How Vigorous Exercise Supports Glucose Control and Heart Health

Dr. Rhonda Patrick: But the other metabolic effects that are, I, I think are also important, and again, not black and white, um, is that if you are doing more of a vigorous type of exercise, going to, going again to lactate being a signaling molecule, lactate signals to your muscle to get more glucose in it, right? Because your muscles are using so much glucose that your body's going, I gotta get more of this in here so that I can keep making energy. And so what it does is it increases the production. It's actually what it does, it increases the translocation of what are called GLUT4 transporters, GLUT4. transporters, which are just below the surface of the muscle, and lactate causes them to go up to the cell surface and kind of— it opens up the floodgates for glucose to come in, right?

Rich Roll: Mm-hmm.

Dr. Rhonda Patrick: And this is really, really beneficial because it is a way of getting glucose out of your circulation, bringing it to your muscle where you want it, right? So the elevations in your GLUT4 transporters last for like 48 hours. And it's why there have been studies that have come out recently showing that you can do 10 bodyweight squats, 10 bodyweight squats every 45 minutes throughout about an 8-hour workday, and that'll improve your blood glucose regulation better than a 30-minute walk.

Rich Roll: Wow.

Dr. Rhonda Patrick: And I timed myself—

Rich Roll: Is that why you were just doing those before we started the podcast?

Dr. Rhonda Patrick: I was doing it for the brain.

Rich Roll: Yeah, okay.

Dr. Rhonda Patrick: But again, so the more vigorous the intensity of the exercise, the more improved glucose regulation you are going to have. And that is absolutely time and time again proven.

So you will improve your glucose regulation by doing more vigorous types of exercise, again through lactate, which is that signaling molecule. And it's really important to realize, we talked about the heart, the aging heart, how it gets stiffer and smaller with age. Well, the stiffness of the heart is actually partly caused by glucose in the vascular system. The longer you have glucose sitting around in your vascular system, it reacts with proteins, um, it reacts with DNA, lipids, but specifically it reacts with proteins, including collagen. And through what's called the Maillard reaction, it forms something called advanced glycation end products, or AGEs for short. And these things, they basically cause your proteins to become stiff, and they, and they, and they last.

Like, if you're talking about collagen, collagen in your vascular system or in your myocardium, for example, your pericardium has collagen.

Rich Roll: Mm-hmm.

Dr. Rhonda Patrick: Um, it gets stiff as, you know, as these advanced glycation end products form, and it's all a byproduct of glucose being around for too long. So, people with type 2 diabetes, for example, have, you know, problems, stiffness of the blood vessels, they, you know, get cardiovascular disease sooner, all sorts of problems. And so, I think one of the reasons that exercise plays an important role in de-stiffening the heart or preventing the stiffness of the heart is because of the just enormous improvement in glucose regulation that you're getting from exercise.

And it's not that you're not getting glucose improvements from doing, like, zone 2, you absolutely are, for sure, especially, like, now, if you're comparing, again, 20 minutes to 20 minutes, you're going to get better glucose regulation with more vigorous-intensity exercise. But, you know, generally speaking, any type of cardiovascular exercise is going to improve glucose regulation. However, the more vigorous the intensity, the better the improvement, and that is because lactate increases— is the signal. That's increasing those glucose transporters to come up to your muscle and bring in more glucose.

Rich Roll: I'm trying to understand the distinction between taking that glucose that's sitting around and putting it to work and the impact that that has on, you know, not stiffening up the heart, as you described, because you're deploying it, you're making use of it, right? But your ability to regulate glucose is a different thing, right? Like, those are 2 different things. So, what is— glucose regulation, you know, that gets modulated or improved as a result of the high-intensity exercise? I mean, there's— that doesn't happen with endurance or strength training.

Dr. Rhonda Patrick: I don't know that there is something that doesn't happen with other endurance training. I just think it's a more robust effect, if that makes more sense.

Rich Roll: Okay, sure.

Dr. Rhonda Patrick: And there's a lot of different things that are happening, but I'd say one of the main things is the disposal of glucose, getting rid of it, right? And that's going into muscle rather than adipose tissue. where when it's stored in adipose tissue, that's not a good thing either, right? So you want it to go to your muscle. And so really the regulatory role I'm talking about here is like disposal, like getting rid of it through muscle, right? So it's not sitting around in your vascular system for a longer period of time, but there's so many different aspects of glucose regulation.

Rich Roll: Right, I guess what I'm getting at is more like, okay, so you're, yes, you're making use of it, you're putting it to work, you have these receptors on the cells that are able to kind of take the glucose in.

But on some level, like, metabolic health or glucose regulation is a function of pancreatic health, right? Like, how sensitive are you to insulin, and how functional is that aspect of metabolic health kind of, like, working? So, does exercise have an impact, like, impact on the insulin sensitivity aspect of it as well?

Dr. Rhonda Patrick: Yes, yes, yes, yes. Okay. It's affecting so many different areas of, you know, insulin sensitivity, glucose regulation, with respect to the transporters bringing it into muscle. You know, there's a lot of different things that are going on with exercise. Again, it's not like this one thing only. It's many, many things. But the transport, getting that glucose into muscle, is a big— it's like a sink.

It's like a big— it's a big reason why exercise does improve, you know, your blood glucose levels in general, right? It lowers the long-term marker of glucose, HbA1c. But the thing about HbA1c is, you know, it's a long-term marker of blood glucose, it's, you know, what, 120 days or so, I think is what it is. It's how long your blood cells turn over. But you have to realize, you know, the collagen that's inside of your vascular system that's lining your myocardium and your pericardium, like that's there forever, right?

Rich Roll: Mm-hmm.

Dr. Rhonda Patrick: And so, when you have glucose reacting with that collagen, we're talking about a long-term effect that's forever. It's contributing to the chronic insidious type of stiffening of the collagen surrounding your heart and also in your vascular system.

So, it's playing a role in hypertension, but also in the— the stiffening of the heart, you know, through the myocardium and pericardium.

Rich Roll: Right, right, right, interesting.

Dr. Rhonda Patrick: Yeah, it is, it really is. I think one of the big reasons why exercise is so important for cardiovascular health also comes down to basically just glucose disposal, getting that glucose out of your vascular system. You know, there's another thing I wanted to mention that comes down to sleep, and, you know, not getting enough sleep also changes a lot of the glucose regulatory system, including insulin sensitivity, including glucose disposal, so going, you know, all those things we just talked about.

And what's interesting is that doing high-intensity interval training can really ameliorate most of those negative effects from not getting enough sleep in terms of like glucose and how it's like your glucose isn't being regulated. And that's something that I learned firsthand by wearing a continuous glucose monitor while I was a new mom and not getting sleep.

Rich Roll: Yeah.

Dr. Rhonda Patrick: The first year I was a new mom. I mean, it was like, I was appalled by what was happening to my glucose. Like, the first month, I would say, when I wasn't exercising, I was like in a cave, you know? And my blood glucose levels were looking pre-diabetic. I mean, it was like really crazy, 'cause I was eating healthy, you know? I wasn't eating a bunch of processed foods.

I wasn't eating a lot of highly refined sugars or anything like that. And that's what sort of instigated me to sort of look into the literature and go, what is going on? If you're getting fragmented sleep, how is it causing diabetes? And sure enough, there's a study, after study after study. I mean, just endless data out there showing that it does. And then I came across some studies. What I started to do was spin class and noticed that it was totally better. Like, my— it lasted about 48 hours, so I'd have to do a spin class like every 48 hours.

Rich Roll: The poor sleep remaining constant?

Dr. Rhonda Patrick: The poor sleep was constant. I mean, you have to feed your baby. You're a mom with a baby.

Rich Roll: Yeah.

Dr. Rhonda Patrick: But the high-intensity interval training, I mean—

Rich Roll: It buffered it.

Dr. Rhonda Patrick: It really buffered it. It really did buffer it.

And then, sure enough, you look in the literature and there's a few studies showing the same thing. And I do think it comes down to that. Again, it's increasing those glucose transporters, which are just, when you have a really high density of those on your muscle, it's like just having the sink open. So, the blood glucose goes into your vascular system and the sink's there and it just goes into it. And it's pretty sensitive for, like I said, about 48 hours. The first 24 hours are the most, sensitive, but it's very important. It's very important. Exercise is important to do, you know, even, even when you're not feeling like it, is the bottom line.