Healthy training and fine dining to combat diabetes Uranienborg Rotary Klub Feinschmecker, 28.11.2013 Jørgen Jensen Department of Physical Performance.

Healthy training and fine dining to combat diabetes

Uranienborg Rotary Klub

Feinschmecker, 28.11.2013

Jørgen JensenDepartment of Physical PerformanceNorwegian School of Sport Sciences

&Department of Public Health

Aarhus University

Balansér mat/energiinntak og trening for å unngå overvekt og type 2 diabetes

Diabetes

• Diagnosis:– Fasting blood glucose > 7.0 mM (126 mg/dL)– Blood glucose 2 h after 75 g oral glukose

> 11 mM (200 mg/dL)

• Fasting glucose 5.6 – 6.9 mM.– Blood glucose 2 h after 75 g oral glukose

mellem 7.8 and 11 mM– Insulin resistance– Glucose intolerance– Pre-diabetes

• Glycosylated hemoglobin (HbA1c)

Skeletal muscles and insulin sensitivity

Diabetes is diagnosed by elevated blood glucose.

Glucose and other carbohydrates are stored as glycogen in liverand skeletal muscles.

Skeletal muscle (40 % of body weight) store ~ 400 g glycogen.

Insulin stimulates skeletal muscles glucose uptake.

Skeletal muscles removes blood glucose.

Exercise utilises skeletal muscle glycogen.

Liver (1.5 kg) stores ~ 100 g glycogen.

Framingham Heart Study, MA

1948: 5209 non-industrial white subjects recruited; 2336 males; 2873 females age 28-62 yExamination: Every 2. year.1999: 993 survivingLS: Life span Yashin et al. 2009

Mech Ageing & Dev, 130:611-

Quality of life

• Constitution of the World Health organization:– Health is a state of complete physical, mental and social well-

being and not merely the absence of disease and infirmity.– The enjoyment of the highest attainable standard of health is

one of the fundamental rights of every humans being .......• Aging is associated with sarcopenia and reduced physical

function.• Type 2 diabetes increases development of sarcopenia and

reduces quality of life and decrease life span.• Exercise reduces the risk for type 2 diabetes, CAD,

reduction in cognitive function, ......

Risk factors for type 2 diabetes

• Obesity• Inactivity• Diet• Genetic• Age• Mental stress

Exercise and food/energy intake

Justitia – “Lady Justice”

Our genes are importantfor outcome of diet andexercise.

Food is energy

Food also contains vitamins, polyphenols and taste/smell molecules

Carbohydrate Protein Fat

Food is energy

Food also contains vitamins, polyphenols and taste/smell molecules

Fine dining is pleasure

Carbohydrate Protein Fat

Food – movement -body weight

70 kg

140 kg

Energy utilisation – 10 km

0.5 L gasoline

700 kcal

1.0 L gasoline

1400 kcal

Food – movement -body weight

70 kg

140 kg

Energy utilisation – 10 km

0.5 L gasoline

700 kcal (0.08 L Olive oil or 0.875 kg potato)

1.0 L gasoline

1400 kcal (0.15 L Olive oil or 1.75 kg potato)

How to prevent type 2 diabetes

• Avoid obesity• Weight reduction• Exercise• Diet (low intake of carbohydrate - low fat

intake).• High intake of fibres.

Intervention to prevent diabetes

Intervention:Weight reduction: > 5%Fat intake: < 30%Saturated fat intake <10%Fibre intake: >15 g/1000 kcalExercise: > 4 h/week

Detailed advice about the interventionDietary advices (food record) by nutritionist (7 meetings first year)

Exercise: walking, running, swimming, aerobic ball games or skiingResistance training (circuit-type) for large muscle groups: moderate-high number of repetitionsrest periods: 15-60 s (Adherence: 50-85 % at centres during the firsts year).

Subjects:522 overweight with impairedglucose tolerance (2 h: 7.8-11 mM)

Incidence of diabetes (3.2 years) Control group: 23%Intervention group: 11%

Tuomilehto et al., 2001N Eng J Med 18:1343-

Taste and flavour

Taste receptors:SweetUmaniBitterSourSalty

Fat?

Depoortere, 2013Gut

Evolutionary functions of taste:Evaluate food for toxins and nutrientsPrepare the body for metabolismRecognise food items

Taste and flavour

Taste receptors:SweetUmaniBitterSourSalty

Fat?

Functions of taste:Taste signal pleasure and rewardTasty, energy-dense food cause obesity

Breslin, 2013Cur Biol 23:R409-

Fine dining to prevent type 2 diabetes?

High protein & low glycaemic index diet is superior to maintain weight reduction

Larsen et al., 2010N Eng J Med 363:2101-

Subjects:938 Overweight on low-calorie diet (800 kcal)773 completed weight reduction > 8% (8 wk)Randomly assigned to:High protein low glycaemic indexHigh protein high glycaemic indexLow protein low glycaemic indexLow protein high glycaemic indexControl

All groups: Intention to maintain weight reductionFood ad libitum, 25-30 % fatHigh protein: + 12 % of total energyHigh glycaemic index: + 15 glycaemic-index units

Fine dining for athletes?

Healthy dietMiddle-aged and inactive The young athlete

2,500 kcal Energy requirement 8,000 kcal/day

200 kcal/ h Exercise 1,000 kcal/h

Healthy dietMiddle-aged and inactive The young athlete

2,500 kcal Energy requirement 8,000 kcal/day

500 kcal/h Exercise 1,000 kcal/h

30 ml/min/kg Maximal oxygen uptake 90 ml/min/kg

Old people

200 kcal/h Exercise 700 kcal/h15 ml/min/kg Maximal oxygen uptake 50 ml/min/kg

Sufficient food for athletes

High oxygen uptake predicts high insulin sensitivity

Maximal oxygen uptake (ml/kg/min)

20 30 40 50 60

M-v

alu

e (

mg

/kg

/min

)

0

2

4

6

8

10

12

14

16

Healthy controls after trainingInsulin resistant after trainingHealthy controls before trainingInsulin resistant before training

MyoGlu, 2013

Healthy training

• Train endurance and strength.• Exercise/walk 30 min five days a week and perform 2

sessions (60 min) of moderate/high intensity strength or endurance exercise.

• Avoid long periods of sitting without activity – 2 min of activity 1-2 times per hour.

• Find exercises that improve wellbeing and not cause pain in tendons and joints.

• Dynamic flexibility training.• Find types of exercises you like.• Train continuously and systematic.

Mental stress

• Stress is recruitment of energy.

• Training may be most important when you are mentally stressed!

Motivation to train

René Descartes (1596-1650)

Af alle ting er den sunde sans det, som er mest retfærdig fordelt;for hver og en mener at være så vel forsynet dermed,at selv de, der er sværest at stille tilfreds i alt andet,ikke har for vane at ønske sig mere deraf, end de har.

MetodenGyldendal, 1967

René Descartes (1596-1650)

Af alle ting er den sunde sans det, som er mest retfærdig fordelt;for hver og en mener at være så vel forsynet dermed,at selv de, der er sværest at stille tilfreds i alt andet,ikke har for vane at ønske sig mere deraf, end de har.

MetodenGyldendal, 1967

Derfor kommer forskellen i anskuelser ikke af, at nogle er mere fornuftige end andre,men alene af, at vi i vore tanker ledes ad forskellige veje og ikke overvejer de samme ting.

For det er ikke nok at have en god forstand; det vigtigste er at bruge den godt.

René Descartes (1596-1650)

Le bon sens est la chose du monde la mieux partagée: car chacun pense en être si bien pourvu,

que ceux même qui sont les plus difficiles à contenter en toute autre chose, n'ont point coutume d'en désirer plus qu'ils en ont.

DISCOURS DE LA MÉTHODE1637