Wednesday, August 24, 2016

The Effect of Regular Exercise on Insulin Sensitivity in Type 2 Diabetes Mellitus



Diabetes Metab J. 2016 Aug 2. [Epub ahead of print]
The Effect of Regular Exercise on Insulin Sensitivity in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis.

Way KL1,2,3, Hackett DA1, Baker MK4,5, Johnson NA1,2,6.

Author information

1University of Sydney Faculty of Health Sciences, Lidcombe, Australia.
2Charles Perkins Centre, University of Sydney, Camperdown, Australia.
3Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Sydney Medical School University of Sydney, Camperdown, Australia.
4Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Sydney Medical School University of Sydney, Camperdown, Australia.

5Australian Catholic University School of Exercise Science, Strathfield, Australia.
6Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Sydney Medical School University of Sydney, Camperdown, Australia.


The purpose of this study was to examine the effect of regular exercise training on insulin sensitivity in adults with type 2 diabetes mellitus (T2DM) using the pooled data available from randomised controlled trials. In addition, we sought to determine whether short-term periods of physical inactivity diminish the exercise-induced improvement in insulin sensitivity.

Eligible trials included exercise interventions that involved ≥3 exercise sessions, and reported a dynamic measurement of insulin sensitivity. There was a significant pooled effect size (ES) for the effect of exercise on insulin sensitivity (ES, -0.588; 95% confidence interval [CI], -0.816 to -0.359; P<0.001). Of the 14 studies included for meta-analyses, nine studies reported the time of data collection from the last exercise bout. There was a significant improvement in insulin sensitivity in favour of exercise versus control between 48 and 72 hours after exercise (ES, -0.702; 95% CI, -1.392 to -0.012; P=0.046); and this persisted when insulin sensitivity was measured more than 72 hours after the last exercise session (ES, -0.890; 95% CI, -1.675 to -0.105; P=0.026).

Regular exercise has a significant benefit on insulin sensitivity in adults with T2DM and this may persist beyond 72 hours after the last exercise session.


Diet and Back Pain: What’s the Link?


Newswise — Can a diet high in processed fat and sugar and Type 2 diabetes cause degeneration of intervertebral discs in the spine? If so, what is happening, and can it be prevented? As part of an ongoing collaboration between Rensselaer Polytechnic Institute and the Icahn School of Medicine at Mount Sinai – a partnership that draws upon the expertise of both schools to address significant health problems – researchers hope to answer those questions by investigating the link between diet, obesity-linked Type 2 diabetes, and intervertebral disc degeneration.

Researchers on the project suspect the diet associated with Type 2 diabetes – one high in processed fats and sugars – causes inflammation and modification of disc tissue, triggering a chain of responses, which leads to degeneration. To test this hypothesis, the researchers have set three goals: to establish whether mice fed a diet associated with Type 2 diabetes will develop intervertebral disc degeneration (IDD), isolate the effect of diet causing changes in the tissue, and evaluate how the diet modifies proteins within the disc.

The project is supported by a $3.3 million grant from the National Institutes of Health and is led by Dr. James Iatridis, a professor and vice chair for research in the orthopaedics department at the Icahn School of Medicine.

“Back pain caused by spinal disc degeneration is the number one cause of global disability, so it’s a hugely important problem that needs to be addressed,” said Dr. Iatridis, who has long specialized in spinal disc degeneration.

Deepak Vashishth, a professor of biomedical engineering and the Rensselaer lead on the project, said the partnership makes it possible to tackle a project of this complexity.

“We’re trying to establish the mechanism whereby this diet, and Type 2 diabetes, leads to disc degeneration, and that’s not an easy thing to do because, within the body, various processes are linked and feedback loops are difficult to unravel,” said Vashishth, who is also the director of the Center for Biotechnology and Interdisciplinary Studies. “To investigate this question, you need the mix of experts from different disciplines with different skill sets that the partnership allows.”
At the core of the research project are the effects of advanced glycation endproducts (AGE) – proteins or lipids that have become coated in sugars, which damage their function. Research suggests that a diet high in heat-processed foods, including fried foods, plays a role in AGE formation. Research also indicates the accumulation of AGEs causes structural deterioration, increases inflammation that could lead to disc degeneration, and contributes to a host of degenerative diseases such as diabetes, atherosclerosis, and Alzheimer’s.

In the first part of the project, researchers at Mount Sinai will raise mice – both regular mice and so-called “knock-out” mice that have been genetically modified to reduce the ability of their cells to bind to AGEs – on a diet of foods high in AGEs, accelerating AGE accumulation in the mice, and observing whether the mice develop the various of health conditions associated with Type 2 diabetes, including disc degeneration. This part of the research helps establish the systemic effects of AGEs on the body.

To separate the systemic effects AGEs may have on the body from local effects in specific tissues, researchers will also look at spinal bone and disc tissue in vitro. In that research, bone and disc tissue from both normal and AGE “knock-out” mice fed on a regular diet will be bathed in a high AGE medium, accelerating the exposure of these specific tissues to AGEs. Selected tissue samples will be exposed to a drug that may be able to block AGEs in disc tissue, limiting exposure to bone and disc tissue. In all samples, the researchers will look at changes in indicators of disc and bone health such as the activity of proinflammatory cytokines and AGE formation over time. This research will separate the relative contribution of AGEs to tissue degeneration from systemic damage that may occur as a result of Type 2 diabetes-associated hyperglycemia.

Tuesday, August 23, 2016

Men with More Muscle Do Not Need More Protein



Newswise — Sports nutrition recommendations may undergo a significant shift after research from the University of Stirling has found individuals with more muscle mass do not need more protein after resistance exercise.

Health and exercise scientists from Scotland’s University for Sporting Excellence found no difference in the muscle growth response to protein after a full body workout between larger and smaller participants.

Kevin Tipton, Professor of Sport, Health and Exercise Science in the Faculty of Health Sciences and Sport, said: “There is a widely-held assumption that larger athletes need more protein, with nutrition recommendations often given in direct relation to body mass.

“In our study, participants completed a bout of whole-body resistance exercise, where earlier studies — on which protein recommendations are based — examined the response to leg-only exercise. This difference suggests the amount of muscle worked in a single session has a bigger impact on the amount of protein needed afterwards, than the amount of muscle in the body.”
Experts also found participants’ muscles were able to grow and recover from exercise better after a higher dose of protein.

Consuming 40 grams of protein after exercise was more effective at stimulating muscle growth than 20 grams. This increase occurred irrespective of the size of the participants.
Professor Tipton continued: “Until now the consensus among leading sports nutritionists, including the American College of Sports Medicine and the British Nutrition Foundation, is that weightlifters do not need more than around 25 grams of protein after exercise to maximally stimulate the muscle’s ability to grow.

“In order for nutritionists to recommend the correct amount of protein we first need to consider specific demands of the workout, regardless of athletes’ size. This throws commonly held recommendations into question and suggests the amount of protein our muscles need after exercise may be dependent on the type of workout performed. These results are limited to younger, trained men so we may see different results with other groups, such as older individuals or females digesting different amounts of protein.”

Young, resistance-trained males were recruited for the study and divided into two groups, one with lower lean body mass of less than 65 kilograms and one with higher lean body mass of more than 70 kilograms.

Each volunteer participated in two trials where they consumed protein after resistance exercise. In one trial participants consumed 20 grams of whey protein and in the second, they consumed 40 grams of whey protein after exercise. Scientists measured the muscle’s ability to grow at an increased rate with metabolic tracers and muscle biopsies.

Monday, August 22, 2016

Swimming is an effective part of the treatment for fibromyalgia



A study performed by researchers at the Federal University of São Paulo (UNIFESP) shows swimming is as effective as walking to relieve pain and improve quality of life for patients with fibromyalgia.

“Physical exercise is an essential component of any treatment for fibromyalgia, and plenty of studies have demonstrated that low-impact aerobic exercise offers the most benefits. However, not everyone likes or is able to do the same kind of physical activity, so our group decided to test alternatives,” said Jamil Natour, a professor of rheumatology at UNIFESP.

In an article published in 2003, Natour’s team showed that walking was better than stretching not only to reduce pain but also to improve depression and other emotional aspects of patients with fibromyalgia, in addition to enhancing cardiorespiratory fitness, as expected. A study performed by the group in 2006 showed that deep-water running was also a good option for treatment of the disease.

“Swimming hadn’t been evaluated with proper scientific rigor. The results of this clinical trial showed swimming was as beneficial as walking, whose positive effects have clearly been demonstrated. Swimming can be a preferable option for a person who suffers from both fibromyalgia and knee arthrosis, for example,” Natour said.

The study involved 75 sedentary women aged between 18 and 60 years who had fibromyalgia. They were divided randomly into two groups: 39 practiced freestyle swimming and 36 undertook moderate open-air walking. Both groups underwent the training three times a week for 12 weeks. The 50-minute sessions were overseen by physical education professionals specializing in rheumatology.
The volunteers were evaluated according to several parameters both before and after the 12-week training period. Pain intensity, for example, was evaluated using a visual scale ranging from 0 cm (no pain) to 10 cm (unbearable pain). Individuals chose the appropriate number to classify the pain experienced at the time of the evaluation.

Pain intensity fell from 6.2 to 3.6 on average in the walking group and from 6.4 to 3.1 in the swimming group. According to Natour, a decrease of at least 2 on the pain scale is considered clinically significant.

Quality of life was assessed using two clinically validated questionnaires. One was specific to people with fibromyalgia (Fibromyalgia Impact Questionnaire). The other was the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), suitable for the general public.

Statistically significant improvements were found for all SF-36 subscales in both groups. In social interaction, for example, the average rose from 56 to 80 in the swimming group and from 52 to 72 in the walking group. In mental health, the swimming group improved from 55.7 to 68, and the walking group from 51.1 to 66.8. These scales all range from 0 to 100, with rising scores pointing to improving quality of life.

Both groups improved an equivalent amount based on the Fibromyalgia Impact Questionnaire and on a spiroergometric test measuring peak oxygen uptake (VO2 max) and anaerobic threshold.
Natour said patients with fibromyalgia experience chronic diffuse non-inflammatory pain in the musculoskeletal system deriving from malfunctioning of the system that transmits and modulates the transmission of nervous stimuli between the periphery of the body and the brain.

“A prod or poke to a leg or arm may be interpreted as a painful stimulus by a patient with fibromyalgia,” he said. “In addition to magnified pain signals, the patient may experience spontaneous pain. Diffuse tenderness with no anatomical explanation lasting for at least three months is a defining feature of this disease.”

Fibromyalgia is about ten times more common in women than men, and it can be disabling. In addition to pain, people who suffer from the disease often also experience sleep disorders. Reduced levels of serotonin (a key neurotransmitter in mood regulation and pain sensitivity) are frequent, as well as alterations in the autonomic nervous system, which controls bodily functions such as heart rate, blood vessel contraction, sweating, salivary flow and intestinal movements. Taken together, all these symptoms strongly affect the quality of fibromyalgia patients’ lives.

“Many patients have no anatomic defects, not even arthrosis, but suffer from worse deterioration in the quality of their lives and functionality than people with joint disease,” Natour said. “Some studies have compared fibromyalgia with ankylosing spondylitis and rheumatoid arthritis, both of which are deforming joint disorders. Also, some 30% of people with fibromyalgia suffer from depression.”
Because it affects approximately 5% of women, fibromyalgia is a significant public health issue, according to Natour. “But, not being fatal, it isn’t very visible in government statistics,” he noted.
Specialists now agree that treatment should be multimodal, combining chronic pain medication and antidepressants with physical exercise and control of concomitant disorders that may also cause pain, such as arthrosis.


Vitamin D deficiency changes the intestinal microbiome reducing B vitamin production in the gut. The resulting lack of pantothenic acid adversely affects the immune system, producing a “pro-inflammatory” state associated with atherosclerosis and autoimmunity


Med Hypotheses. 2016 Sep;94:103-7. doi: 10.1016/j.mehy.2016.07.007. Epub 2016 Jul 14.
Vitamin D deficiency changes the intestinal microbiome reducing B vitamin production in the gut. The resulting lack of pantothenic acid adversely affects the immune system, producing a “pro-inflammatory” state associated with atherosclerosis and autoimmunity.

Gominak SC1.

Author information

11635 NE Fremont St., Portland, OR 97212, United States. Electronic address:



Vitamin D blood levels of 60-80ng/ml promote normal sleep. The present study was undertaken to explore why this beneficial effect waned after 2years as arthritic pain increased. Pantothenic acid becomes coenzyme A, a cofactor necessary for cortisol and acetylcholine production. 1950s experiments suggested a connection between pantothenic acid deficiency, autoimmune arthritis and insomnia. The B vitamins have been shown to have an intestinal bacterial source and a food source, suggesting that the normal intestinal microbiome may have always been the primary source of B vitamins. Review of the scientific literature shows that pantothenic acid does not have a natural food source, it is supplied by the normal intestinal bacteria. In order to test the hypothesis that vitamin D replacement slowly induced a secondary pantothenic acid deficiency, B100 (100mg of all B vitamins except 100mcg of B12 and biotin and 400mcg of folate) was added to vitamin D supplementation.


Vitamin D and B100 were recommended to over 1000 neurology patients. Sleep characteristics, pain levels, neurologic symptoms, and bowel complaints were recorded by the author at routine appointments.


Three months of vitamin D plus B100 resulted in improved sleep, reduced pain and unexpected resolution of bowel symptoms. These results suggest that the combination of vitamin D plus B100 creates an intestinal environment that favors the return of the four specific species, Actinobacteria, Bacteroidetes, Firmicutes and Proteobacteria that make up the normal human microbiome.


1) Seasonal fluctuations in vitamin D levels have normally produced changes in the intestinal microbiome that promoted weight gain in winter. Years of vitamin D deficiency, however, results in a permanently altered intestinal environment that no longer favors the “healthy foursome”.

2) Humans have always had a commensal relationship with their intestinal microbiome. We supplied them vitamin D, they supplied us B vitamins.

3) The four species that make up the normal microbiome are also commensal, each         excretes at least one B vitamin that the other three need but cannot make.

4) Improved sleep and more cellular repairs eventually depletes body stores of pantothenic acid, causing reduced cortisol production, increased arthritic pain and widespread “pro-inflammatory” effects on the immune system.

5) Pantothenic acid deficiency also decreases available acetylcholine, the neurotransmitter used by the parasympathetic nervous system. Unopposed, increased sympathetic tone then produces hypertension, tachycardia, atrial arrhythmias and a “hyper-adrenergic” state known to predispose to heart disease and stroke.


Former Abusers of Anabolic Androgenic Steroids Exhibit Decreased Testosterone Levels and Hypogonadal Symptoms Years after Cessation


PLoS One. 2016 Aug 17;11(8):e0161208. doi: 10.1371/journal.pone.0161208. eCollection 2016.

Former Abusers of Anabolic Androgenic Steroids Exhibit Decreased Testosterone Levels and Hypogonadal Symptoms Years after Cessation: A Case-Control Study.

Rasmussen JJ1, Selmer C1, Østergren PB2, Pedersen KB3, Schou M4, Gustafsson F5, Faber J1, Juul A6, Kistorp C1.

Author information

1Department of Internal Medicine, Copenhagen University Hospital, Herlev, Denmark.

2Department of Urology, Copenhagen University Hospital, Herlev, Denmark.
Department of Internal Medicine, Copenhagen University Hospital, Slagelse, Denmark.
4Department of Cardiology, Copenhagen University Hospitals, Herlev and Gentofte, Denmark.
5Department of Cardiology, the Heart Centre, Rigshospitalet, Copenhagen, Denmark.
6Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Denmark.



Abuse of anabolic androgenic steroids (AAS) is highly prevalent among male recreational athletes. The objective of this study was to investigate the impact of AAS abuse on reproductive hormone levels and symptoms suggestive of hypogonadism in current and former AAS abusers.


This study had a cross-sectional case-control design and involved 37 current AAS abusers, 33 former AAS abusers (mean (95%CI) elapsed duration since AAS cessation: 2.5 (1.7; 3.7) years) and 30 healthy control participants. All participants were aged 18-50 years and were involved in recreational strength training. Reproductive hormones (FSH, LH, testosterone, inhibin B and anti-Müllerian hormone (AMH)) were measured using morning blood samples. Symptoms of hypogonadism (depressive symptoms, fatigue, decreased libido and erectile dysfunction) were recorded systematically.


Former AAS abusers exhibited significantly lower median (25th -75th percentiles) total and free testosterone levels than control participants (total testosterone: 14.4 (11.9-17.7) nmol/l vs. 18.8 (16.6-22.0) nmol/l) (P < 0.01). Overall, 27.2% (13.3; 45.5) of former AAS abusers exhibited plasma total testosterone levels below the lower reference limit (12.1 nmol/l) whereas no control participants exhibited testosterone below this limit (P < 0.01). Gonadotropins were significantly suppressed, and inhibin B and AMH were significantly decreased in current AAS abusers compared with former AAS abusers and control participants (P < 0.01). The group of former AAS abusers had higher proportions of participants with depressive symptoms ((24.2%) (11.1; 42.2)), erectile dysfunction ((27.3%) (13.3; 45.6)) and decreased libido ((40.1%) (23.2; 57.0)) than the other two groups (trend analyses: P < 0.05).


Former AAS abusers exhibited significantly lower plasma testosterone levels and higher frequencies of symptoms suggestive of hypogonadism than healthy control participants years after AAS cessation. Current AAS abusers exhibited severely decreased AMH and inhibin B indicative of impaired spermatogenesis.


Low Physical Activity in Spain and Its Association with Diabetes and Other Cardiovascular Risk Factors


PLoS One. 2016 Aug 17;11(8):e0160959. doi: 10.1371/journal.pone.0160959. eCollection 2016.

Low Physical Activity and Its Association with Diabetes and Other Cardiovascular Risk Factors: A Nationwide, Population-Based Study.

Brugnara L1,2, Murillo S1,2, Novials A1,2, Rojo-Martínez G1,3, Soriguer F1,3, Goday A4, Calle-Pascual A5, Castaño L1,6, Gaztambide S1,6, Valdés S1,3, Franch J7, Castell C8, Vendrell J1,9, Casamitjana R1,2, Bosch-Comas A1,2, Bordiú E5, Carmena R1,10, Catalá M1,10, Delgado E11, Girbés J12, López-Alba A13, Martínez-Larrad MT1,14, Menéndez E11, Mora-Peces I15, Pascual-Manich G1,2, Serrano-Ríos M1,16, Gomis R1,2, Ortega E14,17.

Author information

1CIBERDEM-Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Madrid, Spain.
2IDIBAPS-August Pi i Sunyer Biomedical Research Institute / Hospital Clínic de Barcelona, Barcelona, Spain.
3Hospital Universitario Carlos Haya, Department of Endocrinology and Nutrition, Málaga, Spain.
4Hospital del Mar, Department of Endocrinology and Nutrition, Barcelona, Spain.
5Hospital Universitario San Carlos, Madrid, Spain.
6Hospital Universitario de Cruces, UPV-EHU, Diabetes Research Group, Baracaldo, Spain.
7EAP Raval Sud, Institut Català de la Salut, Red GEDAPS, IDIAP, Barcelona, Spain.
8Public Health Division, Autonomous Government of Catalonia, Barcelona, Spain.
9Department of Endocrinology and Nutrition, Hospital Universitario Joan XXIII, Tarragona, Spain.
10Department of Medicine and Endocrinology, Hospital Clínico Universitario de Valencia, Valencia, Spain.
11Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias, Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Oviedo, Spain.
12Hospital Arnau de Vilanova, Valencia, Spain.
13Fundación Hospital de Jove, Gijón, Spain.
14CIBEROBN-Spanish Biomedical Research Centre in Physiopathology of Obesity.
15Canarian Health Service, San Cristóbal de la Laguna, Tenerife, Spain.
16Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
17Department of Endocrinology and Nutrition, ICMDM, Hospital Clinic Barcelona.


Low physical activity (PA), or sedentary lifestyle, is associated with the development of several chronic diseases.

We aimed to investigate current prevalence of sedentariness and its association with diabetes and other cardiovascular risk factors.

PA was evaluated in a population-based, cross-sectional, randomly sampled study conducted in 2009-2010 in Spain.

International Physical Activity Questionnaire (SF-IPAQ) was used to assess PA. 4991 individuals (median age 50 years, 57% women) were studied.

Prevalence of sedentariness was 32.3% for men and 39% for women (p < 0.0001).
Sex differences were particularly notable (age*sex interaction, p = 0.0024) at early and older ages. Sedentary individuals had higher BMI (28 vs. 27 kg/m2) and obesity prevalence (37 vs. 26%).
Low PA was present in 44, 43, and 38% of individuals with known diabetes (KDM), prediabetes/unknown-diabetes (PREDM/UKDM), and normal glucose regulation (p = 0.0014), respectively.

No difference between KDM and PREDM/UKDM (p = 0.72) was found.

Variables independently associated (p < 0.05) with sedentariness were age, sex, BMI, central obesity, Mediterranean diet adherence, smoking habit, HDL-cholesterol, triglycerides and dyslipidemia.
Low PA is on the rise in Spain, especially among women.

Sedentariness is associated with several cardiovascular risk factors and may be responsible for the increasing prevalence of obesity and diabetes in this country.