Exercise
Sedentary behavior worsens insulin resistance and magnifies the post-prandial excursions of glucose and triglycerides. In contrast, exercise improves insulin sensitivity predominantly in the skeletal muscles, and acutely lowers glucose and triglyceride levels in a dose-dependent fashion. A single bout of 90 min of moderate-intensity exercise (walking briskly) within 2 h before or after a meal has been shown to lower post-prandial triglycerides and glucose levels by about 50%.[3,38] A recent study using continuous objective activity monitoring in 173 nondiabetic individuals found that cumulative daily physical activity, even light-intensity activity, was associated in a dose-dependent fashion with lower 2-h post-challenge glucose levels (but not fasting glucose levels) (Fig. 8). The same study showed that cumulative sedentary time was associated with higher 2-h glucose levels.[39]
Figure 8.
Daily Activity Reduces Post-Prandial Glucose. Cumulative daily light-intensity physical activity was inversely associated with post-prandial glucose levels. Data from Healy et al.[39]
Physical activity improves inflammation directly by lowering post-prandial glucose, and indirectly by reducing excess abdominal fat.[39] Studies show that the body will preferentially mobilize and oxidize fatty acids from adipose tissue during exercise after a low glycemic index meal rather than a high glycemic index meal.[40] Thus over time lower glycemic index diets combined with regular exercise may be useful for optimizing loss of excess visceral fat.[10,25,40]
Summary and Recommendations
The modern calorie-dense, nutrient-poor diet of processed foods, especially when combined with a sedentary lifestyle and abdominal obesity, produces exaggerated post-prandial increases in glucose and lipids, which leads to inflammation and atherosclerosis. In contrast, a diet high in minimally processed, high-fiber, plant-based foods such as low glycemic index vegetables and fruits, whole grains, legumes, and nuts will markedly blunt the post-meal increase in glucose and triglycerides. Additionally, lean protein, fish oil, calorie restriction (ideally induced via avoidance of processed foods and excessive portion sizes), weight loss, vinegar, cinnamon, tea,[41] and light to moderate alcohol intake and physical activity positively impact post-prandial dysmetabolism (Table 1).
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Acknowledgements
The authors thank Lori J. Wilson for her assistance with preparation of the manuscript and figures.
Abbreviation Notes
CAD coronary artery disease; CV cardiovascular
Reprint Address
Reprint requests and correspondence: Dr. James H. O´Keefe, 4330 Wornall Road, Suite 2000, Kansas City, Missouri 64111. E-mail: jhokeefe@cc-pc.com .
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Author Information
James H. O´Keefe, MD, Neil M. Gheewala, MS, and Joan O. O´Keefe, RD, from the Mid America Heart Institute and University of Missouri–Kansas City, Kansas City, Missouri.
J Am Coll Cardiol. 2008;51(3) ©2008 Elsevier Science, Inc. |
