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Friday, April 19, 2019

Wake up, people: You're fooling yourself about sleep, study says - Apple News

Wake up, people: You're fooling yourself about sleep, study says
Updated 2:06 PM EDT April 17, 2019
Hey, sleepyheads. What you believe about sleep may be nothing but a pipe dream.
Many of us have notions about sleep that have little basis in fact and may even be harmful to our health, according to researchers at NYU Langone Health's School of Medicine, who conducted a study published Tuesday in the journal Sleep Health.
"There's such a link between good sleep and our waking success," said lead study investigator Rebecca Robbins, a postdoctoral research fellow in the Department of Population Health at NYU Langone Health. "And yet we often find ourselves debunking myths, whether it's to news outlets, friends, family or a patient."
Robbins and her colleagues combed through 8,000 websites to discover what we thought we knew about healthy sleep habits and then presented those beliefs to a hand-picked team of sleep medicine experts. They determined which were myths and then ranked them by degree of falsehood and importance to health.
Here are 10 very wrong, unhealthy assumptions we often make about sleep, an act in which we spend an estimated third of our lives -- or, if we lived to 100, about 12,227 combined days. 
Stop yawning. It's time to put these unsound sleep myths to bed.
1. Adults need five or fewer hours of sleep
"If you wanted to have the ability to function at your best during the day, not to be sick, to be mentally strong, to be able to have the lifestyle that you would enjoy, how many hours do you have to sleep?" asked senior study investigator Girardin Jean-Louis, a professor in the Department of Population Health.
"It turns out a lot of people felt less than five hours of sleep a night was just fine," he said. "That's the most problematic assumption we found."
We're supposed to get between seven and 10 hours of sleep each night, depending on our age, but the US Centers for Disease Control and Prevention says that a third of Americans sleep fewer than seven hours a night. According to World Sleep Day statistics, sleep deprivation is threatening the health of up to 45% of the global population.
"We have extensive evidence to show that sleeping five hours a night or less, consistently, increases your risk greatly for adverse health consequences, including cardiovascular disease and early mortality," Robbins said.
In a longitudinal study of 10,308 British civil servants published in 2007, researchers found that those who reduced their sleep from seven to five hours or fewer a night were almost twice as likely to die from all causes, especially cardiovascular disease.
Science has also linked poor slumber with high blood pressure, a weakened immune system, weight gain, a lack of libido, mood swings, paranoia, depression and a higher risk of diabetes, stroke, dementia and some cancers.
2. It's healthy to be able to fall asleep 'anywhere, anytime'
Falling asleep as soon as the car/train/airplane starts moving is not a sign of a well-rested person, sleep experts say. In fact, it's just the opposite. 
"Falling asleep instantly anywhere, anytime, is a sign that you are not getting enough sleep and you're falling into 'micro sleeps' or mini-sleep episodes," Robbins said. 'It means your body is so exhausted that whenever it has a moment, it's going to start to repay its sleep debt."
You feel sleepy because of a buildup of a chemical called adenosine in the brain, which happens throughout the day as you head toward night. Sleeping soundly reduces that chemical so that when you wake up, the levels are at their lowest, and you feel refreshed.
But the longer you stay awake and the less sleep you get, the more your adenosine levels rise, creating what's called a sleep load or sleep debt.
Want to check your level of sleepiness? Look at the Epworth sleepiness scale, and if you're worried, check in with a sleep doctor who can do more extensive testing in a sleep lab. 
3. Your brain and body can adapt to less sleep
People also believed that the brain and body could adapt and learn to function optimally with less sleep. That too is a myth, experts say. That's because your body cycles through four distinct phases of sleep to fully restore itself.
In stage one, you start to lightly sleep, and you become disengaged from your environment in stage two, where you will spend most of your total sleep time. Stages three and four contain the deepest, most restorative sleep and the dreamy state of REM, or rapid eye movement sleep.
"During REM, the brain is highly reactive," Robbins said. "It almost looks like your brain is awake if we hook you up to two more electrodes and were able to monitor your brain waves."
REM can occur any time during the sleep cycle, but on average, it starts about 90 minutes after you've fallen asleep. REM is when your body and brain are busy storing memories, regulating mood and learning. It's also when you dream. Your arm and leg muscles are temporarily paralyzed during REM sleep, so you can't act out your dreams and injure yourself. 
Because a good night's sleep gives your sleep cycle time to repeat, you'll go through several REM cycles, which take up about 25% of your total sleeping time. 
Another important stage of sleep is deep sleep, when your brain waves slow into what is called delta waves or slow-wave sleep. It's the time when human growth hormone is released and memories are further processed. 
"The deeper stages of sleep are really important for generation of neurons, repairing muscle and restoring the immune system," Robbins said. 
It's tough to wake a person from deep sleep. If you do wake, you can feel groggy and fatigued; mental performance can be affected for up to 30 minutes, studies show. 
4. Snoring, although annoying, is mostly harmless
In your dreams, maybe. In fact, "loud, raucous snores interrupted by pauses in breathing" is a marker for sleep apnea, a dangerous sleep disorder that, according to the National Heart, Lung and Blood Institute, increases risk for heart attacks, atrial fibrillation, asthma, high blood pressure, glaucoma, cancer, diabetes, kidney disease and cognitive and behavior disorders.
"Sleep apnea is extremely exhausting," Robbins said. "These patients sleep and then they wake up over and over; then they are fighting sleep all day long because they're so exhausted. It's also very underdiagnosed. We believe it affects about 30% of the population, and around 10% are diagnosed."
5. Drinking alcohol before bed helps you fall sleep
Do you think a nightcap before bed will help you fall asleep and stay asleep? Dream on.
Alcohol may help you fall asleep, but that's where the benefits end, Robbins said. Instead, it traps you in the lighter stages of sleep and "dramatically reduces the quality of your rest at night."
"It continues to pull you out of rapid eye movement and the deeper stages of sleep, causing you to wake up not feeling restored," Robbins said.
6. Not sleeping? Stay in bed with eyes closed and try and try
You have to admit, it makes sense: How can you fall asleep if you're not in the bed trying? Yet sleep experts say that continuing to count sheep for more than 15 minutes isn't the smartest move. 
"If we stay in bed, we'll start to associate the bed with insomnia," Robbins said. She equates it to "going to the gym and standing on a treadmill and not doing anything." 
In reality, Robbins said, it takes a healthy sleeper about 15 minutes to fall asleep. If you're tossing and turning much longer than that, you should get out of bed, change the environment and do something mindless: "Keep the lights low and fold socks," she suggested.
Some people also believe that it's just as refreshing to your body to lie in bed with eyes closed but not sleeping. Nope. That's another pipe dream, experts say.
7. It doesn't matter what time of day you sleep
Sleep experts say that's another myth that can negatively affect your health.
"We recommend that people have a regular sleep schedule because it controls what we call the biological clock, or circadian rhythm, of the body," Jean-Louis said. "That controls all the hormones of the body, body temperature, eating and digestion, and sleep-wake cycles."
When your inner clock and the outside world are out of phase, you can feel disoriented, mentally foggy and sleepy at times when you need to be functioning at optimal levels. Just think of what happens when you travel across time zones or when daylight savings time kicks in. 
Studies of shift workers, who work unusual hours and live out of sync with their normal biological rhythm, show that they are at increased risk for heart disease, ulcers, depression, obesity and certain cancers, as well as a higher rate of workplace accidents and injuries due to a slower reaction rate and poor decision-making.
8. Watching TV in bed helps you relax
Come on, we all do it -- or we check our laptop or smartphone before we power down for the night. Unfortunately, that sets us up for a bad night.
"These devices emit bright blue light, and that blue light is what tells our brain to become alive and alert in the morning," Robbins explained. "We want to avoid blue light before bed, from sources like a television or your smartphone, and do things that relax you."
According to the National Sleep Foundation, blue light affects the release of melatonin, the sleep hormone, more than any other wavelength of light. Watching TV or using an electronic device within two hours of bedtime means it will take you longer to fall asleep, you'll have less dream state or REM sleep, and even if you do sleep eight or more hours, you'll wake feeling groggy.
If you or your children can't make that two-hour cutoff because of homework or late-night work demands, experts suggest dimming the brightness of the screen or installing an app that can warm the screen to the sunset colors. Red and yellow have higher wavelengths and don't affect melatonin.
9. Hitting snooze is great! No need to get up right away.
Raise your hand if you hit the snooze button. Why not, right? 
"Resist the temptation to snooze, because unfortunately, your body will go back to sleep -- a very light, low-quality sleep," Robbins said. 
As you near the end of your sleep, your body is probably nearing the end of its last REM cycle. Hit that snooze button, and the brain falls right back into a new REM cycle. Now, when the alarm goes off a few minutes later, you'll be in the middle, not the end, of that cycle, and you'll wake up groggy and stay that way longer.
Having trouble kicking the snooze button habit? Put the alarm on the other side of the room, so you have to get out of bed to turn it off. 
And no, you can't tell Google or Alexa to turn it off. That's cheating.
10. Remembering your dreams is a sign of good sleep.
"That's a myth, because all of us do experience dreams four to five times a night," Jean-Louis said. "And we don't remember because we've not woken up and disrupted our sleep."
A study out of France showed that people who frequently remember their dreams have higher brain activity in the information-processing hub of the brains. They also woke twice as often during the night and were more sensitive to sounds when sleeping and awake.
"Now, I will tell you if you have a dream with a strong emotional context, it may come back to you at say, two o'clock in the afternoon, when you have some downtime to relax," Jean-Louis said. "Sometimes, something would trigger that. But if it is a weird little mundane dream, most of us who sleep well don't remember those."
More myths
The research team found more myths that we tend to accept as fact, Jean-Louis said, such as "more sleep is always better" (no, you really can sleep too much and harm your health), "taking a nap in the afternoon can fix insomnia" (actually, if you sleep long enough to enter a REM or deep sleep cycle, it can mess up your body clock even more), and "it's better to have a warm than cool bedroom" (no, you sleep better in cooler temps).
Which means that we could all use a bit of education about good sleep hygiene, a set of habits to form that will set you up for a lifetime of healthy sleep. The National Sleep Foundation has tips, as does the CDC.
After all, there's no amount of caffeine that can help you deal with the adverse implications of insufficient sleep, nor can you train yourself to adapt to sleep deprivation, Robbins said. 
"Sleep is a highly active process," she said. "It's crucial, actually, in restoring the body and is in fact the most efficient, effective way to do so."
Sweet dreams!

Saturday, March 30, 2019

MYTH BUSTER Sugar causing cancer and bicarb killing tumours: Cancer charity appoints nurse to combat ‘fake news’ about disease


Sugar causing cancer and bicarb killing tumours: Cancer charity appoints nurse to combat ‘fake news’ about disease

Macmillan Cancer Support has hired a nurse dedicated to answering questions from people affected by cancer online
A CANCER charity has appointed its first digital nurse to help combat the amount of “fake news” about the disease available online.
Macmillan Cancer Support is worried patients are turning to unverified websites for information on how to treat cancer that leads to them following bogus cures.
Ellen McPake will be dedicated to answering questions from people affected by cancer online
Ellen McPake, from Glasgow, will be dedicated to answering questions from people affected by cancer online on Macmillan’s social platforms.
A quick online search brings up a host of alternative treatments including how baking soda can cure breast cancer, the charity warns.
Janice Preston, head of Macmillan Cancer Support in Scotland, said: “It's understandable that people go online to look up their diagnosis, but it's vital they get information from reliable sources.
“As well as fantastic information and support, the web is full of unverified statistics, fake news and horror stories that can cause people unnecessary worry and distress.
 Unverified websites could be encouraging cancer patients to use bogus cures
Unverified websites could be encouraging cancer patients to use bogus cures
“It's important people have access to trusted information online and know how to separate websites that are accurate and reputable from those with incorrect or even dangerous information.”
The charity is concerned that some patients are Googling their symptoms because they are leaving appointments without all the information they need.
Ms McPake said: “As more and more people seek information about their cancer online, we want them to know that charities like Macmillan are able to offer reliable health advice.
“In my new role, I'm there to make sure people affected by cancer have a real person they can turn to online for information about their symptoms, cancer diagnosis and treatment.”
 Macmillan Cancer Support is worried patients are turning to unverified websites for information on how to treat cancer
Macmillan Cancer Support is worried patients are turning to unverified websites for information on how to treat cancer
Here are six of the biggest myths surrounding cancer.

1. Sugar causes cancer

You may have heard that sugar gives you cancer, or that sugar speeds up the growth of cancer cells.
But that is a myth.
Dr Timothy Moynihan, a cancer specialist at the Mayo Clinic, said: "Sugar doesn't make cancer grow faster.
"All cells, including cancer cells, depend on blood sugar (glucose) for energy.
The theory that sugar can cause cancer to grow faster is a myth, according to some experts
"But giving more sugar to cancer cells doesn't speed their growth.
"Likewise, depriving cancer cells of sugar doesn't slow their growth."
However, eating too much sugar can make you fat and obesity is linked to 11 different types of cancer.
Not to mention obesity causes high blood pressure and is linked to other diseases like heart attack, stroke and diabetes.
So while cutting out sugar will not help cure your cancer or slow the growth of your tumour, cutting back on it will be beneficial to your health.
Another myth is that bicarb soda can cure breast cancer

2. Bicarb soda cures breast cancer

This myth can be potentially life-threatening.
Some websites suggest that consuming bicarb soda can cure breast cancer.
The theory behind this is that is regulates the pH levels of the blood.
The body's natural pH levels should be around 7.3 and it is thought that bicarb soda can help reverse any damage caused by the pH level being altered, such as when cancer strikes.
But there is no scientific evidence to support this.
Some people believe mobile phones can cause brain tumours but there is little scientific evidence to support that

3. Mobile phones cause cancer

You've probably also heard that talking on your mobile phone all the time can cause brain tumours.
The suggestion is that the low-frequency energy released by a phone travel into the brain when we have them pressed against our ears.
But again, scientific studies of the potential health risks of mobile phones have mostly found they pose no risk to human health.
Some studies have concluded that heavy mobile phone use may pose some risk but experts say it is too early to say there is a link given the technology is relatively new.
The worry is around the non-ionising radiation used in a range of communication, electronic and other devices like mobile phones, radio and TV, according to Cancer Research UK.

RAISING AWARENESS What is a brain tumour and what are the signs and symptoms to look out for?

Most non-ionising radiation has less energy than ionising radiation, which means it doesn’t have enough energy to change our cells in the same way as ionising radiation, the charity explains on its website.
The largest study so far on possible links between mobile phones and brain tumours is part of the Million Women Study and looked at nearly 800,000 women.
It found no link between mobile phone and brain tumours and also concluded there was no increased risk of 18 other types of cancer.
And the use of mobile phones has skyrocketed over recent decades yet there has been no spike in brain tumour rates in the UK, according to Cancer Research UK statistics.
Fiona Osgun, Cancer Research UK’s senior health information officer, said: "There is no convincing evidence to show that mobile phones can increase the risk of brain tumours, or any other type of cancer.
"But because mobiles are a fairly new technology, research is continuing to check for any effects over longer periods of time."
 Some therapists suggest a coffee enema three to four times a day that cleanses the bowel can help fight cancer
Some therapists suggest a coffee enema three to four times a day that cleanses the bowel can help fight cancer

4. A coffee enema protects you

Yes, you read that right.
A coffee enema.
Despite what you might have read, there is only one thing you should be doing with coffee and that's brewing a nice hot cup to wake you up in the morning.
Coffee enemas are part of the Gerson therapy to beat cancer, which involves a very specific diet with supplements.
Gerson therapists believe that people with cancer have too much salt in their bodies compared to the amount of potassium.
They also recommend you have three to four coffee enemas a day.


There are many reasons people may opt to use alternative or natural therapies.
But there is little evidence to suggest they work.
All medical treatments, such as chemotherapy and radiotherapy for cancer, have to go through vigorous testing to prove they work before they are made available to patients.
Alternative therapy is not subject to the same testing.
The lack of regulation also means some alternative therapies could be harmful or cause unwanted side effects.
And choosing alternative therapies, or shunning treatment all together, can prove fatal.
Cancer patients who opt for alternative treatments over chemotherapy are twice as likely to die, according to a recent study from the Yale School of Medicine.
Many alternative treatments, such as homeopathy, are based on the idea the body can heal itself through exposure to highly diluted substances that cause an illness.
But July NHS officials launched a consultation to scrap homeopathic medicines saying they are a “misuse of scares funds”.
Alternative therapies can, however, be used alongside traditional medicine.
For example, many people find peppermint oil or ginger to be a successful remedy for nausea which is a nasty side effect of chemo.
For those who don't know, an enema is when fluid in flushed into the lower bowel through the rectum to help relieve constipation.
Gerson therapists believe coffee enemas remove toxins from the body by stimulating the bowel, liver and bile ducts.
Again, there is no scientific evidence to suggest this therapy works as a cure for cancer.
A review in the USA by the National Cancer Institute in 2010 found no evidence that it helped people with cancer.
In fact, many people who have tried the coffee enemas have ended up dehydrated, constipated and some got infections.
Others had to deal with inflammation of the bowel.
Some studies have linked hair dye and cancer but there is no definite proof it can cause the disease

5. Hair dye can cause cancer

There has been some recent evidence to suggest a link between regularly dying your hair and cancer.
But there is no solid proof that definitely ties the two together.
One of the latest studies that have linked the two came from London's Princess Grace Hospital.
Professor Kefah Mokbel, a breast cancer surgeon at the hospital, reviewed studies on hair dye and breast cancer and found a 14 per cent rise in the disease in women who regularly coloured their hair.
He suggests women should dye their hair only two to six times per year and opt for more natural ingredients like beetroot, henna and rose hip to reduce their risk of developing the disease.
But he noted further work is needed to confirm a link between hair dye and breast cancer.
Other studies have also noted that hairdressers who are regularly exposed to the products may have an increased risk of bladder cancer.
But the National Cancer Institute in the US suggests any link between cancer and hair dye has not been solidly proven.

6 Everyday Habits That Can Damage Our Health

6 Everyday Habits That Can Damage Our Health

There are certain things we do every day that actually pose a threat to our health. Some of these habits are common and ordinary, embedded in our day to day activities.

Who would think that even the ordinary activities you engage in could damage your health?

Below are 10 everyday habits that may damage your health. Check them out and see if they are damaging yours.

1. Sitting: Countless studies show time and time again that being physically inactive leads to a whole list of health problems.
The World Health Organization reports that being physically inactive comes in fourth as a leading risk factor for death.
Many people have jobs that require they sit, but do you sit even more when you get home? If you have to sit for work, try standing at every opportunity you get or try taking a walk instead of using the intercom.

2. Snacking: Eating when you’re not hungry can create all kinds of problems.
Most times, when people snack so, unhealthy food is being consumed, causing weight to be gained, sodium to rise and cholesterol levels to go up.

3. Cell phones: Experts revealed that when cellphones are used before bed, the light from the cell phones or tablets triggers our brains to stay awake thereby causing insomnia. There’s also a report that the rays from our mobile device can cause cancer.

4. TV: Everyone likes to sit and watch a good movie, but RD points out that too much of a good thing can become bad.
Sitting at the TV means you’re more prone to snack and less active. Use it wisely.

5. Skipping breakfast: Often people who are trying to control what they eat skip breakfast because they aren’t hungry or just don’t have time. Having your breakfast kick starts your body and triggers your metabolism. Without that trigger, you may end up eating much in the afternoon, thereby gaining more than you lose.

6. Oversleeping: Over-sleeping is actually a medical disorder. The condition causes people to suffer from extreme sleepiness throughout the day. It also causes them to sleep for unusually long periods of time at night. This can trigger headaches. The required sleep duration for an adult is 7-8 hours daily.

Monday, December 3, 2018

IIT-Bombay team creates tiny bubbles for cancer drugs that can make chemo pain-free

SANDHYA RAMESH 6 November, 2018

Patients receiving chemotherapy (Representational image) | Daniel Bockwoldt/picture alliance via Getty Images
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IIT-Bombay team has devised a drug carrier that can be used in combination with chemo to deliver treatment to exact site of tumour, keeping healthy cells safe.
Bengaluru: IIT-Bombay scientists have developed a therapy whereby two microscopic “bubbles” can deliver drugs straight to tumours, thus reducing the amount of healthy cells that would be affected in chemotherapy.
The mice on which the study was carried out reportedly demonstrated a 100 per cent survival rate.
The research has been published in the journal Scientific Reports.
Cancer has affected humans for millennia, and, so far, chemotherapy has proved to be one of the most effective treatments.
However, cancer cells tend to multiply quickly and chemotherapy simply targets the cells that are dividing.
This means that even healthy cells that aren’t affected by cancer will be targeted by chemo drugs, which induce suicide in cells. Thus, whether the treatment is effective or not, the patient invariably tends to be in a lot of pain.

To improve the accuracy of drugs — so they target only an infected tumour and not healthy cells — as well as to reduce cancer cells developing immunity to drugs, lots of experimental work is underway around the world on ‘combination therapy’.
These include the administration of two or more drugs to treat the same disease. With cancer, this is increasingly becoming the norm.

Ball-shaped carriers
The IIT-Bombay team has devised a drug carrier that can be used in combination with chemotherapy to deliver treatment to the exact location of a solid cancerous tumour, keeping healthy cells safe.
The study has been performed on both lab-grown cells (in-vitro), as well as animals (in-vivo), with promising results.
The injectable consists of two microscopic ball-shaped carriers attached together: The smaller one is a capsule that will contain the potent drug to fight a cancer cell, and the bigger one a gas bubble that will act as a tracker that can be seen using ultrasound imaging.
The latter is 500 nanometres in diameter, and known as a “nanobubble”, while the drug carrier is about 200 nanometres and called a “nanocapsule”.
The tiny blobs will have two different effects in the body. First, they will be able to allow tracking through ultrasound as they travel through the bloodstream.
We can monitor their progress and wait for them to reach the precise point of the cancerous tumour. When they hit the region where the affected tumour is, ultrasound therapy can be administered to the exact target area. This process is known as guided cancer therapy.
The second occurs as tissues loosen when ultrasound is applied to the right spot. As the tumour area is administered ultrasound, the tumour tissues relax. The gas bubble undergoes multiple expansions and contractions, before eventually bursting.
The tiny nanocapsule has now been given an easy passageway to enter the tumour, thanks to tissue expansion. The capsule is made up of lipids that occur naturally in our bodies, and thus they are compatible to deliver the drug within the tumour at a precise location.

‘Improved targeting’
“This research presents an image-guided, ultrasound trigger-responsive platform for improved tumour cell targeting, along with real-time monitoring of the disease,” said Rinti Banerjee from the department of biosciences and bioengineering at IIT-Bombay, who led the study.
The two individual bubbles aren’t a new invention. Both technologies exist independently. But they have not been used in conjunction before for treating cancer.
“To the best of our knowledge this is the first time a smart combination therapy with a pro-apoptotic biomolecule, a drug, and nanobubbles have been used together,” said Banerjee.
The study showed that ultrasound with the combination of the two bubbles is much more effective than any other combination of treatments and components.
Ultrasound image-guided therapy and ultrasound application therapy are growing fields in cancer research, and this study could help expedite more efficient treatments based on this technology.

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Saturday, March 3, 2018

Scientists say diabetes is five separate diseases, and treatment could be tailored to each form.

Could there be five types of diabetes rather than just two?

Scientists say diabetes is five separate diseases, and treatment could be tailored to each form.
Diabetes - or uncontrolled blood sugar levels - is normally split into type 1 and type 2.

But researchers in Sweden and Finland think the more complicated picture they have uncovered will usher in an era of personalised medicine for diabetes. 

Experts said the study was a herald of the future of diabetes care but changes to treatment would not be immediate. 
Diabetes affects about one in 11 adults worldwide and increases the risk of heart attack, stroke, blindness, kidney failure and limb amputation.
Type 1 diabetes is a disease of the immune system, which affects around 10% of people with the condition in the UK. It errantly attacks the body's insulin factories (beta-cells) so there is not enough of the hormone to control blood sugar levels. 
Type 2 diabetes is largely seen as a disease of poor lifestyle as body fat can affect the way the insulin works. 
The study, by Lund University Diabetes Centre in Sweden and the Institute for Molecular Medicine Finland, looked at 14,775 patients including a detailed analysis of their blood.
The results, published in The Lancet Diabetes and Endocrinology, showed the patients could be separated into five distinct clusters. 
  • Cluster 1 - severe autoimmune diabetes is broadly the same as the classical type 1 - it hit people when they were young, seemingly healthy and an immune disease left them unable to produce insulin
  • Cluster 2 - severe insulin-deficient diabetes patients initially looked very similar to those in cluster 1 - they were young, had a healthy weight and struggled to make insulin, but the immune system was not at fault
  • Cluster 3 - severe insulin-resistant diabetes patients were generally overweight and making insulin but their body was no longer responding to it
  • Cluster 4 - mild obesity-related diabetes was mainly seen in people who were very overweight but metabolically much closer to normal than those in cluster 3
  • Cluster 5 - mild age-related diabetes patients developed symptoms when they were significantly older than in other groups and their disease tended to be milder

Image copyright
Prof Leif Groop, one of the researchers, told the BBC: "This is extremely important, we're taking a real step towards precision medicine.
"In the ideal scenario, this is applied at diagnosis and we target treatment better."
The three severe forms could be treated more aggressively than the two milder ones, he said.
Cluster 2 patients would currently be classified as type 2 as they do not have an autoimmune disease. 
However, the study suggests their disease is probably caused by a defect in their beta-cells rather than being too fat.
And perhaps their treatment should more closely mirror patients who are currently classed as type 1.
Cluster 2 had a higher risk of blindness while cluster 3 had the greatest risk of kidney disease, so some clusters may benefit from enhanced screening. 
Better classification
Dr Victoria Salem, a consultant and clinical scientist at Imperial College London, said most specialists knew that type 1 and type 2 was "not a terribly accurate classification system".
She told the BBC: "This is definitely the future of how we think about diabetes as a disease."
But she cautioned the study would not change practice today.
The study was only on Scandinavians and the risk of diabetes varies considerably around the world, such as the increased risk in South Asians.
Dr Salem said: "There is still a massively unknown quantity - it may well be that worldwide there are 500 subgroups depending on genetic and local environment effects.
"Their analysis has five clusters, but that may grow."
Sudhesh Kumar, a professor of medicine at Warwick Medical School, said: "Clearly this is only the first step. 
"We also need to know if treating these groups differently would produce better outcomes."
Dr Emily Burns, from Diabetes UK, said understanding the diseases could help "personalise treatments and potentially reduce the risk of diabetes-related complications in the future".
She added: "This research takes a promising step toward breaking down type 2 diabetes in more detail, but we still need to know more about these subtypes before we can understand what this means for people living with the condition."

Friday, October 6, 2017



Why did it take us so long to realise sugar, not fat, was the enemy? In a move that would make most big pharma companies proud, new research published in JAMA Internal Medicine found sugar companies paid to downplay the white stuff's role in heart disease during the 1960s. Scary stuff, even more so because it's had lasting effects on public perceptions. It's time everyone woke up to the truth about fat and sugar. MH investigates...
This morning, as I do most days, I breakfasted on a three egg omelette cooked in coconut oil, with a whole milk coffee. I enjoyed a wedge of full fat cheese with my lunch, poured a liberal dose of olive oil on my evening salad and snacked on nuts throughout the day. In short, I ingested a fair amount of fat and, as a cardiologist who has treated thousands of people with heart disease, this may seem a particularly peculiar way to behave. Fat, after all, furs up our arteries and piles on the pounds – or at least that’s what prevailing medical and dietary advice has had us believe. As a result, most of us have spent years eschewing full fat foods for their ‘low fat’ equivalents, in the hope it will leave us fitter and healthier.
Yet I’m now convinced we have instead been doing untold damage: far from being the best thing for health or weight loss, a low fat diet is the opposite. In fact, I would go so far as to say the change in dietary advice in 1977 to restrict the amount of fat we were eating helped to fuel the obesity epidemic unfolding today. It’s a bold statement, but one I believe is upheld by an array of recent research.
These days I make a point of telling my patients – many of whom are coping with debilitating heart problems – to avoid anything bearing the label ‘low fat’. Better instead, I tell them, to embrace full fat dairy and other saturated fats within the context of a healthy eating plan. It’s an instruction that is sometimes greeted with open-mouthed astonishment, along with my request to steer clear of anything that promises to reduce cholesterol – another of those edicts we are told can promote optimum heart and artery health.
As we will see, the reality is far more nuanced: in some cases lowering cholesterol levels can actually increase cardiovascular death and mortality, while in healthy people over sixty a higher cholesterol is associated with a lower risk of mortality. Why, exactly, we will come to later.
First though, let me make it clear that until very recently, I too assumed that keeping fat to a minimum was the key to keeping healthy and trim. In fact, to say my diet revolved around carbohydrates is probably an understatement: sugared cereal, toast and orange juice for breakfast, a panini for lunch and pasta for dinner was not an uncommon daily menu. Good solid fuel, or so I thought, especially as I am a keen sportsman and runner. Still, I had a wedge of fat round my stomach which no amount of football and running seemed to shift.
That, though, wasn’t the reason I started to explore changing what I ate. That process started in 2012, when I read a paper called ‘The toxic truth about Sugar’ by Robert Lustig in the science journal Nature.  In it, Lustig, a Professor of Paediatrics who also works at the University of California’s Centre for Obesity Assessment, said that the dangers to human health caused by added sugar were such that products packed with it should carry the same warnings as alcohol. It was an eye-opener: as a doctor I already knew too much of anything is bad for you, but here was someone telling us that something most of us ate unthinkingly every day was, slowly, killing us.
The more I looked into it, the more it became abundantly clear to me that it was sugar, not fat, which was causing so many of our problems – which is why, along with a group of fellow medical specialists I launched the lobbying group Action on Sugar last year with the aim of persuading the food industry to reduce added sugar in processed foods
Then earlier this year I had another light-bulb moment. In February Karen Thomson, the granddaughter of pioneering heart transplant surgeon Christian Barnard, and Timothy Noakes, a highly-respected Professor of Exercise and Sports Medicine at the University of Cape Town, invited me to speak at the world’s first ‘low carb’ summit in South Africa. I was intrigued, particularly as the conference hosts are both fascinating characters. A former model, Thomson has courageously battled a number of addictions including alcohol and cocaine, but lately it is another powder – one she labels ‘pure, white and deadly’ – that has resulted in her opening the world’s first carbohydrate and sugar addiction rehab clinic in Cape Town
Noakes, meanwhile, has recently performed a remarkable U-turn on the very dietary advice he himself expounded for most of his illustrious career: that is, that athletes need to load up on carbohydrates to enhance performance. A marathon runner, he was considered the poster boy for high carbohydrate diets for athletes – then he developed Type 2 diabetes. Effectively tearing pages out of his own textbook, Noakes has now said athletes – and this goes for those of us who like to jog around the park too – can get their energy from ketones, not glucose. That is, from fat not sugar.
Alongside them were fifteen international speakers ranging from doctors, academics and health campaigners who between them produced an eloquent and evidence-based demolition of “low fat” thinking – as well as suggesting that it is carbohydrate consumption, not fatty foods, which is fuelling our obesity epidemic.
Opening the conference was Gary Taubes, a former Harvard physicist who wrote The Diet Delusion, in which he argued that it is refined carbohydrates that are responsible for heart disease, diabetes, obesity, cancer, and many other of our Western maladies. The book caused controversy when it was released seven years ago, but his message is finally gaining traction. And that message is this: obesity is not about how many calories we eat, but what we eat. Refined carbohydrates fuel the over production of insulin, which in turn promotes fat storage. In other words: it’s not calories from fat themselves that are the problem.
It’s a robust message that was reinforced time and again at the conference. Take Swedish family physician Dr Andreas Eenfeldt, who runs the country’s most popular health blog Diet Doctor. In his home country, studies show that up to twenty three percent of the population are embracing a high fat, low carbohydrate diet. A ticking time bomb you might think – but contrary to expectations, while obesity rates are soaring everywhere else, they are now starting to show a decline there
More research on this correlation is yet to be done – but in the meantime The Swedish Council on Health Technology has made its position clear. After a two year review involving sixteen scientists, it concluded that a high fat, low carb diet may not only be best for weight loss, but also for reducing several markers of cardiovascular risk in the obese. In short, as Dr Eenfeldt told the conference, ‘You don’t get fat from eating fatty foods just as you don’t turn green from eating green vegetables.’
This, of course, is a difficult message for many to swallow; particularly for heart patients, most of whom have spent years pursuing a low fat, low cholesterol diet as the best way to preserve heart health.
It’s a public health message that was first promoted in the sixties, after the globally respected Framingham Heart study sanctified high cholesterol as a major risk factor for heart disease. It’s a cornerstone of government and public health messages – yet what people didn’t know was that the study also threw up some more complex statistics. Like this one: for every 1mg/dl per year drop in cholesterol levels in those who took part in the study there was a 14% increase in cardiovascular death and an 11% increase in mortality in the following 18 years for those aged over 50.
It’s not the only statistic that doesn’t sit with the prevailing anti-cholesterol message: in 2013, a group of academics studied previously unpublished data from a seminal study done in the early seventies, known as the Sydney Diet Heart study. They discovered that cardiac patients who replaced butter with margarine had an increased mortality, despite a 13% reduction in total cholesterol. And the Honolulu heart study published in the Lancet in 2001 concluded that in the over-sixties a high total cholesterol is inversely associated with risk of death. Startling, isn’t it? A lower cholesterol is not in itself the mark of success, it only works in parallel with other important markers, like a shrinking waist size and diminishing blood markers for diabetes.
Conversely, a mounting slew of evidence suggests that far from contributing to heart problems, having full fat dairy in your diet may actually protect you from heart disease and type 2 diabetes. What most people fail to understand is that, when it comes to diet, it’s the polyphenols and omega 3 fatty acids abundant in extra virgin olive oil, nuts, fatty fish and vegetables that help to rapidly reduce thrombosis and inflammation independent of changes in cholesterol. Yet full fat dairy has remained demonized – until now.
In 2014, two Cambridge Medical Research Council studies concluded that the saturated fats in the blood stream that came from dairy products were inversely associated with Type 2 diabetes and heart disease. Meaning that in moderate amounts – no-one is talking about devouring a cheese board in one sitting here – cheese is actually a proponent of good health and longevity. The same study, incidentally, found that the consumption of starch, sugar and alcohol encourages the production of fatty acids made by the liver that correlate with an increased risk of these killer diseases.
It is around type 2 Diabetes, in fact, that the anti-fat pro-carb message of recent decades has done some of the greatest damage. A lot of patients suffering from Type 2 Diabetes – the most common kind – are laboring under the dangerous misapprehension that a low fat, starchy carbohydrate fuelled diet will help their medication work most effectively. They couldn’t be more wrong. Earlier this year, a critical review in the respected journal Nutrition concluded that dietary carbohydrate restriction is one of the most effective interventions for reducing features of metabolic syndrome. 
It would be better to rename type 2 diabetes “carbohydrate intolerance disease”. Try telling this to the public though. Like the man who called into a national radio show in Cape Town on which I was taking part to discuss the relationship between diet and heart disease. Diagnosed with Type 2 diabetes, he was under the impression he had to consume sugar so his diabetes medications could ‘work’ – when in fact it was going to worsen his symptoms. And how many doctors and patients know that although some of these medications to control blood sugar may marginally reduce the risk of developing kidney disease, eye disease and neuropathy, they don’t actually have any impact on heart attack, stroke risk or reduce death rates? On the contrary dangerously low blood sugar from overmedicating on diabetes drugs has been responsible for approximately 100,000 emergency room visits per year in the United States
But who can blame the public for such misguided perceptions? In my opinion a perfect storm of biased research funding, biased reporting in the media and commercial conflicts of interest have contributed to an epidemic of misinformed doctors and misinformed patients. The result is a nation of over-medicated sugar addicts who are eating and pill-popping their way to years of misery with chronic debilitating diseases and an early grave.
It’s why, these days, I very seldom touch bread, have got rid of all added sugars and have embraced full fat as part of my varied Mediterranean-inspired diet. I feel better, have more energy and – even though I didn’t set out to do so – I’ve lost that fatty tyre around my waist, despite reducing the time I spend exercising.
Perhaps you can’t face making all those changes in one go. In which case, if you do one thing, make it this: next time you are in the supermarket and are tempted to pick up a pack of low-fat spread, buy a pack of butter instead or, better still, a bottle of extra virgin olive oil. Your heart will thank you for it. The father of modern medicine Hippocrates once said, “let food be thy medicine and medicine be thy food”. It’s now time we let “fat” be that medicine.
Dr Aseem Malhotra is a cardiologist, founding member of the Public Health Collaboration and advisor to the National Obesity Forum.