Is Sleep Deprivation a Cause of Diabetes?

Nearly one-third of US adults sleep less than six hours per night and the average night's rest is 6.8 hours [1]. In other words, we're a tired, sleep-deprived country.

Speaking of country-wide health issues, 25.8 million Americans have diabetes with another 79 million diagnosed with prediabetes. As discussed in a previous post, our lifestyles can be the cause of type 2 diabetes. Considering that sleep habits make up a component of lifestyle, it's only logical to wonder if this sleep issue is contributing to the diabetes epidemic.

Fortunately, there are answers.

The Associations and Causes Between Sleep and Diabetes

A meta-analysis is a study that combines the results of several studies to develop comprehensive statistics that measure the relationship between several factors. The idea is to establish a more universal relationship or statistical effect.

A 2010 meta-analysis combined 10 studies that measured the connection between baseline sleep habits and diabetes development [2]. The follow-up periods for the studies averaged 9.5 years later, although the studies ranged from 4.2 to 32 years. Overall, this analysis included 107,756 people from the US, Japan, and Europe. In addition to average night's sleep. the studies also examined the risk of diabetes in relation to trouble falling asleep and trouble staying asleep.

Sleeping less than six hours a night, when compared to those who averaged six to eight hours, was associated with a 107% greater development with diabetes for men, but only a 7% greater development for women. People who had difficulty falling asleep or staying asleep had 57 and 84% greater risks for developing diabetes (men and women had similar results in these two cases).

Summarizing this data, diabetes is a much greater risk for men who sleep less than six hours per night and for men and women who have trouble initiating or maintaining sleep. However, these results are just associations. Other lifestyle factors could explain both the lack of sleep and development of diabetes.

A study of men in Boston looked at the relationship between initial sleep habits and rate of diabetes 15 years later [1]. In this study, the researchers adjusted the data to remove factors that could influence both sleep quantity and diabetes development. These factors were age, having high blood pressure, smoking status, self-rated health status, education, and waist circumference. When all of these factors were removed, men who slept a maximum of five hours per night developed diabetes at a 95% greater rate. Ouch.

But enough with associations - does sleep deprivation cause physiological changes that lead to diabetes? Researchers at the University of Chicago measured young men, 18 to 27 years old, on the last day of two six-day periods where sleep was intentionally limited or maximized [3]. The limitation period averaged three hours and 49 minutes. The max period averaged nine hours and three minutes.

Blood glucose and insulin were assessed frequently during each measurement day, with meals being consistent throughout. During sleep deprivation, post-meal blood glucose was 20 mg/dl higher, bringing the healthy young men to prediabetic levels. Clearing the excess blood glucose took about 40% more time. This is another sign of type 2 diabetes development.

Summarizing the Information

Here's what you should take from the information above. There's a high rate of diabetes in men who sleep less than six hours, and in men and women who struggle with falling or staying asleep. Young, healthy men who are intentionally sleep deprived can develop symptoms similar to prediabetes in just six days!

Based on the results of the meta-analysis and the University of Chicago study including men only, I can't say that sleep deprivation causes diabetes in women. It may, but this information cannot say for sure. However, men who are sleep deprived can quickly develop precursors for diabetes. 

In the battle of lifestyle versus diabetes, attaining six to eight hours of sleep should be a priority for men.

Red Meat, Heart Disease, and Cancer : Analyzing Study Results

A recent study found no connection between red meat intake and mortality from cancer or heart disease [1], yet we hear about studies that report a connection, such as a highly publicized study released in 2009 [2]. It seems like we get mixed messages about the connection, or lack of connection, for red meat causing death via heart disease or cancer when these studies are reported. So what's the deal with these studies?

The 2009 Study Versus the 2013 Study

Before I break anything down, let's look at details of the studies.

The 2009 study, "Meat Intake and Mortality," assessed men and women with baseline ages between 50 and 71 years old for 10 years. A total of 617,119 people participated, hailing from eight states which represented different regions of the United States. The researchers put the men and women into quintiles based on their sex and frequency of red meat consumption. The results showed the rate of all-cause, cardiovascular, and cancer-related mortalities increase with the frequency of red meat consumption for men and women. The relationships were the same for death rates in men and women when connected with processed meat consumption as well.

The story painted by the 2013 study results was much different. The 2013 study is the third installment of the National Health and Nutrition Examination Survey (NHANES), a series of US population studies taking place over decades. In the NHANES study, 17,611 men and women participated. The study covered a 25-year period. The results showed no association between red meat and any of the mortality causes (all-cause, cancer, or heart disease). In fact, greater meat consumption was associated with lower body mass index and blood pressure.

The studies are, by no means, equal. Obviously the sample sizes and durations vary, as do the results. Which truly indicates the risk of heart disease you get from eating red meat? 

Neither.

Here's why:

1. Both are longitudinal studies, or types of studies that can determine associations but cannot prove causation. These studies lack the control of other life factors to prove that any one factor leads to another factor. If you take the 2009 study's association of red meat with heart disease or cancer-related death to be causation, then you must also say that eating red meat helps women get married/avoid divorce: red meat consumption was strongly connected with the status of being married for women.
2. The classifications were different. Red meat in the 2009 study included processed meats, such as bacon, sausage, and meat on pizza or in lasagna. The NHANES study analyzed processed meats only as their own category. In other words, a slice of pepporoni pizza would quality as a serving for the red meat and processed meat categories in one study, but only as a processed meat in the other study.
3. Diets were assessed via questionnaires at the start of each study. This presents a ton of room for error. People can be inaccurate or intentionally lie when it comes to recalling what they ate. Also, there was no dietary follow-up. The study assumes participants keep their diets the same over time. I don't know about you, but my diet has drastically changed in the last five years, let alone the last 10 or 25.

The Objectives of These Studies

Correlation-finding studies such as the two discussed here serve two major purposes: to disprove a causation hypothesis or to keep a hypothesis alive so it can be studied further in causation studies. The studies aren't unanimous in showing a relationship between red meat and death from heart disease or cancer. However, they did both show reductions in some mortality risks for men with higher amounts of white meat and fish, meaning more research should be conducted to see if either can increase men's longevity.

For a number of reasons, you should not walk away from these studies believing that red meat kills people by causing heart disease or cancer. If you do, remember to tell your female friends to eat more red meat if they hope to become or stay married. 

Does Single Set Strength Training Improve Blood Glucose in Diabetics?

Strength training is proven to lower blood glucose in type 2 diabetics [1, 2, 3]. The magnitude of the decrease in blood glucose varies, but the highest average decrease in hemoglobin A1c (a measure of blood glucose over three months) that I have seen in research is 1.1% [1, 2]. This change is especially impressive when considering that the comparison groups, whom did not strength train, experienced changes in the other direction. Not only does strength training prevent the progression of type 2 diabetes, it reverses the condition.

These studies used two or three sets per exercise. I train my clients and myself using one set per exercise. I prefer single set training for the efficiency - my clients are busy people, as am I, and the single set training allows us to directly train all major muscles twice per week in only two or three 20-minute workouts. Working out for such little total weekly time also leads to a high rate of adherence, which is an area that people generally struggle with.

For type 2 diabetics who have little free time, don't like exercise, or prefer a single set routine for other reasons, can using one set per exercise improve your blood glucose?

Single Set Training for Diabetics

To answer this, I'm going to talk about a client experience, then discuss some research.

Ron was a 68-year old man who had diabetes over 10 years. Besides daily house work, he performed no exercise and followed no dietary guidelines. Ron and I worked together three times per week performing one set till complete fatigue for five exercises: the leg press, row, chest press, shoulder press, and biceps curls. Each workout required about 10-15 minutes.

Within six months, Ron's hemoglobin A1c decreased from 6.5% to 6.1%. This is enough of a change to bring Ron from a diabetic to a prediabetic range. I found this change to be impressive considering that Ron made no other lifestyle changes, including diet (at his preference).

Ron is one of several diabetics whom I have used single set routines with while during the process of their transformation from a diabetic to prediabetic or healthy blood glucose range. However, the others made other lifestyle changes, so it's hard to quantify exactly what the role of strength training is.

In regards to research, I have come across one study that used a single set routine with type 2 diabetics [4]. This study, published in The Journal of the American Medical Association (JAMA), studied diabetics who had an average hemoglobin A1c of 7.7% and averaged 56 years old. The strength training group performed nine exercises per workout - one set per exercise - with a frequency of twice per week. The study lasted nine months.

The trainees experienced decreases in hemoglobin A1c ranging from 0.3 to 1.0%. Forty-one percent of the group either experienced an improvement of 0.5% and/or were able to decrease their diabetic medications. In total, the strength training program required only 30 to 40 minutes per week.

However, there's one catch: the participants also walked briskly for about 100 minutes per week. Therefore, I can't say that single set strength training is proven to be enough of a stimulus for improvement by itself.

Putting the Information to Use

Who doesn't enjoy a good anecdote when looking for answers? Ron's success shows that people can improve their blood glucose with single set training. However, anecdotes aren't scientific or generalizable. 

The results of the JAMA study show that single set training can produce major improvements when combined with an activity as simple as walking. The diabetic men and women that I work with support single strength training as an effective pair with another lifestyle change (typically diet). If you have type 2 diabetes, I highly recommend single set training, but complement your training with another lifestyle improvement at some point.

I'll discuss more research-based lifestyle changes for type 2 diabetics in future posts.

Solving Hypertension by Addressing Diabetes

"The Silent Killer."

Sounds scary, huh? Hypertension can be.

Hypertension, or high blood pressure, earned the "silent" part of that nickname because most who have it aren't aware. Many with high blood pressure have no signs or symptoms.

Despite not announcing its presence to the host, high blood pressure can produce significant, detrimental changes, such as hardening of the arteries, an enlargement of the heart's walls, and narrowing of the blood vessels in the kidneys. Ultimately, these effects greatly increase the risk of heart disease, kidney disease, and a stroke. It's no wonder researchers referred to hypertension as the "number one attributable risk for death throughout the world [1]."

For the 70-plus million Americans who have hypertension, medication is a popular treatment. Medications are necessary in many cases. However, the underlying situation with hypertensive people may explain why the condition exists and why addressing high blood pressure directly might not be the most effective way to solve it.

High Blood Pressure: A Diabetic Undertone

While I love writing about the latest research, a key point about hypertension was established a while ago. The major points from the paragraphs below come from a 1988 research article from Standford University [2].

 

In that article, the author's main point on hypertension was this: people with high blood pressure typically have high blood glucose (hyperglycemia), elevated levels of insulin in their blood (hyperinsulinemia), and insulin resistance. 

Insulin resistance is the state where muscle and liver cells become less efficient in taking glucose from insulin. When glucose is not taken from insulin, it often stays in the blood. As a result, the pancreas typically responds by producing more insulin to store the extra glucose, which leads to high blood insulin.

Essentially, insulin resistance is the precursor for the other two, and all three of those conditions make up the metabolic situation found in type 2 diabetics. Therefore, the conditions typically found in hypertensive people are typically found in people who have or are developing diabetes.

To test the connection between insulin resistance, high blood insulin, and hypertension, a study was conducted where rats were fed high amounts of fructose, which is a known cause of insulin resistance [2]. To no surprise, the rats developed insulin resistance. However, they also were diagnosed with hyperinsulinemia and hypertension.

A coincidence? I think not.

Making Sense Out of the Diabetes and Hypertension Connection

There's a purpose to this rant on metabolism and hypertension: if you have hypertension, regulating your blood pressure with medications may not return you to a healthy state. There's a strong connection between the precursors of type 2 diabetes and hypertension. If you have high blood pressure, you may not have high blood glucose, but you could have insulin resistance and high blood insulin. Consider testing your blood insulin and insulin resistance. 

To solve the problem, your best route could be making anti-diabetic lifestyle changes, not taking hypertension medications. 

What are those lifestyle changes? Stay tuned.

Your Lifestyle CAN Prevent Diabetes

Whether or not you believe in fate, you may be worried that type 2 diabetes is inevitable for you. The situation may be that you are currently prediabetic, your parents and/or siblings have diabetes, or that diabetes is extremely common among people of your ethnicity. 

In other words, you're tied to the tracks and the diabetes train is coming through.

If this is true, your actions are irrelevant...you're going to get diabetes regardless. Let's see what research has to say about this.

The Diabetes Prevention Program

The Diabetes Prevention Program was a study by George Washington University that took place in the late 1990s [1]. In this study, over 3,000 prediabetic men and women (average fasting blood glucose of 105 mg/dl) were randomly split into one of three groups: a medicated group (MED), a lifestyle group (LS), or a control group (CON).

The MED group took the popular diabetic medication Metformin. The LS group was recommended to participate in 150 minutes of physical activity per week, reduce their total food intake, and follow generic dietary advice (i.e. eat more fruits and vegetables). The control group was given a placebo pill.

After three years, the results below were found.

The researchers combined each year lived by all of the 3,234 participants during the study. Then, they took the number of diabetes diagnoses per group and came up with the numbers displayed above.

As you see, the LS group had a much lower diagnosis rate than the CON ("no treatment") or MED groups. This difference becomes even more prominent with age.

Overall, the MED group reduced the rate of diabetes by 31% when compared to the CON group. The LS group reduced the risk of diabetes by 58%. 

These results are even more impressive than you may think. Less than two-thirds of the LS group were meeting the recommended goal of 150 minutes of weekly physical activity. In addition, the dietary and exercise recommendations were, in my opinion, very generic and far from ideal. If given more effective recommendations for nutrition and exercise, the risk reduction could be much greater than 58%.

 My Take-Home Messages

These are the messages you should take from this study:

1. Improving your lifestyle is an effective way to prevent diabetes, even when diabetes is knocking on your doorstep.
2. If changing your lifestyle can prevent diabetes, then it stands to reason that your lifestyle could cause diabetes.

The second conclusion is not meant to place blame. No one wants to intentionally develop diabetes. The point should be empowering to you. If your blood sugar is increasing, you can take yourself out of the control group and move yourself into the lifestyle group. You have the power to choose your outcome.

Use your power wisely.