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Diabetes, weight training and post-workout nutrition
A friend of mine has made tremendous progress lowering his weight in order to control his type 2 diabetes better. I recently gave him reading recommendations such as New Rules of Lifting and The Metabolism Advantage, and he has concerns with the recommendations of post-workout carb meals and drinks (such as Surge).
I thought I'd see if anyone here has any comments.
My friend says:
First, I've been controlling my blood sugar through diet (low-carb) and have managed to get my A1c score to 5.7 without drugs (5.7 is in the non-diabetic range and I expect it to go lower with more consistent exercise). I know from prior experience that foods like oatmeal and oranges make my blood sugar really spike (a healthy range is 80-130, 1 hour after one serving of oatmeal has seen me as high as 240. I'm concerned with that much of a blood sugar spike with foods like that and really concerned with simple sugar recovery drinks like Surge.
Second, I also know from experience that slow exercise (moderately paced walking with some hills) for an hour will reduce my blood sugar but faster paced jogging/intervals tend to raise it a little. I'd like to know if anyone has experience with diabetics and this plan to see how much the more intense exercise plus post-workout (relatively) high carb intake impacts blood sugar spikes.
A friend of mine has made tremendous progress lowering his weight in order to control his type 2 diabetes better. I recently gave him reading recommendations such as New Rules of Lifting and The Metabolism Advantage, and he has concerns with the recommendations of post-workout carb meals and drinks (such as Surge).
I thought I'd see if anyone here has any comments.
My friend says:
First, I've been controlling my blood sugar through diet (low-carb) and have managed to get my A1c score to 5.7 without drugs (5.7 is in the non-diabetic range and I expect it to go lower with more consistent exercise). I know from prior experience that foods like oatmeal and oranges make my blood sugar really spike (a healthy range is 80-130, 1 hour after one serving of oatmeal has seen me as high as 240. I'm concerned with that much of a blood sugar spike with foods like that and really concerned with simple sugar recovery drinks like Surge.
Second, I also know from experience that slow exercise (moderately paced walking with some hills) for an hour will reduce my blood sugar but faster paced jogging/intervals tend to raise it a little. I'd like to know if anyone has experience with diabetics and this plan to see how much the more intense exercise plus post-workout (relatively) high carb intake impacts blood sugar spikes.
Dextrose or the like within sports recovery drinks isn't critical to have postworkout unless you've trained for an extended period in an overnight fasted state minus a preworkout meal. I'd stay conservative about your total amounts of carb in a single swoop, based on your personal history & individual response.
I am pre-diabetic with complications, retinopathy(perhaps from my days before low carbing). I control, not very good, totally by diet. Never have highs, but likewise very few normal readings. I have an appt up at UW in Seattle for later this spring.
I do have 10-12 carbs from Dove candy before I work out, otherwise some lightheadedness, nausea, bonking. My PWO is whatever low carb protein powder I buy, currently from Costco, about 7 grams carb per 45 gram protein.
In a recent research article, diabetics did the best by incorporating both resistance and aerobic activity, so your friend defininitely should do both. It wouldn't shock one to see a little rise in the blood sugar in response to intense exercise, since stress hormones such as cortisol may be activated. This would be off set by the benefits of the metabolism being boosted in the longer term and the calories being burned off and the cardiovascular benefits of intense aerobic exercise. What to do about post-workout carbs is a tougher question that I don't fully know the answer. The most simple answer, given that his A1C is so good would be to rearrange his current diet to put some carbs before and after exercise. Although, in theory, we don't want wild fluctuations in the blood sugar, in real life we don't know that an A1C with fluctuations is any worse than the same A1C with stable numbers. Given that the A1C is a test of the blood sugars over 3 months he'll have to do some experimenting and watch and wait a while for an answer. I'd be very interested in any follow-up you can give us.
NMR studies of muscle glycogen synthesis in insulin-resistant offspring of parents with non-insulin-dependent diabetes mellitus immediately after glycogen-depleting exercise.
To examine the impact of insulin resistance on the insulin-dependent and insulin-independent portions of muscle glycogen synthesis during recovery from exercise, we studied eight young, lean, normoglycemic insulin-resistant (IR) offspring of individuals with non-insulin-dependent diabetes mellitus and eight age-weight matched control (CON) subjects after plantar flexion exercise that lowered muscle glycogen to approximately 25% of resting concentration. After approximately 20 min of exercise, intramuscular glucose 6-phosphate and glycogen were simultaneously monitored with 31P and 13C NMR spectroscopies. The postexercise rate of glycogen resynthesis was nonlinear. Glycogen synthesis rates during the initial insulin independent portion (0-1 hr of recovery) were similar in the two groups (IR, 15.5 +/- 1.3 mM/hr and CON, 15.8 +/- 1.7 mM/hr); however, over the next 4 hr, insulin-dependent glycogen synthesis was significantly reduced in the IR group [IR, 0.1 +/- 0.5 mM/hr and CON, 2.9 +/- 0.2 mM/hr; (P < or = 0.001)]. After exercise there was an initial rise in glucose 6-phosphate concentrations that returned to baseline after the first hour of recovery in both groups. In summary, we found that following muscle glycogen-depleting exercise, IR offspring of parents with non-insulin-dependent diabetes mellitus had (i) normal rates of muscle glycogen synthesis during the insulin-independent phase of recovery from exercise and (ii) severely diminished rates of muscle glycogen synthesis during the subsequent recovery period (2-5 hr), which has previously been shown to be insulin-dependent in normal CON subjects. These data provide evidence that exercise and insulin stimulate muscle glycogen synthesis in humans by different mechanisms and that in the IR subjects the early response to stimulation by exercise is normal.
Effects of a glucose polymer sports drink on blood glucose, insulin, and performance in subjects with diabetes.
Regular exercise has long been recognized as a cornerstone of diabetes management along with diet and medication. The purpose of this study was to determine the effects of a glucose polymer sports drink (GPSD) on blood glucose and electrolyte levels in persons with type I or type II diabetes. Twenty-five subjects controlled with insulin were randomized in a double-blind, two-period, crossover design study. Blood glucose and electrolyte levels were measured at intervals during a 60-minute, submaximal treadmill test and for 60 minutes postexercise. Wide variations in blood glucose levels within and between subjects hindered statistical analysis. However, a significant difference in mean blood glucose levels was determined, with overall blood glucose levels higher in the GPSD group compared with placebo. The use of the GPSD also prevented the onset of postexercise hypoglycemia and did not cause or contribute to hyperglycemia.
From what I gather from these mere 2 studies, he could get a recovery drink or get a nice higher carb meal immediately after the workout to replenish glycogen stores but get on his normal diet after that. The underlined and not bolded text suggests that mileage may vary though. There's nothing like trying it.
From what I gather from these mere 2 studies, he could get a recovery drink or get a nice higher carb meal immediately after the workout to replenish glycogen stores but get on his normal diet after that. The underlined and not bolded text suggests that mileage may vary though. There's nothing like trying it.
As per the question of the OP, we still need to know the type and duration of exercise in question, not to mention preworkout feeding protocol.
Andrew - The studies you listed were done on subjects who were overnight-fasted minus a preworkout meal, as is typical to control the confounding variables. The reality of the matter remains that preworkout CHO eliminates the urgency of speedy of postworkout CHO, unless we're talking about a 2+ hour continuous endurance bout wherein midworkout and immediate postworkout CHO would benefit. Otherwise, given the conditions of compromised glucose control, a gradual upward titration of carb dose could be employed, starting from a low amount. This way, the threshold of diminishing or risky returns can be pinpointed.
Which type of diabetes plays a big role. If you have type 2 diabetes you need to keep a form of simple sugar with you at all times during and post workout. You do not however want to overdrive your kidney's so go easy on the protein, only take in what you need.
Best method and the one I recommend is to do a 2:1 Ratio broken down between simple/complex carbs and quality protein.
It could look like this.
20 grams of brown rice
20 grams of honey
20 grams of lean chicken breast
Making it a 2:1 Carb/Protein ratio, supplying the simple sugar for re-feed for circulation and a complex and protein for repair.
As per the question of the OP, we still need to know the type and duration of exercise in question, not to mention preworkout feeding protocol.
Andrew - The studies you listed were done on subjects who were overnight-fasted minus a preworkout meal, as is typical to control the confounding variables. The reality of the matter remains that preworkout CHO eliminates the urgency of speedy of postworkout CHO, unless we're talking about a 2+ hour continuous endurance bout wherein midworkout and immediate postworkout CHO would benefit. Otherwise, given the conditions of compromised glucose control, a gradual upward titration of carb dose could be employed, starting from a low amount. This way, the threshold of diminishing or risky returns can be pinpointed.
Yeah, well, although there are some limits to those studies, hey're the only ones that I've seen which studied the effect of PWO drink. But I agree with you : trial and error, while monitoring blood glucose.
I'm the person being discussed in this thread. I'd like to thank all of you who have responded. The responses have been very informative and make me feel quite a bit better about moving forward with this plan. As a quick update, we went to the gym last Wednesday for a workout but it was more of an introduction the gym than a serious effort. I kept track of my BG for the day, here's how things went:
Fasting BG when I got up was 116
Had a bowl (about 1.5 servings) of Special K Protein Plus and a couple of left over chicken thighs.
We did about a 30-45 minute weight lifting session, mostly lower body, but like I said it wasn't seriously strenous. Followed that with 15 minutes of interval cardio on the treadmill (walking, very light jog at incline).
Drank a 16oz berry smoothie (the muscle builder kind you get in a gym) when I left.
About 2 hours later, just prior to lunch, my BG was 63. This, for me, is pretty low.
Had fish tacos for lunch with black beans
Prior to dinner that night, BG was back to normal
Night time BG was also normal, around 115-ish.
I'm starting at the gym this Monday with a personal trainer. I plan on keeping a close eye on how my BG reacts to exercise and to the post-workout carb intake.
At this point, given the responses from you all and last Wednesday, I'd say things are looking favorable. I hope to be a former fat guy very soon.
I can't comment too much on your particular dietary needs because I have only the most superficial knowledge of diabetes. What range does your BG need to stay within?
Quote:
We did about a 30-45 minute weight lifting session, mostly lower body, but like I said it wasn't seriously strenous. Followed that with 15 minutes of interval cardio on the treadmill (walking, very light jog at incline).
Drank a 16oz berry smoothie (the muscle builder kind you get in a gym) when I left.
The only comment I could make here is that you can save money by getting the components for a whey drink and make it yourself. That would be whey (any flavor you like) and milk or water. The dex and maltodextrin is something you'd have to research as to whether it is ok for you and how great the effect on your BG.
Quote:
About 2 hours later, just prior to lunch, my BG was 63. This, for me, is pretty low.
Had fish tacos for lunch with black beans
Prior to dinner that night, BG was back to normal
Night time BG was also normal, around 115-ish.
Do you like oatmeal? Boil it up in pureed fruit/berries it's pretty good.
I can't comment too much on your particular dietary needs because I have only the most superficial knowledge of diabetes. What range does your BG need to stay within?
A normal person would usually wake up 75-85. After a meal they would briefly go up, maybe as high as 120, but often not. Within 90 minutes they will be back to 85 or so.
There is a contentious argument on what a pre(diabetic) should aim for. Right now FBG under 100 is considered normal. 'diabetic' is readings over 120. Some in the field consider anything over FGB 90 as unacceptable. They are in a minority, but many of us, me included, think the lower readings are the correct ones.
Regina W's blog, Weight of the Evidence is really good on this, and has a lot of great links - except for people who think pre/diabetic diagnosed people won't benefit by normal blood glucose readings.
I thought I'd post an update to anyone interested. I've been working out for just under two weeks (weight lifting and interval cardio). I've been consuming half a serving of Surge, half of that during the weight lifting, the other half during the cardio. I work out in the morning so I'm getting up, testing my blood, eating breakfast (usually eggs and/or low-carb cereal), then exercising. My blood sugar readings have been (roughly):
fasting BG: 95
post-workout: 150
pre-lunch (~3hours later): 95
I'm assuming this means things are happening as expected. I'm working the muscles, giving them simple sugars which are being absorbed fairly quickly.
I tried a full serving of Surge on one day and my BG was almost 200 post-workout so I'm sticking to half a serving for now.
If your interested, I'll post another update in a couple of months after my next doctor checkup to see how my A1c is affected.
Hope that this means that your are feeling OK also. Your blood sugar numbers look good. For people with more normal metabolism, more carbs are recommended before lifting with the thinking that the carbs are helpful to help fuel the workout. That would be an interesting experiment to try. Add another 10grams of carbs about 30 min before a workout and see if you feel better and how this effects how you perform and how your blood sugars behave. Just a thought. Congratulations on your success thus far.
rj - you might want to read Bernstein's book, Diabetes Solution, be sure and get the 2007 version. He advocates very strict control. One thing he does not do well is address what to do if you are pre-diabetic, which you numbers seem to indicate. From what I am reading any time spent above 140 is damage being done to your general system. All of this is controversial, but I am persuaded that if you want to stay healthy stay below 140.
It's nice to hear that my numbers sound as though they're pre-diabetic. I was diagnosed in February of 06. I've managed my #'s down to where they are by eating low-carb and doing a lot of moderate treadmill work (slow but long does great for reducing BG). I've lost about 35 lbs but haven't moved any farther than that so I'm trying this approach to get more weight off.
I'm working out in the morning so I was already trying the experiment drs suggested by adding a few carbs to my breakfast prior to a workout. So far, so good. I'll ask my doctor about brief periods above 140 to see if I should avoid it. I think I could avoid those #'s if I skip using the Surge during/post workout but I wonder if doing that would increase my recovery time.
Diabetes, weight training and post-workout nutrition
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