Type 1 Caused by lifestyle?

Gary Thom · Apr 20, 2016

I was reading an a story in The Herald today talking about a study to investigate whether or not there may be a link between lifestyle and type 1 diabetes. The idea is that poor lifestyle causes direct damage to beta cells and these damaged cells are then attacked my the immune system, finishing them off.

In my opinion it's certainly NOT the case that all Type 1 diabetes are caused by lifestyle or even a sizeable minority of cases. Given a lot of people have diabetes from infancy it's hardly likely to have been caused by lifestyle! However, the triggers aren't very well known as this seems like as good a theory as any for a small number of cases of adults getting diabetes?

I appreciate I'm only a sample size of 1 but when I was diagnosed I was really shockingly unhealthy. Obese, drinking too much, eating terribly and so on. I was sure I had type 2 and my GP suspected as much as well until my ketone results came back which were sky high. So could there be a link for SOME people? I was actually always glad 1 was Type I rather than Type 2, partly because I felt like I hadn't brought it on myself, but perhaps I did? If I did though I don't think it would bother me as much now as it would have back then given the very positive force diabetes has been in my life in terms of sorting out my health.

A PIONEERING new study is set to test the theory that type 1 diabetes is triggered by lifestyle and environmental stresses by trialling whether an existing drug treatment can prevent the condition from ever developing among high-risk individuals.

There are around 6,400 families in Scotland affected by type 1 diabetes. The clinical evaluation aims to tracks down all Scottish children aged five to 16 who have a sibling or parent with the condition and invite them to undergo a blood test to discover whether they are genetically predisposed to developing it.

If so, they will be invited to participate in the trial.

The results could help to explain why rates of type 1 diabetes have increased five-fold in the past 40 years. Scotland has been chosen as the launchpad for the trial because it has the third highest incidence of type 1 diabetes in the world.

The study, a join initiative between the Universities of Exeter and Dundee, will test the theory that the trigger for type 1 diabetes is rooted in many of the same modern stresses associated with the type 2 version, such as obesity, a sedentary lifestyle, excessive alcohol consumption, smoking and air pollution.

In type 1 diabetes, patients are unable to make insulin because the cells in their pancreas responsible for producing the hormone are too damaged. As a result, their body is unable to regulate blood-sugar levels naturally and, without regular insulin injections, the glucose in their bloodstream would become toxic.

Previously scientists believed type 1 diabetes was an autoimmune disorder caused by a faulty immune system which attacks and destroys insulin-producing beta cells in the pancreas.

However, this has been called into question by disappointing results from clinical trials testing drugs that suppress the immune system.

The new Scottish study will turn the theory on its head by investigating whether it is lifestyle and environmental stresses that first damage the beta cells, and that once damaged these cells transmit signals triggering the immune system to attack them.

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The theory, known as the 'accelerator hypothesis', was first put forward in 2001 by Exeter University academic, Professor Terence Wilkin, who will lead the study.

If correct, high-risk individuals should be able to prevent the onset of type 1 diabetes by taking metformin - a common and inexpensive diabetes drug known to protect the beta cells from stress.

Prof Wilkin said: “It is possible that a modern environment accelerates the loss of beta cells by overworking and stressing them.

“If successful, the trial will offer a means of preventing type 1 diabetes with a cost-effective medication, and could be made immediately available to children at risk.”

The adAPT study, based out of Ninewells Hospital in Dundee, will initially split participants into metformin and placebo groups for four months.

The study will gradually be expanded to include all the health boards in Scotland and extended to England.

Co-researcher Professor Stephen Greene, a specialist in child and adolescent health at Ninewells and director of the Scottish Children’s Research Network, said the findings could be "extremely important".

He said: "A simple, safe and effective drug that would prevent the development of type 1 diabetes in young people would be a major breakthrough.”

azure · Apr 20, 2016

I think lifestyle - or rather life - can bring Type 1 on earlier than it might have happened otherwise eg some women get Type 1 during pregnancy (extra strain on pancreas) and some people finally tip over into Type 1 after a period of illness, but no, I don't think it's lifestyle related, at least only in the broadest sense.

I was told by my consultant that Type 1 is an auto immune disease and who I asked what had caused it, she said it was 20% genes and 80% environmental. She said the 'environment' was what they were still unsure about - that is, what triggered the Type 1 - a virus, milk, wheat, bacteria, etc etc.

Juicyj · Apr 20, 2016

When you consider that a high % of people are diagnosed as children then it seems impossible that it's triggered by lifestyle.

However personally I think it can be triggered by many factors, so it could be lifestyle related, why though think that it's just one factor ? I know there is a higher incidence of type 1 in northern hemisphere countries, so possible sunshine/vitamin d link, and also people are diagnosed after illness so the attack starts with illness depressing the immune system. Maybe this is where we are going wrong and trying to pinpoint a particular reason rather than many, it's how the immune system responds and perhaps if we focus more on strengthening immune systems then this could prevent many from becoming type 1 ?

pinewood · Apr 20, 2016

The question is what is meant by "lifestyle". There may be something in a person's "lifestyle" that triggers T1 but there is so much evidence out there that shows it's not eating unhealthily or being overweight; it's something we don't know. Stress of some kind? Lack of vitamin D? A virus? Who knows.

I actually take issue with the article you posted. Saying "Previously scientists believed type 1 diabetes was an autoimmune disorder caused by a faulty immune system which attacks and destroys insulin-producing beta cells in the pancreas" is SO wrong and misleading. It's not "previously", it's still the case.

staffsmatt · Apr 20, 2016

Whilst lifestyle *may* have an effect (personally I think not). It's definitely not the case in the vast majority of people. I was diagnosed at 16 months (just after on of the childhood jabs) so I think the autoimmune idea is far more likely (it got stressed by the jab and that kicked the whole thing off...)

azure · Apr 20, 2016

The auto immune response has been proven, I believe. There may be things that speed up the develop of Type 1 but that's all, in my opinion.

Gary Thom · Apr 20, 2016

pinewood said:
The question is what is meant by "lifestyle". There may be something in a person's "lifestyle" that triggers T1 but there is so much evidence out there that shows it's not eating unhealthily or being overweight; it's something we don't know. Stress of some kind? Lack of vitamin D? A virus? Who knows.

I actually take issue with the article you posted. Saying "Previously scientists believed type 1 diabetes was an autoimmune disorder caused by a faulty immune system which attacks and destroys insulin-producing beta cells in the pancreas" is SO wrong and misleading. It's not "previously", it's still the case.

I agree. The Herald's standards have fallen off a cliff recently though so I'm not surprised.

julie56 · Apr 20, 2016

It's an interesting theory - I myself am diagnosed type 2, but have other autoimmune conditions and so have other members of my direct family. There seems to be an increasing number of people suffering from a number of autoimmune related disorders and it would be a huge leap if scientist could find a link with something in the environment that triggers these attacks on susceptible people. Sadly the word "lifestyle" used in conjunction with "diabetes" is usually taken to mean overeating and being sedentary - which we all know is not the case in type 1 and often not the case in other types.

azure · Apr 20, 2016

Gary Thom said:
I agree. The Herald's standards have fallen off a cliff recently though so I'm not surprised.

Complain if you think it's inaccurate. There's enough confusion about diabetes without any more being added!

Bic · Apr 20, 2016

Juicyj said:
When you consider that a high % of people are diagnosed as children then it seems impossible that it's triggered by lifestyle.

However personally I think it can be triggered by many factors, so it could be lifestyle related, why though think that it's just one factor ? I know there is a higher incidence of type 1 in northern hemisphere countries, so possible sunshine/vitamin d link, and also people are diagnosed after illness so the attack starts with illness depressing the immune system. Maybe this is where we are going wrong and trying to pinpoint a particular reason rather than many, it's how the immune system responds and perhaps if we focus more on strengthening immune systems then this could prevent many from becoming type 1 ?

Regarding the lack of vitamin D-hypothesis, I'd just like to remind that Sardinia is amongst the
regions with the highest T1 incidence in Europe, yet it is a very warm and sunny place, with no big industrial cities and a thoroughly 'Mediterranean' lifestyle as for diet, rural living, sunlight exposure, moderate drinking and so on. So, well, I think research still has a long way to go…

tim2000s · Apr 20, 2016

A link to a similar article on the BBC. http://www.bbc.co.uk/news/uk-scotland-36083055

The research that this is linked to came out of Exeter in 2001, which is well known for its quality of Diabetes research.

Robinredbreast · Apr 20, 2016

azure said:
I think lifestyle - or rather life - can bring Type 1 on earlier than it might have happened otherwise eg some women get Type 1 during pregnancy (extra strain on pancreas) and some people finally tip over into Type 1 after a period of illness, but no, I don't think it's lifestyle related, at least only in the broadest sense.

I was told by my consultant that Type 1 is an auto immune disease and who I asked what had caused it, she said it was 20% genes and 80% environmental. She said the 'environment' was what they were still unsure about - that is, what triggered the Type 1 - a virus, milk, wheat, bacteria, etc etc.

Mine was 'triggered' by shock, stress and upset and yes, an auto immune condition. My then 2 1/2 year old granddaughter was diagnosed with type 1 ? so I would definitely say not 'lifestyle' or mine come to that.

SkylineFrontier · Apr 20, 2016

Hi,

Type 1 diabetes is an autoimmune disorder. Muddying the waters with issues of 'lifestyle', is I feel distinctly unhelpful. Particularly given the negative public perception of diabetes whether T1 or T2.

Robinredbreast · Apr 20, 2016

julie56 said:
It's an interesting theory - I myself am diagnosed type 2, but have other autoimmune conditions and so have other members of my direct family. There seems to be an increasing number of people suffering from a number of autoimmune related disorders and it would be a huge leap if scientist could find a link with something in the environment that triggers these attacks on susceptible people. Sadly the word "lifestyle" used in conjunction with "diabetes" is usually taken to mean overeating and being sedentary - which we all know is not the case in type 1 and often not the case in other types.

I got another auto immune condition, Coeliac, when I was going though another worrying and a very stressful time.

julie56 · Apr 20, 2016

Robinredbreast said:
I got another auto immune condition, Coeliac, when I was going though another worrying and a very stressful time.

Hi @Robinredbreast I was also diagnosed with Graves disease shortly after a family bereavement and believe stress played a part in triggering an autoimmune response. I guess it is all a part of the human condition.

TorqPenderloin · Apr 20, 2016

SkylineFrontier said:
Hi,

Type 1 diabetes is an autoimmune disorder. Muddying the waters with issues of 'lifestyle', is I feel distinctly unhelpful. Particularly given the negative public perception of diabetes whether T1 or T2.

Why is it unhelpful? The fact that it is an autoimmune disorder has no relevance to this discussion. AIDS is also an autoimmune disorder and for some....that could have been avoided.

Furthermore, why is it "Unhelpful" to at least CONSIDER the possibility that type 1 and type 2 are similar in that lifestyle COULD have contributed to the disease for some people while for others it was inevitable? Maybe "Type 1" encompasses many different types of auto-immune diabetes, some of which could have been avoided.

I see nothing wrong with discussing a topic that is largely unproven, and very possibly could be (partially) true.

catapillar · Apr 20, 2016

Professor Wilkin (Exeter) was on the Today programme this morning talking about this - it is a huge trial aimed at testing every child in Scotland with a parent or sibling with type 1, if the test show they are at high risk they will be put on metformin in the hope that this will protect the beta cells from "stressors" that they suspect are accelorating the rate of beta cell loss.

They don't know what the stressors are, but the rate of type 1 is increasing, so they hypothesise that it must be something (some unidentified thing) about modern living that stresses the beta cells, this stress flags them up to the immune system and gets them totally killed off.

I admit, when heard that it made me itch, because when they say "life style" or modern living I just hear fat. But that really really isn't what they are saying at all (that's just my own media brain washing) they say there is maybe something, some external factor is stressing out the pancreases of people with a pre disposition to an over active immune system. They are just trying to figure out how to stop impact of the stress (possibly with metformin) so as to either prolong insulin production or to catch it befor the immune system catches sight of the stressed out beta cells and goes nuclear on them (which would mean, hooray, no type 1 diabetes for that kid on the metformin). I didn't hear anyone offer an explaination for what causes the stress; the vague term of lifestyle was used, but that covers literally everything - yes it could mean the classic diet and exercise, it could also mean stress/trauma, it could mean some increase in chemical/additive etc in the "modern diet".

It's really hard (for me anyway) to hear "type 1 diabetes might be caused by lifestyle" and not think they mean it was your fault. But I really don't think that's what this study is saying & it wasn't what they were saying on the radio this morning - I haven't read the articles mind.

Here's the Exeter press release / website - http://www.exeter.ac.uk/news/featurednews/title_506628_en.html

Robinredbreast · Apr 20, 2016

catapillar said:
Professor Wilkin (Exeter) was on the Today programme this morning talking about this - it is a huge trial aimed at testing every child in Scotland with a parent or sibling with type 1, if the test show they are at high risk they will be put on metformin in the hope that this will protect the beta cells from "stressors" that they suspect are accelorating the rate of beta cell loss.

They don't know what the stressors are, but the rate of type 1 is increasing, so they hypothesise that it must be something (some unidentified thing) about modern living that stresses the beta cells, this stress flags them up to the immune system and gets them totally killed off.

I admit, when heard that it made me itch, because when they say "life style" or modern living I just hear fat. But that really really isn't what they are saying at all (that's just my own media brain washing) they say there is maybe something, some external factor is stressing out the pancreases of people with a pre disposition to an over active immune system. They are just trying to figure out how to stop impact of the stress (possibly with metformin) so as to either prolong insulin production or to catch it befor the immune system catches sight of the stressed out beta cells and goes nuclear on them (which would mean, hooray, no type 1 diabetes for that kid on the metformin). I didn't hear anyone offer an explaination for what causes the stress; the vague term of lifestyle was used, but that covers literally everything - yes it could mean the classic diet and exercise, it could also mean stress/trauma, it could mean some increase in chemical/additive etc in the "modern diet".

It's really hard (for me anyway) to hear "type 1 diabetes might be caused by lifestyle" and not think they mean it was your fault. But I really don't think that's what this study is saying & it wasn't what they were saying on the radio this morning - I haven't read the articles mind.

Here's the Exeter press release / website - http://www.exeter.ac.uk/news/featurednews/title_506628_en.html

Often, the deprived area's have the largest amount of people with diabetes. So, could this factor be the same in the suburbs of Scotland. Could it be down to the poorer area's, poor lifestyles ie parents on benefits, out of work, cheap processed foods, poor housing, smoking, alcohol or children under achieving at school ? There is definitely a rise happening in the 21st century ?

JRW · Apr 20, 2016

I'm type 3.5 but not sure if I'm in the 'lifestyle' category, as much as I kicked the **** out of life at the time it's not the cause IMO.

catapillar · Apr 20, 2016

Robinredbreast said:
There is definitely a rise happening in the 21st century ?

I think it's something like 4% annual increase in incidence of type 1 - http://diabetes.diabetesjournals.org/content/51/12/3353.full - this article charts the rise from discovery of insulin & considers a lot of potential factors in the increase, from type 1 genes actually surviving (thanks insulin), to cows milk, to children's growth rate picking up & putting more stress on the pancreas.

I have no idea about the other questions & I don't think the research community are pretending to know the answers either. But here's hoping that those are things this study looks at cos if they can find a hint at a cause, maybe they can do something to stave off the cause. Ever the optimist

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