Health care professionals should prescribe better sleep to prevent and treat metabolic disorders
Evidence increasingly suggests that insufficient or disturbed sleep is associated with metabolic disorders such as type 2 diabetes and obesity, and addressing poor quality sleep should be a target for the prevention – and even treatment – of these disorders, say the authors  of a Review, published in The Lancet Diabetes & Endocrinology journal.
“Metabolic health, in addition to genetic predisposition, is largely dependent on behavioural factors such as dietary habits and physical activity. In the past few years, sleep loss as a disorder characterising the 24-hour lifestyle of modern societies has increasingly been shown to represent an additional behavioural factor adversely affecting metabolic health,” write the authors.
Addressing some types of sleep disturbance – such as sleep apnoea – may have a directly beneficial effect on patients’ metabolic health, say the authors. But a far more common problem is people simply not getting enough sleep, particularly due to the increased use of devices such as tablets and portable gaming devices.
Furthermore, disruption of the body’s natural sleeping and waking cycle (circadian desynchrony) often experienced by shift workers and others who work outside daylight hours, also appears to have a clear association with poor metabolic health, accompanied by increased rates of chronic illness and early mortality.
Although a number of epidemiological studies point to a clear association between poor quality sleep and metabolic disorders, until recently, the reason for this association was not clear. However, experimental studies are starting to provide evidence that there is a direct causal link between loss of sleep and the body’s ability to metabolise glucose, control food intake, and maintain its energy balance.
According to the study authors, “These findings open up new strategies for targeted interventions aimed at the present epidemic of the metabolic syndrome and related diseases. Ongoing and future studies will show whether interventions to improve sleep duration and quality can prevent or even reverse adverse metabolic traits. Meanwhile, on the basis of existing evidence, health care professionals can be safely recommended to motivate their patients to enjoy sufficient sleep at the right time of day.”
 The authors of the Review are Dr. Sebastian Schmid, University of Lübeck, Germany; Dr Manfred Hallschmid, University of Tübingen, Germany; and Professor Bernd Schultes, eSwiss Medical and Surgical Centre, St Gallen, Switzerland.
By JENNIFER CORBETT DOOREN
People who increased their consumption of red meat during a four-year period were more likely to develop Type 2 diabetes in a subsequent four-year period, according to an analysis involving about 150,000 people.
The analysis, led by researchers at the National University of Singapore, took data from three long-running Harvard University studies involving mostly nurses and doctors. The results were published online Monday in JAMA Internal Medicine, a journal of the American Medical Association. The studies were funded by grants from the National Institutes of Health.
While bumping up red-meat intake can raise diabetes risk, some experts suggest eating lean cuts of meat like certain steaks or lamb instead of fattier options like sausage.
While prior studies have also found a link between red-meat consumption and the development of Type 2 diabetes, the new analysis is believed to be the first time researchers have tracked changes in red-meat consumption over time with the risk of developing Type 2 diabetes. Study participants filled out detailed questionnaires about the types of food and drinks they consumed at the beginning of the study and every four years. The analysis looked at some 20 years of data.
Broadly, the study showed that, compared with a group of people who had no change in red-meat intake, increasing red-meat consumption by more than a half-serving per day over a four-year period was associated with a 48% increase in the risk of developing Type 2 diabetes during the next four years.
However, reducing red-meat consumption by the same amount during the same time period didn’t cut the risk of diabetes during the next four years. It did reduce the risk by 14% over a longer time period, though.
The changes were independent of other factors such as body weight and overall diet quality.
“Our results confirm the robustness of the association between red meat and [Type 2 diabetes prevention] and add further evidence that limiting red-meat consumption over time confers benefits for…prevention,” the study authors wrote. An Pan, an assistant professor at the National University of Singapore’s Saw Swee Hock School of Public Health, was the study’s lead author.
Other doctors say red meat in and of itself isn’t necessarily the trouble.
“It is not the type of protein (or meat) that is the problem; it is the type of fat,” said William J. Evans, who is affiliated with both Duke University and GlaxoSmithKline PLC., GSK.LN -1.67% and who wrote a commentary about the study that was also published online in JAMA Internal Medicine. “It’s mischaracterizing red meat as high fat,” Dr. Evans said in an interview.
He said consumers could choose lean cuts of red meat such as sirloin tips or round steak over high-fat cuts like rib-eye.
Dr. Pan could not be reached for comment Monday.
Similar to general dietary guidelines from the U.S. government, the American Diabetes Association recommends people with diabetes eat lots of vegetables and fruit and choose whole-grain foods including dried beans, as well as eating fish two or three times a week. Lean meats include cuts of beef or pork that end in “loin,” such as pork loin and sirloin.
Diabetes affects about 26 million Americans and is characterized by high blood-glucose levels caused by the body’s inability to either make or properly use insulin. Type 2 diabetes, the most common form of the disease, is often associated with weight gain and older age. The disease raises the risk of heart attacks and strokes, kidney disease, blindness, amputations and nerve damage. The other type of diabetes, Type 1, is an autoimmune disease and often diagnosed in childhood.
The Centers for Disease Control and Prevention has projected that as many as 1 in 3 U.S. adults could have diabetes by 2050. The disease is currently the seventh leading cause of death in the U.S.
Doctors say that improving diet is important not only for managing diabetes, but for keeping the adult-onset Type 2 at bay for those with the highest risk. The CDC estimates that 35% of U.S. adults age 20 and older—nearly 80 million Americans, by the agency’s estimate—are affected with prediabetes, a condition in which people have higher-than-normal blood-glucose levels. People with prediabetes also have a higher risk of developing problems like heart disease and stroke.
Researchers said one of the limitations of the study was that participants were mostly white, educated U.S. adults. Some groups have a higher risk than others for developing Type 2 diabetes, according to the diabetes association, including African-Americans and Hispanics.
The diabetes and red-meat analysis involved data from the Health Professionals Follow-Up Study collected between 1986 and 2006, as well as information from two groups of women in the Nurses’ Health studies collected during a similar time period.
A Diabetes Primer for Carnivores
- 347 million people world-wide have diabetes
- 26 million in the U.S. have it (19 million diagnosed, 7 million undiagnosed)
- 8.3% of the U.S. population is affected
- 27% of Americans with diabetes don’t know they have it
- 35% of the U.S. population age 20 years or older has prediabetes
RED MEAT CHOICES FOR DIABETICS
- The American Diabetes Association recommends that meat eaters opt for Choice or Select grades of beef that are trimmed of fat. Cuts include chuck, rib, flank, Porterhouse, T-bone, rump roast, sirloin and tenderloin.
- Other acceptable options: lamb chop, leg or roast, Canadian bacon, beef jerky, organ meats, game meat (including buffalo, duck, goose, venison), veal loin chop or roast.
EFFECTS OF DIABETES
Type 2 diabetes is the seventh-leading cause of death in the U.S. and the leading cause of these conditions:
- Kidney failure
- Non-traumatic lower-limb amputations
- New cases of blindness among adults
—SOURCES: Centers for Disease Control and Prevention; American Diabetes Association; World Health Organization
Write to Jennifer Corbett Dooren at firstname.lastname@example.org
New evidence is emerging for how important it is for pregnant women to eat good, nutritious food. Expecting mothers who eat vegetables every day seem to have children who are less likely to develop type 1 diabetes, is revealed in a new study from the Sahlgrenska Academy at the University of Gothenburg, Sweden.
The study was performed in collaboration with Linköping University, which is conducting a population study called ABIS (All Babies in Southeast Sweden). The results have been published in the journal Pediatric Diabetes.
“This is the first study to show a link between vegetable intake during pregnancy and the risk of the child subsequently developing type 1 diabetes, but more studies of various kinds will be needed before we can say anything definitive,” says researcher and clinical nutritionist Hilde Brekke from the Sahlgrenska Academy.
Blood samples from almost 6,000 five year-olds were analyzed in the study. In type 1 diabetes, certain cells in the pancreas gradually get worse at producing insulin, leading to insulin deficiency. Children at risk of developing type 1 diabetes have antibodies in their blood which attack these insulin-producing cells.
Of the 6,000 children tested, three per cent had either elevated levels of these antibodies or fully developed type 1 diabetes at the age of five. These risk markers were up to twice as common in children whose mothers rarely ate vegetables during pregnancy. The risk was lowest among children whose mothers stated that they ate vegetables every day.
“We cannot say with certainty on the basis of this study that it’s the vegetables themselves that have this protective effect, but other factors related to vegetable intake, such as the mother’s standard of education, do not seem to explain the link,” says Brekke. “Nor can this protection be explained by other measured dietary factors or other known risk factors.”.
The term “Vegetables “in this study included all vegetables except for root vegetables.
Type 1 Diabetes
Around 50,000 Swedes have type 1 diabetes, a chronic disease which normally emerges before the age of 35. It is not yet known what causes type 1 diabetes, but some of the factors believed to play a role are:
- various immunological mechanisms,
- environmental toxins and
- genetic variations.
Type 1 diabetes is found throughout the world but is most common in Finland and Sweden.
A study in the American Journal of Clinical Nutrition reveals the not so surprising result that whole grains in the diet reduce disease risk factors. One wonders why our food policies and agricultural subsidies promote disease over good health.
Background: Studies of whole grain and chronic disease have often included bran-enriched foods and other ingredients that do not meet the current definition of whole grains. Therefore, we assessed the literature to test whether whole grains alone had benefits on these diseases.
Objective: The objective was to assess the contribution of bran or cereal fiber on the impact of whole grains on the risk of type 2 diabetes (T2D), obesity and body weight measures, and cardiovascular disease (CVD) in human studies as the basis for establishing an American Society for Nutrition (ASN) position on this subject.
Design: We performed a comprehensive PubMed search of human studies published from 1965 to December 2010.
Results: Most whole-grain studies included mixtures of whole grains and foods with ≥25% bran. Prospective studies consistently showed a reduced risk of T2D with high intakes of cereal fiber or mixtures of whole grains and bran. For body weight, a limited number of prospective studies on cereal fiber and whole grains reported small but significant reductions in weight gain. For CVD, studies found reduced risk with high intakes of cereal fiber or mixtures of whole grains and bran.
Conclusions: The ASN position, based on the current state of the science, is that consumption of foods rich in cereal fiber or mixtures of whole grains and bran is modestly associated with a reduced risk of obesity, T2D, and CVD. The data for whole grains alone are limited primarily because of varying definitions among epidemiologic studies of what, and how much, was included in that food category.