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Category: healthy living

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The following is a list of nutrients that some researchers (from the Institute of Food Technology) think of as especially beneficial to the brain. Other researchers may (or probably will) focus on other nutrients. I am posting it even though I generally dislike articles that talk about "superfoods" or an itemized list of foods that one should eat to the exclusion of others. Because, of course, focusing on some nutrients may leave out many just as important nutrients.

Also, medical thinking changes over time and what was once considered "unhealthy" may later be considered a wonderful food (remember when eggs, nuts, and coconuts were almost considered evil?). And vice versa (remember when margarine with partially hydrogeneated oils and trans-fats was considered healthier than butter?) And study after study says it is better to eat the foods, rather than take supplements. So keep in mind that the following nutrients are found in whole foods and in a varied diet. And when they mention a specific food such as blueberries, remember that ALL berries have benefits (though they vary), so eat a variety of berries. Same with nuts - eat a variety and not just walnuts. From Science Daily:

Eight nutrients to protect the aging brain

Brain health is the second most important component in maintaining a healthy lifestyle according to a 2014 AARP study. As people age they can experience a range of cognitive issues from decreased critical thinking to dementia and Alzheimer's disease. In the March issue of Food Technology published by the Institute of Food Technologists (IFT), contributing editor Linda Milo Ohr writes about eight nutrients that may help keep your brain in good shape.

1. Cocoa Flavanols: Cocoa flavanols have been linked to improved circulation and heart health, and preliminary research shows a possible connection to memory improvement as well. A study showed cocoa flavanols may improve the function of a specific part of the brain called the dentate gyrus, which is associated with age-related memory (Brickman, 2014). {NOTE: good sources are cocoa and dark chocolate}

2. Omega-3 Fatty Acids: Omega-3 fatty acids have long been shown to contribute to good heart health are now playing a role in cognitive health as well....Foods rich in omega-3s include salmon, flaxseed oil, and chia seeds.

3. Phosphatidylserine and Phosphatidic Acid: Two pilot studies showed that a combination of phosphatidylserine and phosphatidic acid can help benefit memory, mood, and cognitive function in the elderly (Lonza, 2014). {NOTE: good sources are fish and meat}

4. Walnuts: A diet supplemented with walnuts may have a beneficial effect in reducing the risk, delaying the onset, or slowing the progression of Alzheimer's disease in mice (Muthaiyah, 2014).

5. Citicoline: Citicoline is a natural substance found in the body's cells and helps in the development of brain tissue, which helps regulate memory and cognitive function, enhances communication between neurons, and protects neural structures from free radical damage.... {NOTE: Citocoline is synthesized in the body from choline, so see foods high in choline}

6. Choline: Choline, which is associated with liver health and women's health, also helps with the communication systems for cells within the brain and the rest of the body. Choline may also support the brain during aging and help prevent changes in brain chemistry that result in cognitive decline and failure. A major source of choline in the diet are eggs. { NOTE: Good sources of choline are eggs, meat, fish, beans, and cruciferous vegetables.}

7. Magnesium: Magnesium supplements are often recommended for those who experienced serious concussions. Magnesium-rich foods include avocado, soy beans, bananas and dark chocolate.

8. Blueberries: Blueberries are known to have antioxidant and anti-inflammatory activity because they boast a high concentration of anthocyanins, a flavonoid that enhances the health-promoting quality of foods. Moderate blueberry consumption could offer neurocognitive benefits such as increased neural signaling in the brain centers.

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This research found that the beneficial gut bacteria Lactobacillus rhamnosus GG (LGG) interacts and facilitates (modifies the activity) of other gut bacteria. This isn't surprising. All our microbiomes are communities or ecosystems of microbes. But the really important bacteria have been called keystone species by other researchers. From Medical Xpress:

New research sheds light on how popular probiotic benefits the gut

In recent years, research into the benefits of gut bacteria has exploded. Scientists across the globe are examining how these microbes can help improve health and prevent disease. One of the most well-known of these is Lactobacillus rhamnosus GG (LGG). This strain of bacteria, which is part of many popular probiotic products, has a reputation as a helpful microbe. Researchers have found evidence that it can help with intestinal problems, respiratory infections and some skin disorders. Some research suggests that it may even help with weight loss. But a key question has remained unanswered: How does LGG actually produce benefits?

Now, researchers at the University of Maryland School of Medicine (UM SOM) have come up with an explanation. It appears that LGG may act as a facilitator, modifying the activity of other gut bacteria....Claire M. Fraser, PhD, professor of medicine at the UM SOM, as well as director of the Institute for Genome Sciences, studied the effect of LGG on a group of elderly subjects.

She and her collaborator, Dr. Patricia Hibberd at Massachusetts General Hospital, tested 12 subjects, who ingested LGG twice a day for 28 days. She analyzed gut bacteria before and after this regimen, and found that ingesting LGG led to increases in several genes that foster several species of gut bacteria, including Bacteroides, Eubacterium, Faecalibacterium, Bifidobacterium and Streptococcus. These microbes have been shown to have a range of benefits in humans, including the promotion of a healthy immune system. (Fraser notes that LGG may also have direct effects, in addition to its ability to modify the overall ecosystem.)

"This is a new idea, that some probiotics may work by affecting the overall ecosystem of the gut," said Prof. Fraser. "Previously we tended to think that LGG and other probiotics worked directly on the host. I think this finding has many exciting implications." For one, Fraser says, it lends support to the idea that we need to look at the microbes in the gut as an interconnected ecosystem rather than a series of solitary bacteria. Modifying the behavior of microbes already in the gut may be just as important as adding any single species to this population.

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Depressing because the 4 chemicals (benzene, toluene, ethylbenzen, xylene) are so pervasive in indoor air. And now to find that at levels considered "safe" by the EPA there may be disruption of our hormones (endocrine systems). Of course they are already known to have health effects on the human body other than what is discussed in this study. For example, toluene has a number of central nervous system effects. The EPA says toluene , which is found in highest concentrations in indoor air from the use of common household products (paints, paint thinners, adhesives, synthetic fragrances, and nail polish). Outside - the biggest source of toluene is from automobile emissions. Some ways to lower exposure to these 4 chemicals: read product labels and when using a product that says to use with proper ventilation - open the windows and let the room ventilate!  Don't smoke. (For example: the EPA says tobacco smoke contains benzene and accounts for nearly half the national exposure to benzene) The study researchers themselves said the EPA should be paying more attention to these air contaminants. I read this at Scientific American, but it came from EHN:

Scientists warn of hormone impacts from benzene, xylene, other common solvents.

Four chemicals present both inside and outside homes might disrupt our endocrine systems at levels considered safe by the U.S. Environmental Protection Agency, according to an analysis released today.

The chemicals – benzene, toluene, ethylbenzene and xylene – are ubiquitous: in the air outside and in many products inside homes and businesses. They have been linked to reproductive, respiratory and heart problems, as well as smaller babies. Now researchers from The Endocrine Disruption Exchange (TEDX) and the University of Colorado, Boulder, say that such health impacts may be due to the chemicals’ ability to interfere with people’s hormones at low exposure levels. “There’s evidence of connection between the low level, everyday exposures and things like asthma, reduced fetal growth,” said Ashley Bolden, a research associate at TEDX and lead author of the study. “And for a lot of the health effects found, we think it’s disrupted endocrine-signaling pathways involved in these outcomes.”

Bolden and colleagues – including scientist, activist, author and TEDX founder Theo Colborn who passed away last December – pored over more than 40 studies on the health impacts of low exposure to the chemicals.They looked at exposures lower than the U.S. Environmental Protection Agency’s reference concentrations for the chemicals, which is the agency’s estimated inhalation exposure level that is not likely to cause health impacts during a person’s lifetime.

Many of the health problems – asthma, low birth weights, cardiovascular, disease, preterm births, abnormal sperm – can be rooted in early disruptions to the developing endocrine system, Bolden said. The analysis doesn’t prove that exposure to low levels of the chemicals disrupt hormones. However, any potential problems with developing hormone systems are cause for concern.

“Hormones are how the body communicates with itself to get work done. Interrupt that, you can expect all sorts of negative health outcomes,” said Susan Nagel an associate professor at the University of Missouri-Columbia Obstetrics, Gynecology and Women's Health School of Medicine who was not involved in the study.

The four chemicals are retrieved from the wellheads during crude oil and natural gas extraction and, after refining, are used as gasoline additives and in a wide variety of consumer products such as adhesives, detergents, degreasers, dyes, pesticides, polishes and solvents. Ethylbenzene is one of the top ten chemicals used in children’s products such as toys and playground equipment, according to a 2013 EPA report. Toluene is in the top ten chemicals used in consumer products such as fuels and paints, the report found. 

All four get into indoor and outdoor air via fossil fuel burning, vehicle emissions and by volatizing from products. Bolden said studies that measure the air in and around homes and businesses find the chemicals 90 to 95 percent of the time. In several of the monitoring studies Bolden and colleagues examined, levels of the chemicals were higher in indoor air than in outdoor air, suggesting that people might be exposed within their homes. “A lot of time indoor air is poorly circulated,” Bolden said.

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A big question for many adults is: how can one age well and live to a ripe old age? The author of the book The Blue Zones has dedicated a lot of time to studying communities throughout the world where there are a lot of centanarians and they age well (healthy). What are their secrets to aging well? The answer seems to be: while the diets vary, overall they have a lot of plant based whole foods, they have a lot of physical activity, are committed to their families, take time to de-stress, and they have social networks with healthy behaviors. From NPR:

Eating To Break 100: Longevity Diet Tips From The Blue Zones

Want to live to be 100? It's tempting to think that with enough omega-3s, kale and blueberries, you could eat your way there. But one of the key takeaways from a new book on how to eat and live like "the world's healthiest people" is that longevity is not just about food.

The people who live in the Blue Zones — five regions in Europe, Latin America, Asia and the U.S. researchers have identified as having the highest concentrations of centenarians in the world — move their bodies a lot. They have social circles that reinforce healthy behaviors. They take time to de-stress. They're part of communities, often religious ones. And they're committed to their families.

But what they put in their mouths, how much and when is worth a close look, too. And that's why Dan Buettner, a National Geographic explorer and author who struck out on a quest in 2000 to find the lifestyle secrets to longevity, has written a follow up to his original book on the subject. The new book, called The Blue Zones Solution, is aimed at Americans, and is mostly about eating.

Why should we pay attention to what the people in the relatively isolated Blue Zone communities eat? Because, as Buettner writes, their more traditional diets harken back to an era before we Americans were inundated with greasy fast food and sugar. And to qualify as a Blue Zone, these communities also have to be largely free of afflictions like heart disease, obesity, cancer and diabetes. So clearly they're doing something right.

But in a nutshell,Buettner in 2004 rounded up a bunch of anthropologists, demographers, epidemiologists and other researchers to travel around the world to study communities with surprisingly high percentages of centenarians. He and the scientists interviewed hundreds of people who'd made it to age 100 about how they lived, then did a lot of number crunching to figure out what they had in common. A year after that book was published, the team announced they'd narrowed it down to five places that met all their criteria. They gave them official Blue Zone status: Ikaria, Greece; Okinawa, Japan; Ogliastra Region, Sardinia; Loma Linda, Calif.; and Nicoya Peninsula, Costa Rica. 

In the new book, which was released April 7, Buettner distills the researchers' findings on what all the Blue Zones share when it comes to their diet. Here's a taste: - Stop eating when your stomach is 80 percent full to avoid weight gain. - Eat the smallest meal of the day in the late afternoon or evening. - Eat mostly plants, especially beans. And eat meat rarely, in small portions of 3 to 4 ounces. Blue Zoners eat portions this size just five times a month, on average. - Drink alcohol moderately and regularly, i.e. 1-2 glasses a day.

Ikaria, Greece You may remember this Blue Zone from Buettner's wonderful 2012 New York Times Magazine article entitled "The Island Where People Forget To Die." As we've reported, health researchers have long praised the Mediterranean diet for promoting brain and physical health and keeping chronic diseases at bay. 

"Their tradition of preparing the right foods, in the right way, I believe, has a lot to do with the island's longevity," writes Buettner. And "what set it apart from other places in the region was its emphasis on potatoes, goat's milk, honey, legumes (especially garbanzo beans, black-eyed peas, and lentils), wild greens, some fruit and relatively small amounts of fish."Ikaria has a few more "top longevity foods:" feta cheese, lemons and herbs like sage and marjoram that Ikarians use in their daily tea...The Ikarians do eat some goat meat, but not often.

Sardinia, Italy ...Buettner writes that the Sardinians explain their exceptional longevity with their assets such as "clean air," "locally produced wine," or because they "make love every Sunday." But when Buettner brought along a researcher to dig deeper, they found that pastoralism, or shepherding livestock from the mountains to the plains, was most highly correlated with reaching 100.

So what are those ancient Sardinian shepherds eating? You guessed it: goat's milk and sheep's cheese — some 15 pounds of cheese per year, on average. Also, a moderate amount of carbs to go with it, like flat bread, sourdough bread and barley. And to balance those two food groups out, Sardinian centenarians also eat plenty of fennel, fava beans, chickpeas, tomatoes, almonds, milk thistle tea and wine from Grenache grapes.

Loma Linda, Calif. There's a Blue Zone community in the U.S.? We were as shocked to learn this as you may be. Its members are Seventh-day Adventists who shun smoking, drinking and dancing and avoid TV, movies and other media distractions. They also follow a "biblical" diet focused on grains, fruits, nuts and vegetables, and drink only water. ...Another key insight? Pesco-vegetarians in the community, who ate a plant-based diet with up to one serving of fish a day, lived longer than vegan Adventists.Their top foods include avocados, salmon, nuts, beans, oatmeal, whole wheat bread and soy milk.

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There have been a number of studies over the years finding environmental links to testicular cancer (such as some pesticides, smoking, and endocrine disruptors). Now another one - muscle-building supplements with creatine and androstenedione . From Science Daily:

Testicular cancer link found for muscle-building supplements

Men who reported taking muscle-building supplements, such as pills and powders with creatine or androstenedione, reported a significantly higher likelihood of having developed testicular cancer than men who did not use such supplements, according to a new study in theBritish Journal of Cancer. Moreover, said study senior author Tongzhang Zheng, the associated testicular germ cell cancer risk was especially high among men who started using supplements before age 25, those who used multiple supplements and those who used them for years.

"The observed relationship was strong," said Zheng, who led the study at Yale University before joining the Brown University School of Public Health as a professor of epidemiology. "If you used at earlier age, you had a higher risk. If you used them longer, you had a higher risk. If you used multiple types, you had a higher risk." Testicular cancer incidence rose to 5.9 cases per 100,000 men in 2011, from 3.7 cases in 100,000 in 1975, Zheng said. Researchers aren't sure why. The work was inspired by mounting evidence that that at least some supplement ingredients may damage the testes.

To conduct the study, Zheng's research team conducted detailed interviews of nearly 900 men from Massachusetts and Connecticut -- 356 of whom had been diagnosed with testicular germ cell cancer, and 513 who had not. In the interviews, researchers asked the men not only about their supplement use but also about a wide variety of other possible factors such as smoking, drinking, exercise habits, family history of testicular cancer, and prior injury to their testes or groin....The researchers defined "use" as consuming one or more supplements at least once a week for four consecutive weeks or more.

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People are living longer these days, but the desire is to age with mental faculties intact. Thus it is great to find research that looks at how one can increase the odds of not having cognitive problems or dementia in old age.

The research here suggests several things one can do, starting in middle-age, that may help in delaying thinking and memory problems: participating in arts, crafts, socializing, and computer activities. The lead researcher Dr. Roberts said: "The key point we want to get across is that you need to start these activities early"....if you start these activities earlier, perhaps in your 20s, "keep doing them throughout your life; don't stop as you get older."

Note that: Mild cognitive impairment (MCI) is an intermediate stage between the expected cognitive decline of normal aging and the more serious decline of dementia. It can involve problems with memory, language, thinking and judgment that are greater than normal age-related changes. From Medical Xpress:

Can arts, crafts and computer use preserve your memory?

People who participate in arts and craft activities and who socialize in middle and old age may delay the development in very old age of the thinking and memory problems that often lead to dementia, according to a new study published in the April 8, 2015, online issue of Neurology.

People age 85 and older make up the fastest growing age group in the United States and worldwide."As millions of older US adults are reaching the age where they may experience these memory and thinking problem called Mild Cognitive Impairment (MCI), it is important we look to find lifestyle changes that may stave off the condition," said study author Rosebud Roberts, MB, ChB, MS, of Mayo Clinic in Rochester, Minn. and a member of the American Academy of Neurology. "Our study supports the idea that engaging the mind may protect neurons, or the building blocks of the brain, from dying, stimulate growth of new neurons, or may help recruit new neurons to maintain cognitive activities in old age."

The study involved 256 people with an average age of 87 who were free of memory and thinking problems at the start of the study. The participants reported their participation in arts, such as painting, drawing and sculpting; crafts, like woodworking, pottery, ceramics, quilting, quilting and sewing; social activities, such as going to the theater, movies, concerts, socializing with friends, book clubs, Bible study and travel; and computer activities such as using the Internet, computer games, conducting web searches and online purchases.

After an average of four years, 121 people developed mild cognitive impairment. Participants who engaged in arts in both middle and old age were 73 percent less likely to develop MCI than those who did not report engaging in artistic activities. Those who crafted in middle and old age were 45 percent less likely to develop MCI and people who socialized in middle and old age were 55 percent less likely to develop MCI compared to those who did not engage in like activities. Computer use in later life was associated with a 53 percent reduced risk of MCI.

On the other hand, risk factors such as having the APOE gene, having high blood pressure in middle age, depression and risk factors related to blood vessels increased the risk of developing MCI.

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More benefits of exercise or physical activity (this time lowering risk of early death), especially if there are short bursts of vigorous activity. The researchers suggest it for people of all ages.

From Science Daily: Working up a sweat: It could save your life

Physical activity that makes you puff and sweat is key to avoiding an early death, a large study of middle-aged and older adults has found. The researchers followed 204,542 people for more than six years, and compared those who engaged in only moderate activity (such as gentle swimming, social tennis, or household chores) with those who included at least some vigorous activity (such as jogging, aerobics or competitive tennis). They found that the risk of mortality for those who included some vigorous activity was 9 to 13 per cent lower, compared with those who only undertook moderate activity.

"The benefits of vigorous activity applied to men and women of all ages, and were independent of the total amount of time spent being active," said lead author Dr Klaus Gebel from James Cook University's Centre for Chronic Disease Prevention."The results indicate that whether or not you are obese, and whether or not you have heart disease or diabetes, if you can manage some vigorous activity it could offer significant benefits for longevity."

The current advice from the World Health Organization -- and health authorities in countries including the US, UK and Australia -- is for adults to accumulate at least 150 minutes of moderate activity or 75 minutes of vigorous activity per week.

So who should get huffing and puffing, and how much do you need to do? "Our research indicates that even small amounts of vigorous activity could help reduce your risk of early death," Dr Gebel said."Previous studies indicate that interval training, with short bursts of vigorous effort, is often manageable for older people, including those who are overweight or obese."

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Another excellent reason to exercise - for better erectile and sexual function in men! The researchers say that their research supports the idea that "that exercise might one day be prescribed as a treatment for erectile dysfunction".

And they're not talking about that much exercise: the highly active men in the study did a moderately intense activity such as brisk walking, cycling, or tennis at least an hour 3 to 4 times a week. Other research has suggested that erectile dysfunction can be reversed naturally by changing lifestyle factors see October 27, 2014 post Reversing Erectile Dysfunction Naturally). From Reuters:

Older men who exercise more have better erectile function

Men who exercise more have better erectile and sexual function, suggests a small study of older overweight men. The authors say their results support the idea that exercise might one day be prescribed as a treatment for erectile dysfunction.

Vidal and colleagues examined exercise habits and sexual function in 295 healthy men who were part of a research project evaluating prostate cancer risk at the Durham Veterans Affairs Medical Center in North Carolina. On average, the men were about 62 years old, and they were all overweight or obese. Roughly one third had diabetes or a history of chest pain or heart attacks. About three quarters were current or former smokers. Ninety-three men, or about a third of the group, were African-American.

Men were scored based on a measure known as metabolic equivalent of task (MET) hours per week and placed in four categories ranging from sedentary, with three or fewer MET hours/week, to highly active, with at least 18 MET hours/week. Most often, the men were sedentary, with 44 percent reporting little activity. But a substantial proportion, 26 percent, were highly active.Researchers also questioned the men about their sexual function, focusing on their ability to get erections and have orgasms, as well as the quality and frequency of their erections...Added up, responses could lead to a total score from 0 to 100....Men who reported more frequent exercise also reported higher sexual function scores. Half of the highly active men reported sexual function scores of at least 70, compared with a median score of about 33 for sedentary men.

SOURCE: bit.ly/1NilZYI The Journal of Sexual Medicine, online March 20, 2015.

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People have asked me if it is healthy to exercise or ride a bicycle in the congested and polluted New York metro area. According to this much quoted in the past week study from the University of Copenhagen - it is better to exercise than not in polluted cities when looking at death rates. But is their air pollution even comparable to ours? What does it do to our lungs to bicycle daily behind smoke belching buses?

Even the researcher said:"It is also important to note that these results pertain to Denmark and sites with similar air pollution levels, and may not necessary be true in cities with several fold higher air pollution levels, as seen in other parts of the world." They also stated: "...we would still advise people to exercise and cycle in green areas, parks, woods, with low air pollution and away from busy roads, when possible." From Science Daily:

Exercise can outweigh harmful effects of air pollution

The beneficial effects of exercise are more important for our health than the negative effects of air pollution, in relation to the risk of premature mortality, new research shows. In other words, benefits of exercise outweigh the harmful effects of air pollution.The study shows that despite the adverse effects of air pollution on health, air pollution should be not perceived as a barrier to exercise in urban areas. "Even for those living in the most polluted areas of Copenhagen, it is healthier to go for a run, a walk or to cycle to work than it is to stay inactive," says Associate Professor Zorana Jovanovic Andersen from the Centre for Epidemiology and Screening at the University of Copenhagen.

It is well known that physical activity reduces, while air pollution increases the risk of premature mortality. Physical activity amplifies respiratory intake and accumulation of air pollutants in our lungs, which may increase the harmful effects of air pollution during exercise."However, we would still advise people to exercise and cycle in green areas, parks, woods, with low air pollution and away from busy roads, when possible," she adds.

The Danish study includes 52,061 subjects, aged 50-65 years, from the two main cities Aarhus and Copenhagen, who participated in the cohort study Diet, Cancer and Health..,5,500 participants died before 2010, and the researchers observed about 20% fewer deaths among those who exercised than among those who didn't exercise, even for those who lived in the most polluted areas, in central Copenhagen and Aarhus, or close to busy roads and highways.

"It is also important to note that these results pertain to Denmark and sites with similar air pollution levels, and may not necessary be true in cities with several fold higher air pollution levels, as seen in other parts of the world," concludes Andersen.

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Note that both eggs and high-fat dairy products were basically considered evil by the medical establishment for many years. Remember egg white omelettes?And now both are thought to have health benefits, especially reducing the risk of diabetes. From Science Daily:

Eating eggs reduces risk of type 2 diabetes, study indicates

Egg consumption may reduce the risk of type 2 diabetes, according to new research...Research has shown that lifestyle habits, such as exercise and nutrition, play a crucial role in the development of the disease. A new study has found that egg consumption was associated with a lower risk of type 2 diabetes as well as with lower blood glucose levels. Men who ate approximately four eggs per week had a 37 per cent lower risk of type 2 diabetes than men who only ate approximately one egg per week. This association persisted even after possible confounding factors such as physical activity, body mass index, smoking and consumption of fruits and vegetables were taken into consideration. The consumption of more than four eggs did not bring any significant additional benefits.

The dietary habits of 2,332 men aged between 42 and 60 years were assessed at the baseline of the Kuopio Ischaemic Heart Disease Risk Factor Study, KIHD, at the University of Eastern Finland in 1984-1989. During a follow-up of 19.3 years, 432 men were diagnosed with type 2 diabetes.

Also note that high meat consumption is linked to higher risk of diabetes. From Science Daily:

High-fat dairy products linked to reduced type 2 diabetes risk

Consumption of high-fat yoghurt and cheese are linked to a reduction in the risk of type 2 diabetes by as much as a fifth, according to new research. High meat consumption, on the other hand, is linked to a higher risk.

However, the new study indicates that it is high-fat dairy products specifically that are associated with reduced risk."Those who ate the most high-fat dairy products had a 23 per cent lower risk of developing type 2 diabetes than those who ate the least. High meat consumption was linked to an increased risk of type 2 diabetes regardless of the fat content of the meat," said Ulrika Ericson, who conducted the study.

The researchers studied the eating habits of 27,000 individuals aged 45 to 74. The participants took part in the Malmö Diet and Cancer study in the early 1990s, in which they provided details of their eating habits. Twenty years on, over ten per cent -- 2 860 people -- had developed type 2 diabetes.