Garvan Breakthrough magazine - Aug 2018

Trust your gut

Dr Dorit Samocha-Bonet is discovering how your microbiome could hold the key to blood sugar regulation.

Here’s the twist It seems like the solution is straightforward – lose weight and prevent diabetes. But, as we all know, many people struggle to lose weight and sustain the reduction. “I acknowledge how hard it is for people to lose weight. The percentage of people who maintain weight loss after five years is less than 20%,” says Dorit, who has practised as a dietitian for more than 20 years.

It’s a difficult topic, but one we can’t ignore. Half of the world is overweight and this is causing serious health problems. Here in Australia, that percentage is even higher – 65%. And almost 30% of us are obese (a body mass index over 30 kg/m2). And it’s about more than just extra weight. Obesity increases the risk of many other diseases – and this year, obesity was recognised as a disease itself. “Our strength here at Garvan is understanding the metabolic consequences of being overweight in an individual,” says Dr Dorit Samocha-Bonet, clinical scientist and dietitian with the Diabetes and Metabolism Division. “Obesity is very easily diagnosed, you do not need sophisticated equipment. But, the metabolic impairments are diverse. Each person is different.” Pre-diagnosis One of the major conditions travelling hand-in-hand with obesity is prediabetes – the precursor to type 2 diabetes in which blood sugar is abnormally high, mostly after meals. “Prediabetes affects around 40% of American adults and here in Australia we are following the same trend,” says Dorit. Prediabetes can fly under the radar for years – until the symptoms crash down like Jenga blocks. Prediabetes on its own is a risk factor for everything that diabetes can herald – cardiovascular disease, certain types of cancer, fatty liver. “It’s not just a marker of a disease to come, a person with prediabetes could already have many of those conditions that are affected by type 2 diabetes.” But if we do know about prediabetes (and being overweight is one of the warning signs) there’s a lot we can do, explains Dorit. This is the focus of Garvan’s new clinical trial PREDICT. “When you are already diagnosed with diabetes, it can be too late for your pancreas, because your body has been dealing with insulin resistance for many years. But during prediabetes it’s possible to prevent the development of type 2 diabetes.”

Some foods cause blood sugar to spike in some people and have no effect on others – and this can be predicted.

Also, weight loss does not reverse prediabetes in everybody. “On average, weight loss of about 5% of body weight, if maintained, is very beneficial for health. But we see in the clinic, and it has been documented in medical literature, that many individuals who lose a large amount of body weight and fat, do not reverse prediabetes. “Glucose regulation remains impaired in these individuals. It’s clear that weight loss as a blanket treatment for everybody isn’t the whole story in battling the prediabetes epidemic.” Which leads us to the gut Across the board, scientists, more than ever before, are investigating the role of the microorganisms living in our gut (our microbiome) in the current diabetes epidemic. “Our collaborators at the Weizmann Institute in Israel have shown that some foods can cause blood sugar to spike in some people, but have no effect on others – and that the sugar response to food can be predicted by the composition of the gut microorganisms and other clinical and blood parameters.”

6 Breakthrough

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