Lifestyle better than drugs for long term prevention of Type 2 diabetes

CBC Second Opinion, November 2018

When I talk about exercise being the solution to just about everything, I see some people roll their eyes but it turns out to be very true. Given the wide range of health problems that come with diabetes, this fact is especially pertinent to those suffering from or at risk of this disease. Here’s the latest:

‘Even for people at high risk, it is possible to stop the diabetic disease progression. Sometimes a medication is prescribed. Most often people are encouraged to lose weight and become more active. Which method lasts longer?

Dr. Sonya Haw, an endocrinologist at Emory University in Atlanta, wanted to find out.

She analyzed a series of clinical trials investigating ways to prevent diabetes in high-risk populations — people who are considered pre-diabetic based on measurements of blood glucose levels.

Without intervention more than 50 per cent of those people would be expected to develop diabetes within three years.

Haw’s conclusions? In clinical trials that tested drugs for diabetes prevention, the effects were short term.

“With medications, when you stop the effect goes away right away.,” she told CBC News.

But intensive diet and exercise kept diabetes at bay for years.

“It should be encouraging for people who are pre-diabetic to see that if they are very diligent about lifestyle changes — exercise and healthy diet, which are the two biggest components of lifestyle modification — that they can prevent diabetes, and continue to prevent diabetes for a fairly significant amount of time.”

The study is also further proof that diabetes can be prevented even in high-risk people.

“If individuals in this high-risk group continue to do the 150 minutes of physical exercise a week, and continue to eat a low-calorie, low-carb diet, and continue those efforts long term they may be able to continue to prevent progression to diabetes.”

The study also confirmed that losing even a small amount of weight helps prevent diabetes.

“Even just one kilogram of weight loss was associated with reduced diabetes risk,” Haw said.’

No More Excuses – Research Confirms You Can Get Fit Fast

Since the 70s, but more convincingly since the 90s, research has been accumulating to confirm that workouts that involve short bursts of any activity that gets your heart rate up are actually more effective than long cardio workouts. And I mean really short – like 20 seconds!

The latest research is collected in a 2017 book by a Canadian scientist, Dr. Martin Gibala, called The One Minute Workout. I’d highly recommend you read it. Research study after study has proven that going hard, then slower, then hard again and repeating that pattern at least 4 times, 2-3 x per week, will provide an equal or even greater level of cardiovascular fitness than the equivalent number of much longer workouts.

In my training to date, I have been careful with intervals because many of my clients are seniors and not ready (yet!) to go “all out”. There are workouts in this book that can be adapted for that population, as well as for those who have suffered heart attacks and other serious illnesses.

Another reason I have not aggressively pushed intervals is that it is hard to believe a 10 minute cardio workout can provide as much benefit as a 30 minute run. But I was wrong. That doesn’t mean I’m going to cut back on my own running, but it does mean that if I don’t have time to get in my usual 35 minute run/walk, I will definitely do a short interval workout.

So if you are on my client list, be prepared to hear me start raving about intervals!


No Time to Work Out? No Excuse!

2017 CBC Second Opinion

Having trouble getting in a workout these days? Well all you need is 10 minutes and a set of stairs, according to researchers at McMaster University. They tested two different workout routines on 31 inactive but otherwise healthy women. For the first you need a staircase long enough to climb straight up for 20 seconds. For the second, any staircase will work for 60 seconds going up and down – the perfect home workout. Each needs to be repeated three times, with rest in between. After completing the workout three times a week over six weeks, both routines resulted in improvements in cardiorespiratory fitness similar to that experienced by doing intervals on a stationary bike.

Exercise May Cut Your Risk of 13 Types of Cancer

Tufts Health and Wellness Letter, September 2016

Greater activity linked to lower odds of three of the most common cancers.

Need fresh motivation to lace up those walking shoes? A study of 1.44 million adults reports that physical activity is associated with lower risk of 13 types of cancer, including three of the four most common – breast, colon and lung cancer. Generally, meeting the recommended 150 minutes a week for moderate exercise, such as walking, or 75 minutes a week of vigorous activity, was associated with lower risk. But people who exercised more were found to have even lower risk.

“Minimizing your risk of many types of cancer, including several of the most common, yet again gives us all a great reason to strive to obtain the weekly recommendation for moderate-to-vigorous activity,” says Jennifer M. Sacheck, PhD, an associate professor in Tufts’ Friedman School who specializes in studying physical activity. “Importantly, these effects were found to be independent of several key dietary factors.”

COMBINED DATA: The study from the National Cancer Institute, published in JAMA Internal Medicine, pooled data from a dozen US and European studies on adults ranging from age 19 to 98. The findings relied on self-reported physical activity and can’t prove cause and effect, however.

The link between greater leisure-time physical activity and lower cancer incidence largely held even when smoking history and obesity were factored in. The lower risk was most significant for esophageal cancer – 42% – which researchers noted as important because such tumors are particularly deadly. Greater levels of physical activity were associated with a 10% lower risk for breast cancer, 16% for colon cancer, and 26% for lung cancer. Other cancers less likely among those exercising more were leukemia, myeloma and cancers of the liver, kidney, stomach, endometrium, rectum, bladder, and head/neck.

Two types were actually more common among the most physically active – melanoma and slow-growing prostate tumors. (Prostate cancer is the third most common type.) Researchers suggested this might be because people who exercise get more frequent checkups and thus are more likely to be diagnosed. They also spend more time in the sun, increasing skin-cancer risk.

MECHANISMS: It’s not certain how physical activity might help protect against cancer. Lead author Steven Moore, PhD, said exercise might cause beneficial changes in hormone levels, inflammation levels, digestion and overall energy balance.

The connection between excess weight and cancer was clear in the study, but the news was positive even for those who have a hard time losing weight: Overweight and obese participants who exercised were much less likely to develop most cancers than their sedentary peers.

TO LEARN MORE: JAMA Internal Medicine, June 2016

How Much Exercise is Enough?

Tufts Health and Nutrition Letter, April 2016

This is a question I am often asked. The answer changes by the year, but consistently comes down to “more is better” – without overdoing it.

Nobody questions the health benefits of even just a little exercise, but you may wonder about what might be called the “Goldilocks” question: How much physical activity is “just right”? And is it possible to get too much or to overdo the intensity? Two large new studies, both published in JAMA Internal Medicine, attempt to answer such questions and identify the “sweet spot” of the ideal amount of exercise.

Miriam E. Nelson, PhD, associate dean of the Tisch College and a professor in Tufts’ Friedman School, author of the “Strong Women” series of books, served as vice-chair of the committee for the US government’s first-ever Physical Activity Guidelines for Americans in 2008. Those guidelines call for at least:

– 150 minutes per week of moderate activity OR
– 75 minutes per week of vigorous activity OR
– Some equivalent combination.

Says Nelson, “This amount is the base level to promote health; greater improvements in health will come with more activity.”

MORE IS MOSTLY BETTER: The first new study compared adherence to these guidelines with data combined from six National Cancer Institute studies totaling 661,137 men and women, average age 62 years, who were followed for an average of 14.2 years. During that time, 116,686 participants died.

As expected, engaging in any leisure-time physical activity was better than being sedentary; in fact, the biggest relative benefits were associated with just getting moving. Those who reported some activity – but less than recommended levels – saw a 20% lower mortality risk than those with zero activity. Meeting the minimum guidelines, up to twice as much exercise (the equivalent of 300 minutes weekly of moderate activity), was associated with 31% less mortality.

Risk continued to drop with ever-increasing activity levels: 37% lower at two to three times the minimum guidelines and 39% lower at three to five times. But at that point – the equivalent of 450 to 750 minutes of moderate weekly activity – the association plateaued. There was no additional mortality benefit for even more exercise, but neither were there any negative associations.

Similar relationships were observed for mortality due to cardiovascular disease and to cancer.

Researchers concluded, “Health care professionals should encourage inactive adults to perform leisure time physical activity and do not need to discourage adults who already participate in high activity levels.”

GETTING VIGOROUS: The accompanying study countered suggestions from other recent research that overdoing exercise, with frequent, strenuous workouts, might actually contribute to mortality risk. Australian scientists examined data on 204,542 adults, ages 45 through 76, who were followed for an average 6.5 years; 7,435 deaths were recorded.

Adding a little vigorous activity to a regimen of moderate exercise was linked to a lower risk of dying. Compared to those reporting only moderate exercise, those who spent up to 30% of their workout minutes exercising vigorously were at 9% lower mortality risk. Boosting the vigorous activity to more than 30% of workout time was associated with a 13% lower mortality risk. Nor was there any excess risk associated with even the greatest amounts of intense physical activity.

Researcher Klaus Gebel, PhD, of James Cook University, said the findings show that anyone who is physically capable should try to “reach at least 150 minutes of physical activity per week and have around 20 to 30 minutes of that be vigorous activity.” If you’re up for even more, there’s no apparent downside.

The Risks of NOT going meatless

Not that I’m suggesting we all become vegetarians – I’m not giving up my fish and chicken –  but just a reminder that there are benefits to a diet full of fruits and vegetables. Sue

Mayo Clinic Health Letter, October 2015

When people think of drastically reducing or even eliminating meat and other animal products from their diet, their first thought is often: “What are the nutritional risks?”

I suggest that this question be flipped around. It’s really more valid to ask: “What are the risks of continuing to eat meat?”

Foods that come from animals — including meat, poultry (especially with the skin) and dairy products containing fat — are generally high in calories. Consuming them can make it harder to lose weight or maintain a healthy weight. In addition, these foods are generally high in saturated fat and cholesterol, which are key contributors to your risk of heart attack, stroke and other diseases related to artery health.

In contrast, the risks of going without eating animal products are easily manageable, as you can read in our April 2010 Health Tips article “Going without meat.” Most important, the nutritional risks of going meatless pale in comparison with the potential benefits of a well-balanced, plant-based diet.

But what about getting enough protein? It’s a common concern, but in reality, most people eat much more protein than they need. So, as long as you consume enough calories and eat a wide variety of plant-based foods, you will get enough protein — even if you consume no animal-based products.

Another common concern is getting enough iron. Studies have shown that those who don’t eat meat have slightly lower iron stores than do those who eat meat. However, it’s not clear if this is a problem — and it may even be a good thing. Regardless, those who don’t eat meat have no greater prevalence of iron deficiency (anemia) than do meat-eaters.

As mentioned in the article, the only true nutritional issues for those who consume no animal-based products are getting enough vitamin B-12 and calcium. And these potential deficiencies can easily be remedied with fortified foods or supplements.

The bottom line is that drastically reducing or even eliminating animal-based foods is healthier, not more risky!


Staying Highly Fit Slows Signs of Aging

Tufts has recently put out a number of articles on the benefits of keeping active, such as “Brief Walks May Counter Health Risks of Too Much Sitting (October 2015)”, and “Take a Hike to Lower your Risk of Stroke (May 2015)” but I thought this December item sums it all up really well.

Tufts Health & Nutrition Letter, December 2015

Older people who are highly fit, such as recreational cyclists, are physiologically more similar to young people than to more sedentary seniors. That’s the conclusion of a new British study that sought to explore the effect of physical activity on key indicators of aging. As one scientist put it, “Being physically active makes your body function on the inside more like a young person’s.”

Published in The Journal of Physiology, the study recruited 85 men and 41 women, ages 55 to 79, who were serious recreational cyclists. Participants were put through a battery of physical and cognitive tests, with results compared against standard benchmarks of normal aging. On most of the tests, the highly fit cyclists performed more like young adults. Even participants in their 70s scored decades “younger” in metabolic health, balance, memory and reflexes.

Roger A. Fielding, PhD, director of Tufts’ HNRCA Nutrition, Exercise, Physiology and Sarcopenia Laboratory, comments, “We have known for a long time that regular exercise can reverse some of the age-related declines in aerobic fitness and muscle strength, and preserve physical functioning. This study reinforces this concept and highlights that lifelong regular exercise can sustain these improvements.”

Typical of the cyclists’ youthful performance were their scores on a standard test called Timed Up and Go. The test times how long it takes someone to stand up from a chair without using his arms, briskly walk 10 feet, turn, walk back and sit down again. Older adults considered on the edge of frailty might take 9 or 10 seconds to perform the test, while a typical score for a healthy senior is 7 seconds. But even the oldest cyclists in the study whipped through the test in an average of 5 seconds – “well within the norm reported for healthy young adults.”

Fitness couldn’t slow the aging clock for every physiological measure, however. Compared to cyclists in their 50s and early 60s, participants in their 70s had lower overall aerobic capacity and less muscle mass and muscular power. But those scores were still better than what would be viewed as average for their age.

Protein Plus Exercise Equals Less Muscle Loss with Aging

Tufts Health and Nutrition Letter, June 2015

Good reminder for us to keep track of the protein you’re eating if we want to continue to build muscle. 

“Most Americans get plenty of protein – in fact, their problem isn’t too little protein but too much of the calories and saturated fat that accompany such popular protein sources as cheeseburgers or fried chicken. But people over age 50 might need to pay attention to getting adequate protein, not just at dinner time but throughout the day. Tufts researchers are finding that a steady intake of protein from healthy sources, combined with aerobic activity and weight-training exercises, can help counter the loss of muscle mass often associated with aging.

“It’s estimated that 20% of people between the ages of 51 and 70 have an inadequate protein intake,” says Paul Jacques, DSc, director of Tufts’ HNRCA Nutritional Epidemiology Program.

In research published in the British Journal of Nutrition, Jacques and Martha Savaria Morris, PhD, looked at the combination of protein intake and physical activity in 2,425 people over age 50 during a four-year period. The Tufts scientists studied measures of skeletal muscle mass, protein intake, and exercise patterns in both obese and non-obese subjects. To get the most out of exercise, the study found, participants also had to be consuming enough protein. In fact, people who did muscle-strengthening exercises without protein intake of at least 70 grams daily actually had lower muscle mass.

UNDERSTANDING SARCOPENIA: “Low muscle mass is a cause of poor muscle strength,” Morris explains. “One risk is the inability to carry out activities of daily living and, consequently, a lack of independence. Another risk is falls, which often result in serious injury among older adults.”

The gradual loss of lean muscle mass that can occur with aging is called sarcopenia, a term coined by Health & Nutrition Letter Editor Irwin H. Rosenberg, MD, and fellow Tufts scientist William Evans, PhD. Skeletal muscles reach peak mass by the third decade of life, and with each subsequent decade muscle fibers decrease in size and number. This process speeds up in the later years of life; by age 80, up to 30% of muscle bulk may be lost. Sarcopenia affects 15% of people older than age 65, and 50% of people older than age 80.

Since protein is the building block for muscle tissue, it makes sense that adequate protein intake is important to preventing sarcopenia. The NIH-sponsored Health, Aging and Body Composition Study, published in 2008, compared dietary protein intake with lean muscle mass in 2,066 men and women, ages 70 to 79. Over three years, participants consuming the highest amount of protein (an average 91 grams daily) lost 40% less lean muscle mass than those in the bottom one-fifth of protein intake (average 57 grams a day). Researchers concluded, “Dietary protein may be a modifiable risk factor for sarcopenia in older adults and should be studied further.”

PROTEIN MATH: How much protein do you need? The Daily Value (DV) used on Nutrition Facts panel percentages is 50 grams, but your requirements might be quite different. “It depends on your body weight – 0.8 grams of protein per 2.2 pounds,” Morris explains. “The range is between 40 and 70 grams per day. For example, a 125-pound woman would need 46 grams of protein per day, while a 175-pound man would need 64 grams per day.”

Other Tufts studies have shown that exercise increases your body’s need for protein. Athletes need at least 0.9 grams of protein per kilogram of body weight per day – and maybe as much as 1.3 grams. And a 2005 review of the evidence concluded that older adults engaged in resistance training need 1.0 to 1.3 grams of protein per kilogram of body weight per day (4.5 to 5.9 grams per 10 pounds).

You may also want to spread your protein consumption through the day, rather than concentrating it at dinner time; changing body chemistry means older adults benefit from a more even distribution of protein intake. Some experts recommend that seniors consume 25 to 30 grams of high-quality protein with each meal to maximize the body’s synthesis of muscle protein. That’s a lot more protein than you’ll get from a typical breakfast of cereal and juice, which delivers only about eight grams. Consider adding an egg, low-fat cottage cheese, whole-wheat toast, meatless breakfast sausage or even fish to your breakfast to make sure your body has plenty of protein to start the day.

The bottom line, says Morris, is: “Muscle mass won’t maintain itself without your help. Exercise as vigorously as your body, your doctor and your physical therapist will allow. Begin at mild levels and work up to moderate and vigorous activities. Make sure your diet includes an adequate amount of high-quality protein. It may take a combination of all three to avoid losing muscle mass as you age.”