Good examples

In the meeting with patients important research questions arise

Julia Otten

Julia Otten moved from Germany after her doctor's degree, a choice she has not regretted. Here she has been able to combine family life with the job as a senior physician and researcher. Last year she defended her thesis on stone age diet and currently works as a senior physician at Norrlands University Hospital. As a researcher, she would like to show scientifically that it is possible to treat diabetes with a change of lifestyle.

It is late afternoon. Within walking distance of central Umeå lies Norrland University Hospital, situated high with city views. Julia Otten, a diabetic physician at the Medical Center, has just finished working for the day and is settled down in a conference room.

On the table is a copy of her doctoral thesis. In October 2016 she defended her thesis on paleolite diet at the University of Umeå: "Effects of a paleolithic diet and exercise on liver fat and insulin sensitivity". In several studies, she has shown how powerful the paleitic diet is and how it can improve cardiovascular risk factors such as overweight, liver fat, insulin sensitivity, blood lipids and blood pressure in obese subjects with type 2 diabetes in just twelve weeks.

– Our western lifestyle is the main cause of cardiovascular disease. This may be because our metabolisms are still programmed to live as hunters and collectors.

Stone-age people

Depite living in the 21st century in a high-tech era, we are still in many respects still stone-age people. Until the beginning of the agricultural community about 10,000 years ago, we lived as hunters and collectors, and our diet was based on what nature and the sea offered: vegetables, fruits, berries, lean meats, fish, seafood, nuts and eggs. In our time, there are still indigenous peoples, such as inuites in Greenland, as well as residents of Kitava Island, east of New Guinea, who live as hunters and collectors and eat a stone-age diet similar to the one used during the older stone-age (Paleolitikum).

– These individuals have a pronounced low frequency of cardiovascular disease, which makes it highly interesting to study the metabolic effects of paleolithic diet, with and without the addition of physical activity, says Julia Otten.

Lifestyle interventions

It has been over 16 years since Julia Otten left Germany to do her general medical training programme in Sweden. Together with her husband, who is also a researcher and chief physician in orthopedics, they first moved to Sollefteå where Julia got a job at the hospital.

– We both wanted to move from Germany, mostly because of working conditions and a tough job market. As a woman in my home country, it is difficult to combine family and career, many women are forced to make a choice. If you choose children and family, you usually work part-time and do not have the same opportunities to do a career as a researcher and doctor.

Thanks to a well-developed childcare and generous parental insurance, Sweden offers that opportunity, Julia Otten says.

– Here in Sweden, I can still focus on my job as a doctor and have a research career, and at the same time have time for the family. It is extremely valuable and important to me.

From Sollefteå, the family moved to Umeå in 2007. Julia Otten chose to complete her residency in internal medicine and endocrinology at Norrlands University Hospital. There she also began her doctoral studies at the Department of Public Health and Clinical Medicine.

One of her great interests is about lifestyle interventions in type 2 diabetes.

– It is a lifestyle disease and it would therefore be logical to initiate treatment in collaboration with the patient to change the lifestyle in order to improve health. Today, drug treatment is quickly prescribed, and too little is invested in lifestyle interventions that could cure type 2 diabetes

Looking for a combination of clinical work and research

It is a great advantage to work clinically while also doing research, she believes.

– In the meeting with patients, many ideas and questions arise that we can test scientifically to try to increase our knowledge and improve healthcare and treatment. But questions can also be raised in the lab or in experimental studies and generate hypotheses that we can then test in clinical studies. I can not imagine not to do research. It offers great opportunities to broaden the views and perspectives.

Since her dissertation last year she works mostly as a clinician and has less time left for research. It is too bad, she believes, because great knowledge leaps can be taken when clinical work and research are combined.

Julia Otten also highlights the important collaboration between different research groups and also with other universities like the Karolinska institutet.

– In Umeå we have an exciting research team where preclinical researchers and clinical researchers work together, which is a great advantage and asset, says Julia Otten.

In the best of worlds she would like to have a combination job that gave her the opportunity to do research half-time. Today, she has to spend some of her free time to relinquish the research she is passionate about.

– I am looking for opportunities to continue research on lifestyle intervention in type 2 diabetes. The subject is so close to my heart and is a counterweight to the extensive research on drugs.

Julia Otten finds that patients are very interested in participating in clinical research studies. She tells about a patient who had type 2 diabetes with a far too high long-term blood sugar. He decided for a lifestyle change. Half a year later, the patient had lost 15 kilos and the long-term blood sugar had returned to a normal value.

– The diet change had a powerful effect, and as physicians, it is of course extremely pleasing when we can support and motivate our patients to get healthy, just by changing their lifestyle.

Fruitful cross-fertilisation

Julia Otten is currently preparing a clinical study on lifestyle interventions and type 2 diabetes. She is also planning short stays with different research groups in Canada, France and England. The aim is, inter alia, to learn new scientific methods in protein metabolism.

Cross-fertilization between clinical work and clinical research is a strong driving force, says Julia Otten. When she needs to collect her thoughts and find the concentration, she sometimes goes to a small cabin outside Holmsund in Umeå. There she can calmly focus on important research issues.

– I would not be the physician I am without research. Sometimes we get strange results that generate exciting hypotheses. It, in turn, raises many interesting discussions and questions that require new investigations, and hopefully taking on new knowledge. Something that hopefully benefits patients in the end.