Saturday, August 3, 2019

Retrospective #168: Does Exercise Work?

This is a hard subject for me to address. I rarely speak of exercise, but when I do, I say I don’t do it. I don’t like exercise.
Another reason I don’t mention it is that from the first day in 2002 that I began eating Very Low Carb, I have succeeded in losing a great deal of weight (my original goal) and vastly – very, very dramatically – improved my health (my Type 2 diabetes, my cholesterol and my blood pressure), all without regular exercise. I don’t go to the gym, or take long walks, or follow any other regular routine. Never have. Never will. And this sets me apart from virtually everyone else who uses “diet and exercise” as part of a treatment plan for “healthy living.”
Almost everyone who adheres to an exercise program does it 1) with a low-fat, high-carb weight loss diet that is doomed to fail and 2) with the hope and expectation that they will lose weight. And worse, unfortunately, the diet part of that formula will further damage their health. They will not lose weight and keep it off eating “high-carb,” and they will worsen their lipid health, in particular HDL and triglycerides which are a major part of CVD risk.
So, why write about “Does Exercise Work?” Because, apparently it does work, and here’s when and how I reluctantly came 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 explained 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 (80% or more) of functioning beta cells in the pancreas, which makes insulin. So, anything a Type 2 diabetic can do to increase his/her insulin sensitivity is 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. I work every “nice” day from spring to fall in the garden, 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. Some MDs and RDs tell me that that’s exercise. Gardening and kayak fishing may not be a formal exercise program, but they are regular for me.
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, what kind of exercise you chose to do “depends.”
Age and physical condition are factors, of course, and perhaps your gender should be considered too; therefore, goals should be individualized.” That works for me, and apparently for my health care providers too. They think they collaborate as “we” set my individual goals. And then they can write on my chart, “patient compliant.”
There’s lots of good advice out there, though. The best “conventional” advice I remember was from low-carb guru Dr. Richard K. Bernstein. Chapter 14 in 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, my favorite 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 a week. Volek also co-authored, with Phinney and Eric Westman, MD, the updated Atkins primer, The New Adkins for a New You.  
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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