By James Fell, Special to Tribune Newspapers
8:37 PM EDT, November 1, 2012
Those poor polar bears, they can't catch a break.
Not only do they have to contend with melting ice caps, but the constant Coke guzzling puts them at increased risk for developing Type 2 diabetes, which can lead to problems like erectile dysfunction and limb amputation.
Of course, bears don't really drink soda, but a scathing video satire of the portly polar dwellers by the Center for Science in the Public Interest called "The Real Bears" has recently gone viral, cautioning against the dangers of excess sugar consumption and poking fun at Coke's marketing tactics at the same time.
But what if you already have Type 2 diabetes? The first step is to optimize medications to jump-start treatment quickly, said Dr. Tim Church, a professor at the Pennington Biomedical Research Center in Louisiana. And it's never too late to cut back on sugar intake, but it turns out that exercise is a much more critical component of fighting this life-threatening condition.
After that, "It's all about physical activity," Church said. "Our studies have shown the power of getting active. It makes sense because diabetes is the failure of the body to regulate sugar. And skeletal muscle is the biggest consumer of sugar in the body."
"Exercise is the most effective therapy for Type 2 diabetes, period," agreed Dr. Michael Joyner, a physician-researcher and expert in exercise physiology at the Mayo Clinic in Minnesota. "If people with Type 2 diabetes start to exercise and lose just a little bit of weight, it is incredible what it will do in terms of improving glucose control."
Tony Sekulich, 42, is a television writer in Toronto. Last year he was feeling low in energy, he couldn't concentrate on his work, and he'd developed a rapid heartbeat. Compelled to visit his doctor, he was diagnosed with Type 2 diabetes.
Sekulich's fasting blood glucose level was 310 mg/dL. The normal range is 72-108 mg/dL. His doctor echoed Joyner and Church, telling Sekulich that exercise was the most important thing he could do to treat his condition, and Sekulich took it to heart.
"I was so out of shape that at first I would go for only 5-mile bike rides," he said. His diet changed too, but not dramatically. He replaced soda with water, ate more fruit and simply ate less. He also started taking the drug Metformin.
"After a few weeks, I built up stamina on my bike, and added in some swimming too," said Sekulich. Coupled with the dietary changes and drug therapy, a month later his fasting glucose had dropped to 155 mg/dL, and the target for most patients with diabetes is below 126 mg/dL, so getting better. "My doctor was surprised I'd turned it around so fast."
Joyner asserts that, for treating Type 2 diabetes, getting active "is twice as effective as drug therapy." This doesn't mean not to take the meds, which both he and Church support using, but it puts in perspective just how critical getting sweaty is to lowering blood glucose. Couple dietary changes with exercise for what Joyner called a "synergistic effect" to control diabetes. Church used that exact same phrase.
"You don't need to have unrealistic weight-loss goals," Joyner said. "More weight loss is better, but losing just a little and cleaning up diet some — like getting rid of sugar-sweetened beverages and potato chips — can make a difference."
"I think people put exercise on par with using margarine instead of butter," said Church. "I don't think diet is even close to being as important as exercise for treating Type 2 diabetes. This isn't a 5 or 10 percent thing. This is a 50 to 100 percent thing."
Sekulich kept up with the lifestyle change, adding more and more exercise — including starting a weight-lifting regimen — and losing close to 20 pounds. After another four months his fasting glucose had dropped to 108 mg/dL — within the target range — and his Metformin dosage was cut in half. "The plan is to see if I can get off the pills by the end of the year," he told me.
His experience is in line with what Church told me: "If you're a regular exerciser, the amount of meds you're going to need will be a lot less."
But what kind of exercise is best? Aerobic? Resistance? A combination?
"We've done a lot of work on this," Church said. "The bottom line is, resistance is of some benefit, and aerobic (endurance) is of a lot of benefit. Doing them both is like taking two different medications; you're hitting two different pathways." Joyner echoed these sentiments, and agreed that a combination is best, but if you can only do one, choose aerobic.
"Exercise trumps a lot of other bad behaviors," Joyner said. "Large people who are very physically active are only at a slightly increased risk of all-cause mortality and cardiovascular disease compared to those who are lean and fit." But those who are large and sedentary are at a two to four times the risk, he says.
As for how long should you exercise, Church lauds the 2008 U.S. physical activity guidelines as being adequate to treat Type 2 diabetes. "One-hundred-and-fifty minutes of walking a week is enough, but if you jog it drops to 75 minutes." The higher the intensity, the less you need to do.
And for resistance exercise, "There is a big return on investment," Church said. "You only need to do it for 20 minutes, twice a week to get great benefits." Both Church and Joyner say you don't need a gym or fancy equipment either.
"Do some push-ups," Joyner said.
Fell is a certified strength and conditioning specialist.
Why exercise helps treatment
According to Dr. Tim Church, a professor at the Pennington Biomedical Research Center in Louisiana, and Dr. Michael Joyner, a physician-researcher and expert in exercise physiology at the Mayo Clinic in Minnesota, exercise is an effective treatment because:
•When skeletal muscles are active, they pull glucose out of the blood.
•It makes the cells more sensitive to insulin, so less is needed.
•It strengthens the muscle cells' ability to take sugar out of the blood in ways other than insulin.
•It reduces visceral fat (fat surrounding internal organs), and this reduced liver fat makes the liver more effective at getting glucose out of the blood.
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