Exercise in Pill FormPosted: November 11, 2013 in Obesity Medicine by Craig Primack MD FACP
Yes, it’s true! Drug companies are working to put exercise in a pill!! Actually the article I am referencing states that there are probably 2 dozen or so drug companies that are currently working on this. This week’s New England Journal of Medicine discusses some basic research findings having to do with muscle physiology.
This magic pill would allow all of us and especially diabetics to get the metabolic benefits of exercise without having to put in the time. Great for all of us!! Right?
Let’s take a moment to review the basics of muscle physiology. There are 2 types of muscle fibers: type 1 slow-twitch (red) and type 2 fast-twitch (white). Muscle is highly adaptable and after regular aerobic exercise type 2 changes to type 1 fiber. This causes the muscle to better process byproducts of activity such as lactic acid, store more glycogen and better transport sugar (energy) into the muscle. As a whole, these changes increase insulin sensitivity of the muscle and overall improve glucose control for the body.
This effect is why exercise is great for diabetics. Inactivity does the opposite by converting more muscle fibers to type 2 and contributing to insulin resistance. Insulin resistance is the core problem in type 2 diabetes.
This study showed that the 2 enzymes discussed regulate the metabolic and contractile properties of the muscle fibers. Drugs that activate these enzymes show improvement in exercise performance by 44% and an increase in endurance by 70% without exercise. There has been a lot of research done on these drugs but unfortunately there are many currently insurmountable problems, including poor absorption, dosage limitations to IV form only and requiring an increased intake of food (not so good for weight loss). Overall, these are not good side effects to have for someone who is unable to exercise or has diabetes.
So while there are many who are hoping this “exercise pill” will be a magic cure for weight loss, this isn’t the case. There are too many potential issues and not enough evidence to support the concept of a pill replacing a session at the gym.
Without a pill, it’s back to sweating and spending the time outside or at the gym for all of us who are able and willing. Remember, nothing replaces exercise! Exercise has numerous beneficial effects. For diabetics, it greatly helps with glucose control and for the rest of us it is a time for stress relief, a time to get away and process the events of the day, perhaps time to catch up on TV or movies and best of all a good source of calorie burn. If this pill ever does come out, I can predict that my insurance, like yours, will not cover it anyway.