Mar
01
2004

Less Diabetes With Coffee

A Dutch Study has shown previously that coffee consumption was reducing the risk for developing diabetes. Now Dr. Salazar-Martinez and co-workers have confirmed this in a study involving even larger numbers of both men and women. This was published in the Annals of Internal Medicine and the research team is from the Harvard School of Public Health, Channing Laboratory, Harvard Medical School, and the Brigham and Women’s Hospital, Boston, Massachusetts. A total of 41,000 men and 84,000 women from the Nurses’ Health Study and the Health Professionals’ Followup Study were followed between 12 and 18 years. 1,333 men and 4,085 women developed diabetes during the time of observation. All of the data was analyzed carefully by controlling for other factors such as obesity, smoking, high blood pressure etc. to be certain that the only difference in the observed groups was the amount of coffee consumed.

According to the authors the gender differences are probably unimportant and may have to do with the different sample sizes. However, as the graph shows clearly, with the consumption of around 4-5 cups of coffee per day there is a significant 30 % drop in risk to develop diabetes.

The Dutch Study showed a 50% drop in risk with 7 cups or more per day and the study here suggests a similar drop with 6 cups or more.

Less Diabetes With Coffee

Less Diabetes With Coffee

Dr. Frank Hu, associate professor of nutrition and epidemiology at Harvard School of Public Health, who co-authored this study stated that physicians should still recommend to patients first to exercise and to loose weight to control diabetes. It would be premature to recommend heavy coffee consumption to patients for diabetes control.

Diabetes risk decreases with coffee consumption (%reduction)
 Less Diabetes With Coffee1

This beneficial effect was also observed to a lesser extent with decaffeinated coffee, but not with tea. According to Dr. Hu caffeine, chlorogenic acid and magnesium likely play a role in the protective effect with regard to diabetes prevention. Further studies will be done to see whether diabetes patients who drink coffee have a better outcome when they develop a heart attack.

Reference: Ann Intern Med – 6-JAN-2004; 140(1): 1-8

Last edited December 8, 2012

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Mar
01
2004

Inflammatory Marker Linked To Blindness

This outline is about “inflammatory marker linked to blindness”. Up to now age-related blindness or “age-related macular degeneration” (AMD) as it is medically called, has been a mystery. Notably, the retina is the light-sensitive area of the eye similar to the film in a camera. Specifically, the “macula” is that part of the retina that has the highest visual acuity. It is important to realize that several studies have been conducted lately regarding age-related blindness. Most compelling evidence sheds more light on this important health hazard of old age. One day these studies might even lead to a cure or powerful preventative measures to avoid AMD from ever developing.

Macular degeneration related to C-reactive protein

Particularly, one such study is the one by Dr. Johanna M. Seddon and co-workers published in the Feb. 11, 2004 issue of the Journal of the American Medical Association. Almost 1000 patients with various degrees of age-related degrees of blindness from the Age-Related Eye Disease Study (AREDS) were classified by the degree of their macular degeneration. As an illustration, I have produced the bar graphs below based on these studies.

Details of AMD in relation to CRP

For one thing, the researchers defined four groups, namely those with no AMD who served as controls. The second group were those with mild AMD, the third group those with moderate AMD. And the fourth group were those with severe AMD who were legally blind. Specifically, they suspected that an inflammatory marker in the blood stream of these patients, called C-reactive protein (CRP), might be present in the more severe cases of blindness when compared to the control group who did not have any inflammatory changes in the macula. Indeed, the bar graphs below show exactly what the test results indicated. Another key point, they also found that smokers (blue bars) tended to have slightly worse blood tests in terms of CRP (more inflammatory substances circulating in the system) within the same severity category of the age-related eye changes.

CRP (mg/L) Levels in Various Degrees of Severity of Age-related Macular Degeneration (AMD)

Inflammatory Marker Linked To Blindness

Inflammatory Marker Linked To Blindness

Risk of AMD depends on value of CRP

The investigators studied the risk for the highest percentile of the CRP tests within various subgroups of AMD. They found several differences as shown in the next table. First there was a low probability to develop AMD in a person with a normal looking macula. The investigators took this risk as the 1.0 point for comparison. In contrast a person with a normal looking macula who smokes has a 1.5-fold risk of developing AMD later. Patients with a moderate degree of AMD have about a 2-fold risk of getting a severe degree of AMD. This is true for smokers and non-smokers. Once the inflammatory cycle has started, the process of causing a moderate degree of AMD is so strong. This means that the effect of smoking will not add that much in comparison.

This is the first study of this kind that established that CRP is useful as a screening for the risk to develop AMD. Physicians already use CRP  as a test for monitoring progress in rheumatoid arthritis or to monitor for the risk of developing a heart attack or stroke.

AMD risk studied by another research group

Another study by Dr. Johanna M. Seddon and co-workers was published recently in the Archives of Ophthalmology. 261 people aged 60 years and older with established AMD were followed for 4.6 years and checked for deterioration. 101 patients had deterioration of their AMD.

Risk of Developing Age-Related Macular Degeneration (AMD) in Highest CRP Percentile
 Inflammatory Marker Linked To Blindness1

Omega-3 fatty acids protect against AMD

The authors analyzed the patients’ diet habits and found that increased fat intake was a high risk factor for deteriorating AMD. Both vegetable and animal fat had a 2-to 3-fold increased risk for deterioration of the AMD to a more severe stage (legal blindness). Fish, omega-3 fatty acid and nuts had a protective effect, but only when omega-6 fatty acid (linoleic acid) intake was low in the same group. The studies showed that the risk of age-related blindness was reduced by 40% when patients ate nuts at least once per week. The authors concluded that a “fat conscious diet” would be good for “maintaining good eye health” and at the same time be beneficial for prevention of heart attacks and strokes.

The authors will do further studies to investigate potential ways of helping patients with AMD and to understand the mechanisms of the disease process better.

References

1. JAMA 2004;291:704-710  2. Arch Ophthalmol – 01-DEC-2003; 121(12): 1728-37

Oct
02
2003

Heart Scan Saves Lives In Diabetics

A simple new nuclear perfusion study of the heart when applied to healthy appearing diabetics (adult onset or “type 2 diabetics”) showed silent hardening of the coronary arteries in 21.6%. This large study of an American medical team was recently presented at the 18th Congress of the International Diabetes Federation in Paris/France. Dr. F. Wackers, professor of medicine from Yale University school of medicine and one of the lead investigators, explained that 1,124 patients with diabetes in the age range of 55 to 75 years who were all thought to not have any heart blood vessel disease, either had nuclear perfusion studies performed and a control group did not.

As indicated above to the surprise of the investigators 113 patients of 522 (=21.6%) had positive heart scans showing perfusion difficulties of the heart muscle. Further testing with other methods revealed that 73% indeed had perfusion defects and 27% had other heart disease, electrocardiogram abnormalities and other heart dysfunctions. Conventional assessment tools such as a smoking history, determination of degree of obesity, blood pressure,kidney disease , high blood lipid levels, high C-reactive protein levels, the diabetes test hemoglobin A1C or homocysteine levels in the blood were also assessed. However, these conventional tests did not help in predicting that these patients would have developed perfusion defects in their heart muscle. This was due to hidden narrowing of the heart blood vessels (=coronary arteries) and this affected the supply of nutrients and oxygen to the heart even though these patients were completely symptom free at the beginning of the trial.

Heart Scan Saves Lives In Diabetics

Heart vessels and nuclear scan

Dr. Vivian Fonsega, a professor of medicine and pharmacology at Tulane University in New Orleans and co-researcher of the team, added that after a follow-up of 1 year those who had normal initial nuclear perfusion studies of the heart only 1% developed serious heart disease. These control patients who have now been followed for 3 years overall remained very healthy. In other words a normal (called “negative”) nuclear perfusion test in diabetics predicts a better longterm outcome than a positive perfusion test.

With this heart scan the cardiologist can identfy the high risk group among diabetics and can subsequently concetrate on doing something actively about the identified diseased heart blood vessel(=”coronary artery”) disease. Identified narrowing in the coronary arteries (“stenotic arterial lesions”) can be overcome by prying them open and placing heart stents across the affected section utilizing catheters (angiography). In other cases heart bypass surgery can be done by the heart surgeon to improve the perfusion of the heart muscle. The researchers stressed that those diabetics at risk can be identified with this test and the life expectancy of this high risk group of patients can be significantly prolonged. The study will continue for several more years so that the longterm results of any intervention can be measured when compared to controls.

Based on The Medical Post (Sept. 23, 2003 ): p. 55.

Here is a link to a chapter on diabetes and here is a link to heart attacks.

Last edited December 9, 2012

Jan
01
2003

The Liverpool Eye Study…How Often The Eye Sight Of Patients With Diabetes Should Be Examined

In the January 18, 2003 issue of the Lancet (Lancet 2003; 361:195-200) Dr. Dr. Naveed Younis and his collegues published a study from the Royal Liverpool University Hospital, U.K. where diabetic patients underwent thorough eye examinations in regular intervals for 5 years. The question of this study was whether it mattered at what interval patients would be examined with regard to their eye-sight, so that perhaps blindness could be postponed or avoided through early interventions.

At the baseline of the study a special eye-photography method (three-field mydriatic photography) was used to document the blood vessel changes in the back of the eye. This helps the physician to assess whether or not there is a degree of retinopathy (blood vessel damage from diabetes) of the eyes or not. The investigators defined three groups:

For group one (no eye damage in the beginning of the study) there was a retinopathy rate of 0.3% at the end of the first year. Group two (moderate retinopathy in the beginning) showed a worsening of the retinopathy at the end of the first year of 5% (threatening blindness). Group three (significant retinopathy in the beginning) showed a rate of 15% of worsening retinopathy (threatening blindness) at the end of one year.

The Liverpool Eye Study...How Often The Eye Sight Of Patients With Diabetes Should Be Examined

The Liverpool Eye Study…How Often The Eye Sight Of Patients With Diabetes Should Be Examined

This shows that not every person with diabetes is equal with respect of having the threat of blindness. The medical investigators found that about 70% of patients fell into the group that did not have serious diabetic retinopathy. However, the other 30% would not do well with simply yearly eye examinations as it is recommended now. Instead the authors of the Liverpool study were able to make practical recommendations as follows:

After a baseline eye examination those who belong into group one would get an eye examination every 3 years. Those with prior moderate retinopathy (group2) on the initial baseline examination would get examinations at yearly intervals (until the degree of retinopathy worsens). Group 3 with significant retinopathy at the beginning would, however, be examined every 4 months (new recommendation) so that blindness hopefully could be avoided or significantly postponed through interventional therapies.

The following link is telling you about hardening of the artieries (arteriosclerosis) and how diabetes accelerates this process:

The following site is about the metabolic effects of diabetes on the body and in particular also about the danger of diabetic retinopathy:

Diabetes: http://www.nethealthbook.com/articles/hormonalproblems_diabetesmellitus.php

Last edited December 10, 2012

Oct
18
2002

Work Stress Is A Killer…More Than 2-Fold Over A Period Of 25 Years

In mid October 2002 the British Medical Journal(BMJ 2002;325:p.857-860) published a paper by Dr. Mika Kivimäki from the University of Helsinki where 812 healthy factory workers were followed for about 25 years. The issue was whether stress from work would have negative consequences, which could be measured in terms of cardiovascular disease. Various risk groups were defined from low stress to high stress.

Low stress jobs were classified as people who often had more training, more responsibilities, better salaries, physically less strenuous jobs with more job security. High stress jobs involved the opposite(high demand/low job control/low salary/no job security). Depending on which subgroups of high versus low risks were compared, the investigators found a 2.2 to 2.4-fold increase of strokes and heart attacks due to cardiovascular disease.The team measured other cardiovascular risk factors. They found a significant increase of cholesterol in the high stress job group after 5 years. After 10 years there was a marked weight gain in the stressed group with obesity becoming much more frequent. The authors noted that this likely led to a change of metabolism in the sense of hyperinsulinism, which is known to cause high cholesterol levels and leads to hardening of the arteries with heart attacks and strokes.

Work Stress Is A Killer...More Than 2-Fold Over A Period Of 25 Years

Work Stress Is A Killer…More Than 2-Fold Over A Period Of 25 Years

Visit these useful related links to chapters of my free Internet based Nethealthbook:
Hyperinsulinism or syndrome of insulin resistance:
http://www.nethealthbook.com/articles/hormonalproblems_diabetesmellitus.php

Heart disease:
http://www.nethealthbook.com/articles/cardiovasculardisease_heartdisease.php

Stroke:
http://nethealthbook.com/cardiovascular-disease/stroke-and-brain-aneurysm/hemorrhagic-stroke/

Last edited October 25, 2014