All you can have is a few sips of water during this time so most women schedule the test early in the morning. However if your blood glucose level is within the normal range but you are at high risk for gestational diabetes you may be tested again later in your pregnancy. If you have been diagnosed with gestational diabetes you will need to be tested six to 12 weeks after giving birth to see whether the diabetes is still present.
Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Dubai Hospital Dubai Health Authority & Head of the Emirates Diabetes Society the Burj Al Arab was lit in all hues of blue in a symbolic gesture of its commitment towards reducing the prevalence of diabetes in the if they developed gestational diabetes during While gestational diabetes is cause for concern a healthy diet regular exercise In fact many women with gestational diabetes do not experience any symptoms at all.
The epidemiology of lifestyle and risk for type 2 diabetes Eventually insulin deficiency is absolute. Pre-diabetes has no symptoms but there is a range of risk factors including obesity smoking heart disease polycystic ovary syndrome and high blood pressure.
Umumnya pada penderita diabetes tipe 1 mempunyai kesehatan serta berat badan yang cukup baik pada saat penyakit ini mulai dideritanya. Can anyone explain to me how vitamin d diabetes dosage this is different from eating meat which I’m assuming majority of the disgusted people in this thread do? Without the assisance from the book I don’t think I would have made changing my lifestyle this far. According to diabetes 2 diet and exercise research your gut bacteria are the most accurate preditors for obesity compared to any other risk factors found what are the symptoms for diabetes in your genetic pool1. The bes thing I’ve found about pumping is the stark reduction in the number types and intensity of the hypos experienced. This Quinoa Zucchini Carrot Mushroom Burger is easy to make tastes great and – most importantly – stays together while you cook zwangerschapsdiabetes gevaarlijk it and eat it! Snce healthy food pyramid for diabetes my wife was used to the Japanese versions of the bidets she was initially skeptical about an after market accessory that can be installed on an existing bathroom fixture.
Diabetes affects 18% of people over the age of 65, and approximately 625,000 new cases of diabetes are diagnosed annually in the general population. Rationale: Provides ongoing estimate of volume replacement needs, kidney function, and effectiveness of therapy.
Rationale: Provides the best assessment of current fluid status and adequacy of fluid replacement. Rationale: Changes in mentation can be due to abnormally high or low glucose, electrolyte abnormalities, acidosis, decreased cerebral perfusion, or developing hypoxia. Rationale: Type and amount of fluid depend on degree of deficit and individual patient response.
Rationale: Potassium should be added to the IV (as soon as urinary flow is adequate) to prevent hypokalemia. Diabetes mellitus is a condition in which the pancreas no longer produces enough insulin or cells stop responding to the insulin that is produced, so that glucose in the blood cannot be absorbed into the cells of the body. The most common form of diabetes is Type II, It is sometimes called age-onset or adult-onset diabetes, and this form of diabetes occurs most often in people who are overweight and who do not exercise. The causes of diabetes mellitus are unclear, however, there seem to be both hereditary (genetic factors passed on in families) and environmental factors involved.
In Type II diabetes, the pancreas may produce enough insulin, however, cells have become resistant to the insulin produced and it may not work as effectively. Diabetes mellitus is a common chronic disease requiring lifelong behavioral and lifestyle changes. Several blood tests are used to measure blood glucose levels, the primary test for diagnosing diabetes. Random blood glucose test — for a random blood glucose test, blood can be drawn at any time throughout the day, regardless of when the person last ate. Fasting blood glucose test — fasting blood glucose testing involves measuring blood glucose after not eating or drinking for 8 to 12 hours (usually overnight).
Oral glucose tolerance test — Oral glucose tolerance testing (OGTT) is the most sensitive test for diagnosing diabetes and pre-diabetes.
Oral glucose tolerance testing is routinely performed at 24 to 28 weeks of pregnancy to screen for gestational diabetes; this requires drinking a 50 gram glucose solution with a blood glucose level drawn one hour later. When diet, exercise and maintaining a healthy weight aren’t enough, you may need the help of medication.
The most widely used form of insulin is synthetic human insulin, which is chemically identical to human insulin but manufactured in a laboratory. Advice patient about the importance of an individualized meal plan in meeting weekly weight loss goals and assist with compliance. Assess patients for cognitive or sensory impairments, which may interfere with the ability to accurately administer insulin. Review dosage and time of injections in relation to meals, activity, and bedtime based on patients individualized insulin regimen. Instruct patient in the importance of accuracy of insulin preparation and meal timing to avoid hypoglycemia. Advise patient to assess blood glucose level before strenuous activity and to eat carbohydrate snack before exercising to avoid hypoglycemia.
Assess feet and legs for skin temperature, sensation, soft tissues injuries, corns, calluses, dryness, hair distribution, pulses and deep tendon reflexes. Advice patient who smokes to stop smoking or reduce if possible, to reduce vasoconstriction and enhance peripheral flow.
About Juvenile Diabetes Research Foundation JDRF has been responsible for more than 600 million direct funding of the most promising and groundeaking type 1 diabetes research around the world. Diarrhoea Dry Skin Female Sterility Ear-Ache Emphysema Epilepsy Fever Gallstone Gall Bladder Disorders Gastritis Goitre Gout Hair Loss Halitosis Headaches High Blood Cholesterol High Blood Pressure Increased Tiredness.
Clinical and experimental studies on the treatment of diabetes mellitus with berberine Frequent urination means needing to urinate more often than usual. And if you were not routinely checked for diabetes during pregnancy and you delivered a baby nine pounds or larger it may be a symptom of diabetes. Diabetes mellitus is a chronic disease involving abnormalities in the body’s ability to use sugar. Science, Technology and Medicine open access publisher.Publish, read and share novel research. Nutritional Therapy in Diabetes: Mediterranean DietPablo Perez-Martinez1, Antonio Garcia-Rios1, Javier Delgado-Lista1, Francisco Perez-Jimenez 1 and Jose Lopez-Miranda1 Department of Medicine, IMIBIC, Hospital Universitario Reina Sofia,Universidad de Cordoba and CIBEROBN Instituto de Salud Carlos III, Madrid, Spain1. Good nutrition is especially important during pregnancy if you’ve developed gestational diabetes.
Before this test your doctor will ask you to fast which means having nothing to eat or drink except water for at least eight hours.
Insulin-shock therapy also had more value in the treatment of paranoid and catatonic has been widely used how to control diabetes with exercise and diet in treating disturbances in which severe depression is the predominant Some have side effects from it though have you? My first cup didn’t lastas long as my second one has before become discolored and chalky. The effect of cinnamon on glucose and blood lipids levels on people with type 2 diabetes was tested in a recent randomized placebo-controlled trial. In our Healthy Cooking section we have delicious low-carb low-fat foods for the diabetes-conscious. Gestational diabetes is high Foods zwangerschapsdiabetes roken from this group are excellent sources of B vitamins protein iron and zinc. Moreover keeping a track of how you plan prepare and eat foods can significantly lower the dosage of insulin to be administered daily thus helping you lead a healthy and a happy life. Journal of Diabetes & Metabolism is a free medical journal that publishes discoveries and current Understanding how insulin affects your blood sugar can help you better manage your condition. Canine and feline diabetes mellitus indian fods to avoid for diabetics diabetes grain free diet diabetes questionnaire validation Cable connections are worse than Fios because cable is like being on a peer to peer network.
Diabetic Neuropathy (diabetic nerve damage) of the foot is a common complication of diabetes.
A game called Pandemic where you take control of the evolution of a pathogen and try to infect the whole world. Demonstrate adequate hydration as evidenced by stable vital signs, palpable peripheral pulses, good skin turgor and capillary refill, individually appropriate urinary output, and electrolyte levels within normal range.
Note: Potassium phosphate may be drug of choice when IV fluids contain sodium chloride in order to prevent chloride overload.
Type II is considered a milder form of diabetes because of its slow onset (sometimes developing over the course of several years) and because it usually can be controlled with diet and oral medication.
Symptoms of Type II diabetes can begin so gradually that a person may not know that he or she has it.
It is best managed with a team approach to empower the client to successfully manage the disease. The body’s primary energy source is glucose, a simple sugar resulting from the digestion of foods containing carbohydrates (sugars and starches). It is used to monitor blood glucose control in people with known diabetes, but is not normally used to diagnose diabetes. However, the OGTT is not routinely recommended because it is inconvenient compared to a fasting blood glucose test. The person then drinks a 75 gram liquid glucose solution (which tastes very sweet, and is usually cola or orange-flavored).
For women who have an abnormally elevated blood glucose level, a second OGTT is performed on another day after drinking a 100 gram glucose solution. These medications, such as repaglinide (Prandin), have effects similar to sulfonylureas, but you’re not as likely to develop low blood sugar. Metformin (Glucophage, Glucophage XR) is the only drug in this class available in the United States.
These drugs block the action of enzymes in your digestive tract that break down carbohydrates. These drugs make your body tissues more sensitive to insulin and keep your liver from overproducing glucose. By combining drugs from different classes, you may be able to control your blood sugar in several different ways. Diabetes Type 2 Side Effects California Thousand Oaks however after this holiday season my readings are much higher. This is why recognizing the early signs of ketoacidosis is key to steering clear of ketoacidosis. If you’re suffering from constant bothersome type 2 diabetes symptoms weight gain and rising blood sugar numbers that you don’t want to get worse Diabetes Type 2 Side Effects California Thousand Oaks then there is hope for you to stop your rising blood sugar problem once and for all!
Types of diabetes Type 1 diabetes was previously called insulin-dependent diabetes mellitus (IDDM) or Women who have had gestational diabetes have a 20% to 50% chance of developing diabetes in National diabetes fact sheet: general information and national estimates on diabetes in the United Type 1 diabetes (Type I diabetes) Early signs are tiredness extreme thirst and frequent urination. But our results suggest we should also be concerned about elevated blood sugar levels in non-diabetics as well. 2009 12-16 JJustad MD DDP Best Practice Guidelines 3 Management of Type 2 Diabetes Hypertension: Hypertension is a common problem in type 2 gestational diabetes test while sick me portland diabetes.
Bikram Yoga is the single best form of yoga for the achievement and maintenance of perfect health a perfect body and a sharp mind. IntroductionDiabetes mellitus is a chronic illness which has an outstanding impact on public health due to its increasing prevalence, poor prognosis, and due to the high impact on cardiovascular health. Garg, 1998High-monounsaturated-fat diets for patients with diabetes mellitus: a meta-analysis.
Prevalence of gestational diabetes mellitus and pregnancy outcomes in Asian women with polycystic ovary syndrome. These women end up with high blood sugar or gestational diabetes at around the 20th to 24th week of pregnancy. Curet MD Professor and Vice-Chair of Obstetrics and Gynecology; Director Prophylactic insulin in the management of gestational diabetes. The 3-hour glucose tolerance test GTT is used during pregnancy to rule out or diagnose gestational diabetes.
While diabetes has a variety of symptoms associated with it only a proper medical diagnosis will let you know for sure whether or not you actually have this disorder. What diet in gestational diabetes ppt orange california is your current knowledge level about preventing gestational diabetes? 1994] Review [Alternative to insulin therapy: diet and physical exercise] Krenko and whatserface were from Ravnica Neferox Grixis Overlord was from. Diabetes Prevalence Worldwide 2014 otherwise you get a head rush every time you stand up which is a bit annoying.
While gestational diabetes usually disappears once the mother has given birth five to ten percent of sufferers develop type diabetes immediately after diabetes treatment by diet delivery.7 Women with gestational diabetes Healthy eating physical activity and insulin therapy are the three basic treatments for type diabetes in cats muscle weakness 1 diabetes. Insulin Forward is an education program designed to empower patients vertigo diabetes symptom who use insulin to manage their diabetes and caregivers who assist with treatment.
Information on diabetes testing methods when to be tested for diabetes and diabetic diagnosis. PCOS is an adjunct to insulin resistance therefore on top of Studies have shown that the body has an especially difficult time detoxifying organic substances thathave been chlorinated. Leonard Roy Franks Anti-psychiatry activist and psychiatric survivor talks about his experiance with insulin coma shock therapy. For you ladies whom have had children: Have you ever had gestational diabetes while pregnant?
Presence of infectious process results in fever and hypermetabolic state, increasing insensible fluid losses. The treatment includes changes in diet, oral medications, and in some cases, daily injections of insulin. The consequences of uncontrolled and untreated Type II diabetes, however, are the just as serious as those for Type I. In Type I diabetes, the immune system, the body’s defense system against infection, is believed to be triggered by a virus or another microorganism that destroys cells in the pancreas that produce insulin. As part of the team the, the nurse plans, organizes, and coordinates care among the various health disciplines involved; provides care and education and promotes the client’s health and well being. Glucose from the digested food circulates in the blood as a ready energy source for any cells that need it.
The blood glucose level is measured before, and at one, two, and three hours after drinking the solution.
Everyone with type 1 diabetes and some people with type 2 diabetes must take insulin every day to replace what their pancreas is unable to produce. One of its chief failings is that it doesn’t mimic the way natural insulin is secreted. It works by inhibiting the production and release of glucose from your liver, which means you need less insulin to transport blood sugar into your cells. That means sugar is absorbed into your bloodstream more slowly, which helps prevent the rapid rise in blood sugar that usually occurs right after a meal. Side effects of thiazolidinediones, such as rosiglitazone (Avandia) and pioglitazone hydrochloride (Actos), include swelling, weight gain and fatigue.
This textbook continues to evolve and address the newest and most important insights into this very old but very normal blood sugar levels canada iowa davenport challenging disease.
When you have type 2 diabetes taking time to plan your meals goes a Be aware that milk yogurt and other dairy foods have natural sugar even when they do not contain added sugar. Such is its importance, that diabetes is actually considered an independent predictor of cardiovascular disease (which includes coronary heart disease and stroke). So I’m 35 weeks pregnant and have gestational diabetes and I got sick about 2 weeks ago since I got sick 2 weeks ago my blood sugar levels have been high I’m not on any medication and for the past few weeks have been able american diabetes association type 2 treatment algorithm san diego california to control it with my diet Gestational Diabetes Mellitus Is it physiological?
Canadian Diabetes Association 2003 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance of varying degrees of severity with onset or first recognition during pregnancy. Every five years the Canadian Diabetes Association (CDA) updates the Clinical Practice Guidelines used by health care professionals to help you manage your diabetes.
Diabetologia publishes original clinical and experimental research within the field of diabetes. Then a few months ago my husband and I watched Dr Bronner’s Magic Soapbox on DVD (and thoroughly enjoyed the documentary) and we had to try the soap. We were looking for something affordable and Diabetes Prevalence Worldwide 2014 natural for the dishwasher. Obviously there’s a pretty god biological reason for everything about the body from a survival point of view.
DKA is a life-threatening emergency caused by a relative or absolute deficiency of insulin. This form is also called noninsulin-dependent diabetes, a term that is somewhat misleading.
Other symptoms may include sudden weight loss, slow wound healing, urinary tract infections, gum disease, or blurred vision.
Insulin is a hormone or chemical produced by cells in the pancreas, an organ located behind the stomach.
Unfortunately, insulin can’t be taken in pill form because enzymes in your stomach break it down so that it becomes ineffective.
But newer types of insulin, known as insulin analogs, more closely resemble the way natural insulin acts in your body. Second-generation sulfonylureas such as glipizide (Glucotrol, Glucotrol XL), glyburide (DiaBeta, Glynase PresTab, Micronase) and glimepiride (Amaryl) are prescribed most often. One advantage of metformin is that is tends to cause less weight gain than do other diabetes medications.
Most doctors prescribe two drugs in combination, although sometimes three drugs may be prescribed.
But with modest weight loss and moderate daily physical activity you can delay or even prevent type 2 diabetes and lead a normal life. Although no one knows for certain what causes type 2 diabetes there seems to be a genetic risk.
Hypertension is also thought to Palmer AJ Annemans L diabetes in pregnancy management in labour mn minneapolis Roze S et al. Low blood sugar is most often a side effect of insulin and other Type 2 Diabetes medications. Donate Treatment of chronic renal failure depends on the degree of kidney function that remains. Moreover, the cardiovascular risk of individuals with diabetes is considered to be equivalent to the risk of nondiabetic individuals with pre-existing cardiovascular diesease.
Lemberg, 2002High-sensitivity C-reactive protein is the most effective prognostic measurement of acute coronary events. Recommended maximum what are 3 symptoms of diabetes clarksville tennessee blood sugars Please check out his web and the movie they shot of his work with 2 Indigenous Tribes in Canada.
Low Blood Sugar If your blood sugar has been elevated during the pregnancy, your baby may have low blood sugar, called hypoglycemia, shortly after birth. Others have already mentioned it but yes it does sound like you just need a little support in te nursing childhood obesity and diabetes facts direction.
Having to buy larger size clothing to accommodate your belly fat (and perhaps fat elsewhere too) can be really frustrating, not to mention more expensive if you have to move into plus size or big and tall sizes.
Many people with Type II diabetes can control the condition with diet and oral medications, however, insulin injections are sometimes necessary if treatment with diet and oral medication is not working. It is not unusual for Type II diabetes to be detected while a patient is seeing a doctor about another health concern that is actually being caused by the yet undiagnosed diabetes. Insulin bonds to a receptor site on the outside of cell and acts like a key to open a doorway into the cell through which glucose can enter. For that reason, many people inject themselves with insulin using a syringe or an insulin pen injector,a device that looks like a pen, except the cartridge is filled with insulin. The most common side effect of sulfonylureas is low blood sugar, especially during the first four months of therapy.
Possible side effects include a metallic taste in your mouth, loss of appetite, nausea or vomiting, abdominal bloating, or pain, gas and diarrhea. Although safe and effective, alpha-glucosidase inhibitors can cause abdominal bloating, gas and diarrhea.
The thiazolidinedione troglitzeone (Rezulin) was taken off the market in March 2000 because it caused liver failure. Newer medications, such as Glucovance, which contains both glyburide and metformin, combine different oral drugs in a single tablet. Symptoms of type I diabetes may appear suddenly and can include the following Usage and dosage: As dietary supplement take 30 pills each time 2 times a day. Therefore, persons with diabetes mellitus have an increased susceptibility to atherosclerosis and an increased prevalence of ahterogenic risk factors, notably hypertension, obesity, and anormal lipids.
Cases of gestational diabetes are reported as in pregnancy in childbirth or in the – aiming for fairly high protein snacks. For patients with type 2 diabetes Bydureon taken as an injection after the user mixes the medication with a powder and a liquid solution and should be refrigerated before use.
With low carb foods being so great for almost any diet just which ones are best and how easy is it to include them in your weekly shopping? The other thing about eating in basic is what I and many others call EFE or Eat For Effect.
Some of the glucose can be converted to concentrated energy sources like glycogen or fatty acids and saved for later use. Others may use an insulin pump, which provides a continuous supply of insulin, eliminating the need for daily shots.
You’re at much greater risk of low blood sugar if you have impaired liver or kidney function. These effects usually decrease over time and are less likely to occur if you take the medication with food. If your doctor prescribes these drugs, it’s important to have your liver checked every two months during the first year of therapy.
This compendium of the abnormalities can be found in people with metabolic syndrome (MetS) which is now regarded as a prelude to diabetes and such as diabetes, MetS is a substantial predictor of cardiovascular disease and all-cause mortality(Ford, et al.
Giugliano, 2010Prevention and control of type 2 diabetes by Mediterranean diet: a systematic review. Giugliano, 2009bAdherence to a Mediterranean diet and glycaemic control in Type 2 diabetes mellitus. Slide 35 : Tips for diet management Small eakfast Mid morning snack High protein lunch Mid afternoon snack Usual dinner Bed time snack. Results in 12 practices of general joslin diabetes center peng yi practitioners] Our study reports the experience of the structure and medical management of a population-representative collective of patient with 2DM under the care of 2000-2014 Unbound Medicine Inc.
Positive and negative experiences from patients with okra cures diabetes snopes Diabetes Insipidus that take Calcium Fill up your water bottle accu chek glucose meter flipkart at night and put a tea bag in. When there is not enough insulin produced or when the doorway no longer recognizes the insulin key, glucose stays in the blood rather entering the cells. A rare but serious side effect is lactic acidosis, which results when lactic acid builds up in your body. Contact your doctor immediately if you experience any of the signs and symptoms of liver damage, such as nausea and vomiting, abdominal pain, loss of appetite, dark urine, or yellowing of your skin and the whites of your eyes (jaundice). Since neuropathy and nephropathy are microvascular Type 2 diabetes (T2D) complications relationships between skin conductance estimated glomerular ltration rate (eGFR) and urine albumin:creatinine ratio (UACR) were assessed. 2002).Morbidity and mortality from these chronic diseases in the general population have a multifactorial origin, resulting from the interaction between genetic background and environmental factors. Jialal, 2008High-fat, energy-dense, fast-food-style breakfast results in an increase in oxidative stress in metabolic syndrome.
Dietz, 2002Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. It’s what is touching your leg right now what is type 2 diabetes nhs diabetes log book free download Diabetes Res Clin Pract. It is very responsive to the slightest noise so if you don’t want the volume to suddenly spike up best to leave it off. These may not always be related to diabetes medications, but your doctor will need to investigate all possible causes. Among the latter, diet is probably the most relevant factor in order to prevent acute complications and to reduce the risk of long-term complications. Tinahones, 2008Fat overload aggravates oxidative stress in patients with the metabolic syndrome. Stefanadis, 2004Adherence to the Mediterranean diet attenuates inflammation and coagulation process in healthy adults: The ATTICA Study.
Astrup, 2008Comparison of 3 ad libitum diets for weight-loss maintenance, risk of cardiovascular disease, and diabetes: a 6mo randomized, controlled trial. On a microscopic level it looks more like shards of broken ketones diabetes levels glass rather than the normally smoothed rounded look of sand. Lactic acidosis is especially likely to occur if you mix this medication with alcohol or have impaired kidney function. Thus, it has been demonstrated that medical nutrition therapy is important in preventing diabetes, managing existing diabetes, and preventing, or at least slowing, the rate of development of diabetes complications. Willett, 2007Dietary patterns, insulin resistance, and prevalence of the metabolic syndrome in women. The basis of what constitutes optimal nutrition has been the subject of decades of research spanning the whole range of study designs, from ecological studies to in vitro modulation of gene expression.
Giugliano, 2004Effect of a mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial.
Gonzalez-Correa, 2010Virgin olive oil administration improves the effect of aspirin on retinal vascular pattern in experimental diabetes mellitus.
Fuentes, et al.2008Chronic dietary fat intake modifies the postprandial response of hemostatic markers to a single fatty test meal.
Marrugat, al, 2007Effect of a traditional Mediterranean diet on lipoprotein oxidation: a randomized controlled trial.
Perez-Jimenez, 2008Chronic effects of a high-fat diet enriched with virgin olive oil and a low-fat diet enriched with alpha-linolenic acid on postprandial endothelial function in healthy men. Ordovas, et al.2001Mediterranean and low-fat diets improve endothelial function in hypercholesterolemic men.
Thus, the MedDiet pattern is built on the basis of a consumption of fat primarily from foods high in MUFA (olive oil as the principal source of fat), and emphasizes the consumption of fruits, vegetables, legumes, nuts, and fish, as well as a moderate consumption of alcohol.
In this regard, the MedDiet pattern has been associated with higher survival due to lower all cause mortality(Knoops, et al. A recent meta-analysis of prospective studies based on 1.5 million subjects and 40,000 fatal and non-fatal events showed that a greater adherence to this dietary pattern was significantly associated with a reduction of overall mortality, cardiovascular mortality, cancer incidence and cancer mortality, and incidence of Alzheimer’s disease and Parkinson’s disease(Sofi, et al. In addition, a recently cross-sectional assessment of baseline data from a cohort of high-risk participants in the PREDIMED study, a large-scale feeding trial of primary cardiovascular prevention(Sanchez-Tainta, et al. 2008), showed that adherence to the MedDiet was inversely associated with the clustering of diabetes mellitus, obesity, hypertension and hypercholesterolemia. The follow-up of large cohorts of healthy populations living in Mediterranean countries, such as the Greek EPIC(Psaltopoulou, et al.
2009) study cohorts, are providing new information suggesting that increasing adherence to the MedDiet relates to a reduced prevalence of risk phenotypes. In this regard, the MedDiet pattern is being reconsidered as the one of the more holistic approaches for the control of metabolic diseases including at the same time salutary and pleasure components.
In this regard, pioneering nutritional strategies, such as nutraceuticals, have been developed aimed at reducing the main metabolic risk factors and promoting cardiovascular health.
In this context, a growing body of clinical evidence has demonstrated positive cardiovascular effects associated with olive oil, antioxidants, and polyphenols intake. Traditionally, many beneficial properties associated with olive oil have been ascribed to its high oleic acid content. Olive oil, however, can be considered a functional food that, besides having high-MUFA content, contains other minor components with biological properties(Perez-Jimenez, et al. Thus, phenolic compounds have shown antioxidant and antiinflammatory properties, prevent lipoperoxidation, induce favorable changes of lipid profile, improve endothelial function, and disclose antithrombotic properties(Lopez-Miranda, et al. Therefore, all those evidences suggest that MedDiet could serve as an antiinflammatory dietary pattern, which could help fighting diseases that are related to chronic inflammation, such as MetS and type 2 diabetes.
In this context, it has been clearly demonstrated that many components of the MedDiet have been considered to be important in the treatment and modulation of cardiometabolic diseases. In the present chapter, we review the state of the art illustrating the relationship between MedDiet rich in olive oil and metabolic diseases, including MetS and diabetes mellitus and to discuss potential mechanisms by which this food can help in disease prevention and treatment.2. Mediterranean diet and diabetesIn the last decade the incidence of conditions associated with insulin resistance, including metabolic syndrome and diabetes mellitus, is increasing rapidly worldwide. Although pharmacological interventions are available for minimizing or delaying the comorbidities associated with insulin resistance and the metabolic syndrome, as well as diabetes, initial management for the vast majority of the affected population remains focused on lifestyle modification, consisting of sustainable changes in dietary habits and physical activity. Lifestyle modification, in particular recommendations to follow an appropriate dietary pattern, has generally been accepted as a cornerstone of treatment for people with these conditions, with the expectation that an appropriate intake of energy and nutrients will improve glycaemic control and will reduce the risk of complications. The factors that regulate body fat distribution, insulin resistance, and associated metabolic disturbances are not fully understood. Nevertheless, increasing scientific evidence suggests that dietary habits may be an important environmental factor regulating glucose and fat metabolism(Phillips, et al.
Epidemiological studies indicate that Western-style dietary patterns promote the MetS, while diets rich in vegetables, fruits, grains, fish and low-fat dairy products have a protective role(Esmaillzadeh, et al. In the same line, two studies in Southern European populations showed that a greater adherence to the MedDiet was associated with reduced prevalence (Panagiotakos, et al. To date, several feeding trials have assessed the effect of dietary patterns on the metabolic syndrome status (Azadbakht, et al. These studies used a behavioral program to implement a relatively low-fat MedDiet(Esposito et al. 2004), intensive lifestyle intervention with inclusion of a vegetable-rich diet restricted in animal fat (Orchard et al. 2005) used energy-restricted diets that led to some degree of weight loss, while one study(Salas-Salvado et al. In all these studies, a decreased prevalence of metabolic syndrome was shown in the intervention groups. Moreover, in a subgroup of this study including the Reus PREDIMED Centre some components of the MedDiet, such as olive oil, legumes and red wine were associated with lower prevalence of MetS (Babio, et al.
On the other hand, results of a study in overweight, insulin-resistant patients also suggest that, by comparison with a low-fat diet, a MUFA-rich diet prevents the redistribution of body fat from peripheral to visceral adipose tissue without affecting total body weight(Paniagua, et al.
2010).Because diabetes is a frequent outcome in patients with sustained MetS, it is reasonable to assume that the MedDiet might also prevent the development of diabetes in predisposed persons or beneficially influence the metabolic abnormalities associated with the diabetic status(Giugliano and Esposito 2008). In this context, two prospective studies from Southern European cohorts suggest a lower incidence of diabetes with increasing adherence to the MedDiet in previously healthy persons(Martinez-Gonzalez, et al.
In contrast, in the absence of weight loss, the low-fat diet used in the Women’s Health Initiative trial(Tinker, et al. Furthermore, in the set of the PREDIMED study, it has been tested the effects of two MedDiet interventions versus a low-fat diet on incidence of diabetes. Interestingly, when the two MedDiet groups were pooled and compared with the control group, diabetes incidence was reduced by 52%. In all study arms, increased adherence to the MedDiet was inversely associated with diabetes incidence.
It is also important to highlight that diabetes risk reduction occurred in the absence of significant changes in body weight or physical activity. These results extend those of prior studies showing that lifestyle interventions can substantially reduce the incidence of diabetes in individuals at high risk(Knowler, et al.
However, in these studies, the interventions consisted of advice on a calorie-restricted diet plus physical activity and, except for one study(Ramachandran et al. 2006), weight loss was a major driving force in reducing the incidence of diabetes(Salas-Salvado, et al. 2011).Diets high in SFA consistently impair both insulin sensitivity and blood lipids, while substituting carbohydrates or MUFA for SFA reverts these abnormalities(Riccardi, et al.
Postprandial lipemia and glucose homeostasis are also improved after meals containing MUFA from olive oil compared to meals rich in SFA(Lopez, et al. Thus, an examination of the association of dietary and membrane fatty acids with insulin secretion in the cross-sectional Pizarra study(Rojo-Martinez, et al. 2006) showed that dietary MUFA contributed to the variability of ?-cell function, with a favorable relationship of MUFA with ?-cell insulin secretion, independently of the level of insulin resistance.The question as to what was the best nutrient to replace energy sources from SFA in the diabetic diet, carbohydrates or MUFA, was also hotly debated.
Since the late 1980’s, many feeding trials have compared the effects of isoenergetic high carbohydrates (CHO) and high MUFA diets on insulin sensitivity in healthy subjects and on glycemic and lipid control in diabetic patients(Garg 1998; Ros 2003). Garg’s meta-analysis(Garg 1998) favored high MUFA diets, but most of the studies reviewed therein were performed with metabolic diets having wide differences in total fat content between the two experimental diets, ranging from 15% to 25% of energy.
Nevertheless, high MUFA diets generally had more favorable effects on proatherogenic alterations associated with the diabetic status, such as dyslipidemia, postprandial lipemia, small LDL, lipoprotein oxidation, inflammation, thrombosis, and endothelial dysfunction(Ros 2003). Although we will discuss this point later, of particular interest is the ability of the olive oil-rich MedDiet to improve mild systemic inflammation, as shown by the reduction of C-reactive protein and inflammatory cytokines in the study of Esposito et al.(Esposito et al. 2006) in diabetic patients and other subjects at high risk for coronary heart disease (CHD). In addition, in a cross-sectional analysis of a population of type 2 diabetic patients, the adherence to a MedDiet was inversely associated with glycosylated haemoglobin and postprandial glucose levels during free living conditions, independent of age, adiposity, energy intake, physical activity and other potential confounders(Esposito, et al.
This association was apparent even although no strong associations were evident for each of the components of the MedDiet score, except for a modest association with whole grains and the ratio of MUFA to saturated lipids. However its cross-sectional nature does not allow us to make inference about cause and effect.
Furthermore a systematic review of the available studies confirmed that adopting a MedDiet may help to prevent type 2 diabetes, and also improve glycaemic control and cardiovascular risk in persons with established diabetes(Esposito, et al. 2010).Despite the beneficial effect attributed to the MedDiet, the American Diabetes Association (ADA) recommends that patients with newly diagnosed type 2 diabetes be treated with pharmacotherapy as well as lifestyle changes(Nathan, et al.
The rationale for combination therapy is presumably that each form of treatment alone is imperfect. Lifestyle changes are often inadequate because patients do not lose weight or regain weight or their diabetes worsens independent of weight. After 4 years, they found that the MedDiet delayed the need for antihyperglycemic drug therapy.
There were no differences in the degree to which participants in each group increased their physical activity or decreased their caloric intake, so the effect seems specific to the MedDiet and is probably, although not exclusively, linked to its ability to induce greater weight loss, in accord with results of a recent trial(Shai, et al. The between-group difference in the proportion of people needing antihyperglycemic drug therapy increased over the course of the trial and favored the MedDiet, whereas the between-group differences in weight loss decreased. 2008), and this component of the diet might explain the favorable effect of the MedDiet on the need for drug therapy.
In summary, although more data are mandatory, there is good scientific support for MedDiet diets, especially those based on olive oil, as an alternative approach to low-fat diets for the medical nutritional therapy in MetS and diabetes.3.
Protective mechanisms of mediterranean diet Several mechanistic links offer potential explanations of protective effect of the MedDiet on type 2 diabetes. Excessive oxidative stress and inflammation are closely associated with the pathogenesis of many human diseases (such obesity, MetS, diabetes, cardiovascular diseases, neurodegenerative diseases and aging). The potential reversal of those conditions can be achieved by reducing the levels of inflammation through the consumption of an anti-inflammatory dietary pattern. Usually this may occur through the reduction of systemic vascular inflammation and endothelium dysfunction without having a drastic effect on body weight. Phenolic compounds are the focus of intense research in the last years, due to the biological properties that they have proven, mainly as potent antioxidants and anti-inflammatory agents; therefore, they can modulate signal transduction pathways to elicit their beneficial effects in human diseases. It is of note that phenols are not uniquely represented in olive oil in the traditional MedDiet, but also in other classic foods, such as wine, fruits and vegetables. Beyond this, epidemiological and interventional studies have revealed a protective effect of the MedDiet against mild chronic inflammation and its metabolic complications (Chrysohoou, et al.
Inflammation and oxidative stressThe origins of heightened inflammatory activity in diabetes are diverse. In type 1 diabetes, islet inflammation is thought to be a local phenomenon driven by a focal autoimmune attack on islet antigens. By contrast, in type 2 diabetes, activation of inflammation results from systemic etiologic factors, such as central obesity and insulin resistance. Ultimately inflammatory mediators activate a series of receptors and transcription factors such as NF-?b, toll-like receptors, c-Jun amino terminal kinase, and the receptor for advanced glycation end products, which lead to ?-cell dysfunction and apoptosis, impaired insulin signaling in insulin-sensitive tissues, systemic endothelial dysfunction, and altered vascular flow. NF-?B is a pleiotropic transcription factor activated by low levels of reactive oxygen species (ROS) and inhibited by antioxidants(Mantena and Katiyar 2006).
This factor regulates the expression of several cytokines, chemokines, cell adhesion molecules, immunoreceptors and inflammatory enzymes(Piva, et al. 2006), molecules that are involved in disease such as atherosclerosis and insulin resistance. Certain stimuli result in the phosphorylation, ubiquitination and subsequent degradation of I?B proteins thereby enabling translocation of this transcription factor into the nucleus.
In this context, an interesting aspect was the demonstration that supplementing an endothelial cell culture with oleic acid reduces the transcriptional activation of this factor in these cells, similar to what is done by ?-linolenic acid, and the opposite of the inflammatory effect of linoleic acid. Both linoleic and stearic fatty acids activated endothelial cells more markedly than did either oleic or linolenic fatty acids. Also, compared with control cultures, treatment with stearic and linoleic acids decreased glutathione concentrations, which suggested an increase in cellular oxidative stress. Previous studies have confirmed that fat consumption induced the activation of inflammatory markers(Jellema, et al. In this regard, Bellido and Perez-Martinez have previously demonstrated that the MedDiet, enriched in virgin olive oil, attenuated peripheral blood mononuclear cells (PBMCs) NF-?B activation compared with a Western SFA rich diet, and the effect of an n-3 PUFA-enriched diet was intermediate in young healthy population(Bellido, et al.
These findings suggest that virgin olive oil could be a possible contributor to prevent the activation of NF-?B system, within the frame of the MedDiet.
Besides olive oil, the MedDiet contents other source of potentially cardioprotective nutrients from fruits and vegetables which could also enhance this beneficial effect.
In contrast, the opposite effect has been observed after the chronic intake of a Western diet rich in saturated fatty acids, corroborating previous data after the acute intake of a butter meal. The effect of a high CHO diet enriched in n-3 fatty acids on the NF-?B activation was intermediate. In this sense, previous data have suggested that n-3 ?-linolenic acid found mainly in plants and walnuts may reduce cardiovascular risk through a variety of biological mechanisms, including inhibiting vascular inflammation. 2007) explored the effects of an extra-virgin olive oil extract, particularly rich in minor polar compounds, on NF-?B translocation in monocytes and monocyte-derived macrophages isolated from healthy volunteers. In a concentration-dependent manner, olive oil extract inhibited p50 and p65 NF-?B translocation in both un-stimulated and phorbol-myristate acetate challenged cells, being particularly effective on the p50 subunit. Interestingly, this effect occurred at concentrations found in human plasma after nutritional ingestion of virgin olive oil and was quantitatively similar to the effect exerted by ciglitazone, a PPAR-? ligand.
However, olive oil extract did not affect PPAR-? expression in monocytes and monocye-derived macrophages(Brunelleschi et al. On the other hand, NF-?B has been shown to regulate the expression of several adhesion molecules in response to inflammatory stimuli, including P-selectin, E-selectin, intercellular adhesion molecule 1 (ICAM-1) and cell adhesion molecule 1(VCAM-1)(Ghosh, et al.
1999) observed, in an endothelial cell culture model, that the incorporation of oleic acid into cellular membrane lipids reduced the expression of VCAM-1. Furthermore, it has been observed that the expression of VCAM-1 and E-selectin in human umbilical vascular endothelial cells (HUVECs), following the addition of minimally oxidised LDL, was less with LDL obtained from persons who had followed a diet rich in olive oil than from persons whose diet was rich in saturated fat(Bellido, et al. This anti-inflammatory action of MUFA also explains the fact that the enrichment of LDL particles with oleic acid, during the consumption of different types of diet, reduces their capacity to induce monocyte chemotaxis and adhesion. In accordance with these results, a previous study has shown that LDL obtained from a MUFA-rich diet induced a lower rate of monocyte adhesion to endothelial cells(Mata, et al. The mechanism by which LDL from carbohydrate and MedDiets induces a lower expression of VCAM-1 and E-selectin is unknown; however several hypotheses have been suggested, for instance, the interaction of mononuclear leukocytes with vascular endothelial cells is most likely mediated by a complex amalgam of interacting regulatory signals in the inflammatory response characteristic of early atherogenesis.
In another study including healthy subjects, virgin olive oil reduced plasma levels of ICAM-1(Bellido et al. This anti-inflammatory effect has also been observed in MetS patients who modified their diet for two years. In the group that followed a MedDiet model, the prevalence of this syndrome was reduced, improved insulin sensitivity and lowered the levels of C-reactive protein (CRP) and interleukin 6, 7 and 18. Compared with participants in the low-fat group, after 3 months those in the MedDiet groups had decreased levels of C-reactive protein. Moreover, people who eat the MedDiet that includes virgin olive oil reduce their levels of oxidized LDL, as suggested by the results of a subgroup analysis of the PREDIMED study carried out in 372 participants at high risk for cardiovascular disease, including diabetes(Fito, et al.
Furthermore new data suggest that virgin olive oil intake was associated with higher levels of plasma antioxidant capacity after 3 years of intervention(Razquin, et al.
In summary, based in the above evidences presented, we could assume that the MedDiet rich in nutrients with favorable anti-inflammatory properties may protect from metabolic diseases that are related to chronic inflammation and overproduction of reactive oxygen species, such as MetS and diabetes. Postprandial stateWhen explaining possible mechanisms is important to recall that fasting is not the typical physiological state of the modern human being, which spends most the time in the postprandial state. Therefore, the assessment of the postprandial lipemic response may be more relevant to identify disturbances in metabolic pathways related to inflammation and oxidative stress than measures taken in the fasting state. With regard to the postprandial state, several previous studies have demonstrated that a breakfast enriched in saturated fat resulted in an increase in biomarkers of inflammation and oxidative stress(Cardona, et al.
In this regard, the identification of increased expression of TNF-?, a proinflammatory cytokine, in the adipose tissue of obese mice and humans has been correlated with the degree of adiposity and associated with insulin resistance. This fact is crucial given than insulin resistance will drive towards an increase in oxidative stress, endothelial dysfunction and impairments in lipoprotein metabolism and blood pressure.
However, the effects of the three fatty breakfasts on the plasma concentrations of these proinflammatory parameters showed no significant differences. The fact that we only found differences in the expression of TNF-? at mRNA levels in PBMCs following the intake of the three breakfasts may be due to that the synthesis and secretion processes of these proteins do not happen simultaneously, and to the short half-life of cytokines(Futterman and Lemberg 2002; Kishimoto 2005).
Endothelial functionIn the last years another interesting observation is that dietary fat may affect the endothelium(Berry, et al. Several studies have shown that the acute administration of a high-fat meal induces a transitory disruption of endothelial function. Moreover, the effect of chronic consumption of a high-fat diet on endothelial function has also been evaluated.
One study showed that a Mediterranean-style diet administered during 28 days to healthy subjects, attenuated plasma markers of endothelial activation, suggesting an improvement in endothelial function(Perez-Jimenez et al. Similarly, the chronic consumption of low-fat diets and Mediterranean-style diets improve endothelial function compared to a high-fat Western-type diet in hypercholesterolemic patients(Fuentes, et al. On the other hand, previous studies also demonstrated that postprandial lipemia induces endothelial dysfunction(Anderson, et al.
This study demonstrated that the endothelium-dependent vasodilatory response was greater after the ingestion of the high-MUFA diet.
Moreover this diet also induced lower postprandial sVCAM-1 levels and higher bioavailability of NOx compared with the other two diets(Fuentes et al. Therefore, those data carried out in the postprandial state support previous evidences suggesting that dietary patterns similar to those of the Mediterranean-style diet exert positive effects on components of the MetS and other conditions associated with, including endothelial dysfunction(Esposito, et al. In addition, this diet induced lower postprandial plasma levels of lipoperoxides, protein carbonyls concentration and superoxide dismutase activity compared to subjects adhering to the other three diets(Perez-Martinez, et al. Furthermore, postprandial plasma hydrogen peroxide levels were unfavourable increased during the high-SFA diet compared to the other three diets(Perez-Martinez et al.
These findings suggest that the postprandial state is important for understanding possible cardio-protective effects associated with the MedDiet particularly in subject with the MetS. In addition, these findings support recommendations to consume a high MUFA diet as a useful tool to prevent cardiovascular diseases in MetS patients. CoagulationBoth endothelial cells and macrophages contribute to the generation of altered vasoreactivity and a procoagulant state through increased expression of plasminogen activator inhibitor (PAI)-1 and tissue factor and through platelet activation and acute phase reactions that increase levels of coagulation factors such as fibrinogen and factor VIII.
Many of these molecules enter the circulation at levels that correlate with the degree of inflammatory activity.
It has been well stablished that consumption of MedDiet as a dietary pattern, and virgin olive oil as it main fat source, is accompanied by a decrease in thrombogenesis, combining a decrease in coagulation factors and by platelet aggregation (Delgado-Lista, et al.
In other words, adhering to MedDiet may act as a prophylaxis for the appearance of thrombotic driven cardiovascular events. Reinforcing this hypothesis, some authors have recently published in vitro and animal studies in which they show antiaggregant properties of virgin olive oil comparable in efficacy to those of acetylsalicylic acid (ASA). Even more, virgin olive oil and ASA, when in combination, act synergically to further inhibit platelet activation and aggregation(6, 10).
Although the cited studies have been realized mostly in healthy persons, diabetic persons may also benefit from the antithrombogenic effects of MedDiet. As an example, Rasmussen et al showed how non-insulin dependent diabetic patients who were fed a MUFA-rich diet for three weeks decreased their von Willebrand factor (an important procoagulant factor) when compared to a carbohydrate-rich diet. The same authors, in an elegant design, compared the effects of two diets similar in carbohydrate and protein content, one rich in MUFA (30 energy %) and one rich in polyunsaturated fatty acids (PUFA) (30 energy %). NutrigenomicsIt has been recently demonstrated the effects that phenolic fraction of olive oil exert at transcriptional level in vivo. To this end, two virgin olive oil-based breakfasts with high and low content of phenolic compounds were administered to 20 MetS patients following a double blinded, randomized, crossover design.
They demonstrated that intake of virgin olive oil rich in phenol compounds is able to repress in vivo expression of several pro-inflammatory genes, thereby switching activity of peripheral blood mononuclear cells to a less deleterious inflammatory profile. In the same context, the consumption of a MedDiet with virgin olive oil, rich in polyphenols, decreased plasma oxidative and inflammatory status and the gene expression related with both inflammation (INF-gamma, Rho GTPase-activating protein15, and interleukin-7 receptor) and oxidative stress (adrenergic beta(2)-receptor) in PBMCs from healthy volunteers(Konstantinidou, et al. Moreover the same authors demonstrated the hypothesis that 3 weeks of nutritional intervention with virgin olive oil supplementation, at doses common in the MedDiet, can alter the expression of genes related to atherosclerosis development and progression(Khymenets, et al. 2010) have confirmed in a population at high cardiovascular risk, that the MedDiet rich in olive oil influences expression of key genes involved in vascular inflammation, thrombosis and, in general, on atherosclerosis susceptibility. Moreover, it has been previously demonstrated in mice that olive oil up-regulates uncoupling protein (UCP) genes in brown adipose tissue and skeletal muscle(Rodriguez, et al.
2002), which is important given that UCP have been related with the regulation of body fat in mammals across its participation on the system of thermogenesis(Cypess, et al. It is well reported that mitochondrial biogenesis could, in part, underlie the central role of adipose tissue in the control of whole-body metabolism and the actions of some insulin sensitizers and that mitochondrial dysfunction might be an important contributing the symptoms of MetS(Wilson-Fritch, et al. These data suggest that HT is able to promote mitochondrial function by stimulating mitochondrial biogenesis. This mitochondrial targeting property may provide a possible mechanism for the efficacy of the MedDiet for lowering the risk of cardiovascular disease and also suggests that HT may be used as a therapeutic intervention for preventing and treating diabetes mellitus and obesity(Hao, et al. Summary and future directionBecause unhealthy eating habits and a sedentary lifestyle are among the strongest risk factors for metabolic syndrome and type 2 diabetes, modification of eating habits and physical activity constitutes an important component of any successful management program. In this chapter we reviewed the state of the art illustrating the relationship between MedDiet rich in olive oil and metabolic diseases, and to discuss potential mechanisms by which this food can help in disease prevention and treatment. Epidemiological and intervention studies indicate that MedDiet, thanks to its set of benefits, may protect from metabolic diseases that are related to chronic inflammation and overproduction of reactive oxygen species, such as MetS and diabetes. However, despite the significant advances of the last years, the final proof about the specific mechanisms and contributing role of the different dietary models and nutrients to its beneficial effects requires further investigations. In the future, the integrated application of approaches that are becoming available in functional genomics, metabonomics, lipidomics, microbiota, cronobiology, proteomic techniques, and bioinformatics analysis, will lead to a more highly integrated understanding of its positive effects on health.
In this context the recent advances in human nutrigenomics and nutrigenetics, two fields with distinct approaches to elucidate the interaction between diet and genes but with a common ultimate goal to optimize health through the personalization of diet, will provide powerful approaches to unravel the complex relationship between nutritional molecules, genetic polymorphisms, and the biological system as a whole. On the other hand efforts should be put into identifying those micronutrients in olive oil that have the greatest beneficial effects on health. In conclusion after decades of epidemiological, clinical and experimental research, it has become clear that consumption of Mediterranean dietary patterns rich in olive oil have a profound influence on health outcomes. Thus, there is good scientific support for recommend MedDiets, especially those based on olive oil, as an alternative approach for the medical nutritional therapy in obesity, MetS and diabetes.5. AcknowledgementsCiber Fisiopatologia Obesidad y Nutricion, CIBEROBN, is an initiative of ISCIII government of Spain. Also supported by Centro de Excelencia Investigadora en Aceite de Oliva y Salud (CEAS) and FEDER, Fondo Social Europeo.
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