Insulin Sensitivity in the Obese State: Is it as Easy as Stopping the FAT(10)?
Obesity is recognized as a risk factor for type 2 diabetes (T2D), cardiovascular disease and certain types of cancer. Inflammation, both local and systemic, is an appreciated catalyst of obesity-associated metabolic complications such as insulin resistance and glucose intolerance. Examining time course models of high fat diet fed mice has associated inflammation with weight gain, insulin resistance, glucose intolerance and β-cell dysfunction. Studies utilizing mouse knock out models of genes involved in inflammatory signaling cascades show protection from obesity, insulin resistance, glucose intolerance, and/or β-cell dysfunction.
The Human Leukocyte Antigen F-adjacent transcript 10 (FAT10) is a recently characterized protein that plays a role in obesity-associated insulin resistance. FAT10, or diubiquitin, functions as a regulator of the NF-κB pathway. FAT10 also interacts with p53, and both NF-κB and p53 are known to regulate obesity-associated insulin resistance. The FAT10 knock out (FAT10KO) mouse was generated in Dr. Weissman’s lab at Yale University and was first reported in 2006. Recently, it was shown that FAT10KO mice subjected to a 12-week regimen of high fat diet feeding become obese but retain systemic insulin sensitivity.
Obesity-associated insulin resistance is coincident with accumulation of ectopic lipid in peripheral tissues such as skeletal muscle and liver. Skeletal muscle (quadriceps) total triglyceride levels are significantly reduced in the FAT10KO compared to WT control. FAT10KO mice also had elevated expression of genes that promote lipid oxidation, coincident with elevated levels of phosphorylated ACC protein. These results are consistent with the maintenance of insulin resistance in FAT10KO mice, given that insulin resistant mice lose the capacity of lipid oxidation, which balances the lipid influx into skeletal muscle. Analysis of inflammatory gene expression in muscle furthermore revealed up-regulation of IL-10, an anti-inflammatory, insulin-sensitizing cytokine. Circulating and skeletal muscle IL-10 protein was also increased in the FAT10KO.
Obesity in 12-week high fat diet fed FAT10KO mice is characterized by increases in body weight similar to that of wild type (WT) control mice (42 g) with no difference in fat storage in subcutaneous and visceral adipose tissue. However, FAT10 KO mice exhibit dramatic up-regulation of IL-4 and IL-13, two anti-inflammatory genes that maintain insulin sensitivity in adipose tissue, and further reinforce IL-10 action. There was no difference in adipocyte area between genotypes illustrating that the anti-inflammatory environment is not promoted by smaller adipocytes that normally produce IL-4 and IL-13. Isolation of adipocytes from stromal vascular cells illustrates that adipocytes from obese FAT10 mice are producing the majority of the IL-4 and IL-13 compared to stromal cells.
Many questions remain as to how and where deletion of FAT10 promotes insulin sensitivity. Additionally, there are currently no studies in human obesity that associate FAT10 expression and insulin resistance, although a human orthologue has been described. There is a common theme of up-regulation of anti-inflammatory cytokines in the FAT10 KO mouse. Notably however, NF-κB also activates IL-10 apart from its more widely recognized function as a pro-inflammatory cytokine, thus it is possible that FAT10 is a master regulator of cytokine balance. More detailed analysis of promoter regions responding to inflammatory stimuli may reveal a role
for FAT10 in balancing pro/anti-inflammatory gene responses in order to shed light on this concept. These data indicate that FAT10 may be a novel target for attempts aimed at restoring insulin sensitivity in obese individuals.
Insulin Sensitivity in the Obese State – Reported by Obesity.org
February 9th, 2012Centers for Medicare and Medicaid Services Decision Memo for Intensive Behavioral Therapy for Obesity
February 8th, 2012The Centers for Medicare and Medicaid Services (CMS) has determined the following:
The evidence is adequate to conclude that intensive behavioral therapy for obesity, defined as a body mass index (BMI) ≥ 30 kg/m2, is reasonable and necessary for the prevention or early detection of illness or disability and is appropriate for
individuals entitled to benefits under Part A or enrolled under Part B and is recommended with a grade of A or B by the U.S. Preventive Services Task Force (USPSTF).
Intensive behavioral therapy for obesity consists of the following:
1. Screening for obesity in adults using measurement of BMI calculated by dividing weight in kilograms by the square of height in meters (expressed in kg/m2);
2. Dietary (nutritional) assessment; and
3. Intensive behavioral counseling and behavioral therapy to promote sustained weight loss through high intensity interventions on diet and exercise.
The intensive behavioral intervention for obesity should be consistent with the 5-A framework that has been highlighted by the USPSTF:
1. Assess: Ask about/assess behavioral health risk(s) and factors affecting choice of behavior change goals/methods.
2. Advise: Give clear, specific, and personalized behavior change advice, including information about personal health harms and benefits.
3. Agree: Collaboratively select appropriate treatment goals and methods based on the patient’s interest in and willingness to change the behavior.
4. Assist: Using behavior change techniques (self-help and/or counseling), aid the patient in achieving agreed-upon goals by acquiring the skills, confidence, and social/environmental supports for behavior change, supplemented with adjunctive
medical treatments when appropriate.
5. Arrange: Schedule follow-up contacts (in person or by telephone) to provide ongoing assistance/support and to adjust the treatment plan as needed, including referral to more intensive or specialized treatment.
For Medicare beneficiaries with obesity, who are competent and alert at the time that counseling is provided and whose counseling is furnished by a qualified primary care physician or other primary care practitioner and in a primary care setting, CMS
covers:
* One face-to-face visit every week for the first month;
* One face-to-face visit every other week for months 2-6;
* One face-to-face visit every month for months 7-12, if the beneficiary meets the 3kg weight loss requirement as discussed below.
At the six month visit, a reassessment of obesity and a determination of the amount of weight loss must be performed. To be eligible for additional face-to-face visits occurring once a month for an additional six months, beneficiaries must have
achieved a reduction in weight of at least 3kg over the course of the first six months of intensive therapy. This determination must be documented in the physician office records for applicable beneficiaries consistent with usual practice. For beneficiaries who do not achieve a weight loss of at least 3kg during the first six months of intensive therapy, a reassessment of their readiness to change and BMI is appropriate after an additional six month period.
What Is Degenerative Disc Disease?
September 14th, 2010Many people that are diagnosed with degenerative disc disease may be a little confused to what exactly they are in for. The term degenerative usually means long term bone troubles that can be crippling. This is why you need to know what exactly this disc condition is about.
The spine is made up of bones called vertebra. In between these bones are cushions called discs. The discs are made up of fibrous tissue around the outer edges. These outer edges are named the annulus. This is where the degenerative process in this disc disease begins.
The aging process causes the discs between vertebra to become damaged and worn out. Injury also incurs damage as well, sometimes being more serious than that of aging. When the annulus experiences damage to it, the fibrous tissues it is made of tears. When these tears heal, they form scar tissue. Too much injury and too much scar tissue weaken the it and allow the inner core if the disc to lose the water in it that actually provides the cushioning for the bones.
When there is not enough water in the disc, it simply collapses. This is when the trouble and pain usually start in this disease. The bones are then able to rub together. In many cases this cause the formation of bone spurs. Bones spurs are sharp and can cut into the nerves in the spinal cord, causing great and severe pain.
When the disc has gotten this far and the bones have formed spurs, some movements can be excruciating. This causes major interruptions in the daily activities of the sufferer. Most times, the only position that can help to provide pain relief is lying down.
Patients with this condition should consult with their doctor about disc replacement surgery. Although it is a fairly new procedure, it may the very answer to spinal fusion and non surgical procedures that only treat the symptoms of pain.
Seeking help with our spine specialists at RB Spine Center can help you stay pain free and maintain what you have. Visit rbspinecenter.com and for more information.
Do You Suffer From Bulging Discs?
September 14th, 2010Have you heard the term bulging discs? Some call it a herniated disc, which refers to the same condition. It is basically a term that refers to the discs in the spine that for one reason or another become inflamed and bulges out and cause pain.
Many people have this condition and are limited in movement because any time they bend over or reach up; they are met with a lot of pain. But the problem is not always very serious and can be relieved with anti inflammatory medication.
Also, many people find relief after a visit to their chiropractor. Many people become worried or even frightened when they hear that they have a problem with their spine. They start thinking the worse case scenario. They think that they might need surgery or that they might end up paralyzed.
This is only natural, because most people know how delicate the spinal cord is. But if you have a disc problem, in many cases, all you need to do is rest your back and allow your back to heal itself.
There are many ways that you can injure your back. But a disc problem can occur simply from sitting down all day at work. You have to realize that the human body was not meant to sit down for extended periods of time. The sitting position puts extra strain and stress on the spine which can cause inflammation in the discs which leads to the bulging of the gel like material in the spine which leads to pain.
Your chiropractor can suggest stretching exercises that will help the blood circulate in the area of your spine so that the inflammation will be relieved. In fact, in many cases, if you practice the right type of exercise for your back, you might avoid bulging discs altogether.
Stress Management
July 28th, 2010Stress Management
What is Stress?
Stress is the “wear and tear” our bodies experience as we adjust to our
continually changing environment; it has physical and emotional effects on us
and can create positive and negative feelings. As a positive influence, Stress
can help compel us to action; it can result in a new awareness and an exciting
new perspective. As a negative influence, it can result in feelings of distrust, rejection, anger, and depression, which in turn can lead to health problems such as headaches, upset, stomach, rashes, insomnia, ulcers, high blood pressure, heart disease, and stroke. With the death of a loved one, the birth of a child, a job promotion, or a new relationship, we experience stress as we readjust our lives. In so adjusting to different circumstances, stress will help or hinder us depending on how we react to it.
How can I eliminate stress from my life?
As we seen, positive stress adds anticipation and excitement to life, and we
all thrive under a certain amount of stress. Deadlines, competitions,
confrontations and even our frustrations and sorrows add depth and enrichment to our lives. Our goal is not to eliminate stress but to learn how to manage it and how to use it to help us. What we need to do is find the optimal level of stress which will individually motivate but not to overwhelm each of us.
How can I tell what is optimal stress for me?
There is no single level of stress that is optimal for all people. We are all
individual creatures with unique requirements. As such, what is distressing to
one may be a joy to another. And even when we agree that a particular event is distressing, we are likely to differ in our physiological and psychological
responses to it. It has been found that most illness is relevant to unrelieved stress. If you are experiencing stress symptoms, you have gone beyond your optimal stress level; you need to reduce the stress in your life and/or improves your ability to manage it.
How can I manage stress better?
Identifying unrelieved stress and being aware of its affect on our lives is not sufficient for reducing its harmful effects. Just as there are many sources of stress, there are many possibilities for its management. However, all require work towards change; changing the source of stress and/ or changing your reaction to it. How do you proceed?
1. Become aware of your stressors and your emotional and physical reactions
Notice your distress. Don’t ignore it. Don’t gloss over your problems. Determine what events distress you. What are you telling yourself about meaning of these events? Determine how your body responds to the stress. Do you become nervous or physically upset? If so, in what specific ways?
2. Recognize what you can change. Can you change your stressors by avoiding or eliminating them completely?
Can you reduce their intensity (manage them over a period of time instead of
on a daily or weekly basis) Can you shorten your exposure to stress (take a break, leave the physical premises)? Can you devote the time and energy necessary to making a change (goal setting, time management techniques, and delayed gratification strategies may be helpful here)?
3. Reduce the intensity of your emotional reactions to stress. The stress reaction is trigger by your perception of danger…physical danger and/ or emotional danger. Are you viewing your stressors in exaggerated terms and/or taking a difficult situation and making it a disaster?
Are you expecting to please everyone? Are you overreacting and viewing things as absolutely critical and urgent? Do you feel you must always prevail in every situation? Work at adopting more moderate views; try to see the stress as something you can cope with rather than something that overpowers you. Try to temper your excess emotions. Put the situations in perspective. Do not labor on the negative aspects and the “What if’s.”
4. Learn to moderate your physical reactions to stress. Slow, deep breathing will bring your heart rate and respiration back to normal. Relaxation techniques can reduce muscle tension. Electronic biofeedback can help you gain voluntary control over such things as muscle tension, heart rate, and blood pressure. Medications, when prescribed by a physician, can help in the short term in moderating your physical reaction. However, they alone are not the answer. Learning to moderate these reactions on your own is a preferable long time solution. Our preventative management focuses on the individual not the disease.
5. Build your physical reserves. Exercise for cardiovascular fitness three or four times a week (moderate, prolonged rhythmic is best, such as walking, cycling, swimming, or jogging). Eat well-balanced, nutritious meals.
Maintain your ideal weight. Avoid nicotine, excessive caffeine, and other stimulants. Mix leisure with work. Take breaks and get away when you can.
Get enough sleep. Be as consistent with your sleep schedule as possible.
6. Maintain your emotional reserves. Develop some mutually supportive
friendship/relationship, Pursue realistic goals which are meaningful to you, rather than goals others have for you that you do not share. Expect some frustration, failures, and sorrows. Always be kind and gentle with yourself- be a friend to yourself.
How integrated medicine can help you achieve your goals? Health care is about choices, your choices. At our facility we offer you options for choosing natural and allopathic treatment methods. Our health professional takes a cooperative approach to your need by integrating the best of both worlds and offering you the utmost in quality healthcare choices.
Our philosophy:
We believe that the highest priority in health care delivery should be good
health through disease prevention, not disease treatment. Disease treatments reflect system failure. Often it is possible to restore good health by making behavioral and life changes even after disease has developed.
Dr. Kancilia D.C believes in correcting the cause of a patient’s condition and doesn’t advocate “long term non specific treatment programs.”
The RB Spine Center is built on the close relationship between staff and our patients. We take pride in getting to know you and how you lived your life prior to your injury or condition and how it had affected you. Due to
this limit the number and type of patients we accept into our practice.
Contact us for free consultation.
Natural Method of Health Care
June 12th, 2010Perhaps this article is your first introduction to chiropractic as a health care profession. If this is the case, we are sure that you have some questions pertaining to what chiropractic is, and how the natural approach of chiropractic may aid in revealing many health ailments. Since these questions are normal and commonplace for a new patient, we will explain to you about chiropractic’s approach to health. We will also explain to you the application of chiropractic to your specific health problem.
Chiropractic is a branch of the healing arts, and as a science is based on the premise that good health depends, in part, upon a normally functioning nervous system. When body structures such as cells and organs are functioning normally, a state of health or normal physiology is said to exist. However, when the body’s physiology is abnormal, a disease state begins. Thus, we begin to understand that abnormal physiology leads to abnormal function, predisposing the body to disease process.
Your spinal column, or vertebral column, is a series of movable bones which begin at the base of your skull and end in the center of your hips. Although the spine is composed of 24 individual vertebrae, it functions as one dynamic organ upon which the structure is dependent for support and movement. These vertebrae are stacked up like building blocks, and between them are located fibrocartilages (or discs). These discs help o cushion shock, reduce friction and allow movement to occur.
The examination of your spine to evaluate structure and function is what makes chiropractic different from other health care procedures. Accidents, falls, uneven stress, tension, over-extension or any other factor may cause an inability of the spine to move as a dynamic organ, can result in minor displacements or derangements of one or more of these vertebrae, causing irritation to spinal nerve roots directly by pressure or indirectly through reflexes.
These irritations, in turn, may cause malfunctions in your body. Chiropractic teaches that nerve pressure, or nerve reflex can cause a disturbance of delicate body functions resulting in an increased susceptibility to disease processes. Alleviating the irritation to spinal nerves by re-establishing normal spinal mobility, the doctor of chiropractic seeks to cause your body to operate more efficiently and more comfortably.
Chiropractic can help with new innovations of treatment that can be found at RB Spine Center. We are the leader in progressive treatment of disc bulges, disc herniation, sciatica, low back pain and neck pain in Rancho Bernardo. Our San Diego specialists have technology and knowledge to help you out of pain fast and drug free. Our Rancho Bernardo Chiropractor has over 25 years experience in treating complicated spinal conditions from injuries related to auto accidents, sports or work injuries.
Chiropractic Study
May 6th, 2010Chiropractic is More Effective Than
Medication And Acupuncture!
A study in the July 15, 2003 issue of Spine reports that in a clinical study of patients with chronic spinal pain, patients receiving chiropractic care responded much more favorably and with better results than patients who went through a regimen of medication or acupuncture.
The study involved 115 patients admitted to an Australian multidisciplinary spinal pain outpatient clinic. Each patient was randomly assigned to receive either chiropractic care, needle acupuncture or medication. Each patient was initially assessed with the Oswestry Back Pain Disability Index (simply known as Oswestry), the Neck Disability Index (NDI), the Short-Form-36 Health Survey questionnaire (SF-36), visual analog scales (VAS) of pain intensity and ranges of movement. The same tests were given again at 2, 5 and 9 weeks into their respective care programs.
According to the results, 27.3% of the patients under chiropractic care experienced early pain relief. Only 9.4% of the acupuncture patients and 5% of the medication patients experienced early pain relief.
The chiropractic patients also had the most improvement when measured by the other tests with improvements of 50% on the Oswestry, 38% on the NDI, 47% on the SF-36 and 50% on the VAS for back pain.
This study concentrated on the early relief of pain, obviously an important concern for the patients experiencing it. And as important as your pain relief may be, your chiropractor is also concerned about the long-term correction of your spinal problems.
Try Chiropractic To GET and STAY Healthy!
call us for an appointment
858-345-4114
Records High Pollen Count
May 6th, 2010Record High Pollen Counts!
Across the nation, pollen counts are setting record highs. In many areas, especially the South, Midwest, and the Plains, pollen is visible in the air and leaves a yellow-green dust on nearly everything that is left outside.
With an extended winter freeze, many trees did not pollinate during their usual time. When April began, many areas saw record-breaking high temperatures. This resulted in a sudden burst of pollination from trees and plants of many varieties.
What causes allergies?
An allergy is caused by an oversensitive immune system, which leads to a hypersensitive immune response. If the immune system is out of balance, it will treat harmless substances as hostile irritants and attempt to expel them from the body. Symptoms such as runny nose, sneezing, itchy and watery eyes are the result of the body reacting to these irritating substances or allergens.
Diabetes and You
March 29th, 2010| Nutrition , Exercise and Diabetes
What is diabetes? Over seventeen million Americans have diabetes. Almost 6 million Americans are unaware they have the disease. There are two main types of diabetes. Both types are caused by problems in how a hormone called insulin (that helps regulate blood sugar) works. Type 1 diabetes most often appears in childhood or adolescence and causes high blood sugar when your body can’t make enough insulin. Over 90% of all diabetes cases are what we call type 2 diabetes. Type 2 diabetes is usually diagnosed after age forty; however it is now being found in all ages including children and adolescents. Type 2 diabetes is linked to obesity and physical inactivity. In this form of diabetes your body makes insulin but can’t use its insulin properly. At first, your body overproduces insulin to keep blood sugar normal, but over time this causes your body to lose its ability to produce enough insulin to keep blood sugar levels in the normal healthy range. The result is sugar rises in your blood to high levels. Over a long period of time, high blood sugar levels and diabetes can cause heart disease, stroke, blindness, kidney failure, leg and foot amputations, and pregnancy complications. Diabetes can be a deadly disease: over 200,000 people die per year of diabetes related complications. Does being overweight effect type 2 diabetes? Carrying extra body weight and body fat go hand and hand with the development of type 2 diabetes. People who are overweight are at much greater risk of developing type 2 diabetes than normal weight individuals. Being overweight puts added pressure on the body’s ability to properly control blood sugar using insulin and therefore makes it much more likely for you to develop diabetes. Almost 90% of people with type 2 diabetes are overweight. The number of diabetes cases among American adults jumped by a third during the 1990s. This rapid increase in diabetes is due to the growing prevalence of obesity and extra weight in the United States population, and may also be related to the poor nutritional habits of the population today. Prevention ? Yes, type 2 diabetes is largely preventable. Research studies have found that lifestyle changes(nutritional) and small amounts of weight loss in the range of 5-10% can prevent or delay the development of type 2 diabetes among high-risk adults. Lifestyle interventions including diet and moderate-intensity physical activity (such as walking for 150 minutes per week) were used in these research studies to produce small amounts of weight loss. Managing your weight is the best thing you can do to prevent the development of diabetes. The best alternative for balancing your body and shed those extra pounds are by evaluating your blood for nutritional deficiencies, and correcting those with natural nutritional measures. Natural Treatment of diabetes? You can have a positive influence on your blood sugar and your overall health by choosing foods wisely, exercising regularly, reducing your stress level, and making modest lifestyle changes.. Overall better nutrition, physical activity, and control of blood glucose levels can delay the progression of diabetes and prevent complications. A blood based nutrition program can greatly reduces your body weight, naturally and prevent the risk of diabetes if treated at an early stage. Call our office for further information and how we can help you with our Blood Nutrition Services. Visit RBALTHEALTH.COM for more information on how to feel up 10 years younger in up 10 10 weeks! |
RB Spine Center
10801 Thornmint Rd #250
San Diego, CA 92127
858-345-4887
Also visit our Los Angeles Office
15 Fwy exit Camino Del Norte exit - head west - to exit on RT -Camino San Bernardo - go down to light at corner of Camino San Bernardo and Thornmint RD, RT turn -turn RT into first driveway - RT to front building facing street, enter to suite #250
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