Obesity-Linked Diabetes Resists Treatment

From New York Times:

Obesity and the form of diabetes linked to it are taking an even worse toll on America’s youths than medical experts had realized. As obesity rates in children have climbed, so has the incidence of Type 2 diabetes, and a new study adds another worry: the disease progresses more rapidly in children than in adults and is harder to treat.

“It’s frightening how severe this metabolic disease is in children,” said Dr. David M. Nathan, an author of the study and director of the diabetes center at Massachusetts General Hospital. “It’s really got a hold on them, and it’s hard to turn around.”

Before the 1990s, this form of diabetes was hardly ever seen in children. It is still uncommon, but experts say any increase in such a serious disease is troubling. There were about 3,600 new cases a year from 2002 to 2005, the latest years for which data is available.

The research is the first large study of Type 2 diabetes in children, “because this didn’t used to exist,” said Dr. Robin Goland, a member of the research team and co-director of the Naomi Berrie Diabetes Center at Columbia University Medical Center in New York. She added, “These are people who are struggling with something that shouldn’t happen in kids who are this young.”

Why the disease is so hard to control in children and teenagers is not known. The researchers said that rapid growth and the intense hormonal changes at puberty might play a part.

The study followed 699 children ages 10 to 17 at medical centers around the country for about four years. It found that the usual oral medicine for Type 2 diabetes stopped working in about half of the patients within a few years, and they had to add daily shots of insulin to control their blood sugar. Researchers said they were shocked by how poorly the oral drugs performed because they work much better in adults.

The results of the study and an editorial were published online on Sunday by The New England Journal of Medicine.

The findings could signal trouble ahead because poorly controlled diabetes significantly increases the risk of heart disease, eye problems, nerve damage, amputations and kidney failure. The longer a person has the disease, the greater the risk. So in theory, people who develop diabetes as children may suffer its complications much earlier in life than previous generations who became diabetic as adults.

“I fear that these children are going to become sick earlier in their lives than we’ve ever seen before,” Dr. Nathan said.

But aggressive treatment can lower the risks.

“You really have to be on top of these kids and individualize therapy for each person,” said Dr. Barbara Linder, a senior adviser for childhood diabetes research at the National Institute of Diabetes and Digestive and Kidney Diseases, which sponsored the new study.

Sara Chernov, 21, a college senior from Great Neck, N.Y., learned that she had Type 2 diabetes when she was 16. Her grandfather had had both legs amputated as a result of the disease, and one of the first questions she asked was when she would lose her legs and her eyesight.

A doctor scolded her for being fat and told her she had to lose weight and could never eat sugar again. She left the office in tears and did not go back; soon after, she joined the study at Columbia. Like many of the children in the program, she did not even know how to swallow a pill.

Ms. Chernov believes that the disease “is not a death sentence,” she said, if she is careful about controlling her blood sugar. But it has been a struggle. Her family tends to be overweight, she sometimes craves sweets and she has orthopedic problems that have required surgery and have made it hard for her to exercise. She is also being treated for high blood pressure.

A few weeks ago, because her blood sugar shot up despite the diabetes pills she was taking, Ms. Chernov began using insulin.

Most of the participants in the study came from low-income families: 42 percent had yearly incomes under $25,000, and 34 percent below $50,000. About 40 percent were Hispanic, 33 percent black, 20 percent white, 6 percent American Indian and less than 2 percent Asian. Poor people and minority groups have some of the highest rates of obesity and diabetes in both adults and children.

Dr. Phil Zeitler, an author of the study and a professor of pediatrics at the University of Colorado, Denver, said many participants lived with a single parent or guardian and, like Ms. Chernov, came from families with a history of diabetes and had relatives with kidney failure or amputations.

“They’re wrapped up in a lot of family chaos,” Dr. Zeitler said, calling them a “challenging population” with a lot of stress in their lives, on top of the normal chaos of the teenage years.

Type 2 diabetes used to be so rare in children that it was called adult-onset diabetes. Type 1, a much less common form, was most likely to strike children and teenagers, and was called juvenile diabetes. Both forms of the disease cause high blood sugar, but their underlying causes are different.

Type 1 occurs because the patient’s own immune system mistakenly destroys the cells in the pancreas that make insulin, a hormone needed to control blood sugar levels. Patients have to take insulin.

Type 2 is thought to be brought on by obesity and inactivity in people who have a genetic predisposition to develop the disease when they gain weight. And they may also have an inborn tendency to put on weight. The pancreas still makes insulin, though not enough, and the body does not use insulin properly — a condition called insulin resistance. High blood pressure and cholesterol often come with the disease. Initial treatments include dietary changes, exercise and oral medicines, but many people eventually need insulin.

Doctors began noticing an alarming increase in Type 2 cases in children in the 1990s, especially among blacks and Hispanics from poorer families. The problem had started even earlier in American Indians, who have had sharp increases in obesity in recent years.

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“Wake-Up Call” Video

From Healthy Child Healthy World:

Eating Organic

From HealthyChild:

Is eating organic more expensive? In the long-run the answer would be NO. Synthetic pesticides or fertilizers used on vegetables and fruits affects our health. Pesticides have demonstrably elevated rates of asthma, leukemia, and prostate cancer.

Pesticide Drift

From Red Bluff Daily News:

Pesticide drift from a commercial strawberry field in the Bend area has a group of residents actively concerned about how the chemicals used will affect their health.

When Sam Sleezer, 37, and his father-in-law Manuel Silveira, 65, installed new scientific devices to measure air quality on their neighboring properties in the Bend area, they hoped that they would find their concerns were unwarranted.

I’m not against farming, Silveira said.

However, results came back that levels of a toxic chemical found were far above safe levels beyond the time frame that it was supposed to be in the air.

The two men brought their concerns to the state capitol March 20 as discussion in the Department of Pesticide Regulation reached a climax over the use of methyl iodide that was approved under Gov. Arnold Schwarzenegger.

The following day, the manufacturer for methyl iodide pulled the product and decided to no longer distribute it for use in the U.S.

However, similar chemicals, such as methyl bromide and chloropicrin are still in use and part of the compound applied in the Bend strawberry fields.

Concerned about his children, Sam and Manny, ages 3 and 5, who play just feet from the 50-plus acre field, Sleezer is considering moving if the county continues to allow the company to use dangerous chemicals.

Another neighbor already moved because of concerns, he said. There are still 17 children total that live all around the same field.

County officials say that Driscoll Strawberry Associates Inc., the owners of the field next to the Silveira and Sleezer properties, is within the legal limits and they have no good reason to deny the company a permit to fumigate.

County Agricultural Commissioner Rick Gurrola, who has the authority to approve or deny the grower’s pesticide use permit, based his decision on scientific data and evaluation from a legal standpoint, he said.

There’s risk with all chemicals, Gurrola said.

There’s risk with gasoline.

However, California is one of the most heavily regulated states and many chemicals banned here are used in other states, he said.

The chemicals used by Driscoll are within regulation.

The scientific data collected by the residents is flawed, Gurrola said.

Data was collected incorrectly and they are using uncertified equipment or techniques.

Sleezer and Silveira, who helped form Healthy Tehama Farms, a group of at least 20 individuals who are working to protect the community from dangerous exposure to fumigants, got a grant for $3,000 to perform the air quality tests.

The equipment, Drift Catchers invented by the Pesticide Action Network, collects air samples in small tubes that can be analyzed later for pesticide levels.

After analysis was completed at University of California at Davis, the report showed that over the eight-day study, during and after the fumigants were applied, Nov. 4-11, 2011, concentrations of chloropicrin, a known carcinogen, were on average twice as high as the acceptable levels determined by the California Department of Pesticide Regulation.

The results imply that lifetime exposure at those levels would cause 151 excess cases of cancer per 1 million people on average.

Silveira bought his property from a man who suffered from thyroid cancer, and with a quick glance across the field, he could name several other neighbors who had incidents of cancer as well.

He and Sleezer had heard complaints about sore throats, burning eyes and other illnesses when the fumigants were used, but nobody could prove it was from the pesticides.

Sleezer, a former soldier, remembered checking the mail in a community locked box next to the strawberry field when he suddenly felt as if he was back inside a gas chamber, he said. He and his wife felt their eyes and throats burning.

Some of the families are given a stipend and asked to stay away for three days when the fumigants are applied.

Sleezer, who works as a child guardian for supervised family visitations, keeps free-range specialty chickens as a hobby.

After a time away, he returned home to a nightmare, he said.

I came home and 28 chickens were strewn all over the yard dead, Sleezer said.

Clearing them out before his sons could see them, he saved some of the animal carcasses to try to find out what killed them.

After some testing, he still doesn’t know why they died, but the timing of the pesticide use was odd, he said.

Healthy Tehama Farms and the Pesticide Action Network have asked three times for the county to deny a permit to Driscoll Strawberry Associates without success.

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The Truth About Regulation

Rena Steinzor has posted her article “The Truth About Regulation in America (Harvard Law & Policy Review, Vol. 5, pp. 323-346, 2011) on SSRN.  Here is the abstract:

The special interests leading the accelerating crusade against regulation have re-ignited a potent coalition of industry lobbyists, traditional conservatives, and grassroots Tea Party activists. The politicians speak in generic terms for public consumption: “the nation is broke,” “big government is bad,” “regulation costs trillions.” Behind the scenes, industry lobbyists target for repeal dozens of regulations that are designed to control pollution, ensure drug, product, and food safety, and eliminate workplace hazards. In an effort to bring light and air to an often misleading and always opportunistic national debate, this essay presents five truths about the state of health, safety, and environmental regulation in America: First, regulatory dysfunction hurts many people. At the same time, big, bad government and powerful, protective regulation are two different things. The current system is sufficiently weak, especially with respect to enforcement, that even scoundrels are not stopped. Fourth, regulated industries understand the benefits of regulation and could negotiate compromises with agencies and public interest representatives if deregulatory opportunists would back off. Finally, if left alone, health, safety, and environmental agencies could accomplish great things.

Six “protector agencies” with the mission to safeguard people and natural resources from the hazards of the industrial age are the focus of the essay. In the descending order of size include the Environmental Protection Agency (EPA), the Food and Drug Administration (FDA), the Mine Safety and Health Administration (MSHA), the Occupational Safety and Health Administration (OSHA), the National Highway Traffic and Safety Administration, and the Consumer Product Safety Commission (CPSC).

In a nutshell, I argue that stringent regulation has enabled this country to achieve a remarkable level of industrialization while maintaining its natural environment to a remarkable degree, with the admittedly huge exception of the eroding ozone layer that is causing severe climate change. For verification of this observation, we have only to consider China, where a break-neck pace toward industrial development has left the environment in shambles, causing as many as 2.4 million deaths annually as a direct result of contaminated water and air (adjusted for population, the American equivalent would be 558,000 deaths).

The truth about regulation in America is that we cannot prosper without it, as many corporate executives will admit when they are standing outside the herd. The agencies that protect health, safety, and the environment cost less than one percent of the federal budget and projected benefits exceed costs by at least two to one. But the agencies are growing weaker and less able to enforce the law effectively. Further, as happened on Wall Street, even egregious violators continue business as usual until disaster strikes (and, in some painfully notorious cases, even afterwards — see, for example, British Petroleum’s chronic violations of worker safety and environmental laws that were left undeterred over the decade leading up to the Gulf oil spill).

Download the paper for free.