High-carbohydrate Meal Research Articles

Hypokalemic periodic paralysis as the first sign of thyrotoxicosis- a rare case report from Somalia

BackgroundThyrotoxic hypokalemic periodic paralysis (THPP) is a rare complication of hyperthyroidism characterized by thyrotoxicosis, hypokalemia, and paralysis. It is the most common form of acquired periodic paralysis. THPP is precipitated by strenuous exercise, a high carbohydrate diet, stress, infection, alcohol, albuterol, and corticosteroid therapy. It is most common in Asian men with hyperthyroidism and exceptionally rare in black people.Case PresentationA 29-year-old man was admitted to the emergency department in Somalia with a sudden onset of paralysis after a high carbohydrate meal. Laboratory investigations showed low serum potassium 1.8 mEq/l (3.5–4.5), and biochemical thyrotoxicosis with TSH 0.006 miu/l (0.35–5.1), total T3 3.2 ng/ml (0.9–2.8) and total T4 13.5 ng/ml (0.6–1.2). He was successfully treated with potassium chloride infusion and an antithyroid drug, methimazole.ConclusionTo prevent life-threatening cardiac and respiratory complications, it is critical to consider and diagnose THPP early, even in populations where the condition is rare.

Saliva insulin tracks plasma insulin across the day following high-carbohydrate and low-carbohydrate meals.

Non-invasive monitoring of insulin could hold promise to identify those with, or at risk for developing, insulin resistance. We aimed to examine saliva insulin responses across the day following high- and low-carbohydrate meals and evaluate whether changes in saliva insulin might accurately reflect changes in plasma insulin. In two randomized crossover studies, young normal weight men (NW; n=8; Study 1) and adults with overweight/obesity (OO; n=8; Study 2) completed two 9-h experimental trials in which the participants consumed isocaloric mixed high-carbohydrate (HC) or low-carbohydrate (LC) meals at 0, 3, and 6 h. Plasma and saliva samples were collected at fasted baseline and every 30 min for a total of 19 samples across 9 h. Overall, findings revealed a similar trend for postprandial saliva and plasma insulin responses regardless of the time of the day with a ∼30-45 min lag between saliva and plasma insulin responses. In both NW and OO groups, saliva and plasma insulin area under the curve (AUC) and incremental AUC were significantly higher in HC condition as compared to LC condition (all P≤0.002). Nine-hour plasma and saliva insulin total AUCs were strongly and very strongly correlated in both HC (r=0.68; P=0.007) and LC (r=0.84, P<0.001) conditions, respectively. Saliva insulin is proportionate to and appears to reasonably track plasma insulin across the day with a ∼30-45 min delay. Saliva insulin shows promise as a non-invasive method to discern between low and high plasma insulin and may have utility in predicting the degree of insulin resistance (NCT03374436).

Влияние пищевого термогенеза низкокалорийной углеводной нагрузки на энерготраты покоя

Basal metabolic rate (BMR) differs from resting energy expenditure (REE) by less than 10 %, the latter being measured under similar conditions, but after a low-calorie meal. Presently, the two terms are used interchangeably, although resting energy expenditure is the preferred one. However, the cycling to exhaustion test commonly used in assessing the physical performance of elite athletes should not follow a 12-hour fasting. Consequently, the subjects are given a standardized low-calorie highcarbohydrate breakfast before the test, which, according to the authors, does not distort the obtained REE values. Therefore, the aim of this study was to determine the thermic effect of a standardized high-carbohydrate meal on resting energy expenditure and body composition. Materials and methods. The anthropometry and body composition were analysed in healthy young men (n = 10) using the ACCUNIQ BC380 system; REE was assessed using indirect calorimetry; the thermic effect of a low-calorie high-carbohydrate breakfast was calculated as a difference between fasting REE and postprandial metabolism. Results. The research showed that a high-carbohydrate (91 %) food intake (250–300 kcal) produces no significant effect on REE. The meal’s thermic effect was 36.0 ± 5.7 kcal, which increased REE (1887.2 ± 111.7 kcal) by 2 % compared to baseline BMR (1851.2 ± 106.0 kcal). In the subjects, REE varied depending on the total amount of water in the body (p = 0.038), fat mass (p = 0.021), and an energy substrate (carbohydrate) intake (р = 0.046). Thus, in people, including athletes, it is acceptable to measure REE after a high-carbohydrate breakfast that does not exceed 300 kcal.

Plasma metabolomic response to high-carbohydrate meals of differing glycaemic load in overweight women

BackgroundMetabolomic dysregulation following a meal in overweight individuals with the Metabolic Syndrome (MetS) involves multiple pathways of nutrient storage and oxidation.ObjectiveThe aim of the current study was to perform an acute cross-over intervention to examine the interactive actions of meal glycaemic load (GL) on the dynamic responses of the plasma metabolome in overweight females.MethodsPostmenopausal women [63 ± 1.23y; Healthy (n = 20) and MetS (n = 20)] ingested two differing high-carbohydrate test meals (73 g carbohydrate; 51% energy) composed of either low glycemic index (LGI) or high (HGI) foods in a randomised sequence. Plasma metabolome was analysed using liquid chromatography–mass spectrometry (LC–MS).ResultsIn the overweight women with MetS, there were suppressed postprandial responses for several amino acids (AAs), including phenylalanine, leucine, valine, and tryptophan, p < 0.05), irrespective of the meal type. Meal GL exerted a limited impact on the overall metabolomic response, although the postprandial levels of alanine were higher with the low GL meal and uric acid was greater following the high GL meal (p < 0.05).ConclusionsMetS participants exhibited reduced differences in the concentrations of a small set of AAs and a limited group of metabolites implicated in energy metabolism following the meals. However, the manipulation of meal GL had minimal impact on the postprandial metabolome. This study suggests that the GL of a meal is not a major determinant of postprandial response, with a greater impact exerted by the metabolic health of the individual.Trial registration Australia New Zealand Clinical Trials Registry: ACTRN12615001108505 (21/10/2015)

Low- or moderate-carbohydrate calorie–restricted diets have similar effects on body composition and taekwondo performance after high-carbohydrate recovery meals

ABSTRACT Low-carbohydrate (LC) diets are popular among general and athletic populations attempting to lose body mass. This study investigated the effect of a 7-day LC or moderate-carbohydrate (MC) calorie–restricted diet followed by 18-h recovery on body composition and taekwondo-specific performance. In this randomised cross-over study, 12 male taekwondo athletes consumed an LC (10% of carbohydrate, 41% of protein, 49% of fat, and 15.8 ± 0.4 kcal/kg/day) or an isocaloric MC diet (60% of carbohydrate, 30% of protein, and 10% of fat) for 7 days. The participants then consumed a carbohydrate-rich recovery dinner (39.2 ± 3.1 kcal/kg) followed by breakfast (6.2 ± 0.4 kcal/kg) in both the trials. Three repeated sprint ability (RSA) tests were conducted after breakfast. The taekwondo-specific reaction battery was administered before the first RSA test and after each RSA test. The participants experienced similar magnitudes of significant loss of body mass in the LC (−2.4 ± 1.7%) and MC (−2.3 ± 1.7%) trials. Fat mass and fat percentage significantly decreased in the MC trial but remained unchanged in the LC trial after body mass loss. Fat free mass was maintained in both the trials. The average and peak power in the RSA tests and the premotor reaction time were similar between the trials. The participants experienced significantly higher fatigue in the LC trial. In conclusion, both the diets can help athletes rapidly lose body mass while maintaining performance as long as an adequate amount of carbohydrate is consumed during the recovery period.

Determinants of blood glucose concentrations following a high carbohydrate meal in type 2 diabetes: A multiple linear regression analysis

This study showed that in relatively well-controlled type 2 diabetes blood glucose levels after a high carbohydrate meal were associated positively with fasting blood glucose, but also positively with gastric emptying in the first hour and negatively with the increments in plasma glucagon-like peptide-1 (GLP-1) in the later postprandial phase.

Modifying Effect of Diet on Daily Variations of Certain Liver Constitutents

The sequential effect on certain liver enzymes and on liver glycogen of high-carbohydrate or carbohydrate-free diets. The pattern of glycogen deposition and repletion on the various treatments was indicative of a rapid takeover of gluconeogenic reactions to maintain appreciable glycogen stores during a carbohydrate-free dietary regimen. This ability disappeared following a single high-carbohydrate meal. The activity of glutamic-pyruvic transaminase (GPT) varied significantly with respect to time after feeding. This effect was somewhat modified by the carbohydrate-free, high-fat regimen. Glucose-6-phosphatase (G-6-Pase) activity showed some evidence of substrate induction 24 hours after high-carbohydrate meals, but this also disappeared during carbohydrate-free feeding. Glucose-6-phosphate dehydrogenase (G-6-PDH) exhibited no definite 24-hour pattern, but its activity was depressed considerably during the carbohydrate-free regimen. At 24 hours after a meal of the high-carbohydrate diet, however, G-6-PDH activity was significantly increased over previous values obtained during carbohydrate-free feeding.

The efficacy of a home-use metabolic device (Lumen) in response to a short-term low and high carbohydrate diet in healthy volunteers.

Based on stoichiometric assumptions, and real-time assessment of expired carbon dioxide (%CO2) and flow rate, the Lumen device provides potential for consumers/athletes to monitor metabolic responses to dietary programs outside of laboratory conditions. However, there is a paucity of research exploring device efficacy. This study aimed to evaluate Lumen device response to: i) a high-carbohydrate meal under laboratory conditions, and ii) a short-term low- or high-carbohydrate diet in healthy volunteers. Following institutional ethical approval, 12 healthy volunteers (age: 36±4yrs; body mass: 72.1±3.6 kg; height: 1.71±0.02 m) performed Lumen breath and Douglas bag expired air measures under fasted laboratory conditions and at 30 and 60min after a high-carbohydrate (2g·kg-1) meal, along with capilliarized blood glucose assessment. Data were analyzed using a one-way ANOVA, with ordinary least squares regression used to assess the model between Lumen expired carbon dioxide percentage (L%CO2) and respiratory exchange ratio (RER). In a separate phase, 27 recreationally active adults (age: 42±2yrs; body mass: 71.9±1.9 kg; height: 1.72±0.02 m) completed a 7-day low- (~20% of energy intake [EI]; LOW) or high-carbohydrate diet (~60% of EI; HIGH) in a randomized, cross-over design under free-living conditions. L%CO2 and derived Lumen Index (LI) were recorded daily across morning (fasted and post-breakfast) and evening (pre/post meal, pre-bed) periods. Repeated measures ANOVA were employed for main analyses, with Bonferroni post-hoc assessment applied (P ≤0.05). Following the carbohydrate test-meal, L%CO2 increased from 4.49±0.05% to 4.80±0.06% by 30min, remaining elevated at 4.76±0.06% by 60min post-feeding (P <0.001, ηp2=0.74). Similarly, RER increased by 18.1% from 0.77±0.03 to 0.91±0.02 by 30min post-meal (P =0.002). When considering peak data, regression analysis demonstrated a significant model effect between RER and L%CO2 (F=5.62, P =0.03, R2=0.20). Following main dietary interventions, no significant interactions (diet × day) were found. However, main diet effects were evident across all time-points assessed, highlighting significant differences for both L%CO2 and LI between LOW and HIGH conditions (P <0.003). For L%CO2, this was particularly noted under fasted (4.35±0.07 vs. 4.46±0.06%, P =0.001), pre-evening meal (4.35±0.07 vs. 4.50±0.06%, P <0.001), and pre-bed time-points (4.51±0.08 vs. 4.61±0.06%, P =0.005). Our findings demonstrated that a portable, home-use metabolic device (Lumen) detected significantly increased expired %CO2 in response to a high-carbohydrate meal, and may be useful in tracking mean weekly changes to acute dietary carbohydrate modifications. Additional research is warranted to further determine the practical and clinical efficacy of the Lumen device in applied compared to laboratory settings.

Olive Leaf Tea Impact on Postprandial Glycemia: A Randomized Cross-Over Trial.

This study investigates the effect of olive leaf tea (OLT) on postprandial glycemia in healthy volunteers when ingested with a high-carbohydrate meal, compared with a placebo tea (CON). Healthy adults participated in a double-blind, randomized, placebo-controlled, and cross-over design trial receiving a high-rich carbohydrate meal with either 250 mL of OLT or CON at two different times after a washout period. The sequence order was randomized at a ratio of 1:1. Capillary blood glucose was measured in a 2 h period after ingestion. Eighteen participants were initially randomized. Of these, thirteen completed the trial and were analyzed. The consumption of OLT resulted in a delay in peak time (48.5 ± 4.2 min vs. 35.7 ± 4.0 min, p = 0.03) and a significant increase in glucose area under the curve compared to placebo (14,502.7 ± 640.8 vs. 13,633.3 ± 869.4 mg/dL·min, p = 0.03). Results are depicted as mean ± SEM. The OLT and CON palatability were generally well accepted. No adverse effects were reported. OLT did not ameliorate a glycemic curve induced by carbohydrate-rich meal ingestion, suggesting that at least when ingested acutely in a single meal, OLT does not have antihyperglycemic effects. Future studies should account for chronic consumption providing a better understanding of glycemic regulation over time.

The efficacy and tolerability of intermittent prandial acarbose to reduce glucose spikes in healthy individuals

Acarbose is an α-glucosidase inhibitor that slows the digestion of carbohydrates and can prevent sharp increases in blood sugar levels after meals (spikes). Excessive postprandial blood glucose spikes have been associated with chronic conditions, increase all-cause mortality, and may contribute to aging. Therefore, the prevention of glucose spikes may contribute to the preservation of human healthspan. Indeed, acarbose has been associated with increased lifespan in animal models. However, its tolerability profile has limited acarbose use in healthy individuals. We hypothesized that using low-dose acarbose right before the occasional high-carbohydrate meal may prevent glucose spikes in healthy individuals. We performed a prospective clinical study to evaluate the tolerability and efficacy of acarbose in healthy individuals. Participants were randomized into two arms, each performing two control tests and two treatment tests. Continuous glucose monitor (CGM) measurements were collected for 2 h after high carbohydrate meals with or without pre-meal 50 mg acarbose intake. Tolerability was assessed using questionnaires. Twelve patients had evaluable results. Acarbose pretreatment resulted in reductions in CGM glucose measurements, with a significant decrease in glucose levels at the start, after 15 min, and at peak glucose levels. Few participants reported acarbose adverse events, and these included flatulence, bloating, nausea, abdominal pain, and stomach aches. No statistical difference in tolerability was detected between periods with and without acarbose. In conclusion, treatment with 50 mg of acarbose before meals was found to be well tolerated and efficacious in blunting the postprandial glucose spike by over 17% in healthy individuals.

Comparison of the effects of high-carbohydrate and low-carbohydrate meals on drowsiness and biological indices

Comparison of the effects of high-carbohydrate and low-carbohydrate meals on drowsiness and biological indices

ODP525 Thyrotoxic Periodic Paralysis

Abstract Thyrotoxic periodic paralysis manifests with painless muscle weakness, mostly in the proximal lower extremities. It is often precipitated byexercise, high carbohydrate meals, and occasionally fasting. Though most cases are hereditary, and affect Asian men disproportionately, some cases may occur sporadically. This thyrotoxicosis is most often attributable to Graves disease and patients typically have symptoms of thyrotoxicosis for months leading up to the episodes of paralysis. This is an 18-year-old Asian man with a history of Autism Spectrum Disorder who presents for evaluation of lower extremity weakness. He was seen two weeks prior for similar complaints. At that time, he had hypokalemia, hypomagnesemia, hypophosphatemia and was repleted and discharged home. The day prior to admission, he had pain in his bilateral posterior legs. On the morning of presentation, he could no longer ambulate which led him to present to the emergency room. Per his collateral, he had lost forty-five pounds in the last 6 months. He has not been tolerating oral food well with early satiety. He denies any diarrhea or constipation, fever/chills, or recent illness. He denies any family history of muscle disorders, thyroid disease, or any other autoimmune disease. He does not smoke tobacco, drink alcohol, or use any illicit substances. On physical exam, he is notably tachycardic to 120 bpm. He has thyromegaly but no palpable nodules. He has no exophthalmos on eye exam. On his neurologic exam, patient has 2/5 strength in his bilateral lower extremities. On laboratory evaluation, patient has fully suppressed TSH &amp;lt;0. 0015 mcunit/mL, free thyroxine of 3.43 ng/dL, total T3 of 463 ng/dL, TSI &amp;gt;40 IU/L, and TSH Receptor Antibody 31 IU/L. His potassium is low at 2.8 with a magnesium of 1.7. His thyroid ultrasound is without evidence of any nodules, has a homogenous parenchymal pattern, with increased vascularity diffusely. Patient is started on methimazole 20mg daily which is then increased to 20mg twice daily as well as propranolol 120mg daily, with plans for definitive therapy in the future. Though mechanism by which thyrotoxicosis can produce electrolyte abnormalities including hypokalemia leading to periodic paralysis is poorly understood, it is thought that thyroid hormone may increase tissue responsiveness to B-adrenergic stimulation like exercise or stress. This may lead to hyperpolarization of the muscle membrane and relative excitability. A variety of other factors play a role in the pathogenesis of thyrotoxic paralysis including insulin and testosterone through activation of the sodium potassium ATPase. Treatment for TPP includes aggressive electrolyte repletion, correction of the underlying cause with methimazole and propranolol-taking advantage of its beta adrenergic blocking ability, and often times planning for definitive therapy. Presentation: No date and time listed

ODP614 Two cases of Graves Disease Associated Hypokalemic Periodic Paralysis

Abstract Introduction Periodic paralysis (PP) is a rare neuromuscular disorder due to a defect in ion channels in muscle, characterized by episodes of painless muscle weakness or paralysis, which may be precipitated by heavy exercise or high-carbohydrate meals. Hypokalemic PP (HPP) is most common of the periodic paralyses, however is still very rare, with an estimated prevalence of 1 in 100,000. An acquired form of hypokalemic PP can be seen in thyrotoxicosis of any cause. We present 2 cases of HPP due to thyrotoxicosis. Case 1 27 year old Asian male presented to the ED due to sudden onset of acute weakness/near paralysis in lower extremities, with weakness of bilateral upper extremities. He was found to be hypokalemic with a potassium of 2.0 mmol/L (3.5-5.1). At the same time, he was also found to be hyperthyroid with a suppressed TSH of 0.03 uIU/Ml (0.35-5.5) and a free T4 2.2 ng/mL (0.5-1.3), Total T3 225 ng/Dl (70-204), Free T3 5.9 pg/mL (1.5-4.1). TSI antibodies elevated at 1.39 IU/L (&amp;lt;0.10). He was started on potassium supplements and methimazole. At a 3-month follow-up, patient reported no further episodes of weakness or paralysis. Case 2 23 year old White male presented to ED with severe muscle weakness and was found to have hypokalemia of 2 mmol/L (3.5-5.1). On further labs, TSH was undetectable at less than 0.01 uIU/mL (0.35-4.94), Free T4 2.81 ng/dL (0.61-1.82), Total T3 of 451 ng/dL(48-178), TSI antibodies were positive at 178%(&amp;lt;/=122%). Nuclear uptake scan confirmed Graves’ disease with radioactive iodine uptake of 58.1% at 4 hours and 70% at 24 hours with homogenous uptake in the entire gland and no evidence of hot or cold nodules. He was started on methimazole and propranolol for tachycardia and palpitations and potassium supplements. Muscle weakness resolved on treatment methimazole. Discussion and conclusion We present two cases of HPP likely caused by Graves’ disease. Both patients presented with hypokalemia and further workup revealed underlying thyrotoxicosis. The exact mechanism behind HPP due to thyrotoxicosis is not well understood. It is proposed that excess thyroid hormone may predispose to paralytic episodes by increasing the susceptibility to the hypokalemic action of epinephrine or insulin. This condition has been most widely reported in Asian populations, in which the incidence is approximately 2% in contrast to non-asian population with incidence of 0.1 to 0.2%, and is more common in men. Treatment of thyrotoxicosis with restoration and maintenance of euthyroid state ceases attacks. To summarize, few case series report the association of HPP with Graves’ disease. These patients usually present acutely with severe muscle weakness or paralysis. In conclusion, in diagnosis of HPP, possibility of thyrotoxicosis should be considered, especially in the absence of family history of PP. Presentation: No date and time listed

PSAT339 Long-term Follow Up of Three Cases of Periodic Paralysis

Abstract Introduction Periodic paralysis (PP) is a disorder of muscle ion channels. It is clinically manifested by episodes of painless muscle weakness and often precipitated by heavy exercise, fasting, or high-carbohydrate meals. Although first described in 1951, there is limited information for its long term course. We describe long term follow up of 3 cases of PP. Case 1 A 28-year-old male presented to the emergency room for abnormal sensations of lower extremities and inability to move his legs. Symptoms progressed to upper extremities with serum potassium of 1.7 mmol/L. He was treated with potassium chloride and discharged the next day with diagnosis of PP. He reported high intensity exercise precipitating these episodes and milder symptoms two years previously. Patient also had symptoms of hyperthyroidism, confirmed by thyroid functions tests. Physical examination showed normal vitals, small but palpable thyroid, and no neurological deficit. He was treated with methimazole, propranolol and KCl 20meq. Serum potassium normalized in 4 weeks and KCl was stopped. Following 3 months of treatment, patient developed hypothyroidism and was prescribed levothyroxine. Patient is currently euthyroid and able to perform daily activities without episodes of PP for the next 6 years of follow up. Case 2 A 29-year-old male presented with severe exertional muscle weakness for 1.5 years. Symptoms worsened with exercise. He had no family history of any neurologic diseases. Physical examination: normal vitals, thyroid, muscle, and neurologic exam. Laboratory values: normal thyroid function, serum potassium, liver function, and creatine kinase. EMG showed decreased amplitude of the compound muscle action potential (CMAP), with reduced motor unit recruitment or electrical silence. Patient was prescribed propranolol 20mg. Genetic testing revealed CACNA1S mutation consistent with hypokalemic periodic paralysis. He was prescribed eplerenone and acetazolamide. He has displayed no new symptoms from exertion and continues to perform normal daily activities on the current regimen. Case 3 A 72-year-old male presented with episodes of flaccid paralysis that lasted several minutes. Patient reported each episode started about an hour after eating dinner. During one episode serum potassium was 3.2 mmol/L and his symptoms slowly resolved after receiving potassium. His medical history was notable for hyperlipidemia, hypertension and pre-diabetes. Vital signs revealed stage-1 hypertension. Physical examination during the episode was notable for weakness greater in the proximal muscles and hyporeflexia. Laboratory values with TSH 2.03 mcIU/mL and follow-up potassium level 4.3 mmol/L. He continues to perform normal daily activities without any PP symptoms for the next 9 years following the initial episode. Conclusion Limited information is available regarding the long-term follow up of patients diagnosed with PP. Our 3 patients illustrate a relatively benign long-term course with appropriate treatment. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

LBSUN152 The Warburg Effect And Complex Thermomics Inform Phenotypic Expression

Abstract Introduction As technology reveals biological complexity, integration of vast clinical and multi-omic data utilizing artificial intelligence promises to clarify confusion. We have utilized challenge tests to inform algorithmic graphs recognizing heat as foundational for understanding phenotypic variation. Thermomics, describing complex thermic influences that are difficult to objectively quantify thereby compromising application to AI, are readily included in practice-derived models. Methods For the past 45 years cases have been evaluated with oral calcium challenge and immersion in water while observing changes in urinary composition. Between 2001 and 2010 respiratory gas exchange following a high carbohydrate meal combined with pulsatile insulin revealed metabolic variance that combined with basic, translational and clinical data of others informed generation of algorithmic graphs. COVID 19 served to clarify the effect of ACE2 disruption by predicting divergent phenotypic expression mediated by calciotropic hormones. Results Extraction of O2 from glucose, a consequence of fatty acid synthesis producing R/Q &amp;gt; 1 is modeled as foundational for metabolic evolution. This Warburg effect, recognized in proliferating malignant cells, was observed at the systemic level in humans and, modeled as mediated by hypoxia inducible factors regulating glucose uptake and suppression of beta-oxidation. Higher order orchestration is governed by a signaling structure including PTH, PTHrP, FGF23, Klotho, prolactin, growth hormone, IGFs, insulin, SGLT2, thyroid, adrenal and vit D while salt inducible kinase contributes to understanding of terrestrial adaptation. Inclusion of thermomics leads to prediction of a favorable effect of sub-cutaneous adipose beiging on CNS function mediated by circulating Klotho as a constraint on FGF23 in amelioration of Long COVID by phentermine that is also effective in hypophosphatasia where the exercise induced beiging, induced by irisin is known to be dependent upon alkaline phosphatase. The post-exertional malaise of Myalgic Encephalomyelitis, where exercise induces elevation in R/Q and reduced work capacity, has informed modeling of the systemic Warburg effect. The models are further validated with mechanistic explanation for recent reports of marked increases of R/Q in human Paget's disease and CEBPb expression dependence mimicking Alzheimer's and limiting life span in mice. Conclusions The value of practice is demonstrated by the ability to model thermomics even when difficult to quantify. The work is validated by explanation of old conundrums, discovery of treatment for unresolved problems, facilitation of case-based discovery and integration of emerging data from basic sciences. The Warburg effect when recognized as foundational to biology, contributes to a General Theory of Metabolism applicable to effective personalization of care. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Processing Alaska Pollock Protein (Theragra chalcogramma) into Kamaboko Protein Mitigates Elevated Serum Cholesterol and Postprandial Glucose Levels in Obese Zucker fa/fa Rats

Fish paste products such as kamaboko (KB) are traditional Japanese foods prepared from fish meat. The health-promoting properties of fish proteins and their lysates include improving glucose and lipid metabolism. Although the KB manufacturing process and quality have been examined, limited studies have reported the health-promoting function of KB. This study aimed to evaluate the effects of processing Alaska pollock protein (APP) into KB protein (KBP) on serum lipids levels and postprandial glucose tolerance. Obese male Zucker fa/fa rats were fed on different diets for 4 weeks as follows: APP group, fed on a diet in which APP constituted 25% of total protein intake; KBP group, fed on a diet with APP-processed protein as the protein source; control group, fed on a diet with 100% casein as the protein source. Compared with those in the control group, the serum total cholesterol (TC) level was reduced and the elevated postprandial blood glucose level was mitigated during the high-carbohydrate meal tolerance test in the APP and KBP groups. Further, KBP exerted significantly higher effects on serum TC levels and glucose tolerance than APP.

The Beneficial Effect of Cinnamon and Red Capsicum Intake on Postprandial Changes in Plasma Metabolites Evoked by a High-Carbohydrate Meal in Men with Overweight/Obesity.

The relationship of high-carbohydrate (HC) meal intake to metabolic syndrome is still not fully explained. Metabolomics has the potential to indicate metabolic pathways altered by HC meals, which may improve our knowledge regarding the mechanisms by which HC meals may contribute to metabolic syndrome development. The fasting and postprandial metabolic response to HC or normo-carbohydrate (NC) meals with/without cinnamon + capsicum intake was evaluated using untargeted metabolomics and compared between normal-weight (NW) and overweight/obese (OW/OB) healthy men. Healthy male participants (age-matched) were divided into two groups (12 subjects per group). One was composed of men with normal weight (NW) and the other of men with overweight/obesity (OW/OB). On separate visits (with 2–3 week intervals), the participants received standardized HC or NC meals (89% or 45% carbohydrates, respectively). Fasting (0 min) and postprandial (30, 60, 120, 180 min) blood were collected for untargeted plasma metabolomics. Based on each metabolic feature’s intensity change in time, the area under the curve (AUC) was calculated. Obtained AUCs were analyzed using multivariate statistics. Several metabolic pathways were found dysregulated after an HC meal in people from the OW/OB group but not the NW group. The consumption of HC meals by people with overweight/obesity led to a substantial increase in AUC, mainly for metabolites belonging to phospholipids and fatty acid amides. The opposite was observed for selected sphingolipids. The intake of cinnamon and capsicum normalized the concentration of selected altered metabolites induced by the intake of HC meals. A HC meal may induce an unfavourable postprandial metabolic response in individuals with overweight/obesity, and such persons should avoid HC meals.

The effect of dietary intake on apneic performance, cardiovascular and splenic responses during repeated breath holds.

Static apneas performed after an overnight fast as opposed to postprandially have been evinced to improve apneic performance. However, no study has explored the effect of dietary intake on apneic performance, cardiovascular or splenic responses over a series of repeated apneas. Ten healthy adults attended the laboratory on three separate occasions (≥48-h apart): after a 14-h fast (F14), 1 h postconsumption of a high-calorie, high-carbohydrate (HCHC) meal, or 1 h postconsumption of a low-calorie, low-carbohydrate (LCLC)-based meal. During each visit, the subjects performed a hyperoxic rebreathing trial and a series of three repeated maximal static apneas. Heart rate, peripheral oxyhemoglobin saturation ([Formula: see text]), and gas exchange were monitored continuously, whereas splenic volume (SV) and hematology were assessed after the rebreathing and apneas. At rest, after HCHC, the respiratory exchange ratio (0.87 ± 0.17, P ≤ 0.043), expired minute volume of carbon dioxide (CO2; HCHC, 0.35 ± 0.09 L/min, P ≤ 0.014), and SV (227 ± 45 mL, P ≤ 0.031) were higher compared with F14 (0.71 ± 0.08; 0.23 ± 0.04 L/min; 204 ± 49 mL) and LCLC (0.72 ± 0.07; 0.25 ± 0.03 L/min; 199 ± 49 mL). A faster CO2 accumulation was recorded during the HCHC (96 ± 35 s) rebreathing trial (F14, 162 ± 42 s, P = 0.001; LCLC, 151 ± 23 s, P = 0.002). Longer apneas were reported in F14 compared with HCHC (apneas 1-3, P ≤ 0.046) and LCLC (apneas 2-3, P ≤ 0.006). After the first apnea, SV was lower in F14 (141 ± 43 mL, P = 0.015) compared with HCHC (180 ± 34 mL). Moreover, after the third apnea, end-tidal partial pressure of oxygen and nadir [Formula: see text] were lower in F14 (8.6 ± 2.2 kPa, P = 0.028; 77 ± 13%, P = 0.009) compared with HCHC (10.1 ± 1.7 kPa; 84 ± 9%). No differences were measured in end-apneic end-tidal partial pressure of CO2, heart rate nor hematology across diets. Fasting improved apneic performance with apneas being terminated at lower oxygen levels through altering the rate of CO2 accumulation but without affecting the cardiovascular responses.

Preexercise High-Fat Meal Following Carbohydrate Loading Attenuates Glycogen Utilization During Endurance Exercise in Male Recreational Runners.

Iwayama, K, Tanabe, Y, Yajima, K, Tanji, F, Onishi, T, and Takahashi, H. Preexercise high-fat meal following carbohydrate loading attenuates glycogen utilization during endurance exercise in male recreational runners. J Strength Cond Res 37(3): 661-668, 2023-This study aimed to investigate whether one preexercise high-fat meal can increase glycogen conservation during endurance exercise, as compared with one preexercise high-carbohydrate meal. Ten young male recreational runners (22.0 ± 0.6 years; 171.3 ± 0.9 cm; 58.3 ± 1.9 kg; maximal oxygen uptake [V̇ o2 max], 62.0 ± 1.6 ml·kg -1 ·min -1 ) completed 2 exercise trials after high-carbohydrate loading: eating a high-carbohydrate (CHO; 7% protein, 13% fat, 80% carbohydrate) meal or eating a high-fat (FAT; 7% protein, 42% fat, 52% carbohydrate) meal 3.5 hours before exercise. The order of the 2 trials was randomized, and the interval between trials was at least 1 week. The experimental exercise consisted of running on a treadmill for 60 minutes at 95% of each subject's lactate threshold. Muscle and liver glycogen content were assessed using noninvasive carbon magnetic resonance spectroscopy before the experimental meal as well as before and after exercise; respiratory gases were measured continuously during exercise. The respiratory exchange ratio during exercise was statistically lower in the FAT trial than in the CHO trial ( p < 0.01). In addition, muscle ( p < 0.05) and liver ( p < 0.05) glycogen utilization during exercise was less in the FAT trial than in the CHO trial. Therefore, one high-fat meal following carbohydrate loading reduced muscle and liver glycogen use during the 60-minute exercise. These results suggest that this dietary approach may be applied as a strategy to optimize energy utilization during endurance exercise.

Thyrotoxic Periodic Paralysis in the Post-COVID Era: A Case Report with Literature Review

Thyrotoxic Periodic Paralysis (TPP) is an acute potentially lethal emergency in patients with hyperthyroidism who present with sudden muscle weakness and hypokalemia. It is commonly precipitated by high carbohydrate or high salt content meals, strenuous exercise, stress, trauma, glucocorticoids, epinephrine, alcohol, or respiratory infections. COVID-19 infection or vaccination may represent a novel trigger for TPP. Furthermore, COVID-19 infection or vaccination may incite inflammatory processes leading to thyrotoxicosis, which can manifest as TPP. While COVID-19 causing subacute thyroiditis, euthyroid sick syndrome, Hashimoto’s disease, or Graves’ disease have been well documented in the literature; there have only been six case reports of post-COVID-19 TPP. Notably, all cases thus far have been restricted to male patients, and there is paucity of literature from North America. The purpose of this paper is to outline the first case of post-COVID-19 TPP in a female patient, who presented to the emergency department with acute paralysis and severe hypokalemia (2.2 mmol/L) three months after COVID-19 infection. Investigations in the emergency department showed thyrotoxicosis. She was treated with potassium replacement, which improved her paralysis. Subsequent investigations revealed severe hyperthyroidism from Graves’ disease, which is currently managed with metoprolol and methimazole. Her hyperthyroidism improved without recurrent hypokalemia or paralysis. In addition, we outline the epidemiology, pathophysiology, precipitants, and management of TPP, with a particular focus on COVID-19 infection or vaccination precipitating TPP. We discuss post-COVID-19 TPP cases thus far described in the literature. Knowing that North American COVID-19 infection waves lagged Asia, we could anticipate additional future TPP cases.