Interval hypoxic training (IHT) and morning fasting: recovery factors in diabetes patients

• ¹London Neurology & Pain Clinic, 100 Harley St. London W1G 7JA, UK

• ²Physician, Research Pharmaceutical Company, London, UK

All healing cases, for any disease, as it is the case with type 2 diabetes (T2D), begin when the body itself engages in the fight against the disease. This is the principle of naturopathy and holistic therapy, which includes Interval Hypoxic Training (IHT) and therapeutic fasting.

Optimal therapeutic outcomes depend on the restoration of synchrony of body functions, and this is achieved by combining IHT with morning fasting. Interval Hypoxic Training involves alternating exposure to low doses of oxygen, which can be considered as triggers for training the whole body. There is evidence that IHT increases the amount of β-cells and their secretion [1]. Fasting has also been shown to increase the number of receptors on cell membranes and elevate their sensitivity to insulin [2]. Hypoxia increases glucose transporter activity via GLUT1 [3] and also by opening K-ATP channels, which are critical regulators of insulin secretion by β-cells and glucose metabolism [4, 5, 6]. These evidence data support the value of IHT for patients with type 2 diabetes.

IHT helps enhance the antioxidant potential of the organism. Adaptation to intermittent hypoxia improves blood circulation, increases mitochondrial efficiency and promotes stimulation of the expression of genes responsible for the formation of new mitochondria, reducing the production of free radicals. This is apparently one of the main benefits of IHT, which immediately makes an effect on antioxidant protection and optimizes mitochondrial energy productivity and, therefore, exerts an impact on inflammation, immunity and aging progression. Antioxidant protection is known to prolong the lifespan of mammals by 30-40%.

The reduction in free radical production during IHT is mediated by various molecular mechanisms, primarily related to the dynamic functioning of the MitoK-ATP channel. This channel, located in the inner mitochondrial membrane, plays a key role in protecting cells from hypoxia by reducing the formation of reactive oxygen species (ROS). The dynamic func- tioning of the MitoK-ATP channel during IHT can be compared to a mini-workout for mitochondria. At low oxygen levels, the ATP level decreases that promotes the opening of the channel. At the normal oxygen level, when the ATP level is high, the MitoK-ATP channel closes. Opening of the MitoK-ATP channel allows potassium ions (K+) to enter the mitochondria that leads to depolarization of the inner mitochondrial membrane. This decreases the electrical potential of the membrane that reduces the formation of ROS and decreases oxygen consumption. Short-term hypoxia induced by interval hypoxic training promotes the formation of free radicals, which act as triggers for the synthesis of antioxidants. Repeated short-term hypoxic effects lead to an accumulation of antioxidants, a decrease in the ROS level and protection of mitochondria from oxidative stress. In this context, free radical activity does not pose a threat to mitochondria, since interval hypoxia corrects this process. This is a key transformation occurring in the mitochondrial ATP-dependent potassium channels. The dialectical law of struggle and unity of opposites is obvious here: one stimulates the other, and one cannot exist without the other. A properly selected IHT session promotes achieving a homeostasis balance.

Hypoxic interval training is a method according to which the organism is exposed to alternating periods of hypoxia (low oxygen content) and normoxia (normal oxygen content). IHT promotes increasing the body’s non-specific resistance by adapting to hypoxia. The method originated in the 1970s in the former USSR and has been improving, finding its application in space, sports and clinical medicine.

A 60-minute IHT session takes into account :

• 1.    The degree of hypoxemia: the percentage of oxygen in the inhaled air (from 10 to 12.5%).

• 2.    The number of cycles per session: from 5 to 8. Each cycle (6-10 minutes) includes:

  – hypoxic episodes: 3-5 minutes.

  – episodes with breathing room air: 3-5 minutes.

• 3.    The number of hypoxia sessions: from 5 to 23, held daily or every other day.

• 4.    Evaluation of the effectiveness of the session: The effectiveness of the session is assessed by fluctuations in oxygen saturation in blood. The greater the gap between the saturation in the hypoxic episode and that when breathing room air, the more effective the session. In this case the duration of the session can be reduced to 30-45 minutes.

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Experience shows that to achieve the maximum therapeutic effect during one IHT session, a 4-6-fold decrease in blood oxygen saturation (SpO2) from 94-99% to 78-86% is necessary. We used a moderate hypoxia protocol: patients received oxygen (O2) at a concentration of 10-12%, with 5-7 episodes per day, lasting 40-60 minutes. This is a protocol confirmed by our 24-year clinical experience.

Previous clinical studies by T. Voronina (7) have shown that fasting for 5-7 days under hospital conditions provides significant benefits for treated in-patients with type 2 diabetes.

Outpatient treatment can be more comfortable and safe with partial (morning) fasting. Twelve patients with type 2 diabetes mellitus (disease duration from 3 to 12 years), five of whom with high BMI (obesity stage I), underwent morning fasting (fasting for 16-18 hours of 24). The first meal was at 15:00-16:00, the second one was offered at 19:00-20:00. All patients had decompensated diabetes. Before treatment, one patient received insulin therapy, and seven other patients were given oral hypoglycemic agents (OPA); one patient kept a diet.

The key to successful use of IHT in the morning or before the afternoon is achieving normoglycemia, maintained by morning fasting, oral hypoglycemic drugs, and sometimes small doses of insulin. Conducting IHT sessions, which were carried out with normoglycemia achieved even for a short time, gives immediate results: within 3-5 days, the symptoms of neuropathy disappear, patients note increased sensitivity in their extremities and a feeling of significant warmth.

Why is IHT more effective when used under normoglycemic conditions? Hyperglycemia is the main factor preventing the production of nitric oxide (NO), hyperglycemia causes oxidative stress and inhibits the synthesis of NO. IHT promotes the synthesis and effective action of nitric oxide, which plays a decisive role in neuroprotection, maintaining the blood supply and the vascular function throughout the body, facilitating vasodilation.

In type 2 diabetic patients, insufficient or absent NO production leads to endothelial dysfunction, which in turn causes vascular spasm, smooth muscle proliferation, platelet activation/aggregation, and leukocyte adhesion to the endothelium [8]. All diabetic complications arise from impaired capillary circulation that is difficult to normalize. This leads to retinopathy, renal failure, early strokes and heart attacks, and neuropathy. The main cause of complications in patients with diabetes is impaired nitric oxide synthesis. Therefore, the key to preventing and eliminating complications of type 2 diabetes is the use of IHT. During the first 2–3 days of treatment, the insulin dosage was gradually reduced. After 2–3 weeks of daily treatment, diabetes was compensated by diet and insulin in 4 patients receiving insulin therapy. Seven patients who had been taking oral hypoglycemic agents on a regular basis were able to maintain the compensatory status keeping diet only after received therapy. One patient with mild diabetes mellitus achieved stable compensation by keeping diet after treatment. The patients were observed for periods ranging from nine months to three years. Positive results were maintained with regular morning fasting and keeping diet.

Thus, the use of IHT in patients with type 2 diabetes mellitus significantly accelerates compensation of carbohydrate metabolism, eliminates or reduces the need for insulin and hypoglycemic agents, which in turn reduces the risk of complications. Physiological stimuli such as interval hypoxic training and fasting act at three main levels: training, activation, and distress. To achieve optimal training and activation effects in our therapy, it is necessary to more accurately determine the appropriate intensity, dose, rate and time of exposure to these stimuli, as well as to take into account the state of the body. Further research can significantly improve the results of using these treatment methods in patients with diabetes mellitus and make them available for widespread introduction in health care practice.