Skip exercise now, pay later -- that's the warning from a study that found that younger people who didn't exercise were more likely to develop diabetes in 20 years than those who stayed fit.
Researchers examined data from the Coronary Artery Risk Development in Young Adults study, a longitundinal study of 5,115 adults initially ages 18 to 30 that looked at lifestyle and how cardiovascular disease risk factors changed over time. The participants were given a treadmill test at the beginning of the study, then at year seven and 20. They were also tested for diabetes.
At the study's start, white men were the most fit, followed by black men, white women and black women. White and black men had the highest fasting glucose levels in the beginning, followed by white women and black women.
Body mass index was the strongest predictor of developing diabetes. And despite the fact that black men and white men started off on a fairly even BMI level at the beginning of the study, BMI was a bigger predictor of developing diabetes for black men. Researchers also found that the less fit people were, the higher the incidence of diabetes.
Via a release, lead author Mercedes Carnethon, assistant professor of preventive medicine at Northwestern University's Feinberg School of Medicine, said, "The overwhelming importance of a high BMI to the development of diabetes was somewhat unexpected, and leads us to think that activity levels need to be adequate not only to raise aerobic fitness, but also to maintain a healthy body weight. If two people have a similar level of fitness, the person with the higher BMI is more likely to develop diabetes."
So the next time your mother says, "An ounce of prevention is worth a pound of cure," maybe you'll listen to her.
The study appears in the July issue of the journal Diabetes Care.
Type 2 diabetes isn't one of those illnesses that strikes suddenly. Years of overeating, excessive weight and lack of physical activity get the process rolling and, a new study shows, blood glucose and insulin sensitivity begin to change several years before the full onset of the disease.
The study began with 6,538 adults without Type 2 diabetes. Over a 10-year follow-up period, researchers diagnosed 505 cases of Type 2 diabetes. They then looked back at the trajectories of the patients' fasting blood glucose levels, glucose levels after a standard glucose test, insulin sensitivity and the function of the insulin-producing beta cells of the pancreas. They found that in the diabetic patients, a linear increase was seen in fasting glucose followed by a steep increase starting three years before their diagnoses. Post-meal glucose levels also showed a rapid increase starting three years before diagnosis. Beta-cell function increased three to four years before diagnosis but then decreased in the final three years before diagnosis.
The research, by scientists in the United Kingdom and Denmark, may help doctors design models to predict diabetes. If people can be identified in these early stages of the disease, treatment may help prevent full onset.
"Although most prevention studies focused on prediabetic people, our findings suggest that people with prediabetes are already on the steep part of the glucose trajectory," the authors said.
The study was presented today at the American Assn. of Diabetes annual meeting in New Orleans and is published online today in the Lancet.
-- Shari Roan
Photo: A person with diabetes uses a makeshift tourniquet to draw her blood for blood-sugar testing. Credit: Tom Strickland / AP
... if it's loaded with antioxidants, that is. New research suggests that such vitamins can actually make exercise less beneficial than it otherwise would be, at least in terms of insulin sensitivity and thus the risk of diabetes.
In a study published in Proceedings of the National Academy of Sciences, researchers at Harvard Medical School and elsewhere studied the vitamins' effect on 39 young men. Half of the participants regularly got more than six hours of exercise per week and were assessed as pretty darn fit; the other half normally got less than two hours of exercise a week, which included the not-too-strenuous demands of daily life.
During the study, some of the men got extra daily doses of vitamin C and vitamin E (1,000 milligrams and 400 IU, respectively). Some of them didn't. All were put through a four-week regimen of exercise.
And those workouts did increase insulin sensitivity -- as such exercise is supposed to do -- but only among the men not taking the vitamins.
The key here is free radicals -- much-maligned molecules that we're all happy to fight, regardless of whether we understand their function. Antioxidants, of course, are free-radical fighters -- noble chemicals we're all happy to purchase and consume, regardless of whether we understand their impact.
In this case, free radicals seem to enhance the body's sensitivity to insulin. And antioxidants get in the way of that. Even in nutrition, few things are black and white.
Here's an explainer from the Nutrition Blog on about.com:
"The increased levels of free-radicals stimulates your body to take certain steps to protect itself -- like increasing insulin sensitivity. Taking those antioxidant vitamins may wipe out enough free-radicals so that threshold isn't reached. It doesn't mean the exercise isn't beneficial for other reasons, but at least in this study, the lack of free radicals appear to have reduced some of the benefit of exercise."
The Big Money posits that this is further evidence we should avoid vitamin supplements.
And FuturePundit offers some additional context and the conclusion that, really, we just need an all-benefits-of-exercise-with-no-downside pill.
As for the post-workout smoothie, seriously, have you considered the calories in those things? Here's a look, courtesy of ABC News.
-- Tami Dennis
Photo: Don't kid yourself. The message here is not "don't exercise."
Small changes can often yield big results, health experts have been saying for years, and here's more proof: By slightly reducing sugar and increasing fiber, Latino teenagers may lessen some risk factors linked with Type 2 diabetes.
Latino teens (average age 15) were part of a study looking at the effect minor dietary and activity changes over 16 weeks had on their metabolism and body composition. Of the 54 Los Angeles County teens who participated, some were assigned to a nutrition group, attending one nutrition class a week; some were assigned to a nutrition and strength training group, taking one nutrition class per week and doing two strength training classes per week; and others were in a control group that received no health-related interventions. The goals of the nutrition classes were to get the teens to decrease added sugar and increase fiber consumption.
Researchers found that 55% of all participants cut their sugar consumption by 47 grams per day — the equivalent of one can of soda — and 59% of all teens upped their fiber by an average of 5 grams a day—the amount in about half a can of beans. That decreased sugar intake accounted for an average 33% decrease in insulin secretion. More fiber resulted in an average 10% less visceral fat, which is known to increase the risk of diseases such as diabetes.
And yes, that was all participants — even the ones in the control group. Researchers believe they might have made the dietary changes because they knew the purpose of the study and may have been more motivated to make changes.
The authors cited other research that found Latino children are more insulin resistant than white children, making them more likely to develop chronic diseases linked to obesity. In the study, they wrote: "Modest changes in sugar and fiber consumption ... could lead to substantial improvements in adiposity and metabolic parameters. Furthermore, given that the control group demonstrated similar dietary changes as the intervention groups, our results suggest that intensive interventions may not be necessary to achieve modifications in sugar and fiber intake."
A March 22 story in the Los Angeles Times about the increasing number of foot amputations in people with diabetes led to an outpouring of ideas, information and comments from readers. About 100,000 Americans -- and many thousands more worldwide -- undergo foot amputations each year due to complications from diabetes. Doctors, however, believe that more limbs could be saved with better preventive care and aggressive medical treatment. Below, I'm sharing some of the many thoughtful comments and suggestions for people with diabetes that were sent in after the story appeared.
--St. John's Well Child & Family Center Clinics will open a new building at Hoover and 57th streets in Los Angeles in May that will house a Diabetes Center. The center will give the organization more ability to meet the needs of diabetics in under-served communities and who lack the ability to pay for care. The S. Mark Taper Foundation building will also house medical exam rooms, exercise and fitness rooms, a classroom/demonstration kitchen, gymnasium, mental health rooms and offices. The clinic is equipped to handle at least 7,000 new primary care visits for patients with chronic diseases and a minimum of 5,000 preventive care visits.
--The American Podiatric Medical Assn. has a Web page for the public with information on diabetes and amputation prevention. The information is in English and Spanish. www.apma.org/diabetes
--A comment from Jeff Everson, Woodland Hills: "Reading your March 22 article, "Doctors Target Diabetic Foot Loss," in 1971, as my father was wheeled out of surgery after his diabetic-induced amputation for a gangrenous (posterior surface) foot ulcer infection, he turned to mom and sarcastically harrumphed, “Well, at least you can’t nag me now when I lose one of my socks in the laundry.” Problem was 3 years later his other leg had to be amputated too. While medicine may now be ‘targeting’ foot loss with diabetics, I am sure that my father would have preferred they had started that more than 40 years ago."
--One reader notes that researchers at the U.S. Department of Veterans Affairs are using a system called Health Buddy "that keeps patients in touch with health care providers every day, letting doctors catch problems and intervene before they become costly hospitalizations ... they have seen substantially lower hospitalization and mortality rates in diabetic patients who use a small electronic device in their homes to check in with their doctors every morning. What the doctors are finding is that by having patients answer some basic health questions every day, they are able to jump in early before small problems like foot wounds become full blown crises. They are also finding that patients who know they are going to have to report their blood sugar and answer questions about their self-care each day also end up staying healthier because they have better habits."
--Suggestion from a reader: "I have a problem with calluses on my heals. I have seen a podiatrist and she uses a scalpel to cut away the calluses making my feet very sore and requires medication to prevent infection. I found a much better way to keep the calluses down to the minimum. It is called a Pet Egg Professional. Cost about $10.00 and 3 replacement blades $10.00. You hold this device in your hand and remove the callus. The callus that is scrapped off collects in the hand holding device. Check it out. (TELE Brands Fairfield NJ 07004 www.TeleBrands.com) This device eliminates many trips to the podiatrist that want to cut on you ... The last time I have seen my doctor he remarked how good my feet looked."
--From Marilyn Zeitz Norwood, registered nurse practitioner, Los Angeles: "The costs, both human and financial, are ludicrous in the presence of our ability to save the patients limbs ... I am proud to say that I am one of eight women volunteers and one man, a wonderful, generous ,trusting volunteer M.D. who founded the T.H.E. Clinic Inc. in South L.A. 35 years ago. Thanks to the outstanding stewardship and leadership of Jamesina Henderson C.E.O, and the excellent, dedicated medical, educational and ancillary staff, T.H.E. Clinic is alive and well, and taking care of hundreds of patients each and every week. Please take time to look us up on www.theclinicinc.org. It may be of benefit to those you know who need low cost, excellent health care ... The majority of our patients are low income, uninsured African American, African from other countries, Hispanic and South East Asian. Included in our medical services is a comprehensive program for diabetic patients. This includes a monthly class conducted by a dedicated corps of volunteer registered nurses and specialists in various disciplines. Anyone is free to attend at no charge.They do not have to be a patient but they have to contact the program coordinator to reserve a space."
--From Dr. Jack E. Rubin, medical director, Los Angeles Vascular Access Center. "I read with great interest your article on diabetic foot amputations in last Sunday's Los Angeles Times. I would suggest to you that another way to treat the problem of peripheral arterial disease (PAD) is having an angiogram done of the limb that has a non-healing wound or symptoms of claudication, cramping of the calf muscles whilst walking. ... The Los Angeles Vascular Access Center has been doing angiograms and angioplasties on the limbs of patients with PAD since 2007. Most of our patients have had their limbs saved due to correction of the PAD present in their legs. This is done without general anesthesia, is cheaper than an in-hospital admission and has fewer complications than in patient surgery."
--From Dorothy Liener, Orange County: "I have just started a Kidney For Life organization in Newport Beach. Diabetes and kidney disease usually go hand-in-hand. Kidney for Life is a nonprofit organization that focuses on improving patient care and quality of life for anyone suffering from kidney disease. Our goal is to raise awareness of kidney health and prevent the need for dialysis." For more information, call (949) 759-0622.
-- Shari Roan
Photo: An exercise class in the new S. Mark Taper Foundation Building of the St. John's Well Child & Family Center. Credit: St. John's Well Child & Family Center
Regular aerobic exercise helps prevent diabetes. But if you don't have time for several lengthy workout sessions each week, researchers have come up with a speed-dial approach to diabetes prevention. They have shown that a mere 7.5 minutes per week of high-intensity exercise substantially improved insulin sensitivity in healthy, sedentary people.
The study involved 16 young men who performed two weeks of supervised, high-intensity interval training. The training consisted of four to six 30-second sprints on an exercise bike. The men rested four minutes between each sprint. The total time commitment of each workout session ranged from 17 to 26 minutes, and they burned a mere 250 calories a week from the workouts. The study participants were given an oral glucose test, which measures how the body responds to sugar, before and after the two-week training period. In the later test, the amount of time the men's blood sugar and blood insulin levels were above normal was reduced by 12% and 37%, respectively.
The authors of the study, from Heriot-Watt University in Edinburgh, Scotland, say they think the brief workout program works so well on insulin because it involves large muscle groups. Skeletal muscle is the major tissue responsible for the uptake of glucose following a meal. The kind of muscle contractions and breakdown of muscle fibers that occurs in high-intensity interval training seem to result in changes in muscle insulin sensitivity.
"While regular exercise training represents one of the most powerful strategies to reduce the development of metabolic disease in healthy adults, most adults fail to meet current guidelines," the authors wrote. High-intensity interval training, such as running up the stairs a few times twice a week, is "a preventative intervention that could logically be implemented as an early strategy to prevent age-related development of cardiovascular disease."
Here's a good reason to get your blood sugar under control: Another study has linked diabetes with a decline in several types of mental functions. The study, published today in the journal Neuropsychology, also found that these mental deficits appear in people who are in the early stages of the disease and persist into old age.
Researchers at the University of Alberta in Edmonton, Canada, studied 41 adults with diabetes and 424 adults in good health. The study participants were between the ages of 53 and 90 and were tracked for several years. The findings support earlier studies that have found diabetes impairs cognition. But the new study also showed that the deficits seem to begin early in the course of the disease and are not limited to elderly people. The researchers also found that adults with diabetes scored worse on two of five mental processing tasks that were measured: executive functioning and speed. There were no differences between the two groups in memory, verbal fluency, reaction time and perceptual speed. The deficits detected were not enough to impair a person's ability to work or function in daily life, the authors said, but they appear to predict additional cognitive decline.
"Speed and executive functioning are thought to be among the major components of cognitive health," Roger Dixon, a co-author of the study, said in a news release. "There could be some ways to compensate for these declines, at least early and with proper management."
With diabetes reaching epidemic levels and affecting people of younger ages, Dixon suggested that health professionals should consider checking the cognitive status of people with more advanced cases of the disease. Last week, a study in the journal Annals of Neurology, showed that even modest increases in blood sugar levels in people who are not diabetic can lead to changes in the brain that impair mental function.
Teenagers who undergo gastric bypass surgery are often immediately relieved of Type 2 diabetes, according to research published today in the journal Pediatrics.
Studies on adults with Type 2 diabetes show that gastric bypass can result in disease remission or better disease control. However, this study is the first to explore the effects of the surgery in children. The study examined adolescents with Type 2 diabetes, which is usually related to obesity and is being diagnosed with alarming frequency in American children and teenagers.
Dr. Thomas Inge, director of the Cincinnati Children's Surgical Weight Loss Program for Teens, studied 11 extremely obese teens with Type 2 diabetes who had gastric bypass surgery and 67 obese teens who were receiving medical management for Type 2 diabetes. Among the 11 teens who underwent surgery, all but one had a remission in diabetes. The response was so rapid, the patients often discontinued medication for diabetes control before leaving the hospital after surgery. These teens lost an average of 34% of their body weight one year after surgery. In contrast, the teens who were medically managed did not have any weight change after one year and were all still taking medication for diabetes. The adolescents who had surgery also had improvements in blood pressure, cholesterol and triglyceride levels.
"The results have been quite dramatic and to our knowledge, there are no other anti-diabetic therapies that result in more effective and long-term control than that seen with bariatric surgery," Inge said in a news release.
Inge and his co-authors noted that future studies will be needed to track the long-term health of teenagers who participated in the study. Cincinnati Children's Hospital is home to a study funded by the National Institutes of Health that will collect and report outcomes on 200 teens undergoing weight-loss surgery nationwide.
-- Shari Roan
Photo: Amanda Munson is among the participants in Cincinnati Children's study on gastric bypass surgery. Credit: Ernest Coleman / Cincinnati Enquirer
People with diabetes need to choose their foods carefully to minimize the effects of the illness. But science hasn't always provided a clear picture of the best way to do that. For example, the findings of studies examining the usefulness of a diet high in low-glycemic foods to improve blood-sugar control and risk factors for cardiovascular disease have been mixed.
However, research published today shows that people with Type 2 diabetes who consume low-glycemic-index diets had greater improvements in their glycemic control and cardiovascular disease risk factors compared with people on a diet that emphasized fiber. Low-glycemic foods include nuts, beans and lentils. These foods break down slowly in the body and therefore do not raise blood sugar as quickly has high-glycemic foods, such as white bread and starchy vegetables. In contrast, high-fiber diets slow the rate of carbohydrate absorption, thus helping control blood sugar.
The study, by researchers at the University of Toronto, assigned 210 patients with Type 2 diabetes to a low-glycemic-index diet or a high-cereal fiber diet for six months. The participants were also treated with medications to control blood sugar. Those on the low-glycemic-index improved more than the other patients on several measures, such as blood-sugar control and cholesterol levels.
Although the improvements were modest, adopting a low-glycemic-index diet may be important because medications to improve glycemic control in Type 2 diabetes are often ineffective in reducing the risk of cardiovascular disease, said the lead author of the study, Dr. David J.A. Jenkins, in a news release. People with Type 2 diabetes have a two- to four-times increased risk of cardiovascular disease.
Genetic testing can yield some information about one's risk for various diseases. But when it comes to the chances of developing Type 2 diabetes, undergoing gene testing is not significantly better than an assessment based on traditional risk factors for the disease, such as weight, blood pressure and blood sugar levels, according to a study published today in the New England Journal of Medicine.
The study showed that gene testing can reveal risk-associated gene variants, and the more you inherit, the greater the chance for developing the disease. But for now, a standard checkup will "tell what you need to know about your Type 2 diabetes risk," said the lead author of the study, Dr. James Meigs of Massachusetts General Hospital.
The researchers analyzed records from the Framingham Offspring Study, which follows a group of adult children of participants of the original Framingham study. The database included more than 2,700 participants, with 255 of them developing Type 2 diabetes after 28 years of follow-up.
It's possible that as more genes associated with Type 2 diabetes are discovered, the value of gene testing may become more useful. But, for now, old-fashioned methods of predicting risk are just as good. Still, gene testing may turn out to be a good thing to do, says Meigs, if it makes some patients more willing to change their lifestyles to reduce the risk of developing the disease.
-- Shari Roan
Photo: A plate containing samples of DNA for testing. Credit: Elise Amendola / AP
Tami Dennis, who takes the word "skeptic" to previously uncharted territory, is the Times' Health and Science editor. She's adamant that pitches promoting awareness days, weeks or months are, by their nature, non-stories. And, because she's an adult, she refuses to use words like "veggies," "tummy" and "yummy."
Rosie Mestel, deputy Health and Science editor, studied genetics before abandoning flies, fungi and DNA for health/medical writing. Her hero is the biologist Ernst Haeckel, whose jellyfish paintings inspired snazzy chandeliers. Her favorite toast-spread is Marmite, a British delicacy made of yeast extract. Her least-favorite word is "millenniums."
Melissa Healy is a staff writer for the Health section reporting from Washington D.C. Healy's a veteran of The Times' National staff, having covered the Pentagon, Congress, poverty and social welfare, the environment, and the White House before shifting to Health in 2003. She writes frequently about mental health and human behavior, about federal health policy, prescription medication and ethics in medicine. More wonk than wellness freak, Healy chooses to believe in the health benefits of coffee and wine, and considers water a better work-out medium than beverage.
Karen Kaplan covers genetics, stem cells and cloning. She and colleague Thomas H. Maugh II comprise about 25% of the unofficial MIT-Alumni-in-Journalism Club, and she is proud to have taken more math (5) than English (0) courses in college. Her contributions to Booster Shots will, she hopes, appear more frequently than postings to her mommy blog.
Thomas H. Maugh II has been a science and medical writer at the Times for 23 years. Before that, he was on the staff of the journal Science for 13 years.
He has bachelor's degrees in English and chemistry from MIT and a doctorate in chemistry from UC Santa Barbara.
After a brief stint as a sports writer, Shari Roan turned to health journalism and has covered the topic for The Times for 18 years. She is the author of three books and the mother of two daughters, both teenagers who refer to her as a "health freak." She likes to jog, watch baseball and is very happy that dark chocolate contains some health benefit.
Jeannine Stein writes about fitness, sports medicine and obesity for the Health section. She’s a gym rat from way back and never met an elliptical trainer she didn’t like. Well, maybe one or two. She tempers exercise with a steady diet of reality television because she believes it’s all about balance.
Regular aerobic exercise helps prevent diabetes. But if you don't have time for several lengthy workout sessions each week, researchers have come up with a speed-dial approach to diabetes prevention. They have shown that a mere 7.5 minutes per week of high-intensity exercise substantially improved insulin sensitivity in healthy, sedentary people.
Here's a good reason to get your blood sugar under control: Another study has linked diabetes with a decline in several types of mental functions. The study, published today in the journal 
Teenagers who undergo gastric bypass surgery are often immediately relieved of Type 2 diabetes, according to research published today in the journal 
People with diabetes need to choose their foods carefully to minimize the effects of the illness. But science hasn't always provided a clear picture of the best way to do that. For example, the findings of studies examining the usefulness of a diet high in low-glycemic foods to improve blood-sugar control and risk factors for cardiovascular disease have been mixed.
Genetic testing can yield some information about one's risk for various diseases. But when it comes to the chances of developing Type 2 diabetes, undergoing gene testing is not significantly better than an assessment based on traditional risk factors for the disease, such as weight, blood pressure and blood sugar levels, according to a study published today in the 