See the rest of the posts in this series here.

I’d hoped to be able to add a post to this series once or twice a week, and am finding it tricky to find the time. Darn day job. Anyway, if you want to see the collection of studies I’m pulling from for this series, it’s all pinned on my Inactivity and Metabolic Health pinterest board. I add new stuff there all the time.

The study I’m looking at today was part of the Heritage Family Study, which is a pretty massive undertaking looking at the role of genetics in a person’s cardiovascular and metabolic response to exercise. The Heritage Family Study is funded by grants from the NHLBI, which is one branch of the NIH. IE, the government. So naturally, some will dismiss this study as biased (anything government funded is highly suspect to a certain dogmatic faction of the alternative health and diet industry), although I’m not sure what investment the government has in getting people to exercise, other than improving public health and reducing health care costs. In any case, that’s a brief overview of the ‘parent’ study, take it as you will.

The Effects of Exercise Training on Glucose Homeostasis

This specific study was designed to

“…examine the effects of a 20-week endurance training program on insulin sensitivity, insulin secretion, and other IVGTT-derived [IVGTT=intravenous glucose tolerance test] variables while considering the potentially confounding effects of sex, race, age, and BMI.”

In other words, they wanted to see how people of different ages, genders, races and weight status responded to 20 weeks of exercise training. All participants were sedentary at study outset. 316 women and 280 men participated, so it’s a good sized study. The exercise protocol consisted of 3 session a week of cycling, starting at a duration of 30 minutes and increasing in intensity and duration to 50 minutes 3 times a week at study end. Each participant had an IVGTT before commencing exercise, and again very near the end of the 20 weeks (there was some variation in exact time of the second IVGTT due to availability and menstrual status of female participants, they wanted to ensure all the women were at the same stage of their cycle when the test was performed). Fasting plasma glucose and insulin were also tested 1 and 3 days after the last exercise session.One drawback of the study is that there was no control group, a limitation of the structure of the Heritage Family Study.

As you can probably expect, there were improvements across the board in metabolic parameters. Improved insulin sensitivity, glucose tolerance, insulin response, etc. There were also patterns in the differences in response between groups. Men and people with initially poorer metabolic responses saw greater improvements than women and those who were initially more metabolically healthy. There were some interesting findings in regard to a protective effect of exercise in regards to both hyperglycemia and the hunger and food seeking behaviors associated with hypoglycemia, as well as this tidbit:

“…the quartile with the [initially] lowest glucose tolerance registered an increase in insulin secretion following regular exercise. This increase in insulin secretion as well as the overall 11% increase in glucose effectiveness, which reflects the capacity of glucose to mediate its own disposal, may have contributed to the improvement in glucose tolerance.”

Ie, an increase in insulin secretion accompanied an increase in glucose effectiveness and tolerance. Insulin is not the bad guy. Insulin RESISTANCE is. And insulin resistance is caused by energy imbalance, inactivity and genetics. This study gives some insight into that genetic component.

There’s a lot of information here, and the full text of the study is available for free, so take a look, I try to keep these posts short and user friendly, so I won’t go into further detail here, and I’ll invite you to read the science for yourself.

Or, the Go Kaleo Theory of Everything™.

Obnoxiously overdramatic visual.

My lightbulb moment: the day I understood that my body and my health were a reflection of my habits, and that in order to have a healthy body I needed to engage consistently in the behaviors that promoted optimal health. The body needs certain conditions to be met in order to function optimally, we in the ‘real food community’ are all very cognizant of this on a nutritional level. We understand nutritional deficiencies:

• A Vitamin D deficiency leads to Rickets.
• A Vitamin C deficiency leads to Scurvy.
• A protein deficiency leads to Kwashiorkor.
• A calorie deficiency leads to Marasmus.
• A B12 deficiency leads to pernicious anemia.

Etcetera. We understand that these conditions are the result of fundamental needs not being met, and that the ‘cure’ is to meet that need. It’s not really a ‘cure’ though, it’s returning the body to homeostasis, the body’s natural state when the conditions for health are in place. We don’t further alter the diet or lifestyle to mitigate the symptoms of the deficiency. That would be silly. Lets consider what that might look like (cue dream-sequence harp music):

Imagine for a moment that you are dealing with the symptoms of a vitamin D deficiency. You’re experiencing bone and muscle pain, you’ve had a few bone fractures, and you’re developing multiple cavities. You find a blogger online who also has those symptoms, and that blogger has developed a novel new approach to addressing them: daily painkillers for the pain, using a scooter to get around to reduce the risk of falls (and subsequent fractures), and teeth removal to eliminate the cavity issue. Indeed, this approach seems to mitigate all of your symptoms! A miracle indeed! And no need to resort to pesky vitamin D supplements. Why supplement when you can simply take painkillers, pull out all your teeth, and use a scooter to get around? Deficiency be damned. You do some further investigation and discover that there’s a huge online community of people who’ve adopted this lifestyle to deal with their symptoms. Blogs, facebook pages, books, heck, there are even doctors who advocate this lifestyle! You fit right in. You join a few facebook groups, make some online friends, and settle in to your new lifestyle. There are even conferences and social gatherings where you can meet fellow ‘low-Ders’, exchange tips and stories, and generally receive affirmation and reinforcement for your lifestyle choices.

Of course this sounds absolutely absurd. But we do it all the time. Let me explain…

I had my lightbulb moment long before I’d heard of ‘evolutionary health’. At first, my understanding was nebulous and visceral. I sensed that I needed to create the conditions that my body was evolutionarily adapted to in order to improve my health. You know, the way zoos try to recreate animals’ natural habitat in order to keep them healthy? You put a lion in a penguin habitat and pretty soon you’ve got a sick, or dead, lion. Well, I sensed that my ‘habitat’ and lifestyle wasn’t appropriate for my health. I was sick after all.

I began with simple logic. What conditions are humans evolutionarily adapted to? Remember, I hadn’t heard of evolutionary health yet. I was just thinking critically. What conditions were ubiquitous for our species as we evolved? I could only think of a few, as we’ve managed to thrive in so many different environments, and those few constants, as I saw them were:

High levels of physical activity.

I’ve since heard the speculation that primitive man’s life was largely sedentary, but this argument makes zero sense to me. Without technology to do the tasks of daily life, living is hard work, no matter how you slice it. Even the simple act of pooping requires physical exertion. Don’t believe me? Stop using a toilet to poop for a few months and see what happens to your thighs. Mmm-hmm. That’s right.

No, up until the last 50 years or so, when we started sitting down most of the time, life was hard work. Everywhere you went you walked, or later, rode a horse, but even that requires physical exertion. You carried things, you climbed things, you dug things up, you skinned animals, you chased prey (or ran from predators), you built shelters, you migrated to follow the seasons or the herds. And there was no TV or internet, so when you weren’t working your ass off in the pursuit of food and shelter, you DID stuff to keep yourself occupied. You danced, you played games, you made stuff with your bare hands, you explored. You never sat motionless for hours on end. That is a 20th century invention. Studies on modern-day hunter-gatherer societies show that even though their total energy expenditure is about the same as westerners, hunter-gatherers are significantly more physically active.

Our genome is evolutionarily adapted to high levels of physical activity. It just is. I hate to break it to you. Physical activity is a fundamental requirement for normal metabolic function, without adequate physical activity we develop insulin resistance and then a whole cascade of metabolic and endocrine dysfunction. I’m not pulling this out of my ass, or cherry picking data, by the way. The Mayo Clinic, Johns Hopkins, the NIH and the NDIC and other reputable scientific organizations agree that inactivity is a primary driver of metabolic dysfunction. Attempting to treat the symptoms of insulin resistance with extreme dietary restrictions (which is what SO MANY in the ancestral health community are trying to do) is like treating the symptoms of vitamin D deficiency with pain killers and teeth pulling. Pain killers and teeth pulling may help in the short term, but establishing healthy vitamin D levels is what is necessary to return the body to ‘normal’ function. The answer is not to tailor the diet to one’s activity level, the answer is to maintain the activity level that supports healthy metabolic function. Otherwise you are merely treating the symptoms of the deficiency. The physical activity deficiency.

Sunlight and sleep.

Variations in skin color are an indication that our genome is adapted to sun exposure. The more sun a geographic location gets, the darker the skin of the people who traditionally inhabited that area. We require sunlight to synthesize vitamin D (there’s my analogy, lol), an essential nutrient for health, which indicates, to me at least, that sunlight has been a ubiquitous condition during our evolution. Same with sleep, we can’t be healthy without it. Attempting to circumvent the health ramifications of sunlight or sleep deficiency by simply addressing the symptoms would be foolish. If you have a sunlight or sleep deficiency, the solution is simple and obvious, get some sleep or sunlight. Fortunately we can get vitamin D from food, an adaptation to living in geographic areas with less sun exposure I’m sure, but just try to hack sleep deficiency. Not happening. We require these things to be healthy, because we’ve evolved under these conditions.

Whole or minimally processed foods.

For the vast majority of human history we’ve eaten foods in the form nature provides to them, or very close. Until the last century, processing of food was minimal: cooking, grinding, fermenting, drying, etc. Only recently have we begun extracting, isolating fractionating, hydrolyzing, etc. Given enough time we could surely adapt to these processes  (we are a highly adaptable species after all, a trait that accounts for our success) but that adaptation hasn’t occurred yet and likely won’t for many more generations. Our bodies are adapted to absorbing and metabolizing nutrients in synergy with the other nutrients that occur together in whole foods.

That said, I’ve heard arguments that we’re evolutionarily adapted to specific macronutrient ratios, and I find this line of thinking completely ridiculous. Because we’ve found ways to thrive in almost every environment on earth, we’ve been able to adapt to the foods provided by those environments. The Inuits thrive on a diet of mostly fat, while the Kitavans thrive on a diet of mostly carbs. And somewhere on earth, you’ll find a culture that thrives on every macronutrient ration in between. We eat animals, we eat plants, we eat grains and legumes, we eat insects, we eat fungi, we eat crustaceans, we eat mollusks, we eat honey, we eat algae. And more. We like sweet things and we like fatty things. We’ve found ways to thrive on virtually anything the earth can provide. The common thread isn’t a macronutrient ratio, the common thread is whole, or minimally processed, foods.

Energy balance.

Here’s where I get really philosophical. I believe that any given environment provides a finite amount of caloric energy to support the life that exists there. The variation in human size from individual to individual (and from culture to culture) suggests to me that different ‘strains’ of humans evolved symbiotically with their environment. Environments that provided more caloric energy produced larger humans, and vice-verse. A person’s energy needs are directly proportional to their size (and to a lesser extent their activity level, but BMR makes up the lion’s share of our daily energy expenditure, and BMR is in direct proportion to body weight). When we consistently, over time, consume more or less energy than our body requires, we develop metabolic dysfunction. Too much energy leads to excess adipose storage, and excess adipose produces inflammatory compounds, excess estrogen, and drives insulin resistance. Insufficient energy intake leads to thyroid and reproductive hormone imbalance, fatigue, depression and insomnia, bone and organ deterioration, and a whole host of other issues. We’ve strayed from our natural relationship with our environment and the energy it provides. We have unlimited calories available to us for the first time in human history, and some of us go to the opposite extreme and decide to restrict our intake below what is necessary to sustain health. When we had a more symbiotic relationship with our environment, our bodies adapted to the energy resources it provided. We’re all out of whack now. And energy balance DOES matter. Anyone who claims otherwise is selling a magic pill.

There you have it. My Go Kaleo Theory of Everything™. Re-create the conditions we’re evolutionarily adapted to if you want to support metabolic health (because metabolism is, after all, everything). When I started out on this path five years ago it was an instinctive sense that I needed to change my behaviors and lifestyle conditions to improve my health. Over the years I’ve done research that has consistently reinforced my original instinct, so that at this point I’ve fleshed out my ideas with facts and scientific data. Putting my ideas into practice in my own life WORKED, not only did I lose weight, but I reversed PCOS and several other nagging conditions. I’m five years in and have maintained my weight loss and health by maintaining health-promoting lifestyle behaviors.

me·tab·o·lism

/məˈtabəˌlizəm/

The chemical processes that occur within a living organism in order to maintain life.

See the rest of the posts in this series here.

Today we’re looking at a cross-sectional study on 456 adolescents between the age of 10 and 18, conducted in Brazil. The purpose of this study was to measure and analyze the association between metabolic syndrome and physical activity in this population. You can see the study here:

Physical activity, cardiorespiratory fitness, and metabolic syndrome in adolescents: A cross-sectional study

Anyone with diabetes or on medication that altered blood pressure, glucose, or lipid metabolism was excluded. Each subject was evaluated for height, weight, waist circumference, and blood pressure, and blood tests were conducted to determine HDL, blood glucose and triglycerides. Results were used to evaluate the prevalence of metabolic syndrome, using standard Metabolic Syndrome criteria (abdominal obesity, high blood pressure, low HDL, high blood glucose and high triglycerides).

Each subject also completed a Three-Day Physical Activity Record, and their cardiorespiratory fitness was estimated using the 20-meter shuttle run test. Then this information was used to determine the prevalence of MetS and its components with respect to different cardiorespiratory fitness and physical activity categories.

The results? Higher cardiorespiratory fitness was inversely correlated with Metabolic Syndrome. Physical activity itself wasn’t correlated, which means that is exercise specifically, and the cardiorespiratory fitness it produces, that provides the protective effect.

In this study low cardiorespiratory fitness was shown to already be affecting metabolic health even in adolescence. I will be posting more studies in the upcoming weeks exploring this connection across the lifespan (no, it’s not just kids that are protected by exercise. The protective effect continues throughout life).

Inactivity and energy imbalance are scientifically established fundamental CAUSES of metabolic dysfunction (see: Johns Hopkins, Mayo Clinic, NIH and NDIC). Any diet program that doesn’t address inactivity and energy imbalance is merely addressing the SYMPTOMS of metabolic dysfunction.

That doesn’t mean one shouldn’t address the symptoms. If I had a brain tumor that was causing headaches, you can bet I’d be taking painkillers for the pain. But I wouldn’t stop there, I’d treat the tumor as well.

Treating the symptoms of metabolic dysfunction is all well and good, but for true health to manifest, the CAUSES must also be addressed. It seems to me that a lot of dietary dogma is little more than a desperate attempt to circumvent the negative consequences of poor lifestyle choices: too much or too little food, inadequate physical activity, or in some more rare circumstances, overtraining (although I think most cases of overtraining could be resolved by simply eating enough calories to fuel the increased activity), inadequate sleep.

This is not to say dietary optimization is useless. Quite the contrary, maximizing the nutrient density of one’s diet can be very helpful, as can optimizing the macronutrient ratio to meet one’s unique goals and needs, just as painkillers can be helpful to the victim of a brain tumor. But far too often, dietary optimization is taken to an extreme, by dieter and guru, while simultaneously ignoring energy balance and physical activity, or worse, claiming that energy balance and physical activity don’t matter as long as a person is eating the ‘right’ foods. This is irresponsible in the extreme. It’s akin to prescribing painkillers alone as a treatment for a brain tumor. Helpful in the short term, but ineffective in establishing long-term health

My primary criticism of dietary dogma (aside from the divisiveness it breeds) is it’s general tendency to shift focus onto the symptoms of metabolic dysfunction, rather than the cause. Both are important. Without addressing and changing the behaviors and lifestyle factors that foster metabolic dysfunction, there will be no true healing.

(Warning, this post contains some graphic descriptions of female bodily functions. If you’re easily offended by such things, you might want to consider not reading any further.)

By age 8 I was struggling with my weight, and by my early teens it was evident there was something amis hormonally. I started menstruating around the same time as all my friends, but then I stopped for several years. Yes, years. For some reason this didn’t seem to raise any flags with my health care providers. I had horrible cystic acne starting right around age 13, on my face and also on my chest and back. Two courses of Accutane barely made a dent. I started growing hair in places girls aren’t ‘supposed’ to grow hair (like my chin). My weight was all over the place and by the time I graduated from high school I was clinically obese. My periods, once they started up again, were beyond irregular. I’d get them a few weeks apart for a while, and then not again for 6 or 8 months.

For some reason, I thought this was all normal.

A young Go Kaleo, already exhibiting visible signs of hormonal dysfunction.

My 20′s were much of the same, with the addition of chronic yeast infections, migraines, thinning hair and crippling bouts with anxiety and depression. My doctors would periodically put me on birth control to try to regulate my periods, and antidepressants to combat the depression. I continued to struggle with my weight and my cystic acne, sometimes seeing some mild success, but mostly just frustration. As I got closer to 30, my blood pressure started to read high here and there, although not consistently.  When I asked my doctors about all this, they would say something about exercise and weight loss, but to me it felt like a brush off.

I got pregnant quite unexpectedly at 30, and for a few years my own health took a back seat. I suffered some pretty intense PPD after my first baby, but otherwise I actually have very little recollection of those first two years of motherhood. I don’t think I ever got a checkup, and acne and my weight were really low on my priority list at the time. I felt like crap all the time, I can tell you that.

When I got pregnant with my second baby, all hell broke loose. The beginning of the pregnancy was uneventful, but the second half was awful. I gained weight way too fast. I swelled up like a water balloon. I developed pre-eclampsia and had to go to the hospital for monitoring twice a week for the last several weeks of the pregnancy.

After my second daughter was born, I had problem after problem with my milk supply. My weight continued to go UP. My blood pressure remained high. I started losing hair in clumps, specifically on the front of my head, in the typical male-pattern baldness. I had an epic case of PPD, complete with daily panic attacks. My period returned about 6 weeks post partum, but it was crazy irregular, and heavier than it had ever been and I started passing chicken-egg sized clots. In 2006 I had a breast ultrasound to diagnose some recurrent pain I’d been experiencing. It turned out to be cysts. In 2007, another ultrasound to diagnose recurrent pelvic pain showed multiple ovarian cysts. I reached my highest weight of 231 pounds.

I’d started to put the pieces together and asked my doctor about the possibility that I might have PCOS. She was hesitant to give me a formal diagnosis because I didn’t appear to have infertility issues, and as she explained it, the only good a diagnosis would do would give her the option to prescribe fertility treatments, and since I didn’t want any more babies anyway, there wasn’t really a point of getting a formal diagnosis. She told me to exercise and lose weight. I felt brushed off again. I ate pretty healthy. I was active. I walked a lot, and chased my kids around I told her (and myself). I wanted an answer, a treatment, but she was just giving me the ‘exercise and lose weight’ brush off. I felt frustrated and hopeless.

So, like many women reading this, I started doing some research on my own. Every time I researched one of my symptoms, the trail I picked up led to the same place: metabolic syndrome and insulin resistance. Through my research, I identified other symptoms I had that I’d never thought could be connected to my hormonal issues, especially my panic attacks, which I’d determined were probably being triggered by wild blood sugar swings. I had virtually every symptom of metabolic syndrome and insulin resistance in the book, and in 25 years no one had put the pieces together.

So, since all trails were leading back to insulin resistance, I decided to look a little deeper into it. I wanted to know WHY I was having these symptoms, not just how to ameliorate them. WHY was my hormonal system all whacked out (insulin is a hormone)? As a critical thinker and skeptic, I was pretty good at spotting dubious sources. A lot of the ‘information’ I ran across in my internet research was actually thinly veiled advertising for supplements and diet books. In fact, I was sort of appalled by how much of that I ran across. I started to identify credible sources, and I followed the science. What I realized was that all of the established, reputable medical and scientific organizations were in a fair bit of agreement on the cause of insulin resistance. The common theme I kept running across was energy imbalance (and its role in obesity), inactivity, and genetics. According to Johns Hopkins, Metabolic Syndrome and IR are caused by “…obesity, coupled with a sedentary lifestyle…[as well as] genetic variations in a person’s ability to break down lipids (fats) in the blood.” The Mayo Clinic says “Some people may be genetically prone to insulin resistance, inheriting the tendency from their parents. But being overweight and inactive are major contributors.” The NIH and NDIC are very clear that “scientists have identified specific genes that make people more likely to develop insulin resistance and diabetes. Excess weight and lack of physical activity also contribute to insulin resistance.” Notice none of the resources I link to are bloggers or alternative practitioners selling remedies and ebooks. I like science. I looked for science, and favored science from reputable sources. I found study after study after study after study after study after study after study after study after study after study after study after study (I have more) showing that physical activity levels are inversely correlated with the incidence of insulin resistance, and that insulin sensitivity is improved with physical activity. The science was pretty clear: genetics, energy imbalance and obesity, and inactivity are the drivers of insulin resistance.

I don’t have a huge genetic factor. A few of my grandparents and aunts and uncles developed diabetes when they were older, but my parents and siblings are so far relatively metabolically healthy. I was obese though, and I was obese for one reason: I ate more food than my body needed. And when I was honest with myself, I wasn’t really that active. Yeah, I walked a little, but it wasn’t really as much as I kept telling myself (and my doctor). And I certainly didn’t walk vigorously enough to raise my heart rate or break a sweat. In fact, when I was really, truly honest with myself, I had to admit that I spent most of every day sitting down. So, at 35, I decided to actually do what my doctor had told me to do all along: lose weight and exercise.

I’ve talked elsewhere about how I determined the proper energy balance that would allow me to lose weight gradually and keep my metabolism from tanking. It took me about 6 months to get that figured out. I explain what I mean by ‘energy balance’ in this video:

It also took me about 6 months to get into an exercise routine. Those first six months were frustrating and frequently discouraging. I lost about 15 pounds, which was really disappointing to me considering how much effort I was putting in. I had some small improvements in some of my symptoms, but I still felt like crap most of the time. I nearly quit so many times. But I kept telling myself that I needed to be a good role model for my daughters, who I knew would follow in my footsteps, and I wanted them to be footsteps in the direction of health and self-care. So I kept going.

That six month mark was really a turning point, for a couple reasons. A BIG one was that I started weight lifting. I have since done more research and decided that weight lifting/strength training is VITAL to improving insulin sensitivity because muscles, very simply, behave very differently, metabolically, than fat. Muscles suck all that glycogen out of the blood and USE it. I also had improved my endurance and conditioning to a point that I was able to perform the amount and intensity of physical activity that I think was necessary to really improve my metabolic function. When I was just doing cardio, the magic number seemed to be 60 minutes a day of an activity that kept my heart rate elevated (once I added a significant amount of muscle mass from strength training, I could get away with much less, these days I typically average half that). I also got my diet ‘dialed in’, in that I settled into an calorie and nutrient intake that gave me the nutrition and energy I needed but wasn’t more than my body could use in a day. Over the next six months I dropped about 50 pounds. I also saw my periods normalize into a steady 28 day cycle for the first time in my LIFE. I never got another panic attack or migraine after that. To this day. About a year in I realized my hair had started to grow back, fuller than it had been in my adult life, and over the next year my acne had all but disappeared save for a little breakout before my period. My blood pressure has been optimal at every checkup since then. My HDL, which has been hovering in the high 30′s before I started all this, is now in the high 60′s. My triglycerides are routinely in the 30s and 40s. My glucose is ALWAYS in the low 80′s no matter what I’ve eaten or not eaten beforehand. In short, I am, for the first time since I was 8 years old, metabolically healthy.

And I did it by following my doctor’s advice: lose weight and exercise.

Fancy that.

(***I am not a doctor. AS ALWAYS, if you suspect you have a metabolic problem, please find a qualified, reputable medical professional to work with, and never, ever, EVER rely on bloggers for your medical information and health care.***)