When most athletes think of prediabetes, they picture someone who is overweight, inactive or has a poor diet. While those are well-known risk factors, the reality is that prediabetes can affect athletes, too. In fact, I have seen more than my fair share of highly trained athletes who are metabolically unhealthy despite training regularly. Spoiler alert: training (a lot) doesn’t automatically make you “healthy”. Let’s dig into this a bit more...

Prediabetes is a condition in which blood glucose levels are higher than normal but not yet high enough to be diagnosed as type 2 diabetes. The more common diagnostic criteria include:

• Hemoglobin A1c (HbA1c) between 5.7 - 6.4%
• Fasting blood glucose between 100 - 125 mg/dL
• 2-hour glucose during an oral glucose tolerance test between 140 - 199 mg/dL

The first two are super easy to have measured and while it is possible, I wouldn’t necessarily recommend doing an oral glucose tolerance test because it isn’t that pleasant.

Surprisingly, prediabetes is more common in the United States than you may think. It is estimated that more than one in three U.S. adults have prediabetes, and many are unaware of it because there are often no noticeable symptoms (which is why frequent testing is so important).

Athletes are generally at a lower risk than sedentary individuals because regular exercise improves insulin sensitivity. However, exercise training alone does not guarantee optimal metabolic health. As I mentioned previously, I have been rather surprised in the uptick in prediabetes cases that I have personally seen with endurance athletes, masters athletes and recreational exercisers. 

Are you wondering why athletes are not immune to having prediabetes? Here is a small list, of which some probably will not surprise you.

• High intake of refined carbohydrates and sugary sports products outside of training needs.

• Chronically low energy availability, which can alter hormonal and glucose regulation.

• Poor sleep quality or insufficient sleep, reducing insulin sensitivity.

• High psychological or training stress, leading to elevated cortisol levels.

• Genetics and family history, which remain important regardless of fitness level.

• Aging, particularly in masters athletes, as insulin sensitivity naturally declines over time.

• Periods of reduced training due to injury, travel or the off-season without periodizing nutrition appropriately. 

Because athletes often consume large amounts of carbohydrates to support training, matching carbohydrate intake to actual training demands becomes especially important.

The main strategy for preventing prediabetes, or reducing your risk, is simple - adopt my Metabolic Efficiency Training concept. You have likely heard me say it over and over again, “optimize your blood sugar by periodizing your nutrition to support health and training.” Here are some helpful tips:

1. Periodize daily carbohydrate intake to your training needs.

Consume more carbohydrate around higher-intensity and longer training sessions, while reducing intake on lighter training or recovery days. Prioritize whole-food carbohydrate sources such as fruits, vegetables, legumes, whole grains and minimally processed starches.

2. Build every meal around protein (something I have been saying for 20 years now!)

Aim for approximately 25 - 40 grams of high-quality protein per meal to support muscle recovery, improve satiety and help moderate post-meal blood glucose responses.

3. Include fiber daily (but no fibermaxxing please)

Fiber slows glucose absorption and promotes a healthy gut microbiome. Most adults should aim for 25 - 38 grams of fiber per day from vegetables, fruits, legumes, nuts, seeds and whole grains.

4. Emphasize strength training

Strength exercise improves insulin sensitivity by increasing muscle mass and enhancing the muscles' ability to store glucose as glycogen. Include 3 - 5 three per week for optimal metabolic benefits.

5. Prioritize sleep

Consistently obtaining 7 - 9 hours of quality sleep each night supports recovery, hormonal balance and healthy glucose regulation.

6. Manage stress

Easy to say, hard to do but do your best. Chronic stress elevates cortisol, which can contribute to higher blood glucose levels. Recovery strategies such as mindfulness, breathing exercises, easy walking and adequate recovery between training sessions can help.

7. Monitor key biomarkers

Get routine blood work done at least twice per year and be sure to include fasting glucose, HbA1c, fasting insulin in a comprehensive screening such as THIS ONE.

Athletic performance and metabolic health are closely connected, but they are not always the same thing. An athlete can be lean, strong and highly trained while still developing early signs of impaired glucose regulation.

Reach out to our Team of Sports Dietitians at eNRG Performance to help guide your nutrition, health and longevity planning.