In an article in the July issue of the Archives of Pediatric and Adolescent Medicine, University of Michigan’s C.S. Mott Children’s Hospital pediatric endocrinologist Dr. Joyce Lee warns that the most damaging effects of childhood obesity have yet to surface.

Lee’s findings suggest childhood obesity will likely result in an epidemic of type 2 diabetes among young adults, which could lead to a greater number of diabetes complications, and ultimately, lower life expectancy.

“The full impact of the childhood obesity epidemic has yet to be seen because it can take up to 10 years or longer for obese individuals to develop type 2 diabetes,” said Lee, a member of the Child Health Evaluation and Research Unit at Mott. “Children who are obese today are more likely to develop type 2 diabetes as young adults.”

“It use to be called Adult-Onset Diabetes and we saw it in adults, later in their life,” said Palo Pinto General Hospital’s Dr. Edgar Lockett. “Two years ago [a study revealed] 50 percent of newly diagnosed type 2 diabetes were age 18 and under.”

Lockett said the cause is not the quantity of food kids eat, but a “general trend toward poor nutrition.”

“[Americans] are literally starving with plenty of ‘food’ around,” he said, adding that the vast majority of diabetes cases are caused by poor nutritional choices.

“There’s no nutrition in the diet,” said Lockett. “Americans are eating the wrong fats, there’s an overabundance of corn syrup, white rice, white bread (white flour) and sugar in everyday diets.”

He said all of this “taxes the [body’s] system and can propagate the onset of type 2 diabetes.”

Lockett said the trend toward poorer nutrition began in the 1970s, with the onset of fast food and convenience foods.

“Each successive generation gets sicker quicker,” he said. “Children in general are becoming susceptible to disease,” Lockett said, because of their diets.

Lee’s recent article states that the longer a person has diabetes, the more likely he or she is to develop devastating complications.

“It’s hard to tell someone they can’t eat certain things,” said Lockett. However, he added, “If poorly regulated, diabetes causes organ damage, blindness, heart attacks, stroke and loss of limbs – starting with the lower extremities.”

He added that among other side effects, improper nutrition also leads to poor immune systems and an epidemic of asthma in children – seen younger than ever before – in addition to eventual type 2 diabetes.

Why should the community care about a potential epidemic of type 2 diabetes in children?

“First of all it will be a tremendous taxation of health care resources,” said Lockett. “That’s if [type 2 diabetes] is recognized [early]. Many cases go undiscovered.”

“Anytime we have this type of onslaught on the health care system, it diverts more healthcare dollars to something that is a preventable disease,” he added.

While he said there are genetic tendencies toward diabetes, Lockett maintains it’s a result of an accumulation of a lot of bad habits, “So the question is, ‘Is it really a disease?’”

Also on Monday, the American Academy of Pediatrics released guidelines, which have stirred debate among pediatricians. The guidelines suggest some children, as young as 8, be given cholesterol-lowering drugs to ward off future heart problems.

According to an Associated Press report, this is the strongest guidance ever given on the issue by the American Academy of Pediatrics. The academy also recommends low-fat milk for 1-year-olds and wider cholesterol testing.

Lockett calls prescribing statins for children, “the epitome of the ludicrous.”

“This sounds like a pharmaceutical-based initiative being promoted through the American Academy of Pediatrics,” he added.

He maintains that the issues surrounding diabetes and high cholesterol can be remedied without using drugs and instead implementing a plant-based diet.

“If it’s cancer, heart disease, diabetes, liver problems, there’s one diet that can impact everything,” he said. “Really there’s one disease – the cells of your organs are not functioning well. Two reasons for this are the lack of quality raw materials – ‘you are what you eat’ – and, or an accumulation of toxins or poisons.”

Lockett shared information from a study conducted by Dr. James Anderson who researched the effects of a diet consisting of high-fiber, high complex-carbohydrates and low in fats on 25 type1 diabetics and 25 type 2 diabetics.

“Whole plant foods and a cold cut or two a day was the basis of the diet,” cited Lockett.

He said he uses this study and findings from others in talks he gives, because of the results of the diet.

This includes:

• Type 1 patients had lowered insulin requirements by 40 percent and their cholesterol levels dropped by 30 percent.
• All but one Type 2 diabetics were able to get off their medication within a few weeks.

Diabetes: Underrated, Insidious and Deadly

In a set of recent focus groups, participants were asked to rank the severity of various health problems, including cancer, heart disease and diabetes.

On a scale of 1 to 10, cancer and heart disease consistently ranked as 9s and 10s. But diabetes scored only 4s and 5s.

“The general consensus seems to be, ‘There’s medication,’ ‘Look how good people look with diabetes’ or ‘I’ve never heard of anybody dying of diabetes,’ ” said Larry Hausner, chief executive of the American Diabetes Association, which held the focus groups. “There was so little understanding about everything that dealt with diabetes.”

But diabetes is anything but minor. It wreaks havoc on the entire body, affecting everything from hearing and vision to sexual function, mental health and sleep. It is the leading cause of blindness, amputations and kidney failure, and it can triple the risk for heart attack and stroke.

“It is a disease that does have the ability to eat you alive,” said Dr. John B. Buse, a professor at the University of North Carolina School of Medicine who is the diabetes association’s president for medicine and science. “It can be just awful — it’s almost unimaginable how bad it can be.”

Diabetes results when the body cannot use blood sugar as energy, either because it has too little insulin or because it cannot use insulin. Type 2 diabetes, which accounts for 90 to 95 percent of cases, typically develops later in life and is associated with obesity and lack of exercise. Type 1 diabetes, which is often diagnosed in children, occurs when the immune system mistakenly destroys cells that make the insulin.

The disconnect between perception and reality is particularly worrisome at a time when national diabetes rates are surging. Just last week, the Centers for Disease Control and Prevention announced that the number of Americans with diabetes had grown to about 24 million, or 8 percent of the population. Almost 25 percent of those aged 60 and older had diabetes in 2007. And the C.D.C. estimates that 57 million people have abnormal blood sugar levels that qualify as pre-diabetes.

To be sure, diabetes is treatable, and an array of new medications and monitoring tools have dramatically improved the quality of care. But keeping the illness in check requires constant vigilance and expensive care, along with lifestyle changes like losing weight, exercising regularly and watching your carbohydrates.

Dr. Buse says patients who are focused on their disease and who have access to regular medical care have a good chance of living out a normal life span without developing a diabetes-related disability.

But some patients say they are too busy to take better care of themselves, and many low-income patients can’t afford regular care. Even people with health insurance struggle to keep up with the co-payments for frequent doctor visits and multiple medications.

And to make matters worse, diabetes is associated with numerous other health problems. Last week, for example, The Journal of the American Medical Association reported that people with depression were at higher risk for Type 2 diabetes, and vice versa.

That is not surprising: according to data published last year in the journal Diabetes Care, depression tends to interfere with a patient’s self-care, which requires glucose monitoring, medications, dietary changes and exercise.

Ultimately, diabetes can take a toll from head to toe. In the brain, it raises the risk not only for depression but also for sleep problems and stroke. It endangers vision and dental health. This month, The Annals of Internal Medicine is reporting that the disease more than doubles the risk of hearing loss.

Moving down the body, diabetes can lead to liver and kidney disease, along with serious gastrointestinal complications like paralysis of the stomach and loss of bowel control. Last year the journal Diabetes Care reported that in a sample of nearly 3,000 patients with diabetes, 70 percent had nonalcohol fatty liver disease.

Poor circulation and a loss of feeling in the extremities, called neuropathy, can lead to severe ulcers and infections; each year in the United States, there are about 86,000 diabetes-related amputations.

Diabetes can also take a toll on relationships. By some estimates, 50 percent to 80 percent of men with diabetes suffer from erectile dysfunction. Experts say women with diabetes often lose their libidos or suffer from vaginal dryness.

The challenge for doctors is to convince patients that diabetes is a major health threat. For years, the message from the American Diabetes Association has been one of reassurance that the disease is treatable. Now, beginning in 2009, the association plans to reframe its message to better communicate the seriousness of the disease.

“Our communication strategy is going to be that diabetes has deadly consequences, and that the A.D.A. is here to change the future of diabetes,” said Mr. Hausner, a former executive with the Leukemia and Lymphoma Society who came to the association 10 months ago. “It’s the word ‘deadly’ that was the potentially controversial word for the organization. In the past, people said, ‘We don’t want to get anybody scared.’ ”

The new strategy is not a scare tactic, he added. Prevention and hope will still be part of the message.

“It’s not that we don’t want people to have hope,” he said. “We want people to understand this is serious.”

Hypoxia: its short - and long-term effects on the developing fetus
Dino Giussani
University of Cambridge, Cambridge, UK.

In addition to traditional risks, such as smoking and obesity, the quality of our prenatal development plays a role in determining whether we suffer disease. In turn, the quality of the intrauterine environment is largely determined by the available nutrient and oxygen supply to the growing young. As such, the association between poor conditions in utero and increased risk of disease in adulthood has exploded a number of studies investigating the effects of changes in materno-fetal nutrition on programming of disease. In contrast to this international research effort, the contribution of fetal hypoxia, of the type that can occur during pre-eclampsia or placental insufficiency, to developmental programming has been comparatively ignored. Further, the mechanisms underlying the early programming of disease in complicated pregnancy remain unknown, preventing the identification of potential therapeutic targets for clinical intervention. Here, we put forward the hypothesis that oxidative stress in the fetus underlies the molecular basis via which prenatal hypoxia alters fetal growth and contributes to the developmental programming of disease. Observations in human pregnancy at high altitude and experiments in chick and rat embryos show that developmental hypoxia independent of changes in maternal nutrition not only alters the trajectory of fetal growth, but it also induces changes in the cardiovascular, metabolic and endocrine systems, which are normally associated with disease states in later life. Treatment with antioxidants of animal pregnancies complicated with reduced oxygen delivery to the fetus prevents the alterations in fetal growth, the fetal cardiovascular, metabolic and endocrine remodelling, and the increased oxidative stress. Combined, the human and experimental data support the hypothesis tested and the work offers both insight into mechanisms and possible therapeutic targets for clinical intervention against the early origin of disease in risky pregnancy.

Hormones are molecules that act as signals from one type of cells to another. Most hormones reach their targets via the blood.

All multicellular organisms need “coordinating systems to regulate and integrate the function of differentiating cells.” Two mechanisms perform this function in higher animals: the nervous system and the endocrine system. The endocrine system acts through the release (generally into the blood) of chemical agents and is vital to the proper development and function of organisms. As Hadley notes,[1] the integration of developmental events such as proliferation, growth, and differentiation (including histogenesis and organogenesis) and the coordination of metabolism, respiration, excretion, movement, reproduction, and sensory perception depend on “chemical cues, substances synthesised and secreted by the specialised cells within the animals hair.”

Endocrinology is concerned with the study of the biosynthesis, storage, chemistry, and physiological function of hormones and with the cells of the endocrine glands and tissues that secrete them.

The endocrine system consists of several glands, in different parts of the body, that secrete hormones directly into the blood rather than into a duct system. Hormones have many different functions and modes of action; one hormone may have several effects on different target organs, and, conversely, one target organ may be affected by more than one hormone.

In the original 1902 definition by Bayliss and Starling (see below), they specified that, to be classified as a hormone, a chemical must be produced by an organ, be released (in small amounts) into the blood, and be transported by the blood to a distant organ to exert its specific function. This definition holds for most ‘classical’ hormones, but there are also paracrine mechanisms (chemical communication between cells within a tissue or organ), autocrine signals (a chemical that acts on the same cell), and intracrine signals (a chemical that acts within the same cell).[2] A neuroendocrine signal is a ‘classical’ hormone that is released into the blood by a neurosecretory neuron (see article on Neuroendocrinology).

Hormones act by binding to specific receptors in the target organ. As Baulieu notes, a receptor has at least two basic constituents:

* a recognition site, to which the hormone binds
* an effector site, which precipitates the modification of cellular function.[3]

Between these is a “transduction mechanism” in which hormone binding induces allosteric modification that, in turn, produces the appropriate response.