【Objective】In previous studies, it was clarified that lactic acid bacteria LAB4（Lactobacillus delbrueckii LAB4） has an inhibitory effect on blood glucose spikes, but in order to elucidate the mechanism of action, the relationship between autonomic nervous response and G/I-spike was investigated.

【Methods】In Study 1, heart rate variability（HRV） spectra were analyzed in 77 FMS（fibromyalgia syndrome） subjects with G-spikes. The control group was 60 healthy subjects. In Study 2, 22 cases of FMS were subjected to 3-hour spectral analysis of 75gOGTT and HRV in synchronization, and BS, IRI, LF / HF ratio, and HF amp were measured every 30 minutes. Max BS-Min BS≧60mg/dL after glucose loading was designated as G-spike, and Max IRI-Min IRI≧ 20μU/mL was designated as I-spike.

【Results】In Study 1, HRV was more predominantly dys-P type in the target group（63.4%）. In Study 2, of the spike type（9 cases）, 7 cases（77.8%） had a match between G-spike and I-spike.

【Discussion】In the early I-spike type, basal insulin secretion was insufficient, and after glucose loading, the initial additional secretion reacted excessively, resulting in postprandial hyperglycemia. In the late type of I-spike, the initial additional secretion did not occur sufficiently, and the late additional secretion reacted excessively. G-spike was 77.8% insulin dependent. Although the pancreatic parasympathetic responses of the subjects were insufficient, the pancreatic parasympathetic nerve was overreacted to the glucose load stimulus. As a result, insulin was excessively secreted to create G/I-spike. Dys-P type was seen in all cases, suggesting impaired insulin secretory function. Administration of LAB4 suppressed the sympathetic nerve activity of the pancreas, and as a result, the initial increase in blood glucose level immediately after glucose intake was suppressed（phase 1 suppression of postprandial hyperglycemia）. It also reduced the peak of late additional insulin secretion and suppressed hypoglycemia（improvement of phase 2）. After that, subject get to optimize the blood glucose level（Phase 3）. This is probably because in the phase 2, LAB4 acted on the hepatic sympathetic nerve to promote gluconeogenesis, and further acted on the pancreatic parasympathetic nerve suppresses the excessive secretion of insulin. In this way, Lactobacillus delbrueckii LAB4 is considered to have contributed to homeostasis（optimization; phase 3） of blood glucose level. The above effects were more pronounced in the glucomannan added LAB4 group than in the LAB4 group.

Patients with functional somatic syndromes（FSS） are seen in general practice medicine. However, the pathogenesis of FSS is complex, and single-discipline treatment is often ineffective. In order to solve complex problems, multiple disciplinarity is attempted. There are three types of approaches: multidisciplinary, interdisciplinary, and transdisciplinary. We have introduced the biopsychosocial- existential medical model（BPS-E model） to achieve a transdisciplinary approach in regional orthopedic practice. We believe this may contribute to the treatment of FSS or the prevention of the development of chronic disabling bodily distress （CDBD） and the reduction of chronic pain refugees.

Psychosocial stress is a risk factor for diabetes mellitus. On the other hand, persistent diabetes mellitus can cause symptoms of depression, and rapid blood glucose variability can induce psychiatric symptoms such as anxiety and irritability. We reviewed studies on the association between blood glucose variability and psychiatric symptoms reported in Japan and overseas, and extracted issues from the studies. In addition to diabetes being a risk factor in psychiatric symptoms, it has been suggested that hypoglycemia may also cause psychiatric symptoms. Results of 5-hour glucose tolerance test indicate that hypoglycemia and hypoglycemic symptoms may occur at a relatively high frequency even in healthy subjects. However, symptoms may not be explained by hypoglycemia alone. They may be related to changes in glycemic variability, insulin secretion, and autonomic nervous function. Although continuous glucose monitoring （CGM） is useful in examining the relationship between blood glucose variability in real life and psychiatric symptoms, there are few studies reporting a correlation between the results of 5-hour glucose tolerance test and continuous glucose monitoring, and psychiatric symptoms. It is, therefore, necessary to examine these associations in a large number of cases in the future to establish evidence.

The physical therapist（PT）specializing in musculoskeletal physical therapy traditionally applies a biomedical model to restore function in musculoskeletal disorders. However, patients with functional somatic syndrome（FSS）are seen in general orthopedic practice. Since single-discipline treatment of FSS is a challenge, a multiple disciplinarity approach is required. We have introduced a transdisciplinary approach, the biopsychosocial-existential medical model（BPS-E model）,as a clinical system in our hospital. The PT on this team aims to realize comprehensive treatment beyond the boundaries of specialty. Although this presents a challenge for the PT, it adds new purpose in the treatment of FSS, preventive medicine, and the relative health of patients, which will expand the possibilities of musculoskeletal physical therapy.

What types of consciousness do clinical psychotherapists encounter in the clinical setting in the face of patient’s agony? Viktor E. Frankl never takes “distress” negatively. “distress” leads people to a higher level of consciousness, and is positioned as a process in which each individual moves toward a unique existence value. In this paper, I discuss the state of consciousness as a psychotherapist and the attitude required to realize it, while looking back on my clinical experience and referring to the words of Viktor E. Frankl.

An important starting point for the psychotherapist in dealing with patient’s agony is to be aware that it belongs to the patient. In this paper, I attempt to express the processes through which the clinical psychotherapist begins the dialogue from the question of patient’s own agony and reaches recognition of the meaning of patient’s own distress. As a psychotherapist, I focus on the potential of the human psyche and continue to seek dialogues to realize patient’s own values.

I will imagine a dialog between Frankl and Fromm. Actually, they never engaged in a dialog: however, both had enough reasons to produce meaningful dialogs. Both were contemporaneous Jews, both fought bravely against the Nazis, and both were thinkers who sought to create a system of existential psychoanalysis from Freud’s psychoanalysis. They both thought that our fundamental desire was not libido but the desire for meaning, individuals wanting to realize meaningfulness in their lives. Frankl said, “We find meaning in life through a sincere effort to answer the questions that life throws at us.” Fromm said “The sense of responsibility is nothing but the voluntary consciousness that we have the ability to respond, so we surely respond that we want to.” Then Fromm pointed out, that a lively and abundant reproduction of response-relationships are just the spiritual task of today.