What do I do about IR? Executive summary – stay lean, lose your belly fat, eat no processed sugar and limit your starchy carbohydrates. Exercise.
I and many other doctors believe that this is the single most important thing you can alter to reduce your chances of many diseases. 2017 Update: Here is Dr Georgia Ede's explanation of how this works. Her website is a wonderful resource.
Here is a scientific article
explaining in detail what effects IR and diabetes (the stage after IR) have on AD.
Here is an article
showing that IR is linearly associated with cognitive decline 1. Keep a healthy weight.
a. BMI is a crude tool, but it is a guide. Unless you are very muscular you should have a BMI <25. If you are small framed or of Indian or other Asian ethnicity 23 is a better goal. But you can have a BMI of 23 or 22 and still have IR - the best measurement is the following:
b. You should have no or minimal intra-abdominal fat/belly fat. This both causes IR and also shows that a person has IR. The reasons why this is related to IR are complex. Here is a link
to learn a little more. *By belly fat I don't mean fat just under the skin. This fat under the skin is called subcutaneous fat and is not as dangerous as the fat inside the abdomen. "intra" is the Latin word for "inside. Fat inside the abdomen latter creeps into the organs such as liver, pancreas and heart and causes nasty things such as inflammation and reduced function of these organs. The American term belly fat is ambiguous and not used in other countries. We should be more specific and use the words "subcutaneous fat" and "intra-abdominal fat" rather. We attended a wonderful lecture on this by Dr Worm from Germany at LowCarbSan Diego 2017
c. Waist circumference is a better measure of IR than BMI. Below are charts – but everyone is individual. A tape measure is very cheap. Or use a mirror. You don’t necessarily need expensive blood tests.
d. If you have intra-abdominal/belly fat don’t despair! We can help you drop it. It will take time but it is doable. 2. Avoid “sugar” aka simple carbohydrate containing foods.
a. These are often hidden in the food label. Don’t trust anything in a box or packet and learn to read a food label.
b. Other sneaky words used for hidden sugar are: Sucrose, Maltose, Dextrose, Fructose, Glucose, Galactose, Lactose, High fructose corn syrup, Glucose solids, honey (just because a bee made it doesn’t make it any better for IR), agave, molasses, Cane juice, Dehydrated cane juice, Cane juice solids, Cane juice crystals, Dextrin, Maltodextrin, Dextran, Barley malt, Beet sugar, Corn syrup, Corn syrup solids, Caramel, Buttered syrup, Carob syrup, Brown sugar, Date sugar, Malt syrup, Diatase, Diatastic malt, Fruit juice, Fruit juice concentrate, Dehydrated fruit juice, Fruit juice crystals, Golden syrup, Turbinado, Sorghum syrup, Refiner's syrup, Ethyl maltol, Maple syrup, Yellow sugar.
c. Remember we use the word "sugar" loosely to mean a few things: table sugar aka sucrose, small carbohydrate molecules or disaccharides (for instance maltose which is 2 molecules of glucose joined together is just as bad as sucrose) , and also we use it as a synonym for blood glucose levels when we use fingerpick measurements. The last one is often abbreviated as BSL or blood sugar level. 3. Limit starchy carbohydrates.
a. Starch is a word used for a long carbohydrate molecule that is basically a long chain of glucose. This is what a potato is made of for instance, it is a concentrated storage form for energy to the baby plant will use when it starts growing. Also wheat, rice, maize and cassava. Your body will chop up the chain into glucose molecules in no time at all. Brown rice is no different ultimately in the body, neither are whole grains. They are just broken down a little slower, sometimes not that much slower. They are still made up of glucose chains.
b. This means I and many mainstream doctors recommend limiting breads, rice, pasta, grains, also limiting starchy veggies like potato, sweet potato and focussing on non-starchy veggies like leafy greens, broccoli, cauliflower, zucchini, eggplant, carrot, tomato, yellow bell pepper and mushrooms etc (use your imagination – I have tried to pick one of each colour) – all the veggies across the rainbow of healthy yummy colours. The latter are made up of carbohydrates too, but there is far less amount in for instance greens than a potato and it is digested slower by the body because it is trapped in fibre that the body has to break down first before it can get at the glucose, giving it time to digest it without the glucose in the blood going too high.
c. Start by looking at how much of the starchy carbohydrates you are eating and try to slowly reduce these and replace them with the non-starchy veggies. The other reason for eating lots of veggies is to have heaps of nutrients – more on this later.
d. What about fruit? Fruit contains simple sugars – but much less than for instance a potato, because of the fibre it is absorbed slowly, and has much less impact on blood glucose levels. Berries are thought to be the best kind of fruit for IR people and for us ApoE4s because they are digested very slowly, have heaps of fibre, and also contain heaps of good chemicals. Eat the skin of your fruit eg of an apple. Don’t eat too many fruits a day and not all at once – maybe two portions a day for a woman and three for a man to start with. Fruit juice is a no no – the fibre is all gone and the carbohydrates get absorbed very fast. It is as bad as sugar. Manufacturers use “contains fruit juice” to con you into buying their product. It is pure glucose and fructose.
e. What about fuel for exercise? Absolutely if you cannot exercise without starchy carbs, then please make sure you don't eat more of them pre-exercise than you will burn off. This is where I recommend checking that your blood glucose levels don't go too high and that you are not overestimating the amount of carbohydrates that you will need as fuel for a workout. I for instance can do a hour long intense boxing class on an apple and a glass of milk. 2017 Update: Now I do it fasting. in 2015 I had to eat before exercise as I was not yet keto-adapted
. Perhaps in our discussions we can explore how much each of you needs for exercise. Many of us on the forum exercise fasting, they can do this because they are using ketones as fuel rather than glucose (this is why I mentioned the way mitochondria can produce fuel in the form of ATP both from glucose and from fats). This is an area you can explore later if you wish. 4. Exercise.
a. This makes the cells more sensitive to the insulin, so that body has to make less of it to get the glucose into the cells. It is crucial both for IR and for other reasons we will discuss later.
b. We recommend starting slowly at 5 to 10 mins at a time if you are unfit and ultimately aim for 30 to 45 mins, most days of the week. Please do not start too fast and injure yourself. This has to be sustainable. This amount of exercise should not need any extra food as fuel.
c. You should aim for being puffed out in your exercise; you should still be able to talk though. Depending on your age, you might want to aim for a heart rate of 120 to 160/min or whatever is comfortable while still working moderately hard. Here is a start
as a rough guide - but this is very individualized. If you have significant medical conditions please discuss with your doctor first.
e. Anything you enjoy is great – options are walking fast, running, cycling, swimming, group classes, boxing, dance – whatever you wish. The important thing is to develop a sustained programme of at least moderate intensity exercise.
f. Yoga, tai chi or pilates are good for other reasons (muscle strength, co-ordination, balance, stress management), but are not enough IMO for reducing IR.
g. I and most doctors do recommend a mixture of aerobic exercise and weight /strength training because we want you to maintain or build muscle as well. Muscle is very important for at least a couple of reasons - for reducing IR, and muscle loss is thought to be a risk factor for AD.Glossary for Primer
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