UNIVERSITY Health Glucose Management Lesson Overview • • • • • • • • • • • What is Insulin resistance and inflammation? Why does it matter to us? PED effect on Insulin resistance and inflammation How we test for insulin resistance? What we about poor markers of blood glucose? Sleep and Stress Nutrition culprits and strategies AAS, GH, Insulin Metformin vs Berberine Other Supplement Aids Practical Summary What is Insulin Sensitivity vs Resistance In bodybuilding the term insulin sensitivity is a buzz word that is overused and lacks clear definition and application Insulin resistance: Decreased tissue sensitivity or responsiveness to insulin What is the issue with Insulin Resistance? Insulin resistance first develops in target tissues and there is a compensatory increase in insulin to manage blood glucose (normal blood glucose, high serum insulin) This can progress to decline in pancreatic beta cell function and decreased insulin secretion and subsequential hyperglycemia and glucotoxicity Decreased adipocyte insulin sensitivity leads to lipolysis and elevated serum fatty acids, leading to increased hepatic glucose production This can cause major adverse health outcomes such as type diabetes, cardiovascular disease, dyslipidemia, chronic kidney disease and cancer One mechanism behind this is potentially low-grade chronic inflammation.1 Inflammation and Insulin Resistance • • • • • Chronic Inflammation associated with body fat and weight gain (2) High chronic inflammation lead to muscle mass loss (3) After 20% body fat (30% females), with visceral fat accumulation, IL-6 and CRP Levels increase Visceral fat releases much larger cytokines than Sub Q body fat and related to muscle mass loss (3) This may impede inflammatory muscle growth signaling Rises in Autocrine and Paracrine cytokines local within muscle increases hypertrophy (4) Why does this matter for us? • Steroid users current and former display lower insulin sensitivity via increases in visceral adipose tissues and total body fat % (5) • Multivariate adjustment identified VAT as independent predictor of differences in insulin sensitivity, between current AAS abusers and control participants, even though current AAS abusers displayed lower body fat % • Elevated CRP levels, with low grade inflammation • Visceral fat increases increases inflammation and decreases insulin sensitivity Issues may occur at lower body fat % than natural athletes • You may notice swelling, joint pain, lethargy, poor digestion, decreased appetite • Higher risk for morbidity and mortality • Potential decrease in muscle hypertrophy response How we test for Insulin Resistance? Lab test Reference range Interpretation and Optimal Fasting serum Glucose Normal: 70 – 99 mg/dl or 3.9 – 5.5 mmol/l Prediabetes: 100 – 125 mg/dl or 5.6 – 6.5 mmol/l Diabetes: Greater than 126 mg/dl or mmol/l on more than one test sample Most be fasted only water Poor sleep prior can elevate No GH prior to test May give insight into adrenal issues Optimal 7585mg/dL HgbA1c Normal: Less than 5.7% Prediabetes: 5.7% to 6.4% Diabetes: greater than 6.5% Average blood glucose over months, screens for DM Fasting Serum Insulin to 20 mIU/mL Optimal 3g per day increase d oxidatio n n/a Stimulate glucose uptake in muscle via AMPk 300-600mg per day Ceylan Cinnamon Inhibit digestive enzymes, methylhydroxy chalcone polymer acts as insulin mimetic Contains other bioactive flavonoids Toxic in high dosages Ceylon is lower in coumarin (toxin) compared to cassia No evidence 1-6g per day with meals Overview of Practical Application Year Round Any Phase Monitor fasting BG 1-3x per week Quality sleep practices, address sleep apnea Stress management Variety of Fruity and Veggies, Mixed fiber intake, omega 3s Limit large cheat meals Curcumin/ALA/Cinnamon Keep NEAT high, walking after meals Mass/Blast phase Limit Body fat gain 15% male, 24% female Minimum 3-5 days moderate intensity cardio Limit oral AAS Early initiation of Slow Active insulin (Lantus) Further BG coverage at meals with Fast insulin (Humalog, etc) Metformin and/or Berberine in combination (Limit Metformin to 500mg) Sensitization Phase Food reduction to maintenance level Shift carbohydrate to protein/fats Reduce total AAS load and GH