More Protein Please

A great study shows an inverse association between Protein intake and body composition (Clin Med Insights Endocrinol Diabetes. 2010; 3: 25–35. Higher Dietary Protein Intake is Associated with Lower Body Fat in the Newfoundland Population. Kristian K. Green, Jennifer L. Shea, Sudesh Vasdev, Edward Randell, Wayne Gulliver, and Guang Sun).

Results:
Significant inverse relationships were observed between dietary protein intake (g/kg body weight/day) and weight, waist circumference, waist-to-hip ratio, BMI, %BF, and %TF (P < 0.001). Significant positive relationships were observed with %LM and %TLM (P < 0.001). Additionally, significant differences in weight (12.7 kg in men, 11.4 kg in women), BMI (4.1 BMI units in men, 4.2 units in women), and %BF (7.6% in men, 6.0% in women) were observed between low and high dietary protein consuming groups (P < 0.001). Dietary protein explained 11% of the total variation in %BF in the NL population.

Conclusion:
This study provides strong evidence that higher protein intake, even in the absence of energy restriction, is associated with a more favorable body composition in the general population.

Eat more protein, get leaner.

 

Weightlifting Standards

One Rep Max (1 RM)

In weightlifting the maximum weight that a person can do of a particular lift is called a One Rep Max (1 RM). There are standards for the 1 RM which are divided by levels of training (Weightlifting Performance Standards). These standards are also divided by gender and body weight. So, for instance, a male who weighs 181 lbs and is untrained should be able to deadlift 150 lbs. This is helpful for determining the weight a beginner should be lifting as well as the progressions they they should be making/should expect. As that same person moves from Untrained to Novice he should be moving from the 150 lbs to 275 lbs.

Levels of Training

From that page:

Untrained

An individual who has not trained on the exercises before, but can perform them correctly. This is the minimum level of strength required to maintain a reasonable quality of life.

Novice

An individual who has trained regularly for up to several months. This level of strength allows for the demands of vigorous recreational activities.

Higher levels are beyond the discussions in this page.

Rep Scaling

There are calculators which can be used to predict a One Rep max based on the number of lbs lifted in a larger set. So, for example, if you can do 5 reps unbroken of 65 lbs that corresponds to a one rep max of 73 lbs. Here are the various numbers this corresponds to:

At CrossFit they list a prescribed (Rx) weight for males and females. These are based on a 1 RM (1 rep max). There is a single number prescribed for males and a different, single number prescribed for females.

 

Thoughts on the Zone Diet

The Zone Diet seeks to create a fixed mix of macros by specifying fat, carbs and protein levels. The starting point is:

The numbers are in percentage of calories. On a “standard” 2000 calorie diet that would be:

  • Carbs = 2000 * 0.40 = 800 calories (200 grams)
  • Protein = 2000 * 0.30 = 600 calories (150 grams)
  • Fat = 2000 * 0.30 = 600 calories (67 grams)

Zone vs Standard American Diet (SAD)

According to the CDC (Trends in Intake of Energy and Macronutrients in Adults From 1999-2000 Through 2007-2008):

In 2007-2008 the average energy intake for men was 2,504 kilocalories (kcals) and for women it was 1,771 kcals.

The average carbohydrate intake was 47.9% of total kilocalories (% kcals) for men and 50.5% kcals for women; average protein intake was 15.9% kcals for men and 15.5% kcals for women; average total fat intake was 33.6% kcals for men and 33.5% kcals for women; and average saturated fat intake was 11.0% kcals for men and 11.1% kcals for women.

That means the Zone Diet is lower in carbohydrates, much higher in protein, and a lower fat than the Standard American Diet (SAD).

Macro SAD (Men) SAD (Women) ZONE Difference
Carb 47.9 50.5 40 Zone Lower
Protein 15.9 15.5 30 Zone Much Higher
Fat 33.6 33.5 30 Zone Lower

The main lever of the Zone then appears to be Protein. Doubling someone’s Protein should do some very good things for their health. Added to that is the advantage of the lower number of total calories on the zone.

But would the Zone be a good thing for a Type 2 Diabetic? Certainly it would help some who are diagnosed as pre-diabetic. Anything they do to reduce their carbohydrate consumption will help their pre-diabetes.

Zone vs Ketogenic Diet

The Ketogenic diet has various protein goals depending on you who follow. For a 200 lb male typical numbers would be (using a higher level of protein in this example):

Macro grams kCal/macro Calories % Cals
Carb 20 4 80 4%
Protein 160 4 640 32%
Fat 142 9 1280 64%
2000

Where the two diets differ are their fat and carbohydrate macros.

Macro ZONE Ketogenic
Carb 40% 4%
Protein 30% 32%
Fat 30% 64%

Carbohydrate Effects on a Type 2 Diabetic

Carbohydrates raise blood sugar and therefore Insulin levels much more dramatically in a Diabetic than in a non-Diabetic person. That’s what makes a person an Diabetic. Before I went on the Ketogenic diet I was averaging only 100 grams of carbohydrates per day. I know this since my Insulin pump required me to enter any carbohydrates I ate. And, in spite of being on an average of 100 units of Insulin a day, my blood sugars were all over the place.

My highs were over 200 and my lows never got to 100. Around the start of August I went on the Ketogenic diet. For me, that was going from 100 grams (on the average) of carbohydrates a day to less than 20 grams. I was also not tracking the other macros (fat, protein). Here are my blood sugar numbers from the first three months of the Ketogenic diet.

That chart is the very definition of stable blood sugars. It took being at 20 grams or less of carbs a day to get stable. And before the Ketogenic diet I was nowhere near the Zone Diet carbohydrate levels. I can only imagine how messed up my blood sugar numbers would have been if I had been on the “balanced” zone diet.

 

Christmas Status Letter

Reflections

Holidays provide time to reflect on the past year. It’s long overdue to circle back to the purpose of this BLOG. I started this journey of hacking my Type 2 Diabetes almost 18 months ago. In that time, I fixed my Diabetes and so much more.

No More Insulin or Medications

I am on ZERO medications. No diabetes medications. No hypertension medications. I still use a CPAP machine since I am afraid of quitting the machine.

Weight Loss

I have lost over 100 lbs. My starting weight was around 285 and it was 178 this morning. I’ve been in maintenance for a month now and my weight has stayed steady. I wish I had charted better in the beginning.

Added Exercise

After I lost most of my weight (around 80 lbs) I added exercise. I have been doing CrossFit for about four months now. I can lift weights that match the girl’s weights. I usually finish the Workout of the Day (WOD) last but I do finish – even the hard ones. I workout five days a week. The typical CrossFit workout is less than one hour. I take rest days Thursday and Sunday.

Blood Sugar Control

My blood sugar after working out last night was 65 (US units) which is really good. I most often see numbers in the mid 80s. My last HbA1C was taken this summer (before CrossFit) and it was 5.8 (which is at the bottom end of the prediabetes range).

My Macros

My diet consists largely of chicken, nuts and broccoli.

Chicken is a good Protein and different cuts provide different amounts of fat. Kim Chee (from Walmart refrigerated veggie section) is a good probiotic (good for stomach biome). Broccoli is a good veggie and easy to heat in a microwave bag. Finally, nuts fill in the fat numbers in a healthy way.

My Macros

My daily macros are:

My current macros are 1800 calories with 125g of Protein, 20g of Carbohydrates and 136g of Fat. Protein is a minimum. Carbs are a maximum. Fat fills up the remaining calories to meet the limit. If I go over on Protein I will go under on Fat to match. In percentages of daily calories this is 27% Protein, 5% Carbohydrates, and 68% fat.

Supplements

Here is what I take daily.

Breaking Stalls

I had a long stall this year which lasted for maybe six months. I did some extended fasts which helped a little bit. I then tripped across the idea of doing Protein Sparing Modified Fasting. That broke the fast and gave me a way to make progress with the last 25 lbs that I needed to lose.

My Goals

My goals have shifted over the past 18 months. They started with hacking my Diabetes. I wanted to get off Insulin. That took two weeks.

Since then I have worked at improving my Insulin Sensitivity. For me, the main tool was Intermittent Fasting (IF). One thing that interferes with this is getting in enough Protein. I have added a Protein meal at lunch time. This hasn’t hurt my Blood Sugar numbers.

Another way of improving Insulin Sensitivity is High Intensity Training. I do CrossFit. Training with increasingly heavier weights and intensity will improve Insulin Sensitivity. I hope to keep up this training and there are plenty of goals to reach. I got my first box jump and pullup in the past month.

 

Learning the Lifts – Mirror Neurons

I really hate to memorize stuff. More than that I really hate to memorize stuff related to physical activity. Even more than that I hate to memorize weight lifting moves.

But I need to improve. I need to remember what the basics of each lift are. And there are not all that many to learn. Sure it takes years to learn the specifics of the move but the general idea is another thing.

This brings me to another concept, that of Mirror Neurons. They are the part of the brain that allows us to watch someone do something and be able to see ourselves doing that same thing. I think mine are pretty much broken.

I can watch someone do something and appreciate their athleticism. But I don’t see myself doing that same motion when I watch someone else. I think that I am seriously broken. And I think it’s a lifetime defect, not just a recent defect.

I am looking for ways to improve this. I looked for flashcards on the Olympic lifts but I can’t find any. Maybe I can make some flashcards of my own?

I’ve watched hours of videos on CrossFit YouTube channel. Same thing. I can appreciate what they do but I just don’t feel the same motions in myself when I watch them.

Plan of Attack

Lacking any other plan, here’s what I am going to do. This is based on my coaches who said I need to tape myself to see how I am doing particular movements. I am going to watch each of the CrossFit Foundational videos and record myself doing the same moves and compare the two videos. Maybe I can empathize enough with myself to fix myself.

If you have a better idea how to tackle this, let me know.

Protein Requirements by Type of Workout

The conventional wisdom is that 20-25 g of Protein is optimal at a meal for Protein Muscle Synthesis has been challenged by a recent study. Turns out that most of the previous studies looked at exercise of isolated muscle groups rather than whole body resistance exercise.

The study (Physiol Rep. 2016 Aug; 4(15): e12893. The response of muscle protein synthesis following whole‐body resistance exercise is greater following 40 g than 20 g of ingested whey protein. Lindsay S. Macnaughton, Sophie L. Wardle, Oliver C. Witard, Chris McGlory, D. Lee Hamilton, Stewart Jeromson, Clare E. Lawrence, Gareth A. Wallis, and Kevin D. Tipton) took a look at how much Protein is optimal at a meal after larger muscle group exercise. The conclusion?

Our data indicate that ingestion of 40 g whey protein following whole‐body resistance exercise stimulates a greater MPS response than 20 g in young resistance‐trained men.

Since the subjects of this study were young trained men who were healthy this may even be more true with older, untrained and diabetic individuals. See  (British Journal of Sports Medicine. A systematic review, meta-analysis and meta-regression of the effect of protein supplementation on resistance training-induced gains in muscle mass and strength in healthy adults. Robert W Morton, Kevin T Murphy, Sean R McKellar, Brad J Schoenfeld, Menno Henselmans, Eric Helms, Alan A Aragon, Michaela C Devries, Laura Banfield, James W Krieger, Stuart M Phillips.)

Dietary protein supplementation significantly enhanced changes in muscle strength and size during prolonged resistance exercise training (RET) in healthy adults. Increasing age reduces and training experience increases the efficacy of protein supplementation during RET. With protein supplementation, protein intakes at amounts greater than ~1.6 g/kg/day do not further contribute RET-induced gains in FFM.

 

Healing Diabetic Neuropathy

In diabetic neuropathy, one of the most common forms of peripheral neuropathy, nerve damage occurs in an ascending pattern. The first nerve fibers to malfunction are the ones that travel the furthest from the brain and the spinal cord. Pain and numbness often are felt symmetrically in both feet followed by a gradual progression up both legs. Later, the fingers, hands, and arms may become affected. (Peripheral Neuropathy Fact Sheet).

Is this a permanent condition?

It is a progressive condition which gets worse. The only solution is to reverse the underlying diabetes. That’s where Low Carb comes in. Once the underlying condition gets reversed the body begins to repair/regrow the nerves. Nerves can regrow around 1 mm/day. The growth starts at the spine and goes to the extremities. So neuropathy in the feet or hands can be reversed in around three years or so.

 

Protein Timing – Bro-Science?

Protein timing is the question of how long after you workout should you eat protein. Until fairly recently, conventional wisdom was that there was a 30-60 minute window to eat protein after a workout to maximize protein muscle synthesis.

Here’s a good article on Protein timing (The New Rules of Protein Timing) which states that there’s newer science which indicates that the window is wider and also affected by what you ate earlier.

Here’s one of the studies (Human Kinetics Journals, Volume 19 Issue 2, April 2009. Effect of Protein-Supplement Timing on Strength, Power, and Body-Composition Changes in Resistance-Trained Men . Jay R. Hoffman, Nicholas A. Ratamess, Christopher P. Tranchina, Stefanie L. Rashti, Jie Kang, Avery D. Faigenbaum).

Results indicate that the time of protein-supplement ingestion in resistance-trained athletes during a 10-wk training program does not provide any added benefit to strength, power, or body-composition changes.

Here is another similar result from analysis of many studies (Journal of the International Society of Sports Nutrition 2013 10:53, The effect of protein timing on muscle strength and hypertrophy: a meta-analysis. Brad Jon SchoenfeldEmail author, Alan Albert Aragon and James W Krieger.):

These results refute the commonly held belief that the timing of protein intake in and around a training session is critical to muscular adaptations and indicate that consuming adequate protein in combination with resistance exercise is the key factor for maximizing muscle protein accretion.

 

Cholesterol and Low Carb Diets

There’s long been a concern about cholesterol and Low Carb diets. For many people, Low Carb diets improve their LDL and HDL numbers. Nearly everyone has a significant increase in their HDL. But some people actually have an increase in their LDL on Low Carb diets (wrong direction).

HDL to LDL Ratio

Sometimes the increase in LDL is small (but the wrong direction) and the increase in HDL is significant. This yields an improved ratio in spite of the increase in the LDL. That’s probably still a good thing relatively. From (the Mayo Clinic):

To calculate your cholesterol ratio, divide your high-density lipoprotein (HDL, or “good”) cholesterol number into your total cholesterol number. An optimal ratio is less than 3.5-to-1. A higher ratio means a higher risk of heart disease.

So if your LDL goes up but the ration goes below 3.5 then the Mayo Clinic would call that a good thing.

LDL Big/Small Fluffy Particles

The LDL gives a single number for something that is more complicated. LDL consists of two types of particles, big fluffy ones and small sticky ones. The big fluffy ones don’t stick to the arteries. It’s the small sticky ones that stick to the arteries. For many of the people who have increases in LDL.

This is based on various studies like (JAMA. 1996;276(11):875-881. Association of Small Low-Density Lipoprotein Particles With the Incidence of Coronary Artery Disease in Men and Women. Christopher D. Gardner, PhD; Stephen P. Fortmann, MD; Ronald M. Krauss, MD):

Results.  —LDL size was smaller among CAD cases than controls (mean ±SD) (26.17±1.00nm vs 26.68±0.90nm;P<.001).The association was graded across control quintiles of LDL size. The significant case-control difference in LDL size was independent of levels of high-density lipoprotein cholesterol (HDL-C), non—HDL cholesterol (non-HDL-C), triglyceride, smoking, systolic blood pressure, and body mass index, but was not significant after adjusting for the ratio of total cholesterol (TC) to HDL-C (TC:HDL-C). Among all the physiological risk factors, LDL size was the best differentiator of CAD status in conditional logistic regression. However, when added to the physiological parameters above, the TC:HDL-C ratio was found to be a stronger independent predictor of CAD status.

There is a test that can be done to differentiate the particle sizes. It is the NMR (Nuclear Magnetic Resonance) Test. From The NMR and Your Risk of Heart Disease.

The NMR uses advanced spectroscopy to uniquely provide rapid, simultaneous and direct measurement of LDL particle number and size of LDL particles, as well as a direct measurement of HDL and VLDL subclasses.  This detailed lipoprotein particle information allows clinicians to make more effective individualized treatment decisions as compared to standard lipid panel testing.

If you get an increase in LDL when you do Low Carb don’t just give up on Low Carb. Ask for the NMR test. Your doctor may not be familiar with this test. Mine was aware of the test but doesn’t regularly prescribe the test. There may be some cost associated depending on your coverage.

 

Types of Exercise and Glycogen

I have been trying to tease out the limits of low carb performance. Here is a key paper (Metabolism. 1983 Aug;32(8):769-76. The human metabolic response to chronic ketosis without caloric restriction: preservation of submaximal exercise capability with reduced carbohydrate oxidation. Phinney SD, Bistrian BR, Evans WJ, Gervino E, Blackburn GL).  Buried within the paper is:

In agreement with this were a three-fold drop in glucose oxidation (from 15.1 to 5.1 mg/kg/min, P less than 0.05) and a four-fold reduction in muscle glycogen use (0.61 to 0.13 mmol/kg/min, P less than 0.01).

This seems buried because of the units used. Another site (September 13, 2017. Why Am I Getting Low Ketone Readings on a Ketogenic Diet? By Mark Sisson) translates these units as:

During the high-carb arm, the group began the workout with 150 grams of glycogen and ended it with 50 grams. While eating ketogenic, the group began the workout with 75 grams and also ended it with 50 grams.

The time of this test was approx 150 minutes.