Study: diabetes more deadly than fat

[NorthernSpy]

Interesting study out of Emory U School of Medicine and the University of Kentucky's Chandler Hospital:


http://news.xinhuanet.com/english/2006-09/26/content_5138880.htm

BEIJING, Sept. 26 (Xinhuanet) -- Researchers from two southern universities in the U.S. found that people with diabetes are more at risk of developing a critical illness and dying than people that are obese.

(...)

Results of the study, published in the Sept. 24 issue of Critical Care, took into account body-mass index (BMI), the presence of diabetes and history of critical illness and death within a three-year time frame.

Researchers discovered obese people not suffering from diabetes have less risk of suffering from acute organ failure or dying from acute organ failure than people who are not obese.

But people with diabetes -- regardless of their BMI -- are three times more likely to become critically ill from acute organ failure and three times more likely to die from any cause than people without diabetes.

The study followed 15,408 middle-aged Americans over the course of three years.

One interesting tidbit that's likely to get overlooked: the study finds that among non-diabetics, organ failure and deaths from organ failure are more common among the "healthy weight" population than among those who are overweight. This fits nicely with the results of the NHANES study by Flegal et al that caused such hysteria when it was published.

[niallmac]

1. I don't get it. Why am I hearing about an Emory study

from the China News Service? Is the study published or about
to be published in a peer reviewed journal?

[NorthernSpy]

5. the answer to that was in the article...

According to the excerpt I posted, the study was published Sept. 24th in Critical Care.

[niallmac]

6. Ah yes. I found the link to the Journal Article also.

I find it odd that the conclusion stated in the China News Service emphasizes
the BMI end organ relationship where the study seems to be reminding us
of the damage diabetes can inflict on end organs and the relationship to
obesity and the development of diabetes. I do not see the intent of the
study to be supporting a high BMI.

"Results

At baseline, participants with a BMI of at least 30 were more likely than those in lower BMI categories to have DM (22.4% versus 7.9%, p < 0.01). Overall, BMI was not a significant predictor of developing acute organ failure. The risk for developing acute organ failure was increased among subjects with DM in comparison with those without DM (2.4% versus 0.7%, p < 0.01). Among subjects with organ failure, both in-hospital mortality (46.5% versus 12.2%, p < 0.01) and 3-year mortality (51.2% versus 21.1%, p < 0.01) was higher in subjects with DM.

Conclusion

Our findings suggest that obesity by itself is not a significant predictor of either acute organ failure or death during or after acute organ failure in this cohort. However, the presence of DM, which is related to obesity, is a strong predictor of both acute organ failure and death after acute organ failure."

[Rene]

24. Can you imagine how many jobs we could create and how

medical costs would actually be reduced if we had a Universal Health care where EVERYONE in this country could receive treatment/tests etc.
We should start TRAINING medical people NOW....and pass legislation so EVERYONE gets Healthcare when the Dems take over.

When my husband had a stroke 2 years ago....(we have insurance) they didn't actually TREAT him with anything....just ran him all around the hospital for days, taking every conceivable test.
We were the only ones going into many of the various rooms. I think they were using him so they could bill some insurance company for use of the equipment/staff.


We're both 'diabetics' now, in our 60's.
Probably should have been diagnosed years ago....but our old family doctor never tested for it.
He left medicine and the new doc 'found' it.

[Irreverend IX]

26. It's easier than that.

We can go a long way toward wiping out diabetes if we stop allowing the food industry to feed people chemical sewage. You can bet that the freaky preservatives you see on ingredients lists have something to do with all the cancers and chronic diseases that have been appearing since the 20th century, and there's no reason garbage like Twinkies and soda should even exist. But thanks to the Coke lobby and others like them, the FDA is banned from saying that if you consume those things you might as well be drinking diluted antifreeze.

[sendero]

2. My wife..

... is diabetic. I didn't need a study to know that. Diabetes is a horrible disease, and we should have a cure by now but we don't. I wonder why.

[NorthernSpy]

12. sadly, it really WILL come as news to many...

... that merely being fat won't kill you, but having an actual disease might.

After all, we live in the time of the Great Anti-Fatness Crusade. Public health officials have compared fat to terrorism and the bubonic plague outbreak that wiped out a third of Europe's population.

:eyes:

So I try to give people a more reasoned view of this issue.


I join you in hoping that there will be a diabetes cure soon.

[CornField]

31. Amen

My husband is a type 1 diabetic. What a shitty, shitty disease.

[TreasonousBastard]

3. Yeah, but...

how many of the obese develop diabetes, compounding their problems?

From an older study...

<...>

"The study found strong and significant associations between overweight, obesity, diabetes, high blood pressure, high cholesterol, asthma, and arthritis. Compared to adults with healthy weight (BMI values from 18.5 to 24.9), those with a body mass index of 40 or higher had an increased risk of being diagnosed with diabetes (7.37 times greater), high blood pressure (6.38 times greater), high cholesterol levels (1.88 times greater), asthma (2.72 times greater), and arthritis (4.41 times greater).
"If we continue on this same path, the results will be devastating to both the health of the nation and to our healthcare system," Gerberding said."

<...>

http://www.cdc.gov/OD/OC/MEDIA/pressrel/r021231.htm

[NorthernSpy]

4. Gerberding is the nitwit who said obesity is worse than the Black Death

:rofl:

She's also one source of the notorious "400,000 obesity deaths per year!" claim that first had to be downsized when someone caught a math mistake -- and was finally debunked altogether by a review of the NHANES data.

A BMI of "40 or higher" (which is what the material you've cited is talking about) represents extreme obesity. That's a pretty small percentage of the population. Where the anti-fatters got into trouble was in insisting the medical problems linked to extreme obesity also held true for the "overweight" and "mildly obese" categories. So it was unwelcome news for some, to say the least, when a review of the NHANES found that mortality rates are lower among the overweight and mildly-obese than among those of "healthy weight".

Science suggests that it is the "overweight" category that should be considered ideal.

[TreasonousBastard]

7. Geberding may be an asshole, but...

when I was diagnosed with Type II I wasn't morbidly obese, but pretty heavy. "Diabetes" not being one particular condition, but a set of several possible reasons for excessive blood sugar, my case was one where diet and exercise was the prescription, and it works for me.

According to every medical professional I talked to, the links between diet, body weight, and diabetes were beyond doubt.

Different body types and metabolisms probably do have different ideal weights, but I don't see that as stretching it to a defense of obesity, as some seem to have done.

[NorthernSpy]

11. most fat people will NOT develop diabetes -- only a subset of them will...

According to every medical professional I talked to, the links between diet, body weight, and diabetes were beyond doubt.

There are "links" between a lot of things. The problem lies in the facile assumption that the "link" in question must be one of simple causation.

Consider:

Compared to overweight women, slender women are at increased risk for premenopausal breast cancer. This link is well-known, and it shows up across studies. Among black women, slenderness is always linked to a higher likelihood of developing breast cancer, regardless of age. And yet we never, ever hear anyone recommending weight gain to women considered to be at a high risk for breast cancer.

The thing is, both the slenderness and the breast cancer risk may be outcomes of some underlying physiological phenomenon: we don't know for sure that the low proportion of body fat actually causes the cancer; and we don't know whether trying to gain enough weight to put oneself in the "overweight" group would lower the risk.

The case with weight and type II diabetes is similar. Adult-onset diabetes occurs at every level of BMI (from the very thin, to the very fat, and people in between these extremes), though the disease is more common among persons of high BMI than those of low BMI.

However, we don't know that the fatness itself causes the diabetes. As with slenderness and breast cancer, both the obesity and the diabetes may be the result of some underlying physiology.

It is true that increased exercise can help to re-sensitize the body to insulin and in turn control the diabetes, and that this and related "lifestyle" changes can also cause weight loss. But an effective anti-diabetic regimen actually results in very little weight loss on average -- something on the order of 7 pounds for a 200 pound person, perhaps. That's not much at all; certainly, it's not nearly enough to put an obese person into the "normal weight" category.

And yet it works. In fact, that small weight loss appears to be about as effective for diabetes control as losing enough weight to reach a "healthy" BMI would be. Odd as this may seem, major weight loss is not much better than modest or slight weight loss for obese diabetics -- which suggests that the weight loss may be more a side-effect of sucessful insulin-resensitization than the primary factor in good diabetes control*.

Clearly, the relationship between obesity and diabetes is NOT simple. Only a subset of the obese will develop diabetes, and a high BMI is only one of the markers thought to distinguish the 'at-risk' population. So why don't we concentrate on helping people to determine whether they truly are at high risk for diabetes, instead of promoting this false impression of fat people in general as ticking metabolic timebombs? Moreover, why don't we tell people just how modest the diet and exercise changes can be and still be effective in preventing or controlling type II diabetes? Thanks to the obesity hysteria, the public has this notion that you'd have to live on sprouts and keep jogging until you look like a bikini model in order to become unimpeachably "healthy" -- and nothing could be further from the truth. Legitimate public health education rests on accurate information and reasonable advice -- and the anti-fat crusade clearly has become an obstacle to these things.





*Incidentally, a heavy person diagnosed with type II diabetes typically has a better prognosis than a thinner person diagnosed with this disease has. While partial insulin resistance is associated with high compensatory insulin output and high body weight, extreme insulin resistance is associated with insufficient insulin output and low body weight.

[KurtNYC]

13. This is a huge issue

and one about which you seem to feel strongly so let me be careful.

Some part of the crassness which plagues our culture has told many people that it is okay to make fun of, discriminate against and generally harrass overweight people. That behavior and the (appropriate) backlash against it has clouded the issue about whether and how unhealthy it is to be overweight.

Being overweight correlates with DM -- the more overweight, the higher the correlation. There is an element of causation in that. DM in simple terms means your cells are resistant to the effects of insulin. Therefore the body needs to use more insulin in order to metabolise blood sugar and feed the cells. In a horribly cruel irony, many diabetic are hungry all the time, regardless of food intake because they are insulin resistant (meaning the cells don't get fuel). There is a limit to how much insulin your body can produce and once you exceed that rate your blood sugar remains elevated for long periods of time -- that is the definition of Type II diabetes. You don't have to be overweight to develop diabetes but being overweight makes it far more likely that you will.

I doctor I consulted told me that in his view having diabetes (and suffering its effects) was not and yes/no situation but rather a range which begins in almost everyone as soon as you are more than 30 pounds overweight. The more insulin resistant you become from there, the worse the effects will be.

[Lurking Dem]

14. I think there is a cart/horse issue here.

There is a direct correlation between obesity and type 2 diabetes. It cannot be denied.

However, the vast majority of type 2's have been hyperinsulinemic for YEARS before getting a clinical diagnosis of DM. Insulin is a fat growth hormone. What is making them fat is the fact they have subclinical diabetes in the form of hyperinsulinemia.

Disclaimer: There are numerous syndromes which cause type 2 diabetes and the above is just one example. There are non obese type 2's as well. And I am not a medical professional but I once had a career as a medical journalist specializing in diabetes and DM translation issues.

[TreasonousBastard]

25. Well, what I feel strongly about is...

jumping on a report of a study claiming it justifies one's shaky position. I know we all do that, but it just confuses the issue and adds more hot air without coming to reasonable conclusions.

The denigration of the overweight seems to be a modern phenomenon. Past cultures, even ours, have celebrated heft as being signs of wealth and good nutrition. Even today there are parents in some ethnicities around here who force food on their small children to fatten them up, thinking a thin kid is an unhealthy one.

"Yonder Crassus is a thin man. I trust him not."

I suspect that now the ability to afford "healthy" foods and a gym membership are the signs of wealth. Bony movie stars and models as ideals doesn't help. Nor do the fitness gurus all over the place pointing fingers at those who didn't get the message and adding to the guilt and recriminations.

Anyway, the science is still trying to sort out the carts and horses. My own, highly unscientific, observations of many overweight people, and my own ups and downs in belt size, is partly the volume of food and calories, but also the type of foods. A number of overweight diabetics I know had a diet consisting largely of mountains of pasta or rice and weren't at all shy about the dessert trays. Things like the prevalence of high fructose corn syrup everywhere, which has different effects on blood sugar, triglycerides and such than cane sugar have been talked about, but not fully explored.

On the other hand, the diabetes class at the hospital was over half thin men. No women in that class, though, so no observations there.

[Lurking Dem]

27. High Fructose Corn Syrup

is a nightmare. I refer to it as "death by Con Agra". It's in everything - even canned soup! Why in G-d's name does anyone need corn syrup in their soup?

I have been considering some of the eating habits of the people around me. It's amazing to me what people eat and I often wondered if nearly 30 years of type 1 had skewed my perceptions since I look at food so differently and have in the past suffered, as many type 1's do, from an eating disorder.

But now I'm wondering if the hyperinsulinemia doesn't cause intense cravings? Maybe turns off the "off switch"? And a large part is societal. I remember (dating myself) when Quarter Pounders with Cheese came out on the market and we all talked about how HUGE they were. Now it's super size, double meat, triple meat, pound of bacon on that eating.

Then there is our medical understanding of metabolism which appears to be somewhere approaching nil. My Chinese doctor says that ALL medications effect your metabolic rate in a negative fashion. And we now give people pills for everything! Like being shy!

Seeing 40, 50, 60 pound toddlers on tv does give one pause for thought.

[TreasonousBastard]

23. I didn't say most fat people will develop...

diabetes, just that the links between diet, body weight and diabetes are pretty well accepted. I'm aware of much of the science, but it changes so fast that I'll let the experts sort out the details and just keep finding out what works for me.

[REP]

18. Diabetes May Cause Overweight; Not Vice Versa, According to Some Studies

I don't have the studies in front of me and I'm too tired to dig them up, but there is evidence that the conditions that lead to NIDDM cause overweight/obesity, not that being fat causes diabetes. The doctors to whom I have spoken agree with this research (they are regarded as leading endocrinologists in this area and specialize in diabetes).

The current fad is to blame fat for everything, and if you don't think researchers follow fads (and therefore, the money), there's a research study I'd like you to fund... :) Of course, there are some who are doing the heavy lifting and doing real research to see why there is so much more obesity than there was in addition to what really causes NIDDM, how to prevent it and how to cure it.

[Scout]

28. i think you are correct

for some people "pre-diabetes" is what makes it so easy to put on weight, and so difficult to take it off and keep it off.

add the explosion of processed foods over the last century, and high fructose corn syrup more recently, into the average american diet and there you go, diabetes/obesity "epidemic"

[flaminbats]

29. a type 1 diabetes symptom is losing weight..

a close friend of mine dropped to under 95 pounds, and he was over six feet tall! He only returned to a normal size after being placed on insulin.

[Lurking Dem]

32. And after he has been on insulin for 30 years

he will be able to gain weight on air.

The problem with type 2 which doesn't use insulin efficiently and type 1 which doesn't produce insulin, is the body tries to self regulate. So type 2's produce more and more insulin in an effort to stabilize their blood glucose and they gain more and more weight because of that.

When they have to put a type 2 on insulin it is generally agreed that every unit of insulin will equal one pound in weight gain. And because they're resistant to the insulin they take upwards of 60-80 units a day.

There are now recognized forms of bulemia with type 1 girls stopping their insulin or putting distilled water in their pumps to lose weight.

[cap]

39. it can go both ways... circular causality

if your body isnt processing insulin and glucose properly it can lead to weight gain; excess weight can cause the conditions where your body goes diabetic.

My poor hubby has insulin sensitivity -- was eating 5 candy bars a day and couldnt hold to a diet. His body was going give me candy, give me carbs.... Finally found a bariatric physician who understood his condition and gave him 2 metformin (he's not diabetic) and the metformin killed the cravings for 5 candy bars a day immediately. Got on a low carb diet and lost a bunch of weight and now is going in for bariatric surgery in 5 days -- because he's hit the limit of what he can do.

All the males on his dad's side are diabetic.

[Jack from Charlotte]

34. I've never understood why virtually everyone diagnosed with Type II

diabetes, doesn't do what you did. Clean up the diet, big time, lose weight and exercise all you can. I've read many accounts of people who got as thin as a greyhound and exercised like mad where their blood chemistry improved so much they were no longer considered diabetic. They essentially, cured themselves. Compared to having your feet amputated and losing your sight, I'd think that'd be an actractive.... and popular.... alternative.

[wickerwoman]

36. Losing weight is the easy part...

keeping it off full-time is the hard bit.

My dad has diabetes. When he had neuropathy so bad he couldn't sit for more than 5 minutes, he lost almost 100 pounds because he was in too much pain to eat. Diabetes is often combined with other problems like hypertension, heart disease and depression. He went on the neurontin for the neuropathy and gained almost 150 pounds in 2 months. Seriously.

Now he has the choice of being in excruciating pain and dieting and still not losing very much weight, or taking his medicine and not being able to lose weight.

Trust me, when a solution seems too simple to be true, it probably is.

[ziggy_luv]

8. Read My Lips, Universal Health Care

We need universal health care, and regular check ups. That might help.

[Taoschick]

9. And we need

To get rid of that stupid food pyramid and teach people the dangers of a diet loaded in refined carbohydrates.

[CountAllVotes]

10. try eliminating all junk food and transfats

you'll be shocked I tell you, shocked!

:kick:

[diamidue]

15. MSG is also causing obesity & insulin problems.

It is hidden in just about everything processed and it has also been implicated in diabetes. It is even in baby formulas & beginning in the 1960's was added to baby food. (Later forced to take it out). By the way, I can't tell you how many relatively thin people I know who were diagnosed as being "pre-diabetic".

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9283637&dopt=Abstract

[Beausoir]

30. I just did! 6 weeks ago...and the pounds are literally melting off.

I went on the Diabetic Diet. I'm not diabetic..but my glucose was trending up. So I took the initiative and asked my doc to set me up with a nutritionist.

I am absolutely thrilled with my results. I eat very well. Am rarely hungry and I am dropping pounds like crazy.

[NotGivingUp]

33. so what can you eat on the diabetic diet? i would love to lose

a few pounds.

[Beausoir]

35. Lots of fruit, veggies, protein. Moderate carbs.

Whole grains and dairy.

It's a great lifestyle plan. I can really stick to it because I am not deprived of much.

[kineneb]

16. got to look at big picture

(no pun intended)

Some people are genetically prone to developing Type II DM and have weight issues. Others can be normal weight and develop Type II. There are some generalizations- that overweight people often (but not always) eat the wrong foods, which can (but does not always) lead to developing diabetes. This does not mean that the overweight person who exercises and eats a healthy diet will develop diabetes, just that they should be observant. Then there are the thin people who eat poorly, and then go on to develop diabetes. There must be both environmental (weight and diet) plus genetic factors involved (possibly an inherent "weakness" that leaves a person susceptible to insulin resistance).

I can look at the health differences between me and and my husband. He was overweight as a child, never ate properly (until I started cooking for him), and now has insulin-dependent Type II, with a multitude of complications. Apparently, his family also may have had a history of diabetes, as well. Only my biological father has developed Type II, in late middle age, probably due to diet; on my mother's side, folks live into their late 80s and early 90s, with no diabetes. Even though I am somewhat overweight, I still have to watch out for hypoglycemia, and eat at regular times. Other than mental health issues, I have few health problems. Some of my weight issues are possibly due to the anti-depressants I must take.

[Lurking Dem]

17. Correction

The only type of diabetes that is directly related to actual diet is the kind many African kids get from frank malnutrition. That is actually a kind of type 1 diabetes caused by starvation. Which, I guess, makes it related to what you don't eat.

The cause of diabetes is strictly genetic. Diet plays a role in type 2 because body fat causes insulin resistance. So you can prevent or delay onset of clinical diabetes by remaining slender or even, sometimes, by simply getting adequate aerobic exercise even if you remain overweight. Even walking half an hour 4 times a week can delay or prevent onset.

But if the genes aren't there you don't get it no matter what you ate.

[REP]

19. Steroids Can Bring It On, Too

I'm not sure if one needs the genes for it or not, but I know steroid use can induce diabetes. Been there, done that, test four times a day. (I'm sure I have the genes - both types, both sides of the family - but not diabetic per years of testing before the steroids.)

[Lurking Dem]

20. Yes one needs the genes.

Think of steroids as a pancreatic stress test. They increase your blood glucose level astronomically by counteracting the effects of insulin.

Pregnancy related diabetes is kind of the same thing. A stress test.

If your pancreas is below normal or "insulin challenged" the steroids (and we're talking about corticosteroids, not anabolic steroids like what people take to build muscle) push it over the edge.

Most women who suffer from gestational diabetes have normal blood glucose readings after they give birth. But most of them develop type 2 later in life.

I have a disease for which corticosteroids would be the first line of treatment but I can't take them because I have type 1 diabetes as well. There just isn't enough insulin in the world to control my blood glucose on those things.

[CountAllVotes]

21. my late uncle took steroids for a very long time

and he became diabetic because of it. Diabetes does not run in that side of my family. He was using steroids for many years and wow, what a wreck he was when he died. Steroids (long-term use) also effect the brain and mind as well. Scary stuff. :(

[noonwitch]

22. Dental problems can cause diabetes and vice versa, per my dentist

It doesn't surprise me that diabetes is more dangerous than a high-fat diet, as there are ways to counter-act a high-fat diet, like exercise or balancing the fat with other foods that help rid the body of fat.

If someone is diabetic, they can do their best to follow the prescribed diet, take their insulin, get exercise, and still have their bodies break down. There are so many potential complications-one of my friend's mom is a brittle diabetic, who has lost a couple of toes due to gangrene related to the diabetes, and has lost most of her vision due to diabetes. Her mom is approximately 65, developed the disease in her early 40s, and is not overweight. I used to babysit for a family in which the mom was a diabetic who didn't take care of herself (she would give herself extra insulin so she could eat more, then forget to eat enough and have an insulin reaction, plus she would drink to excess). She never had the same complications as my friend's mom, who ate properly, took her insulin as prescribed and never drank alcoholic beverages.

[JennyB]

37. I'm a diabetic

I was just diagnosed as a diabetic last year but I had gestational diabtetes with my second baby who was born in July 2005. So essentially I've been dealing with this for 2 years. My diabetes never went away after the birth of my daughter so my doctors think I might be a type 3 diabetic. This is a really new term for adults diagnosed as diabetics who don't fit the profile of having no insulin and being born that way (juvenile,or type 1) and don't have the problem of having insulin that is resistant and being an adult(type 2). I have some but not alot of insulin left and am not obese or overweight, nor does diabetes run in my family. I am only 30 years old but I must take insulin shots every day and eat a meal plan called "carbohydrate counting". I can eat pasta but it should be whole wheat. Fruit, veggies, whole grains, and some dairy is encouraged but I can have 60 grams of carbs for meals and 30 for snacks. I eat carbs all day long so I don't have a low blood sugar reaction, but it is not all at once and alot of the diet is portion control. Diabetes IS a sucky disease. I have to inject myself with needles 3 times a day and test my blood 5 times a day. You get over being squeamish to blood and needles real fast. Plus, try doing all this with a 1 and 2 year old running around you all day. I am grateful that I have great doctors and have really good control of my diabetes. My AIC (level of blood sugar for last 3 months) is a 6 which is considered to be normal. I hope we can come up with a cure for this disease and fix my pancreas. I have a broken one according to my endocronologist. Sadly, right now no one can ever be cured of diabetes, you have to watch your blood sugars like a hawk or risk complications. You can also never go off your pills or insulin or stop following ypur diet. Stem cell research could help discover a cure but of course Bush cares less about helping those already alive like my 2 young daughters who now are susceptible to getting my disease.
At least I have insurance (I'm lucky).
Jenny

[Lurking Dem]

38. Don't take this as glib

but the type 3 designation is so cool. We all (the DM community) argued for years there were somewhere around 26 different syndromes causing diabetes and each of those needed to be treated differently.

Maybe they are waking up.

The best thing a doctor could tell me this past year was, "Well, the diabetes will kill you before the lupus does."

Jolly.