Slides to accompany Max Peto's talk about high-intensity interval training ("HIIT") and its dramatic, positive effect on insulin sensitivity at the Health Extension Salon in September 2012. You can see the video here: https://vimeo.com/50895380 In this video, Max also presents a modified (shorter, easier, effective) version of a published HIIT protocol which he developed. Slides are not visible in video - use these slides to follow the video

1. Short-Duration, High-Intensity
Interval Training Dramatically
Improves Insulin Sensitivity
Health Extension Salon, 2012.09.13
Paper: Babraj, Timmons et al., 2009
Presented by: Maximus Peto

2. Format of This Presentation
1. Review the aspects of disease that insulin is
involved in (e.g. athero, cancer)
2. Mention a paper (Timmons, 2009) showing
HIIT improves insulin sensitivity
3. Discuss an exercise intervention I
developed to replicate Timmons’ insulin
sensitivity enhancements, but with much
less time/effort

3. Why talk about insulin sensitivity?
 Insulin signaling relates to many aspects of
health and longevity, including:
1. Cholesterol synthesis
2. Cell division
3. Substrate utilization (oxidation (“burning”) of fat
or carbs, depending on insulin status, among
other things). This will then strongly influence
body fatness, which influences inflammation and
other disease factors
 Others (not discussed today)

4. [Insulin] and Cholesterol Synthesis
 Insulin + insulin sensitivity enables glucose to
enter cells; insulin resistance prevents it
 High glucose (e.g. via insulin resistance)
activates HMG-CoA Reductase
 HMG-CoA Reductase is the rate-limiting
enzyme involved in cholesterol biosynthesis,
and the target of cholesterol lowering drugs
like statins
 I.e. Statins are largely prescribed for people
with insulin resistance – DON’T BE!

5. [Insulin] and Cell Division (Specifically:
Cancer Proliferation)
 Insulin is an anabolic hormone – required for
cell growth and division
 Type 1 diabetics, despite high glucose, have
metabolic and wasting problems due to lack
of insulin production (glucose can’t get used)
 Many (most? all?) cancers need insulin
signaling for cell division – this is one big
reason why calorie restriction has been
shown to inhibit cancer (CR enhances insulin
sensitivity

7. [Insulin] and Substrate Utilization (What
Macronutrients are Used as Fuel)
 Low insulin = burn fat; high insulin = NOT
 Insulin decreases autophagy (i.e. its lack
enhances it!)
 Insulin increases lipid esterification
(preparation for storage of lipids in fat cells –
i.e. you get fatter)
 Insulin decreases proteolysis (which is why
many bodybuilders eat high-glycemic diets –
to retain muscle mass)

8. Measuring [Insulin] Indirectly – The
OGTT
 OGTT = “Oral Glucose Tolerance Test”
 75 g glucose, dissolved in water
 Fast for 12 hours, drink glucose water
 Measure blood glucose every 30 mins for 2
hours (5 data points: 0, 30, 60, 90, 120 mins)

9. Measuring [Insulin] Indirectly – The
OGTT
 High glucose during OGTT most likely
illustrates poor insulin action (e.g. secretion,
sensitivity)
 Low glucose during OGTT suggests poor
digestion (e.g. high fiber/low glycemic) or
excellent insulin sensitivity, or both

10. Max’s Personal Experiments – Lowering
the OGTT and Postprandial Glucose
 I have tried many, many, many things to
enhance insulin sensitivity (as measured by
both OGTT, and fasting insulin), for all the
reasons I’ve described before
 E.g. intermittent fasting, calorie restriction,
low-carb diet, low-glycemic diet, exercise
(low, moderate, and high-intensity),
combining fat w/ meals (lowers glycemic
index) among others. Lost 65 lbs back in
2007 (effective, yay!)

11. Max’s Personal Experiments – Lowering
the OGTT and Postprandial Glucose
 Achieved much better body fat and fasting
insulin, but OGTT won’t change much (damn
it!)
 Tried many things to change it
 Only found a single way to improve
OGTT reliably – HIIT, the topic of
today’s paper

12. Experimental Parameters in Timmons,
et. al 2009
 Take a group of healthy people, test OGTT
before experiment
 Do exercise protocol: HIIT: bicycle sprint 30
sec, rest 4 min, repeat 4-6x in one session.
Do 3 sessions/week for 2 weeks
 Wait 2 or 3 days (washout acute effects)
 Take OGTT again

15. Max Developed His Own Protocol
 Fast 12+ hours (e.g. overnight)
 Before breakfast, sprint as long as possible
(15-30 sec), rest 60 seconds, sprint as long
as possible (10-20 seconds)
 Rest until you feel like eating (~2-4 mins;
you’ll be really out of breath, and maybe
nauseous)
 Have breakfast; go about your day as normal
 Perform 3-5x per week

16. Max, Pre-HIIT
180 Postprandial OGTT
Glucose (mg/dL)
160
140
120
100
80
60
0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 2
Time (hours)

17. Max, Post-HIIT
180 Postprandial OGTT
Glucose (mg/dL)
160
140
120
100
80
60
0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 2
Time (hours)

18. A Few Notes
 I measured glucose, NOT insulin. So this is
actually representative of enhanced
GLUCOSE DISPOSAL, which is related to,
but not identical to, insulin sensitivity
 My glucose AUC findings were similar to
what Timmons et. al found, so I'm
ASSUMING my insulin sensitivity is ALSO
enhanced (I will be testing soon)
 I would like to do actual scientific study

19. Disclaimers! If you are trying this...
 Be sure you are in decent cardiac/vascular
health. This is very strenuous, and you could
give yourself a stroke or heart attack if you
have current cardiac/vascular issues
 Jog 30 mins/day, 3x/week for 2 weeks before
doing this, to get muscles ready
 EXPECT to be sore the next few days when
starting (this goes away with training). I was
sore in abs & hip flexors, but not now

20. QUESTIONS?