So how do we do it?

First, include PROTEIN with each meal. A common dietary issue I've seen with insulin resistant/ Syndrome X patients is that they eat "junk meals" of carb and fat (e.g. pastry and apple juice for breakfast) with very little protein content. Not surprisingly, they're back at it come lunch time (e.g. giant pretzel with cheese sauce and a sugary cola).

You see, protein offers high satiety (fullness, satisfaction)(14, 22), moderates blood sugar swings/ insulin concentrations (14), and provides amino acids that, when combined with those moderate insulin levels can build muscle. It's kind of the opposite of the "Skinny Bastard Diet" proposed by Cy Willson. That diet was actually designed to reduce satiety and keep a rail-skinny guy with an ever-bottoming-out blood sugar to stimulate hunger.

Our next step designed to control insulin is to include 5-10 g soluble fiber with "non-exercise-related" meals. Fiber slows gastro-intestinal (GI) transit by forming a gel, binding glucose, and retarding certain enzymes like alpha amylase,(17) thus moderating blood glucose and insulin concentrations (7, 18)–all while reducing cholesterol (and some fat) absorption.(5, 8)

Chances are you're not getting the 11.5 grams of total fiber per 1000 kcal daily that's recommended for men. Oh, and the usual suggestion to go with straight carbs–possibly with insoluble fiber in post-exercise meals–apparently doesn't apply to pre-workout carbs. (Not that I usually eat carbs pre-workout anyhow, as they blunt fat oxidation.[2, 16]) There are data suggesting little effect when 14.5 g soluble fiber accompanies 75 g glucose prior to exercise.(18)

Third, eat medium-sized, frequent meals. This is a modification of the "small frequent meals" concept.(10, 21) Keep them coming all morning; it'll prevent compensation later in the evening hours when you're less active (barring evening workouts), less glucose tolerant and have less satiety to meals.(6)

Don't risk an unplanned "cheese puff cheat session" before bed! Limiting carbs to say, 50 grams per meal (depending upon body size) is a start. Multiply that times four morning meals that's still 200 grams of carbs by lunch time. Add-in 100 to 150 grams of glucose polymers (like those found in Surge) with maybe 5-10 g insoluble fiber (e.g. All Bran cereal, wheat bran hot cereal) in the two-hour post-workout period (the sooner the better) and you're up to 300 to 350 grams of carbs for the day.

Remember though, it's not just carbohydrate but total kcal load that matters to insulin production (and body fat mass), so keeping fat down during the morning is helpful while you're "dancing with Dr. Jekyll" (purposefully stimulating moderate insulin production with carbs, soluble fiber and protein).

Fourth, reduce total carbohydrate load in the evenings of the days you don't train, just in case. We experience reduced insulin secretion in the evening hours (which sounds good for fat reduction perhaps) but also hampered peripheral glucose uptake.(12, 24) Hampered muscle glucose uptake is not a good scenario for the physique–or performance–conscious.

Admittedly, it's hypothetical at this point whether muscle tissue is more hampered late-day than is fat tissue; the studies generally look at whole-body, systemic glucose tolerance. It's a reasonable assumption, however, because muscle is our primary site of carb (glucose) deposition. In any case, there are no direct data to my knowledge that diurnal carb timing significantly changes fat mass or muscle glycogen content in calorie-controlled, macronutrient-controlled, activity-controlled studies.

We just can't be sure that the surplus evening carbs are flooding into adipocytes. (I'd love to see carbohydrate load/ muscle biopsy/ magnetic resonance studies done 8:00 AM versus 8:00 PM to investigate the magnitude of muscle carb resistance at night.) So remember, we're just stacking the odds in our favor as much as possible to garner optimal nutrient partitioning. And of course we all realize that insulin and blood glucose are not the only regulators of body fat, right?

There is observational evidence, however, that tons of carbs at night are disadvantageous. Simply look at the average person who skips early meals and lives on coffee-only to pound back a huge pasta dinner at 8:00 PM, then some cookies or ice cream at 10:00 PM in a compensatory fit.

Despite an equal number of calories for the day, he's still pulling a physiological and psychological gun-in-the-mouth maneuver. Do you think he'll look the same while naked as a guy who carefully manages insulin levels (and glycogen content and hunger) with moderate carb-plus-protein intake all morning, during the more active hours of his day? Yo! Mr. Fatty McButter-pants! You're dropping the nutritional ball somewhere.

I believe there are benefits to heeding diurnal rhythms. No one needs excess evening blood glucose for health reasons and besides, why overeat carbs when muscles–our primary glucose recipient–are resistant? As physique athletes, we eat carbs to create full, anabolic, glycogen bristling, performance-ready muscles. Sedentary evenings don't appear conducive to this.

Fifth, consider reducing total carbohydrate load on days of head-to-toe crushing muscle soreness. Go back and read Muscle Masochism for more on this. Eccentric muscle "damage" and impaired muscle glucose uptake/ glycogen resynthesis is well established and may be one reason that chronically sore bodybuilders (unlike runners who aren't as chronically sore) complain that "carbs make them fat." That is, if carbs aren't entering muscle tissue readily, where are they being stored?

Adipose tissue is a real possibility. But again, we're just stacking those nutrient partitioning odds in our favor; don't over-consider this as a critical body fat-reducing move unless you have reason to believe you're carb intolerant (clinically or sub-clinically). Like so many biologically messy, free-living scenarios, we may never know for sure the impact of muscle microtrauma on body fatness.

Sixth... lift... and run! Muscle cells have both "GLUT 4" (insulin-stimulated) and GLUT-1 (non-insulin stimulated, basal state) glucose transporters. I was once at a keynote lecture on glucose metabolism where renowned researcher, Aaron Bonen, suggested moderate resistance training in addition to typical aerobic activity. The idea was to optimally stimulate expression/ activity of GLUT-1 transporters with weights.

According to his research team, faster FOG muscle fibers–the type common to bodybuilders–are associated with greater GLUT-1 content while slow twitch (oxidative phenotype) are associated with the GLUT-4 type.(11) Get them all working for you! Be patient, however: GLUT-1 transporters take longer to increase in response to training,(several weeks [19]), so stay consistent. And of course, many readers already realize that aerobic activity/ muscle contraction stimulates muscle-specific glucose uptake without the need for insulin – improving glucose tolerance.(9,20)

The take home message on exercise-carb interactions? Chronic exercise– any exercise– creates adaptations that improve your ability to dispose of dietary carbs in the right place. Acutely it helps, too. Whether you train before a meal and create a nice nutrient window in which you can indulge, or you train after a meal when muscle contractions take-up the resulting glucose (insulin secretion might even get blunted if you begin soon enough after the meal), you'll end up less fat than if you sit on your rump in "storage mode."

Sure, exercise gets a dieter closer to negative energy balance but there are clearly other mechanisms at work! Teach your body to send glucose where it belongs–to your muscles!

Wrapping Things Up: Getting Practical in the Kitchen

They're fast, they're easy, they might just make a ripped yet "full" man out of you yet! If you're a healthy T-man with no contraindications/ intolerances/ allergies, try these tried-and-true recipes that incorporate the above concepts!

Breakfast Recipe/ Example: Gluc-Oats

I love this stuff. After years of cold cereal and early morning scrambling to, uh, get some eggs scrambled, I found a way to still get my protein and carbs prepared and eaten in a flash. It's also amenable to adding a couple of tablespoons of ground flax.

Prep time: about 10 minutes

Eat 1/2 immediately upon waking, then 1/2 just before leaving for work, 30-60 min. later. (I repeat the whole process mid-morning.)

You get: about 60 g CHO, 15 g fiber (a whopping 13 g of which are soluble), 50 g PRO, 3 g fat before work (double these numbers if you can sneak the recipe in again mid-morning) AND moderated insulin levels throughout the morning, protein/ fiber-induced satiety, little caffeine interference with muscle glycogen re-synthesis,(23) and an antioxidant bonanza.(1,13)

Lunch Recipe/ Example: Fish Tacos

This recipe's name is an open target for any sick-minded T-man but I'll refrain from crass commentary. I created this meal out of desperation and utter jonesing for Rubio's Fish Tacos that I used to bulk-up on when I lived in San Diego.Ahh, Rubio's...

Prep time: about 20 minutes

Eat one stuffed soft taco with extra fish on side and 1/2 c. additional black beans (optional salsa), then eat the remainder of meal 60 min. later.

You get: about 55 g CHO (15 g fiber), 65 g PRO, 10 g fat AND moderated insulin levels throughout the afternoon (less food coma!), protein/ fiber-induced satiety, no caffeine interference with muscle glycogen re-synthesis, and another phytochemical bonanza.(1,4)

Dinner Recipe/ Example (Lower carbs, PM): Peanut Poultry

This one is ludicrously simple and I don't care! Time is admittedly less of an issue in the evening but if you're like me, you want to spend more of your time eating than cooking. Besides, it tastes great if you're into oriental peanut chicken stir-fry. (Get some sugar-free gelatin chilling in the fridge with some ice cubes to speed up the firming process and you'll have a nighttime snack later for dessert.)

Prep time: about 30 minutes

Eat half of everything, then wait 60 min., eat other half.

You get: about 32 g CHO (16 g is fiber), 84 g PRO, 60 g fat AND moderated calorie load throughout the evening, protein/fiber satiety at a time-of-day when you're at risk of an ice cream or Lucky Charms freak out, no caffeine interference with sleep or sugary drinks to jack blood glucose sky-high, plentiful monounsaturated fat to help your glucose tolerance, and yet another antioxidant/ phytochemical bonanza. (3,4,15)

In the famed words of Ferris Bueller... "You're still here? That's the end... go home...

References:

1. Adom, K., Liu, R. Antioxidant activity of grains. J Agric Food Chem. 2002 Oct 9;50(21):6182-7.

2. Ahlborg, G. and Felig, P. (1977). Substrate utilization during prolonged exercise preceded by ingestion of glucose. Am J Physiol 233(3): E188-E194.

3. Bonanome, A., et al. Evidence of postprandial absorption of olive oil phenols in humans. Nutr Metab Cardiovasc Dis 2000 Jun;10(3):111-20.

4. Chu, Y. et al. Antioxidant and antiproliferative activities of common vegetables. J Agric Food Chem. 2002 Nov 6;50(23):6910-6.

5. Davy B. and Melby, C. The effect of fiber-rich carbohydrates on features of Syndrome X. J Am Diet Assoc 2003 Jan;103(1):86-96..

6. deCastro, J. (1987). Circadian rhythms of the spontaneous meal pattern, macronutrient intake, and mood of humans. Physiol Behav 40(4): 437-446.

7. Giacco, R., et al. Dietary fibre in treatment of diabetes: myth or reality? Dig Liver Dis. 2002 Sep;34 Suppl 2:S140-4.

8. Hsiao-Ling Chen, et al. Mechanisms by which wheat bran and oat bran increase stool weight in humans. Am J Clin Nutr 1998;68:711–9.

9. Ivy, J. The insulin-like effect of muscle contraction. Exerc Sport Sci Rev 1987;15:29-51.

10. Jenkins, D., et al. (1989). Nibbling versus gorging: metabolic advantages of increased meal frequency. N Engl J Med 321(14): 929-934.

11. Johannsson, E., Effect of cross-reinnervation on the expression of GLUT-4 and GLUT-1 in slow and fast rat muscles. Am J Physiol. 1996 Jun;270(6 Pt 2):R1355-60.

12. JVerrillo A, De Teresa A, Martino C, et al. Differential roles of splanchnic and peripheral tissues in determining diurnal fluctuation of glucose tolerance. Am J Physiol 1989; 257(4 pt 1):E459.

13. Kay, C. and Holub, B. The effect of wild blueberry (Vaccinium angustifolium) consumption on postprandial serum antioxidant status in human subjects. Br J Nutr. 2002 Oct;88(4):389-98.

14. Layman, D., et al. (2003). A reduced ratio of dietary carbohydrate to protein improves body composition and blood lipid profiles during weight loss in adult women. J Nutr 133(2): 411-417.

15. Lauheranta, A., et al. Association of the fatty acid profile of serum lipids with glucose and insulin metabolism during 2 fat-modified diets in subjects with impaired glucose tolerance. Am J Clin Nutr. 2002 Aug;76(2):331-7.

16. Mick, T., et al. (2002). Comparison of sports drinks on substrate oxidation during exercise. (Abstr) CCF Dept Orthopaed Surg 12th Ann Res Day, Cleveland, Ohio, USA.

17. Ou, S. In vitro study of possible role of dietary fiber in lowering postprandial serum glucose. J Agric Food Chem. 2001 Feb;49(2):1026-9.

18. Parcell, A., et al. The effect of encapsulated soluble fiber on carohydrate metabolism during exercise. Int J Sport Nutr. 1999 Mar;9(1):13-23.

19. Phillips, S., et al. Increments in skeletal muscle GLUT-1 and GLUT-4 after endurance training in humans. Am J Physiol. 1996 Mar;270(3 Pt 1):E456-62.

20. Smutok, M., et al. (1994). Effects of exercise training modality on glucose tolerance in men with abnormal glucose regulation. Int J Sports Med 15(6): 283-289.

21. Speechly, D. and Buffenstein, R. (1999). Greater appetite control associated with an increased frequency of eating in lean males. Appetite 33(3): 285-297.

22. Stubbs, R., et al. (1996). Breakfasts high in protein, fat or carbohydrate: Effect on within-day appetite and energy balance. Eur J Clin Nutr 50(7): 409-417.

23. Thong, F. and Graham, T. (2002). Caffeine-induced impairment of glucose tolerance is abolished by beta-adrenergic receptor blockade in humans. J Appl Physiol 92(6):2347-2352.

24. Wu, M., et al. (1986). Diurnal variation of insulin clearance and sensitivity n normal man. Prc Natl Sci Counc Repub China B 10(1): 64-69.