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Chronic Disease, Health and Fitness, In the News, Nutrition, Obesity, Stanford News

A conversation about the diabetes epidemic

A conversation about the diabetes epidemic

On this morning’s KQED’s morning radio show, Forum, several doctors including Stanford’s Bryant Lin, MD, discussed how diabetes is affecting the health of millions of people globally.

A recent study in the Journal of the American Medical Association estimated that about half of all adults have diabetes (diagnosed or undiagnosed) or pre-diabetes. Lin and his fellow panelists talked about how changes in our diet and lifestyle have fueled the number of diabetic cases, as well as how genetics can tip the odds against certain patients. Lin mentioned that Asians have a higher rate of diabetes than whites, for example.

Like Lin, I have a family history of diabetes. (Like Lin, I’ve also struggled to maintain my weight). That history has made me keenly interested in staying abreast of recent findings about diabetes – and I surprised to hear that among young people, high rates of liquor consumption is influencing diabetes rates. It’s not just soda intake that we have to watch out for.

Another surprising finding that Lin described was that for pre-diabetics, taking Metformin, a drug that helps control diabetes and blood sugar, can help stave off full-blown diabetes. Eventually, it may become routine to prescribe this medication in certain populations, but Lin said that guidelines haven’t caught up with this aspect of diabetes care.

Other factors at play, Lin noted, include the role of the microbiome in promoting or protecting people from diabetes. And people who undergo bariatric surgery for weight management often find their diabetes is cured, but doctors don’t understand exactly why that’s the case.

Despite the staggering number of people affected, it’s clear that we still don’t understand all the complex factors that influence this disease.

Previously: Faulty fat cells may help explain how Type 2 diabetes beginsThe role of nutrition in diabetes prevention and managementThe importance of regular exercise in delaying and treating diabetes and Examining the role of exercise in managing and preventing diabetes

Health and Fitness, Obesity, Pediatrics, Public Health

Taking breaks for physical activity may benefit children’s long-term health

Taking breaks for physical activity may benefit children’s long-term health

109320999_8b61257d14_zHere’s an eye-opening statistic: Children in the United States spend on average 6 hours per day sitting or reclining. As we head into the fall and winter months, it’s likely that the shorter, darker days and chilly weather will only add to our kids being more sedentary.

National exercise standards advocate for children getting at least 30 minutes of exercise daily to curb the risk of obesity, diabetes and other conditions. But for those days when achieving this goal isn’t possible, new research shows that short activity breaks can help offset a lack of exercise.

In the study (subscription required), researchers invited 28 healthy, normal-weight children to visit the National Institutes of Health on two separate occasions. During the first visit, participants were randomly assigned to two groups. One group watched TV, read or engaged in other sedentary activities for three hours; the other group alternated sitting with three minutes of moderate-intensity walking on a treadmill every 30 minutes for the three-hour period. On the return visit, the children switched groups. Each one took an oral glucose tolerance test at both visits. According to an NIH release:

On the days they walked, the children had blood glucose levels that were, on average, 7 percent lower than on the day they spent all 3 hours sitting. Their insulin levels were 32 percent lower.   Similarly, blood levels of free fatty acids — high levels of which are linked to type 2 diabetes — were also lower, as were levels of C-peptide, an indicator of how hard the pancreas is working to control blood sugar.

After the sessions, the children were allowed to choose their lunch from food items on a buffet table. Based on the nutrient content of each item, the researchers were able to calculate the calorie and nutrient content of what each child ate. The short, moderate-intensity walking sessions did not appear to stimulate the children to eat more than they ordinarily would, as the children consumed roughly the same amounts and kinds of foods after each of the sessions.

The study authors concluded that, if larger studies confirm their findings, interrupting periods of prolonged sitting with regular intervals of moderate-intensity walking might be an effective strategy for reducing children’s risk of diabetes and heart disease.

While regular walking breaks may not excite the average child, three-minute dance parties or stomping on bubbles are other options for getting kids out of their seat and moving.

Previously: Pediatrics group issues new recommendations for building strong bones in kids, Understanding the impact of sedentary behavior on children’s health and British government urging toddlers to ‘get physical’
Photo by Miika Silfverberg

Nutrition, Obesity, Research

A call to focus on the nutritional value of foods, rather than calorie counts

A call to focus on the nutritional value of foods, rather than calorie counts

10331709463_60f2188a69_zTo reduce obesity rates, cardiovascular risk and chronic diseases, ditch calorie counting and instead emphasize the nutritional content of foods. That’s the message from a group of British researchers in an editorial recently published in Open Heart.

Drawing on past scientific evidence, the authors argue that physicians, patients and society’s focus on low-calorie foods and diets has resulted in a sacrifice of good nutrition and failed to improve overall public health. According to a press release:

Daily consumption of a sugary drink (150 calories) is associated with a significantly increased risk of type 2 diabetes whereas daily consumption of a handful of nuts (30 g of walnuts, 15 g of almonds and 15 g hazelnuts) or four tablespoons of extra virgin olive oil (around 500 calories) is associated with a significantly reduced risk of heart attack and stroke.

It has been estimated that increasing nut consumption by two servings a week could stave off 90,000 deaths from cardiovascular disease in the US alone.

And the Action for Health in Diabetes trial shows that a low calorie diet on top of increased physical activity in patients with type 2 diabetes was not associated with a reduced risk of cardiovascular death despite significant weight loss and a monitoring period of 13.5 years, [the authors] point out.

“It is time to stop counting calories, and time to instead promote good nutrition and dietary changes that can rapidly and substantially reduce cardiovascular mortality. The evidence indeed supports the mantra that ‘food can be the most powerful form of medicine or the slowest form of poison’,” they write.

Previously: The trouble with the current calorie-counting system, Homemade: Community-based project teaches how to cook for health and Cooked food, calorie counts and food labels
Photo by Mariya Chorna

Ask Stanford Med, Health and Fitness, Nutrition, Obesity, Precision health, Stanford News

A Stanford physician takes a precision health approach to living a healthier lifestyle

A Stanford physician takes a precision health approach to living a healthier lifestyle

timthumbNearly 70 percent of Americans ages 20 or older are overweight or obese, including Larry Chu, MD, a Stanford anesthesiologist and executive director of Medicine X.

Chu, who has struggled with his weight for over a decade, knew he was overweight but didn’t think it was a serious threat to his health. This changed during a routine doctor’s visit. As he explains in a podcast, Chu was shocked to learn that lab results showed he was at high risk for stroke and heart attack. He decided to take action and launch precision:me, a personal blog project chronicling the first 90 days of his journey to live a healthier lifestyle.

Why most of us try to slim down by shunning carbs, stepping up our exercise routines and secretly weighing ourselves each morning, Chu is tracking his health data using a range of gadgets and other tools and sharing the every detail of his progress publicly on his blog. He is also posting photos and podcasts.

Below Chu discusses why he choose to take this unique approach to achieve his weight-loss goals, how he hopes it will inform the broader conversation about obesity and its potential to demonstrate the value of digital tools in enhancing personal health.

What was the catalyst for precision:me?

One of the misconceptions about obesity is that it is a lifestyle disease and if people would only eat less and move more they would be fit. In my case, this is a health journey I have been struggling with since my residency training at Stanford. Using precision health tools to address obesity is a new approach that we are focusing on in precision:me. Stanford has recently announced exciting plans for precision health. I thought it was a good time to share how we at Medicine X see precision health as a novel approach that individuals and their providers can use today to tailor precise and individualized care. It is a very practical and personal dive into developing and implementing a precise plan to modify my diet and metabolic profile to forestall the development of more significant chronic diseases, such as diabetes and heart disease, using data and analytics provided through digital health tools and expert medical, nutritional and fitness collaborators.

Why did you decide to make all of your health data available online for public consumption?

It was an easy and difficult decision at the same time. There is incredible stigma associated with obesity, which we discuss on the precision:me website. Being overweight or obese is a subject that many of us find difficult to talk about. Sharing information can make it easier to start a dialogue. Advances in precision health at Stanford and around the world will depend upon patients sharing their personal health data in a secure and protected fashion with researchers. By sharing my data with the public, I hope to help everyone see what it is like to live with obesity as a condition, break down misconceptions and misperceptions about the disease, and help shine a light on the value of sharing data to help others.

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Health and Fitness, Nutrition, Obesity, Research

Can food mentions in newspapers predict national obesity rates?

Can food mentions in newspapers predict national obesity rates?

New_York_TimesFood words trending in today’s newspapers could help predict a country’s obesity rates in three years, according to findings recently published in the journal BMC Public Health. 

In the study, researchers examined whether media mentions of food predate obesity prevalence by analyzing mentions of foods in New York Times and London Times articles over the past 50 years. Using this data, they statistically correlated it with each country’s annual Body Mass Index, or BMI. Brennan Davis, PhD, lead author of the study and an associate professor of marketing at California Polytechnic State University, said in a release that results showed:

The more sweet snacks are mentioned and the fewer fruits and vegetables that are mentioned in your newspaper, the fatter your country’s population is going to be in 3 years, according to trends we found from the past fifty years … But the less often they’re mentioned and the more vegetables are mentioned, the skinnier the public will be.

Researchers say the research could help public health officials better understand the effectiveness of current obesity interventions.

Previously: Adventurous eaters more likely to be healthy, new study shows, Want kids to eat their veggies? Researchers suggest labeling foods with snazzy names, Can edible “stop signs” revive portion control and curb overeating? and Can dish color influence how much you eat?
Photo by Jaysin Trevino

Behavioral Science, Health and Fitness, Obesity, Public Health, Sleep

How insufficient sleep can lead to weight gain

How insufficient sleep can lead to weight gain


I don’t think I’ve ever met a person who hates sleep and can’t wait to get less of it. Yet, even though most people want more sleep and know it’s important for their health, few people get as much shut-eye as they need. If you’re one of the many who needs a bit more motivation to get to bed earlier, a recent BeWell@Stanford article on how sleep can affect your weight may do the trick.

In the Q&A, sleep expert Emmanuel Mignot, MD, PhD, director of the Stanford Center for Sleep Sciences and Medicine, explains why and how insufficient sleep can increase your risk of weight gain:

It is very clear that if you’re not sleeping enough, you’re putting yourself at risk for increasing your weight.  If you sleep less than six hours a night, you’re likely to have a higher BMI (body mass index). Longitudinal data — and the evidence is quite strong — shows that if you sleep more over time, you’ll lower your BMI, which correlates with weight reduction.

In the first centuries of human life on earth, if humans weren’t sleeping they were probably looking for food or fleeing a predator. Not sleeping enough was a sign that we were in danger or that we were under stress. When we are sleep deprived, we feel hungry. Data indicates that if you sleep less, you eat more, and it disrupts your hormones. This problem is magnified in today’s world because food is too available!

Mignot also discusses the top reasons why people sleep so little, the importance of naps, and how being sleep-deprived skews our perception of doing and performing well. “[W]e have to make sure we don’t burn the candle at both ends, Mignot said. “Sleeping brings creativity, productivity and the ability to perform at a higher level.”

The piece is a quick, and informative, read.

Previously: Exploring the history and study of sleep with Stanford’s William Dement“Father of Sleep Medicine” talks with CNN about what happens when we don’t sleep wellStanford doc gives teens a crash course on the dangers of sleep deprivation, Narcoleptic Chihuahua joins Stanford sleep researcher’s family and More evidence linking sleep deprivation and obesity
Photo by Goodiez

Events, Health and Fitness, Nutrition, Obesity, Stanford News, Women's Health

Women’s health expert: When it comes to prevention, diet and exercise are key

Women's health expert: When it comes to prevention, diet and exercise are key

16262076932_96f8309b43_zThis Monday was the sixth annual Stanford Women’s Health Forum, hosted by Stanford’s Women and Sex Differences in Medicine center (WSDM), and I was happy to have been present for the lively talks. The forum focused on prevention, and the keynote, delivered by Marcia Stefanick, PhD, professor of obstetrics and gynecology and WSDM director, highlighted physical activity and weight management as the key preventative actions for women to take.

High blood pressure remains the number one preventable cause of death in women, with physical inactivity and high BMI, both of which contribute to high blood pressure, in third and fourth place. (For the curious readers, smoking comes in second.) Because prevention requires changes in behavior, behavior was what Stefanick focused on. Rather than reinforcing many women’s feelings of embarrassment about their weight, she said, providers should help women feel that they can do something about it.

Healthier behaviors must include diet and exercise. Both fatness and low fitness cause higher mortality; realistic expectations about how to change both should factor into care. Stefanick emphasized that weight loss should be slow: 10 percent of one’s body weight baseline over six months, or one pound per week for moderately overweight people, and no more than two pounds per week. And we need to stop being so sedentary, Stefanick exclaimed. The classic principles of exercise apply – gradually increase the frequency, intensity, and/or duration of exertion. Adults should be getting at least two and a half hours of moderate-intensity aerobic physical activity per week, in addition to doing muscle-strengthening activities at least twice a week, the conference flyer read.

However, citing the problems of eating disorders and older women losing weight without trying, Stefanick stressed that “weight management is a spectrum; there are extremes at both ends.” In describing variations on mesomorphic, endomorphic, and ectomorphic body types, she stated that “we don’t know what the optimal body type is.” It probably varies for each person.

Something I found particularly interesting was Stefanick’s description of gynoid vs android fat distribution patterns (which I learned as “pear” and “apple” body shapes, respectively). Gynoid distribution around the hips, thighs, and butt is more common in women, and includes more subcutaneous fat, while in android distribution, which is more common in men, fat collects around the belly and chest and is actually dispersed among the organs. Such intra-abdominal fat is more damaging to health, as it affects the liver and lipid profile and can cause heart disease, but it’s also much easier to get rid of through exercise (which is one reason men overall have less trouble losing weight than women).

In the spirit of more personalized care, Stefanick also discussed how recommended weight changes during pregnancy should vary according to the person’s prenatal BMI. Someone underweight could gain up to 40 pounds and be healthy, she pointed out, while obese people might actually lose weight during pregnancy for optimal mother-baby health.

Previously: Why it’s critical to study the impact of gender differences on diseases and treatmentsWhen it comes to weight loss, maintaining a diet is more important than diet typeApple- or pear-shaped: Which is better for cancer prevention?A call to advance research on women’s health issues and To meet weight loss goals, start exercise and healthy eating programs at the same time
Photo by Mikaku

NIH, Obesity, Public Health, Research

Capturing the metabolic signature of obesity

Capturing the metabolic signature of obesity

scale_weightWorldwide obesity rates have more than doubled since 1980, and today the majority of the global population live in areas where being overweight kills more people than being underweight, according to data from the World Health Organization. But new research that provides a comprehensive view of the metabolic signature that may correlate with obesity could help scientists develop more effective ways to manage and prevent obesity, and it offer insights into how variability in genes, environment, metabolism and lifestyle affect our health individually.

As reported today on the NIH Director’s Blog:

The new analysis uncovered changes to 29 molecular metabolites, or biomarkers, that correlated with obesity in 1,880 people from the United States. Most of those biomarkers—25 to be exact—also turned up in the urine of obese people from the other side of the Atlantic, offering confirmation that the findings represent a shared metabolic signature of obesity.

Several of the biomarkers are byproducts of what a person eats, which may reflect differences in the diets of obese and non-obese people. For example, urine from obese people was more likely to contain a metabolite that comes from eating red meat, while thinner folks were more likely to have a metabolite indicative of citrus fruit consumption.

However, not all of the biomarkers were directly related to food. Some appeared to stem from widespread changes in kidney function, skeletal muscle, and metabolism that may occur as a person packs on extra pounds. And, intriguingly, nine of the biomarkers significantly associated with obesity weren’t even produced by the human body, but rather by the trillions of microbes that live inside our guts. Those microbial partners play important roles in the breakdown of essential vitamins, amino acids, and protein. In fact, recent research findings suggest that a significant portion of obesity risk may be explained by the activity of gut microbes. This discovery adds to mounting evidence, spurred in recent years by the NIH-funded Human Microbiome Project, for the intricate and essential role of microbes—collectively known as the microbiome—in many aspects of our health.

The piece goes on to say that the findings also “raise the intriguing possibility that people might one day be able to visit their health-care providers, receive a blood or urine test, and leave with precise, individualized information regarding their risk” for obesity and other health issues.

Previously: Childx speaker Matthew Gillman discusses obesity prevention, Discussing how obesity and addiction share common neurochemistry, Stanford team awarded NIH Human Microbiome Project grant and Obesity is a disease – so now what?
Photo by Matthew

Events, Obesity, Pediatrics, Stanford News, Videos

Childx speaker Matthew Gillman discusses obesity prevention

Childx speaker Matthew Gillman discusses obesity prevention

The inaugural Childx conference was held here last month, and video interviews featuring keynote speakers, panelists and moderators are now on the Stanford YouTube channel. To continue the discussion of driving innovation in maternal and child health, we’ll be featuring a selection of the videos this month on Scope.

The prevalence of childhood obesity in the United States has not changed significantly since 2004 and remains at about 17 percent. However, the rate of obesity among preschool children, ages 2 to 5, has dropped from nearly 14 percent to 8.4 percent, according to data from the Centers for Disease Control and Prevention. Matthew Gillman, MD, a professor in the Department of Nutrition at Harvard Medical School, is among the group of researchers working to understand why rates of obesity among younger children have decreased.

In the above video interview from the Childx conference, Gillman discusses two possible reasons why fewer children under the age of five are obese and how this statistic points to potential prenatal underpinnings that influence a child’s risk of obesity. He goes on to explain how researchers previously believed that our health habits in adulthood gave rise to chronic disease, but that studies have shown the risk for these conditions may be determined early in life, even before birth. Watch his full interview to learn more about how fetal development influences our overall health.

Previously: “It’s not just science fiction anymore”: Childx speakers talk stem cell and gene therapy, Global health and precision medicine: Highlights from day two of Stanford’s Childx conference, Innovating for kids’ health: More from first day of Stanford’s Childx and “What we’re really talking about is changing the arc of children’s lives:” Stanford’s Childx kicks off

Autoimmune Disease, Chronic Disease, Health and Fitness, Nutrition, Obesity, Research

Study clarifies link between dieting, exercise and reduced inflammation

Study clarifies link between dieting, exercise and reduced inflammation

4503404991_13da58b6e6_bIf you’ve ever wondered how dieting and exercise reduce inflammation, read on. According to new research, a compound that our bodies crank out when energy supplies are low could be the link between diet and exercise, and reduced swelling in the body.

When diet, fasting and exercise starve the body for calories, the body increases production of a compound called beta hydroxybutyrate (BHB). This compound has long been known as an alternate source of energy; the new research suggests that BHB can also block the inflammatory response.

In their study, published this week in Nature Medicine online (subscription required), a team of scientists co-led by Yun-Hee Youm and Kim Yen Nguyen at the Yale School of Medicine, discovered that the compound BHB reduces swelling in the body by inactivating a group of proteins, called the inflammasome, that drive the inflammatory response.

The research team used human immune cells and mice to explore the effects of BHB in the body. They found that mice given BHB directly, and mice fed a low-carbohydrate diet (that prompted their bodies to synthesize their own BHB), both benefited from reduced inflammation.

These results are noteworthy because a better understanding of the mechanism that links diet, exercise and inflammation could help scientists develop more effective treatments for inflammatory disorders such as Type 2 diabetes, atherosclerosis and Alzheimer’s disease.

Previously: Newly identified type-2 diabetes gene’s odds of being a false finding equal one in 1 followed by 19 zeroesImproving your health using herbs and spices, Exercise may alleviate symptoms of arthritis regardless of weight loss, Study points to inflammation as cause of plaque buildup in heart vessels and Examining the role of exercise in managing and preventing diabetes
Via ScienceDaily
Photo by Dave Nakayama

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