Pro triathlete Lionel Sanders found out he's prediabetic

Well, I think this thread shows that there is a discussion to be had…and quite honestly, it has existed for awhile…but Sanders case will likely push it further to the forefront.

I didn’t day anything about being able “to perform”…I said it will likely ignite the discussion as to whether high-carb diets are healthy. “Performance” and “healthy” are obviously not the same thing.

Now, it appears that Sanders may be (is likely?) a fringe case, as he admits his entire diet was trash, not just his fueling. Nonetheless, there is still a discussion to be had re: how performance fueling may impact your overall health.

I’ve done a bit of digging on the potential health affects of ingesting massive amounts of simple carbs during training and I never found much definitive info beyond it being really bad for your teeth. My general take is that it falls into same category of most of the things we do when training hard for endurance sports - it’s not terrible for you, but it’s certainly not good for you. Being a competitive endurance athlete who trains really hard and eats a bunch of carbs is better for you than a sedentary lifestyle sitting on the sofa with beer and pizza, but anything beyond a reasonable level of exercise and normal diet is doing more harm than good (in my opinion). Pushing things to extreme levels is seldom healthy, but that’s sometimes the tradeoff for performance.

Yeah, I agree with this, 100%…but high-carb fueling is still in its relative infancy and time will tell if there are longer-term ill effects. Especially for pros who are pushing the limits of what they can ingest while training / competing. Supposedly some triathletes are getting close to 200g / hour now.

Lots of learning still to come with this, IMO…

I think there’s a few important things to note:

  1. Impact of massive amounts of simple carbs on blood sugar would be my largest concern by far. With the rise of type 2 diabetes and the agreed upon understanding that it can be caused by a poor diet, this is a real and known concern. The effect of this, at a high level, can be observed by monitoring blood sugar while ingesting these carbs. From what I have seen, during 3-4 hr endurance ride, I can ingest 300-400 calories/hr in simple carbs and my blood sugar status in a normal healthy range. Around 30-45 minutes post exercise, my blood sugar soared and then dropped to a level not seen throughout a normal days activities and eating. I have another CGM and need to do more detailed experiments now that I’m riding and eating a lot more.

  2. Impact on overall digestive health. Not sure what the ramifications are and haven’t looked too far into it.

  3. Impact on heart health. Also not too sure.

  4. Impact on teeth. I always brush and floss before and brush/floss/mouthwash at least two more times that day after the ride.

Since I only have one really long ride a week, I don’t worry as much about the sugary fueling during that ride. My other 1.5-2 hr rides I find no real need to drink mix. I can usually get by with oatmeal before, a few peach rings, fig newtons, and maybe a gel during the ride if needed.

If I was doing 4-5 hr rides several times throughout the week, I’d work to incorporate fueling with much more Whole Foods that mix simple and complex carbohydrates to help dampen the blood sugar concerns. Even something like fig newtons or pop tarts would be a marked improvement, although still far from being considered any sort of complex - at least they are Whole Foods that slow the digestion.

I’ve seen a couple refences to monitoring carbs with a CGM. Is there a go-to device available in the US? I haven’t researched options in a while, but last time I looked at it they were expensive and seemed focused on people monitoring on Dr’s orders (ie - they have insurance to help pay for it).

So 100 calories per hour or around 25g of carbs per hour. Not the high carb rates others have mentioned.

There are a number of CGM available in the US, but as you noted they are not cheap and without a Rx, you are gonna have to pay out of pocket.

I know there were a bunch of Asian suppliers looking to enter the CGM market here in the US, but I have to imagine that the current tariff situation has put a significant kink in those plans.

While A1C can be part of the process of diagnosing diabetes, the reference range is complete trash with regards to extreme endurance athletes on the far side of the bell curve. It’s no different than a bodybuilder using the BMI chart to diagnose obesity.

Let me explain. You will have a transient elevation in blood glucose any time you do endurance training, period, with or without carbohydrate fueling. If you train a LOT, the duration that it stays elevated will cause the hemoglobin to remain exposed to higher levels of blood glucose, which can slightly raise A1C on it’s own. Also, if you do a lot of intensity (which Lionel does) and have chronically elevated stress hormones (like cortisol, in an overreached or overtrained state) it can temporarily blunt insulin sensitivity causing an exercise induced pre-diabetes like state. This temporary insulin resistance is actually worsened by not taking in enough carbs for recovery. You can literally see this state with a CGM in training, with unstable whip-saw like blood glucose levels throughout your training.

I would put $100 on Lionel being 1) overreached/under recovered and 2) training with too much intensity and 3) would have zero symptoms (like his peeing 8 times a night) if he would take a recovery week or two and go back to doing more low intensity work at or below zone 2. The man has great genetics and clearly a freak of nature, but he has little comprehension of why his body is doing what it is doing.

Why would you want to slow digestion if your body is burning 700-1200 calories an hour? This is silly. Pop tarts being healthier than pure glucose/fructose is also silly. The Red #40, titanium dioxide, and vegetable oil makes it better for you?

Chronically dysfunctional mitochondria is the root cause of T2D, and high carbohydrate intake in highly trained endurance athletes will not cause this.

400 calories of sugar is 100 carbs per hr….

Slowing digestion of carbohydrates will put a bit of a buffer of the spikes/crashes. Although what I have found is that during exercise the blood sugar spike is really only after the exercise is over, so maybe either cutting the calories the last hour or using a slower digesting carb as a buffer?

As an example, if I eat a ton of sugar, sedentary, my blood sugar will spike and then crash. If I eat the same amount of sugar in my steel cut oatmeal, the spike and crash is significantly less severe.

Also, I never used the words “healthier” for eating actual food vs pure sugar. I said that it slows the rise and crash of blood sugar levels. Are you saying that a pop tart or fig newton will have the same spike/crash for blood sugar levels as pure sugar, in equal amounts of carbohydrates? That was the point that I made, neither is “healthy.”

High carbohydrate consumption in highly trained endurance activities during training activities may not cause T2D, however a crap diet fill with sugar and other garbage while sedentary can absolutely cause T2D. I don’t know that massive amounts of sugar, while sedentary, would discriminate in causing insulin resistance in someone who exercises vs someone who doesn’t. Especially if they are training in the morning and eating mounds of crap before bed. It may be different if their consumption was still very close to exercise, although I’ve seen blood sugar sky rocket right after exercise just from the sugar consumed during the endurance activity.

Lingo is $89 for 4 weeks (2 disposable sensors…)

I haven’t tried it, but I’m thinking about it…

Try doing the same ride you are seeing the spike then/crash without any carbs at all. Typical blood sugar spike will happen once you stop regardless. During exercise your body stops producing (as much) insulin and your liver is going to start to release glucose into the blood stream. It’s going to try to maintain this elevated blood glucose level, so when you stop exercising, there’s usually a temporary blip upward in blood glucose as the body tries to re-zero itself to a normal state. This could be slightly exacerbated if taking in sugar, but it’s not a bad thing at all. Your muscles are the most insulin sensitive post exercise, so taking in MORE carbohydrate post training is going to restore glycogen stores much quicker and completely than doing it 5-6 hours later. This is why you’ll see pros slamming those post race sugars immediately after.

Again, a blood glucose spike post ride is NOT what causes insulin insensitivity and has nothing to do with diabetes. It’s totally normal.

Edit: When I’m not overtrained, and riding really well, within an hour of cycling I can pretty much ingest as much or little sugar as i want while riding my my blood glucose will plod along at 110-140 depending on effort level. I can’t make it go too high and it won’t ever go much below 110-120. Now when I stop it might blip to 160-180, but pretty much immediately comes back to 90-120 within minutes. When I am over cooked on intensity and need recovery time, it’s easy to see whip saws from 70-180 on the bike without ANY form of carb ingestion at all. It’s a total disaster. Resting blood glucose is still ok, but while exercising it’s garbage in this state.

The numbers you are probably talking about are between 80-200, and most likely VERY transient. The reason why diabetic patients have to turn to “complex” carbs or whole foods is because their body CAN’T control blood glucose very well, and it can spike and remain elevated well above 200. An athlete with healthy mitochondria don’t need to worry about this, especially when talking about the time right before, during, or after endurance exercise.

Interesting, since that devices is by Abbott and I’m willing to bet it is just a rebadged, perhaps slightly modified, Libre sensor. Note the acknowledgements you need to check before you can buy it…specifically the ones re: medical use / treatment / diagnosis.

Supersapiens struggled for years to get FDA clearance for their Abbott-supplied device and I always wondered why they simply didn’t use similar verbiage in order to obtain a 510(K).

Now Abbott has gotten it…will be interesting to see if they make it available for more devices than just an iPhone.

Strongly disagree. Carbs are going to make your blood sugar go up—it’s what they do and they’re part of how our bodies operate. CGMs are raw data, and you need to know a lot to actually understand what that data is telling you. A simple rise in glucose levels from eating a banana isn’t bad, but the vast majority of people would not know how to interpret that.

Wearable CGMs are also relatively new, so there isn’t much data on what a non-diabetic’s daily fluctuations are like with longitudinal data evaluating the then likelihood of developing T2D.

When CGMs were being pushed heavily as a wellness device, there was an ad with a woman saying “I ate a banana and couldn’t believe what it did to my blood sugar” which is just such an incredibly bad thing to say.

That’s a fair statement for people who know absolutely nothing about the topic.

My statement was more meant that more people should understand how the system works AND wear one, to see how things interact. No one should just go in blindly, which admittedly, would probably happen.

Personally, I saw a huge difference in blood sugar levels between instant oats and steel cut oatmeal. Like… a spike to 160ish then a sudden drop soon after, vs a steady rise to around 125ish, then a steady decline. That type of information might make health conscious people make smarter decisions.

Again, and back to your point, that’s for knowledgeable health conscious people. We can’t even get the majority of Americans to stop shoving crap down to avoid obesity, so it probably is a pretty big ask lol.

I really wanted to discuss this because the fallout is all over the internet, I see people commenting on Sam Long’s workouts all week bringing this up and trying to teach him to be careful about eating “junk food” on his long rides.

First of all I want to make one point :: There is an end of the road for every athlete in the top echelon of competition, it would be cool if there wasn’t and somehow the 70 year old guys were the fastest because they were training for 55 years consistently, but it’s not like that. Lionel is 37 in a sport where you can stay on top being older because of the steady state efforts and lack of risk and punch. That being said, what does the end of the road actually look like ? Well insulin resistance in the leg muscles is for sure a part of it. Most people probably don’t quantify it in that way, from the less studied perspective they just say “man I just don’t have that X factor anymore” or an onlooker will just say “he is just not as strong as he used to be” But under the hood insulin resistance particularly in the muscles of the legs is one of the big contributing factors.

The fact that becoming insulin resistant leads to performance decline suggests a need to periodize carbohydrate consumption and this in fact makes it MORE IMPORTANT for these guys to eat lots of carbs on the bike and at the gas station during the rest stops (contrary to what the idiots commenting on Sam Long’s strava posts say).

We know already about GLUT4 and we already know that it is an insulin independent transporter which means for all intents and purposes that there is not a significant spike in insulin when the carbs are consumed (even in bolus doses) during or immediately after exercise above LT1.

However, when you take the same bolus dose of carbs on the rest day or on a rest week, or like lionel was saying in the middle of the night because of cravings… this does come with an insulin spike and is in fact able to eventually overwhelm the aerobic metabolism of even the most seasoned athletes and diminish it or even grind it to a halt.

Granted the levels of aerobic stimulus are so high in the professional ranks of cycling these days there are probably guys that could take a willy wonka magical 7000g of sugar in a single pill capsule and still not have their latent aerobic ketosis shut down… for the aging masters athlete on 6 hours per week… the number is much smaller. If you bolus dose carbs outside of the so called glycogen window or outside of being on the bike… there is a cost.

This cost in terms of reduced insulin sensitivity and increased insulin resistance has to be weighed against the energy demands of the sport. Some guys like lionel are doing 6 x 15m threshold sessions and have a massive FTP so in terms of their dietary needs it’s A LOT of carbs which may not be possible to get down after the ride within a reasonable time frame to achieve energy balance or glycogen replenishment.

So what does this mean for an athlete eating a donut at the gas station? It means that this is ABSOLUTELY CRITICAL in order to maintain energy balance and to refuel during the appropriate glycogen window. A rider that is thinking, oh well the gas station only has junk and I only eat the highest quality Himalayan blueberries which are in my fridge 2.5 hours away from here, that doesn’t work in practice because the glycogen window is now and eating 3kg of blueberries every training day wouldn’t be realistic. It would be better if you had a team car with the highest nutritional carb sources rather than getting a 7/11 donut, but the donut is much better than eating nothing and missing the glycogen window.

This is why the emphasis on fueling on the bike is so important, this is why the TDF guys are drinking 120g carb per hour even on the easy days of the TDF, because they know that they are periodizing their carb consumption AND because they know that it gets them a head start on the massive mountain of pasta they will have to eat before bed time.

So what is up with Lionel ? Well he alludes to it in the video. Basically he developed a pathological eating habit likely associated with already having a very positive relationship with carbs on the bike, remember when you are doing 6 x 15m @ 390w as your threshold day and then running in the afternoon there is nothing on this earth, not your wife, not your kids, not your god, nothing that can sustain that kind of energy demands in a healthy way other than sugar. So these guys develop these eating habits around it, start suffering… bottle up… hard interval coming… bottle up… climb coming… extra gel…

They do it because it works, but where this becomes an issue is when they are facing life related stressors and try to take benefit from the bottle in an absence of exercise or absence of GLUT4. Then you end up with guys sweating their workout tomorrow or the race in the coming days, slamming candies in the middle of the night with a pathological eating disorder associated with improper periodization of their sugar intake. This is what Lionel has/had and this is why sports are for the young, because kids can literally do this and see a positive improvement in their glycogen stores and still sleep like a baby, master riders not so much, they see insulin resistance reduced LT1 and impacted sleep.

As an interesting extension topic :: What aspects of diabetes would be beneficial to elite endurance athletes ?

Except that the person who posted the original statement indicated that the 300-400 calories was during a 3-4 hour ride. Maybe they meant that they consume 300-400 per hour during a 3-4 hour ride, but that is not what they wrote.

You didn’t say per hour

You seem to have a good understanding of human biochemistry processes. Could you elaborate on the “peeing 8 times a night”? Asking for a friend :wink:

Also, while I agree with your take on sugar and endurance athletes, do we have something similar for other markers in endurance athletes? I know the ranges can be irrelevant for some markers but in my case specifically, I am interested in total cholesterol and HDL cholesterol. Comparing my labs from the time I wasn’t exercising my total cholesterol went up a lot. While before I had LDL and HDL equal, now it is more like 3:2 for LDL:HDL (well, precisely that in mmol/l). I couldn’t find much when I researched the topic a couple of years ago.

Similarly, I found that high bilirubin can actually be a good thing but wasn’t sure how well researched thing it is and what would be normal for endurance athlete.

I am sorry for being slightly off topic but at least it is still in the general vein of health of an endurance athlete .