WEBVTT - The Future of Diabetes Part Two 0:00:00.160 --> 0:00:07.480 Brought to you by Toyota. Let's go places. Welcome to 0:00:07.640 --> 0:00:16.000 Forward Thinking. Hey there, and welcome up Forward Thinking, the 0:00:16.040 --> 0:00:18.920 podcast that looks at the future and says, dance with 0:00:19.079 --> 0:00:24.520 me across the sea. I'm Jonathan Strickland and I'm Joe McCormick. 0:00:24.640 --> 0:00:29.560 What is the connection there, doctor doctor, You don't know 0:00:29.640 --> 0:00:36.720 the Thompson twins. Oh my god, Oh my god. I 0:00:36.800 --> 0:00:38.920 was joking in our last episode that I'm too old 0:00:38.960 --> 0:00:42.320 and now I really am too old Thompson twinses, doctor Doctor. 0:00:42.320 --> 0:00:44.120 It's a great song and it has to do with 0:00:44.200 --> 0:00:46.960 the doctor, so medicine. And then we're talking about diabetes 0:00:47.000 --> 0:00:50.040 again in this episode, and that's why. So, guys, this 0:00:50.120 --> 0:00:52.840 is part two of our our series about the future 0:00:52.840 --> 0:00:56.440 of diabetes. In our first episode we talked about what 0:00:56.560 --> 0:01:00.680 the diseases and it's history. It's a long, long, long history, 0:01:00.760 --> 0:01:05.920 the history that dates back more than years. So we 0:01:06.080 --> 0:01:08.480 talked all about that in the last and includes drinking. 0:01:08.840 --> 0:01:12.160 We should, yes, yes, So if you if you missed 0:01:12.200 --> 0:01:15.520 that episode, you clearly want to check it out. Let 0:01:15.520 --> 0:01:18.800 me revise drinking is probably not fair tasting, like a 0:01:18.880 --> 0:01:22.920 wine taste where you're not supposed to swallow us the urine. Yes, 0:01:23.560 --> 0:01:29.759 absolutely true, because diabetes is all about glucose level management 0:01:29.800 --> 0:01:32.280 in the blood but also comes through in the urine, 0:01:32.720 --> 0:01:36.680 and UH, water tasters would be able to detect the 0:01:36.720 --> 0:01:39.680 presence of sugar in patient's urine and thus diagnose them 0:01:39.720 --> 0:01:43.000 with diabetes. Now, of course, our diagnostic and research methods 0:01:43.000 --> 0:01:48.120 have improved significantly since the dark ages with sipping urine UH, 0:01:48.160 --> 0:01:51.520 and in fact, we're learning a lot about diabetes just 0:01:51.600 --> 0:01:55.080 in recent years that really could lead to significant changes 0:01:55.120 --> 0:01:58.400 in understanding what the disease is at its core and 0:01:58.440 --> 0:02:00.840 how to treat it. Now, one thing should say before 0:02:00.880 --> 0:02:03.320 we even go any further is that that there are 0:02:03.320 --> 0:02:07.200 two major types of diabetes. There's type one and type two. 0:02:07.720 --> 0:02:10.600 And as Lauren pointed out in our last episode, type 0:02:10.600 --> 0:02:15.320 one is a type of autoimmune disorder. Type two is different, 0:02:15.560 --> 0:02:19.359 UM it is UH developed in a different way, And 0:02:19.440 --> 0:02:21.360 so some of the stuff we're going to talk about 0:02:21.840 --> 0:02:24.600 is largely focused on on type two. I mean, the 0:02:24.639 --> 0:02:28.359 treatment levels can be for both UH, but there will 0:02:28.400 --> 0:02:30.760 be some stuff on type one as well, right, and so, 0:02:31.280 --> 0:02:34.200 but but just keep that in mind that when we 0:02:34.240 --> 0:02:39.560 talk about diabetes, it's not always universal across both types. Okay, well, 0:02:39.560 --> 0:02:41.640 I thought we we should look at some studies that 0:02:41.680 --> 0:02:45.919 have come out mostly this year here in that have 0:02:46.120 --> 0:02:49.760 detailed interesting developments in diabetes research, a lot of which 0:02:49.760 --> 0:02:51.560 you might not have predicted if you just went a 0:02:51.600 --> 0:02:55.119 few years back. And here here's a really interesting one 0:02:55.440 --> 0:02:58.960 to start with. Now, I would not have expected that 0:02:59.040 --> 0:03:02.880 you would ever disc cover any link between a metabolic 0:03:03.280 --> 0:03:09.480 metabolic disorder like diabetes and air pollution. Yeah, this is 0:03:09.520 --> 0:03:12.760 a very strange correlation that has been found. That that 0:03:12.919 --> 0:03:15.000 is odd. Like, you know, air pollutions one of those 0:03:15.000 --> 0:03:18.720 things where certain conditions you could easily imagine like asthma, 0:03:18.919 --> 0:03:22.880 other you know, respiratory illnesses, um complications and things like 0:03:22.919 --> 0:03:25.919 bronchitis or possibly pneumonia. All of that I could easily 0:03:25.960 --> 0:03:28.760 even heart disease I can think of. But when you 0:03:29.080 --> 0:03:31.040 if you had told me a couple of years ago 0:03:31.440 --> 0:03:34.519 that there was a link between air pollution and diabetes, 0:03:34.560 --> 0:03:37.160 I well, I mean, I'm like, well, small gets into 0:03:37.200 --> 0:03:40.920 your pancreas and then what Yeah, I'm still confused. Specifically, 0:03:40.960 --> 0:03:43.800 what we're looking at here is not not fully diabetes, 0:03:43.840 --> 0:03:47.280 but insulin resistance. So it's a you know, a pre 0:03:47.600 --> 0:03:52.640 precursor related issue here so to diabetes type two, yes, yes, 0:03:52.680 --> 0:03:55.600 So in August, there was a study published in the 0:03:55.680 --> 0:03:59.119 journal Diabetes that looked at the link between long term 0:03:59.160 --> 0:04:03.560 exposure to air pollution and signs of insulin resistance. And 0:04:03.680 --> 0:04:07.560 insulin resistance, of course, it's a condition that often precedes 0:04:07.640 --> 0:04:12.360 type two diabetes. It's influenced by inherited and lifestyle factors 0:04:12.400 --> 0:04:15.160 as well as environmental factors, as we're about to see. 0:04:15.680 --> 0:04:18.360 So the study had a sample size of two thousand, 0:04:18.480 --> 0:04:22.080 nine hundred forty four people in southern Germany between two 0:04:22.080 --> 0:04:24.360 thousand six and two thousand eight, and these people had 0:04:24.360 --> 0:04:27.800 previously they've been participants of a project known as the 0:04:27.880 --> 0:04:33.240 Cooperative Health Research in the region Augsburg and they so 0:04:33.279 --> 0:04:36.920 the researchers looked for links in the data on these 0:04:36.920 --> 0:04:40.280 people between exposure to air pollution at their place of 0:04:40.680 --> 0:04:45.080 residence and the presence of biomarkers that give you a 0:04:45.120 --> 0:04:50.000 sign that the person is probably experiencing insulin resistance, and 0:04:50.040 --> 0:04:53.680 they found a correlation. So, they found a correlation between 0:04:53.720 --> 0:04:57.680 the level of airborne pollutant concentrations at residence sites and 0:04:57.839 --> 0:05:03.000 some biomarkers, particularly those associated with pre diabetes, more so 0:05:03.080 --> 0:05:07.400 than than full diabetes, and so from the press release, 0:05:07.680 --> 0:05:11.360 the lead author Dr Catherine Wolfe said, quote, the results 0:05:11.440 --> 0:05:15.599 revealed that people who already have an impaired glucose metabolism, 0:05:15.640 --> 0:05:20.200 so called pre diabetic individuals, are particularly vulnerable to the 0:05:20.200 --> 0:05:24.240 effects of air pollution. In these individuals, the association between 0:05:24.400 --> 0:05:27.640 increases in their blood marker levels and the increases in 0:05:27.800 --> 0:05:33.320 air pollutant concentrations is particularly significant. Thus, over the long term, 0:05:33.440 --> 0:05:37.480 especially for people with impaired glucose metabolism, air pollution is 0:05:37.520 --> 0:05:42.880 a risk factor for type two diabetes. And that's interesting. 0:05:43.320 --> 0:05:46.720 I mean, I didn't come across any information about what 0:05:46.839 --> 0:05:50.320 the what the link is? Well, and maybe, I mean, 0:05:50.360 --> 0:05:54.080 there are times where one we don't fully understand the mechanism, 0:05:54.160 --> 0:05:57.799 and sometimes it ends up just being that they are correlated, 0:05:57.800 --> 0:06:01.000 but there's not necessarily causal relationship up right. It may 0:06:01.040 --> 0:06:03.800 be that there may be some underlying link that that 0:06:03.960 --> 0:06:07.000 connects the two exactly right. There might be you go 0:06:07.160 --> 0:06:09.840 further back and you realize, oh, well, this one thing 0:06:10.200 --> 0:06:14.520 is affecting both branches. The branches themselves are independent and 0:06:14.520 --> 0:06:17.479 are not necessarily affecting one another, but are both a 0:06:17.520 --> 0:06:21.400 result of this prime source. We don't know, at least 0:06:21.400 --> 0:06:23.760 not based upon the research that we came across for 0:06:23.880 --> 0:06:27.159 this podcast, But it is an interesting thing to look 0:06:27.200 --> 0:06:31.279 at and obviously would be something that if if in fact, 0:06:31.320 --> 0:06:35.559 there is causation there, would guide us to know about 0:06:35.800 --> 0:06:39.320 or or to to look into the possibility of increase 0:06:39.760 --> 0:06:42.520 rates of diabetes in parts of the world where this 0:06:42.600 --> 0:06:46.039 type of air pollution is particularly prevalent. Or it could 0:06:46.120 --> 0:06:50.440 also lead to uh to you know, prevention measures even 0:06:50.520 --> 0:06:53.839 if you recognize this, even without necessarily understanding what the 0:06:53.880 --> 0:06:57.839 cause is yet. Uh. Let's say you develop pre diabetes. 0:06:58.200 --> 0:07:01.400 You know a doctor who if this research is validated, 0:07:01.440 --> 0:07:04.920 if it's replicated and shown multiple times, the doctor might 0:07:04.960 --> 0:07:08.400 want to say, if you want to avoid progression into 0:07:08.480 --> 0:07:11.360 full type two diabetes, you you know, depending on where 0:07:11.360 --> 0:07:13.760 you live, you might want to move right And for 0:07:13.800 --> 0:07:16.239 some people that might be a possibility. Some people, of course, 0:07:16.320 --> 0:07:19.160 that may not be an option. UM. You could also 0:07:19.240 --> 0:07:23.679 argue that this is one more reason out of the 0:07:23.720 --> 0:07:28.120 thousands that we have often listed on this show too 0:07:29.640 --> 0:07:34.800 clean that stuff up man of our carbon emissions. We've 0:07:34.840 --> 0:07:38.080 got plenty of reasons for that already, but adding another 0:07:38.120 --> 0:07:42.200 one is yet another argument to say, look like, if 0:07:42.200 --> 0:07:45.200 you add up all the even from an economic standpoint, 0:07:45.480 --> 0:07:48.400 if you just add up all the negative impact from 0:07:49.040 --> 0:07:53.560 pollution and you assigned a dollar amount, it makes financial 0:07:53.680 --> 0:07:57.200 sense to get to to make a transition, not just 0:07:57.720 --> 0:08:00.200 you know, yeah, it's gonna be hard. It's not. It's 0:08:00.200 --> 0:08:02.520 not an easy thing. It's not a convenient thing, but 0:08:03.040 --> 0:08:06.760 it ultimately is the best thing, not just for people's health, 0:08:07.240 --> 0:08:11.480 for the environment, but for the wallet and so and 0:08:11.560 --> 0:08:15.920 thus we can excuse Ferngully to capitalism, and and it 0:08:15.960 --> 0:08:18.280 will be a terrific movie that is beloved by future 0:08:18.320 --> 0:08:21.320 generations of children. Um, there was a fern gully too, 0:08:21.400 --> 0:08:24.000 wasn't there? Oh? I'm pretty sure there was. Was there? Really? 0:08:24.040 --> 0:08:26.600 I think there was? And I is there a rapping 0:08:26.680 --> 0:08:28.679 bat in it? I don't know that there's a rapping 0:08:28.800 --> 0:08:32.040 Probably not. I was about to say, Bruce Willis, where 0:08:32.040 --> 0:08:35.160 did that come from, Robert Williams. Yeah, you're turning into 0:08:35.240 --> 0:08:37.480 me Lauren where I just will take names and then 0:08:37.640 --> 0:08:41.079 if there's a name that is even remotely similar, I'm like, Nope, 0:08:41.200 --> 0:08:43.199 that's the name I wanted. You know what. There was 0:08:43.240 --> 0:08:47.600 a lot of infern gully Flora, there was oh and 0:08:47.640 --> 0:08:50.160 that's a great transition to our next one. This is 0:08:50.160 --> 0:08:53.480 actually my favorite one because gut flora is my new 0:08:53.520 --> 0:08:58.520 favorite topic. I love. I love how much the bacteria 0:08:58.640 --> 0:09:02.560 that overpopulate um or don't don't overpopulate, but but but 0:09:03.240 --> 0:09:05.679 massively overwhelmed the amount of cells of you that there 0:09:05.679 --> 0:09:08.520 are in your body have so much to do also 0:09:08.880 --> 0:09:11.559 all of your health. Gut Flora is also a great 0:09:11.640 --> 0:09:13.520 name for a future Bruce Willis movie. I'm just going 0:09:13.559 --> 0:09:16.200 to throw that out there before we get too far 0:09:16.240 --> 0:09:19.480 away from Bruce Willis. We're never too far away from 0:09:19.480 --> 0:09:24.439 Bruce Willis, but do continue well, So so let's talk 0:09:24.480 --> 0:09:26.840 about this. So what is the influence of gut flora 0:09:26.960 --> 0:09:30.040 on diabetes? Well, this one is perhaps a little more 0:09:30.120 --> 0:09:35.119 intuitive than than a possible correlation between air pollution and diabetes. 0:09:35.240 --> 0:09:38.280 So this was based on a sixteen study in the 0:09:38.320 --> 0:09:41.760 American Journal of Pathology that reported on effects of a 0:09:41.880 --> 0:09:46.880 type of gastric bypass surgery on mice with a with 0:09:46.960 --> 0:09:51.360 a model condition designed to sort of replicate the effects 0:09:51.360 --> 0:09:55.320 of type two diabetes. And it has been observed that 0:09:55.600 --> 0:09:59.400 gastric bypass surgery, so a surgery that that sort of 0:09:59.440 --> 0:10:04.640 reroutes part of the digestive process can cause remission of 0:10:04.720 --> 0:10:10.520 type two diabetes in humans and in mice. So you 0:10:10.720 --> 0:10:14.520 think that this might be because gastric bypass leads to 0:10:14.679 --> 0:10:17.880 weight loss. Right, that's probably good, and weight gain is 0:10:17.880 --> 0:10:20.880 is one of the comorbidities, what one of the co 0:10:21.080 --> 0:10:27.960 signs of diabetes. Right but right, But medical researchers conclude 0:10:28.000 --> 0:10:30.960 that the remission can't be explained by weight loss alone. 0:10:31.040 --> 0:10:35.240 There's something else going on here. And so after the surgery, 0:10:35.280 --> 0:10:40.240 subjects show improvements in both insulin sensitivity and glucose tolerance. 0:10:40.520 --> 0:10:44.040 So what's going on here And what they found in 0:10:44.080 --> 0:10:46.960 this study was there was an examination of gut micro 0:10:47.200 --> 0:10:51.560 organisms before and after the bypass surgery that showed a 0:10:51.679 --> 0:10:57.400 decrease in pathogenic bacteria and an increase in other micro 0:10:57.520 --> 0:11:00.320 organisms in the gut that are considered beneficial old for 0:11:00.400 --> 0:11:04.920 gut health. And these changes seem to coincide with improvements 0:11:04.920 --> 0:11:10.120 in metabolic and glycemic regulation. So the researchers, again, this 0:11:10.200 --> 0:11:12.280 is one of these things where they've just found an 0:11:12.280 --> 0:11:15.920 early interesting result and they're recommending more direct research into 0:11:15.960 --> 0:11:18.960 the subject. But essentially, what we need to figure out 0:11:19.040 --> 0:11:23.280 is how changes in gut micro biota influenced diabetes and 0:11:23.360 --> 0:11:28.360 metabolism in general. Mm hmm, that is really I mean, 0:11:29.280 --> 0:11:32.720 the more I learn about gut flora, the more I 0:11:32.800 --> 0:11:38.960 am pretty convinced that I'm not in charge of myself. Yeah, 0:11:39.080 --> 0:11:42.200 you're you're a you're a hybrid organism. Well, you know, 0:11:42.400 --> 0:11:44.240 I like to think of myself as an involved being. 0:11:44.920 --> 0:11:47.120 There's a book out about that that I've actually been 0:11:47.160 --> 0:11:49.080 meaning to read. I haven't read it yet, but it's 0:11:49.120 --> 0:11:52.080 by the science writer Ed Young, who I like. In 0:11:52.240 --> 0:11:55.520 the book is called I Contain Multitudes, and it's about 0:11:55.720 --> 0:11:59.600 that title. It's about microbiota. It came out either this 0:11:59.679 --> 0:12:02.440 year of the year before, and keep meaning to read it. 0:12:02.559 --> 0:12:06.560 I've heard it's very good. Wow. Cool. All right. So 0:12:07.520 --> 0:12:11.080 uh again, more understanding of that could lead to a 0:12:11.200 --> 0:12:16.040 greater understanding of how to to manage diabetes. But the 0:12:16.040 --> 0:12:20.360 picture is about to get even more complicated. So yet 0:12:20.440 --> 0:12:24.280 another study came out this year in and Diabete a 0:12:24.320 --> 0:12:29.400 logica diabeto logica, however you pronounced. That study found that 0:12:29.440 --> 0:12:33.559 people who have an abundance of healthy fat stem cells 0:12:34.120 --> 0:12:38.000 in their body were more resistant to developing diabetes, even 0:12:38.040 --> 0:12:42.480 in equally obese patients. Um, so people with obesity that 0:12:42.600 --> 0:12:46.520 have the presence of the certain adipose cells fat stem 0:12:46.600 --> 0:12:53.360 cells makes their organs more more better, more efficient at 0:12:53.520 --> 0:12:57.400 storing fat in a way that is not ultimately detrimental 0:12:57.440 --> 0:13:00.720 to the body and leading to conditions that are associated 0:13:00.760 --> 0:13:06.000 with obesity, like cardiovascular disease and diabetes. And so they 0:13:06.040 --> 0:13:11.720 the researchers concluded that understanding the molecular mechanisms that underlie 0:13:11.760 --> 0:13:16.319 this difference between obese patients with healthy fat stem cells 0:13:16.360 --> 0:13:19.480 and obese patients without them could help us develop new 0:13:19.480 --> 0:13:24.120 therapies to prevent insulin resistance in type two diabetes. But man, 0:13:24.160 --> 0:13:27.120 we're starting to get a really complicated picture of all 0:13:27.160 --> 0:13:31.480 the different influences that might work themselves out in the body. 0:13:31.600 --> 0:13:34.480 To me, this is a continuation of that story that 0:13:34.559 --> 0:13:38.240 we explored in the first episode about the history of 0:13:38.280 --> 0:13:42.320 our understanding of diabetes, which not a big surprise, but 0:13:42.440 --> 0:13:48.520 over time becomes more complex and involved. Uh. I mean, obviously, 0:13:48.559 --> 0:13:53.559 anytime you're looking at a really complicated subject, that progression 0:13:53.600 --> 0:13:55.559 is going to go in that direction. Right. We're not 0:13:55.559 --> 0:13:58.320 gonna suddenly have a huge understanding and then go backward 0:13:58.520 --> 0:14:01.120 unless we have another dark ages. But I'm just sure, 0:14:01.120 --> 0:14:03.080 but yeah, no, it's just interesting to think that, like 0:14:03.120 --> 0:14:05.839 the same way that people in the nine twenties might 0:14:05.880 --> 0:14:09.200 have been looking back at previous centuries and millennia of 0:14:09.240 --> 0:14:11.840 researchers going like, you thought it had to do with 0:14:11.880 --> 0:14:16.160 the kidneys, you idiots, But now we're like, oh, it 0:14:16.160 --> 0:14:19.880 has to do with the bacteria and stem cells. And yeah, 0:14:20.040 --> 0:14:22.760 one really more brief note to complicate it even more, 0:14:22.840 --> 0:14:25.600 there was also there was also a study this year 0:14:25.600 --> 0:14:30.840 in the journal psycho neuro into Chronology that essentially identified 0:14:30.880 --> 0:14:38.080 a pathway from psychological state two diabetes, and the pathway 0:14:38.240 --> 0:14:42.520 was from a type of executive function known as low inhibition. 0:14:42.800 --> 0:14:47.600 Essentially that is correlated with the state that's known as 0:14:47.640 --> 0:14:56.480 anxious arousal emotional anxiety, and then correlated to inflammation, which 0:14:56.560 --> 0:15:00.480 is then correlated to diabetes, which is that actually also 0:15:00.480 --> 0:15:03.680 correlated to gut bacteria, the so so all of these 0:15:03.720 --> 0:15:08.400 things so so anyway, but this becomes a self fulfilling 0:15:08.400 --> 0:15:11.480 prophecy because knowing this is making me anxious, which is 0:15:11.520 --> 0:15:16.120 therefore eat a yogurt you'll be fine. So yeah, this 0:15:16.200 --> 0:15:19.400 is even possible. I mean, this is one of these 0:15:19.440 --> 0:15:21.000 things that's making me think that there have got to 0:15:21.000 --> 0:15:23.240 be a lot of false trails here. I mean, I'm 0:15:23.240 --> 0:15:27.440 sure all these different areas of research or turning up 0:15:27.480 --> 0:15:29.160 some things that are going to turn out to not 0:15:29.320 --> 0:15:32.040 really be primary causes. Right. They may be may be 0:15:32.160 --> 0:15:37.120 a factor that influences but perhaps not is is you know, 0:15:37.240 --> 0:15:40.760 definitive in causing, or or it could be an indicator 0:15:40.840 --> 0:15:43.920 that this other thing is happening and not not a 0:15:44.000 --> 0:15:48.680 cause of right. Right, But anyway, I mean, I feel like, nevertheless, 0:15:48.720 --> 0:15:52.600 our picture of the cause and effect relationship with whole 0:15:52.640 --> 0:15:58.760 body state versus metabolic regulation is getting very complicated. Yeah, 0:15:59.000 --> 0:16:01.880 seems likely based upon the last few stories you've shared 0:16:01.880 --> 0:16:04.800 with us, Joe. But then, of course there is another one. 0:16:04.840 --> 0:16:08.440 This one has more to do with type one diabetes. Okay, 0:16:08.600 --> 0:16:10.760 this is uh. There was a study that came out 0:16:10.760 --> 0:16:16.359 in called hotspot Autoimmune T cell receptor binding underlies pathogen 0:16:16.400 --> 0:16:22.120 and insulin peptide cross reactivity explicable. Let's let's let's break 0:16:22.200 --> 0:16:24.120 that one down just a little bit. This was in 0:16:24.160 --> 0:16:27.760 the Journal of Clinical Investigation. All these have been sixteen studies. 0:16:28.120 --> 0:16:31.960 This one is um Uh. It found something pretty interesting 0:16:32.360 --> 0:16:38.160 the presence of pathogens germs maybe the cause or a 0:16:38.320 --> 0:16:43.200 cause of type one diabetes. So how how would you 0:16:43.200 --> 0:16:45.800 figure that? Well, here's how it goes. There are these 0:16:45.840 --> 0:16:49.560 insulin producing cells that we talked about in the previous episode, 0:16:49.560 --> 0:16:53.280 known as pancreatic beta cells, and in type one diabetes, 0:16:53.640 --> 0:16:57.480 immune system cells known as T cells. White blood cells 0:16:57.560 --> 0:17:01.760 attack these beta cells and destroy the body's ability to 0:17:01.800 --> 0:17:06.359 produce insulin. But what causes the autoimmune response? Like, why 0:17:06.480 --> 0:17:08.800 do the T cells attack the beta cell? They didn't 0:17:08.840 --> 0:17:10.800 like the cut of their jib because they're dumb as 0:17:10.840 --> 0:17:13.400 a bag of hammers. They are pretty dumb. They don't 0:17:13.400 --> 0:17:15.680 even have brains. You wouldn't believe it. I well, as 0:17:15.680 --> 0:17:19.439 someone who suffers massive all allergic reactions, I am not 0:17:19.560 --> 0:17:22.200 a big fan of the way my my body's immune 0:17:22.200 --> 0:17:27.000 system will misidentify certain allergens and then go into yeah, 0:17:27.080 --> 0:17:31.560 you know exactly then, Jonathan, how how strange, how poorly 0:17:31.640 --> 0:17:35.040 understood states within the body at the cell level of 0:17:35.040 --> 0:17:39.800 cell function um can cause complex systemic reactions that are 0:17:39.920 --> 0:17:43.560 not necessarily what your body intended intended in quotes, you know, 0:17:43.600 --> 0:17:45.840 as we said, the cells don't have brains, but they 0:17:45.840 --> 0:17:48.600 do have a sort of programmatic function. They're supposed to 0:17:48.640 --> 0:17:53.280 be attacking pathogens to keep them out. But the study 0:17:53.480 --> 0:17:56.800 here found that these T cells were cross reactive in 0:17:56.800 --> 0:17:59.040 a particular way, and that means they react to a 0:17:59.080 --> 0:18:03.640 complex set of conditions that determine their behavior. And these conditions, 0:18:03.880 --> 0:18:06.760 the study found, could be brought on by the presence 0:18:06.800 --> 0:18:10.840 of particular pathogens. Uh. A quote from the study abstract 0:18:10.960 --> 0:18:16.080 is T cell cross reactivity with pathogen derived antigens might 0:18:16.320 --> 0:18:20.760 break self tolerance, which that that's a great term self tolerance. 0:18:20.880 --> 0:18:23.960 I assume that means the immune system not attacking your body. 0:18:24.359 --> 0:18:29.600 I've got very low self tolerance. But that's something else, yeah, yeah, 0:18:30.760 --> 0:18:33.600 in the end to induce autoimmune disease. So it demonstrates 0:18:33.640 --> 0:18:37.159 the value in looking at the various ways external influences 0:18:37.200 --> 0:18:40.480 such as germs and other pressures might alter T cell 0:18:40.560 --> 0:18:44.760 function to cause autoimmunity. Autoimmunity being not a good thing 0:18:44.840 --> 0:18:48.120 when the immune system attacks you, and that would include 0:18:48.200 --> 0:18:51.600 type one diabetes. So there can be certain there can 0:18:51.640 --> 0:18:54.480 probably be certain germs present in your body in certain 0:18:54.520 --> 0:18:58.840 ways that can trigger this chain reaction of autoimmune response 0:18:58.880 --> 0:19:06.920 against your betas holes. So that's heavy stuff you've laid 0:19:06.920 --> 0:19:12.479 down on us. Joe, it's really fascinating learning more about 0:19:12.560 --> 0:19:15.920 this disease that we keep thinking we've got, like or 0:19:15.920 --> 0:19:18.119 at least the indication I always felt this was that 0:19:18.160 --> 0:19:20.159 we had a pretty good handle on it, but it 0:19:20.200 --> 0:19:23.720 turns out that it's far more complicated than I had anticipated. Well, 0:19:23.720 --> 0:19:25.640 I think we do understand a lot of the basics. 0:19:25.640 --> 0:19:28.600 Sure well, sure, yeah, but it's just that our pictures 0:19:28.720 --> 0:19:31.159 becoming and you know, the broader picture is becoming more 0:19:31.240 --> 0:19:34.760 and more complicated, right, right, But we also have a 0:19:34.840 --> 0:19:38.600 lot of research into the practical means of how we 0:19:38.640 --> 0:19:43.600 could uh improve the treatment for diabetes. And I've got 0:19:43.640 --> 0:19:46.560 one more little bit of of research that I found 0:19:46.720 --> 0:19:50.280 that that that could potentially help lead to better understanding 0:19:50.359 --> 0:19:54.000 and better therapies in the future. Um. There was a 0:19:54.040 --> 0:19:56.480 recent study that was published in the Journal of Clinical 0:19:56.520 --> 0:20:00.240 Investigation that looked into those early stages of type two 0:20:00.280 --> 0:20:02.880 diabetes that you were talking about a minute ago, UM 0:20:02.920 --> 0:20:05.919 that that that insulin resistance. UM. The authors of this 0:20:05.960 --> 0:20:10.200 study were investigating whether there's a link between the processes 0:20:10.720 --> 0:20:15.679 processes that lead to accumulated fat in muscle tissue, which 0:20:15.720 --> 0:20:21.720 again obesity being a common alongside to insulin resistance. Um 0:20:21.800 --> 0:20:25.959 the others of this one. We're looking specifically at UM 0:20:26.480 --> 0:20:31.119 whether there's a link between accumulated accumulated fat and muscle 0:20:31.160 --> 0:20:33.359 tissue that that that obesity kind of issue that we 0:20:33.359 --> 0:20:38.480 were talking about earlier, and the decreased glucose uptake that 0:20:38.720 --> 0:20:42.080 is one of those early indicators of insulin resistance and 0:20:42.200 --> 0:20:46.359 therefore of type two diabetes. And there is UM. There's 0:20:46.400 --> 0:20:50.320 this protein that's called mondo A that is a link 0:20:50.400 --> 0:20:56.879 between accumulated fat and muscle tissue and decreased glucose uptake UM. 0:20:56.960 --> 0:21:01.359 And this protein, the single protein appears to regulate genes 0:21:01.359 --> 0:21:05.440 that control both fat synthesis and insulin signals. They think 0:21:05.480 --> 0:21:08.240 that this protein might be what's telling your cells to 0:21:08.280 --> 0:21:14.000 stop taking in glucose and instead convert it into fact um. 0:21:14.040 --> 0:21:16.320 But they think that when the protein is activated too often, 0:21:16.359 --> 0:21:19.760 when there's just so much glucose in your blood, that 0:21:19.760 --> 0:21:23.120 that that this protein is being triggered constantly, it could 0:21:23.119 --> 0:21:26.520 make your cells permanently resistant to insulin instead of just 0:21:26.680 --> 0:21:33.160 temporarily resistant to glucose UM. So, you know, but potentially 0:21:33.200 --> 0:21:35.480 in the future, this this could lead to treatments that 0:21:35.520 --> 0:21:40.760 could target and inhibit mondo A. Maybe hopefully, um. I mean, 0:21:40.760 --> 0:21:43.040 the researchers think that it could even help people manage 0:21:43.040 --> 0:21:46.760 their overall metabolism and body weight by managing the function 0:21:46.800 --> 0:21:50.320 of the single protein. That's cool. And so it's important 0:21:50.359 --> 0:21:55.320 to also uh reiterate that a lot of these areas 0:21:55.359 --> 0:22:00.040 of research may ultimately not uh not result in a 0:22:00.280 --> 0:22:04.520 useful treatment, but there's a lot of potential out there, 0:22:04.560 --> 0:22:08.160 and there's so many different avenues of exploration that there's 0:22:08.200 --> 0:22:11.160 a lot of hope that we can find much more 0:22:11.240 --> 0:22:16.680 effective ways of either preventing type two diabetes from forming, 0:22:16.760 --> 0:22:19.200 or even type one in the case of the possibility 0:22:19.240 --> 0:22:22.840 that germs play an important role in the development of 0:22:22.960 --> 0:22:27.399 that type of diabetes, or the management making management more 0:22:29.119 --> 0:22:32.600 less of a pain, both literally and figuratively. Uh. And 0:22:32.680 --> 0:22:36.399 to that end, there's a lot of different approaches that 0:22:36.400 --> 0:22:40.320 people have been looking into on one aspect of diabetes management, 0:22:40.359 --> 0:22:43.480 and that is monitoring your glucose levels in the first place, 0:22:43.760 --> 0:22:46.600 because we mentioned like the original tests were all about 0:22:46.640 --> 0:22:50.520 testing the sugar levels and urine, which are not necessarily 0:22:50.640 --> 0:22:54.440 as precise as you would want as reading of your 0:22:54.480 --> 0:22:58.679 blood glucose levels. That's more of a relevant measurement. But 0:22:58.760 --> 0:23:01.480 blood glucose. The way you measure that typically is that 0:23:01.560 --> 0:23:04.400 you have to prick a finger or some other part 0:23:04.440 --> 0:23:07.879 of your body and uh get a blood sample and 0:23:07.920 --> 0:23:12.120 then use a device to analyze it. So it's invasive 0:23:12.640 --> 0:23:14.760 by definition, right, you have to get at the blood. 0:23:15.400 --> 0:23:17.520 So there's been a lot of look into the possibility 0:23:17.640 --> 0:23:22.520 of developing non invasive means of measuring blood glue close levels, 0:23:22.560 --> 0:23:25.119 which would remove at least one of those barriers. And 0:23:25.160 --> 0:23:29.159 one of those frustrations that people UM encounter when it 0:23:29.200 --> 0:23:31.320 comes to diabetes, could you do a breath a wizer, 0:23:32.240 --> 0:23:34.159 one would hope, And that was not one of the 0:23:34.160 --> 0:23:37.680 ones that I read about. There was a paper published 0:23:37.720 --> 0:23:40.080 in the National Institutes of Health back in two thousand 0:23:40.160 --> 0:23:44.200 twelve that was sort of a review of various processes 0:23:44.240 --> 0:23:47.920 that had been UM experimented with. In some cases even 0:23:47.960 --> 0:23:52.400 products were brought to market, but ultimately uh spoiler alert 0:23:52.760 --> 0:23:57.480 did not perform very well, and uh they wanted to. 0:23:57.760 --> 0:24:00.679 It was specifically looking at these noninvasive appre which is like, 0:24:00.800 --> 0:24:04.280 are there any that are on a level that is promising, 0:24:04.640 --> 0:24:10.080 if not as good as monitoring glucose levels through actually 0:24:10.440 --> 0:24:13.520 analyzing blood directly. So here's some of the ones that 0:24:13.600 --> 0:24:18.119 they looked at, they looked at UH bio impedence spectroscopy. 0:24:19.320 --> 0:24:23.080 So this is measuring the resistance to electric current flowing 0:24:23.119 --> 0:24:28.400 through tissue impedence UM. So this is not that different 0:24:28.440 --> 0:24:32.280 from things that use like capacitis touch screens, that kind 0:24:32.280 --> 0:24:35.800 of stuff. I mean, our bodies we've talked about many times. UH, 0:24:36.640 --> 0:24:39.720 we conduct electricity. We also have stuff in us that 0:24:39.760 --> 0:24:43.720 impedes the conductance of electricity, and that changes depending on 0:24:43.720 --> 0:24:46.760 our body chemistry. So the key here is that there 0:24:46.760 --> 0:24:51.320 are variations in glucose concentrations that change the number of 0:24:51.400 --> 0:24:54.840 sodium id ions and potassium ion concentrations in our blood. 0:24:54.920 --> 0:24:59.440 So typically sodium ion concentration goes down, potassium ion concentration 0:24:59.480 --> 0:25:03.439 goes up. This changes our resistance to electricity. UM. So 0:25:03.520 --> 0:25:05.720 if you were able to measure that in a meaningful way, 0:25:05.800 --> 0:25:09.720 you would be able to make some UH, you would 0:25:09.760 --> 0:25:12.280 be able to to figure out what the gluecoast levels 0:25:12.280 --> 0:25:16.239 of blood were. However, all of these different approaches I'm 0:25:16.280 --> 0:25:18.679 going to talk about have different drawbacks. The one for 0:25:18.720 --> 0:25:21.200 this one is that it's not as reliable as other 0:25:21.320 --> 0:25:24.360 methods of checking blood glucost levels, and at the time 0:25:24.400 --> 0:25:27.000