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Tags acromegaly , diabetes , sugar

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Old 2nd May 2018, 01:30 PM   #1
casebro
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Evolutionary advantage of Type 2 Diabetes?

T2D is such a common genetic disease there must be an advantage to it, or it would have been eliminated from the gene pool.

My theory is that it is not just "thrifty genes", but another system all together.

Seems the disease is only superficially the high blood sugar called Diabetes. The real root is "insulin resistance", where in your cells do not accept insulin the way they ought to. So your sugars go high, as in after a meal, for everybody including healthy subjects. At which point your pancreas puts out enough insulin to lower sugars. Meantime, you have perhaps ten times the circulating insulin level. Eventually the pancreas reaches it's limit, and your sugars stay high- diagnosed as Diabetes.

Those high levels of insulin act as- get this- 'Insulin like Growth Factor' ! (Who would have thought that insulin can act like an insulin-like compound? ) That IGF is what the body builders and wrestler use, called 'steroids'.

So, my theory is that those of us with the T2D gene can grow larger and stronger, and that is the evolutionary advantage that has kept the T2D in the gene pool.

Go ahead and google <pseudo acromegaly> See why diabetics have more carpal tunnel, trigger fingers, blown discs, tendinopathy, bone spurs, arthritis, cardiomyopathy, enlarged hearts, ... all the symptoms of Andre the Giant, Hulk Hogan, and soon, Arnold Schwarzenegger....
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Old 2nd May 2018, 01:38 PM   #2
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It doesn't have to be advantageous, just not disadvantageous enough to stop you passing on your genes. Until very recently, type 2 diabetes tended to strike at an age where breeding was long past.
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Old 2nd May 2018, 01:48 PM   #3
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Originally Posted by The Don View Post
It doesn't have to be advantageous, just not disadvantageous enough to stop you passing on your genes. Until very recently, type 2 diabetes tended to strike at an age where breeding was long past.
And not only that, some of the risk factors for Type 2 diabetes (obesity, lack of exercise, smoking) were probably not problems that our ancestors had to deal with.
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Old 2nd May 2018, 03:15 PM   #4
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Ooops, I meant to put this thread in SMMT, but my stiff numb fingers (see above) hit the wrong keys.
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Old 2nd May 2018, 03:20 PM   #5
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Originally Posted by The Don View Post
It doesn't have to be advantageous, just not disadvantageous enough to stop you passing on your genes. Until very recently, type 2 diabetes tended to strike at an age where breeding was long past.
Originally Posted by Segnosaur View Post
And not only that, some of the risk factors for Type 2 diabetes (obesity, lack of exercise, smoking) were probably not problems that our ancestors had to deal with.
But you are both ignoring the gist of my point that the positive side effects happen long before the negatives or the aggregate exposure to our modern lifestyle. There is more to evolution than life span.
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Old 2nd May 2018, 03:31 PM   #6
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Some comprehensive information.

Type 2 diabetes

Quote:
Studies have identified at least 150 DNA variations that are associated with the risk of developing type 2 diabetes.
... And remission.
Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial
Quote:
Interpretation:

Our findings show that, at 12 months, almost half of participants achieved remission to a non-diabetic state and off antidiabetic drugs. Remission of type 2 diabetes is a practical target for primary care.
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Old 2nd May 2018, 03:58 PM   #7
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Originally Posted by casebro View Post
But you are both ignoring the gist of my point that the positive side effects happen long before the negatives or the aggregate exposure to our modern lifestyle. There is more to evolution than life span.
You may be drastically underestimating the time scales on which evolution operates. H. Sapiens hasn't really been around long enough for us to be confident about the evolutionary implications of its traits and mutations.

Type 2 diabetes could easily be irrelevant to the evolution of the species, in the sense of not affecting the actual evolutionary path of the species.

This is additionally confounded by human ability to counteract or ignore evolutionary pressures and effects.

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Old 2nd May 2018, 04:45 PM   #8
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Indeed.. For instance, males with other than the most spectacular tail feathers, still manage to breed.
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Old 2nd May 2018, 06:17 PM   #9
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Originally Posted by theprestige View Post
You may be drastically underestimating the time scales on which evolution operates. H. Sapiens hasn't really been around long enough for us to be confident about the evolutionary implications of its traits and mutations.
'

Humans do have PLENTY of evolutionary traits. Many of which have proven implications- sickle cell disease protecting again malaria frinstance. And sickle cell is not world wide, only in Africans. Proof that traits do not need to be universal to be advantageous.

Originally Posted by theprestige View Post
Type 2 diabetes could easily be irrelevant to the evolution of the species, in the sense of not affecting the actual evolutionary path of the species.

This is additionally confounded by human ability to counteract or ignore evolutionary pressures and effects.
I never thought EVERYBODY is T2, only that there is a reason it hasn't died out. Similar to sickle cell.

In evolution, advantages only need to offset disadvantages to keep the gene alive. Which was my premise, that since T2 is extant, there must be some advantage.

But nowadays, with ED meds for males, and HRT for woman, things may shift, eh? Towards, or away from my hypothesis?
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Old 2nd May 2018, 08:01 PM   #10
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Could you expand on your phrase "Insulin like Growth Factor"?
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Old 2nd May 2018, 08:32 PM   #11
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There's no advantage, and it's really not a genetic disease. It's generally a result of lifestyle choices. Over 90% of diabetics are type 2, and it's rare to see in someone who isn't overweight or obese.

As others have said, evolution is messy, and traits are not selected for or against if they get passed on via breeding before they manifest.

It's only been an issue recently, as type 2 has become much more common in places with abundant food supplies, where people eat themselves into it, as well as all over the other issues that come with obesity.
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Old 2nd May 2018, 08:39 PM   #12
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Originally Posted by RecoveringYuppy View Post
Could you expand on your phrase "Insulin like Growth Factor"?
The way the growth hormone system works is that the Pituitary gland puts out Growth Hormone. That hormone only effects the liver, where it triggers the output of the active hormone, Insulin Like Growth Factor, IGF for short. IGF-1 is made only by infants. Igf-2 is what adults make, so we can drop the -2. Body builders use an artificial analog, hundreds of time stronger than the natural kind.

The IGF molecule is similar to Insulin. So when insulin is in great enough concentration it can have the same growth effects on the body.

The disease Acromegaly is caused by an excess of IGF. Which is usually caused by too much growth hormone excreted by the Pituitary. Usual cause is a tumor of the Pituitary that puts out the GH. Giantism is the same thing, except the tumor happens at an earlier age, while the bones can still grow in length, so the victim grow as much as eight feet tall.

I have a lean body mass of over 220 lbs, and 40 of the 50 symptoms of Acromegaly, yet low IGF. Hmmm, why did I get so big? I talked the docs into doing a brain scan, looking for a tumor. While waiting for the results, I wonder if there was such a thing as "pseudo Acromegaly"? That is when I found the tie to Insulin Resistance. And I have been wondering ever since why T2 hasn't died out of the gene pool... there must be some advantage to it....

I even compiled a list of my symptoms that are also a list of Acromegaly: skin tags, colon polyps, heart murmur, artery disease, trigger fingers, carpal tunnel, ruptured discs, vetebral scalloping, bone spurs, tendonitis, osteoarthritis, sleep apnea, enlarged liver, ad on to 45 items. Oddest one was "pseudo foramin" of a thumb, looked like I drilled a hole through my thumb bone. Cause is bone overgrowth.
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File Type: jpg Thumb Foramin.jpg (28.0 KB, 10 views)
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Old 2nd May 2018, 08:53 PM   #13
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Originally Posted by rustypouch View Post
There's no advantage, and it's really not a genetic disease. It's generally a result of lifestyle choices. Over 90% of diabetics are type 2, and it's rare to see in someone who isn't overweight or obese.

As others have said, evolution is messy, and traits are not selected for or against if they get passed on via breeding before they manifest.

It's only been an issue recently, as type 2 has become much more common in places with abundant food supplies, where people eat themselves into it, as well as all over the other issues that come with obesity.
Diabetes is only a symptom, the disease is Insulin Resistance. Which goes back to before the patients turn diabetic.
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Old 2nd May 2018, 09:21 PM   #14
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Originally Posted by casebro View Post
Diabetes is only a symptom, the disease is Insulin Resistance. Which goes back to before the patients turn diabetic.
Yep. A step in the process, which is why it's also known as prediabetes.

As I said, with rare exceptions, it's a result of excess weight and a sedentary lifestyle.
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Old 3rd May 2018, 05:43 AM   #15
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Originally Posted by rustypouch View Post
Yep. A step in the process, which is why it's also known as prediabetes.

As I said, with rare exceptions, it's a result of excess weight and a sedentary lifestyle.
Cart/horse? With all of those soft tissue problems, is it any wonder I don't feel like running a marathin? I did do much better when gobbling Ibuprofen, but kidney limitations took that off the table. And I think I left kidney disease off the list .Nah, it's a result of a genetic variation. Genes is why so few people manage to actually lose weight, and even fewer can keep it off. And see post 6 above, after a whole year only half of the subjects managed to get off the meds.

Also same post link, 150 genes related to diabetes, doesn't matter. It's not quantity, it's quality. Hmmm, I wonder which genes the two groups had? Controlled w/ d&e, not controllable with d&e? The data could show a uselessness to your advise for half the patients?

Genes effect EVERYTHING- mood, intellect, size,endurance, strength, digestion, libido,even whether we like rutabagas. Problem is that at this point science has picked all the low hanging fruit- the one-to-ones of genotype<->phenotype. Next it needs to figure out which combination of several of those 150 genetic variants cause YOUR diabetes.

There are some 1:1 genetic probs related to diabetes, like defects in the insulin receptor. But much of the resistance is caused by variations of metabolic defects. Say, a defect in a gene for making COQ10. Then your body can't burn fats, they build up in your cells, causing not only poor endurance, bur the fats get in the way, clogging your insulin receptors. "If you think you understand metabolism, you missed something."

That COQ10 gene is named COQ2, I am homozygous for a defect there. Treatable with COQ10 supplements, a gram per day. That gene is in 11% of the population. (I bet it is one of the 150 cited) Many other defects are about that percentage. Having two such defects makes you 1/100, three 1/1,000. four 1/10,000. We each have 40 million to pick 4 from. We are all unique, baby. Our treatment can not be "one size fits all".
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Old 3rd May 2018, 07:10 AM   #16
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So this, then, is the real-world counterpart to the XMen. How very depressing!

Although look at the bright side : people can now go prancing around in skin-tight costumes, with a large “D” emblazoned on the garish T-shirts covering their shrunken chests. That spectacle (and, barring an actual spectacle, that thought) can give those of us who have no taste and no sense of empathy some cheap laughs.



(Sorry, couldn’t help that! But you did start this under Community.)
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Old 3rd May 2018, 07:14 AM   #17
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I think it is somewhat misleading to consider a trait such as T2D as either you have it or not, and given so many people (at least in the USA) have it there must have been an evolutionary selection for it. T2D is just one extreme result of the complex regulatory mechanisms that control energy metabolism in humans and other mammals. These regulatory mechanisms have been selected by evolution to produce the most appropriate physiology possible within each of a wide range of different diets, caloric intake, stress, environment (temperature, etc.) etc. And these mechanisms usually work quite well: one can eat three doughnuts one morning, have a salad for lunch, and an a 3000 calorie steak and potatoes dinner and still function in your job as a furniture mover reasonably well (at least you will not pass out). Or one can be a vegan, work in a library, and also get through a typical day. Or you can eat for, train for and run a marathon. Very different energy intakes and very different energy demands, yet the same molecular mechanisms do the best they can to keep you going and alive.

As noted up thread, most of human evolution was under a very different diet and life style than we now have in Western society. So the evolutionary selections on these regulatory mechanisms were in response to those circumstances: before agriculture probably cycles of feast (killed a wooly mammoth) and famine (can't catch another one). After agriculture the diet steadied a bit, but there were still more mild feasts (crop harvest) and famines (winter or, more severely, a failed crop). The current circumstances in Western society, of most people having access to as many calories as they wish and relatively modest physical effort requirements, causes the regulatory mechanisms to respond in the feast mode, but without the famines intervening. These circumstances, outside of the evolutionary pressure that programmed these mechanisms, result over time in negative outcomes such as T2D.

So casbro is correct that evolution did select for the mechanisms that lead to T2D, but by selecting for mechanisms that were appropriate under very different circumstances and that now produce T2D as an error given the inputs (our current diets and life styles) lie outside the parameters for which the regulatory algorithms were designed.
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Old 3rd May 2018, 07:17 AM   #18
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How's this for a convoluted explanation of sorts?

I've personally seen instances of people who, when diagnosed with diabetes, dramatically altered their lifestyle choices, so that their general health (and, I suppose, their general prospects for a longer life) actually improved as a result of the diagnosis.

Mightn't that actually help in the evolutionary scheme of things?
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Old 3rd May 2018, 07:19 AM   #19
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Originally Posted by casebro View Post
T2D is such a common genetic disease there must be an advantage to it, or it would have been eliminated from the gene pool.
Is there some evolutionary advantage of not having Type 2 Diabetes? There must be, because if there weren't then the lack of the disease would have been something that was eliminated from the gene pool.
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Old 3rd May 2018, 07:23 AM   #20
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I don't know why anyone would think that a disease needs to confer an evolutionary advantage. In fact, to even look for such an advantage is misguided and a waste of time, particularly with a disease which typically occurs past breeding age. The whole premise of the thread is nuts.
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Old 3rd May 2018, 07:31 AM   #21
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Originally Posted by MikeG View Post
I don't know why anyone would think that a disease needs to confer an evolutionary advantage. In fact, to even look for such an advantage is misguided and a waste of time, particularly with a disease which typically occurs past breeding age. The whole premise of the thread is nuts.

Ah, but nuts tend to stay functional far longer these days than in ages past. (If only because the owners of the nuts tend to live so much longer.)

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Old 3rd May 2018, 07:40 AM   #22
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Originally Posted by MikeG View Post
I don't know why anyone would think that a disease needs to confer an evolutionary advantage.
There MUST be an advantage to make up for the disadvantages or it would not have evolved to such ubiquitousness. "Thrifty gene" is the usual explanation, I have merely brought up an alternative or additional advantage.

Originally Posted by MikeG View Post
In fact, to even look for such an advantage is misguided and a waste of time, particularly with a disease which typically occurs past breeding age. The whole premise of the thread is nuts.
But past breeding age is only pertinent for the one latter generation. How about being around to raise the grand kids, pass down knowledge, etc. There is more to evolution than ONE next generation. Besides, males don't become sterile with age. What was that old lion's name? So old he couldn't walk by himself, but a pair of lionesses would brace him up while he inseminated another?
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Old 3rd May 2018, 07:45 AM   #23
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Aside, re: 150 genes known to be related to diabetes: It's called a Gene Set, a group of gene SNPs that when combined have a particular outcome. The genes entailing the GS may not even be closely related. In this disease, some in metabolism and some in endocrine could do it.
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Old 3rd May 2018, 07:50 AM   #24
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Originally Posted by casebro View Post
There MUST be an advantage to make up for the disadvantages or it would not have evolved to such ubiquitousness.......
No. It's a disease. You may as well ask what the evolutionary advantage of grey hair or bad backs is. What is the evolutionary advantage of age-related eyesight deterioration?
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Old 3rd May 2018, 08:07 AM   #25
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Originally Posted by casebro View Post
But you are both ignoring the gist of my point that the positive side effects happen long before the negatives or the aggregate exposure to our modern lifestyle. There is more to evolution than life span.
The key is reproductive success, considering that as far as we know most Type II diabetes seems associated with high carbohydrate diets and low levels of exercise, why would it have been selected out of the population in the past, prior to the 1970s?

Most people who develop Type II diabetes are capable of reproduction and many do reproduce, that is all that matters in evolution, a negative trait must impact reproduction and cause individuals to not reproduce.

My mother did not develop Type II diabetes until 20 years after she had three children
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Old 3rd May 2018, 08:10 AM   #26
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Originally Posted by casebro View Post
'

Humans do have PLENTY of evolutionary traits. Many of which have proven implications- sickle cell disease protecting again malaria frinstance. And sickle cell is not world wide, only in Africans. Proof that traits do not need to be universal to be advantageous.
It's a mutation. Beneficial in some environments, not so much in others. It's far too early in the evolutionary history of H. sapiens to tell if it has any real evolutionary advantage for the species. Over the next million years or so, it could very well get lost in the noise.

Not every transient trait in a species' genetic evolution is going to have an evolutionary significance. Not every transient trait needs to be assigned an evolutionary Just So Story.

Quote:
I never thought EVERYBODY is T2, only that there is a reason it hasn't died out. Similar to sickle cell.
Nobody said you thought everyone had it. It hasn't died out because it doesn't significantly impact the species' ability to reproduce and pass on its genes - especially now that we can treat it, and keep people with it alive and healthy well past their reproductive period.

Quote:
In evolution, advantages only need to offset disadvantages to keep the gene alive. Which was my premise, that since T2 is extant, there must be some advantage.
Not even that: Things can even be a disadvantage, as long as they're not such a great disadvantage that they prevent the species from reproducing at replacement rate or better. Your idea of genetic traits is too binary.

Quote:
But nowadays, with ED meds for males, and HRT for woman, things may shift, eh? Towards, or away from my hypothesis?
I don't see what any of those things have to do with your hypothesis, except to further confound any study of it.
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Old 3rd May 2018, 08:10 AM   #27
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Originally Posted by casebro View Post
There is more to evolution than ONE next generation.
Not really
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Old 3rd May 2018, 08:29 AM   #28
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Originally Posted by theprestige View Post
It's a mutation. Beneficial in some environments, not so much in others. It's far too early in the evolutionary history of H. sapiens to tell if it has any real evolutionary advantage for the species. Over the next million years or so, it could very well get lost in the noise.

.....
10,000 generations, 200,000 years is plenty adequate.
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Old 3rd May 2018, 08:30 AM   #29
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Originally Posted by William Parcher View Post
Is there some evolutionary advantage of not having Type 2 Diabetes? There must be, because if there weren't then the lack of the disease would have been something that was eliminated from the gene pool.
You won't answer this so I'll do it using your logic.

Of course there is an evolutionary advantage to not having T2D. If that weren't true then people without the disease would have been weeded out of the gene pool.

So we have a situation. People with the disease have an evolutionary advantage, and people without the disease have an evolutionary advantage.

Is that awesome, or what?
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Old 3rd May 2018, 08:30 AM   #30
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Are you just looking for a way to recast your disease as something positive?
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Old 3rd May 2018, 08:40 AM   #31
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Originally Posted by MikeG View Post
No. It's a disease. You may as well ask what the evolutionary advantage of grey hair or bad backs is. What is the evolutionary advantage of age-related eyesight deterioration?
At least you do understand that there are genes for all of your examples.

And I didn't say that ALL diseases have a plus side, only that T2D might. Same way the sickle cell does.

Hmm, thought exercise- Age Related Macular Degeneration, ARMD. Seems it can be eased or prevented with vitamin and protein supplements. Perhaps the gene causes those additives to be used to greater advantage elsewhere in the body? What if to make adrenaline? Upside, fright or flight to save your life, downside blindness in old age? ( I know there are several genes involved in ARMD,I have quite the likely hood from them)
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Old 3rd May 2018, 08:42 AM   #32
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Originally Posted by Chanakya View Post
How's this for a convoluted explanation of sorts?

I've personally seen instances of people who, when diagnosed with diabetes, dramatically altered their lifestyle choices, so that their general health (and, I suppose, their general prospects for a longer life) actually improved as a result of the diagnosis.

Mightn't that actually help in the evolutionary scheme of things?
As has been pointed out repeatedly in this thread.

Even if people were susceptible to type 2 diabetes, it's only relatively recently in evolutionary terms that we have enough of a calorie surplus for people to go on and develop in in any appreciable numbers.

Then there's the question of whether it strikes early enough to have an impact on breeding success. If I've already passed on my genes successfully at 25, it really doesn't matter that much whether I get sick at 55 from an evolutionary perspective.

The treatment of type 2 diabetes through diet and exercise is so very recent that it cannot have had an evolutionary effect in any case.
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Old 3rd May 2018, 08:59 AM   #33
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Originally Posted by Porpoise of Life View Post
Are you just looking for a way to recast your disease as something positive?
I know that, and I don't need to post here to know it. But sharing my thoughts just might lead to a deeper understanding of the disease by others. Frinstance, diet and exercise ARE THE BEST TREATMENT. Because taking insulin only exacerbates the pseudo-acromegaly.

But the basic point is that Diabetes is a genetic disease, you can't 'catch' it from your diet, you need the genes. And that it is very difficult to control w/ d&e, if you have the particular gene set. Think of it as the Voracious Appetite Gene. Diet and exercise won't change your eye color either.

I wonder if there's been a long term study of soft tissue diseases in diabetics who take Metformin? It lowers sugars via a different mechanism, but probably does not change insulin resistance.

Hmm speaking of metformin, it lowers sugars by cutting down on the liver's production of sugars. THAT is not treated by diet and exercise, looks like that venue may be the reason for only 50% efficacy in the study mentioned up-thread?
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Old 3rd May 2018, 09:06 AM   #34
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Originally Posted by casebro View Post
.......But the basic point is that Diabetes is a genetic disease, you can't 'catch' it from your diet.......
In the same way as dodgy knees and back are genetic, decreasing athletic performance with age is genetic, hair greying with age is genetic, hearing deterioration with age is genetic. What you are doing is delusional: you are trying to delude yourself and anyone who falls for it that there is a positive evolutionary reason for the disease which people have inflicted on themselves pretty much only in the last 50 or 60 years. There isn't.

Originally Posted by casebro View Post
At least you do understand that there are genes for all of your examples.......
There's a reason I chose them.
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Old 3rd May 2018, 09:31 AM   #35
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How Type 2 Diabetes Survived Evolution

Originally Posted by Science Life
...The current epidemic is attributed to unhealthy lifestyles, obesity and lack of exercise, but if it’s so clearly damaging to health, how did it evolve in the first place? Shouldn’t the genetic variants for the disease have been removed from the human population by natural selection long ago?

A popular explanation is that insulin resistance, a predisposition to type 2 diabetes, actually provided a protective benefit to humans who lived as hunter-gatherers. Insulin resistance limits the body’s intake of glucose by muscle and liver cells, therefore allowing its storage by fat cells. The body could use this extra glucose, so the theory goes, during cycles of feast and famine when people couldn’t be sure of their next meal. This so-called “thrifty genotype” hypothesis was proposed by University of Michigan geneticist James Neel in 1962, and still holds a lot of sway in the scientific community.

Another similar explanation, called the “carnivore connection,” is that insulin resistance developed in hunter-gatherers and herders because they had a low-carbohydrate (and low glucose), protein-rich diet, resulting in the need to save glucose in the blood to make it accessible for the brain. This same resistance was no longer needed in early farmers, however, because they had begun to incorporate carbohydrates into their diets as they learned to cultivate grains...
https://sciencelife.uchospitals.edu/...ived-evolution
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Old 3rd May 2018, 11:23 AM   #36
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Originally Posted by theprestige View Post
It hasn't died out because it doesn't significantly impact the species' ability to reproduce and pass on its genes -
The species ability to reproduce? What does that even mean? It's individuals that reproduce, and evolution occurs as the differential representation of genes in the gene pool across generations.

If a particular gene is selected against, even at a low rate, given time it will no longer be present in the gene pool. Of course, as you point out selection pressures change all the time and genes get selected for, then against, over and over again, sometimes due to changing environments, other times due to random change (genetic drift). Some genes that are selected against are renewed in the gene pool through mutation, so, the story is certainly more complicated than casebro is implying.
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Old 3rd May 2018, 11:28 AM   #37
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If you kept to a pre-agricultural diet you would most likely not develop any Diabetes symptoms. Hence there was no pressure to remove the mutation from the gene pool.
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Old 3rd May 2018, 11:44 AM   #38
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Originally Posted by The Great Zaganza View Post
If you kept to a pre-agricultural diet you would most likely not develop any Diabetes symptoms. Hence there was no pressure to remove the mutation from the gene pool.
The highlighted words don't square with your conclusion.
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Old 3rd May 2018, 01:50 PM   #39
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Originally Posted by casebro View Post
...
Hmm speaking of metformin, it lowers sugars by cutting down on the liver's production of sugars. THAT is not treated by diet and exercise, looks like that venue may be the reason for only 50% efficacy in the study mentioned up-thread?
Right, instead of correcting the problem, just take a drug to alleviate the symptoms. The drug companies love that..

But then:
Quote:
This drug has a Black Box Warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients to potentially dangerous effects.

The 50% efficacy, probably had more to do with non-adherence, and other co-founders not accounted for.
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Old 3rd May 2018, 02:22 PM   #40
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Originally Posted by casebro View Post
I know that, and I don't need to post here to know it. But sharing my thoughts just might lead to a deeper understanding of the disease by others. Frinstance, diet and exercise ARE THE BEST TREATMENT. Because taking insulin only exacerbates the pseudo-acromegaly.

But the basic point is that Diabetes is a genetic disease, you can't 'catch' it from your diet, you need the genes. And that it is very difficult to control w/ d&e, if you have the particular gene set. Think of it as the Voracious Appetite Gene. Diet and exercise won't change your eye color either.

I wonder if there's been a long term study of soft tissue diseases in diabetics who take Metformin? It lowers sugars via a different mechanism, but probably does not change insulin resistance.

Hmm speaking of metformin, it lowers sugars by cutting down on the liver's production of sugars. THAT is not treated by diet and exercise, looks like that venue may be the reason for only 50% efficacy in the study mentioned up-thread?

What comes first, the voracious appetite, or the obesity?
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