How Exercise Protects Blood Vessels From High Blood Sugar
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In this clip from Dr. Rhonda Patrick's appearance on The School of Greatness, she explains how sustained high glucose can promote advanced glycation end products. Glycation creates cross-links in long-lived proteins such as vascular and myocardial collagen, which can reduce tissue compliance over time and connect chronic metabolic exposure with cardiovascular aging. [1]
Exercise gives skeletal muscle another route for handling glucose. Muscle contraction moves GLUT4 transporters to the cell surface, while insulin sensitivity remains elevated after activity. These responses help explain why regular exercise improves glycemic control and why physically active muscle can dispose of glucose more effectively. [2]
Activity timing can add another benefit. A meta-analysis of eight crossover trials found that exercise after eating reduced post-meal glucose excursions more than exercise before eating or inactivity, with earlier post-meal activity generally producing a larger effect. Walking and brief muscle activity offer practical ways to interrupt sedentary time and support glucose handling. [3]
This clip is excerpted, with permission, from Dr. Rhonda Patrick's appearance on The School of Greatness. Thank you to The School of Greatness for allowing us to share it.
- ^ Aronson D (2003). Cross-linking of glycated collagen in the pathogenesis of arterial and myocardial stiffening of aging and diabetes. J Hypertens 21, 1.
- ^ Stephens FB; Tsintzas K (2018). Metabolic and molecular changes associated with the increased skeletal muscle insulin action 24-48 h after exercise in young and old humans. Biochem Soc Trans 46, 1.
- ^ Engeroff, Tobias; Groneberg, David A.; Wilke, Jan (2023). After Dinner Rest A While, After Supper Walk A Mile? A Systematic Review With Meta-analysis On The Acute Postprandial Glycemic Response To Exercise Before And After Meal Ingestion In Healthy Subjects And Patients With Impaired Glucose Tolerance Sports Medicine 53, 4.
Lewis Howes: Something I wanted to talk about, which you mentioned earlier, from lack of sleep to also high-intensity exercise or resistance training. And a lot of the talk that's been in the health world or just in the atmosphere lately has been about glucose spikes. When you lose sleep, what happens to your glucose spikes, I guess, in the body? And also when you're high-intensity training, What happens to your glucose levels?
Dr. Rhonda Patrick: Yeah. So it depends on, you know, what a person is referring to when, like, an average person is saying glucose spike. Probably, they're talking about postprandial, maybe, like, after a meal. And so when you are training, those spikes are not gonna be as high because, again, it goes down to what I already talked about.
Dr. Rhonda Patrick: As soon as you get glucose into your body, It's going— it's shuttled into your muscle because for 48 hours, those glucose transporters, they're called GLUT4 transporters, they are ready. They're like this— just like this big open, like, sink that's, like, taking it in, taking it in. And anyone can wear a continuous glucose monitor and see that, right? That happens. Now, you know, I would say the bigger concern isn't necessarily the spikes if you clear it properly.
Lewis Howes: Yeah.
Dr. Rhonda Patrick: The bigger concern is the long-term glucose where it's just constantly around because this goes back to the heart stiffening with age I talked about. So what happens is, is that when you have glucose that's continually around, let's say you're sedentary, you just never exercise.
Dr. Rhonda Patrick: So, you know, your muscles aren't that responsive to the glucose. It might be taken up into your adipose tissue instead. And of course, you're going to gain more fat that way. But also, it might just sit around longer. And so what happens when glucose sits around in your vascular system is it reacts with— it forms something called advanced glycation end products or AGEs. And they do age us, so it's easy to remember.
Lewis Howes: Oh, wow.
Dr. Rhonda Patrick: And these react with DNA, proteins, collagen in our body. And what they do, it's called— it's like the chemical reaction is called the Maillard reaction. And it cross-links collagen and stuff together. When it's collagen, collagen is there forever, right? So collagen's lining our blood vessels, it's lining our myocardium, our pericardium, right?
Dr. Rhonda Patrick: And when that collagen gets cross-linked, it gets stiff. It gets stiff.
Lewis Howes: Sure.
Dr. Rhonda Patrick: When it gets cross-linked in our vascular system, it gets stiff. That causes hypertension. It causes what's called vascular compliance to go down. And so you're basically stiffening your heart through glucose. And the way around that really—
Lewis Howes: Is that with sedentary, with being sedentary or with having too much sugar consistently?
Dr. Rhonda Patrick: Yeah, it's really— okay, being sedentary is really what's facilitating it in people. So diabetics have the worst of the worst because they have a hard time regulating their blood sugar. So they have the most advanced glycation end products. The most problems with this issue, unfortunately.
Lewis Howes: Does that mean when they eat processed or sugary foods, they have a high glucose spike, and then if they don't move, they can't process it better? Is that what it is?
Dr. Rhonda Patrick: They're not disposing of the glucose correctly, right? And, you know, it's—
Lewis Howes: And that consistently every day over years.
Dr. Rhonda Patrick: Every day adds up. It's cumulative, right? Exactly. So when you have a person that, let's say, is very physically active and they go eat a Twinkie, they're gonna get a little bit of glucose spike. It's not gonna be like the sedentary person that eats the Twinkie, right? Because they're, again, it's going right into their muscle. It's like this, like, you know, pipeline right to the muscle.
Lewis Howes: Boom.
Dr. Rhonda Patrick: So it really— exercise is really helping a lot with that.
Dr. Rhonda Patrick: And it's not like— if you're getting the spike, you know, everyone kind of spikes after a meal, but like if you do that— in fact, there's been studies showing that like doing those exercise snacks we were talking about, If you time them around meals, most of the studies have been done with people that have metabolic syndrome or type 2 diabetes. And they get these people to do, like, 30 minutes of exercise, like, before a meal, anywhere between, like, an hour or so before a meal or after a meal. And it really dramatically improves their glucose disposal.
Lewis Howes: Really?
Dr. Rhonda Patrick: So they're not getting that big spike.
Lewis Howes: Before and after?
Dr. Rhonda Patrick: You can do the exercise before or after, either, either or. It doesn't have to be both.
Lewis Howes: Wow.
Dr. Rhonda Patrick: But, yeah, so timing it around a meal also really— and again, it's the vigorous exercise that's the best. You always hear about, oh, you should go for a walk after a meal. Actually, the bodyweight squats or something that's really going to get, like, heart rate high, higher, is the lactate you want to generate because that's what's causing the glucose transporters to basically become, you know, able to take the glucose in. So that's where the vigorous comes in.
Lewis Howes: After a meal. So you enjoy a meal out with friends, you know you're going to eat poorly, you're having a celebration, you're eating desserts, you're having all the fats, all the things. When should you do this vigorous workout? Like right after you finish or like 30 minutes after?
Dr. Rhonda Patrick: You could do it 30 minutes after.
Dr. Rhonda Patrick: Like, I was in, you know, I was in Mallorca, Spain this last summer.
Lewis Howes: Living the dream.
Dr. Rhonda Patrick: And I don't know about you, but like anytime in Europe, Like gelato is just like everywhere.
Lewis Howes: Oh, everywhere.
Dr. Rhonda Patrick: 3 times a day. And I've got like a kid. It's like, yeah. I mean, like, and how could I not? So I was absolutely on the street doing air squats. I was doing bodyweight squats.
Lewis Howes: You're eating and squatting right in the same spot.
Dr. Rhonda Patrick: After the gelato. But like, yes, I do stuff like that where it's like, we were also walking a lot, but I did the body— like if it was like, I'm going to eat something that I never eat that's just really high in sugar, I'm going to get that— I'm going to do something.
Lewis Howes: How long are you doing it for? Are you doing like 10 minutes right then? Or are you doing like 2 minutes?
Dr. Rhonda Patrick: Oh, no. I mean, yeah, I was just doing like... 20 air squats. Right. And then I was continuing walking, so I was still getting that. But, you know, if it was someone that like I wasn't like on a vacation, but like, yeah, if you want to stop and do like 5 minutes of like bodyweight squats, it's hard. You do 5.
Lewis Howes: Sure. Nonstop, just 5 minutes?
Dr. Rhonda Patrick: Yeah. I mean, you'll rest like for like 20 seconds, like, but it's hard.
Lewis Howes: How much benefit would that actually give you? Let's say you have a bucket of ice cream. You know, you eat and then you have like 3 scoops of ice cream. You know, you have a lot of ice cream after you eat, big meal. You know, you're having cheese, you're having the breads, you're having everything. Then you got your ice cream. I mean, it's like a glucose spike, right? How much can just 5 minutes of air squats actually—
Dr. Rhonda Patrick: It's going to help a little, but that's a situation where you want to make sure you have gotten your 20 or 30-minute exercise in. Or even if you did it earlier in the day.
Lewis Howes: Right, because—
Dr. Rhonda Patrick: but add the extra 5 minutes on top of that. It'll really help. It does. Meal timing, like around the mealtime, a little extra helps. But, yeah, that's the case where if you're already physically active and you're doing— you do that extra— I like to do mine in the morning. It's just how I like. Even though I perform better performance-wise, if I go for a run in the afternoon, I'll be, like, faster, I still like the pump I get in the morning.
Lewis Howes: It feels good to get a complete workout.
Dr. Rhonda Patrick: It does.
Lewis Howes: It feels good to get it complete. You get tired later in the day sometimes.
Dr. Rhonda Patrick: It does, yeah. And then also, I was talking about that mental toughness. Like, when I lift in the morning and I do those, like, hard squats and stuff, other things are easier. I can do anything today.
Lewis Howes: Let's go.
Dr. Rhonda Patrick: But it's true. I mean, it's not anything. Yeah, it's still hard, but, like, it is a little easier. It really is. Like, I for sure know it.
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