Flaxseed, C-Reactive Protein and Central Obesity

"Flaxseeds are a good source of dietary fiber and omega-3 fatty acids." And flaxseed may be beneficial in other ways. One study has shown that flaxseed consumption may aid in reducing the amount of C-reactive protein (CRP) in the blood. And another study has shown that flaxseed consumption may also aid in the reduction of central obesity.

According to one of the studies mentioned above, CRP is related to inflammation or swelling of the arteries. And this swelling is associated with cardiovascular problems. In the study, which was a Harvard  women's study consisting of 18,000 subjects, researchers noticed that CRP appeared to be more indicative of cardiovascular risk than cholesterol levels. In fact, a high CRP level could increase the risk of cardiovascular problems by a factor of three.

And flaxseed, which contains a large amount of dietary fiber, has been shown to lower the levels of CRP in the blood. In one study, consisting of 27 men who had cardiovascular risk factors, there was a decrease in CRP after the men were given flaxseed. The researchers indicated that "a decrease in inflammatory markers (CRP and TNF-alpha) was observed after flaxseed intake." The researchers suggested "that flaxseed added to a weight loss diet could be an important nutritional strategy to reduce inflammation markers..."

Furthermore, flaxseed added to a diet may reduce central obesity. In a 12 week flaxseed study, 60 overweight and obese women were randomized into two groups. Both groups were put on a balanced diet. However, the control group consumed 30 g/day of milled rice, while the treatment group consumed 30 g/day of milled flaxseed. At the end of the 12 week intervention, the researchers found that "there was [a] significantly higher reduction rate in waist circumference (WC) and waist to hip ratio (WHR) ... in the flaxseed consuming group compared to the control group."

Healthcare providers often look for ways to enable a person to improve his or her health through diet. Using flaxseed as part of a healthy diet may be a way to do that. Therefore, the use of flaxseed may be something healthcare providers might want to consider.

 

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More Rigid Criteria for Prediabetes May Be in Order in the National Diabetes Prevention Program

To delay or prevent type 2 diabetes, the CDC’s National Diabetes Prevention Program Lifestyle Change Program (National DPP LCP) treats individuals with prediabetes. Prediabetes is a condition where a person's blood glucose is elevated, but not elevated enough to be called diabetes. Prediabetes is often a precursor to type 2 diabetes. The prediabetes criteria used by the National DPP to admit persons into its prevention program are the same criteria used by the American Diabetes Association (ADA) and the CDC. However, those criteria allow individuals into the program who may be at a very low risk of contracting type 2 diabetes. So, looking at the probability of contracting diabetes at different points in the ADA's prediabetes criteria range may be beneficial. And one study has done the analysis.

The ADA uses the following criteria for prediabetes: a fasting plasma glucose (FPG) greater than or equal to 100 mg/dL and less than or equal to 125 mg/dL; an impaired glucose tolerance (IGT) where the glucose is greater than or equal to 140 mg/dL and less than or equal to 200 mg/dL; and an HbA1c greater than or equal to 5.7% and less than or equal to 6.4%.

The study mentioned above was done in Spain. There were 1184 participants in the study. And the participants in the study group satisfied two of the ADA's prediabetes criteria. These criteria were FPG between 100 mg/dL and 125 mg/dL and  HbA1c between 5.7% and 6.4%. The mean follow-up for the group was 4.2 years.

The researchers found that individuals at the lower ends of the prediabetes criteria ranges had a lower probability of advancing to type 2 diabetes. Specifically, the researchers stated that "The lowest incidence rate of diabetes was observed in the prediabetes category for isolated FPG 100–109 mg/dL; and the highest, in individuals with FPG within 110–125 mg/dL plus HbA1c 6.0–6.4%. As for reversion to normoglycemia, the highest rate was in the group with isolated HbA1c 5.7–5.9%, and the lowest in the category with FPG 110–125 mg/dL plus HbA1c 6.0–6.4%."

Therefore, focusing on individuals with prediabetes at the higher levels of blood glucose within the ADA's prediabetes criteria ranges may be a better use of resources.

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Higher Levels of Testosterone May Lower Risk of Diabetes for Prediabetic Individuals

There are a number of known risk factors for prediabetes and diabetes. Prediabetes is one of the risk factors for diabetes. And a low testosterone level may be another risk factor for diabetes in males with prediabetes.

Testosterone is a hormone that is found in men, women and other animals. However, men have more testosterone than women. And the testosterone levels decrease as we age. Furthermore, there are undesirable conditions associated with low testosterone levels making higher levels more desirable. One of the undesirable conditions of low testosterone may be an increased risk for diabetes for males with prediabetes. Indeed, one study has shown that a higher level of testosterone can lower the risk of progression from prediabetes to diabetes for men.

The study was a retrospective study done in Vienna. It consisted of 423 males and 287 females. Both the men and women had prediabetes. The average age of the females in the study was 58.6 years of age. And for males, the average age was 58.4 years.

The researchers concluded that “an increase of testosterone levels in males was related to a more favorable glucose metabolism, including lower HbA1c, lower stimulated glucose levels and higher insulin sensitivity...”

Establishing methods to estimate the risk of prediabetes and diabetes is important in healthcare. The American diabetes Association (ADA) and the Centers for Disease Control and Prevention (CDC) have devised a risk test for prediabetes and diabetes. That test includes questions on age (advancing age raises the risk of diabetes); gestational diabetes, parents or siblings who have had diabetes, high blood pressure, physical activity, being overweight, and gender (males have a higher risk of diabetes than females). Perhaps, low testosterone levels in males with prediabetes could be another risk factor for diabetes.

Low testosterone levels can have undesirable effects in men in general. These effects include a lower sex drive, lower energy, lower self-esteem, weight gain and other conditions. Diabetes is one of the most serious and costly chronic conditions in the U.S. So, more research into the possibility that low levels of testosterone might increase the risk of diabetes for men who have prediabetes may be in order.

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Intensive Lifestyle Intervention Can Benefit Health While Changing Our Microbiota

Trillions of microbiota live in our gut. Some of these microbiota perform activities such as the extraction of calories from food and the management of nutrients. While the microbiota are common to all people, each individual has a unique set of the microbiota. And some of the microbiota have a positive impact on our health, while some do not. And one study has concluded that intensive lifestyle intervention plus an energy-restricted Mediterranean diet can improve heath while causing a change in certain microbiota.

The study consisted of two groups: an intensive lifestyle intervention group (IG) and a control group (CG). Both groups followed a Mediterranean diet. The IG participants followed an energy-restricted Mediterranean diet and the participants were advised to engage in physical activity. The CG participants followed a non energy-restricted Mediterranean diet with no advice on physical activity.

The study consisted of men and women from the age of 55 to 75. Participants did not have a “documented history of cardiovascular disease at baseline.” The participants' BMI range from 27 to 40. Each participant also had at least three of the components of metabolic syndrome as defined by American Heart Association and the National Heart, Lung, and Blood Institute.

There were 400 participants in the study. The participants were randomized to one of the two groups, each group consisting of 200 subjects. The CG participants received information on the Mediterranean diet, along with one individual and one group session every six months, to keep the participants on track. The information was delivered by trained dietitians and nurses.

The IC participants received more individualized attention, including motivational interviewing delivered by trained dietitians. The IC group also participated in group sessions. And for one year, the IC participants received a monthly follow-up phone call. The IC group members were also given specific weight loss goals.

At the end of the one-year study, the researchers concluded that for the IC participants, there was a  decrease in “BMI, fasting glucose, glycated hemoglobin, and triglycerides and an increase in HDL cholesterol” compared to the CG participants. There was also a decrease in microbiota, including "Butyricicoccus, Haemophilus, Ruminiclostridium 5, and Eubacterium hallii in the IG compared with the CG."

So, there appears to be a relationship between an intensive lifestyle intervention plus a Mediterranean diet and gut microbiota.  Of course, more research is needed to determine what the relationship is, but intensive lifestyle intervention appears, once more, to be a positive factor in improving health.

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Waist Circumference and Waist-To-Height Ratio for Determining Diabetes Risk

BMI is probably the most commonly used obesity related measurement. However, BMI is not necessarily the best measurement for abdominal obesity. And BMI is not the best predictor of cardiometabolic risks, such as diabetes. Anthropomorphic measurements involving waist are better indicators of these risks in many cases. These measurements include waist circumference (WC), waist-to hip ratio (WHR), and waist-to-height ratio (WHtR).

Two reasons why BMI is the measurement used most often for obesity are its ease of calculation (Weight in Kilograms/(Height in Meters^{2 )} and the U.S. government's recommendation that the measurement be used by physicians. The "government guidelines urge physicians to screen all adult patients for obesity, and offer health and lifestyle counseling for those with a high body mass index (BMI)."

However, a recent study shows that WC and WHtR are better measurements for predicting diabetes risk than BMI. The study was done in China, and consisted of 4052 adult  participants, who were at least 40 years of age. Sixty-seven percent of the participants were women.

The researchers used face-to-face interviews or physical examinations to obtain the data. The researchers found that the risk of diabetes increased with the age of the participants and when related family members had had diabetes. Also, the risk of diabetes was less in those participants with a college degree or more. The researchers also found that WC and WHtR were more closely related to diabetes, and, therefore, better predictors of the disease.

It should be noted that investigators in one study did find that WHtR was a more useful measurement in Asians than in non-Asians. Still, the investigators indicated that their study results supported "the use of WHtR in identifying adults at increased cardiometabolic risk."

Physicians and other healthcare providers might want to consider using WC and WHtR, as well as BMI, as part of patient assessment tools. Including WC and WHtR in their set of patient assessment tools could give providers more insight into unhealthy cardiometabolic conditions like diabetes.  Using these measurements could help providers deliver better care to the patient.

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Prediabetes Affects Body Composition and Handgrip

The generally accepted definition of prediabetes is as follows: prediabetes is where an individual has abnormally high blood glucose, but the blood glucose is not high enough to be called diabetes. Prediabetes can affect the body in a number of ways. According to a recent study done in India, prediabetes can cause unwanted changes in body composition and hand grip. Treating prediabetes may mitigate these changes.

One of the blood-based criteria India typically uses to diagnose prediabetes is as follows: a fasting plasma glucose (FPG) greater than or equal to 100 mg/dL and less than or equal to 125 mg/dL. This is also one of the criteria the American Diabetes Association uses.

In the India study, 200 subjects were examined. One hundred of the subjects had prediabetes and 100 had normal blood glucose. The researchers used special measuring devices to assess the body fat percentage, the visceral fat, and the handgrip strength.

After crunching the data, the researchers found that the mean body fat percentage for the subjects with prediabetes was approximately 29% compared to approximately 25% for the subjects who had normal blood glucose. The visceral fat percentage was approximately 11% for the subjects with prediabetes compared to approximately 7% for the subjects who had normal glucose. And the handgrip strength was approximately 12% less for the subjects with prediabetes compared to the subjects who had normal blood glucose.  

So, the body fat percentages were higher for persons with prediabetes, while handgrip was lower compared with persons with normal glucose. Therefore, the researchers concluded that "changes in body composition and handgrip strength can be included as a primary care strategy to motivate lifestyle modifications."

Many people are interested in being slim and maintaining strength. Being slim is associated with attractiveness. And treating prediabetes to improve appearance and handgrip strength may be something a lot of people will be interested in. 

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Chronic Pain, Weight Loss and the Diabetes Prevention Program

The CDC’s Diabetes Prevention Program (DPP) is a program whose objective is to delay or prevent type 2 diabetes, and one of the key tools used in the program is weight loss. The DPP is a lifestyle change program. And lifestyle change programs can be very effective in weight loss. However, chronic pain can hamper the weight loss process. Therefore, chronic pain could be a negative factor for some participants in a diabetes prevention program, as well as other weight loss programs.

Chronic pain can exacerbate problems associated with weight loss and weight gain. Chronic pain increases inflammation, and inflammation can make it more difficult to lose weight and easier to gain weight. And persons experiencing chronic pain may be more likely to overeat. “The overeating occurs either as a response to pain itself, depression, and/or sleeplessness due to pain.” And of course, chronic pain often leads to less exercise because exercise is painful and chronic pain can hamper enthusiasm for exercise.

A recent retrospective study was done to determine the effect of chronic pain on weight loss. Health records were analyzed to identify persons who suffered from chronic pain during a weight loss study. Three-hundred and ninety-seven adults were studied. The study lasted 24 months. One third of the participants experienced chronic pain.

At six months, participants with and without chronic pain lost about 7 kg of weight. However, after 24 months, the participants with chronic pain lost less weight, losing 3.6 kg compared to 5.2 kg for the participants without chronic pain. The researchers concluded that "participants with chronic pain lost ∼33% less weight over 2 years, which was driven by greater weight regain after the first 6 months.”

Of course the effect that chronic pain has on weight loss and weight regain requires more research. Chronic pain might be an impediment in diabetes prevention, because the existence of chronic pain could hinder weight loss. And this would make it harder for a participant to meet the weight loss goals of the diabetes prevention program.

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