Fitness

Hungry at night? Study proclaims cottage cheese the ideal before-bed snack

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 If you’ve been on the lookout for the perfect late night snack, look no further. Researchers from Florida State University say that cottage cheese before bed has a positive effect on the metabolism and overall health, helps promote muscle recovery, and doesn’t result in any body fat gains.

If cottage cheese isn’t exactly your snack of choice, the study’s authors say any helping of 30 grams of protein about a half hour before turning in for the night should do the trick.

For the study, a group of active young women in their early 20s were asked to eat cottage cheese 30-60 minutes before going to bed. Researchers specifically wanted to see what effect the cottage cheese would have on the participants’ metabolisms and muscle recovery process.

This study is especially noteworthy because it is among the first ever to have subjects consume a whole food product before bed, as opposed to a dietary supplement such as a protein shake.

“Until now, we presumed that whole foods would act similarly to the data on supplemental protein, but we had no real evidence,” comments Michael Ormsbee, Associate Professor of Nutrition, Food and Exercise Sciences at FSU, in a release. “This is important because it adds to the body of literature that indicates that whole foods work just as well as protein supplementation, and it gives people options for presleep nutrition that go beyond powders and shaker bottles.”

According to study co-author Samantha Leyh, a research dietitian with the U.S. Air Force, these findings will serve as a helpful jumping off point for future research investigating the impact of whole food consumption on precise metabolic responses.

“While protein supplements absolutely have their place, it is important to begin pooling data for foods and understanding the role they can play in these situations,” Leyh says. “Like the additive and synergistic effects of vitamins and minerals when consumed in whole food form such as fruits or veggies, perhaps whole food sources may follow suit. While we can’t generalize for all whole foods as we have only utilized cottage cheese, this research will hopefully open the door to future studies doing just that.”

Moving forward, the research team plan to conduct additional research on other potential late night snacks, in an effort to determine the optimal food choices one can make before bed in order to promote muscle regeneration and overall improved health.

“There is much more to uncover in this area of study,” Ormsbee concludes.

Is Body Positivity Doing More Harm Than Good?

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‘You don’t have to love your body to be kind to it.’ – Alissa Rumsey

Body positivity is a major topic of conversation these days. From social media to commercials on TV, there has been a growing effort to push a more inclusive image of the human body. While the concept of accepting our individual flaws is a generally positive idea, when does it go too far and start endangering your health? When it comes to wellness, the line should be drawn at obesity — as the condition contributes to life-long health problems if left untreated.

Body positivity is about how our perception of body image (our own and others) shapes our concept of self, mental health, well-being, and relationships. It refers to how you feel about your own appearance, and how you feel about your height, weight, and shape.

Moreover, the term body positivity describes a mindset that the shape or size of someone’s body does not determine their worthiness of love. It challenges the roles of cultural, social, and media influences in the development of our relationship with our body, ourselves, and how we perceive others. Body positivity can also refer to cultivating confidence and self-love, and appreciating your body for all that it can do, despite its flaws. It’s about inclusivity and acceptance of all physical traits.

If the goal of body positivity is to encourage the media to present images of “real” people, rather than idealized images, the movement is succeeding. It’s my unscientific observation that more television ads and programming, as well as print media, feature more overweight models and actors.

Woman looking at herself in mirror, body image
(© Maridav – stock.adobe.com)

When does body positivity cross a line into harmful self-indulgence?

Weight is just one aspect of body positivity, but let’s use it to examine the movement.

For children and adolescents between two and 19 years-old, almost 20 percent are obese – that’s about 15 million kids. The older the child, the higher obesity rates rise.

It’s 12.7 percent among kids two to five, and 22.2 percent among children 12 to 19. About 26 percent of Hispanic children are obese, as are 25 percent of Black children.

We are seeing diseases in these young people which previously were seen almost exclusively in adults. This includes cases of high blood pressure, high cholesterol, Type 2 diabetes, gall bladder disease, sleep apnea, and joint problems. There is more obesity in proportion to decreasing education among parents and lower household incomes.

Obesity in children is associated with:

Obesity in adults is associated with:

Teen boy eating junk food, drinking soda while looking at smartphone
(© New Africa – stock.adobe.com)

These negative consequences are increasing in frequency as the incidence of overweight and obesity in our culture increases, while the body positivity movement gains attention.

Body positivity purports loving your body. You care for what you love. Does that make being overweight, or self-indulgence, body negativity? Let’s just get rid of the positive vs. negative and replace them with wellness.

How Can You Practice ‘Body Wellness’?

There are several ways to discover what “being healthy” means to you – physically, mentally, and emotionally. This includes cultivating a realistic perception of your body, including its flaws.

1. Practice positive self-talk: It can increase your confidence and self-esteem. Replace negative thoughts with positive affirmations and focus on your strengths. Use statements such as “I am courageous,” and “My body is capable of great things.” You can put these on sticky notes and post them on your bathroom mirror.

2. Seek out community: Surround yourself with people who support and uplift you.

3. Add more physical activity: Move in ways that make your body feel good, such as yoga, dancing, or walking. Focus on how your body feels during these activities, rather than how it looks.

4. Write a gratitude list: List things about your body and yourself you are grateful for. This can help shift your focus from negative thoughts to positive ones.

5. Nourish yourself with nutrient-rich food: Eat whole foods that make you feel good and provide energy. Avoid restrictive diets.

6. Wear clothing that builds confidence: Be comfortable, and bold with color. Don’t worry about following fashion trends or certain sizes.

7. Practice self-compassion: Treat yourself with the same compassion and love you would show to a friend.

8. Ask your healthcare provider for support: Discuss with your doctor your personal path to greater wellness.

Many people stick with boring workouts and relationships for the same reason — comfort

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Many Americans apparently think about their workout routines in the same way they think of their romantic partners — and that’s not a compliment. A new survey finds that over half of Americans stick with the same old exercises for the same reason they choose to stick it out with a less-than-exciting partner — it’s easier than moving on!

That’s according to a survey of 2,000 Americans who work out at least once a week. The poll also finds that one in five Americans find it harder to commit to a fitness routine than a partner. Over the last 10 years, Americans tried about five different workout regimens and had four different, serious partners.

More than two-thirds (68%) are likely to stick with a workout routine that doesn’t necessarily work for them simply because it’s comfortable. More than half (53%) of respondents are likely to stay with the wrong partner for the same reason!

Conducted by OnePoll on behalf of Freeletics, the survey digs into the idea of what makes a “perfect match.” The results reveal that it’s most closely defined as something or someone who helps them reach their goals (66%). Others say it’s something or someone who gives them warm, fuzzy feelings (61%) or someone or something who pushes them to be the best version of themselves (47%).

The average American has already found four perfect matches and those include their best friend (46%), therapist or psychiatrist (41%), partner (41%), doctor (40%), and even a gym (32%).

Infographic people surveyed reveal why this stick with fitness routine and wrong partner

While 45 percent have already found their perfect workout, 24 percent are still searching for it.

The survey also uncovered the biggest deterrents when it comes to both relationships and workout routines. When starting a new romantic relationship, top dealbreakers include the amount of money they’d have to spend on their partner (52%), where they live (52%), and how much time they’d need to dedicate to them (40%).

Interestingly, those same three factors are the top dealbreakers when starting a new fitness routine. Beyond that, respondents also consider if they actually enjoy doing the routine (27%).

When combining those two aspects of life, a little more than one-third (35%) believe that working out with a partner would help them achieve their fitness goals.

“The data shows that balancing fitness and romantic relationships often involves navigating the same waters – time investment, cost considerations, and finding joy in the process,” says spokesperson Confidence F. Udegbue, Director of Product and UX at Freeletics, in a statement. “This common ground highlights how intertwined our personal well-being and relationships can be, influencing our decisions in health and love.”

Happy older senior couple exercising or working out
(© NDABCREATIVITY – stock.adobe.com)

Though 20 percent of respondents struggle more with the initial commitment to a fitness routine, a similar number (22%) find it more difficult to let it go when it’s time to change their routine. When it comes time to leave a workout regimen in the past, respondents experience a multitude of emotions including relief (42%), sadness (41%), anxiety (38%), and even happiness (29%).

This may be why Americans have faced barriers such as time constraints (51%), lack of customizable options (45%) and high costs (44%) when it comes to finding the “perfect” workout. Beyond that, 44 percent admit they simply have a fear of commitment. 

At the end of the day, 78 percent of respondents would commit to a workout routine for longer if they knew they’d get the results they’re looking for.

“Not every match is a ‘perfect match,’ and the search can be challenging,” adds spokesperson Daniel Sobhani, CEO of Freeletics. “It’s important to find ways to simplify the fitness journey, such as personalized, adaptive workout plans built by human augmented AI technology. Finding an approach that meets you where you are and that evolves with your needs makes it easier to build and maintain a fitness habit that fits your life for life.”

Survey methodology:

This random double-opt-in survey of 2,000 Americans who work out at least once a week was commissioned by Freeletics between Nov. 27 and Nov. 29, 2023. It was conducted by market research company OnePoll, whose team members are members of the Market Research Society and have corporate membership to the American Association for Public Opinion Research (AAPOR) and the European Society for Opinion and Marketing Research (ESOMAR).

Pancreas gene finding gives new insights into human development and aids search for type 1 diabetes cure

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The Bashir Twins

Understanding how the human pancreas develops is crucial to allow scientists to make insulin producing–beta cells in the quest to cure Type 1 diabetes. Now, scientists have made a unique and surprising discovery – a gene that is essential for making the pancreas in humans is not present in almost all other animals.

Beta cells within the pancreas produce insulin that regulate blood sugar. Every mammal needs the pancreatic beta-cells to survive. In established Type 1 diabetes there are no, or very few, working beta-cells.

The new finding, published in Nature Genetics, challenges assumptions about how the regulation of development evolves. Until now, scientists had assumed that genes essential for development of key organs and functions were highly conserved through evolution, meaning the genetic pathway remains the same between different species, from fish to humans. However, the gene, called ZNF808, is only found in humans, other apes such as chimpanzees and gorillas, and in some monkeys, such as macaques.

This Wellcome Trust-funded research was carried out by researchers at the University of Exeter Medical School, the University of Cambridge and the University of Helsinki in Finland. The study shows just how different humans can be to other animals often used in research, such as mice, emphasising the importance of studying the human pancreas.

Lead author Dr Elisa De Franco, of the University of Exeter Medical School, said: “Our finding is really surprising – this is the only example we know of where a gene that is fundamental to the development of an organ in humans and primates is not present in other animals. You’d expect a gene only found in primates to regulate a feature that is specific to primates, such as brain size, but it is not the case for this gene, which instead is involved in development of an organ shared by all vertebrates! We think this shows that there must have been an evolutionary shift in higher primates to serve a purpose.”

Senior author Professor Andrew Hattersley, of the University of Exeter Medical School, said: “One hypothesis that we are exploring is that the evolutionary benefit is to the pancreas in the fetus. Human babies are born through the pelvis, so they cannot stay in the uterus for a longtime as they would grow too large for birth. Instead to cope with being born early and needing to survive without continual feeding they need to be born with more fat than any other animal.  This fat is laid down when the fetus’ pancreas produces more insulin. Our research has shown that human fetuses have more insulin-related growth than other animals.

Dr Nick Owens, of the University of Exeter Medical School, remarked “This research really emphasises the importance of studying the human pancreas in order to understand and find new treatments for diabetes. Animal research is important, but it can only tell us so much. We know there are fundamental differences between humans and other animals, such as mice which are often the subject of research in this field. The human pancreas is different in how it looks, works and develops. Our genetic finding could help us understand why that’s the case.”

ZNF808 belongs to a family of recently evolved proteins which bind and ‘switch off’ specific regions of the DNA which have also developed recently in evolutionary terms. These DNA regions were among the regions considered “junk” DNA with no meaningful purpose for decades, but new technology have recently allowed us to discover their functions. Our findings confirm that these regions of our DNA are playing important roles during human development.

Dr Michael Imbeault, from the University of Cambridge, said “These findings show that genes like ZNF808, even if relatively ‘recent’ in evolution, can have a crucial role in human development. ZNF808 is a member of the largest, but also least studied family of proteins that regulate our genome. There are hundreds of genes like ZNF808 in our DNA, many primate or even human specific, and our results demonstrate how these can be key players in human health.”.

The identification of ZNF808 as being involved in human pancreas development occurred after researchers at the University of Exeter examined genetic samples from patients recruited across the world who were born without a pancreas and found that they all had genetic changes resulting in loss of ZNF808. They then teamed up with colleagues at the University of Cambridge and Helsinki University to study the effect of ZNF808 loss using stem cells in the lab. The results showed that ZNF808 plays an important function early during human development when cells need to ‘decide’ whether to become pancreas or liver.

Among those who shared their genetic samples was Tania Bashir, aged 12, from Luton. Her father Imran Bashir welcomed the Exeter team’s progress. “Having an answer to why this happened is important. We’ve always wanted to know – now we do. The next important step is to understand what this means to the future of science. My dream is that one day, scientists will be able to genetically modify a stem cell and grow a human pancreas, and implant that into Tania, and potentially cure her. I don’t know if that will ever be possible, but I do know that this understanding is a crucial step forward.”

Professor Timo Otonkoski from University of Helsinki remarked “The input of people born without a pancreas was fundamental to this discovery. Nobody would have ever thought that ZNF808 played a role in pancreatic development if we hadn’t found the changes in this gene in these patients. The ultimate goal of our research is for this knowledge to be translated into being able to manipulate stem cells to produce beta cells that can produce insulin in the laboratory. That could be the key to curing type 1 diabetes. Our finding is a significant step in understanding what makes the human pancreas unique, which could help progress this area.”

Two Randomized Trials of Low-Dose Calcium Supplementation in Pregnancy

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Abstract

Background

The World Health Organization recommends 1500 to 2000 mg of calcium daily as supplementation, divided into three doses, for pregnant persons in populations with low dietary calcium intake in order to reduce the risk of preeclampsia. The complexity of the dosing scheme, however, has led to implementation barriers.

Methods

We conducted two independent randomized trials of calcium supplementation, in India and Tanzania, to assess the noninferiority of a 500-mg daily dose to a 1500-mg daily dose of calcium supplementation. In each trial, the two primary outcomes were preeclampsia and preterm birth, and the noninferiority margins for the relative risks were 1.54 and 1.16, respectively.

Results

A total of 11,000 nulliparous pregnant women were included in each trial. The cumulative incidence of preeclampsia was 3.0% in the 500-mg group and 3.6% in the 1500-mg group in the India trial (relative risk, 0.84; 95% confidence interval [CI], 0.68 to 1.03) and 3.0% and 2.7%, respectively, in the Tanzania trial (relative risk, 1.10; 95% CI, 0.88 to 1.36) — findings consistent with the noninferiority of the lower dose in both trials. The percentage of live births that were preterm was 11.4% in the 500-mg group and 12.8% in the 1500-mg group in the India trial (relative risk, 0.89; 95% CI, 0.80 to 0.98), which was within the noninferiority margin of 1.16; in the Tanzania trial, the respective percentages were 10.4% and 9.7% (relative risk, 1.07; 95% CI, 0.95 to 1.21), which exceeded the noninferiority margin.

Conclusions

In these two trials, low-dose calcium supplementation was noninferior to high-dose calcium supplementation with respect to the risk of preeclampsia. It was noninferior with respect to the risk of preterm live birth in the trial in India but not in the trial in Tanzania. (Funded by the Bill and Melinda Gates Foundation and others; ClinicalTrials.gov number, NCT03350516. opens in new tab; Clinical Trials Registry–India number, CTRI/2018/02/012119. opens in new tab; and Tanzania Medicines and Medical Devices Authority Trials Registry number, TFDA0018/CTR/0010/5. opens in new tab).

Hypertensive disorders of pregnancy, which include preeclampsia, complicate 2 to 8% of pregnancies and are estimated to cause 45,000 maternal deaths annually.1,2 These disorders are also associated with an increased risk of preterm birth, the leading cause of death among children worldwide.3,4 Therefore, the implementation of effective strategies to prevent hypertensive disorders of pregnancy and preterm birth will be essential for countries to reach the maternal and child mortality targets of the United Nations Sustainable Development Goals by 2030.

Calcium supplementation in pregnancy has been recommended by the World Health Organization (WHO) since 2011 to reduce the risk of preeclampsia in populations with low dietary calcium intake.5,6 In placebo-controlled trials, high-dose calcium supplementation of at least 1000 mg per day reduced the risk of preeclampsia by more than half and the risk of preterm birth by 24%; the reduction in the risk of preeclampsia appeared to be greater in trials that had been conducted in populations with low-calcium diets.7 On the basis of this evidence, the WHO has recommended calcium supplementation of 1500 to 2000 mg per day, divided into three doses, taken a few hours apart from iron–folic acid supplements.6 In more than a decade since the 2011 recommendation, only a few countries have implemented routine high-dose calcium supplementation in pregnancy, mainly owing to adherence concerns and high programmatic costs associated with the complex dosing scheme.8,9 Trials of low-dose calcium supplementation of less than 1000 mg per day in pregnancy, most of which evaluated a single 500-mg calcium supplement per day as compared with placebo and have had relatively small sample sizes, have generally shown a magnitude of reduction in the risks of preeclampsia and preterm birth similar to that seen in the trials of high-dose supplementation.7

We hypothesized that low-dose calcium supplementation in pregnancy may be as efficacious as high-dose supplementation with respect to the incidence of preeclampsia and preterm birth. We conducted two randomized, noninferiority trials to compare the efficacy of 500 mg of calcium supplementation per day with 1500 mg per day in India and Tanzania.

Methods

Trial Designs

We conducted two independent, individually randomized, parallel-group, double-blind, noninferiority trials of low-dose calcium supplementation as compared with high-dose calcium supplementation in nulliparous pregnant women in India and Tanzania. The trials were designed to have similar interventions, methods, and outcome definitions but were independently powered and were planned to be analyzed separately. The methods for the trials have been published previously.10 The third, fifth, and last authors vouch for the accuracy and completeness of the data and for fidelity of the trial to the protocol, which is available with the full text of this article at NEJM.org.

Participants were enrolled at health clinics in Bangalore, India, and in Dar es Salaam, Tanzania. Participants were adult (≥18 years of age) nulliparous pregnant women who were at less than 20 weeks’ gestation (according to the date of the last menstrual period), who intended to stay in the trial area until 6 weeks post partum, and who provided written informed consent. Women were excluded from enrollment if they had a history, signs, or symptoms of nephrolithiasis; had a history of parathyroid disorder or had undergone thyroidectomy; or had a disease for which digoxin, phenytoin, or tetracycline therapy was indicated.

Interventions

Participants in India and Tanzania were randomly assigned to receive either 500 mg or 1500 mg of elemental calcium supplementation to be taken orally each day until delivery. The 500-mg calcium supplementation group received one tablet that contained 500 mg of elemental calcium as calcium carbonate and two placebo tablets each day, and the 1500-mg calcium supplementation group received three 500-mg tablets each day. In India, vitamin D3 is recommended to be taken with calcium supplements, and therefore the two groups in the India trial also received 250 IU of vitamin D3 per day.11 There was no vitamin D3 added to the tablets in the Tanzania trial.

In each trial, pregnant participants received a 35-day supply of tablets in blister packs at each trial visit. The blister packs contained a 7-day supply of the trial tablets, with columns indicating the tablet to be taken in the morning, midday, and evening. Blister packs were delivered to the homes of pregnant participants who could not attend follow-up visits at trial clinics. Adherence was assessed by means of pill counts. Influx Healthcare (in Maharashtra, India) manufactured the tablets for both trials. The company was paid full price for the tablets and had no role in the trial design, data collection, the interpretation of the results, or the writing of the manuscript.

Randomization and Blinding

Randomization procedures were independently conducted in the India and Tanzania trials. The assignment sequence for each trial was generated by a statistician not otherwise involved in the trial by means of a computer-generated list of participant identification numbers with block randomization, stratified according to trial clinic. At the randomization visit, participants were assigned the next available participant identification number, which corresponded to a set of prelabeled blister packs. All the calcium and placebo tablets were identical in appearance, taste, and smell and were packaged in indistinguishable blister packs. The codes linking participant identification numbers with the randomly assigned calcium supplementation groups were broken after the blinded analyses were conducted.

Data Collection and Outcomes

Participants had follow-up clinic visits each month during pregnancy, at delivery, and at 6 weeks post partum. Pregnant participants’ baseline dietary intake was assessed by means of an open-ended 24-hour diet recall. Pregnant participants had a finger-prick blood sample obtained at the time of randomization and at 32 weeks’ gestation to assess hemoglobin concentrations.

The primary efficacy outcomes were preeclampsia and preterm birth. Preeclampsia was defined as the meeting of at least one of the following criteria from 20 weeks’ gestation to delivery: gestational hypertension and proteinuria among participants without chronic hypertension, gestational proteinuria among participants with chronic hypertension (superimposed preeclampsia), clinical diagnosis of preeclampsia, or the development of preeclampsia with severe features with or without proteinuria.12,13 Blood pressure was assessed at each trial visit by means of digital blood-pressure monitors. Dipsticks were used to assess the presence of protein in urine samples at each pregnancy visit and at delivery. Among patients without chronic hypertension, gestational hypertension was defined as a systolic blood pressure of at least 140mm Hg or a diastolic blood pressure of at least 90mm Hg as measured on two occasions at least 1hour apart or as severe hypertension with a systolic blood pressure of at least 160mm Hg or a diastolic blood pressure of at least 110mm Hg as measured on two occasions at least 1minute apart in pregnancy or as measured on one occasion during the time of labor or delivery. Proteinuria was defined as a dipstick reading of at least 1+. Preeclampsia with severe features was defined as the presence of severe gestational hypertension (with or without proteinuria), eclampsia, end-organ dysfunction, clinical diagnosis of the HELLP (hemolysis, elevated liver-enzyme levels, and low platelet count) syndrome, the development of pulmonary edema, or new-onset central nervous system or visual symptoms.

Preterm birth was defined as a live birth before 37 weeks’ gestation as assessed by means of the best obstetrical estimate approach, which combined information from both the date of the last menstrual period and ultrasonographic assessment. The menstrual date–derived estimated date of delivery was changed to the ultrasound-derived estimated date of delivery if the dating differed by a prespecified number of days, which varied depending on the timing of ultrasonography. The methods for gestational-age dating in the trials have been described in greater detail previously.10

Secondary outcomes included gestational hypertension, preeclampsia with severe features, pregnancy-related death, fetal death, stillbirth (at ≥28 weeks’ gestation), low birth weight (<2500 g), small-for-gestational-age status at birth defined according to the INTERGROWTH-21st standard (<10th percentile regarding size for gestational age),14 and infant death before 42 days of age. Maternal hospitalization (excluding hospitalization for delivery) and third-trimester severe anemia (hemoglobin concentration, <7.0 g per deciliter) were evaluated as safety outcomes. Details of the outcome definitions are provided in Table S1 in the Supplementary Appendix, available at NEJM.org.

Standard of Care and Ethics

All the participants in India and Tanzania received standard-care antenatal and postpartum services that were aligned with the country-specific antenatal care guidelines. In India, pregnant participants received daily supplements that contained 5 mg of folic acid during the first trimester and then supplements that contained 60 mg of elemental iron and 0.4 mg of folic acid during the second and third trimesters. In Tanzania, pregnant participants received daily iron–folic acid supplements that contained 60 mg of elemental iron and 0.4 mg of folic acid starting at the first antenatal care visit. The protocols of the trials were approved by institutional review boards. A data and safety monitoring board oversaw the trial.10

Statistical Analysis

The India and Tanzania trials were independently powered and analyzed separately. Assuming a randomization ratio of 1:1, a one-sided test with a type I error of 0.05, and a 10% incidence of loss to follow-up or missing outcome data, we planned to enroll 11,000 pregnant participants in each trial. The cumulative incidences of preeclampsia and preterm birth were expected to be as low as 1.5% and 10%, respectively, in the high-dose supplementation group. The noninferiority margins for relative risk were 1.54 for preeclampsia and 1.16 for preterm birth (see the Methods section in the Supplementary Appendix).

The primary analyses used the intention-to-treat principle and included all the participants who had undergone randomization and had data available for the outcome of interest. Per-protocol analyses were also conducted for the primary outcomes (see below). All the models included fixed effects for trial clinic to account for the stratified randomization. Our protocol did not include a plan to adjust for the two primary efficacy outcomes in each trial, but we applied a Bonferroni correction to account for multiplicity (one-sided alpha of 0.025). Two-sided 95% confidence intervals are presented, which have an upper boundary equivalent to a one-sided 97.5% confidence interval.

Log-binomial models were used to estimate the relative risk of preeclampsia between the 500-mg group and the 1500-mg group. The per-protocol analyses of preeclampsia included pregnant participants who had more than 75% adherence to the assigned regimen and had a birth outcome assessed at 20 weeks’ gestation or later. Sensitivity analyses excluded participants with pregnancy loss and those who withdrew consent before 20 weeks’ gestation. Kaplan–Meier curves with gestational age as the time metric were also constructed.

The analyses of preterm birth were restricted to live births. Generalized estimating equations with log links and compound symmetry working correlation matrixes to account for multiple gestations were used to estimate the relative risks of preterm birth. Per-protocol analyses of preterm birth included live births among pregnant participants who had more than 75% adherence to the assigned regimen. Sensitivity analyses were restricted to singleton live births.

Log-binomial models were used to estimate relative risks for nonrepeatable secondary maternal outcomes, and generalized estimating equations were used for secondary infant outcomes in order to account for multiple gestations. Poisson regression models were used to estimate incidence rate ratios for the repeatable safety event of maternal hospitalization. Relative risks or incidence rate ratios with 95% confidence intervals are presented for all secondary and safety outcomes and were not adjusted for multiple comparisons. Fixed- and random-effects meta-analyses were conducted to produce pooled effect estimates. We conducted post hoc exploratory sensitivity analyses for early-onset preeclampsia (at <34 weeks’ gestation) and for preeclampsia onset at less than 37 weeks’ gestation, as well as an analysis of preterm birth that was restricted to participants with spontaneous birth. Statistical analyses were performed with the use of SAS software, version 9.4 (SAS Institute).

Results

Participants

Figure 1. Follow-up of the Pregnant Women and Infants in the India and Tanzania Trials.

In the India trial, from November 2018 through February 2022, we screened 33,449 women and enrolled 11,000 pregnant participants. In the Tanzania trial, from March 2019 through March 2022, we screened 45,186 women and enrolled 11,000 pregnant participants. The flow diagrams for the follow-up of the pregnant participants and infants in each trial are presented in Figure 1 and in Figures S1 and S2. Pregnancy outcomes were known for 99.5% of the pregnancies in the India trial and for 97.9% of those in the Tanzania trial. The median percentage adherence to calcium supplementation was 97.7% (interquartile range, 93.2 to 99.2) in the India trial and 92.3% (interquartile range, 82.7 to 97.1) in the Tanzania trial.Table 1. Characteristics of the Participants at Baseline in the India and Tanzania Trial Populations.

The characteristics of the participants at baseline were generally well-balanced between the groups in each trial (Table 1). In both trials, most of the pregnant participants were between 18 and 24 years of age and had normal blood pressure at baseline. The percentage of the participants with a baseline dietary calcium intake of less than 800 mg per day was approximately 87% in India and 67% in Tanzania.

Primary Outcomes

Table 2. Primary Efficacy Outcomes in the India and Tanzania Trials.

In the India trial, the cumulative incidence of preeclampsia was 3.0% in the 500-mg group and 3.6% in the 1500-mg group (relative risk, 0.84; 95% confidence interval [CI], 0.68 to 1.03); in the Tanzania trial, the cumulative incidence of preeclampsia was 3.0% in the 500-mg group and 2.7% in the 1500-mg group (relative risk, 1.10; 95% CI, 0.88 to 1.36) (Table 2). In both trials, the 500-mg dose of calcium was shown to be noninferior to the 1500-mg dose with regard to the risk of preeclampsia. Kaplan–Meier curves for the timing of preeclampsia are shown in Figures S3 and S4. In sensitivity analyses, there were no between-group differences in the incidence of early-onset preeclampsia at less than 34 weeks’ gestation or of preeclampsia onset at less than 37 weeks’ gestation (Table S2).

The incidence of preterm birth in the India trial was 11.4% in the 500-mg group and 12.8% in the 1500-mg group (relative risk, 0.89; 95% CI, 0.80 to 0.98); the incidence in the Tanzania trial was 10.4% in the 500-mg group and 9.7% in the 1500-mg group (relative risk, 1.07; 95% CI, 0.95 to 1.21). The findings were consistent with noninferiority in the India trial but not in the Tanzania trial.

Results of the per-protocol analyses, sensitivity analyses, and analyses with adjustment for potential baseline imbalance were similar to the primary analyses in each trial (Table 2 and Tables S3 and S4). There were no apparent between-group differences in the incidence of preterm birth in post hoc sensitivity analyses that were restricted to spontaneous births.

Secondary and Safety Outcomes

Table 3. Secondary and Safety Outcomes in the India and Tanzania Trials.

Results of the secondary and safety outcomes in the two trials are shown in Table 3. There was no evidence favoring the 1500-mg group over the 500-mg group with regard to the secondary or safety outcomes in either trial.

Meta-analyses

Fixed- and random-effects meta-analyses of the outcomes in the two trials did not indicate a difference between the 500-mg group and 1500-mg group with regard to the risks of preeclampsia, preterm birth, and the secondary and safety outcomes. Details are provided in Figures S5 through S15.

Discussion

In two large, randomized trials conducted in India and Tanzania, each of which enrolled 11,000 nulliparous pregnant participants, the use of low-dose calcium supplementation at a dose of 500 mg per day was noninferior to standard high-dose supplementation of 1500 mg per day with respect to the incidence of preeclampsia. For preterm birth, the use of low-dose calcium supplementation was noninferior in the India trial but did not show noninferiority in the Tanzania trial. Meta-analyses of data from the two trials were consistent, with no material difference between low-dose and high-dose supplementation for the primary, secondary, and safety outcomes.

Calcium supplementation may lower blood pressure by reducing parathyroid hormone release and intracellular calcium, resulting in reduced vascular smooth-muscle contractility.15 By means of a similar mechanism, calcium supplementation could also reduce uterine smooth-muscle contractility and prevent preterm labor.16,17 Placebo-controlled trials that evaluated high-dose calcium supplementation regimens at doses of 1500 to 2000 mg per day informed the WHO guidelines.7 Our two trials showed that low-dose supplementation with 500 mg of calcium per day was noninferior to high-dose supplementation for the prevention of preeclampsia. A review of diet studies suggests that pregnant populations in low- and middle-income countries have a mean calcium intake of approximately 600 mg per day.18 In these contexts, and in our trial populations, which had a median intake of approximately 400 mg per day, an additional 500-mg calcium supplement would fill the nutrient gap for most pregnant persons.19 There is also limited evidence that calcium supplementation before conception and in early pregnancy may provide greater beneficial effects on preeclampsia than supplementation initiated after 20 weeks’ gestation.20 In our trials, only approximately one third of the participants started calcium supplementation in the first trimester of pregnancy. Furthermore, the benefit of coadministration of calcium supplements with vitamin D, aspirin, or other cointerventions for the prevention of preeclampsia remains unclear.21

We found that low-dose calcium supplementation was noninferior to high-dose supplementation for preterm birth in the India trial; however, this was not the case in the Tanzania trial, in which the upper boundary of the confidence interval crossed the noninferiority margin. In the Tanzania trial, the risk of preterm birth in the 1500-mg group was slightly less than predicted in the power calculations, and therefore the confidence intervals were somewhat wider than expected.

The high-dose calcium supplementation regimen that is currently recommended by the WHO requires pregnant populations with low dietary calcium intake to take four nutritional supplements per day (calcium three times daily plus a daily iron–folic acid or multivitamin supplement); adherence to taking a drug or supplement decreases as the number of doses per day increases.22 Fewer supplements per day may also make it easier to take iron–folic acid and calcium tablets at different times. Furthermore, the cost of a three-tablet calcium supplementation regimen per pregnancy is estimated to be $11.50, which far exceeds the approximate $1 cost per pregnancy for iron–folic acid supplementation.6 The 500-mg dose that we studied as a comparator reduces the pill burden and would be expected to reduce program costs.

Our trials have some limitations. The two trials used the best obstetrical estimate for gestational age on the basis of the reported last menstrual period and fetal ultrasonography; however, we cannot rule out some measurement error and misclassification for preterm birth. We also assessed participant dietary intake with the 24-hour diet recall method, which is prone to measurement error owing to day-to-day variation in diets.23 However, the dietary data support the assumption that the trials were conducted in populations with low dietary calcium intake. Given the noninferiority focus of the trials and ethics considerations, we did not include a placebo group and cannot compare outcome risks with regard to no calcium supplementation. Our trials also enrolled only nulliparous pregnant women owing to their increased risk of preeclampsia.24 As a result, the trial populations generally included young participants who had a low risk of chronic hypertension. Therefore, care should be taken when considering the generalizability of our findings to other pregnant populations. The representativeness of the trial participants is shown in Table S5.

Overall, our findings in these two trials showed that low-dose calcium supplementation in pregnancy was noninferior to high-dose supplementation with respect to the risk of preeclampsia. The trial in India, but not the one in Tanzania, showed that low-dose supplementation was noninferior to high-dose supplementation with respect to the risk of preterm birth.

“My Back Is Killing Me!”

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“My back is killing me!” Haven’t we all heard that countless times? And not just in our clinical practice, classrooms, at dinner parties, out shopping, or during phone calls with friends and family. How many of us stop in our tracks to offer help on the spot?

I’ve shared various examples of my spontaneous sessions (from a deli floor in New York City to a bank teller’s chair in Rome) in previous columns.1-2 Some of you asked me to share yet more tips to deal swiftly with niggling back pains that don’t mask a serious health issue. The following tips can be integrated with most forms of ABT, and as a prelim to needling where appropriate.

The “Frisk” Position

Yes indeed – the receiver is pressed up against the wall, arms and legs outstretched. This is a great way to apply pressure-counterpressure. Involve the receiver in a visual “waterfall” of qi from neck to ankles. Initially, do a “qi sweep” with your flat hands along either side of the spine, and then down the back of each leg so you have a quick insight into UB blocks, distortions or painful areas from neck to ankle.

Repeat a couple of times. Then do a subtle diagonal stretch with one hand on the receiver’s butt, and the other on the opposite shoulder blade.

Return to areas that seem to “call you.” Make a note of any specific back shu point involvements worth discussing with the receiver. That in itself will help ease tension.

Then start thumbing down UB on either side of the spine; or utilize the “pinch” or “squeeze” technique: one hand supporting the lower back, the other “pinching” the UB on either side of the spine between your thumb and the knuckle of your first finger.

This “two-handed” technique, a classic in zen shiatsu, provides harmony between the ”moving” hand and the “listening” hand. Easy to perform. Very comfortable for the receiver. Followed by a simple palming down the legs and finally, a slow pinch of the Achilles, the UB 60 / K 3 area.

UB 36, in the middle of the gluteal fold, zaps lower back pain. Sink your thumbs bilaterally into those points with a slight lifting technique, with your fingers pointed upwards. Also a great way to ease sciatic pain. Pinching the Achilles and applying upward pressure to UB 36 simultaneously is also a great way to ease lower back pain.

Don’t Forget to Ask the Receiver to Stretch!

Between each technique, ask the receiver to step away from the wall to do some simple qi stretches in slow motion. Deep breathing helps throughout, as a lot of folks tend to hold their breath while you work on them, and that’s counterproductive.

Yes, I’ve used the “frisk” position in classrooms, offices, airports, in public during political demonstrations, in cafes, and in clinical practice, especially on clients experiencing computer overload! Often, 10 minutes work like a charm, especially in a crowded or busy situation.

Techniques During Pregnancy or Labor?

When your pregnant client is in the supine position, knees atop a pillow, it’s helpful to reach under her back, keeping your hands flat on the table, fingertips raised to apply pressure down the UB meridian. Her bodyweight does the work.

It’s a very effective technique to give, but remember your hands need to be flat on the futon or table under the receiver at all times so you don’t strain your wrists. .

I have done this successfully in any situation in which the receiver cannot lie in the prone or side positions. I have also performed this hour after hour during a long labor, pausing during contractions, and then continuing before the next contraction. Again, feedback is crucial. In some instances your client might ask you to pause in one section of her back. In other situations she may ask you to keep applying pressure to one point after another.

Side Positioning

Very comfy for folks unable to lie in either prone or supine, and/or/if you also need good access to GB meridians. Make sure the receiver’s upper leg is bent and resting on a pillow for stability. Some receivers also like to hug an additional pillow.

Also a good technique during pregnancy. Great stretch for the lumbar region and a good way to thumb around the sacrum, where we all carry a lot of tension and “pooled” qi.

Stretches in the Side Position

Rest both elbows, palms up, in the middle of the torso and then move your hands apart and swivel your hands around, palms down, to maximize a wonderful side stretch. Repeat a couple of times. Then palm down either side of the spine to enhance qi flow along the UB meridian. Note which back shu points seem to “hold” you, ask you to pause. And communicate with the receiver to gain more information about the specific areas that add relief – or discomfort.

Once the receiver seems more flexible, lean over, cup their knee in your elbow, and rotate the hip. Your opposite hand provides pressure on the sacrum. Bring the knee up as high as possible according to the receiver’s comfort level. And do everything in slow motion.

Chairwork in Public: Don’t Forget to Ask Questions

I recall a moment at an open house when several bodyworkers were giving volunteer chair sessions. A young woman cried out in pain when a teacher started to perform some vigorous wrist-rolling tuina down her back. He’d neglected to ask her some basic questions about injuries, surgeries, chronic problems etc. It turned she had cancer of the spine, but alas, hadn’t said anything.

Even in a public situation, it’s helpful to engage the receiver in simple “backtalk” while running a hand gently down his/her spine. It’s also good to have a demo spine on display (if it’s a school) or at least a colorful anatomy book or open laptop program to discuss both anatomical and acupoint associations.

It’s always helpful to start chairwork with some thumb pressure along the shoulders (pausing in GB 21) and thumbing around the T1-T3 zone to ease upper back tension. Also a great technique to release the first glimmerings of a headache.

Bob the Lawn Guy

When I noticed Bob struggling with his lawn mower, I invited him to my next class so we could work on his back, and demo some useful lifting and movement techniques. I had also noted Bob and his guys quaffing one iced Coke after another while working along the block.

I suggested he fill his cooler with bottled water, flat and sparkling. He did this and included green tea. Within a couple of weeks he told me his back pain had eased and he no longer experienced sugar lows.

Jack and Jill Decide to Buy a New Mattress

Friends of mine were both experiencing back pain, so I offered to make a house call on my way home one evening. I walked into their bedroom and checked their futon.

“Seriously?” I laughed. “You’re sleeping on this lumpy old futon and wonder why you wake up each morning with back pain?” They stared at me.

“But that’s our wonderful college futon!” Jack wailed. “Our first love nest!”

“It saw us through graduate school,” said Jill.

“We can’t just toss it away!” said Jack.

“Compromise?” I suggested. “Convert it into a snug corner loveseat for you and the dogs. Drape it with colorful rugs and cushions. Don’t waste money paying me for shiatsu; treat yourselves to a new futon or mattress instead!”

They did – and were amazed at how quickly their back pains vanished!

The association of exhaled nitric oxide with air pollutants in young infants of asthmatic mothers

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Abstract

Background

Exhaled nitric oxide is a marker of airway inflammation. Air pollution induces airway inflammation and oxidative stress. Little is known about the impact of air pollution on exhaled nitric oxide in young infants.

Methods

The Breathing for Life Trial recruited pregnant women with asthma into a randomised controlled trial comparing usual clinical care versus inflammometry-guided asthma management in pregnancy. Four hundred fifty-seven infants from the Breathing for Life Trial birth cohort were assessed at six weeks of age. Exhaled nitric oxide was measured in unsedated, sleeping infants. Its association with local mean 24-h and mean seven-day concentrations of ozone, nitric oxide, nitrogen dioxide, carbon monoxide, sulfur dioxide, ammonia, particulate matter less than 10 μm (PM10) and less than 2.5 μm (PM2.5) in diameter was investigated. The air pollutant data were sourced from local monitoring sites of the New South Wales Air Quality Monitoring Network. The association was assessed using a ‘least absolute shrinkage and selection operator’ (LASSO) approach, multivariable regression and Spearman’s rank correlation.

Results

A seasonal variation was evident with higher median exhaled nitric oxide levels (13.6 ppb) in warmer months and lower median exhaled nitric oxide levels (11.0 ppb) in cooler months, P = 0.008. LASSO identified positive associations for exhaled nitric oxide with 24-h mean ammonia, seven-day mean ammonia, seven-day mean PM10, seven-day mean PM2.5, and seven-day mean ozone; and negative associations for eNO with seven-day mean carbon monoxide, 24-h mean nitric oxide and 24-h mean sulfur dioxide, with an R-square of 0.25 for the penalized coefficients. These coefficients selected by LASSO (and confounders) were entered in multivariable regression. The achieved R-square was 0.27.

Conclusion

In this cohort of young infants of asthmatic mothers, exhaled nitric oxide showed seasonal variation and an association with local air pollution concentrations.

5 Benefits of Endurance Running You Should Know

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From your brain to your heart to your joints, Abbott’s experts reveal how endurance running can benefit your health.

5 Benefits of Endurance Running You Should Know

Nutrition, Health and Wellness|Aug. 2, 2022

Endurance running is as physical as it is mental. A workout of the muscles and the mind that tests our limits over hours and miles.

And like most challenges, long-distance running can come with great rewards, no matter your pace or personal best. 

Done right — with adequate nutrient intake, attentive recovery and any necessary medical clearance — endurance running has the potential to change your mind and body from the cell level up, making your heart function better, transforming your muscles and improving your memory.

Want to know more? Get the facts from Abbott experts on the many ways running benefits your body.  

1. Strengthen your heart

While running, your heart rate rises as your heart pumps increasing amounts of blood and oxygen to the working muscles. “This increase in activity and blood flow over time improves your heart’s efficiency, which can lead to a lower resting heart rate and blood pressure levels,” said Robert Standley, Ph.D., a marathoner and principal scientist in clinical research for Abbott’s vascular business.

In fact, a 2020 study found that first-time marathoners experienced beneficial reductions in blood pressure and aortic stiffness equivalent to approximately a four-year reduction in vascular age.

2. Develop fatigue-resistant muscles

“Your muscles adapt very specifically to the type of exercise you’re doing,” said Lonnie Lowery, Ph.D., senior research scientist, adult nutrition in Scientific and Medical Affairs at Abbott. “Your body will give you the proper tools that you need to be successful.”

For endurance runners, this means increasing their type 1 muscle fibers, which makes the muscles increasingly fatigue resistant, Lowery said. 

If looking to maintain or build some of the stronger, more explosive type 2 muscle fibers, Lowery suggests adding strength exercises to endurance training. Doing so may help reduce risk of injury, increase running efficiency, and boost muscle power, Lowery said.  

3. Build healthy joints

“When it comes to joint health, exercise can be very important and beneficial,” Lowery said. 

Research shows that cartilage disorders, such as osteoarthritis, are less likely to seriously impact people who are regularly active, including runners. One study on half-marathoners suggested that running acts as a “therapeutic tool” to limit chronic inflammation and positively affect cartilage cells. 

“Cartlidge is typically considered avascular meaning it doesn’t have blood vessels, so you need those changes in joint fluid pressures to help nutrients diffuse into the cartilage tissues. Running can stimulate that pressure change,” Lowery said.

4. Improve memory and mood 

Just like muscles and joints, our brain relies on exercise to keep it in shape, regardless of age.  

Exercise boosts blood flow to the brain and releases feel-good neurotransmitters, dopamine and endorphins, all of which can lay the groundwork for immediate, as well as long-lasting benefits, including lower stress, improved mood, enhanced memory and increased focus and mental resilience, said Dr. Beth McQuiston, a neurologist and medical director for Abbott’s diagnostics business.  

“You don’t have to be an endurance runner to get the neurological benefits of running. But endurance runners are likely running consistently, so they’re likely building up more of those benefits,” McQuiston said. 

5. Accelerate your metabolism

Metabolism is a chemical process that takes place as your body stores, and then converts, nutrients from foods and drinks into energy. “Think of it as the internal fire that keeps our energy processes going,” said Pam Nisevich Bede, a sports dietitian working with Abbott who is training for her 27th marathon.  

“As we become more active and our fitness improves, a metabolic shift takes place. Optimally, metabolically active lean tissue replaces excess fat tissue, leading to improvements in health, performance, and metabolic burn,” Nisevich Bede said. “You see this metabolic shift happen in runners and often in marathoners in the lead up to race day.

Reaching a healthy weight and improving metabolism often follows this type of increase in activity and fitness. The same lean muscle tissue needed to support the demands of training burns an increased number of calories when compared to fat tissue.” 

Remember these running benefits the next time you need a little motivation to lace up your shoes and hit the trail, or road or track. 

“People often say, ‘I don’t have time to exercise.’ But the truth is, you don’t have time not to,” McQuiston said.

Shift Work and Diabetes: How to Manage Blood Glucose With Irregular Work Hours

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ular Work Hours

Diabetes management plans often assume a standard daytime schedule, but this isn’t the case for those doing shift work. If you work night shifts, here are some ways you can better manage your glucose.

Do you work variable shifts? Are you headed to work when most people are going to bed? First of all, thank you from the rest of us; without those willing to work at night, there’d be no one to run crucial 24-hour operations, such as hospitals, police forces, or transportation systems.

Those late shifts, however, can leave you short on sleep. In addition, shift work can throw a wrench in your blood glucose management. But it doesn’t mean you can’t adequately manage glucose levels. There are strategies to help you achieve your A1C, time in range, and other health goals.

How night shifts and rotating schedules affect diabetes management

In diabetes care, timing is everything. Given that everything from medication to meal timing has an impact on blood glucose levels, variable shift work – specifically rotating, night, and waterfall shift schedules – largely affects blood glucose management.

Increased risk for low blood sugars

With shift work often comes an increased risk for hypoglycemia, said Aleida M. Saenz, a certified diabetes educator at the Diabetes Research Institute in Miami. “Frequently, you spend the majority of your shift on your feet. This physical demand is not only tiring but there’s a potential risk of hypoglycemia,” she said.

Increased risk for high blood sugars

Surprisingly, you may also experience high blood sugar. Why? For starters, research shows that nurses eat a larger amount when working the night shift, and that people working nights tend to consume more irregular meals and more snacks. They also eat less core nutrient-dense foods and more calories from sugar-sweetened foods.

Inconsistent insulin timing

Next, your medication timing may be out of whack. If you’re supposed to take insulin at every meal, but you’re snacking all night to keep your eyes open, you may be underdosing yourself. And these may not be the only reasons for elevated blood sugars.

How variable shifts impact the body’s circadian rhythm

Circadian rhythm is the internal clock that is involved in multiple processes in your body. The clock runs on a 24-hour schedule and is regulated by daylight. For this reason, working at night and sleeping during daylight hours disrupts your circadian rhythm.

Night shift work is linked to circadian disruption, poor sleep quality

Circadian disruption is linked with several health problems. For instance, shift work increases the risk of metabolic syndrome, a major risk factor for developing diabetes.

Hormones such as melatonin and cortisol are closely regulated by the presence (and absence) of daylight. Normally, melatonin levels would be high at night and low in the morning, and cortisol follows the opposite trend. This is so that you fall asleep and wake up after an adequate night’s rest.

As a result, when you are sleeping as cortisol levels are at their peak, you don’t sleep as well.

Nighttime lows can cause even more sleep interruptions

And if you have diabetes, often cortisol isn’t the only variable disrupting sleep – there’s low blood glucose, too. “When these dedicated professionals return home to rest, they run the risk of hypoglycemia while asleep,” said Saenz. As a result, many shift workers are deprived of much-needed rest.

Is being a night owl bad for your health?

What if you just like staying up late? Is there harm in being a night owl? The short answer: possibly.

Recent research has highlighted the increased risk of type 2 diabetes in those who prefer late nights. It seems as though early-to-bed and early-to-rise are better for overall health. When the research team compared night versus morning people, night owls were more likely to have health behaviors such as smoking, drinking, inferior diet quality, and less physical activity.

That said, it’s important to remember that other behaviors, like creating lasting healthy lifestyle habits, make the biggest difference.

Diabetes technology for better diabetes management during shifts

The age of technology has ushered in numerous options for managing blood glucose. Continuous glucose monitors, insulin pumps, and smart insulin pens are some of the many advancements that aim to make living with diabetes easier.

For most, quitting the job isn’t an option. Besides prioritizing healthy habits, such as adequate sleep, regular physical activity, and optimizing diet quality, using diabetes technology is to your advantage. Here are some ways technology can help those burning the midnight oil.

Continuous glucose monitors (CGMs)

A continuous glucose monitor or CGM is a device that tracks glucose levels in real-time. CGMs have a number of benefits, one being tighter blood glucose control. When possible, Saenz recommends CGMs for shift workers with diabetes.

“You can set up an alarm system designed to trigger when your blood sugar levels approach the critical low threshold, typically set around 80 mg/dL. This ensures you receive warnings well before the onset of hypoglycemia,” she said.

The same goes for high blood sugar alerts. And because you are getting real-time data, you can make informed decisions about food, activity, and insulin dosing. You’ll know exactly how that stressful shift impacted your blood sugar – and be able to do something about it.

Insulin pumps with automated insulin delivery systems

For shift workers who are on rapid-acting insulin, Saenz highly recommends insulin pump therapy with automated insulin delivery: “The Tandem t:slim, Omnipod 5, and the Medtronic 780G are some of the pumps available that sync with a CGM to fine-tune insulin delivery and temporarily pause if necessary.”

Insulin pumps deliver small amounts of insulin as your body needs it. Adjustments are easy and can be done to suit your schedule – for your night shifts and days off – and automated insulin delivery software has been shown to increase time in range.

Smart insulin pens

A smart insulin pen is an insulin delivery device that records when you administer insulin, and how much you’ve taken. It will also remind you when it’s time to take your insulin dose.

Smart pen sensors, such as InPen and Bigfoot (at left), work by connecting to your smartphone via Bluetooth. From there, you use the device’s compatible app to review your data.

If you’re groggy from yet another crazy shift, using smart insulin pens means that you don’t have to worry about double-dosing yourself. Likewise, you’ll see if you forgot to take your dose. One more benefit: You’ll be able to skip dosing math, as the smart pen will do it for you.

Can You Really Lose Weight By Exercising?

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Exercise is a central part of most weight-loss programs, and yet there remains some doubt about just how much it can actually contribute to your efforts to shed fat.

After many decades of study and debate, there is an unfortunate consensus forming among the community of doctors, researchers, and obesity experts: Exercise usually just doesn’t help very much with weight loss.

This article will explore not only why this is true, and exceptions to this rule, but will discuss another consensus among experts:Tthat exercise, even in the absence of weight loss, is incredibly important to overall health. This is especially true for people with diabetes.

This article will explain:

  • Why exercise should cause weight loss
  • Why exercise usually doesn’t cause weight loss
  • How much exercise you really need to lose weight
  • Why you should be exercising

Why Exercise Should Cause Weight Loss

It seems simple: exercise burns calories. The more you work out, the more calories you’ll burn.

Weight loss revolves around one unescapable fact: You need to burn more calories than you consume.

A calorie is a unit of energy. The calories we get from food are the fuel that our bodies need to run and survive.

Your body only needs a certain amount of energy. If you eat more than this amount (too many calories), the energy is stored as fat, and you will gain weight. If you eat less (too few calories), your body harvests the stored energy (chiefly in your fat), and you will lose weight.

Exercise should, in theory, tip the calorie balance so that you’re storing less fat, and burning more. In theory.

Why Exercise Usually Doesn’t Cause Weight Loss

Burn more calories, lose more weight, right? What could go wrong?

Unfortunately, it doesn’t really work that way. The body has an incredibly frustrating habit of ruining your weight loss plans. When you exercise, the body makes two sneaky adjustments that work to counteract the weight loss progress you think you’re making:

1. You get hungrier.

This shouldn’t exactly be a shocker. It makes all the sense in the world that your body wants more calories to compensate for the extra energy you’ve expended. It’s something we’ve all felt before.

This added hunger can’t just be easily dismissed. Hunger is probably the reason that most diets eventually fail. To put it simply, it is unreasonable to expect anyone to cope with hunger for a sustained amount of time. Any diet that requires you to tolerate hunger is probably not sustainable. And if an exercise session demands you to put up with hunger pangs in order to reap the weight loss benefits, it’s not likely to be effective. (Also, you could eat less and ignore your hunger without exercising in the first place).

This compensatory effect is fairly complex, and still the subject of much investigation. Your body doesn’t necessarily try to replace every single calorie you’ve just burned, and different types of exercise may have greater or lesser effects on hunger. But the central truth is unavoidable: If you exercise more, you’ll probably end up eating more, too.

And if you’ve ever used a treadmill or elliptical machine that tracked calories burned, you already know how quickly you can undo the effect of exercise. A muffin can wipe out a 30-minute run in just a few bites. The math is unforgiving.

2. Your metabolism slows down.

When you exercise, your body sneakily lowers its metabolic rate, meaning you’re burning fewer calories than you usually would. This metabolic compensation means that exercise in controlled scientific settings often results in half as much weight loss as predicted by simple calorie counters.

The problem of a slowing metabolism was most famously illustrated by a study of contestants from television’s The Biggest Loser. Drastic weight loss dramatically changed the metabolism of these reality show contestants; years later, participants were still struggling with a slower basal metabolic rate, even the ones that had gained back every pound. The study’s lead author called the body’s capacity to slow its metabolism “frightening and amazing.”

There’s also some evidence that exercise inspires us to be even lazier once the workout is complete, causing us to burn fewer calories than usual as we spend extra time loafing to recover from the exertion.

One expert review concluded that “based on the present literature, unless the overall volume of aerobic exercise training is very high, clinically significant weight loss is unlikely to occur.”

Lots and Lots of Exercise

It is possible to override these effects by exercising even more. Imagine hiking the entire Appalachian Trail — you’d probably lose weight. If you’re capable of a “very high” volume of training, perhaps you can be the rare adult to outrun a bad diet.

Where is the threshold at which weight loss becomes realistic?

A recent study tried to come up with the answer. Researchers from the University of Kentucky asked a group of sedentary obese and overweight adults to exercise. One group performed two sessions per week, the other group six sessions per week. The 2-session group didn’t lose weight, and the 6-session group did. As we would expect, both groups compensated for the extra energy expenditure with more hunger and slowed metabolism, but surprisingly, the group that exercised more did not experience a more intense compensatory effect. The body, perhaps, has a limit beyond which it ceases to fight against weight loss. So if you work out up to and beyond that limit, you’re in the money.

Where’s the limit? This study suggests that the adult body can compensate for about 1000 calories per week of added exercise before you begin to think about losing weight. For a 185-lb adult, that means a minimum of about 6 hours of walking, 4 hours of shoveling snow, or 3 hours of jogging, all before you can expect to lost an ounce. You need to keep working out beyond that first 1000 calories to see a difference.

The researchers therefore suggest a general target of 300 minutes (5 hours) per week of exercise for real weight loss. If you can devote that much time to exercise, and enjoy doing so, then I congratulate you and wish you the best of luck. The rest of us, though, may be stuck with modifying our diets to get results.

Why Exercise Still Matters

So, for most of us, exercise isn’t viable as a primary weight loss strategy. But that doesn’t mean we’re ready to dismiss exercise out of hand.

The vast health benefits of exercise are totally undisputed, especially for people with diabetes. Even if you don’t lose weight, increased exercise should deliver the type of results you’d expect from weight loss — you’ll feel healthier and you’ll be healthier. Physical activity should be a major part of any lifestyle change.

And while we tend to assume that obesity is a decent proxy for overall metabolic health, the fact is that people of similar body weights can have wildly different fitness levels. An adult who is obese but fit can have much lower risk factors for cardiovascular disease than an adult that is lean and out of shape. Even people with extreme obesity who are otherwise fit have comparable health profiles to unfit people who weigh significantly less. In short, exercise really matters, even if it doesn’t lead to weight loss.

A study of very successful dieters — people who lost at least 30 pounds and kept it off for an entire year — found that they tend to engage in a ton of exercise, averaging 2,621 calories burned per week. Many experts have concluded that exercise, while not necessarily critical to weight loss, is hugely important to keeping weight loss off and avoiding weight gain.

And while exercise may not itself drive the caloric deficit that creates weight loss, it can help with many other factors that contribute to dieting success, such as improved mood, lower stress, and improved sleep quality.

In short, you should definitely be exercising for your overall health, independent of how much weight you do or do not want to lose. Don’t mentally tie your exercise to your weight, because the benefits of exercise aren’t necessarily related to the numbers on the bathroom scale.

Exercise in the Ozempic Era

Recently, the rise of diabetes drugs like semaglutide (Ozempic, Wegovy, Rybelsus) and tirzepatide (Mounjaro, Zepbound) has changed the way people view weight loss. For the first time, we have developed weight loss medications that operate something like a magic pill, letting people shed pounds without having to put in all the hard work and self-sacrifice.

If you’re lucky enough to have affordable access to one of these drugs, then you may be on your way to your goal weight without even breaking a sweat. Nevertheless, experts still believe that exercise remains crucial for people who lose weight with these new medications. Physical activity may even have special benefits for patients experiencing rapid weight loss with a drug like Ozempic, such as enhancing the preservation of lean muscle mass.

Conclusion

It’s not easy to exercise enough to lose weight. The body has a way of fighting back against your efforts, by driving hunger and slowing its metabolism.

Therefore, for most people, exercise will only be of minor importance to weight loss efforts. While weight loss can support your diet in a variety of ways, by far the more important factor is the food that you eat — or the medications that you use.

If you do have the time and ability to exercise multiple for many hours per week, you may be able to counteract the body’s compensatory effects. Five hours per week is a good starting point.

No matter your weight, however, exercise remains extraordinarily important for overall health, and it can very effectively prevent weight gain. For people with diabetes, especially, exercise will confer exactly the sort of health improvements that weight loss itself can deliver.