Thursday, December 12, 2013

The Nutrition Debate #168: Does Exercise Work?

This is a hard subject for me to address. As most readers here know, I rarely speak of exercise; but when I do, I say that I don’t do it. Sometimes I joke that I’m allergic to it as it makes me sweat; or, as others have said, including my guru Gary Taubes, exercise makes you hungry, as in “work up an appetite.” I don’t like exercise.

Another reason I don’t mention it is that from the very first day I began this Very Low Carb Way of Eating, (VLC WOE) on Atkins Induction in 2002, I have succeeded in losing weight (my original goal) and vastly – I mean, very, very dramatically – improved my metabolic health (my type 2 diabetes) and my lipid health and my blood pressure, all without a regular exercise program. That is, I don’t go to the gym, or take long walks, or do some other routine on a regular basis. Never have. Never will. And this sets me apart from virtually everyone who uses “diet and exercise” as part of a treatment plan for dealing with Metabolic Syndrome or its components.

Almost everyone who adheres to an exercise program does it 1) with the hope and expectation that they will lose weight and 2) with a low-fat, high-carb weight loss diet that is doomed to fail. And worse, it will further damage their health. They will not lose weight and keep it off, and they will definitely worsen their lipid health, especially their HDL and triglycerides which are a major part of CVD risk.

So, why write about the topic “Does Exercise Work?” Because, apparently it does, and here’s how I have finally come to understand and accept it. At approximately 19:30 in “Fat Chance: Fructose 2.0,” Dr. Robert Lustig’s sequel to his wildly popular YouTube video, “Sugar, the Bitter Truth,” he explains it quite simply.

Lustig: “Exercise does not cause weight loss – does not cause weight loss. What does exercise do? It causes muscle gain. And that’s good, because muscle has mitochondria, and mitochondria burns energy. So, you stay insulin sensitive because you have a place to put your energy instead of in your liver where it causes problems. So, exercise is the single best thing you can do for yourself, but don’t think it’s going to show up on the scale.”

Okay. Simply said, and understood. Type 2 diabetes is characterized by insulin resistance (IR) and, in advanced cases, the depletion of beta cells in the pancreas (80% or more) combined with the inability of the pancreas’s islets of langerhans to make more insulin. So, anything a type 2 diabetic can do to increase his/her insulin sensitivity is really important. And if those little energy factories in my muscle mass work to keep me insulin sensitive, then I need to maintain my muscle mass. But, as part of a regular exercise program? Sorry… Not me.

If I have to switch tactics to rationalize my resistance to a regular exercise program, so be it. My mind is good at this. It reminds me how I have protested to a diabetes educator or medical doctor that “I don’t exercise,” or “I won’t exercise.” Then I tell them that I work from spring to fall in my garden, often 4 to 6 or more hours a day 4 or 5 days a week. Then, in the winter in Florida, I fish from my pedaling kayak in the Indian River lagoon several days a week and sometimes crash the kayak out through the surf to fish in the ocean. They tell me that that’s exercise. Gardening and kayak fishing may not be a formal exercise program, but they are regular.

So, for those of you who do exercise, or know you should, know that it is, in the words of Dr. Lustig, “The single best thing that you can do for yourself.” But don’t look to me to tell you what to do or how to do it. I suppose, like almost everything else (excepting what you eat, I maintain) what kind of exercise is best depends. Age and physical condition are factors, of course, and perhaps your gender should be considered too.

This might be a good place to invoke the novel “workaround” of the new ADA Position Paper on Nutrition Therapy with respect to macronutrients. Paraphrasing, the “evidence is inconclusive as to the ideal type of exercise (replacing the ADA’s “macronutrient distribution”); therefore, goals should be individualized.” That works for me, and apparently for my health care providers too. They “collaborate” as we set my individual goals together. And then they can write on my chart, “patient compliant,” and everything is hunky-dory. 

There’s lot of good advice out there, though. The first advice I remember (back in 2005-2006) was from Dr. Richard K. Bernstein. Chapter 14 of his Diabetes Solution offers his advice on the optimal exercise routine: intense, progressive, anaerobic exercise with no rest in between, alternating days for different muscle groups.

Jeff Volek, PhD, RD, an exercise physiologist who with Stephen Phinney, MD, PhD, wrote The Art and Science of Low Carbohydrate Living, recommends the same: resistance training 2-3 days/week. Volek also co-authored, with Phinney and Eric Westman, MD, the updated Atkins primer, The New Adkins for a New You.  

There are numerous other exercise physiologists, most of them of the Paleo persuasion, who have also written books. Two that come to mind are Loren Cordain (The Paleo Diet) and Robb Wolf (The Paleo Solution).
For me though, the question is settled. Exercise is good for me because it increases my insulin sensitivity. And I’m going to continue and perhaps increase my regular, intensive gardening and kayak fishing activities.

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