Meal Frequency: Managing Insulin Resistance in Pre-Diabetes

Q: Meal Frequency: Managing Insulin Resistance in Pre-Diabetes

Dear Mr. <br>Ah Xiang： The term "small frequent meals" is often mentioned in daily life; however, it has never been precisely defined, making it easy to misuse. <br>For instance, what constitutes a small amount? What is the glycemic index (GI) of the food? What is the glycemic lo

Regarding small frequent meals for diabetes?

Hello Doctor, I have been concerned about the term "frequent small meals." In the past, doctors and news reports often mentioned that frequent small meals help control insulin secretion and food intake.
However, I have recently come across new perspectives stating that "a normal meal takes about 6 hours to fully digest and metabolize.
If you eat frequently, it means one wave of digestion hasn't finished before another begins, which can easily lead to insulin resistance, abnormal glucose tolerance, and hyperlipidemia."
I am a prediabetic patient with slightly elevated blood sugar levels.
I maintain strength training and aerobic exercise 5 to 7 times a week, with each session lasting at least 30 to 60 minutes.
I also control my diet in terms of portion size and types of food (low GI).
However, I have the following concerns:
1.
Regarding the insulin issue mentioned above, under the conditions of regular timing, portion control, and exercise, could frequent small meals actually lead to insulin resistance?
2.
Assuming I have sufficient exercise, does eating after a workout count as a form of frequent small meals? For example, after strength training, I drink soy milk, milk with a banana, or sweet potato.

3.
If I start exercising 1 to 2 hours after a meal, and then eat again after an hour of exercise (which would be 3 hours after the meal), could this repeated insulin secretion pose the same issues as mentioned in question 1, potentially being detrimental?
These questions have been troubling me for a long time, and I would like to seek your clarification!

Axiang, 20~29 year old female. Ask Date: 2016/07/09

Dr. Xiao Yongxun reply Internal Medicine

Dear Mr.
Ah Xiang: The term "small frequent meals" is often mentioned in daily life; however, it has never been precisely defined, making it easy to misuse.
For instance, what constitutes a small amount? What is the glycemic index (GI) of the food? What is the glycemic load (GL)? What food additives are present? What are the fat and protein content and characteristics of the food? How many meals define "frequent"? In fact, there are many questions that remain to be discussed.
I can only tell you that the total amount of food and its content should be particularly noted; avoid excess, and do not consume overly refined or highly processed foods.
1.
"Regarding the insulin issue mentioned above, under conditions of guaranteed timing, quantity, and exercise, could small frequent meals actually lead to insulin resistance?" Previously, medicine only believed that elevated blood sugar would increase insulin secretion; later research revealed that after eating, food stimulates the secretion of various incretins in the gastrointestinal tract, which in turn stimulates a significant release of insulin.
Insulin not only enhances the body's cells' utilization of blood sugar but also promotes the conversion of carbohydrates and amino acids into fat.
When the body does not adequately utilize glucose or stores too much fat and calories, insulin resistance can emerge.
If each portion in "frequent meals" is too large, combined with the previous meal not yet being metabolized, it theoretically could lead to insulin receptor resistance.
2.
"If the exercise volume is sufficient, does eating after exercise count as a form of small frequent meals? For instance, after weight training, I drink soy milk, milk, or eat a banana or sweet potato?" Regular exercise indeed contributes significantly to improving insulin resistance; however, medical knowledge suggests that this contribution is about 20-30%.
Dietary contribution accounts for about 30-40%, with the rest related to genetics or environment.
My point is that regular exercise is crucial, but dietary control and lifestyle adjustments must also be carefully considered.
Therefore, does eating after exercise count as small frequent meals? I still believe that the total amount and calories of food should not exceed what the body can metabolize, which is the most important factor.
3.
"If I start exercising 1 to 2 hours after a meal and exercise for an hour, is it equivalent to eating again 3 hours after the meal? Would the repeated secretion of insulin be detrimental like in question 1?" Actually, there is no definitive answer; it depends on your exercise volume and intensity, as well as the energy expended.
Additionally, is the total daily caloric intake already sufficient? However, if every exercise or meal is meticulously calculated, it truly contradicts the common sense of living and can increase life's burdens and stress; I believe this is unnecessary for the average person.
If three meals are already appropriately portioned and regular, after exercising, it is sufficient to replenish fluids at a moderate pace and amount.
In cases like military training or athletes, electrolyte replenishment may be necessary; please use your discretion in your situation.
However, if commercially available sports drinks are too salty or sweet, consider diluting them.
I suggest discussing your questions further with your family physician or nutritionist; if necessary, consult with a sports medicine expert.
Here, I can only provide a rough outline.

Reply Date: 2016/07/09

More Info

Managing insulin resistance, particularly in the context of pre-diabetes, is a multifaceted approach that involves understanding meal frequency, dietary choices, and physical activity. Your concerns about the concept of "small frequent meals" versus traditional meal patterns are valid and reflect a growing body of research that examines how meal timing and frequency can impact metabolic health.

1. Small Frequent Meals and Insulin Resistance: The traditional advice of eating small, frequent meals was based on the idea that this could help regulate blood sugar levels and insulin secretion. However, recent studies suggest that for some individuals, particularly those with insulin resistance or pre-diabetes, this approach may not be beneficial. When meals are consumed too frequently, it can lead to a constant state of insulin release, which may contribute to insulin resistance over time. This is because the body may become less responsive to insulin when it is constantly exposed to it. Therefore, if you are managing your diet and exercise effectively, it might be worth experimenting with fewer meals that are more substantial, allowing for longer periods of fasting between meals.

2. Post-Workout Nutrition: Consuming a post-workout snack, such as a protein shake or a combination of carbohydrates and protein (like milk and a banana), is generally recommended to aid recovery and replenish glycogen stores. This does not necessarily count as "small frequent meals" if it is strategically timed around your workout. The key is to ensure that this intake does not lead to excessive calorie consumption or frequent insulin spikes. If your workout is intense and you feel the need for recovery nutrition, this can be a beneficial practice.

3. Timing of Exercise Relative to Meals: Engaging in physical activity 1-2 hours after a meal can be a good strategy for managing blood sugar levels. Exercise helps to lower blood sugar levels by increasing glucose uptake by muscles, which can be particularly beneficial for those with pre-diabetes. If you eat a meal and then wait a couple of hours before exercising, your body will have had time to digest the food, and the insulin response from the meal will have started to decline. This means that when you exercise, you are less likely to experience a significant insulin spike, which could help mitigate the risk of developing insulin resistance.

In summary, while the traditional advice of "small frequent meals" has its merits, it may not be suitable for everyone, especially those with insulin resistance. It is essential to listen to your body and monitor how different eating patterns affect your blood sugar levels. Maintaining a balanced diet with low glycemic index foods, regular physical activity, and possibly fewer meals per day could be more beneficial for managing insulin resistance. Consulting with a registered dietitian or a healthcare provider who specializes in metabolic health can provide personalized guidance tailored to your specific needs and lifestyle.

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