Is Alzheimer's Type 3 Diabetes? | Hacker News Reader

Is Alzheimer's Type 3 Diabetes?

opinionator.blogs.nytimes.com

129 pointstimr53 comments

This article is one of many that throws in "Processed food" as a presumed unhealthy food type. For example, "The good news is that laying off soda, doughnuts, processed meats and fries could allow you to keep your mind intact until your body fails you". Soda, doughnuts, and fries I get; they're essentially low-nutrition sugar sources, sometimes with ω−6 heavy vegetable oils thrown in for flavor. But how is processed meat any worse than any other sort of meat?

Later he complains about how Americans "overconsume hyperprocessed foods" without further explanation.

Is there any evidence or even a credible physical hypothesis why fast food processed mystery meats would be meaningfully less healthy than the roughly similar unprocessed cuts from the same animal?

It has been shown recently that you consume more calories the same amount of processed meat as you do unprocessed meat. The definition of processing is broad, it basically includes anything you do to the meat except eat it raw. It likes having a machine prechew all your food so it's easier for you body to extract energy from it.

"Processed food" tends to have preservatives added into the mix, for example. It's not really a matter of "flesh cut right off the animal" vs "flesh that's been mashed a bit before arriving at the supermarket."

I was going to point that out as well. The article is about insulin and throwing "processed meats" in there is simply confusing, since protein and fat are fairly minor players in the insulin game.

FWIW, One of the links in the article http://www.doctoroz.com/videos/alzheimers-diabetes-brain indicated a correlation between nitrates and Alzheimer's. This has also been published elsewhere http://www.sciencedaily.com/releases/2009/07/090705215239.ht...

Very interesting! Any recommendations out there for how to avoid nitrates in one's food?

I imagine the following are relevant concerns:

http://en.wikipedia.org/wiki/Sodium_nitrite

http://en.wikipedia.org/wiki/Nitrosamine

http://en.wikipedia.org/wiki/Advanced_glycation_end-product

A hot dog is going to be both high in Sodium nitrite and AGEs for example.

Those might be valid health concerns in general, but what do they have to do with insulin and diabetes?

One possible hypothesis could be: since diabetes causes accelerated accumulation of AGEs, and Alzeihmer's is correlated with accelerated accumulation of AGEs, and processed food is high in AGEs, consumption of processed food is also bad.

One way to negate this hypothesis would be to show that the accumulation of exogenous AGEs is insignificant compared to the endogenous production of AGEs. I'm not knowledgeable enough on the subject to say if this has been studied.

"But how is processed meat any worse than any other sort of meat?"

It's thought to be because of the preservatives and other chemicals. If you look at studies of meat eaters vs vegetarians, vegetarians tend to be healthier. But once you correct for differences in processed meat consumption the difference is much less large. (At least according to Michael Pollan in In Defense of Food.)

> Is there any evidence or even a credible physical hypothesis why fast food processed mystery meats would be meaningfully less healthy than the roughly similar unprocessed cuts from the same animal?

The typical processed meat product contains additional ingredients that are not just meat. Particularly nitrates and added sweeteners.

Because you're supposed to accept arguments based on the Naturalistic Fallacy at face value when discussing food, and pretend the FDA is explicitly out to get you every time it approves something you personally aren't familiar with.

Right, because FDA approval means that it's impossible for something to cause issues 30 years down the line... because, you know, we do long-term effects studies like that.

Hm. I'd just rather eat food with known ingredients than food and supplements with unknown ingredients, especially given that the supplement industry is fighting tooth and nail to prevent itself from being subject to the same level of scrutiny McDonald's is.

http://scienceblogs.com/insolence/2012/07/02/dietary-supplem...

The author of this article gets so many basic facts wrong that it's difficult to take anything he writes seriously.

Straight from the American Diabetes Association's website:

'Myth: Eating too much sugar causes diabetes.

Fact: No, it does not. Type 1 diabetes is caused by genetics and unknown factors that trigger the onset of the disease; type 2 diabetes is caused by genetics and lifestyle factors. Being overweight does increase your risk for developing type 2 diabetes, and a diet high in calories, whether from sugar or from fat, can contribute to weight gain. If you have a history of diabetes in your family, eating a healthy meal plan and regular exercise are recommended to manage your weight.'

Agreed. Also just generalizes type I as "the type you're born with", which technically isn't true - you can get type I in your teens, 20s, 30s, etc...

Age 20 for me.

"Straight from the American Diabetes Association's website"

The American Diabetes Association is sponsored by Kraft Foods and other junkfood sellers/manufacturers, so it might be prudent to take their advice with a grain of salt.

Especially since the idea that sugar doesn't cause diabetes is fucking ridiculous.

> The American Diabetes Association is sponsored by Kraft Foods and other junkfood sellers/manufacturers, so it might be prudent to take their advice with a grain of salt.

Cite?

> Especially since the idea that sugar doesn't cause diabetes is fucking ridiculous.

Why?

"Cite?"

Their list of corporate sponsors on their website.

"Why?"

http://en.wikipedia.org/wiki/Insulin_resistance#Diet

Sugar intake is not listed amongst the environmental risk factors for Insulin Resistance:

http://en.wikipedia.org/wiki/Insulin_resistance#Associated_R...

The biggest controllable risk factor for Type II Diabetes is obesity. This finding has been confirmed by numerous studies.

I don't really care about sponsors, but for those who do, Splenda and Equal both sponsor the American Diabetes Association as well.

I'd say that those two companies would much prefer for the ADA to declare sugar a cause of Type II Diabetes.

The New York Times recently seems to be willing to give up its journalistic reputation in the medical stories on its hosted blogs and go straight for eyeballs at any price in credibility. The Alzheimer's Association has a good fact sheet about diabetes

http://www.alz.org/national/documents/topicsheet_diabetes.pd...

The order of causation may be the other way around for whatever association there is between diabetes and Alzheimer disease, if a hypothesis about a genetic variant in insulin processing related to Alzheimer disease holds up.

http://www.bbc.co.uk/news/health-18445701

But right now it is much too early to say yes to to the question posed in the headline of the submitted article. The underlying study

http://www.ncbi.nlm.nih.gov/pubmed/22810099

has several desirable design features for a human nutrition study, but it still needs to be replicated, and it's an observational study, not an experimental study, so we don't know what kinds of interventions are likely to be of most help in preventing Alzheimer disease.

http://norvig.com/experiment-design.html

See another thread just posted by another HN participant

http://news.ycombinator.com/item?id=4578600

about how rarely supposed breakthrough medical discoveries are even replicated. Don't believe the easy, breakthrough answers until they have been verified.

AFTER EDIT:

The comment responding to my The New York Times recently seems to be willing to give up its journalistic reputation in the medical stories on its hosted blogs and go straight for eyeballs at any price in credibility is of course correct that the New York Times has disclosed that the writer is writing as a blogger, not as a journalist. I think it's regrettable that he nonetheless is able to slap the New York Times brand on an overly speculative post that assumes matters of fact that are not well verified. I'm not sure if all readers are as aware as many HN participants that some long-established journalistic organizations host blogging webpages that have no editorial oversight. I think it would be helpful for readers to be able to distinguish at a glance what sources are professionally edited, and which are people doing their own personal expressions of opinion.

Giving up its journalistic reputation?

The author is listed as an "Opinionator columnist". I think that's nytimes-speak for "blogger".

So I thought this headline was far-fetched as well when I read it. After all, not only is it a provocative concept, but damnit, I'm acquainted with both Alzheimer's and insulin resistance (as are many HN'ers) and I/we should've heard of a connection before, right?

So then I found this paper, which discusses Alzheimer's and insulin, and suggests rosiglitazone as a possible treatment:

http://www.ingentaconnect.com/content/adis/cns/2003/00000017...

And here's how that worked:

http://scholar.google.com/scholar?q=alzheimer%27s+rosiglitaz...

And that's pretty amazing, considering it has been my understanding that there are no effective treatments for Alzheimer's. A successful prediction is also the gold standard of scientific evidence. Unfortunately, the floor fell through on rosiglitazone:

http://content.karger.com/produktedb/produkte.asp?doi=318845

More circumstantial evidence shows up in the fact that coffee, known to improve insulin sensitivity, is correlated with a reduced risk of Alzheimer's:

http://scholar.google.com/scholar?q=alzheimer%27s+coffee&...

And the kicker is this paper from 2005...

http://iospress.metapress.com/content/qunmpv4q3w77e5vm/

"Impaired insulin and insulin-like growth factor expression and signaling mechanisms in Alzheimer's disease - is this type 3 diabetes?"

So now we know where the NYT got its headline. And this may not be as loony as I originally thought. Are they right? Well, we thought we had Alzheimer's figured out about four different times now. First it was choline, then it was amyloid plaques, then it was tau phosphorylation, then it was aluminium toxicity, now it's insulin resistance.

This has the potential to be extraordinary, but I'm not holding my breath.

> coffee, known to improve insulin sensitivity

Known? I've seen interventional studies on the effects of caffeine claiming effects in either direction. Here are two studies showing decreased insulin sensitivity:

Effects of Coffee Consumption on Fasting Blood Glucose and Insulin Concentrations (http://care.diabetesjournals.org/content/27/12/2990.full)

Caffeine Impairs Glucose Metabolism in Type 2 Diabetes (http://care.diabetesjournals.org/content/27/8/2047.extract)

The first link you cite gives what I might call a complete picture:

>Higher habitual coffee consumption was associated with higher insulin sensitivity (1) and a lower risk for type 2 diabetes (2–6) in diverse populations. In contrast, short-term metabolic studies showed that caffeine intake can acutely lower insulin sensitivity (7–9) and increase glucose concentrations (10–15). Randomized intervention studies are needed to examine whether tolerance to these acute effects develops after longer-term consumption (16). We therefore examined the effects of coffee and caffeine on fasting blood concentrations of glucose and insulin over 2–4 weeks in two crossover studies in healthy volunteers.

So caffeine causes a problem, but something in coffee, possibly not caffeine itself ( http://ajcn.nutrition.org/content/84/4/682.short ), has a long-term protective effect. Weight control doesn't seem to explain everything: coffee has a protective effect even when consumption is associated with higher BMI ( http://www.sciencedirect.com/science/article/pii/S0140673602... ). In the latter study: "Higher coffee consumption was associated with male sex, a low educational level, a higher body-mass index, cigarette smoking, alcohol use, less leisure time physical activity, and a generally less favourable diet" -- these are not things I would expect to be good for diabetes prevention! Yet the coffee consumers got less diabetes.

Chlorogenic acid, rather than caffeine, seems a likely culprit. Other antioxidants in coffee may play a role.

You might be interested in this article

http://www.wired.co.uk/magazine/archive/2012/02/features/tri...

Regardless of the fact that it's written by a man who resigned from the NYTimes because of plagiarism, it's still interesting imo.

The gist is: the body is complex, so complex that often research mistakes causality with a simple accumulation of facts.

Keep holding your breath.

"... I think it's regrettable that he nonetheless is able to slap the New York Times brand on an overly speculative post that assumes matters of fact that are not well verified. I'm not sure if all readers are as aware as many HN participants that some long-established journalistic organizations host blogging webpages that have no editorial oversight. ..."

Been down that road before with the NYT, "The Google Way: Give Engineers Room" ~ http://www.flickr.com/photos/bootload/1685662827/in/set-7215...

I don't think reporting on a minority opinion among researchers is such a horrible thing to do. Yes, he could have emphasized the fact that it is a minority opinion and said more about the counter arguments. What he did is point to an article in the NewScientist that does just that.

Any reporting on new theories within science will include things for which it is "too early to say yes to the question posed in the headline". And any such reporting can easily be criticized for "going straight for eyeballs".

Columnists have always had the liberty to write stuff that doesn't reflect on the newspaper, often stuff that goes contrary to the official stance of the newspaper. This is not something new.

I guess what is new is that newspapers have been marginalized to a degree that otherwise well educated people no longer necessarily know the editorial conventions that govern them.

> the New York Times has disclosed that the writer is writing as a blogger, not as a journalist.

I am confused.

Just responded to a FB post about this. The link to nitrosamines appears somewhat dubious to me. After some scouring I found the root to be this paper: http://www.molecularneurodegeneration.com/content/4/1/54#B51 which to me appears to have some statistically poor evidence.

>"We used to think there were two types of diabetes"

We still do.

Honestly what a ridiculous way to introduce the article. Like there's already widespread consensus on there being three types of diabetes.

The cited articles barely prop up the authors assertions.

And who is the grand 'We'?

Seems to me that you, along with some others, are getting a tad overheated. He goes on to say "The idea that Alzheimer’s might be Type 3 diabetes has been around since 2005, but the connection between poor diet and Alzheimer’s is becoming more convincing". A perfectly reasonable statement.

This is a short opinion piece which will alert those interested to look further. If this is not to your liking then check out this one: http://www.monbiot.com/2012/09/10/the-mind-thieves/ which has plenty of references. May be right, may be wrong but it's an interesting idea.

It's a blog post, not a paper.

Not to mention the problems with the rest of that paragraph: >"the type you’re born with (Type 1) and the type you “get.” That’s called Type 2, and was called “adult onset” until it started ravaging kids. Type 2 is brought about by a combination of factors, including overeating, American-style."

I have Type 1 Diabetes and I "got" it when I was 19. Type 1 means your pancreas has zero capability of producing insulin, Type 2 means your pancreas has reduced ability to regulate or has reduced insulin production capabilities. Maybe he could have said Type 1 is a genetic disorder and Type 2 is generally brought on due to environment or lifestyle.

Linking Alzheimer's to insulin is a new one to me - I've heard about plaque on the brain and toxic proteins called beta amyloid…the question around all of these is still whether they're a symptom or a cause.

To simplify the path to a cure: they've found the genetic predisposition towards Alzheimer's and dementia, step two will be narrowing down the epigenetic markers that trigger the condition, and step three will be preventing the condition being triggered in the first place. I predict within 10 years we'll have a pill. (I hope! I spend a lot of time in a high care nursing home visiting a much loved family member, and the cost of this devastating disease affects not just the afflicted, but family members and society as a whole as our population ages and resources are stretched).

The Alzheimer's link is a relatively new one (at least in the media) and looks to be a little bit of sensationalism: it sounds scary, makes for a good story and there's plenty of ways to angle it.

Pragmatically, there's little downside to publishing it as well - if people eat healthier and exercise a little more as a result, brilliant. For researchers given the wide base of ground to cover in the disease, if it gives more funding in their fields, also brilliant.

Taking a step back and looking at Alzheimer's just as a metabolic disease (which does have some merit, let me find the papers) does give some new avenues to explore. Same as you will be interested to see what comes out of it. It truly is a crushing disease for all involved.

Just to further overload the name, here's a paper making a case for calorie restriction / fasting to be thought of as a form of "benevolent diabetes":

http://www.fightaging.org/archives/2012/06/benevolent-diabet...

Calorie restriction (CR), which deactivates the nutrient-sensing mTOR pathway, slows down aging and prevents age-related diseases such as type II diabetes. Compared with CR, rapamycin more efficiently inhibits mTOR. Noteworthy, severe CR and starvation cause a reversible condition known as "starvation diabetes" [and] chronic administration of rapamycin can cause a similar condition in some animal models. ... Here I introduce the notion of benevolent diabetes and discuss whether starvation-like effects of chronic high dose treatment with rapamycin are an obstacle for its use as an anti-aging drug.

It would make no more sense to call Alzhimers Type III diabetes than it would to call diabetic nephropathy or poly neuropathy type 3 diabetes. Nevertheless Mark Bittmans articles are some of the most interesting and thought provoking pieces on health and nutrition that I've come across of recent.

Giving yourself numerous insulin spikes as a matter of daily routine is bad anyway. Eat less, exercise more, eat less insulin-spiky stuff (high glycemic index food), perhaps even experiment with brief fasting once in a while.

A bit earlier today I read from here an article about Metformin (a drug lowering insulin) to reduce cancer onset by 20% - http://www.bloomberg.com/news/2012-09-25/five-cent-diabetes-... and discussion on http://news.ycombinator.com/item?id=4576555

This begs a simple question: can't we use the same analysis to test the hypothesis whether insulin is indeed linked to Alzheimer - simply by taking the same approach and replacing "cancer" by "alzheimer" in the database query?

After all, if we know these same patients have had a lower rate of cancer, maybe we know also about which other diseases they may have had at the same time.

If the data had been openly available, it could have been done, maybe easily if the data is properly coded (using ICD codes, replacing cancer by alzheimer or even broadening the query to other neurodegeneratives diseases is just a "or" away in SQL)

Yet with the current closed-garden-behind-a-paywall approach of science, we can't.

There are many wild hypothesis about nutrition thrown around.

But until I see actual data, I will not call any of them "hypothesis".

EDIT: added HN URL for the discussion about metformin

The problem with your idea is that Alzheimer's disease is not easy to study.

1) There is no good diagnostic test for Alzheimer's outside of a brain biopsy (although Lilly just got a diagnostic approved). Today, it's usually diagnosed by a process of elimination (i.e. you don't have any signs that it's another organic brain disease, thus it must be Alzheimer's).

2) The time of onset to the time of death for Alzheimer's is often measured in decades. You'd have to run a REALLY long study to be able to capture that data.

The other issue is that analyzing data from studies retrospectively (studies that weren't designed to test your given hypotheses) are generally regarded as "lower quality". It may support your hypotheses, but it's pretty weak support.

1) Lilly's diagnostic is about beta amyloid plaques, not Alzheimer directly. There is some questions whether amyloid plaques are good indicators of Al Zheimer or not, and this will need to be validated in the future.

Thanks for mentioning that, it's a good point.

Amyloid plaques are a symptom of Alzheimer's disease, but it's still up in the air as to whether they are the cause of Alzheimer's or the result.

It would appear that the connection between type II diabetes and Alzheimer's disease is pretty tenuous at this point.

The important thing to remember is that insulin has effects on the human body that go far beyond controlling blood glucose levels. The first one that comes to mind is it's roll as a growth factor.

It's an interesting hypotheses, but I think a lot more data has to be collected before anyone could claim an actual connection between the two diseases.

Regardless the truth of the article, why on earth is no government in this world taxing the crap out of Coca cola, McDonalds and the like, just like they do with cigarettes?

Bad eating seems to be causing a whole LOT more victims than cigarettes and alcohol.

"Fixing" food should be among the top priorities of any so called civilised country, together with health system, education and research.

And what's to be said of perfectly healthy, fit elderly people getting it? Is it like genetic high cholesterol, where you would never guess the person is a ticking time bomb?

I suspect Alzheimer's may turn out to be another symptom cluster, like cancer. The manifestations may be similar, but the etiologies diverse.

There definitely seems to be a genetic component. Whether or not this is an interaction and/or amplification of the dietary/insulin connection ... TBD.

http://people.csail.mit.edu/seneff/alzheimers_statins.html

I wish journalists would stop using headlines that would allow the article to be summarized as 'no'.

No. Cells affected by Alzheimer's disease seem to undergo a metabolic slow down, and reduced insulin sensitivity is a consequence.

My bet is that Alzheimer's disease is a viral defense run amok. Most cells simply destroy themselves to defend against viruses, but most neurons need to last a lifetime. Therefore they must have a way of choking off viral replication and signaling their neighbors to make their own preparations. This fits with the metabolic collapse and with the fact that amyloid beta spreads to nearby cells and propagates the collapse. The mystery is why it becomes self-reinforcing.

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