June 11, 2012 · 2:00 AM

Evidence in Favor of HIIT

Tabata’s team used stationary bicycles

I ran across this recent scientific review article on HIIT (high-intensity interval training) and thought you might be interested. Looks like it’s slated for publication in The Journal of Physiology.

I’m interested in HIIT as a means to achieve fitness in much less time than the 150 minutes a week of exercise recommended by various public health authorities.  I don’t like to exercise, so I’m searching for a program with substantial benefits at only 60-90 minutes a week!  Can I get a “Amen!”?

Why didn’t the authors at least mention the oft-cited and apparently pioneering work of Izumi Tabata et al from 1996?

Steve Parker, M.D.

References:

Gibala et al. Adaptations to low-volume, high-intensity interval training (preliminary draft). Journal of Physiology, doi: 10.1113/jphysiol.2011.224725

Tabata, I., et al. Effects of moderate-intensity endurance and high-intensity intermittent training on anaerobic capacity and VO2max. Medicine and Science in Sports and Medicine, 1996 Oct;28(10):1327-30.

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June 9, 2012 · 7:20 AM

Denise Minger on the Purported Cherry-Picker Ancel Keys

Keys lived his last years in Pioppi, Italy, not near the Tower of Pisa

Here’s her take on Ancel Keys, the father of cardiovascular epidemiology and the what we now consider the healthy Mediterranean diet. She is funny. Warning: Her post is only for serious nutrition science geeks.

Too bad he’s not alive to defend himself. He died young, almost reaching 101.  Check out his New York Times obituary.

Steve Parker, M.D.

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June 4, 2012 · 9:04 AM

What Everybody Ought to Know About Exercise’ Effect on Weight

  • Your genetics largely determines your response to an exercise program
  • Physical activity isn’t a great way to lose weight
  • School-based or other programs to increase childhood physical activity probably won’t reverse childhood obesity statistics
  • Disregarding weight loss, exercise has other worthwhile metabolic advantages
  • Highly advanced societies shouldn’t blame our overweight problem on decreased levels of physical activity

Skyler Tanner slaughters some sacred cows in his blog post June 4, 2012. I pulled these bullet points from his post. Click on his embedded links for details.

Steve Parker, M.D.

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June 3, 2012 · 12:54 PM

A Little Known Way to Reduce Your Stroke Risk Starting Today

Older adults with high olive oil consumption have a lower risk of stroke, according to French investigators.

Caprese salad: mozzarella cheese, basil, tomatoes, extra virgin olive oil

The Mediterranean diet, rich in olive oil, has long been linked to lower rates of stroke.  French researchers wondered if that might be related to higher olive oil consumption.  Triglyceride esters of oleic acid comprise the majority of olive oil, and oleic acid blood levels reflect olive oil consumption.

Have you heard of monounsaturated fatty acids?  Oleic acid is one.

Methodology

Over 7,000 older adults without history of stroke were surveyed with regards to olive oil consumption.  Oleic acid plasma levels were measured in over a thousand of the study participants.  Over the course of five years, 175 strokes occurred.

Compared with those who never used olive oil, those with the highest consumption had a 41% lower risk of stroke.  The researchers made adjustments for other dietary variables, age, physical activity, and body mass index.

In looking at the plasma oleic acid levels, those in the highest third of levels had 73% lower risk of stroke compared to those in the lowest third.

Comments

Results suggest that the olive oil in the Mediterranean diet  may help explain the diet’s protection against stroke.  The researchers didn’t suggest an amount of olive oil that would reduce stroke risk.  I suggest at least one or two tablespoons (15–30 ml) a day, on average.  Olive oil is a key component of the Low-Carb Mediterranean Diet and Advanced Mediterranean Diet.

Steve Parker, M.D.

Reference:  Samieri, C. et al.  Olive oil consumption, plasma oleic acid, and stroke incidence: the Three-City Study.  Neurology, Published online before print June 15, 2011, doi: 10.1212/WNL.0b013e318220abeb

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May 31, 2012 · 4:09 PM

Pioglitazone and Bladder Cancer

MedPage Today reports that another study links pioglitazone with bladder cancer in the U.K.  I’m not sure how the U.S. Food and Drug Administration will react to this.

We have 11 classes of drugs for treatment of diabetes.  Thiazolidinediones, aka glitazones or TZDs, are one class.  Pioglitazone and rosiglitazone are the only two drugs in the class, at least in the U.S.  Rosiglitazone is already highly restricted due to concern about heart toxicity.

This latest news confirms my inclination to treat type 2 diabetes with weight management, exercise, and a low-carbohydrate diet, when able.

Steve Parker, M.D.

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May 31, 2012 · 9:17 AM

Diabetes Blogger Jenny Ruhl Questioning Her Use of Facebook

Details here.

-Steve

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May 30, 2012 · 6:20 PM

TV’s Biggest Loser Plan Improves Diabetes and Prediabetes

TV’s “The Biggest Loser” weight-loss program works great for overweight diabetics and pre diabetics, according to an article May 30, 2012, in MedPage Today.  Some quotes:

For example, one man with a hemoglobin A1c (HbA1c) of 9.1, a body mass index (BMI) of 51, and who needed six insulin injections a day as well as other multiple prescriptions was off all medication by week 3, said Robert Huizenga, MD, the medical advisor for the TV show.

In addition, the mean percentage of weight loss of the 35 contestants in the study was 3.7% at week 1, 14.3% at week 5, and 31.9% at week 24…

The exercise regimen for those appearing on “The Biggest Loser” comprised about 4 hours of daily exercise: 1 hour of intense resistance training, 1 hour of intense aerobics, and 2 hours of moderate aerobics.

Caloric intake was at least 70% of the estimated resting daily energy expenditure, Huizenga said.

At the end of the program, participants are told to exercise for 90 minutes a day for the rest of their lives. Huizenga said he is often told by those listening to him that a daily 90-minute exercise regimen is impossible because everyone has such busy lives.

“I have a job and I work out from 90 to 100 minutes per day,” he said. “It’s about setting priorities. Time is not the issue; priorities are the issue.”

Of the 35 participants in this study, 12 had prediabetes and six had diabetes.  This is a small pilot study, then.  I bet the results would be reproducible on a larger scale IF all conditions of the TV program are in place.  Of course, that’s not very realistic.  A chance to win $250,000 (USD) is strong motivation for lifestyle change.

Steve Parker, M.D.

PS: Although not mentioned in the article, these must have been type 2 diabetics, not type 1.

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May 29, 2012 · 11:09 PM

Diabetes Plus Bulimia Equals Diabulimia

MedPage Today has a brief article on “diabulimia,” a disorder in type 1 diabetics who withhold insulin in order to lose weight.

After following the women for 11 years, the researchers found that those who restricted insulin had increased rates of diabetes complications, shortened lifespan, and increased mortality risk.

Factors that were associated with insulin restriction included greater eating disorder symptoms, diabetes-specific distress, overall psychological symptoms, and fear of hypoglycemia at baseline.

Diabulimics believe the theory that insulin is a major fat-storage hormone.  Furthermore, the high blood sugar levels resulting from inadequate insulin dosing lead to loss of calories (sugar) via urine.

Steve Parker, M.D.

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May 29, 2012 · 6:45 AM

Hot Off the Press: New ADA Hyperglycemia Management Guidelines

I’ll get to the following article when time allows.  It’s in a June, 2012, issue of Diabetes Care.  (Didn’t they publish management principles just six months ago?  Jeez.)

Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach:  Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

-Steve

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May 28, 2012 · 2:00 AM

Do Calcium Supplements Cause Heart Attacks?

A new European study suggests that calcium supplements almost double the risk of having a heart attack, at least in Germans.  You can read the full report in the current issue of Heart.

The medical literature on this issue is a confusing mess.  In other words, lots of conflicting results.

Huge numbers of women in the U.S. are taking calcium supplements either to treat or prevent osteoporosis and the associated broken bones (e.g., hips, wrists, spine).

What I’d like to know, and what nobody knows, is what is the effect of calcium supplementation on average longevity and quality of life.  Maybe I’d accept a higher risk of heart attack if calcium supplementation prolonged lifespan by two years.

In the interest of brevity, I’ll just say that the best way to get your calcium is probably through food rather than supplements.

Shereen Jegtvig has an article at About.com listing foods rich in calcium.

Exercise can also help keep your bones strong and break-resistant.

Steve Parker, M.D.

PS: If your doctor has you on a calcium supplement, you’d best get his blessing before you stop it.

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