Minimal effective dose exercise to improve insulin sensitivity

(Gabe “No Dogma, Only Science Please!” ) #1

So I lost 10kg in 10 weeks in summer/fall 2016. Since then, I dropped barely any more and I’ve stagnated around 80-82kg. I should be around 74kg.

I am convinced by blood testing and a couple of doctors that I’m borderline insulin resistant. My fasting insulin is 10, the very top of the “normal” range. Convinced this is the reason my body won’t shed the rest of it.

Doctors are prescribing me metformin, mild dietary changes in addition to LCHF, and 4 hours exercise per week. I live in NYC so I get lots of incidental exercise.

My question is: what is the minimal effective dose to get my insulin sensitivity up? Obviously YMMV, but I’m interested in what you’ve found to have worked for you.

#2

This is the first question Dr. Fung addressed in the 3rd episode of the Obesity Code podcast. The short answer is it takes a long time (years) to reverse insulin resistance.

Extended fasting is the most efficient way of lowering insulin. It keeps insulin levels at the lowest level and gives the pancreas a break. The next most effective is intermittent fasting. Followed by a HFLC diet.

(You've tried everything else; why not try bacon?) #3

For what it’s worth, Dr. Phinney’s company, Virta Health, keeps their patients on (reduced levels of) metformin, even after they’ve been taken off all other diabetes drugs. I’m not sure I fully understand or agree with their reasoning, but you might find it relevant.

#4

For MED of exercise, Doug McGuff’s protocol looks incredibly interesting to me (and it takes a whopping 20 -30’/week). He’s interested in LC eating - found that when his clients added that piece into the mix, their results were even better - and cites some research about the incredible health benefits of resistance training and superslow/to failure in particular.

Most folks do these workouts at a gym but I believe that @SlowBurnMary is doing a home exercise program based on the McGuff principals. You can look at some of her recent posts in which she goes into some nice detail about it all.

#5

Yep, insulin resistance can take some time to change - when we think about all the time that went into throwing our metabolisms off, a few years to correct is really not that long!

Minimal effective dose of exercise is not the whole picture - you need to look at WHAT kind of exercise.

Cardio/jogging etc are actually not the greatest for whole body muscle development - and cross-fit as well as fast weight lifting are problematic in that folks generally get injured a lot and philosophies that say the building of muscle mass requires living at gyms… In terms of metabolic healing (though if you love those activities, do them for the enjoyment factor) it’s the muscle fiber changes in the fibers that are worked to fatigue rather than superficially that count for most people who aren’t endurance sports champs. It’s what takes the LCHF/keto dietary body recomposition as well as athletic performance & endurance to a whole new level. Anyway, the films about keto champion athletics, Cereal Killers I and II is inspiring for doing any exercise at all - and the films show that many athletes are pre-diabetic, and may die early due to cardiac disease! We’re all in the same boat - and we all benefit from a less processed LCHF/keto way of life!

I love what Virta Health is up to - specifically with folks who are significantly insulin resistant and morbidly obese - but the idea is to expand it throughout public health. Currently it costs $400/mo for medical case management/labs/on-call professional coaching etc. A lot of folks can’t afford it, and it’s not covered by insurance - but for those who can afford it (it’s the equivalent of weekly in-home personal training for example) it’s quite an initiative. Though most of their patients eliminate medications, they do keep some people on them for some time.

And for non-morbidly obese folks, adding intense, deep strength training for just 30mins a week can do amazing things to boost the metabolism - and save you the trouble of EF. There are metabolic changes that happen when we work with resistance weights to very near total fatigue - a huge reset. Plus, being that it doesn’t take much time per week, you can free up some of those exercise hours!

Check out the book Body by Science by Doug McGuff MD - who advocates a LCHF eating lifestyle - and strength training slow and to near fatigue in order to kickstart the mitchondrial energy and thermogenesis - which both enhance metabolic healing. Everything you might want to know about the science of that stuff is in that book.

One of McGuff’s first students, Fred Hahn - a master teacher of the Super Slow technique as well as a senior level, 20 year practitioner of karate - went on to make some adjustments to it for more precision metabolic improvements - and he co-wrote a book with Dr. Michael Eades and Dr. Mary Dan Eades (who started the first chain of urgent care centers in the U.S.) called Slow Burn Fitness Revolution where he provides a handy home weight lifting routine (dumbbells and ankle weights) as well as a routine for a gym if you prefer that. Hahn’s main training studio is in NYC btw, if you have time & money for private coaching. His blog, and Dr. Eades’ blog, are chock full of great info.

I also enjoy the collection of studies and comparisons of studies plus personal story reporting in the book Ketone Power: Superfuel for Optimal Mental Health and Ultimate Physical Performance by Cristian Vlad Zot - a brainiac who wrote it at the tender age of 27. Encouraging keto training guidance and tasty easy recipes too. His newest book is Persistent Fat Loss: Combining Ketosis and Intermittent Fasting for Year-Round Fitness :sparkles: :zap:

#6

And, from Dr. Phinney’s new article on the Virta Health blog:

"And now we at Virta Health are well along with a study in collaboration with Indiana University Health of 262 patients with T2D who are coached to follow a well-formulated ketogenic diet and closely supported by remote continuous care (the Virta Clinic). At 70 days, 92% of these patients remain under our care, HbA1c values were reduced from 7.5% to 6.5%, diabetes medications were reduced by more that 45%, and weight declined by 7%.18

Which brings us back to the question: can type 2 diabetes be reversed? Given the recent discoveries that beta-hydroxybutyrate triggers dramatic reductions in oxidative stress and inflammation, which in turn reduce the root cause of insulin resistance, there is just one remaining question—can a well-formulated ketogenic diet be followed long term? If the answer to this question is yes, then it follows that type 2 diabetes definitely can be reversed.

…“It is our expectation that the majority of our patients will remain in the non-diabetic range after 1 and then 2 years off all diabetes medications other than metformin. If we achieve this goal, we will have laid the foundation to revise the basic treatment paradigm for type 2 diabetes.”

http://blog.virtahealth.com/reversing-type-2-diabetes-with-nutritional-ketosis/

(You've tried everything else; why not try bacon?) #7

Professor Noakes certainly thinks he’s reversed his. . . .

(Sacha Beauregard) #8

I had read Body By Science some years ago. I quite liked it but some people I spoke with (again, years ago) had dismissed it, so I never invested. Perhaps I need to reconsider this too, while I’m reconsidering nearly everything else I used to think was right =D

#9

Here’s to neuroplasticity and new ketones-nourished brainz too, haha!

(Gabe “No Dogma, Only Science Please!” ) #10

Amazing responses everyone – I’ve been traveling a bit for work so I’ve only had a chance to respond now. I’ll be picking through your responses for a while, and I’ve already begun looking into Body By Science. And meanwhile I’m back at the gym doing some interval training and strength training.

On The Obesity Code podcast “Non-scale victories” at 3:30, @carl says that it’s a myth that exercise is necessary to lower insulin. Maybe that’s technically true, because you can lower insulin other ways, but I think it’s a bit deceptive, because as far as I understand it, exercise certainly is a key tool to lower insulin. Even @richard cycles mainly to improve his insulin sensitivity, right?

(Richard Morris) #11

Actually I ride cos I want to … but yeah I blow through my glycogen as well to help my insulin sensitivity. My fasting insulin is over 13 despite 3.5 years keto so I am severely deranged.

(Donna ) #12

Thanks for your post! I just ordered Slow Burn Fitness Revolution and can’t wait to get started! :smiley:

(Gabe “No Dogma, Only Science Please!” ) #13

I want you to know that I just did my first McGuff session today, and am going to start with my trainer on it next week. Working my way through all the resources you posted. Really appreciate the thoughtful replies!

(Richard Hanson) #14

Nice Post Mary,

As many different primitive people around the world had survived for hundreds of generations eating LCHF, while not exhibiting the diseases of western civilization, I think the answer to that one remaining question is obvious.

What would an Eskimo eat? What would a Maasai eat?

What is needed is funding for objective, double blind, large scale, long duration, clinical trials to demonstrate conclusively what is already obvious epidemiologicaly.

Keto for Life!

Warm Regards,
Richard

#15

The Masaii and Inuit have unusually high proportion of animal food in their diets; there are many indigenous peoples who eat much higher carb. Those carbs are unrefined and often fermented, so it’s not comparable to SAD carbs (and their lifestyles are generally supportive of health in many ways that we’re only beginning to understand), but still - there’s a wide variation of macronutrient ratios in ancestral diets, and our genes usually reflect some of those differences.

(Richard Hanson) #16

I am not arguing that LCHF is the only healthy diet, but it is clearly a healthy diet for a wide range of native peoples if we define a healthy diet as the diet eaten by a healthy people. The fact that some primitive populations ate higher carbs does not make a LC diet unhealthy. Another example is the Tokelau people of the South Pacific who ate LCHF sourced primarily from fish and coconuts and also the nomadic tribes of the American plains.

The evidence from observing primitive peoples is often dismissed as a “genetic adaptation” of those people to the diet they are eating, this is convenient, but I don’t know of any science that demonstrates that these many different peoples are all genetically adapted to be able to eat a diet specific to each of their unique dietary heritages. Consider exactly how different are the traditional diets of these peoples, and yet they are all general healthy at least before they start consuming a western diet.

So … either each people have a special genetic adaptation to their own traditional diet, or no one, including us, has a genetic adaptation to eating SAD as every people that starts eating SAD ends up suffering from the diseases of civilization.

I still think the answer is obvious, obvious enough for me to sustain the personal choice to eat keto, but the science must be done to prove that this is true if we are ever going to show just how detrimental is eating SAD in the face of decades of promoting that diet to the American people, and the world at large.

Interesting discussion.

Keto for Life!

Warmest Regards,
Richard

#17

Yes, interesting!

I’m not suggesting that just the HF folks have a genetic adaptation for the foods available in their environment. I think that we ALL have some genetic traits that will in part determine what we need and how we thrive. There’s some research on this if you’re interested. I’m no expert but from what I’ve read here are some examples: the Inuit have a genetic mutation that prevents them from going into ketosis; there’s a wide range of starch enzymes in peoples of different backgrounds (here’s an example - I haven’t read it through but I’ve seen many references to this kind of variation).

Someone with ancestors who lived for hundreds of generations with lots of tubers will likely do much better with some (high-quality) carbohydrates in their diet at least some of the time, and I think it’s worth questioning whether long-term very low carb eating is a good idea in ALL cases. (Serious insulin resistance trumps all of this, though, in my opinion and from what I’ve seen of people’s stories - I think that until that is resolved, the priority is probably keeping carbohydrates very low.)

(Gabe “No Dogma, Only Science Please!” ) #18

Update: I started the McGuff protocol, and a couple of days ago I went to Fred Hahn’s studio for a trial session.

@SlowBurnMary: how long have you been doing it for? Do you do the Big Five workout? How effective has it been for you?

#19

About 5 months, before a break.

The Hahn home routine that works smaller muscle groups is what I do - not the McGuff version. I think the fact that Hahn was a senior student of McGuff’s - and thus a master Super Slow teacher is compelling. As a good student Hahn experimented and maximized on Super Slow through his own practice as well as through observations with clients.

I would say it’s been max effective in terms of actual metabolic boost and muscle mass forming - plus the psychological benefits from slow burn are extraordinary, very spiritual (as Tony Robbins has been quoted saying about it - because heck, when doing such an intense practice for mitochondrial powerhouses, it’s a different level). :smile:

I read most all of Hahn’s past blog articles in the early phases of weight lifting, because I needed that encouragement… In offline life, normally one would work w/ a coach, etc.

(Justin Jordan) #20

There’s at least some evidence that HIIT and not a particularly large amount of it is helpful for insulin sensitivity. In the study mentioned in the link, they saw considerable improvement with what amounted 30 minutes of actual work a week (in two weeks, even) although the actual time working out would something more like 90 minutes a week,

In any case, I’m going to take a stab at it in addition to my regular walking.

http://www.cbass.com/SubMaxIntervals.htm