Is there a link between Pancreatic Cancer and Diabetes?

Link Between Pancreatic Cancer and Diabetes Not Fully Understood

July 31, 2009
Dear Mayo Clinic:
Does having diabetes increase the chance of pancreatic cancer? Would a test at the time diabetes is diagnosed help in the early detection of pancreatic cancer? Does going from diabetes pills to insulin increase the chance of getting pancreatic cancer?

Considerable research has been done to examine the complex relationship between pancreatic cancer and diabetes. While long-standing diabetes may slightly increase the risk of pancreatic cancer, new-onset diabetes is more likely tosignal the presence of underlying cancer. However, distinguishing those who have pancreatic cancer-induced diabetes from the more common type 2 diabetes is a significant challenge. Complicating the issue further are results of recent studies suggesting that certain treatments for diabetes may decrease or increase the risk of pancreatic cancer.

Your pancreas makes insulin, a hormone that regulates blood sugar levels. Diabetes is a state in which blood sugar levels are high. Diabetes develops when your pancreas produces little or no insulin or when your body becomes resistant to insulin.

Studies focusing on people with long-standing diabetes (five or more years) have found that their risk for pancreatic cancer is slightly elevated. This phenomenon has been of interest to scientists who are trying to understand why some people get pancreatic cancer. However, since pancreatic cancer is rare, this small increase doesn’t represent a significant health risk, nor does it call for increased cancer screening of patients with long-standing diabetes.

On the other hand, new development of diabetes after age 50 may be a harbinger of pancreatic cancer. Recently, Mayo Clinic researchers studied people who developed diabetes after age 50. They examined the participants’ medical records to determine when their blood sugar levels were elevated to the point of becoming diabetic. Then, they reviewed the medical records for three years thereafter. The rate of pancreatic cancer in the study group was eight times higher than in the general population.

The researchers theorize that in some people who developed pancreatic cancer within this group, diabetes was actually caused by the cancer. They believe that pancreatic cancer reduced the pancreas’ ability to produce insulin, resulting in diabetes.

While these results may seem to call for everyone diagnosed with diabetes after age 50 to be screened for pancreatic cancer, it isn’t that easy. There is no simple screening test for pancreatic cancer. No blood test exists to determine if a person has pancreatic cancer, and imaging tests — such as computerized tomography (CT) scans — can’t reliably detect pancreatic cancer in its early stages.

The search for a marker that could be detected by a blood test and distinguish between diabetes caused by pancreatic cancer and other forms of diabetes is an important area of research. If such a marker could be found, some cases of pancreatic cancer could be diagnosed in the early stages of the disease and treatment started promptly, when it’s most effective.

One test that can reliably detect pancreatic cancer, endoscopic ultrasonography, is an invasive and expensive procedure. Many insurance companies won’t cover the cost of this study based on a diabetes diagnosis alone. In addition, having large numbers of people undergo this type of invasive test isn’t feasible in many medical centers.

Further complicating matters, people who develop diabetes as a result of pancreatic cancer usually have diabetic symptoms similar to individuals who develop diabetes for other reasons. But prior to the onset of cancer symptoms, there does seem to be one subtle clue that may hint at a difference. People who develop diabetes because of pancreatic cancer tend to experience unexplained weight loss at the onset of diabetes. Those who have type 2 diabetes often gain weight. So, endoscopic ultrasonography or other testing for pancreatic cancer does seem appropriate for patients diagnosed after age 50 who experience weight loss after developing diabetes.

Recently, diabetes treatment has also come under scrutiny for a possible link to cancer. These studies have examined the risk of pancreatic cancer in diabetic individuals taking specific anti-diabetic medications. One study conducted in Germany concluded that a newer form of insulin (glargine) may increase cancer risk, but that other forms — including human insulin and other new insulins (aspart and lispro) — do not. However, the study didn’t take into account the fact that pancreatic cancer is more common shortly after a diagnosis of diabetes. Other recent studies suggest that subjects on the oral antidiabetic drug metformin were less likely to develop pancreatic cancer. These findings are intriguing, as metformin is known to inhibit cancer growth in the laboratory. More research is necessary to determine what, if anything, the findings mean for the treatment of diabetic patients.

As you can see, there are many more questions than answers regarding the connection between diabetes and pancreatic cancer. A significant amount of research is ongoing. If you’re a diabetic patient concerned about your risk of cancer, talk to your doctor. And remember, never discontinue treatment or change medication without consulting your doctor first.

— Suresh Chari, M.D., Gastroenterology, Mayo Clinic, Rochester, Minn.


Is coffee good or bad?

Coffee and Your Health

Say it’s so, Joe: The potential health benefits — and drawbacks –- of coffee.
WebMD Feature

Coffee may taste good and get you going in the morning, but what will it do for your health?

A growing body of research shows that coffee drinkers, compared to nondrinkers, are:

  • less likely to have type 2 diabetes, Parkinson’s disease, and dementia
  • have fewer cases of certain cancers, heart rhythm problems, and strokes

“There is certainly much more good news than bad news, in terms of coffee and health,” says Frank Hu, MD, MPH, PhD, nutrition and epidemiology professor at the Harvard School of Public Health.

But (you knew there would be a “but,” didn’t you?) coffee isn’t proven to prevent those conditions.

Researchers don’t ask people to drink or skip coffee for the sake of science. Instead, they ask them about their coffee habits. Those studies can’t show cause and effect. It’s possible that coffee drinkers have other advantages, such as better diets, more exercise, or protective genes.

So there isn’t solid proof. But there are signs of potential health perks — and a few cautions.

If you’re like the average American, who downed 416 8-ounce cups of coffee in 2009 (by the World Resources Institute’s estimates), you might want to know what all that java is doing for you, or to you.

Here is a condition-by-condition look at the research.

Type 2 Diabetes

Hu calls the data on coffee and type 2 diabetes “pretty solid,” based on more than 15 published studies.

“The vast majority of those studies have shown a benefit of coffee on the prevention of diabetes. And now there is also evidence that decaffeinated coffee may have the same benefit as regular coffee,” Hu tells WebMD.

In 2005, Hu’s team reviewed nine studies on coffee and type 2 diabetes. Of more than 193,000 people, those who said they drank more than six or seven cups daily were 35% less likely to have type 2 diabetes than people who drank fewer than two cups daily. There was a smaller perk — a 28% lower risk — for people who drank 4-6 cups a day. The findings held regardless of sex, weight, or geographic location (U.S. or Europe).

More recently, Australian researchers looked at 18 studies of nearly 458,000 people. They found a 7% drop in the odds of having type 2 diabetes for every additional cup of coffee drunk daily. There were similar risk reductions for decaf coffee drinkers and tea drinkers. But the researchers cautioned that data from some of the smaller studies they reviewed may be less reliable. So it’s possible that they overestimated the strength of the link between heavy coffee drinking and diabetes.

How might coffee keep diabetes at bay?

“It’s the whole package,” Hu says. He points to antioxidants — nutrients that help prevent tissue damage caused by molecules called oxygen-free radicals. “We know that coffee has a very strong antioxidant capacity,” Hu says.

Coffee also contains minerals such as magnesium and chromium, which help the body use the hormone insulin, which controls blood sugar (glucose). In type 2 diabetes, the body loses its ability to use insulin and regulate blood sugar effectively.

It’s probably not the caffeine, though. Based on studies of decaf coffee, “I think we can safely say that the benefits are not likely to be due to caffeine,” Hu says.

Hold the Caffeine?

The fact that coffee contains good stuff does not necessarily mean that it’s good for us, says James D. Lane, PhD, professor of medical psychology and behavioral medicine at Duke University Medical Center in Durham, N.C.

“It has not really been shown that coffee drinking leads to an increase in antioxidants in the body,” Lane tells WebMD. “We know that there are antioxidants in large quantities in coffee itself, especially when it’s freshly brewed, but we don’t know whether those antioxidants appear in the bloodstream and in the body when the person drinks it. Those studies have not been done.”

Regular coffee, of course, also contains caffeine. Caffeine can raise blood pressure, as well as blood levels of the fight-or-flight chemical epinephrine (also called adrenaline), Lane says.

Heart Disease and Stroke

Coffee may counter several risk factors for heart attack and stroke.

First, there’s the potential effect on type 2 diabetes risk. Type 2 diabetes makes heart disease and stroke more likely.

Besides that, coffee has been linked to lower risks for heart rhythm disturbances (another heart attack and stroke risk factor) in men and women, and lower risk for strokes in women.

In a study of about 130,000 Kaiser Permanente health plan members, people who reported drinking 1-3 cups of coffee per day were 20% less likely to be hospitalized for abnormal heart rhythms (arrhythmias) than nondrinkers, regardless of other risk factors.

And, for women, coffee may mean a lower risk of stroke.

In 2009, a study of 83,700 nurses enrolled in the long-term Nurses’ Health Study showed a 20% lower risk of stroke in those who reported drinking two or more cups of coffee daily compared to women who drank less coffee or none at all. That pattern held regardless of whether the women had high blood pressure, high cholesterol levels, and type 2 diabetes.

Parkinson’s and Alzheimer’s Diseases

“For Parkinson’s disease, the data have always been very consistent: higher consumption of coffee is associated with decreased risk of Parkinson’s,” Hu tells WebMD. That seems to be due to caffeine, though exactly how that works isn’t clear, Hu notes.

Coffee has also been linked to lower risk of dementia, including Alzheimer’s disease. A 2009 study from Finland and Sweden showed that, out of 1,400 people followed for about 20 years, those who reported drinking 3-5 cups of coffee daily were 65% less likely to develop dementia and Alzheimer’s disease, compared with nondrinkers or occasional coffee drinkers.


The evidence of a cancer protection effect of coffee is weaker than that for type 2 diabetes. But “for liver cancer, I think that the data are very consistent,” Hu says.

“All of the studies have shown that high coffee consumption is associated with decreased risk of liver cirrhosis and liver cancer,” he says. That’s a “very interesting finding,” Hu says, but again, it’s not clear how it might work.

Again, this research shows a possible association, but like most studies on coffee and health, does not show cause and effect.


In August 2010, the American College of Obstetricians and Gynecologists (ACOG) stated that moderate caffeine drinking — less than 200 mg per day, or about the amount in 12 ounces of coffee — doesn’t appear to have any major effects on causing miscarriage, premature delivery, or fetal growth.

But the effects of larger caffeine doses are unknown, and other research shows that pregnant women who drink many cups of coffee daily may be at greater risk for miscarriage than non-drinkers or moderate drinkers. Again, it’s not clear whether the coffee was responsible for that.

Calories, Heartburn, and Urine

You won’t break your calorie budget on coffee — until you start adding the trimmings.

According to the web site — part of the U.S. Department of Agriculture’s Center for Nutrition Policy and Promotion — a 6-ounce cup of black coffee contains just 7 calories. Add some half & half and you’ll get 46 calories. If you favor a liquid nondairy creamer, that will set you back 48 calories. A teaspoon of sugar will add about 23 calories.

Drink a lot of coffee and you may head to the bathroom more often. Caffeine is a mild diuretic — that is, it makes you urinate more than you would without it. Decaffeinated coffee has about the same effect on urine production as water.

Both regular and decaffeinated coffee contain acids that can make heartburn worse.



Obesity: The Gateway Condition

By: Joe Miller
September 2011

The number of people in the United States that are overweight and obese increases every year.  One study conducted by a national wellness provider suggests that even with awareness of their health status, the average person will gain just under two pounds every year. Consider before-and-after pictures of people that have been in the workplace for the past 20 years.

While the numbers get more and more discouraging every year, it appears the general opinion of the obesity epidemic in this country is similar to the opinion of freeway speeding: almost everyone does it and no one seems to care until it directly impacts their life.

This is particularly hard to fathom since the consequence of speeding is a ticket, versus life-long ailments that can permanently degrade the quality of your life.

Can you really put things such as a stroke, heart disease or diabetes in the same compartment as a speeding ticket? Many people are ignoring the obesity issue, which affects more than two-thirds of the American population and is estimated to account for more than $147 billion in medical expenses each year.

The rise of obesity cannot be overstated, which is defined as body mass index (BMI) over 30. According to the Centers for Disease Control and Prevention:

  • In 1990, there was not a single state in the U.S. that had an obesity rate of more than 15 percent of their population.
  • In 2000, that number rose, but there was not a single state above a 25 percent rate of obesity.
  • In 2010, 12 states had obesity rates of more than 30 percent of their populations.
  • The national rate of obesity now stands at 33 percent. About one-third of U.S. adults are obese.

The reason that this issue is so neglected can be boiled down to a simple analysis of cause and effect.  Without immediate consequences for their actions, humans are not wired to trace the root cause of their situation over time and use that as motivation to change behavior.

Take a simpler case. Everyone knows that smoking is bad for you and can cause medical issues like cancer and COPD, or chronic obstructive pulmonary disease. Does this make people stop smoking? Not nearly at the rate that it should. If every time someone took a puff of a cigarette they had a 25 percent change of falling over and dying, do you think the immediate and visual consequence of this would make more people quit?

The obesity epidemic in the United States is misunderstood, and this is another reason for the inattention. Most people think obesity is something that affects only our vanity. No one ever says, “Oh boy, do I hope I don’t have to have a leg amputated because I developed type 2 diabetes due to my morbid obesity.”

What people don’t realize is that obesity should be looked at as a “gateway condition.” Just as people refer to gateway drugs leading to the use of more dangerous drugs, obesity is a precursor to several conditions which people do not realize are considerably more dangerous…Very few people in the United States have ever heard the term metabolic syndrome (MetS), let alone, do they know what it means, nor do they understand the diagnosis. This condition isn’t like cancer, where doctors identify a tumor that you have for diagnosis or like HIV, where there is a clear test to see if the virus is living in your system. MetS is a grey diagnosis. The diagnosis for MetS is when you have three out of five measurements out of range (glucose, HDL cholesterol, triglycerides, waist circumference, and blood pressure) at a given time.  It should be noted that in any given day, these numbers can change up or down and is therefore a hard condition to put your finger on…

Obesity is the gateway Metabolic Syndrome, and the rate of MetS nationally is only slightly lower than that of obesity, estimated around 25 percent.

What can be done about this terrible epidemic? There are two simple things that will draw out the issue and make it more palpable for the public to gravitate toward. In fact, these are not complex issues that deal with standard of care or major overhauls of the health system. These can be looked at as the “street smart” ways to make a difference on obesity and MetS rates.

The first technique to impact these two issues is to start thinking outside of the box and look at a new way to consider obesity. In a sense, it needs to be marketed to the masses in a way that is more intimidating and real. What if obesity were considered as stage 1 heart disease and MetS considered stage 2 heart disease? This approach would allow people to better identify the fact that they are on a path with serious consequences. Another way to look at it is the gruesome pictures that other countries require as a warning on cigarette packs.  If the consequence is more clearly identified along with the cause or issue, the subject may be more likely to change behavior. The medical field seems to have adopted this approach with single factors such as pre-diabetes and pre-hypertension. Let’s adopt the same approach with obesity.

Secondly, another message that is so simple to get across to the American public which can help drive home the issue of obesity is “Get off your butt!”  Most people intrinsically know this message, but a vast majority of people may not realize their true level of activity, may be in denial, or may be too overwhelmed to know how to work activity into their daily routine.

A recent sampling of an office environment that was studied showed that on average, employees had taken about 3,500 steps from the time they left their house to the end of business. Now, factor in the drive home, a few hours of television and a good night sleep.  Many people are not reaching 5,000 steps per day, let alone 10,000 or better yet, the 30 minutes of exercise that is recommended most days.

In a survey of more than 25,000 participants in a wellness program in 2010, 80 percent of respondents said they wanted to increase their level of activity and 73 percent said they wanted to lose weight.  Furthermore, when comparing the obese population from the year before, 9 percent of respondents had lost enough weight that they were no longer obese.  The problem was that 96 percent of this positive impact was completely offset by others becoming obese.  The issue for the U.S. healthcare system and the employers that pay for this, is like bailing water from a boat that is sitting under a waterfall.

Another recent study showed that participants with MetS that walked 10,000 steps per day were able to lose one entire risk (remember the definition is having three or more risks of the five) in a single four-month period. Companies can tackle obesity head on with simple gains in activity.  By offering contests or programs designed around walking, employers can engage their employees in an activity that is fun, make the employees feel like they are cared for and more part of a team, form work camaraderie and, as a result, lower their health care costs and increase productivity.


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