Jochen Steiniger

Is Metabolic Flexibility Altered in Multiple Sclerosis Patients

Objectives Metabolic flexibility is defined as ability to adjust fuel oxidation to fuel availability. Multiple sclerosis (MS) results in reduced muscle strength and exercise intolerance. We tested the hypothesis that altered metabolic flexibility contributes to exercise intolerance in MS patients. Methods We studied 16 patients (all on glatiramer) and 16 matched healthy controls. Energy expenditure (EE), and carbohydrate (COX) and lipid oxidation (LOX) rates were determined by calorimetry, before and after an oral glucose load. We made measurements either at rest (canopy device) or during 40 min low-grade (0.5 W/kg) exercise (metabolic chamber). We also obtained plasma, and adipose tissue and skeletal muscle dialysate samples by microdialysis to study tissue-level metabolism under resting conditions. Results At rest, fasting and postprandial plasma glucose, insulin, and free fatty acid levels did not differ between patients and controls. Fasting and postprandial COX was higher and LOX lower in patients. In adipose, fasting and postprandial dialysate glucose, lactate, and glycerol levels were higher in patients vs. controls. In muscle, fasting and postprandial dialysate metabolite levels did not differ significantly between the groups. During exercise, EE did not differ between the groups. However, COX increased sharply over 20 min in patients, without reaching a steady state, followed by an immediate decrease within the next 20 min and fell even below basal levels after exercise in patients, compared to controls. Conclusions Glucose tolerance is not impaired in MS patients. At rest, there is no indication for metabolic inflexibility or mitochondrial dysfunction in skeletal muscle. The increased adipose tissue lipolytic activity might result from glatiramer treatment. Autonomic dysfunction might cause dysregulation of postprandial thermogenesis at rest and lipid mobilization during exercise.

Grade of adiposity affects the impact of fat mass on resting energy expenditure in women.

Body fat mass (FM) adds to the variance in resting energy expenditure (REE). However, the nature and extent of this relationship remains unclear. Using a database of 1306 women and a linear regression model, we systematically analysed the contribution of FM to the total variance in REE at different grades of adiposity (ranges of body %FM). After adjusting for age, the relative contribution of FM on REE variance increased from low (<or= 10 %FM) to normal (>10- <or= 30 %FM) and moderately elevated (>30- <or= 40 %FM) grades of adiposity but decreased sharply at high (>40- # 50 %FM) and very high (>50 %FM) grades of adiposity according to the ratio between regression coefficients. These data suggest that the specific metabolic rate of fat tissue is reduced at high adiposity. This should be considered when REE is normalized for FM in obesity.

Metabolic response to epigallocatechin-3-gallate in relapsing-remitting multiple sclerosis: a randomized clinical trial

BACKGROUND Muscle weakness and fatigue are common symptoms in multiple sclerosis (MS). Green tea catechins such as (-)epigallocatechin-3-gallate (EGCG) are known to improve energy metabolism at rest and during exercise. OBJECTIVE We tested the hypothesis that EGCG improves energy metabolism and substrate utilization in patients with MS. DESIGN Eighteen patients (8 men) with relapsing-remitting MS (expanded disability status scale score <4.5, all receiving glatiramer acetate) participated in this randomized, double-blind, placebo-controlled, crossover trial at a clinical research center. All patients received EGCG (600 mg/d) and placebo over 12 wk (4-wk washout in between). After each intervention, fasting and postprandial energy expenditure (EE), as well as fat oxidation (FAOx) and carbohydrate oxidation (CHOx) rates, were measured either at rest or during 40 min of exercise (0.5 W/kg). At rest, blood samples and microdialysates from adipose tissue and skeletal muscle were also taken. RESULTS At rest, postprandial EE and CHOx, as well as adipose tissue perfusion and glucose supply, were significantly lower in men but higher in women receiving EGCG compared with placebo. During exercise, postprandial EE was lower after EGCG than after placebo, indicating an increased working efficiency (men > women). After placebo, exercise EE was mainly fueled by FAOx in both men and women. After EGCG, there was a shift to a higher and more stable CHOx during exercise in men but not in women. CONCLUSIONS Our data indicate that EGCG given to patients with MS over 12 wk improves muscle metabolism during moderate exercise to a greater extent in men than in women, possibly because of sex-specific effects on autonomic and endocrine control.

Einfluss von therapeutischem Fasten und Ausdauertraining auf den Energiestoffwechsel und die körperliche Leistungsfähigkeit Adipöser

Einleitung: Saftfasten nach Buchinger ist ein traditionsreicher therapeutischer Ansatz der Naturheilkunde zur Gewichtsreduktion bei Adipositas. Als kritisch wird dabei allerdings der angeblich schädliche Eiweißverlust betont. Daten dazu sind jedoch kaum vorhanden. Fragestellung: Wie hoch ist der tatsächliche Eiweißverlust Adipöser nach 28-tägigem Saftfasten und führt ein zusätzliches Ausdauertraining zu einer Überforderung der physiologischen Anpassungsfähigkeit und nicht tolerierbaren pathologischen Folgeerscheinungen? Patienten und Methode: In den Jahren 1974–1990 wurde unser Therapiekonzept «Komplexe Rekonditionierung Adipöser», eine Kombination aus Saftfasten nach Buchinger und Ausdauertraining, in Form einer Gruppentherapie getestet. In der durchschnittlich 28 Tage dauernden Behandlung wurden an verschiedenen Untergruppen Parameter des Energie-, Kohlenhydrat-, Fett-und Eiweißstoffwechsels sowohl in Ruhe als auch unter definierter körperlicher Belastung untersucht. Ergebnisse: Zusätzliches Ausdauertraining führte einerseits zu einer größeren Abnahme an Körpergewicht (12,2 ± 3,2 vs. 10,4 ± 2,2 kg; p < 0,001) und Fettmasse (8,1 ± 1,6 vs. 5,9 ± 1,3 kg; p < 0,001), andererseits zu erhöhter Fettverwertung und körperlicher Leistungsfähigkeit. Dabei fiel die Absenkung des Energieumsatzes pro Kilogramm fettfreier Masse geringer aus (–7,6 ± 12,4 vs. –14,3 ± 12,2%; p < 0,001). Ohne Training belief sich der Eiweißverlust in den 28 Tagen auf rund 1000 g (Männer) bzw. 650 g (Frauen). Mit Training war nur bei den Männern ein zusätzlicher Eiweißverlust von 130 g / 28 d (p < 0,01) zu beobachten. Schlussfolgerungen: Ausdauertraining ist eine sinnvolle und notwendige Ergänzung während des Saftfastens nach Buchinger.

Die Vitalität adipöser Patienten nach einer Gewichtsreduktion durch Fasten

The Vitality of Obese Patients after a Weight Reduction by Fasting Introduction: The objective documentation of the positive results of natural medicine or physiotherapy gains raising importance in medicine. Objective: The aim of the study was to investigate the application of the vitality test according to Pöthig® in the objective holistic evaluation of treatment by natural and physical medicine. Subjects and Methods: In 48 obese patients (28 males and 20 females) with a body mass index of 32.1 to 56.5 kg/m2 a weight reduction therapy was carried out for 21 days (16–25 days) by means of fasting according to Buchinger, accompanied by physiotherapeutic treatments. At the beginning and at the end all patients underwent a multidisciplinary functional diagnosis by means of the vitality test according to Pöthig® and a bioelectrical impedance analysis. On the basis of the 47 measured parameters of the entire body function (physical, mental and emotional/social) the Vitality Index and the Functional Age Index (FAI) were calculated. Results: The reduction of body weight was 9.1 ± 2.4 (5.1–15.0) kg, the reduction of body fat 5.5 ± 1.3 (3.3–8.5) kg. At the beginning 31% of the patients showed a reduced vitality, i.e. the FAI was at least 5 years (maximum 16 years) higher then the real age. 56% of the patients matched the real age and in 13% of the patients the FAI was better with respect to the corresponding age group. During the treatment 94% of the patients showed an improvement of their FAI by 5 ± 3 years on average (maximum 12 years). Conclusions: With the help of the presented multidisciplinary vitality test it is possible to objectively document the positive results of natural medicine and physical medicine on the whole human organism.

Zur Eiweissfrage beim Fasten

Das therapeutische Heilfasten verlangt vom menschlichen Orga-nismus eine tiefgreifende Umstellung in fast allen seinen Stoff-wechselvorga¨ngen. Die dabei auftretende negative Stickstoffbilanzund die damit verbundenen Stoffwechselvera¨nderungen sind im-mer wieder Bestandteil teilweise unberechtigter oder unsachlichpolemischer Kritik am Fasten; dem Heilfasten wird eine «patho-logische» Wirkung unterstellt.In den letzten 25 Jahren wurden in unserer Klinik mehr als5000 Patienten ohne Komplikationen durch Saftfasten (nach Buch-inger) behandelt (Metabolisches Syndrom) und zahlreiche wissen-schaftliche Untersuchungen zur Physiologie und Biochemie desFastens durchgefu¨hrt.