Why running on fat does't work for moderate distance events - technical details

Everyone knows that burning a gram of fat produces more energy than burning a gram of glucose - roughly twice the amount. However, that fact is of little relevance to most athletes, as the supply of fuel is not the rate limiting parameter when it comes to performance. (ultra long races excepted)

The rate limiting step is the supply of oxygen to the working muscle. As much as Tim Noakes would like to, you can't magically increase the amount of oxygen that your heart pumps to your muscles during a race where you are running at close to VO2 max.

Rather than looking at the energy supplied by one gram of fat, we need to look at the amount of energy produced per unit of oxygen when burning fat vs that produced when burning glucose.
Check the biochem textbooks:

Glucose   467.1 kJ/mol O2

Fat           436.5 kJ/mol O2

Glucose is the clear winner. If you are running fast, and want your muscles to generate the maximum amount of energy in a given time, you want to be burning glucose, not fat.

Low carb guru Prof Tim Noakes - read this review before you buy his book

Tim is a hero of the low carb movement, and you may be thinking of buying his recent diet book "The Real Meal Revolution"
Before you do take this quick quiz.

Here are Tim's online running results

Mine? Today I did a 10.6km trail run -the Tour de Ridges - in 51 minutes flat. Last year  49:21 Using a Master Athletics age grade calculator, this equates to 50:20 for a 63 year old doing a 10 km trail run.

Unlike myself, Tim does not have diabetes, does not have Addison's, doesn't have 2 screws in his ankle, hasn't had a laminectomy (afaik), takes his running very seriously, and eats low carb on race day. The question is this. Which of those 6 factors do you think might account for the fact that Tim runs way slower than me?

While Low Glycaemic Load/Low GI/Low Carb works well in many situations, race day at moderate distances is not one of them.
People say fat burns long and slow. They are certainly right about the slow bit.

note : I am by no means fast. The fastest locals in my age group are waaay ahead of me.

Technical details about the benefits of glucose as a fuel are in the next post.

Best way to carry emergency glucose

Here is the best way I have found to carry an emergency glucose supply.

Buy glucose in flat rectangular blocks. I find it in the sport supplement section of the supermarket, not the pharmaceutical aisle.

Wrap in a small amount of plastic wrap. I wrap one single, and two end to end.

Three 3g blocks fit longitudinally in a credit card slot of a standard leather tri-fold wallet.

You can see a faint bulge at the right hand edge. As the glucose does not overlie the bulk of the cards it only increases the thickness of the wallet by about 1mm. Having 3 teenagers means my wallet is never too fat from banknotes.

If 9g is not enough of an emergency supply for an average day, you really ought to re-think your diabetes management.



Addit. For watersports, use waterproof adhesive tape to form a loop at the base of a gel packet. Tie it to the waist string of your swimmers or anywhere else convenient. This way you can even carb up under water.

For skiing, mountaineering etc wear the gel as a necklace. You can take on carbs using only one hand and without taking off your gloves/mittens by biting off the gel top. Please also tape the gel top to the body so that the gel top doesn't become litter on the ski track.

Great advice from a physio for those on steroids.

When a running friend of mine heard that I had Addison's disease, what was her first comment?

"I hope you're doing your upper limb weight bearing exercises"

She wasn't going to tell me how to suck eggs, but she thought that this advice was particularly important because
1. Surgery for osteoporotic upper limb fractures in steroid users happens way too often at our local trauma hospital, and
2. Despite point 1, she knew it was very unlikely that any Canberra doctor would have given me that advice.

85 years with T1 diabetes. How did he do it?

Although it is now a few years since Bob  Krause died after living with type 1 diabetes for 85 years it is important to remember how he did it.

His regular diet was low carb and very low GI. Nuts and prunes (GI about 30) for breakfast, often no lunch, and meat and salad for dinner. ( sources differ, but not by much)
He used extra carbs on active days. Prunes may not be approved by the hard-line VLCers, but there is no argument about the low glycaemic load. He got plenty of fat from the nuts and meat.

There is no way that the Australian medical establishment would approve of such a diet. A Australian dietitian has recently been de-registered for promoting an eating pattern similar to this. Yet it got Bob to the age of 90.

Case study of one you say? Show me just one diabetic in good health who has made it to old age without some form of glycaemic load reduction, be it low carb, low GI, or just skipping dessert when all their friends didn't. Case study of zero.

Almost as important as his diet was Bob's education. He was a mechanical engineer. He knew how to model inputs and outputs of a system mathematically. He knew how to titrate inputs to effect. No, he didn't have formal education in the biological sciences. Not important.

My own informal study many years ago found that the majority of diabetics who met my pre-determined definition of being very successful had formal tertiary education in the non-biological sciences.  My survey turned up many graduates in the hard sciences, but no lawyers or nurses, and perhaps most interestingly, no doctors who did not also have a science as well as a medical education at university level.

If one of your kids gets diabetes in their early teen years, you should look with more modern data at what sort of educations are associated with good diabetic outcomes and steer them in that direction, or at least give them the facts so they can make up their own mind.

Addit. 19.12.15 On second thoughts, his education was actually more important than his diet, as it was his education that led him to reject medical "evidence" and design his own diet.


added 1.3.16
To those readers who call my stories on Winsome and Bob selective information presentation, please forward me details of any or all similar Type 1s who have done as well by eating a population average amount and type of carbs as part of a low fat diet, and I will gladly include them here.
I have been unable to find any myself in my online sampling.

I never inject insulin at the recommended abdominal site

No Abdominal Site Administration, or what I learned from NASA and the Challenger disaster about diabetes. My essay on one of the reasons I use non-approved sites has been accepted for publication. You may see it in an upcoming issue of a local diabetes mag in edited form. If it is too heavily edited I will post the full investigation results on my blog.

I used to donate blood, until I learned how much was wasted.

There is ample evidence of overuse of donated blood products by doctors. One contributing factor must be the obscene financial incentives for doctors to give a patient a blood transfusion, rather than use a colloid or electrolyte solution.
Item number 22002 in the Medical Benefits Schedule pays doctors a large amount of money on top of their already generous remuneration if they choose blood rather than another fluid. The amount doctors receive depends on what billing schedule is in place.
The AMA List, which many doctors use, values this "service" at $324.00! That is an additional amount, on top of the usual fee. Nice work if you can get it.
Of course patients who require blood are often sicker, take more time, or may be having more complicated procedures than others. These factors are all separately compensated in the Medical Benefits Schedule.
And ill patients still require close monitoring, irrespective of whether they are receiving blood or colloid.
The Health Minister, Ms Sussan Ley and her Government are now proposing to fund this growing largesse by imposing the GST on fresh food. The inertia of bureaucrats responsible for the MBS, and the propensity for Australians to only voice their opinion after legislation is in place make this increasingly likely.
There are also financial incentives for hospitals to favour blood transfusion, but that is another story.
Let the Health Minister know what you think.

Yet more evidence of poor medical outcomes

The Australian Addison's Disease Association website addisons.org.au contains 15 stories of typical patients. Read them all or just read on to see in summary what average patients are like well after the difficult period around the time of diagnosis is passed.
1. Crisis, doctors clueless
2. Several hospital admissions for Addison's
3. Absent from school often
4. Lethargic, underweight
5. Several crises. Used to sprint, now can only jog
6. Very vague sometimes, forgetful, not fit enough
7. Underweight, teary episodes
8. Multiple crises
9. Retired early due to not coping
10. Feels "not right"
11. Crisis. Firing on 5 cylinders rather than 8
12. Fatigues, osteoporotic
13. Given wrong drugs, health slipping
14. Multiple medical problems, health delicate
15. Overweight, fatty liver, unstable

Equivalent websites for people with type 1 diabetes are replete with stories of success. Not so Addison's. Is there anyone in Australia with Addison's disease who is doing well on standard treatment?

My brain used to go fuzzy. Now it doesn't.

When I followed standard medical protocols for diabetes, my brain used to get the fuzzies at a much higher blood sugar. I still get the physical symptoms when my blood sugar is low, but not the cerebral dysfunction.
Half an hour ago, my glucometer read 1.8 (32mg/dl). Without eating, I then defeated my chess program Fritz (V8, error level 1.0/10, lightning) several times, before re-checking my bsl on my spare glucometer.

Why does this matter?
Doctors refuse to even entertain the possibility that the treatment they are prescribing affects the level at which patients experience cerebral dysfunction. Of course there is no evidence from clinical trials of harm from standard treatment because doctors refuse to collect that evidence, and no one else has access to the data.
If your brain goes woozy at a bsl of 3.5 (63 for the non SI), don't accept that as normal for diabetics, or assume that it will always be the case. Do something about it.

You don't have to believe me. Look for yourself at the non-existent peer-reviewed medical evidence base on this topic. Doctors just pretend to be knowledgeable on the topic.

note : looking at local chess club results, I figure 99.5% of the adult population can't play chess at this level, even with a normal blood sugar.

Yet more deaths due to Addison's in Australia

Yet more deaths. 20 kg unintended weight loss and still not tested for Addison's. I offered to talk to doctors about Addison's before these people died. The professor said "No one is interested"