Anti-Aging Medicine

by Ronald Klatz, MD, DO, and Robert Goldman, MD, PhD, DO, FAASP

www.worldhealth.net

An Anti-Aging Approach to Diabetes Prevention

A group of diseases marked by high levels of blood glucose resulting from defects in insulin production, insulin action, or both, diabetes is the seventh leading cause of death in the US. The disease is also a major cause of heart disease, stroke, kidney failure, and adult-onset blindness.

Diabetes costs the US an estimated $116 billion (direct costs – medical care) and an additional $58 billion (indirect costs – disability, work loss, and premature deaths). Medical expenses for people with diabetes are over two-times higher than for people without diabetes.

Further, we now know that blood sugar dysregulation may associate with other chronic, debilitating, serious medical conditions. Researchers from the University of Washington (Washington, USA) report that higher glucose levels correlate with an increased risk of dementia. Paul K. Crane and colleagues analyzed data collected on 2,581 men and women, ages 65 and older between 1994 and 1996, enrolled in the Group Health Cooperative, who did not have dementia at the study’s start; an additional 811 subjects enrolled between 2000 and 2002. Participants were asked to return at 2-year intervals for dementia evaluation, and 2,067 of the participants, each of whom were members for at least 5 years prior to the study’s start and had at least five measurements of blood glucose or glycated hemoglobin (HbA1c) over 2 or more years prior to the study, had at least one follow-up visit. The final analysis encompassed 35,264 glucose measurements and 10,208 measurements of HbA1c obtained from 839 men and 1228 women who had a baseline mean age of 76. The participants included 232 patients with diabetes. During a median follow-up of 6.8 years, 524 participants developed dementia, consisting of 74 with diabetes and 450 without. Patients without diabetes and who developed dementia had significantly higher average glucose levels in the 5 years before diagnosis of dementia), equating to a hazard ratio of 1.18. Among the patients with diabetes, glucose levels averaged 190 mg/dL in those who developed dementia versus 160 mg/dL in those who did not, equating tot a hazard ratio of 1.40. The study authors conclude: “ Our results suggest that higher glucose levels may be a risk factor for dementia, even among persons without diabetes.”

Type 2 diabetes, previously called non–insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes, accounts for 90% to 95% of all diagnosed cases of adult diabetes.

In this column, we review present the latest study findings suggesting nutritional and lifestyle approaches that may help to minimize your risks of developing type 2 diabetes.

Crane PK, Walker R, Hubbard RA, et al. Glucose levels and risk of dementia. N Engl J Med. 2013;369:540–548.

US Centers for Disease Control & Prevention. 2011 National diabetes fact sheet [Web page]. http://www.cdc.gov/diabetes/pubs/factsheet11.htm. Accessed 2 Jan. 2014.

Short Walks Protect Against Diabetes

High postmeal blood sugar is a strong determinant of excessive 24-hour glucose levels, and research suggests that people who eat a big afternoon or evening meal and often then are sedentary for the remainder of the day are at risk for rapid blood sugar spikes that could cause damage. Loretta DiPietro and colleagues from George Washington University School of Public Health & Health Services (Washington D.C., US) enrolled 10 men and women, ages 60 years and older, who were otherwise healthy but at risk of developing type 2 diabetes due to higher-than-normal levels of fasting blood sugar and to insufficient levels of physical activity. Subjects completed 3 randomly-ordered exercise protocols spaced 4 weeks apart. Each protocol comprised a 48-hour stay in a whole-room calorimeter, with the first day serving as a control period. On the second day, participants engaged in either walking for 15 minutes after each meal or 45 minutes of sustained walking performed at 10:30 in the morning or at 4:30 in the afternoon. All walking was performed on a treadmill at an easy-to-moderate pace. Participants ate standardized meals and their blood sugar levels were measured continuously over each 48-hour stay. The researchers observed that the most effective time to go for a postmeal walk was after the evening meal. The exaggerated rise in blood sugar after this meal – often the largest of the day – often lasts well into the night and early morning, and this was curbed significantly as soon as the participants started to walk on the treadmill. The study authors write: “Short, intermittent bouts of postmeal walking appear to be an effective way to control postprandial hyperglycemia in older people.”

DiPietro L, Gribok A, Stevens MS, Hamm LF, Rumpler W. Three 15-min bouts of moderate postmeal walking significantly improves 24-h glycemic control in older people at risk for impaired glucose tolerance. Diabetes Care. June 11, 2013.

Lower Glycemic Load to Lower Diabetes Risk

Previously, a number of studies have shown that adherence to a Mediterranean diet – rich in olive oil, and nuts as well as fruits, vegetables, and legumes, and limited amounts of dairy products, red meat, soda drinks, processed meats, and sweets – inversely associates with cardiovascular risks. Italian researchers report that following the traditional Mediterranean diet and limiting high-glycemic-load foods such as those high in refined sugars and grains may reduce a person’s risk of type 2 diabetes. Carlo La Vecchia and colleagues from the Mario Negri Institute of Pharmacological Research (Italy) examined data collected on 22,295 study subjects who resided in Greece and participated in the European Prospective Investigation into Cancer and Nutrition (EPIC) trial. Over 11 years of follow-up, 2330 cases of type 2 diabetes were identified. The researchers observed that those subjects adhering closely to the Mediterranean diet were at lower risks of developing type 2 diabetes. Glycemic load was positively associated with a lower risk for diabetes for the highest versus the lowest glycemic load quartile.

Rossi M et al. Mediterranean diet and glycaemic load in relation to incidence of type 2 diabetes: results from the Greek cohort of the population-based European prospective investigation into cancer and nutrition (EPIC). Diabetologia. 2013; doi:10.1007/s00125-013-3013-y.

Fiber Improves Metabolic and

Cardiovascular Markers

Daily supplements of soluble fiber help to improve metabolic and cardiovascular measures, among diabetics. Valesca Dall’Alba and colleagues from Universidade Federal do Rio Grande do Sul (Brazil) enrolled 44 type 2 diabetics, average age 62 years, and randomly assigned each subject to one of two groups: an intervention group, who consumed a usual diet supplemented with an additional 10 grams per day of guar gum, or a control group, who consumed a usual diet only. After six weeks, the fiber-supplemented group decreased glycated hemoglobin (HbA4c) by 0.31% and lowered trans fatty acid levels from 71 to 57 mg/L; their waist circumference dropped from 103.5 cm to 102.3 cm. The only change in the control group was a 0.9 cm reduction in waist circumference. The study authors conclude: “The addition of [soluble fiber] to the usual diet improved cardiovascular and metabolic profiles by reducing [waist circumference], [glycated hemoglobin], [urinary albumin excretion], and [serum trans-fatty acids].”

Dall’Alba V, Silva FM, Antonio JP, et al. Improvement of the metabolic syndrome profile by soluble fibre – guar gum – in patients with type 2 diabetes: a randomised clinical trial. Br J Nutr. April 2, 2013.

More Fruit Lessens Diabetes Risk

Whole fruits are an abundant source of fiber, antioxidants, and other phytochemicals that may help to promote overall health. Qi Sun and colleagues from Harvard School of Public Health (Massachusetts, US) analyzed data collected on 66,105 women enrolled in the Nurses’ Health Study, 85,104 from the Nurses’ Health Study II, and 36,173 men from the Health Professionals Follow-up Study. Every 4 years, participants were surveyed as to how often they ate various foods and on their diabetes status, among other measures. While all participants were free of major chronic diseases at baseline, 6.5% developed diabetes during follow-up. Adjusted hazard ratios pooled across the three studies for diabetes risk per 3 whole-fruit servings per week were: 0.74 for blueberries; 0.88 for grapes and raisins; 0.93 for apples and pears. Cantaloupe elevated the diabetes risk by 10%, whereas the risk was neutral for peaches, plums, apricots, prunes, oranges, and strawberries. Interestingly, the researchers found that the same amount of fruit juice correlated with a significant 8% elevated risk of developing diabetes. The study authors conclude: “Greater consumption of specific whole fruits, particularly blueberries, grapes, and apples, is significantly associated with a lower risk of type 2 diabetes, whereas greater consumption of fruit juice is associated with a higher risk.”

Muraki I, Imamura F, Manso JE, Sun Q, et al. Fruit consumption and risk of type 2 diabetes: results from three prospective longitudinal cohort studies. BMJ. 29 August 2013;347:f5001.

Dairy Decreases Diabetes

Dairy milk, cheeses, and yogurts are rich sources of calcium, a mineral that increases insulin secretion and may reduce insulin resistance. Dagfinn Aune and colleagues from the Norwegian University of Science and Technology (Norway) completed a meta-analysis of 17 cohort studies of dairy product intake and risk of type 2 diabetes. The team observed that high intake of dairy products was associated with a significant decrease in the risk of type 2 diabetes, with low-fat dairy products conferring the most pronounced effect. The study authors conclude: “This meta-analysis suggests that there is a significant inverse association between intakes of dairy products, low-fat dairy products, and cheese and risk of type 2 diabetes.”

Aune D, Norat T, Romundstad P, Vatten LJ. Dairy products and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis of cohort studies. Am J Clin Nutr. August 14, 2013.

Among Americans aged 65 years and older, 10.9 million – or 26.9% of this age group – have diabetes. Overall, the risk for death among people with diabetes is about twice that of people of similar age but without diabetes. Diabetes is likely to be underreported as a cause of death. Studies have found that about 35% to 40% of decedents with diabetes had it listed anywhere on the death certificate and about 10% to 15% had it listed as the underlying cause of death.

To stay updated on the latest breakthroughs in natural and accessible approaches that may help to reduce your risk of developing type 2 diabetes, visit the World Health Network (www.worldhealth.net), the official educational website of the A4M and your one-stop resource for authoritative anti-aging information. Be sure to sign up for the free Longevity Magazine e-journal, your weekly health newsletter featuring wellness, prevention, and biotech advancements in longevity.