When I was in pharmacy school, one of my classmates and good friends suffered from obesity. He had been overweight almost his entire life, but his poor dietary choices through his time in college contributed to his significant weight gain. Even worse, his doctor told him that he was now classified as pre-diabetic, meaning that if his poor diet and lifestyle choices continued, he would eventually develop type 2 diabetes and would have to be put on medication to manage the disease. All of this was happening at the young age of 23 years old!
With the encouragement of his friends, Jeff started exercising regularly, combining weight lifting with a regular routine of jogging. In his first workout, he could barely jog half a lap before stopping for rest. Within 2 weeks, he was jogging half a mile. Within a couple months, he was jogging 2-3 miles per workout! Over the course of pharmacy school, Jeff cleaned up his diet lost over 100 pounds and is no longer classified as a pre-diabetic. Unfortunately, the weight he lost seemed to distribute to all of his classmates, as we all seemed to gain weight over the same time period. I am happy to say that nearly 10 years later, Jeff has kept the weight off and is happier and healthier than ever!
With the right strategy in place, Jeff's story can also be yours! Let me show you how.
In this week's blog post, we will take a look at the role exercise can play in reducing and even eliminating risks associated with type 2 diabetes. We will understand:
1. Type 2 diabetes and the role that insulin plays in its development
2. Why exercise can help manage and even reverse diabetes
3. What types and how much exercise have been shown to be most beneficial
4. The benefits of non-exercise movement
Understanding Type 2 Diabetes, Insulin Resistance, and The Role of Insulin
All food is comprised of three parts, known as macronutrients. This includes fats, protein, and carbohydrates. The body digests and processes each of these three macronutrients differently. As soon as you begin eating food, the body begins breaking down and processing the foods. Carbohydrates break down into sugar, also known as glucose, which upon digestion, enters the blood stream. Insulin is hormone in the body that helps to regulate blood sugar levels. Specifically, it is like a key that allows glucose to enter into channels on cells throughout your body. Once inside the cell, the sugars are processed further to provide immediate energy for that cell. However, if we eat more carbohydrates than what is required for our immediate energy needs, this excess sugar is converted into triglycerides by the liver so that they can be stored as fat.
Moreover, each time we eat carbohydrates, our blood sugar levels rise and our bodies produce insulin in response. This process is more pronounced when we eat highly refined carbohydrates, known as high glycemic load foods. The more often we produce insulin, the less sensitive the insulin receptors get. When insulin receptors are less sensitive, the body has to produce higher amounts of insulin to have the same effect, eventually leading to a condition called insulin resistance.
It's kind of like how, over time, we have drink more and more coffee to achieve the same energy boosting effect. Because cells are 'resisting' the effects of insulin, glucose cannot go inside the cells for use as energy. Blood sugar and insulin levels remain high. The high insulin levels signal the liver to turn that excess sugar into fat to be stored away in fat cells. Meanwhile, the cells still aren't getting glucose needed for energy, which triggers our appetite, causing us to eat even more carbohydrates. Therefore, the higher amounts of insulin in our bloodstreams keep our bodies in a fat storage mode instead of the desired fat burning mode that is triggered from having lower insulin levels. As insulin resistance progresses, it leads to pre-diabetes and eventually, type 2 diabetes.
How Can Exercise Help?
Exercise can help reduce the risk of developing diabetes in a number of ways.
First, as mentioned in the previous section, the first priority for sugar in the blood stream is to be shuttled to the cells to be used for immediate energy. However, if the immediate needs of the cells are fulfilled, then excess sugar is stored away as fat. Exercise helps lower blood sugar by increasing the muscle cells' demand for energy. After all, when we exercise, we exert quite a bit of energy.
Secondly, exercise helps develop muscle mass, which is highly sensitive to insulin compared to other tissues in our bodies. Because it is more sensitive to insulin, muscle cells end up consuming more glucose, leaving less to circulate in the blood. It turns out that exercise increases the amount of insulin receptors on the muscle cells. Earlier, we mentioned that insulin is the key that opens doors, allowing glucose to go inside the cell to be used as energy. Imagine if the keyhole on the door is blocked with gum. In this case, sugar cannot get into the cells (which is the case in insulin resistance and diabetes.) Exercise increases the amount of keyholes for insulin to unlock, thus increasing muscular sensitivity to insulin.
Thirdly, exercise increases mitochondrial capacity. Mitochondria are the powerhouses in the cells that process sugar into energy that the cells can use. The more mitochondria we have and the more efficiently they operate, the more quickly our bodies can process sugar. Interestingly, every pound of muscle burns 50 more calories per day compared to fat, without any additional effort.
Fourth, exercise increases our metabolism, which helps us process sugar and burn calories even when we are not exercising. One study found that as little as 75 minutes of total exercise per week, which includes warm up and cool down periods can not only lower blood sugar levels 24 hours after exercise, but it can also reduce blood sugar spikes after meals.
Fifth, exercise enhances muscular uptake of glucose independent of insulin. Back in the 1980's, scientists discovered that exercise induces glucose uptake into the muscle cells regardless of whether or not insulin is present. This effect increases with the intensity and duration of exercise and persists for hours after completing the workout. Overall, this leads to profound blood sugar lowering effects even in between workouts.
What type and how much exercise is best for reversing diabetes?
There have been several studies that have analyzed the benefits of exercising on diabetes. One particular study followed over 35,000 women for a 14 year year period. Researchers found that compared to women who performed no strength training, women engaging in strength training enjoyed 17 percent lower rate of heart disease and a 30 percent lower rate of type 2 diabetes.
Moreover, women who added 120 minutes of aerobic exercise per week in addition to any kind of strength training had 65% lower rates of type 2 diabetes compared to women who did neither. This evidence seems to suggest that combining aerobic exercise with strength training is the most potent combination for reversing type 2 diabetes.
High intensity interval training (HIIT) seems to be particularly beneficial in mitigating risks of diabetes. HIIT, as the name suggests, involves short bursts of high intensity activity, alternating with longer periods of rest. One study had overweight Type 2 diabetics ride a stationary bicycle at 90% of maximal effort for 60 seconds followed by 60 seconds of rest. This pattern was completed 10 times. They completed this workout routine 3 times per week for a total of 60 minutes of exercise per week. After just two weeks of this routine (6 total workouts), their average 24 hour blood glucose concentration reduced from 140 to 120 mg/dl!
The study's authors concluded that “low-volume HIIT can rapidly improve glucose control and induce adaptations in skeletal muscle that are linked to improved metabolic health in patients with Type 2 diabetes.”
In another study, participants performed similar type of routine, but performed the exercise bouts at 60% of maximal effort. After just 6 sessions over two week, insulin sensitivity improved by about 35% after training. Both of these studies were very small, so only limited conclusions can be drawn from their results. Nonetheless, it certainly indicates the potential that this type of exercise has in helping type 2 diabetics.
Overall, as little as 20 to 30 minutes of exercise, 3 to 5 times per week in a HIIT format, mixing aerobic type exercises with strength training seems to be most effective combination in preventing or reversing diabetes. Before starting any exercise, check with a medical professional, especially if you are a senior citizen, have other chronic conditions, or have little experience with exercising.
The Importance of Non Exercise Movement
One of the best health interventions both diabetics and non-diabetics can make is to increase non-exercise movement. The results from a couple different studies (here and here) have led journalists to write attention grabbing headlines such as "Sitting is the New Smoking."
We have already seen the importance of exercise in treating diabetes. Recent research indicates that the timing of the exercise also plays a significant role. One study compared two groups of people, both getting the recommended 150 minutes of exercise per week. The first group exercised 30 minutes per day, all in one workout. The second group was instructed to go for three, 10 minute walks after each meal. Interestingly, the second group experienced better blood sugar control, lowering post meal blood sugar levels by 22%!
Another study found that as little as 3 minutes of walking every 30 minutes significantly improved blood fat profiles, reducing their risk of developing heart disease, which is common in diabetic patients. The lead author, Megan Grace, Ph.D., recommends for diabetics to simply "Stand up, sit less, and move more — particularly after meals."
The research is undeniable. Exercise is like a super drug for not only diabetes, but also for countless other chronic conditions. Perhaps author Dana G. Smith put it best in her article, "This Is What Exercise Does to Your Brain," when she says "If exercise were a drug, we would say its benefits were too good to be true. Not only does it keep us healthy and help us live longer, it makes us smarter and happier, too."
In conclusion, it is clear that exercise plays a vital role in the overall strategy in defeating diabetes. If you like what you're reading and would like to get more information on the topic, subscribe to my newsletter at This Site.
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