Diet, Exercise and Metformin Help Prevent Diabetes

 Today is American Diabetes Association Alert Day, and in recognition today’s posts will be covering topics in diabetes.

Diabetes Mellitus Type II (DM2) is common in the U.S. and worldwide and it’s incidence and prevalence are increasing. The implications of DM2 are serious and widespread, including kidney and eye disease, heart and blood vessel disease, and neuropathies.

Because of the large numbers of people with DM2, there has been much research looking at ways to prevent or forestall its development. A landmark study in this area was published in 2002, and was conducted at George Washington University and 27 affiliated centers.

Over three thousand participants with elevated fasting and post-load plasma glucose concentrations were included in the study. Subjects were randomly assigned to a lifestyle modification plus metformin group (850 mg twice a day), a lifestyle modification plus placebo group, or a program of intense lifestyle modifications. The goals for the intensive lifestyle modification group were to maintain a 7% weight reduction and engage in moderate physical activity for at least 150 minutes each week. The average follow-up period was 2.8 years.

The primary outcome measure of this preventative study was the development of diabetes. The incidence of diabetes was 58% lower in the intensive lifestyle intervention group compared to the placebo group, while the incidence of diabetes in the metformin group was 31% lower than the placebo group.

Comparing the intensive lifestyle-modification group to the metformin group shows the incidence of diabetes was 39% lower in the intensive lifestyle modification group.

One of the important features of the study design were that substantial numbers of female subjects were enrolled (68% female, 32% male), and that a large percentage of African-American, Hispanic, Indian American and Asian-American individuals were enrolled, which supports the generalizeability of these results to a broad heterogeneous population such as seen in the U.S.

This study demonstrates that substantial lifestyle modifications including weight loss and increased exercise may have a profound impact in preventing or delaying the development of DM2 in those at risk. Given the serious health implications of DM2 perhaps those who are in the pre-diabetic stage may want to consider incorporating improved diet, exercise and weight loss in to their daily regimen.

 

(Source- New England Journal of Medicine, Vol. 346, No. 6)

This blog is a review of medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

Acupuncture For Depression

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In our second post for Mental Illness Awareness Week we will examine research which shows support for acupuncture in treating depression.

In an article published in the Journal of Psychiatric Research a Chinese research group found benefit for acupuncture in treating major depression. This particular study looked at manual acupuncture as well as electro-acupuncture, in a group of patients who received the commonly prescribed anti-depressant paroxetine.

The study included 160 patients diagnosed with moderate to severe depression. One treatment group received paroxetine only, while the other two groups received manual acupuncture or electro-acupuncture in addition to the paroxetine.

The patients in the acupuncture groups received three sessions of acupuncture per week over six consecutive weeks. Assessment of the patients in the manual and electro-acupuncture groups showed significant improvement in depression scores compared to paroxetine alone beginning at week one and continuing through week six of the study. In addition, in the group which received electro-acupuncture, the benefits continued four weeks after the electro-acupuncture treatments were stopped.

The results of this study are significant, especially in light of the beneficial effect of acupuncture when added on to a commonly used anti-depressant. The finding that acupuncture helps with depressive symptoms almost immediately is particularly important, as the beneficial effects of medications often take longer to materialize. Given the generally safe nature of acupuncture treatments, they may offer a supplemental treatment choice for depression.

(Source- Journal of Psychiatric Research 47, 2013 )

This blog is a review of medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

Curcumin Helps With Depression

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October 2nd-8th is designated as Mental Illness Awareness Week, and this week’s posts will be related to mental health.

Curcumin is an active ingredient of the Asian spice turmeric, which is a member of the ginger family. Turmeric is a widely used spice in South Asian and Middle Eastern cooking and is grown in India, Nepal, Indonesia, Thailand, Vietnam and elsewhere. Turmeric is also used in Ayurvedic Medicine, and is currently being studied in Western Medicine for possible uses. Curcumin has been shown to have antioxidant and anti-inflammatory properties.

A study published in 2013 in Phytotherapy Research looked at using curcumin as a treatment for major depression. The researchers were located in India and Texas. The study examined the use of fluoxetine and curcumin, both alone and in combination in the treatment of major depression. The Hamilton Depression Rating Scale (HAM-D) was used, and was checked at the start of therapy, at two weeks, at four weeks, and at the conclusion of the study at six weeks.

Forty-five enrollees completed the six-week study. Curcumin was found to be equivalent in terms of improvement in the HAM-D scores. 75% of the subjects taking curcumin had a “good” or “excellent” response, while 70.5% of the subjects taking fluoxetine had a “good” or “excellent” response. Curcumin was also found to have a benign side effect profile.

This was the first randomized clinical trial to look at curcumin for major depression , and while  larger studies are certainly needed this pilot study provides hope that this ancient spice may have benefit for an illness which affects nearly 300 million people worldwide. Lifetime prevalence rates are highest in the U.S. with 17%, and lowest in Japan at 3%.

(Source- Phytotherapy Research, 2013)

This blog is a review of medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

Black Cumin Helps With Symptoms of Metabolic Syndrome

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Today’s post is about metabolic syndrome and lipids, another in our series of blogs for Cholesterol Education Month.

Black cumin (Nigella Sativa) is an annual flowering plant found in southern Europe, southwest Asia and north Africa. The black cumin seeds have long been used as a spice in both Indian and Middle Eastern cuisines. Written references to black cumin appear in ancient texts, and the Book of Isaiah (28: 25,27) references cumin seeds. Modern research has focused on the pharmacologic properties of black cumin.

A group of researchers in Pakistan recently performed an interesting study in which they looked at black cumin to treat the symptoms of metabolic syndrome (also known as insulin resistance). There are five metabolic risk factors associated with metabolic syndrome, these include large waistline, high triglyceride level, low HDL (“good cholesterol”), high blood pressure, and high fasting blood sugar. Having at least three of these five symptoms is considered to be a diagnosis of metabolic syndrome. Recent data estimates from 2011-2012 show that 35% of all U.S. adults and 50% of those 60 years and older meet the criteria of metabolic syndrome. As metabolic syndrome is very often a precursor to diabetes this is a national health issue of first order.

The researchers enrolled 159 subjects into the study, of which there was a black cumin supplemented group, and a non-supplemented group. All subjects were recently diagnosed with metabolic syndrome, and the study included both men and women, ages 25-65 years.  All subjects were on a standard treatment regimen for metabolic syndrome, including pharmaceutical medicines such as atenolol, clopidogrel, enalapril, metformin, and simvastatin. In addition the black cumin group took Nigella seeds in a capsule form 250 mg twice daily. The study ran for six weeks.

Several clinical parameters of metabolic syndrome were measured, both at the start of the study and then again at conclusion. These included body mass index (BMI), circumference of the abdomen and hip, body weight, waist-hip ratio, blood pressure, blood glucose, total cholesterol, LDL (“bad cholesterol”), triglycerides, and HDL.

At the conclusion of the six-week trial the clinical parameters were again measured. There were improvements in all parameters, both in the standard treatment group as well as in the black cumin supplemented group, as one would expect. In addition, in the black cumin seed group, there was a statistically significant improvement in fasting blood sugar, LDL and HDL, over the standard treatment (non black cumin seed supplemented) group. To see a statistically significant improvement in just six weeks is profound.

Metabolic syndrome is a serious health issue, not only in the U.S., but world-wide. Proper diet and exercise are a mainstay of treatment, as well as medications. Part of the solution may well be use of ancient or traditional foods, such as black cumin.

(Source- African Journal of Biotechnology, Vol. 11948), June 2012).

This blog is a review of medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

Pantothenic Acid Helps Lower Cholesterol

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September is designated as Cholesterol Education Month. Several of our blogs this month will address issues related to cholesterol.

Pantothenic acid, also known as vitamin B5, is an essential nutrient and water-soluble vitamin. Pantothenic acid is found in many foods, including meats, nuts, whole grains and vegetables such as avocados and broccoli. Pantothenic acid is converted in the body into a related compound called pantethine, which is more biologically active.

A recent study by a multi-national research team looked at using pantethine in a group of subjects who were considered low to moderate risk for cardiovascular disease. This group would ordinarily be considered candidates for statin medications to lower their cholesterol.

This was a randomized placebo controlled trial. Both the placebo group and the pantethine treatment group started the study with four weeks of dietary therapies. After four weeks, patients were placed at random into either a placebo group or a pantethine treated group. Labs were checked at the start of the study, then at weeks 2, 4, 8, 12, and finally at week 16, at which time the study was concluded.

Participants in the pantethine group received 600 mg/day from week 1 through week 8, and then 900 mg/day from week 9 to week 16. Subjects received the pantethine in the form of a pharmaceutical grade proprietary product.

At conclusion, the participants who received pantethine had a 6% decrease in total cholesterol and a 11% drop in LDL, compared to baseline levels. In addition, hs-crp an inflammatory marker dropped over the 16 week study period. In general, there were few significant side effects with the pantethine therapy.

This study demonstrates that the commonly available substance pantethine present in a variety of food sources or as by supplement such as used in this study was helpful in lowering cholesterol and appears to be well tolerated.

(Source- Vascular Health and Risk Management 2014:10)

This blog is a review of medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

Run For Your Life

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As the Rio Olympics wind down, track and field events have entered center stage. Therefore today’s post will look at the relationship between running and cardiovascular risk.

Research published in the Journal of the American College of Cardiology shows the health benefits of running, even at slow speeds and at short distances, on cardiovascular health and mortality.

The study looked at over 55,000 adults, both men and women, ages 18 to 100 years, with an average age of 44 years. The amount of exercise in the study group was assessed by a medical history questionnaire, with a mean follow-up period of 15 years.

Runners were found to have lower risk of mortality including cardiovascular mortality compared to non-runners. Runners had 30% lower risk for all-cause mortality, and 45% lower risk for cardiovascular mortality.

Interestingly, even modest amounts of running such as 5-10 minutes/day and at slow speeds (greater than 10 minutes/mile) yielded significant mortality benefits. Not surprisingly, for those runners who were persistent in their efforts there was a stronger association with reduced mortality.

Given these health benefits, perhaps you may consider adding some running or jogging to your exercise routine.

Source- Journal of the American College of Cardiology, Vol. 64, No. 5, 2014)

“Running! If there’s any activity happier, more exhilarating, more nourishing to the imagination, I can’t think of what it might be. In running the mind flees with the body, the mysterious efflorescence of language seems to pulse in the brain, in rhythm with our feet and the swinging of our arms.”          Joyce Carol Oates

This blog is a review of medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

You Have Time To Exercise

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Every four years the Olympics inspire not only a new generation of athletes to pursue their Olympic dreams, but also gives encouragement to the less physically active to incorporate some exercise into the daily schedule. Unfortunately already overloaded schedules and time commitments end up causing many if not most to quit the new exercise or activity, or even discourages them from starting in the first place.

Can you spare 30 minutes a week for exercise? This is 30 minutes per week total, broken up into ten minute sessions, three times each week? Even the busiest of us can probably find 30 minutes in the course of a week to commit to exercise.

Researchers from McMaster University in Canada enrolled sedentary men ages 19-37 and placed them into one of three different groups- a sprint interval training (SIT) group, a moderate intensity continuous training (MICT) group, and a control group.

The training protocols were straightforward. The sprint interval training protocol involved a two-minute warm-up on the stationary exercise bike, followed by three “all out” cycling efforts of twenty seconds each, separated by two minutes of low intensity cycling, and finally a two-minute cool-down, for a total of ten minutes. This was done three times each week.

The moderate intensity continuous training protocol consisted of a two-minute warm-up on the exercise bike, followed by 45 minutes of continuous cycling at 70% of maximum heart rate, and finally a three-minute cool-down, for a total of 50 minutes. This was also done three times each week.

A 12 week training program then followed. Researchers measured plasma glucose and insulin, and performed muscle analysis, among other measures.

What the researchers discovered was profound- the sprint interval training group (aka the 30 minute per week group) had comparable improvements in cardiopulmonary fitness, insulin sensitivity, and skeletal muscle mitochondrial content to the moderate intensity continuous training group (aka the 150 minute per week group) over the 12 week training program.

Another way to consider this is that the sprint interval group, with only 1/5 of the time commitment of the moderate intensity group, had equal cardiometabolic benefits.

McMaster University in Hamilton Ontario is one of the leading centers of research in High Intensity Interval Training (HIIT). This recent paper adds to the growing body of research on this topic.

So you can you spare 30 minutes a week?

 

(Source- PLOS ONE, April 26, 2016)

This blog is a review of medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone, Discuss any health concerns with your personal physician.

Swimming Improves Cholesterol in Women

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As we say goodbye to the swimming events for the Rio Olympics we will have one more post on the benefits of swimming.

A group of researchers from Pusan National University in South Korea designed a study to examine the effect of swimming on physical strength as well as lipid profile. Participants were women, ages 40-60, who were either in a swimming group or a control group of non-swimmers.

The swimming group swam for sixty minutes, three times/week, for a total of 12 weeks. Physical composition, strength and blood lipid measurements were taken upon entry to the study as well as at the conclusion at 12 weeks.

At the end of the 12 week study the swimming group showed improvements in total cholesterol, HDL, and triglycerides. On the other hand, the control group (non-swimmers) showed no significant change.

This small study shows the possible benefits of a simple intervention, in this case swimming three times per week, may have upon lipids parameters. It would be interesting to see if these same results would be found in a group of men.

(Source- Journal of Exercise Rehabilitation 2015; 11(5); 266-271)

This blog is a review of medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

Swimming and Cycling Help With Symptoms of Osteoarthritis

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In honor of the Rio Olympics today’s post will examine research on the benefits of swimming or cycling on the symptoms of osteoarthritis.

Osteoarthritis is a progressive disease that leads to damage of the underlying bone and cartilage. It is very common, and it is estimated that osteoarthritis affects approximately 30 million in the U.S. and perhaps 250 million worldwide. Symptoms of osteoarthritis often progress leading to increasing joint pain and decreased function.

A group of researchers from the University of Texas at Austin enrolled a group of 48 participants into the study, including both men and women, with an average age of about 60 years. Subjects had mild to moderate signs of osteoarthritis on x-ray, and in addition were symptomatic with joint pain and decreased function.

Subjects were randomized to a swimming group or a cycling group. They started with 20-30 minutes of exercise 3 days/week at an exercise intensity of 40-50% of heart rate reserve. As fitness improved, participants moved to a goal of 40-50 minutes of exercise/day, 3 days/week at 60-70% of reserve. Swimmers used the breaststroke, freestyle or a combination of the two strokes, while the cyclists used a stationary bike. Both swimming and cycling groups were followed for 12 weeks.

Participants were tested upon entry into the study, and again after 12 weeks of either cycling or swimming. Participants in both the swimming and cycling groups showed reductions in joint pain and stiffness, with improvements in function. There was also significant improvement in a six-minute walk test in both groups. Body mass, as well as hip and waist circumference decreased in both swimmers and cyclists.

This study is important in that it may be the first to look at swimming (not water aerobics) as an intervention for osteoarthritis symptoms. The active cycling control group showed similar improvements to the swimming group, thus giving another possible treatment method for patients with osteoarthritis. It would be interesting to see if the improvement in function and decreases in joint pain would continue if the swimming or cycling continued beyond 12 weeks. Swimming and cycling are low risk activities that may yield large benefits for those suffering with osteoarthritis.

 (Source- The Journal of Rheumatology 2016; 43:3)

This blog is a review of medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

Acupuncture May Improve Exercise Performance and Recovery

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For some, seeing Michael Phelps and other swimmers on the starting blocks this week with the distinctive circular bruises left by cupping may have been their first exposure to this alternative health practice. However cupping in one form or the other has been in practice for thousands of years, and there are references in ancient Egyptian, Greek, Chinese and Persian texts regarding this technique. In honor of the Rio Olympics today’s post will examine another ancient health practice, acupuncture, specifically the use of acupuncture to enhance  both exercise performance, as well as post-exercise recovery.

Australian researchers reviewed data from four different acupuncture studies, three of which looked at its effect on exercise performance, while one study examined the effect of acupuncture on post-exercise recovery. There were 84 total participants in the four studies, both men and women. As the design of each study was varied (such as different treatment protocols, different outcome measures, different placebo controls, etc.) the Australian researchers did not pool the data from the four studies but instead examined each study on its own merits. One thing all four studies did have in common was the use of a cycle ergometer as the exercise method.

The Australian research group noted that one study (Li et al.) showed significantly increased peak power output in the acupuncture group versus the control group. On the other hand two studies (Dhillon et al. and Karvelas et al.) did not show benefit.

Also, in the  study that examined post-exercise recovery (Lin et al.) it was demonstrated that acupuncture needles inserted prior to exercise significantly lowers the blood lactate level sixty minutes after exercise.

Taken in whole the four studies show some possible benefits for acupuncture treatment, both for exercise performance as well as post-exercise recovery. What are now needed are additional well designed studies with larger numbers of participants to determine if these treatment effects are real. Acupuncture is a generally well tolerated treatment modality with a good safety profile, and may offer benefits to athletes and those that exercise.

(Source- The Journal of Alternative and Complementary Medicine, Volume 19, Number 1, 2013).

This blog is a review of medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.