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Vinegar Improves Insulin Sensitivity to a High-Carbohydrate Meal in Subjects With Insulin Resistance or Type 2 Diabetes
Abstract
The number of Americans with type 2 diabetes is expected to increase by 50% in the next 25 years; hence, the prevention of type 2 diabetes is an important objective. Recent large-scale trials (the Diabetes Prevention Program and STOP-NIDDM) have demonstrated that therapeutic agents used to improve insulin sensitivity in diabetes, metformin and acarbose, may also delay or prevent the onset of type 2 diabetes in high-risk populations. Interestingly, an early report showed that vinegar attenuated the glucose and insulin responses to a sucrose or starch load (1). In the present report, we …
... During the literature search, 15 studies within 11 references were identified that investigated the effects of acute vinegar administration on glycemic control. These 15 studies were metaanalyzed (29-31, 33, 34, 38-43) for PBG responses in healthy individuals, with 7 in metabolically compromised individuals (31,32,(43)(44)(45). Five of the healthy volunteer studies (30,40,42,43) and 6 of the nonhealthy volunteer studies (32,(43)(44)(45) were also meta-analyzed for the postprandial insulin response. ...
... These 15 studies were metaanalyzed (29-31, 33, 34, 38-43) for PBG responses in healthy individuals, with 7 in metabolically compromised individuals (31,32,(43)(44)(45). Five of the healthy volunteer studies (30,40,42,43) and 6 of the nonhealthy volunteer studies (32,(43)(44)(45) were also meta-analyzed for the postprandial insulin response. ...
... These 15 studies were metaanalyzed (29-31, 33, 34, 38-43) for PBG responses in healthy individuals, with 7 in metabolically compromised individuals (31,32,(43)(44)(45). Five of the healthy volunteer studies (30,40,42,43) and 6 of the nonhealthy volunteer studies (32,(43)(44)(45) were also meta-analyzed for the postprandial insulin response. ...
Background
Non-communicable disease development is related to impairments in glycaemic and insulinemic response, which can be modulated by fiber intake. Fiber's beneficial effect upon metabolic health can be partially attributed to the production of short-chain fatty acids (SCFAs) via microbial fermentation of fiber in the gastrointestinal tract.
Objective
We aimed to determine the effect of the SCFAs, acetate, propionate, and butyrate on glycemic control in humans.
Methods
CENTRAL, Embase, PubMed, Scopus and Web of Science databases were searched from inception to the 07/12/2021. Papers were included if they reported a randomized, controlled trial measuring glucose and/or insulin compared to a placebo in adults. Studies were categorized by the type of SCFA and intervention duration. Random effects meta-analyses were performed for glucose and insulin for those subject categories with ≥3 studies, or a narrative review was performed.
Results
We identified 43 eligible papers, with 46 studies within those records (n = 913), 44 studies were included in the meta-analysis. Vinegar intake decreased acute glucose response, standard mean difference (SMD) and (95% CI) –0.53 (–0.92, –0.14) (n = 67) in individuals with impaired glucose tolerance or type 2 diabetes and in healthy (SMD) –0.27 (–0.54, 0.00) (n = 186). The meta-analyses for acute acetate as well as acute and chronic propionate studies had no significant effect.
Conclusions
Vinegar decreased glucose response acutely in healthy and non-healthy. Acetate, propionate, butyrate, and mixed SCFAs had no effect on blood glucose and insulin in humans. Significant heterogeneity, risk of bias, and publication bias were identified in several study categories, including acute vinegar glucose response. As evidence was very uncertain, caution is urged when interpreting these results. Further high-quality research is required to determine the effect of SCFAs on glycemic control.
... Some studies have demonstrated that vinegar intake has some effects in increasing insulin sensitivity and decreasing blood glucose levels in either healthy adults or diabetes subjects (Johnston and Gaas, 2006;Johnston et al., 2013;Johnston et al., 2004;Johnston et al., 2009). Vinegar intake with meals can reduce fasting blood glucose levels in healthy adults (Johnston et al., 2013). ...
... Vinegar intake with meals can reduce fasting blood glucose levels in healthy adults (Johnston et al., 2013). A small cross-over study had shown that the postprandial glucose and insulin levels reduction and vinegar can improve insulin sensitivity in healthy and insulin resistant subjects but not for diabetic patients (Johnston et al., 2004). But a later study has shown that vinegar can reduce HbA1c level up to 0.16% in diabetes after 12 weeks of regular daily ingestion of vinegar and the positive effects of vinegar intake was found in diabetic subjects (Johnston et al., 2009). ...
... Our results showed that the change of glucose and insulin response and under area curve of OGTT before and after black vinegar intake for eight weeks is not statistically significant. It is not consistent with the results of the Johnston et al. (2004) study, which indicated that vinegar intake can improve insulin sensitivity for insulin resistant or type 2 diabetes subjects. These inconsistent results may be due to the short duration of study period or the study population with minor cardio-metabolic abnormalities. ...
This open-label non-controlled study is to evaluate the effects of black vinegar intake for 8 weeks on the anthropometric measures, cardiometabolic profiles, and insulin sensitivity among impaired fasting glucose adults. 32 subjects (14 males and 18 females) were recruited with the mean age of 56.3 (from 25 to 65). Black vinegar 50 ml was diluted to 500 ml with drinking water and was given to all subjects for 8 weeks. At baseline and 8-week, all study subjects received 75 g of oral glucose tolerance test (OGTT) after 10 h of fasting. Venous blood was collected at 0, 30, 60, 90 and 120 min. Plasma glucose and insulin levels were measured using the glucose oxidase method and radioimmunoassay method. Anthropometric variables, blood pressure and blood lipid profiles were measured using standard methods. The Wilcoxon signed-rank test was used to compare the difference between baseline and after eight weeks. After eight weeks, the body weight and BMI decreased from 68.2 ± 14.4 kg to 67.6 ± 14.2 kg and 26.3 ± 4.5 kg/m2 to 26.0 ± 4.4 kg/m2, respectively, with statistical significance (p < 0.05). Triglyceride level decreased from 152.5 ± 134.7 to 140.6 ± 93.8 mg/dl but without statistical significance. The blood glucose levels at 120 min of OGTT decreased from 178.8 ± 57.0 to 173.7 ± 57.5 mg/dl and the insulin levels at 120 min of OGTT increased from 117.5 ± 74.2 to 126.4 ± 95.9 IU/L but not statistically significant (p > 0.05). There is a slight decrease of body weight and BMI, but no significantly change in blood pressure, lipid profiles, and insulin sensitivity after eight weeks of black vinegar intake among impaired fasting glucose adults. However, further large-scale and longer studies are needed to explore the effects of black vinegar on cardiometabolic profiles and insulin sensitivity. Keywords: Black vinegar, anthropometric measures, lipid profiles, insulin sensitivity, impaired fasting glucose.
... Apple vinegar is widely used and appreciated by the Moroccan population and around the world. Several studies clearly demonstrated many benefits of vinegar consumption such as glucose-lowering effect in patient with glucose abnormalities [16][17][18], improved insulin sensitivity in insulinresistant patients [19], decreasing the glycemic index of carbohydrate food for people with and without diabetes [19], antihyperlipidemic [18], hepatoprotective effect [20,21], and modulation of lipid peroxidation [22]. ...
... Apple vinegar is widely used and appreciated by the Moroccan population and around the world. Several studies clearly demonstrated many benefits of vinegar consumption such as glucose-lowering effect in patient with glucose abnormalities [16][17][18], improved insulin sensitivity in insulinresistant patients [19], decreasing the glycemic index of carbohydrate food for people with and without diabetes [19], antihyperlipidemic [18], hepatoprotective effect [20,21], and modulation of lipid peroxidation [22]. ...
... Additionally, in prophetic medicine, the Prophet Mohammed peace be upon him recommended drinking vinegar in the prophetic 3 Journal of Diabetes Research hadeeth: "vinegar is the best edible." Moreover, the apple vinegar has been shown to reduce fasting blood glucose [16,19,[33][34][35], by reducing the post-prandial insulin response [35]. The intake of apple vinegar ameliorates the insulin sensitivity and increase the uptake of glucose in the skeletal muscles [17]. ...
The main objective of this study is to determine the effects of apple vinegar on the metabolic changes caused by hypercaloric diet in Wistar rats. Apple vinegar was first analyzed to find out the total acidity, the polyphenolic and flavonoid contents, the total antioxidant capacity, and the free radical scavenging activity. In vivo study on adult male and female Wistar rats was conducted by administering a drink containing either 10% D-glucose or water (control) for five weeks. Apple vinegar is administered daily by gavage (2 mL/kg) to rats fed D-glucose for 5 weeks. The results showed that the polyphenolic content in apple vinegar was 148.02±10.16 mg GAE/100 mL, flavonoid content was 22.93±0.73 QE/100 mL, and total antioxidant capacity was 13.4±0.47 mg AAE/100 mL. Free radical IC50 apple vinegar scavenging activity (DPPH) was 0.74±0.154 μL/mL. The total acidity was (3.24±0.02 mg AAE/100 mL). The treatment during five weeks with D-glucose leads to increased plasma glucose, lipid profile, hepatic enzyme levels, urea, and creatinine. Simultaneous treatment with apple vinegar improves the parameters studied. These results clearly show that the daily consumption of vinegar can reduce the rise in blood sugar and lipid profile induced by hypercaloric diet in rats. Therefore, the use of apple vinegar would have a very beneficial effect in the prevention of metabolic disorders caused by high-caloric food.
... The sour taste of vinegar is due mostly to its content of acetate, which occurs as acetic acid. Whereas some opine that published clinical data claiming that apple cider vinegar can manage glucose, lipid levels, and weight loss are limited and equivocal, there is a large and convincing body of published studies to the contrary that cite several salutary properties of vinegar-reduction in the gastric emptying rate, improved insulin sensitivity, and reduced postprandial hyperglycemia among insulin-dependent diabetes mellitus patients [95][96][97][98]. Other studies, in normal and diabetic humans, revealed that acetate and/or vinegar ingestion is associated with a multitude of salutary effects, not all of which have been confirmed. ...
... Before the introduction of modern hypoglycemic agents, vinegar teas were used to control diabetes [106]. Small amounts of vinegar (~25 g) consumed with or without food reduce the glycemic index of carbohydratecontaining food for diabetic and non-diabetic persons [96,114,115]. This has been expressed as lower glycemic index ratings (~30%) [116,117]. ...
... Vinegar improves insulin sensitivity in normal and metabolic syndrome subjects [96,97], an effect that would be expected to reduce adipocyte lipolysis, thereby lowering plasma NEFA, hepatic TG production and secretion, and plasma TG levels [118]. Moderate daily alcohol intake is also associated with lower insulin secretion [56,57]. ...
Ingestion of alcohol is associated with numerous changes in human energy metabolism, especially that of plasma lipids and lipoproteins. Regular moderate alcohol consumption is associated with reduced atherosclerotic cardiovascular disease (ASCVD), an effect that has been attributed to the concurrent elevations of plasma high-density lipoprotein-cholesterol (HDL-C) concentrations. More recent evidence has accrued against the hypothesis that raising plasma HDL concentrations prevents ASCVD so that other metabolic processes associated with alcohol consumption have been considered. This review explored the roles of other metabolites induced by alcohol consumption—triglyceride-rich lipoproteins, non-esterified free fatty acids, and acetate, the terminal alcohol metabolite in athero-protection: Current evidence suggests that acetate has a key role in athero-protection but additional studies are needed.
... An efficient strategy to reduce the glycaemic response to a starchy meal in normal, [8][9][10][11][12][13][14] insulin resistant, 15 and diabetic subjects 16,17 is to lower its pH by pairing it with an acidic food or drink (typically vinegar). The same holds true for processes that result in the acidification of the food itself, sourdough bread fermentation for example. ...
... Additional samples, 2 mL each, were collected from the chime's supernatant at 3,6,9,15,20,30,45, 60, 75, 90 and 120 min, after a 30 s interruption of stirring to allow particles to sediment. Immediately after being collected, samples were transferred to a dry bath (99°C, 150 rpm, 5 min) for enzyme inactivation and kept at −20°C until required for further analysis. ...
... This mechanism is likely to explain, at least in part, the attenuation of the glycaemic response observed in the following 15 studies. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] The possibility that this effect results from a reduced rate of starch digestion and/or impaired enzymatic activity has been investigated before, but the results were sometimes contradictory and conclusions unclear. 21,23,42 This is most probably due to the protocols used, which tend to standardize the pH in a way that is not always representative of human physiology. ...
Numerous studies have reported that the glycaemic response to starch-rich meals can be reduced by 20-50 % with acidic drinks or foods. A number of candidate explanations have been put forward, but this phenomenon still remains vaguely understood. This study intends to demonstrate the remarkable effect of acid inhibition of salivary α-amylase during oro-gastric hydrolysis of starch, shedding light on this often overlooked mechanism. Oro-gastric digestions of bread, wheat and gluten-free pastas, combined with either water or lemon juice were performed using a dynamic in vitro system that reproduces gastric acidification kinetics observed in humans. In the presence of water, large proportions of starch (25-85 %) and oligosaccharides (15-50 %) were released from all foods within the first hour of gastric digestion (pH > 3.5). In the presence of lemon juice (pH < 3.5 at all time), starch release was about twice as low, and amylolysis into oligosaccharides was completely interrupted. Acid-inhibition of salivary α-amylase may explain, at least in part, the reduction of the blood glucose response through acidification of starch-rich foods/meals. This offers new perspectives for the development of strategies to improve the glycaemic response elicited by starch-rich diets.
... This ingredient also decreases pH; therefore, it increases products shelf life and retard spoilage. 4 Salad dressings are emulsions which need to have emulsifiers to be stable. Generally, egg yolk is used as an emulsifier in their production. ...
... In describing the particle size, D [4,3] represents volume average particle and span index shows dispersion around the mean. The results show that by increasing gum concentration of 0.25% to 0.75%, all particle size description parameters, including D [4,3] and span index reduced significantly (Table 4). ...
... In describing the particle size, D [4,3] represents volume average particle and span index shows dispersion around the mean. The results show that by increasing gum concentration of 0.25% to 0.75%, all particle size description parameters, including D [4,3] and span index reduced significantly (Table 4). ...
Purpose: Lipid oxidation and rheological properties are the main qualitative parameters determined in food emulsions. Salad dressings are food emulsions important in our daily diet, but conventional salad dressings have high amounts of cholesterol and saturated fatty acids because of egg yolk in their formulations. There are many studies on the modification of salad dressing formulations to replace egg yolk and saturated fats. The present study describes new formulation of salad dressing with olive oil and apple vinegar to produce a functional food product.
Methods: This study investigated the qualitative properties, oxidative stability, rheological behavior and microstructure of the salad dressing without egg yolk. Oil-in-water emulsions were prepared with virgin olive oil and apple vinegar stabilized with various percentages of xanthan (T1: 0.25%, T2: 0.5%. T3: 0.75%). Samples were stored at refrigerator for 90 days and experiments were performed at production day and during storage.
Results: The obtained results showed that peroxide value was increased for all samples during storage, but it was at an acceptable level. Fatty acid changes were not significant during storage. Droplet size was reduced by increasing xanthan gum. T2 had the best rheological properties during storage. Generally, T2 and T3 had higher scores and were more acceptable in organoleptic assay.
Conclusion: Obtained results showed that T2 had suitable qualitative and rheological properties and can be a proper egg yolk free salad dressing to introduce to the market.
Keywords: Lipid oxidation, Xanthan gum, Rheological behavior, Emulsion stability, Microstructure
... In the present study, DA soaked with vinegar containing 1.5 g of acetic acid achieved a 1.0-mmol/L reduction in the average glucose peak, a 1.1mmol/L reduction of glycemic excursion in 240 minutes, and a 35-point reduction in the GI. Vinegar's effect on carbohydrate metabolism was explained by improving insulin sensitivity [36] by increasing glucose uptake of skeletal muscle [37], delaying gastric emptying, slowing absorption, and inhibiting hepatic glucose production [38]. ...
... A high satiety score and a stable glucose level at 210 minutes indicated a potential for reducing energy intake of the subsequent meal. A previous study reported that vinegar ingestion could increase satiety in a dose-effect manner [36]. The satiety-enhancing property of vinegar ingestion might be associated with slowed gastric emptying [49] and the activation of the free fatty acid receptors FFA2 (previously GPR43) and FFA3 (previously GPR41) [50]. ...
This study investigated 2 possible approaches to dietary control of acute postprandial responses to a rice-based meal under equicarbohydrate conditions: (1) a dried apple (DA) preload and (2) co-ingestion of vinegar-soaked DA. We hypothesized that both approaches would counteract hyperglycemia with no negative effect on satiety, possibly explained by an inhibitory effect on digestive enzyme activity and/or the effect of the sugar component of the DA. Fifteen healthy female subjects consumed (1) rice, (2) co-ingestion of DA and rice (DA + R), (3) DA preload and rice (PDA + R), (4) rice with sugar solution (same sugar profile as in DA) preloaded (PSS + R), or (5) co-ingestion of rice with vinegar-soaked DA (VDA + R) in a randomized crossover trial. Acute postprandial glycemic response tests and subjective satiety tests were conducted for each test meal. Compared with rice reference, the PA + R and PSS + R achieved 31.4% and 36.3% reduction of the incremental area under the curve0-120, 24.3% and 27.0% decreases in the average glucose peak, along with 21.6% and 27.0% decreases in glycemic excursion in 240 minutes, whereas the VDA + R resulted 42.4%, 27.0%, and 29.7% reductions in the incremental area under the curve0-120, peak, and glycemic excursion, respectively. The DA-containing meals had no effect or a favorable effect on satiety. The in vitro assay found larger resistant starch and smaller rapid digestible starch fractions in DA + R and VDA + R meals compared to those of the rice reference (P < .001). The result of this study supported the research hypothesis, and the DA-containing meals could be considered as a potential dietary approach for glycemic management.
... While vinegar was once used as a simple seasoning, its use has expanded to health-related fields, and its various biological activities are actively undergoing study. Many bio-active ingredients, including amino acids, peptides, carbohydrates, organic acids, minerals, vitamins, and polyphenolics, that are effective for health care have been found in vinegar [43][44][45] . In particular, fruit vinegars produced using apples, grapes, pineapples, or berries contain various flavonoids and polyphenolics, and they are known to increase physiological abilities and improve in vitro and in vivo body fat accumulation and overweight states [43][44][45][46][47] . ...
... Many bio-active ingredients, including amino acids, peptides, carbohydrates, organic acids, minerals, vitamins, and polyphenolics, that are effective for health care have been found in vinegar [43][44][45] . In particular, fruit vinegars produced using apples, grapes, pineapples, or berries contain various flavonoids and polyphenolics, and they are known to increase physiological abilities and improve in vitro and in vivo body fat accumulation and overweight states [43][44][45][46][47] . There are numerous articles regarding the anti-obesity effect of compounds detected from fruit vinegars, including caffeoylsophorose, chlorogenic acid, p-hydroxybenzoic acid, ferulic acid, syringic acid, and catechin 46,[48][49][50] . ...
Previous studies have suggested that vinegar intake can help to reduce body fat and hyperglycemia. Therefore, this study aimed to evaluate the anti-obesity efficacy of vinegar fermented using Cudrania tricuspidata fruits (CTFV) and its main phenolic constituents and to analyze its molecular mechanism and changes in obesity-related metabolizing enzymatic activities. We found that HFD significantly caused hepatic steatosis; increases in body fats, feed efficiency, liver mass, lipids, insulin, oxidative parameters, cardiovascular-associated risk indices, lipase and α-amylase activities, whereas CTFV efficaciously attenuated HFD-induced oxidant stress, fat accumulation, obesity-related enzymatic activity, and the activation or reduction of obesity-related molecular reactions via improving metabolic parameters including phosphorylated insulin receptor substrate 1, protein tyrosine phosphatase 1B, phosphorylated phosphoinositide 3-kinase/protein kinase B, phosphorylated mitogen-activated protein kinases, sterol regulatory element-binding protein 1c, CCAAT/enhancer-binding protein, and fatty acid synthase; and decreases in adiponectin receptor 1, leptin receptor, adenosine monophosphate-activated protein kinase, acetyl-CoA carboxylase, and peroxisome proliferator-activated receptor, subsequently ameliorating HFD-induced obesity. Therefore, CTFV might provide a functional food resource or nutraceutical product for reducing body fat accumulation.
... We have also shown that pairing lemon juice with the same meals was an effective means to interrupt the amylolytic activity of saliva at the gastric stage through early acid inhibition of HSA [11,12]. In our view, this pH-mediated mechanism could explain, at least in part, the 20-50% reduction of the glycemic response to starch-rich meals that have been acidified by the addition of vinegar [13][14][15][16][17][18][19][20][21], pickled foods [22], pomegranate juice [23], or by acid bread fermentation [24][25][26][27][28][29]. Besides pH, other properties of foods and beverages, such as their polyphenol content, may also inhibit digestive amylases and glucosidases. ...
... The glycemic index also tended to be, on average, 23% lower (though this was not statistically significant, with p = 0.10). Altogether, these results are in agreement with the 20-50% lower glycemic response observed in numerous other clinical trials on the effects of vinegar, pickled foods, pomegranate juice, and acid bread fermentation [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. This reinforces the reasoning presented in the introduction, describing the key role of the low pH of these drinks and foods in the underlying mechanism. ...
PurposeThe inhibition of enzymes that hydrolyze starch during digestion could constitute an opportunity to slow down the release, and ultimately the uptake, of starch-derived glucose. Simple dietary approaches consisting in pairing starch-rich foods with beverages that have the capacity to inhibit such enzymes could be an effective and easily implementable strategy. The objective of this work was to test the impact of black tea and lemon juice on the glycemic response to bread and subsequent energy intake in healthy adults.MethodsA randomized crossover study was conducted with equal portions of bread (100 g) and 250 ml of water, black tea or lemon juice. Capillary blood glucose concentrations were monitored during 180 min using the finger-prick method. Ad libitum energy intake was assessed 3 h later.ResultsTea had no effect on the glycemic response. Lemon juice significantly lowered the mean blood glucose concentration peak by 30% (p < 0.01) and delayed it more than 35 min (78 vs. 41 min with water, p < 0.0001). None of the tested beverages had an effect on ad libitum energy intake.Conclusion
These results are in agreement with previous in vitro studies showing that lowering the pH of a meal can slow down starch digestion through premature inhibition of salivary α-amylase. Furthermore, the effect of lemon juice was similar to what has been repeatedly observed with vinegar and other acidic foods. Including acidic beverages or foods in starchy meals thus appears to be a simple and effective strategy to reduce their glycemic impact.Graphic abstract
... As noted in these tables, most of the studies supporting a role for vinegar as a glucose-lowering nutraceutical are based on acute tests on its interaction with carbohydrate-rich meals. The usual studied dose is 20 g of vinegar per meal [25e30], which is equivalent to 1 g of acetic acid [26]. Converting to homemade measures, 20 g of vinegar corresponds to approximately 4 tablespoons [26]. ...
... The usual studied dose is 20 g of vinegar per meal [25e30], which is equivalent to 1 g of acetic acid [26]. Converting to homemade measures, 20 g of vinegar corresponds to approximately 4 tablespoons [26]. ...
Vinegar intake is considered a food item that improves blood glucose in humans. This review aimed to discuss studies that investigated the impact of vinegar intake on the glycemic profile in humans and the putative mechanistic cellular pathways in both human and animal models. A search of literature was performed on the Cochrane, MEDLINE and Web of Science databases for articles published between 1995 and 2018. There is considerable support for vinegar having a positive acute effect on blood glucose levels when combined with carbohydrate-rich meals. Conversely, there are few chronic interventions analyzing the impact of vinegar intake on blood glucose. Based on available evidence, we hypothesize three pathways by which vinegar may improve blood glucose: The inhibition of α-amylase action; increased glucose uptake; and mediation by transcription factors. When evaluating the current body of literature, daily vinegar intake in amounts of ∼10-30 mL (∼2-6 tablespoons) appear to improve the glycemic response to carbohydrate-rich meals; however, there is a paucity of studies investigating chronic effects of vinegar intake.
... Furthermore, in healthy individuals at risk of developing type II diabetes mellitus, ingestion of 0.75-g acetic acid as a vinegar drink twice daily at mealtime, for 12 weeks, reduced fasting blood glucose levels, and to a greater extent than diabetic pharmaceutical medications (Johnston, Quagliano, & White, 2013). This is in agreement with an earlier study by Johnston, Kim, and Buller (2004), which showed that ingestion of a vinegar drink (20 g vinegar, 40 g water, 1 tablespoon saccharine) by individuals with insulin resistance (prediabetic) had a marked reduction in postprandial glycaemia (64%) and improved insulin sensitivity (34%) (Johnston et al., 2004). ...
... Furthermore, in healthy individuals at risk of developing type II diabetes mellitus, ingestion of 0.75-g acetic acid as a vinegar drink twice daily at mealtime, for 12 weeks, reduced fasting blood glucose levels, and to a greater extent than diabetic pharmaceutical medications (Johnston, Quagliano, & White, 2013). This is in agreement with an earlier study by Johnston, Kim, and Buller (2004), which showed that ingestion of a vinegar drink (20 g vinegar, 40 g water, 1 tablespoon saccharine) by individuals with insulin resistance (prediabetic) had a marked reduction in postprandial glycaemia (64%) and improved insulin sensitivity (34%) (Johnston et al., 2004). ...
... К сожалению, нет и подтверждений пользы от его продолжительного ежедневного употребления. [24,25] Как правильно употреблять яблочный уксус, чтобы избежать побочных эффектов? ...
В статье рассмотрены основные свойства яблочного уксуса и его воздействие на организм человека. Проведен систематический обзор современной специализированной литературы и актуальных научных данных. Указан химический состав и пищевая ценность продукта, рассмотрено использование яблочного уксуса в различных видах медицины и эффективность его применения при различных заболеваниях. Отдельно проанализированы потенциально неблагоприятные эффекты яблочного уксуса на организм человека при определенных медицинских состояниях и заболеваниях.
... Vinegar was used as a food preservative because its acidity retards growth of microbial, contributes to the sensory properties of a number of foods [4] and several useful applications in human living such as cleaning, disinfection [5]. It was also recognized as having a number of health benefits due to therapeutic compounds [6]. ...
... Sirkede bulunan organik asitler, fenolik bileşikler, amino asitler, vitaminler ve melanoidinler gibi maddelerin antidiyabetik, antimikrobiyel, antitümör, antioksidan, antienfeksiyon, antikarsinojenik etkilerinin olduğu ve çeşitli sağlık uygulamalarında kullanıldığı rapor edilmiştir (38). Sirke kan şekeri seviyesini pozitif yönde etkilemesinden dolayı, son yıllarda diyabetik hastalıkların tedavisinde kullanılmaktadır (39). ...
... Fasting administration of a solution (containing 20 g of apple cider vinegar, 40 g of water and 1 tsp saccharine) compared to placebo, 2 min before the ingestion of a test meal (containing 87 g of carbohydrates), raised whole-body insulin sensitivity in the first hour of postprandial condition by 34% in insulin-resistant subjects and by 19% in T2DM subjects. The potential mechanism may be explained by the suppressing effect of C2 on disaccharidase activity [68] and by the rising effect on glucose-6-phosphate concentrations in skeletal muscle [69]. ...
Diabetes mellitus is a disease with multiple gastrointestinal symptoms (diarrhea or constipation, abdominal pain, bloating) whose pathogenesis is multifactorial. The most important of these factors is the enteric nervous system, also known as the “second brain”; a part of the peripheral nervous system capable of functioning independently of the central nervous system. Modulation of the enteric nervous system can be done by short-chain fatty acids, which are bacterial metabolites of the intestinal microbiota. In addition, these acids provide multiple benefits in diabetes, particularly by stimulating glucagon-like peptide 1 and insulin secretion. However, it is not clear what type of nutraceuticals (probiotics, prebiotics, and alimentary supplements) can be used to increase the amount of short-chain fatty acids and achieve the beneficial effects in diabetes. Thus, even if several studies demonstrate that the gut microbiota modulates the activity of the ENS, and thus, may have a positive effect in diabetes, further studies are needed to underline this effect. This review outlines the most recent data regarding the involvement of SCFAs as a disease modifying agent in diabetes mellitus type 2. For an in-depth understanding of the modulation of gut dysbiosis with SCFAs in diabetes, we provide an overview of the interplay between gut microbiota and ENS.
... (1) It also improves insulin sensitivity and ameliorates type 2 diabetes. (2) Furthermore, acetic acid has been reported to have antitumor effects. It has been reported that "Kibizu", produced on Amami Oshima Island, Japan, induces apoptosis in leukemia cells and stops the cell cycle in the G1 phase, thereby, suppressing the growth of tumor cells. ...
Acetic acid is a major component of vinegar and is reported to have beneficial health effects. Notably, it causes oxidative stress and enhances the production of reactive oxygen species (ROS) in gastric cancer cells. ROS play important roles in cellular signal transduction, resulting in the regulation of protein expression and apoptosis. We previously reported that ROS upregulate heme carrier protein 1 (HCP1). Moreover, ROS increase the cellular uptake of porphyrins, which are precursors of heme and substrates for uptake by HCP1. Therefore, we hypothesized that photodynamic therapy (PDT) for cancer treatment using laser irradiation and photosensitizers, such as porphyrin, is enhanced via ROS produced by acetic acid. Herein, we used the rat gastric mucosal cells, RGM1, its cancer-like mutated cells, RGK1, and a manganese superoxide dismutase (MnSOD)-overexpressing RGK cell line, RGK-MnSOD. We confirmed that cancer-specific cellular uptake of porphyrin is increased upon acetic acid treatment and enhances the PDT cytotoxicity in RGK-1, not in RGM-1 and RGK-MnSOD. We believe that this occurs because of the overproduction of ROS and subsequent upregulation of HCP1 in cancerous cells. In conclusion, acetic acid can elevate the effect of PDT by inducing cancer-specific HCP1 expression via ROS production.
... A few clinical trials have also been conducted in individuals with prediabetes and/or T2DM. Vinegar intake before or together with a meal was associated with improved glycemia, reduced post-meal area under the curve for glucose, reduced fasting blood glucose, insulin and triglycerides, increased muscle glucose uptake, and reduced the need for fast-acting insulin in subjects with T1DM [398][399][400][401][402][403]. However, in another study, postprandial plasma glucose or insulin were unaffected by vinegar co-ingestion [404]. ...
As years progress, we are found more often in a postprandial than a postabsorptive state. Chrononutrition is an integral part of metabolism, pancreatic function, and hormone secretion. Eating most calories and carbohydrates at lunch time and early afternoon, avoiding late evening dinner, and keeping consistent number of daily meals and relative times of eating occasions seem to play a pivotal role for postprandial glycemia and insulin sensitivity. Sequence of meals and nutrients also play a significant role, as foods of low density such as vegetables, salads, or soups consumed first, followed by protein and then by starchy foods lead to ameliorated glycemic and insulin responses. There are several dietary schemes available, such as intermittent fasting regimes, which may improve glycemic and insulin responses. Weight loss is important for the treatment of insulin resistance, and it can be achieved by many approaches, such as low-fat, low-carbohydrate, Mediterranean-style diets, etc. Lifestyle interventions with small weight loss (7–10%), 150 min of weekly moderate intensity exercise and behavioral therapy approach can be highly effective in preventing and treating type 2 diabetes. Similarly, decreasing carbohydrates in meals also improves significantly glycemic and insulin responses, but the extent of this reduction should be individualized, patient-centered, and monitored. Alternative foods or ingredients, such as vinegar, yogurt, whey protein, peanuts and tree nuts should also be considered in ameliorating postprandial hyperglycemia and insulin resistance. This review aims to describe the available evidence about the effects of diet, chrononutrition, alternative dietary interventions and exercise on postprandial glycemia and insulin resistance.
... Several studies indicate apple cider vinegar (ACV)'s usefulness in lowering postprandial glycemic response, specifically by slowing of gastric motility, which would seem paradoxical with respect to its potential value for upper GI symptoms [41][42][43]. However, these studies were small and yielded heterogenous outcomes. ...
Nutritional ingredients, including various fibers, herbs, and botanicals, have been historically used for various ailments. Their enduring appeal is predicated on the desire both for more natural approaches to health and to mitigate potential side effects of more mainstream treatments. Their use in individuals experiencing upper gastrointestinal (GI) complaints is of particular interest in the scientific space as well as the consumer market but requires review to better understand their potential effectiveness. The aim of this paper is to review the published scientific literature on nutritional ingredients for the management of upper GI complaints. We selected nutritional ingredients on the basis of mentions within the published literature and familiarity with recurrent components of consumer products currently marketed. A predefined literature search was conducted in Embase, Medline, Derwent drug file, ToXfile, and PubMed databases with specific nutritional ingredients and search terms related to upper GI health along with a manual search for each ingredient. Of our literature search, 16 human clinical studies including nine ingredients met our inclusion criteria and were assessed in this review. Products of interest within these studies subsumed the categories of botanicals, including fiber and combinations, and non-botanical extracts. Although there are a few ingredients with robust scientific evidence, such as ginger and a combination of peppermint and caraway oil, there are others, such as melatonin and marine alginate, with moderate evidence, and still others with limited scientific substantiation, such as galactomannan, fenugreek, and zinc-l-carnosine. Importantly, the paucity of high-quality data for the majority of the ingredients analyzed herein suggests ample opportunity for further study. In particular, trials with appropriate controls examining dose–response using standardized extracts and testing for specific benefits would yield precise and effective data to aid those with upper GI symptoms and conditions.
... A growing body of evidence from randomized, controlled, crossover trials reinforces the viability of lowering postprandial glycemic responses to starchy foods by 20-50% with increased meal acidity. Previous works focused on pomegranate juice [16], vinegar [17][18][19][20][21][22][23][24][25], pickled foods [26] and acid bread fermentation [27][28][29][30][31][32]. Recently, we have also observed that lemon juice can significantly reduce (by 30%) and delay (more than 35 min) average peak blood glucose concentrations [33]. ...
Purpose:
Numerous studies, including our previous work with lemon juice, have reported that low-pH meals reduce the glycemic response to starchy foods. However, the underlying mechanism is not yet understood. Tea, for its polyphenol content, has also been investigated. The main objective of this research was to concurrently study gastric emptying, appetite perceptions and glycemic responses to bread consumed with water, tea, or lemon juice.
Methods:
In this randomized, crossover intervention, ten participants consumed equal portions of bread (100 g) with 250 mL of water, water-diluted lemon juice, or black tea at breakfast. Gastric volumes, blood glucose concentrations and appetite perceptions were alternately assessed over 180 min using magnetic resonance imaging, the finger-prick method and visual analogue scales, respectively.
Results:
Compared to water, lemon juice led to a 1.5 fold increase of the volume of gastric contents, 30 min after the meal (454.0 ± 18.6 vs. 298.4 ± 19.5 mL, [Formula: see text] ± SEM P < 0.00001). Gastric emptying was also 1.5 times faster (P < 0.01). Conversely, lemon juice elicited a lower glycemic response than water (blood glucose concentrations at t = 55 min were 35% lower, P = 0.039). Tea had no effect. Changes in appetite perceptions and gastric volumes correlated well, but with no significant differences between the meals.
Conclusions:
Lemon juice lowered the glycemic response and increased both gastric secretions and emptying rate. The results are compatible with the hypothesis that the reduction of the glycemic response is mainly due to the interruption of starch hydrolysis via the acid-inhibition of salivary α-amylase.
Trial registration number:
NCT03265392, August 29, 2017.
... Ocet owocowy jest powszechnie stosowany jako konserwant żywności, gdyż skutecznie hamuje rozwój mikroorganizmów zanieczyszczających produkty spożywcze [5,6]. Uzyskany w procesach fermentacji ocet owocowy jest bogaty w kwasy organiczne: octowy, cytrynowy, mlekowy, bursztynowy i jabłkowy, enzymy, pektyny oraz przeciwutleniające związki fenolowe (kwas galusowy, kawowy, chlorogenowy, katechiny, epikatechiny) o potwierdzonych walorach prozdrowotnych [4,9,13,14,15,16,18,30]. Zawiera także niezbędne we wszystkich procesach życiowych składniki, takie jak: aminokwasy, pierwiastki (żelazo, fluor, potas, wapń, miedź, magnez, sód, fosfor, siarkę, krzem) oraz witaminy, w tym: B 1 , B 2 , B 6 , C, E, P, A [4,5,12]. ...
Octy owocowe uzyskane metodami fermentacyjnymi stanowią atrakcyjny rodzaj żywności funkcjonalnej, która znajduje coraz większe uznanie wśród konsumentów ze względu na swoje walory prozdrowotne. Celem badań było opracowanie innowacyjnej technologii produkcji octu owocowego z wykorzystaniem lokalnych szczepów mikroorganizmów, pochodzących z kolekcji kultur Instytutu Biotechnologii Przemysłu Rolno-Spożywczego (IBPRS). Surowcem do biosyntezy octu były naturalne, tłoczone na zimno soki jabłkowe pozyskiwane od rolników i małych przedsiębiorców rolnych z województwa łódzkiego, śląskiego oraz mazowieckiego. Soki poddano wstępnym badaniom mikrobiologicznym i fizykochemicznym, polegającym na określeniu: liczby drożdży i pleśni, zawartości ekstraktu ogólnego, cukrów ogółem, kwasowości i pH oraz zawartości kadmu i ołowiu. Pierwszy etap produkcji octu stanowiła beztlenowa fermentacja soków jabłkowych, w wyniku której otrzymano wina, w których oznaczono zawartość alkoholu i cukrów. Drugim etapem była biosynteza kwasu octowego z użyciem win jabłkowych oraz szczepów bakterii octowych Acetobacter pasterianus O4 i Acetobacter pasterianus MW3. Podczas procesu biosyntezy oznaczano zawartość alkoholu oraz moc powstającego octu. Opracowana w Zakładzie Jakości Żywności IBPRS technologia otrzymywania octu owocowego umożliwiła uzyskanie produktu o mocy w zakresie 3,3 ÷ 4,5 g kwasu octowego w 100 cm3, pozbawionego chemicznych konserwantów, o wyjątkowych walorach smakowo-zapachowych, charakteryzującego się wysoką jakością i wartością żywieniową.
... Rhodospirillales, one of the strongest predictors in the current study, was found to be predictive for fasting and 2-h insulin in a 48-month follow-up. The order Rhodospirillales consists of bacteria that are known to produce acetic acid (17), which has been shown to improve insulin sensitivity (18,19). Several other detected microbial predictors have been previously described elsewhere as being associated with T2D or glucose regulation. ...
The incidence of type 2 diabetes (T2D) has been increasing globally, and a growing body of evidence links type 2 diabetes with altered microbiota composition. Type 2 diabetes is preceded by a long prediabetic state characterized by changes in various metabolic parameters. We tested whether the gut microbiome could have predictive potential for T2D development during the healthy and prediabetic disease stages. We used prospective data of 608 well-phenotyped Finnish men collected from the population-based Metabolic Syndrome in Men (METSIM) study to build machine learning models for predicting continuous glucose and insulin measures in a shorter (1.5 year) and longer (4 year) period. Our results show that the inclusion of the gut microbiome improves prediction accuracy for modeling T2D-associated parameters such as glycosylated hemoglobin and insulin measures. We identified novel microbial biomarkers and described their effects on the predictions using interpretable machine learning techniques, which revealed complex linear and nonlinear associations. Additionally, the modeling strategy carried out allowed us to compare the stability of model performance and biomarker selection, also revealing differences in short-term and long-term predictions. The identified microbiome biomarkers provide a predictive measure for various metabolic traits related to T2D, thus providing an additional parameter for personal risk assessment. Our work also highlights the need for robust modeling strategies and the value of interpretable machine learning.
IMPORTANCE
Recent studies have shown a clear link between gut microbiota and type 2 diabetes. However, current results are based on cross-sectional studies that aim to determine the microbial dysbiosis when the disease is already prevalent. In order to consider the microbiome as a factor in disease risk assessment, prospective studies are needed. Our study is the first study that assesses the gut microbiome as a predictive measure for several type 2 diabetes-associated parameters in a longitudinal study setting. Our results revealed a number of novel microbial biomarkers that can improve the prediction accuracy for continuous insulin measures and glycosylated hemoglobin levels. These results make the prospect of using the microbiome in personalized medicine promising.
... 64 Indeed, the effect of dietary acetic acid supplementation on FBG levels in individuals with T2DM is consistent with acute studies that report improved regulation of glucose and insulin levels in adults with metabolic dysfunction and T2DM after acute vinegar consumption. 27,65 The mean difference of À35.73 mg/dL seen in this meta-analysis also suggests that longer-term supplementation reduces FBG to a greater extent than that seen after acute supplementation. 66 A primary mechanism through which acetic acid is proposed to have therapeutic action is via binding of G proteinecoupled receptor 43 (GPR43), which is expressed on human peripheral blood mononuclear cells, adipose cells, and in colonic cells, of which acetic acid is a strong activator at physiological concentrations of 50 to 200 mmol/L. ...
Background
Acetic acid is a short-chain fatty acid that has demonstrated biomedical potential as a dietary therapeutic agent for the management of chronic and metabolic illness comorbidities. In human beings, its consumption may improve glucose regulation and insulin sensitivity in individuals with cardiometabolic conditions and type 2 diabetes mellitus. Published clinical trial evidence evaluating its sustained supplementation effects on metabolic outcomes is inconsistent.
Objective
This systematic review and meta-analysis summarized available evidence on potential therapeutic effects of dietary acetic acid supplementation via consumption of acetic acid–rich beverages and food sources on metabolic and anthropometric outcomes.
Methods
A systematic search was conducted in Medline, Scopus, EMBASE, CINAHL Plus, and Web of Science from database inception until October 2020. Randomized controlled trials conducted in adults evaluating the effect of dietary acetic acid supplementation for a minimum of 1 week were included. Meta-analyses were performed using a random-effects model on fasting blood glucose (FBG), triacylglycerol (TAG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), glycated hemoglobin (HbA1c), body mass index (BMI), and body fat percentage. Statistical heterogeneity was assessed by calculation of Q and I² statistics, and publication bias was assessed by calculation of Egger’s regression asymmetry and Begg’s test.
Results
Sixteen studies were included, involving 910 participants who consumed between 750 and 3600 mg acetic acid daily in interventions lasting an average of 8 weeks. Dietary acetic acid supplementation resulted in significant reductions in TAG concentrations in overweight and obese but otherwise healthy individuals (mean difference [MD] = −20.51 mg/dL [95% confidence intervals = −32.98, −8.04], P = .001) and people with type 2 diabetes (MD = −7.37 mg/dL [−10.15, −4.59], P < .001). Additionally, acetic acid supplementation significantly reduced FBG levels (MD = −35.73 mg/dL [−63.79, −7.67], P = .01) in subjects with type 2 diabetes compared with placebo and low-dose comparators. No other changes were seen for other metabolic or anthropometric outcomes assessed. Five of the 16 studies did not specify the dose of acetic acid delivered, and no studies measured blood acetate concentrations. Only one study controlled for background acetic acid-rich food consumption during intervention periods. Most studies had an unclear or high risk of bias.
Conclusion
Supplementation with dietary acetic acid is well tolerated, has no adverse side effects, and has clinical potential to reduce plasma TAG and FBG concentrations in individuals with type 2 diabetes, and to reduce TAG levels in people who are overweight or obese. No significant effects of dietary acetic acid consumption were seen on HbA1c, HDL, or anthropometric markers. High-quality, longer-term studies in larger cohorts are required to confirm whether dietary acetic acid can act as an adjuvant therapeutic agent in metabolic comorbidities management.
... Although numerous studies have shown that FAJ could prevent T2DM (Morgan & Mosawy, 2016, Kausar, Humayun et al., 2019, only very few studies have focused on the effect of FAJ on insulin resistance. For example, ACV ingestion raised wholebody insulin sensitivity during the 60-min postmeal interval in insulinresistant subjects (Johnston, Kim et al., 2004). Simultaneously, postprandial fluxes in both glucose and insulin were significantly reduced in insulin-resistant subjects. ...
Chronic non-communicable diseases are one of the major human health challenges in the 21st century. Fermented apple juice rich in polyphenols has a beneficial effect on the prevention of non-communicable diseases. This review illustrates that the fermentation process involved in biotransformation significantly changes the composition and content of polyphenols in cloudy apple juice related to apple varieties, fermentation types, and fermentation strains. The enzymatic transformation reaction converts polyphenols into small molecules phenolic compounds with higher biologically activity. These small molecular weight active substances could help prevent cardiovascular disease and type 2 diabetes mellitus by mediating the AMPK pathway, the Nrf2 signaling pathway, the polyol pathway, and the NF-κB pathway. Moreover, this review is intended to provide a systematic theoretical basis for researchers to further study the bioactive function of fermented apple juice for the first time.
... While vinegar was once used as an acidic seasoning, its usage has expanded to the medical fields owing to its biological activities, which have been studied extensively. Vinegar contains various bioactive ingredients, including vitamins, minerals, organic acids, carbohydrates, peptides, and polyphenolics, which are beneficial for health [44][45][46]. In particular, fruit vinegars produced from berries, pineapples, grapes, and apples have various polyphenols and flavonoids that are known to possess biological properties such as anti-oxidant and anti-inflammatory effects [10,11,47]. ...
Vinegar has been found to have in vitro improvement effect on inflammatory biomarkers, and clinically used to improve inflammation and obesity-related diseases. This study was designed to analyze in vitro anti-inflammatory effects of Cudrania tricuspidata fruits vinegar (CTFV) in a co-culture system with macrophages and adipocytes. We analyzed the physicochemical properties and polyphenolic ingredients of CTFV, and investigated in vitro anti-inflammatory effects of CTFV in a co-culture system with macrophages and adipocytes. The cells were cultured in the presence of CTFV for 24 h in contact with each other, then, harvested. The levels of monocyte chemoattractant protein (MCP)-1, tumour necrosis factor (TNF)-α, inducible nitric oxide synthase (iNOS), nitric oxide (NO), and interleukin (IL)-6 were evaluated by using the Griess reagent, western blot, or enzyme-linked immunosorbent assay assays. We found that increasing levels for NO, iNOS, TNF-α, IL-6 and MCP-1 were caused by LPS treatment and co-culture using the contact method, whereas CTFV efficaciously attenuated inflammatory response by improving inflammatory parameters including NO, iNOS, TNF-α, IL-6 and MCP-1. The present study indicates that CTFV might provide a nutraceutical product or functional food resource for improving inflammation processed via the interaction of adipocytes and macrophages.
... Furthermore, when hepatocytes were in high glucose-induced IR states, ZAVE increased glucose uptake ( Fig. 1C and D) and glucose consumption (Fig. 1E) in a dose-dependent manner. It has been reported that daily intake of 15 mL vinegar could be considered beneficial for prevention of metabolic syndrome in humans (Kondo, Kishi, Fushimi, Ugajin, & Kaga, 2009) Recent studies reported that daily consumption of vinegars (20 mL and 30 mL) can significantly improve insulin sensitivity in humans with insulin resistance and metabolic abnormalities (Johnston, Kim, & Buller, 2004;Mitrou et al., 2015). In the present study, 400 μg/ mL ZAVE significantly ameliorated high glucose-induced IR in human liver cells. ...
Zhenjiang aromatic vinegar is a famous traditional fermented cooking ingredient in China, with multiple nutritional and medicinal applications. Zhenjiang aromatic vinegar extract (100-400 μg/mL) is rich in polyphenols increased the glucose uptake and glucose consumption in high glucose-induced insulin resistant HepG2 (IR-HepG2) cells. Zhenjiang aromatic vinegar extract enhanced glycogen synthesis and attenuated gluconeogenesis by regulating key enzymes in IR-HepG2 cells. In addition, Zhenjiang aromatic vinegar extract ameliorated high glucose-induced IR by inhibiting phosphorylated insulin receptor substrate-1 (IRS-1) expression and activating phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt) pathway in IR-HepG2 cells. Moreover, Zhenjiang aromatic vinegar extract reduced reactive oxygen species generation and phosphorylated c-Jun NH2 terminal kinase (JNK) expression in IR-HepG2 cells. The attenuation of the high glucose is owned to the PI3K/Akt pathway activation, glycogen synthesis induction and gluconeogenesis suppression in IR-HepG2 cells.
... Traditional rice wine vinegar is produced in Asia, coconut and cane vinegar is common in India and Phillippines and date vinegars are popular in the Middle East. Some scientific investigation clearly states the benefits of vinegar such as antimicrobial properties (Vijayakumar and Wolf Hall., 2002.), prevent inflammation and hypertension (Murooka and Yamshita, 2008), lower serum cholesterol (Fushimi et al., 2006), reduction in systolic blood pressure (Kondo et al., 2000), enhanced calcium absorption and retention (Kishi et al.,1999), decrease the glycemic index of carbohydrate food for people with and without diabetes (Sugiyama et al., 2003;Johnston et al., 2004). Antiglycemic effects of vinegar have been known for more than a century and have been demonstrated in animal as well as human studies (Salbe et al., 2009). ...
Type 2 diabetes is the most common metabolic disorder worldwide and its prevalence is growing at an alarming rate in both developed and developing countries. It is characterized by abnormalities in carbohydrate, lipid and lipoprotein metabolism, which lead to hyperglycemia and many complications such as hyperlipidemia, hyperinsulinemia, hypertension and atherosclerosis. In order to prevent diabetes, in addition to oral hypoglycaemic drugs, the dietary component such as Apple cider vinegar seems to be promising for glycemic control in patients with type 2 diabetes as well as for diabetes related medical conditions. Apple cider vinegar is fermented juice from crushed apples. Acetic acid in vinegar seems to suppress disaccharidase activity and increase glucose-6-phosphate levels in skeletal muscle. Thus an attempt is made in the present study to find out the impact of apple cider vinegar in patients with type 2diabetes. Apple cider vinegar was purchased from local market and 15ml was given before meals – twice a day for 3 months. The study was conducted for three month with 40 individuals with type 2 diabetes and divided randomly in to two equal groups are as vinegar group (n=20) and control group (n=20). Information pertaining to the socio economic status, anthropometry assessment, biochemical assessment, dietary pattern, health status and personal habits were collected from the selected subjects. There was a significant decrease in BMI, WHR, fasting blood sugar, post prandial blood sugar levels and HbA1c in vinegar group after supplementation of apple cider vinegar (p value <0.05). No such differences were found among the control group during study period. On conclusion, the above results revealed that apple cider vinegar has got an exclusive antidiabetic property and help in preventing diabetic complications. Vinegar is inexpensive, readily available, and a flavor enhancer. Apple cider vinegar was most effective to decrease glucose, total cholesterol, triglycerides, LDL and increases HDL because of its higher concentration of organic acids and phenolic compounds.
... This finding suggests that daily intake of vinegar could be useful in prevention of obesity. Other studies demonstrated that vinegar improved insulin sensitivity in humans with insulin resistance or type 2 diabetes (Johnston, Kim, & Buller, 2004), and enhanced muscle blood flow and glucose uptake in humans with impaired glucose tolerance and hypertriglyceridaemia (Mitrou et al., 2015), suggesting that vinegar may be considered beneficial for improving insulin resistance and metabolic abnormalities. Generally, organic acids in vinegars were not only considered as nutrients but bioactive compounds, which have benefit effects of antimicrobial, suppression of fat accumulation and hyperlipemia, improvement of insulin resistance and metabolic abnormalities reduction of hypertensive and anti-fatigue. ...
Vinegar has been widely used as acidic condiment worldwide for thousands of years. Vinegar contains various nutrients and bioactive components, which are brewed by liquid-state and solid-state fermentation techniques. This review highlights the nutrients and bioactive components in different types of vinegars and their functional properties. Nutrients in vinegar include amino acids, sugars, vitamins, and minerals. The functions of these nutrients were providence energy, regulation of cell metabolism regulation, immunoregulation, antioxidation, anticoagulation and improvement of brain development. In addition, the bioactive components in vinegar include organic acids, polyphenols, melanoidins, and tetramethylpyrazine, which have the functions of antioxidative activity, regulation of lipid metabolism, liver protection, blood pressure and glucose control, anti-fatigue and anti-tumor. However, further studies are needed to explore the novel functional compounds in vinegars and their molecular mechanisms on health benefits in future.
... เซลลู โลส (Raj & Ranganathan, 2018) ที ่ สามารถย่ อยสลายด้ วยเอนไซม์ ได้ นํ ้ าตาลรี ดิ วซ์ เป็ นผลิ ตภั ณฑ์ สุ ดท้ าย ส่ วน เมล็ ดขนุ นประกอบด้ วยแป้ งประมาณร้ อยละ 22 (Ulloa et al., 2017) สามารถย่ อยสลายด้ วยจุ ลิ นทรี ย์ จนกระทั ่ งได้ นํ ้ าตาลรี ดิ วซ์ เช่ นเดี ยวกั น นํ ้ าตาลรี ดิ วซ์ สามารถนํ าไปเป็ นสารตั ้ งต้ นในการผลิ ตนํ ้ าส้ มสายชู หมั กที ่ อาศั ยกระบวนการ หมั กตามธรรมชาติ นํ ้ าส้ มสายชู เป็ นผลิ ตภั ณฑ์ เติ มแต่ งรสชาติ อาหาร และช่ วยถนอมอาหาร รวมทั ้ งยั งมี การบริ โภค ในรู ปแบบของเครื ่ องดื ่ มเพื ่ อสุ ขภาพ เพื ่ อช่ วยลดค่ าดั ชนี ไกลซี มิ ก (Leeman et al., 2005) ช่ วยลดระดั บการเพิ ่ มขึ ้ น ของนํ ้ าตาลกลู โคส และอิ นซู ลิ นหลั งการรั บประทานอาหาร ลดความเสี ่ ยงต่ อการเป็ นโรคเบาหวาน (Johnston et al., 2004) ลดระดั บคอเลสเตอรอลในเลื อดของหนู ทดลอง (Fushimi et al., 2006) และมี ผลต่ อการลดนํ ้ าหนั กเนื ่ องจาก ช่ วยลดความอยากอาหาร ที ่ ผ่ านมาได้ มี การศึ กษานํ าซั งขนุ นไปผลิ ตเป็ นกระดาษสํ าหรั บงานประดิ ษฐ์ (Chulacupt, 2012) และเพิ ่ มใย อาหารในขนมทองม้ วน (Chinchai, 1993) ขนมปั ง เค้ ก และคุ กกี ้ (Khadtao et al., 2001) ...
... Sirke kan şekeri seviyesini olumlu yönde etkilemekte ve son yıllarda diyabetik hastalıkların tedavisinde kullanılmaktadır. Yapılan çalışmalarla sirke tüketiminin insülin-dirençli insidanslarda postprandiyal glisemiyi plasebo değerlerine kıyasla %64 oranında düşürdüğü belirlenmiştir [99]. Bununla birlikte %0.3 ve % 2 asetik asit çözeltisinin tüketiminin kandaki glukoz seviyesini önemli seviyede düşürdüğü tespit edilmiştir [100,101]. ...
Vinegar is a special kind of condiment used as a flavoring and preservative agent in various foods since ancient times. Many types of vinegars are produced worldwide, especially in the Far East and European countries, using different raw materials and production techniques. Vinegar microflora mainly composed of acetic acid bacteria and yeasts, but some molds and lactic acid bacteria species can serve an important role in the production of various special vinegars. Vinegar shows many positive health effects, particularly antimicrobial, antioxidant, antidiabetic, antitumor, anticarcinogenic, antidiabetic and antiinfection effects, because of the substances found in vinegar such as organic acids, phenolic compounds, vitamins, minerals and melanoidins. In this review, recent studies on microflora, bioactive content and health effects of different kinds of vinegars are presented.
... This finding buttressed the reports that the gut is emerging as a critical player in the establishment and maintenance of human health. In line with our finding, acetate has been reported to contribute to metabolism by improving insulin sensitivity, regulate glucose-stimulated insulin secretion (GSIS) (Johnston et al. 2004;Yamashita et al. 2007), and suppress body fat accumulation, through modification of either fatty acid oxidation (Kondo et al. 2009) or fatty acid synthesis and AMPactivated protein kinase activity (Yamashita et al. 2009). This is in consonance with the finding of the current study that acetate ameliorated COC-induced hepatic TG accumulation and glucose dysregulation which are major components of metabolic syndrome. ...
Combined oral contraceptive (COC) treatment has been shown to be associated with glucose deregulation and increased triglyceride levels, but the mechanisms are elusive. Soluble dipeptidyl peptidase-4 (sDPP-4) and adenosine deaminase (ADA) are involved in the initiation and/or progression of cardiometabolic disorders. We therefore, hypothesized that increased DPP-4 and ADA activities are involved in glucose deregulation and hepatic triglyceride accumulation induced by COC treatment. This study also investigated whether short-chain fatty acid, acetate, would protect against COC-induced dysmetabolic effects. Female Wistar rats received (p.o.) vehicle and COC (1.0 μg ethinylestradiol plus 5.0 μg levonorgestrel) with or without sodium acetate (ACE; 200 mg) for 8 weeks. Treatment with COC led to increased plasma triglyceride-glucose index, 1-h postload glucose response, insulin, free fatty acid, insulin resistance, and impaired glucose tolerance. COC treatment also resulted in increased plasma and hepatic triglycerides (TG), TG/HDL-cholesterol ratio, malondialdehyde, uric acid, lactate dehydrogenase, DPP-4, ADA, and xanthine oxidase (XO) activities. On the other hand, COC led to reduction in nitric oxide level. However, ACE significantly ameliorated the alterations induced by COC treatment, but XO activity remains elevated during COC treatment. This result also demonstrates that increased DPP-4 and ADA activities are at least in part involved in glucose deregulation and hepatic TG accumulation induced by COC treatment. Therefore, sodium acetate would impact positively on cardiometabolic disorders, at least in part, by inhibition of DPP-4 and ADA activities.
... 196 A number of open-label and RCTs trialling postbiotic butyrate and SCFAs within IBD and colitis patients have been conducted, the results of which are summarised in Table 3 212 In small human studies, vinegar consumption reduces post-prandial insulin and glucose fluctuations in healthy and insulin resistant subjects. 213,214 Long-term consumption of fermented foods such as yoghurt has been associated with a reduction in symptoms of allergy. 215,216 Indeed, murine splenocytes incubated with Lactobacilli from traditional Korean kimchi decreased production of IL-4, a mediator of Th2 hypersensitivity reactions, highlighting a potential immunomodulatory mechanism. ...
Background
Butyrate, propionate and acetate are short chain fatty acids (SCFA), important for maintaining a healthy colon and are considered as protective in colorectal carcinogenesis. However, they may also regulate immune responses and the composition of the intestinal microbiota. Consequently, their importance in a variety of chronic inflammatory diseases is emerging.
Aims
To review the physiology and metabolism of SCFA in humans, cellular and molecular mechanisms by which SCFA may act in health and disease, and approaches for therapeutic delivery of SCFA.
Methods
A PubMed literature search was conducted for clinical and pre‐clinical studies using search terms: ‘dietary fibre’, short‐chain fatty acids’, ‘acetate’, ‘propionate’, ‘butyrate’, ‘inflammation’, ‘immune’, ‘gastrointestinal’, ‘metabolism’.
Results
A wide range of pre‐clinical evidence supports roles for SCFA as modulators of not only colonic function, but also multiple inflammatory and metabolic processes. SCFA are implicated in many autoimmune, allergic and metabolic diseases. However, translating effects of SCFA from animal studies to human disease is limited by physiological and dietary differences and by the challenge of delivering sufficient amounts of SCFA to the target sites that include the colon and the systemic circulation. Development of novel targeted approaches for colonic delivery, combined with postbiotic supplementation, may represent desirable strategies to achieve adequate targeted SCFA delivery.
Conclusions
There is a large array of potential disease‐modulating effects of SCFA. Adequate targeted delivery to the sites of action is the main limitation of such application. The ongoing development and evaluation of novel delivery techniques offer potential for translating promise to therapeutic benefit.
... Traditional rice wine vinegar is produced in Asia, coconut and cane vinegar is common in India and Phillippines and date vinegars are popular in the Middle East. Some scientific investigation clearly states the benefits of vinegar such as antimicrobial properties (Vijayakumar and Wolf Hall., 2002.), prevent inflammation and hypertension (Murooka and Yamshita, 2008), lower serum cholesterol (Fushimi et al., 2006), reduction in systolic blood pressure (Kondo et al., 2000), enhanced calcium absorption and retention (Kishi et al.,1999), decrease the glycemic index of carbohydrate food for people with and without diabetes (Sugiyama et al., 2003;Johnston et al., 2004). Antiglycemic effects of vinegar have been known for more than a century and have been demonstrated in animal as well as human studies (Salbe et al., ...
Apple cider vinegar otherwise known as cider vinegar or ACV, Is a type of vinegar made from cider or apple must and has a pale medium color. Unpasteurized or organic ACV contains mother of vinegar. Apple cider vinegar is fermented juice from crushed apples. Like apple juice , it likely contain some pectin, vitamin b1, vitamin b2, and vitamin b6, biotin, folic acid, niacin pantothenic acid and vitamin c.Using apple cider vinegar (ACV) diabetes significantly reduces haemoglobin A1C (HbA1C), lower density lipoprotein (LDL), cholesterol and triglycerides and increase high density lipoprotein (HDL) cholesterol. In another patient model, ―apple cider vinegar‖ decreased triglycerides and very low density lipoprotein (VLDL) cholesterol. it’s nutrient- rich, especially in unfiltered and organic verities, and contains acetic acid, pectin, potassium and calcium. It also controls the blood levels, loss weight, improves cardio-vascular health, regulate body pH & detoxify body. Two spoonfuls of Apple Cider Vinegar‖ and mix it glass of water. Take this regularly before having a meal.
... One study showed that vinegar consumption significantly improved postprandial insulin sensitivity in insulin-resistant individuals by inhibiting disaccharide activity in the small intestine and by increasing glucose-6-phosphate levels in skeletal muscle. In the same study, vinegar was suggested to have similar physiological effects with metformin and acarbose (Johnston, Kim, and Buller 2004). Another health benefit of vinegar is increased calcium ion absorption, caused by the binding calcium ion of acetic acid, an active compound in vinegar, in the small intestines (Garcia-Parrilla et al. 2017). ...
In the past, the beneficial effects of fermented foods on health were unknown, and so people primarily used fermentation to preserve foods, enhance shelf life, and improve flavour. Fermented foods became an important part of the diet in many cultures, and over time fermentation has been associated with many health benefits. Because of this, the fermentation process and the resulting fermented products have recently attracted scientific interest. In addition, microorganisms contributing to the fermentation process have recently been associated with many health benefits, and so these microorganisms have become another focus of attention. Lactic acid bacteria (LAB) have been some of the most studied microorganisms. During fermentation, these bacteria synthesize vitamins and minerals, produce biologically active peptides with enzymes such as proteinase and peptidase, and remove some non-nutrients. Compounds known as biologically active peptides, which are produced by the bacteria responsible for fermentation, are also well known for their health benefits. Among these peptides, conjugated linoleic acids (CLA) have a blood pressure lowering effect, exopolysaccharides exhibit prebiotic properties, bacteriocins show anti-microbial effects, sphingolipids have anti-carcinogenic and anti-microbial properties, and bioactive peptides exhibit anti-oxidant, anti-microbial, opioid antagonist, anti-allergenic, and blood pressure lowering effects. As a result, fermented foods provide many health benefits such as anti-oxidant, anti-microbial, anti-fungal, anti-inflammatory, anti-diabetic and anti-atherosclerotic activity. However, some studies have shown no relationship between fermented foods and health benefits. Therefore, this paper aims to investigate the health effects of fermented foods.
... Vinegar has been adopted as flavoring dating from around 3000 BC in Asian, European and other traditional cuisines of the world [1]. As evidences accumulated, vinegar was proved to exhibit therapeutic properties, including blood pressure reduction [2], antioxidant activity [2], antibacterial activity [2], reduction in the effects of diabetes [3] and prevention of cardiovascular disease [4]. It is also used as a kind of accessory documented in Lei's treatise on processing of drugs (Leigongpaozhi-Lun) (618-907 AD). ...
Background
Rice vinegar (RV) and white vinegar (WV) as daily flavoring, have also used as accessory in traditional Chinese medicine processing. As we know, the promoting blood circulation efficiency could be enhanced when herbs processed by vinegar. Number of reports focused on health benefits derived by consumption of vinegar. However, few concerned the blood circulation bioactivity.
Methods
In this paper, a metabolomics guided strategy was proposed to elaborate on the chemical constituents’ variation of two kinds of vinegar. GC–MS coupled with multivariate statistical analysis were conducted to analyze the chemical components in RV and WV and discriminate these two kinds of vinegar. The anti-platelet activities in vitro were investigated by whole blood aggregometry platelet test. And the anticoagulant activities were monitored by the whole blood viscosity, plasma viscosity, packed cell volume, prothrombin time, and four coagulation tests (PT, TT, APTT, FIB) in vivo.
Results
Constituents of RV and WV were globally characterized and 33 potential biomarkers were identified. The contents of four potential alkaloid biomarkers increased with aging time prolonged in RV. RV and its alkaloids metabolites exhibited some anti-platelet effects in vitro and anticoagulant activities in vivo. WV failed to exhibit promoting effects.
Conclusions
Alkaloid metabolites were demonstrated to be the principal compounds contributing to discrimination and it increased with aging time prolonged in RV. RV exhibited the blood circulation bioactivity. The alkaloids of RV contributed to the blood circulation bioactivity.Graphical abstractThe diagram of metabolomics guided promoting blood circulation bioactivity compounds screening strategy
Electronic supplementary material
The online version of this article (doi:10.1186/s13065-017-0265-5) contains supplementary material, which is available to authorized users.
Health-conscious people, all over the world, focus their attention toward fitness and have shifted their preference from caffeinated and sugar-based energy drinks towards natural alternatives. Coconut water is one of the universally accepted/appealing natural beverages for proper health and metabolism due to the presence of naturally occurring bioactive enzymes. Fresh coconut water is ideally consumed as a refreshing soft drink. However, many value added products could be made using coconut water. Coconut water is considered as an energy drink since it could provide an isotonic electrolyte balance when consumed. It is also being promoted as a natural sports drink, which can be consumed before, during, or after a workout to provide optimal replenishment and rehydration applicable for all levels of activity. Many research results are available on the potential/favourable use of coconut water in plant and animal biotechnology. Mature coconut water has been extensively used as raw materials in the preparation of Nata de coco and vinegar, which offer many benefits. Coconut water can also be used in production of various innovative value-added products such as lassi (tender coconut beverage), honey and coconut spread from mature water concentrate, soufflé, yoghurt, sugar, exopolysaccharides, docosahexaenoic acid, probiotics, coconut water kefir, Gama- aminobutyric acid, bacterial cellulose, carbon dots, mannosylerythritol lipids, dihydropyrimidinone etc. This chapter amply elaborates the potential and possibility of using coconut water in the production of array of high value products.
Background
This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) is intended to provide clinicians an overview of the body weight effects of concomitant medications (i.e., pharmacotherapies not specifically for the treatment of obesity) and functional foods, as well as adverse side effects of common supplements sometimes used by patients with pre-obesity/obesity.
Methods
The scientific information for this CPS is based upon published scientific citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership.
Results
This CPS outlines clinically relevant aspects of concomitant medications, functional foods, and many of the more common supplements as they relate to pre-obesity and obesity. Topics include a discussion of medications that may be associated with weight gain or loss, functional foods as they relate to obesity, and side effects of supplements (i.e., with a focus on supplements taken for weight loss). Special attention is given to the warnings and lack of regulation surrounding weight loss supplements.
Conclusions
This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on concomitant medications, functional foods, and supplements is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of pre-obesity/obesity. Implementation of appropriate practices in these areas may improve the health of patients, especially those with adverse fat mass and adiposopathic metabolic consequences.
The side effect of Diabetes mellitus is the decrease in the reproductive function which could be observed by the Gonadosomatic Index. Gonadosomatic index is a value that expresses the proportion of testis weight to body weight. Pineapple peel vinegar is a diabetic therapy that has been proved in decreasing the blood sugar levels in diabetic rats, but the effect in restoring GSI has not been evaluated yet. This study aimed to evaluate the effect of pineapple peel vinegar in GSI in diabetic rats. Eighteen male rats were divided into 6 groups, i.e., control (C); negative control (Cn), diabetic rats treated with water; positive control (Cp), diabetic rats treated with 0.4 ml apple vinegar; P1, P2, and P3 (diabetic rats s treated with 0,2 ml, 0,4 and 0,8 ml of pineapple peel vinegar). They were treated for 21 days. The day after the last treatment, rats were sacrificed, and testes were isolated and weighted. The GSI was determined by calculated the proportion of the gonad mass to the total body mass. The result showed there was a significant difference (p<0.05) in GSI between treated Cn (0,59 ± 0,05), P1 group (0,62 ± 0,06), P3 (0,70 ± 0,04) when compared to C (0,52 ± 0,03) and Cp (0,36 ± 0,24) groups. The P2 group (0,53 ± 0,08) showed has no significant difference (p>0.05) when compared to C (0,52 ± 0,03) and Cp (0,36 ± 0,24). It could be concluded that pineapple peel vinegar has high potency in restoring the GSI on diabetic rats.
ይህን መጽሀፍ ለምን ለመተርጎም ወሰንኩ?
እኔ ዶ/ር ዘውዱ ወንዲፍራው የደ/ማረቆስ ዩኒቨርስቲ ባለደረባ ስሆን በ2008 ዓ.ም ጥቅምት ወር መጀመሪያ አካባቢ ከፍተኛ የውሃ ጥም፣ በተደጋጋሚ ከፍተኛ መጠን ያለው ሽንት መሽናት፣ የሰውነት የድካም ስሜት፣ ብዥ የሚል ዕይታና የትኩረት ማጣት ችግሮች በአንድ ዕለት ሌሊት ተከሰቱብኝ፡፡ ዕለቱ እንደጠባ ጧት ሆስፒታል ሄድኩ የደም የስኳር መጠኔን ተመረመርኩ ምግብ ሳልወስድ 280 mg/dl ሆኖ አገኘሁት፡፡ በጣም የገረመኝ ከዚያ በፊት አንድም ቀን እንኳ ስለስኳር በሽታ አስቤ የቅድሚያ ምርመራ አለማድረጌ ነው፡፡ በወቅቱ የሰውነት ክብደቴ 82 ኪ.ግ ነበር፡፡ ቁመቴ 1 ሜትር ከ65 ሳ.ሜ ሲሆን በሰውነት ክብደት መረጃ ጠቋሚ መሰረት 30.12 ነበርኩ ይህም በሰውነት ክብደት ምደባዎች አማካኝነት ከልክ ያለፈ የሰውነት ውፍረት ነበረኝ ማለት ነው፡፡ ከምርመራ በኋላ ሁለት አይነት በአፍ የሚወሰዱ መድሃኒቶችን ማለትም ሜትፎርሚንና ዳይዎኔል የሚባሉትን መድሃኒቶችን እንድወስድ ሀኪሙ አዘዘልኝ፡፡ የታዘዙትን መድሃኒቶች ለ 10 ተካታታይ ቀናት ወስጄ አቋረጥኩ፡፡ ምክንያቱም አዕምሮዬ በፍጹም የህይወት ዘመን የስኳር በሽተኛ መሆንን ሊቀበለው አልቻለም፡፡
በምትኩ በሳምንት 4 ቀናት ለአንድ ስዓት ያህል ጠንከር ያለ የአካል ብቃት እንቅስቃሴ ለ4 ተከታታይ አመታት ያለማቋረጥ መስራት ጀመርኩ፡፡ በተጨማሪም ዝቅተኛ የካሮቦሃይድሬት ይዘት ያላቸውን ምግቦች ብቻ መመገብ ጀመርኩ እንዲሁም አልፎ አልፎ ጧት ላይ ቁርስ መብላቴን አቆምኩ፡፡ ምንም አይነት አልኮሆል መጠጣቴን አቋረጥኩ፡፡ በዚህም ምክንያት የደም ስኳሬ መጠን እየተስተካከለ መጣ ከመነሻው ከ280 mg/dl ወደ 114 mg/dl ወይም 5.6% የሂሞግሎቢን ኤዋንሲ የተረጋጋ ውጤት ደረሰ፡፡ የሰውነቴ ክብደት በአራት አመት ጊዜ ውስጥ 14 ኪ.ግ. በመቀነስ 68 ኪ.ግ. ደረሰ፡፡ አሁን የቀነስኩትንም ክብደት በዘለቄታው አስጠብቄያለሁ፡፡ በዕየለቱ በውስጤ ደስታና ቀለል የሚል ስሜት እንዲሁም የበለጠ የሰውነት ብርታትና ጥንካሬ ይሰማኛል፡፡
ከዚሁ እንቅስቃሴ ጎን ለጎን ስለ ስኳር በሽታ ከኢንተርኔት ላይ መጽሃፍትን፣ የምርምር ወረቀቶችን፣ ቪዲዮዎችን ማንበብና ማዳመጥ ጀመርኩ፡፡ እነዚህን ሁሉ መረጃዎች ሳገናዝብ የሁለተኛው አይነት የስኳር በሽታ ሊድን የሚችል በሽታ እንደሆነና በርካታ ሰዎችም ከበሽታው እንደተፈወሱ ብዙ መረጃዎችን ለማየት ሞከርኩ፡፡ በዚህ ረገድ ካናዳ ቶሮንቶ ከተማ ውስጥ ጥብቅ የሆነ የአመጋገብ ቁጥጥር በማድረግ የሁለተኛው አይነት የስኳር በሽታ ያለባቸውን ህሙማን የሚያክም ዶ/ር ጀሰን ፈንግ የሚባል የኩላሊት ሀኪም መኖሩን ከድረ-ገጽ መረጃ አገኘሁ፡፡ እርሱም በዚሁ በሽታ ዙሪያ በርካታ የህዝብ ንግግሮችን ያደረገ ሲሆን መጽሃፍትንም ጽፏል፡፡ እርሱ ከጻፋቸው መጽሃፍት ውስጥ The-Diabetes-Code and The-Obesity-Code ዋናዎቹ ናቸው፡፡ ስለሆነም The-Diabetes-Code የተሰኘውን መጽሃፍ በዶ/ር ሩቅያ ሀሰን አማካኝነት ወደ አማርኛ “የስኳር በሽታ ቁልፍ” በሚል ርዕስ ተተርጉሞ አሁን በኢትዮጵያ ገበያ ላይ የሚገኝ ሲሆን እኔም በእርሷ የስራ ትጋት መነሻነት The-Obesity-Code የሚለውን መጽሃፍ ወደ አማርኛ “የሰውነት ውፍረትን የሚያመጡ ሚስጥራዊ እውነታዎች” በሚል ርዕስ ለመተርጎም ወሰንኩ፡፡ ይህ መጽሃፍ አማዞን በተሰኘው የድረ ገጽ መጽሃፍ መደብር ውሰጥ ከፍተኛ ሽያጭ ያሰገኘ ሲሆን እኔም ለኢትዮጵያዊያን ወገኖቼ በሚረዱት ቋንቋ ቢቀርብላቸው በርካቶች እንደእኔ ሊጠቀሙበት ይችላሉ ብዬ በማሰብ ለመተርጎም ችያለሁ፡፡
በዚህ መጽሃፍ ውስጥ ለሁለተኛው አይነት የስኳር በሽታ መሰረታዊ መንስኤ ከልክ ያለፈ የሰውነት ውፍረት መሆኑን ዶ/ር ፈንግ በዝርዝር ያስረዳል፡፡ ስለሆነም ምክንያታዊ በሆነ መልኩ የሰውነት ውፍረት ወሳኝ ትኩረት ያስፈልገዋል የሚል እምነት አለው፡፡ ብሎም ከልክ ያለፈ የሰውነት ውፍረት እና ሁለተኛው ዓይነት የስኳር በሽታ ብዙ ጠቃሚ የሆኑ ተመሳሳነትና ልዩነት እንዳላቸው ያሳያል፡፡ ኢንሱሊን በሰውነት ክብደት ውስጥ ያለውን ማዕከላዊ ሚና እንዲሁም የሰውነት የኢንሱሊን መቋቋም ችግር በሰውነት ክብደት ውስጥ የሚጫወተውን ወሳኝ ሚና በሚገባ ያስረዳል፡፡ በመጽኃፉም የሰውነት የኢንሱሊን መጠን የመጨመር ችግርን በመቆጣጠር ከልክ ያለፈ የሰውነት ውፍረትን መከላከል የሚያስችሉ መመሪያዎችን ይሰጣል፡፡ የአመጋገብ መመሪያዎች ኢንሱሊንን ለመቀነስ በተለይ የስኳር እና የተጣሩ የሰብል ውጤቶችን በመቀነስ፤ የፕሮቲንን ፍጆታ የተመጣጠነ እንዲሆን በማድረግ እና የጤናማ ስብ እና የአሰርን ፍጆታ በመጨመር ማስተካከል እንደሚቻል ይገልጸል፡፡ የካሎሪ ቅነሳ በሰውነት ጤንነት ላይ አሉታዊ ተጽዕኖ ሳያስከትል ጠንካራ ጾም በመጾም የሰውነት የኢንሱሊን የመቋቋም ችግር የሚያሰከትለውን አሉታዊ የሆነ ወሳኝ ሚና ለማስተካከል ውጤታማ መንገድ መሆኑን ያስረዳል፡፡ በመጽሐፉ ውስጥ ደራሲው በሰዎች ላይ የተደረጉ ጥናቶችን እና በአብዛኛው በታዋቂ ባለሙያዎች ተገምግመው በከፍተኛ ጥራት በሚታወቁ ጆርናሎች የታተሙትን ከ450 በላይ የምርምር ግኝቶችን እንደዋቢነት ተጠቅሟል፡፡
ስለሆነም ለኢትዮጵያዊያን ወገኖቼ መግለጽ የምፈልገው ይህ መጽሃፍ የእኔን ተስፋና ህይወት ቀይሮታል በዚህም መሰረት ይህ ችግር ያለባቸውን ሰዎች ህይወት ይቀይራል ብየ በጽኑ አምናለሁ፡፡ ስለዚህ ከልክ ያለፈ የሰውነት ውፍረትና የሁለተኛው አይነት የስኳር በሽታ ያላባቸውም ሆነ የሌለባቸው ሰዎች መጽሃፉን አግኝተው ቢያነቡት ብዙ ጠቃሚ መረጃ ያገኛሉ ብዬ በእጅጉ አምናለሁ፡፡
Some studies have reported that vinegar ingestion at mealtime attenuates postprandial glycemia in healthy adults and individuals with type 2 diabetes. Emerging data suggest that chronic vinegar ingestion impacts fat...
Diabetes mellitus (DM) is a globally growing health problem and one of the most prevalent endocrine disorders worldwide. Chronic hyperglycemia status favors the manifestation of oxidative stress by increasing the production of reactive oxygen species and/or by reducing the antioxidant defense system activity. In this study, the beneficial effects of apple cider vinegar (ACV) supplementation on blood glucose level, hepatic and renal toxicity and antioxidant enzyme activities in normal and diabetic rats were investigated. Four groups (8 animals/group) of male Wistar rats were used. The animals were fasted overnight and DM was induced by an intraperitoneal injection of freshly prepared streptozotocin (STZ). Control rats were injected with citrate buffer only. ACV was administrated orally for 4 weeks. Our findings indicated that ACV increased the activity of antioxidant enzymes (superoxide dismutase (p < 0.001), catalase and glutathione peroxidase) as well as thiol concentration (p < 0.05). It also reduced lipid peroxidation levels (TBARS) and the indices of toxicity in liver and kidneys, by significantly decreasing aspartate and lactate transaminase (AST & ALT) activity, total and direct bilirubin (p < 0.001), urea (p < 0.001) and creatinine (p < 0.001) levels. Moreover, the plasma concentration of magnesium, calcium (p < 0.001) and copper increased after ACV administration. Iron levels however decreased. The concentration of vitamin E, an important antioxidant in vivo, was raised. In conclusion, the findings show that ACV possesses significant antihyperglycemic and antioxidant effects in an experimental model of DM, by preventing diabetic complications in liver and kidneys.
Recently, in human health care scenario most of the people are suffering by arrhythmia which is a type of the cardiovascular diseases and it occurs during a person has irregular or abnormal heart rate. To diagnose such condition, there should be continuous monitoring of electrocardiogram signal irrespective of the location confined to the subject and the appropriate physician. In this research, wireless ECG monitoring system using AD8232 signal conditioning module for real time signal acquisition was proposed. The proposed system performs continuous ECG signal monitoring that integrates Wi-Fi technology which acquires the ECG signal and transmit it to cloud wirelessly. Also, feature extraction algorithm has been developed to extract features such as RMSSD, SDNN, Mean RR, Ratio SR and slope of linear regression of IBI from ECG signal of BioVid Heat pain database for different pain levels. The same feature extraction algorithm can be applied on real time ECG signal to extract the features. From the results, it is clear that the proposed system is advantageous for the physicians to provide the right health care to the subject without being in close proximity. © 2018, Indian Journal of Public Health Research and Development. All rights reserved.
Background
Adaptation to a ketogenic diet (keto-induction) can cause unpleasant symptoms, and this can reduce tolerability of the diet. Several methods have been suggested as useful for encouraging entry into nutritional ketosis (NK) and reducing symptoms of keto-induction. This paper reviews the scientific literature on the effects of these methods on time-to-NK and on symptoms during the keto-induction phase.
Methods
PubMed, Science Direct, CINAHL, MEDLINE, Alt Health Watch, Food Science Source and EBSCO Psychology and Behavioural Sciences Collection electronic databases were searched online. Various purported ketogenic supplements were searched along with the terms “ketogenic diet”, “ketogenic”, “ketosis” and ketonaemia (/ ketonemia). Additionally, author names and reference lists were used for further search of the selected papers for related references.
Results
Evidence, from one mouse study, suggests that leucine doesn’t significantly increase beta-hydroxybutyrate (BOHB) but the addition of leucine to a ketogenic diet in humans, while increasing the protein-to-fat ratio of the diet, doesn’t reduce ketosis. Animal studies indicate that the short chain fatty acids acetic acid and butyric acid, increase ketone body concentrations. However, only one study has been performed in humans. This demonstrated that butyric acid is more ketogenic than either leucine or an 8-chain monoglyceride. Medium-chain triglycerides (MCTs) increase BOHB in a linear, dose-dependent manner, and promote both ketonaemia and ketogenesis. Exogenous ketones promote ketonaemia but may inhibit ketogenesis.
Conclusions
There is a clear ketogenic effect of supplemental MCTs; however, it is unclear whether they independently improve time to NK and reduce symptoms of keto-induction. There is limited research on the potential for other supplements to improve time to NK and reduce symptoms of keto-induction. Few studies have specifically evaluated symptoms and adverse effects of a ketogenic diet during the induction phase. Those that have typically were not designed to evaluate these variables as primary outcomes, and thus, more research is required to elucidate the role that supplementation might play in encouraging ketogenesis, improve time to NK, and reduce symptoms associated with keto-induction.
Yellow ripe apple were used to produced natural apple cider of the way home. The aim of this study was to investigate the effect of apple cider vinegar (ACV) containing people drinking water (10 ml (ACV) in 100 ml water) on people who have high lipid and diabetic. This study was conducted on 50 people of both sexes for period 8 weeks, divided into 23 men and 20 women have high lipid and diabetic 4 men and 3 women have not any problem with high lipid and diabetic (control group) Was measured sugar, cholesterol and triglyceride levels in the blood. The results showed decreased levels of cholesterol ,triglyceride and sugar in people who have high lipid and diabetic levels when compared with normal people (control pattern).
Custard apple (Annona squamosal )is highly
susceptible to spoilage, softens very rapidly during
ripening, and becomes squashy and not easy to consume
fresh. The custard apple has nearly 24% sugars; it was
hypothesized that this can be further processed by
fermentation into a valuable product such as vinegar. The
present study was carried out to develop vinegar from
custard apple and it was compared with market vinegars
sample for sensory evaluation. The physiochemical
properties of custard apple vinegar were analysed. The
custard apple vinegar production process took 30 days
and had physiochemical characteristics of 1.019 gm/ml
specific gravity, 1 % alcohol content, 5.39% (v/v) acetic
acid, 2.0°Brix, and pH of 2.8 which complied with the
standard ranges of brewed vinegar after complete
fermentation. The sensory evaluation of vinegar samples
was done by ten panel members. The overall acceptability
of the market vinegar samples were rated as like
extremely on the nine point hedonic scale, while custard
apple vinegar was rated as like very much on the nine
point hedonic scale.
To evaluate baseline risk factors for coronary artery disease in patients with type 2 diabetes mellitus.
A stepwise selection procedure, adjusting for age and sex, was used in 2693 subjects with complete data to determine which risk factors for coronary artery disease should be included in a Cox proportional hazards model.
3055 white patients (mean age 52) with recently diagnosed type 2 diabetes mellitus and without evidence of disease related to atheroma. Median duration of follow up was 7.9 years. 335 patients developed coronary artery disease within 10 years.
Angina with confirmatory abnormal electrocardiogram; non-fatal and fatal myocardial infarction.
Coronary artery disease was significantly associated with increased concentrations of low density lipoprotein cholesterol, decreased concentrations of high density lipoprotein cholesterol, and increased triglyceride concentration, haemoglobin A1c, systolic blood pressure, fasting plasma glucose concentration, and a history of smoking. The estimated hazard ratios for the upper third relative to the lower third were 2.26 (95% confidence interval 1.70 to 3.00) for low density lipoprotein cholesterol, 0.55 (0.41 to 0.73) for high density lipoprotein cholesterol, 1.52 (1.15 to 2.01) for haemoglobin A1c, and 1.82 (1.34 to 2.47) for systolic blood pressure. The estimated hazard ratio for smokers was 1.41 (1.06 to 1.88).
A quintet of potentially modifiable risk factors for coronary artery disease exists in patients with type 2 diabetes mellitus. These risk factors are increased concentrations of low density lipoprotein cholesterol, decreased concentrations of high density lipoprotein cholesterol, raised blood pressure, hyperglycaemia, and smoking.
The purpose of this retrospective study was to evaluate the changes in diabetes-related lower extremity amputations following the implementation of a multidisciplinary programme for prevention and treatment of diabetic foot ulcers in a 0.2 million population with a 2.4% prevalence of diabetes. All diabetes-related primary amputations from toe to hip from 1 January 1982 to 31 December 1993 were included. In 294 diabetic patients, 387 primary major (above the ankle) or minor (through or below the ankle) amputations were performed, constituting 48% of all lower extremity amputations. The annual number of amputations at all levels decreased from 38 to 21, equalling a decrease of incidence from 19.1 to 9.4/100,000 inhabitants (p = 0.001). The incidence of major amputations decreased by 78% from 16/1 to 3.6/100,000 inhabitants (p < 0.001). The absolute number of amputations with a final level below the ankle showed no increase, but their proportion increased from 28 to 53% (p < 0.001) and the reamputation rate decreased from 36 to 22% (p < 0.05) between the first and last 3-year period. Thus, a substantial long-term decrease in the incidence of major amputations was seen as well as a decrease in the total incidence of amputations in diabetic patients. Seventy-one per cent of the amputations were precipitated by a foot ulcer. These findings indicate that a multidisciplinary approach plays an important role to reduce and maintain a low incidence of major amputations in diabetic patients.
To study the prevalence and determinants of glucose intolerance in a general Caucasian population.
A random sample of 50- to 74-year old Caucasians (n = 2,484) underwent oral glucose tolerance tests. Multiple regression analyses were performed to study the association of 2-h postload plasma glucose values with potential determinants.
Prevalence of known and newly detected diabetes and impaired glucose tolerance was 3.6, 4.8, and 10.3%, respectively. In women, but not in men, the association of body mass index with 2-h glucose was fully accounted for by the waist-to-hip ratio. Maternal history of diabetes was twice as prevalent as paternal history, but paternal history only was associated with 2-h glucose. In addition, paternal history was a stronger determinant in men than in women. An independent positive association with 2-h plasma glucose was found for alcohol use of > 30 g/day in women and for intake of total protein, animal protein, and polyunsaturated fatty acids in men. An independent inverse association with 2-h plasma glucose was demonstrated for height (both sexes), alcohol use of < or = 30 g/day (both sexes), energy intake (in men), and, unexpectedly, current smoking (in men).
The prevalence of diabetes in elderly Caucasians was 8.3%. In men, dietary habits may unfavorably influence glucose tolerance independent of obesity.
To evaluate the incidence and investigate determinants of insulin underdelivery events occurring with implanted pumps using peritoneal route from a 103 patient-year experiment.
Of the MiniMed (MIP 2001) pumps implanted in 47 type I diabetic patients, 70 were refilled quarterly with four successive batches (A, B, C, D) of U400 Hoechst 21 PH neutral insulin during a 3-year study period. Any reduction of insulin flow rate > 15% was considered as abnormal insulin delivery. Diagnosis of the cause of underdelivery was established according to the response to the following steps: 1) 0.01 mol/l NaOH rinse of pump circuits to solubilize insulin aggregates, 2) surgical examination and replacement of blocked catheters, and 3) postsurgical 0.01 mol/l NaOH rinse of pump. Step 2 was selected first if the increase of insulin requirements or reduction of flow rate were > 50%. Relative contributions of insulin and the implanted system to underdelivery events were analyzed.
There were 76 episodes of insulin underdelivery that occurred during the study, resulting in an incidence of 74 events per 100 patient-years. Of 52 NaOH pump rinses, 30 restored normal flow rate. Surgery, performed after rinse failure (n = 22) or as the first step (n = 24), disclosed catheter blockages due to tip obstructions in 28 cases and omental encapsulations in 18 other cases. Five combined severe reductions of pump flow rate requiring pump replacements were diagnosed during surgery, and additional NaOH rinses had to be performed after catheter change in 12 other cases. Analysis of the incidence of underdelivery events indicated that both pump- and catheter-related problems were significantly increased while implanted systems infused batches B, C, and D versus batch A (P < 0.01), whereas the duration of pump implantation had no significant influence.
Underdelivery events constitute serious limiting obstacles to prolonged peritoneal insulin infusion from implanted pumps. Progress in insulin pump compatibility is expected to reduce their occurrence and, thus, to improve the feasibility of this treatment.
The product of nitric oxide (NO) synthase is the most potent endogenous vasodilator known. No not only is a potent vasodilator, it also inhibits platelet adherence and aggregation, reduces adherence of leukocytes to the endothelium, and suppresses proliferation of vascular smooth muscle cells. A number of disorders are associated with reduced synthesis and/or increased degradation of vascular NO. These include hypercholesterolemia, diabetes mellitus, hypertension, and tobacco use. The endothelial dysfunction caused by these disorders contributes to the alterations in vascular function and structure observed in these conditions. A reduction in the activity of vascular NO likely plays a significant role in the development of atherosclerosis. Insights into the mechanisms by which NO production or activity is altered in these states will lead to new therapeutic strategies in the treatment of a number of vascular disorders, including hypertension, atherosclerosis, restenosis, and thrombosis.
To improve understanding of the etiology of IDDM by analyzing spatial and space-time distribution of the incidence in children.
Statistical tests to detect clustering were applied to a population-based register of 1,490 children (aged 0-16 years) with IDDM in Yorkshire, northern England. The Knox test analyzed clustering in space and time, and the Potthoff-Whittinghill test quantified spatial differences in incidence between small-area census units (electoral wards). The Potthoff-Whittinghill test was conditioned for childhood population density and deprivation (Townsend index).
Both tests demonstrated clustering of IDDM in Yorkshire children. Space-time and spatial clustering is strongest in the younger children (0-4 and 5-9 years of age), even after conditioning for known associations. Clustering was more common in the county of Humberside during the years 1982-1985 and in wards of low population density (< 0.26 0- to 16 year-old subjects per hectare).
The study revealed a nonrandom space-time distribution of IDDM in children not accounted for by known covarying demographic factors. The Potthoff-Whittinghill test has not previously been applied to childhood IDDM. The new finding of strong clustering in young children is consistent with early exposure, possibly in utero, to infectious agents or localized environmental sources.
It was hypothesized that psychophysiological insomniacs, who have been shown to have elevated heart rate, body temperature, and whole body metabolic rate, would also have increased low frequency and decreased high frequency power in the spectral analysis of their heart period data.
Groups of 12 objectively defined insomniacs and age-, sex-, and weight-matched controls with normal sleep were evaluated on sleep and EKG measures over a 36-hour sleep laboratory stay.
Heart period was decreased (ie, heart rate was increased) and its SD was decreased in all stages of sleep in the insomniacs compared with the controls. Spectral analysis revealed significantly increased low frequency power and decreased high frequency power in insomniacs compared with controls across all stages of sleep.
Because increased low frequency spectral power is an indicator of increased sympathetic nervous system activity, these data imply that chronic insomniacs could be at increased risk for the development of disorders, such as coronary artery disease, that are related to increased sympathetic nervous system activity.
Human hepatocyte GF (hHGF) has strong neoangiogenesis activity. The present study was designed to investigate the possible involvement of hHGF in neovascularization in proliferative diabetic retinopathy (PDR) by measuring vitreous hHGF concentrations. The mean vitreous hHGF concentration was higher in subjects with PDR (5.70 +/- 0.68 ng/mL, n = 33) than in nondiabetic control subjects (1.50 +/- 0.20 ng/mL, n = 18, P < 0.01), nondiabetic subjects with proliferative vitreoretinopathy (3.31 +/- 0.57 ng//mL, n = 10, P < 0.05), or diabetic subjects without PDR (1.29 +/- 0.28 ng/mL, n = 8, P < 0.01). PDR subjects with neovascularization of iris, which suggests advanced retinal ischemia, showed a higher mean vitreous hHGF concentration than those without iridal neovascularization [7.33 +/- 1.16 ng/mL (n = 14) vs. 4.49 +/- 0.72 ng/mL (n = 19), P < 0.05]. The mean vitreous hHGF concentration was higher in PDR subjects with retinal neovascularization at the optic disc than in those with neovascularization elsewhere [7.3 +/- 1.1 ng/mL (n = 15) vs. 4.4 +/- 0.7 ng/mL (n = 18), P < 0.05]. Our results indicate that vitreous hHGF may play a role in retinal neovascularization in PDR.
To understand how blood glucose level is lowered by oral administration of vinegar, we examined effects of acetic acid on glucose transport and disaccharidase activity in Caco-2 cells. Cells were cultured for 15 d in a medium containing 5 mmol/L of acetic acid. This chronic treatment did not affect cell growth or viability, and furthermore, apoptotic cell death was not observed. Glucose transport, evaluated with a nonmetabolizable substrate, 3-O-methyl glucose, also was not affected. However, the increase of sucrase activity observed in control cells (no acetic acid) was significantly suppressed by acetic acid (P < 0.01). Acetic acid suppressed sucrase activity in concentration- and time-dependent manners. Similar treatments (5 mmol/L and 15 d) with other organic acids such as citric, succinic, L-maric, L-lactic, L-tartaric and itaconic acids, did not suppress the increase in sucrase activity. Acetic acid treatment (5 mmol/L and 15 d) significantly decreased the activities of disaccharidases (sucrase, maltase, trehalase and lactase) and angiotensin-I-converting enzyme, whereas the activities of other hydrolases (alkaline phosphatase, aminopeptidase-N, dipeptidylpeptidase-IV and gamma-glutamyltranspeptidase) were not affected. To understand mechanisms underlying the suppression of disaccharidase activity by acetic acid, Northern and Western analyses of the sucrase-isomaltase complex were performed. Acetic acid did not affect the de novo synthesis of this complex at either the transcriptional or translational levels. The antihyperglycemic effect of acetic acid may be partially due to the suppression of disaccharidase activity. This suppression seems to occur during the post-translational processing.
Hepatocyte growth factor (HGF) is an endothelium specific growth factor that has been implicated in angiogenesis, a crucial event for the development of proliferative diabetic retinopathy (PDR). The aim of the study is to determine the intravitreous concentrations of HGF in diabetic patients with PDR, and to investigate whether its serum levels could contribute to its intravitreous concentration.
17 diabetic patients and seven non-diabetic patients in whom a vitrectomy was performed were studied. Both groups were matched by serum levels of HGF. Venous blood and vitreous samples were collected simultaneously at the time of vitreoretinal surgery. Vitreous and serum HGF were determined by ELISA.
Intravitreous concentrations of HGF (median and range) were higher in diabetic patients (17.04 ng/ml (9.98-80)) in comparison with non-diabetic patients (5.88 ng/ml (2.57-14.20); p=0. 003). Intravitreous HGF concentrations were strikingly higher than serum HGF concentrations both in diabetic patients (17.04 ng/ml (9. 98-80) v 0.66 ng/ml (0.26-1.26); p<0.001) and in the control group (5.88 ng/ml (2.57-14.20) v 0.68 ng/ml (0.49-0.96); p=0.003). No correlation was found between serum and vitreous levels of HGF in both groups (diabetic patients, r= -0.31; p=0.5 and control subjects r= -0.15; p=0.5).
The high vitreous levels of HGF observed in diabetic patients with PDR cannot be attributed to serum diffusion across the blood-retinal barrier. Therefore, intraocular synthesis appears to be the main contributing factor for the high vitreous HGF concentrations in diabetic patients, a cytokine that seems to be directly involved in the pathogenesis of PDR.
Insulin autoimmune syndrome (IAS) has been reported mainly in Japan and so far only 27 IAS cases have been described from outside Asia. We describe two unrelated Portuguese patients with IAS and characterise their insulin autoantibodies and HLA alleles.
Patient 1, a 24-year-old white female suffered an episode of unconsciousness in the late postprandial state and blood glucose was found to be 33 mg/dl with serum insulin levels of >3980 microIU/ml (normal range 0-30 microIU/ml). She was receiving monthly injections of penicillin G for the prophylaxis of recurrent tonsillitis. Patient 2, was a 19-year-old white female, with episodes of sweating, hand tremor, weakness and hunger occurring in the postprandial state and blood glucose levels during the attacks of 28-56 mg/dl. Very high insulin levels (602-708 microIU/ml) were present.
Anti-insulin antibodies, determined by a semi-quantitative method, were strongly positive in both patients (91.7% in patient 1 and 88.6% in patient 2; normal range < or =7%). Sephadex G-100 chromatography of the sera showed most of insulin immunoreactivity present in the void volume which was retained by an affinity column with anti-human-immunoglobulin G antibodies (87% and 95% from patients 1 and 2 respectively). Scatchard plot analysis and molecular typing of the DRB1 gene revealed a polyclonal antibody and DRB1*0406 in patient 1, and a monoclonal antibody and DRB1*0403 in patient 2.
These two Portuguese patients with IAS had different HLA-DR4 subtypes and insulin autoantibodies: DRB1*0406 and a polyclonal antibody in a patient treated with penicillin, and DRB1*0403 and a monoclonal antibody in a patient with "idiopathic" IAS.
A definitive model for predicting absolute risk of coronary heart disease (CHD) in male and female people with Type II diabetes is not yet available. This paper provides an equation for estimating the risk of new CHD events in people with Type II diabetes, based on data from 4540 U.K. Prospective Diabetes Study male and female patients. Unlike previously published risk equations, the model is diabetes-specific and incorporates glycaemia, systolic blood pressure and lipid levels as risk factors, in addition to age, sex, ethnic group, smoking status and time since diagnosis of diabetes. All variables included in the final model were statistically significant (P<0.001, except smoking for which P=0.0013) in likelihood ratio testing. This model provides the estimates of CHD risk required by current guidelines for the primary prevention of CHD in Type II diabetes.
The antibody responses to a novel rapid-acting insulin analog, insulin aspart (IAsp), and their potential clinical correlates were studied with a specifically developed method in 2,420 people with diabetes treated for up to 1 year with preprandial subcutaneous injections of IAsp.
Circulating insulin antibodies were analyzed by radioimmunoassay with (125)I insulin or IAsp tracers and polyethylene glycol precipitation. Four multinational, open, parallel group studies were conducted in Europe and North America, with a total of 1,534 people with diabetes exposed to IAsp and 886 people exposed to human insulin (HI) as meal-related insulin for 6-12 months.
Insulin antibodies specific to HI or IAsp were absent in a majority of patients throughout the 6- to 12-month study periods. A majority of the patients (64-68%) had antibodies cross-reacting between HI and IAsp when entering the studies, with baseline levels (means +/- SD of percent bound/total) of 16.6 +/- 16.3% in study 1 and 10.3 +/- 14.0% in study 4. In all four studies, cross-reactive antibodies increased in patients exposed to IAsp, with a maximum at 3 months, and thereafter there was a decline toward baseline levels at 9-12 months (levels at 3 and 12 months: 22.3 +/- 19.7 and 16.8 +/- 16.5% in study 1 and 21.5 +/- 21.9 and 16.9 +/- 17.4% in study 4). Antibody levels showed similar changes in people with type 1 and type 2 diabetes, and there was no consistent relationship between antibody formation and glycemic control or between antibody formation and safety in terms of adverse events.
Treatment with IAsp is associated with an increase in cross-reactive insulin antibodies, with a subsequent fall toward baseline values, without any indication of clinical relevance because no effect on efficacy or safety could be identified.
Homodimer formation activates all nitric-oxide synthases (NOSs). It involves the interaction between two oxygenase domains (NOSoxy) that each bind heme and (6R)-tetrahydrobiopterin (H4B) and catalyze NO synthesis from L-Arg. Here we compared three NOSoxy isozymes regarding dimer strength, interface composition, and the ability of L-Arg and H4B to stabilize the dimer, promote its formation, and protect it from proteolysis. Urea dissociation studies indicated that the relative dimer strengths were NOSIIIoxy > NOSIoxy > NOSIIoxy (endothelial NOSoxy (eNOSoxy) > neuronal NOSOXY (nNOSoxy) > inducible NOSoxy (iNOSoxy)). Dimer strengths of the full-length NOSs had the same rank order as judged by their urea-induced loss of NO synthesis activity. NOSoxy dimers containing L-Arg plus H4B exhibited the greatest resistance to urea-induced dissociation followed by those containing either molecule and then by those containing neither. Analysis of crystallographic structures of eNOSoxy and iNOSoxy dimers showed more intersubunit contacts and buried surface area in the dimer interface of eNOSoxy than iNOSoxy, thus revealing a potential basis for their different stabilities. L-Arg plus H4B promoted dimerization of urea-generated iNOSoxy and nNOSoxy monomers, which otherwise was minimal in their absence, and also protected both dimers against trypsin proteolysis. In these respects, L-Arg alone was more effective than H4B alone for nNOSoxy, whereas for iNOSoxy the converse was true. The eNOSoxy dimer was insensitive to proteolysis under all conditions. Our results indicate that the three NOS isozymes, despite their general structural similarity, differ markedly in their strengths, interfaces, and in how L-Arg and H4B influence their formation and stability. These distinguishing features may provide a basis for selective control and likely help to regulate each NOS in its particular biologic milieu.
Individuals with type 2 diabetes are particularly vulnerable to cardiovascular disease. Insulin resistance is a major determinant of this increased risk and is a potential therapeutic target. This study was undertaken to establish the natural biological variation of insulin resistance in individuals with type 2 diabetes.
The biological variation of insulin resistance was assessed by measuring insulin resistance at 4-day intervals on 10 consecutive occasions in 12 postmenopausal women with diet-controlled type 2 diabetes and in 11 weight- and age-matched postmenopausal women without type 2 diabetes. Insulin resistance was derived using the homeostasis model assessment for insulin resistance (HOMA-IR) method.
The distribution of HOMA-IR was log Gaussian in the type 2 diabetic study group and Gaussian in the control group. The HOMA-IR in the type 2 diabetic group was significantly greater than that of the control group (mean +/- SD: 4.33 +/- 2.3 vs. 2.11 +/- 0.79 units, P = 0.001). After accounting for analytical variation, the mean intraindividual variation was also substantially greater in the type 2 diabetic group than in the control group (mean 1.05 vs. 0.15, P = 0.001). Consequently, at any level of HOMA-IR, a subsequent sample must increase by >90% or decrease by >47% to be considered significantly different from the first.
HOMA-IR is significantly greater and more variable for individuals with type 2 diabetes. Therefore, this inherent variability needs to be accounted for in studies evaluating therapeutic reduction of HOMA-IR in this group.
Current National Cholesterol Education Program guidelines recommend that non-high-density lipoprotein cholesterol (non-HDL-C) be considered a secondary target of therapy among individuals with triglycerides >2.26 mmol/L. It is not known whether non-HDL-C relates to prognosis among patients with coronary heart disease.
Lipid levels were available at baseline among 1514 patients (73% men; mean age, 61 years) enrolled in the Bypass Angioplasty Revascularization Investigation (BARI); all had multivessel coronary artery disease. Patients were followed for 5 years. Outcomes of death, nonfatal myocardial infarction, and death or myocardial infarction were modeled using univariate and multivariate time-dependent proportional hazards methods; angina pectoris at 5 years was modeled using univariate and multivariate logistic regression. Non-HDL-C was a strong and independent predictor of nonfatal myocardial infarction (multivariate relative risk, 1.049 [95% confidence intervals, 1.006 to 1.093] for every 0.26 mmol/L increase) and angina pectoris (multivariate odds ratio, 1.049 [95% confidence intervals, 1.004 to 1.096] for every 0.26 mmol/L increase), but it did not relate to mortality. HDL-C and LDL-C did not predict events during follow-up.
Among patients with lipid values in BARI, non-HDL-C is a strong and independent predictor of nonfatal myocardial infarction and angina pectoris at 5 years, even after consideration of powerful clinical variables. Our data suggest that non-HDL-C is an appropriate treatment target among patients with coronary heart disease.
Short-term sleep restriction results in impaired glucose tolerance. To test whether habitually short sleep duration increases the risk of developing diabetes, we studied a cohort of 70,026 women enrolled in the Nurses Health Study, without diabetes at baseline, and who responded to a question about daily sleep duration in 1986. Subjects were followed until 1996 for the diagnosis of diabetes (1,969 cases). Long and short sleep durations were associated with an increased risk of diabetes diagnosis. The relative risks (RRs) for short (slept < or =5 h per day) and long (slept > or =9 h per day) sleepers were 1.57 (95% CI 1.28-1.92) and 1.47 (1.19-1.80), respectively. After adjustment for BMI and a variety of confounders, the RR was not significantly increased for short sleepers (1.18 [0.96-1.44]) but remained modestly increased for long sleepers (1.29 [1.05-1.59]). We then performed a similar analysis using only symptomatic cases (n = 1,187). Adjusted RRs for symptomatic diabetes were modestly elevated in both short (1.34 [1.04-1.72]) and long (1.35 [1.04-1.75]) sleepers. Our data suggest that the association between a reduced self-reported sleep duration and diabetes diagnosis could be due to confounding by BMI, or sleep restriction may mediate its effects on diabetes through weight gain. Sleep restriction may be an independent risk factor for developing symptomatic diabetes.
Recent research has shown that adipose tissue is not simply an inert storage depot for lipids but is also an important endocrine organ that plays a key role in the integration of endocrine, metabolic, and inflammatory signals for the control of energy homeostasis. The adipocyte has been shown to secrete a variety of bioactive proteins into the circulation. These secretory proteins, which have been collectively named adipocytokines (1), include leptin (2), tumor necrosis factor (TNF)-α (3), plasminogen-activator inhibitor type 1 (PAI-1) (4), adipsin (5), resistin (6), and adiponectin (7). Adiponectin, the gene product of the adipose most abundant gene transcript 1 (apM1) (7), is a novel and important member of the adipocytokine family. Adiponectin cDNA was first isolated by large-scale random sequencing of the human adipose tissue cDNA library (7). It is a collagen-like protein that is exclusively synthesized in white adipose tissue, is induced during adipocyte differentiation, and circulates at relatively high (microgram/milliliter) concentrations in the serum. Both murine and human forms of adiponectin have been isolated independently by several groups, and various descriptive names have been given to the same compound by different investigators: adipocyte complement-related protein of 30 kilodalton (Acrp30) (8), Adipo Q (9), and gelatin binding protein of 28 kilodalton (GBP28) (10). The former two are murine analogs and the latter the human counterpart. Throughout this review, we will be referring to the protein by its most commonly used name, adiponectin.
Adiponectin has been postulated to play an important role in the modulation of glucose and lipid metabolism in insulin-sensitive tissues in both humans and animals. Decreased circulating adiponectin levels have been demonstrated in genetic and diet-induced murine models of obesity (11), as well as in diet-induced forms of human obesity (12). Low adiponectin levels have also been strongly implicated in the development of insulin resistance …
Vitiligo has been often associated with the host's susceptibility, metabolic abnormality and/or autoimmunity. Interestingly, autoimmunity and environmental factors have been suggested to be contributing factors for vitiligo susceptibility. It is therefore desired to identify families with vitiligo to confirm such hypothesis. Here are reported 39 subjects with vitiligo in a rural Romanian community of 1710 Caucasian habitants with a prevalence of the disease of >2.3%. A structured questionnaire was distributed to the population and the survey has been conducted by two experienced dermatologists. The population has distressing condition of living based mainly on their economic status, agriculture being the principal occupation. 25/39 subjects with ages between 29-89 have been investigated for one year focusing on their clinical characteristics and potential association with autoimmune diseases. Familial aggregation is present in 9 patients (36%). Most patients are of generalized (92%) and progressive forms (52%). In 72% of the patients, the disease started at an age of over 30. We have also found associated autoimmune thyroidopathies (44%), rheumatoid arthritis (24%), diabetes mellitus (20%). Significant ocular abnormalities were present in 5 patients (20%). Although genetic association cannot be ascertained at present, most families appear to be associated with one origin. The disease appears to worsen during summer and work load. The data suggests that the presence of vitiligo in this community might be related to autoimmunity, genetic factor, stress and sun exposure. This is the first Romanian study that evaluates a group of vitiligo patients from a restricted isolated community.
Diabetes mellitus is known to be a major risk factor for the development of coronary artery disease (CAD). The aim of this study was to investigate angiographically the coronary arteries of diabetic persons, focusing on the type and distribution of CAD, sex differences in CAD anatomy, and the size of the coronary vessels. This was a randomized study and included two groups of patients with angiographically demonstrated CAD. Group A included 463 diabetics, aged 60.3 years, and Group B 210 nondiabetic patients, aged 58.5 years. The two groups were matched by age, sex, weight, and classic risk factors. The authors evaluated the regional location of CAD, left ventricular (LV) function, and the width of the lumen of coronary arteries. The diabetics had three-vessel disease more frequently (p<0.001) and one-vessel disease less frequently (p<0.001). The CAD was more extensive in Group A (mean 2.2 vessels, compared to 1.8 vessels in Group B, p<0.01). The right coronary artery was affected more often in diabetics (p<0.01), as was the anterior descending artery in three-vessel disease (p<0.05). The male diabetics had the same angiographic CAD severity as the females, although the latter had a better LV ejection fraction (p<0.05). The female diabetics < 55 years old had CAD findings comparable with those from women 4 years older in Group B. Diabetics show more diffuse and severe CAD than the general population. There are no sex-related differences in the severity of CAD.
Humoral autoimmunity plays an important role in the pathogenesis of two forms of hypoglycemia. In one syndrome, antireceptor autoantibodies bind to the insulin receptor, mimic insulin action, and cause fasting hypoglycemia. In most patients with autoantibodies to the insulin receptor, there is other evidence of autoimmune disease as well. Interpretation of the standard tests used in evaluation of hypoglycemia may be confusing in these patients. For example, antireceptor antibodies may inhibit insulin binding, thereby inhibiting insulin clearance and elevating levels of plasma insulin. Nevertheless, because hypoglycemia suppresses beta-cell secretion, C-peptide levels are usually low. This constellation of data is consistent with surreptitious insulin injection. The most important laboratory test in the differential diagnosis is a direct assay for the presence of antibodies directed against the insulin receptor. Therapy with prednisone appears to alleviate the hypoglycemia rapidly, usually within 24 hours. This effect of prednisone appears to result from antagonism of the effects of antireceptor antibodies without actually lowering their titer. The natural history of this syndrome is that the antireceptor antibodies disappear and the syndrome resolves over a time course of several months to several years. In North America, the presence of anti-insulin antibodies in a hypoglycemic patient most commonly suggests that the patient has been immunized with exogenous insulin. However, some patients--especially in Japan--develop spontaneous autoantibodies directed against insulin. These antibodies can cause hypoglycemia, which is generally reactive in that it occurs several hours after a meal or a glucose challenge rather than in a fasting state. The most effective therapy is frequent small feedings and avoidance of large meals.
Most clinical chemical analytes vary in a random manner around a homeostatic set point. Replicate analyses of a series of specimens collected from a group of subjects allows estimation of analytical, within and between subject components of variation. The preferred experimental procedures and statistical methods for evaluation of data and analysis of variance are described; a detailed example is provided in the Appendix. The many uses of data on biological variation in clinical chemistry are reviewed, including setting analytical goals, deciding the significance of changes in serial results from an individual, evaluating the utility of conventional population-based reference values in patient management, and other applications.
A child presenting severe hypoglycemia despite low or normal secretion of insulin was found to have IgM antibodies to the insulin receptor. These antibodies stimulated lipogenesis in fat cells in vitro and competed with insulin for binding to insulin receptors. After treatment with glucocorticoids, the anti-receptor antibodies and the hypoglycemia both disappeared, and antibodies to insulin appeared in the patient's serum. The anti-insulin antibodies were isolated by affinity chromatography and were found to inhibit the anti-insulin-receptor antibodies that were present earlier. The interaction between the patient's anti-insulin antibodies and his anti-receptor antibodies suggests that these two species of antibodies are related as idiotypes and anti-idiotypes. We also studied the interaction of the hypoglycemic patient's anti-receptor antibodies with anti-insulin antibodies of a diabetic patient and with anti-insulin antibodies of mice immunized to insulin. The hypoglycemic patient's anti-receptor antibodies were neutralized by the diabetic patient's anti-insulin antibodies, indicating that anti-insulin antibodies with a common idiotype may arise in both diabetes and hypoglycemia. Moreover, mouse anti-insulin antibodies that interacted with mouse anti-receptor antibodies neutralized the hypoglycemic patient's anti-receptor antibodies. In contrast, mouse anti-insulin antibodies that did not interact with the mouse anti-receptor antibodies did not neutralize the hypoglycemic patient's anti-receptor antibodies. Thus, the human anti-insulin antibodies share an idiotype with a specific class of mouse anti-insulin antibodies.(ABSTRACT TRUNCATED AT 250 WORDS)
Using the nationwide childhood-onset diabetes register in Sweden, we were able to trace children who contracted diabetes before the age of 15 years and who were born at a specific hospital in Sweden where maternal sera from delivery had been stored during the years 1969-1989. Sera obtained at delivery from 57 mothers of diabetic children were compared with sera from 203 mothers of control subjects who were delivered at the same hospital during the same time period. The sera were analyzed blindly using a group-specific enzyme-linked immunosorbent assay for enteroviral IgG and IgM antibodies before and after urea wash as an avidity test. On the same plates, IgG antibodies to herpes, mumps, and toxoplasmosis were analyzed. The mean absorbance values of enteroviral IgG antibodies against enteroviral antigens (echo30, coxsackie B5, and echo9) were significantly higher among mothers whose children later developed diabetes (P = 0.002, P = 0.02, and P = 0.04, respectively). When reduction in activity after urea wash, indicating recently formed antibodies, was compared, the differences were even more pronounced (P < 0.001 for all three antigens). No significant differences were found for antibodies against herpes (all types), herpes type 2, mumps, or toxoplasmosis. When IgM activity and/or a significant decrease in avidity index, an indication of recent enterovirus infection, was used as a risk exposure, the odds ratio standardized for year of birth (95% confidence interval) was 3.19 (1.39-7.30). We conclude that the results of this study indicate that enteroviral infection during pregnancy is a risk factor for childhood-onset diabetes in the offspring.(ABSTRACT TRUNCATED AT 250 WORDS)
To measure the 12-year incidence (1982-1994) of nontraumatic lower extremity amputations (LEAs) in Nauruans, a population at high risk for NIDDM, and to determine the risk factors for amputation in Nauruans with diabetes.
Amputation data were abstracted from operating theater records in Nauru, hospital databases in Australia, and Nauru government records. Baseline characteristics of a cohort of 1,564 Nauruans aged > or = 20 years examined during a population-based survey in 1982 were used to determine risk factors for first LEAs.
Over this 12-year period, 46 first LEAs were performed on people with NIDDM, of whom 30 were members of the 1982 study cohort. The incidence of first LEAs in Nauruans aged > or = 25 years with NIDDM was 8.1 per 1,000 person-years in the study cohort and an estimated 7.6 per 1,000 person-years nationally. Amputations were associated significantly with lower BMI, lower blood pressure, higher fasting plasma glucose (FPG) level, and longer mean duration of diabetes at baseline, but levels of other risk factors, including cigarette smoking, plasma triglycerides, and plasma cholesterol, were also elevated in amputees. There were no amputations among individuals with baseline FPG levels < 7.8 mmol/l, irrespective of diabetes duration. FPG, baseline diabetes duration, and male sex were independent risk factors for first amputation using the Cox proportional hazards model. There was a decrease in the incidence of amputations after the commencement of a national foot care health education and prevention campaign in June 1992.
The incidence of LEAs in diabetic Nauruans was higher than in other populations after adjusting for age and duration. Given the apparent success of the Nauruan footcare program in reducing amputation rates, other populations with high rates of NIDDM and LEAs should consider population-wide prevention strategies.
Insulin lispro [Lys (B28), Pro (B29) human insulin] is a rapidly absorbed analog that has diminished tendency to self-associate. In four open-label, 1-year-long international randomized trials, we contrasted the immunogenicity of insulin lispro versus regular human insulin (RHI) in patients previously treated with insulin who had IDDM or NIDDM. Using a self-blank subtraction assay, we assessed sera for the presence of insulin-specific antibodies (ISA), insulin lispro-specific antibodies (LSA), and cross-reactive antibodies (CRA). Basal insulin needs were provided either with human ultralente (UL) or NPH insulins. After 2 to 4 weeks of therapy with RHI plus UL or RHI plus NPH, 50% of patients were randomly assigned to begin insulin lispro or continue on RHI. At baseline, few pretreated patients had LSA (0-4%) and approximately 10% had ISA, whereas 41-45% of patients with IDDM and 23-27% of patients with NIDDM had CRA (IDDM vs. NIDDM, P < 0.001). Within studies, no significant differences were noted over time in ISA, LSA, or CRA attributable to the type of short-acting insulin. When data were pooled, inconsistent changes were noted in ISA and LSA (LSA were greater in NIDDM vs. IDDM at baseline, P = 0.001, and ISA were greater in IDDM vs. NIDDM at 6 months, P = 0.007). Significant levels of CRA were more common in IDDM at all times (P < 0.001, P = 0.022, and P = 0.002 at baseline, 6 months, and 12 months, respectively). For patients receiving insulin lispro, no significant changes occurred in antibody status among IDDM and NIDDM patients throughout the study (became positive, remained positive, became negative, or remained negative). IDDM patients were more likely to develop or maintain CRA levels (P = 0.008 vs. NIDDM), whereas antibody levels were comparable among positive individuals. No evidence was noted that insulin lispro differs in immunogenicity from RHI in previously treated IDDM and NIDDM patients.