correlation of FPG with plasma glucose at other times ranges from 0.50-0.70. Nor is the correlation of FPG with HbA1c very strong: in hundreds of determinations of HbA1c and FPG in our patients, the coefficient of correlation was not greater than 0.73. For the same FPG value, HbA1c varied markedly, and vice versa; further, the correlation between PPG and HbA1c was no higher than that between FPG and HbA1c (r = 0.65). Thus, monitoring in type 2 diabetes should include PPG along with FPG and HbA1c. Recent data provide direct and indirect evidence suggesting that PPG is independently related to cardiovascular disease (CVD), and supporting the idea that PPG should be assessed and glucose excursions with meals should be controlled: 1. Studies conducted by other investigators and ourselves in patients with type 2 diabetes have shown that the incidence of CVD is independently related to postprandial or post-OGTT (oral glucose tolerance test) blood glucose at baseline. In addition, data collected in the general population show an association between 2-hour OGTT plasma glucose (a surrogate of PPG) and cardiovascular morbidity and mortality that is independent of FPG. Also, subjects with impaired glucose tolerance (IGT) and isolated post-challenge hyperglycaemia have an increased cardiovascular risk over subjects with normal glucose tolerance (NGT). We found that IGT subjects had a risk of carotid stenosis 3-fold higher than subjects with NGT, even after adjustment for several confounders. Thus, a modest increase in post-OGTT plasma glucose and, by extrapolation, PPG seems to have a major detrimental effect on the arteries. 2. When FPG and/or HbA1c were the targets of glucose control in studies of patients with type 2 diabetes (the UGDP, VACSDM, and UKPDS) the effects on CVD were minimal. However, when the targets of glucose control included PPG (the Kumamoto Study and DIGAMI Study) favorable effects on CVD were observed. 3. There is experimental data suggesting that acute hyperglycaemia can exert deleterious effects on the arterial wall through mechanisms including oxidative stress, endothelial dysfunction, and activation of the coagulation cascade. This evidence prompted the European Diabetes Policy Group to set postprandial targets for blood glucose control: postprandial peaks should not exceed 135 mg/dl (7.5 mmol/ml) to reduce arterial risk and should not exceed 160 mg/dl (8.9 mmol/l) to reduce microvascular risk. Thus, glucose care in diabetes is not only "fasting glucose care" or "HbA1c care" but is also "postprandial glucose care."
hyperglycemia  diabetes  type  2  T2D  blood  glucose  postprandial  spike  peak  SMBG  self  care  risk  cardiovascular  excursion  peer-reviewed  research 
4 days ago by Michael.Massing
Peak-time determination of post-meal glucose excursions in insulin-treated diabetic patients. - PubMed - NCBI
The mean peak time after breakfast was 72+/-23 min, which was reached in less than 90 min in 80% of the patients. The apparent glucose rate of increase from pre-meal to the maximum postprandial value was 1.23+/-0.76 mg/dL/min, while the glucose rate of decrease was 0.82+/-0.70 mg/dL/min. Peak time correlated with the amplitude of postprandial excursions, but not with the peak glucose value. Also, peak times were similar after breakfast, lunch and dinner, and in type 1 and type 2 diabetic patients.
To best assess peak postprandial glucose levels, the optimal time for blood glucose monitoring is about 1h and 15 min after the start of the meal, albeit with wide interpatient variability. Nevertheless, 80% of post-meal blood glucose peaks were observed at less than 90 min after the start of the meal.
hyperglycemia  diabetes  type  2  a  T1D  T2D  blood  glucose  postprandial  spike  peak  rhythm  meal  SMBG  timing  insulin  dependent  excursion  peer-reviewed  research 
4 days ago by Michael.Massing
Effect of carbohydrate distribution on postprandial glucose peaks with the use of continuous glucose monitoring in type 2 diabetes. - PubMed - NCBI
We investigated the effect of carbohydrate distribution on postprandial glucose peaks with continuous blood glucose monitoring (CGMS), when consuming a moderate carbohydrate diet in energy balance in subjects with type 2 diabetes.
Twenty-three subjects with type 2 diabetes were randomly assigned to each of four 3-d interventions in a crossover design with a 4-d washout period. Identical foods were provided for each treatment with a ratio of total carbohydrate to protein to fat of 40%:34%:26% but differing in carbohydrate content at each meal: even distribution (CARB-E; approximately 70 g carbohydrate), breakfast (CARB-B), lunch (CARB-L), and dinner(CARB-D), each providing approximately 125 g carbohydrate in the loaded meal in a 9-MJ diet. Glucose concentrations were continuously measured with CGMS. Outcomes were assessed by postprandial peak glucose (G(max)), time spent > 12 mmol/L (T > 12), and total area under the glucose curve (AUC(20)).
Daily G(max) differed between treatments (P = 0.003) with CARB-L (14.2 +/- 1.0 mmol/L), CARB-E (14.5 +/- 0.9 mmol/L), and CARB-D (14.6 +/- 0.8 mmol/L) being similar but lower than CARB-B (16.5 +/- 0.8 mmol/L). Meal G(max) was weakly related to carbohydrate amount and glycemic load (r = 0.40-0.44). T > 12 differed between treatments (P = 0.014), and a treatment x fasting blood glucose (FBG) interaction (P = 0.003) was observed with CARB-L (184 +/- 74 min) < CARB-B (190 +/- 49 min) < CARB-D (234 +/- 87 min) < CARB-E (262 +/- 91 min). Total AUC(20) was not significantly different between treatments. After adjustment for FBG, treatment became significant (P = 0.006); CARB-L (10 049 +/- 718 mmol/L x 20 h) < CARB-E (10 493 +/- 706 mmol/L x 20 h) < CARB-B (10 603 +/- 642 mmol/L x 20 h) < CARB-D (10 717 +/- 638 mmol/L x 20 h).
CARB-E did not optimize blood glucose control as assessed by postprandial peaks, whereas CARB-L provided the most favorable postprandial profile.
hyperglycemia  diabetes  type  2  T2D  blood  glucose  postprandial  spike  peak  rhythm  meal  excursion  peer-reviewed  research 
4 days ago by Michael.Massing
Can Postprandial Blood Glucose Excursion Be Predicted in Type 2 Diabetes?
We investigated the relationship between carbohydrate intake and postprandial blood glucose (BG) levels to determine the most influential meal for type 2 diabetic subjects treated with basal insulin and needing prandial insulin.


Three-day BG profiles for 37 type 2 diabetic subjects, with A1C levels of 7.7%, treated with sulfonylurea and metformin, and well titrated on insulin glargine, were analyzed using a continuous glucose monitoring system. Food intake from 680 meals was recorded and quantified during continuous glucose monitoring.


The median BG excursion (ΔBG) was higher at breakfast than at lunch or dinner (111 [81; 160] vs. 69.5 [41.5; 106] and 82.5 mg/dl [53; 119] mg/dl, P < 0.0001). There was a weak overall correlation between ΔBG and carbohydrate intake. Correlation improved when mealtime was taken into account. Simple relationships were established: ΔBG (mg/dl) = 65 × carbohydrate/body weight + 73 for breakfast (R2 = 0.20, P < 0.0001); the slope was reduced by half at lunch and by one-third at dinner. Twelve relevant variables likely to affect ΔBG were integrated into a polynomial equation. This model accounted for 49% of ΔBG variability. Two groups of patients were identified: responders, in whom ΔBG was well correlated with carbohydrate intake (R2 ≥ 0.30, n = 8), and nonresponders (R2 < 0.30, n = 29). Responders exhibited a greater insulinopenic profile than nonresponders.


The carbohydrate intake in responders clearly drives ΔBG, whereas, in nonresponders, other factors predominate. This sort of characterization should be used to guide therapeutic choices toward more targeted care with improved type 2 diabetes management.
blood  glucose  excursions  SMBG  metabolic  rhythms  mealtime  self  management  care  peak  excursion  spike  peer-reviewed  research 
8 days ago by Michael.Massing
Increasing Adiposity | Lifestyle Behaviors | JAMA | The JAMA Network
Ninety years ago, an editorial in JAMA questioned the prevailing approach to obesity treatment: “When we read that ‘the fat woman has the remedy in her own hands—or rather between her own teeth’ . . . there is an implication that obesity is usually merely the result of unsatisfactory dietary bookkeeping. . . [Although logic suggests that body fat] may be decreased by altering the balance sheet through diminished intake, or increased output, or both . . . [t]he problem is not really so simple and uncomplicated as it is pictured.”1 Since then, billions of dollars have been spent on research into the biological factors affecting body weight, but the near-universal remedy remains virtually the same, to eat less and move more. According to an alternative view, chronic overeating represents a manifestation rather than the primary cause of increasing adiposity. Attempts to lower body weight without addressing the biological drivers of weight gain, including the quality of the diet, will inevitably fail for most individuals. This Viewpoint summarizes the evidence for this seemingly counterintuitive hypothesis, versions of which have been debated for more than a century.2
fat  management  control  carbohydrates  insulin  high  glycemic  processed  food  peer-reviewed  research  correlation  causation  diet  foods 
9 weeks ago by Michael.Massing
Always Hungry? Here’s Why - The New York Times
As it turns out, many biological factors affect the storage of calories in fat cells, including genetics, levels of physical activity, sleep and stress. But one has an indisputably dominant role: the hormone insulin. We know that excess insulin treatment for diabetes causes weight gain, and insulin deficiency causes weight loss. And of everything we eat, highly refined and rapidly digestible carbohydrates produce the most insulin.
fat  management  control  carbohydrates  insulin  high  glycemic  processed  food  peer-reviewed  research  correlation  causation  diet  foods 
9 weeks ago by Michael.Massing
Think you know why obesity rates are rising? You’re probably wrong. | Public Health
Work isn’t taking time away from cooking: We’re actually working fewer hours; what’s increased is leisure time and transportation time.

We may be exercising more. Four minutes more per day in 2012 than in 2003, although that’s self reported. The authors also believe a decline in physically demanding work doesn’t account for obesity rates, since obesity has risen equally among all groups, including children.

Food isn’t too expensive. Or at least, we’re only spending less than 10% of our income on it, compared to 20% in the 1950s and 25% in the 1930s (which is comparable to medium-income countries today). The implication: we could afford to spend more on food, we just don’t want to.

We’re eating lots of fruit and veggies. Now, it’s not enough to meet guidelines (in fact, even if we ate all the veggies produced in the US, we still wouldn’t meet the guidelines). But fruit and vegetable availability has increased over time, and consumption has been relatively steady.

It’s not food deserts. Low-income neighborhoods have fewer supermarkets, but distance to a supermarket doesn’t correlate with obesity or the quality of a person’s diet. When a new supermarket opens, residents’ fruit and vegetable consumption doesn’t change.

It could be TV and video games. That fits the time trend; they specifically track the introduction of VCRs.

It could be sodapop. Consumption of sugar-sweetened beverages is going up and up, and the timing is right.

Or carbs in general. The authors don’t dig into this one, but see this JAMA article (or the accompanying NYT op-ed) for an explanation. Carbs promote insulin which promotes hunger and weight gain. And back to the economists, they point out that carb intake increased most sharply during the 1980s focus on lowering dietary fat.
obesity  correlation  causation  trend  peer-reviewed  research  public  health  epidemiology  earnest 
9 weeks ago by Michael.Massing
Do multivitamin supplements increase mortality risk? | Public Health
An unescapable facet of public health is that we lumber forward with our scientific methods in an inescapable fight against powerful industries that produce the conditions in which ill-health forms and is reproduced.
vitamin  supplements  benefit  mortality  risk  peer-reviewed  research 
9 weeks ago by Michael.Massing
Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. - PubMed - NCBI
9 of 11 trials testing high-dosage vitamin E (> or =400 IU/d) showed increased risk (risk difference > 0) for all-cause mortality in comparisons of vitamin E versus control. The pooled all-cause mortality risk difference in high-dosage vitamin E trials was 39 per 10,000 persons (95% CI, 3 to 74 per 10,000 persons; P = 0.035). For low-dosage vitamin E trials, the risk difference was -16 per 10,000 persons (CI, -41 to 10 per 10,000 persons; P > 0.2). A dose-response analysis showed a statistically significant relationship between vitamin E dosage and all-cause mortality, with increased risk of dosages greater than 150 IU/d.
High-dosage (> or =400 IU/d) trials were often small and were performed in patients with chronic diseases. The generalizability of the findings to healthy adults is uncertain. Precise estimation of the threshold at which risk increases is difficult.
High-dosage (> or =400 IU/d) vitamin E supplements may increase all-cause mortality and should be avoided.
vitamin  E  mortality  risk  dosage  dose-dependent  peer-reviewed  research 
9 weeks ago by Michael.Massing
Is Sexual RacismReallyRacism? Distinguishing Attitudes Toward Sexual Racism and Generic Racism Among Gay and Bisexual Men | SpringerLink
Sexual racism is a specific form of racial prejudice enacted in the context of sex or romance. Online, people use sex and dating profiles to describe racialized attraction through language such as “Not attracted to Asians.” Among gay and bisexual men, sexual racism is a highly contentious issue. Although some characterize discrimination among partners on the basis of race as a form of racism, others present it as a matter of preference. In May 2011, 2177 gay and bisexual men in Australia participated in an online survey that assessed how acceptably they viewed online sexual racism. Although the men sampled displayed diverse attitudes, many were remarkably tolerant of sexual racism. We conducted two multiple linear regression analyses to compare factors related to men’s attitudes toward sexual racism online and their racist attitudes more broadly. Almost every identified factor associated with men’s racist attitudes was also related to their attitudes toward sexual racism. The only differences were between men who identified as Asian or Indian. Sexual racism, therefore, is closely associated with generic racist attitudes, which challenges the idea of racial attraction as solely a matter of personal preference.
sexual  racism  gay  community  ethos  mores  Australia  correlation  peer-reviewed  research  self-esteem  internalized 
12 weeks ago by Michael.Massing
Sexual racism in gay communities: negotiating the ethnosexual marketplace
This qualitative study was an in-depth examination of sexual racism (i.e., racism occurring in sexual contexts) within the gay community of the Seattle metropolitan area. Data was collected through key informant interviews and focus groups with self-identified gay Asian/Pacific Islander, African American/Black, and White men. Data analyses using a grounded theory approach revealed a variety of social locations in which sexual racism manifests including the internet, pornographic media, gay clubs and bars, casual/anonymous sexual encounters, and romantic relationships. Within these locations, sexual racism was reported to take different forms, manifesting as ethnosexual stereotypes, racial fetishism, and race-based sexual rejection. Participants of color identified internalized sexual racism, decreased self-esteem, and psychological distress as the primary psychological consequences of sexual racism. The data analyses revealed quantitatively and qualitatively distinct racial pressures operating in the gay community in Seattle. Participants estimated that compared to the heterosexual community, their gay community was more racially stratified and exhibited higher rates of sexual racism. They described the uniquely sexual basis of racial stereotypes and pointed to a skewed set of social norms operating in the gay community which allow greater expression of sexual racism than in the heterosexual community. Finally, the data revealed key differences in the psychological impact of sexual racism reported by Asian and Black gay men. An emergent hypothesis is presented outlining the relationships between experienced sexual racism and its sequelae, as well as protective factors. Theoretical, research, and clinical implications are discussed.
sexual  racism  gay  community  ethos  mores  US  Seattle  peer-reviewed  research  self-esteem  internalized 
12 weeks ago by Michael.Massing
Persistence of the efficacy of zoster vaccine in the shingles prevention study and the short-term persistence substudy. - PubMed - NCBI
In the STPS as compared to the SPS, vaccine efficacy for HZ burden of illness decreased from 61.1% to 50.1%, vaccine efficacy for the incidence of PHN decreased from 66.5% to 60.1%, and vaccine efficacy for the incidence of HZ decreased from 51.3% to 39.6%, although the differences were not statistically significant. Analysis of vaccine efficacy in each year after vaccination for all 3 outcomes showed a decrease in vaccine efficacy after year 1, with a further decline thereafter. Vaccine efficacy was statistically significant for the incidence of HZ and the HZ burden of illness through year 5.
shingles  prevention  study  followup  short-term  persistence  herpes  zoster  vaccine  efficacy  peer-reviewed  research 
april 2017 by Michael.Massing
Salacia reticulata (Kothala himbutu) revisited; a missed opportunity to treat diabetes and obesity?
The evidence available from animal and human studies point towards effective reduction of plasma glucose and weight in SR treated subjects. Alpha glucosidase inhibition is the most likely mechanism for the reduction of postprandial glucose. Reduction of fasting glucose, improvement in glucose handling following glucose loading and weight is most likely explained by decreased insulin resistance mediated through increasing adiponectin, suppression of lipogenesis and increased lipolysis.

Meticulously planned studies both animal and human, addressing the unresolved issues as well as studies that involve larger number of human subjects specifically addressing long-term outcomes and safety of SR treatment needs to be performed in the future.
Salacia  reticulata  diabetes  glucose  blood  insulin  postprandial  plasma  HbA1c  serum  lipids  peer-reviewed  research  in  vivo  vitro  clinical  human  body  fat  management  review  overview 
april 2017 by Michael.Massing
Anti-diabetic and Anti-hyperlipidemic Effects and Safety of Salacia reticulata and Related Species. - PubMed - NCBI
Extracts of Salacia reticulata Wight (Hypocrataceae) roots, stems, and leaves have been used in Asia for hundreds of years for the folkloric treatment of diabetes and other health problems. Constituents that have been identified as exhibiting anti-diabetic effects include salacinol, kotalanol, ponkorinol, salaprinol, and their corresponding de-0-sulfonated compounds. Mangiferin, kotalagenin 16-acetate and various proanthocyanidin oligomers have also been isolated. Studies indicate that Salacia extracts modulate multiple targets that influence carbohydrate and lipid metabolism including α-glucosidase, aldose reductase, pancreatic lipase, peroxisomal proliferator-activated receptor-α, glucose transporter-4 mediated glucose uptake, and angiotensin II type 1 receptor. Furthermore, Salacia extracts exhibit free radical scavenging, antioxidant and hepatoprotectant activities. In human studies, Salacia extracts have been shown to decrease plasma glucose and insulin levels, decrease HbA1c, and modulate serum lipid levels with no adverse effects being reported. Similar results have been demonstrated in rat and mouse models as well as in vitro systems. Safety of S. reticulata and other Salacia species as S. oblonga and S. chinensis in rats and mice indicate that extracts are exceedingly safe. No clinical studies have examined the effects of Salacia extracts on human weight loss, although weight loss and decreases in weight gain have been demonstrated in animal models. Because of the large number of pharmacologically active compounds, it is difficult to establish standards for extracts.
Salacia  reticulata  diabetes  glucose  blood  insulin  postprandial  plasma  HbA1c  serum  lipids  peer-reviewed  research  in  vivo  vitro  clinical  human  body  fat  management 
april 2017 by Michael.Massing
Clinical and microbiological effects of Lactobacillus reuteri probiotics in the treatment of chronic periodontitis: a randomized placebo-controlled study
Thirty chronic periodontitis patients were recruited and monitored clinically and microbiologically at baseline, 3, 6, 9 and 12 weeks after therapy. All patients received one-stage full-mouth disinfection and randomly assigned over a test (SRP + probiotic, n = 15) or control (SRP + placebo, n = 15) group. The lozenges were used two times a day for 12 weeks.

At week 12, all clinical parameters were significantly reduced in both groups, while there was significantly more pocket depth reduction (p < 0.05) and attachment gain (p < 0.05) in moderate and deep pockets; more Porphyromonas gingivalis reduction was observed in the SRP + probiotic group.

The results indicate that oral administration of L. reuteri lozenges could be a useful adjunct to SRP in chronic periodontitis.
periodontitis  scaling  root  planing  SRP  Lactobacillus  reuteri  probiotic  adjunct  therapy  peer-reviewed  research 
april 2017 by Michael.Massing
The Obesity-Impulsivity Axis: Potential Metabolic Interventions in Chronic Psychiatric Patients. - PubMed - NCBI
Recently, a strong association was found between impulsivity and obesity which may explain the high prevalence of metabolic disorders in individuals with mental illness even in the absence of exposure to psychotropic drugs. As the overlapping neurobiology of impulsivity and obesity is being unraveled, the question asked louder and louder is whether they should be treated concomitantly. The treatment of obesity and metabolic dysregulations in chronic psychiatric patients is currently underutilized and often initiated late, making correction more difficult to achieve. Addressing obesity and metabolic dysfunction in a preventive manner may not only lower morbidity and mortality but also the excessive impulsivity, decreasing the risk for aggression. In this review, we take a look beyond psychopharmacological interventions and discuss dietary and physical therapy approaches.
self  treatment  management  behavior  dietary  diet  intervention  correlation  obesity  impulsivity  impulse  control  metabolic  disorder  metabolism  mental  illness  neurobiology  peer-reviewed  research  aggression  physical  therapy 
april 2017 by Michael.Massing
A double-blind, placebo-controlled, exploratory trial of chromium picolinate in atypical depression: effect on carbohydrate craving. - PubMed - NCBI
In a small pilot trial, patients with atypical depression demonstrated significant positive therapeutic response to chromium picolinate. This finding is of interest because of the demonstrated link between depression, decreased insulin sensitivity, and subsequent diabetes and chromium picolinate's insulin enhancing effect.
: In this double-blind, multicenter, 8-week replication study, 113 adult outpatients with atypical depression were randomized 2:1 to receive 600 mug/day of elemental chromium, as provided by chromium picolinate (CrPic), or placebo. Primary efficacy measures were the 29-item Hamilton Depression Rating Scale (HAM-D-29) and the Clinical Global Impressions Improvement Scale (CGI-I).
: Of the 113 randomized patients, 110 (70 CrPic, 40 placebo) constituted the intent-to-treat (ITT) population (i.e., received at least one dose of study medication and completed at least one efficacy evaluation) and 75 (50 CrPic, 25 placebo) were evaluable (i.e., took at least 80% of study drug with no significant protocol deviations). In the evaluable population, mean age was 46 years, 69% were female, 81% were Caucasian, and mean body mass index (BMI) was 29.7. There was no significant difference between the CrPic and placebo groups in both the ITT and evaluable populations on the primary efficacy measures, with both groups showing significant improvement from baseline on total HAM-D-29 scores during the course of treatment (p < 0.0001). However, in the evaluable population, the CrPic group showed significant improvements from baseline compared with the placebo group on 4 HAM-D-29 items: appetite increase, increased eating, carbohydrate craving, and diurnal variation of feelings. A supplemental analysis of data from the subset of 41 patients in the ITT population with high carbohydrate craving (26 CrPic, 15 placebo; mean BMI = 31.1) showed that the CrPic patients had significantly greater response on total HAM-D-29 scores than the placebo group (65% vs. 33%; p < 0.05) as well as significantly greater improvements on the following HAM-D-29 items: appetite increase, increased eating, carbohydrate craving, and genital symptoms (e.g., level of libido). Chromium treatment was well-tolerated.
: The study did not include a placebo run-in period, did not require minimum duration or severity of depression, and enrolled patients with major depression, dysthymia, or depression NOS.
: In a population of adults with atypical depression, most of whom were overweight or obese, CrPic produced improvement on the following HAM-D-29 items: appetite increase, increased eating, carbohydrate craving, and diurnal variation of feelings. In a subpopulation of patients with high carbohydrate craving, overall HAM-D-29 scores improved significantly in patients treated with CrPic compared with placebo. The results of this study suggest that the main effect of chromium was on carbohydrate craving and appetite regulation in depressed patients and that 600 mug of elemental chromium may be beneficial for patients with atypical depression who also have severe carbohydrate craving. Further studies are needed to evaluate chromium in depressed patients specifically selected for symptoms of increased appetite and carbohydrate craving as well as to determine whether a higher dose of chromium would have an effect on mood.
carbohydrate  craving  chromium  picolinate  peer-reviewed  research  depression  psychotropic  effects 
march 2017 by Michael.Massing
Dietary chromium supplementation for targeted treatment of diabetes patients with comorbid depression and binge eating. - PubMed - NCBI
Dietary chromium supplementation for the treatment of diabetes remains controversial. The prevailing view that chromium supplementation for glucose regulation is unjustified has been based upon prior studies showing mixed, modest-sized effects in patients with type 2 diabetes (T2DM). Based on chromium's potential to improve insulin, dopamine, and serotonin function, we hypothesize that chromium has a greater glucoregulatory effect in individuals who have concurrent disturbances in dopamine and serotonin function--that is, complex patients with comorbid diabetes, depression, and binge eating. We propose, as suggested by the collective data to date, the need to go beyond the "one size fits all" approach to chromium supplementation and put forth a series of experiments designed to link physiological and neurobehavioral processes in the chromium response phenotype.
chromium  picolinate  comorbidity  depression  T2D  type  2  diabetes  individual  response  variability  treatment  intervention  psychotropic  appetite  carbohydrate  craving  peer-reviewed  research  Plexus  opinion  overview 
march 2017 by Michael.Massing
Psychiatric Disorders and Polyphenols: Can They Be Helpful in Therapy? - PubMed - NCBI
The prevalence of psychiatric disorders permanently increases. Polyphenolic compounds can be involved in modulation of mental health including brain plasticity, behaviour, mood, depression, and cognition. In addition to their antioxidant ability other biomodulating properties have been observed. In the pathogenesis of depression disturbance in neurotransmitters, increased inflammatory processes, defects in neurogenesis and synaptic plasticity, mitochondrial dysfunction, and redox imbalance are observed. Ginkgo biloba, green tea, and Quercus robur extracts and curcumin can affect neuronal system in depressive patients. ADHD patients treated with antipsychotic drugs, especially stimulants, report significant adverse effects; therefore, an alternative treatment is searched for. An extract from Ginkgo biloba and from Pinus pinaster bark, Pycnogenol, could become promising complementary supplements in ADHD treatment. Schizophrenia is a devastating mental disorder, with oxidative stress involved in its pathophysiology. The direct interference of polyphenols with schizophrenia pathophysiology has not been reported yet. However, increased oxidative stress caused by haloperidol was inhibited ex vivo by different polyphenols. Curcumin, extract from green tea and from Ginkgo biloba, may have benefits on serious side effects associated with administration of neuroleptics to patients suffering from schizophrenia. Polyphenols in the diet have the potential to become medicaments in the field of mental health after a thorough study of their mechanism of action.
polyphenols  depression  psychotropics  treatment  peer-reviewed  research  overview  pycogenol  green  tea  extract  gingko 
march 2017 by Michael.Massing
Natural polyphenols in the management of major depression. - PubMed - NCBI
Natural polyphenols, the non-essential micronutrients, found in array of plant products, are known to affect various physiological and biochemical functions in the body. Studies have shown the protective effect of these polyphenols in different neurological and mental disorders. These polyphenols modulate monoaminergic neurotransmission in the brain and thus possess antidepressant-like activity at least in animal models of depression.
The present review discusses the use of these natural polyphenols in the treatment of major depression. The review article discusses the antidepressant potential of some important polyphenols such as amentoflavone, apigenin, chlorogenic acid, curcumin, ferulic acid, hesperidin, rutin, quercetin, naringenin, resveratrol, ellagic acid, nobiletin and proanthocyanidins. The mechanism of action of these polyphenols in the treatment of major depression is also discussed in detail.
There is an exciting prospect in the discovery of natural polyphenols as therapeutic agents in the treatment of major depression.
polyphenols  depression  psychotropics  treatment  peer-reviewed  research  chlorogenic  acid 
march 2017 by Michael.Massing
Dietary supplementation of n-3 PUFA reduces weight gain and improves postprandial lipaemia and the associated inflammatory response in the obese JC... - PubMed - NCBI
JCR:LA-cp rats (14 weeks of age) were fed either a control, isocaloric, lipid balanced diet (15% w/w total fat, 1.0% cholesterol, P:S ratio 0.4), a lipid balanced diet with 5% n-3 PUFA [fish oil derived eicosapentaenoic acid (EPA)/docosahexaenoic acid (DHA)] or a lipid balanced diet with 10% n-3 PUFA for 3 weeks. Fasting plasma lipid, cytokine levels, postprandial chylomicron (apoB48) metabolism and the postprandial inflammatory response [haptoglobin and lipopolysaccharide binding protein (LBP)] were assessed following a standardized 'oral fat challenge'.
n-3 PUFA treatment resulted in a significant improvement (i.e. decrease) in the postprandial response for triglyceride (45%) (p < 0.05), apoB48 (45%) (p < 0.03) and LBP (33%) (p < 0.05) compared to controls (measured as area under the clearance curve). In contrast, we observed a significant elevation in postprandial haptoglobin (165%) (p < 0.001) in obese rats supplemented with 10% n-3 PUFA. Treatment with 5% n-3 PUFA in the JCR:LA-cp obese animals resulted in a complementary decrease in total body weight gain (6%) (p < 0.001) and an increase (i.e. improvement) in adiponectin (33%) (p < 0.05) compared to controls, without a concomitant reduction in food intake.
Acute dietary n-3 PUFA dietary supplementation can improve fasting as well as postprandial lipid metabolism and components of the associated inflammatory response in the JCR:LA-cp rat. Further, moderate dose n-3 PUFA supplementation may reduce corresponding body weight during conditions of hypercholesterolaemia and/or modulate inflammation associated with obesity and the metabolic syndrome
fish  oil  omega-3  fatty  acids  EPA  DHA  peer-reviewed  research  overview  risk  benefit  diabetes  triglycerides  dyslipidemia  animal  in  vivo 
march 2017 by Michael.Massing
Effects of eicosapentaenoic acid (EPA) treatment on insulin sensitivity in an animal model of diabetes: improvement of the inflammatory status. - PubMed - NCBI
The major goal of this study was to analyze the effects of fatty acid supplementation on both insulin sensitivity and inflammatory status in an animal model of type 2 diabetes. Diabetic rats (Goto-Kakizaki model) were treated with eicosapentaenoic acid (EPA) or linoleic acid at 0.5 g/kg body weigh (bw) dose. In vivo incorporation of (14)C-triolein into adipose tissue was improved by the ω-3 administration. In vitro incubations of adipose tissue slices from EPA-treated rats showed an increase in (14)C-palmitate incorporation into the lipid fraction. These observations were linked with a decreased rate of fatty acid oxidation. EPA treatment resulted in a decreased fatty acid oxidation in incubated strips from extensor digitorum longus (EDL) muscles. The changes in lipid utilization were associated with a decrease in insulin plasma concentration, suggesting an improvement in insulin sensitivity. These changes in lipid metabolism were associated with an activation of AMP-activated protein kinase (AMPK) in white adipose tissue. In addition, EPA treatment resulted in a decreased content of peroxisome proliferator-activated receptor-α (PPARα) and PPARδ and in increased GLUT4 expression in skeletal muscle. Moreover, EPA increased 2-deoxy-D-[(14)C]glucose (2-DOG) uptake in C2C12 myotubes, suggesting an improvement in glucose metabolism. Concerning the inflammatory status, EPA treatment resulted in a decreased gene expression for both tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) both in skeletal muscle and adipose tissue. The data suggest that EPA treatment to diabetic rats clearly improves lipid metabolism although the evidences on insulin sensitization are less clear.
omega-3  fatty  acids  EPA  DHA  peer-reviewed  research  inflammation  benefit  diabetes  triglycerides  dyslipidemia  insulin  sensitivity  in  vivo  animal 
march 2017 by Michael.Massing
Role of ω3 long-chain polyunsaturated fatty acids in reducing cardio-metabolic risk factors. - PubMed - NCBI
Fish oil, rich in eicosapentaenoic (EPA, 20:5ω3) and docosahexaenoic (DHA, 22:6ω3) acids, has been found to cause a modest reduction in blood pressure at a dose level of >3g/d both in untreated and treated hypertensives. Whilst a multitude of mechanisms may contribute to the blood pressure lowering action of ω3 LC-PUFA, improved vascular endothelial cell function appears to play a central role. Recent studies which evaluated the potential benefits of fish oil in type-2 diabetes have helped to alleviate concerns raised in some previous studies which used relatively large dose (5-8 g/d) and reported a worsening of glycemic control. Several meta-analyses have confirmed that the most consistent action of ω3 LC-PUFA in insulin resistance and type-2 diabetes is the reduction in triglycerides. In some studies, fish oil has been found to cause a small rise in LDL-cholesterol, but a change in the LDL particle size, from the smaller more atherogenic form to the larger, less damaging particle size, have also been noted. ω3 LC-PUFA are effective modulators of the inflammation that accompanies several cardio-metabolic abnormalities. Taking into consideration the pleiotropic nature of their actions, it can be concluded that dietary supplementation with ω3 LC-PUFA will lead to improvements in cardio-metabolic health parameters. These fatty acids pose only minor side effects and more importantly, do not interact adversely with the common drug therapies used in the management and treatment of hypertension, dyslipidemia, type-2 diabetes, and obesity/metabolic syndrome, but in some instances work synergistically, thereby providing additional cardiovascular benefits.
fish  oil  omega-3  fatty  acids  EPA  DHA  peer-reviewed  research  overview  risk  benefit  diabetes  triglycerides  dyslipidemia 
march 2017 by Michael.Massing
Omega-3 Supplementation and the Neural Correlates of Negative Affect and Impulsivity: A Double-Blind, Randomized, Placebo-Controlled Trial in Midli... - PubMed - NCBI
In clinical trials, omega-3 fatty acid supplementation improves symptoms in psychiatric disorders involving dysregulated mood and impulse control, yet it is unclear whether in healthy adults omega-3 fatty acid supplementation affects mood, impulse control and the brain systems supporting these processes. Accordingly, this study tested the hypotheses that eciosapentaenoic (EPA) and docosahexaenoic (DHA) acid supplementation reduces negative affect and impulsive behaviors in healthy adults and that these changes correspond to alterations in corticolimbic and corticostriatal brain systems which support affective and impulsive processes.
Healthy volunteers (N = 272) consuming 300 mg/day or less of EPA and DHA were enrolled in a double-blind, randomized, placebo controlled clinical trial. Participants received either capsules providing 1000 mg of EPA and 400 mg of DHA versus identical appearing soybean oil capsules per day for 18 weeks. Negative affect and impulsivity were measured by questionnaire and ecological momentary assessment (EMA), as well as functional alterations in corticolimbic and corticostriatal brain systems evoked by standardized fMRI tasks.
There were no group-by-time interactions for any questionnaire or EMA measures of mood and impulsivity. Likewise, no group-by-time interactions were observed for fMRI responses evoked within corticolimbic and corticostriatal systems.
In healthy adults with low intake of omega-3 fatty acids, moderate-dose supplementation for 18 weeks did not alter affect or impulsive behaviors, nor alter corticolimbic and corticostriatal brain functionality.
impulse  control  impulsivity  mood  disorders  omega-3  EPA  DHA  supplements  brain  treatment  psychiatric  peer-reviewed  research 
march 2017 by Michael.Massing
The effects of low dose n-3 fatty acids on serum lipid profiles and insulin resistance of the elderly: a randomized controlled clinical trial. - PubMed - NCBI
This study assessed the effects of low-dose n-3 fatty acids on serum lipid profile, lipoprotein(a), apolipoprotein B, fasting glucose, insulin, and insulin resistance in a group of elderly Iranians.
A 6-month randomized, double-blind placebo-controlled clinical trial was carried out in 124 elderly residents of Kahrizak Charity Foundation aged >or= 65. The intervention group was supplemented with 1 g/day fish oil capsule (with 180 mg eicosapentaenoic acid, EPA; and 120 mg docosahexaenoic acid, DHA; a total of 300 mg n-3 fatty acids as effective constituents). Fasting blood samples were collected at baseline and after 6 months of the trial.
There were no significant effects of fish oil on the studied variables in the intervention group. In the placebo group, serum triglyceride significantly increased and high-density lipoprotein cholesterol significantly decreased (p = 0.01 and p = 0.009, respectively). By repeated measurement analysis after adjustments, the overall decrease in serum triglycerides compared with placebo was significant (p = 0.04).
Supplementation with low dose n-3 fatty acids for 6 months could significantly protect elderly Iranians from a rise in serum triglycerides.
supplements  fish  oil  EPA  cholesterol  dyslipidemia  high  risk  benefit  blood  lipids  insulin  resistance  aging  peer-reviewed  research 
march 2017 by Michael.Massing
Gut bacteria may play a role in Alzheimer’s disease -- ScienceDaily
Gut bacteria may play a role in Alzheimer’s disease

#alzheimersdisease #GutBacteria #microbiome #hcsm #hcsmeu
gut  flora  bacteria  Alzheimer's  brain  correlation  peer-reviewed  research  in  vivo  animal  etiology  progression  GutBacteria  hcsmeu  hcsm  microbiome  alzheimersdisease 
february 2017 by Michael.Massing
Depression From the Inside Out
My depression feels like nothing. It feels numb. It feels like not feeling. As with neuropathic pain, I can be unaware of it for long stretches of time, until I look into a mirror and see the classical mask of tragedy—that’s pain. For depression, I’m more likely to look around me, and ask myself: am I living like a depressed person? Here are six instances where the answer was yes.
Douglas  Michael  Massing  T2D  depression  type  2  diabetes  peer-reviewed  research 
november 2016 by Michael.Massing
Probiotic Therapy for Irritable Bowel Syndrome
Probiotics will likely have an emerging adjunctive therapeutic role in treating IBS. The studies to date simultaneously provide interesting observations and raise fundamental questions. Overall, many of the studies involved were small in size, of short duration, and had significant design flaws, but there is growing evidence that B. infantis is becoming the frontrunner for treatment of IBS. If larger, well-controlled studies involving other strains of probiotics are performed, we may begin to have other options regarding different probiotic species and for the treatment of more specific subsets of IBS symptoms.47

Additional issues that still need to be determined include the most effective probiotic strain, dose, and duration of therapy; whether patients should be treated for specific IBS symptoms only; and whether there is a role for maintenance IBS therapy or only IBS therapy on an as-needed basis. In addition, cost-effectiveness analysis and safety profiles still need to be addressed in large, well-designed trials. As probiotics are not considered pharmaceutical drugs, they are not currently regulated by the US Food and Drug Administration, which would promote standardization for consistent clinical trials in the future.

Probiotics may have a role as a delivery vehicle for therapeutic payloads that are released at targeted areas of inflammation throughout the intestinal tract. The majority of this research has involved probiotics in the treatment of inflammatory bowel disease, but these studies may translate into future studies for IBS. One such example is the study conducted by Steidler and Neirynck in which recombinant Lactococcus lactis, engineered to secrete interleukin-10, was administered to mice with experimental inflammatory bowel disease, which showed that the probiotic was similar to steroids.48

A recent systematic review performed by the American College of Gastroenterology Task Force on the management of IBS concluded that Lactobacillus does not appear to be effective in single organism studies and studies involving combinations of probiotics, though Bifidobacterium demonstrates some efficacy (Grade 2C evidence).47 Future avenues of research should focus on treating subtypes of IBS; evaluation of patients according to the Rome III criteria; safety, dosing, and concentrations of certain probiotics; and duration of treatment.
probiotics  supplements  peer-reviewed  research  inflammatory  bowel  syndrome  disease  review  Lactobacillus  Bifidobacterium  IBS  infantis 
august 2016 by Michael.Massing
Dexcom's Evidence Builds Case for CGM Dosing Ahead of Key FDA Meeting
Collectively, the Dexcom abstracts showed that (1) patients who engaged more frequently with their CGM device had better glucose control,2,3 (2) patients who set their low-glucose alerts (LGL) at lower levels had less variation in glucose,2 and (3) those who use CGM consistently perform fewer blood glucose tests, but have better glycemic control.3
CGM  continuous  glucose  monitoring  SMBG  self-monitored  blood  clinical  research  peer-reviewed  outcome  management  in  vivo  human 
july 2016 by Michael.Massing
Empagliflozin Slows Progression of Renal Disease in Diabetes
Dr Wanner noted, however, that the EMPA-REG trial lasted only 3 years, "so we are certainly looking to the future for more on this."

And both he and discussant of the findings at ADA, endocrinologist and epidemiologist, William Herman, MD, MPH, of the University of Michigan, Ann Arbor, stressed that the results are applicable only "to the population studied in the EMPA-REG trial" (ie, older patients with type 2 diabetes at high cardiovascular risk).

Currently, about a third of the population of type 2 diabetes fall into that category, Dr Herman said....

But Dr Herman pointed out in his talk that "the absolute differences are relatively small" in EMPA-REG and the number needed to treat with empagliflozin to achieve the renal benefits was 200.

In addition, it's possible that the findings "had to do with medications not administered," he said. "So it may not be a benefit of empagliflozin but the fact that those in the empagliflozin group did not receive medications causing harm [as patients in the trial were also allowed certain other standard therapies for diabetes]."

Overall, as well as the demonstrated renal effects, empagliflozin is "moderately effective" at lowering HbA1c and results in a 2- to 3-kg reduction in body weight, with no issue with hypoglycemia, although it does increase the risk of genitourinary infections, Dr Herman surmised....

"The range of cost between a generic established evidence-based oral therapy like metformin, the sulfonylureas, and now pioglitazone and the new agents is 100-fold. That is a big increase for, in some cases, a modest theoretical or practical advantage. So it's a problem for physicians and patients in the US."
kidney  renal  disease  drug  effects  benefit  clinical  trial  peer-reviewed  research  in  vivo  human  NNT  risk  cost  pharma  caveat 
july 2016 by Michael.Massing
Niacin Alternatives for Dyslipidemia: Fool's Gold or Gold Mine? Part I: Alternative Niacin Regimens. - PubMed - NCBI
Niacin was the first drug demonstrating lowered cholesterol prevents coronary heart disease (CHD) events, with two clinical CHD outcome studies establishing a cardioprotective niacin regimen: 1 g thrice daily with meals. Though cardioprotective, skin toxicity limits niacin's use, fostering several variations to improve tolerability. One of these, an extended-release (ER) alternative, proved immensely successful commercially, dominating clinical practice despite departing from the established regimen in several critical ways. Hence, improved tolerability may have come at the cost of diminished efficacy, posing a conundrum: Does it still help the population at risk for CHD to broaden a drug's acceptance by "watering it down"? This question is crucial at this stage now that the ER alternative failed to recapitulate the benefits of the established cardioprotective niacin regimen in two trials of the alternative approach: AIM-HIGH and HPS2-THRIVE. Part I of this review discusses how vastly the ER alternative departs from the established cardioprotective regimen, why that is important physiologically, and how it may explain the findings of AIM-HIGH and HPS2-THRIVE. Given important gaps left by statin therapy, the established cardioprotective niacin regimen remains an important evidence-based therapy for the statin intolerant or statin averse.
niacin  vitamin  B  3  overview  peer-reviewed  research  blood  glucose  supplement  interaction  risk  benefit  cholesterol  lipids  HDL  treatment  dyslipidemia  systematic  review  statin  intolerance  ER  dosage  administration  guidelines  standards 
june 2016 by Michael.Massing
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