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IHCAN March 2017

When it’s not the gut, it’s the

In Type 2 diabetes, it’s all about blood sugar control.

“Most diabetes treatment plans involve keeping blood sugar levels as close to normal or target goals as possible. This requires frequent at-home and doctor-ordered testing”, as Medical News Today’s expert-reviewed summary says.

Poorly controlled blood sugar is a major risk factor for the “complications” of diabetes, since it’s a given that hyperglycaemia leads to inflammation and that can lead to kidney disease, vision loss and nerve damage, among other nasties.

But wait. What if that’s not true?

There are some flaws in that mechanism, since even people who manage the sought-after “tight control” can still see the disease progress. Harvard’s Dr Robert Shmerling, MD, says: “‘Tight control’ is not always helpful – and it may even cause harm. For example, in studies of people with longstanding type 2 diabetes, the type that usually begins in adulthood and is highly linked with obesity, those with the tightest control either had no benefit or had higher rates of cardiovascular disease and death”.

Is there something else going on?

Well yes, according to “shattering” (their word) research findings from Dr Barbara Nikolajczyk’s team at the University of Kentucky and MIT’s Prof Douglas Lauffenburger. In breakthrough research using specific human cells, they have disproved the conventional wisdom.

Glucose, they say, is NOT the primary driver of chronic inflammation in type 2 diabetes. Instead the blame lies in changes to mitochondria that then drive chronic inflammation from cells exposed to certain fatty acid metabolites.

This research (briefly reported on page 8) explains why some people with “tight control” still get very ill. It may revolutionise the treatment of type 2.

Taking out the trash

Meanwhile, fresh from Nobel Prize recognition a scant three years ago, a new research field is beginning to blossom: autophagy. The cellular waste management system, no one thought it worth studying. But Nobel laureate Dr Yoshinori Ohsum reminds us that life itself is a dynamic balance between synthesis and “degeneration” – and degeneration holds many clues. Right now, he says, they know at most 30% of how autophagy works.

Foods and fasting and the new supplements known as “senolytics” can encourage effective autophagy, without which cell debris and toxic waste can build up and ruin us.

It has to be involved in cancer – and may also explain why orthodox cancer treatments so often fail.. Enjoy our introductory articles on autophagy and inflammation (page 24).

Simon Martin

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