Metabolic Syndrome …

  • High blood pressure
  • High blood glucose
  • Excess fat around the waist
  • Raised cholesterol
  • Raised triglycerides

If you have any three of these you are in the gun. Your risks of type 2 diabetes and heart disease are higher.

Syndromes are not diseases they are clusters of signs that have a high chance of occurring together. Presumably there is an underlying cause but it may not be obvious. In this instance, though, your money would be pretty safe on insulin resistance.

According to the Mayo Clinic website if you have any one of these it’s time to see your doctor. They go on to say …

  • Metabolic syndrome is increasingly common, and up to one-third of U.S. adults have it. If you have metabolic syndrome or any of its components, aggressive lifestyle changes can delay or even prevent the development of serious health problems.

My score is one out of five. I have seen the doctor. The aggressive life style change is underway. You didn’t think I was just writing this for your benefit, did you?

When I look in the bathroom mirror my belly doesn’t look too bad. If I turn my head 90 degrees to the right the awful truth is revealed in a mirror in the adjacent walk-in robe. I guess that’s why friends and the ever solicitous Gayle were so keen to get me on the bike. I’m sure they didn’t expect an instant cycling tragic.

I googled “ideal girth” and got the shock of my life. I was quite competitive though. That’s something you can checkout for yourself or leave a mystery.

I then googled “ideal waist size” and found what I wanted. Then I found a tape measure. And then I contemplated my future.

A man’s waist should be no greater than 40 inches or 102 cm. A woman’s should be no more than 35 inches or 89 cm. Oh, the shame … 44 inches.

Armed with that and your height you can get a reasonably close estimate of your percentage of body fat. The theory is <Here> a calculator can be found <Here>. It is a better measure than BMI which suffers from a number of deficiencies. Arnold Schwarzenegger at his peak had a BMI of 34 (or thereabouts, accounts vary). That puts him securely in the obese range (30 – 39.9). Doesn’t look it …

Actually my BMI ain’t that different. Should be OK.

Well no. It’s time for exercise and diet. Which diet?

Why Surrender …

Diabetes comes in several flavours. Diabetes mellitus is the sweet one – the problem is in the pancreas, diabetes insipidus is a less famous alternative that has it’s origin in the pituitary gland.

At university I learnt a very neat summary that I could regurgitate at exam time, “Diabetes mellitus is characterised by polydipsia, polyurea, ketosis, coma and death”.

Polydipsia, polyuria are excessive drinking and excessive peeing. They are the features that make the disease a diabetes which is a name that comes from the Greek meaning passing through or a siphon. Mellitus is from the Latin, why be consistent, meaning sweet. And yes, back in the day the doctor had to taste the urine to make the diagnosis, or at least his apprentice did.

Type 1 diabetes (mellitus) usually has its origin in childhood. It’s due to an autoimmune attack on the cells that make insulin in the pancreas. Death can be averted by regular injections of insulin, a treatment that was first used in 1922.

What I didn’t learn about at university was the work of Frederick Allen. He pioneered the treatment of diabetes with a low carbohydrate diet. The link that describes Allen’s work has this to say …

Allen’s diet was far from a cure. It essentially brought people with severe diabetes to the brink of starvation in order to control the disease.

The brink of starvation, really? Fat and protein are essential nutrients and are as calorie rich as carbohydrate. The body can make as much glucose as it needs from these sources by the process of gluconeogenesis. Nor is insulin a cure it’s a lifetime’s treatment. A lifetime in which even well controlled diabetics face complications like blindness, heart disease and severe vascular problems. Carbohydrate is not an essential nutrient although it would be almost impossible to dream up a diet that was entirely carbohydrate free. Our Frederick may have been on to something that the addition of lower doses of insulin could have made even better.

Now please don’t take anything that I’m saying here as individual advice. A low carb diet will bring down blood glucose and blood pressure. If you’re on antidiabetic agents or antihypertensives this could put you in more than a spot of bother. If you’re on medication and considering a low carb diet a discussion with your doctor is essential.

For adults with pre-diabetes or as yet on oral antidiabetic agents a vigorous fight back appeals to me far more than a surrender.

In the last post I mentioned the Diabetes Australia web site. If you search the site you can find their statement on low carb diets. For type 1 diabetes the verdict is unproven, more studies needed. For type 2 they have this to say …

In summary, this research indicates that lower carb diets are more effective at reducing blood glucose levels in the short term (three to six months) than higher carb diets and appear to be at least as effective as higher carb diets for long term blood glucose management (12-24 months) and weight loss.

So why are they steering people away from it?

 

 

Insulin …

Broadly speaking plants get their energy by converting sunshine into sugar. Animals have to eat. Either way the currency of energy is glucose. C₆H₁₂O₆. Burning it consumes oxygen and yields carbon dioxide, water and releases the means to cause muscle to contract, brains to think and all the other processes living things have to carry out.

And a lot of those processes are aimed at keeping the interior environment of the organism in a fairly constant state consistent with continued survival, a process called homeostasis. When a meal is ingested a very complex chain of events follows. To coordinate it all cells and organs need to communicate with each other and they do this by a number of means.

Think of a thermostat , a thermometer and a heater. At a certain temperature the the thermometer triggers a message that turns on the heater. The temperature rises. When it reaches another temperature the thermometer triggers another message that turns the heater off. The temperature stays within set limits and we have a simple example of a negative feed back loop.

Now magnify that many times over. The messages can travel by nerves or by chemicals. Some chemicals may not go far, some enter the circulation and have their effect remotely. Think about something delicious and you will prepare the pleasure centres of your brain for impending enjoyment and your salivary glands will get to work. This will intensify as you see it or smell it. Start chewing and your taste buds will bring more information to your brain’s attention. When your stomach begins to fill the distention will trigger an impulse  via the vagus nerve to tell the brain to think about stopping eating. The gut gets to work on digestion. Nutrients are absorbed, transported, processed and stored. All this has to happen without pushing the internal environment out of kilter. And feedback loops are working at every step of the way.

The number of chemical messengers is staggering. For a glimpse at how complex it all is try this <Paper> even if only to see how much I’ve simplified what comes next.

Among the chemicals at work there are some internet stars, Ghrelin, Leptin and Insulin among them.

When your tummy grumbles think of Ghrelin. It is mainly secreted by the stomach and acts mainly on the hypothalamus. Levels are high when fasting and as meal times approach. Injection of Ghrelin will stimulate the desire to eat. After your successful weight loss diet Ghrelin will help you put the weight back on.

Leptin on the other hand will help you stay the same weight. Leptin comes from happy fat cells, levels rise in obesity and fall during weight loss. If it’s allowed to do its job it triggers a complex series of events in the brain which suppress appetite.

Evolution came up with a system that prompted us to eat when energy was needed and stop when we’d eaten enough. It also had to permit storage of excess energy when available against the times when food was scarce. We store excess glucose by turning it into fat, we have no similar mechanism for storing excess protein. The diet that evolution got to work on for almost all of human existence was a hunter gatherer diet. Tubers, meat, fat, fruit in season and maybe honey once in a blue moon.

The agricultural revolution began about 12,000 years ago. Grains became much more prominent. Evolution continued to work and has made it possible for some of us to consume milk after infancy. Has it brought us to a point where we are as well in tune with our diet as we were before?

The industrial diet has seen sugar intake rise from negligible amounts to a point where we are eating almost our own weight of sugar a year. Our weight at the beginning of the year that is.

taken from unimedliving.

Processed food now consumes 22.9% of our food expenditure, more than all other categories with meat in second place.

Westerners are eating about a third more calories than we actually need.

This dietary change is recent. Evolution has had no time to hand a Darwin award to the unfit but it’s working on it. We are getting fat and we are getting sick (not necessarily both, some obese people are metabolically well).

We don’t like being fat, just look at the shelves in the book shop. We diet, we join the gym … and we fail. So if it’s not a hedonistic plunge into gluttony and sloth why are we in the midst of an epidemic of obesity, diabetes type 2, metabolic syndrome, cardiovascular disease, cancer and dementia?

Well obesity and diabetes are obviously related to what we put in our mouths. Could the culprit be the newly abundant refined carbohydrates we’ve added to our diet?

Sucrose is a molecule of glucose joined to a molecule of fructose. These are quickly split asunder in the gut and absorbed individually. Glucose can be metabolised by virtually every cell in the body. Fructose can only be metabolised in the liver. Glucose goes every which way, only a fraction ends up in the liver. All the fructose goes to the liver. Fructose is about twice as sweet as glucose.

In the liver spare glucose is stored as glycogen. Good stuff, ask any endurance athlete. Excess is exported for storage as fat. Bad stuff ask any endurance athlete. None of the fructose ends up as glycogen, if it’s not used immediately for energy it goes to fat. If the liver is swamped the fat doesn’t get exported fast enough. Now we have a fatty liver.

Fructose was present in our hunter gatherer diet. Our ancestors enjoyed fruit, it’s delicious and a rich source of energy. It was seasonal and in limited quantities, gorge on it now, store the energy for the lean times. It made good evolutionary sense. That was then, now we have fructose on demand, our livers are swimming in the stuff, every day. Not only in fruit, its in almost everything that comes in a packet or a bottle.

When sugars hit the bloodstream the pancreas sends out insulin. The job of insulin is to pack glucose away into cells. Muscle cells grab what they need and store it as glycogen. This will be used as fuel during muscle activity. There is no mechanism for getting it out again. Fat cells will store it as fat. This can be re-exported when needed but not while insulin levels are high. Other cells take what they need for energy.

The Leptin level is rising, blood glucose and insulin are coming down. The pleasure centres of the brain are buzzing. All is well with the world.

Soon the blood glucose is getting low again. We can leave it to our physiology to sort that out or we can have another soft drink, gee that was good. All too often our pleasure  centres  opt for the quick fix.

Over the years of repeated bursts of sugar our cells begin to be less responsive to insulin. The pancreas responds by making more. Glucose levels remain normal but fasting insulin levels are raised. This means that fat cells cannot export glucose. Raised insulin prevents Leptin delivering its message to the brain. Hunger now has the upper hand, fat utilisation has ceased, weight is going up.

A few years later the poor old pancreas will not be able to keep up. Insulin output drops,  blood glucose soars. This is now type 2 Diabetes.

By now the fat is surrounding your organs, your arteries are narrowing and stiffening. Your blood pressure is rising along with the risk of a heart attack or stroke.

Diabetes Australia recommends following the Australian Dietary Guidelines but eating little and often. Apart from some chocolate and the odd icecream isn’t that how we got into this mess? In time you will have to start injecting Insulin …

When insulin is required, it is important to understand that this is just the natural progression of the condition.

So just surrender.

A Lifestyle Diet …

When people find out that I’m a vegetarian they often ask whether I did it for health reasons or for ethical reasons. The answer is very simple. My conscience became slowly more troubled by the fact that animals suffered and died in order for me to eat. I stopped eating dead animals. I eat eggs and dairy produce and yes, there are questionable practices there but I still had to live in the real world.

Gayle was traveling a similar journey but we were actually in different parts of the country when the final straw was put on the load. For Gayle it was the sight of sheep awaiting live export at Portland during a strike that held up their embarkation. They were held in appalling conditions. For me it was a few weeks among some vegos having no trouble with a meat free diet, something that I had hardly felt possible.

That was more than 25 years ago. We had kids to fees, we fed them meat. We feed the dog meat. There are some internal contradictions there but it does prove one thing. A major change in lifestyle diet is possible.

A vegetarian diet has to overcome some real deficiencies.

  • We have the gut of an omnivorous animal. Herbivore guts are longer and equipped with large caecums to ferment fibre.
  • There are nutrients that can only be obtained from animal sources such as B12.
  • Animal protein is complete in the essential amino acids whereas the balance is different in plant proteins  and a plant based diet is generally poorer in the proportion of protein.
  • Omega-3 fatty acids are poorly represented in a plant based diet.

It surprises me that there is an assumption that being vegetarian is more healthy. But there are studies that show lower rates of all cause mortality and lower rates of heart disease for example <Here> and <Here>. I do wonder whether a fair comparison has been made here. We all know what a non-vegetarian is don’t we?

Vegetarians, vegans and the plant plus fish pescatarians have all made conscious adjustments to their diet, they take it seriously. The non-veg folk may have just gone on eating what their mother fed them as kids adding things that they found delicious on the way. We may have compared a thoughtful diet with the Standard American or Australian Diet (SAD for short either way) that has seen the money spent on processed food double since 1982 while spending on meat and veg has fallen. Pass me another energy drink, will you, I’m hypoglycemic.

For the first time in history the poor are fatter than the rich.

And I’m fat too. How did that happen? I avoided saturated fat, abandoned butter, got my calories from whole grains, ate my bread, 6 serves of fruit and veg a day. I followed the guidelines. I was good.

What is this stuff called insulin?

Diet and the Older Athlete …

I’m losing weight faster than you because I’m busy doing stuff not sitting reading about nutrition.                           Gayle.

The story so far … overweight, unfit, somewhat depressed old dude starts cycling in an attempt to reduce his weight and improve his health. Finds it exhilarating and becomes obsessed.

I’m no stranger to losing weight. I’m actually quite good at it. It’s just that I’m even better at gaining it. It’s practically an annual cycle. Weight loss diets work, the kilos drop off, the will power is reinforced by the success but the hunger mounts, the weight loss stalls and I crack. Six weeks in, six kilos down, six months in back to square one. At least the annual average is slightly lower and there are some benefits that last a while even though the weight has returned.

The last couple of diets have been 5/2 style exercises. The first was very effective. I ate nothing two separate days in the week and my normal diet the other five. Weight loss was quick. It slowed after about 7 kg. I suspect the main reason was increasing my intake on the eating days led to a stalemate. The regime collapsed on a holiday in Japan and I didn’t find the enthusiasm to resume.

The weight crept back up. A year later I tried again. This time I ate a small evening meal on the fast days. It was not quite as effective but the rebound was.

A wise man once said “Don’t make any change to your diet that you’re not prepared to make permanent”. That was Ogie Shaw. What he recommended instead was an exercise regime well outside my capabilities physically and not in the least appealing. Nonetheless the advice is good. Lets make it a lifestyle diet not a weight loss diet.

So what should the older cyclist eat?

Stuffed if I know, but there are several places to go for advice. Quickly categorised these are

  • Doctors and dieticians
  • Government issued dietary guidelines
  • Cycling mythology
  • Medical literature
  • Dr Google
  • Fads, quacks and influencers

There is a lot of overlap in these broad groups, the professionals may reinforce the dietary guidelines and you’d hope that they occasionally delve into the literature. However there is a subset of doctors who take issue with the guidelines and they’ve certainly found literature to support their case – ask Dr Google about Low Carb.

Cycling specific advice is interesting. As always the brains are attracted to the money. In cycling the money is with national bodies hoping to bring home gold medals. Top exercise physiologists and coaches are working with elite riders with peak performance as their goal. The result is an extraordinarily high carbohydrate intake.  Peak performance in a brief competitive career may not equate to long term health. I am not expecting to win any gold medals so I will not be sucking on any gels, my liver and pancreas deserve better and I’m very fond of my teeth.

Back in my marathon running days I knew that long runs build stamina, patience and experience but could never fit in as many as I would have liked. enough time to run many long distances in training. I would find myself increasing the length of my sessions as the big day approached aiming to do one 20 miler a week or so before the race. At the same time I was very conscious that being lighter was being faster. Let me tell you from experience that calorie restriction and an increasing workload do not sit well together.

So, while Gayle has been out chopping down trees and replacing fences I have been doing some research. Stay tuned.

 

LSD …

Something I’m trying to cultivate an addiction for, Long Slow Distance.

In my cross training days, 30 odd years ago cycling had to be fitted in with running and swimming and was pared back to fit the available time. I tried to do one long ride, one session of intervals and one or two short rides a week. A short ride was usually followed immediately by a run to help get used to the transition between the two activities. Long slow distance was helpful for building stamina without leaving yourself so over-tired that the next session could not be faced. Sadly all my swim sessions were short slow distance, not my strong suit the swimming.

Now that I’m a born again cyclist I’m looking forward to introducing both a long ride and some interval sessions into the routine. With three months of setting down a base during which time three kilograms just went away without dietary modification I’m ready for the LSD. The added bonus is that exercising at a relatively gentle pace will metabolise fat.

Back in the jogging boom of my middle years I came across a rule of thumb for calculating your chances of surviving a long run. If you had a base fitness derived from four or five sessions a week you could expect to cope with a run that was up to three times your average run. You would need to back off on your pace a bit. It worked well enough for me.

So in working out what my long ride should be I took my typical ride of 20 km and multiplied it by three and scaled it back a bit in deference to my advanced age. I completed the second one today …

Achievements, my goodness, Strava just keeps on giving!

Post exercise recovery is slower in older athletes largely because of poorer muscle repair processes. A very readable article on the subject can be found by clicking <Here>. It suggests that …

 

  • Masters athletes should consider implementing age-specific dietary protein strategies. Specifically, increasing their post-exercise protein intake to ~0.4-0.6 g.kg-1, and consuming high quality leucine-rich whey (milk-based) protein, particularly if previous training has resulted in muscle-damage.

  • Masters athletes should consider implementing the above dietary protein strategies, namely increased dose of protein at all main meals and post-exercise to optimise daily protein synthesis rates for muscle protein remodelling and thus facilitate adaptation to training.

Going too hard too soon will make you feel lousy and leads to abandoning your exercise routine. With that in mind I don’t intend to start high intensity training (intervals) right away.

It is, however, a good time to scrutinise my diet.

 

Exercise and the Elderly …

The theme of late has been resumption of exercise in an older dude who was recently sedentary. As always I have a need to know that drives me to the books or the internet. It’s easy to find material on getting older people out walking eg <This paper> that details a beneficial impact on the frontal cortex or strength training as in<This one>. Clearly the training effect occurs in older folk just as it does in the young.

When it comes to cycling it is hard to find papers that deal with sedentary older people taking up a cycling regime. Research has focused on comparisons of masters athletes with those at peak performance or with the inactive. The bad news is that performance declines after a certain age. VO2max, the highest rate that we can use up oxygen as we burn our fuel, declines largely because our maximum heart rate declines. Muscle mass is reduced (sarcopenia) and body fat tends to go up. The good news is that these effects are less in those who continue to train. <See here> and <Here> or you can take my word for it!

The battle with age is fought and won. I say won because we are the survivors. The decline in performance is just one of the battle scars. The choice now is between this you or a fitter you. Go for it.

Are you fit enough to get fit? That is a discussion you should definitely have with your doctor. There may be some preparation to do first. Certainly, if you can’t lift your bike off the ground don’t get on it!

Which activity?

Here are some recommendations based on my reading and own experience.

I think cycling is an excellent choice. It’s far lower impact than running but like running can start right outside your front door. The amount of exertion is infinitely variable because you are in charge of the distance and the speed.

I wouldn’t buy a bike right off the bat. I would see if you can’t rent an eBike for a month. The big advantage to that is hills and headwinds can knock the enthusiasm right out of you. You don’t need that. When your speed drops below say 10 km/hr up the level of assistance until the going gets easier then drop it back. Try and ride five times a week, work slowly up to about an hour and then endeavour to get a little further in that time. Never bust a gut. Today’s exercise will do you no good if it prevents you getting out again tomorrow.

Ride somewhere safe. Wear a helmet. Carry your mobile phone.

Towards the end of the month try riding without the motor.

The improvement in the first month is terrific. It’s time to make some decisions. If you got on well without the motor consider a good old fashioned bike. It will be much lighter than an eBike, the transition will not be too hard. If you ride with a partner and can’t keep up or headwinds and hills will spoil your rides get an eBike. There is no shame in riding an eBike you can still put in a big effort and get great benefits.