“P.S. I’m over 50 and one or more of the following is also true about me: high blood pressure, my waist is bigger than my hips, my waistline is bigger than my hips, I’ve been overweight for more than five years, I can lose weight repeatedly—but I always regain it, my triglycerides are high on my cholesterol test, my blood sugar is a little high, I am a woman who has had babies weighing 9 lbs or more.”
If ANY of the above P.S. statements could be yours, you probably have a condition called “metabolic syndrome,” a precursor to type 2 diabetes. I heartily congratulate you on wanting to turn your health around, because that is exactly what you will do when you are successful at losing fat and gaining muscle. If you can turn belly fat into a bulging bicep, it will be easier for you to maintain a normal weight over time. You will make your doctor happy with your next lab tests, and maybe even get off your blood pressure medications. You will sleep better, have a better sex life (!) and keep your brain healthy as you age.
Cutting to the Chase
You won't solve the problem with exercise alone. Exercise will help, but 80-90% of the benefit comes from changing your diet.
Your body, with a little practice, can be guided to better health, and you can burn fat rather than store it. You will, however, keep storing fat if you’re relying on carbs for fuel, which most of us have trained our bodies to do. No matter how much you exercise, a high carb diet will not serve you well, no matter how many carbs your coach tells you to eat.
Coaches and nutritionists have advised carbs because carbs promote the release of insulin, and insulin is a "growing" hormone. Insulin is used to grow muscle (great, sign me up!) but it is also used to grow fat and lock it into deep storage.
Once you have metabolic syndrome, you are much more likely to respond to insulin by growing fat, not muscle.
High carbs might work for those who are not prone to metabolic syndrome, but not for those who are either prone or already there. There are many good studies, here’s just one, concluding that athletes who eat less carbs, and more FAT, actually become twice as efficient at burning fat for fuel. The super-good news is that not only do you lose your love handles, but thinking of performance: even as you trim down, your fat stores are way greater than your carb stores. No one can store more than 2500-3000 calories of carbohydrate; even Lance Armstrong has 40,000 calories of fuel stored as fat. Learn to burn fat for fuel, and you can go all day. There’s way more good news than that, let’s go into more detail.
Triple C Conundrum
The secret for training as an older athlete with metabolic syndrome lies in mastering the biochemistry of carbohydrates, cortisol and calories.
Carbohydrates. Most people, and certainly most athletes, have long valued carbs as a key fuel for human performance, both mental and physical. Once our mothers weaned us, most of us learned to get the majority of our calories from carbohydrates. It also happens to be absolutely true that the daily human requirements for carbohydrates is zero. That’s right, zero. Athletes performing short bursts of high intensity sports are often dependent on some carbohydrates, but once the exertion is up to several minutes, they’re in the same boat with the rest of us. Zero carbs required.
Why even think about zero carbs? Much as we enjoy that syrup-drizzled stack of pancakes, carbohydrates of any type can be problematic for someone with metabolic syndrome.
Let’s back up: When we eat carbohydrates (grains, vegetables, fruits, dairy and sweets), they are broken down and absorbed as sugar molecules in our bloodstream. Our pancreas responds to increasing levels of blood sugar by releasing insulin, which keeps our blood sugar in a normal range. Insulin is a miraculous hormone with many useful effects, beyond the benefit of normalizing blood sugar. Insulin is also a “building” hormone, essential to general tissue repair and the building of both muscle and fat stores. Insulin interacts with tissues and other hormones throughout the body in complex ways that challenge a good biochemist to understand.
On a practical level, though, we know two things about insulin:
- that some insulin is helpful when you want to build muscle, and
- that having too much insulin makes it very hard to burn fat.
High insulin raises blood pressure and is a hallmark of type 2 diabetes. Most people who carry extra fat pounds, especially if those fat pounds live around the waistline, have consistently high levels of insulin. Other folks with high insulin are those who complain of hypoglycemia: they get the sugar blues when a normal meal causes their body to make too much insulin and plummet their blood sugar. Athletes who rely primarily on carbohydrates for fuel can also have surprisingly high levels of blood sugar and insulin, even lean and fit athletes. In the nutrition world, skinny folks with high insulin are known as TOFI: thin on the outside but fat on the inside. In their case, the fat is likely congregating quite dangerously in the liver and pancreas.
Tim Noakes, a leading exercise scientist and running guru from South Africa, was shocked to develop type 2 diabetes as a lean endurance athlete. In his first book on performance, Lore of Running, he celebrated the role of carbohydrates as a proper fuel for both endurance and sprint runners. In his later book, The Real Meal Revolution, he told the story of his own switch from carbohydrates to fat as an endurance fuel, and his recovery from type 2 diabetes. He would not call it a cure but rather a form of learning: relying on fat for fuel is a learning process. Anyone who has metabolic syndrome also has high insulin levels, whether their doctor has ordered the test or not. Switching to a lower carb diet will not “cure” the problem but will manage the problem if permanently maintained.
Your body has to re-learn how to rely on fats and protein for fuel.
To burn fat for fuel requires a few steps.
- First your brain has to UNLEARN all the fear of fat that my noble medical colleagues have circulated over the last 5 decades. There are healthy fats and problematic fats, but so long as you avoid processed foods (trans fats, omega 6 fatty acids) and rely on real food (meat, eggs, fish and full fat dairy), you will be eating only healthy fats.
- Secondly, your body must develop fat-burning mechanisms. Mostly our bodies have forgotten how to rely on fat for fuel, and have switched to burning sugar from carbohydrates. Every part of our body can burn sugar for fuel, but only a small part of our fuel must be sugar. Our red blood cells and a small part of brain activity requires sugar. Everything else can be powered by fat or by ketones, after a little period of adaptation.
What’s a ketone? Our liver, with a bit of practice, turns fats into ketones which are a fantastic source of fuel. Brains in particular like ketones, particularly brains damaged by trauma, or dementia, or suffering from epilepsy.
There is nothing essential or required about carbohydrates. We can get all we need from just 100 calories a day worth of carbohydrate foods. We actually can get a bit of carbohydrate or sugar from fat itself. Fat is stored in our adipose tissue as triglycerides, in which each three molecules of fat are linked to a sugar backbone known as glycerol. When we burn that fat for fuel, we liberate a molecule of sugar that can be used for fuel. So maybe we don’t even need 100 calories of carbs, and indeed there are people who thrive on a zero-carbohydrate diet!
Let's talk a little more about #2 above, insulin's problematic side.
Have you ever wondered how you can feel hungry or “bonk” or “hit the wall” when you clearly have fat stores that you would be happy to burn for fuel? (Happened to me on a backpacking switchback on the way to Big Bear Lake in the Trinities. Just could NOT take one more step...until I ate some trail mix. Doesn't happen anymore.) Here’s the thing about insulin: If you've been eating mostly carbs and have a highish background level of insulin, it's a problem. While insulin makes things grow (both muscle and fat tissue), it quite specifically PREVENTS fat tissue from shrinking. Insulin’s action is helpful when you eat carbohydrates: burn some sugar for fuel, but store the rest, safely out of the blood stream. Store it and keep it there! When you’re healthy, your insulin peaks after eating carbs, and goes back to normal. When you have metabolic syndrome, you always have a moderate to high level of insulin, and you will always find it easy to store, but difficult to burn fat for fuel.
Tip #1 for burning stored fat: reduce your intake of carbohydrates. Reduce by how much, you ask? With the help of a smart phone app such as Carb Manager or My Fitness Pal, reducing your level of net carbs to 30-50 grams a day, is usually low enough to train your body to burn fat for fuel. There can be a period of adjustment as your body learns, sometimes referred to as the “low carb flu.” Take processed foods and concentrated carbs (dessert!) out of the picture.
Tip #2 for maintaining muscle: keep eating a normal amount of protein, which would be based on your weight. Take your ideal weight in pounds and calculate 2/3 of that number: eat that many grams of protein daily. Say I’m shooting for 150 lbs, looking good: I should eat 100 grams of protein daily while I’m keeping up my athletic schedule, working out 2-4 times weekly, and working out hard. (NOT 6 or 7 hard workouts a week: see Cortisol section below.)
Tip #3 derives from the common sense observation that you’ve cut carbs, you’ve maintained protein, you have to eat something to fuel your day: let it be fat! You will increase the amount of fat you eat while you cut carbs. You can eat bacon, please eat the yolks of your eggs, keep the skin on your chicken, allow yourself to eat cheese, avocados, and nuts. Drizzle your salad with olive oil.
Cautions are few but real: Young children and pregnant women should only make a significant dietary change with the okay of their physician but for other folks it’s quite safe to reduce carbs. The cautions I suggest to people are two: consume some form of broth or bouillon every day to avoid a feeling of weakness or dehydration, AND watch your blood pressure: it’s quite common for once-elevated blood pressure to fall rapidly when insulin levels decline. For some people that’s a couple days, for others it’s over several months.
The second C is for Cortisol.
Cortisol is the “wake up and greet the day” hormone released by our adrenal glands shortly before dawn. The level of cortisol normally rises and peaks in the middle of the day, falling low into the afternoon and the darkness of evening. It is the absence of cortisol at night that allows our sleepy hormone, melatonin, to grant us a sweet and dreamy night of sleep. Well-behaved cortisol works in harmony with other hormones, each allowing the other to work as needed.
On the other hand, cortisol levels that are too high can interfere with the smooth functioning of every hormone in the body. High cortisol interferes with melatonin (can wake you from sleep), thyroid hormone (inactivates some of the active forms of thyroid hormone) and can interact with insulin as well. Elevated cortisol actually raises our levels of blood sugar and can thus lead to even higher levels of insulin.
Cortisol is important to consider for an athlete, because it works in a way opposite to insulin: while insulin helps our bodies build muscle, cortisol leads more to the breakdown of muscle. Both hormones work the same when it comes to fat: they both, when high, contribute to more fat cells and more fat tissue and harder times whittling away at the fat.
So if you’ve decided you want to eat fewer carbs and lower your insulin levels, you would also want to keep your cortisol levels in their normal range, and it turns out there are a few parts of your training plan that might need a little attention. Cortisol goes up in response to perceived stress and is usually measured in either saliva or urine.
Athletes might want to check their cortisol levels, as it has been seen that athletes who over-train (skipping well-timed rest and recovery days) can have atypical cortisol levels or patterns. That’s really good news, actually: perhaps you need an extra day or two of rest a week to normalize cortisol levels and let your insulin levels normalize! You get to rest and your body gets a little healthier. There is another problem that can come up with cortisol, however, and that is when and if your body perceives your low carbohydrate choices as significant stress! “Hey, I need some carbs, what’s going on?!” If you’re trying out a low carb diet and your sleep quality tanks, your mood heads south, taking with it your sex drive, you’re stressing yourself too much. Add in a few starchy carbs (either after your workout or before bed) such as sweet potatoes or rice. Keep the concentrated sweets out of the picture.
Stress is a tricky thing to figure out because it’s not the quantity of the stress itself, but how that stress affects you. Eating low carb can be a big switch, and how much of a switch your body perceives is highly individual. Athletes that work out hard are stressing their bodies, that’s how muscles get stronger. You work them hard, make them a little sore and damaged, and allow them to rebuild themselves stronger than before. To do that without disrupting your cortisol levels, you must take rest days in between your hard work days.
You want good levels of cortisol, that cycle normally and allow you to work hard during the day, rest well and recover at night. Healthy cortisol can increase the benefit of low carb messaging, but wacky cortisol (manifest in disrupted sleep, anxiety or excessive fatigue) is a sign that something needs to be tweaked. If you can’t find an area to tweak, add back in a few more carbs: it might not take much.
Calories can in general be ignored when you’re on a low carb diet. Definitely ignore them while you’re adapting to low carb. When you’re consistently low carb, you might tweak calories for a specific purpose: if your weight loss stalls or isn’t happening, you might look to see if your lowcarbhighfat diet has been a little too over the top with the highfat part. Yes, eat lots of fat at your meals, but maybe you don’t need three coffees with whole cream or that one butter-rich coffee first thing in the morning. Your body will burn fat on low carb, but not if you offer it too many dietary carbs: they will be burned first!
About the Exercise
Yes, some of your change can and should come from exercise. You can take a lot of walks all seven days of the week: grab that Fit Bit and look for 10,000 steps, great idea! In addition to generally moving more than most of us do, the exercise that will help you reverse metabolic syndrome involves:
- Some high intensity intervals. Pick an exercise you are comfortable doing, where you can ramp up the intensity knowing you won't injure yourself. (I use the rowing machine for this, but you can walk uphill or jog upstairs, or do push ups or whatever!)
- Warm up for a solid five minutes.
- Cycle through all out intensity and really gentle rest. I like to go all out for 30 seconds and then recover for 90-180 seconds. The length of recovery is whatever it takes for your interval intensity and speed to stay the same for the fourth interval as it was for the first.
- Four to eight cycles are a set.
- If you want to do two sets, rest well between sets.
- Schedule your intervals' workout TWICE weekly, no more. You have to work hard enough to stress your muscles, and allow them plenty of time to recover
- Lift some heavy weights: this can be body weight exercises (plank, push-ups, or squats) and ideally I'd like to see you be coached through these. Proper technique can keep you in the game for decades rather than sidelined early with an injury!
- Flexibility is important as you build muscle. Maybe a yoga class for some camaraderie and down time in the midst of your exercise time. ("Hot" or Ashtanga yoga wouldn't fall into this category: think prana yoga, relaxation or stretching yoga.)
You can't improve what you don't measure, but you must measure the right variable!
You can step on the scale every few months, but there is a memorable meme on the internet showing a woman at 152 pounds in three different shots: the first shows her spilling out of her bathing suit, and by the third she has incredible muscle definition and a bikini celebrating body. Same weight, different body comp.
Most important measures are simple ones: how do your clothes fit, what does your waist measure? Waist size should drop the most of any body measurement on a low carb diet.
And finally: celebrate with a steak, not a sundae! and more importantly--hang out and celebrate with like-minded friends, your journey will be a lot more fun!