Longevity Bloomington Newsletter # 22 - (Pre)Diabetes
Plus the effect of running on your knees and a new member spotlight
Research Roundup - (Pre)Diabetes
What is diabetes?
When you eat a meal containing carbohydrates, your body’s digestive system breaks down those carbohydrates into various types of sugar in your blood. As blood sugar levels rise, the pancreas releases a hormone called insulin into your blood. In non-diabetic individuals, insulin prompts cells to absorb blood sugar for energy or storage. This results in a lowering of your blood sugar.
Diabetes is a disease in which the body’s ability to produce or respond to insulin is impaired, resulting in abnormal metabolism of carbohydrates and elevated levels of sugar (glucose) in the blood and urine. Over time, high levels of glucose in your blood can cause serious damage to your heart, blood vessels, eyes, kidneys and nerves.
There are two main types of diabetes: Type 1 and Type 2. Type 2 diabetes (“diabetes”) occurs when the body becomes resistant to insulin or doesn't make enough insulin. This comprises 90-95% of all diabetes cases in the United States and will be our focus today.
Even if you aren’t diabetic, the information below is still important. Many individuals have a condition called “prediabetes” or are insulin resistant and don’t even know it. Prediabetes is a serious health condition where blood sugar levels are higher than normal, but not high enough yet to be diagnosed as type 2 diabetes. Approximately 96 million American adults—more than 1 in 3—have prediabetes. 50% of individuals 65 years and older have prediabetes. Of those with prediabetes, more than 80% don't know they have it.
According to the American Diabetes Association, nearly 70% of individuals with prediabetes will go on to develop type 2 diabetes. Therefore, it is important to be aware of your fasting blood sugar levels so that you can take action and prevent yourself from developing type 2 diabetes.
How common is diabetes?
Currently, 37.3 million people in the United States (~ 11% of the population) have diabetes. If current trends continue, this number could double or even triple by 2050. It is projected that as many as 1 in 3 adults will be diabetic by 2050 if things do not change!
What are the health effects of diabetes?
Elevated levels of sugar in your blood for a prolonged period of time is a big problem. Prolonged levels of high blood sugar can result in a host of health complications. These include heart disease, stroke, blindness, depression, kidney disease, nerve damage and even amputation. Diabetes can also shorten your life. Estimates suggest that adults with type 2 diabetes die, on average, 6 years earlier than their counterparts without diabetes. It is important to take action now to control your blood sugar and avoid these complications.
What can you do about it?
There are five main treatments for type 2 diabetes: exercise, healthy eating, weight loss, medication and blood sugar monitoring. Today, we will focus on exercise, healthy eating and weight loss.
How does exercise improve your blood sugar levels?
Exercise can help reduce your blood sugar levels in many ways. Most of the benefits of physical activity on blood sugar levels occur through acute and chronic improvements in insulin action. Your cells become more responsive to insulin over time with regular exercise. This increased responsiveness allows your body to move the sugar from your blood into the cell.
When you exercise, your muscles require more energy to sustain that movement than they would sitting on the couch. As a result, physical activity causes increased blood sugar uptake into active muscles to fuel your exercise. In other words, the sugar (glucose) moves out of your blood and into your working muscles. Amazingly, this increased blood sugar uptake into your muscles lasts long after you are done exercising. In fact, increased blood sugar uptake into your muscles remains elevated for up to 72 hours after exercise!
Another way that exercise (specifically resistance training) improves your blood sugar control is by increasing your muscle mass. As we have discussed before, skeletal muscle is essential for blood sugar clearance. It is the largest organ in the body by mass and is responsible for 80% of blood sugar uptake after a meal! The more muscle you have, the more places you have to put the sugar! Low levels of muscle mass have been shown to increase your risk for type 2 diabetes compared to individuals with more muscle mass.
What kind of exercise should I perform to control my blood sugar?
The research is clear: a combination of aerobic and resistance training is more effective for blood sugar management than either type of exercise alone. Participation in regular physical activity improves blood sugar control and can prevent or delay the onset of type 2 diabetes.
Aerobic exercise should be performed at least 3 days per week (ideally 5) with no more than 2 consecutive days between bouts of activity for a total of at least 150 minutes per week. It should be performed at least at moderate intensity (40-60% of VO2 max), but vigorous aerobic exercise is more effective at controlling your blood sugar. From the authors of a 2010 study on the effects of exercise and diabetes: “those already exercising at a moderate intensity should consider undertaking some vigorous physical activity to obtain additional blood glucose (and likely cardiovascular) benefits.” If enhanced insulin action is a primary goal, then daily moderate or high-intensity exercise is likely optimal. Some is good. More is better.
Resistance training should be performed 2-3 times per week at a moderate to vigorous intensity for optimal gains in strength and insulin action. Aim for 3-4 sets of 8-10 reps with exercises involving the major muscle groups.
A 2003 study reviewed the current research on the benefits of resistance training for individuals with diabetes/prediabetes. What did they find? From the authors:
“progressive resistance training promotes favorable energy balance and reduced visceral fat deposition through enhanced metabolism and activity levels while counteracting age- and disease-related muscle wasting. Resistance training improves insulin sensitivity and glycemic control; increases muscle mass, strength, and endurance; and has positive effects on bone density, osteoarthritic symptoms, mobility impairment, self-efficacy, hypertension, and lipid profiles. It also alleviates symptoms of anxiety, depression, and insomnia in individuals with clinical depression and improves exercise tolerance in individuals with cardiac ischemic disease and congestive heart failure; all of these aspects are relevant to the care of diabetic elders”
What should I eat to reduce my risk of diabetes? Or, if I have diabetes, what I should I eat to improve my blood sugar and potentially put my diabetes into remission?
The current research does not fully support one particular type of diet or an ideal percentage of calories from carbohydrate, protein or fat for those with diabetes or prediabetes. The “ideal” diet for each individual will differ based on current eating patterns, preferences, meal prep skills and physical activity levels. Although there is not an ideal diet for diabetics, there are overarching principles that can be applied to all diets to improve blood sugar and insulin sensitivity.
Regardless of which diet you choose, total calorie intake should be appropriate to attain weight management goals. There is an abundance of evidence indicating that weight loss is effective in preventing progression from prediabetes to type 2 diabetes and in managing cardiovascular health for those with type 2 diabetes. For those with type 2 diabetes, 5% weight loss is the minimum amount recommended for clinical benefit. Optimal results can be seen around 15% of weight loss. For those with prediabetes, weight loss of 7-10% can prevent progression to type 2 diabetes.
A 2017 study looked at the effects of a low calorie diet in a group of diabetics versus a diabetic control group that did not make any changes to their diet. After 3-5 months, 46% (!) of the low calorie diet group achieved complete diabetes remission! This means that almost half of the intervention group were no longer diabetic and did not need any diabetic medication! They achieved this remission with only a low calorie diet.
In addition to weight loss, here are some other rules of thumb to control your blood pressure via diet:
Get enough fiber: 21-25 grams/day for women; 30-38 grams/day for men
Emphasize non-starchy vegetables
Minimize added sugars and refined grains
Choose whole foods over highly processed foods
Replace sugar sweetened beverages with water
How much can lifestyle interventions reduce your risk of developing diabetes and its associated complications?
A 2002 study looked at the effects of weight loss and physical activity compared to metformin (a common diabetes medication) in its ability to reduce the risk of diabetes in study participants that were prediabetic. Both the metformin and the weight loss/physical activity were effective in reducing the risk of diabetes but the group that focused on changing their lifestyle had a much more significant reduction. Specifically, the group that achieved a 7% or greater weight loss and exercised for 150 minutes per week reduced their risk of developing diabetes by 58%, compared to 31% in the medication group.
The Look AHEAD trial compared intensive lifestyle changes (7% weight loss and 175 minutes of exercise/week) to a diabetes support/education control group in adults 45+ with diabetes. The group that was able to lose weight and exercise regularly:
“achieved significantly greater sustained improvements in weight loss, cardiorespiratory fitness, blood glucose control, blood pressure, and lipids with fewer medications; less sleep apnea, severe diabetic kidney disease and retinopathy, depression, sexual dysfunction, urinary incontinence, and knee pain; and better physical mobility maintenance and quality of life, with lower overall health care costs.”
Is Running Bad for Your Knees?
Is recreational running associated with an increased risk of hip or knee arthritis? No. It appears to protect against it.
A study in 2017 reviewed the existing research on the association between running and knee/hip arthritis. They compared recreational runners and individuals who were not active. What did they find?
10% of the sedentary individuals had knee and hip arthritis
3.5% of the recreational runners had knee and hip arthritis
That’s right. The folks that were running consistently had a far LOWER chance of having hip and/or knee arthritis than the individuals that were not doing any physical activity at all. As we have discussed before, osteoarthritis (OA) is a lot more complicated than “wear and tear”. OA is a whole body disorder that has a lot of different causes. These include genetic, environmental, hormonal, and metabolic factors that interact and contribute to the start and progression of the disease. Inactivity appears to be the far riskier option.
This is great news. If you enjoy running, keep it up! Do not stop out of fear it is increasing your risk of arthritis. If anything, it is reducing the likelihood!
One caveat: competitive runners did exhibit a slightly higher (13%) risk of arthritis than did the sedentary individuals. So should you stop running competitively? No again. The innumerable physical and mental health benefits of improved cardiorespiratory fitness FAR OUTWEIGH the slight risk increase in arthritis.
Protein Pyramid for Adults 50+
Another protein article?! We are going to continue to stress the importance of adequate protein consumption in adults 50+. Why?
Low muscle mass in adults 50+ can have profound effects on function and quality of life. One of the major threats to living independently is the loss of muscle mass, strength, and function that progressively occurs with aging.
In order to maximize the benefits of resistance training, you must make sure you are getting enough protein in your diet. How should you prioritize your protein intake?
In order of importance:
1. Protein Amount: 1.0-1.2 g/kg of bodyweight; a 150 pound individual should try to get ~ 70-80 grams of protein per day
2. Protein Per Meal: 25-35 grams spread evenly during each meal
3. Protein Quality: not all protein is created equal. Focus on complete proteins that include all of the essential amino acids. These usually come from animal sources.
4. Protein Timing: this is not as important as once believed, but there may be a small benefit in consuming protein shortly following exercise
If you aren’t getting enough protein - roughly half of your bodyweight in grams - don’t worry about the other details. Start by getting enough. As we have discussed before, it may be easier to increase your protein intake by supplementing your diet with a protein shake or high protein smoothie.
After you are consistently hitting the mark on your protein, then focus on the other details above. Slowly work your way up the “protein pyramid” over time.
Longevity Members In Action
Member Spotlight/100 Class Club
This month’s member spotlight is on M’Lissa Baye. M’Lissa consistently attends the 1:30 functional fitness class and works hard - even on the medicine ball exercises she doesn’t enjoy! She also joined the 100 class club earlier this month!
How long have you been a member of Longevity? Since my 1:30 class began in late July 2022
What is your favorite exercise at Longevity? Least favorite? No favorite, but balance work is easiest for me. Least is anything medicine ball.
Where are you from originally? Where did you go to school? I am a Texas girl, born and bred. Graduated from Texas A&M University, and ironically came to Purdue for graduate school.
What do you like to do when you’re not working out at Longevity? I walk for exercise almost every day, I practice yoga several times a week, I read a lot, I knit in the evenings, and I try to be of service to others in various volunteer roles in the community and my church.
What’s the next place on your travel bucket list? Probably the next national park to hike; we’ve done several so I think it’s now a pattern.
New Longevity Members
Welcome to Longevity Bloomington! It has been great having you all in class.
Well Attended
We would like to recognize the Longevity Bloomington members that made it to all or most of the classes since our most recent newsletter and the folks that joined the 100 class club! Well done!
Yoga Pose of the Month
Yoga Pose of the Month: Standing Half Moon Pose
Known by several different names, Standing Half Moon Pose uses the body to create a long crescent shape. Less poetically, Standing Half Moon Pose is a lateral or side bend.
Practicing Standing Half Moon strengthens and lengthens the body. The entire core section activates to find the shape. As the core muscles activate they are both strengthening and stretching. You will be able to feel your oblique muscles working to hold the shape, and you will feel the stretch on the lifted side of your waist. As the spine gently arches in one direction and then the other, we build flexibility in the spine itself.
To practice this pose, you will want to remember to keep the abdominals engaged throughout. You should create a gentle draw in and up: imagine drawing the belly button back toward the spine and slightly up.
Be sure to keep this a lateral bend. No rounding the torso forward or dropping the torso back. Think about being a piece of toast: you don’t want to touch the toaster, either with your belly or your back.
Here’s how to find Standing Half Moon:
1. Begin from Mountain Pose: Feet are parallel, if possible. They don’t need to touch. Just find a stance where you find sturdy. Knees have a small, micro-bend, hips are stacked over heels, shoulders over hips, the crown of the head is reaching to the ceiling, and arms are by your sides.
2. With your next inhale, reach the arms overhead. Palms come together. Abdominal muscles are engaged. This is important: don’t forget to pull the belly in!
3. With your next exhale, reach up and then over to your right, coming into a side bend.
4. You can stay for a full round of breath or two.
5. With your next inhale, return to center, arms reaching to the ceiling.
6. As you exhale, reach up and over to your left, coming into a side bend.
7. You can stay for a full round of breath or two.
8. With your next inhale return to center, arms reaching to the ceiling.
9. As you exhale, return the arms to your sides.
You can repeat these steps as desired.
Check out this video:
I hope you’ll give this beautiful stretch a try!
Come join us for practice Mondays and Wednesdays 2:00-3:00. Absolute beginners are absolutely welcome!
~Patricia