Sugar Blues
Many years ago I went to a meeting of the Neurootologic and Equilibriometric Society in Turku, Finland.
A physician from the upper New York State, Dr. William Updegraff [1], presented a paper about impaired carbohydrate metabolism and idiopathic Menière's disease. I was quite impressed with his insulin tolerance curves, based on the work of Dr. Joseph Kraft [2]. I became interested in this study and began to order glucose and insulin tolerance curves in my patients with a clinical suspicion of carbohydrate metabolic disorders. In a period of one year I collected 100 of these tolerance tests.
In 1992 my associate and dear friend Yotaka Fukuda was working on a research project for his Doctorate thesis. He had to abandon the project, however, due to insurmountable difficulties and discussed the problem with me. I offered him my collection of glucose and insulin tolerance curves, suggesting that he could use this material for his doctorate thesis.
I was simply collecting materials. Yotaka, however, took the study to a much higher level. He contacted the Department of Biochemistry of our medical school and gathered all of the available information on carbohydrate metabolism, including the Krebs cycle. And he looked at the literature for papers related to the use of insulin in Guinea pigs.
He found that Koide et al. [3], in 1960, studied the action of insulin in the inner ear of Guinea pigs and noticed that a reduction of cochlear microphonics occurred three hours after the administration of 80 µUI of insulin per kg of body weight. This reduction lasted for approximately 80 minutes. The administration of glucose or other Krebs cycle substrates resulted in a partial recovery.
He also found that Mendelsohn and Roderique [4], in 1972, administered insulin to Guinea pigs and reported changes in the chemical composition of endolymph: progressive reduction of potassium concentration and progressive increase in sodium concentration. Three hours after insulin administration, the potassium concentration varied from 147.8 mEq/L to 57.1 mEq/L, and the sodium concentration increased from 5.85 mEq/L to 96.4 mEq/L. There was a simultaneous reduction of the endocochlear potential and also of cochlear microphonics.
Yotaka also came up with the concept of a metabolic endolymphatic hydrops, resulting from the changes in the composition of endolymph and the necessity of more water in the endolymph space to adjust the osmotic pressure.
His thesis was excellent. My late friend, Dr. Antonio De la Cruz, an eminent otologist, wrote me a letter stating that Yotaka’s thesis was the most complete study on carbohydrate metabolism that he had come across.
From then on, we had a constantly evolving research program. We published many papers, and presently reached 1,400 glucose and insulin tests. We also found that brush border membrane disease, a disorder of the small intestine mucosa, could cause metabolic changes in the inner ear [5].
In 2004 Yotaka published a book: Açúcar, Amigo ou Vilão? (Sugar, Friend or Villain?) [6]. Destined to the general public, it contained all of the information regarding the possible consequences of eating too many carbohydrates, including obesity and diabetes.
Dr. Joseph Kraft’s book, Diabetes Epidemic and You [7], published in 2008, makes nice references to Yotaka (and also to me).
Yotaka’s untimely death prevented him from continuing his investigations, but we kept working on this project and recently published an extensive revision [8].
I miss him very much. He was an excellent physician and an excellent surgeon. He was also a very good friend, who taught me many, many things.
[1] Updegraff WR. Impaired carbohydrate metabolism and idiopathic Meniere’s disease. Ear Nose Throat J. 1977;56(4):160–3.
[2] Kraft JR. Detection of diabetes mellitus in situ (occult diabetes). Lab Med. 1976;6:10–22.
[3] Koide Y, Tajima S, Yoshida M, Konno M. Biochemical changes in the inner ear induced by insulin, in relation to cochlear microphonics. Ann Otol Rhinol Laryngol. 1960;69:1083–97.
[4] Mendelsohn M, Roderique J. Cationic changes in endolymph during hypoglycemia. Laryngoscope. 1972;82:1533–40.
[5] Mangabeira-Albernaz PL, Fukuda Y, Vilela MP, Miszputen SJ. Vestibular disorders caused by defective enzyme mechanisms in the small intestine. Acta Otolaryngol (Stockh). 1985;99:330–5.
[6] Fukuda Y. Açúcar, Amigo ou Vilão? São Paulo, Manole, 2004.
[7] Kraft JR. Diabetes epidemic and you: Trafford Publishing; 2008.
[8] Albernaz PLM, Zuma e Maia FC, Carmona S, Cal RVR, Salazar G. Glucose, Insulin, and Inner Ear Pathology. In Albernaz PLM, Zuma e Maia FC, Carmona
S, Cal RVR, Salazar G, The New Neurotology, p 197-210. Cham, Switzerland, Springer, 2019. doi 10.1007/978-3-030-11283-7_15.
A physician from the upper New York State, Dr. William Updegraff [1], presented a paper about impaired carbohydrate metabolism and idiopathic Menière's disease. I was quite impressed with his insulin tolerance curves, based on the work of Dr. Joseph Kraft [2]. I became interested in this study and began to order glucose and insulin tolerance curves in my patients with a clinical suspicion of carbohydrate metabolic disorders. In a period of one year I collected 100 of these tolerance tests.
In 1992 my associate and dear friend Yotaka Fukuda was working on a research project for his Doctorate thesis. He had to abandon the project, however, due to insurmountable difficulties and discussed the problem with me. I offered him my collection of glucose and insulin tolerance curves, suggesting that he could use this material for his doctorate thesis.
 |
| Yotaka Fukuda, between Jun-Ishi Suzuki, from Tokio, and Naoaki Yanaghirara, from Ehime. |
I was simply collecting materials. Yotaka, however, took the study to a much higher level. He contacted the Department of Biochemistry of our medical school and gathered all of the available information on carbohydrate metabolism, including the Krebs cycle. And he looked at the literature for papers related to the use of insulin in Guinea pigs.
He found that Koide et al. [3], in 1960, studied the action of insulin in the inner ear of Guinea pigs and noticed that a reduction of cochlear microphonics occurred three hours after the administration of 80 µUI of insulin per kg of body weight. This reduction lasted for approximately 80 minutes. The administration of glucose or other Krebs cycle substrates resulted in a partial recovery.
He also found that Mendelsohn and Roderique [4], in 1972, administered insulin to Guinea pigs and reported changes in the chemical composition of endolymph: progressive reduction of potassium concentration and progressive increase in sodium concentration. Three hours after insulin administration, the potassium concentration varied from 147.8 mEq/L to 57.1 mEq/L, and the sodium concentration increased from 5.85 mEq/L to 96.4 mEq/L. There was a simultaneous reduction of the endocochlear potential and also of cochlear microphonics.
Yotaka also came up with the concept of a metabolic endolymphatic hydrops, resulting from the changes in the composition of endolymph and the necessity of more water in the endolymph space to adjust the osmotic pressure.
His thesis was excellent. My late friend, Dr. Antonio De la Cruz, an eminent otologist, wrote me a letter stating that Yotaka’s thesis was the most complete study on carbohydrate metabolism that he had come across.
From then on, we had a constantly evolving research program. We published many papers, and presently reached 1,400 glucose and insulin tests. We also found that brush border membrane disease, a disorder of the small intestine mucosa, could cause metabolic changes in the inner ear [5].
In 2004 Yotaka published a book: Açúcar, Amigo ou Vilão? (Sugar, Friend or Villain?) [6]. Destined to the general public, it contained all of the information regarding the possible consequences of eating too many carbohydrates, including obesity and diabetes.
Dr. Joseph Kraft’s book, Diabetes Epidemic and You [7], published in 2008, makes nice references to Yotaka (and also to me).
Yotaka’s untimely death prevented him from continuing his investigations, but we kept working on this project and recently published an extensive revision [8].
I miss him very much. He was an excellent physician and an excellent surgeon. He was also a very good friend, who taught me many, many things.
[1] Updegraff WR. Impaired carbohydrate metabolism and idiopathic Meniere’s disease. Ear Nose Throat J. 1977;56(4):160–3.
[2] Kraft JR. Detection of diabetes mellitus in situ (occult diabetes). Lab Med. 1976;6:10–22.
[3] Koide Y, Tajima S, Yoshida M, Konno M. Biochemical changes in the inner ear induced by insulin, in relation to cochlear microphonics. Ann Otol Rhinol Laryngol. 1960;69:1083–97.
[4] Mendelsohn M, Roderique J. Cationic changes in endolymph during hypoglycemia. Laryngoscope. 1972;82:1533–40.
[5] Mangabeira-Albernaz PL, Fukuda Y, Vilela MP, Miszputen SJ. Vestibular disorders caused by defective enzyme mechanisms in the small intestine. Acta Otolaryngol (Stockh). 1985;99:330–5.
[6] Fukuda Y. Açúcar, Amigo ou Vilão? São Paulo, Manole, 2004.
[7] Kraft JR. Diabetes epidemic and you: Trafford Publishing; 2008.
[8] Albernaz PLM, Zuma e Maia FC, Carmona S, Cal RVR, Salazar G. Glucose, Insulin, and Inner Ear Pathology. In Albernaz PLM, Zuma e Maia FC, Carmona
S, Cal RVR, Salazar G, The New Neurotology, p 197-210. Cham, Switzerland, Springer, 2019. doi 10.1007/978-3-030-11283-7_15.
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