Diabetes: Is It Now a Surgical Disease?

Hi. I’m Dr. Henry Black. I’m Clinical Professor of Internal Medicine at the New York University School of Medicine, a member of the Center for the Prevention of Cardiovascular Disease at that institution, and former President of the American Society of Hypertension. If I had said 10 years ago that diabetes was going to become a surgical disease, I think I would have been laughed off the stage; yet, increasing evidence shows that this may not be a completely far-out idea. Two very small but important studies were recently published in the New England Journal of Medicine, one from the Cleveland Clinic[1] and one from Italy.[2] Both of them looked at people with high body mass index (BMI). BMIs were somewhat lower in the Cleveland Clinic study, with an average of about 34; in the Italian study, the average BMI was 45 and the average weight was about 300 lb. The investigators compared intensive medical therapy given by experts with surgical approaches. The Cleveland study looked at sleeve gastrectomies and bypass, and the Italian study compared intensive medical therapy (including exercise, which wasn’t specifically done in the Cleveland Clinic study) with ileojejunostomy and bypass.

The results were strikingly similar. These were small studies; there were about 20 patients per group in the Italian study and about 50 per group in the Cleveland Clinic study. They both showed dramatic reductions in weight that were generally seen within 3 months. Patients were followed for 1 year in Cleveland and 2 years in the Italian study, and a significant improvement in all the metabolic parameters that we follow in diabetics — including lipids, hemoglobin A1c, and even blood pressure — happened before the weight loss was completely achieved. Patients with jejunostomy and bypass were able to be taken off diabetic medicines and, in some cases, lipid-lowering therapy, something that was never seen in patients who received only medical therapy.

This implies that we have to start thinking about using one of these techniques sooner until we can find a way to deliver behavioral therapy that people will follow. There is no question that some things in this study are not necessarily generalizable. The Cleveland Clinic study had a single surgeon and the Italian study had teams that were well trained. We don’t know whether this is going to translate into every surgeon in every community, but it is an important thing to bear in mind. We also have to do some assessment of outcomes.

These were very small studies. Reoperations were necessary in both studies, but there were no fatalities. BMIs went to under 30 in the Italian study and were similar in the Cleveland Clinic study. It’s time for those of us who see obese patients with diabetes to start talking about this as something that is getting close to being proven. An old Swedish study[3] showed outcome improvement with what was more complicated surgery than we are doing now. Also, how are we going to better deliver behavioral therapy? This is something the public needs to know and needs to know now. Thank you.

References

  1. Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366:1567-1576. Abstract
  2. Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366:1577-1585. Abstract
  3. Sjostrom L, Lindroos AK, Peltonen M, et al; Swedish Obese Subjects Study Scientific Group. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683-2693. Abstract

Source: Medscape.com

New NASA Supercomputer Facility Set to Advance Earth Research .


NASA soon will open a new chapter of discovery using enhanced Landsat Earth-observing data in a state-of-the-art, high-performance computing and data access facility called NASA Earth Exchange (NEX). This new facility is a virtual laboratory that will allow scientists to tackle global Earth science challenges with global high-resolution satellite observations.

After extensive development and testing, NASA is making the NEX facility available to the research community for further research and development. With NASA’s state-of-the-art supercomputing capacity, researchers can use NEX to explore and analyze large Earth science data sets in hours rather than months. Scientists can produce complex, interdisciplinary studies of world phenomena and share their findings instantly on the NEX platform.

“Because of the large volume of high-resolution Landsat data, scientists who wanted to study the planet as a whole prior to NEX needed to invest tremendous amounts of time and effort to develop high-end computational methods rather than focus on important scientific problems,” said Tsengdar Lee, high-end computing program manager at NASA Headquarters in Washington. “NEX greatly simplifies researchers’ access to and analysis of high-resolution data like Landsat.”

This new facility boasts a large collection of global data sets and analysis tools from NASA and other agencies, including surface weather records, topography, soils, land cover and global climate simulations. Using NEX, scientists now can fit Landsat scenes together like a giant jigsaw puzzle to create snapshots of global vegetation patterns containing more than a half-trillion pixels in less than 10 hours. These global vegetation products, referred to as the Normalized Difference Vegetation Index, complement the more standard products from the Moderate Resolution Imaging Spectroradiometer on NASA’s Aqua satellite but with 10 times higher resolution.

“The science community is under increasing pressure not only to study recent and projected changes in climate that likely impact our global environment and natural resources, but also to design solutions to mitigate, or cope, with the likely impacts,” said Rama Nemani, a senior Earth scientist at NASA’s Ames Research Center in Moffett Field, Calif. “We want to change the research paradigm by bringing large data holdings and supercomputing capabilities together, so researchers have everything they need in one place.”

Developed by a team at Ames, NEX combines Earth-system modeling, remote-sensing data from NASA and other agencies, and a scientific social networking platform to deliver a complete research environment. Users can explore and analyze large Earth science data sets, run and share modeling algorithms, collaborate on new or existing projects and exchange workflows and results within and among other science communities.

Scientists believe costs and time associated with research development may be reduced significantly by allowing NEX members to collaborate instantly in this type of large-scale supercomputing work environment. For example, NEX may relieve researchers from redundantly retrieving and integrating data sets and building modeling analysis codes.

NEX uses Landsat data, which constitute a large collection of images collected over 40 years by a series of satellite sensors. The enhanced collection of Landsat data gives scientists the opportunity to study and understand changes on a planetary scale, looking at one-quarter acre at a time.

NASA, in cooperation with the Interior Department and its science agency, the U.S. Geological Survey, launched the first Landsat satellite in 1972. The resulting 40-year archive of Earth observations from the Landsat fleet supports the improvement of human and environmental health, biodiversity, energy and water management, urban planning, disaster recovery and crop monitoring. The Landsat program is jointly managed by NASA and the Interior Department.

Source:NASA

3 Reasons You May Not be Getting Enough Vitamin D this Summer.


While mainstream media continues to blast health warnings about the dangers of sun exposure, the news reports have it all wrong―instead of too much sun, it’s likely most people are not getting enough.

Even though summer is a time when more people are outside―and theoretically exposed to more sun, which is the ideal way to boost your vitamin D levels―there are three good reasons why you still many not be getting enough …

Three Reasons Why You May be Vitamin D Deficient

It’s estimated that over 95 percent of U.S. senior citizens may be deficient in vitamin D, along with 85 percent of the American public. Researchers have noted that vitamin D deficiency is prevalent in adults of all ages who have increased skin pigmentation (such as those whose ancestors are from Africa, the Middle East, or India), or who always wear sun protection or limit their outdoor activities.1

The truth is that many are under the false impression that they’re getting enough vitamin D, when their levels are seriously deficient. Three major reasons for this are:

1.  Relying Too Much on Vitamin-D Fortified Foods or Poor-Quality Supplements

First of all, it is my firm belief that we were not designed to swallow our daily dose of vitamin D we were designed to absorb it from the sun. There are very few foods that actually have therapeutic levels of vitamin D naturally. It is a great backup to have the ability to absorb it orally, but it is my belief that oral vitamin D is significantly inferior to vitamin D derived from the sun.

Having said that, dairy processors producing pasteurized milk have been fortifying milk with vitamin D since 1933. Today, about 98 percent of the milk supply in the U.S. is fortified with approximately 400 International Units (IU) of vitamin D per quart. While dairies used to fortify their milk with vitamin D2, most have now switched over to the far superior D3.

Because of this fortification, many people believe that drinking milk is enough to support healthy vitamin D levels, but it is very difficult to get enough vitamin D from food sources alone. As I mentioned, very few foods naturally contain vitamin D — and those that do will not contain enough to optimize your levels, even if you include fortified foods into the mix.

Additionally, it’s important to realize that not all food sources provide the same kind of vitamin D. Plant sources provide you with D2. The more beneficial D3 can only be had through animal-based sources such as salmon, which has about 450 IUs per serving. While other animal-based foods do contain some naturally occurring vitamin D, it is typically at very low levels. One large egg yolk, for instance, contains just 41 IUs of vitamin D.

So, again, consuming these foods is not likely to give you enough vitamin D, as it appears as though most adults need at least 8,000 IU’s of vitamin D a day in order to raise their serum levels to healthy levels.2

As for supplements, while safe sun exposure or safe tanning bed use are the best ways to optimize vitamin D, oral supplementation can be used. However, many are taking vitamin D2 (the type used in many prescription vitamin D supplements), unaware that this form is unlikely to give you the health benefits you’re seeking.

Vitamin D3 is approximately 87 percent more potent in raising and maintaining vitamin D concentrations and produces 2- to 3-fold greater storage of vitamin D than does D2.3

Regardless of which form you use, your body must also convert it into a more active form, and it is estimated that vitamin D3 is converted 500 percent faster than vitamin D2. Vitamin D2 also has a shorter shelf life, and its metabolites bind poorly with cellular receptor sites, further hampering its effectiveness. So if you decide to supplement with an oral form of vitamin D, make sure it’s D3, not D2.

2.  You Slather on Sunscreen

Do you dutifully slather your body with sunscreen before heading outdoors, and then assume your vitamin D levels are fine because you spend plenty of time in the sun? This, too, is a risk factor for deficiency, because sunscreens effectively block the type of ultraviolet light – UVB — needed in order for your body to produce vitamin D in response to the exposure.

According to vitamin D researcher Michael Holick:4

“ … a sunscreen with a sun protection of 15 absorbs 99% of the incident UVB radiation, and, thus, when topically applied properly will decrease the synthesis of vitamin D3 in the skin by 99%.”

3.  You’re Sunbathing in the Wrong Place

While laying on a glass patio or soaking up rays through a window may feel good on your skin, the warmth that comes through is deceiving because vitamin D-producing UVB rays cannot pass through glass. So you’ll get absolutely no boost to your vitamin D levels if the sunlight passes through a window before hitting your skin.

Worse still, the skin-damaging UVA light, which penetrates your skin more deeply than UVB, and may be a much more important factor in photoaging, wrinkles and skin cancers, does pass through glass. This means that getting sun exposure through a window gives you none of the beneficial UVB, and all of the cancer-causing UVA!

A study in Medical Hypotheses5 even suggested that indoor workers may have increased rates of melanoma because they’re exposed to sunlight through windows, and only UVA light, unlike UVB, can pass through window glass. At the same time, these indoor workers are missing out on exposure to the beneficial UVB rays, and have lower levels of vitamin D.

How to Maximize Your Vitamin D from Safe Sun Exposure

Occasional sunlight exposure to your face and hands is not sufficient for vitamin D nutrition for most people. To optimize your levels, you need to expose large portions of your skin to the sun, and you may need to do it for more than a few minutes. Contrary to popular belief, the best time to be in the sun for vitamin D production is actually as near to solar noon as possible (you need to figure in Daylight Saving Time, which typically pushes solar noon to 1 p.m. for most).

This is because while UVA rays are quite constant during ALL hours of daylight, throughout the entire year, UVB are low in morning and evening and high at midday. So to use the sun to maximize your vitamin D production and minimize your risk of skin damage, the middle of the day (roughly between 10:00 a.m. and 2:00 p.m.) is the best and safest time. During this UVB-intense period you will likely need the shortest sun exposure time to produce the most vitamin D.

As far as the optimal length of exposure, you only need enough to have your skin turn the lightest shade of pink. This may only be a few minutes for those who have very pale skin.

Once you have reached this point your body will not make any additional vitamin D and any further exposure will only result in damage to your skin. Most people with fair skin will max out their vitamin D production in just 10-20 minutes, or, again, when their skin starts turning the lightest shade of pink. Some will need less, others more. The darker your skin, the longer exposure you will need to optimize your vitamin D production.

The skin around your eyes and your face is typically much thinner than other areas on your body and is a relatively small surface area so will not contribute much to vitamin D production. It is strongly recommended to protect this fragile area of your body, as is at a much higher risk for cosmetic photo damage and premature wrinkling. You can use a safe sun block in this area or wear a cap that always keeps your eyes in the shade, which is what I do when I am outside seeking to increase my vitamin D levels.

From a health perspective it doesn’t make much sense to expose your skin to the sun when it is lower than 50 degrees above the horizon because you will not receive any valuable UVB rays, but you will expose yourself to the more dangerous and potentially deadly UVA rays. UVA’s have a longer wavelength than UVB and can more easily penetrate the ozone layer and other obstacles (like clouds and pollution) on their way from the sun to the earth. So while it will give you a tan (mainly by oxidizing melanin instead of producing new melanin), unless the companion UVB rays are available you’re likely doing more harm than good and should probably stay out of the sun to protect your skin.

During the times of the year when UVB rays are not present where you live you essentially have two options: You can use a safe tanning bed or you can swallow oral vitamin D3.

What are the Optimal Levels to Aim For?

I would strongly encourage you to have your blood level checked to confirm that your sun exposure is putting you at the right level, as there are many variables that can influence this, including the darkness of your skin, your age and your geographical location. If it isn’t, or if sun exposure is not a practical option for you, then you should consider supplementing with oral vitamin D3. Remember, unless you get a deep dark tan, which is a pretty good indicator that your vitamin D levels are where they need to be, it is wise to get your blood levels checked — that is the only way to know for certain you have reached therapeutic levels.

Please do take this information seriously, and share it with your friends and family, as correcting a vitamin D deficiency is simple, and it may cut your risk of dying by more than half, according to an analysis conducted last year.6 People with low levels of vitamin D were found to be more likely to have diabetes, high blood pressure, and diseased heart muscle — and were three times more likely to die from any cause compared to those with normal levels. Vitamin D is also emerging as a key player in the fight against cancer, so it is very much to your advantage to get your levels up where they need to be.

Source: Dr. Mercola.

 

 

 

 

New Seal Flu Could Pose Threat to Humans.


A new influenza strain found in New England harbor seals could potentially threaten people as well as wildlife, new research suggests.

Scientists cautioned that viruses like the newly discovered seal flu must be monitored in order to predict new strains and prevent a pandemic flu emerging from animals.

The report was published online July 31 in mBio.

“There is a concern that we have a new mammalian-transmissible virus to which humans haven’t been exposed yet. It’s a combination we haven’t seen in disease before,” report editor Dr. Anne Moscona, professor of pediatrics and of microbiology and immunology at Weill Cornell Medical College in New York City, said in a journal news release.

Another expert agreed that the flu strain could someday pose a threat to people.

“Infections that threaten wildlife and human lives remind us how our health is intermingled on this dynamic planet,” said Dr. Bruce Hirsch, attending physician in infectious diseases at North Shore University Hospital in Manhasset, N.Y. He said that while transmission via direct contact between humans and harbor seals is unlikely, the virus could find other ways to get to people.

“A dangerous virus infecting mammals increases the risk to us — not by direct infection — but by evolutionary development of even more riskier strains,” Hirsch explained. For example, he said, the strain might pass from seals to birds, expand its presence in the environment and mutate in ways that make it easily passed to or between humans.

Scientists from several organizations, including Columbia University and the National Oceanic and Atmospheric Administration, co-wrote the new report. They said that flu viruses found in mammals, such as the H1N1 “swine flu” that emerged in 2009, can put people’s health at risk. The new seal flu, they warned, presents a similar threat to humans.

The researchers analyzed the DNA of a virus linked to the death of 162 harbor seals in 2011 off the coasts of Massachusetts, New Hampshire and Maine. Five autopsies revealed that the seals died from infection with a type of flu known as H3N8.

The report pointed out that the seal flu is very similar to a flu strain found in North American birds since 2002. The virus, the researchers noted, adapted to living in mammals. It also has mutations that are known to make viruses easier to spread and more dangerous. They added the seal flu, which is able to target a protein found in the human respiratory tract, may have the potential to move between species.

The researchers warned that pandemic flu can originate in unexpected ways, so preparation is essential.

“Flu could emerge from anywhere and our readiness has to be much better than we previously realized. We need to be very nimble in our ability to identify and understand the potential risks posed by new viruses emerging from unexpected sources,” said Moscona. “It’s important to realize that viruses can emerge through routes that we haven’t considered. We need to be alert to those risks and ready to act on them.”

Still, viral strains typically must undergo several key mutations to become the source of a human pandemic, Hirsch said.

“Each time the flu virus infects a cell, it is a roll of the dice,” he said. “There are eight separate segments of genes inside the virus — simple viral versions of chromosomes — which recombine at random, producing unique viruses. Cells can be infected with multiple viruses, so a dangerous gene from a bird can get mixed in with a gene that makes it easy to infect humans.”

More information

The U.S. Centers for Disease Control and Prevention provides more information on the spread of flu viruses from animals to people.

Source: Yahoo News