Triglycerides tied to diabetes nerve loss

[xMenace]

Triglycerides tied to diabetes nerve loss - UPI.com (http://www.upi.com/Health_News/2009/05/20/Triglycerides-tied-to-diabetes-nerve-loss/UPI-35751242858736/)

Triglycerides tied to diabetes nerve loss

Published: May 20, 2009 at 6:32 PM

ANN ARBOR, Mich., May 20 (UPI) -- Monitoring blood fat levels as closely as blood sugar may help stem diabetic neuropathy, U.S. researchers suggest.

Researchers at the University of Michigan and Wayne State University in Michigan analyzed data from 427 diabetes patients with neuropathy -- tingling, numbness, burning and pain -- and found those with higher blood triglycerides were more likely to develop a worsening of nerve loss symptoms within the year.

"These results set the stage for clinicians to be able to address lowering lipid counts with their diabetes patients with neuropathy as vigilantly as they pursue glucose control," Dr. Eva Feldman of the University of Michigan Medical School, who was the study's senior author, said in a statement.

"Aggressive treatment can be very beneficial to patients in terms of their neuropathy."

Feldman says people can reduce blood triglyceride levels with the same measures that reduce cholesterol levels, such as avoiding harmful fats in the diet and exercising regularly.

The findings are published in the journal Diabetes.

[xMenace]

Feldman says people can reduce blood triglyceride levels with the same measures that reduce cholesterol levels, such as avoiding harmful fats in the diet and exercising regularly.



Unbelieveable! :eek: :mad:


Triglyceride - Wikipedia, the free encyclopedia (http://en.wikipedia.org/wiki/Triglyceride#Reducing_triglyceride_levels)

Reducing triglyceride levels
To lower triglyceride levels, one may reduce consumption of fats, alcohol and carbohydrates, particularly in rice, and engage in aerobic exercise.[citation needed] The American Heart Association notes that diets high in carbohydrates, with carbohydrates accounting for more than 60% of the total caloric intake, can increase triglyceride levels.[3] Carbohydrate consumption increases insulin production, which is associated with increased triglyceride production.[4] Increased exercise and reduced carbohydrate consumption ameliorate one potential cause of insulin overproduction to help maintain sensible triglyceride levels. Triglyceride levels are also reduced by omega-3 fatty acids from fish, flax seed oil and other sources. Recommendation in the US is that one ingest up to 3 grams a day of such oils. In Europe the recommendation is for up to 2 grams. These omega-3 fatty acids should be associated with Omega-6, ideally in a ω_6/ω_3 ratio unless one is under the care of a physician.[5] Ingestion of Omega-6 fatty acids, more than 1 gram of niacin, mega-dose vitamin B-3, a day, and statins is also recommended.

It has been found that residents in Western countries do not ingest sufficient quantity of food with omega-3. It is therefore common for them to eat excessively high levels of saturated or monounsaturated fatty acids to assimilate sufficient quantity of omega-6 fatty acids. The ideal ratio ω_6/ω_3 is almost never met, and the ratio is often too high, about 12 in France, up to 80 among whites in the US and Canada. Unused saturated or monounsaturated fatty acids accumulate in the body in the form of triglycerides that do not participate in the metabolism of the body.[citation needed]

In some cases, fibrates have been used to bring down TGs substantially. However, prescription of fibrates is not considered as a safe treatment, since they can have unpleasant or dangerous side effects. In one case, clofibrate was withdrawn from the market in North America on the evidence that it might cause an increase in mortality.[6]

Alcohol abuse can elevate triglycerides levels.[7]

Carnitine has the ability to lower blood triglyceride levels, <Balch, Phyllis A. Prescription for nutritional healing. 4th ed. New York: Avery, 2006. pg. 54 Carnitine> ♥

[fgummett]

"...those with higher blood triglycerides were more likely to develop a worsening of nerve loss symptoms within the year"

What were their BG levels during the same time period?

It is my understanding that BGs and Trigs are connected such that better BG control leads to lower Trigs.

As for the "avoiding fats" advice... the usual self-propagating myth... "experts say..."

---

"as vigilantly as they pursue glucose control"... maybe they need to read some of the threads here to learn how "vigilantly" our Doctors are pursuing glucose control.

[NoraWI]

The fat issue is the same old, same old. The relationship is between triglycerides and carbohydrates. Those who cut their intake of carbs find their triglycerides plummet.

[It Ain't Over]

Frank, maybe not quite the same old fat stuff. Seems to be drawing a conclusion as to the ratio of Omega 3 and other fat consumption. We must admit there is something wrong with the western diet. Doesn't take much more than a casual observation to question the extreme levels of hi carb and hi fat consumption. I know fats are not the enemy here, but such excesses are punishable. By death in many cases.
If we could alter our food intake to go with fish, instead of donuts maybe? I work in a large office with a big cafeteria. The line of happy faces coming back with plates of donuts is amazing. I know I have a different viewpoint with the D of course, but I mean this is nuts.

[fgummett]

Is the problem with the donut the fat it is fried in or the refined carbs it is made from? Maybe its both... but my money would go on the carbs first.
I do agree about the imbalance with fats of all types in the modern diet... but at least part of that must come down to the low-fat/high-carb dogma we have been force fed for the last many decades.

[It Ain't Over]

My reading of Bersnstein indicates he thinks the culpret is the carbs. Said fats and carbs are digested and sent into the bloodstream as lipids. Doesn't matter how they start, that is where they go.
Problem today is the level of carbs. Donuts are a great example. Hi fats, hi in trans fats, and hi carbs. All in a big package. No wonder why there is a problem in the West.

[foxl]

But what about those of us who never ate that way, and STILL got T2D??? (I am assuming at this point that is what I have ... the meds diet and ex are working ... so far. And no data to the contrary ... ).

[yannah]

for whatever reason this has just pissed me off. I am so angry.

I never cut fat - I prabably have some as I just eat alot less, but carbs are what I cut. My tryglycerides went from some ungodly number 300 somethin to 84.

what?

what??

what??????

almost everything I have read says it is carbs.

what????

I must be tired.

[It Ain't Over]

But what about those of us who never ate that way, and STILL got T2D??? (I am assuming at this point that is what I have ... the meds diet and ex are working ... so far. And no data to the contrary ... ).

That is a puzzle not easily answered. Seems the everyone wants to fix blame on people with diabetes for doing it to themselves. Words I have heard are no different from any type 2, although much less now than in years gone by.
I don't suscribe to the blame game at any level. I work with a very good guy that is a recovering alcoholic and a type 2. He says the years of abuse caused the problem. I still do not see the need to hand him more blame. He has enough to deal with as it is. There are apparently a lot of reasons one can end up with type 2.

[BlueSky]

Triglycerides tied to diabetes nerve loss

Published: May 20, 2009 at 6:32 PM

ANN ARBOR, Mich., May 20 (UPI) -- Monitoring blood fat levels as closely as blood sugar may help stem diabetic neuropathy, U.S. researchers suggest.

Researchers .... found those with higher blood triglycerides were more likely to develop a worsening of nerve loss symptoms within the year.

"These results set the stage for clinicians to be able to address lowering lipid counts with their diabetes patients ...

"Aggressive treatment can be very beneficial to patients in terms of their neuropathy." ...
It looks like another case of jumping to conclusions. The data shows a correlation between lipid levels and neuropathy. But there is no evidence of causality. For all we know, the triglycerides could be caused by the neuropathy, or both high triglycerides and neuropathy could be caused by something else. In other words, high triglycerides could just be a marker for developing neuropathy.

[REDLAN]

Bluesky wrote
The data shows a correlation between lipid levels and neuropathy.

I think we can challenge even this correlation. The study is quite probably a null result.

The abstract from Diabetes Journal is here

http://diabetes.diabetesjournals.org/content/early/2009/04/29/db08-1771.abstract?sid=c1208992-6702-4f82-94c5-cd38260ac7ed

What you will notice immediately is

To evaluate mechanisms underlying diabetic neuropathy (DN) progression using indices of sural nerve morphometry obtained from two identical randomized placebo-controlled clinical trials.

So we have two clinical trials showing a null result (p=0.87 for the drug group i.e no effect). So what the researchers have done in attempt to salvage a result is to perform a sub-group analysis on their trials.

Using significance testing is like saying, I want to see whether rolling dice could have produced my result. So let's assume that my experiment is completely down to chance. If I take p=0.05 this means that if I use a 20-sided die a roll of 1 gives a significant result - a False Positive. I perform my experiment and get a 15 - oh dear it's clearly a null, and 5 years of data down the drain. But wait I have a trick up my sleeve....

If I keep analysing the data - a sub-group analysis - I can keep rolling my 20-sided dice, and the more I roll it, the more chances I have of getting that magic 1 on the dice. just to give you an idea....

1 roll gives me a 5% chance of getting a 1

2 rolls gives a 10% chance of getting a 1

5 rolls gives a 23% chance of getting a 1

10 rolls gives a 40% chance of getting a 1

And what's this?

Among all variables tested, elevated triglycerides and decreased peroneal motor NCV at baseline significantly correlated with loss of MFD at 52 weeks (p=0.04).


Among all? How many times did they roll that dice?

NCV is neural conductive velocity, the slower the signal travels down a nerve the more neuropathy is present.

and p=0.04 this is no where near good enough to claim significance.

if you're interested in further reading about sub-group analysis there is a good post about on Ben Goldacre Bad Science Blog

http://www.badscience.net/2009/04/a-frankly-thin-contrivance-for-writing-on-the-fascinating-issue-of-subgroup-analysis/#more-1105

[CountYourselfIn]

What levels are we talking about to start seeing damage?

Anything outside the "normal" range?

Special limit for diabetics?

I don't even really know what the symptoms of neuropathy are. For all I know, the nerves in my feet are already dead.

It's interesting information, but at what point do people need to start being concerned?

Here's some info on what Normal looks like:

Triglycerides and Glucose Fasting Levels: Units Conversion (American Vs. Canadian) - Full of Health Inc. (http://www.reducetriglycerides.com/reader_triglycerides_conversion.htm)

[CountYourselfIn]

I'm tired of reading... the internet should speak to me more often.

Some random Canadian Dr on cholesterol:

Dr. Qaadri - Cholesterol Facts & Information (http://www.doctorq.ca/cholesterol.html)

[cyberus]

(shake head)

I eat high fat low carb, my trigs dropped, my neuropathy improved, along with neurotin admittedly but it kept improving long after I started taking it.

[BlueSky]

Thanks for that insight, Redlan. It reminds me of a little book I read many years ago called "How to Lie with Statistics". I don't remember the contents, but the title stuck in my memory. It seem this study is yet another case in point.

[BlueSky]

What levels are we talking about to start seeing damage? ...
Cholesterol doesn't cause any damage. In fact, a major function of cholesterol is to repair damage. But it can cause problems with blocking arteries if the amount of damage is is excessive. A more rational approach would be to focus on preventing that damage in the first place.

[ShottleBop]

"Diabetes Update" for May 24 addresses the study. Excerpt: From Science News we read that a lead researcher on the study had this to say:

"Aggressive treatment can be very beneficial to patients in terms of their neuropathy," says Feldman, who is also director of the A. Alfred Taubman Medical Research Institute and director of the Juvenile Diabetes Research Foundation Center at U-M for the study of complications in diabetes.

People can reduce blood triglyceride levels with the same measures that reduce cholesterol levels: by avoiding harmful fats in the diet and exercising regularly. [emphasis mine]
But wait! High triglycerides are NOT produced by eating "harmful fats." They are produced by eating excess carbohydrate. Lower your carbohydrate intake for even a month and you'll see your triglyceride levels plummet no matter how much fat you eat.

So what this study actually found is not more proof of the dangers of eating a high fat diet. What we have is instead more proof that diabetic complications are a associated with the excess consumption of carbohydrates. Which makes total sense since when people with diabetes eat excess carbohydrates they not only get high triglycerides, they get high blood sugars.

DUH.

You can lower your fat intake all you want and exercise daily, but if you are a person with diabetes whose blood sugars are running higher than normal because you are eating more carbs than your body can burn you are going to have blood sugars at least reaching the pre-diabetic level after meals, the level where solid research has proven diabetic neuropathy begins to occur, if not at frankly diabetic levels.

Is the neuropathy caused by the high triglycerides? Probably not. It's probably caused by the high glucose levels in your blood stream that clog your tiny capillaries and starve nerve fibers.

So what this study probably "proved" is only that high triglycerides are a marker for the elevated carbohydrate intake that produces the high blood sugars that cause neuropathy.

[It Ain't Over]

"So what this study actually found is not more proof of the dangers of eating a high fat diet. What we have is instead more proof that diabetic complications are a associated with the excess consumption of carbohydrates. Which makes total sense since when people with diabetes eat excess carbohydrates they not only get high triglycerides, they get high blood sugars. "
Bingo! I know most here understand this, but it seems the ADA and our friendly dieticians need to get this one. Goes back to that idiotic pyramid scheme diet we are told to eat.