Melatonin is a hormone that is secreted by the pineal gland in the skull. It is also available in many foods that include cherries, olives, walnuts and goji berries.
A Japanese study evaluated the amount of dietary melatonin reports that over a 16 year period, those who had higher dietary melatonin intakes had slightly lower mortality form cardiovascular and non-cardiovascular mortality.
American Journal of Epidemiology
My comment: We already know that cherries are beneficial for gout, that olives contain healthy fats, and that walnuts have useful Vitamin E. Here is another reason to eat them.
Exercise training for resistant hypertension
A small trial from Portugal reports that blood pressure can be reduced by a moderate intensity aerobic programme. The participants were supervised in 40 minute sessions three times a week. The systolic blood pressure dropped by 7 mm Hg and the diastolic by 5 mm Hg.
Journal of the American Association of Cardiology
Blood sugar control affects cardiovascular mortality across the whole spectrum
A follow up of 300,000 people in the UK Biobank Study shows, as we know, type two diabetes substantially increases the risk of atherosclerotic cardiovascular disease, chronic kidney disease and heart failure. The gradient of severity of these conditions exists on a gradient of risk from pre-diabetes to poorly controlled type two diabetes. This indicates that we should strive for normal blood sugars if we reasonably can.
Forever Strong: A new science based strategy for aging well by Dr Gabrielle Lyon.
I read this book when it came out in October 2023. It costs £16.99 from Amazon in paperback.
Dr Lyon has worked in psychiatry, geriatrics and nutrition. She thinks that over fatness is less of a problem to being under muscled when it comes to general health, ageing and efforts to live longer in better shape.
She advocates a high protein diet of no less than 100g of protein a day for all adults. This can be more depending on a person’s ideal lean body weight. It is also a lot higher for those who aim to build more muscle.
She offers three different eating regimes. The first is for longevity. For this she recommends higher protein meals for breakfast and dinner and a lighter protein snack at lunch time. Carbohydrates are generally restricted to the same number of grams as the protein spread over the day. These can be increased for those engaged in more than one hour’s vigorous exercise a day. Fat is eaten according to the remaining calories available to maintain weight.
For those wanting to lose weight, she recommends that protein is spread evenly over three meals a day. Carbohydrate should be no more than 30g per meal. Fat intake should be low as the aim is to cut back by 10-20% of maintenance calories daily. She thinks that it is crucial to prioritise dietary protein as this reduces muscle loss and improves satiety. Carbohydrates should be low sugar fruit and low starch vegetables in order to minimise calories and insulin response.
For those who want to gain weight, protein intake is higher and usually needs to be spread over 4 meals. Carbohydrate and fat can be increased as the aim is to exceed maintenance caloric intake. A well planned exercise regime needs to be undertaken and this will usually require a personal trainer at a gym.
The exercise regime offered is based at the beginner in the book but she offers different programmes from her website. I wasn’t able to find these when I looked but perhaps they are still undergoing development.
The book covers the science behind her nutritional advice, a discussion of the mental roadblocks that stop people taking control of their diet and exercise regimes, baseline measurements that will help you figure out what exactly you should be eating and some recipes.
I exercise daily and have been weight training since the age of 27. I also have been low carbing for 20 years. Did I learn anything? YES.
I’ve been making several big mistakes regarding my diet and exercise regime.
Firstly, although I eat about double the protein that I see my friends eating, this is still not likely to be high enough for optimal muscle gain.
Secondly, I really should be eating a lot more protein first thing in the morning so that dietary leucine levels come up to the threshold that prevents muscle breakdown and ensures the best use of protein in the body and for muscle development.
Thirdly, like a lot of low carbers my fat intake is very high, and I pile it on oblivious of the caloric intake.
Fourthly, I do indulge in the odd sugar /starch item and during weight loss efforts these would be better cut out entirely. Same for alcohol.
Fifthly, my weight training regime needs altered. I used to do alternate days resistance training and something else but various injuries and back pain led me to experiment with more stretching and back exercises and this led to a definite improvement in my chronic back pain. I have altered my regime again to add in more resistance work. Dr Lyon thinks that three times a week is best. I’ll see how this goes but at my age I need to consider the injuries and degenerative problems that accumulate.
Overall this is a very helpful book for those who seek the best of physical health and contains information that I was not previously aware of.
Q: Can you speak to the ability or inability to “cure” T2D? Does it have to do with the loss of the pancreatic beta cells?
A: Yes, it has generally been shown that new-onset type 2 diabetes is easier to “reverse,” meaning that blood glucose levels can be so well managed that it appears diabetes has been cured. Over time, a loss of some insulin-making capacity occurs in people with long-standing T2D, particularly if it has not been well-managed, related both to the impairment of pancreatic β-cell function and the decrease in β-cell mass. (PMID: 27615139)
Q: Isn’t insulin resistance now found to be in T1DM as well?
A: Yes, anyone can develop insulin resistance, and it occurs in at least a third of people with type 1 diabetes as well, although it is not always associated with excess weight gain or overweight. Since people with T1D lack insulin due to the body’s own immune system killing off the pancreatic β-cells, greater resistance increases the total doses of insulin needed (whether injected, pumped, or inhaled). Thus, they have developed characteristics of both types and have “double diabetes.” (PMID: 34530819)
Q: Under lifestyle goals, would you include stress management?
A: Stress management was not assessed in the large multi-center clinical trials on type 2 diabetes prevention, but mental stress can certainly raise blood glucose levels due to the greater release of glucose-raising hormones like cortisol and adrenaline. It certainly would be beneficial to address better ways to manage mental stress as part of lifestyle goals for optimal blood glucose outcomes. (PMID: 29760788)
Q: As each person has their own limitations, how important is it to get a physician clearance and exercise guidelines before working with the client?
A: It really depends on the person’s circumstances. How intense will the planned activities be? Is the person currently sedentary? Has he/she been getting annual checkups to monitor blood glucose management and to check the status of any complications? Does he/she have diabetes-related or other health complications that could be worsened by physical activity? The lower the intensity, the more active an individual has been, and the lower the risk for cardiovascular complications, the less likely medical clearance is absolutely necessary.
The latest ACSM Consensus Statement on activity and T2D will be released in early 2022 in Medicine & Science in Sports & Exercise and states, “For most individuals planning to participate in a low- to moderate-intensity physical activity like brisk walking, no pre-exercise medical evaluation is needed unless symptoms of cardiovascular disease or microvascular complications are present. In adults who are currently sedentary, medical clearance is recommended prior to participation in moderate- to high-intensity physical activity.”
Q: Can flexibility training be used for warmups, or do you recommend it only after the workout?
A: While it is possible to do flexibility training at any point during a workout, joints tend to have a greater range of motion after blood flow to those areas has been increased with a light or short aerobic warmup. It may be prudent to do a quick aerobic warmup, some stretching, the full workout, and then more extensive stretching afterwards for optimal results.
Q: Was there any particular protocol for strength training? sets, reps, periodization? What is considered “intense” resistance work? Would fatigue based off of several sets of moderate intensity be recommended then?
A: That is a tough question, and it depends on who you ask. I have seen a lot of debate over the optimal strength training protocol during the many years I have been in the exercise/fitness world. If people are just starting out with resistance training, they will gain from doing even a minimal amount of training.
Starting out with 1-3 sets of 8 to 10 main exercises that work all of the large muscles groups at a light to moderate intensity is considered appropriate for most older or sedentary adults, many of whom have joint limitations or health issues. Moderate intensity is considered 50%-69% of 1-RM (1 repetition maximum) and vigorous is 70%-85% of 1-RM. Both intensity (fewer reps at a higher intensity) and the number of sets (3-5) or days of training (starting at 2, progressing to 3 nonconsecutive days) can increase over 2 to 3 months. Periodization is usually not undertaken by older adults, but may be appropriate for younger, fitter ones.
Q: Do you have any insight or are aware of any studies that involve high intensity (%1-RM) resistance training and T2DM? Or any studies that compare resistance training volume (Sets x Reps x Load)?
A: Some older studies have determined that glycemic management is improved by supervised high-intensity resistance training in people with type 2 diabetes (PMID 12351469). Others have also found that home-based (and, therefore, unsupervised) resistance training results in a lesser impact on blood glucose levels, likely due to reductions in adherence and exercise training volume and intensity (PMID 15616225).
Q: I’m still confused about glucose response to acute exercise. Which is better if you want to bring down your BG right now? Can you speak to the possibility of increased blood sugars with intense aerobic exercise?
A: Most light-to moderate-intensity aerobic exercise will lower blood glucose levels, assuming that some insulin is present in the body. (People who are very insulin deficient may have a rise in blood glucose from doing any activity.) Any activity that gets up into the intense/vigorous range, even if only during occasional intervals, has the potential to raise blood glucose due to a greater release of glucose-raising hormones during the activity. This is particularly true if the activity is short and intense. In individuals with any type of diabetes, declines in blood glucose during high-intensity interval exercise are smaller than those observed during aerobic exercise.
That said, if someone wants to lower blood glucose right now with exercise, it also depends on the timing of exercise. Doing something light to moderate for at least 10 to 30 minutes is the best bet, particularly after a meal when insulin levels are generally higher. Avoid doing intense aerobic or heavy resistance training as those may have the opposite effect. For early morning exercise, any intensity can potentially raise blood glucose due to higher levels of insulin resistance then and lower circulating levels of insulin in the body.
Q: I had an endocrinologist say that long runs or walks are better, and another one said to do a bit of weights.
A: Which activities someone chooses to do should depend on the goal of the training. Is it increased fitness, lowering blood glucose levels acutely, or gaining strength and improving overall blood glucose management? Long, slow aerobic training does have the benefit of increasing cardiorespiratory fitness and lowering blood glucose levels (in most cases). Resistance training, on the other hand, increases muscular strength and endurance and helps people gain and preserve muscle mass, which is where most carbohydrates are stored in the body. It may not, however, lower blood glucose levels, at least not acutely.
Both have their place in a weekly training regimen. Insulin resistance is lowered for 2 to 72 hours following a bout of aerobic training. Resistance training has more of a long-term impact on insulin action by enhancing carbohydrate storage capacity. The best advice is to do some aerobic training at least every other day and some resistance training at least 2, and preferably 3, nonconsecutive days per week. These activities can be done on the same days or different ones.
Around one in four UK adults is living with obesity. Previous research has established that the most effective way to lose weight is through behaviour change with diet and physical activity counselling. It has not been clear whether one to one sessions or group sessions produce the better outcome. Thus a review of 7 studies which included 2,576 participants from the UK, US, Australia, Germany and Spain was done.
The study looked at the outcome of reaching at least a 5% reduction in body weight after a year. This means that a person of 100kg would lose 5kg.
Compared to one to one sessions, people in group sessions:
Lost on average 1.9kg more weight
Were 58% more likely to lose at least 5% of their body weight
Group classes had 12-55 hours treatment time and those in one to one sessions had 2.5 to 11 hours.
The costs of treating people in groups is also lower than one to one sessions. The quality of life of people who are obese would be more likely to improve and their would be fewer cases of diabetes, heart disease, stroke, and cancer that all require medical treatment.
NICE are intending to publish revised guidelines on the treatment of obesity in 2023.
Healthcare professionals can now confidently say that group educational programmes are at least if not more effective than one to one sessions when referring or advising patients. Social support in groups and more intensive interventions may account for greater success but for some people eg who are anxious in groups or who need translators, or even just patient preference, will mean that one to one sessions will still need to be offered. Further research into what specific factors improve results would be helpful.
Adapted from Nutrients and exercise affect tumour development by Carla Martinez May 27 2022 and
Three pronged approach may reduce cancer risk in the elderly by Nadine Ekert June 7 2022 Medscape
In a Madrid Oncology conference researchers discussed an update on lifestyle factors and cancer.
Diet and lifestyle can have an influence on each of the successive stages that occur in the development of cancer: initiation, promotion and progression.
A deficit of certain nutrients is one of the factors involved in the initiation stage. Various deficiencies affect different parts of cell metabolism adversely. Such nutrients include folate, B12, B6 and B3, Vitamin C, Selenium, Zinc, Magnesium and Vitamin D.
Aflatoxins from foods of vegetable origin are detrimental. The foods include cassava, pepper, corn, millet, rice, sorghum, wheat, sunflower seeds and peanuts, but the effect very much depends on how these foodstuffs are stored.
Added nitrates to foods such as processed meats and sausages because they become nitrosamines which affect cancer development. Natural nitrates in food however do not cause cancer.
Smoking causes 72% of lung cancer and 15% of all cancers. Eating processed meat causes 13% of intestinal cancers and 1.5% of all cancers. The most problematic foods for nitrosamines are cured meat, and smoked meat and fish. Cooking meats also causes polycyclic aromatic hydrocarbons especially chicken.
Various cooking strategies will reduce the formation or dilute the effects of polycyclic aromatic hydrocarbons.
Marinate mean in an acid solution for more than one hour.
Season meats and fish before grilling them. Good spices to use are: pepper, paprika, garlic, onion, ginger, turmeric, cumin, cinnamon, clove, fennel, and star anise.
Cook at a low temperature eg boiling.
Eat meats with lots of brassicas such as broccoli, cabbage, kale, turnip, brussel sprouts and mustard.
Grilled foods contain benzopyrene which can cause a mutation in DNA and thus cause cancer. Brassicas are rich in sulforphane which works on genes that produce glutathione s-transferase which promotes the elimination of benzopyrene.
Other factors that promote cancer include psychological stress, circadian disruption such as shift work, physical inactivity, obesity, hyperglycaemia, hyperinsulinaemia, gut bacteria disruption, and vitamin D deficiency.
The common factor here is increased inflammation. Some nutrients act as anti-inflammatories including the omega 3 oils EPA and DHA. Ginger, green tea, turmeric and broccoli all help too.
Daily rituals determine our health, so think about how you can optimise your routines.
The influence of exercise on cancer has only been studied in the last ten years.
Hypoxia is one of the main triggers of tumour aggression. Exercise has been shown to improve oxygenation and reduce hypoxia. Physical exercise in combination with chemotherapy has been proven to reduce tumour volume and progression. The best exercises in this regard are those that build up lactate in the muscle such as resistance exercise and cycling.
In the DO-HEALTH study, more than 2,000 healthy elderly people over the age of 70, were observed over three years. A combination of high dose vitamin D, omega 3 fatty acids and a simple home training programme reduced the risk of cancer by 61% compared to placebo.
The risk of getting cancer increases as you get older. Apart from not smoking and sun protection, getting appropriate vaccines and screening, there is not that much left to do. As Vitamin D, omega 3 fatty acids and physical exercise are all promising factors in cancer reduction, various combinations of them were tried. Blood pressure, physical performance, cognition, fractures and infections were looked at. They were divided into 8 groups looking at placebo, training only, and then various combinations and single interventions.
Most groups showed no difference from placebo but the combination of vitamin D, omega 3s and training did. The number needed to treat to prevent one cancer over the three years was 53 which is considered pretty good. Researchers thought the outcome was good enough to recommend this to any one over 70 who was looking to improve their health.
Adapted from BMJ 30 Oct 21: A study from the Mayo Clinic indicates that cardiorespiratory fitness tests were a better predictor of of survival in older people than blood lipids, diabetes, smoking and hypertension.
6,500 people aged 70 or over were tested on treadmills. The fittest showed the lowest mortality rates ten years on, and the burden of other risk factors made no difference at all.
Adapted from Diabetes in Control 10 August 21: Sheri Colberg says: Aging successfully takes a lot of work, If you don’t use it, you lose it. Physical fitness peaks around the age of 25 and then declines. Balance gets worse after the age of 40, bones get thinner, muscle bulk diminishes, and even with training maximal aerobic capacity declines. Your reflexes get slower and recovery from workouts takes longer.
The good news is that you can’t stop the aging process but you can slow it down to some extent. This means paying attention to regular physical training, nutrition, sleep and stress management.
Her advice is:
In addition to regular activities like walking, cycling, and swimming, add in some faster intervals to any workout such as walking faster for ten to sixty seconds at a time during your normal walk or doing a hill profile on a cardio training machine. This will improve your cardio respiratory fitness and improve insulin sensitivity for longer. It is fine to to high intensity interval training once a week, but if you don’t already do this you need to work up to it slowly. You should vary the intensity of your workouts to allow recovery and reduce the risk of injury.
Pick at least eight to ten resistance exercises that cover the major muscle groups in the upper, core and lower body and do them two or three days a week. You can use your own body weight, weights, kettlebells, resistance bands or water bottles. Improving muscle mass and strength is critical to being able to live independently through your lifespan.
Improve your balance by standing on one leg for a minute at a time. Make sure you can grab something if you feel unsteady. Once you can do this, make it harder by moving the raised leg in different directions. My comment: Wii Fit has a lot of balance exercises included. Ballet and Yoga also include balance exercises and Tai Chi is a good starting point.
High blood sugars take a particular toll on the flexibility of joints and tendons. Stretch two or three times a week. The worse your flexibility and the older you are the longer you should hold the stretch. Up to a minute with each stretch may be necessary. My comment: There are lots of You Tube videos on stretching. You may like to use rubber bands and yoga blocks or use props such as chairs.
Weight bearing exercises to reduce bone loss can be achieved by weight training, carrying shopping in both hands, and hopping up and down on one leg at a time, and by doing body weight exercises such as press ups.
It is very important that you can get off of a chair as you get older. Practice standing up from the sitting position without using your hands. You can enhance your strength by sitting against a wall with your knees at 90 degrees. My comment: I used to do this for two minutes at a time. I would suggest 30 seconds to start with.
Last, but not least, pelvic floor exercises. You pull in all the muscles around your urethra and anus and practice a combination of long holds and pulses. This improves continence.
Exercises can help maintain your physical abilities and independence during the aging process.
Aging successfully needs a lot of work. If you don’t use it, you lose it! Our body system peaks at 25 and declines thereafter. Even if you exercise diligently you will lose aerobic capacity as you age.
Balance also worsens from the age of 40. Bones also thin, particularly for women post menopausally. Muscles get smaller and weaker, reflexes get slower and recovery from workouts takes longer.
Although you can’t do that much about neurological decline but by regular physical training, nutrition, enough sleep, and stress management you can delay or prevent a lot of normal aging and even sometimes reverse damage done from inactivity.
These are my top tips for exercises to reduce aging:
Cardio workouts with faster training intervals. Apart from walking, cycling and swimming add in faster intervals lasting 10 to 60 seconds at a time. You can walk up hills deliberately or do a hill programme on a cardio machine. High intensity interval training can be done up to once a week but start low and build up.
Resistance exercises covering your upper body, core and lower body will help your muscles. Do 8 to 10 exercises covering these groups two to three days a week. You can use your body weight, dumbells, kettlebells, resistance bands. You should be able to get in and out of a chair without using your arms at the very least.
Standing on one leg at a time helps balance. My comment: one of my friends says doing this helped her not feel dizzy when riding on the London Underground.
Stretches for all of your joints helps your joint mobility and cartilage health. Do this two or three days a week. Diabetics are particularly prone to stiffness from glycation. Hold the stretch for up to a minute for each one.
Hopping up and down on one leg helps bone mineral density and so does carrying shopping in both hands. Press ups, against a door or kitchen counter are a good start.
Pelvic floor exercises are good for the prevention of stress incontinence.
Adapted from Diabetes in Control Aug 10 2021 by Macrina Ghali, Pharm D candidate, Florida.
Hyperglycaemia has been linked to reduced cognitive function and can impair life through impairing memory and language. Mistakes with medication are more likely. Some studies have shown that exercise can reduce the risk of dementia on the long term.
The meta-analysis sought to answer the question, does cognitive ability change from baseline, while on the exercise programme compared to the non-exercising controls? Just over 2,500 patients with diabetes were analysed, almost evenly split to control groups and exercise groups.
The exercise group did aerobic exercise, resistance exercise and non aerobic exercise. The control groups did monthly telephone calls, stretching, gentle movement and education. The interventions ranged in time from 12 months to 9.8 years and sample sizes ranged from 47 to over a thousand.
Standard tests such as the mini-mental state examination, mental state examination and global cognitive score were undertaken.
Surprisingly the study found that the greatest change in cognitive scores between both groups was in the studies done for 12 months rather than longer periods. They were not sure if this was due to patient drop out or the development of dementia. They think that more studies would need to be done to clarify the issue.
Meanwhile they think that physical activity programmes should be started soon after diagnosis of type two diabetes to prevent a worsening of cognitive functioning as time goes on.
After a heart attack, the risk of sudden death is influenced by your past levels of physical activity.
People who performed moderate levels of leisure time exercise reduced their risk by 33% and those who performed high levels of exercise reduced the risk by 45%.
This study combined data from ten European longitudinal studies and found 30,000 people who had a heart attack. Around 5,000 people (18%) died within 28 days. Of these, 3,000 (62%) died instantly.
European Journal of Preventative Cardiology
Fish oil supplements however had no worthwhile cardioprotective effects according to a Cochrane Systemic Review done several years ago. A study looking at secondary prevention in 70-80 year olds, recently found similar effects. There was no difference between the omega 3 fish oil supplemented group and placebo over two years.
Adapted from BMJ Sept 19 Promoting physical activity to patients by Christine Haseler et al.
The Academy of Medical Royal Colleges has described walking as a miracle cure. Despite this many of us are not as active as we should be and inactivity is thought to result in as many deaths as smoking. More than a quarter of UK adults do less than 30 minutes physical activity a week.
Quantified, these are the benefits of just plain walking:
30% lower all cause mortality, even 10 minutes a day is worthwhile.
20-30% lower risk of dementia.
Better relief from back pain than back exercises
30% lower risk of colon cancer
30% reduction in falls for older adults
22-83% reduction in osteoarthritis
even lower body fat than playing sports
20-35% lower risk of cardiovascular disease
20% lower risk of breast cancer
30-40% lower risk of metabolic syndrome or type two diabetes
The people who need to see their GP before undertaking exercise are few but include people with unstable angina, aortic stenosis or uncontrolled severe hypertension.
In pregnancy the sort of activities that need to stop are: impact activities, lying on the back for long periods, high altitude activities and underwater activities.
Diabetes Diet 