Field Notes

Low Vitamin D Levels May Increase Pain During Labor

Pregnant women with low vitamin D levels experience an increased amount of pain during labor, according to a study presented at the ANESTHESIOLOGY 2014 annual meeting.

Vitamin D deficiency has long been associated with depression and pain, but this is the first study to demonstrate its association with increased consumption of pain medication during childbirth.

“Women often experience lower than normal levels of vitamin D during pregnancy,” said Andrew W. Geller, MD, physician anesthesiologist at Cedars-Sinai Medical Center in Los Angeles and senior author of the study. “We found that patients with low levels of vitamin D experienced an increase in pain during childbirth.”

According to the American College of Obstetricians and Gynecologists, vitamin D deficiency is common during pregnancy, particularly among high-risk groups, including vegetarians, women with limited sun exposure, and ethnic minorities. Vitamin D is obtained largely from consuming fortified milk or juice, fish oils, and dietary supplements.

Researchers measured the vitamin D levels of 93 pregnant women before delivery. All of the women requested an epidural for pain during labor. Researchers then measured how much pain medication each woman required during labor. The researchers then examined the quantity of pain medicine used by the women with higher levels of vitamin D compared with those with lower levels of vitamin D.

The study found that the patients with lower levels of vitamin D consumed more pain medication than patients with higher levels of vitamin D.

“Given the research results, prevention and treatment of low vitamin D levels in pregnant women may have a significant impact on decreasing labor pain in millions of women every year,” Geller said. “This topic needs to be revisited and additional research should be conducted to determine how we can improve the labor experience for women everywhere.”

— Source: American Society of Anesthesiologists


Scientists Discover a ‘Good’ Fat That Fights Diabetes

Scientists at the Salk Institute and Beth Israel Deaconess Medical Center (BIDMC) in Boston have discovered a new class of molecules—produced in human and mouse fat—that protects against diabetes.

The researchers found that giving this new fat, or lipid, to mice with the equivalent of type 2 diabetes lowered their elevated blood sugar, as detailed in Cell. The team also found that levels of the new lipids are low in humans with a high risk of diabetes, suggesting that the lipids could potentially be utilized as a therapy for metabolic disorders.

Lipids, like cholesterol, typically are associated with poor health. But in recent years, researchers have discovered that not all lipids are bad for you; omega-3 fatty acids, which are found in fish oils and have been touted as healthful, are one example. The newly discovered lipids, called fatty acid hydroxy fatty acids (FAHFAs) were lower in humans with early stages of diabetes and were much higher in mice resistant to diabetes.

“Based on their biology, we can add FAHFAs to the small list of beneficial lipids,” says Alan Saghatelian, a professor in the Clayton Foundation Laboratories for Peptide Biology and a senior author of the study. “These lipids are amazing because they can also reduce inflammation, suggesting that we might discover therapeutic opportunities for these molecules in inflammatory diseases, such as Crohn’s disease and rheumatoid arthritis, as well as diabetes.”

FAHFAs hadn’t been noticed previously in cells and tissues because they’re present in low concentrations, making them difficult to detect. Using the latest mass spectrometry techniques, Saghatelian and Barbara Kahn, vice chair of the department of medicine at BIDMC and a senior author of the study, uncovered the FAHFAs when they examined the fat of a diabetes-resistant mouse model that Kahn developed.

“We engineered these mice to have more of a sugar transporter, called Glut4, in their fat because we had shown that when levels of this transporter are low, people are prone to developing diabetes,” Kahn says. By examining how this sugar transporter might help protect against diabetes, the team noticed more fatty acid synthesis in mice that had improved insulin activity (and thereby were less likely to develop diabetes). The team collaborated to find out what lipids were involved.

“While many of the other lipids were essentially the same between normal mice and these diabetes-resistant mice, we saw these FAHFA lipids elevated by 16-fold in mice that were resistant to diabetes, standing out really clearly as a big change,” Saghatelian says. “After that, we elucidated their structures using a combination of mass spectrometry and chemical synthesis. We basically uncovered a whole new class of molecules using these techniques.”

Once they identified FAHFAs as being the lipid that was different between normal mice and these diabetes-resistant mice, they found something else important: when the mice ate FAHFAs, blood sugar levels dropped and insulin levels rose, indicating the potential therapeutic value of FAHFAs.

To determine whether FAHFAs also are relevant in humans, the team measured FAHFA levels in humans who are insulin-resistant (a condition that’s often a precursor to diabetes) and found that their FAHFA levels were lower in fat and blood, suggesting that changes in FAHFA levels may contribute to diabetes.

“The higher levels of these lipids seem to be associated with positive outcomes in mice and humans,” says Kahn, who’s also a professor at Harvard Medical School. “We show that the lipids work through multiple mechanisms. When blood sugar is rising, such as after a meal, the lipids rapidly stimulate secretion of a hormone that signals the pancreas to secrete insulin. In addition, these novel lipids also directly stimulate sugar uptake into cells and reduce inflammatory responses in fat tissue and throughout the body.”

These combined effects make the therapeutic potential of the lipids tremendous, say the researchers. Aside from existing in low levels within a wide range of vegetables, fruits, and other foods, FAHFAs also are—unlike the other known beneficial lipids—produced and broken down inside the body. Potentially, new drugs could target the pathways that make or break down lipids to control FAHFA levels.

In the new paper, the team also identified the cellular receptor that FAHFAs bind to, called GPR120, to control how much glucose is absorbed into fat cells. The team thinks that increasing the body’s levels of FAHFAs also may be a way to activate GPR120 to treat or prevent diabetes.

“This work may suggest that changes in FAHFA levels are a new mechanism in diabetes that was underappreciated before because these lipids weren’t known,” Saghatelian says. “We hope this work points to novel therapeutics that could boost the body’s own way of managing blood sugar.”

“Because we can detect low FAHFA levels in blood before a person develops diabetes, these lipids could serve as an early marker for diabetes risk,” Kahn adds. “We want to test whether restoring the lipids before diabetes develops might potentially reduce the risk or even prevent the disease.”

— Source: Salk Institute for Biological Studies