Recent Topic of Saturated Fatty Acid (SFA) for Atherosclerotic Diseases

Whether saturated fatty acid (SFA) has a clinical influence on atherosclerotic cardiovascular disease (ASCVD) or not has been disputed. Prospective Urban Rural Epidemiology (PURE) study was recently summarized from 21 countries with about 150 thousand data. Dairy intake was negatively correlated with the prevalence of metabolic syndrome and the incidence of diabetes and hypertension. To increase the intake of dairy products would be easy and inexpensive to continue for treatment. Polyunsaturated fatty acid (PUFA) and monounsaturated fatty acid (MUFA) may reduce atherosclerotic diseases with beneficial effects. Clinical evidence of SFA will be hopefully accumulated for practice and research in the future

Unsaturated Fatty Acid for Preventive Cardiovascular Disease

Obesity and metabolic syndrome have lipids intake problems including Monounsaturated Fatty Acid (MUFA) and Polyunsaturated Fatty Acid (PUFA). For decreasing the Atherosclerotic Cardiovascular Disease (ASCVD) risk, to replace of Saturated Fatty Acid (SFA) with PUFA and/or MUFA would be adequate. Finn Study including 2200 cases showed that Odd Ratio (OR) for obesity was SFAs: 1.28, MUFAs: 1.38, PUFAs: 0.70, Linoleic Acid (LA): 0.67 and DHA: 0.75. In Norwegian study with 3706 cases, higher LA levels were significantly associated with lower values of LDL-C, triglycerides, blood glucose, body mass index, blood pressure and eGFR. These current data are useful for practice

Clinical effect of sound sleep support sound player “Lullaby reverberation” for sleep quality

Clinical effectiveness of sedative music on sleep quality was investigated. Subjects were 14 females aged 40s to 70s, and methods included listening to music during going to sleep using by sound sleep support sound player “Lullaby reverberation (Komoriuta-no-Hibiki)”, which was evaluated by Pittsburgh Sleep Quality Index (PSQI) in 0,4,8 weeks. Thirteen cases showed decreased points of PQSI. Time to sleep and sleep duration were almost the same. The relationship figure for PSQI and time until sleeping showed general tendency of left and horizontal/lower directional arrows. These results suggest positive beneficial effect of music for sleep quality evaluated by PSQI

Difference of Glucose variability between Low Carbohydrate Diet (LCD) and Calorie Restriction (CR)

Background: There have been lots of discussion and controversy concerning the difference between Low Carbohydrate Diet (LCD) and Calorie Restriction (CR). The important points include glucose variability, glucose-lowering effect, weight reduction degree and influence on lipid metabolism. Subjects and Methods: Enrolled subjects were 47 patients with T2DM. Methods included the study for providing subjects CR meal with 60% carbohydrate on day 1-2 and LCD meal with 12% on day 3-14. Daily profile of blood glucose was studied seven times a day on day 2 and day 4. Further, biomarkers including HbA1c, average blood glucose, and M value were investigated and analyzed for mutual correlations. Results: Subjects were categorized into 4 groups according to the average glucose value, which were 124mg/dL, 160mg/dL, 206mg/dL, and 281mg/dL, respectively. Data in 4 groups were as follows: Number; 12,12,12,11, Male/Female; 6/6, 3/9, 6/6, 5/6, mean age; 51.3, 60.9, 65.3, 60.6 years old, HbA1c; 6.1%, 7.1%, 8.0%, 8.9%, fasting glucose on day 2; 109 mg/dL, 136 mg/dL, 178 mg/dL, 224mg/dL, respectively. Daily profiles of blood glucose in 4 groups on day 4 were remarkably decreased than those of day 2. The levels of M value indicating average blood glucose and mean amplitude of glycemic excursions (MAGE) on day 2 vs 4 were compared in 4 groups, which are 7.1 vs 10.5, 39.7 vs 5.0, 139 vs 15.7, 367 vs88, respectively. Correlations among HbA1c, M value and average blood glucose showed significant correlations (p<0.01). Discussion and Conclusion: Obtained results showed that the distribution of daily profile of blood glucose in 4 groups is separated. Further similar tendency was observed in HbA1c and M value. There was remarkable decrease of blood glucose from CR to LCD. These findings suggested that LCD would have remarkable efficacy for improving glucose variability. Furthermore, obtained findings could become basal and reference data for the developing research for CR and LCD

Remarkable Improvement of Glucose Variability by Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors using Continuous Glucose Monitoring (CGM)

Authors have continued clinical research of Calorie Restriction (CR) and Low Carbohydrate Diet (LCD) and present a case with precise observation of continuous glucose monitoring (CGM). The patient is 38 years-old females with type 2 diabetes mellitus (T2DM), who showed BMI 19.6, postprandial blood glucose 277 mg/dL. HbA1c 12.6%, glycoalbumin 31.8% (11.6-16.4), HOMA-R 2.8, HOMA-β 8.5, urinary excretion of C-peptide 67 μg/day, and normal range of liver, renal, lipid exams. She was given three stage intervention. The protocol was • Day 1-2; CR meal with 60% carbohydrate, • Day 3-5; LCD meal with 12% carbohydrate, • Day 6-13; LCD+Sodium–glucose cotransporter 2(SGLT2) inhibitors (Suglat 50 mg, Ipragliflozin L-Proline). The glucose variability was monitored using FreeStyle Libre Pro (Abbott) for 14 days. Blood glucose was decreased as • More than 350 mg/dL, • 180-200 mg/dL, • 100-150 mg/dL in day 7-9, and 90-120 mg/dL in day 10-13. Acute decrease of blood glucose was found 3 hours after giving Suglat, which was remarkable finding. These results suggest the improving glucose variability of LCD in short term, the acute and strong efficacy of SGLT2 inhibitors for glucose metabolism, and clinical usefulness of simultaneous observation of glucose fluctuation

Short Term Effect of Low Carbohydrate Diet in Diabetic Male Patients

Background: Low Carbohydrate Diet (LCD) and Calorie Restriction (CR) have been discussed for long. Authors have continued clinical research on LCD, CR and M value. Subjects and Methods: Subjects were 67 male patients with type 2 diabetes mellitus (T2DM). Methods were i) daily profile of blood glucose, average glucose, M value for CR meal, ii) same exam of i) after 2 days of LCD, iii) Delta and AUC ratio for 70g of carbohydrate (0 - 30 minutes) in meal tolerance test (MTT), iv) Triglyceride check for 12 days of LCD, v) analyses of correlation of biomarkers. Results: Obtained data were as follows: average age 61.2 years old, median values are HbA1c 7.8%, fasting glucose 151 mg/dL, IRI 4.4 μU/mL, HOMA-R 2.1, HOMA-β 15.9, respectively. Median values on day 2 vs 14: average glucose 198 vs 151 mg/dL, M value 134 vs 14.4, respectively. AUC ratio for Carbo70 showed more separate distribution as insulin secretion ability than Delta ratio. There were significant correlations among HbA1c, average glucose and M value. Discussion and Conclusion: These results suggested that LCD would have beneficial effects for glucose variability. Furthermore, it would become basal and reference data for the future research development in this field

Response of Insulin Secretion to Small Amount of Meal on Low Carbohydrate Diet (LCD)

Diabetic nutritional therapy has been changing from Calorie Restriction (CR) to a Low Carbohydrate diet (LCD). Authors et al. have developed LCD medically and socially through the Japan LCD promotion association (JLCDPA), and proposed meal tolerance test (MTT) using LCD breakfast. For our research protocol, healthy subjects (n=8, M/F=4/4, BMI 20.5kg/m2) received 75g oral glucose tolerance test (OGTT) and MTT, and changes in blood glucose and immunoreactive insulin (IRI) were measured. LCD meal included energy 307kcal, protein 13.8g, fat 23.9g, and carbohydrate 5.7g. The results from 0-30 min in average showed: i) 75gOGTT; 87.3-124.6mg/dL, 4.9-41.4μU/mL, ii) LCD; 90.3-84.3mg/dL, 5.4-12.2μU/mL, respectively. Decreased glucose may be from enough ability to secrete insulin to a glucose stimulus. These results would become reference data for future diabetic research

Investigation of Low Carbohydrate Diet for Type 2 Diabetes Mellitus with Elevated Immunoreactive Insulin

Background: There are discussion of Calorie Restriction (CR) and Low Carbohydrate Diet (LCD). Authors and colleagues have continued research concerning LCD, CR and Morbus (M) value. Furthermore, this study also included homeostasis model assessment (HOMA). Subjects and Methods: Subjects enrolled were 40 type 2 diabetes mellitus (T2DM) cases with more than 10 μU/mL of fasting immunoreacitve insulin (IRI). Methods included fundamental tests such as glucose, IRI, HOMA-R, HOMA-β, average blood glucose on day 2 and 14 during CR and LCD meal. Results: Current data were in the following: average age 56.8 ± 12.3 years old, median values are HbA1c 7.2%, fasting glucose 141 mg/dL, IRI 13.1 μU/mL, HOMA-R 4.6, HOMA-β 57.1. Median values on day 2 vs 14 were average blood glucose 160 vs 120 mg/dL, M value 37.1 vs 7.4, Triglyceride 137 vs 97 mg/dL, respectively. M value showed significant correlation with HOMA-R (p<0.05) and HOMA-β (p<0.01). Discussion and Conclusion: The results suggested that LCD showed clinical effect for decreasing of glucose and M value in glucose variability and those patients would have insulin resistance and decreased β cell function. Furthermore, these findings would become basal and useful data for future research in this field