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Vitamin D no protection against type 2 diabetes

A study investigated the claim that elevated levels of vitamin D might protect people against type 2 diabetes, but found no positive link.
There's no genetic evidence that high levels of vitamin D can prevent type 2 diabetes, a new study says.
No connection
Some previous research had suggested that elevated levels of vitamin D might protect people against type 2 diabetes, raising the possibility of a link between vitamin D deficiency and the blood sugar disease.
In this study, British researchers investigated the association between diabetes risk and vitamin D by focusing on genes that control blood levels of vitamin D. They found no connection between different variants of these genes and the risk of developing type 2 diabetes.
The results were published in The Lancet Diabetes & Endocrinology.
"Our findings suggest that interventions to reduce the risk of type 2 diabetes by increasing concentrations of vitamin D are not currently justified. Observational studies that show a strong and consistent higher risk of type 2 diabetes with lower levels of vitamin D may do so because they have thus far not been able to adequately control for distorting or confounding factors, such as physical activity levels," study author Dr. Nita Forouhi, of the University of Cambridge's School of Clinical Medicine, said in a journal news release.
Diet and exercise
The findings add to evidence showing that taking vitamin D supplements does not prevent diabetes. The only proven ways to prevent type 2 diabetes are diet and exercise, Forouhi said.
One expert noted that long-term trials that are still looking at any possible connection should be weighed in the final analysis.
The results "need careful interpretation, and long-term randomized trials of vitamin D supplementation, which are underway, remain important," Dr. Brian Buijsse, from the German Institute of Human Nutrition Potsdam-Rehbruecke in Germany, wrote in an accompanying commentary in the journal.
"The results of an [analysis] of 35 short-term trials, however, do not offer much hope that vitamin D supplementation can be used to prevent type 2 diabetes. The sky is becoming rather clouded for vitamin D in the context of preventing type 2 diabetes," he said.

Exercise combats diabetes

We have always known that exercise is good for our health, but did you know that exercise also wards off diabetes by increasing your insulin sensitivity?
We have always known that exercise is good for our health, but did you know that exercise also wards off diabetes by increasing your insulin sensitivity?
According to researchers, exercise helps increase the body's sensitivity to insulin by making reactive oxygen species, or "free radicals," which antioxidants work against. These free radicals are thought to damage cells and speed the ageing process, but they are also used by the body to prevent cell damage after exercising.
"When you exercise you do improve your insulin sensitivity, and if you are at risk for diabetes improving insulin sensitivity is good," said Dr C Ronald Kahn, the Mary K Iacocca Professor at the Joslin Diabetes Centre and Harvard Medical School.
Part of the reason that exercise improves insulin sensitivity is that it causes oxidative stress on the muscles. The muscles respond to this stress by creating free radicals, Kahn said.
Antioxidants may be counterproductive
The beneficial effects of exercise on insulin sensitivity may, however, be blocked by taking antioxidants like vitamins C and E. These vitamins block the creation of free radicals that promote insulin sensitivity.
"If you take antioxidants like vitamins C and E, you block the oxidative stress response, but you also block the beneficial effects of exercise on insulin sensitivity," said Kahn in an online report of the Proceedings of the National Academy of Sciences.
For the study, Kahn's team looked at the benefit of exercise in increasing insulin resistance in 39 young men, roughly half of whom were taking supplemental vitamins C and E. Kahn's group found that men taking vitamin supplements had no change in their insulin resistance, but men not taking vitamins had an increase in free radicals, which increases insulin resistance. A month after stopping the vitamin supplements insulin sensitivity was restored, the researchers noted.
"If you are exercising, in part, to reduce diabetes risk, you shouldn't take vitamin C and E, because you are going to block some of the beneficial effect of the exercise to prevent the diabetes," Kahn said.
“Substantial uncertainty” on use of antioxidants
This study raises doubts about the benefits of taking antioxidant supplements, but not about the value of these vitamins in the foods people eat, according to Dr David L Katz, director of the Prevention Research Centre at Yale University School of Medicine.
"We have long held out hope that antioxidant supplements, among them vitamin C, vitamin E, beta carotene, and more recently lycopene and others, would help prevent diseases from the common cold to cancer, heart disease to diabetes," Katz said. "But to date, virtually all of the best research evidence is contrary to this hope."
This study has a counter-intuitive conclusion, namely that antioxidant supplements may actually interfere with the beneficial effects of exercise on insulin sensitivity, Katz said. "This is a small and short-term study, and thus cannot tell us definitively that antioxidant supplements are harmful in diabetes or the insulin-resistant state that often precedes it. But that is precisely what the study suggests may be true," Katz said.
For now, there is substantial uncertainty about any health benefits and the potential harms of antioxidants as supplements, Katz said. "But we have no such confusion about the powerful health-promoting effects of wholesome, mostly plant-based diets and regular physical activity." (Steven Reinberg/HealthDay News, May 2009)

Diabetes: Mediterranean diet best

A low-carbohydrate, Mediterranean-style diet is more effective than a typical low-fat, kilojoule-restricted diet for diabetes management.
A low-carbohydrate, Mediterranean-style diet is more effective than a typical low-fat, kilojoule-restricted diet for diabetes management, according to a study released Monday.
Not only did the Mediterranean diet lead to greater weight loss, it also resulted in better blood-sugar control, delayed the need for blood sugar-lowering medication, and improved some heart-disease risk factors, the study team found.
Mediterranean-style eating generally means plenty of fruits, vegetables and whole grains, limited amounts of red meat and processed foods, and a relatively high amount of fat from olive oil and nuts, and few carbohydrates. A typical low-fat diet advises cutting down on all types of dietary fat.
Both Mediterranean and low-fat diets are recommended for weight loss in overweight and obese patients with type 2 diabetes. However, there have been few direct, long-term studies comparing the two.
Greater weight loss, less medication
This led Dr Dario Giugliano, from the Second University of Naples, Italy, and associates to randomly assign 215 type 2 diabetic patients to follow either a low carbohydrate, Mediterranean-style diet or a low-fat diet for four years.
Nutritionists and dieticians counselled both groups of patients in monthly sessions for the first year and bimonthly sessions for the next three years.
After four years, 44% of patients in the Mediterranean-style diet group required medication to lower their blood sugar compared to 70% in the low-fat diet group, the researchers report in the September 1st issue of the Annals of Internal Medicine.
After one year, patients in the Mediterranean diet group also experienced greater weight loss. The absolute difference in weight loss between the two groups was -2.0 kg. The Mediterranean dieters also had trimmer waistlines.
In addition, significantly greater increases in "good" HDL-cholesterol levels and greater decreases in harmful blood fats called triglycerides were seen in the Mediterranean diet group and these heart-healthy benefits were maintained for the duration of the study.

These findings, the investigators conclude, "reinforce the message that benefits of lifestyle interventions should not be overlooked despite the drug-intensive style of medicine fuelled by the current medical literature."

Diabetes and weight loss surgery

Bariatric or weight loss surgery should be considered earlier in treatment of eligible patients to stem complications that can result from type 2 diabetes, experts say.
Bariatric (weight loss) surgery should be considered earlier in the treatment of eligible patients to help stem the serious complications that can result from diabetes according to an International Diabetes Federation (IDF) position statement presented by  leading experts at the 2nd World Congress on Interventional Therapies for Type 2 Diabetes in New York.
The statement was written by 20 leading experts in diabetes and bariatric surgery who have made a series of recommendations on the use of weight loss surgery as a cost effective treatment option for severely obese people with type 2 diabetes.
The combination of obesity and type 2 diabetes is looming as the biggest epidemic and public health issue in human history. Type 2 diabetes is one of the fastest growing diseases today with close to 300 million people affected worldwide and 450 million people forecast to have diabetes by 2030.
According to the statement there is increasing evidence that the health of obese people with type 2 diabetes, including their glucose control and other obesity related comorbidities (conditions), can benefit substantially from bariatric surgery under certain circumstances.
'Health and cost-effective therapy'
The IDF’s Taskforce on Epidemiology and Prevention of Diabetes convened the expert group with specific goals to:
•           Develop practical recommendations for clinicians on patient selection and management
•           Identify barriers to surgical access
•           Suggest health policies that ensure equitable access to surgery
•           Identify priorities for research
Co-chairperson, Professor Sir George Alberti, Senior Research Investigator, Imperial College, London, said: “Bariatric intervention is a health and cost effective therapy for type 2 diabetes and obesity with an acceptable safety profile. Bariatric surgery for severely obese people with type 2 diabetes should be considered much earlier in management rather than held back as a last resort. It should be incorporated into type 2 diabetes treatment protocols.” He also pointed out that the cut-points for action may be lower in Asian populations because of their increased risk of diabetes and heart disease.
Professor Paul Zimmet AO, Director Emeritus, Baker IDI Heart and Diabetes Institute, Melbourne and co-chairperson, said: “Bariatric surgery is a treatment that can be recommended  for people with type 2 diabetes and obesity not achieving recommended treatment targets with existing medical therapies, especially when there are other major co-morbidities such as hypertension, high cholesterol or sleep apnoea.  Surgery should be an accepted option in people who have type 2 diabetes and a body mass index (BMI) of 35 or more. The procedures must be performed within accepted guidelines and require appropriate multidisciplinary assessment prior to surgery and on-going care as well. ”
'Urgent need for world expert guidance'
Professor Francesco Rubino, Chief of the Gastrointestinal Metabolic Surgery Program at New York-Presbyterian Hospital/Weill Cornell Medical Center and Director of the 2nd World Congress on Interventional Therapies for Type 2 Diabetes said: “This is the first time the International Diabetes Federation or any major international organisation has made recommendations on this rapidly developing area of therapy. It did so because of the urgent need for world-wide expert guidance on the use of bariatric surgery because of the increasing usage. We note the need to establish appropriate measures in education and selection of patients and safe and standardised surgical procedures. Long-term follow up after surgery is essential.”
Professor John Dixon, Head of Obesity Research Unit, Department of General Practice, Monash University, Melbourne, said: “It is very important for health authorities and policy makers to understand that almost all severely obese patients cannot achieve and maintain significant weight loss. They should be treated where appropriate with bariatric surgery which can lead to remission of diabetes in up to 80% of patients. National guidelines and registers for bariatric surgery need to be developed and implemented for people with type 2 diabetes.”
The expert group warns the situation in low and middle income nations presents special problems because severe obesity is increasing at an alarming rate. As health care resources are limited, bariatric surgery should only be performed where the health budget can afford it, and that the expertise is available for both the surgery and the long-term follow up.

Weight loss surgery effective for type 2 diabetes
Several small trials have found greater weight loss and type 2 diabetes remission after bariatric surgeries compared to nonsurgical methods.
More than 20 years of evidence suggests that bariatric surgery produces greater weight loss and more type 2 diabetes remissions than nonsurgical treatments for the obese, according to a review.
Bariatric surgeries more routine
The results, from a National Institutes of Health (NIH) symposium held last year, support the idea that weight loss surgeries are effective and safe, at least within the first two to five years after surgery. But more studies of long term effects are needed, the authors say.
The NIH last held a consensus panel on the issue in 1991. Since then, bariatric surgeries have become much more routine and more small clinical trials and large observational studies on the outcomes of surgery have been done.
In a new clinical review in JAMA Surgery, experts from the National Institute of Diabetes and Digestive and Kidney Diseases and the National Heart, Lung, and Blood Institute at the NIH in Bethesda, Maryland, as well as the Group Health Cooperative in Seattle and the University of Pittsburgh Medical Centre summarise the evidence since 1991.
Several small trials have found greater weight loss and type 2 diabetes remission after bariatric surgeries compared to nonsurgical methods like dieting and behavioural therapies, they write.
Most bariatric surgeries are only approved for patients who have failed to lose significant weight with diet and exercise.
People who get the surgery tend to lose around 20 to 30 percent of their body weight in the following years, compared to little or no weight loss for similar people who do not get the surgery, according to recent long-term studies.
But there are still gaps in bariatric surgery research, the authors point out.
More studies are needed to determine how long type 2 diabetes remission lasts, to assess how often complications occur from surgery and what predicts those complications, and to measure long-term health outcomes, they write.
Common complications include hypoglycaemia, nausea or vomiting and insufficient weight loss, according to the authors.
There should also be more research into optimal dietary and nutritional management following bariatric procedures, as well as how to manage specific complications of bariatric operations. Much more evidence
In 1991, the consensus panel concluded that Roux-en-Y gastric bypass and vertical banded gastroplasty procedures were safe and effective for people with a body mass index (BMI) of 40 or more, or with a BMI of 35 or more in addition to serious medical problems like diabetes, coronary heart disease, sleep apnoea, high blood pressure or severe arthritis.
Whether or not it was meant as such, that consensus became "gospel" for doctors, hospitals and insurers, who to this day rarely agree to cover the surgery for people who do not meet those criteria, said Dr. Justin B. Dimick, chief of minimally invasive surgery at the University of Michigan in Ann Arbor.
"The evidence base then was pretty weak," he said. "Now we have much more evidence, but it's not being brought to bear on decision making."
Studies now suggest that bariatric surgery may be the best option for reversing type 2 diabetes for people with a BMI as low as 30, but the new consensus panel did not revise their 1991 guideline in this regard, he said.
"The relationship between BMI and mortality is not as strong as we thought it was, but between type 2 diabetes and death, it is," Dimick said. "A lot of people with a BMI of 40 are fairly healthy, but others are at a BMI of 33 and have type 2 diabetes and are at greater risk."
Gastric sleeve surgery
Dimick was not involved in the new review, but coauthored an accompanying editorial in JAMA.
Today, lap band surgery, in which an adjustable device is placed over the top portion of the stomach, has dropped off in popularity due to long-term complications, erosion and poor weight-loss results, Dimick said.
The most common option now is gastric sleeve surgery, in which much of the stomach is removed and the remainder is stapled into a small sleeve. The gastric sleeve procedure itself carries more risks but has had fewer long-term complications, Dimick said.
The authors do state that bariatric surgical techniques and their short-term outcomes have improved greatly since 1991.
"In general what we have learned in the last five years is it is very safe and extraordinarily effective when you compare it to nonsurgical options like diet and behavioural therapy," Dimick told Reuters Health.

Diabetes to triple by 2050

Up to a third of adults could have diabetes by 2050 if Americans continue to gain weight and avoid exercise, the Centres for Disease Control and Prevention has projected.
Up to a third of US adults could have diabetes by 2050 if Americans continue to gain weight and avoid exercise, the Centres for Disease Control and Prevention projected.
The numbers are certain to go up as the population gets older, but they will accelerate even more unless people change their behaviour, the CDC said.
"We project that, over the next 40 years, the prevalence of total diabetes (diagnosed and undiagnosed) in the United States will increase from its current level of about one in 10 adults to between one in five and one in three adults in 2050," the CDC's James Boyle and colleagues wrote.
Alarming numbers
"These are alarming numbers that show how critical it is to change the course of type-2 diabetes," CDC diabetes expert Ann Albright said.
"Successful programmes to improve lifestyle choices on healthy eating and physical activity must be made more widely available because the stakes are too high and the personal toll too devastating to fail."
The CDC says about 24 million US adults have diabetes now, most of them type-2 diabetes linked strongly with poor diet and lack of exercise.
Boyle's team took census numbers and data on current diabetes cases to make models projecting a trend. No matter what, diabetes will become more common, they said.
Projected increases
"These projected increases are largely attributable to the aging of the US population, increasing numbers of members of higher-risk minority groups in the population, and people with diabetes living longer," they wrote.
Diabetes was the seventh-leading cause of death in the United States in 2007, and is the leading cause of new cases of blindness among adults under age 75, as well as kidney failure, and leg and foot amputations not caused by injury.
"Diabetes, costing the United States more than $174 billion per year in 2007, is expected to take an increasingly large financial toll in subsequent years," Boyle's team wrote. (Reuters Health/ October 2010)

Giving up sugar no piece of cake


Veronica Schmidt dropped 3kg and became "freakishly energetic" after she gave up sugar, but it wasn't easy.
The thing that really got me was the dreams: In one, I plunged my hands into a moist, rich chocolate cake and shovelled huge hunks of it into my mouth, crumbs collecting on my chest like a bib of shame. In another, the smoking habit I gave up more than a decade ago came back to haunt me: My packet of cigarettes was empty and I needed one so badly that I crashed a cliff-top party full of shady characters and desperately searched their hands for fags.
They were the dreams of an addict. How mortifying, how incredible, that they were the result of giving up sugar. Who would have thought that saying no to biscuits, bananas and balsamic vinaigrette could have you Jonesing in your sleep? Not me.
I am not the fad-diet type. I last attempted one – the joyless liver cleansing diet – circa 1998. But in the past year or so, books and articles about quitting sugar have surfaced everywhere. Eventually I got around to reading one and immediately recognised myself in the descriptions of lethargic, spotty, overweight sugar addicts.
I was struggling to drag myself out of bed in the morning (my husband often had to pull the duvet right off me to instigate movement), yawning my way through the day and constantly fighting chocolate cravings, then beating myself up when I inevitably gave in. As always, I was fighting to keep my weight at the top end of the healthy range for my height and frequently ending up a few kilos over. Oh, and my skin was starting to look like that of a hormonal teenager.
The anti-sugar movement seemed to provide a way to finally ditch the grinding battle between want and will power. Painting sugar as an energy-sapping, skin-destroying, liver-poisoning, disease-causing addiction, it promised salvation. But diet books always do, so I went into research overdrive, reading Sarah Wilson's I Quit Sugar, Why We Get Fat by American journalist Gary Taubes and everything penned by the Australian anti-sugar crusader David Gillespie.
The science behind the movement made sense. Sugar (sucrose) is made of fructose and glucose. The fructose portion is trouble. While our bodies convert food into glucose for energy, our bodies don't make fructose and, until recent times, we only ever ate it in small amounts when fruit came into season. Every cell in the body uses glucose, while only the liver can metabolise fructose. Eating loads of the stuff means bombarding the liver, which turns fructose to fat. Fructose also bypasses the usual appetite control system so we never feel full.
But it was the experiments on sugar addiction that clinched it for me. Lab rats fed a diet high in sugar at Princeton University underwent neurochemical changes similar to those that occurred in the brains of rats addicted to cocaine and heroin. When the addicted rats were denied sugar, they withdrew so badly their teeth chattered.
No wonder that despite my best intentions I could never beat the craving for a chocolate bar: I was a fructose junkie. And what addict can consume their poison in moderation? I was ready to go cold turkey. Slavishly following Sarah Wilson's instructions, I quit all sugar – including fruit – for six weeks, before reintroducing only a small amount of high-fibre, low-sugar fruit back into my diet.
My body tingled with anxious energy and I developed an unattractive habit of ringing my hands. I thought about chocolate. A lot. I also thought about the juicy, sweet flesh of oranges. And the night my husband came home smelling of Snickers, I very nearly crawled into his mouth.
I was surprised to find that it wasn't just the sweet treats that needed to go. My basic diet, which I thought was healthy, was hiding buckets of fructose. The natural, insipid muesli I was eating for breakfast was 18 percent sugar, the balsamic vinegar I was using to make salad dressings was 15 percent sugar, and the organic, probiotic yoghurt I was spooning into my mouth was 14 percent sugar.
The overhaul paid off. The cravings disappeared and so did my spotty skin. There was a surprise bonus, too; my wrinkles retreated. Even the deep one down the middle of my forehead, known in my household as 'the axe mark', looked less cavernous. It was like someone had given me a secret shot of Botox.
I dropped three kilos and my cheek bones made a jaunty appearance. My husband kept staring at me and going on about how white the whites of my eyes were – once he woke up, that is, for I was now freakishly energetic and leaping out of bed long before him.
I felt so much better that I only just managed to stop myself becoming the type of crashing bore that preaches endlessly about her new lifestyle. I was also convinced that of all the ideas swirling around on how to halt the obesity problem – taxing certain foods, limiting food advertising to children, educating people about how to tackle emotional eating – Robert Lustig's was the only sensible one. The child obesity expert and anti-sugar campaigner insists the key to ending the epidemic is to banish sugar. Yes, I had become a sugar-free evangelist.
If only that was where the story ended. But the weight loss stopped and eventually I grew frustrated at trying sugar-free recipe after sugar-free recipe and finding them at best insipid, at worst disastrous.
I was tired of trying to eat out and finding there was nothing sugar-free on the menu, but the disenchantment really set in during times of stress. Buried under a pile of deadlines, I found myself in front of the computer shovelling popcorn into my mouth.
I wasn't hungry; I was comfort eating. Again. It pissed me off. I thought giving up sugar was going to end my long-fought battle with food and yet here I was still eating calories I didn't need, rebuking myself and then continuing to stuff my face.
Four months after I last ate sugar, I mixed up my favourite cake – a syrupy lemon and polenta number – and watched it bake, saliva pooling in my mouth. It hadn't even cooled properly when I sliced a hunk off the edge and scoffed it. It was so sweet – cloyingly sweet – and I was amazed to find that I didn't really like it. I was just as amazed to find that familiar, addictive part of me whispering, "More, more, more!"
In that moment, I realised two things: I wanted to stay sugar-free, and there is no one magic bullet for weight problems – mine or the world's. Like so many of life's problems, the answer is more complex than that. Damn it.
Sugar is found in most things that make up a healthy diet and is actually needed by the brain to function properly, says Auckland dietitian Angela Berrill.
"If someone is therefore to go 'sugar-free', they would in fact be eliminating the majority of foods we eat and need to survive. It's not only used to impart flavour to the food we eat but also as a preservative, and even as a 'filler'."
Still, cutting down is no bad thing. It's just a matter of gradually retraining your taste buds. Here are some tips to get you on your merry way:
- Fill up on nutrient-dense meals and snacks from the four main food groups. It means less likelihood of giving in to cravings.
- Try drinking herbal tea in place of sugary treats, or have a herbal tea after your meals if you're craving pudding.
- Instead of sugary fizzy drink, try soda water with a dash of mint, lemon or lime.
- Look inside your head: "Cravings can often be brought on by a 'trigger' or habit," says Berrill. "Try retraining yourself to work out why it is you feel you need something sweet."
- If you usually have something sweet after a meal, try brushing your teeth once you've eaten.
Dunedin-based dietitian Jennifer Douglas says exercise or gardening are effective distractions when you're on the verge of caving in to your cravings. Add a diet rich in wholegrain breads and cereals, protein and fruit and vegetables, to ensure a good nutrient intake over the day.
Also: "Choose low glycaemic index carbohydrates to maintain steady glucose levels in the blood and avoid the big highs and lows that can lead to sugar cravings," says Douglas.
Skipping meals won't help those sugar lows and things like chocolate and biscuits need to be out of the pantry and out of the house.
If you sense your 'addiction' to sugar may be emotionally driven, "seek support from friends, family or counselling services to work through the causes of this".

Carbohydrates are more harmful than saturated fats: new study

LONG-derided saturated fats — which are associated with an array of health problems such as heart disease — have caught a break as research reveal their intake could be doubled or even nearly tripled without driving up their level in a person’s blood.
Carbohydrates, meanwhile, are associated with heightened levels of a fatty acid linked to increased risk for diabetes and heart disease, the same study showed.
“The point is you don’t necessarily save the saturated fat that you eat, and the primary regulator of what you save in terms of fat is the carbohydrate in your diet,” senior author Jeff Volek of Ohio State University, said in the report.
The top three sources of saturated fat in Australian diets are milk and dairy products (including foods like ice-cream); biscuits, cakes and pastries; and meat and poultry (including processed meats).
Not a fan of carbs ... High-profile chef Pete Evans is among the chorus of voices backing the paleo diet, which largely eschews carbohydrates. Source: Supplied
To conduct the study, which appeared in the journal PROS ONE, scientists put 16 participants on a strict dietary regime that lasted four and a half months.
Every three weeks their diets were changed to adjust carbohydrate and total fat and saturated fat levels.
The scientists found that when carbs were reduced and saturated fat was increased, total saturated fat in the blood did not increase, and even went down in most people.
The fatty acid called palmitoleic acid, which is associated with “unhealthy metabolism of carbohydrates that can promote disease,” went down with low-carb diets and gradually increased as carbs were reintroduced, the study said.
An increase in this fatty acid indicates that a growing proportion of carbohydrates is being converted into fat instead of being burned by the body, the researchers said.
“When you consume a very low-carb diet your body preferentially burns saturated fat,” Volek said.
“We had people eat two times more saturated fat than they had been eating before entering the study, yet when we measured saturated fat in their blood, it went down in the majority of people,” he said.
Put down the fork ... Saturated fat is not the enemy. Carbohydrates are. Source: ThinkStock
The finding “challenges the conventional wisdom that has demonised saturated fat and extends our knowledge of why dietary saturated fat doesn’t correlate with disease,” Volek added.
By the end of the trial, participants saw “significant improvements” in blood glucose, insulin and blood pressure and lost an average of 22 pounds (10 kilograms).
“There is widespread misunderstanding about saturated fat. In population studies, there’s clearly no association of dietary saturated fat and heart disease, yet dietary guidelines continue to advocate restriction of saturated fat. That’s not scientific and not smart,” Volek said.

Metformin beats other type 2 diabetes drugs

Researchers have found that the drug metformin might be more effective than others in controlling blood sugar.
People newly diagnosed with type 2 diabetes who are initially given the drug metformin are less likely to eventually need other drugs to control their blood sugar, a new study suggests.
Second drug or insulin
The study found that, of those started on metformin, only about one-quarter needed another drug to control their blood sugar. However, people who were started on type 2 diabetes drugs other than metformin often needed a second drug or insulin to control their blood sugar levels, the researchers said.
"This study supports the predominant practice, which is that most people are started on metformin," said lead researcher Dr. Niteesh Choudhry, an associate professor of medicine at Harvard Medical School in Boston. "Metformin might be more effective than others in controlling blood sugar," he noted.
"Metformin, which is one of the oldest drugs we have and which the guidelines recommend as being the first drug to use, is associated with a lower risk of needing to add a second drug or insulin compared to any of three other commonly used classes of drugs," Choudhry said.
The report was published in the online edition of JAMA Internal Medicine.
A hallmark of type 2 diabetes is insulin resistance, according to the American Diabetes Association (ADA). That means the body doesn't effectively use the hormone insulin. Insulin is produced by the pancreas and helps usher sugar from foods into the body's cells to be used as energy.
Serious complications
When people have insulin resistance, too much sugar is left in the blood instead of being used. Over the long-term, high blood sugar levels can lead to serious complications, such as heart and kidney disease, according to the ADA.
There are eight classes of oral type 2 diabetes medications, according to the ADA. Each class works a bit differently. For example, metformin makes the body's cells more sensitive to insulin. It also decreases the amount of sugar naturally produced in the liver, the ADA reports. Sulfonylureas, on the other hand, encourage the pancreas to produce more insulin, according the ADA.
For the current study, Choudhry's team collected data on more than 15,000 people starting treatment for type 2 diabetes from July 2009 through June 2013. The average follow-up time was slightly longer than one year.
Of those patients, almost 60 percent were initially treated with metformin, and about one-quarter began treatment with a sulfonylurea, such as Glucotrol, according to the study. Just 6 percent were started with a thiazolidinedione, such as Actos, and 13 percent with a DPP-4 inhibitor, such as Januvia, the report indicated.
 The researchers found that around 40 percent of people taking a sulfonylurea, a thiazolidinedione, or a dipeptidyl peptidase 4 inhibitor (DPP-4 inhibitor) added a second drug to their diabetes treatment regimen during the study. Just 25 percent of those on metformin added an additional oral drug during the study period.
In addition, 5 percent of those started on metformin later added insulin to their treatment, according to the study. About 9 percent of those who started on a sulfonylurea, 6 percent started on a DPP-4 inhibitor and 6 percent started on thiazolidinediones, also took insulin, the investigators found.

First-line drugs
Choudhry said that many patients are being started on other drugs, but this study indicates that treatment should start with metformin.
"These findings emphasize the use of metformin as the first-line drug for type 2 diabetes," he said.
Dr. Jodi Segal, co-director of the Centre for Drug Safety and Effectiveness at Johns Hopkins Bloomberg School of Public Health and co-author of an accompanying journal editorial, said, "It is already well established that metformin is the preferred first-line option for patients who can tolerate it."
But, she added that doctors should pay more attention to their patients' worries about needing to intensify therapy when choosing medications.
  "Doctors might want to help their patients understand that intensifying therapy does not mean that the patient has failed," Segal said.
Dr. Joel Zonszein, director of the Clinical Diabetes Centre at Montefiore Medical Centre in New York City, doesn't think that metformin alone is sufficient to treat type 2 diabetes. He believes that treatment needs to aggressively lower blood sugar.
"We don't start treatment with a single drug," Zonszein said. "We use a combination from the get-go."
Zonszein said even this study shows that treatment with a single drug doesn't work. "So why do we wait to intensify treatment rather than treating more aggressively?"

Metformin is an oral blood-glucose-lowering drug.
Metformin is the active ingredient of Arrow Metformin, Austell-Metformin, Bigsens, Forminal, Glucophage, Metforal and Sandoz Metformin.
Metformin is also one of multiple active ingredients found in Glucovance (metformin + glibenclamide).
General information
Metformin is an oral blood-glucose-lowering drug. It is prescribed in the treatment and management of type 2 diabetes (a disease caused by a problem in the way the body makes or uses insulin, which is necessary for glucose to move from the blood to the inside of the cells) that is not adequately controlled by diet and exercise alone.
Type 2 diabetes makes up 90 per cent or more of all cases of diabetes.
Treatment with oral anti-diabetic drugs should only be started once all lifestyle and dietary measures have been tried for at least three months and have not controlled blood glucose adequately. Once treatment with this medication is started, diet and exercise should however not be stopped.
Metformin is the oral anti-diabetic drug of choice in overweight type 2 diabetics. It induces mild loss of appetite and thereby helps to control weight.
Metformin can be used on its own - and treatment is often started with one drug only - or in combination with other oral blood-glucose-lowering drugs.
For metformin to remain effective, it needs to be taken regularly.
Lactic acidosis (high levels of lactic acid in the blood which may be fatal) is a potential, but rare side effect seen with the use of metformin. The use of alcohol while being treated with metformin increases the risk of lactic acidosis.
Generally, this medication is used when the body is still producing some insulin.
How does metformin work?
Metformin reduces the amount of glucose supplied by the liver, and also enhances the uptake of glucose in muscles. It furthermore reduces the absorption of glucose from the digestive tract into the bloodstream.
Fast facts
Drug schedule: schedule 3
Available as: metformin is available as tablets
What does it do? metformin lowers blood sugar
Overdose risk: high
Dependence risk: low
Is metformin available as a generic? no
Is metformin available on prescription only? yes
User information
Onset of effect: within 2 hours
Duration of action: up to 15 hours
Dietary advice: metformin should be taken with meals to reduce gastrointestinal side effects
Stopping this medicine: consult your doctor before stopping this medication; diabetes may worsen with premature discontinuation
Prolonged use: long-term use may lead to anaemia as a result of vitamin-B12 depletion
Special precautions
Consult your doctor before using this drug if:
•           you have congestive heart failure
•           you have kidney or liver disease
•           you have a history of alcohol abuse
•           you are taking other medication
Pregnancy: avoid. Potential risk to the foetus has been reported. Consult your doctor before use, or if you are planning to fall pregnant.
Breastfeeding: avoid. This medication is passed through breast milk and may affect your baby adversely. Consult your doctor before use.
Porphyria: safe to use.
Infants and children: this medication is not intended for use in children.
The elderly: caution is advised in the elderly as adverse effects are more likely.
Driving and hazardous work: caution is advised as use of this medication may lead to dizziness or light-headedness. Avoid such activities until you know how this medication affects you.
Alcohol: avoid concomitant use of alcohol with this medication.

Possible side effects
Side effect      Frequency     Consult your doctor
            Common       Rare    Only if severe           In all cases
loss of appetite         x                      x         
metallic taste in mouth     x                      x         
nausea/ vomiting    x                      x         
diarrhoea      x                      x         
dizziness        x                      x         
confusion      x                                  x
abdominal bloating             x                                  x
rapid shallow breathing                 x                      x
unusual sleepiness/ weakness                  x                      x
rapid pulse                x                      x
blurred vision                      x                      x
pulse               x                      x
Drug interactions
alcohol           increased risk of lactic acidosis
cimetidine     increased risk of metformin toxicity
corticosteroids         may diminish effect on blood sugar
diuretics        may diminish effect on blood sugar
Disease interactions
Consult your doctor before using this drug if you have congestive heart failure, kidney or liver disease or if you have a history of alcohol abuse.
Overdose action
An overdose of this medication can be serious. Seek immediate emergency medical attention.
Recommended dosage
Adults: 500mg three times daily, or 850mg twice daily. Maximum dose is 3000mg/day.
Interesting fact
Metformin is being used increasingly in treating polycystic ovarian syndrome (PCOS).
This material is not intended to substitute medical advice, but is for informational purposes only. Please consult a physician for specific treatment and recommendations

Do all diabetics get insulin injections?

No. Most diabetics have type 2 diabetes, which can be controlled through exercise, diet, regular medical checkups and medication, if necessary.
Only people with type 1 diabetes are insulin-dependent, which means that they have to get regular insulin injections. This group is, however, in the minority (10%).
Regular blood-glucose monitoring is recommended for all diabetics