ChrisM:

You're not the only person to give that feedback, so I'm sure my 2012 presentation will get a similar treatment.

tam:

That's beyond the scope of a comment: Petro digs into it in this very technical article. 

v:

I think part of the problem is that, unlike (apparently) the rest of the Internet, I don't feel comfortable giving medical advice to diabetics.

I've been assuming, perhaps wrongly, that anyone with a major medical diagnosis -- whether that be diabetes, anaphylaxis-level allergies, lupus, or anything else -- would need to filter any of my recommendations for general health through the needs of their specific condition, let alone any second-hand recommendations from sources I've found valuable for myself. 

If you feel misled by that, I apologize.

Yes, anyone with a known disorder of glucose metabolism should trust their glucometer over anything anyone else says.  I have long-term diabetic relatives who were first diagnosed decades ago and given advice even worse than what diabetics get now.  The reason they're still healthy is because they decided to trust the glucometer over the books full of terrible advice like "beans are great for diabetics."

Anyway, I'll be interested to hear what Paul says.  If I recall correctly, he does say that the "stock" PHD is not a diabetic diet, and that they will need to modify it appropriately to their needs.

JS

Dave:

Thank you!  I prefer to give my readers a meal of solid, information-dense meat -- not a fluffy, sugary, low-information snack that leaves you hungry for real knowledge. (e.g. listicles) 

And yes, it takes longer to digest the meat.

JS

Amy:

"maybe the reason the "giving glucose somewhere to go" idea is at least somewhat accurate is *because* of metabolic/mitochondrial flexibility"

"Giving glucose somewhere to go" is only one part of it.  Exercise allows glucose to be transported into muscle tissues independent of pre-existing insulin resistance, post-exercise, which indeed helps dispose of glucose.  But met flex towards fat is an independent issue, which is mitochondrially mediated and improves over time as we exercise consistently: the mitos that reproduce tend to be those that are in the best shape, e.g. spewing less ROS.

I am convinced this is what's behind the need to keep snacking every few hours: blood tests show that you're not actually hypoglycemic (the common refrain from the medical profession "Reactive hypo is a myth"), but if you have trouble using fat for energy, you're going to feel crummy and need a sugar hit to keep going, regardless of whether your blood glucose has dropped or not.

And I strongly agree that leaving behind the concept of "I must burn X calories" frees us to do what we enjoy instead of grinding away on a treadmill/Stairmaster/bicycle that goes nowhere.  There are many mental benefits to being outside and physically moving around, in addition to the physical benefits of activity -- benefits lost by moving in place on a machine. 

"If the metabolism has no reason to adapt to fat, or ketones, or carbs, or *whichever* of those is available at a given time, then it won't." --> Yes.  Train in the energy system you want to improve.  PCr, glycolytic, aerobic glucose, aerobic fat...

And I've met Carl, but I've never been on his show.  Perhaps that should change.

Thank you for the note of appreciation!  Once you really "get" met flex, the light goes on -- and so many real-world phenomena that were once dark become illuminated.

eddie:

I agree completely.  I have to make a conscious effort to continue learning, because there is no encouragement to do so as you get older, particularly in today's emotion-driven consumer society.  Don't think!  Don't make rational decisions!  Let the beautiful flashing images on the TV screen determine your wants...and go consume them. 

People who make rational decisions don't make the economy grow in the absence of actual productivity (long since outsourced to Asia).  For that you need a population willing to take on debt.

JS

Paul:

The irony in having made our lives so effort-free that we must "exercise" to remain healthy has not been lost on me.

Seriously: drive to the health club so I can ride a bicycle that goes nowhere?  As I said to Amy, there are many mental benefits to being outside and physically moving around, in addition to the physical benefits of activity.  Standing on a treadmill and watching TV isn't the same thing at all.

tam:

The equipment is usually found in exercise physiology labs.  It's generally used to measure athletic performance -- and I'm not aware of any MD who uses it as a health diagnostic.

Amy:

I've heard the same thing, that a rapid fall in BG produces hypos even though the absolute level is still "OK".  I'm still inclined to pin this on metabolic inflexibility, because as I note in the presentation, fat oxidation fails first.  You don't just randomly start having poor BG control (perhaps unless you're an incipient Type I diabetic)...the failure of fat oxidation is what appears to cause the poor BG control.  Petro at Hyperlipid has been going through the mechanisms for how this might be happening at the mitochondrial level.

pam:

It's interesting how everyone always gets hungry enough about 30-45 minutes after exercise to replace the calories they just burned!

Yes, the PHD is a good starting point for most people.  I tend to consume somewhat higher protein than it recommends, but I'm nowhere close to sedentary.

JS