#15 - Exercise and type 2 diabetes with Dr John Hawley
Inside Exercise2022-09-15
993 views|1 years ago
💫 Short Summary
The video emphasizes the benefits of exercise for individuals with type 2 diabetes, highlighting the importance of incorporating physical activity throughout the day. It discusses the impact of genetics and environment on metabolic diseases, the significance of meal timing and exercise intensity, and the value of continuous glucose monitoring. The speaker advocates for prioritizing exercise and nutrition over medication, emphasizing the need for personalized approaches to health management. Overall, the video stresses the role of consistent physical activity and balanced lifestyle interventions in optimizing glucose control and overall health outcomes.
✨ Highlights
📊 Transcript
✦
Benefits of exercise for individuals with type 2 diabetes.
00:12Exercise leads to increased insulin sensitivity and glucose reduction during and after physical activity.
Emphasis on incorporating physical activity throughout the day, rather than rigid structured exercise recommendations.
Mention of time-restricted feeding and potential use of continuous glucose monitors for monitoring glucose levels.
Importance of balancing medication with lifestyle interventions like exercise and diet for optimal management of blood glucose levels.
✦
Importance of prioritizing exercise and nutrition over medication for health management.
03:24Emphasis on integrating exercise and nutrition education into medical school curriculum for more effective health solutions.
Speaker's background discussed, highlighting mixed nationality and interest in rugby.
Praise for New Zealand All Blacks rugby team for their winning record compared to other sports teams.
Acknowledgment of potential lack of knowledge about rugby among American listeners, offering comparison with NBA teams.
✦
Exercise improves glucose control in type 2 diabetics.
07:1745 minutes of moderate intensity exercise at 70% max heart rate can reduce blood glucose levels to normal.
Muscles remain insulin sensitive post-exercise, able to absorb glucose effectively.
Carbohydrate uptake into muscles is similar for type 2 diabetics and healthy individuals.
Short bouts of exercise before and after meals, known as 'exercise snacking,' are recommended for better glucose control.
✦
Benefits of Breaking Up Exercise Bouts Throughout the Day for Diabetics
10:47Just 10-15 minutes of brisk walking before meals can lower blood glucose levels.
High-intensity afternoon exercise is more beneficial for blood glucose regulation.
High intensity reps lead to increased glucose release from the liver.
Exercise intensity and timing are crucial for managing blood glucose levels in individuals, especially those with type 2 diabetes.
✦
Importance of exercise intensity selection in preventing hypoglycemia during high intensity exercise.
12:38Complexity of exercise options like HIT, SIT, and MICT can confuse the general public, impacting adherence to exercise recommendations.
Simplifying messages around exercise, such as incorporating vigorous walking throughout the day, can improve compliance.
Studies have shown health benefits of simple activities like stair climbing, with climbing six flights being sufficient for health benefits.
✦
Importance of Breaking Periods of Inactivity for Health.
15:41Short walks during meetings can improve productivity and well-being.
Walking meetings help break up sedentary behavior and increase overall activity levels.
Short bouts of activity can have positive effects on glucose uptake in muscles, benefiting individuals with diabetes.
Prioritize movement throughout the day to counteract negative impacts of prolonged sitting.
✦
Importance of physical activity in compensating for defective insulin pathways and promoting glucose uptake.
18:17Modern lifestyle changes have disrupted circadian patterns and contributed to the rise in metabolic diseases.
Environmental factors, not just genetics, play a key role in triggering genetic predispositions to obesity.
Genetics and environment interact to shape health outcomes, highlighting the complex interplay between the two factors.
✦
Impact of genetics and environment on cardiovascular disease and type 2 diabetes.
21:55Importance of environmental factors in reducing risk of metabolic diseases.
Critique of focusing solely on diet for weight loss, advocating for consideration of body composition.
Mention of ineffective exercise machines and gimmicks in the fitness industry.
✦
Importance of diet and exercise interactions in improving health.
24:49Introduction of time-restricted eating as a method to enhance metabolic health benefits.
Optimism expressed about the effectiveness of time-restricted eating compared to traditional diets.
Emphasis on adjusting meal timing rather than restricting specific foods for sustainable health improvements.
Promising results from studies supporting the benefits of time-restricted eating.
✦
Impact of late-night snacking on blood glucose control.
28:11Discretionary foods consumed late at night are non-essential and should be avoided after 6 or 7 o'clock.
Monitoring glucose levels can provide instant feedback on dietary habits.
Early bedtime and early rise may positively impact body composition by reducing late-night snacking.
Controversy surrounding the importance of breakfast as the most important meal of the day, with personal examples showcasing varying preferences for morning eating habits.
✦
Importance of circadian rhythms in exercise and meal timing.
31:57Shifting meal times earlier in the day can have metabolic benefits.
Negative impact of modern lifestyles on circadian biology, such as late-night eating and prolonged sitting.
Exercise and proper meal timing can recalibrate the circadian clock, emphasizing the need for daylight exposure and avoiding sedentary behaviors.
Lack of emphasis on meal timing in national food guidelines is mentioned as a potential oversight.
✦
Importance of timing in meals and exercise.
33:25Spreading out exercise throughout the day can be more beneficial than a single session.
The term 'three square meals a day' originated from the British navy in the 1940s and 1950s.
Various diets like intermittent fasting and the 5:2 diet can alter eating patterns.
Caution is advised against prolonged fasting diets due to potential negative impacts despite reduced energy intake.
✦
Importance of maintaining muscle mass for overall body composition.
36:50Fasting diets like the 5:2 diet can reduce muscle building capacity by 20%, leading to muscle mass loss over time.
Personalized meal timing and composition based on individual needs, work environment, and social/family factors are crucial.
Exercise in the afternoon is beneficial for type 2 diabetics in managing glucose control during sleep.
Timing in physical activity is important for managing diabetes and weight-related conditions.
✦
Importance of Glucose Control for Type 2 Diabetes Patients.
40:05Traditional fasting glucose tests and oral glucose tolerance tests have limitations in tracking glucose levels accurately.
Continuous glucose monitoring provides valuable insights by tracking glucose levels throughout the day.
Real-life meal testing is proposed as a more accurate method to evaluate glucose response.
Emphasis on the need for practical and meaningful assessments for better diabetes management.
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Importance of real-world data in glucose monitoring for athletes and type 2 diabetic patients.
43:25Athletes with good glucose control may not benefit from wearing monitors.
Monitors provide valuable instant feedback on glucose responses to different foods for type 2 diabetic patients.
Clinicians need to update their practices to incorporate advancements in sports nutrition.
Focus on the practicality and effectiveness of glucose monitors for personalized health management.
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Regular exercise can help maintain insulin sensitivity for 24-48 hours, benefiting those with type 2 diabetes.
46:43Walking is a valuable form of exercise, with even small amounts leading to glucose drops.
Any level of exercise is beneficial, with walking uphill considered high intensity.
The importance of consistent physical activity is emphasized, with the duration and intensity adjusted based on individual needs.
Utilizing continuous glucose monitoring systems can provide valuable feedback on the impact of exercise on blood sugar levels.
✦
Interval training involves alternating higher intensity with lower intensity recovery, making it an effective way to start high-intensity training.
48:43Gradually building up activity levels and focusing on forming long-term lifestyle changes is key, rather than seeking immediate results.
Consistency is crucial, with three months being a turning point for habit formation.
Every bout of exercise adds up like money in the bank, providing long-term benefits.
Missing a day is not catastrophic, the focus should be on overall consistency and gradual progress.
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Importance of longitudinal studies in diabetes research.
52:40Funding constraints hinder the ability to conduct real-world studies.
Validity of lab findings in practical scenarios is questioned.
Challenges of applying research results to the general population with type 2 diabetes.
Need for more inclusive and comprehensive studies with real-world subjects.
✦
Importance of long-term studies in diabetes research.
54:58Quick fixes and fad diets are ineffective in managing diabetes.
Emphasis on sustainable lifestyle changes for diabetes management.
Influence of marketing and advertising on seeking rapid health solutions.
Call for a realistic and holistic approach to managing conditions like type 2 diabetes.
✦
Benefits of exercise training on insulin sensitivity, glucose uptake, and muscle efficiency.
57:51Resistance exercise leads to increased muscle mass and glucose transporters, improving metabolic function.
Combining exercise and diet is optimal for stimulating signaling pathways and mitochondrial growth.
Diet alone does not have the same impact on muscle turnover and metabolic health.
The concept of 'flux in the system' highlights the importance of continuously using and replenishing muscle stores for metabolic balance.
✦
Athletes and type 2 diabetics differ in muscle fat storage and fuel turnover.
59:51Athletes burn and replace fuel through exercise, while sedentary individuals face insulin resistance.
The analogy of two cars in a garage is used to explain the importance of maintaining high fuel turnover in the body.
The video emphasizes the effectiveness of combining exercise and diet to achieve optimal fuel turnover.
00:00hello and welcome to inside exercise
00:01just finished chatting with john hawley
00:03from australian catholic university a
00:05wealth of knowledge on all things
00:06exercise nutrition type 2 diabetes etc
00:10we talked about how acute exercise and
00:12people with type 2 diabetes reduces the
00:14glucose actually during exercise and
00:16then also makes the muscle more
00:17sensitive to insulin for 24 to 48 hours
00:21also talked a lot about how
00:23we need to try and get away from being
00:24so structured with exercise so you know
00:27try to snack so do exercise throughout
00:29the day
00:31do brisk walking
00:32not so you know rigid recommendations
00:35about exercise you know 150 minutes a
00:37week etc just try and accumulate the
00:39exercise
00:41talked also about nutrition so in
00:43particular time restricted feeding
00:45we discussed whether people with type 2
00:47diabetes should perhaps wear a
00:49continuous glucose monitor to get
00:51feedback on their glucose levels with
00:53various foods and exercise for a couple
00:55weeks we discussed findings in the lab
00:57compared to real world situations we
01:00also talked about how
01:02most studies and people with type 2
01:03diabetes are not your sort of garden
01:05variety person with diabetes but people
01:07that are diet controlled and whether we
01:10can apply those results we talked about
01:12how diet and exercise are very different
01:14because exercise you're actually turning
01:16over your substrates and that might be
01:17very important so for example you're
01:19burning your fat you'll be synthesizing
01:21glycogen diet doesn't really turn over
01:23the substrates like exercise does i
01:25really think you'll get a lot out of
01:26this one so stick around
01:28hi john how are you
01:30good glenn good to see you actually just
01:32back from south korea last week at a
01:34diabetes meeting so no jet lag but
01:38a considerable drop in temperature from
01:40their summer so a nice interesting
01:42meeting there
01:43well there you go yeah i saw that on
01:44twitter
01:45yeah
01:47so it was a nice meeting they decided to
01:49have it live at the last minute and a
01:50few of the speakers were
01:52were coming in remotely but there's
01:54about six or seven hundred people there
01:55really really good interest in meeting
01:57um not much on exercise there was a lot
01:59on drugs a lot on uh you know some of
02:02the hepatic glucose inhibitors and the
02:04such light but it was a little bit
02:05disappointing to see how perhaps the
02:08primary intervention such as exercise
02:10and nutrition have probably been left
02:12behind in the rush to find a
02:14a drug target for type 2 or insulin
02:16resistant patients so yes a little a
02:18little disappointing but a great meeting
02:20and great hospitality
02:21well it's the way it tends to be isn't
02:23it you know my wife kathy she used to
02:24work at the international diabetes
02:26institute i think it's got a bit better
02:27now but they always said you know that
02:29there's the three pillars of treatment
02:31so there's the
02:32the medicine the diet and the exercise
02:34but they had all these medical doctors
02:35and all these dietitians but they didn't
02:37really kathy ended up being the
02:39the combined dietitian and exercise
02:42person so yeah well what i i don't think
02:45uh you know it's not to belittle the
02:47drugs the drugs have a place but once
02:49you've got the blood glucose control you
02:52know fairly well manageable then you can
02:54add the exercise and nutrition that
02:55seems to the way the physicians think
02:57about it now rather than looking at the
02:59primary preventions and then saying well
03:01perhaps we don't need as much insulin or
03:03as much insulin sensitizing drugs or
03:05whatever they happen to be so you can
03:07attack it both ways it's almost like a
03:10a cumulative causation model you've got
03:11to you know knock into that circle at
03:13some point but i'd prefer to knock in
03:15with the exercise and nutrition to start
03:16with but that's just me well that's
03:18that's exactly that's my feeling i know
03:21i went to some it was like a meeting in
03:22melbourne and there was i can't remember
03:24who it was but as a medical uh
03:26endocrinologist up there and he was
03:28saying look i know ideally we'd like to
03:30say you know diet and exercise and if
03:32things don't work
03:34then we'll think about the medications
03:35but he said you know on average people
03:37just don't do it so all we've done is
03:39wasted months and months so he likes to
03:41put them on metformin straight away and
03:42i was just like oh no
03:44well that seems to be that's the it's an
03:46easy thing and again it's not an
03:48anti-physician
03:49uh diatribe here at all but the point is
03:52it's much easier to write a prescription
03:53and get them out of your surgery than it
03:55is to spend hours telling them about
03:57exercise and nutrition which all due
03:59respect to the medical fraternity they
04:01get about six years in medical school so
04:03it's very frustrating and i think until
04:05we actually change the medical
04:06curriculum and put exercise and
04:08nutrition in a more prominent place that
04:10we'll continue to have this problem for
04:12for many many years the other thing
04:13which um don't get me started on is the
04:16old bariatric surgery of course you know
04:18and you get the same argument from the
04:20you know the the clinicians there that
04:22you've wasted three or six months trying
04:23to get them to do exercise and diet it
04:26doesn't work you know bring them in i
04:27can give them surgery and within
04:29overnight or within at least a week you
04:31know you've got blood glucose control
04:33managed fantastically so
04:35i hear it i hear it from both sides as
04:37you've obviously done as well
04:39well you're a new zealander originally
04:40right you're in baby think about date
04:42remember david longhie the new zealand
04:44prime minister he had he just stapled
04:46and then he busted them wow that was a
04:48that was a long while ago well actually
04:50let me just go back to your question am
04:51i in new zealand well yes i have a new
04:53zealand and a british passport born in
04:55new zealand parents emigrated did all my
04:57schooling in new zealand then went back
04:58to the uk to do my undergraduate degree
05:00at loughborough then as you know because
05:02we both went to the center went to
05:04boston university studied with dave
05:05costell and then the university of cape
05:08town medical school for 10 years
05:10including a postdoc with tim know so uh
05:12i'm a little confused nationality wise
05:15but yes i always watch the all blacks
05:17with a much more interest than i do the
05:19wallabies
05:21and south africa exactly
05:22well no i don't like the south africans
05:24they play too much of a kicking game but
05:26uh all blacks as you are of course
05:28absolutely all blacks all blacks
05:29although they are having a bad run but
05:31let's we don't have a lot of american
05:32listeners and they probably don't know
05:34that much about rugby although anyway
05:38you can take any nba team the all blacks
05:40still have the most winningest record of
05:42any sports team ever at 79
05:45although that is plummeting as we speak
05:47but uh still greater than you know la
05:50lakers or any other team that you care
05:51to think about so uh apologies to the
05:54americans in the audience it's funny you
05:55say that actually because i i always
05:57said that to everyone as well they've
05:58got the winningest record of any
06:00international but then the america's cup
06:02so it's a bit of a weird one but you
06:03know they they won that for 132 years in
06:05a row or something yeah but i think
06:07you're watching that on netflix
06:10that's not a proper sport
06:12all right so if you think about let's
06:13try and redress this thing let's talk
06:15about exercise rather than drugs here so
06:17um let's redress the balance exercises
06:19medicine as you know
06:21so if we think about you know what's
06:22happening so a person's got type 2
06:24diabetes here
06:26um so if we can get later we can talk
06:28about okay how do we try and prevent
06:30this but if someone's got type 2
06:31diabetes let's just set the scene so
06:33when they exercise
06:34you know a lot of people don't realize
06:36but you know their glucose uptake is
06:37pretty normal yeah did you want to just
06:39flesh that out so during exercise
06:42what's happening to the metabolism then
06:43we can think a bit more later on about
06:45you know what happens after exercise
06:47all right look that's a good place to
06:48start there glenn i mean as as you know
06:50most of the type 2 subjects have uh not
06:53profound hyperglycemia but they may come
06:56in with a blood glucose of around seven
06:58or eight nine millimolar bearing in mind
07:01that the normal concentration for normal
07:02healthy individuals is you know four to
07:04five millimolar so we know that if you
07:06give them one acute bat of exercise in
07:08other words a single bout of moderate
07:11intensity exercise and this study was
07:13done actually many years ago by a guy
07:15called nick musee in laurie goodyear's
07:17lab he showed that just 45 minutes of
07:19moderate intensity exercise exercising
07:22at a heart rate of around 70 percent of
07:24your max was sufficient to reduce blood
07:27glucose concentrations to normal
07:29glycemic levels so if you look at the
07:31two graphs you would see that they type
07:342 diabetics started with a much higher
07:35glucose but after all only 15 minutes of
07:38exercise their glucose was the same as
07:40non-diabetic subjects the interesting
07:43thing about that study is that they all
07:44show followed them up post-exercise and
07:47they saw that the muscle was still what
07:48we call
07:49insulin sensitive which means that
07:52you've overridden some of the defects in
07:53the muscle and the muscle is capable of
07:56soaking up that glucose after exercise
07:58so when they looked at the amount of
08:00carbohydrate or glucose being put back
08:02into the muscle as glycogen they noticed
08:04the curves were exactly the same for the
08:06type 2 and the and the untrained or i
08:08should say the healthy individual so the
08:10point of that is that acute exercise can
08:13literally if you like overnight cure
08:16glucose control very very rapidly
08:19and that's a good thing because we know
08:21that type 2 diabetics spend a lot of
08:23time in hyperglycemia and we may get
08:26onto this later but we've got a trend
08:28now with our patients in our clinic that
08:30we
08:30rather than give them a long exercise
08:33back you know as well as i do the
08:34recommendations don't work people don't
08:36do 150 minutes of exercise they're not
08:38going to do 30 or 40 minutes continuous
08:40exercise unless they're an athlete or
08:42unless they've got a background
08:44we're into this sort of what we call
08:45exercise snacking
08:48now what do we mean by that we don't
08:49mean food snacking we mean taking small
08:52bouts of exercise before and after meals
08:55perhaps twice a day and accumulating
08:57exercise over the course of the day and
08:59i think that's the way to go i think to
09:02continually say to people these are the
09:04recommendations from
09:06american college of sports medicine
09:07american heart diabetes association no
09:10matter what it is you've got to
09:11accumulate exercise let's start
09:14accumulating it over the day
09:16rather than over the whole week so i
09:18think one message to get home a
09:20take-home message for the listeners
09:21would be if you are a diabetic maybe
09:23think about breaking your exercise bouts
09:25up and spacing them either before or
09:27after meals perhaps at midday perhaps
09:30another 10 minutes at night and
09:31accumulating that 20 or 30 minutes a day
09:34okay so basically just being more active
09:36right so we've been trying to say this
09:37for a while you know get off the get off
09:39the tram and stop early you know park
09:41don't park so close i guess the thing
09:43you start to think about there is you
09:45know the sort of intensity of the
09:46exercise so a couple of the podcasts
09:48i've had um
09:50leading up to this i've had ben levine
09:52on
09:53talking about how walking is great
09:56metabolically
09:57but it doesn't you know
09:59have cardiac effects it doesn't increase
10:01your left ventricle volume
10:03it doesn't increase your vo2 max et
10:05cetera
10:06so i guess are you saying just walking
10:08is good enough or you're saying they'd
10:10have to do something a little bit more
10:12intense and i guess it depends on how
10:14fit they are because for some people if
10:15they're really unfit and i guess we're
10:17talking about people with type 2
10:18diabetes on average
10:20i guess walking may be moderate
10:21intensity for them
10:23well let's go back to come forward so
10:24firstly ben levine here's a tip ben
10:26levine's brother was one of the
10:27producers on lord of the
10:30rings no well i didn't until we went to
10:33dinner once with him in newcastle and he
10:34pointed that out um that's a sidebar at
10:37least so your questions there are very
10:38important the study that we did which
10:41was published by monique francis a few
10:42years ago in diabetes
10:45was exercise snacking as i said and it
10:47was only 10 to 15 minutes of brisk
10:50walking and that was before
10:53the main meals of the day and the
10:54interesting thing is as we started with
10:57the acute effect is such that it lowers
10:59blood glucose but the interesting thing
11:00is over the course of the day it has a
11:03blood glucose lowering effect and that's
11:04very important and maybe something we'll
11:07make a note of and talk about later is
11:08this nocturnal glucose thing which i'll
11:10i'll get into perhaps we can delve into
11:12a little bit deeper later on as far as
11:14the exercise intensity in those people
11:16because remember that around 70 percent
11:18of type 2 diabetic people are a little
11:21bit overweight sometimes brisk walking
11:23is adequate yeah um and maybe that that
11:27is a good bridge to
11:28to another study we talk about the
11:30exercise and the type of exercise there
11:32was a very
11:33let's say controversial study published
11:35a couple of years ago from julian
11:36zerath's lab which looked at type 2
11:39diabetes
11:40and the effects on blood glucose and it
11:42looked at morning versus afternoon
11:45exercise
11:46and the conclusion from that paper if
11:48you remember was that afternoon exercise
11:50was more beneficial but we have to tell
11:51the listeners that it was a high
11:53intensity exercise protocol well they
11:56did high intensity reps now when you do
11:58high intensity exercise there's a
12:01response in the body which means the the
12:03liver puts out more glucose into the
12:05systemic circulation so after they're
12:08hit after their high intensity exercise
12:10there was actually profound hypoglycemia
12:13so in actual fact the high intensity
12:15exercise in these people was having the
12:17opposite effect to what you wanted to do
12:19so your point about the exercise
12:21intensity is very important i would err
12:23on the side of conservatism at the
12:25moment rather than doing the high
12:26intensity stuff yeah especially when
12:29you're trying to get as you said earlier
12:30on we're trying to get people to
12:31exercise and sometimes you wonder if
12:33it's getting too complicated now should
12:35i be doing hit should i be doing sit
12:37which i have to clarify because people
12:39might think oh yeah i do i do lots of
12:40sid
12:42is some sprint intensity training yeah
12:45um but yeah i'm tending to lean that way
12:48as well and in the podcast same with
12:50jerry dempsey there was talk about
12:52uh you know athletes and you can get a
12:54drop in oxygen that can limit their vo
12:55to max and whatever it's all true
12:57and you know and the heart you can get
12:59you know build up of calcium in plaques
13:02and whatever but you know they're not
13:04dangerous and and you said a couple of
13:06times i've said this is fantastic stuff
13:07but let's not scare people off here and
13:10yeah let's try and keep it simple yeah
13:12it's lagging that is the big problem
13:14though glenn i mean as we said and you
13:16said in the introduction people
13:18do not exercise we know that certainly
13:20here in australia 60 odd percent of the
13:22population do not meet the normal
13:24recommendations it's probably exactly
13:26the same in most of the western world
13:28so
13:29the prescription may be valid and
13:32scientifically proven but it's useless
13:34if people aren't doing it so
13:36um i think we've got to really rethink
13:38the wheel here just continually
13:40regurgitating the same message to the
13:42public is not working we need a simpler
13:45message often and i agree you know we've
13:47got we've got set we've got hit we've
13:49got mict moderating intensity continuous
13:53training yeah it's confusing for us so
13:55why is it
13:56why should it not be confusing for the
13:58lay public and i realized that when i
14:00started saying oh what about intensity i
14:02actually straight away started thinking
14:03i i'm making it complicated but that's
14:06the good thing as well because
14:08as ben levine said it's true
14:10sort of normal walking may not uh
14:12increase your vo to max and whatever and
14:14it's going to have your metabolic help
14:16your metabolic health but you know then
14:18you say oh you've got to do something
14:19more vigorous well why not just do
14:20vigorous walking that's a very
14:22sensible you know just do normal walking
14:25yeah include some vigorous walking yeah
14:27now do it throughout the day the
14:29exercise snacking that's a simple
14:31message that people should be able to
14:32handle well here's the other thing and
14:34marty gibala from um from mcmaster
14:36university done some wonderful studies
14:38of just stair climbing
14:39i mean there's some interesting data on
14:41that so
14:42at a conference i was at recently i
14:44forget where it was somewhere in the
14:45world um the average uh stairs that
14:49people would climb is 2.8 flights
14:52so people will take the lift you know if
14:54the lifts weight in and you've got to
14:56wait 10 minutes for the lift people will
14:57climb on average 2.8 flights but
15:00anything after that they'll wait for the
15:01lift marty's study showed that you know
15:03just climbing six flights of stairs was
15:05absolutely enough to get almost close to
15:0880 or 90 percent of maximal heart rate
15:10in some of these individuals and again
15:12you only need to do that two or three
15:13times a day the interesting thing there
15:15we're talking a little bit earlier on
15:17about
15:18sitting
15:19the prolonged sitting is also public
15:21enemy number one and there's again been
15:23a lot of work done in that area and just
15:25to break
15:26the periods of inactivity i find myself
15:29tomorrow for example is a train smash i
15:31know i have meetings from nine o'clock
15:33till four o'clock and i said to my pa
15:35when am i going to go to the bathroom
15:37when am i going to stand up when am i
15:38going to do anything yes i think we've
15:39got to get the message over that
15:41breaking inactivity is important it's
15:43not exercise per se but it's part of the
15:46message and i think once we've got
15:48simpler messages you set across we may
15:50get a greater uptake of some of the
15:52things that we're trying to convey well
15:54the other thing is um
15:56i often have meetings with people where
15:57i just go for walk now people always say
15:59let's meet for coffee i said let's go
16:00for walk i live next to the yarra river
16:02i know you live in the city as well it's
16:03kind of weird we're probably about 300
16:04meters away
16:06i often say let's just go for a walk and
16:08they go up that's true
16:10it's funny you say that we started doing
16:12that at lab meetings going around the
16:14park and having meetings and it and it
16:16did work we got out it was a nice day we
16:18got some fresh air yeah there's
16:21yeah yeah i just say tomorrow i've got
16:23meetings in the boardroom from nine till
16:25four so yeah
16:26you can't take the whole board for walk
16:28boardwalk there you go maybe i should
16:30maybe i should be doing more of my own
16:32uh recommendations do as i say not do as
16:34i do i actually just i just signed up
16:36stuart middle as you know he's
16:39queensland and he's going to be on and
16:41it's a classic he used to be at victoria
16:42university so we're both there and he
16:44had a sign he'd wear and it would say uh
16:46walking meeting please don't interrupt
16:48because he likes him walking and he'd
16:50have a thing on because people came up
16:52in chat chat chat no this is actually a
16:54proper meeting i can imagine what
16:56they're in there now that's very good
16:57you've got to sometimes be a bit of a
16:58maverick and do things a little
16:59differently yeah yeah
17:01step back a bit make sure people were
17:03clear on that thing you said earlier but
17:04i think it's very important so you were
17:06saying with the music study from you
17:07know laurie goodyear's lab
17:09um that was actually during the exercise
17:11because sometimes i put that in grants
17:13and things i think they don't quite get
17:14it they think the exercise is improving
17:16you're talking about actually during
17:17that 45 minutes of exercise right now
17:20came down to normal and us and others
17:22have shown that if you look at leg
17:23glucose uptake so you actually look at
17:25the glucose uptake across the leg it's
17:27totally normal yeah that's the thing
17:29people don't get people with diabetes
17:31have problems with their insulin
17:33stimulated glucose uptake in their
17:35muscle yeah and that's the direction
17:37it's normal ex and that's the point so
17:40again for the listeners you know you've
17:42got insulin that takes glucose into the
17:44muscle cell and the muscle cell is the
17:45main
17:46as we know glucose tank for for taking
17:48up glucose after a meal but you've got
17:51contraction as well and even if uh the
17:54insulin pathways are defective the
17:56contraction in other words the exercise
17:58pathways are intact so
18:00it works you know if the body's
18:03remarkable as you know glenn i mean if
18:04something's knocked out or doesn't work
18:06quite as well something usually steps up
18:08in his place so we've been designed by
18:10someone very wise and she said well
18:12basically if glucose uptake via the
18:15insulin pathway doesn't work why that's
18:17exercise which of course makes totally
18:19evolutionary sense it makes complete
18:22sense but it is an important message
18:23yeah and we were we were hundreds and
18:25gatherers so what does that mean we were
18:27active the whole time you're walking
18:28around you know picking berries yeah and
18:30then you throw in the occasional you
18:32know high intensity when a lion runs out
18:34at you you run up a tree and then you
18:35sit up there and you know chew away on
18:37your berries or whatever we're not
18:38designed to like sit
18:40for hours and hours and hours so it's
18:42just kind of logic right well this is
18:44the problem at the moment and one of the
18:46talks i gave um last week at south korea
18:48was about exercise time and meal time
18:51and one of my slides basically said well
18:53we've completely unraveled our evolution
18:55you know we can now get i shouldn't be
18:57advertising but uber eats or food
18:59delivered to us any time of the day or
19:01night we're on our laptops at night we
19:04are not necessarily outside as much as
19:06we should be we're sitting all day some
19:09people do shift work all these things
19:11have basically messed our normal
19:13circadian patterns up but they've also
19:15created a lifestyle which means we're
19:18very very prone to metabolic diseases
19:20and i call these
19:21literally lifestyle related diseases
19:23because it's the lifestyle that has
19:25changed so drastically in the last
19:27probably 30 or 40 years that we're now
19:29paying the consequences and i think
19:31ultimately
19:32certainly in the states the the medical
19:34and health care system will crush the
19:35economy eventually
19:37yeah so talking about that then so how
19:40things have changed the last 30 or 40
19:41years it does my head in a little bit
19:43and i always think maybe i just haven't
19:45looked into it enough but you know
19:46people talking about arts genetics the
19:48genetics that's the hunger enzyme the
19:50hunger hormones and things that you
19:53can't help it so you know you're just
19:55going to
19:56be overweight you can't help it because
19:58if you lose weight your hunger hormones
19:59crank up and whatever what do you what
20:02do you think about that it's like hang
20:03on but people had hunger hormones
20:04several years ago the human genome has
20:07not changed the last 10 000 years what
20:10has changed is the environment so
20:12there's a wonderful saying and i forget
20:15who this should be attributed to i think
20:17it was
20:18elliot joslin who was the founder of the
20:20jocelyn diabetes research institute at
20:22harvard university he said
20:24genes load the gun
20:27environment pulls the trigger
20:29i think that is a fantastic thing
20:31because i get completely
20:34frustrated and fed up when i pick up a
20:35newspaper no matter what country and i'm
20:37and researchers find new gene for
20:40obesity no they didn't they found gene
20:42which was associated with the myriad of
20:44environmental factors which have
20:46combined to make that person overweight
20:48obese or type 2 diabetes so yes genetics
20:52plays an important part we know that
20:53there's familial history will predispose
20:56you to cardiovascular disease or type 2
20:58diabetes or whatever
21:00but if the environment is correct your
21:02chances of that eventuating are far less
21:04so i really do believe that you know all
21:07these claims that the gene is
21:09responsible for this and the other go so
21:11far but they absolutely do not explain
21:14why people get the current metabolic
21:16diseases in the rates of incidents that
21:19we're currently experiencing in the
21:20western world yeah i know surely that
21:22makes sense
21:24well i think it does i think it makes
21:25scientific sense logical sense
21:27teleological sense an evolutionary sense
21:29but um you still get people perhaps
21:32arguing that it doesn't so anyway yeah i
21:33think we agree on that point all right
21:35cool i only invite people that agree
21:37with me on this
21:40something we can disagree on
21:43so um see touched on you know we simply
21:46talk about uh exercise but you've done a
21:48lot of stuff with diet and timing of
21:50diet et cetera how about we think a
21:52little bit about you know with type 2
21:55diabetes how much do you think's diet
21:57how much is exercise obviously it's a
21:58balance in terms of their body weight
22:01um you know this seems to be i don't
22:02know about you but i keep finding people
22:04always just talking about diet diet you
22:06know ah
22:07i even heard the other day someone said
22:08oh you do diet to lose weight and you do
22:10exercise to get buff
22:13really
22:14i i have a problem with most diets
22:16because most diets are actually
22:18unsuccessful let's be honest i mean you
22:20can calorie restrict an individual you
22:22can put them in a study and you can do
22:24this and you follow them up a year later
22:25and they're back to their original
22:27weight i guess the one thing i'd
22:29second message that's important to your
22:31listeners i don't give a damn what the
22:33scales say scales measure your body mass
22:37we as exercise physiologists or
22:39dietitians nutritionists athletes
22:42whatever you are out there listening you
22:44should be interested in your body
22:46composition namely the proportion of you
22:49which is fat mass and the proportion of
22:51you which is lean or other mass that has
22:55direct links to your health prognosis so
22:57let's just throw away the scales and i
22:59get i again i was in the gym in south
23:01korea last week firstly i was having to
23:03wear a mask because max are mandated
23:06indoors and it's hard to exercise at
23:07three and a half liters a minute if
23:09you're trying to do high-intensity
23:10exercise with the mask on so point
23:12number one point number two why don't
23:14gyms have fans i have no idea
23:17that before that wasn't that great
23:19forever it's crazy and point number
23:22three there was a machine which uh
23:24people stood on and actually a lot of
23:25people because i was next to the machine
23:27on my exercise bike and it had a
23:29vibrating rubber belt and you put it
23:31around your waist and you stopped it for
23:3410 minutes i have no idea what that did
23:36i haven't got the heart to tell these
23:37people that hey you're not burning any
23:39calories and b you're not losing any fat
23:40i think that machine know that machine
23:4250 years ago i saw it on twitter
23:44historical thing i thought that was way
23:46out the window or maybe it's a torture
23:47machine they started this vibration
23:49thing it's a thing nowadays anyway yeah
23:51it's ridiculous and you know there are
23:52so many gimmicks and things out there i
23:54mean we we're coming back to the diet
23:56but the point is
23:58weight is one thing yes whose lean mass
24:01is not a good thing so the diet plays an
24:04important part and interacts with the
24:06exercise and i don't think you can
24:08divorce the two we always look at what
24:10we call the exercise
24:12diet interactions because that's very
24:14important if you're going to train you
24:15need the fuel to train but you need the
24:17correct fuel if you're trying to build
24:19muscle mass and i'm sure you've had
24:20speakers on to talk about this you
24:22probably need more protein and the such
24:24like so i i think most diets are doomed
24:27to failure unfortunately and yeah your
24:30diet to lose weight you exercise to get
24:31buff bowl
24:32there's a little bit of a little bit of
24:34truth in that but i don't think that the
24:36diets are as successful as people think
24:38one thing that i do think and we don't
24:40need to talk about this at too much
24:41length but one thing that does seem to
24:43be working in our clinical trials and
24:45the human clinical trials throughout the
24:47world is something called time
24:49restricted eating and if you want i can
24:51just give you a very quick overview of
24:54that so
24:55if you're listening now just think uh of
24:58the first time
24:59that you have an energy intake in the
25:01morning it's usually your breakfast and
25:02let's just say that you have breakfast
25:05at seven o'clock
25:06then i want you to think of the last
25:08time you had a calorie intake or an
25:11energy intake on a normal week
25:13and that's probably you know eight or
25:15nine o'clock at night so we say your
25:17eating window there is from seven
25:19o'clock to perhaps eight or nine o'clock
25:21so it's a 12 13 14 hour eating window
25:25now here's the interesting thing about
25:27what we call time restricted eating
25:29i'm not going to tell you to stop eating
25:32ice cream stop eating carbohydrate stop
25:34doing this that and the other because
25:36when we tell people do not do that they
25:38want to do it
25:39it's like telling you not to have a
25:41drink of alcohol playing of course
25:42you're gonna have a drink but the point
25:43at two and a half years i haven't had a
25:45drink i know that's why i said that i'm
25:47very stern you got me a treat
25:49i told you i didn't agree with
25:50everything um
25:52the point here is we say to people and
25:54then bewildered they said what do you
25:56mean i can still eat this i can still
25:57have ice cream i say yes but here's the
25:59butt i want you to shift your breakfast
26:01till later by an hour or so and i want
26:03to shift your evening meal earlier by a
26:05couple of hours so your eating window is
26:07reduced from perhaps 12 13 14 hours to
26:10perhaps 9 10 maybe even 11 if they were
26:14really extreme
26:16even independent of any weight loss so
26:18in the studies that have been done
26:20there's an excellent study too now
26:22showing that even when people do not
26:23lose weight
26:25they still get many of the metabolic
26:27health benefits so simply reducing the
26:30time over the day of which you're eating
26:33without telling people do not do not do
26:36not do not and i think this is holding a
26:38lot of promise i've been more encouraged
26:40by this than any other diet study that
26:41we've done in the last decade yes i know
26:44you've done a lot of work in this time
26:45restricted feeding and it just occurred
26:46to me because i'm a bit of a night owl
26:48and i'm a shocker and i wonder how many
26:50people have problems with their you know
26:53their their body was going to say their
26:55weight but their body composition
26:57because of the way we tend to stay up
26:59late
27:00uh when you stay when i stay up late i
27:02snack
27:03if i go to bed early and my wife kathy's
27:06away in the u.s for two months she
27:08normally 10 o'clock in bed that's it
27:11i'm just like
27:12snacking all over the place
27:16i've greatly increased that time window
27:18that i'm eating well here's the thing
27:20glenn we should give you a continuous
27:22glucose monitor so again for your
27:23listeners we stick a little patch on
27:25your arm and we can literally
27:28monitor every minute of the day for two
27:30weeks of your data and one of the
27:32i think really important findings from
27:34the time restricted eating studies is
27:36that once you bring that evening meal in
27:38earlier unlike you snacking at late
27:40night which is not what you're meant to
27:42do your blood glucose control in the
27:44night is remarkably good it's massively
27:47improved now what people don't realize
27:49is that you know you spend eight to ten
27:51hours in bed or lying down or whatever
27:53that's you know almost fifty percent of
27:55the day so if you can take care of that
27:57fifty percent of the day and you're
27:59doing some exercise second in the day
28:01your glycemic control can be returned to
28:03normal within two to three months it's
28:05incredible so we call those you know
28:07what you're describing is the late night
28:09snacking phenomenon we call those
28:11discretionary foods because if you think
28:13about well let me ask you what do you
28:14eat late at night is it candies
28:17alcohol ice cream it's snack stuff isn't
28:20it yeah exactly it's not essential food
28:22it's not food yeah exactly it's that's
28:25the common number one so we call those
28:27with our subjects discretionary foods
28:29and we say don't cut out the
28:30discretionary foods but after six or
28:32seven o'clock you don't need them
28:34anymore and once they see their glucose
28:37profile is improved during the night and
28:39it gives them literally instant feedback
28:41that's it
28:42they tend to really
28:44very rapidly after their dietary intake
28:46yeah i wonder if the old adage you know
28:48early to bed early to rise i wonder if
28:50people have looked at their body
28:52composition people that do that because
28:55yeah yeah they're cutting out the snacks
28:57i i'm kind of getting a bit away from
28:59your time so your point there though is
29:01if you try and um you know finish eating
29:04a bit early at night then start eating
29:06and that's the interesting thing as well
29:07i don't know about you it's a personal
29:09thing but quite often in the morning so
29:11forget the thing about going to bed
29:12later whatever just if i'm on a normal
29:13schedule i often don't feel like eating
29:15that much in the morning i feel a bit
29:16sort of um nauseous just a little bit
29:19like i don't feel like eating but people
29:20say oh but breakfast is the most
29:22important meal of the day
29:23well that's quite a controversial thing
29:26at the moment so i'll give you a
29:27personal example so
29:29some of your listeners may know who my
29:30wife is it's louise burke who yeah your
29:33podcast and if i had a dollar for every
29:35time i was introduced as louise works
29:37husband i could have retired like
29:38years ago um but be that as it may she's
29:41a she's a
29:42an early morning riser she's a she's a
29:45lock or an owl i'm not sure which is
29:46which but she's up before i even get out
29:49of bed she's on the extra cycle she's
29:50done her exercise she prefers to do it
29:52in the morning i can't do that i can't
29:54do any intensity in the morning i'm
29:57usually a late afternoon exerciser now
30:01there are what we call circadian
30:03phenotypes which make us either ours or
30:06larks you can change that to some degree
30:09but yeah the breakfast meal is important
30:11she'll get up and she'll be fasted
30:13she'll do exercise there as we know if
30:16you're fasted after an overnight fast
30:18you'll generally burn more fat in the
30:20morning than you would if you'd had
30:22breakfast and the such like so again
30:24it's this exercise nutrient interaction
30:26that we're talking about yeah um but
30:28again if you think about western society
30:30we tend to back end most of our calories
30:33there's an excellent study done by
30:35sachin panda from the salk institute and
30:37he gave people
30:38a smartphone app and he asked them 150
30:41odd people they asked them to record
30:42every time they took in a calorie or any
30:45energy intake and he found that they
30:47back-ended their calorie intake so most
30:49of the calories were eaten after one
30:51o'clock in the afternoon so the total
30:53daily consumption i think it was 64
30:56percent were eaten after one o'clock and
30:58just simply by shifting that evening
31:00meal in a little bit earlier and trying
31:02to get people to redistribute their
31:04energy not change their energy
31:06redistribute it has enormous metabolic
31:08benefits
31:09yeah yeah
31:10and and there's also the circadian stuff
31:12i know you've looked at that a little
31:13bit as well so you know we know the
31:15shift workers have
31:16more diabetes and all sorts of problems
31:19you wonder how much of that is they're
31:21eating at the wrong time of the day
31:22but also that they tend to eat well i
31:25think this is a bit controversial but
31:26they tend to not eat as well so you'll
31:28tend to sort of grab
31:31so what about the sort of chrono biology
31:34side of things
31:35well again it gets back to what we were
31:37discussing earlier we've sort of messed
31:38up the normal patterns of circadian
31:40rhythms as i said by snacking late by
31:43working 24 7. uh access to computers and
31:47the light late in the day prolonged
31:49sitting etc so all these things tend to
31:51mess up the circadian biology
31:53can you correct them well i like to
31:55think that exercise
31:57and diet can recalibrate the circadian
32:00clock and that's the way we look at it
32:01with our subject so if you can add the
32:03exercise you can get rid of a lot of the
32:05prolonged sit in if you can get outside
32:07get some daylight because the main time
32:10giver for the circadian clock is the
32:12light dark cycle so if you're indoors
32:14for example you know in south korea last
32:16week and as you know because you've been
32:18to many conferences glenn you go to a
32:20conference and you basically
32:21you're inside sitting down all day
32:23thinking hold on the guy at the front's
32:25telling me i should be doing this that
32:26and the other i'm doing exactly the
32:27opposite i'm sitting in a dark room for
32:29eight hours a day not getting any
32:31exercise going out at late at night
32:33eating blah blah blah so we've
32:35completely messed up the normal
32:36circadian biology and as i say
32:39the work that we're doing is to try and
32:41recalibrate if you like the circadian
32:43clock by putting exercise in there and
32:45appropriate timing of meals and
32:47one thing we touched on we mentioned
32:49earlier that the exercise
32:50recommendations but here's an
32:51interesting point
32:53in no
32:54national
32:55food guidelines is there any mention of
32:58the timing of food
33:00we talk about the energy
33:02we talk about the meal composition in
33:05other words how much of your diet is
33:06carbohydrate fat and protein there is no
33:09mention yet i think it will come in the
33:12next decade of the timing of meals and i
33:14think science will push that along such
33:17that the national recommendations at
33:19least in countries who who are looking
33:21at the scientific literature will take
33:22up the message and say hold on timing
33:25timing should be added maybe we should
33:26mention something about timing so that's
33:28vitally important and again it gets back
33:30to what we're talking about earlier the
33:32timing of exercise is important only
33:34recently of the american college of
33:37sports medicine that knowledge that
33:38these exercise snacks taking little bits
33:41of exercise and accumulating throughout
33:43the day are just as beneficial and in
33:45some cases more beneficial than your
33:48traditional
33:49bang 30 minutes of exercise continuous
33:51moderate intensity so i think the times
33:54they are changing but they are changing
33:56very slowly well i just had uh two weeks
33:59ago i had eddie coyle on and he was
34:00talking about how if you do exercise
34:03that you don't do enough steps during
34:04the day you don't have the same benefits
34:06the next day as well so so that's what
34:08he does you know sorry traditional so
34:10like an hour of exercise in the evening
34:12yes found they didn't have as good fat
34:15oxidation the next day if they didn't do
34:16steps as well during that day so you
34:19need the snacking well that's a that's a
34:21really that's a great study in jp that i
34:24read and i i completely okay so
34:27does the hour in the gym make up for the
34:28rest of the day and and the answer is no
34:31of course the hour in the gym is great
34:32but not if you're going to sit for the
34:34next you know 10 11 hours so yeah i'm
34:37dreading tomorrow because i know i'm
34:38literally gonna be sitting for eight
34:40hours i will exercise at night but i'm
34:42fully aware that with a reduced step
34:45intake in the day i'm not really
34:47optimizing the beneficial effects of
34:48exercise perfect
34:50right now just i also thought when you
34:52were talking about the exercise snacking
34:54it's kind of peripheral but remember for
34:56a while there people were saying you
34:57know we shouldn't really be having like
34:59three big meals a day that was sort of
35:01like the industrial revolution they
35:02brought it in so you could get them to
35:04eat before work and then have a break
35:06and then eat afterwards
35:08do you know what where that's that for a
35:10while there people used to say you're
35:11better off eating a little bit
35:12throughout the day okay well let's
35:14narrow the time of course but um do you
35:17know where that's at by any chance it
35:19should be slacking and exercise snacking
35:22let me give you some information which
35:23your readers will never ever ever use
35:25need to use so this was in my talk last
35:27week the term three meals a day actually
35:30comes from the british navy in the 40s
35:32and 50s because the cell the the sailors
35:35on the ship used to collect their meals
35:37in square containers and square meals a
35:39day and and it was that's where the term
35:41three square meals a day comes from now
35:44to bridge that to your question we've
35:46got all sorts of these and i'll call
35:48them diets for want of a better word you
35:50know the intermittent fasting the the
35:52five plus two that all these things
35:55which can change the patterns of eating
35:58now
35:59i am very wary and i'll put this on the
36:01record of
36:02these prolonged fasting type of diets
36:05for the main reason that
36:07even when you reduce your energy intake
36:10by as little as 500 kilocalories a day
36:13for three or four days
36:14we have shown and others have confirmed
36:16this that your rates of protein
36:19synthesis in other words your muscle
36:21building capacity is reduced by about 20
36:23percent
36:24now if you're fasting let's say doing
36:26the five plus two diet and you're
36:28fasting for two days whether it's the
36:30weekend or two days in the week you
36:32think of that over the course of the
36:34year you're fasting for many many many
36:36days you're losing muscle mass and as i
36:38said earlier i don't care what your
36:40weight is i can
36:41really i'm concerned about your body
36:43composition so i worry about the fasting
36:46diets in that you may lose weight you
36:48may lose scale weight but it's not good
36:50if you're losing muscle mass and again
36:53when you reduce by a very small
36:55proportion your energy intake we have
36:57clearly shown that your rates of protein
37:00synthesis are reduced that is not a good
37:02thing that's why i'm a little
37:04against that now let's get that to your
37:07question i mean maybe i'm not a good
37:10example but i have a pretty big
37:11breakfast i go most of the day with
37:14either a yogurt or chocolate milk or
37:16some protein at lunch time and an
37:18evening meal again i'm a little bit tre
37:21i've finished eating by eight o'clock
37:22and i've usually finished eating in the
37:24evening by six or seven o'clock
37:26i don't have the traditional three
37:28square meals a day um my staff look at
37:30me and think you know this is crazy i
37:32think what works for the individual is
37:34very important i think a blanket
37:36recommendation one size fits all is not
37:38what we're looking at i think very much
37:41it's a
37:42work environment thing it's a social
37:44thing uh it's a family thing you know if
37:47you've got kids you're going to be
37:48eating with family at night and this
37:50that the other so there are many things
37:51there and i think just to say this works
37:54or that works and you should be doing
37:56this is a little bit too rigid
37:58yeah it just occurred to me this is all
38:00great stuff but i guess we haven't
38:01talked about applying this to people
38:03talk to you about diabetes that much
38:04we've just been talking about general
38:07sort of discussion
38:08would most of these things we've talked
38:09about i know you probably can't you've
38:11got to think i'm going to be talking
38:12about i'm fit with person with type 2
38:14diabetes as well i guess it depends on
38:16if they're on medications or not if
38:18they're
38:19no no no look most of most of what we
38:21said is absolutely the same for the type
38:232 diabetic patient or someone with
38:25insulin resistance or obesity in fact
38:27most of our studies have been
38:28done by evelyn parr in our laboratory
38:30and they've been on type 2 diabetic
38:32subjects and i think
38:33let's just focus very much on exercise
38:35and type 2 diabetes any time you do
38:38exercise and it looks from the studies
38:40at the moment that the afternoon
38:42exercise is more beneficial and why is
38:44that well it's for the reason that your
38:47nocturnal glucose in other words your
38:49glucose concentrations while you're in
38:51bed asleep
38:52is much better maintained and much
38:54better controlled when you've done some
38:57later in the day exercise i'm not going
38:59to say even exercise i'm going to say
39:00later in the day exercise as opposed to
39:03exactly the same amount of exercise in
39:05the morning and i think for the type 2
39:07diabetic patient and again the person
39:09who is predisposed to overweight obesity
39:12or type 2 diabetes i think we should be
39:14looking more at the glucose control over
39:17the day whereas at the moment the
39:18physician brings you in for a you know a
39:20fasting glucose it's like what the heck
39:22that doesn't mean anything i'm sorry
39:24glenn it means absolutely nothing yeah
39:27i totally agree i mean you mentioned
39:28continuous glucose monitors the other uh
39:30before
39:32um you know i'm a big fan i still
39:33started doing some research at
39:34copenhagen where you know even the clamp
39:37the gold standard clamp measurement of
39:39insulin sensitivity i don't think this
39:41is relevant is what's happening with the
39:42continuous glucose monitor because you
39:44clamp it at five millimole
39:46which is unrelevant it's not relevant to
39:48when you eat and it goes up and down so
39:50anyway that's a bit of a long story but
39:51i actually agree that i think continuous
39:54glucose
39:55um is a good way to actually see what's
39:57going on it's a fantastic way you do
39:59exercise you see what happens you you
40:01see what happens you look overnight you
40:02see what happens but along those lines
40:05though i i've keep seeing this talk on
40:07some of these sort of influences and
40:09things they make it sound like everyone
40:10should be wearing a continuous glucose
40:12monitor
40:13i mean
40:15okay what do you think about that first
40:17but but also what do you think about
40:19someone with type 2 diabetes being
40:20encouraged to wear continuous glucose
40:22monitoring at the moment we tend to
40:23think about people with type one
40:25but you know even for a little while it
40:28seemed may be sensible right for them to
40:29get that feedback yeah look it's like
40:32the new gimmick on town they're very
40:33good these monitors the technology is
40:35evolving continually such that now you
40:37can put a patch on someone and bring
40:39them back two weeks later and you've got
40:41you know millions of data points more
40:43more data than you know what to do with
40:45let me just go back and answer one
40:46question first we mentioned about you
40:49mentioned about the clamp and
40:51i mentioned about something else
40:53what i would like to see more happen
40:55we're trying to get this back to the
40:57real world so your audience can relate
40:59to it
41:00typically when you go into a clinician
41:02now you'll get a fasting glucose which
41:03you and i agree on is a total waste of
41:05time it's a snapshot of what happened
41:07there you're probably a bit nervous in
41:08the doctor's surgery it's like blood
41:10pressure you know it's not really a very
41:12good measure if you just do a one-off
41:15the oral glucose tolerance test is
41:17another thing which i think is just
41:18completely irrelevant so again for your
41:21listeners we typically give around an 80
41:23gram bolus of glucose we get someone
41:25sitting down we take glucose for two
41:27hours and we see how they respond to
41:29that
41:30that's not real life we've moved away
41:32from that and we do real live meal
41:35testing we look at the response to a
41:37mixed meal of what the subject or
41:39participant or clinical person whatever
41:41it happens to be would eat during the
41:43day because that's relevant for them
41:46just banging down 80 grams of glucose
41:49there's no way you could drink
41:51uh it's no way in nature you get you
41:53know 80 grams of glucose and indeed you
41:55know michelle klesky from deakin she's
41:57actually shown that you do an oral
41:59glucose tolerance test it reduces your
42:01muscle blood flow you can do a meal test
42:05because insulin is meant to increase
42:06your blood flow yeah but when you do it
42:08so artificially it actually decreased it
42:10yeah you did it with a meal test it
42:12increased it which is what you'd expect
42:14yeah well again we're exactly on the
42:16same track here so i would
42:18firstly again and i'm not poo poo in the
42:20clinicians i realize that you know you
42:22probably can't do some of these
42:23sophisticated tests that we can do in
42:25the laboratory but really a fasting
42:27overnight glucose get rid of it uh oral
42:30glucose tolerance test well again the
42:33fact that you give 80 grams of glucose
42:35to a person who weighs 50 kilos and to
42:38someone who gains 100 kilos where
42:40they've got totally different blood
42:41volume what is going on there
42:44i just do not understand that and i
42:46think we've we've both done enough well
42:48it's like it's like when we used to
42:49carbohydrate and justin because we used
42:51to give everyone 250 mils during
42:53exercise every 15 minutes yeah i'm like
42:56a minute this guy's 50 kilograms this
42:58guy's 100 kilograms yeah so we started
43:00doing three mils per kilogram maybe 15
43:02minutes
43:03we've changed in sport that's the
43:05interesting thing there glenn you've hit
43:06the nail on the head sports nutrition
43:08has recognized that but the clinicians
43:10still are in the dark ages and you know
43:13we'll probably get some flack for saying
43:15that but it's also easier it's more
43:16expedient yeah yeah it is as i said it's
43:19practical it's it's much easier to do
43:21but the point is it's not real world and
43:23for your listeners you want real world
43:25things and again the cgms get back back
43:28to your question should everyone be
43:29wearing them well
43:31no they shouldn't certainly i don't
43:32think there's any use in athletes
43:33wearing them and i gave a talk to um to
43:36a company the other day about the use of
43:37heart not heart rate monitors blood
43:39glucose monitors for athletes and
43:41i i don't think there's any point to be
43:43completely honest because athletes have
43:45very good glucose control they're very
43:46insulin sensitive and it's a waste of
43:48time and money
43:49i think one study that we're actually
43:51doing at the moment that evelyn parr is
43:52doing is where we give
43:54type 2 diabetic patients glucose
43:56monitors
43:57and instead of masking them which is
43:59what we normally do in studies where the
44:01subject or patient doesn't see their
44:03data but we can collect it and then we
44:05give them feedback obviously after the
44:06study we unmask it and i wore one of
44:09these for a couple of weeks and you know
44:12i eat a lot of ice cream and you know i
44:13like chocolate as well
44:15the response to ice cream and some of
44:17these foods is like whoa you need to
44:18knock this on the head of it you know
44:20your glucose excursions are quite wild
44:22so i think they're a really good tool to
44:24give very instant feedback on an
44:27individual basis to patients or whoever
44:30the population happens to be that they
44:32can see okay this is my response to this
44:35meal at this time of the day this is my
44:36response at this time of the day whoa my
44:39glucose is completely out of whack i've
44:41either gone not this on the head or i've
44:43got to bring it in earlier so in answer
44:45to that question i think they can
44:46definitely be used there you don't need
44:48them for months and months and months
44:50you can get that every couple of weeks
44:52yeah i agree i mean i i wonder though
44:54like you know as i was saying getting a
44:56person with type 2 diabetes one for a
44:58couple weeks i think that would be
44:59really important and it's unmasked um
45:04like you said the type ones yes i mean
45:06they have a different sort of a problem
45:08and you know hypoglycemia is as much a
45:10problem when they exercise as as
45:12hyperglycemia in the type two but
45:15if you've got someone out there
45:16listening and they've got access to one
45:18of these cgms's and someone who can you
45:20know download the data for them and take
45:22a peek
45:23it's really very very valuable and i
45:25think on an individual basis it's
45:28essential because one size again doesn't
45:30fit all and i'd urge definitely a two or
45:33three week period where you're in normal
45:35daily living situations you know not on
45:37holiday you're not doing a job which you
45:39don't normally do you're not changing
45:41your exercise or nutrient patterns or
45:43whatever it happens to be i think it's i
45:45think it's great instant feedback and
45:47unless they don't do any exercise so
45:49you'd encourage them if they don't do
45:50any exercise do some exercise and see
45:52what actually happens because that's
45:53that's the amazing thing so yeah yeah so
45:56getting back again to some of the stuff
45:58we said at the start so you know during
46:00exercise and people have type 2 diabetes
46:02you know i mean fair to say though the
46:04music study was fairly intense so 45
46:06minutes of uh it was
46:09pretty intense but the gluca the point
46:11is that the glucose comes down during
46:12exercise and then as you said
46:15the muscle then remains more sensitive
46:16to insulin for you know 24 to 48 hours
46:19or even longer right yes so why don't we
46:22just flesh that out a little bit so so
46:24it's beautiful because you know if you
46:26do exercise every couple of days your
46:27insulin sensitivity is going to remain
46:31elevated and that's the point it's not
46:33we're not saying to people you've got to
46:34go out and run a marathon every day we
46:36are saying exactly like you just said
46:38glenn that the muscle's insulin
46:40sensitivity
46:41remarkably well maintained for at least
46:4324-48 hours so
46:46just get people to do something on a
46:47monday wednesday or friday and then
46:49perhaps go out at the weekend and you
46:51know walk with your partner or do
46:52whatever you want to do type thing we're
46:55not prescribing you know
46:57what i think are ridiculous amounts of
46:59exercise and just on that you said you
47:01mentioned that the music protocol was
47:04quite intense exercise and it and it was
47:06and it was continuous i'd like to point
47:08out in our exercise snacking study where
47:10we only got subjects to to walk we did
47:12see you know drops of one and a half to
47:14two millimoles in glucose just from
47:16people walking so again the walking was
47:19adequate stimulus and i went away from
47:21this fact that people have to be out
47:23there running around the park or or
47:25cycling and doing triathlons they don't
47:27particularly if they're inactive to
47:29start with any exercise is good any
47:32exercise is good and i think walking is
47:34vastly underrated you put a hill in and
47:36walk up a hill absolutely most people
47:39that's high intensity exercise we
47:41mentioned new zealand we mentioned new
47:42zealand
47:43i used to live in dunedin you know well
47:45my mom lived in dunedin and i'd go back
47:47there and that was ridiculous i'd go for
47:49a ride and you'd see on my strava it
47:51would be like a star because i'd go up
47:53this oh that's too hard because
47:55you know depending on where you live
47:57they have don't they have the world's
47:59they have the world's steepest street
48:00don't know something and they have a
48:01racing street it's a it's the most
48:03ridiculous thing i tried to start
48:05running up at once and i thought no blow
48:07this for a lot
48:08but if you don't oh my gosh no no no
48:10don't do that no no i didn't even think
48:12about that i i walked up it but again
48:15hills hills are an easy way to overload
48:18the other way of course is just to do
48:20you know when we think of
48:21high intensity training or interval
48:23training let's get the high intensity
48:25out of it let's just think of interval
48:26training you've got your overweight
48:28uh
48:30subject who's predisposed to type 2
48:32diabetes
48:33walk gently between two lamp posts walk
48:36briskly between the next two that's
48:38interval training guys it doesn't have
48:40to be on a track with a stopwatch that
48:43is interval training all interval
48:44training means is periods of higher
48:47intensity with periods of lower
48:48intensity recovery so that's the way to
48:51start even when people are starting on
48:53you know marathon running programs i say
48:55well you know jog a couple of lamp posts
48:57then walk jog a couple then walk i said
48:59oh yeah you know i can do two or three
49:01days like that yes but you couldn't do
49:03it continuously just build up gradually
49:05and remember rome wasn't built in a day
49:08you know a lot of people come in to us
49:10and say look you know i'm overweight i
49:12put on so blah blah it's like that that
49:15didn't happen overnight please don't ask
49:18me to cure you overnight all right just
49:20remember this takes some time and more
49:23importantly it's a lifestyle change and
49:25i say to people once you've done three
49:27months of this that's habit changing we
49:30need to change your behavioral patterns
49:32and that's very important and generally
49:34after three months they don't fall off
49:36the wagon again they're that's it for
49:38life you've got to get them to that
49:39three month point though glenn and
49:40that's sometimes very hard what a long
49:43time i guess and the other thing is they
49:45they you can't be too hard on yourself
49:47so
49:48you know i've spoken to people with type
49:502 diabetes i did exercise for a while
49:52then you know they they miss
49:54that's it they miss a date it's like
49:55hang on
49:56every bout of exercise is good for you
49:59try and do that like that oh okay and
50:01let's get away from exercise so every
50:03bout of activity
50:05is good for you you don't have to focus
50:07on oh i missed i missed an exercise
50:08about forget it
50:10money in the bank the way that we always
50:11say to them what you depositing money in
50:13the bank every exercise session is money
50:15in the bank you can withdraw on it later
50:17okay the more you do you know the more
50:20you've got to withdraw later so i like
50:21your analogy you know don't panic if you
50:23miss a day you're not going to fall
50:25apart hey i've got on twitter i asked
50:27people like before you came in if
50:29there's any questions i got a couple
50:31there's a good chap jeff rothschild from
50:33um
50:34new zealand he asked me to ask you
50:36if what would be your dream study if
50:38there was no resources logistics
50:41whatever you could just someone gave you
50:42five i was gonna say a million five
50:44billion dollars
50:46well i came up maybe not five billion
50:48that would you change the whole system
50:50what would you do a dream study yeah
50:52that's a great question because it's one
50:54i always ask post docs at the interview
50:56and inevitably to
50:58it it fluxes them they they they can't
51:01think of an answer a dream study oh now
51:03i've got you on there do you mean in the
51:04area of type 2 diabetes yeah i guess
51:07well
51:08yeah well
51:10well that's a bit of a tough one yeah
51:11that's just just a dream in diabetes i
51:14mean i would really like to do some very
51:17well controlled laboratory studies to
51:19start with to show what we call proof of
51:21concept but and i think what's missing
51:24in science at the moment is taking it
51:26out into the real world and let me give
51:28you an example you know the work that
51:29we're doing in the in the labs at the
51:31moment we're doing lots on time
51:32restricted feeding we learn lots on
51:34exercise and type 2 diabetes and let's
51:36just keep it in the type 2 diabetes
51:37realm because it makes my life a little
51:39bit easier at the moment as well
51:41a lot of the studies we do are very good
51:43they're very well controlled they're
51:44laboratory control we feed subjects we
51:46bring them in we monitor this we measure
51:48that we do this fantastic
51:50they last for about four weeks sometimes
51:52eight weeks and i've just told you that
51:54to change people's habits we need three
51:57months so firstly i don't think we need
51:59five billion dollars i just think we
52:01need more longitudinal studies we've got
52:04a study which we're doing at the moment
52:06with leonie helbron at the university of
52:07adelaide where we're looking at time
52:09restricted feeding and it's a year
52:12long study a lot of money million
52:13dollars
52:14that is really what we should be doing
52:17because doing these very short term
52:19studies and you may say the audience may
52:22say well why are you doing these short
52:23term studies because that's all the
52:25money that we get that's literally and
52:27that's another discussion you should
52:29have someone background funding is a
52:32major headache for researchers such as
52:34myself who have a lab with running costs
52:36which are you know keep me awake at
52:38night type thing the point is we do
52:40these lovely little proof of concept
52:42studies in the laboratory as i said very
52:44well controlled let's take them out into
52:46the real world with real people with
52:49real families with real jobs with
52:51children with meals that have to be
52:54fitted around kids schedules and
52:55everything else and then let's see
52:57what's going on that's the thing
53:00so talking about real world i can't help
53:02thinking sometimes when we do our
53:03studies and people with type 2 diabetes
53:05we get your diet controlled people
53:08they're not your real average person
53:10with type 2 diabetes do you think we can
53:12apply and who knows because most of the
53:14studies haven't been done
53:15can we apply most of these findings to
53:17real world people with type 2 diabetes
53:20yes
53:22i have to say yes because otherwise i'll
53:24get my funding taken away but the real
53:25answer is probably not um in all honesty
53:28now you're right it's it's somewhat of
53:29an artificial thing and again
53:31the type of subjects who we get to come
53:33in for these studies uh you know
53:36they're volunteers they usually have
53:37time in the day they're they're not the
53:39typical everyday person so it worries me
53:42a lot that's a lot of the laboratory
53:44conclusions may not even apply to real
53:46world
53:47findings or real world living as we've
53:50got it so again the question was what
53:53would you do if you had five million or
53:54five billion dollars i'd like to do
53:56longitudinal studies with real world
53:58people in real world settings and see if
54:01some of the laboratory results and data
54:03that we've got hold up i think some of
54:06them would but props perhaps not as much
54:08as we might think yeah we tend to be
54:10interested in mechanisms and getting
54:11people in and we do biopsies and things
54:13but probably the most important thing
54:14would be to have a whole bunch of
54:16of you know diet control people type
54:18diabetes controls and then some of your
54:20sort of garden variety people with type
54:222 diabetes follow them for a year with
54:24continuous glucose monitoring
54:26absolutely i mean though well that's
54:28what we're doing essentially in this
54:29study at the moment with time restricted
54:31eating
54:32but again
54:33as far as i know this is the the longest
54:35study and we scour the clinical trials
54:37registry worldwide i think this is the
54:39longest study at the moment most of the
54:40studies has just been one published in
54:42the new england journal of medicine 14
54:44weeks and i'm like well that's quite a
54:45long while anything 14 weeks isn't a
54:47long while in someone's life it's
54:49absolutely not it didn't take you took
54:52you more than 14 weeks to get type 2
54:53diabetes so you know what's 14 weeks the
54:56other side so that that's what i would
54:58do it's a really good question i must um
55:00give that a little bit more thought
55:03but i guess everything in life nowadays
55:05is a quick fix here people want a quick
55:07fix
55:08you know this diet didn't work this
55:09exercise didn't work this this i don't
55:11know whatever it is isn't working
55:13yeah it's hard nowadays
55:15maybe our attention spans are
55:17well you're dead right i mean don't
55:19don't the news people say now that
55:21they've reduced the news bulletins
55:22because people's attention spans are so
55:24small but i'll tell you another reveal
55:26in fact when we look at uh
55:28when we interview the lots of the
55:29participants who come in particularly
55:31for our weight loss studies the alarm
55:33thing glenn is that some of the been on
55:3513 or 14 different diets
55:38they've literally tried you're you're
55:40absolutely correct they've tried this
55:43didn't work quick fix let's move on to
55:44the next one you know the victoria
55:46principal grapefruit diet or you know
55:47someone's soup diet or whatever it is or
55:50i mean these are just nonsense things
55:51most of these celebrity
55:53stuff are just you know a bunch of
55:55you know what they're just they're just
55:57not worth
55:58promulgating or even talking about but
56:01they look like they might work so people
56:04you know your type 2 subject your
56:07athlete anyone
56:08is absolutely prone to marketing
56:10advertising and your quick fix is the
56:12way that people want to go and that's
56:15not a message which i
56:17i think needs turning around completely
56:19as i say you don't wake up one day and
56:21think wow i've got 20 kilos on overnight
56:23it doesn't work like that so don't
56:25expect to reverse it in a day or a week
56:28yeah quick fixes
56:30i wanted to talk to you about a bit
56:31about some mechanisms and things but i
56:33think you've got to go is that right
56:34i've got a few more minutes we can talk
56:36mechanisms and take a bit of a deep dive
56:38i'll um i'll keep the other people in
56:39the boardroom waiting that's okay you're
56:41my
56:42yeah i'm sure
56:43you're only big time
56:46well i guess i guess you know what what
56:48are the mechanisms going on there with
56:50um so okay we've talked about acute
56:52exercise there's all sorts of stuff
56:54going on in the muscle during that time
56:56but we think more importantly probably
56:58over the long term
56:59what do you think the mechanisms are
57:01that you're getting the improvements in
57:02insulin sensitivity and then and the
57:04thing also about um you know as you know
57:08we tend to talk about exercise training
57:10being like a series of acute belts just
57:12wondering what you think is going on
57:14there
57:15okay well let's take the last point
57:16first because that's a good one let's
57:18and it gets back to what we said earlier
57:20about what i said about money in the
57:22bank each acute exercise bout
57:25adds up and eventually all these little
57:27exercises about make you a trained
57:30individual and that's in essence what
57:32we're doing we're trying to accumulate
57:34uh the acute benefits of exercise over
57:36the long term and that's a really good
57:38way to think about it because as we said
57:40you know half an hour ago the acute
57:42bouts of exercise are very good at low
57:44in blood glucose are very good at taking
57:46glucose into the muscle post exercise so
57:49if you keep doing that every other day
57:51bang you're in business and you become a
57:53trained individual
57:54now lots is going on at the muscle
57:56hopefully if you're doing a little bit
57:57of resistance exercise you've got a
57:58greater muscle mass you've got to go to
58:00sync for blood glucose to be disposed of
58:02number one you're up regulating a lot of
58:04pathways in skeletal muscle you're
58:06increasing what we call glucose
58:09transporters this protein that we have
58:11on the membrane called glute4 when
58:13you've done a lot of work in this area
58:14so you know an awful lot more about this
58:16than i do we're literally
58:19initiating a whole lot of cascade of
58:21events and skeletal muscle which make
58:22the muscle more efficient at taking up
58:25blood glucose more efficient at
58:27oxidizing it and in some cases more
58:29efficient at storing it so we tend to
58:32attack this problem from three if you
58:34like
58:34prongs and exercise does all of these
58:37and that's the beneficial effect of
58:39exercise as opposed to just the diet the
58:41diet yes you can increase insulin
58:43sensitivity by doing various things but
58:46you do not increase muscle mass just by
58:48diet alone you need the contraction
58:51you do not upregulate some of these
58:53signaling pathways in the muscle which
58:54are responsible for you know getting
58:56more mitochondria getting the muscle
58:58more insulin sensitive getting more
59:00glucose transporters and the such light
59:02so again exercise on its own is
59:05fantastic diet on its own not so
59:07fantastic but exercise and diet combined
59:10give you the best of the both worlds
59:11exactly because you've got to be like
59:13turning it over right so if you're
59:14dieting you're not actually turning over
59:16what's in the muscle
59:17if you're turning it over so you know
59:18the classic thing with the intramuscular
59:20fat you know i had brett good pasta on
59:23right at the start a few months ago you
59:25know that that you can have increased
59:27interest muscular fat if you're a
59:29trained athlete
59:30increase intramuscular fat if you're
59:32obese type 2 diabetic but you're not
59:34turning it over no and that's the whole
59:36point it's it's what we call the flux in
59:38the system so it's literally you've got
59:40this inert store and you've used the
59:41example and brett's done great work in
59:43this area of the fact that athlete is
59:45called the athletes paradox so both
59:48athletes for your listeners who didn't
59:49hear brett's talk both the athletes and
59:51the type 2 diabetic have large stores of
59:54fat within the muscle but the athlete's
59:57turning it over on a daily basis and so
59:59it doesn't just sit there inert and
01:00:01cause all the problems with cigarette
01:00:03the type 2 diabetic subject on the other
01:00:05hand may not be exercising and it
01:00:07becomes a problem for them and makes
01:00:08them insulin resistant so it is what we
01:00:11call the athlete's paradox and the i
01:00:14guess the idea there and the way i like
01:00:15to when i talk to undergrad students
01:00:17about exercise is my and maybe we'll
01:00:20leave the the listeners with this the
01:00:21analogy is that you drive two cars into
01:00:24the garage one's a if you like a porsche
01:00:26and you drive it into the garage you
01:00:28park it you take out the key the other
01:00:30one's a dumpy old volkswagen doesn't do
01:00:32any mileage or this at the other so
01:00:34one's the athlete and one's the
01:00:36overweight or sedentary individual you
01:00:38take both the keys out the door you
01:00:39close the garage doors you go home you
01:00:41know you have your moving watch your tv
01:00:43or do whatever you do
01:00:44the analogy is that overnight the
01:00:47porsche is still turning over it's like
01:00:49humming along and it's almost in first
01:00:51gear so it's burning fuel it's turning
01:00:53stuff over
01:00:54the inert car the the beetle or the vw
01:00:57or whatever the one who doesn't do any
01:00:58exercise or doesn't do any driving
01:01:00during the day that's turned off
01:01:01completely the switch is off you get
01:01:04back in the morning the porsche is ready
01:01:06to go it's been pouring along all night
01:01:08it's ready it's turned over fuel the
01:01:10other one's not it stutters it starts it
01:01:12may start second or third time
01:01:14and that's the way we should think of
01:01:15the human body we want to be in a
01:01:17continual state of turning fuel over
01:01:20what's the best way to do that it's to
01:01:22the burn the fuel to replace the fuel to
01:01:25burn the fuel to replace the fall sub
01:01:28date substrate turnover is very
01:01:30important and what's the best thing to
01:01:31do that the combination of exercise and
01:01:34diet
01:01:35correct all right perfect
01:01:37all right so thank you very much i know
01:01:39you've got a board room waiting for you
01:01:41there so thank you very much for taking
01:01:42the time no it's great it's been a good
01:01:44chat so
01:01:46i'll see you next time good to see you
01:01:48again and uh the fact that we live 400
01:01:50meters apart maybe it means we should
01:01:51probably do one of these uh walk-in
01:01:53meetings walking along the river well
01:01:54you know what's funny it's because you
01:01:56don't sleep in an apartment you're
01:01:57talking about cars in the garage but
01:01:59twice mine's died because i never use it
01:02:01because i just walk around the city
01:02:03i i don't have a i have three car park
01:02:05spaces i don't have a car in melbourne i
01:02:07walk everywhere do you rent them out
01:02:09okay it's another story
01:02:11if you want to rent one you can okay
01:02:13good on you john out on that night we'll
01:02:15leave thanks glenn cheers
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