More on d-chiro inositol

DCI has been shown to work orally at least in PCOS, Type 2 diabetes, & general insulin resistance, both in human studies & anecdotally. Anecdotally, d-pinitol (Inzitol) is getting some attention in athletic/bodybuilder circles.

d-chiro-inositol

One of the central studies seems to be one in the New England Journal of Medicine (Nester, et al. Ovulatory and metabolic effects of d-chiro-inositol in the polycystic ovary syndrome. New England Journal of Medicine 340 (1999): 1314-1320). They used 1200 mg. oral doses of D-chiro-inositol in the form of a product-in-development called INS-1 from Insmed Pharmaceuticals. 22 women with PCOS were matched against a placebo group of 22 women also with PCOS. Conclusions: "D-Chiro-inositol increases the action of insulin in patients with the polycystic ovary syndrome, thereby improving ovulatory function and decreasing serum androgen concentrations, blood pressure, and plasma triglyceride concentrations."

More research: Insmed was developing INS-2 for use in PCOS, diabetes, & dyslipidemia (high blood lipids) & ran Phase II clinical trials in 2001-2002. But they discontinued development of INS-2 in Sept. 2002, saying that "INS-1 was safe and well tolerated but did not achieve statistical significance on its primary efficacy measures" -- in spite of earlier press releases about the same trials that said there were statistically significant improvements (in Type 2 diabetes; in obese women w/ PCOS & nondiabetics with dyslipidemia). Anecdotally, women on the Soulcysters PCOS board reported participating in the clinical trials & experiencing big improvements on INS-1 — for example, regular periods (which sometimes go by the slang term "AF" meaning "Aunt Flo") & ovulation, lower hirsutism, better skin, no more hypoglycemia — improvements that disappeared after the trials ended & they were no longer getting the INS-1. People have also reported better weight loss. All of which makes me think that Insmed's decision to discontinue was premature. It sure was from the POV of PCOS-sufferers. (I'm not trying to get preggers myself, but a lot of women with PCOS are, & inability to have periods or to ovulate creates a problem.)

Anecdotally, women at Soulcysters say that eating food sources of d-chiro-inositol such as "PCOS-blaster" muffins containing buckwheat bran brings improvements, & so do the oral DCI supplements from the company Chiral Balance. Chiral Balance is a small company run, I gather, by a couple of biochemists who seem to be approaching DCI supplementation from a nutritional supplement rather than drug/pharmaceutical angle. Unfortunately, it's still expensive, & nutritional supplements aren't usually covered by health insurance.

Other studies in humans with related to DCI — Iuorno et al. 2002 (DCI supplementation in PCOS); Baillargeon et al. 2004 (metformin for PCOS seems to increase DCI-containing inositolphosphoglycan). There still seems to be a lot of study of DCI's mechanisms in insulin metabolism in mice & other animals too.

D-pinitol

An alternative oral supplement is d-pinitol (3-O-methyl-chiroinositol) — which it seems d-chiro-inositol can easily be made from, possibly even in insulin resistant people. (I'm still trying to understand the science — I'm smart enough I guess, but not a biochemist.) Pinitol is found in high concentrations in some legumes (such as soy), plants, fruits, and parts of pine trees like the sugar pine. Two manufactured supplements containing it: Inzitol & ViTAL Nutrients d-Pinitol 600. (About $120 per 60-cap bottle on Amazon — just about as expensive as Chiral Balance's DCI. But $79.95/bottle at this point from this source.)

Inzitol is found in a product called Meta-Cel, which also contained creatine & is aimed at bodybuilders. Also apparently in another bodybuilder supplement called Nitro-Tech that makes all kinds of (who knows if they're valid) claims. Also apparently in some products from PVL Nutrients, but it's not readily apparent which ones. A Google search on Inzitol brings up a lot of hits about the use of Inzitol in athletics, including bodybuilding, where it's alleged to help with creatine utilization. E.g., this interview with someone at the New Zealand company that makes Inzitol.

In one human study on pinitol I found in PubMed, pinitol was found to increase levels of d-chiro-inositol in the body (14-fold increase in DCI levels with 20 mg pinitol per kg of body weight per day for four weeks in diabetic patients), but not to improve insulin sensitivity (Davis et al. 2000). Another found it didn't help insulin sensitivity in nondiabetic older people (Campbell et al. 2004). On the other hand, Kim et al. 2007, in a study of poorly controlled Type 2 diabetics, found "fasting glucose, post-prandial glucose levels, and hemoglobin A1c were significantly decreased." Similarly, Kang et al. 2006. (Both these latter two studies uses pinitol from soy sources, not sure what the other studies used. I believe Inzitol is manufactured from pine tree sources.)

Mechanism

From the best I understand, the proven low levels of d-chiro-inositol in Type 2 diabetics & women w/ PCOS (& other insulin resistant people) appears to be a deficiency caused by an inability to transform myo-inositol into d-chiro-inositol within the body. Whether that's from some sort of genetic problem or due to environment (hyperglycemia &/or hyperinsulinemia, perhaps) isn't clear. But I'm thinking it's quite similar to how we as human beings are supposed to be able to change the omega-3 DHA found in flax seed into the essential omega-3s EPA & DHA. But, we're pretty inefficient at it, & many people can't seem to do it at all, so therefore we eat fish oil in order to get enough EPA/DHA. Most people can make DCI in their own bodies, but insulin resistant people's bodies are lousy at it; so we need supplementation.

So... this might not have that much utility as I thought it might for insulin sensitive dieters, who probably don't have this deficiency... but for those of us who are insulin resistant, & eating moderate to high-carb diets, it might be very helpful indeed. Meantime, the bodybuilder supplement industry seems to be embracing Inzitol, though whether it's anything more than something else to make money with — in an industry that sells all kinds of expensive supplements that may or may not be beneficial for the purposes advertised — is a question.

At any rate, for anyone who wants to experiment, seems that both DCI & pinitol are different from Metformin (glucophage) as insulin-sensitizers in that they are naturally found in the human body, & all reports seem to be that oral supplementation is well-tolerated & doesn't give the nasty side effects Metformin sometimes does.

According to Joseph Larner, who's been studying d-chiro-inositol for a couple of decades, DCI was "originally discovered as a component of a putative mediator of intracellular insulin action, where as a putative mediator, it accelerates the dephosphorylation of glycogen synthase and pyruvate dehydrogenase, rate limiting enzymes of non-oxidative and oxidative glucose disposal." Further explained, most of it understandable even to non-biochemist-me, in the journal article of his I posted yesterday, D-chiro-inositol – its functional role in insulin action and its deficit in insulin resistance. International Journal of Experimental Diabetes Research 3(1) (2002): 47-60.

D-chiro inositol

Yesterday on an email list I'm on, someone mentioned d-chiro-inositol (DCI) (part of the B-vitamin group), which I'd never heard of before, but which plays a part in carbohydrate metabolism as some sort of helper to insulin. It turns out insulin resistant/Type 2 diabetic people in general, & women with polycystic ovarian syndrome (PCOS) in particular (which affects about 10% of all women, including me), have been found to have deficient levels of DCI in their bodies.

It's theorized that this is due to an impairment in whatever it takes for the closely related myo-inositol to be changed into d-chiro-inositol in the body. Furthermore, studies have shown that women with PCOS & Type 2 diabetics who are given supplements of DCI have improvements in insulin sensitivity, blood sugar levels, blood insulin levels, etc. -- as well as improvement of the additional symptoms (high androgen levels, irregular to nonexistent menstrual periods, infertility) that tend to accompany PCOS. On an anecdotal level, there are a number of women at the forums at Soulcysters.com (a major PCOS support site) who report having successfully regulated their menstrual cycles & achieving pregnancy (as well as other improvements) through supplementation with DCI. The word "miracle" tends to show up. (Well, I guess miracles do happen when deficiencies are addressed. That's how sailors must've felt when they learned all they had to keep from getting scurvy was to eat citrus fruits.)

Here's some relevant studies. All of these have full-text available online:

• Ostlund, et al.D-chiro-inositol metabolism in diabetes mellitus. Proceedings of the National Academy of Sciences 90 (1993), 9988-9992.
  
  
• Nester, et al. Ovulatory and metabolic effects of d-chiro-inositol in the polycystic ovary syndrome. New England Journal of Medicine 340 (1999): 1314-1320.
  
  This is a really central study related to PCOS. Obese PCOS-affected women on doses of 1200mg/day showed marked improvements on a bunch of different things when compared with controls on placebo.
  
  
• Larner, Joseph. D-chiro-inositol – its functional role in insulin action and its deficit in insulin resistance. International Journal of Experimental Diabetes Research 3(1) (2002): 47-60.
  
  Larner has apparently been involved in the investigation of d-chiro-inositol in carbohydrate metabolism in mice for a couple of decades, per his 2005 press release from UVa.
  
  
• Shashkin, et al. Fasting decreases the content of d-chiroinositol in human skeletal muscle. International Journal of Experimental Diabetes Research 3(3) (2002): 163-169.
  
  I'm wondering from this if DCI is one of the substances mentioned in Lyle McDonald's The Ketogenic Diet that gets downregulated during fasting & ketogenic diets. [Later: I asked Lyle, who answered that "arguably the primary effector for the fasting issue is PDH downregulation" — PDH is pyruvate dehydrogenase.]
  

Unfortunately there are few sources of DCI supplements, & they tend to be expensive (e.g., Chiral Balance). Apparently the mega-pharmaceutical companies haven't found it worth their while to bring their own versions to market. Less expensive supplements called simply inositol or myo-inositol seem to be helpful for some people, but since the problem insulin resistant people seem to have is in changing myo-inositol to DCI, it's really DCI that needs to be supplemented. Another supplement that might work, though, is d-pinitol (aka D-chiro (+)-o-methyl inositol), which is available under the trade name Inizitol (New Zealand company, but there are distributors in the U.S. & Canada); this is also recommended as a possible supplement for PCOS by Richard Bernstein in Dr. Bernstein's Diabetes Solution. Apparently d-pinitol is also used a lot by athletes and affects whole-body creatine retention. More info on d-pinitol & DCI from a PCOS-suppement supplier here.

The food source with the highest level of DCI is buckwheat (which is actually a rhubarb relative, not a grain), especially in buckwheat bran (farinetta) (available in quantity from Minndak.com). Apparently some other legumes (e.g., garbanzo beans) also contain small quantities of DCI. People at Soulcysters, who have become quite expert at creating recipes containing these foods, have also mentioned carob syrup & soy lecithin -- I think those are supposed to be sources of pinitol. Carob syrup is something of a problem since it's got a lot of sugar.

... Since I'm insulin resistant & have PCOS, I probably have this deficiency in d-chiro-inositol, so I am likely going to get some of this stuff no matter how expensive & experiment with it when I get back from my trip.

Rapid weight loss & the gall bladder

I decided a few days ago to follow Lyle McDonald's version of a Protein Sparing Modified Fast (PSMF) (as detailed in The Rapid Fat Loss Handbook). This diet is designed to "spare protein" — that is, loss of lean body mass–by giving an adequate amount of calories from protein, plus 10 grams daily of omega 3 fats through fish oils, plus nonstarchy veggies. Versions of PSMF programs seem to be used a lot for safe rapid fat loss among obese people (which I qualify as). There are a number of references at PubMed to therapeutic use of PSMF diets.

When I decided to embark on it, I'd forgotten all about the relationship between rapid weight loss & gall bladder issues — in spite of having had some rather nasty gall bladder attacks 10 years ago after fairly rapid weight loss (due to loss of appetite from grief & stress about a personal situation). One of those attacks even resulted in my being taken to the emergency room, mostly because one of my coworkers thought it might be a heart attack. An ultrasound the following day found I had no gallstones (possibly I passed one) but my gall bladder was larger than usual.

In any case, I did a bit of research at the time, & opted against a gall bladder removal, for which I'm glad. But my doctor told me to eat "low fat" which seems to be the standard medical advice. Now I think that rather the opposite is true — that low-fat diets (at least the extreme ones) are at least part of what sets one up for gall bladder attacks. Turns out that one of the fundamental issues with gall bladder health is eating enough dietary fat so that your gall bladder empties.

The short version of what I've just researched in the last couple days: if you're going on a rapid weight loss diet or will be undergoing gastric bypass surgery or some other bariatric surgery which will have the same effect, make sure that you are eating at least 10 grams of healthy dietary fats a day to reduce your risk of gall stones.

Now here's the long version:

Turns out that there is a really really high percentage of gastric bypass patients who get gallstones or sludge in the gall bladder (which can also lead to gall bladder attacks). See, for example:

• Shiffman, et al. Gallstone formation after rapid weight loss: a prospective study in patients undergoing gastric bypass surgery for treatment of morbid obesity. Am J Gastroenterol. 1991 Aug;86(8):1000-5.

• Al-Jiffry, et al. Changes in gallbladder motility and gallstone formation following laparoscopic gastric banding for morbid obesity. Can J Gastroenterol. 2003 Mar;17(3):169-74.

From a little research, it seems one of the biggest contributor to gall bladder issues is low fat diets which prevent gall bladder emptying. In a blog post called "Oh the gall of it", Mary Eades (wife of & coauthor with Michael Eades of the low-carb diet Protein Power), criticizing the laughable notice that low-fat diets prevent gall bladder disease, explains:

What makes the gall bladder empty? As any basic human physiology text will you, it’s fat entering the first portion of the small intestine. When saturated, monounsaturated, or even polyunsaturated fat reaches this area, its entry triggers the release of cholecystokinin (CCK) which is the hormone that causes the gall bladder to squeeze and squirt bile into the intestine to emulsify the fat.

This is what the gall bladder is supposed to do, for crying out loud; it’s its raison d’etre.

Basically, if you eat hardly any dietary fats, your gall bladder sits around doing nothing, & gets sludgy from bile that never gets do to its job & just sits there getting blechy. Inactive gall bladders are also more likely to form gallstones. Then, if you do eat a meal high in dietary fat, boom! gall bladder attack. All the g.b. attacks I had in 1998 were immediately after eating a high fat meal (Wendy's burgers in one case, a crapload of M&Ms in another), after having lost a lot of weight during my aforementioned Official Grief & Dumbfoundedness Weight Loss Diet. The medical advice I got at the time was to eat a very low fat diet. Thank gods I learned differently later down the road.

Since the PSMF diet I'm following includes 10 grams daily of omega 3 fatty acids distributed among the meals throughout the day, as well as whatever amounts of fat come packaged with the protein foods I'm eating, I should be okay. Some of the studies at PubMed indicate the low calorie diets that include fat are successful at preventing gall bladder problems; but low fat (say, less than 10 g/day) dieters are much more likely to develop gallstones.

Another strike against ultra low-fat dieting.

Some of the studies showing this:

• Festi D, et al. Gallbladder motility and gallstone formation in obese patients following very low calorie diets. Use it (fat) to lose it (well). Int J Obes Relat Metab Disord. 1998 Jun;22(6):592-600.
  
  In the obese during rapid weight loss from a very low calorie diet, a relatively high fat intake could prevent gallstone formation, probably by maintaining an adequate gallbladder emptying, which could counterbalance lithogenic mechanisms acting during weight loss.
  
  In this case, "relatively high fat intake" involved daily 12 grams of dietary fat (108 calories) on a 577 calorie diet during the first three months of the diet. By comparison, the people on the low-fat diet were eating 3 grams of fat (27 calories) on a 535.2 calorie diet for the first three months. Both groups had higher calorie diets for the second three months. 54.5% of the low fat dieters developed (nonsymptomatic) gallstones; none of the higher fat dieters did.

• Festi, et al. Review: low caloric intake and gall-bladder motor function. Ailment Pharmacol Ther 2000: 14 (Suppl. 2): 51—53.
  
  A threshold quantity of fat (10 g) has been documented to obtain efficient gall-bladder emptying.... Adequate fat content of the VLCD [very low calorie diet] may prevent gallstone formation, maintaining adequate motility and may be more economic and physiologically acceptable than administration of an pharmacalogical agent.
  
  This appears to be based on the same study as the prior document.

• Gebhard, et al. The role of gallbladder emptying in gallstone formation during diet-induced rapid weight loss. Hepatology. 1996 Sep;24(3):544-8.
  
  The findings suggest that gallstone risk during rapid weight loss may be reduced by maintenance of gallbladder emptying with a small amount of dietary fat. Ultimately, weight loss reduced bile cholesterol saturation and improved highdensity lipoprotein (HDL) levels.
  
  But it's not foolproof. This study showed lower levels of gallstone formation for people on 30 g/day of fat than for 16 g/day of fat on liquid 900 cal/day diets, but a few people on each diet developed gallstones over 13 weeks on the diet.

• Vezina, et al. "Similarity in gallstone formation from 900 kcal/day diets containing 16 g vs 30 g of daily fat: evidence that fat restriction is not the main culprit of cholelithiasis during rapid weight reduction." Dig Dis Sci. 1998 Mar;43(3):554-61.
  
  Substantial fat for rapid weight-reducing diets resulted in gallstone formation. Since experiments have shown that our higher fat diet, containing 10 g fat per meal, results in maximal gallbladder emptying, cholelithiasis from rapid weight loss may not be solely attributable to gallbladder stasis.
  
  So something else was also going on. Might it have to do also with pre-diet nutrition? I.e., maybe those who formed gallstones had low-fat diets prior to this diet... just speculating here. Mary Eades ties gall bladder disease squarely to insulin resistance, so maybe it has something to do with that.

Adequate protein — & a protein-sparing crash diet

Two additional things I've learned from Lyle McDonald & his Body Recomposition website so far, that are having a pretty immediate effect on my nutritional planning:

First, he's convinced me that "dieting by percentages" — that is, figuring out my nutrition based on macronutrient percentages — doesn't really make a whole lotta sense (see "Dieting by Percentages, part 2"). Mainly because if I'm going only by the percentages of carbs, fats, & protein I'm eating, I can really screw up on how much protein I should really be eating. Too little protein is bad, too much protein is bad too. Basically, what I need (or anybody else needs) is adequate protein. I don't think I was probably getting quite enough before I started doing any meal tracking; but I've also got to be careful that I'm not getting too much. So my protein intake should be defined more by my overall activity level than by its percentage of my diet — it should for the most part be a constant. Which is why the real changes are between low-carb/high-carb & hence also between high-fat/low-fat (or moderate levels of each). Since I'm going low-carb, that by definition means that I'm going to be eating, percentagewise, a "high-fat diet" (healthy fats, of course). Okay, now, doesn't that go against the long-lived "fat is evil" propaganda that's been going around the past three or so decades? And a fat lot of good its done for us too. (Literally. The dominance of the "low fat" mantra has correlated quite closely to the rise of the obesity epidemic that we hear so much about these days.)

Second, & more radically, McDonald has convinced me that it is possible to do crash dieting in a safe, healthy way. The Rapid Fat Loss Handbook: A Scientific Approach to Crash Dieting. I've already have this book in hand (or rather, computer), since it was available for purchase via electronic download at McDonald's website. With all the reading about nutrition I've done over the past couple of years — this stuff makes sense. Basically, this diet is his version of a protein-sparing modified fast (PSMF) — a low calorie "crash" diet which avoids muscle wasting by providing those calories that are eaten mostly in the form of dietary protein, with the addition of essential fatty acids (omega 3s) & nonstarchy carbs. How exactly to do it depends on one's body fat percentage — obese people with high body fat percentages (which I qualify as) can afford to use this diet for a longer period of time than people of middling body fat percentages or people who are fairly lean (e.g., bodybuilders on a pre-contest diet). (This accords with stuff that Tom Venuto has said: that people with high body fat percentages can afford much higher calorie deficits than people who are leaner, though Venuto overall would not recommend a PSMF diet.) McDonald's got built in free meals, refeeds, & two to three-week diet breaks in order to prevent metabolic slowdown & boredom.

I think what I'm coming to is an understanding that:

(1) Yes, my overall changes in how I eat — which started with my dietary overhaul two years ago after my mother's death — must by necessity be a permanent, lifestyles changes in how I eat. No way will I will ever go back to the vending machine diet I was on before). But —

(2) There is also a certain science to "dieting" that I can make use of — techniques, like this protein-sparing modified fasting "crash" diet, that of course are not sustainable over the long haul, that by their nature must be limited in duration & scope, but which can nonetheless be extremely helpful for the shorter term.

So, yeah. I'm gonna give a try to this over the next two or three weeks. Actually, someone with my body fat % can, according to McDonald, go for as long as 10 or 12 weeks on this diet before a two-week break from it (including two "free" meals per week during the diet itself), but I think it's better to try it out for a shorter time first, especially since I'll be traveling down to Seattle & Eugene for ten days at the end of the month & will need more flexibility about what I'm eating then.

One of the effects this will have on workouts is that because the PSMF diet is by its nature ketogenic, it cannot sustain too much cardio & definitely not high intensity intervals — because there won't be enough glucose in my system to turbocharge my muscles for those kinds of workouts. So, Turbulence Training is on hold for the moment. What I can do is moderate straight cardio, & I can do traditional strength workouts.

So that's basically the plan through about May 21 or 22. I fly down to Seattle on the evening of May 23, so on the 22nd or 23rd I'll start increasing my caloric intake to more "maintenance" levels, chiefly by adding more healthy fats into my diet but also probably some low glycemic carbs.

I'm not actually fully on the PSMF diet yet, but approaching it — eating very few carbs, & lower amounts of fats. I do want to make use of the apples I've got at home so they don't go bad. But after they're eaten... well, we'll see how it goes.

I've considered this pretty carefully, & will be watching myself carefully too to see how it goes. Please believe me that I will up my intake if anything seems to be going wrong. I expect by the nature of ketogenic diets that my energy levels will go down a bit as I transition from burning glucose to burning ketones, & also that I'll initially have some hunger; but hunger pangs are reported to disappear in the absence of carbs, & my energy should improve after a few days too (except not to the point of sustaining high intensity workouts, which require the turbocharging provided by glucose).

Learning about ketosis

Rather to my surprise over the past few months, I've become convinced that eating a ketogenic diet (in which body energy is mostly supplied by free fatty acids & ketones derived from body fat, rather than glucose from carbs), at least for a time, might be exactly the route I need to go. But I needed to know more, because most of the info I've seen on ketosis is warped by the epic battle between low-carb cheerleaders who consider ketosis the be-all & high-carb cheerleaders who consider ketosis the great evil that will lead without inevitably to kidney disease (which, best I can tell, is absolutely not the case, unless one's kidneys are already compromised).

So, I plugged the word "ketosis" into the Search field at Amazon.com, & low & behold came upon the book that I think can absolutely answer my questions, not only about ketosis itself but also about how to still have kick-ass powerhouse workouts (whether cardio or strength training) through targeted nutrition around a workout(i.e., having carbs pre, during, & post-workout, because otherwise your workout will really really suck).

The book is by Lyle McDonald, The Ketogenic Diet: A Complete Guide for the Dieter and Practitioner. Amazon is out of stock at the moment, so I ordered it directly from McDonald's website. Since coming across this book, I've seen references to it elsewhere, which agree with McDonald's own assessment that it's a thoroughly researched from the scientific literature, at least to the point of its publication in 1998, along with being the best "bible" out there about how to do a ketogenic diet, including support for workout-related nutrition. So.

I might add that an ultra-low carb (ketogenic) diet is pretty much what is prescribed by Dr. Richard Bernstein for his Type 1 & Type 2 diabetic patients (Dr. Bernstein's Diabetes Solution) which I think is arguably the best single source on diabetes treatment through nutrition & medicine. It's more restrictive on carbs than what I may need for my metabolic state — I'm insulin resistant but not, at this point, diabetic — but it's a damn good starting point. Bernstein is all about making diabetics as healthy as they possibly can be, which is a damn site healthier than the American Diabetes Association has ever remotely imagined: Bernstein's methods lead to (1) normal blood sugars; (2) the remission/reversal of virtually all diabetic complications except for those that have already led to irreparable damage; & (3) diabetics who are overall more healthy than most nondiabetics. Bernstein doesn't talk about ketosis in his book, but it's obvious from the low levels of carbs that his way of eating includes that it is ketogenic. Bernstein himself has been eating that way since around the mid-1970s.

From moderate-carb to low-carb

Being who I am, I have continually been mucking over the past few months with my nutrition. In this context, "being who I am" means that I can go geek with just about anything that interests me. So, when I was pursuing my master's degree (Master of Fine Arts in Creative Writing, earned Dec. 1997), focusing on poetry, I became a prosody geek. (Prosody is the technical stuff in poetry having to do with rhythm, rhyme, etc.) When I became interested in family history, I became a genealogy geek. Now, as I try to improve my health, I am a nutrition geek.

I demonstrated that recently in some conversations I participated in with Tom Venuto at his Burn the Fat Inner Circle membership site about Gary Taubes' book Good Calories, Bad Calories... & since my participation in that conversation ended (or went into abeyance, or whatever) I've been continuing to read & learn. I find that I agree with Tom about some stuff, but not about other stuff. For example, I agree with him that fat loss requires a caloric deficit. But I seem to disagree with him about how exactly the energy balance business works — i.e., is a calorie just a calorie, regardless of what kind of nutrient it is? Well, yes; but also no. That is, it’s a lot more complex than simply “calories in = calories out,” due to the complexities of how metabolism works inside the body. Being a geek, I am trying to learn more about how it all actually works.

Okay, well Tom has tended to focus in those conversations on the weight, specifically fat loss, aspects of energy balance (calories in/calories out). But for me, an insulin resistant prediabetic, I'm concerned about the health aspects of what I’m eating even more, so whether the calories are carb calories, protein calories, or fat calories is absolutely critical to me. And because of the emphasis of Burn the Fat Inner Circle is much more on fat loss than on metabolic health, it has appeared personally to me that there is a reluctance there to attend in much more than a (relatively) cursory fashion to the problems of insulin resistance. At least, relative to what I feel I need. Really, I think the deal is that while BFIC absolutely recognizes that insulin resistant (or, as they call it there, carb sensitive) people need a different diet than the moderately high carb diet recommended there for people who are insulin sensitive... there’s a wariness there of providing a any possible platform there for low-carb cheerleaders who make bigger claims for low-carb eating than what's actually warranted. That’s a reasonable fear, given that "one size fits all" approaches only ever really work for just some people. Evidence seems to show that while low-carb works very well for some people, it doesn’t work so well for many others.

Problem is that the overall skew in our culture about nutrition comes from the high-carb cheerleaders, led by organizations such as the U.S. Department of Agriculture with its food pyramid & the American Diabetes Association with its "let's make diabetics even sicker than they already are" high-carb diets. These diets, again, only work for some people. They definitely do not work for diabetics or prediabetics. Unless, of course, you're a pharmaceutical company for whom the sickness of diabetes is a perennial cash cow.

Given that many people who are trying to burn off the fat are insulin resistant, & the overwhelming evidence that high-carb diets are absolutely disastrous for us — well, I’ll just say that while BFIC continues to be a crucial part of my “fat loss” support system, that I’m also on the lookout for other resources as well, which are more natural supports for the kind of nutrition that I as an insulin resistant person need.

Am I a low-carb cheerleader? Well, no. In fact, two years ago, when I first began to overhaul my way of eating, I was quite wary, one might say suspicious, of low-carb approaches. After I read The Schwarzbein Principle, which provided what seemed the perfect model for me of how I should be eating, I was always at pains to refer to what I did as “moderate carb.”

But I’ve been undergoing a slow change of consciousness, especially over the past three months after diving back into nutrition geek mode. Especially after reading some of Richard K. Bernstein’s important work Dr. Bernstein’s Diabetes Solution. It comes down to this: if it makes my blood sugar go above normal levels, then I shouldn’t eat it.

And by normal levels, I mean normal levels. Not “what’s normal for a diabetic” or “what’s normal for a prediabetic.” I mean normal. And at this point in the game, that means eating fewer carbohydrates than what I was eating “moderate carb” level. And so, much to my surprise, I’m turning into a low-carber. Not because I think “low carb is for everyone.” But because it will work better for me. And yes, probably for most diabetics & prediabetics.

A new resource I found last week sums it up quite nicely for me:

My general experience has been that individuals who respond very well to high-carbohydrate/lower fat diets tend to do very poorly on low-carb/higher-fat diets. They feel terrible (low energy and a mental fog that never goes away), don't seem to lean out very effectively and it just doesn't work.

This cuts both ways: folks who don't respond well to higher carbs do better by lowering carbs and increasing dietary fat. Sometimes that means a moderate carb/moderate fat diet, sometimes it means a full blown ketogenic diet. I should also note that some people seem to do just as well on one diet as another.

— from "Insulin Sensitivity and Fat Loss" by Lyle McDonald

I think Tom Venuto would actually agree with most of that, though perhaps not the part about ketogenic diets, which he seems quite wary of. But me...well, in fact, I ran into Lyle McDonald because rather to my surprise over the past few months, I've become convinced that eating a ketogenic diet (in which body energy is mostly supplied by free fatty acids & ketones from body fat, rather than glucose from carbs), at least for a time, might be exactly the route I need to go.

But more on that in another post.

Recovery

Note: My Start Walking posts can easily be found by clicking on the label Start Walking 2008.

Oh boy do I need to update my blog.

I learned a few lessons from my half-marathon row on April 18. Live & learn, indeed. Considering that the prior week I'd done 15,266 meters in one sitting, with no ill effects, it's pretty incredible that the addition of just another 5k was enough to mess me up as badly as it did. Or atleast, I'm guessing that something about that row is behind the effects I experienced, mainly having to do with energy levels.

Well, it was to be expected I'd be a bit wiped out the day following a 13-mile row. So on that following day (a Sunday) I did nothing exercise-wise, just hung about my apartment & enjoyed a well-earned vege-out (complete with the consumption of plenty of veggies). After that — let's see, I'm looking at my little spreadsheet on my Palm — I got the equivalent of 9K to 15K steps over the next five days, but rowed on only three of those days, & that at fairly low levels — a max of 3k meters. And I felt kinda yucky every time. Which is, of course, why I didn't row more. Nor did I have the oomph to do any of my Turbulence Training workouts. All of this was accompanied by an abrupt increase in daytime sleepiness, that whole falling into a drowse mid-typing at my computer, which was remedied only through influxes of caffeine. This in spite of actually succeeding, for once, in getting at least 7 hours of sleep every night that week.

The following weekend (i.e., Apr. 26-27) I couldn't bring myself to do a damn thing. Slept in, vegged. I was able to pick up the last week, including an increase in rowing workouts, but I didn't really feel good doing a row until Thursday, May 1. That was a 10K row, a fitting beginning to the new rowing season. (On the Concept 2 website, seasons run from May to April, so even though we still have most of 2008 yet to go, in rowing terms we're now in the "2009 season.") I even put myself at the very front of the pack in the rankings for a 10K row in my class (women aged 40- to 49 heavyweight)! Of course, that might have something to do with the fact that I was the only person in my class to record a 10K row for the 2009 season to that point. (As of this morning, I'm now 5th out of 8.)

So, my energy levels seem to have returned, & the daytime sleepies seem to be improving slightly. I also finally got the weight bench & dumbbell stand for the Bowflex SelectTech dumbbells I purchased a few weeks ago put together over the past weekend, so I'm set to get back on the weight training workouts.

Here's what I think led to all this: I screwed up in how I set up the half-marathon row. First, I did it way too late at night. When it got that late, I should have just gone to bed, & saved the row for the following day or even put it off to the following weekend. (To meet the challenge, I had until April 30). Second, I had inadequate nutrition around the workout itself -- preworkout, during workout, postworkout. I did have a protein/carb drink (more protein than carbs) that I sipped at during brief rest periods (such as when I had to stop to give my poor sore bum a break), but that wasn't enough. You can sure bet that I've been doing some research on pre, during, & post-workout nutrition since then. In any case, between the poor timing of the workout & the poor workout-related nutrition, I sabotaged my recovery. That's what I think, anyway.

Good to have the energy back, though. Starting on May 1, I've done four long straight cardio (i.e., not HIIT) rows, & have felt good both during & afterwards, with no ill effects.

Weight-wise — well, it's been fluctuating a bit up & down by about two or three lbs., but no further weight lost. I'm not too worried about that, though; I think it goes with the absence of HIIT & weight training these past two weeks, & at least there hasn't been a precipitate weight increase. Now that my energy's back up, things should improve again.

I have, in virtual "ascent of Everest" terms, reached Everest Base Camp. So that's pretty cool.

5-HTP & depression

I learned recently that 5-HTP is an intermediate between the amino acid tryptophan (oh ye of post-Thanksgiving turkey dinner sleepiness fame) & the neurotransmitter serotonin, whose activity is targeted by a lot of antidepressants. Thus, 5-HTP is alternative to antidepressants–& from my standpoint, a superior one. This is important to me given my history of problems with depression. Since I'm also insulin resistant (prediabetic), the metabolism of carbs & their intimate relationship with tryptophan & hence serotonin levels is crucial.

When I overhauled my diet to a low glycemic/moderate carb diet a couple of years ago, I discovered that I was just as prone to fall into depression if I went too low in carbs as I did when I was my carb intake was too high. I don't seem to be having that problem so much now, as I go to a lower carb diet. Maybe I've adapted. But I'm now also supplementing now with 5-HTP.

Here's how I understand the mechanism relating carbs & insulin to tryptophan > 5-HTP > serotonin to mood disorders like depression (& probably other things like road rage, anxiety, etc.).

Low serotonin levels frequently (especially in insulin resistant people whose blood sugars are all over the map) lead to carb cravings because intake of carbs brings (as most of use here will know) increase in insulin secretion. The insulin works not only to control blood glucose (as best it can), but also to cause various amino acids to be absorbed into body tissues -- except apparently tryptophan isn't absorbed as much. This then leads to tryptophan to have less competition from other amino acids for riding the carrier molecule they use to get through the blood-brain barrier, where the tryptophan is synthesized into 5-HTP & from 5-HTP into serotonin. The effect of eating carbs for the depressed person is, thus, to increase serotonin levels into the brain -- but at a cost (higher blood sugars, higher blood insulin, increase in insulin resistance & obesity, etc.).

The reason it might be better to supplement with 5-HTP than tryptophan is because: (1) tryptophan is also used in the body to synthesize other products, which might not hold as much advantage for mood issues, whereas (I think) 5-HTP is used mainly to synthesize serotonin; & (2) 5-HTP has a much easier time getting through the blood/brain barrier than tryptophan -- apparently doesn't require the carrier molecule that tryptophan does (in which tryptophan competes with other amino acids).

My source for this info is the book Hunger Free Forever: The New Science of Appetite Control by Michael T. Murray, N.D. and Michael R. Lyon, M.D. Murray has also written a book specifically about 5-HTP. I'll see if I can find actual scientific cites. In any case, so far it's working well for me.

Update 12 May 2008: I finally got around to finding a reference. Here is is, with its abstract.

• Birdsall TC.. 5-Hydroxytryptophan: a clinically-effective serotonin precursor. Altern Med Rev. 1998 Aug;3(4):271-80.
  
  (Full article with references is available at http://www.thorne.com/altmedrev/.fulltext/3/4/271.pdf.)
  
  5-Hydroxytryptophan (5-HTP) is the intermediate metabolite of the essential amino acid L-tryptophan (LT) in the biosynthesis of serotonin. Intestinal absorption of 5-HTP does not require the presence of a transport molecule, and is not affected by the presence of other amino acids; therefore it may be taken with meals without reducing its effectiveness. Unlike LT, 5-HTP cannot be shunted into niacin or protein production. Therapeutic use of 5-HTP bypasses the conversion of LT into 5-HTP by the enzyme tryptophan hydroxylase, which is the rate-limiting step in the synthesis of serotonin. 5-HTP is well absorbed from an oral dose, with about 70 percent ending up in the bloodstream. It easily crosses the blood-brain barrier and effectively increases central nervous system (CNS) synthesis of serotonin. In the CNS, serotonin levels have been implicated in the regulation of sleep, depression, anxiety, aggression, appetite, temperature, sexual behaviour, and pain sensation. Therapeutic administration of 5-HTP has been shown to be effective in treating a wide variety of conditions, including depression, fibromyalgia, binge eating associated with obesity, chronic headaches, and insomnia.