Diabetes Could Double The Risk Of Esophageal Cancer In Patients With …

Diabetes, a component of metabolic syndrome, has previously been linked to Barrett’s esophagus — where the esophageal lining becomes similar to that of the stomach — but the prevalence of diabetes in patients with the esophageal disease has never been researched. Now, a new study has found that diabetes could double the risk of developing esophageal cancer in patients with Barrett’s esophagus.

“There has been a rising incidence of metabolic syndrome over the past decades, which seems to correlate with an increase in esophageal cancer,” lead researcher Prashanthi N. Thota, who presented the team’s findings at the annual meeting of the American College of Gastroenterology, told MedPage Today.

People develop Barrett’s esophagus when their esophageal muscles fail to close tightly enough, and allow gastric acid to enter the esophagus. When this happens, it can damage, and eventually change the lining of the esophagus. These changes can eventually cause dysplasia — an increased population of immature cells — and possibly even cancer.

Thota’s team of researchers looked at data from 1,623 patients who had Barrett’s esophagus and were seen between 2000 and 2013. Of these patients, 274 also had diabetes or were diagnosed with it during the duration of the study.  After accounting for sex, race, and length of Barrett’s esophagus segment, the researchers found adenocarcinoma — cancer of the epithelium — in 15.8 percent of those without diabetes and 25.9 percent of those with diabetes during the 16-month follow-up. They also saw high-grade dysplasia or cancer in 17.9 percent of patients with diabetes compared to only 9.7 percent of those without.

Interestingly, the researchers also found that 61.9 percent of patients who had hypertension didn’t develop dysplasia compared to 56 percent of those who had hypertension — the researchers had expected the opposite. “I suspect that this relates to the use of antihypertensive drugs rather than the condition per se,” Thota told MedPage Today.

A 2012 study also found that diabetic men could have an increased risk for developing esophageal cancer. Looking at data from 17 other studies, the researchers concluded that diabetics had a “modestly increased risk” of esophageal cancer and adenocarcinomas, and that men were significantly more at risk. 

Does the process of diseasification hold any promise in obesity?

In a thoughtful, measured and well-reasoned blog post, Dr. Keith Ayoob recently discussed the AMA’s decision to classify obesity as a disease. As he concluded his post, Dr. Ayoob wrote: “I don’t care how obesity is categorized. I care about what’s being done about it … We need to stop talking about whether obesity is or is not a disease and start talking about preventing it altogether.” This got me thinking: does the process of diseasification hold any promise at all in obesity? And are there downsides to this approach that should cause us concern?

Diseasification is a funny and not entirely real word, but I didn’t make it up. Sure, if you look for it in an online dictionary, you won’t find it — but if you Google it, you’ll find over 6,000 hits. Most seem to focus on one of the most problematic aspects of diseasification: that of classifying all sorts of mental states and psychological issues as diseases, a tendency that has arguably contributed to our nation’s overreliance on pharmacology to ease the vicissitudes of daily living. But some of these Google hits refer to issues in prevention, including obesity. While I didn’t coin the term, I think its meaning is self-evident: labeling as a “disease” a condition that is typically not so construed. Clearly, the AMA’s action would fit under this intuitive definition.

Of course, this begs the question: what is a disease? A typical definition of disease provides guidance, if not absolute clarity: “any deviation from or interruption of the normal structure or function of any body part, organ or system that is manifested by a characteristic set of symptoms and signs and whose etiology, pathology and prognosis may be known or unknown.”

In holding obesity up to this standard, its appropriateness could hinge on whether a body with a body mass index (BMI) greater than 30 would be considered a normal structure; this in turn depends on how we define normal. Ironically, if we refer to a standard statistical concept of outliers — usually, the most extreme 5 percent or so of a population — then the more widespread our so-called national obesity epidemic, the more “normal” obesity becomes. Currently, more than a third of the entire U.S. population is obese; in certain states and in some ethnic/racial groups, the proportion is closer to half. Clearly, these are not outliers.

But I think the annals of preventive medicine have demonstrated that diseasification has its place. Let us look at a reasonably successful story of diseasification: that of hypertension. Some readers might be surprised that I’m considering this diseasification: after all, isn’t hypertension clearly a disease? Well, no, it’s not. There are no symptoms, illnesses or dysfunctions related to hypertension per se. Hypertension refers to an elevated blood pressure, where elevated was established in a discretionary (though certainly not arbitrary) manner. Coincidentally, about a third of all Americans fit the definition of people with hypertension, so these are also not outliers in the traditional sense. But what we do know is that high blood pressure is a major, modifiable risk factor for things that are diseases — important ones, such cardiovascular diseases, of stroke and heart attack. Moreover, we know that pharmacological efforts to lower blood pressure below established cutpoints leads to a reduction in the risk of such diseases. So diseasifying hypertension has led to helpful treatments and to a reduction in disease outcomes.

Obesity, however, is a wholly different animal. First, while obesity has been shown to be a risk factor for certain diseases — indeed, many of the same diseases predicted by high blood pressure — its association with those diseases is neither so strong nor so direct as that with hypertension. Moreover, healthcare practitioners do not have the sorts of treatments in their toolkits to treat obesity that they do for high blood pressure, and even more significantly, there is no direct evidence that using treatments to lower BMI will in turn reduce the risk of the real diseases that are associated with obesity — the ones we really care about.

Thus, the presumed upsides of this new AMA-endorsed classification are hard to imagine. Given the lack of effective and proven therapies, what benefit do we seek? Prevention, as Dr. Ayoob indicated, is key — but our rapidly exploding national obesity prevalence isn’t caused by lack of adequate medical care; rather, it is due to wholesale changes in diet and lifestyle, largely promoted by corporate marketing, governmental policies, new technologies and changing norms of behavior. These are amenable (alas, not easily) to public health interventions and policy change, but not to increased doctor visits.

An open question is: if this relabeling of obesity has an impact on the stigmatization of the overweight, will it be for good or ill? On the good side, perhaps, is recognizing that it isn’t necessarily a sign of sloth or weakness of will, but something that may be beyond volitional control, much as classification as disease may have improved the situation for alcoholics or substance abusers. On the other side — do we really want to equate obesity with such things? I think we ought to heed lessons from the fat acceptance movement, and consider that the overweight seem to be the last social group that it is deemed acceptable to malign.

Certainly, there are many fat people comfortable in their own bodies; do we really want to say to them, “Sorry, it doesn’t matter what you think, you’re sick”? Not a necessary corollary of diseasification, I think, but a cause for concern.

Paul Marantz is associate dean, clinical research education and director, Center for Public Health Sciences, Albert Einstein College of Medicine. He blogs at The Doctor’s Tablet.

Diseasification of Obesity

 

Bathroom scale with faces instead of numbers

 

In a thoughtful, measured and well-reasoned blog post in these pages, Dr. Keith Ayoob recently discussed the AMA’s decision to classify obesity as a “disease.” As he concluded his post, Dr. Ayoob wrote: “I don’t care how obesity is categorized. I care about what’s being done about it…. We need to stop talking about whether obesity is or is not a disease and start talking about preventing it altogether.” This got me thinking: does the process of “diseasification” hold any promise at all in obesity? And are there downsides to this approach that should cause us concern?

“Diseasification” is a funny and not entirely real word, but I didn’t make it up. Sure, if you look for it in an online dictionary, you won’t find it—but if you Google it, you’ll find over 6,000 hits. Most seem to focus on one of the most problematic aspects of diseasification: that of classifying all sorts of mental states and psychological issues as diseases, a tendency that has arguably contributed to our nation’s overreliance on pharmacology to ease the vicissitudes of daily living. But some of these Google hits refer to issues in prevention, including obesity. While I didn’t coin the term, I think its meaning is self-evident: labeling as a “disease” a condition that is typically not so construed. Clearly, the AMA’s action would fit under this intuitive definition.

Of course, this begs the question: what is a “disease”? A typical definition of disease provides guidance, if not absolute clarity: “any deviation from or interruption of the normal structure or function of any body part, organ or system that is manifested by a characteristic set of symptoms and signs and whose etiology, pathology and prognosis may be known or unknown.” In holding obesity up to this standard, its appropriateness could hinge on whether a body with a body mass index (BMI) greater than 30 would be considered a “normal structure”; this in turn depends on how we define “normal.” Ironically, if we refer to a standard statistical concept of outliers—usually, the most extreme 5 percent or so of a population—then the more widespread our so-called national obesity epidemic, the more “normal” obesity becomes. Currently, more than a third of the entire U.S. population is obese; in certain states and in some ethnic/racial groups, the proportion is closer to half. Clearly, these are not “outliers.”

But I think the annals of preventive medicine have demonstrated that diseasification has its place. Let us look at a reasonably successful story of diseasification: that of hypertension. Some readers might be surprised that I’m considering this “diseasification”: after all, isn’t hypertension clearly a disease? Well, no, it’s not. There are no symptoms, illnesses or dysfunctions related to hypertension per se. Hypertension refers to an elevated blood pressure, where “elevated” was established in a discretionary (though certainly not arbitrary) manner. Coincidentally, about a third of all Americans fit the definition of people with hypertension, so these are also not “outliers” in the traditional sense. But what we do know is that high blood pressure is a major, modifiable risk factor for things that are diseases—important ones, such cardiovascular diseases, of stroke and heart attack. Moreover, we know that pharmacological efforts to lower blood pressure below established cutpoints leads to a reduction in the risk of such diseases. So diseasifying hypertension has led to helpful treatments and to a reduction in disease outcomes.

Obesity, however, is a wholly different animal. First, while obesity has been shown to be a risk factor for certain diseases—indeed, many of the same diseases predicted by high blood pressure—its association with those diseases is neither so strong nor so direct as that with hypertension. Moreover, healthcare practitioners do not have the sorts of treatments in their toolkits to treat obesity that they do for high blood pressure, and even more significantly, there is no direct evidence that using treatments to lower BMI will in turn reduce the risk of the real diseases that are associated with obesity—the ones we really care about. Thus, the presumed “upsides” of this new AMA-endorsed classification are hard to imagine. Given the lack of effective and proven therapies, what benefit do we seek? Prevention, as Dr. Ayoob indicated, is key—but our rapidly exploding national obesity prevalence isn’t caused by lack of adequate medical care; rather, it is due to wholesale changes in diet and lifestyle, largely promoted by corporate marketing, governmental policies, new technologies and changing norms of behavior. These are amenable (alas, not easily) to public health interventions and policy change, but not to increased doctor visits.

An open question is: if this relabeling of obesity has an impact on the stigmatization of the overweight, will it be for good or ill? On the good side, perhaps, is recognizing that it isn’t necessarily a sign of sloth or weakness of will, but something that may be beyond volitional control, much as classification as disease may have improved the situation for alcoholics or substance abusers. On the other side—do we really want to equate obesity with such things? I think we ought to heed lessons from the fat acceptance movement, and consider that the overweight seem to be the last social group that it is deemed acceptable to malign. Certainly, there are many fat people comfortable in their own bodies; do we really want to say to them, “Sorry, it doesn’t matter what you think, you’re sick”? Not a necessary corollary of diseasification, I think, but a cause for concern.

Paul Marantz, M.D., M.P.H.

Go for comprehensive health plans covering diabetes

Recently, public sector insurer New India Assurance did away with the practice of charging extra premium from those suffering from diabetes and hypertension, under its revised health policy. The insurer’s move is aimed at reducing claim procedure.

Some pointed to the fact that this comes close on the heels of new guidelines that don’t allow extra loading, effective October. Sooner or later, all companies would have to comply with this. Currently, health insurers such as ICICI Lombard, Apollo Munich and Bajaj Allianz cover diabetes and hypertension as pre-existing diseases (after a waiting period). New India Assurance would have a four-year waiting period for a cover on the two diseases.

Renuka Kanvinde, head (health insurance) at Bajaj Allianz General Insurance, says the insurer covers diabetes as a pre-existing disease, without any extra loading at any stage of the disease. While ICICI Lombard covers diabetes and hypertension without loading, albeit only mild cases, Star Health has a rider for diabetes cover — it is priced taking into account diabetes-related risks to kidney, heart, eyes and brain.

Increasing cases of diabetes and related ailments have led a few insurers such as Apollo Munich and Religare Health Insurance to consider a standalone diabetes cover. There are also bank-provided group policies that cover diabetes.

How should a policyholder choose between these? While there aren’t any standalone covers yet, experts believe these would come at a price—15-25 per cent compared to health insurance plans. Antony Jacob, chief executive officer of Apollo Munich, says research suggests healthcare costs of a diabetic is 1.5-2 times the cost incurred by a non-diabetic, and the company’s premium would be in line with this finding.

Amit Bhandari, ICICI Lombard’s vice-president (health underwriting product), says though standalone plans may not cover any other ailment, these might have features such as discounts on diabetes-specific medicines or health check-ups. Before taking a decision, one should carefully weigh the extra premium loading vis-a-vis the sum of benefits.

Experts say insurers who don’t charge extra for covering diabetes may do so after a couple of claims. However, these plans would be helpful for more than one health issue. Group health plans offered by banks cover hospitalisation for any ailment related to diabetes. Typically, these policies don’t have sub-limits, premium loading or co-pay clauses.

S Prakash, executive director, Star Health Insurance, says, “Those who don’t have health coverage yet should obviously buy a comprehensive plan that covers diabetes also, if they suffer or are at risk. But those who already own a health policy can opt for a rider.” Kanvinde says disease-specific covers are required only if the comprehensive cover you have or have chosen doesn’t cover that particular disease.

Premium loading is not a short-term measure; it would increase your annual premium and should be a key determinant of your choice of insurer.

Comprehensive covers have an edge over other options, even in terms of premium. Star Health rider costs Rs 6,385 for a Rs 5-lakh-cover for 25-35 years. A comprehensive cover would cost about Rs 5,000 (26-40 years) for the same cover (Bajaj Allianz General Insurance), while a group policy could cost Rs 10,000-12,000. For group policies, premium increases only after the age of 65, and again after 80. The premium could also rise based on claims or the age bracket.

New India Assurance exempts diabetes, BP patients from paying extra premium …

Here is some good news for those who suffer from diabetes or hypertension. No, it is not about any wonder drug.

Individuals with these two conditions can now buy health insurance cover from New India Assurance without paying any extra premium.

The public sector insurance major, which dominates the health insurance space in the country, has decided to eliminate the 10-20 per cent premium loading — that is, extra premium charged — on these two conditions. Sure, many general insurance companies still charge a higher premium for offering health cover to individuals with such existing ailments at the time of issuing policies.

“In case an individual suffers from chronic conditions such as diabetes or hypertension, it is apparent that the health risk applicable on this particular individual is greater than a similar individual without such afflictions. This leads to the insurance company applying an additional loading on the premium of the latter,” adds Antony Jacob, CEO of Apollo Munich.

Also, some insurance companies continue to refuse offer covers to individuals with these conditions. “Some companies charge a loading of around 30-40 per cent while others insist on incorporating a co-pay clause, where, say, 30 per cent of the approved claim is payable by the insured,” says Divya Gandhi, principal officer and head — general insurance, Emkay Insurance Brokers. “There are some companies which simply do not extend cover to people with such pre-existing diseases,” she adds.

Slowly, insurance companies are rethinking on the practice of loading the premium for lifestyle diseases like hypertension and diabetes, which are afflicting many young insurance seekers these days. For instance, New India took the decision to stop loading the premium for diabetes and hypertension to simplify the process.

“There were problems in determining admissibility of claims for persons. Several questions arose: whether they had paid the loading or not; whether they had declared that they suffered from diabetes or hypertension at the time of buying the cover or whether they got afflicted later,” explains Segar Sampathkumar, general manager of New India Assurance.

Since these issues used to delay claim settlement and making the entire process tedious, the insurance company decided to do away with the practice of loading the premium. Since the loading of premium is not a short-term measure and it inflates your annual premium as long as the policy is in force, it should be one of the key determinants of your choice of insurer.

Type 2 Diabetes? Hypertension? Get Tested for Sleep Apnea!

If you suffer from Type 2 diabetes or hypertension, you should be evaluated for obstructive sleep apnea (OSA) by a physician who is board-certified in sleep medicine. This is a recommendation recently issued for the first time by the American Academy of Sleep Medicine (AASM). This new guideline could have a significant impact on diagnostic procedures for tens of millions of adults in the United States. Type 2 diabetes and hypertension are all-too-common conditions among U.S. adults, and their numbers are rising alarmingly. More than 25 million people in the U.S. have diabetes, and approximately 90-95 percent of these are cases of Type 2 diabetes. Hypertension — high blood pressure — affects a third of American adults, roughly 67 million people.

OSA frequently is found in people with Type 2 diabetes and with cardiovascular conditions, including hypertension. Estimates vary, but it is believed that approximately half of patients with high blood pressure also have OSA. The overlap may be even higher with Type 2 diabetes, with a majority of these patients also suffering from the sleep disorder.

There is an enormous body of research to suggest that people who suffer from OSA are at significantly increased risk for diabetes and hypertension, and vice versa. The relationships of OSA to diabetes and hypertension are complicated and appear to be multi-directional. All three conditions share risk factors, particularly obesity. In addition to exploring the consequences of shared risk factors, scientists are also investigating other biological connections between sleep apnea, hypertension and Type 2 diabetes. We don’t know all of the connections between these three health issues, but we do know that in the cases of both Type 2 diabetes and hypertension, the presence of OSA is extremely common and can complicate treatment if left unattended. OSA, like many sleep disorders, continues to be seriously under diagnosed. Those with undiagnosed sleep apnea are at particular risk for complications of diabetes and hypertension.

The Sleep Heart Health Study is a long-term, ongoing, population-based investigation of the health consequences of sleep-disordered breathing on cardiovascular health. This research has revealed a strong association between the disordered breathing that is a symptom of sleep apnea and hypertension. The results are striking, in particular because they indicate the risks of OSA to high blood pressure are not limited to traditional high-risk groups such as the obese, men and older adults. Instead, the study has found elevated risk for high blood pressure among middle-aged and older adults, men and women, people who are overweight and those who are normal weight. Other recent research has also demonstrated the relationship between OSA and high blood pressure:

  • The risk of hypertension appears to increase with the severity of obstructive sleep apnea. Researchers at the University of Wisconsin School of Medicine analyzed data on sleep and blood pressure for 709 adults over a four-year period. They found the risk of hypertension increased with the frequency of apnea episodes per hour of sleep. Those with 15 or more apnea episodes per hour were at three times the risk for hypertension as those without sleep apnea.
  • Severe OSA has also been strongly linked to resistant hypertension. Resistant hypertension is a form of high blood pressure that does not respond to medication. When a group of men and women with resistant hypertension were tested for obstructive sleep apnea, researchers found 83 percent had the sleep disorder.

Attempting to treat high blood pressure through medications or other therapies without also addressing the possible presence of OSA may undermine the success of treatment.

The same likely is true for Type 2 diabetes. Research has established links between obstructive sleep apnea and diabetes, which have been described as “interacting epidemics.” Studies indicate that OSA may disrupt normal glucose metabolism and increase insulin resistance, which is the underlying biological mechanism of Type 2 diabetes:

  • Researchers at the University of Chicago found the presence of OSA in patients with Type 2 diabetes was linked to a decline in glucose control. Compared to diabetes patients without obstructive sleep apnea, those with mild, moderate and severe sleep apnea demonstrated poorer glucose control. As severity of OSA increased, glucose control in these patients deteriorated significantly.
  • Obesity is an important risk factor for both obstructive sleep apnea and Type 2 diabetes. But research indicates that a relationship between the two conditions may exist independent of obesity. Researchers at Pennsylvania State University found an association between insulin resistance and sleep apnea in a group of non-obese middle-aged men.

There’s some good news behind this AASM recommendation as well. In both hypertension and Type 2 diabetes patients with OSA, treatment for sleep apnea can not only improve the sleep disorder, but also help improve the other conditions as well. Research shows that effectively treating OSA can lead to improvements in hypertension and Type 2 diabetes:

  • Regular use of continuous positive airway pressure (CPAP), the most common treatment for OSA, appears to play a role in lowering glucose levels, according to new research from the University of Chicago’s Sleep, Metabolism and Health Center. Patients with both sleep apnea and Type 2 diabetes who used CPAP continuously for one week lowered both their daily average glucose levels and their morning glucose levels. (Morning spikes in glucose levels are common among those with Type 2 diabetes.)
  • CPAP also can help reduce both nocturnal and daytime blood pressure in patients with obstructive sleep apnea. A single night of CPAP use resulted in a reduction of nighttime systolic blood pressure, and 2 months of sustained CPAP lowered daytime systolic blood pressure as well. Other research has shown that 12 weeks of CPAP therapy resulted in lowered daily blood pressure values.

This recommendation by the AASM makes a great deal of sense, based on the abundance of evidence we have linking these conditions and the complications we know can arise when sleep apnea is left untreated. Now it is up to patients and doctors to follow through and make sure these evaluations take place, with qualified physicians. If you are one of the millions who suffer from either Type 2 diabetes or hypertension, your can improve your health and lower your risks if you are properly evaluated for obstructive sleep apnea.

Sweet Dreams,
Michael J. Breus, PhD
The Sleep Doctor®
The Sleep Doctor’s Diet Plan: Lose Weight Through Better Sleep
Everything you do, you do better with a good night’s sleep™
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Grizz Chapman gets new lease on life with kidney transplant

Grizz Chapmen, the 30’s Rock star who had a kidney transplant after he was diagnosed with kidney failure two years ago, has a new zest for life . According to www.people.com, the actor feels grateful to have another ‘chance at life’ and has started to live a fuller life.

“When you go through something like, you learn to appreciate little things – the birds, trees, flowers,” he was quoted as saying . The 36-year-old star went on to say, “I pay attention to everything now – the taste of bread, the taste of water. It all feels different now.”

As reported by www.huffingtonpost.com, the actor suffered from hypertension for a long time, which led to his kidney.failure in 2008. The body guard turned TV star says that he was scared of dying. Grizz Chapmen, who weighed in at a whopping 505 lbs. had to shed 160 lbs. in order to be eligible for a kidney transplant.

“I didn’t want to die, I wanted to live. I wanted to be with my family and wanted to see my 11-year-old son grow up.”

He explained that the man who came forward to donate a kidney was not even a fan of 30’s Rock, he didn’t even watch it, and that he was going to donate regardless.

In the months since the transplant the two men have developed a close bond and are in regular contact.

Other celebrities who suffered from kidney problems include Natalie Cole.

Read here about how gene discovery could put an end to kidney problems.

For further info about kidney disease and organ donation, go to the National Kidney Foundation Web site.

Dark chocolate may cure liver disorders

A recently conducted study suggests that dark chocolate may help in dealing with high blood pressure and may also pave way for treatment of liver cirrhosis. According to www.reuters.com, the antioxidants known as flavanols which are found in the cocoa may help balance out the blood pressure by relaxing and widening the blood vessel muscle cells. The rise in the blood pressure in the abdominal region is common in cirrhotic patients after they consume a meal which might result in rupture of blood vessels. Cirrhosis is a condition when liver scarring takes place due to excessive intake of alcohol or hepatitis infection.

As reported by www.phyorg.com, the study was conducted on about 21 patients who were in the last stage of liver disorder. It was found that those of who were made to consume meal containing about 85 percent of cocoa rich dark chocolate reported considerably smaller increase in the hypertension or blood pressure. The study also revealed that consumption of dark chocolate may provide certain additional benefits to maintain overall health.

“This study shows a clear association between eating dark chocolate and (lower) portal hypertension and demonstrates the potential importance of improvements in the management of cirrhotic patients,” concluded Professor Mark Thursz, London’s Imperial College.

Celebrities who have dealt with liver problems include Pamela Anderson, who battled Hepatitis C, and David Crosby, who had a liver transplant.

Images: http://www.sxc.hu/photo/88670, http://www.sxc.hu/photo/266004