Daily Archives: 12 July 2024

Beyond Toxicity: Lactate Emerges as a Major Body Fuel Post Carbohydrate Consumption

Robert Leija’s journey from high school athlete to kinesiology student at Fresno State and now a graduate student at the University of California, Berkeley, has been marked by a transformative shift in understanding the role of lactate in the body. Initially obsessed with improving his track and field performance and reducing muscle soreness attributed to lactic acid buildup, Leija’s perspective changed dramatically when he encountered a groundbreaking textbook that challenged conventional wisdom.

At Fresno State, Leija was introduced to an out-of-print textbook authored by George Brooks, a prominent figure in exercise physiology. This text upended Leija’s belief that lactate was merely a metabolic waste product indicating oxygen depletion during exercise. Instead, Brooks’s research posited that lactate was a normal byproduct of metabolic activity essential for fueling muscles during prolonged physical exertion.

As a member of Brooks’s research team at UC Berkeley, Leija has contributed to groundbreaking studies elucidating lactate’s integral role in metabolic processes. Published in the journal Nature Metabolism, their research conclusively demonstrates that lactate is produced naturally in response to carbohydrate ingestion and enters the bloodstream rapidly, sometimes even before glucose. This challenges the traditional view of glucose as the sole energy carrier in the body, highlighting lactate as a crucial component in managing carbohydrate metabolism.

The study involved 15 healthy, physically active adults who underwent rigorous testing involving glucose ingestion and monitoring of lactate levels. The researchers meticulously tracked the kinetics of lactate and glucose in the bloodstream by infusing lactate and glucose tracers into participants before carbohydrate intake. Their findings not only underscored the rapid conversion of dietary glucose to lactate but also revealed that lactate acts synergistically with insulin to regulate blood glucose levels, thereby challenging previous notions about lactate’s role in metabolic processes.

George Brooks’s concept of the “lactate shuttle” was pivotal in reshaping the understanding of lactate’s function beyond exercise physiology. This metabolic feedback loop posits lactate as a preferred fuel source for various tissues, including skeletal muscle, heart muscle, and the brain, even during intense activity. Furthermore, Brooks’s research has demonstrated that lactate is crucial in signalling fat tissue to conserve energy reserves, further highlighting its multifaceted role in metabolic regulation.

Moreover, the study conducted at UC Berkeley extended these findings to non-exercise conditions and debunked the misconception that elevated lactate levels indicate anaerobic metabolism or oxygen deficiency. Instead, it suggests that sustained high lactate levels in the bloodstream may signify disruptions in the lactate shuttle cycle rather than inherent harm to the body.

This research journey has been personally transformative for Robert Leija, aligning his academic pursuits with his passion for athletic performance. From initially grappling with the complexities of lactate metabolism as a high school athlete to contributing to pioneering research at one of the world’s leading institutions, Leija’s story underscores scientific discovery’s profound impact on personal and professional growth. As he continues his doctoral studies, Leija remains committed to unravelling further mysteries surrounding lactate metabolism and its implications for human health and performance.

In essence, Robert Leija’s trajectory from athlete to researcher epitomizes the evolution of scientific understanding, challenging entrenched beliefs and paving the way for a more nuanced appreciation of lactate’s pivotal role in human physiology. His collaboration with George Brooks and their team at UC Berkeley is a testament to scientific inquiry’s transformative power in reshaping our understanding of metabolic processes and their implications for health and performance.

More information: Robert G. Leija et al, Enteric and systemic postprandial lactate shuttle phases and dietary carbohydrate carbon flow in humans, Nature Metabolism. DOI: 10.1038/s42255-024-00993-1

Journal information: Nature Metabolism Provided by University of California, Berkeley

Weight Loss Surgery Reduces Heart Risks and Mortality in Obese Patients with Sleep Apnea: Cleveland Clinic Study

Ali Aminian, M.D., director of Cleveland Clinic’s Bariatric & Metabolic Institute and primary investigator of the MOSAIC study, highlighted that weight loss achieved through bariatric surgery significantly correlates with a 42% reduction in major adverse cardiovascular events and a 37% decrease in mortality risk among patients suffering from obesity and moderate to severe obstructive sleep apnea. This underscores the potential life-saving benefits of surgical intervention for this high-risk population.

Research published in The Lancet Respiratory Medicine indicates that nearly 1 billion adults worldwide are affected by obstructive sleep apnea, with obesity being a primary risk factor. The Obesity Medicine Association reports that approximately 70% of adults diagnosed with obstructive sleep apnea are also obese. This combination exacerbates metabolic disruptions and contributes to heightened risks of severe health conditions, including heart attacks and heart failure.

The MOSAIC (Metabolic surgery for OSA and Incident Cardiovascular disease) study, led by Cleveland Clinic, represents the first comprehensive analysis of long-term cardiovascular outcomes following bariatric surgery in patients with obstructive sleep apnea and obesity. From 2004 to 2018, the observational study involved 13,657 adult patients with a body mass index ranging from 35 to 70 and diagnosed with moderate to severe obstructive sleep apnea through sleep study tests.

Among the participants, 970 underwent bariatric surgery, while 12,687 served as a nonsurgical control group, balanced using overlap weighting methods. Follow-up continued until September 2022, revealing compelling findings about the benefits of surgical weight loss interventions.

Over ten years, the cumulative incidence of major adverse cardiovascular events was markedly lower among those who underwent bariatric surgery (27%) compared to the nonsurgical group (35.6%). This encompassed coronary artery events, cerebrovascular events, heart failure, atrial fibrillation, and all-cause mortality. Similarly, the cumulative incidence of all-cause mortality at ten years was 9.1% in the bariatric surgery cohort versus 12.5% in the nonsurgical group, indicating a significant survival advantage associated with surgical intervention.

Steven Nissen, M.D., Chief Academic Officer of the Heart, Vascular & Thoracic Institute at Cleveland Clinic and senior author of the study, emphasised the lack of approved drug therapies specifically targeting obstructive sleep apnea. Before the MOSAIC study, no intervention had demonstrated efficacy in reducing major adverse cardiovascular events or mortality rates in patients with this condition.

Patients who underwent bariatric surgery experienced substantial weight loss, averaging 33.2 kg over the 10-year study period, in contrast to the nonsurgical group, which lost an average of 6.64 kg. Remarkably, those who underwent surgery maintained a 25% weight loss even after a decade post-procedure, underscoring the long-term efficacy of bariatric interventions in managing obesity.

Nancy Foldvary-Schaefer, D.O., director of Cleveland Clinic’s Sleep Disorders Center, noted that current guidelines for managing obstructive sleep apnea stress the importance of weight loss and lifestyle modifications. The findings from the MOSAIC study reinforce these guidelines but also highlight the necessity for more effective and durable interventions, such as bariatric surgery, to enhance cardiovascular outcomes and survival in affected patients.

Dr. Aminian further emphasised that bariatric surgery can be a life-saving treatment for select patients, suggesting a dose-dependent relationship between weight loss and cardiovascular benefits in those with obstructive sleep apnea. More significant weight loss correlated with lower risks of heart complications, illustrating the potential for substantial health improvements through surgical intervention.

Looking ahead, with the emergence of new obesity medications capable of achieving average weight loss rates of 15-20%, similar cardiovascular benefits may be achievable through medical therapies. This possibility underscores ongoing advancements in obesity management and the potential to broaden treatment options for patients with complex health conditions like obstructive sleep apnea and obesity.

More information: Ali Aminian et al, Adverse Cardiovascular Outcomes in Patients with Obstructive Sleep Apnea and Obesity: Metabolic Surgery versus Usual Care, Journal of the American College of Cardiology. DOI: 10.1016/j.jacc.2024.06.008

Journal information: Journal of the American College of Cardiology Provided by Cleveland Clinic

High Prevalence of Eating Disorder Symptoms Among Individuals with Insulin-Dependent Diabetes

A recent meta-analysis conducted at the University of Eastern Finland reveals that one in four patients aged 16 years and older with insulin-dependent diabetes exhibits symptoms indicative of eating disorders. These symptoms encompass typical manifestations such as binge eating and food restriction, alongside a unique behaviour known as insulin omission. This practice involves intentionally restricting or skipping insulin doses due to fears of weight gain despite its detrimental effects on blood glucose management.

Doctoral Researcher Pia Niemelä underscores the severity of insulin omission, noting its dual impact on weight loss and disrupted diabetes control. The meta-analysis, which synthesised data from 45 previous studies encompassing 11,592 individuals, highlights that 20% of patients reported engaging in intentional insulin omission.

Published in Eating Behaviors, the study reveals a gender disparity in the prevalence of eating disorder symptoms, with a higher incidence among women compared to men. Contrary to assumptions that eating disorders primarily affect younger demographics, the meta-analysis underscores their prevalence across all age groups among adults with diabetes.

Niemelä emphasises the lack of specific care pathways in Finland for patients with both diabetes and eating disorders, underscoring the need for improved identification and management strategies. The coexistence of these conditions significantly elevates the risk of diabetes-related complications and comorbidities, necessitating structured screening methods such as the DEPS-R survey, which yielded positive results in 27% of subjects in this meta-analysis.

Understanding the scope and clinical implications of eating disorder symptoms in individuals with insulin-dependent diabetes is crucial for developing targeted treatment approaches and comprehensive care pathways.

More information: Pia E. Niemelä et al, Prevalence of eating disorder symptoms in people with insulin-dependent-diabetes: A systematic review and meta-analysis, Eating Behaviors. DOI: 10.1016/j.eatbeh.2024.101863

Journal information: Eating Behaviors Provided by University of Eastern Finland

Maternal Inheritance Linked to Higher Alzheimer’s Disease Risk

A recent investigation led by researchers from Mass General Brigham underscores the impact of parental inheritance on the development of Alzheimer’s disease. The study, involving 4,400 cognitively unimpaired adults aged 65-85, revealed that individuals with a family history of Alzheimer’s, particularly on their mother’s side, exhibit heightened levels of amyloid in the brain—a hallmark of the disease. The findings in JAMA Neurology shed light on how familial lineage, especially maternal, can influence biological changes associated with Alzheimer’s.

Senior corresponding author Dr Hyun-Sik Yang, a neurologist at Mass General Brigham, highlighted the study’s key revelations. Previous smaller studies hinted at the maternal link to increased Alzheimer’s risk, prompting the team to delve deeper using a larger dataset from the Anti-Amyloid Treatment in Asymptomatic Alzheimer’s (A4) study. This clinical trial provided insights into memory loss symptoms among participants’ parents, corroborating earlier findings of maternal influence on amyloid levels.

Collaborating with Vanderbilt and Stanford University experts, the researchers explored family histories and clinical data to discern patterns. They discovered that participants with a maternal history of memory impairment, regardless of onset age, exhibited higher amyloid levels. Conversely, paternal history of early-onset memory issues also correlated with elevated amyloid, whereas late-onset paternal symptoms showed no association.

Dr. Mabel Seto, the study’s first author, emphasised the study’s significance in understanding genetic predispositions and sex differences in Alzheimer’s disease. The study found no significant differences between male and female participants in how maternal inheritance influenced amyloid accumulation, challenging previous assumptions.

Despite its insights, the study acknowledges limitations, such as incomplete parental health records and demographic homogeneity among participants. Seto highlighted the need for future research to encompass diverse populations to validate these findings across different ethnicities and races.

Looking ahead, the researchers aim to expand their investigation to explore how parental history influences long-term cognitive decline and amyloid accumulation. This ongoing work could provide critical insights into preventive strategies and personalised healthcare approaches for Alzheimer’s disease.

Dr. Reisa Sperling, a co-author and principal investigator of the A4 Study, underscored the clinical implications of these findings. She suggested that understanding maternal inheritance patterns could help identify asymptomatic individuals at risk, potentially enhancing the efficacy of future prevention trials and clinical interventions.

The study underscores the complex interplay of genetic inheritance, particularly from maternal lines, in influencing Alzheimer’s disease risk markers. By elucidating these relationships, the research contributes to ongoing efforts to understand better, predict, and manage Alzheimer’s disease in diverse populations.

More information: Mabel Seto et al, Parental History of Memory Impairment and β-Amyloid in Cognitively Unimpaired Older Adults, JAMA Neurology. DOI: 10.1001/jamaneurol.2024.1763

Journal information: JAMA Neurology Provided by Mass General Brigham