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Mind Over Diabetes

Posted on February 5, 2013 | No Comments on Mind Over Diabetes

Notwithstanding all the artillery man has created for survival through the course of the ages, nothing could be more powerful than what he has been internally blessed with from the beginning—the mind.

The human brain functions like a computer’s central processing unit, given the regular and proper maintenance, the body is able to reach immeasurable heights. Once neglected, however, it eventually begins to develop certain errors and starts to malfunction.

As powerful as it is, there are a few “errors” the brain may not be able to. escape. Diabetes mellitus is one of them.

According to Dr. Herminigildo Gan, immediate past president of the Philippine Neurologic Association, early studies showed that blood sugar regulation was done only by the pancreas. However, researchers at the Albert Einstein College of Medicine of Yeshiva University, have demonstrated for the first time that the brain may play a key role in regulating glucose metabolism in humans.

It’s all in the brain
As the saying goes, “what we eat affects how we think.” The energy needed by the brain is twice as much as that of the other cells in our body, said Dr. Gan. Despite being two percent of the adult body weight, it accounts for approximately 20 percent of the resting metabolic rate. Since the brain’s neurons could not store glucose, the continuous supply of energy from the bloodstream is crucial for proper mental function.

Aptly called the central nervous system, the brain is connected to all peripheral tissues by a network of nerve fibers that allows it to monitor and regulate remote organs and tissues. Glucose metabolism is not an exemption, said Dr. Marsha Tolentino, the president-elect of the American Association of Clinical Endocrinologist – Philippine Chapter.

In this process, several hormones play an important role in maintaining the blood sugar in the body. Two of these hormones are insulin and leptin.

A car could not function without fuel. The same goes for humans, except the body’s fuel is in the form of food. Once the food is taken in, blood sugar or glucose rises. In response, insulin is then released by the pancreas for glucose to be converted into glycogen and commands the body cells, primarily muscle and fat tissue cells, to store up glucose from the blood, thus decreasing blood sugar levels.

With high insulin levels, the hormone leptin comes to the scene. It inhibits food intake in response to the high insulin level after a meal by triggering cells in the arcu-ate nucleus in the hypothalamus. Leptin also increases glucose oxidation and energy expenditure and activates whole-body glucose metabolism, targeting the liver and peripheral tissues to increase insulin sensitivity.

However, once the cells in the body stop responding to insulin, that’s where the problem begins. With insulin resistance (diminished ability of cells to respond to insulin), diabetes occurs.

Dr. Tolentino also points out that insulin resistance in the brain translates to insulin resistance in the liver, thus causes increased hepatic glucose production such as higher fasting blood sugar levels.

Effects of blood sugar on the brain
Food or drinks with high sugar content are believed to give your brain the instant boost. And indeed, studies have proven this to be true. However, what these common beliefs don’t tell you is that this only works for those with good blood sugar regulation.

“In other words, the faster people metabolized blood sugar, the better their memory functioned,” said Dr. Gan. He explained that once the instant surge of energy has reached its end, without the capability to store glucose, neurons experience an energy crisis. In a few hours, that energy will be drained, thus leaving one weak and/or nervous, while the ability to focus and think suffers.

While a moderate increase in blood glucose effectively enhances short term intellectual functions, too much can be bad as impaired glucose tolerance and diabetes can lead to decline in cognitive function, said Dr. Gan.

Dr. Tolentino cites a clinical study where children with type 1 diabetes who were treated intensively had a three-fold increased rate of hypoglycemia (low blood sugar) in comparison to those treated conventionally.
“One of the brain regions as-sociated with memory, the hippocampus, has receptors which are particularly vulnerable to the effects of hypoglycemia,” she added.

Prolonged exposure to hyper-glycemia (high blood sugar), on the other hand, has been known to cause damage to nerve endings and blood vessels, including the ones in the brain as well.

“Simply put, the longer that the glucose remains in the blood, the less fuel the brain has to function and retain memories,” said Dr. Gan.

The diabetic’s mind problems
Diabetes, according to Dr. Gan, has several neurologic complications affecting both the peripheral and the central nervous system. These include mild cognitive impairment, myopathy, neuropathy, stroke, and hypoglycemia un-awareness. He also added that one of the little known complications of type 2 diabetes is memory decline which may lead to dementia, particularly Alzheimer’s disease.

Citing The Memory in Diabetes (MIND) study, there has been a significant inverse relationship between Al C levels (a blood test reflecting the average blood sugar over 2 to 3 months) and the subjects’ scores on four cognitive tests. This means that patients who had unbalanced Al C levels were found to have grave impact on their cognitive function. No association, however, was found in their daily blood glucose levels and test scores.

When a person experiences hypoglycemia, it is natural to experience warning symptoms such as shaking and sweating. However, when a patient loses sense of these warning signs, it becomes dangerous. This is known as hypoglycemia unawareness.

According to Dr. Tolentino, it is caused by a decrease in the counter-regulatory hormone, glucagon, which is also secreted in the pancreas. Those who experience severe erratic blood sugars are more prone to this condition and that the said condition is more common in type 1 diabetes and insulin-treated patients.

Brain care 101
Despite the dangers imposed by the slow yet deadly diabetes on the brain, the white flag should be stored away as the battle is far from over.

As early as the pre-diabetes stage, or in those with the metabolic syndrome, Dr. Tolentino advises nothing works better than lifestyle modification in halting the progress to worse conditions. Dietary changes, increased physical activity, regular exercise, and modest weight loss are a few ways to pre-vent crossing the point of no return towards diabetes.

For those who already have diabetes, the endocrinologist advises that the best way to go is to maintain ideal blood sugar levels through diet, exercise, and proper medication. Both hypoglycemic and hyperglycemic surges must be avoided at all costs. “Glucose monitoring at home greatly aids in keeping things in control,” noted Dr. Tolentino.

The principle of “mind over matter” may be effective, but with the challenge of diabetes at bay, this principle is not enough. Maintaining a healthy lifestyle and a regulated blood glucose can keep the brain healthy, and thus keep the mind over diabetes.

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