Insulin Sensitivity & Metformin – Episode 183

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Performance Menu: Journal of Health & Athletic Excellence

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Topics:

  1. [7:19] Forced Insulin Sensitivity and Metformin
  2. [19:37] Digestive Supplements for Missing Gallbladder and Gastric Bypass
  3. [23:22] Trace Mineral Tasting for Deficiencies and Detox
  4. [26:32] Training Every Day and Greasing The Groove
  5. [33:20] Making Gains With A Busy Schedule
  6. [39:03] Public Health Administration and Paleo
  7. [51:45] Debunking The Paleo Diet TED Talk
  8. [53:03] Red Meat, Carnitine, and TMAO Study
  9. [1:01:55] Resources for Nutritional Study Info

Questions:

1. Metformin/Insulin Sensitivity

JoBeth says:
Robb,
Thanks to all your FREE information on a paleo lifestyle, I have now largely mitigated my PCOS symptoms.  The only thing left is about 15-20 pounds, which has only once been previously defeated with a metformin intervention, to return again after discontinuation of meds.  You long ago had favorable thoughts on metformin, but have more recently suggested that forcing insulin sensitivity may be defeating an important protective mechanism. Unfortunately, I haven’t been able to piece together your expressed concerns in a cohesive manner.  Could you elaborate further on the potential concerns and mechanisms associated with forced insulin-sensitization (particularly metformin, but perhaps cinnamon is relevant as well) in both pregnant and non-pregnant persons?  (Where metformin is used in PCOS treatment, continuation is often encouraged during pregnancy and I know that insulin and blood sugar issues during pregnancy are somewhat idiosyncratic).

Despite having normal insulin levels, ~80 fasting blood sugar, with spikes to 120-130 with a paleo diet and normal hormones (testosterone, progesterone, estrogen, FSH, LH), metformin is the only thing that has helped me lean out.  My only negative indicator of an insulin issue is a 5.3 a1c. I can’t imagine why met works for weight loss without strong indicators of insulin insensitivity, and I wonder if this is my only hope for achieving the body composition I desire, acknowledging mets drawbacks.

I’d greatly appreciate your insights.

 

2. Ox Bile question

Katie says:
I have read up on your suggestions for those of us without a gall bladder should take ox bile supplements to aid in digestion. Back in 2004 I also had the gastric bypass surgery. I am wondering how that comes into play with the ox bile. I started 100% paleo (food-not exercise yet) about 6 weeks ago. I am taking 2 ox bile pills with each meal and have no relief. With my intestines being re-routed so no stomach acids either, I am not sure I will feel that ‘warming’ sensation you talk about. I am not sure if upping the dose is safe…  Would love your thoughts, suggestions, help!!  I am down 16 pounds (80 ish more ti lose) and seeing great improvements in blood sugar, blood pressure, fibromyalgia, and Hoshimotos issues—the digestion is worse….

 

3. Trace Minerals for detox

Michael says:
Robb,

Have you had any experience with Body Bio’s approach to supplementing trace minerals based on taste test of each mineral?  I recall poliquin discussing zinc tally tests as a relative zinc deficiency index but this was the first I’ve seen for a more comprehensive approach.

Here is a link to the test kit and product:

http://www.bodybio.com/storeproduct404.aspx

And video explanation:

http://www.bodybio.com/content.aspx?page=BodyBioWellnessVideoLibrary

 

4. Greasing The Groove

Tyler says:
Hey Robb and Greg.

First off, your podcasts are gospel. Im at episode 140 and have listened to every one from 70 and up;) front to back. I have a few questions about “greasing the groove” style training. I just recently listened to a question regarding lifting every day but at a low volume. For example, choosing big compound lifts such as cleans and bench presses and performing 2 sets of 5 of these types of lifts and performing this workout every day with no need for rest days. I believe the goal of this training was to steadily and slowly increase strength without any major soreness or overall fatigue.

Question 1) Did I understand this correctly that low volume work but done every day is a legitimate training schedule?

Question 2) Aside from a recovery week every 3rd or 4th week, is a program designed like this safe and reliable for providing good strength gains?

Question 3) If question 1 is true then what is a good upper limit to shoot for in the amount of training that can be done each day to minimize elevated cortisol if this would even be an issue.

I am currently interested in this style of training because I am a severe gym-o-holic and feel the need to lift every day even if it’s in small amounts. My main goal is to gain strength relative to body weight and to generally just feel great day in and day out. Lastly, Im 20 years old, 6ft 155lb with a lean build, and eat a paleo diet of mostly meats, veggies, and safe starches (yams, sweet potatoes, bananas, etc.) just to give you an idea of how I might recover from heavy lifting.

Hope this gets on the podcast so you guys can do what you do best and school the listeners on all your paleo and strength training know-how! Thanks a ton and looking forward to episode 1,040!!!

5. Making gains with a busy schedule

Larry says:
Hi Greg and Robb, as a weightlifter/paleo diet-er/internet nerd, I am a big fan of the work you both put out  My question is about how to adjust training and diet when recovery is not optimal.

I am a year into weightlifting- I train 4 times per week and my best lifts in competition are 104/131 at 87 bodyweight. I have been making steady gains over the year until now. I am in my third year of medical school and just started interning at the hospital. I used to get 8 hours of sleep but now I am forced to get by with 5-6 hours. I am missing more reps now and my strength does not seem to be increasing. Obviously my education is my priority, but if there are changes that I can make to my training or diet that would allow me to continue making progress as a weightlifter I would love to hear them. Should I decrease my training volume/frequency? I am eating paleo but I am not counting my calories/macros, I just eat until I am full.

I look forward to hearing both of your suggestions,

 

6. Current politics limiting Paleo: What to do?

Alex says:
Hi Robb,

I am entering grad school this year for health administration. There is a lot of talk about how physicians and researchers can help the spread of paleo through resources such as the Paleo Physicians Network. What do you see as the role of administrators in public health? In particular, this applies to those that did not start out in medicine and who do not have a strong medical background.

Clearly the politics and money-making opportunities for certain areas of the food industry are a serious issue and limiting factor. On the broad scale, this aspect seems to be typically outside the reach of clinicians. I know the answer to this question can (and will) be lengthy, so what is just the next step that administrators in public health, either those who are experienced or those just entering such as myself, can take to continue the spread of paleo?

I have made this career choice mainly due to the positive impact that you and the rest of the ancestral health community have had on me since coming across all of this one year ago.

Thanks for everything.

7. TED talk bummer

Ben says:
I love the podcast; keep on rockin’.  Check this out: http://youtu.be/BMOjVYgYaG8.  It’s a seemingly scientific argument debunking a paleolithic dietary lifestyle, 20+ minutes of archeological discussion that in my opinion completely misses the point. It seems like the speaker didn’t do any research beyond looking up images of paleo books for the powerpoint.  Please agree, briefly explain, and move on to a more interesting question.  I hope my man-crush on you two is palpable.

 

8. Red Meat and Heart Disease

Manuel says:
Hi. I love red meat. As much as possible, I eat grass-fed beef instead of grain fed. I know that there have been many arguments against consuming red meat, as the saturated fat and cholesterol may contribute to heart problems, so they say. And I also know that you guys and others have responded to the arguments against red meat with good points in support of red meat. But there’s a brand new study in the NYTimes implicating gut bacteria with Carnitine obtained from eating red meat to the risk of getting heart disease. Can you guys comment on this? And should we then be cautious about eating red meat now based on this new research? Here’s the link:

http://www.nytimes.com/2013/04/08/health/study-points-to-new-culprit-in-heart-disease.html?smid=fb-nytimes&WT.z_sma=HE_SPT_20130407&_r=0

Thanks!

 

9. References/Sources for more information

Scott says:
Hey guys,
I just started listening to the podcast and they’re great.  I’ll make my question a quick one.

You may have covered this elsewhere already but could either of you suggest a website or database that a layman like myself can use to research information regarding nutritional studies?  I’m a nursing student interested in learning more about the science behind Paleo outside of the published books that are on the market.

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  1. Chris
    May 15, 2013 at 8:30 am

    Today I am on day #30 of the Whole30 challenge (same concept as your 30 day transformation. Last week I had my A1c tested and the following day got a call from my doctor to see him. So I see him next Tuesday. I listened to this Podcast yesterday about and the high A1c results has me a little freaked out…I am guessing he won’t be throwing me a party for how well I am controlling my blood sugars.

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  3. Steven
    May 22, 2013 at 1:33 am

    Hi Robb, I have a speculation as to why metformin may result in weight loss (not that I have any personal or clinical experience with it): Metformin stimulates AMPK, which increases mitochondrial biogenesis, mitophagy and promotes mitochondrial function. These factors improve mitochondrial dysfunction, which in turn would reduce ER stress, PTP1B and ultimately leptin resistance.

    Perhaps another reason bodybuilders don’t use it is because AMPK antagonises mTOR

  4. Kaila Holtz
    June 1, 2013 at 4:55 pm

    Hi Robb,

    Was listening to your podcast and thought if you haven’t already read it, check out Steve Malin and Barry Braun’s work on the combined effect of exercise and metformin. (Dr. Braun heads up the Energy Metabolism Lab at UMass Amherst). Super interesting findings that metformin may attenuate the benefit of exercise training in those with metabolic syndrome/prediabetes (http://care.diabetesjournals.org/content/35/1/131.short) Dr. Braun’s work is definitely worth looking over given your interest in metformin and he knows the physiology better than anyone. I grant you the diet provided to these subjects was not Paleo but the findings are interesting none-the-less :)

    Enjoy!

    Kaila

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