09 June 2011

Go on, treat yourself

Engineering exercise into our cities

Diabetes is the nation's fastest growing chronic disease, with 3.3 million Australians expected to be diagnosed with Type 2 diabetes by 2031.

The frustration is clear when Professor John Hawley gets started on our misguided approach to health. It's the exasperation of someone who knows what works in tackling the Western world's biggest health issues, has the science to prove it, yet finds himself up against the twin brick walls of human nature: impatience and laziness.

"I don't understand why we spend so much time and money looking for secondary and tertiary treatments when the most natural, inexpensive option is also one of the most effective in preventing these diseases in the first place," he says. "Unfortunately, most people are looking for a quick fix."

Hawley's solution is deceivingly simple: exercise. The Exercise Metabolism Research Group he leads in RMIT's Health Innovations Research Institute is one of a few research groups in the world looking at the role of exercise in the prevention and treatment of obesity-related conditions such as diabetes and insulin resistance in humans.

Insulin resistance, a precursor to Type 2 diabetes, impairs the ability of skeletal muscles to take up and dispose of glucose effectively. One of the team's earlier breakthroughs was finding that exercise was just as effective as insulin-sensitising drugs in treating the condition. But the question remained: why does exercise work so well? The answer lay in the muscles.

"Our research has shown that muscles are the locus of control for the whole body - it's where everything starts to go wrong," Hawley says.

"In a normal, healthy person about 80 per cent of the glucose load from a meal is taken up by our muscles. But in obese people, or those with insulin resistance, the glucose that isn't absorbed stays in the bloodstream and raises blood glucose levels. The diseased muscle can't dispose of glucose in the same way as a healthy muscle, and the key difference is the levels of mitochondria."

Mitochondria are the powerhouses of cells. The more mitochondria in the muscle cells, the better their ability to convert fuels such as carbohydrates and fat into useful energy. "Boosting the mitochondria means your body doesn't just have a bigger engine but a better, more efficient one - like moving from a clapped out 1.2L to a new model V8."

Aerobic exercise, and to some extent resistance-based exercise programs, increases the levels of mitochondria. "Combining aerobic-type exercise such as walking, cycling or swimming with resistance training to increase muscle mass will give you the best bang for your dollar," Hawley says.

Even small amounts of daily exercise can be enough to turn around insulin resistance. And it's here where the design and development of our cities is crucial, Hawley believes.

"We've engineered exercise out of our society and we're paying the costs. But there is an alternative to pouring out billions of dollars on treating these preventable conditions over the next few decades, and right now is the time to act."

A natural alternative to prescription drugs

With the annual financial burden of Type 2 diabetes estimated at $10.3 billion just in Australia, the race to find new and better drugs for treating the disease is intense. Conventional drug discovery is having limited success, but researchers investigating natural products with ancient medical roots are finding great potential.

"Natural products have long been a vital source for drug discovery - about 30 per cent of current drugs originate from natural products," Associate Professor Jiming Ye says.

"Essentially, traditional Chinese medicines are largely natural products that have been used to treat diseases for thousands of years with documented efficacy. But the scientific evidence base that we need for these treatments to become part of the regular armoury of medical approaches to this disease isn't there - and that's where our work comes in."

Ye leads the Molecular Pharmacology for Diabetes Group at RMIT, part of the Traditional and Complementary Research Program in the Health Innovations Research Institute. Their approach targeting traditional Chinese medicine for the discovery of new drugs to treat diabetes - is unique in Australia.

The conventional approach for drug discovery starts from chemicals in a laboratory and the success rate in developing a drug actually used in medical clinics is extremely low. "The advantage of working with Chinese medicine is you have a clue from the clinical usage about which herbs to target before you start, and you already know they are relatively safe for human consumption," Ye says.

Collaborating with the Garvan Institute and chemists in the Shanghai Institute of Materia Medica in the Chinese Academy of Sciences, the researchers look for compounds that have significant effects on blood sugar, blood lipids, body weight, food intakes, glucose tolerance and insulin sensitivity. Two drugs with strong potential have been identified: berberines, found in plants such as Goldthread, and triterpenoids, derived from bitter melons.

Berberine is already in use in China as a non-prescription drug for other conditions and, since the findings, trials by a number of Chinese hospitals have demonstrated its effectiveness in improving insulin action and lowering blood lipids. Laboratory studies have shown both herb-derived compounds work as well as one of the most commonly prescribed diabetes drugs, metformin.

Ye was initially trained in conventional, Western medicine in China, before obtaining his PhD in Australia. With extensive research experience in developing new diabetes drugs with leading pharmaceutical companies, he moved his team to RMIT in 2010 because of the greater potential to combine his basic research work with the University's investigations into Chinese medicine.

"Instead of East meets West, for me it's been more a case of West meets East," he says. "You may start from two different streams in what we do, but eventually they should come together. We should fully embrace the research concepts and tools of the scientific mainstream in our research of Chinese medicine. Science is science - if there's evidence, there's got to be something there."

Sweet! Just text for blood sugar advice

Managing a chronic disease like diabetes could be as simple sending an SMS thanks to new developments in the integration of technology into healthcare delivery in Australia.

RMIT's Professor Nilmini Wickramasinghe is collaborating with INET International on a new interactive health application that takes advantage of the ubiquity of mobile phones and wireless technology to help patients improve their self-care.

Patients will be able to test their blood sugar before or after a meal, send the data to a health care provider via their mobile phone and receive instant feedback.

The advice will detail what kind of exercise they should do or how they should eat, to maintain healthy blood sugar levels.

The research is part of the Healthcare Technology Cluster led by Wickramasinghe, within RMIT's School of Business IT and Logistics. Researchers collaborate internationally with leading healthcare organisations to investigate how incorporating information communication technologies can improve health and to find cost-effective ICT solutions for healthcare systems.

This story was first published in RMIT's Making Cities Work magazine.

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