SEPTEMBER HAS BEEN A GOOD MONTH TO TRAVEL , FRIENDS AND DINNERS

Sept 1 left Miami for Bangalore via Frankfurt.
Sept 5 Bangalore to Kuala Lumpur
Sept 9/10 Malacca
Sept 11 Kuala Lumpur to Singapour
Sept 11 Singapour to London
Sept 12 London to Paris
Sept 18 Paris to London
Sept 19 London to Miami
Sept 21 Miami to Oklahoma City
Sept 22 Oklahoma City to Omaha
Sept 23-29 With American Indians
Sept 30 Back to Miami

The conversations which were memorable : Dr Li KL, Dr Tan and Mrs Irene G in Malacca, Family in Paris, Family in Miami, Steve Avery in Sioux City, Hocank and UmonHon Indians in the Indian country

Good Food to remember: Coconut Grove in Bangalore; Ole Sayang Nyonya in Malacca, Maroosh in Miami, Vivace in Omaha and LAN in Miami

Grateful for every one who made this month special. Merci Beaucoup!

RICE AND DIABETES

White Rice, Brown Rice, and Risk of Type 2 Diabetes in US Men and Women
Qi Sun, MD, ScD; Donna Spiegelman, ScD; Rob M. van Dam, PhD; Michelle D. Holmes, MD, DrPH; Vasanti S. Malik, MSc; Walter C. Willett, MD, DrPH; Frank B. Hu, MD, PhD
Arch Intern Med. 2010;170(11):961-969.

Background Because of differences in processing and nutrients, brown rice and white rice may have different effects on risk of type 2 diabetes mellitus. We examined white and brown rice consumption in relation to type 2 diabetes risk prospectively in the Health Professionals Follow-up Study and the Nurses' Health Study I and II.

Methods We prospectively ascertained and updated diet, lifestyle practices, and disease status among 39 765 men and 157 463 women in these cohorts.

Results After multivariate adjustment for age and other lifestyle and dietary risk factors, higher intake of white rice (5 servings per week vs <1 per month) was associated with a higher risk of type 2 diabetes: pooled relative risk (95% confidence interval [CI]), 1.17 (1.02-1.36). In contrast, high brown rice intake (2 servings per week vs <1 per month) was associated with a lower risk of type 2 diabetes: pooled relative risk, 0.89 (95% CI, 0.81-0.97). We estimated that replacing 50 g/d (uncooked, equivalent to one-third serving per day) intake of white rice with the same amount of brown rice was associated with a 16% (95% CI, 9%-21%) lower risk of type 2 diabetes, whereas the same replacement with whole grains as a group was associated with a 36% (30%-42%) lower diabetes risk.

Conclusions Substitution of whole grains, including brown rice, for white rice may lower risk of type 2 diabetes. These data support the recommendation that most carbohydrate intake should come from whole grains rather than refined grains to help prevent type 2 diabetes.

METFORMIN EFFECT ON TSH HYPOTHYROIDISM

Thyroidal Effect of Metformin Treatment in Patients With Polycystic Ovary Syndrome
Mario Rotondi; Carlo Cappelli; Flavia Magri; Roberta Botta; Rosa Dionisio; Carmelo Iacobello; Pasquale De Cata; Rossella E. Nappi; Maurizio Castellano; Luca Chiovato
Authors and Disclosures
Posted: 09/09/2011; Clin Endocrinol. 2011;75(3):378–381 © 2011 Blackwell Publishing

Metformin is widely used for the treatment of type 2 diabetes. Growing evidence supports the beneficial effects of metformin also in patients with polycystic ovary syndrome (PCOS). It was recently reported that metformin has a TSH-lowering effect in hypothyroid patients with diabetes being treated with metformin.
Aim of this study was to evaluate the effect of metformin treatment on the thyroid hormone profile in patients with PCOS.
Patients and measurements Thirty-three patients with PCOS were specifically selected for being either treated with levothyroxine for a previous diagnosis of hypothyroidism (n = 7), untreated subclinically hypothyroid (n = 2) or euthyroid without levothyroxine treatment (n = 24) before the starting of metformin. The serum levels of TSH and FT4 were measured before and after a 4-month period of metformin therapy.
Results Thyroid function parameters did not change after starting metformin therapy in euthyroid patients with PCOS. In the 9 hypothyroid patients with PCOS, the basal median serum levels of TSH (3·2 mIU/l, range = 0·4–7·1 mIU/l) significantly (P < 0·05) decreased after a 4-month course of metformin treatment (1·7 mIU/l, range = 0·5–5·2 mIU/l). No significant change in the serum levels of FT4 was observed in these patients. The TSH-lowering effect of metformin was not related to the administered dose of the drug, which was similar in euthyroid as compared with hypothyroid patients with PCOS (1406 ± 589 vs 1322 ± 402 mg/day, respectively; NS).
Conclusions These results indicate that metformin treatment has a TSH-lowering effect in hypothyroid patients with PCOS, both treated with l-thyroxine and untreated.

Introduction

Metformin is a widely used drug for the treatment of type 2 diabetes. Metformin is commonly regarded as safe drug, because no clinically relevant pharmacologic interaction was described with most of the commonly used drugs, with the exception of folate and vitamin B12.[1–3] With specific regard to polycystic ovary syndrome (PCOS), metformin is not licensed for the treatment of this condition in any country to date.[4] Nevertheless, in the last few years, growing evidence supported beneficial effects of metformin in PCOS.[5,6] These studies prompted consensus statements and recommendations for the use of metformin in patients with PCOS.[7–10]

Despite the fact that metformin was introduced nearly 50 years ago in the clinical practice for the treatment of diabetes, only recently has this drug was reported to modify the thyroid hormone profile,[11–13] producing a significant decrease in the serum levels of TSH. Vigersky et al. [11] described four patients with primary hypothyroidism, being euthyroid on l-thyroxine (LT4), in whom the administration of metformin led to a significant fall in the serum levels of TSH. In these patients, the serum levels of FT4 were unchanged, and no clinical sign of thyrotoxicosis was observed. The effect of metformin was found to be reversible, because drug withdrawal was accompanied by a significant rise in serum TSH levels, which returned to the premetformin serum concentration.[11] More recently, it was demonstrated that the TSH-lowering effect of metformin is also observed in primary hypothyroid patients with diabetes and primary hypothyroidism, who are not treated with L-T4 replacement therapy.[13]

Despite the clinical relevance of these findings, the mechanisms by which metformin produces a TSH-lowering effect remain largely unknown. To further characterise the effect of metformin treatment on circulating thyroid function parameters, we investigated the impact of metformin treatment on the serum levels of thyroid hormones and TSH in a cohort of patients with PCOS, both euthyroid or hypothyroid

SHORT TERM INTENSIVE THERAPY FOR NEWLY DIAGNOSED TYPE 2 DIABETES

Short-term Intensive Therapy in Newly Diagnosed Type 2 Diabetes Partially Restores Both Insulin Sensitivity and Beta-Cell Function in Subjects With Long-term Remission

Hu Y, Li L, Xu Y, et al.
Diabetes Care. 2011;34:1848-1853

Study Summary

The goal of this Chinese study was to examine the effect of intensive glycemic control therapy (IT) on insulin sensitivity and beta-cell function in newly diagnosed type 2 diabetic patients compared with persons with normal glucose tolerance (NGT) and those with impaired glucose tolerance (IGT). Investigators assigned 48 newly diagnosed type 2 diabetic patients to IT (continuous subcutaneous insulin infusion, multiple daily injections, or oral hypoglycemic agents) with the goal of achieving fasting plasma glucose (FPG) < 6.1 mmol/L (110 mg/dL) and postprandial glucose (PPG) < 8.0 mmol/L (144 mg/dL). Treatments were maintained for 2 weeks after the target was achieved, and patients were followed for 1 year. Hyperglycemia relapse was defined as FPG > 7.0 mmol/L (126 mg/dL) or PPG > 11.0 mmol/L (198 mg/dL). Patients who maintained optimal glycemic control for at least 12 months without medication were defined as being in remission, and those who relapsed during the 1-year follow-up were defined as nonremission. Those in remission received no medication, whereas the relapsed patients resumed oral hyperglycemic agents or IT during the 1-year follow-up period. Homeostasis model assessment (HOMA) was used to estimate insulin resistance (HOMA-IR), beta cell function (HOMA-beta) and the disposition index.

After short-term IT, 21 of 48 newly diagnosed type 2 diabetic patients (44%) achieved remission for 1 year, and 27 patients had relapsed (nonremission). There were no apparent differences in therapeutic effectiveness among the 3 different therapies. Before IT, HOMA-IR in both remission (3.12 ± 1.4 [mean +/= SD]) and nonremission (2.70 ± 1.7) groups was significantly higher than that in IGT (1.96 ± 1.1) and NGT (1.37 ± 0.6) persons. After IT, HOMA-IR in the remission group after treatment (1.72 ± 0.8) and at 1 year (2.12 ± 1.3) was comparable with that in IGT and NGT groups (P > .05). However, in the nonremission group, HOMA-IR was reduced from 2.70 ± 1.7 before IT to 2.34 ± 1.4 immediately after IT and to 2.60 ± 1.9 at the 1-year follow-up. IT restored more HOMA-beta in the remission group (44.6 [95% CI, 32.1-69.1] after therapy; 51.9 [28.8-79.8] at 1 year) than in the nonremission group (26.5 [14.9-43.8] after therapy; 31.9 [18.8-52.7] at 1 year). Although more restoration of HOMA-beta was observed in the remission group than in the nonremission group, there was no statistical difference. Disposition index in the remission group was significantly higher than that in the nonremission group after IT and at 1 year.

Viewpoint

Glycemic control is fundamental to the management of diabetes with the objective of (safely) reducing hyperglycemia to as near normal as possible.[1] The current recommendation for newly diagnosed patients is immediate initiation of metformin.[2] However, studies have shown that early intensive insulin therapy can induce and maintain diabetes remission.[3,4] One important and interesting finding of the current study is that similar remission was achieved with oral agents (metformin plus gliclazide if necessary) as with insulin. Treating diabetes intensively at diagnosis, regardless of therapy, achieved a 1-year remission rate of 44%. Thus, for the patient who wants to try lifestyle modification without drugs, as many do, it appears that such a strategy might be effective after first aggressively reducing hyperglycemia. Another interesting finding was that for patients who achieved remission, insulin sensitivity was nearly fully restored, but beta-cell function was only modestly improved after intensive therapy. This may therefore be an important marker of who can maintain glucose control with lifestyle-only therapy following a course of intensive glucose reduction.

Milder Forms of Yoga will Help Older Adults with Diabetes

By Amy Norton

NEW YORK (Reuters Health) Sep 02 - Gentle yoga classes may help people with type 2 diabetes take off a small amount of weight and improve their glycemic control, a small study suggests.

The study, of 123 middle-aged and older adults, found that those who added yoga classes to standard diabetes care shed some pounds over three months. Meanwhile, their average blood sugar levels held steady -- in contrast to a non-yoga control group, whose blood sugar levels rose.

The findings, reported August 11th in Diabetes Care, do not suggest that yoga should replace other forms of exercise for people with type 2 diabetes.

To really lose weight and control blood sugar, more vigorous exercise would work better, according to Dr. Shreelaxmi V. Hegde of the Srinivas Institute of Medical Science and Research Center in Mangalore, India.

Among the 60 study participants who took yoga classes several times a week, the average body mass index declined from 25.9 to 25.4.

"In our study the effect of yoga on BMI and blood sugar control was marginal," Dr. Hegde, the lead researcher on the work, told Reuters Health in an email.

"But," she added, "it should be noted that yoga controlled the blood sugar levels which otherwise rose in the control group."

In addition to that, markers of oxidative stress declined in the yoga group by 20%, on average.

The significance of that is not clear. Dr. Hegde said that if such a decline in oxidative stress were sustained over time, it might lower the chances of diabetes complications.

Further, long-term studies are needed to see whether that is the case, the researchers say.

According to Dr. Hegde, yoga may curb oxidative stress because it stimulates the parasympathetic nervous system.

There are caveats. The yoga used in this study was a gentle form, Dr. Hegde said, and parts of the practice were adapted for people who had additional health problems; certain poses were avoided in people who had heart disease, for example.

In the real world, yoga classes vary widely. Some are vigorous work-outs involving complicated poses that would not be appropriate for older adults with chronic health conditions.

Older adults with diabetes can look for yoga classes designed specifically for older people and those with chronic medical conditions. In the U.S., hospitals and local community centers are increasingly offering such classes.

Testosterone and Fatherhood

12 September 2011

Fatherhood 'lowers testosterone to keep men loyal'
By Michelle RobertsHealth reporter, BBC News
As soon as a man had a baby, his testosterone levels dropped substantially
Men appear to be biologically wired to care for their babies, say researchers who have discovered levels of testosterone go down after fatherhood.
This drop in the male hormone presumably makes the dad more family-oriented and less likely to stray, say the Northwestern University team.
Testosterone increases a man's sex drive and helps him compete for a mate.
The Proceedings of the National Academy of Sciences work followed 624 young men before and after they became fathers.
This revealed that as soon as a man had a baby, his testosterone levels dropped substantially.
Men with newborn babies less than a month old had especially reduced levels of testosterone.
art Quote
This shows the hormonal and behavioural trade-off between mating and parenting, one requiring a high and the other a low testosterone level”
Prof Ashley Grossman of the Society for Endocrinology
Larger falls were also seen in those who were more involved in childcare.
Biological driver
The lead investigator of the work carried out in the Philippines, Christopher Kuzawa, said: "Raising human offspring is such an effort that it is co-operative by necessity, and our study shows that human fathers are biologically wired to help with the job.
"Fatherhood and the demands of having a newborn baby require many emotional, psychological and physical adjustments. Our study indicates that a man's biology can change substantially to help meet those demands."
And the researchers believe lower testosterone levels might protect against certain chronic diseases, which could, in part, explain why married men and fathers often enjoy better health than single men of the same age.
Prof Ashley Grossman, spokesman for the Society for Endocrinology, said life and biology may be "much more subtle and adaptable than we had previously thought.
"This shows the hormonal and behavioural trade-off between mating and parenting, one requiring a high and the other a low testosterone level."
Dr Allan Pacey, senior lecturer in andrology at the University of Sheffield, said the findings were fascinating:
"Testosterone levels in men generally don't change that much. They can slowly decline as men get older and change in response to some medical conditions and treatment. But to see dramatic changes in response to family life is intriguing.
"The observations could make some evolutionary sense if we accept the idea that men with lower testosterone levels are more likely to be monogamous with their partner and care for children. However, it would be important to check that link between testosterone levels and behaviour before we could be certain."