Unfavourable glucose metabolism is associated with functional somatic disorders. A cross-sectional general population-based study: 2024 Dantoft, Fink+

Full title: Unfavourable glucose metabolism is associated with functional somatic disorders. A cross-sectional general population-based study: The DanFunD study

Highlights

• Population-based study sheds light on the potential role of unfavorable glucose metabolism in functional somatic disorders.
• Study draws on a large dataset of 10,000 randomly selected persons, spanning an age range of 50 years.
• Functional somatic disorders were delimitated using validated questionnaires and clinical diagnostic interviews.
• Results support the hypothesis that functional somatic disorders are associated with increased insulin levels and insulin resistance.
• Increase in blood glucose and HbA1c levels in functional somatic disorders were largely explained by an unhealthier lifestyle.

Abstract

Objectives
Several studies have observed associations between unfavorable levels of blood glucose metabolic markers (i.e., fasting glucose, fasting insulin, glycated hemoglobin (HbA1c), and insulin resistance (HOMA-IR)) and functional somatic disorder (FSD). However, such associations have not yet been systematically analyzed in a general population-based sample using various FSD delimitations simultaneously. The aim of this study was to assess whether an unfavorable glucose metabolism is associated with FSD.

Design
Cross-sectional population-based study

Setting
Ten municipalities in the western part of greater Copenhagen area in Denmark

Participants
A total of 8183 men and women aged 18–76 years were included. Various delimitations of FSD, i.e., chronic fatigue (CF), chronic widespread pain (CWP), irritable bowel (IB), and bodily distress syndrome (BDS), were measured using validated self-administrated questionnaires. In a stratified subsample, BDS was also assessed by diagnostic interviews.

Outcome measures
Logistic regression models were estimated for each delimitation of FSD as outcome and fasting glucose, fasting insulin, HbA1c, and estimated insulin resistance. Results were adjusted for age, sex (model 1), lifestyle, and social factors (model 2) and presented as odds ratios (OR) with 95 % confidence intervals (CI).

Results
When only adjusting for sex and age, positive associations were found between all FSD delimitations and glucose, insulin, and HbA1c, except for between IB and HbA1c. Positive associations were also found between all questionnaire-based BDS groups, and men with BDS confirmed by diagnostic interviews and elevated insulin resistance. After adjusting for lifestyle and social factors, associations remained significant between both CF and glucose and HbA1c and between multi-organ BDS and glucose and HbA1c. Further, CF, single-organ BDS, multi-organ BDS, and women with overall-BDS also remained associated with increased levels of insulin resistance.

Conclusion
FSD seems to be associated with especially an increase in plasma insulin levels and increased levels of insulin resistance. Elevated levels of blood glucose and HbA1c among all FSD groups could also completely be explained by unhealthy lifestyle. Prospective studies are needed for further clarification of the clinical relevance of this observation.

Open access, https://www.sciencedirect.com/science/article/pii/S0306453024003032

 

"Introduction

Functional Somatic Disorder (FSD) is a unifying diagnosis for medical conditions characterized by recurrent and disabling bodily symptoms, such as pain and fatigue, that cannot be better explained by other physical or mental conditions (Burton et al., 2020, Fink and Schroder, 2010, Fink et al., 2007, Rosmalen et al., 2011). FSD is commonly encountered in all medical settings and includes a range of specialty-specific disease labels of functional somatic syndromes (FSS), such as fibromyalgia/chronic widespread pain (FM/CWP), irritable bowel syndrome (IBS), and chronic fatigue syndrome (CFS), as well as the unifying diagnostic construct bodily distress syndrome (BDS) (Burton et al., 2020)."

 

Really milking this study for dozens of useless papers. Their entire concept of FSS is basically BDS, as yet another example of how those dozens of acronyms all mean the same thing, and all they do is ask about symptoms so the whole thing is entirely circular anyway.

The data are presented in a confusing way that makes it unclear where the control data even is, it doesn't even appear like it's in the paper. But they seem to have simply tweaked a few knobs to get results they wanted and present it as a simple "unhealthy lifestyle". As long as you pretend that the people presenting with symptoms are healthy and therefore their "lifestyle" is not affected by, you know, being ill. Because of course it is, but if you take a person holding themselves by their bootstraps, it doesn't make sense for them to be holding themselves by their own bootstraps, unless they're using another person holding themselves by their own bootstraps in a mutual bootstrapping model. Then it's just basic mechanics. Well, delusional fantasy mechanics but still it's physics.

So they created two data models where one is "lifestyle adjusted". Without this "adjustment" there is nothing, just noise. With it, there's a little noise. Those "lifestyle factors" are: healthy diet, smoking, units of alcohol, physical activity, and BMI. To begin with, three of those are clearly affected by having poor health, so they don't make sense as lifestyle factors. Especially when it comes to physical activity, they do the classic "take the output and chain it back as input", which obviously also affects BMI and diet.

They lump this alongside nefarious things like smoking and alcohol, but good luck finding the data on those. Maybe in another paper. Same with diet, evaluated with some arbitrary questionnaire where, again, good luck finding the data. So most of the data they input into that model is hidden, and the model is hidden. You just have to take their word for it.

They went fishing, caught only boots, but carved them in the form of a fish and got a grant from the government for their fishing prowess. What a system.

 

Uncontrolled diabetes can also be a cause of small fibre neuropathy....

 

Yeah just seen a video on admissions interviews talking about how one might come up with scenarios where all the conditions are false but the conclusion is right

I know I don’t have either high or rising HbA1c or anything similar to glucose pretty sure it’s been tested over a pretty long time too

I know my condition isn’t functional anything

does that mean that whatever people answer they can find a way to ‘win’ just by getting people to focus on splitting themselves from the field / dividing people up ?

wouldn’t those who do have glucose issues think that’s a sign it’s not caused by their mind/stress either - particularly if they know it’s not behavioural but then have to convince everyone ? Even though it’s probably both blinking serious snd something that if taken seriously sooner rather than later is cheaper and make a big difference to outcome/resudual long term issues?

is this just more propaganda writing off choosing/suggesting to just stop doing medicine gif more areas of medicine to add those poor souls to a plight if getting worse under someone’s functional kingdom that does nothing helpful?

 

There are so many potential confounds here. Even presuming they are correct in their findings, and I do not, they probably have an association, and from my own experience its a long term ME crash that stopped me eating healthy for years, resulting in a worsening of my type 2 diabetes. Prior to that I had perfect diabetes control. Losing capacity due to ME makes cooking and shopping much harder, so I had to cut corners. Lots of them.

There is no question that high insulin can be a problem though. While some tissues get insulin resistance, not all tissues do. So there are tissues with insufficient insulin signaling, including pancreatic alpha cells, but many tissues will have too much insulin signaling.

The single biggest reason so many have insulin resistance, in my opinion, is a half century of bad medical advice on diet. If it is a behavioral problem, its mostly medical practitioner behavior driving patient behavior. This includes the discouragement of eating dairy fats, and now its increasingly supported, but still not full research proof, that two fats found in ruminants, including butter, cream etc., are actually essential saturated fats that decrease risk of insulin resistance. Early clinical trials are reported as successful, though I have not read the actual studies to investigate.

 

I think it may be interesting that Beentjes and also the study looking at gene combinations from another group flagged up insulin resistance in ME/CFS. This seems to mean that either there is a link to glucose/lipid metabolism that so far we don't have any real grasp of, or that insulin resistance is something that tends to intrude as a confounder signal for groups where diagnosis can be a problem to ascertain.

 

In case it's even faintly relevant, after two viral infections over the last few years that were both probably Covid, I had for the first infection a single evening of desperate thirst, desperate water-drinking and half-hourly peeing that had all simply gone away by the time I got up the next morning; and, for the second infection, two or three days of that but with normal blood sugar tested on Day Three by a visiting medic. I'd read that Covid can cause diabetes, but I don't know how solid a finding that is. But I wonder if other PwME have had a similar experience in response to Covid or other viral infections, or if this has any relation to the Beentjes finding about insulin resistance.

Really thanking my lucky stars that it went away on its own, and quickly.

 

I get the thirst, muscle twitches and pain as part of PEM particularly following more physical stuff which can include having legs down or talking lots where it’s been physical talking rather than thinking strain (type of questions matter vs how much you have to throw your voice etc)

and yes needing to drink water then wee then repeat all night just when your body is exhausted (and when all that dies down ends up with a massive sleeping crash) all these things that makes resting impossible due to pain thirst toilet needing to constantly change position due to discomfort

I have regular blood tests (due to other things) and my blood sugar has always been low /fine and HbA1c also tested and fine and not changing over the years etc

you’d think I have diabetes by the fluid needs and fact I get very thirsty (and many have said it over decades as a whisper from a layperson or other things) but because of this assumption I’ve been really rather tested on that one and not. On the other spectrum I’ve had people only see other bloods to do with other things/different parts of my blood and suggest dehydration must be behind it and sssume im fibbing when I say u drink 1.5l before a blood test so if it is that it’s not due to intake being lower than others. It’s funny how people assume like that and it doesn’t help spot these strange and subtle clues (if they are clues )

On the other hand I wouldn’t be surprised if there is something causing similar symptoms but with totally different tests/area or if it is something different altogether.

 

Our bodies can make most saturated fats, but not all. What we can do is convert some fats that are similar to the essential ones, but I have not investigated the details. The claimed essential fats are named after the number of carbons in the chain, either 15 or 17. The more important one, currently, seems to be c15. That is a saturated fat with 15 carbons. In animal studies, especially dolphins which is where the importance of these fats were first investigated, they increase cell membrane robustness, decrease many degenerative diseases, even cancer. Human clinical trials are underway, but this stuff is marketed commercially right now. However simple butter contains a lot of c15. So do some fish, maybe especially fatty fish, and the fat from ruminants including cows. I am waiting on more and better clinical trials before I start claiming this works as advertised, but it looks very promising. Please note the amount in vegetable is negligible, and non-ruminants have much less, and ruminants fed on grains don't have as much as grass fed ruminants. Ghee, or clarified butter, is one of the richest sources that is commonly available.

 

I feel very dehydrated and need to drink fluids more often during PEM. I find drinking kombu broth helps with the thirst because it's a rich source of minerals and alkaline in nature. I'm not running to the bathroom as much.

 

Hi, anecdotally I have had discussions on this many times with other patients. I have a constant dry sore throat. So do many of us, but it can also come and go. With me its more wax and wane, but its there. Drinking makes things feel better. Gargling mouthwash helps sometimes, and ice cold carbonated water seems the best. Acidic drinks also help, including lemon water. However I know of others who cannot drink some of things, it makes them worse. Doh. It makes consistent advice almost impossible. The sensation, for me, is very hard to distinguish from thirst.

I suspect this is related to changes in the throat that for some reason throat specialists cannot find in me, I suspect its because its a different ME related problem they have no knowledge of. I can choke on certain foods, and cannot swallow. For me this can include bread, and especially kale. My throat gets very dry and foods stick unless they are wet or greasy. Many other patients have said something similar to me on this point.

This sore throat has been with me a very long time. Its predates my diabetes. It occurs in many of us who are not diabetic. I am less sure about those of us who are prediabetic or have a metabolic syndrome. I get this symptom even if I have not eaten a carbohydrate in days, though I have a problem with gluconeogenesis, my body keeps making sugar. Elevated blood sugar can induce something similar to this symptom in diabetics.

 

Those of you with throat issues, do you also have sinus issues?

 

Less commonly now, almost rare, but I used to have them all the time and some I know with ME and sore throat have sinus issues almost constantly.

There is an exception to that, quite recently, that now I can choke on sinus mucus when lying down. This is just a few months old.

 

So are they saying that for a Type 1 Diabetic experiencing a sub 2mmol low, shaking, confused, cold sweat & loss of vision - its nothing to worry about because it is just FSD, you are fine to drive your car?

 

Perhaps an insulin dependent type 2 also ?

 

Daughter yes to both .
Gets worse with severity