1. Healthy training and fine dining to combat diabetes Uranienborg Rotary Klub Feinschmecker, 28.11.2013 Jørgen Jensen Department of Physical Performance Norwegian School of Sport Sciences & Department of Public Health Aarhus University

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

3. Diabetes Diagnosis: – Fasting blood glucose > 7.0 mM (126 mg/dL) – Blood glucose 2 h after 75 g oral glukose > 11 mM (200 mg/dL) Fasting glucose 5.6 – 6.9 mM. – Blood glucose 2 h after 75 g oral glukose mellem 7.8 and 11 mM – Insulin resistance – Glucose intolerance – Pre-diabetes Glycosylated hemoglobin (HbA 1c )

4. Skeletal muscles and insulin sensitivity Diabetes is diagnosed by elevated blood glucose. Glucose and other carbohydrates are stored as glycogen in liver and skeletal muscles. Skeletal muscle (40 % of body weight) store ~ 400 g glycogen. Insulin stimulates skeletal muscles glucose uptake. Skeletal muscles removes blood glucose. Exercise utilises skeletal muscle glycogen. Liver (1.5 kg) stores ~ 100 g glycogen.

5. Framingham Heart Study, MA 1948: 5209 non-industrial white subjects recruited; 2336 males; 2873 females age 28-62 y Examination: Every 2. year. 1999: 993 surviving LS: Life span Yashin et al. 2009 Mech Ageing & Dev, 130:611-

6. Quality of life Constitution of the World Health organization: – Health is a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity. – The enjoyment of the highest attainable standard of health is one of the fundamental rights of every humans being....... Aging is associated with sarcopenia and reduced physical function. Type 2 diabetes increases development of sarcopenia and reduces quality of life and decrease life span. Exercise reduces the risk for type 2 diabetes, CAD, reduction in cognitive function,......

7. Risk factors for type 2 diabetes Obesity Inactivity Diet Genetic Age Mental stress

8. Exercise and food/energy intake Justitia – Lady Justice Our genes are important for outcome of diet and exercise.

9. Food is energy Food also contains vitamins, polyphenols and taste/smell molecules Carbohydrate Protein Fat

10. Food is energy Food also contains vitamins, polyphenols and taste/smell molecules Fine dining is pleasure Carbohydrate Protein Fat

11. Food – movement -body weight 70 kg 140 kg Energy utilisation – 10 km 0.5 L gasoline 700 kcal 1.0 L gasoline 1400 kcal

12. Food – movement -body weight 70 kg 140 kg Energy utilisation – 10 km 0.5 L gasoline 700 kcal (0.08 L Olive oil or 0.875 kg potato) 1.0 L gasoline 1400 kcal (0.15 L Olive oil or 1.75 kg potato)

13. How to prevent type 2 diabetes Avoid obesity Weight reduction Exercise Diet (low intake of carbohydrate - low fat intake). High intake of fibres.

14. Intervention to prevent diabetes Intervention: Weight reduction: > 5% Fat intake: < 30% Saturated fat intake <10% Fibre intake: >15 g/1000 kcal Exercise: > 4 h/week Detailed advice about the intervention Dietary advices (food record) by nutritionist (7 meetings first year) Exercise: walking, running, swimming, aerobic ball games or skiing Resistance training (circuit-type) for large muscle groups: moderate-high number of repetitions rest periods: 15-60 s (Adherence: 50-85 % at centres during the firsts year). Subjects: 522 overweight with impaired glucose tolerance (2 h: 7.8-11 mM) Incidence of diabetes (3.2 years) Control group: 23% Intervention group: 11% Tuomilehto et al., 2001 N Eng J Med 18:1343-

15. Taste and flavour Taste receptors: Sweet Umani Bitter Sour Salty Fat? Depoortere, 2013 Gut Evolutionary functions of taste: Evaluate food for toxins and nutrients Prepare the body for metabolism Recognise food items

16. Taste and flavour Taste receptors: Sweet Umani Bitter Sour Salty Fat? Functions of taste: Taste signal pleasure and reward Tasty, energy-dense food cause obesity Breslin, 2013 Cur Biol 23:R409-

17. Fine dining to prevent type 2 diabetes?

18. High protein & low glycaemic index diet is superior to maintain weight reduction Larsen et al., 2010 N Eng J Med 363:2101- Subjects: 938 Overweight on low-calorie diet (800 kcal) 773 completed weight reduction > 8% (8 wk) Randomly assigned to: High protein low glycaemic index High protein high glycaemic index Low protein low glycaemic index Low protein high glycaemic index Control All groups: Intention to maintain weight reduction Food ad libitum, 25-30 % fat High protein: + 12 % of total energy High glycaemic index: + 15 glycaemic-index units

19. Fine dining for athletes?

20. Healthy diet Middle-aged and inactiveThe young athlete 2,500 kcal Energy requirement 8,000 kcal/day 200 kcal/ hExercise1,000 kcal/h

21. Healthy diet Middle-aged and inactiveThe young athlete 2,500 kcal Energy requirement 8,000 kcal/day 500 kcal/h Exercise 1,000 kcal/h 30 ml/min/kg Maximal oxygen uptake 90 ml/min/kg Old people 200 kcal/h Exercise 700 kcal/h 15 ml/min/kg Maximal oxygen uptake 50 ml/min/kg

22. Sufficient food for athletes

23. High oxygen uptake predicts high insulin sensitivity MyoGlu, 2013

24. Healthy training Train endurance and strength. Exercise/walk 30 min five days a week and perform 2 sessions (60 min) of moderate/high intensity strength or endurance exercise. Avoid long periods of sitting without activity – 2 min of activity 1-2 times per hour. Find exercises that improve wellbeing and not cause pain in tendons and joints. Dynamic flexibility training. Find types of exercises you like. Train continuously and systematic.

25. Mental stress Stress is recruitment of energy. Training may be most important when you are mentally stressed!

26. Motivation to train

27. René Descartes (1596-1650) Af alle ting er den sunde sans det, som er mest retfærdig fordelt; for hver og en mener at være så vel forsynet dermed, at selv de, der er sværest at stille tilfreds i alt andet, ikke har for vane at ønske sig mere deraf, end de har. Metoden Gyldendal, 1967

28. René Descartes (1596-1650) Af alle ting er den sunde sans det, som er mest retfærdig fordelt; for hver og en mener at være så vel forsynet dermed, at selv de, der er sværest at stille tilfreds i alt andet, ikke har for vane at ønske sig mere deraf, end de har. Metoden Gyldendal, 1967 Derfor kommer forskellen i anskuelser ikke af, at nogle er mere fornuftige end andre, men alene af, at vi i vore tanker ledes ad forskellige veje og ikke overvejer de samme ting. For det er ikke nok at have en god forstand; det vigtigste er at bruge den godt.

29. René Descartes (1596-1650) Le bon sens est la chose du monde la mieux partagée: car chacun pense en être si bien pourvu, que ceux même qui sont les plus difficiles à contenter en toute autre chose, n'ont point coutume d'en désirer plus qu'ils en ont. DISCOURS DE LA MÉTHODE 1637