[treyazaghtoth]

Let me put forth a different perspective :
[ am an Orthopaedic Surgeon]

The largest 'system' by weight and area in our body is the musculo-skeletal system [meaning our bones and our muscles]
Thus any food we eat, after 'supplying' the brain, has to go to the MS system.

The percentage of bones in our body is constant, and so is the percentage of the 'other ' systems [ heart/lungs , kidneys, skin , digestive, nervous ]

Now there is only one system in our body, that can increase or decrease in size.

That is the muscle.

What is the primary energy source for muscle ?
Answer : Glucose.

so it follows, if you want to reduce the blood sugar in your body, you have to either increase your muscle mass or reduce food intake

ie either muscle building vs. dieting.

Now suppose there was a way to do both...its like killing two birds with one stone
[more on that later]

Walking, jogging , cycling doesn't build muscle.
nor does doing house work, like cleaning , washing etc

Progressive muscle overload is the only way for muscle building.Think of muscles like sponge absorbing sugar from the blood after a work out.
Another advantage is that it increases our basal metabolic rate [BMR]

Think of BMR like rpm of an engine.
in the same way we burn petrol, by increasing the rpm, similarly, our 'petrol' [aka food aka glucose] gets burned by our elevated BMR .

Muscle hypertrophy also causes our muscles to increase sensitivity to insulin, which again helps the muscle remove sugar from the blood.

If there is any need for clarification, don't hesitate to ask

Dinesh

[am1m]

Originally Posted by treyazaghtoth

Walking, jogging , cycling doesn't build muscle.

Progressive muscle overload is the only way for muscle building.

Another advantage is that it increases our basal metabolic rate [BMR]

Consistent with my experience over the past year.

I used to be a guy who scoffed at gyms and weights, thought they were only for the tight-t-shirt types. A combo of increasing cholesterol numbers and a knee injury made me go to the gym to exercise the leg muscles. In addition to that I started out with some light weight exercises. I'm usually a lot hungrier on days that I do weights than on days that I run in the mornings. Am clearly burning more with weights than anything else. I avoid sugar and fried stuff almost always these days, but the "no-carbs", "keto-only" or other restrictive diets are impractical since I like to travel and can't be too fussy, nor do I want to spend hours sourcing a particular food type and cooking when I'm home. I guess not being a vegetarian helps somewhat. But overall, exercise and avoiding sugar seems to be working well enough, numbers are down.

(Thanks for your post, always illuminating when a real medical professional contributes to threads like these! The rest of us tend to misinterpret things we google or get misled by diet claims by people claiming to be doctors on you tube.)

[alpha1]

Originally Posted by GTO

The Keto world (Keto snacks, meals & restaurants in India (including low-carb stuff)) is at your fingertips now . I get Keto pizza base from YoDeli. It's super yum! Never been a rice lover, but I do have Keto chapatis with lunch. The Keto atta we use is from https://lofoods.fit/ or Ketofy.

I know it works because my post-fasting sugar test was after 3 Keto chapatis = 86 (test results in my previous post) .

I alternate between keto chapatis & high protein khakra which we source locally.



Alternate days between cardio (30 minutes cycle, 45 minutes treadmill) & weight training. Am thinking of moving from weight training to yoga or swimming because I've gotten bored of doing the same exercises, and have been suffering injuries here & there.



You can have coffee as long as it's black! I have 3 cups during my intermittent fasting. Look up our weight loss thread (The Weight Loss Thread); you'll see many BHPians posting on how IF changed their life.

If you could elaborate a bit ... I am curious to know how could Pizza/burger/roti etc be ketogenic??
Pizza's base would require some kind of flour: perhaps something like Almond flour?

How does it taste compared with refined flour or whole wheat? Texture and mouth feel?


Also with respect to the injuries aspect while lifting weights, my observation+experience+intuition is that this happens when people do not offer sufficient rest to their muscles and overall body.
IF one is lifting decently heavy weights (compound multi-joint movements, lesser than 20 reps or so), an average person needs to have several off-days (could be upto 2 weeks) in between repeating the same exercise.

[Ferrari1976]

Originally Posted by treyazaghtoth

Now suppose there was a way to do both...its like killing two birds with one stone
[more on that later]

Please do post on the way to achieve both

[treyazaghtoth]

Part 2 :
Diet and Exercise : why you get a better outcome with exercise + diet , than through diet alone.
[ by exercise I mean progressive muscle building ]

All systems have a tendency to achieve a stability ,where all parts of the whole work in tandem and conjunction with each other.It achieves efficiency that way, which in turn prevents unwanted energy expenditure.

This stability of the body is known as health.

In diabetes, that system is not 'optimally' functioning. Why is it so ? And is there a way to reset this system to make it more efficient ?

For some reason, the body isn't able to utilise the sugar that is being consumed. By utilise I mean, the body is NOT able to use it [ie the sugar] for its internal stability. This sugar, then deposits itself into the blood vessels..and causes problems .Or in other words, efficient use of ingested carbohydrates isn’t happening in the body.

I am generalising here...the cause of diabetes is myriad. I am trying to break it down, so one can make more informed decisions.

Higher fat levels [ obesity ] is a known cause of diabetes. Fats contribute to insulin resistance , So is there a way to increase muscle mass and burn fat at the same time ?

Yes there is : Progressive resistance training.
[ I have used the term progressive . That will be explained later ]
.
We as humans are designed to move . It takes a baby close to a year to be able to walk, because the pathways to mobility ,stability and power generation of the lower limbs need a year to mature and fully form
If those pathways aren't used , [aka sedentary lifestyle ], the stability of the internal system goes for a toss, meaning if a part of the body isn’t being used the way it is supposed to be used, the system will unbalance itself, become less efficient , and cause lack of health..aka disease.

The buttocks and thighs are like the engines of a car.. they are ‘high maintenance’ cause they are designed to be ‘on’ all the time.
By high maintenance I mean, they have a higher metabolic rate [RPM in Team BHP speak ] than the muscles of our forearms or hands.
As I had said before, muscles need glucose for energy .

Now coming to dieting alone as a means of controlling diabetes:

Dieting by definition , means excluding a part or a portion of your meal.
First off, that isn’t practical. The internal stability of the body , will not allow us to be calorie deficient for prolonged periods of time. The result ? …binge eating after a couple of days.

Calorie restriction, signals to the body that it needs to ‘break down’ stuff to provide energy to the starving body. .aka catabolism
Catabolic states are associated with high cortisol levels [ the stress hormone]..which in turn increases our sugar, causes sleeplessness and a host of other unwanted issues.
Prolonged elevated cortisol levels are bad.It isn’t an efficient utilisation of the body’ energy .


Now suppose there was a way to ‘trick’ the body to reset its internal system ?
To trick it to elevate its metabolic rate , utilising more calories[ i.e. the ingested sugar ], such that the balance is once again reached, but at a higher RPM ?

This can be achieved naturally through progressive muscle overload.

This increases efficiency, as the body now does what is was designed to do, to utilise the food that is ingested to feed the growing muscles . Muscles are meant to be hypertrophied [ meaning they are designed to grow large…that is nature ]

[ “But doc, I know children with diabetes “ …like I said, I am trying to generalise here.]
“But doc...I know, many lean people who've diabetes...what gives ?"

The answer to that is low muscle mass. They are known as skinny fat people… i.e. people who have minimal muscle mass, with [relative to they’re body weight] a higher fat percentage. ]

It has been proven in many studies, higher muscle mass correlates with better health and longevity.

Do not hesitate to reach out if you need further clarifications

Dinesh

[msdivy]

Originally Posted by Naetik30

I was fasting for about 13hours at the time of sample collection. Will redo the tests after 3 months and check.

13 hours is long. Recommended is 10~11 hours.

Some more additional queries on diet
Note: I am 86kg/5'9". My ideal weight is 75kg and targeting that in 2023.

Then you need to focus on calories.

Energy consumed = Energy used up (metabolism) + Energy stored + Energy excreted

You want to reduce energy stored. Ensure the equation is balanced - eg, either reduce consumption (reduce calorie intake) or increase metabolism (more physical activity).

1. I read somewhere that 25% of your daily calories should be carbs. But I a finding it difficult to reduce below 50%. Even on days I take mostly protein, carbs still take up about 50%. Is there any way around this? Even most vegetables and fruits end up having more carbs.

You have to work out your food & diet based on your body state, physical activity & goal. When you say you can't avoid carbs means you need rice, roti & desserts. Fasting will help to overcome this. Pick a day and don't eat rice, roti & deserts. You can eat those the next day. You can fix diet days per week.

2. Is kelloggs muesli (no added sugar) 40g + half cup milk per day ok? This is the only milk I take.

Check the calorie & carbs stats behind the box and you can make the decision.

3. Is curd good or bad for pre-diabetes? Can I take 1 or two cups of curd per day? I keep seeing conflicting answers to this. This is a good source of protein but not sure if I can have 2 cups per day.

Does curd have carbs? When you find this answer then you will know whether its good or bad for diabetes. Note that just curd has low carbs. But curd is eaten with rice, roti and you know where the carbs are coming from.

4. My dietician asked me to skip green tea and have black tea instead. Any reason for this?

Eating or drinking *more* of anything won't reduce blood glucose. Just tea, and coffee doesn't matter. What matters is what goes with it and is more carbs like sugar, cookies, cakes, and savories.

5. Can I have 2 fruits per day (150g pear + 150g of grapes, etc)? Or should it be only one fruit of 150 per day.

From the blood glucose level perspective, you are in the normal range. So don't worry about carbs. Since you plan to lose weight, you need to plan your calories and fitness.

[sachinayak]

Originally Posted by treyazaghtoth

Walking, jogging , cycling doesn't build muscle.
nor does doing house work, like cleaning , washing etc

Originally Posted by treyazaghtoth

Part 2 :
The buttocks and thighs are like the engines of a car.. they are ‘high maintenance’ cause they are designed to be ‘on’ all the time.
By high maintenance I mean, they have a higher metabolic rate [RPM in Team BHP speak ] than the muscles of our forearms or hands.
As I had said before, muscles need glucose for energy .

I had one question - but some quick background.

I have been diabetic (Type 2) for the last 10 odd years, but not severe. Never been on insulin and my medication too was mild (Sitagliptin and not Metformin). But I have a rather physically active lifestyle, specially post 2019 (all through the pandemic too).

Since over Oct 2021, I have been practising intermittent fasting (dinner at 5pm, followed by breakfast next day at 9am) at least 4-5 times a week. With limited intake of direct sugar (though I am an avid rice eater and thoroughly enjoy my beer) I have been off any sugar-medication for over 15 months now, maintaining decent Hba1c levels.

While I understand running/cycling is a primarily cardio activity, why would this not lead to muscle gain (specially in thighs/buttocks, which you mentioned need maximum energy). I walk almost 18K steps daily and run 5k twice every week. Post starting running since 2019 - I have absolutely toned thighs and buttocks. I would think my thigh/buttock muscles are developing as a result of my regular running/walking.

Would that not be the case?

[D4d-maniac]

Originally Posted by sachinayak

While I understand running/cycling is a primarily cardio activity, why would this not lead to muscle gain (specially in thighs/buttocks, which you mentioned need maximum energy). I walk almost 18K steps daily and run 5k twice every week. Post starting running since 2019 - I have absolutely toned thighs and buttocks. I would think my thigh/buttock muscles are developing as a result of my regular running/walking.

Would that not be the case?

Yes, that would be the case. You are exercising well and have a good muscle mass. You would not be having good muscle mass if your insulin levels and Hba1c would have been deranged. Although I would advise you to stay off rice and beer. Both of them have a high Glycaemic index.

[sachinayak]

Originally Posted by D4d-maniac

Although I would advise you to stay off rice and beer. Both of them have a high Glycaemic index.

Completely off-topic, but both I find very essential for a good mental health.
But completely understand the feedback - I do try to not to overdo with either.

[D4d-maniac]

Originally Posted by sachinayak

Completely off-topic, but both I find very essential for a good mental health.
But completely understand the feedback - I do try to not to overdo with either.

I understand your opinion. Even I do indulge in both these vices, but being a doctor, and especially a urologist, I have to condone these vices.

[treyazaghtoth]

Part 3 :

Progressive resistance overload.

Suppose I lift a pen up, and I use it to ‘develop’ my biceps.
Muscle activity happens, but does the muscle grow ?

Think of any given muscle like the cylinders of an engine.
Some engines use the additional cylinders, when more power is needed .

The entire muscle does NOT fire up when a ‘small’ weight is lifted.We have muscle units.
And these units work [relatively] independently of each other, within a given muscle [in this case our biceps when lifting the pen ]

{A muscle cramp is nothing more than a misfire of the individual units in a given muscle.}

So if I lift something significantly heavier than a pen, more units get recruited
But mere recruitment does NOT cause the muscle to grow, as recruitment happens only when heavier weights are lifted .

What happens when all the units are used up ? Then the body as no other option but to develop more muscle.

So then how does muscle grow?
It occurs by two ways
A) the individual fibres, become ‘thicker’
B) new muscle fibres are formed.

So if I keep lifting my pen to develop my biceps, the body does NOT have the incentive to recruit new muscle units , as well as to form new fibres., as the weight is suboptimal and well below the threshold weight needed for muscle growth

The reason being, recruitment and new muscle formation is an energy intensive process, and as I had mentioned in my earlier post , our body always maintains a baseline state of ‘rest’, where everything is in balance.

This state of balance is important…and this will explain why cardio, or household work and to a limited extent calisthenics [pushups, burpees , jumping jacks] aren’t effective in muscle building.
Will come to this point later.

So to summarise there is a threshold weight wherein , if that weight is crossed, muscle recruitment of other units happen, and again another threshold, wherein once all the units are used, up, the muscle will start growing.

But on the other hand ,merely lifting weights isn’t enough.
The time under tension is important …meaning the time , the muscle is loaded with the weight is also important..

eg. If I do a single squat of 80 kg..it isn’t enough to stimulate muscle growth .

so again to summarise, we need a threshold weight and a threshold time under tension for muscle development to happen.

Now this is the reason for ‘progressive’ resistance training, wherein we keep elevating the threshold weight or threshold time or both.

This will stimulate muscle growth as well as muscle thickening [hypertrophy ]

So how do we elevate threshold weight ? Increase the weight we use , week to week basis.
How do we elevate time under tension ? Increase the rep range , number of sets or both

This will ‘elevate’ the resting state or the ‘balance state’ of the body, as the body is now more efficient in its energy utilisation, , as evidenced by an elevated basal metabolic rate [BMR aka RPM ]


Now coming back to jogging / walking / cycling .
To generate new muscles in these activities, you will either have to increase the duration of these activities or increase its intensity
e.g. jogging 2km instead of 1km , jogging on an incline slope instead of a flat surface.

Once the body has acclimatised itself to a 2km jog, it has no incentive to develop more muscle or adapt any further.
So the solution is to go for a 3km jog..and so on and so forth.

The issue with this approach is time.we are limited by the time we can spend on these activities.

What about pushups, situps and other calisthenics ?
Same … the only option is to increase the rep number or the intensity .but again we are limited by time.
Doing 100 pushups is taxing..but for new muscle to grow, we’ll have to up it to 125., then 150 ..
I think you can see where I am going with this.

“But doc, my cardiologist told me I have to walk vigoursly for 1 hour, swing both my hands , to control my sugar”

Thats because some exercise is better than no exercise.
Mobility is better than immobility.

please note: I am not saying that jogging , cycling is bad…I’m saying that increasing muscle mass,can be used as a tactic to lower your sugar, and by consequence your medications also

By coincidence, this came in my mailbox [ google are you monitoring me ?]

Here


Do let me know, if you need any further clarifications

[Sheel]

I have not read all posts, but if anyone complains of lack of time to sleep because of work, please do remember, you are REPLACEABLE.

A small story by a doctor https://twitter.com/hyderabaddoctor/...88601898176513

[lapis_lazuli]

One layman question : is metformin bad or worse than, say, Sitagliptin, Glimepiride.. some posts imply 1000mg metformin is strong while 50mg Sitagliptin or 2mg Glimepiride is "light" dose?

Frankly enough, these days you'll find scientific articles suiting your own line of thought, to credit or discredit a line of thinking. Like, metformin is bad. Or, smoking may be beneficial to health.

Request especially resident docs to educate.

[sachinayak]

Folks,
A quick question - I was told earlier to specifically test for my Fasting Insulin levels (in addition to my HbA1c levels) but unfortunatley, I do not have a scale of what is good and what is bad.

In my last blood test (yesterday), my results were not great (this is post a 15 hour fast)
1. FBS: 114
2. HbA1C: 7
3. Fasting Insulin: 4.2

While I have been off any medication for some time, and my HbA1c has dropped from 7.5 to 7.1 to 7 (now, over a period of 6 months), i was hoping for better.

Any pointers on the fasting insulin levels?

[pyrodrive]

Originally Posted by lapis_lazuli

One layman question : is metformin bad or worse than, say, Sitagliptin, Glimepiride.. some posts imply 1000mg metformin is strong while 50mg Sitagliptin or 2mg Glimepiride is "light" dose?

Frankly enough, these days you'll find scientific articles suiting your own line of thought, to credit or discredit a line of thinking. Like, metformin is bad. Or, smoking may be beneficial to health.

Request especially resident docs to educate.

Metformin is still the best drug for T2 diabetes. Plus more recent added benefits are still coming out. Like its cardiac benefits, anti ageing properties etc.
So what we teach our diabetology students is to start metformin first, unless contraindicated. But then metformin can only do so much, it doesn't lower glucose as sharply as say a glimiperide 2mg.
The protocol is start with metformin and then the next drug to be added will depend of patient parameters like body weight, co morbidities like atherosclerotic cardiovascular disease or renal diseases. Sulphonylureas(eg glimiperide) or Gliptins or SGLT2i or GLP drugs are the choices.