How Exercise Intensity, Meat & Fat Consumption, Vitamin D, Body Weight, & Muscles All Affect Type-2 Diabetes. Plus the Paradoxical Effect of Metformin on Exercise

 

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The Back Story

I was "introduced" to Dr. Gabe Mirkin about 10 years ago.

He kept me company on the long rides home from the hospital, on nights when I had to work late.

His evening medical talk radio show was the only decent thing to listen to on the radio after 9:00 pm--back in the pre-podcast/iPod/iPhone days.  And let me tell you, I  had to really search hard to pick up his broadcast on CKLW--an AM station out of Windsor, Ontario.

Dr. Mirkin has since retired, and no longer shares his medical updates on the radio--but, I still keep up with him via his weekly E-Zine Newsletter--and so can you!  He shares "what's new in the medical literature" in the areas of:

• Sports, fitness & exercise
• Diet and wellness
• Lifestyle changes to maximize health

 

Who is Dr. Gabe Mirkin

He was a practicing physician for more than 40 years--and a radio talk show host for 25.  Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is one of a very few doctors board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology.

Dr. Mirkin did his residency at the Massachusetts General Hospital and over the years he has served as a Teaching Fellow at Johns Hopkins Medical School, Assistant Professor at the University of Maryland, and Associate Clinical Professor in Pediatrics at the Georgetown University School of Medicine.

Dr. Mirkin has run more than forty marathons and is now a serious tandem bike rider with his wife, Diana, often doing 30-60 miles in an outing.  Read more about Dr. Gabe Mirkin in his curriculum vitae.

 

Dr. Gabe Mirkin & Wife Diana--Tandem Cycling Enthusiasts

 

When I read the short piece Dr. Mirkin wrote on type-2 diabetes in his E-zine for January 29, 2012, I decided to just share it in its entirety.  It's short.  It's simple.  And it's worth repeating.

 

• Exercise makes a big difference when it comes to preventing & "treating" type-2 diabetes--and exercise intensity matters.
• Weight-training is important--muscles matter.
• Ditch the meat, because fat matters.
• Lose the weight--body fat matters.
• Check your Vitamin D Levels
• Ditch the sugar, the high-glycemic processed carbs--and go for the whole unprocessed high fiber carbs.   According to the world-renowned diabetes researcher, Jennie Brand-Miller PhD, who runs the Glycemic Index database out of the University of Sydney in Australia, the number one best food you can eat for breakfast is steel-cut oats!  Low-glycemic, high fiber, slow-burning satisfying carbs.  If you haven't tried my chocolate oatmeal yet--you don't know what you're missing.  Get the recipe, here and  give it a try.
• Watch Dr. Neal Barnard's Reversing DIabetes with a Plant-Based Diet Video--if you haven't seen it yet.  And read the written summary.

 

Jennie Brand-Miller, PhD, FAIFST, FNSA, holds a personal chair in Human Nutrition in the Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders and the School of Molecular Bioscience at the University of Sydney.  She is one of the world's leading authorities on the glycemic index.

 

 

Dr. Gabe Mirkin Talks Type-2 Diabetes

 

 

Diabetes Should Never Happen to You

Read the January 29, 2012 E-zine here.
 

One of three North Americans will become diabetic, and almost all are pre-diabetic long before they become diabetic. Signs of pre-diabetes include:

• a protruding belly
• small buttocks
• love handles around the belt line
• high triglycerides (greater than 150)
• low HDL (good) cholesterol (lower than 40)
• fatty liver
• fasting blood sugar above 100
• blood sugar above 120, two hours after eating

If you change the habits that cause the signs of pre-diabetes, you can probably avoid ever becoming diabetic.

EXERCISE HELPS TO LOWER HIGH BLOOD SUGAR LEVELS. People who are pre-diabetic have a far more dramatic lowering of high blood sugar and insulin with exercise than non-diabetics (Medicine and Science in Sports and Exercise, December 2011;43(12):2231- 2240). High blood sugar levels cause sugar to stick to the outer surface of cell membranes and destroy them. High blood insulin levels constrict arteries leading to the heart to cause heart attacks.

INTENSE EXERCISE IS FAR MORE EFFECTIVE IN CONTROLLING BLOOD SUGAR LEVELS THAN JUST EXERCISING. In another study, men performed the following workout three times a week: They warmed up by pedaling on a stationary bicycle for five minutes, performed two 20-second hard sprints and then cooled down by pedaling slowly for five minutes (European Journal of Applied Physiology, November 29, 2011). After six weeks, there was an incredible drop in blood sugar and insulin levels, far more than a diabetic achieves by exercising less intensely for more than one hour a day. The authors write: "These sprints break down as much glycogen in two 20-second sprints as moderate endurance exercise would in an hour."

Muscles store sugar inside their cells as glycogen. Emptying muscle cells of glycogen markedly improves the ability of muscle cells to remove sugar from the bloodstream.

BAD HABITS THAT CAUSE DIABETES: If you have type II diabetes, you probably did it to yourself. More than 90 percent of diabetes is caused by inability to respond to insulin. Insulin cannot do its job of driving sugar from the bloodstream into cells until it attaches on special hooks on cell membrane called insulin receptors.

So anything that blocks insulin receptors prevents insulin from working and causes blood sugar levels to rise too high. Also, anything that drives sugar into cells without needing insulin helps to prevent and treat diabetes. Behaviors that block insulin receptors include:

• EATING RED MEAT. The saturated fat in red meat blocks insulin receptors to prevent insulin from doing its job.  Click here and here

• BEING FAT. Full fat cells block insulin receptors.

• LACKING MUSCLE. Contracting muscles can remove sugar from the bloodstream without needing insulin. However this effect lasts only during exercise and up to 17 hours afterwards, so you have to exercise every day. Exercise draws sugar into cells without even needing insulin, and exercise makes your body respond better to insulin (Medicine & Science in Sports & Exercise, December 2011;43(12):2231-2240).

• LACKING VITAMIN D. Vitamin D is necessary for your cells to respond to insulin. Lack of vitamin D blocks insulin receptors and prevents insulin from doing its job of lowering blood sugar levels. Vitamin D levels should be above 75 nmol/L (US measurement equivalent to above 30 ng/mL).   Click here and here

SUGAR AND OTHER REFINED CARBOHYDRATES: Eating or drinking sugar and refined carbohydrates (such as bakery products and pastas) raises blood sugar levels the most. A high rise in blood sugar causes sugar to stick to cells. Once there, sugar can never be removed. It eventually is converted to sorbitol that destroys the cell to cause all the horrible side effects of diabetes: blindness, deafness, heart attacks, strokes, dementia, impotence, kidney failure, amputations and so forth.

 

 

 

 

 

The Intriguiging New Research on How Metformin Might Be Undermining Exercise

 

I first heard about this research back in October, and I've mentioned it to everyone I know who takes Metformin.  It's paradoxical, disturbing, and demonstrates the complex effects of drug therapy.

Metformin is often the first line of defense for those diagnosed with pre-diabetes or type-2 diabetes.  It helps to control blood sugar and improve insulin sensitivity.   All good things.  RIght?

So it's common sense that if you combine exercise with Metformin, you're going to have a synergistic winning effect.   Right?   Wrong!  Too bad that doesn't seem to happen.  

According to two separate studies by researchers at two different universities--the University of Alberta, and the University of Massachusetts at Amherst--Metformin appears to undermine or blunt the beneficial effects of exercise on insulin sensitivity & blood glucose response.   Not at all what anyone was expecting to happen.

But, stay tuned.  As with all research, more studies are in order.  Maybe the timing of one's exercise or the timing of the drug can modify the undermining effect that Metformin has on exercise.   It's just too bad that one of the best things that type-2 diabetics can do for themselves--exercise--might be undermined by the prescription drug they are taking. 

 

Here's what seems to be going on when Metformin is combined with exercise.

 

"Both exercise and the common type 2 diabetes medication Metformin are known to dramatically reduce blood sugar levels in diabetics.

So starting patients on therapies that involve the use of the drug and frequent physical activity has long been supposed to be a valuable tool in fighting high blood sugar.

However, new research published in the journal Diabetes Care indicates that the effects of Metformin and exercise may actually cancel each other [out], potentially leading to even worse blood sugar control in patients with type 2 diabetes.

It is widely believed that Metformin lowers glucose levels by activating exercise-like pathways in the metabolic system. The researchers said that when a person on the medication is physically active, this may result in counter-regulatory reactions that cancel each other out."

 

According to Barry Braun PhD of the University of Massachusetts, one of researchers involved in the study recently published in Diabetes Care:

 

"Metformin is known to increase the breakdown of triglycerides to fatty acids, which we did see--and this may interfere with the uptake of glucose from blood [caused by exercise]."

 

According to Dr. Normand Boule of the University of Alberta, one of the researchers involved in another exercise/Metformin study (read more about this study here) that was published in the July 2011 Diabetes Care:

 

“Metformin reduces glucose in the blood and many believe it does so by activating exercise-like pathways. 

As expected, in our study Metformin lowered the blood glucose concentrations measured during a two-hour period after lunch.

But we found that on the non-exercise day Metformin led to better glucose control after lunch than on the day our participants took Metformin and exercised.”

Boulé thinks that because both Metformin and exercise act to lower glucose levels, the combination may have triggered a counter regulatory response by the body to prevent glucose levels dipping too much. 

“During exercise, glucagon concentrations increased in the blood (a hormone secreted by the pancreas that raises glucose levels) but when we combined exercise and Metformin the glucagon levels were almost twice as elevated.”

Boule also believes his study was the first to document a significantly increased heart rate when performing aerobic exercise of various intensities with Metformin (six beats per minute on average)--which may also undermine exercise in diabetics.

 

 

Comments

[Sue T.]

I was tested recently for vitamin D and had low levels, so my doctor put me on a supplement of 5000 IU/day. However, shortly thereafter, I read a study in the New York Times Science section about the dangers of vitamin D supplements:
http://www.nytimes.com/2012/01/17/health/research/risks-when-too-much-vitamin-d-is-too-much.html?_r=1&scp=1&sq=vitamin%20d&st=cse
It seems like there's so much conflicting health advice out there... it's frustrating. But I'm planning to continue taking the D supplements because the articles about the possible consequences of D deficiency terrify me.

[Jim Richardson]

Thanks for introducing Gabe Mirkin to your readers. I used to listen to him most days on the radio when I lived and worked in DC, not far from Gabe's office. My nephew went to him once to lose weight and was successful, which is why I made a point to listen to Mirkin on the radio. From the beginning, I have never found a more accurate, knowledgeable, walking encyclopedia of *evidence-based medical knowledge,* bar none. And he's not selling any proprietary "stuff." He's genuinely an altruist who doesn't need to do what he does. I have his radio programs saved and listen to them when driving on long trips. They're available here:
http://www.drmirkin.com/iradioshow/mp3_direct.html

But his articles are frequently updated and give even more of much the same information in print, minus the "call in" radio questions which he unhesitatingly answered accurately, year after year, off the cuff. It was amazing, the way he could cite research and especially current research from memory, on seemingly any medical question asked. He was famous for this and I never did find an instance of him being incorrect or out of date. He earned my highest respect after listening to him over the years. The articles are also available on his website. If HHLL readers have a question about nutrition, fitness, or sports medicine, take a moment to do a search on his site first: I doubt you'll be disappointed. Rather than a cartain physician of questionable credentials and motives, one who resembles Santa -- in my judgment Gabe Mirkin, M.D. deserves the title of "America's Most Respected Physician," when it comes to motivation and evidence-based information. And his credentials and certifications.

Yes, sign up for his free email newsletter. You won't be disappointed. I learn something from each one. He's not selling product, he's the genuine article and wants to help his fellow men and women avoid avoidable pain and suffering, same as HHLongLife does here, rather than cash in.

[Pam Wright]

Thanks for the introduction to Dr. Mirkin - I hadn't "met" him before your post.

When I signed up for his free email newsletter, he sent a link to a free e-book (pdf), "Dr. Gabe Mirkin's Pocket Guide to Fitness and Sports," with chapters about Fitness Basics, Serious Competition, Strength Training for Everyone, Injuries and Problems, Eat to Compete, Performance Enhancers, and "It's Never Too Late" (my favorite). I read half the book last night - it's filled with excellent advice that's simple, easy-to-understand, and medically sound.

I learned a little more about Dr. Mirkin when I read "About the Author" in his book. He ran his first marathon in 1954! In the 1960s, he was among the first to host long distance races for women, children and older people.

AND he hosted the first Road Runners Club of America National Championship for women at a time when * women were threatened with a life-time ban from Amateur Athletic Competition if they ran in races of more than 1.5 miles.* (Who knew?)

He founded the Run for Your Life program for fitness runners. He was the medical editor for three running journals.

Dr Mirkin has made a huge difference in the lives of thousands of people, most of whom will never meet him in person or be able to thank him. Thanks for introducing him to your readers!

[Penny]

I LOVE that "where do you get your protein" cartoon! It's happened so many times and again just last week. I chuckle whenever I think of it.