Sheri Colberg: Debunking some physical activity and training myths

Adapted from Sheri Colberg’s article in Diabetes in Control July 6 2019

Exercise does NOT make you more tired.

Most people feel more invigorated after a workout. Regular exercise helps you cope better physically and mentally with your work and personal life.  During periods of acute stress, at work for instance, a short brisk walk can help clear your mind and bump up your energy levels.  Exercise helps reduce insomnia too.

You do NOT have to work out in a “fat burning range” to lose weight.

Just exercise as long and intensely as is reasonable for you if you want to lose weight.  You do use up a little more fat at lower intensity exercise but this mainly happens during the recovery phase.

Your muscles will NOT turn into fat if you stop weight training.

Keep your muscles strong and noticeable by physical activity and exercise and aim to avoid fat gain.

Weight training will NOT bulk you up if you are a woman.

It takes a great deal of effort for men to bulk up doing weight training and this effort is magnified in women because they have very little testosterone. Your total weight may increase if you weight train as muscle is heavier than fat. Pay attention to how you look and feel and how your clothes fit rather than have a fixed idea of the optimum number on a scale.

No pain does NOT mean no gain.

You need to distinguish the feeling of lactic acid in the muscle from a well executed exercise set and delayed muscle soreness a day or two afterward with acute muscle tears and overtraining. The time it takes to recover is a good guide. Also adjust your timing and intensity gradually.

Lifting weights slowly does NOT necessarily mean you will build more muscle.

Lifting slowly can increase the total time that your muscle is under tension. This can increase muscle endurance. Lifting the heaviest weight quickly helps you recruit more muscle fibres and will result in bigger muscles. So if you are lifting a weight slowly during a particular exercise but could lift it faster, to build muscle you either need to move that weight faster or use a heavier weight.

Working on your abdominal muscles WON’T give you a flat belly.

You can’t spot reduce. You can tone up your belly and back muscles but what really helps is getting rid of excess fat covering the muscle. You can do harder workouts to increase your muscle mass and this will help you burn more calories including at rest.

More exercise does NOT mean more fitness

Overuse injuries are more common if you are working out for more than 60-90 minutes of aerobic exercise a day. Cross fit and high intensity interval training are likely to be more beneficial than very long workouts.

You DO NOT have to eat huge amounts of protein.

If you do weight train you do need more protein but only up to twice that for a sedentary person. That is 1.6 to 1.7 grams of protein per kilogram body weight. Most people, especially those on a low carb diet will naturally be eating enough protein. Some protein after exercise may be beneficial especially whey protein. You can eat natural foods eg egg whites or drink chocolate milk (careful about sugar) instead.

You DO NOT need to sweat profusely to do good.

Sweating varies a lot between men and women and individuals. If you are physically trained you may sweat sooner and more. The exercise intensity will affect it. So does the ambient temperature and humidity. Sometimes not sweating enough can be a sign of dehydration so it doesn’t always reflect your effort.

Sheri’s book The Athlete’s Guide to Diabetes: Expert advice for 165 Sports and Activities is available on Amazon and at Barnes and Noble stores.

She has websites to help you:Sheri Colberg.com and DiabetesMotion.com

 

 

 

BMJ: Taking glucosamine long term may reduce cardiovascular disease risk

Adapted from BMJ18 May 19. Association of habitual glucosamine use with risk of cardiovascular disease. Ma h, Li X, Sun D et al. BMJ 2019:365:1628

Just over 466 thousand participants from the Biobank who did not have cardiovascular risk at that point completed a questionnaire about supplement use including glucosamine. Subjects were enrolled between 2006 and 2010 and were followed up in 2016.

After adjusting for age, sex, BMI, race, lifestyle factors, dietary habits, drug use and other supplement use, glucosamine was associated with a significantly lower risk of cardiovascular events. A limitation is that the association may not be causal. Perhaps those who use supplements are healthier than those who don’t.

The results they found were that there was a 15% less risk of total cardiovascular events.

There was a 22% lower risk of cardiovascular death, 16% less risk of ischaemic heart disease and a 9% lower risk of stroke.

My comment: I have been taking glucosamine regularly for the last 19 years because I have found that it completely solved the knee pain I had had for the previous five years. As I have a very strong family history of osteoarthritis of the knee and other joints I was keen to try it. Osteoarthritis is linked to inflammation in the joints, and we know that cardiovascular disease is linked to inflammation in the arterial walls and the bodies attempt to repair minute tears with cholesterol containing plaques. Thus there is a possible mechanism to explain the reduction in cardiovascular disease for those that take it. It is of course also possible that supplement takers take more exercise and I’m not sure to what extent the “lifestyle” factors were adjusted for. 

BMJ: Flu jag timing matters

From BMJ May 2019: Minerva BMJ 2019;365:1993

A review in Science indicates that vaccines for mumps, whooping cough and yellow fever lose their effectiveness more quickly than those for measles, diptheria, tetanus and flu.

The flu vaccine at best only protects about 60% of the people given it in any given year. Its effectiveness also declines after just a few months. If you are first in the queue to get it towards the end of September, much of its effects will be lost by January and February which are the peak months for flu infection.

My comment: Maybe you should plan to get the jag any time from mid November to mid December  if you are very keen on getting maximum effectiveness to prevent flu?

 

My people all together – #type1diabetes

blood testing equipment type 1 diabetesEver sat in a room and thought, “I am with my people”? That was my experience this week as I attended an education session the NHS had put on; my attendance a condition for prescription of the Abbot FreeStyle Libre.

I doubt I’ve ever been in a room with so many other type 1 diabetics. Sure, type 1 is a hidden condition. Perhaps others travel on trains with me or flit about the offices of the University of Glasgow dropping their test strips wherever they go?* Still, my original statement holds. I reckoned on about 200 people there, with perhaps a third of them partners or parents.

All shapes and sizes

I arrived at the Queen Elizabeth University Hospital early and watched in fascination as folks trooped in to the lecture theatre. We come in all shapes and sizes—all ages, all colours and all creeds. Who were the ones with diabetes? I put it down to those of us who carried our precious bag—the FreeStyle Libre and the doctor’s letter handed out when we registered—tightly. I’d expected lots of young people, but that wasn’t the case. The average age, I reckon, was mid to late 30s. Every time I saw someone who looked a lot older come in, I cheered silently.

Take that, reduced life span, and shove it where the sun don’t shine.

Our session took the form of a PowerPoint presentation by one of the diabetologists at the hospital, followed by some Q and As. I didn’t bother asking anything. As an introvert, I’m not going to raise my hand in a room that full of folks—even if they are my people. But there were plenty who didn’t suffer from shyness who dived in.

Can you scan your sensor through clothes? Yup. (So handy!)

Can you swim with it? Yes, but only half an hour is recommended. (Seriously, do people swim for longer than that? It’s the world’s most boring form of exercise unless you’re in open water.)

How long does it take for the prescription to come through once you hand the letter to your doctor? About 48 hours.

Can you connect it to your phone? Yes—there’s an app for it.

What happens if it keeps falling off? Some people have slippier skin than others. Thankfully, the two times I tried the sensor it stayed in place for its allotted fourteen days.

Talking to my people

I longed to talk to my people, but didn’t. See above-mentioned introvert tendencies. Who would I have chosen? The Indian girl who talked about running, exercising and wearing a sensor? The man behind me who asked if the Libre 2—the one with alarms that sound if your blood sugar levels go up or down too rapidly—would be available for us in the future? The glamorous young couple where I couldn’t work out which one would hold out the fingers covered in black dots from too much finger-pricking?

No. The one I’d have picked out was the woman I guessed to be in her late 30s who came in with an older man and woman I took to be her mum and dad. I watched her sit down near me and wiped away a wee tear. That might have been me once upon a time, attending with my lovely, supportive ma and pa. My father died nine years ago and how I’d love to have shared this new, wonderful development in diabetes care with him.

Session over, my precious bag and I got onto the bus to go home. “A new chapter, Emma B,” I said to myself. “How terribly exciting.”

*About to become a non-problem. Yay!

Vitamin D shown to improve blood sugar control in gestational diabetes

From Ojo O et al. The effect of vitamin D supplementation in women with gestational diabetes mellitus. A systemic review and meta-analysis of randomised controlled trials. Int J Environ Res Public Health. 2019:16(10)

A meta-analysis has indicated that various factors relevant to improved blood sugar control are likely to be improved by vitamin D supplementation in  a total of 173 women with gestational diabetes.

Fasting blood glucose decreased by a mean of 0.46 mmol/L

Glycated haemoglobin decreased by a mean of 0.37%

Serum insulin reduced by a mean of 4.10 uIU/mL.

 My comment: Although the improvements are small, vitamin D supplements are inexpensive, easy to take and do not have the side effects of other medications.

 

 

Lower cholesterol may not better if you have neuropathy

From Jende JME et al. Peripheral nerve damage in patients with type 2 diabetes. JAMA Netw Open. 2019;2(5);e194798

In type two patients who had diabetic neuropathy affecting the legs, low total cholesterol and low density lipoprotein cholesterol had more nerve lesions, impaired nerve conduction and more pain and disability than those with higher cholesterol levels.

Almost all type two diabetics will be advised to take statins to keep the cholesterol level down as this is generally accepted as improving the outlook for cardiac and circulatory conditions.

One hundred participants with type two diabetes were tested using magnetic resonance neurography. 64 had diabetic neuropathy and 36 did not.

My comment: Although this was not discussed in the abstract, I wonder whether those people with more advanced complications were being more intensively treated all round and thus had more/higher doses of statins, and so the relationship between low cholesterol and neuropathy severity was simple association, or whether there is a causative factor here. I am aware that statin neuropathy is believed to exist.

Higher blood pressure is linked to LESS cognitive decline

From Streit S et al. Ann Fam Med 1 March 2019 and reported by Sarfaroj Khan UK Clinical Digest 13 March 2019

In my GP career treatment of blood pressure for the general population has become more intensive as time has gone on. This hasn’t always resulted in better long term outcomes overall. Indeed, the target systolic blood pressure, the upper measurement, has been moved from 130 to 140 in the last few years because of this.

A Dutch study of over a thousand patients over the age of 75 showed that those with a systolic blood pressure under 130 showed more cognitive decline than those with a blood pressure over 150 when they had mental functioning tests a year later.

Those with higher blood pressures had no loss of daily functioning or quality of life.

As aggressive blood pressure control in those with diabetes is standard treatment, it is worth knowing this. Perhaps further studies in this subgroup of patients would be worth doing. I have seen reports of impaired kidney function when blood pressure levels are “optimal” but low too.

Another study regarding blood pressure management reported in the British Journal of Sports Medicine indicates that blood pressure reduction of almost 9mm Hg in hypertensive patients when regular structured exercise is undertaken. This is of a degree similar to most anti-hypertensive medications. (Reported in BMJ 5 Jan 2019)