I've lived with type 1 diabetes for 41 years and without complications. Probably the one thing I do have is Diabetic Mastopathy, but it's not a major complication that threatens the rest of my life. I have known other people who have lived by the diabetes book and still developed diabetes complications such as retinopathy, neuropathy, nephropathy.
Recently, an article caught my eye that mentioned new research, out of Joslin Diabetes Center, on why some people seem to be shielded from diabetes complications. In a study of 351 people living type 1 diabetes for 50 years, nearly 43% remained free of diabetes retinopathy, 87% never developed kidney disease, nearly 40% were free of nerve damage or neuropathy and 51% showed no cardiovascular disease.
What makes some people immune from the complications? Dr. George King, Chief Science Officer at Joslin Diabetes Center, basically says they don't know exactly why, but they are looking into why some of us seem to have endogenous protective factors. What is clear is that most of these people manage their diabetes pretty well and clearly better control is part of the recipe for success. Even more striking was the average A1c of the group: 7.7! Most of these people had diabetes well before blood glucose meters, advanced insulin and pump technology and even management for tight control, yet they have little resulting negative consequences.
What was assessed from the data so far is that in relation to HbA1c, lipids, and advanced glycation end products (AGEs), AGEs seem to be a culprit in developing complications. This information is not new, but what is new is the reported low levels of AGEs within this group.
The definition of AGEs is this: Advanced Glycation End Products are the result of a chain of chemical reactions after an initial glycation reaction. AGEs may be formed external to the body by heating (an examples would be cooked food), or they can be formed internally through metabolism and aging. Under certain pathogenic conditions, like oxidative stress due to high blood sugar, AGE formation can be increased beyond normal levels.
AGEs have been attributed to in the progression of age related diseases because they act as photosensitizers implicating AGEs responsibility for cateract development. AGEs has been implicated in Alzhiemer's disease, cardiovascular disease and stroke.
In diabetes, hyperglycemia results in higher cellular glucose levels and those cells are unable to reduce the glucose levels. In turn, this results in increased levels of coenzymes NADH and FADH, increasing the proton gradient beyond a particular threshold at which the coenyme Q, also known as complex III, prevents further increase by stopping the electron transport chain. This results in mitochrondial production of reactive oxygen species, activating PARP1 by damaging DNA. PARP1 activates another protein involved in glucose metabolism, leading to its activation and accumulation of byproducts called metabolites. These metabolites activate the production of high levels of AGEs. (Talk about a chain reaction! And, wiki rocks!)
Everyone produces AGEs, but people with diabetes tend to accumulate more. (AGES are also known to play a role in developing gestational diabetes as well.) AGEs are absorbed during digestion with about 30% efficiency, but the accumulation of AGE-related damage is proportional to the amount of sugar we consume. A 1997 study showed that by adding sugar to egg whites caused people living with diabetes to be 200 times more AGE immunoreactive!
AGEs affect nearly every cell and molecule in the body and are attributed to the aging factor and chronic illness associated with age. There is a strong correlation between AGEs and vascular complications for those living with type 1 and type 2 diabetes.
So what helps decrease AGEs? Several things can help shield us from the damage. David and Gretchen both live low carb diets and Joan has her husband living on a paleo diet. I am a big believer in antioxident vitamins and exercise. Here is a list of links that can offer more education on the choices to combat the effects of AGEs:
David gets tested: http://www.healthcentral.com/diabetes/c/17/13369/testing-ages
Gretchen Becker's book: The First Year with Type 2 Diabetes: An Essential Guide for the Newly Diagnosed. Gretchen has a discussion about AGEs.
If you have not read UltraPrevention, by Mark Liponis and Mark Hymen, two physicians from Canyon Ranch fame, check it out! The doctors do an excellent job of explaining and giving examples of choices you can make. There is a whole Ultra series that has developed from this original book called Ultra Prevention.
Dr. Berstein is a type 1 diabetic and endocrinologist who has lived successfully without diabetes complications. Furthermore, David Mendosa has written extensively on healthcentral about Dr. Berstein's teachings. He has two excellent books: The Diabetes Solution and The Diabetes Diet.
A study on AGEs and moderate exercise showed that exercise reduces AGEs and also shows that regular moderate exercise shows renoprotection, which means that exercise reduces diabetes related kidney disease.
Published On: April 18, 2011