Very nice and informative write up and seems to confirm a lot of my totally anecodotally baesd advice found here:
http://primalnorth.blogspot.ca/p/keto-adaptation-vs-low-carb-limbo.html

(Not sure if links work here but its my keto adaptation vs low carb limbo page on my blog, by far my most read article).

One point on the "Dont exercise until you are fat adapted", I have never heard this and I also seem to think that we can all burn body fat just at impaired rates so think it may be good idea to state that outright incase someone reads this article and thinks they can't burn any at all. Just like impaired glucose metabolism slows the rate of glucose uptake but does not stop it completely...

Anyway on the dont exercise point, I have never heard that, I have always heard not to exercise until you are keto-adapted and the low carb flu has passed. Those not familiar with the more intricate details of a low carb way of eating often misquote this as "fat adapated" which is why I include terminology in my write up... There is a pretty massive differencee between keto and fat adapated states. And exercising during the "low carb flu" is a recipe for a huge uncontrollable urge to binge.

I think your main point though to start with exercise is very valid. I think you are quite right you are better off excercising a few weeks rather than charging head long into any diet (including low carb).

Exercise is a wonderful proven intervention and I have always stated in my own 100+ lb weight loss that I could not have done it without exercise, and I certainly cannot MAINTAIN it without exercise, even eating zero carb I had to include a fair amount of running (even did a half marathon 5 months zero carb).

Maintaining a massive weight loss, to me, is going to require more than one intervention. Exercise + paleo or + calorie restriction or + low carb or even all three! Further gains can seem near impossible without absolutely extreme efforts... there is a massive price to pay for being 400lbs for ten years it seems...

Eventually the course that brought you that surge of weight loss will indeed stall and you may even regain (I lost 150 total, regained 40 and exercised and ate fairly well the entire time!).

Now I focus on building strength and muscle and increasing my lean mass as focusing on further fat loss becomes such an extreme effort as to my mind its not worth missing out the rest of life to accomplish. I am very healthy and fit despite being "overweight" by medical standards. I am free of my old 3 blood pressure meds a day, have excellent labs and glucose control, can run distances, lift massives amounts of real weight, and hold my own in a boxing match, I have learned to accept this is simply more important then getting down to some six pack which, to accomplish, would simply require me to live a life so extreme I could not provide energy to my family and work.

A great article that got me thinking and appreciate that you took the time to share it, a shame the lecture itself did not film.

Good paper.

I prefer reading it like this, to watching a vid. I can read far faster than I can watch.

In passing: When you rework the slides for your next show, you need to use larger fonts. When I was teaching and using an 800x600 projector, I found that I couldn't use smaller than 16 pt font and have it ledgeable at the back of the classroom.

Specifics: On your graphs it is very difficult to tell the filled dots from the open dots. Print below the graph is next to impossible to read. Some of the axis text is difficult to read. And that is after hitting command plus to magnify. Twice.

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The bibliography should be part of the page. You can have a hide/show button so that it isn't present unless someone wants to see it, but it means that someone who wants to save the web page has the bibliography as well.

Once again thanks.

J. I really like this presentation. It explains a lot about what is going on at a cellular level. Would you mind if I put a small quote from this article on facebook and shared a link to the article?

This is what I'd like to quote:

"So, we have successfully restated the problem as “To lose fat, first you must lose fat.”

And now it’s time to talk about exercise. We know that exercise temporarily helps dispose of blood glucose even in the insulin resistant, and that insulin sensitivity temporarily increases after exercise. However, what’s far more important is that exercise, unlike weight loss, is proven to restore fat oxidation—both basal RER and in response to a high-fat challenge meal. "

Brilliant J, very informative and nicely pitched.
"And why did that process accelerate so dramatically after 1979" Do you have data from other countries that also suffer from a large diabetic/obese population, and more importantly does that data corrolate with current dietary guidelines?
Neal

ps what is a moderate aerobic session- would that be fast walking, slow running? being slightly out of breadth but able to hold a conversation running or biking, or being not out of breadth at all, but pushing it a little? again, I like the elegance of language and thought in this presentation.

This was very interesting. Thank you for taking the time to make your presentation available despite the technical glitches at AHS 2013.

I have one question though:
You write that metabolic inflexibility is caused by a defect in the cells, independent of neuronal or hormonal inputs. Yet, you state that exercise can restore met flex in ten days. How is that possible? If the defect is in the cells, ten days seems largely insufficient to change anything about it (I mean, cell or mito turnover must be much longer than that, and neuronal and hormonal changes are irrelevant).

J, a quick mostly unrelated question. I have read very little on variety in diet in the ancestral health community. do you think from a health perspective this offers any benefit given the wider variety of nutrients you would be exposed to? I know for myself that it helps a lot with making sticking with paleo a non issue when you are always eating something new you never really get tempted to eat Neolithic foods but is there anything else to gain from it? I know palaeolithic man ate in excess of 300 types of food per week so maybe we can benefit from it also? Can't find the study that I got those statistics from unfortunately.

Many thanks!

hey J this piece is great, I have just shared it on my Facebook.
what I especially like is how it fits in with all the performance trainers and nutritionists out there too.
the whole cycling of nutrients to get through plateaus (carb/fat/protein cycling while always keeping a baseline of protein etc)
this is fantastic.
I was looking forward to seeing your talk though so am sad about that.
you come across as similar to Dr Ben Goldacre
which is so nice for me, as someone who talks fast and processes information fast, many people in interviews talk too slow and I can't maintain interest.
well the article was still brilliant, if you decide to do this as a video off your own back please let me/us gnolls know!