It should be noted that lactate salts produced from anaerobic glycolysis are not waste products. Lactates are transported out of the musde to the liver for conversion to glucose or glycogen and to the cardiac musde which can use them directly as fuel. Anaerobic glycolysis can provide energy for intense exercise up to 45-60 seconds, beyond which its necessary to use oxygen for further fuel breakdown. If oxygen is present for aerobic metabolism, there can be a continual breakdown of glucose until, theoretically at least, this is exhausted. In this case, pyruvate is involved in further energy breakdown through a process called the Krebs cyde, during which more ATP is produced (around 36 molecules per glycogen molecule compared to 2 under anaerobic conditions) providing more energy for longer effort. As we have seen in Chapter 3, however, the glucose supplies in the body of a 70kg male only amount to around 450g, or the equivalent of 2250 calories, about a day’s energy requirement at rest, and less than would be needed to run a marathon, if glucose was the only fuel source. Hence another source of fuel for physical activity is required.

This is where fat comes into the equation. Fats, in the form of free fatty acids, play little part in the energy equation while there is no oxygen available, because these are only broken down after entering the Krebs cyde where aerobic metabolism is initiated. When oxygen is available, fats take a major role in energy production because each molecule of fat oxidised during this process leads to a production of around 132 ATP molecules, far more than the 36 molecules supplied through slow-aerobic metabolism or the 2 ATP molecules through fast-anaerobic glycolysis.

After stored ATP is reduced to adenosine diphosphate (ADP) (over 4 seconds of maximal effort), creatine phosphate (CP) combines with ADP to reform ATP + creatine and another 4-6 seconds energy at maximal effort is made available. This process occurs in the cytoplasm of the muscle cell, no oxygen is used and the breakdown of neither fat nor glucose is required. Hence lifting a heavy weight, or an explosion of energy such as in a sprint, bums essentially no fat. When a slightly longer term (i.e. 1-2 minutes) of, still intense, muscular contraction is needed, glucose through anaerobic glycolysis is metabolised in the absence of oxygen in the cytoplasm of the cell. Again no fat is involved. Fat provides a better option for longer term performance, simply because it is twice as energy dense and there is relatively much more of it than glucose. The key, however, is that oxygen must be present In other words, the activity must be aerobic for fat to be utilised. The extent to which it becomes utilised as part of the energy mix is then dependent on a number of factors, including genetics, state of glycogen scores, the intensity and duration of exercise, the amount of glucose coming from the gut, and the level and type of obesity. Our specific interests here are the exercise parameters that influence fat utilisation and the practical implications of this for general exercise planning.

*123\186\4*

As we have seen, there are connections between eating disorders and depressive disorders. Studies have shown that between 25 and 80 percent of eating disorder patients have major depression either currently or as part of their history. Of course, the distress of bulimia, like any chronic illness, can cause its victims to feel depressed. That’s a normal reaction, but feeling sad because one is struggling with an illness is a totally different problem from clinical depression. In fact, studies show that in about half of the cases, depression starts a year or more before the bulimia even shows up.

Also, when we look at the relatives of eating-disordered people, we find a much higher incidence of affective disorders than in the normal population. Such findings suggest that susceptibility to these illnesses runs in families.

It’s tempting to conclude that antidepressants only seem to work on bulimia because they treat the underlying mood disorder that so many patients also suffer from, but the evidence shows otherwise. Several studies specifically screened out those bulimic patients who also had depression. Even in the non-depressed group, the medications produced good results. For that matter, some studies found that depressed patients using these medications actually improved less in their eating disorder symptoms than the non-depressed group.

Even though these medications are called “antidepressants,” it doesn’t mean that eating behavior improves because depression lifts. There may be some bulimic people who benefit because the medications change the chemical systems that regulate feelings of hunger and satiety.

*60/35/5*

Debbie, of Durham, North Carolina, traces her struggle with bingeing to her father’s death when she was only 16. “I felt empty, and I tried to fill that emptiness with food,” she explains. When she went away to college 2 years later, her sadness and loneliness only got worse. “I gained about 25 pounds in my first couple of years away from home,” she says.

She managed to take off most of the extra weight while still in college, primarily by watching what she ate. As she got slimmer, her self-esteem improved. But it didn’t last.

By the time she reached her late twenties, Debbie was in the throes of another personal crisis. “Basically, I didn’t know what I wanted to do with my life, and I turned to food for comfort,” she says. “I’d eat until I physically hurt, then I’d lie on the couch until the pain went away.”

Looking back, Debbie attributes her overeating to her desire for control. “I felt powerless in so many areas of my life” she explains. “But I had power over food. I could do with it whatever I wanted.”

The repeated binges drove Debbie’s weight upward. By age 30, she reached 180 pounds. “I felt awful about myself, and that only |made me eat more,” she recalls. |

Debbie knew that she couldn’t continue her erratic eating habits without seriously undermining her health. Determined to get to the bottom of her binges, she decided to join Overeaters Anonymous (OA). There, she began to uncover why she used food to fill voids in her life. She learned better ways of coping with her sadness and loneliness, such as calling a friend on the phone. Most important, she recognized her own strengths and attributes, gradually accepting her value as a person.

It was a painful process, but other members of the OA group gave Debbie the support and understanding that she needed. “I’ll always be grateful to them for standing by me,” she says. “They not only helped me overcome my loneliness but they also taught me how to deal with food.”

What’s more, Debbie’s positive interactions with other OA members gave her the courage to cultivate friendships outside the group, with her neighbors and coworkers. “As I allowed people into my life, I felt less lonely and much happier,” she says. “I no longer needed food as an emotional crutch.”

With the OA group’s guidance and encouragement, Debbie began to transform her eating habits. As Debbie’s eating habits and self-image improved, her bingeing subsided. She was able to drop 30 pounds in about 8 months. Fifteen years later, she’s still holding steady at a healthy 150 pounds.

Debbie believes that self-acceptance gave her the incentive to adopt a healthier lifestyle. “A lot of overweight people feel bad about themselves, and they won’t let themselves love who they are,” she explains. “But once you love yourself, you can give love to others and receive love in return. That gives you a sense of fulfillment that you won’t ever get from overeating.”

*114\89\8*

Finally, how big is your appetite? (Do you regularly gobble up anything that isn’t moving, or is your appetite more restrained?)

In general, smaller, less active people with normal appetites should eat the lower number of recommended servings, while larger, more active people who are used to eating a lot should go for the larger number of servings. If you’re particularly hungry one day, eat the larger number of servings; if your appetite is low, eat the smaller number.

The faster you want to lose weight, the fewer servings you should eat, but do not eat fewer than the lowest number of recommended servings. Eating less means cheating your body of much needed nutrients and can actually slow your metabolism. That’s because your body thinks it has entered a starvation state. Panicked, it shifts into low gear to conserve its energy and begins to burn calories much more slowly. Then, once you start to eat more (which is bound to happen), you’ll find that your body has gotten very good at making body fat. It’s still conserving every single calorie that it can, even though the starvation state may be long past. So keep eating—you’ll be thinner (and healthier) in the long run.

Variety Is Vital!
You should never use just one type of food for all of your servings from a food group (for example, 6 pieces of bread). The greater the variety of foods, the better your chances of getting all the vitamins, minerals, and other good things that your body needs. And the choices are practically limitless! In the grain group alone you can choose from wheat, rye, rice, barley, oats, wild rice, corn, or millet, among others. And these grains can take the form of bread, crackers, tortillas, pita bread, chapatis, and a host of different kinds of pasta. Experiment a little—it makes life more interesting!

*84\29\2*

Way back in 1927, Dr. Joslin, founder of the famous Joslin Clinic, wrote in the Journal of the American Medical Association, “With an excess of fat, diabetes begins; and from an excess of fat, diabetics die . . .”" Today we know that the high-fat diet can make us less responsive to our own insulin.¹⁴ The body makes insulin to control the blood sugar. But if our body cells develop a resistance to insulin, our blood sugar levels soar and we develop diabetes. As I’m writing this, the latest issue of the Journal of the American Medical Association has just arrived. In it is a report titled “Dietary Fiber, Glycemic Load, and Risk of Non-Insulin-Dependent Diabetes Mellitus in Women.”¹⁵ The authors of this study report that a low-fiber diet containing high amounts of sugar increases the risk of diabetes in women. (I’ve found that the same is true for men.) Here are the major ways in which the Fat Blocker Program helps prevent and/or treat this problem:

♦ Losing Weight Reduces the Risk of Type II Diabetes-According to the National Institutes of Health 1986 Consensus Development Conference,¹⁶ nearly 80 percent of those with Type II diabetes were obese when it struck. Increased weight, being obese for long periods of time, and extra fat stored in the upper body are all factors that increase the risk of developing this disease. Thin people can also develop Type II diabetes, but are much less likely to do so than their obese counterparts.

*50\29\2*

I’ve seen a lot of weight-loss ideas, plans, and gimmicks. I’ve also seen thousands of disappointed patients watch with dismay as the pounds that they thought were gone forever returned to their waists, thighs, hips, chins, and upper arms. But I’ve never seen anything that can produce results like the Fat Blocker Program, which is spearheaded by Chitosan.

At 210 pounds, Sam was carrying about 50 pounds of extra weight. I told him that if he followed the Fat Blocker Program he would feel better, get healthier, be able to get rid of most or all of his medicines, and lose about 50 pounds. “But it’s up to you,” I told the ex-soldier, looking him straight in the eye. “I’m giving you responsibility for your health. I’m giving you the power to cure yourself. Are you up to it?” (I especially enjoyed challenging this colonel, for I had only been a lowly buck private when I was in the army!)

“Doc, consider it done.”

Six months later he had completely changed his diet, lost much of the excess weight, and exercised regularly. He felt a thousand percent better and looked great. My examination and the laboratory studies confirmed that he was as healthy as he
felt and no longer needed his medicines. There was no magic involved in this case; it was a simple matter of losing excess fat.

*15\29\2*