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Novel treatment (new drug/intervention; established drug/procedure in new situation)
Towards creating a superstimulus to normalise glucose metabolism in the prediabetic: a case-study in the feast-famine and activity-rest cycle
  1. Louis Crowe1,
  2. Brian Caulfield2
  1. 1Institute of Sport and Health, University College Dublin, Dublin, Ireland
  2. 2UCD School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
  1. Correspondence to Dr Louis, louiscrowe{at}


We live in a time of plenty. During evolution, periods of hunger and simultaneously high activity levels would combine giving a stimulus which is absent from modern lifestyles. This is potentially connected with abnormal glucose metabolism. It was hypothesised that simultaneous fasting and aggressive aerobic neuromuscular electrical stimulation (NMES) exercise, until metabolic exhaustion, may be an acceptable modern equivalent. A healthy subject fasted for 44 h (water allowed) during which he undertook three aerobic NMES sessions at >50%VO2max; heart rate >160 bpm. Metabolic gas analysis of a comparable session in the non-fasting state showed 100% carbohydrate substrate utilisation. With fasting the NMES exercise consumed mostly fat–up to 100% fat utilisation at 42 h. This clear shift away from using carbohydrate as a substrate and hypoglycaemia may indicate that carbohydrate stores are nearly depleted. The authors postulate that this may constitute a metabolic super stimulus mimicking the famine-activity periods of our ancestors.

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  • Competing interests Our project is 90% funded by Enterprise Ireland, an Irish governmental agency. The remaining funding and NMES unit that delivered the treatment was supplied by BioMedical Rearch in whom the corresponding author has a minor holding.

  • Patient consent Not obtained.