Insulin and Triglycerides

Every time I review someone’s blood test results, and then discuss with them what they mean and what they should do to improve their numbers, there’s something I almost always have to explain. And this was the relationship between fasting insulin and triglyceride levels.

Take a look at this plot:

trigs_vs_insulin_gb

Plot showing ten pairs of measurements of insulin and triglycerides, made from the same blood samples. They were collected between 2011 and 2017, and all are from my own blood tests.

It shows measurements of insulin concentration on the horizontal axis in mili units per millilitre (mIU/ml), and triglyceride levels on the vertical axis in milligrammes per decilitre (mg/dl). This is a correlation plot in which independent measurements of one variable are plotted against independent measurements of another in an attempt to see if there is a relationship between them.

Is there an order in the way the dots are organized? They are clearly not randomly distributed as a circular cloud of dots—it would mean that there is no relationship. Instead, we see what looks like a linear relationship in which lower values of insulin correspond to lower values of triglycerides, and higher values of insulin correspond to higher values of triglycerides. It’s not a straight line, but it’s definitely a clear linear relationship, and the value of the correlation coefficient, which quantifies how tight the relationship actually is, of just under 0.9 is pretty close to 1. In other words, it’s a pretty tight linear relationship.

Triglyceride is a fancy word for fat or lipid, because fat molecules are composed of three fatty acids held together by a glycerol structure. This is what triglyceride refers to. The amount of fat in the blood is affected by the amount of fat we eat, and the amount of body fat we have. Naturally, after a fatty meal, triglyceride levels will increase as the fat goes from the digestive system into the blood, they will reach a maximum, and then start to go down. The longer we wait before we eat again, the lower they will go. But there’s a few complications.

The first is that depending on the amount of insulin, one of whose jobs it is to transport nutrients into cells, whatever is circulating in the blood—and this includes glucose, of course, but also protein and fat—will in general be stored away faster if insulin is higher, and slower if insulin is lower. This means that if you eat fat together with sugar or starch, the whole lot will be packed away, and mostly as fat, minus the little bit of glucose your muscles and liver have room to store up as glycogen.

The second is that depending on the state of insulin sensitivity—the fundamental parameter that determines how well or poorly cells can use fat for fuel—triglycerides will in general be used up faster if we are more insulin sensitive and slower if we are more insulin resistant. This means that in the morning, twelve to fourteen hours after having had the exact same meal, the more insulin sensitive person will have lower triglyceride levels than the more insulin resistant.

And in fact, no matter if we have a measure of fasting insulin or not, and no matter how little we know about the person’s overall health, fasting triglyceride concentration is probably the best general marker of insulin sensitivity. Nevertheless, because their levels fluctuate quite a lot over the course of each day as a function of what we eat and drink, it is true for triglyceride levels as it is true for many other blood tests that are affected by the kind and amount of food and drink we’ve had over the last days, and most importantly by the amount of sweet or starchy carbohydrates.

Now, take a look at this second plot:

trigs_vs_insulin_final

Plot showing, in addition to the 10 points shown in the first plot (in red), another 20 pairs of measurements of insulin and triglycerides, also all from the same blood samples, but from seven other persons.

It shows the same 10 data points shown in the first plot from my own results, but with another 20 pairs of measurements taken from other people that I’ve coached and helped with the interpretation of their results. You can see that the relationship is better defined because of the additional points that now together cover a wider range of values on both axes.

However, you can also see that, the relationship is not as tight. In particular, there are a few points that are quite far off the main trend—mostly those at the top of the plot with high triglyceride and low insulin values. We see how these off-trend points affect the tightness of the relationship seen in the initial data set when we compare the values of the correlation coefficients. These off-trend points lead us to the third complication I wanted to bring up.

But first, please take a minute to consider the matter: What could lead to having low insulin and at the same time high triglycerides? What could be the cause of the difference between my numbers, which did contain some very low insulin levels, but all of which were paired with equally low triglyceride values, and this other person’s numbers? What causes insulin to go down? What happens when insulin is low? What could cause triglycerides to go up while insulin is low?

Insulin, no matter how high it is, will start to go down when we stop eating. The longer we fast, the lower it will go. Each person’s baseline will be a little different depending mainly on their metabolic health and their body fat stores. The more efficient the metabolism is at using fat for fuel—the more insulin sensitive, the lower insulin will go. But also the lower the body fat stores are, the lower insulin will go. On the flip side, the more insulin resistant and the fatter we are, the longer it will take for insulin to drop and the higher it will stay at baseline.

This is pretty shitty. I mean, as we develop insulin resistance, average insulin levels will become higher and higher. As a result we’ll store calories into our growing fat cells more and more easily, and will therefore become fatter and fatter, faster and faster. But fat cells also secrete insulin! So, the more fat cells there are, the higher the insulin levels will be, and the harder it will be to lower our basal insulin. To burn fat, we need to lower insulin levels. The fatter we are, the higher the insulin levels will tend to be. And the fatter we are, the harder it will be to lower insulin levels.

It’s a bit of a catch, but in the end, it’s not such a big deal because basically everyone who is overweight and who starts to fast and restrict carbohydrates melts their fat stores away very well. It works incrementally: insulin goes down a little, insulin resistance is reduced a little, fat-burning starts; insulin goes down a little lower, insulin resistance is further reduced, fat-burning increases; and on it goes, until we have lost all those extra kilos of fat that we were carrying on our body, be it 5, 15, 20, 35, 60 or even 100 kg of fat! It’s just a matter of time.

Now, after this little tangent on insulin and fat stores, we can come back to those anomalous points in the plot, the most conspicuous of which is the one just below 120 mg/dl of triglycerides but only 3 mUI/ml of insulin. Have you come up with an explanation? Here it mine:

That point is from one of my wife’s blood tests. It is unusual because it was done after 24 hours of fasting. My 24-hour fasting blood test done a number of weeks before, and my numbers were 41 for trigs at 2.3 for insulin. The difference between her and I was that I was already very lean, whereas she wasn’t. Therefore, as she fasted, her insulin levels dropped very low, and then the body started releasing its fat stores into the bloodstream in high gear. This is why her triglyceride levels were this high while her insulin was that low. It’s almost certainly the same for the other two points up there with trigs at 110 and 90 with insulin around 4 and 2.5 (the latter one of which is also my wife’s).

Since we did many of our blood tests around the same time, there are 9 data points from her on the plot. Several are in the centre of the main trend at insulin values between 6 and 7, but I’d like draw your attention to her lowest insulin value that was measured at 1.8, and at which time her trigs were at 57, and her lowest triglyceride level of 48, at which time her insulin was at 2.2. This shows that on average her values are a little further along the trend than mine are because of the small difference in body fat, but that she has good insulin sensitivity, and a well-functioning metabolism that can efficiently use fat for fuel.

The other off-trend point, but in the other direction on the right hand side, with insulin just above 10 and trigs around 65, is from my mother’s first blood test which I ordered and included insulin and trigs, before I got her off carbs. She was 82 at the time, eating a regular kind of diet, but not a very nutritious or varied diet with plenty of bread and cheese, because she had serious problems moving around and taking care of herself while still living alone. And so, it’s just the result of being older, having plenty of carbs, but not being highly insulin resistant nor highly overweight. Her baseline insulin levels were just generally higher because of her age and diet, but her trigs weren’t excessively high.

However, after just four days of intermittent fasting on a very low carb regime with most calories coming coconut oil spiked green juices and coconut milk smoothies, her insulin went from 10.3 to 4.7, and she lost 5 kilos, which, of course, were mostly from the release of water that the body was retaining to counter the effects of the chronic inflammation that immediately went down with the very-low carb regime and fasting.

Later, having sustained this strict green healing protocol for about 6 weeks, her numbers were at 2.9 for insulin and 56 for trigs. And by then she had lost another 5 kg, but this was now mostly fat. She had, at that point, recovered full insulin sensitivity, had lost most of her body fat stores, and overhauled her metabolism. She was 83 at that time, which shows that this sort of resetting of the metabolism can work at any age.

On this note, let’s conclude with these take-home messages:

First, the next time you get a blood test, request that insulin and triglycerides be measured, because it’s the only way to know what your fasting insulin actually is, and because it is very telling of your level of insulin resistance or sensitivity, overall metabolic health, as well as your average rate of ageing as we’ve seen in a previous post on insulin and the genetics of longevity.

Second, when you get the results back, you will be able to tell from your triglycerides concentration, in light of your insulin level, either how well the body is using fat for fuel—in the case you are already lean, or how fast you are burning your fat stores—in the case you still have excess body fat to burn through.

And third, resetting metabolic health can be done at any time and at any age, and is yet another thing that shows us how incredible our body is—the more we learn generally or individually, the more amazing it reveals itself to be.

Want to lose weight? Here’s what you need to know in under 1000 words

One, you don’t want to lose weight: you want to lose fat. You don’t want to lose muscle or bone because they are very important functionally and metabolically. What you want to lose is fat. So weight loss needs to be reworded as fat loss.

Two, roughly speaking, the body is generally either storing surpluses or using reserves.

Three, the major fuels for the body are glucose and fatty acids.

Four, for the body to use fat reserves, insulin levels must be low. Fat cannot be efficiently utilized as long as insulin is high, because insulin promotes storage.

Five, the thyroid gland regulates metabolism and brain function. It requires adequate amounts of iodine without which it cannot work properly. To ensure healthy metabolic function, iodine supplementation is critical.

That’s what you need to know. If you want more details, I can expand a bit.

Insulin regulates fat storage

Every second that we are alive, trillions of biochemical reactions take place. The energy currency is adenosine triphosphate, ATP. Mitochondria produce ATP primarily using glucose or fatty acids. Fatty acids produces a lot more, but glucose is much easier to use. Both are used but one always dominates. In general, if there is glucose to be used, fatty acids are not much. For fat loss, we want to promote fat burning for ATP production to fuel cellular activity.

High glucose levels from carbohydrate intake trigger insulin secretion. This is necessary to bring the glucose into the cell, and to get rid of it from the bloodstream where it causes damage to the tissues by glycation. Within the cell, glucose can be either fermented without oxygen or oxidised with oxygen. Lower oxygen levels (and very high short term metabolic needs) promote fermentation. Higher oxygen levels (and lower metabolic ATP production rates) favour oxidation. More fermentation leads to greater accumulation of lactic acid, which further decreases oxygen levels. Red blood cells do not have mitochondria and therefore can only produce ATP by fermenting glucose.

Lower glucose leads to lower insulin. This triggers the release of fatty acids and glycogen into the bloodstream. If sustained, low glucose leads to the production in the liver of ketones primarily to fuel the brain whose cells can either use glucose, ketones, or medium chain fatty acids because longer molecules cannot pass the blood-brain barrier.

The higher the glucose, the higher the insulin, and the faster the uptake and storage of nutrients from the bloodstream into cells. The lower the glucose, the lower the insulin, and the faster the stored fat can be released and used.

insulinFatStorageFatRelease

Amount of glucose stored as fat and amount of fat released from fat cells as a function of insulin concentration. Plot taken from https://optimisingnutrition.com

The most metabolically active tissue is muscle. The more muscle we have, the more energy is used, and the faster both glucose and fat are burned to supply fuel to the cells. The more we use our muscles, and the more intensely we use them, the more they grow, and the more efficiently they burn both glucose and fat. Also, the stronger the muscles, the stronger and denser the bones will be. This is very important.

Therefore, as we burn more fat, we burn fat more efficiently. As we use our muscles more intensely, we burn more fat. And as we build more and stronger muscle, we burn even more fat even more efficiently, and make the bones stronger.

Different Carbohydrate Intolerance Levels

These mechanisms are universal in animals, but each animal is different, and each person is different. As far as fat loss is concerned, the individuality of people is related to their predispositions to insulin resistance and carbohydrate tolerance, (or actually, intolerance). Every person is differently intolerant to carbohydrates and differently predisposed to insulin resistance.

This is why in a group eating the same diet, there are people who are thin, people who are chubby, people who are fat, and everything in between. Basically, the greater the predisposition to insulin resistance (and the more sedentary), the lower the tolerance to carbohydrates will be, and the fatter you will tend to get. In contrast, the lower the predisposition to insulin resistance (and the more active), the higher the tolerance to carbohydrates, and the thinner you will tend to be.

This translates into different thresholds in the amount of carbohydrate we can eat without negative metabolic consequences, and consequently, the amount under which we must stay in order to burn fat instead of storing it. As a guideline, if you want to burn primarily fat for your body’s energy needs, this threshold would be around 20–25 grams per day if you are fat; around 30–50 gram per day if you are neither fat nor thin, and could be around 80–100 grams per day if you are very thin.

But no matter what your personal threshold happens to be, it will always be the case that the lower the intake of carbohydrates, the lower the glucose and insulin will be, and the more efficiently your body will burn fat as fuel.

Fat Loss Rate

The amount of fat that is burned is determined by the energy balance. The greater the total amount of energy we use, the greater the total energy needs. Total energy needs will mostly be met by energy from food intake and energy from fat reserves. If food energy intake is high, the need for stored energy will be low. If intake is lower, the need for energy from fat reserves will be higher.

Pushing this to the limit—maximal usage of fat stores—we would provide the protein necessary to maintain muscle and other active tissues and nothing more. In this situation, basically all energy needs would be supplied by stored fat reserves and glycogen when needed. This is greatly enhanced by resistance training.

The amount of protein needed is proportional to muscle mass and muscular activity. As a guideline, you can use 1–1.5 grams per kg of lean mass per day in the case of little physical activity, and 2–3 g/kg/d in the case of high muscular activity levels. Excessive protein is not great, but more is almost always better than less.

Fat burning and protein synthesis can be further optimised by intermittent fasting. Extending the time between feedings allows glucose and insulin to drop lower, which increases the rate of fat burning. And by eating fewer but larger amounts of protein in a meal is better because protein synthesis increases in proportion to the amount consumed.

Thyroid function regulates metabolism. Iodine is used in every cell, but in the thyroid, it is concentrated to more than 100 times the average of other tissues, because iodine is the main structural component of thyroid hormones. Iodine supplementation is critical because most soils are highly depleted. It is water soluble and very safe to supplement with.

Summary

  • High insulin from carbohydrate intake promotes fat storage.
  • Low insulin from restricting carbohydrates promotes fat loss.
  • Individual predispositions determine the threshold of carbohydrate tolerance.
  • Below this threshold fat is used as the main source of cellular fuel.
  • The rate of fat loss depends on balance between energy needs and energy intake.
  • Maximal fat loss rates are achieved by supplying just the protein needed to sustain lean tissues.
  • Iodine supplementation is critical to healthy thyroid, metabolic and brain function.

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Eat your salt, and eat your fat

A couple of months ago, I had just gotten to the locker room at the gym, when a buddy of mine came in. Changing into his workout clothes, looking at himself in the mirror with his shirt off, he said he was tired of this layer of fat over his abs, that he just couldn’t get rid of it no matter how much he tried. He’s a handsome Columbian guy in his mid thirties, super nice, friendly, and easy going, big open smile with nice white teeth. He’s well built, strong, with balanced musculature but … there’s not much definition.

Everyone wants to be cut, of course, and when you’re working out 5 or 6 times a week, like he does, and you can’t get cut, you get frustrated by that. Quite understandable. Meanwhile, I work out typically three times, and I’m “rallado” as he says to me. In english, the term is shredded: so lean that under tension, we see the muscles fibres. In my case, we can see them in every muscle, including the abs. He knew that, obviously, since I’ve been like this ever since we first met a year and a half ago. The only thing that’s changed is that I’ve put on some muscle and use heavier weights in my workouts.

And so, naturally, that was my queue:

– You just need to cut the carbs. The fat is going to melt off on its own in no time. Especially if you are working out the way you do. Just stick to meat and vegetables. Make it simple for yourself. Have eggs and avocados for breakfast, and meat and veggies the rest of the time. If you can skip breakfast, that’s even better: you’ll give your body a longer time to burn fat.

– Alright! I’ll try it!

After our workout, we said goodbye, and he told me he was going to Columbia for a while for his work (he’s part of a several-generation, several-family-member meat business based there, but lives here in Madrid with his wife and young child). He said that even though they always serve so rice, pasta, and potatoes with every meal, he would do his best to stick to the plan of having only meat and veggies. I gave him a good handshake, told him he could do it, and that it was important to be strict for the first month to allow for a good transition to fat-burning.

A few weeks later, he came back. We bumped into each other at the gym again. I was doing chest and back, he had come to do shoulders. He looked noticeably different: his face was smaller, his features more defined, his neck was thinner and more visible, his eyes were whiter and his skin was smoother. He looked 5 years younger! As soon as I saw him, I told him he looked very good, thinner in the face and neck, younger, and clearly healthier. He was happy to hear me say it, of course. He said that many people had told him that he looked younger, and obviously, he could also see it himself when he looked in the mirror. But it’s always nice when someone tells us we look good; it doesn’t happen very often. He had already lost 4 kg.

We saw each other a few more times at the gym like that, working out, but it took a while before he told me that he was feeling weak, that he couldn’t push as much weight as before, that he was often tired, and strangely, often in an angry mood. Naturally, he thought it was because he wasn’t eating carbs. That somehow he was carb-deficient.

– Do you add plenty of salt and fat with your meals meat and veggies?

– No! I don’t! I haven’t added salt to food in years. And I don’t add fat either.

– That’s the problem. You need to start right away. Lots of salt, and lots of fat with your food, whenever you eat.

– What kind of salt, and what kind of fat?

– Unrefined sea salt, organic butter and coconut oil, and olive oil with salads. With every meal. When you go low carb, you not only get rid of accumulated water in your tissues due to the chronic inflammation triggered by carbohydrate exposure (that’s why your face and neck thin out in the first week or two), but you also excrete more salt in the urine. It’s crucial to eat plenty of unrefined salt every day.

butterAndSalt

Organic butter and unrefined salt

 

Two days later, when I got to the gym, he was already into his workout, and he was pushing heavy weights on the benchpress, he was walking around with a spring in his step, and he was smiling. I didn’t even need to ask, but I did anyway:

– So, how are things going? Lots of salt and fat?

– Yes! And I feel great! I feel strong, I feel powerful, I’m not tired, and I’m not angry anymore.

– Fantastic! Glad to hear that. And from now on, you’ll always feel like this. No ups and downs, no weakness or lack of energy, no hunger pangs, no mood swings.

Each time we saw each other at the gym in the next weeks, I could tell he was getting more defined. The last time we met, he was again walking around feeling strong and working heavy weights with a smile on his face, and he looked ripped, a lot more defined. And he knew it too. I could tell by the self-confidence.

When we parted, I told him he looked good, that he looked more defined, and more energetic. He was happy: “Thanks a lot for all your advice. It’s really made a huge difference. I feel great, and my abs are starting to show!”

Not eating enough salt and not eating enough fat is a classic mistake that too many people do. We have been brainwashed into thinking we should avoid fats and we should avoid salt. So, when we cut the carbs, we continue to avoid fat and avoid salt. Then, we get tired and weak, and we think it’s because we don’t eat carbs. Totally not! We’re just not getting enough salt and fat.

And so, we have to repeat this, and repeat it over and over again. Eventually, it sinks in. Especially when we feel the difference it makes. Just like it happened in this case with my Columbian buddy at the gym. So, what’s the moral of the story?

You want to feel strong, and energetic? You want to look healthy and young? You want to get ripped with tight 6-pack abs? The formula is simple:

Cut the carbs. Fast intermittently. Drink alkaline water on an empty stomach. Work heavy weights 3 times a week. Eat enough protein. Eat your salt. And eat your fat. Try it. You’ll see. It works like a charm.

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Keto-adaptation for optimal physical performance

A young man I know recently started to play rugby at a higher level, and thus more seriously than he ever has in the past. Being a smart guy, he wants to get his nutrition “on point”, as he writes, in order to perform at his best. He started reading about nutrition on the internet, and found it to be like “a snake oil convention”, which it most certainly is. So, he contacted me to get my opinion on the subject. I’ve been meaning to start writing about training and performance for a while, and balance out all my writings about disease and overcoming disease conditions, and so I thought this would be the perfect opportunity to start.

The first thing that needs to be said is that there are common aspects as well as differences in the way training and nutrition should be optimised for different disciplines and goals. In common to all disciplines, are that we always want to perform at our best, and recover as fast as possible. Those are the basic and most fundamental drivers.

Differences are much greater in number and far wider ranging in kind, but they can include core aspects like the duration of the event: speed and power versus endurance and stamina (think of the 100 meter dash versus the marathon, or the velodrome cyclist versus the Tour de France rider); the kind of effort required: sustained versus bursty (think of rowing versus tennis); the medium and nature of the forces against which we are working: water or air, with an intervening machine or without (think of swimming versus jumping towards the rim to slam dunk the basketball, skying versus bobsledding, wrestling or judo versus Formula 1 racing).

In every case, there are preferred and optimal skills and trained reactions, fitness and body composition, as well as morphology and muscular development. For now, let’s just look at the basics in the sense of what every athlete would want and would benefit from no matter what kind of activity they do: best performance and fastest recovery.

The most fundamental point is mitochondrial energy production

At the root of all activity of the body, and at all levels, is the generation of ATP by mitochondria. This is really the bottom line for everything, because this is what cells use to function and do what is required of them in every instant. Mitochondria, small organelles thought to have migrated into a cellular membrane early in the history of evolution of life on the planet, are present in every cell in different amounts, and are essential for life. They can oxidise or burn any macronutrient—glucose, amino acids, or fat—to produce ATP, but the bulk is derived either from glucose or fat. In the process, they produce byproducts of different kinds and in different amounts based on the nature of macronutrient used for fuel, and on the energy demands. Therefore, for optimal performance with a fixed number of mitochondria, we want:

  1. the maximum efficiency in ATP energy production, and
  2. the minimum amount of metabolically taxing byproducts.

These question of deriving the most amount of ATP in the most efficient way with the least amount of byproducts that ultimately impede physiological function, has been considered in On the origin of cancer cells (1 and 2)To summarise in very few words: fatty acids are the most efficient way to store energy, on a gram-per-gram basis they produce the most ATP when oxidised by the mitochondria in an oxygen-rich environment, and their oxidation result in the least amount of acidic and physiologically costly byproducts. Therefore, the inevitable and obvious conclusion, is that for optimal physical performance, we want maximum metabolic efficiency, and for maximum metabolic efficiency, we need to provide the conditions that allow our cells to use fatty acids as their primary source of fuel.

The key is efficient fat utilisation

Efficient fat utilisation is achieved in three stages, which are really just two, because the second and third blend into one another seamlessly. The first step is making sure cells can use fat as fuel. Because insulin signals cells to store energy, it prevents fat utilisation (lipolysis). Inhibiting lipolysis is one of insulin’s main functions. To allow cells to burn fat, insulin must be low. To lower insulin levels, we must either fast, or restrict carbohydrates (and to a lesser extent protein). In fasting conditions, most people will reach insulin levels low enough to start fat-burning after 12 to 16 hours. With severe carbohydrate and protein restriction, that means getting all or almost all of your calories from fat, the timescale is probably similar.This first step is therefore achieved within 24 to 48 hours.

The second step is basic adaptation to deriving cellular energy needs from fatty acids, those that we eat, and those that are stored within the body’s fat cells (adipocytes). This is achieved over the course of about 4 weeks by maintaining a very low carbohydrate, low to moderate protein, and high fat diet.

The third and last step is full keto-adaptation, achieved within two to four months of consistent carbohydrate restriction. The word keto in the term keto-adaptation refers to the fact that, from the breakdown of fats, the liver manufactures ketones, the one we measure as a marker is usually beta-hydroxybutyrate, used primarily to fuel brain cells that can only use glucose and ketones. This stands in contrast to most other cells that can use fatty acids directly. An exception to this—the only one, as far as I know—are red blood cells that can only use glucose.

A point that needs to be appreciated relates to the potency of insulin to stop fat-burning. As soon as glucose spikes, insulin will spike, and will stop fat-burning. This is particularly important if we are aiming to burn as much fat as possible or become as efficient fat-burners as possible. Consequently, the very worst thing we can do is to have sugar in the morning, just before or just after training. Even a small piece of fruit will do it. This will generally always stop fat burning in its tracks. And not just for a few minutes, but for hours, all the hours necessary for insulin levels to drop back down low enough to allow lipolysis to start again.

Maximally efficient fat utilisation is where an athlete wants to be, because this will ensure that they always use as much fat and as little glucose as possible, maximising endurance potential while minimising production and accumulation of lactic acid in the muscles. The most important benefits this brings are to be able to sustain long hours of exercise without “hitting a wall” from the exhaustion of glycogen stores, and having muscle fibres that can function smoothly unimpeded by the presence of large amounts of lactic acid, something which also significantly accelerates recovery, as very little time is needed to clear out the small amounts that remain in the muscle after the event or training session.

Fat stores are, for practical purposes, inexhaustible. Even in very lean athletes (below 10% body fat), there will be between 5 and 10 kg of fat reserves to draw on during that ironman, that ultra-marathon, or that mountain-bike-around-the-clock event. Each gram of these 5-10 kg provides 9 kcal of fuel. And so, that endurance event lasting 12 hours during which you burn 7500 kcal could be fuelled with just 830 g of body fat. Naturally, this would not happen, because glycogen from the liver and the muscles will always be used in greater or lesser amounts depending on the level of stress (physiological and psychological), and intensity of the exercise. Nonetheless, this is a good illustration of the massive reservoir of fuel we have at our disposal if we train the body to utilise fat efficiently.

montBlanc-ultraMarathon

The Mont Blanc ultra-marathon. All long distance runners should be keto-adapted.

To get to this point, the muscle cells need to be trained to use fat, first at very low intensity to make sure that they can fuel the activity using mostly fat, and then gradually increasing the level of intensity to force adaptation in continuing to burn fat as the primary fuel. Best way to achieved this, is by doing low intensity endurance work in a fasted state. And over time, gradually extending duration and increasing intensity.

Moreover, doing intense, muscularly demanding, resistance training in the fasted state, is beneficial in many additional ways, including the secretion of greater amounts of growth hormone and testosterone for better growth and repair of tissues, as well as more effective fat utilisation, and protein recycling, which involves the breakdown of damaged, scarred, and otherwise unused tissues in order to maintain, feed and rebuild the muscle tissues that are being used. The same mechanisms involved in protein recycling, act to preserve muscles that are active, while facilitating the breakdown of other tissues, and in particular fat stores, that are not.

There are many benefits to training in a fasted state, and doing both low intensity endurance, as well as high intensity resistance training. This is especially true over the long term, as the body becomes increasingly more efficient at fat utilisation, increasingly better at preserving active muscle mass, and increasingly more effective in repairing damaged tissues and cleaning out metabolic wastes. Such conditions are naturally highly favourable for building strong, healthy, lean muscle mass.

Fast recovery requires minimising inflammation

Whenever we do anything physical, some level of micro tears, fractures, and injuries to the muscle and bone tissues take place. The body’s repair mechanisms involve an inflammatory response. Without a healthy inflammatory response, we would not be able to recover from injuries, recover from training, or build bone or muscle mass. In fact, we would not be able to survive. What we want, is a fast and effective inflammatory response to heal, repair, or build whatever needs fixing as quickly as possible. What we do not want is a low-level of chronic inflammation that cripples the body from functioning at its best.

One of the greatest advantages of running on a fat-based metabolism with maximally efficient fat utilisation, is the fact that the muscle cells are fuelled by burning fatty acids without producing lactic acid. This is in stark contrast to a glucose-based metabolism, where most of the energy is derived from burning glucose, and this always produces lactic acid. As intensity increases, the amount of lactic acid produced will depend first on the intensity, and second on the level of keto-adaptation. The better the keto-adaptation, the more fat will be used to fuel the cells at higher levels of intensity. But, no matter what, the keto-adapted individual, and the athlete in particular, will always, and in all circumstances, produce less lactic acid than the one running a glucose-fuelled metabolism.

All acidic metabolic waste products need to be eliminated from the body. This is the role of the kidneys, whose function we have explored in The kidney: evolutionary marvel. For lactic acid that accumulates in the muscles, the first stage is to get it out of the muscle, and this usually takes quite a while. It can take from hours up to several days. The process of clearing it out can be accelerated using massage, stretching, and very low intensity exercise. Alkalising baths are a fantastic therapy for accelerating recovery, and lowering inflammation. Magnesium chloride and sodium bicarbonate baths are therefore an absolute must for the serious athlete. We have detailed the importance, roles and functions of magnesium in Why you should start taking magnesium today, and discussed inflammation and the importance of alkalisation in Treating arthritis (1 and 2). 

In the end, all metabolic acids lead to increased inflammation, and, when they accumulate in joints and tendons, inevitably to injury. Insulin-stimulating carbohydrates also cause inflammation. They trigger hundreds of inflammatory pathways. And so, by eliminating them from our diet, and allowing the metabolism to run on fat, we have done as much as we could ever do with our food to minimise inflammation in the body. This is what an athlete wants for the fastest possible recovery time, with best training performance, and the smallest risk of injury.

The final and most important element for fast recovery and low inflammation is optimal hydration. This is the most important because all of the body’s cleaning mechanisms, and especially the function of the kidneys, depend intimately on water and salt. Drink alkaline water on an empty stomach—at least 3.5 litres per day. Eat plenty of salt with all your food—at least a full teaspoon. The more you sweat, the more water, and the more salt you need. We looked in detail at how much of each is optimal in How much salt, how much water, and our amazing kidneys.

When do we eat?

If we train in a fasted state, the best is to train in the first part of the day, taking advantage of the fact that the fast has already lasted 12 hours or so. We can rather easily extend that further, and train around noon, following about 16 hours of fasting. Either way, we will want to eat between one to two hours after training, allowing a good amount of time to make sure the body is well hydrated, and stress levels have dropped. This will bring us to having our first meal of the day somewhere between 12:00 and 15:00. Different people have different schedules and preferences depending on the rhythm of their work and personal life. There are no hard rules, and things have to remain flexible, as irregularity is also an important part of training the body to be more adaptable. In fact, you should be somewhat irregular with your schedule for just this reason.

We can have only one meal per day, or we can have two, or we can have one big meal and some snacks, or, best of all, we can sometimes have one meal, sometimes two meals, sometimes have snacks, and sometimes not. The main point in training the body for optimal metabolic efficiency, is to be a significant amount of time, somewhere between 12 and 20 hours, without eating, and to train in a fasted state, in conditions of low blood sugar and low insulin levels. We discussed intermittent fasting in The crux of intermittent fasting, concluding that one of the most important points for successful and effective intermittent fasting is that the body be fuelled by fat and not by glucose. As you will have gathered by this point, our context here relies on the fact that the body is keto-adapted, and therefore, fuelled by fat.

What do we eat?

That was the original question my friend wanted answered, and it is, in a way, very simple to answer: we eat only the least contaminated, least processed, and least insulinogenic, the most natural, most nutrient dense, and most digestible.

Least contaminated means minimising our body’s exposure to toxic substances, heavy metals, hormone disruptors, pesticides, herbicides, chemical additives, anything that is toxic in one way or another. Least processed means minimising manufactured foods, of which we don’t need any. Least insulinogenic means minimising foods that stimulate the secretion of insulin from the pancreas, and this means minimising intake of simple sugars and starches, and not over-eating protein which is about half as insulinogenic as carbohydrates.

Most natural echoes least contaminated and least processed, but additionally implies a freshness, a wholesomeness, an absence of adulterations and manipulations. That’s what we want. Most nutrient dense means maximising mineral content, vitamin content, optimising amino and fatty acid profiles, and overall micronutrient content for a given amount of calories. Most digestible means minimising digestive stress, maximising enzyme content and nutrient absorption.

Digestion, the function and health of the digestive system, is essential. Everything from the food we eat is made available and usable—or not—by and through the digestive system. We have written about digestion on many occasions, but most specifically in Understanding digestion, Intensive natural healing, and Why we should drink water before meals.

But in practice, what do we eat? No junk of any kind. No polyunsaturated oils. No sweet things. No starches. Excellent animal foods and excellent plant-based foods: grass-fed, full-fat meats and organ meats like liver; nutrient dense and non-toxic fish like sardines, herring, anchovies, seafood and wild fish (avoid tuna, swordfish and any other large predatory fish, because they contain large amounts of mercury and other heavy metals); fatty nuts and seeds, especially coconut products, but also walnuts, macadamia, almonds, hazelnuts; dark leafy greens, both in salads (mixed baby greens, baby spinach, arugula, lamb’s lettuce, lettuces of all kinds) and steamed (chard, spinach, and anything similar); green vegetables like celery, cucumbers, broccoli, asparagus, and string beens; colourful vegetables like purple cabbage, red and yellow peppers. You can eat pretty much anything you can think of that is not processed, nutrient poor, or highly insulinogenic.

What should you have for breakfast? We already solved that problem! You do not eat breakfast anymore, remember?

What do you have for lunch after training? You’re in a rush or just lazy? Well, make yourself a coconut milk smoothy. You can put some protein powder (whey or plant-based, but never soy!), some superfood powders, some hemp or chia seeds. You prefer it sweet-tasting? Put some raspberries or blueberries, and stevia extract. You prefer it green and salty? Put some spinach and salt. In both cases, you can add avocado whenever you want. You can make it with cacao powder, with vanilla extract, or with almond extract. You can add raw or roasted almond or hazelnut butter, sunflower seed butter or tahini. Anything you want that is wholesome and healthful. You’ll need to experiment to find combinations you like. Start simple with few ingredients, and add things bit by bit to keep on top of the process and the blends of flavours.

If you’re not in a rush, or don’t want to have a smoothie? In this case you eat exactly as described above: healthy, nutrient dense animal and plant-based foods. This can be as simple as a can of sardines with a bag of organic baby greens. And for supper, the same as for lunch, really. The same simple and basic principles apply to everything you eat at all times, with these two additional points to keep in mind:

The first is that because we do not eat for a significant part of the day, and also because we eat either just one or two meals, it is crucial to get enough calories and fat, nutrition and protein. Otherwise, we will quickly find ourselves in calorie deficit, and this means that if we keep it up for a long time, we will first burn through our fat reserves, and then burn through our muscles. As athletes, we definitely do not want this. So, it is very important to get all the calories we need, especially if we train a hard or long hours on a daily basis.

The second is that for good, deep and comfortable, restful and restorative sleep, we shouldn’t go to bed on a full stomach, and most importantly, not on a stomach full of protein. Digestion is energy intensive. In the case of protein, it is also highly thermogenic, which means that it generates heat. Therefore, going to bed after a large protein meal will  lead to a restless, tossing, turning, hot and uncomfortable sleep. For a deep and restful sleep, we want the opposite: little digestive activity, a slow heartbeat, and a low body temperature. This means that large protein meals should be had several hours before bedtime, in the afternoon or early evening, allowing a good three to five hours for full digestion before going to bed. If you can’t avoid eating late at night, then eat light: a salad is perfect. For a snack instead of a light meal, have a couple of tablespoons of almond butter on cucumber slices or with celery sticks, for example. Because sleep is really the most important part of the body’s recovery process, it is imperative to optimise sleep.

Closing thoughts

With all of what we have discussed mind, is it really any surprise that more and more professional athletes are opting for this metabolic advantage? A number of years ago, the tennis champion Novak Djokovic divulged one of his secrets. What was it? It was exactly this. This year, the third time winner of the Tour de France, Chris Froome, also divulged one of his secrets. What was it? It was exactly this. Are you curious, say, about Froome’s standard first meal of the day? Four poached eggs, smoked Alaskan salmon, and steamed spinach. Surprising breakfast? Not in the least. Indeed, an excellent breakfast!

We are seeing more and more runners, swimmers, triathletes, but also power lifters and body builders making the switch. It is to their advantage, and when they themselves feel the difference it makes, they know it to be true, at which point there is no turning back. Obviously! Who in their right mind would give up such a metabolic advantage? I suspect that eventually, this will be the standard.

And it’s not surprising at athletes from various disciplines have made these changes to their diets and lifestyles. What is surprising is that so few have actually done this. The change is low, but there is a clear shift in this direction. This is attested by witnessing training specialists promoting these principles, training athletes in this way, and demonstrating the immense advantages that it brings to them in their performances. Vespa Power discussing fat utilisation on their website is a good example.

Is all this stuff new? Of course not! Medical doctors, nutrition researchers , diabetes and metabolic medicine specialists have been talking about this for many decades. Some pioneers include Atkins, Rosedale, Volek and Phinney. And the tradition has continued and expanded, especially in the last decade.

Is this the whole story? Of course not! It never is. But it covers the basics. I plan to explore different aspects of what we started discussing here. You can read more about all these things on blogs and websites. Here are three I have read: the athletic MD Peter Attia had a good blog with many informative articles (especially in the beginning) about physical performance at different stages of his own keto adaptation process. The professional ironman triathlete Ben Greenfield also has written about his experience going form fuelling his body with glucose to using fat instead. I point to these because they have articles specifically about the process of keto adaptation we describe above as foundational for optimal sports performance, and also because they were both meticulous in quantifying the physiological changes and writing about them.

Marty Kendall has a very good blog on optimising nutrition in the sense that we have discussed here, and have been writing about for five years, starting with our very first post, What to eat: four basic rules. But what Marty has done is to actually quantify the value of foods, using the USDA nutritional database, assigning to each food an insulin index derived from its insulinogenic potential, and a nutrient density score based on its macro and micro nutrient content. The associated Facebook group is a great resource for information on this and related topics.

Now that we’ve reached the end, I hope this was useful, and that I have managed to show that, whatever the reason or motivation, whatever the sport or skill set required, there is really no other option other than this when you are serious about optimal physical performance.

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Hypoglycaemia as a metabolic impossibility

Last Thursday, the day before the operation, the dental surgeon told me: “Make sure you have a good breakfast. I don’t want you to get hypoglycaemic. It will last several hours.” I replied: “I never have breakfast, and it is impossible for me to become hypoglycaemic.” He was like: “What? What are you talking about? I don’t understand what you’re saying.” I just said: “Because I don’t eat carbohydrates, I cannot become hypoglycaemic.” I’m not sure he understood what I meant, but I suppose that given my response, he figured I knew what I was talking about.

I’m sure you’ve heard, at one point or another in your life, someone say: “I’m hypoglycaemic, I need to have something”, and then seen them pull out a can or bottle of juice, an apple or an orange, a granola or a chocolate bar? Maybe you’ve said it yourself! It sounds scientific; like we know what we’re talking about. Don’t you think? Maybe we’ve heard a doctor or a nurse say it. Maybe we’ve heard other people say it, here and there. And over time, saying this has become common parlance in North America, and surely in the UK as well. But what does it mean? What do we mean when we say that?

Do you know why I said what I did to the dentist? Do you understand why it is impossible for me, (and possibly you too), to become hypoglycaemic, even without eating for 12, 24, or 36 hours? Why is it that so many people suffer from hypoglycaemia on a daily basis, especially type II diabetics, and all the while, I’m writing that it is ‘a metabolic impossibility’? Am I wrong? Am I lying? Am I confused or trying to be confusing? And why is there so much hype about hypoglycaemia? Just Google it and you’ll see: 6.35 million hits! There’s even a Hypoglycaemic Health Association!

First of all, if you don’t already know what it means, hypo means low, and glycaemia means ‘sugar in the blood’. So, hypoglycaemia just means low blood sugar. But the thing is that what people usually mean when they say this, is that they are feeling tired, slow, flat, low-energy, light headed, maybe even dizzy, and interpret these symptoms to reflect a state of low blood sugar, which it usually does. But there’s a caveat: different people will feel the same symptoms at different blood sugar levels! Isn’t that a little weird? Doesn’t that make you wonder about what this means and implies? If there is such as thing as hypoglycaemia, why would it be different for different people? Meaning, why would a certain blood sugar level be fine for one person, and too low for another?

But what is low blood sugar? What is high blood sugar? What is normal blood sugar? Do you have any idea? And how much sugar is that, actually, circulating in the bloodstream? Any idea about that?

Let’s make it simple. Most people have between 5 and 6 litre of blood. Let’s take 5 litres as our baseline to make the numbers easier. Most people, on average, have around 100 mg/dl of glucose in their blood (even if they should have less!) Since there are 10 dl in 1 litre, and 100 mg =0.1 g, this makes 5*10*0.1 g = 5 g. Think on that for a second: in your entire body, there are 5 litres of blood, and in this volume of blood, there are 5 measly little grams of glucose. That’s a teaspoon!

For very low blood sugar levels, we can go down to about 50 mg/dl (half the normal average). This would amount to just 2.5 g in your whole body! And for critically (as in dangerously) high levels, we can go up to around 400 mg/dl (four times the average). In this case, that would amount to still just 20 g! Therefore, we can say that at any given time in our body there is on average 5 g of sugar, very rarely less than 2.5 g, and only extremely rarely, when we are severely diabetic, up to 20 g. So, all things considered, it’s not much, is it?

Now, why is it that most people feel hypoglycaemic at one point or another if they don’t eat for a while, sometimes in as little as a few hours? Why would different people feel these symptoms more or less intensely? And why would different people feel the same unpleasant or even debilitating symptoms of hypoglycaemia at different concentrations of blood glucose?

Well, if you feel symptoms of hypoglycaemia it means that 1) your blood glucose levels are significantly lower than your own usual average level, the level at which your system and cells have gotten used to functioning. This average level could be 200, 150, 120, 100 mg/dl or whatever. And the lower threshold before you start feeling weak, tired or even dizzy could be 40, 50, 60, or even 90 mg/dl. In fact, diabetics or soon-to-be-diabetics, could be walking around, going about their business with an average of 150, 200 or even 300 mg/dl without knowing it, until they get a blood test and someone notices. And they would definitely feel hypoglycaemic at levels that could be quite high. How come?

The key to understanding this conundrum in the apparent subjectivity of hypoglycaemia is the notion of glucose tolerance. But what is glucose tolerance if it is not insulin sensitivity? And what is insulin sensitivity if it is not the flip side of insulin resistance? I hope that by now, having been reading this blog for a while, you know everything about insulin resistance, how it develops and how it manifests itself in the biochemistry and metabolic functions of the body. (If you don’t, then just reread the posts you’ll find in the Diabetes and Carbs categories.)

This notion of tolerance explains it all very neatly: with chronic exposure to glucose, (as in high average levels of glucose in the blood for an extended time), insulin resistance increases, and thus, insulin sensitivity decreases. As insulin sensitivity decreases, more insulin is needed to clear the glucose from the bloodstream, and more glucose stays in circulation longer. The cells get used to this high level of insulin, and become less and less sensitive to it, allowing less and less glucose to get in. When the level of glucose drops below the threshold at which the cells can use it without much effort, muscle but especially brain cells, we feel hypoglycaemic. This is why hypoglycaemia is defined on a subjective and relative scale that depends on our own cells’ sensitivity to insulin, the hormone that shuttles the glucose in. We become hypoglycaemic when the body cannot use fat to fuel its cells, and ketones to fuel its brain. And the more insulin resistant, the more prone to hypoglycaemia.

Moreover, insulin sensitivity, or resistance, exists on a continuous spectrum in the population. It goes from extreme sensitivity to extreme resistance. On the side of high resistance, we have type II diabetics; and on the side of high sensitivity, we have those people like me, and maybe also like you, who restrict carbohydrates, getting most of their calories from fat, and whose cells are consequently fuelled primarily by fat and not by glucose. This makes them, it makes us, not only highly metabolically efficient, but also impervious to hypoglycaemia.

This is why I said what I did to my dentist over the phone the other day: for a body whose cells are highly insulin sensitive from being minimally exposed to glucose/insulin in the bloodstream, the levels of which are delicately and sensitively regulated by the liver (glucose) and pancreas (insulin) throughout the day based on food intake, activity and stress levels, the cells are primed to burn fat efficiently, and the liver is primed to produce all the fat-derived ketones to nourish the brain, which they do far better than glucose can. For a body that works like that, it is physiologically impossible to become hypoglycaemic.

By the same token, it is also physiologically impossible to ‘hit the wall’, just because the cells are fuelled by burning fat, not glucose, and there is always a large reservoir of fat in the body, in terms of calories, at least an order of magnitude larger than the reserves of glycogen in the liver and muscles combined, and this, no matter how thin you may be. For example, even at 8% body fat (like me), which is quite low, a person weighing 63 kg (like me), has 5 kg of fat to draw on, providing a reservoir of 45 000 kcal! This is why we see more and more high level long distance athletes and professionals (like this one), and even power lifters (like this one) switching to a very low carb high fat diet (often abbreviated VLCHF). They do this to get lean and to tap into the metabolic advantages of nutritional ketosis.

Two final points:

1) Insulin sensitivity depends sensitively on exposure to insulin, which depends sensitively on the presence of glucose, which depends sensitively on carbohydrate intake. And it is as simple as this: the less carbohydrate, the less glucose; the less glucose, the less insulin; the less insulin, the more insulin-sensitive. This is always true even if different people have different genetic predispositions to insulin resistance.

2) Nutritional ketosis depends on the ratio of calories derived from fat to those derived from carbs, as well as on a specific maximum amount of insulin-stimulating carbohydrates per day. This threshold depends on each person individually. For one person it can be as high as 100-120 g, whereas for another it could be at low as 15-20 g. In addition, if you deplete your glycogen stores from going for a really long bike ride, for example, you can eat as much as 200 or even 300 g of carbs, and still remain in ketosis, because all of it will go to replete glycogen in the muscles and liver. In most people and in most cases, however, a standard guideline is less than 50 g per day. But, remember, the lower the better.

So, are you clear on what the deal is with hypoglycaemia? And now, what’s it gonna be: carbs, hypoglycaemia, feeling tired and irritable, low in energy and mentally slow, light headed and dizzy; or fats and protein, nutritional ketosis, feeling good and strong, high in energy and mentally sharp, stable and alert.  That’s a no-brainer, right? What do you say?

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Two short fat-loss tales

– You look like you’ve lost some weight.
– Yes, I have! I’ve lost 12 kg in 4 months. You remember, a year ago, I told you I would do my own diet, and I did!
– That’s great, congratulations!
– You know what I did? I stopped eating junk. I didn’t do anything else. I stopped eating chocolate bars and candy; cakes, cookies and ice cream; chips and fried foods, and that’s it. I eat everything: anything that is a whole food, and I do have bread and potatoes, rice and pasta, as well as cheese and fruit. I didn’t do anything crazy or radical, I just eliminated junk food from my diet.
– That’s really good. I’m happy for you. Keep it up!

This is how went a short conversation I had recently with a colleague who, a couple of years ago, was one of the 25 people who attended the talk I gave at ESAC: Water, sugar, protein and fat. It could be (I’d like to imagine) that the talk was like a little seed in her mind that was what eventually grew into enough of a motivation to start what she had been doing for a few months already, making her feel really great about it, as anyone would, of course. And I’m really happy for her, and also very happy to possibly having been a little positive influence somewhere along the line.

Another colleague stopped by my office in the spring to ask about the fitness club (a club to encourage people to exercise by subsidising part of the monthly membership to a great sports club close to where we work for which I was president for several years until a month ago or so). He mentioned in passing that he wanted to start doing sports in order to lose weight. Naturally, I immediately said that exercising wasn’t really the key to fat-loss. He was surprised, as most people are when they hear this. Being interested and inquisitive about this point (he works as a scientist, after all), I gave him a 10-minute summary of the biochemistry of fat loss, and he left very motivated to start on his fat-loss programme.

About one month later we crossed paths on the main road in front of the canteen. He looked much thinner: he actually looked quite trim considering that as little as four weeks before he not only looked but was definitely quite chubby.

– Things are going well, I see! You look like you’ve lost a lot of weight already.
– Yes, I’ve lost 10 kg. Now, after the first four weeks, I’ve started to eat carbs again, but I’m eating 1500 calories and exercising every day. I started eating some complex carbs because I need energy.

I masked my internal cringing, and just said “well, you are much leaner than you were. Good job and keep it up!” But I thought: What in the world!?! How did he come to think like this after I explained to him how fat loss works, and which he seemed to understand? The thing is, he did cut out all carbs for four weeks—there’s no way in the world he would have lost this much fat any other way—but for whatever reason, he now thought he should start again because he was exercising every day and therefore “needed energy”. He really didn’t understand the most important points I had tried to relate in that chat we had in my office. I am, in any case, very happy for him as well, because it is always better to be leaner than fatter, especially considering that a lot of the excess fat accumulating in our abdominal cavity is stuffed in between and all around our vital and digestive organs, putting constant pressure on everything in there, and that’s really bad.

Now, I would like to think that all of you readers of this blog already know what I want to point out and explain in regards to these two short fat-loss tales. Whether you do or not, I thought it was a good occasion to review the essentials of fat-loss in a quick and focused but more informal style than in other articles I have written. You are more than welcome to take a few minutes and try to guess what I’m about to explain about these two cases before moving your eye gaze down onto the first line of the next paragraph.

Why did the first colleague I talked about lose so much weight? Is it because she started exercising? No. She never exercised and still doesn’t. Is it because she starved herself on a low-calorie diet Weight Watchers style? No. She hasn’t been hungry because she hasn’t tried to eat a lot less, and has three meals a day without paying close attention to how much and is certainly not counting calories. Is it even because she stopped eating “junk food”? No, it’s not. The reason why she has lost this weight seemingly so easily is only because she markedly decreased the amount of sugar she ate, which immediately translated in lower blood sugar levels throughout the day and night, which in turn translated into lower insulin levels also throughout the day and night. As insulin drops, fat-burning starts.

Will she continue to lose her fat reserves indefinitely at this rate until there are none left? No, she won’t: fat utilisation, and therefore fat-loss rate, is inversely proportional to insulin levels. So, the lower the blood sugar, the lower the insulin, and the lower the insulin, the faster the fat-loss rate. Because she still eats sugar in the form of starches, the sugar/insulin concentration will only sometimes drop low enough for fat-burning to start, and will not drop very low and stay there to allow the metabolism to fully adapt and settle into a stable and more or less constant fat-burning mode. She will remain in intermittent fat-burning and sugar-burning. Because her fat reserves are at this stage still very large (from the organism’s perspective they are still effectively infinite), the relatively lower blood sugar for periods of several hours will prompt the body to continue to let go of these excessive fat reserves relatively easily until a steady state is reached and fat-loss stops. At that point she will still have plenty of excess body fat, but will be unable to lose any more without dropping insulin levels lower.

Of course, eliminating junk food—mostly commercial sweets and fried stuff—and feeding ourselves with actual food, no matter what it is, makes a huge difference. This is definitely the very first step in any change of diet towards better health. That’s obviously not something worth debating or even discussing. The point is that no matter what the changes in the diet, the biochemistry of fat loss is always the same, and it is the same for everyone. Everything is about insulin for the very simple reason that it is insulin that shuttles nutrients from the bloodstream into cells. This is true for sugar, protein and fat. But insulin is released by the pancreas primarily in response to the presence of sugar in the blood (but also in the absence of stress hormones which block insulin’s action to retain the sugar in circulation as long as the “potential threat” remains). The gist of it is: high insulin—nutrient storage, low insulin—nutrient release; high insulin—fat storage, low insulin—fat-burning.

What about the second colleague exercising and eating only 1500 calories that include starches and some fruit? He will continue to lose fat until the body determines that the bulk of the really excessive fat reserves have been spent, and then will stop. This will happen probably somewhere around 20% body-fat for guys and 30% for women, but will depend on age, exercise level, food, etc. So, he will get lean enough to appear slim, feel light, and also feel pretty good about himself every time someone compliments him on his figure. The more serious problem for him is that exercise, and especially the aerobic exercise like running that he is does to “burn more calories”, breaks down muscle quite quickly but it is not rebuilt.

The low calorie intake places the metabolism in calorie-deficit given that an average man needs about 1500 calories just for basic metabolic functions. This means that all additional calorie requirements have to come from somewhere other than the food that is eaten. Ideally, of course, these would come from fat reserves of which there are plenty; that’s the idea of the low-calorie dieter. But this will and can only happen if insulin levels are at rock bottom: I mean 1–3 units. Otherwise, the body will cannibalise its muscles because it can most easily get the easiest-burning cellular fuel it needs by converting protein into glucose. And the result? Over time he’ll lose most of his muscle, will retain that 15-20% fat, and will inevitably acquire the skinny-fat look. You know what I mean: the look of a slow, 40-50 year-old long-distance runner on a typical high-carb “runner’s diet” who looks skinny but giggly, with barely any visible muscle and no definition at all: muscle tissue broken down and not rebuilt; fat reserves not used because insulin is too high.

Had you guessed all that? Do you now understand how to burn fat without hunger and without losing muscle? Drop sugar levels, drop insulin levels: lose the fat reserves, keep the muscle. Eat fibrous veggies, lots of unprocessed fats and enough clean protein; don’t eat any sugar or starch. Very simple.

And here’s a teaser for a future series: if you want to build muscle and maximally slow down ageing, you will—in addition to this kind of shift in diet—also start lifting weights: squats and dead lifts, bench press and overhead standing press, bent-over rows, dips and pull-ups; and the heavier and more strenuous the better!

But if you’ve never done any of that, don’t go out and start lifting as much as you can right away because you’ll hurt yourself: you have to start slow, and have impeccable form and technique before starting to put on more weight. However, the fact is that there is really nothing more effective than heavy weight lifting to correct metabolic imbalances, postural problems, muscle and joint weaknesses; to burn fat, build muscle, and increase bone density; and totally rejuvenate the body and restore a incredibly youthful hormonal profile. The most amazing thing is that this is true for men and women of any age. I hope to find the time and write about this in the not-so-distant future.

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Two articles that changed my life

Two days ago, on October 23, I turned 40. For me, it feels different than every other birthday I have had: it feels like the marker of the transition between what can be considered young adulthood from 20 to 40, and middle adulthood from 40 to 70, which is then simply followed by old age. Maybe this is also linked to the fact that from the time I started competing, first in running track and field, then in road cycling, duathlon (running and cycling), off-road cycling and eventually in long distance running, I have always been in the normal, standard 18-40 category (like almost everyone else, I thought). And now, starting with my first race in the first level Seniors from 40 to 50 a couple of weekends ago in Bordeaux at the Ariane Cross 2012, I am definitely, and will be for the next 10 years, in the over 40 category. So, I have been reflecting a little on the past and the future: What is really important to me, what have I done and accomplished, what do I want to do in the future and how can I get there? Simple questions whose answers are not so simple.

In this context, I want to share two articles that completely changed my life, and completely changed my state of health, in some respects, rather suddenly, and in others, gradually over the years. Interestingly, I stumbled upon and read them both in the same week almost exactly five years ago. I won’t summarise, discuss their contents, nor describe the positive effects the simple but radical changes in dietary habits they prompted me to instil have had on me, on my wife Kristin and on our son Laurent. I simply encourage you to read them for yourself, and sincerely hope they will benefit you as much as they have us, and, I am sure, everyone who has ever read and applied the information they contain to their diet.

What is clear to me now much more than it has in the past, is that no matter what information we are presented, its impact depends entirely on how receptive we are to it. And this depends on all of what we know and think we know, on how we understand the connections between everything we have been exposed to, on our habits and tendencies, on previous experiences throughout our life, and very importantly, on the circumstances that form the context in which the information is brought to our attention. Thus, let me hope that these two articles come at a time that is ripe for you to appreciate their importance in regards to your own health, that of the people you care about, and everyone else for that matter.

The two articles are Insulin and Its Metabolic Effects by Ron Rosedale, MD, and The Skinny on Fats by Mary Enig, PhD. After reading them, please consider sending this link to those you know will or even might possibly appreciate it. As you will see from the few case histories at the start of Rosedale’s presentation, it is really a matter of life or death.