Diabetes- AGEs

Another harmful factor generated in diabetes are products called 'advanced glycation end-products', or AGEs.  AGEs develop essentially when proteins in your body (or fats or other compounds) are tagged with a sugar molecule.  While this may see relatively harmless, we must understand that a central tenant in biology is that "form dictates function."  When we add sugar residues, we have changed the form of that molecule.  That will invariably lead to an alteration in function.

These AGEs can go on to make blood vessels stiff (not a good thing), generate free radicals and promote inflammation.  If all of that sounds a little to "science-ey" for you, then how about this;  AGEs also make your skin age.

AGEs are often discussed outside of the context of diabetes.  While they can be generated in our body, we also consume them in our diet.  Diet sodas are a common source of AGE consumption because of the aspartame and caramel colourant.  Animal derived foods with lots of fat and protein are another common source of AGEs.

While we always have some level of AGE production, exogenous intake and extraordinary production during diabetes promotes pathogenic processes.  In fact, doctors often monitor a patient's A1C, a marker of glycated end products, to determine how well blood sugar management has been over an extended period of time. 

In summary, diabetes produces AGEs.  AGEs then promote more insulin resistance (with oxidative stress and inflammation) that exacerbate the diabetes.    Then we make more AGEs.... and the vicious cycle goes on and on.

Diabetes- Avandia

Avandia, a medication used to increase insulin sensitivity, has taken a lot of heat over the past several weeks.  This popular diabetes medication has made headlines because of the increased risk of heart attacks and strokes associated with it.  The matter is far from over.  As of today, the FDA is still considering whether or not to pull Avandia from the market.

When these matters are debated, you often find two camps where one group strongly supports the use of a drug while the other group is staunchly opposed.  Both perspectives are often rooted in the naive idea that "drugs are amazing" or "drugs are evil."

Individuals in the natural health community, like myself, are often guilty of decrying the multiple adverse effects of medications and the overuse of these powerful tools.  This leads to the well intentioned but ill informed opinion that "drugs are evil."  News like this can serve as a sort of vindication for anti-drug advocates.

But consider the broader view here.  Medications clearly save lives and improve the quality of life for millions of people in the U.S.  I read this piece in the LA Times which is a bit more fair and balanced than many viewpoints. 

With any medication, you will help some people and hurt others.  It is impossible for a drug to be everything to all people.  

"It's always a balancing act for us," said Karen Riley, a spokeswoman for the Food and Drug Administration. "Products get approval because we see that the benefits outweigh the risks. Then we try to adjust as we go along." LA Times July 1, 2010.

Our natural tendency is to assume that "the powers that be" have clearly determined that the benefits outweigh the risk.  The case of Avandia is evidence that this is a dangerous assumption.  Consider the recalls we hear daily; McDonald's toys, Toyota cars, cribs, baby bottles and more.  Drugs are no different. 

Diabetes- Inflammation

The risks of diabetes are well known.  Individuals run the risk of kidney failure, blindness, poor wound healing, loss of limbs & nerve damage.  As blood sugar is chronically elevated, a number of other physiological events occurs simultaneously. We'll start this series off discussing chronic inflammation.

A rise in blood sugar alone can be problematic enough by itself.  But it appears that with hyperglycemia, diabetics also experience inflammation.  This inflammation also promotes damage to the eyes, kidneys and nerves.

"In general, hyperglycemia is the main initiator of diabetic retinopathy, nephropathy, and neuropathy, and it participates in the development of diabetic cardiovascular diseases. Although the precise role of inflammation in the development of diabetic microvascular diseases is still unclear, it is likely that inflammation induced by diabetes and insulin resistance can accelerate atherosclerosis in patients with diabetes."  J Periodontol 2008 Aug;79(8 Suppl):1527-34.

Inflammation itself has been implicated in many, if not most, chronic diseases.  Take a look at this article that discusses how peripheral inflammation (away from the brain), can actually damage brain cells!

"As a consequence of excessive inflammatory response triggered by pro-inflammatory cytokines in the periphery, free radicals, oxidants and glucocorticoids are over-produced, which can affect glial cell functions and damage neurons in the brain. Indeed, decreased neurogenesis and the dysfunction of neurotrophic system (up- or down-regulations of neurotrophins and their receptors) have been recently found."  Prog Neuropsychopharmacol Biol Psychiatry 2010 Jul 2. [Epub ahead of print]

There's no doubt that with hyperglycemia, we set off on a downward spiral of multiple physiological systems.  While convenient, it is overly simplified to understand the risks of diabetes as being secondary only to high blood sugar.  High blood sugar assaults your body directly, but then promotes inflammation that will also assault your body.  This is a proverbial "double whammy."

Before continuing on with the next posts, let's consider this.  Do you believe that the pathophysiology of diabetes provides a "double whammy?"  Or is it a "triple whammy?"  "Quadruple whammy?"  

Lots of things go wrong.  This is the tip of the iceberg. 

Diabetes

Approximately 24 million Americans suffer from diabetes.  It sucks up $116 billion dollars each year in direct medical costs and $58 billion dollars a year in indirect costs.  More than 90% of diabetics are considered type 2 diabetics, or non-insulin dependent.  There are ever changing medications used to manage diabetes, many of which dramatically help an individual manage blood sugar, but ultimately fall short in correcting a person's physiology.

In the next series, we'll take a look at how diabetes works and why this crippling disease can be almost entirely prevented.  Most of us probably know at least one diabetic in our inner circle of family and friends.  To some, it seems inevitable because of a defeatist attitude that echoes, "my mom had it and so I'll get it too... it's in my genes."  We'll zoom in and look at the vicious chain of degeneration that diabetes sets off.  Then, we'll look at natural means to manage this disorder.

Many people know something about diabetes.  But the reality is; it's much worse than you think.