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Reversing the irreversible

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Treatment of type 1 diabetes is touted as a great medical success story – a condition considered long-since conquered, ever since Sir Frederick Banting and his colleagues at the University of Toronto ground up the pancreas of a cow and injected it into a 14-year-old diabetic boy in 1921.

There’s no doubt that the discovery of insulin has allowed untold millions of people to live a relatively normal life.

However, a glance at the statistics tells a far less rosy story: at least 1.5 million deaths a year directly attributable to diabetes; more than 73,000 lower limb amputations every year in the US; a 75 percent possibility that a diabetic will develop kidney disease, and an even higher likelihood of some form of damage to sight; plus the risk of developing one or more of a litany of other illnesses, from cataracts and hearing loss to erectile dysfunction, depression and infertility.

And even if you manage to avoid all that, just taking high doses of insulin day after day can leave you with a higher risk of heart attack or cancer.

Then there’s type 2 diabetes, the 21st-century epidemic, with some 86 million Americans with abnormally high blood sugar now considered on the verge of developing it.

Up until now, both types of diabetes have resisted a simple causative explanation. Type 1 diabetes, largely an autoimmune disease where the body attacks its own pancreas, has been considered a bad throw of the genetic dice and deemed irreversible. Once your pancreas packs up, that, supposedly, is that.

Type 2 diabetes, blamed exclusively on poor diet and lack of exercise, is considered the more treatable condition, but the fact remains that it has often resisted a simple dietary Band-Aid.

In our cover story this month (page 28), Celeste McGovern has investigated cutting-edge evidence showing that both kinds of diabetes are highly treatable, and possibly even curable. The first evidence is emerging that an inactive pancreas may, in fact, be brought back to life through extreme exercise, diet, special supplements like vitamin D, or even probiotics.

Cutting-edge research implicates a faulty microbiome, that microscopic population of good-guy bacteria recently discovered to be an important aspect of so many biological processes, as being central to whether or not we develop diabetes.

Having certain types of bacteria in your gut essentially is like wearing a bulletproof vest. In fact, new evidence (albeit mainly from animals, which may not apply to us) suggests that restoring the right gut flora may also be able to reverse the abnormal glucose metabolism that underpins diabetes.

Many environmental insults to the gut early in its formation are also being implicated in the development of diabetes. While researching her doctorate in chemistry, a Ph.D. student named Lisa Landymore-Lim studied groups of diabetic children and discovered a number of associations, leading her to suspect that drugs were at the heart of childhood diabetes: different countries had a different incidence of diabetes, and the average age of onset got younger with each passing decade.

As she looked further, she discovered a possible link between early-onset diabetes and high exposure to prescription drugs in utero and in early childhood.

Many drugs were implicated, including benzodiazepine tranquilizers and drugs to prevent miscarriage or morning sickness, but the most common drug of all was antibiotics, which the mothers had taken during pregnancy to treat infections.

As a chemistry student, Landymore-Lim realized that some of the drugs had structural similarities to a number of other drugs known to cause diabetes, but that the key factor linking them was that they were all capable of binding to zinc. As the pancreas is a rich source of zinc, she says, the chemical from the drug may bind to the zinc in the islet cells of the pancreas, displacing some or all of the insulin molecules there.

This would result in damage to the pancreatic cells and “activation of the body’s immune system as it detects ‘deformed’ cells which it regards as ‘foreign,'” she wrote.

All this suggests that the gut plays a central role in this puzzling condition. As ‘death begins in the colon,’ so may the development of diabetes – and also its cure.

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Article Topics: insulin
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