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Regression of Diabetic Neuropathy with Total Vegetarian (Vegan) Diet

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Regression of Diabetic Neuropathy with Total Vegetarian (Vegan) Diet

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Abstract

This study reports alleviation of the sharp, burning pains characteristic of systemic distal polyneuropathy (SDPN) patients with adult-onset (Type II) diabetes mellitus (AODM). Twenty-one patients with known AODM and SDPN, average age 64, were trained in a low fat (10–15% of cats), high fiber, total vegetarian diet (TVD) of unrefined foods and conditioning exercise in a 25-day in-residence life-style program. Complete relief of the SDPN pain occurred in 17 of the 21 patients in 4 to 16 days. The numbness persisted, but had noticeably improved. Weight loss averaged 4-9 ± 2-6 kg during the 25 days. By the 14th day, the fasting blood glucose level averaged 35% lower for the 11 patients who were above 6-6 mmoll1, and the insulin needs had dropped in half the patients. Five no longer needed hypoglycemic agents. Also, serum triglyceride and total cholesterol had decreased by 25-0 ± 23% and 13 ± 15% respectively (p Follow-up studies of 17 of the 21 patients for 1-4 years indicated that 71% had remained on the diet and exercise programme as advised in nearly every item. In all except one of the 17 patients, the relief from the SDPN had continued, or there was further improvement. In our opinion, these results appear to be related to a factor(s) in the TVD, and not necessarily to an improved glucose control, since the serum glucose was not under good control until about the 10th day.

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... 9 Two uncontrolled diet intervention studies showed promising results in individuals with diabetic neuropathy. 10, 11 We therefore hypothesized that a plant-based dietary intervention can reduce diabetic neuropathy pain and conducted a randomized, controlled, pilot study to test this hypothesis. This study was intended to investigate the efficacy of this approach and the suitability of the overall method, permitting larger trials to follow. ...
... Previous studies were conducted on pre-diabetes patients 10 or in a short-term residential program with no control group. 11 Therefore, we chose an exploratory approach that did not limit sample size and accepted all volunteers who met the participation criteria. ...
... It was conducted with community volunteers; therefore, the results are readily translatable to applications outside the research setting. A comparable previous study 11 was done as part of a residential program, in which food was provided and exercise was mandatory. Those authors saw dramatic improvements in a short time, but they did not demonstrate that their intervention was sustainable or their results generalizable. ...
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Diabetic neuropathy is a common and often debilitating condition for which available treatments are limited. Because a low-fat plant-based diet has been shown to improve glycemic control in individuals with type 2 diabetes, we hypothesized that such a diet would reduce painful symptoms of diabetic neuropathy. In this 20-week pilot study, individuals with type 2 diabetes and painful diabetic neuropathy were randomly assigned to two groups. The intervention group was asked to follow a low-fat, plant-based diet, with weekly classes for support in following the prescribed diet, and to take a vitamin B12 supplement. The control group was asked to take the same vitamin B12 supplement, but received no other intervention. At baseline, midpoint and 20 weeks, clinical, laboratory and questionnaire data were collected. Questionnaires included an analog 'worst pain' scale, Michigan Neuropathy Screening Instrument, global impression scale, Short Form McGill Pain Questionnaire, Neuropathy Total Symptom Score, a weekly pain diary and Norfolk Quality of Life Questionnaire. After 20 weeks, body weight change with the intervention was -6.4 kg (95% confidence interval (CI) -9.4 to -3.4, P<0.001) in an effect size analysis. Electrochemical skin conductance in the foot improved by an average of 12.4 microseimens (95% CI 1.2-23.6, P=0.03) with the intervention in an effect size analysis. The between-group difference in change in pain, as measured by the McGill pain questionnaire, was -8.2 points (95% CI -16.1 to -0.3, P=0.04). Michigan Neuropathy Screening Instrument questionnaire score change was -1.6 points (95% CI -3.0 to -0.2, P=0.03). Improvements were seen in some clinical and pain measures. This pilot study suggests the potential value of a plant-based diet intervention, including weekly support classes, for treating painful diabetic neuropathy.
... In fact, more than 25 years ago, Crane and Sample reported regression of neuropathic pain in patients who entered a 25-day lifestyle enhancement program compromising a vegan diet, exercise, and miscellaneous supplemental factors. 17 Approximately 80% of participants reported complete relief of the neuropathic pain within just 4-16 days. ...
... The search yielded only a handful of studies that investigated the effects of a plant-based diet on diabetic neuropathy. 3,17,18 Table 2). The hallmark of this intervention was the calorie-reduced, low-fat vegan diet, which also excluded any refined foods and animal products. ...
... [32][33][34][35] The participants in the study by Crane and Sample and in the trial of Bunner and colleagues experienced significant improvements in terms of weight, blood pressure, and glycemic control. 3,17 Thus, this could be one potential (indirect) factor for the significant DPN improvements as reported by the study subjects. It is worth considering that other factors might complementarily contribute to pain reduction. ...
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Introduction: Diabetic polyneuropathy (DPN) is a debilitating condition and associated with significant morbidity, including gait disturbances, reduced quality of life, and pain, that is often resistant to conventional treatments. Treatment of DPN is based on several major approaches, including risk factor management, intensive glycemic control, and symptomatic pain management. Although some authors argue that none of the existing treatment options are satisfactory, an alternative strategy is frequently overlooked: the use of a whole‐food, plant‐based diet. The aim of this review was to systematically investigate whether a whole‐food, plant‐based diet could beneficially affect patients suffering from type 2 diabetes and DPN. Methods: The electronic databases of PubMed and Google Scholar were searched using the keywords “plant‐based,” “vegetarian,” “vegan,” “diet,” and “diabetic neuropathy.” Results: Only a handful of studies investigated the effects of a plant‐based diet on diabetic neuropathy. These studies suggest that a plant‐based diet may alleviate pain in affected patients while significantly improving glycemic control, overweight, and serum lipids at the same time. Moreover, a plant‐based diet appears to reduce the medication burden in affected patients. However, the results must be interpreted with caution, because the number of clinical trials is limited and all studies have important limitations with regard to their methodology. The dietary intervention was often combined with exercise and other supplemental factors, complicating the interpretation of results. Several potential mechanisms of action including improved blood flow and optimized intake of important nutrients were identified. These factors might complementarily contribute to improved perfusion in the endoneurial microvasculature, thus reducing local hypoxia and improving pain. Conclusion: Physicians should consider recommending a plant‐based diet to patients suffering from DPN, as current studies show favorable effects in terms of pain management, glycemic control, and reduced medication needs. Further well‐designed studies are required to confirm the results of this review.
... These lifestyle principles are individually associated with lower blood pressure-Nutrition (Appel et al., 2006), Exercise (Skutnik, Smith, Johnson, Kurti, & Harms, 2016), Water (Thorton, 2010), Sunlight (Feelisch et al., 2010;Mead, 2008), Temperance such as abstinence from tobacco and alcohol (Hillbom, Saloheimo, & Juvela, 2011;Kannel & Higgins., 1990), fresh Air (Mao et al., 2012), Rest (Calhoun & Harding, 2010;Gangwisch et al., 2006), and Trust in God-spirituality (Charlemagne-Badal & Lee, 2016; Holt-Lunstad, Steffen, Sandberg, and Jensen (2011); Koenig (2015); Nedley and Ramirez (2014); Tartaro, Luecken, & Gunn, 2005). Application of the NEWSTART principles may vary somewhat from place to place and from person to person, particularly with diet-vegan or lacto-ovo-vegetarian diet that includes milk and eggs (Crane & Sample, 1994;Slavíček et al., 2008). The NEWSTART program at Weimar Institute includes a vegan diet; daily walking in the fresh air and sunlight; drinking substantial quantities of water; regular and adequate daily sleep; avoiding intemperate habits such as smoking or drinking; and fostering trust in God. ...
... Decreases in SBP were also recorded in other studies using the NEWSTART lifestyle intervention. SBP decreased by 23 mmHg (−15%) within 3 weeks of intervention among diabetic patients with neuropathy (Crane & Sample, 1994). SBP decreased 6 mmHg in individuals from the general population attending a one-week wellness program using NEWSTART principles (Slavíček et al., 2008). ...
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Hypertension is worldwide and the most common problem in clinical practice in the United States. It is typically treated with medications, but it also responds to various lifestyle principles. This study assessed the effectiveness of reversing hypertension by a multi-lifestyle program. We evaluated retrospective data from the pretest-posttest intervention of the 114 subjects that were hypertensive from among all 173 enrolled in NEWSTART during 2014. Of the 114 individuals with hypertension, there were 37% males and 63% females. Baseline values (Mean±SD) were: 66.5±10.6 years, 31.9±6.6 kg/m2, and 139±20 mmHg. Systolic blood pressure decreased significantly (p<0.001) within 14 days in all population sub-groups from -8% (diabetic) to -31% (normal weight). Forty percent of subjects achieved <120 mmHg. Medications were discontinued or decreased in 93% of the subjects. This lifestyle intervention is appropriate for first-line treatment of hypertension.
... In a small nonrandomized clinical trial, 21 T2D patients with painful diabetic neuropathy received an intervention based on a low-fat, high-fiber, no-cholesterol vegan diet along with exercise (walking every day for >30 min). The results showed that, in <16 d, 17 of the 21 participants completely mitigated their distressingly sharp and burning pain, although numbness persisted (51). ...
... Although results suggest that dietary patterns emphasizing the consumption of plant foods could prevent the development of this diabetes-related complication by reducing the excretion of albumin more than other conventional diets (44)(45)(46), these findings are not supported by the PREDIMED study, the only clinical trial that has evaluated the effect of the MedDiet on the risk of nephropathy (47). Data on retinopathy and neuropathy are also scarce: only 1 clinical trial, the PREDIMED study, has evaluated the effect of the MedDiet on retinopathy (and found a beneficial effect) (47); only 1 nonrandomized clinical trial has assessed the effect of a vegan diet on diabetic neuropathy (and found that it seems to improve this condition) (51). ...
Article
The prevalence of type 2 diabetes (T2D) is increasing worldwide. This complex and multifactorial metabolic condition affects both the quality and expectancy of life in adults. Therefore, appropriate lifestyle strategies are needed in order to reduce the burden of T2D. Dietary patterns characterized by a high consumption of fruits, vegetables, whole grains, legumes, nuts, and seeds, and a minimal consumption of animal products, have been suggested as a dietary approach to prevent and control T2D and related micro- and macrovascular complications. This narrative review summarizes epidemiologic and clinical trial evidence on the role of the most widely studied dietary patterns that emphasize the consumption of plant foods [vegetarian, vegan, Mediterranean, and DASH (Dietary Approaches to Stop Hypertension) diets] in the management of T2D and its complications. Furthermore, their potential underlying mechanisms are discussed. Dietary patterns emphasizing the consumption of plant foods appear to confer beneficial effects on glycemic control in different diabetic populations. Several components of these dietary patterns might confer benefits on glycemia and counterbalance the detrimental effects of animal-based foods. The limited evidence on T2D-related complications makes it difficult to draw solid conclusions.
... 17,[21][22][23][24] Likewise, dietary interventions have been specifically shown to reduce overall symptomatology and improve the quality of life of individuals suffering from PNP due to diabetes, a significant and common comorbidity of leprosy. [25][26][27][28][29] Overall, strategies seeking to improve physiological wellness, including those that reduce inflammation and enhance immune responsiveness to neurotoxic factors, are powerful tools that can influence underlying neuropathic etiologies. This review seeks to synthesize this literature surrounding the intersection of nutrition, PNP and leprosy, providing a knowledge base for further development of nonpharmacological therapeutics for leprous PNP. ...
... [12][13][14]17,24 Likewise, trials assessing the implications of WFPBD in diabetic PNP patients exhibited a statistically significant reduction of overall symptomatology and improvement in quality of life. [21][22][23]25,[27][28][29] As such, WFPBD may have beneficial effects on PNP in leprosy by mitigating adverse events related to nutrient deficiency. Thus, by examining this relationship, one may be able to develop effective lifestyle interventions thereby reducing pharmacological requirements and PNP severity in leprosy. ...
Article
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Leprosy is a neglected tropical disease (NTD) that continues to burden low- and middle-income countries (LMICs), despite being eliminated as a public health concern by the World Health Organization (WHO) in 2000. The causative agents, Mycobacterium leprae and Mycobacterium lepromatosis, affect nearly 200,000 individuals globally each year, with over 19,000 new cases detected in the Americas in 2020 alone. Canada has experienced an increasing incidence of leprosy, due to rising levels of travel and migration from endemic areas, reaching over 37,000 individuals with leprosy by the end of 2020. Patients experience a spectrum of signs and symptoms including hypopigmented cutaneous macules alongside peripheral neuropathy including peripheral neuropathic pain (PNP) and disabling sensory neuropathies. Despite the development of effective and curative therapeutics via multidrug therapy (MDT), many barriers to treatment adherence and effective immunological control of the pathogen challenge the care of patients with leprosy. Socioeconomic barriers, such as disability-related social stigma and often undiagnosed nutritional deficiencies, have resulted in heightened disease severity. PNP therapeutics are associated with significant side effects and remain ineffective as the majority of individuals will not experience a greater than 30% reduction of symptoms. Nutrient supplementation is known to be instrumental in reducing host oxidative stress, strengthening the immune system and mitigating comorbidities. Likewise, dietary lifestyle interventions known to be physiologically beneficial have recently emerged as powerful tools conferring neuroprotective effects, potentially mitigating PNP severity. However, a significant knowledge gap concerning the effect of adequate nutrition on host immunological control of leprosy and PNP severity exists. Further evaluation of this relationship will provide key insight into the pathogenesis of leprosy, strengthening the current body of literature.
... A growing body of literature suggests that lifestyle factors, such as body mass index (BMI) (8)(9)(10), physical activity (11,12), and use of dietary supplements (13)(14)(15), may affect the onset and severity of CIPN in a variety of cancer patient populations. Physical activity (11,16,17) and diet (18)(19)(20) have been associated with diabetic neuropathy, increasing the plausibility that lifestyle factors may be associated with CIPN. To date, the effects of multiple lifestyle factors have not been simultaneously examined in a prospective cohort of breast cancer patients. ...
Article
Background Lifestyle factors may be associated with chemotherapy-induced peripheral neuropathy (CIPN). We examined associations between body mass index (BMI) and lifestyle factors with CIPN in the Pathways Study, a prospective cohort of women with invasive breast cancer. Methods Analyses included 1237 women who received taxane treatment and provided data on neurotoxicity symptoms. Baseline interviews assessed BMI (normal: <25 kg/m²; overweight: 25–29.9 kg/m²; obese: ≥30 kg/m²), moderate-to-vigorous physical activity (MVPA) (low: <2.5; medium: 2.5–5; high: >5 hours/week) and fruit/vegetable intake (low: <35 servings/week; high: ≥35 servings/week). Baseline and six-month interviews assessed antioxidant supplement use (nonuser, discontinued, continued user, initiator). CIPN was assessed at baseline, six months, and 24 months using the Functional Assessment of Cancer Therapy–Taxane Neurotoxicity (FACT-NTX); a 10% decrease was considered clinically meaningful. Results At baseline, 65.6% of patients in the sample were overweight or obese, 29.9% had low MVPA, 57.5% had low fruit/vegetable intake, and 9.5% reported antioxidant supplement use during treatment. In multivariable analyses, increased CIPN was more likely to occur in overweight (odds ratio [OR] = 2.37, 95% confidence interval [CI] = 1.19 to 4.88) and obese patients (OR = 3.21, 95% CI = 1.52 to 7.02) compared with normal weight patients at 24 months and less likely to occur in patients with high MVPA compared with those with low MVPA at six (OR = 0.56, 95% CI = 0.34 to 0.94) and 24 months (OR = 0.43, 95% CI = 0.21 to 0.87). Compared with nonusers, patients who initiated antioxidant use during treatment were more likely to report increased CIPN at six months (OR = 3.81, 95% CI = 1.82 to 8.04). Conclusions Obesity and low MVPA were associated with CIPN in breast cancer patients who received taxane treatment.
... The role of diet in the treatment of chronic pain was highlighted by a pilot study that showed attenuation of neuropathic pain in 17 of 21 patients with adult onset (type II) diabetes mellitus and diabetic neuropathy (DN) [11]. The majority of those who exercised and followed a strict low-fat, high-fiber, total vegetarian diet remained pain free after 1-4 years of follow up. ...
... Increased adherence to a vegetarian diet in the Adventist study demonstrated a reduced risk of developing T2DM in an incremental manner (34) . Clinical dietary studies investigating the impact of vegetarian diets in diabetic patients have shown significant reductions in fasting blood sugar, cholesterol and TAG levels (35)(36)(37) . However, the results are confounded by resulting significant weight loss in the intervention groups throughout the diet period, in addition to increased exercise and lifestyle modifications in some cases. ...
Article
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Objective: To review the epidemiological evidence for vegetarian diets, low-meat dietary patterns and their association with health status in adults. Design: Published literature review focusing primarily on prospective studies and meta-analyses examining the association between vegetarian diets and health outcomes. Results: Both vegetarian diets and prudent diets allowing small amounts of red meat are associated with reduced risk of diseases, particularly CHD and type 2 diabetes. There is limited evidence of an association between vegetarian diets and cancer prevention. Evidence linking red meat intake, particularly processed meat, and increased risk of CHD, cancer and type 2 diabetes is convincing and provides indirect support for consumption of a plant-based diet. Conclusions: The health benefits of vegetarian diets are not unique. Prudent plant-based dietary patterns which also allow small intakes of red meat, fish and dairy products have demonstrated significant improvements in health status as well. At this time an optimal dietary intake for health status is unknown. Plant-based diets contain a host of food and nutrients known to have independent health benefits. While vegetarian diets have not shown any adverse effects on health, restrictive and monotonous vegetarian diets may result in nutrient deficiencies with deleterious effects on health. For this reason, appropriate advice is important to ensure a vegetarian diet is nutritionally adequate especially for vulnerable groups.
... both lacto-ovo vegetarian and vegan diets are associated with a decreased incidence and risk for numerous types of cancers [25], and epidemiological evidence supports protection against metabolic disorders such as type 2 diabetes mellitus through decreases in fasting blood glucose and cholesterol levels in those following vegetarian diets [17,22,[26][27][28][29][30][31][32]. ...
Article
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Although vegetarian diets are considered generally protective against chronic disease, nutrient deficiencies, including protein, are possible due to low bioavailability from plant-based sources. The consequences of inadequate dietary protein include reduced lean body mass (LBM) and muscle weakness. This study examined relationships between protein intake, strength, and LBM in 37 underactive vegetarians and recorded the impact of protein supplementation (18 g/day mung bean protein) on these indices utilizing an eight-week, randomized, controlled, feeding trial. Both handgrip and knee flexor and extensor strength were measured at baseline and week eight. At baseline, LBM was significantly related to grams of protein consumed daily. LBM was also correlated to grip strength (r = 0.569, p < 0.001) and lower body strength (r = 0.763 to 0.784; p < 0.001). Twenty-five vegetarians completed the feeding trial, including 11 in the protein supplementation group (PRO) and 14 in the control group (CON). At the end of the trial, LBM and strength did not differ significantly between groups. However, the average percent change for grip, flexor, and extensor strength did differ between PRO and CON participants (+2.9 ± 7.2% and −2.6 ± 7.3% respectively, p = 0.05). Thus, there were strong associations between dietary protein, LBM, and strength in vegetarians and an indication that supplementary vegetarian protein increased strength in the absence of exercise and independent of LBM.
... While many calorie restrictive diets lead to weight loss and improvements in glycemic control for individuals with T2DM, plant-based diets offer significant cardiometabolic benefits including improvements in blood lipids, C-reactive protein, and other obesity-related inflammatory biomarkers [14,15]. Additionally, plant-based diets may help reduce the microvascular complications of T2DM, including microalbuminuria [14,16] and may positively impact symptoms of diabetic neuropathy [17,18]. ...
Article
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Purpose of Review Lifestyle changes are proven to improve control of Type 2 Diabetes Mellitus (T2DM), and dietary regimens can lead to better outcomes and fewer complications in patients with T2DM. Multiple diets regimens can lead to better outcomes and less complications of type 2 diabetes. These diets include the American Diabetes Association (ADA) diet, low carbohydrate diets, and plant-based diets. The term “plant-based diet” refers to an eating pattern that emphasizes plant foods and limits or excludes animal products including poultry, fish, red meat, dairy, and eggs. Recent Findings A growing body of evidence suggests that a plant-based eating pattern can help manage T2DM and related risks. Plant-based diets offer significant cardiometabolic benefits including improvements in blood lipids, C-reactive protein, and other obesity-related inflammatory biomarkers. They can help reduce the microvascular complications of T2DM including microalbuminuria, and positively impact symptoms of diabetic neuropathy. Summary In our current review, plant-based dietary interventions were associated with significantly improved glycemic control when compared to baseline or control groups. They also lead to substantial weight loss in individuals with T2DM. Plant based dietary interventions significantly reduced diastolic blood pressure, LDL and HDL cholesterol levels.
... Overall, 17 of the participants were followed for 1 to 4 years and 71% remained on the diet and exercise program-of these, all but one had contin- ued pain relief or further improvement. 108 ...
Article
A large body of evidence suggests that vegetarian and plant-based diets provide exceptional health benefits, including a reduced risk of obesity, diabetes, heart disease and some types of cancer, and increased longevity. Vegetarian diets are typically lower in fat, particularly saturated fat, and higher in dietary fiber. They are also likely to include more whole grains, legumes, nuts, and soy protein, which together provide micro-nutrients and protective factors at higher levels than most Western diets. In observational studies, a vegetarian or vegan diet is associated with reduced risk of development of type 2 diabetes and lower risk of complications in those with existing diabetes. Although it is often difficult to separate vegetarianism from other healthy lifestyle behaviors, this eating pattern and the absence of red meat and processed meat products may provide particular benefits in the management of diabetes and prediabetes. This article critically reviews the scientific evidence for the role of vegetarian diets in the prevention and management of diabetes.
... A vegetarian diet specifically has been found to improve symptoms among those with diabetic neuropathy. It is unclear whether this is due to the increased consumption of plant-based foods containing a higher density of vitamins or avoidance of certain foods [14,15]. The association between modifiable factors and CIPN is an understudied area. ...
Article
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Background The pathophysiology of chemotherapy-induced peripheral neuropathy (CIPN) is not well understood. Currently, dose reduction is the only recommendation for alleviating symptoms, often leading to premature treatment cessation. The primary aim of this analysis was to determine the association between components of diet during taxane treatment for breast cancer and change in CIPN symptoms over treatment. Methods Women with stage II or III invasive breast cancer were enrolled into an ancillary study to the North American Breast Cancer Intergroup phase III trial (S0221) led by the Southwest Oncology Group (SWOG). Questionnaires including a food frequency questionnaire and the Functional Assessment of Cancer Treatment Gynecologic Oncology Group—Neurotoxicity were administered to assess diet and neuropathic conditions at baseline and during chemotherapy. Ordinal regression was used to estimate odds ratios (ORs) for associations between various food groups and change in neuropathy score (< 10%, 10–30%, > 30%) (n = 900). Results The odds of worse neuropathy decreased by 21% for each increase in tertile of grain consumption (OR = 0.79, 95% CI 0.66–0.94, p = 0.009). We also observed a nominal 19% increase with higher consumption of citrus fruits (OR = 1.19, 95% CI 1.01–1.40, p = 0.05). Conclusions Distinguishing between those who experienced a moderate and a severe change in neuropathy, we found that citrus fruit and grain consumption may play a role in the severity of symptoms. Since there are no existing dietary recommendations for the management of CIPN, further research is needed to investigate whether there may be certain foods that could worsen or alleviate neuropathy symptoms associated with treatment for breast cancer. Trial registration ClinicalTrials.gov, NCT03413761. Registered retrospectively on 29 January 2018.
... One study demonstrated a remarkable resolution of burning neuropathy in 81% of participants during a 25-day residential lifestyle program in which plantbased meals were provided, including a sustained response in the participants who adhered to the diet after returning home. [89] A recent randomized controlled pilot study also demonstrated how a plant-based diet can effectively treat diabetic neuropathy: among community-dwelling patients with painful diabetic neuropathy, pain scores were significantly improved at 20 weeks on a plant-based diet compared with a control diet. [90] ...
Article
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The prevalence of type 2 diabetes is rising worldwide, especially in older adults. Diet and lifestyle, particularly plant-based diets, are effective tools for type 2 diabetes prevention and management. Plant-based diets are eating patterns that emphasize legumes, whole grains, vegetables, fruits, nuts, and seeds and discourage most or all animal products. Cohort studies strongly support the role of plant-based diets, and food and nutrient components of plant-based diets, in reducing the risk of type 2 diabetes. Evidence from observational and interventional studies demonstrates the benefits of plant-based diets in treating type 2 diabetes and reducing key diabetes-related macrovascular and microvascular complications. Optimal macronutrient ratios for preventing and treating type 2 diabetes are controversial; the focus should instead be on eating patterns and actual foods. However, the evidence does suggest that the type and source of carbohydrate (unrefined versus refined), fats (monounsaturated and polyunsaturated versus saturated and trans), and protein (plant versus animal) play a major role in the prevention and management of type 2 diabetes. Multiple potential mechanisms underlie the benefits of a plant-based diet in ameliorating insulin resistance, including promotion of a healthy body weight, increases in fiber and phytonutrients, food-microbiome interactions, and decreases in saturated fat, advanced glycation endproducts, nitrosamines, and heme iron.
... [18] Furthermore, patients with diabetes or hyperlipidemia who adopt a high-fiber, plant-based diet, including a healthy vegan or vegetarian diet, can often substantially ameliorate their condition. [18][19][20][21][22] In addition to diet's effect on cardiometabolic risk factors, optimal nutrition plays a central role in the pathogenesis of atherosclerosis via multiple mechanisms. Studies have demonstrated that animal protein, [23][24][25] excessive added sugars [26] and saturated fat, [27] which are all hallmarks of a highly processed, animal-based Western diet, increase lowdensity lipoprotein (LDL) cholesterol. ...
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... 260,261,262 A plant-based diet can also eliminate or even reduce a diabetic's need to medicate and it reduces the chance of nerve and eye (retina) damage. [263][264][265][266][267] Cancer Obesity and cancer are strongly linked. 7 Raised BMI increases the risk of cancer of the oesophagus, colon, kidney, gallbladder, breast, cervix, endometrium and prostate. ...
... Prior residential studies of plant-based diet interventions have been very successful and well accepted. [40][41][42][43] C O N C L U S I O N S RoM ranks third in comparative diabetes prevalence among European countries. A new National eHealth System allows for better identification and monitoring of citizens with diabetes. ...
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Background: The Republic of Macedonia (RoM) has experienced a rapid rise in the prevalence of type 2 diabetes (T2D) over the past 2 decades, a period characterized by significant social, political, and economic change. RoM now has one of the highest rates of diabetes in Europe. Objectives: To explore the modifiable conditions that may underlie and exacerbate the T2D epidemic; describe the state of diabetes care; and consider improved mechanisms for prevention and treatment, including research priorities, in RoM. Methods: Methods included data mining from reliable sources and collaboration of authors to consider and describe applications of research from outside RoM and to identify evidence-based strategies to reduce the burden of T2D in RoM. Findings: In 2014, the national prevalence of diabetes was 11.44% of the population (20-79 years) of RoM. Per capita caloric intake has increased significantly over the past 2 decades, with the majority of these calories coming from sugar, pork, chicken, beef, and sunflower oil. Excess calories, in the form of nutrient-deficient foods, animal products, and added oils promote insulin resistance and T2D. Tobacco use and lack of physical activity also contribute to the diabetes epidemic. Insulin, especially insulin analogues, are widely available and used to manage diabetes, often over other interventions that are more appropriate for patients with T2D, and more frequently than in other more developed countries, resulting in higher and unsustainable related costs. Conclusions: A new National eHealth System allows for better identification and monitoring of citizens with diabetes. However, the rapidly growing expense of insulin in the past has been unsustainable. The potential exists for a stronger role for lifestyle interventions in prevention and treatment of T2D. Significant changes in dietary patterns parallel the rise in diabetes prevalence and are likely a leading cause of diabetes and its complications. Research in RoM is needed to determine the impact and acceptability of dietary interventions for prevention and treatment of T2D, as a first step toward reduction of diabetes prevalence and its complications and controlling spiraling health care costs.
... Considering these findings, it is even more remarkable that a simple lifestyle intervention, including a vegan, plant-based diet, can actually lead to complete remission of clinical symptoms (Greger 2015). The rapid regression of neuropathic pain after initiation of lifestyle changes was reported more than two decades ago (Crane and Sample 1994). Patients suffering from diabetes and concomitant moderate or worse systemic distal polyneuropathy were enrolled in this trial. ...
Article
The world is experiencing a cataclysmically increasing burden from chronic illnesses. Chronic diseases are on the advance worldwide and treatment strategies to counter this development are dominated by symptom control and polypharmacy. Thus, chronic conditions are often considered irreversible, implying a slow progression of disease that can only be hampered but not stopped. The current plant-based movement is attempting to alter this way of thinking. Applying a nutrition-first approach, the ultimate goal is either disease remission or reversal. Hereby, ethical questions arise as to whether physicians’ current understanding of chronic illness is outdated and morally reprehensible. In this case, physicians may need to recommend plant-based diets to every patient suffering from chronic conditions, while determining what other socioecological factors and environmental aspects play a role the chronic disease process. This article provides insights to aspects of diet and chronic illness and discusses how the plant-based movement could redefine current understanding of chronic disease. The ethical justifications for recommending of a plant-based diet are analyzed. The article concludes that not advocating for plant-based nutrition is unethical and harms the planet and patients alike.
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Low-fat vegetarian and vegan diets are associated with weight loss, increased insulin sensitivity, and improved cardiovascular health. We compared the effects of a low-fat vegan diet and conventional diabetes diet recommendations on glycemia, weight, and plasma lipids. Free-living individuals with type 2 diabetes were randomly assigned to a low-fat vegan diet (n = 49) or a diet following 2003 American Diabetes Association guidelines (conventional, n = 50) for 74 wk. Glycated hemoglobin (Hb A(1c)) and plasma lipids were assessed at weeks 0, 11, 22, 35, 48, 61, and 74. Weight was measured at weeks 0, 22, and 74. Weight loss was significant within each diet group but not significantly different between groups (-4.4 kg in the vegan group and -3.0 kg in the conventional diet group, P = 0.25) and related significantly to Hb A(1c) changes (r = 0.50, P = 0.001). Hb A(1c) changes from baseline to 74 wk or last available values were -0.34 and -0.14 for vegan and conventional diets, respectively (P = 0.43). Hb A(1c) changes from baseline to last available value or last value before any medication adjustment were -0.40 and 0.01 for vegan and conventional diets, respectively (P = 0.03). In analyses before alterations in lipid-lowering medications, total cholesterol decreased by 20.4 and 6.8 mg/dL in the vegan and conventional diet groups, respectively (P = 0.01); LDL cholesterol decreased by 13.5 and 3.4 mg/dL in the vegan and conventional groups, respectively (P = 0.03). Both diets were associated with sustained reductions in weight and plasma lipid concentrations. In an analysis controlling for medication changes, a low-fat vegan diet appeared to improve glycemia and plasma lipids more than did conventional diabetes diet recommendations. Whether the observed differences provide clinical benefit for the macro- or microvascular complications of diabetes remains to be established. This trial was registered at clinicaltrials.gov as NCT00276939.
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A plant-based eating pattern is associated with a reduced risk of developing type 2 diabetes and is highly effective in its treatment. Diets that emphasize whole grains, vegetables, fruits, and legumes and exclude animal products improve blood glucose concentrations, body weight, plasma lipid concentrations, and blood pressure and play an important role in reducing the risk of cardiovascular and microvascular complications. This article reviews scientific evidence on the effects of plant-based diets for the prevention and treatment of type 2 diabetes. The mechanisms by which plant-based diets improve body weight, insulin sensitivity, and β-cell function are described. Practical considerations including education, nutrition adequacy, and adjusting medications will enhance the success of patients who have diabetes.
Article
Many diet-related chronic diseases take a disproportionate toll among members of racial minorities. Research shows the prevalence of diabetes, hypertension, cancer, and heart disease is higher among various ethnic groups compared with whites. The Guidelines and the Food Guide Pyramid, however, promote the use of multiple servings of meats and dairy products each day and do not encourage replacing these foods with vegetables, legumes, fruits, and grains. The Dietary Guidelines for Americans encourage a 30% caloric reduction in fat intake and make no provision for further reductions for those who wish to minimize health risks. Abundant evidence has shown that regular exercise combined with diets lower in fat and richer in plant products than is encouraged by the Dietary Guidelines for Americans are associated with reduced risk of these chronic conditions. While ineffective Dietary Guidelines potentially put all Americans at unnecessary risk, this is particularly true for those groups hardest hit by chronic disease.
Article
To investigate whether glycemic and lipid control in patients with non-insulin-dependent diabetes (NIDDM) can be significantly improved using a low-fat, vegetarian (vegan) diet in the absence of recommendations regarding exercise or other lifestyle changes. Eleven subjects with NIDDM recruited from the Georgetown University Medical Center or the local community were randomly assigned to a low-fat vegan diet (seven subjects) or a conventional low-fat diet (four subjects). Two additional subjects assigned to the control group failed to complete the study. The diets were not designed to be isocaloric. Fasting serum glucose, body weight, medication use, and blood pressure were assessed at baseline and biweekly thereafter for 12 weeks. Serum lipids, glycosylated hemoglobin, urinary albumin, and dietary macronutrients were assessed at baseline and 12 weeks. Although the sample was intentionally small in accordance with the pilot study design, the 28% mean reduction in fasting serum glucose of the experimental group, from 10.7 to 7.75 mmol/L (195 to 141 mg/dl), was significantly greater than the 12% decrease, from 9.86 to 8.64 mmol/L (179 to 157 mg/dl), for the control group (P < 0.05). The mean weight loss was 7.2 kg in the experimental group, compared to 3. 8 kg for the control group (P < 0.005). Of six experimental group subjects on oral hypoglycemic agents, medication use was discontinued in one and reduced in three. Insulin was reduced in both experimental group patients on insulin. No patient in the control group reduced medication use. Differences between the diet groups in the reductions of serum cholesterol and 24-h microalbuminuria did not reach statistical significance; however, high-density lipoprotein concentration fell more sharply (0.20 mmol/L) in the experimental group than in the control group (0.02 mmol/L) (P < 0.05). The use of a low-fat, vegetarian diet in patients with NIDDM was associated with significant reductions in fasting serum glucose concentration and body weight in the absence of recommendations for exercise. A larger study is needed for confirmation.
Article
Purpose: The purpose of this review is to provide educators with the knowledge and tools to utilize plant-based nutrition education as an intervention for type 2 diabetes. Scientific support for the efficacy, acceptability, and nutritional adequacy of a plant-based diet for people with type 2 diabetes is presented, and practical considerations such as medication adjustment and risk of hypoglycemia are reviewed. Conclusions: Plant-based meal planning is an acceptable and effective strategy that educators can use to improve diabetes management and reduce risk of complications. Studies show that dietary changes that are effective for reducing cardiac risk may also be helpful for management of type 2 diabetes. A low-fat, plant-based diet reduces body weight and improves glycemic control, and has been shown to be remarkably well accepted by patients.
Article
A little-noticed clinical report indicates that a low-fat, whole-food vegan diet, coupled with daily walking exercise, leads to rapid remission of neuropathic pain in the majority of type 2 diabetics expressing this complication. Concurrent marked improvements in glycemic control presumably contribute to this benefit, but are unlikely to be solely responsible. Consideration should be given to the possibility that improved blood rheology - decreased blood viscosity and increased blood filterability - plays a prominent role in mediating this effect. There is considerable evidence that neural hypoxia, secondary to impaired endoneurial microcirculatory perfusion, is a crucial etiologic factor in diabetic neuropathy; the unfavorable impact of diabetes on hemorheology would be expected to exacerbate endoneurial ischemia. Conversely, measures which improve blood fluidity would likely have a beneficial impact on diabetic neuropathy. There is indeed evidence that vegan diets, as well as exercise training, tend to decrease the viscosity of both whole blood and plasma; reductions in hematocrit and in fibrinogen may contribute to this effect. The fact that vegan diets decrease the white cell count is suggestive of an improvement in blood filterability as well; filterability improves with exercise training owing to an increase in erythrocyte deformability. Whether these measures influence the activation of leukocytes in diabetics - an important determinant of blood filterability - remains to be determined. There are various reasons for suspecting that a vegan diet can reduce risk for other major complications of diabetes - retinopathy, nephropathy, and macrovascular disease - independent of its tendency to improve glycemic control in type 2 patients. The vegan diet/exercise strategy represents a safe, 'low-tech' approach to managing diabetes that deserves far greater attention from medical researchers and practitioners.
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Based on what is known of the components of plant-based diets and their effects from cohort studies, there is reason to believe that vegetarian diets would have advantages in the treatment of type 2 diabetes. At present there are few data on vegetarian diets in diabetes that do not in addition have weight loss or exercise components. Nevertheless, the use of whole-grain or traditionally processed cereals and legumes has been associated with improved glycemic control in both diabetic and insulin-resistant individuals. Long-term cohort studies have indicated that whole-grain consumption reduces the risk of both type 2 diabetes and cardiovascular disease. In addition, nuts (eg, almonds), viscous fibers (eg, fibers from oats and barley), soy proteins, and plant sterols, which may be part of the vegetarian diet, reduce serum lipids. In combination, these plant food components may have a very significant impact on cardiovascular disease, one of the major complications of diabetes. Furthermore, substituting soy or other vegetable proteins for animal protein may also decrease renal hyperfiltration, proteinuria, and renal acid load and in the long term reduce the risk of developing renal disease in type 2 diabetes. The vegetarian diet, therefore, contains a portfolio of natural products and food forms of benefit for both the carbohydrate and lipid abnormalities in diabetes. It is anticipated that their combined use in vegetarian diets will produce very significant metabolic advantages for the prevention and treatment of diabetes and its complications.
Article
A new category of anti-anginal drug - exemplified by ranolazine - is believed to work by partially inhibiting cardiac oxidation of fatty acids; oxidation of glucose requires less oxygen per mol of ATP generated, and thus is preferable to fat oxidation when oxygen availability is limiting in underperfused cardiac tissue. Unfortunately, there is no reason to believe that these drugs inhibit fat oxidation selectively in the heart; thus, chronic use of these drugs can be expected to increase body fat stores until the original rate of fat oxidation is restored by mass action - presumably negating the therapeutic benefit in angina, while exacerbating the manifold adverse effects of insulin resistance syndrome. The rational way to decrease cardiac metabolic reliance on fatty acids is to consume a very-low-fat quasi-vegan diet (i.e., 10% fat calories). Indeed, such diets are known to have a rapid and substantial therapeutic impact on anginal symptoms, while concurrently benefiting insulin sensitivity, markedly improving serum lipid profile, promoting leanness, and lessening coronary risk. A reduction in diurnal insulin secretion might also be achieved, which would be expected to decrease sympathetic activity. While reduced myocardial demand for oxygen doubtless contributes to the beneficial impact of such diets on angina, it is likely that improved cardiac perfusion consequent to improved endothelium-dependent vasodilation also plays a role in this regard. Supplemental carnitine, also beneficial in angina, appears to improve utilization of glucose in the ischemic myocardium by lowering elevated acetyl-coA levels and thereby disinhibiting pyruvate dehydrogenase. Certain other nutraceuticals may aid control of angina by improving endothelial function. In the longer term, these measures have the potential to slow or reverse the progression of stenotic lesions that underlie most cases of angina. These safe and relatively inexpensive nutritional strategies for coping with angina deserve far more attention than orthodox medical practice has thus far accorded them.
Article
Vegetarian and vegan diets offer significant benefits for diabetes management. In observational studies, individuals following vegetarian diets are about half as likely to develop diabetes, compared with non-vegetarians. In clinical trials in individuals with type 2 diabetes, low-fat vegan diets improve glycemic control to a greater extent than conventional diabetes diets. Although this effect is primarily attributable to greater weight loss, evidence also suggests that reduced intake of saturated fats and high-glycemic-index foods, increased intake of dietary fiber and vegetable protein, reduced intramyocellular lipid concentrations, and decreased iron stores mediate the influence of plant-based diets on glycemia. Vegetarian and vegan diets also improve plasma lipid concentrations and have been shown to reverse atherosclerosis progression. In clinical studies, the reported acceptability of vegetarian and vegan diets is comparable to other therapeutic regimens. The presently available literature indicates that vegetarian and vegan diets present potential advantages for the management of type 2 diabetes.
Article
Overestimates of the efficacy of surgical and pharmacological interventions for the prevention and treatment of chronic disease and underestimates of the associated risks may bias physicians and patients against lifestyle medicine interventions that can be cheaper, safer, and more effective by treating the underlying cause of disease. The leading causes of both death and disability in the United States are diet, followed by smoking. The food and tobacco industries share similar tactics to downplay and obfuscate the risks associated with their products, but physicians can educate themselves about the role lifestyle interventions can play in the prevention and treatment of chronic disease. For example, a diet centered around whole plant foods can be used to successfully treat angina and painful diabetic neuropathy and may help prevent low-back pain and Alzheimer’s disease, all perhaps because of a common underlying vascular component. The delay between recognizing the risks of smoking and effective public health measures may have cost millions of lives. Similar delays in stopping dietary diseases may cost millions more.
Article
Significant benefits for diabetes prevention and management have been observed with vegetarian and especially vegan diets. This article reviews observational studies and intervention trials on such diets, and discusses their efficacy, nutritional adequacy, acceptability, and sustainability. Research to date has demonstrated that a low-fat, plant-based nutritional approach improves control of weight, glycemia, and cardiovascular risk. These studies have also shown that carefully planned vegan diets can be more nutritious than diets based on more conventional diet guidelines, with an acceptability that is comparable with that of other therapeutic regimens. Current intervention guidelines from professional organizations offer support for this approach. Vegetarian and vegan diets present potential advantages in managing type 2 diabetes that merit the attention of individuals with diabetes and their caregivers.
Article
To review outcomes of randomized controlled clinical trials exploring the efficacy of different types of diets containing various amounts of fiber in the management of type 2 diabetes mellitus. We searched PubMed, Medline, and Google Scholar for published data from the past decade (through December 2009) on dietary patterns and risk of type 2 diabetes mellitus. Only randomized controlled trials investigating the effect of whole grains, fiber, or vegetarian diets on type 2 diabetes were included. Search criteria included whole grain, fruit, vegetable, fiber, and meat intake regarding insulin sensitivity and glycemic responses in healthy, prediabetic, and diabetic persons. A total of 14 randomized clinical trials were included. Addition of insoluble or soluble fiber to meals, increased consumption of diets rich in whole grains and vegetables, and vegan diets improve glucose metabolism and increase insulin sensitivity. The greatest improvement in blood lipids, body weight, and hemoglobin A(1c) level occurred in participants following low-fat, plant-based diets. Increased consumption of vegetables, whole grains, and soluble and insoluble fiber is associated with improved glucose metabolism in both diabetic and nondiabetic individuals. Improvements in insulin sensitivity and glucose homeostasis were more evident in participants following a plant-based diet compared with other commonly used diets.
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Observational studies show that prevalence of type 2 diabetes is 1.6 to 2 times lower in vegetarians than in the general population, even after adjustment for differences in body mass index (BMI). Clinical interventional trials demonstrated that vegetarian diets lead to a greater weight loss and greater reduction in fasting plasma glucose, HbA1c, blood lipids, and hypoglycemic medication than a conventional hypocaloric diet in subjects with type 2 diabetes. We found a greater reduction in visceral fat and greater improvements in insulin resistance and oxidative stress markers with a vegetarian compared to a conventional hypocaloric diabetic diet. Vegetarian diets are sustainable in the long term and may elicit desirable improvements not only in physical health but also in mental health. The American Dietetic Association states that well-planned vegetarian diets are healthy and nutritionally adequate and they may be beneficial in prevention and treatment of some illnesses. Larger clinical trials are needed to confirm the effectiveness and promote the inclusion of vegetarian diets in dietary guidelines for prevention and treatment of type 2 diabetes.
Article
Cancer patients treated with capecitabine and oxaliplatin (XELOX) often develop hand‐foot syndrome (HFS) or palmar‐plantar erythrodysesthesia. Genetic variation in ST6GAL1 is a risk factor for type‐2 diabetes (T2D), a disease also associated with HFS. We analysed genome‐wide association data for ten toxicities in advanced colorectal cancer (CRC) patients from the COIN and COIN‐B trials. 1,055 patients were treated with XELOX ±cetuximab and 745 with folinic acid, fluorouracil and oxaliplatin ±cetuximab. We also analysed rs6783836 in ST6GAL1 with HFS in CRC patients from QUASAR2. Using UK Biobank data, we sought to confirm an association between ST6GAL1 and T2D (17,384 cases, 317,887 controls) and analysed rs6783836 against markers of diabetes, inflammation and psoriasis. We found that 68% of patients from COIN and COIN‐B with grade 2‐3 HFS responded to treatment as compared to 58% with grade 0‐1 HFS (Odds Ratio [OR]=1.1, 95% Confidence Interval [CI]=1.02‐1.2, P=2.0x10‐4). HFS was also associated with improved overall survival (Hazard Ratio=0.92, 95%CI=0.84‐0.99, P=4.6x10‐2). rs6783836 at ST6GAL1 was associated with HFS in patients treated with XELOX (OR=3.1, 95%CI=2.1‐4.6, P=4.3x10‐8) and was borderline significant in patients receiving capecitabine from QUASAR2, but with an opposite allele effect (OR=0.66, 95% CI=0.42‐1.03, P=0.05). ST6GAL1 was associated with T2D (lead SNP rs3887925, OR=0.94, 95%CI=0.92‐0.96, P=1.2x10‐8) and the rs6783836‐T allele was associated with lowered HbA1c levels (P=5.9x10‐3) and lymphocyte count (P=2.7x10‐3), and psoriasis (P=7.5x10‐3) beyond thresholds for multiple testing. In conclusion, HFS is a biomarker of treatment outcome and rs6783836 in ST6GAL1 is a potential biomarker for HFS with links to T2D and inflammation. This article is protected by copyright. All rights reserved.
Article
A little-noticed clinical report indicates that a low-fat, whole-food vegan diet, coupled with daily walking exercise, leads to rapid remission of neuropathic pain in the majority of type 2 diabetics expressing this complication. Concurrent marked improvements in glycemic control presumably contribute to this benefit, but are unlikely to be solely responsible. Consideration should be given to the possibility that improved blood rheology - decreased blood viscosity and increased blood filterability - plays a prominent role in mediating this effect. There is considerable evidence that neural hypoxia, secondary to impaired endoneurial microcirculatory perfusion, is a crucial etiologic factor in diabetic neuropathy; the unfavorable impact of diabetes on hemorheology would be expected to exacerbate endoneurial ischemia. Conversely, measures which improve blood fluidity would likely have a beneficial impact on diabetic neuropathy. There is indeed evidence that vegan diets, as well as exercise training, tend to decrease the viscosity of both whole blood and plasma; reductions in hematocrit and in fibrinogen may contribute to this effect. The fact that vegan diets decrease the white cell count is suggestive of an improvement in blood filterability as well; filterability improves with exercise training owing to an increase in erythrocyte deformability. Whether these measures influence the activation of leukocytes in diabetics - an important determinant of blood filterability - remains to be determined. There are various reasons for suspecting that a vegan diet can reduce risk for other major complications of diabetes - retinopathy, nephropathy, and macrovascular disease - independent of its tendency to improve glycemic control in type 2 patients. The vegan diet/exercise strategy represents a safe, 'low-tech' approach to managing diabetes that deserves far greater attention from medical researchers and practitioners. (C) 2002 Published by Elsevier Science Ltd.
Article
Precision medicine has captured the imagination of the medical community with visions of therapies precisely targeted to the specific individual’s genetic, biological, social, and environmental profile. However, in practice it has become synonymous with genomic medicine. As such its successes have been limited, with poor predictive or clinical value for the majority of people. It adds little to lifestyle medicine, other than in establishing why a healthy lifestyle is effective in combatting chronic disease. The challenge of lifestyle medicine remains getting people to actually adopt, sustain, and naturalize a healthy lifestyle, and this will require an approach that treats the patient as a person with individual needs and providing them with suitable types of support. The future of lifestyle medicine is holistic and person-centered rather than technological.
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Purpose. The purpose of this study was to assess the feasibility and effectiveness of a whole food plant-based diet (WFPBD) to improve day of surgery fasting blood glucose (FBG) among patients with type 2 diabetes (T2D). Patients and Methods. Ten patients with T2D scheduled for a total hip or total knee replacement were recruited. For 3 weeks preceding their surgeries, subjects were asked to consume an entirely WFPBD. Frozen WFPBD meals were professionally prepared and delivered to each participant for the 3 weeks prior to surgery. FBG was reassessed on the morning of surgery and compared with preintervention values. Compliance with the diet was assessed. Results. Mean age of subjects and reported duration of diabetes was 65 and 8 years, respectively, average hemoglobin A1c (HbA1c) was 6.6%, and 6 were women. Mean FBG decreased from 127 to 116 mg/dL ( P = .2). Five of the subjects experienced improvement in glycemic control, with an average decline of 11 mg/dL. Conclusion. A WFPBD is a potentially effective intervention to improve glycemic control among patients with T2D during the period leading up to surgery. Future controlled trials on a larger sample of patients to assess the impact of a WFPBD on glycemic control and surgical outcomes are warranted.
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Near normal glucoregulation was maintained in 10 patients with insulin-dependent (type I) diabetes mellitus for 6 wk with preprogrammed continuous subcutaneous insulin infusion using a portable battery-powered infusion pump (CSII). This form of therapy resulted in a statistically significant increase in motor nerve conduction velocity in the median and peroneal nerves compared with baseline values. There was no significant change in the motor nerve conduction velocity in the ulnar nerve or in the sensory nerve conduction studies. No changes occurred in five additional patients studied in similar fashion while on a conventional insulin regimen. These results suggest that the prevention of sustained hyperglycemia with CSII could theoretically result in the prevention of diabetic neuropathy. However, only long-term studies of CSII will provide the information necessary to determine the clinical relevance of the findings.
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Short-term intervention studies have shown that diets rich in polyunsaturated fats have hypotensive properties. We have studied the long-term effects of dietary fat on blood pressure (BP) using adipose-tissue, fatty acid composition analysis in 399 free-living male subjects (average age, 47 yr). Stepwise-regression analysis showed that adipose linoleic acid (18:2 n-6) was not associated with BP, whereas an absolute 1% increase in linolenic acid (18:3 n-3) was associated with a decrease of 5 mm Hg in the systolic, diastolic, and composite mean arterial BP. Linolenic acid (18:3) comprised only one-eighth the amount of linoleic acid (18:2)--the major polyunsaturate in adipose tissue and hence in the diet (2% vs 16%)--and yet it had a disproportionate association with BP. This may be related to its role as a precursor for the production of prostaglandins and/or other vasoregulators. Dietary manipulation with n-3 fatty acids may be helpful in the treatment and prevention of hypertension.
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Information concerning the metabolism of trans isomers of dietary unsaturated fatty acids is presented. Dietary trans-octadecenoic and trans,trans-octadecadienoic acids are apparently absorbed, activated, oxidized, and acylated into ester lipids much like saturated fatty acids although differences have been observed with regard to their metabolism by different organs. Because of the important role of linoleic acid as the principal precursor of cyclic endoperoxides, prostaglandins and leukotrienes, the potential deleterious effects of trans isomers of this acid are discussed. High levels of dietary trans,trans lineoleate can impair delta 6 desaturase activity and decrease prostaglandin production in rats on experimental diets.
Article
The purpose of this study was to investigate the effects of a high complex-carbohydrate, high fiber, low fat, and low salt diet combined with daily exercise on blood pressure responses during exercise and blood viscosity in patients with essential hypertension. Data were obtained from 23 hypertensive patients (17 receiving antihypertensive medication) before and after completing a 26-day residential program. Maximum work capacity increased during treadmill testing from 6.5 ± 0.5 to 8.6 ± 0.6 METs. During treadmill testing, blood pressure for the total group was reduced from 188 ± 5/85 ± 3 to 170 ± 4/78 ± 2 mm Hg at the same exercise heart rate and from 189 ± 5/86 ± 3 to 167 ± 4/76 ± 2 mm Hg at the same workload. In addition to the reduction in blood pressure, nine patients no longer required their antihypertensive medication, and the remaining eight had their dosage reduced. For the patients not taking medication, blood pressure was reduced from 210 ± 6/90 ± 6 to 167 ± 6/72 ± 4 mm Hg at the same workload and from 206 ± 6/87 ± 6 to 178 ± 4/73 ± 4 mm Hg at the same exercise heart rate. Whole-blood viscosity was significantly reduced, from 4.25 ± 0.15 to 3.84 ± 0.15 cp, while platelet-poor-plasma viscosity was reduced from 1.36 ± 0.03 to 1.23 ± 0.04 cp. These results indicate that a high complex-carbohydrate diet combined with daily exercise can be an effective nonpharmacologic approach to treating hypertension in many patients. The mechanism may be related in part to a decrease in blood viscosity.
Article
• Vegetarians have an apparent diminished risk for the development of ischemic coronary heart disease. This may be secondary to dietary effects of plasma lipids and lipoproteins, but platelets, which may also play a role, have also been observed to have aberrant functions in vegetarians. We measured plasma lipid and lipoprotein levels, platelet function, platelet fatty acid levels, and platelet active prostaglandins in ten strict vegetarians (vegans), 15 lactovegetarians, and 25 age- and sex-matched omnivorous controls. The most striking observations were a highly significant rise in platelet linoleic acid concentration and a decline in platelet arachidonic acid concentration in both vegetarian subgroups as compared with omnivorous controls. Serum thromboxane and prostacyclin levels as well as results of platelet aggregation studies did not differ among the groups tested. Cholesterol levels were significantly lower in both vegetarian groups as compared with controls, but plasma high- and low-density lipoprotein levels were lower only
Article
This paper gives analytical data on the composition of 14 selected consumer-available liquid vegetable oils, including soybean, soybean-cottonseed blends, corn, safflower, peanut, olive and apricot kernel oils. Label information identified six samples as specially processed or refined and three samples as cold pressed with no preservative added; the labels of the remaining five samples did not mention processing. Data are given for fatty acid composition,trans content, location of the double bonds in the unsaturated fatty acids, percent conjugation, tocopherol content, fatty acid composition of the 2-poisition of the triglycerides, polyunsaturated to saturated fatty acid (P/S) ratio, and the ratio of α-tocopherol to polyunsaturated fatty acids (α-T/P). The ranges of values found were: conjugated unsaturation, 0.18–1.09%; α-tocopherol, 0.01–0.60 mg/gm; total tocopherol 0.14–1.52 mg/gm; P/S, 0.5–8.7; and α-TP, 0.03–2.26. The compositions of the fatty acids on the 2-position and on the 1,3-position of the triglycerides were compared with those calculated by the Evans’ hypothesis and found to agree well for all but olive and apricot kernel oils.
Article
Vegetarians have an apparent diminished risk for the development of ischemic coronary heart disease. This may be secondary to dietary effects of plasma lipids and lipoproteins, but platelets, which may also play a role, have also been observed to have aberrant functions in vegetarians. We measured plasma lipid and lipoprotein levels, platelet function, platelet fatty acid levels, and platelet active prostaglandins in ten strict vegetarians (vegans), 15 lactovegetarians, and 25 age- and sex-matched omnivorous controls. The most striking observations were a highly significant rise in platelet linoleic acid concentration and a decline in platelet arachidonic acid concentration in both vegetarian subgroups as compared with omnivorous controls. Serum thromboxane and prostacyclin levels as well as results of platelet aggregation studies did not differ among the groups tested. Cholesterol levels were significantly lower in both vegetarian groups as compared with controls, but plasma high- and low-density lipoprotein levels were lower only in the vegan subgroup as compared with omnivores. If diet produces these changes in platelet fatty acid and plasma lipid levels it may contribute to the decreased risk of coronary heart disease and possibly atherosclerosis in vegetarians.
Article
Fifty brands of margarine were analysed for cis-polyunsaturated acids by lipoxidase, for trans fatty acid by infared spectroscopy, and for fatty acid composition by gas-liquid chromatography. High concentrations of trans fatty acids tended to be associated with low concentrations of linoleic acid. Later analyses on eight of the brands, respresenting various proportions of linoleic to trans fatty acids, indicated that two of them contained still higher levels of trans fatty acids (greater than 60%) and negligible amounts of linoleic acid. It is proposed that margarine could be a vehicle for the distribution of some dietary linoleic acid and that the level of linoleic acid and the summation of the saturated plus trans fatty acids be known to ascertain nutritional characteristics.
Article
This article has no abstract; the first 100 words appear below. PROSTAGLANDINS are potent vasoactive agents with a wide variety of other actions that depend on the species and organ tested and the prostaglandin used. They are synthesized from 20-carbon polyunsaturated fatty acids containing three, four or five double bonds. These fatty acids are present in the phospholipids of the cell membranes of all mammalian tissues. The main precursor of prostaglandins in man is eicosatetraenoic or arachidonic acid (four double bonds), which gives rise to the prostaglandins (PG's) containing two double bonds (PGE2, PGF2α, PGD2, prostacyclin and thromboxane A2). PGE2 and PGF . . . Source Information From the Department of Prostaglandin Research, Wellcome Research Laboratories, Langley Court, Beckenham, Kent BR3 3BS, U.K., where reprint requests should be addressed to Dr. Moncada.
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Recent speculation concerning the relationship of dietary fat and cancer causation is challenged. Correlations between increase in per capita dietary fat intake and cancer mortality over a 60-year period show significant positive correlations for total fat and vegetable fat, and negative or no correlation for animal fat. The significant positive correlation for vegetable fat could not always be explained by the effects of total unsaturated components; individual unsaturated components, such as oleic or linoleic fatty acids; or the saturated component; but could be explained by the trans fatty acid component.
Article
Fatty acid patterns were determined in 83 brands of margarine, 9 brands of low-calorie margarine and 18 brands of shortening, frying and cooking fat purchased at random from the retail marker in the Federal Republic of Germany in 1973/1974, and a second time in 1976. As a result of gas-liquid chromatographic analyses on a Silar 10 C coated packed column, complemented in some cases by the values recorded on a highly selective SP 2340 capillary column, trans-octadecenoic acids ranging from 53.2 to 0.1% were measured. None of the products examined was completely free of trans-fatty acids. High values of trans-octadecenoate were always accompanied by positional isomers of cis-octadecenoate, by 9trans,12trans-octadecadienoate and by 9cis,12trans-octadecadienoate and 9trans,12cis-octadecadienoate. Furthermore, two mixed geometric isomers derived from linolenic acid (probably 9cis,12cis,15trans-octadecatrienoate and 9trans,12cis,15cis-octadecatrienoate) could be identified, provided that the individual brand contained sufficient linolenic acid. Following partial hydrogenation, transhexadecenoate, 0.1 to 0.2%, was detected in some of the edible fats.
Article
After careful analysis of the enormous literature dedicated to the specific and nonspecific complications of diabetes, 2 impressions emerge: The rigor of most of the statistics leaves something to be desired particularly in the controversial sphere of the effects of metabolic control. No one satisfies most of the methodological requirements set out in the introduction. Despite the apparent chaos resulting from the study of different populations examined by different methods, one finds however a general agreement on the relationship between the 3 specific lesions and the duration and intensity of diabetes. The author's study fulfills 22 of the 23 criteria of validity requested by the most severe critics. It conclusively proves that diabetic triopathy and not atherosclerosis is a function of the duration and intensity of diabetes and more precisely of hyperglycemia. Of course, this can be lessened by treatment. This fact should encourage physicians to strive toward normoglycemia in diabetes therapy, while at the same time recommending various methods of hygiene which could slow down the development of atheromatosis and of hypertension.
Article
Evidence that biosynthesis of prostaglandins (PG) in tissues of animals deficient in essential fatty acids is dependent on the availability of their precursors has been demonstrated. The purpose of this study was to determine the following: (1) effects of dietary linoleate enrichment on PG biosynthesis in rats; (2) effects of exogenous PGE2 and dietary linoleate on plasma free fatty acids and serum cholesterol in fed and fasted rats. Rats were fed three different concentrations of dietary linoleate as beef tallow, hydrogenated vegetable fat, or corn oil. The concentrations of PGE1 and PGF2a measured by radioimmunoassay were higher in rats fed the fed the beef tallow diet independent of energy status. A decrease in the concentration of PG between fasted and fed rats receiving hydrogenated vegetable fat is discussed in respect to the possible influence of trans isomers of unsaturated fatty acids on the biosynthesis of PG. There were significant effects of fasting on serum cholesterol concentration regardless of diet and significant interactions among effects of PGE2, fasting, and diet, suggesting regulatory effects of PGE2 on serum cholesterol concentration. The increase in plasma free fatty acids associated with fasting was prevented by PGE2 for all diets, but had the most marked effect on rats fed hydrogenated vegetable fat.
Article
Increased flux through the polyol pathway mediated by the enzyme aldose reductase may be associated with the development of diabetic neuropathy. Fifty-four diabetic patients (median age 56 yr, range 25-65 yr) with chronic neuropathic symptoms were randomly allocated to placebo or aldose reductase inhibition (300 or 600 mg ponalrestat ICI 128436) groups for 24 wk. Patients with vibration perception thresholds (VPTs) greater than 35 V at the great toe or thermal difference thresholds (TTs) greater than 10 degrees C on the dorsum of the foot were excluded from the trial. No significant changes were observed in symptoms of pain, numbness, or paresthesia between ponalrestat and placebo groups, and there were no improvements in VPT or TT at several sites. Posterior tibial nerve conduction velocity changed from 35.3 +/- 4.9 m/s at baseline to 33.4 +/- 4.0 m/s at 24 wk (NS) with placebo compared with 37.6 +/- 5.6 vs. 37.2 +/- 8.7 m/s (NS) with 300 mg ponalrestat and 34.5 +/- 6.1 vs. 36.2 +/- 6.8 m/s (NS) with 600 mg ponalrestat. Further studies are indicated with intervention at an earlier stage in the evolution of neuropathy and for longer periods.
Article
Lipid fractions such as phospholipids (PLs), cholesteryl esters (CEs), and free fatty acids (FFAs) represent source pools for eicosanoid synthesis. To determine whether dietary habits affect the enrichment of 20:4n-6 in these precursor pools, we studied humans with partial or complete arachidonate restriction resulting from chronic avoidance of animal fat and tissue. Fasting serum was obtained from omnivorous control subjects (Omni, n = 100), semivegetarians (Semiveg, n = 16), and vegetarians (Veg, n = 25). PLs, CEs, FFAs, and triglyceride (TG) fatty acids were quantitated by thin-layer and gas chromatography. Serum 20:4n-6 was lower in the PL fraction in both Veg (p less than 0.01) and Semiveg groups (p less than 0.05) than in the Omni group and lower in the CE fraction in the Veg group (p less than 0.05). Serum 18:2n-6 did not differ between groups for any serum lipid fraction. 18:3n-3 was elevated in PLs and CEs of both Veg (p less than 0.05 and 0.01) and Semiveg groups (p less than 0.05 and 0.01) compared with the Omni group but did not result in differences in 20:5n-3 in PLs or CEs between diet groups. The lower concentration of 20:4n-6 in serum PLs and CEs of the Veg group indicates that dietary arachidonic acid enriches its circulating pool in humans; however, 20:5n-3 is not similarly responsive to dietary restriction.
Article
The quantity of leukotrienes produced in an inflammation model, the stimulated mouse peritoneum, was affected by dietary manipulation of tissue arachidonic acid, the immediate leukotriene (LT) precursor. Fifty ng of LTE4 was synthesized (after injection of zymosan) by the peritoneal cavity of mice maintained on olive oil as a dietary source of unsaturated fatty acids. Animals maintained on corn oil, exhibited significantly enhanced leukotriene biosynthesis upon stimulation by zymosan. Mice fed menhaden oil, a fat source rich in n-3 fatty acids produced 50% less leukotriene E4 than animals fed olive oil. The results indicated that production of leukotrienes, potent mediators of inflammatory reactions, are affected by the type of polyunsaturated fatty acids in the diet.
Article
Diabetic neuropathy, long-recognized as an important but complex and poorly understood clinical complication of diabetes, is finally yielding to more than a decade of intense clinical and laboratory investigation. At least one basic biochemical mechanism involving sorbitol and MI metabolism, phosphoinositides, protein kinase C, and the (Na,K)-ATPase has been identified that can rationally account for the neurotoxicity of glucose. This biochemical sequence has been examined in some detail in vitro, but some of its elements, such as the link between abnormal sorbitol and MI metabolism, and between protein kinase C and the (Na,K)-ATPase, remain the subject of ongoing investigation. Through its effect on the (Na,K)-ATPase, this metabolic sequence can explain both the rapidly-reversible functional impairment and the early structural lesions of nerve fibers, such as paranodal swelling in acute diabetes. Extrapolation of early paranodal swelling to the more advanced stages of nerve fiber damage remains somewhat speculative, although axo-glial dysjunction is a likely intermediate step. Impaired axonal transport or microvascular dysfunction may be additional contributing factors, possibly also related to abnormal sorbitol and MI metabolism. Blunted phosphoinositide-mediated signal transduction could potentially explain a putative insensitivity to neurotrophic factors and a diminished regenerative response in diabetic neuropathy. Human morphometric studies and ARI trials support the relevance of these pathogenetic processes to human diabetic neuropathy, and suggest that specific metabolic therapy with agents such as ARIs hold promise as important new elements in the treatment and possibly prevention of diabetic neuropathy.
Article
The albumin (Alb), IgG, and IgM concentrations in the endoneurium of fascicular sural nerve biopsy samples were evaluated in controls (n = 9 or 10), diabetic patients without neuropathy (n = 6), and diabetic patients with polyneuropathy (n = 17 or 18). These values were significantly increased in diabetic patients with and without neuropathy when expressed both per endoneurial dry weight or endoneurial total protein compared to biopsy samples from healthy controls. When these concentrations, expressed per endoneurial total protein, were related to plasma concentrations similarly expressed, the resulting blood-nerve barrier (BNB) indices were significantly increased for Alb (6.1 times; P less than 0.00001), IgG (4.9 times; P = 0.00037), and IgM (2.7 times; P = 0.015). The diabetic patients without neuropathy (defined as having an index of pathology of greater than 0.65; a measure of the severity of the pathological abnormality based on morphological criteria) also had significant increases in two of these BNB indices that were intermediate between the diabetic neuropathy patients and controls (Alb, 3.9 times controls; P = 0.00002: IgG, 4.6 times controls; P = 0.00016: IgM, 1.8 times controls; not significant). No correlations were observed between the endoneurial concentrations of these plasma proteins or the BNB indices and the index of pathology, suggesting that these increases in endoneurial plasma proteins precede the pathologic alterations. The increased values for the diabetics in the absence of pathological abnormalities may prove useful in predicting neuropathic complications. The ratio of the IgG-BNB index to the Alb-BNB index was decreased 19%, and the ratio of the IgM-BNB index to the Alb-BNB index was decreased 56% in diabetic neuropathy patients compared to controls. Although the IgG and IgM concentrations are increased in the diabetic endoneurium, the Alb increase is greater and a mechanism other than size indiscriminate extravasation of plasma proteins, therefore, is suggested. Morphometric assessment of the endoneurial compartments, which would be expected to contain these plasma proteins, suggests that they are not altered in diabetic neuropathy; hence, it is hypothesized that the observed increase in endoneurial concentration of these plasma proteins results from altered transport through the endothelial or perineurial barrier, which supports an underlying vascular mechanism in the development of diabetic polyneuropathy.
Article
Samples of lumbosacral trunk, posterior tibial nerve, and sural nerve obtained at autopsy from diabetic and nondiabetic patients without mononeuropathy multiplex were evaluated using 1-mu-thick epoxy sections and teased nerve fiber preparations. Focal fascicular lesions characterized by reduced density of myelinated axons within fascicles were found predominantly in the specimens from diabetics, mainly in the posterior tibial nerve and lumbosacral trunk. In severe examples, the perineurium and even surrounding epineurium were damaged, stamping the lesions as ischemic. In addition, identical lesions were found in biopsies of nerves of nondiabetics with vasculitis. Density of myelinated fibers at the three sites demonstrated a proximal-distal graded loss that was significantly greater in the diabetic samples. The loss from the lumbosacral trunk to the posterior tibial nerve was correlated with the density of focal lesions in the lumbosacral trunk in the diabetic (p = 0.025), indicating that distal fiber loss was partly due to the focal lesions. Teased nerve fiber abnormalities were common only in sural nerves of diabetics, suggesting that they are secondary. We conclude that beyond the possible metabolic abnormalities involved in the genesis of diabetic polyneuropathy, focal fascicular lesions, likely due to diabetic microangiopathy, are also important in the development of diabetic neuropathy.
Article
Milk fat, before and after randomization, was separated into 8 fractions by crystallization from acetone. The trans-unsaturated fatty acid content of the milk fat was 8.6% and in the fractions ranged from 8.1 to 11.1%. The ratio of trans to total unsaturation was 0.23 in the whole fat and decreased from 0.82 in the highest melting fraction to 0.16 in the lowest melting fraction. As randomization caused only minor changes in these values it was concluded that ttrans-unsaturated fatty acids are distributed at random between glycerides. The 2-monoglycerides isolated from original and randomized milk fat and their fractions contained no measurable amounts of trans unsaturation, and it was, therefore, concluded that virtually all of the trans-unsaturated fatty acids were located in the 1 and 3 positions of the glycerides.
Article
A purified diet containing 10% linseed oil as the fat source was fed to rats over a 56-day period. After the 56th day the rats were fed the same basal diet but containing 10% corn oil in place of the linseed oil. Rats were killed and blood and liver samples were taken from four to six rats on 14 days of the feeding trial. Serum and liver fatty acid profiles were determined. The platelet prostaglandin E2 (PGE2) released in serum as a result of blood coagulation for 1 h at 37 degrees C was determined. Liver homogenates were incubated and PGF2 alpha synthesizing capacity was assayed. Both serum and liver fatty acid profiles reflected the high linolenic content of the linseed oil. There was a progressive increase in fatty acids of the omega 3 series and a decrease in the omega 6 series. Notably the PG-2 series precursor, arachidonic acid (20:4 omega 6) was decreased and the precursor of the PG-3 series timnodonic acid (20:5 omega 3) was increased. These changes were reversed when corn oil was fed. PGE2 content of serum and PGF2 alpha synthesis by liver homogenates progressively decreased as the 20:4 omega 6 levels fell and the 20:5 omega 3 levels increased. PG synthesis was quickly increased in both when corn oil diets were fed. This study has implications for dietary manipulation of PG synthesis by blood components and may provide a basis for manipulation of PG synthesis in systems in which they are regulatory.
Article
Near normal glucoregulation was maintained in 10 patients with insulin-dependent (type I) diabetes mellitus for 6 wk with preprogrammed continuous subcutaneous insulin infusion using a portable battery-powered infusion pump (CSII). This form of therapy resulted in a statistically significant increase in motor nerve conduction velocity in the median and peroneal nerves compared with baseline values. There was no significant change in the motor nerve conduction velocity in the ulnar nerve or in the sensory nerve conduction studies. No changes occurred in five additional patients studied in similar fashion while on a conventional insulin regimen. These results suggest that the prevention of sustained hyperglycemia with CSII could theoretically result in the prevention of diabetic neuropathy. However, only long-term studies of CSII will provide the information necessary to determine the clinical relevance of the findings.
Article
Two adolescents with insulin-dependent diabetes mellitus developed unusually severe diabetic neuropathy which responded to intensive measures to achieve improved metabolic control. Employing home blood glucose monitoring and either frequent insulin injections or a portable insulin infusion pump, painful peripheral neuropathy and autonomic gastrointestinal neuropathy improved after five and 12 months of therapy, respectively. During this period of time, abnormal ocular fluorophotometry, an early change in the eye of diabetic patients, also returned to normal. These patients demonstrate the reversibility of unusually severe neuropathy and early ocular changes in adolescents with diabetes when treated with intensive measures designed to improve metabolic control.
Article
A 16-year-old girl with insulin dependent (Type I) diabetes since age 9 and painful sensory neuropathy for two months was treated with a portable insulin infusion pump, allowing strict control of hyperglycemia. Within 28 days the distal motor latency in all nerves tested had improved and painful incapacitating dysesthesias disappeared. The findings suggest that strict control of hyperglycemia with a portable insulin infusion pump can successfully reverse the changes of recent onset diabetic neuropathy.
Article
In this review the authors have dealt with three basic questions that have vexed renal physiologist and nephrologists for decades: Why are human beings endowed with far more nephron units than are required to maintain external balance for a variety of solutes and water? Why do progressive declines in renal blood flow and glomerular filtration rates and progressive glomerular sclerosis occur after the third decade of life? Why is renal disease inexorably progressive? Insight into all three questions become readily apparent when consideration is given to the possibility of a fundamental mismatch between the evolutionary design characteristics of the human kidney and the functional burden imposed by modern ad libitum eating habits. Sustained rather than intermittent excesses of protein (and perhaps other solutes) in the diet impose similarly sustained increases in renal blood flow and glomerular filtration rates, which require that the 'reserve' glomeruli of the outer cortex be in use more or less continuously. Consequently, time-averaged pressures and flows in outer glomeruli contribute to unrelenting 'intrarenal hypertension' and predispose even healthy people to progressive glomerular sclerosis and deterioration of renal function. The biologic price of this adaptation to ad libitum feeding is acceptable in the absence of diabetes, acquired renal disease, or surgical loss of renal mass. But the more pronounced elevations in glomerular pressures and flows associated with these latter conditions may accelerate the development of glomerular sclerosis, leading to more rapid loss of renal function. Unfortunately, the current treatments for chronic renal insufficiency, including efforts to control systemic hypertension, urinary-tract infection, and secondary hyperparathyroidism, do little to interrupt the hemodynamic mechanisms of progressive renal failure. It is to be hoped that additional therapies aimed at preventing excessive glomerular pressures and flows will be introduced in an effort to check the relentless progression of clinical renal disease. An obvious first step, might be a reduction of protein intake, implemented early in the course of intrinsic renal disease. Rigid metabolic control achieved by continuous insulin infusion or other means and instituted early in the course of juvenile-onset diabetes, could likewise prove effective in preventing glomerulopathy in this high-risk population. Clearly, resolution of these and the many other issues raised in this article will come only from more reseach.
Article
The syndrome of renal tubular acidosis has been categorized into three physiologic types that have different clinical findings and prognostic and therapeutic implications. We reviewed radiographs of the skeleton and kidneys in 92 patients (56 children and 36 adults) with renal tubular acidosis in order to determine whether the radiologic findings could be related to the type of syndrome. Forty-four patients had Type 1 renal tubular acidosis, 18 had Type 2, and 30 had Type 4. Evidence of skeletal abnormalities was uncommon (17 per cent) and was confined to patients who had the Type 2 disorder or azotemia. The children with Type 2 and skeletal abnormalities had rickets; the adults had osteopenia without pseudofractures. Nephrocalcinosis was evident in approximately one fourth of the group (29 per cent) and was restricted to patients with the Type 1 syndrome. In patients with Type 4, osteopenia was evident in 12 per cent, all of whom were azotemic. Our observations indicate that the radiographic manifestations of renal tubular acidosis are influenced by the physiologic type of renal tubular acidosis.
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