Intolerable - Part 2

How to Repair Glucose Intolerance, Part 2

In the first part of this article, we attempted to tease apart the intolerable confusion surrounding a hormone that can be both our enemy and ally: insulin. Sure, it builds muscle and fat indiscriminately but there are ways to control the beast!

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.

– Nuke 1 c. uncooked oat bran in water ~4 min. (I sometimes substitute Quaker Multi-grain hot cereal–rye, barley, oats, wheat).

– Add 1/2 c. frozen berries (provides instant cooling so you can eat immediately, get to work on time AND prevent risk of denaturing the peptides in the protein powder)

– And 1-2 scoops protein powder such as Grow!

– Limit java to one 12 oz. cup or drink green tea

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...

– Pan fry 8 oz. thawed fish (e.g. Pollock) in Pam for about 8 minutes (just until white throughout) the prior night

– At lunch: Place 2 oz fish in each (of two) corn tortillas; to each add:

– 1 Tbsp raw cabbage (optional red pepper slices)

– 1 Tbsp. Black beans

– 1 Tbsp. Guacamole

– Squirt with lime juice (Essential!)

– Drink with water or tea

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.)

– Cut 2 thawed skinless boneless chicken breasts into 1 in.x 2 in. cubes (works well with dedicated scissors)

– Use just enough olive oil to coat base of pan (perhaps 2 Tbsp)

– Pan fry about 8 minutes

– When no longer pink, add 4 Tbsp natural crunchy peanut butter (soy sauce and ginger optional), stir

– Cook another 3 minutes or so

– Meanwhile, nuke 1-2 c. frozen broccoli in 1 c. water (~8 min) as a side dish

– Sprinkle broccoli with shredded cheddar-mozzarella blend if desired

– Drink unsweetened beverage ad libitum

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...


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