obesity

The human microbiome, gut bacteria contribute to obesity.

We traditionally think of bacteria as dirty, something we want to keep outside of our bodies.  Intestinal bacteria are very important for digestion; they break complex fiber polysaccharides (sugar molecules connected to each other), into simple absorbable sugars by a process called fermentation, converting nutrients into calories.  The large intestine houses over 1400 species of bacteria, numbering over 100 trillion.  Reality is that the human body contains ten times more microbial cells than human cells, and the human body is dependent upon the genetic information encoded in these bacterial cells for specific metabolic pathways.

Our microbial partners have coevolved with us, in a beneficial (symbiotic) relationships, involving nutrient sharing.   The ability to store energy would be a beneficial attribute for ancient humans, who had variable access to food, and when nutrient dense food supply was available, consuming it and storing it would benefit both the human and its bacterial symbiotes later when food supplies were diminished. However, in modern, developed societies, where there is ready access to large-portion, high-calorie diets, this “benefit” becomes a detriment, and we develop a previously rare condition (historically seen in the wealthy) called over nutrition, over storage, or obesity

Obese individuals have a different mix of bacteria in their guts than thin people. The ratio of Firmicutes to Bacteroidetes (called the F/B ratio) is higher in obese people than in lean people, and it drops as those people lose weight. Both Firmicutes and Bacteroidetes bacteria are involved in complex polysaccharide breakdown, but Firmicutes are much more efficient than Bacteroidetes bacteria, and having more Firmicutes bacteria in our gut makes more energy available, leading to increased caloric intake and eventually obesity.  Firmicutes overload is also associated slowed intestinal motility [chronic constipation].

In studies of genetically identical twins, bacterial populations have been found to differ, depending on whether the twin is lean or obese, with much higher level of Firmicutes in the obese twins.  In obese patients undergoing gastric bypass surgery, colonic bacteria change to become more like those of normal-weight individuals after the operation, reducing their Firmicutes levels.

Antibiotic over utilization may also indiscriminately eradicate the beneficial bacteria in your gut along with the bad ones.  Conventional farmed meats are doped with antibiotics, with nearly 50-70% of all antibiotics produced in the United States used on healthy livestock to promote growth and weight gain in the animal feed.  Consuming these antibiotic-laden meats may be a significant factor enhancing growth and weight in the human population [obesity] as well.   This further stresses the importance of eating grass-fed and organically raised meats of all kinds.

The amazing thing to keep in mind is that you can rapidly change your gut bacteria within 72 hours, to a healthy ratio, simply by immediately eliminating refined carbohydrates and increasing your fiber intake.  Supplements of “get thin bacteria” will soon be available as well.

 

The missing links in obesity: Glycemic Index and Insulin

Obesity is among the most important medical problems in the United States today. Currently, 1 in 4 children and 1 in 2 adults are overweight, and prevalence rates that have increased by 50% since the 1960s. The Federal government and various official medical agencies, at the behest of grain producers, have advocated decreasing intake of total fat, while increasing consumption of “complex carbohydrate.” Consumption of carbohydrates has increased over the years, and the nation’s levels of obesity, Type 2 diabetes and heart disease have dramatically risen.  Americans, on average, eat 250 to 300 grams of carbs a day, accounting for about 55% of their caloric intake.

All carbohydrates (a category including sugars) convert to sugar in the blood, and the more refined the carbs are, the quicker the conversion. When you eat a glazed doughnut or a serving of mashed potatoes, it turns into blood sugar very quickly. To manage the blood sugar, the pancreas produces insulin, which pushes glucose from the blood stream into cell to be used for energy conversion or storage.

When cells become more resistant to those insulin instructions, the pancreas needs to make more insulin to push the same amount of glucose into cells. As people become insulin resistant, carbs become a bigger challenge for the body. When the pancreas gets exhausted and can’t produce enough insulin to keep up with the glucose in the blood, diabetes develops

The first sign of insulin resistance is a condition called metabolic syndrome — a red flag for impending diabetes and  heart disease. Metabolic syndrome (found in nearly 1/4 of adults) is diagnosed when people have three or more of the following:

  • high blood triglycerides (more than 150 mg)
  • high blood pressure (over 135/85)
  • central obesity (a waist circumference in men of more than 40 inches and in women, more than 35 inches)
  • low HDL cholesterol (under 40 in men, under 50 in women)
  • elevated fasting glucose.

Glycemic Index measures the “effect of food on blood glucose levels.” It is a ranking of foods based on the how quickly the blood sugar levels will increase after ingestion. A low glycemic food gives a slow increase in blood sugar levels. A high glycemic index food gives a more rapid rise in blood sugar levels.

GI is specifically defined as the measurable glucose response curve after consumption of 50 g carbohydrate from a test food, divided by the response after consumption of 50 g glucose.

 

The GI for glucose would be defined as 100.

  • High GIs are above 50
  • Intermediate GIs range between 35 and 50
  • Low GIs are below or equal to 35

[learn_more caption=”High Glycemic Index Foods (GI>50)”]

Corn syrup 115
Beer 110
Glucose (dextrose) 100
Modified starch 100
Glucose syrup 100
Wheat syrup, rice syrup 100
Fried potatoes, scalloped potatoes 95
Potato flour (starch) 95
Rice flour 95
Maltodextrin 95
Potatoes, oven cooked 95
Potato flour 90
Gluten-free white bread 90
Sticky rice 90
Arrow-root 85
Celeriac, knob celery, turnip rooted celery (cooked) 85
Hamburger buns 85
Maizena (corn starch) 85
Pop corn (without sugar) 85
Rice cake/pudding 85
Tapioca 85
White sandwich bread 85
Carrots (cooked) 85
Corn flakes 85
Instant/parboiled rice 85
Parsnip 85
Puffed rice 85
Rice milk 85
Turnip (cooked) 85
White wheat flour 85
Mashed potatoes 80
Lasagna (soft wheat) 75
Rice milk (with sugar) 75
Waffle (with sugar) 75
Doughnuts 75
Pumpkin, gourd 75
Squash/marrow (various) 75
Watermelon 75
Bagels 70
Biscuit 70
Cabbage turnip, rutabaga, Swede turnip 70
Cola drinks, soft drinks, sodas 70
Croissant 70
Gnocchi 70
Millet, sorghum 70
Mush 70
Pealed boiled potatoes 70
Polenta, cornmeal 70
Puffed amaranth 70
Refined cereals (with sugar added) 70
Risotto 70
Special K™ 70
Tacos 70
Whole brown sugar 70
Baguette white bread 70
Brioche 70
Chocolate bar (with sugar added) 70
Corn flour 70
Dried dates 70
Matzo bread (white flour) 70
Molasses 70
Noodles (tender wheat) 70
Plantain/cooking banana/platano (cooked) 70
Potato chips, crisps 70
Ravioli (soft wheat) 70
Rice bread 70
Rusk 70
Standard rice 70
White sugar (sucrose) 70
Chestnut flour 65
Couscous, semolina 65
Hovis, brown bread (with leaven) 65
Maple syrup 65
Mars®, Sneakers®, Nuts®, etc. 65
Pain au chocolat 65
Pineapple (tin/can) 65
Raisins (red and golden) 65
Sorbet (with sugar added) 65
Sweet corn, corn 65
Tropical yam -US-, yam 65
Unpeeled boiled/steamed potato 65
Beet, beetroot (cooked) 65
Chinese noodles/vermicelli (rice) 65
Fava bean, broad bean, horse bean (cooked) 65
Jam (with sugar added) 65
Marmalade (with sugar) 65
Muesli (with sugar or honey added…) 65
Panapen, breadfruit, breadnut 65
Quince (preserve/jelly, with sugar) 65
Rye bread (30% of rye) 65
Spelt, einkorn 65
Tamarind, Indian date (sweet) 65
Unpeeled boiled/steamed potato 65
Whole-grain bread 65
Apricots ( tin/can with syrup) 60
Chestnut 60
Honey 60
Lasagna (hard wheat) 60
Mayonnaise (industrial, sweetened) 60
Milk loaf, milk white 60
Ovomaltine 60
Perfumed rice (jasmine…) 60
Powder chocolate (with sugar) 60
Bananas (ripe) 60
Hard/durum wheat semolina 60
Ice cream (regular, with sugar added) 60
Long-grain rice 60
Melons (cantaloupe, honeydew, etc.) 60
Oatmeal, porridge 60
Pearl barley 60
Pizza 60
Ravioli (hard wheat) 60
Bulgur wheat (cooked) 55
Grape juice (unsweetened) 55
Ketchup 55
Manioc, mandioca, yucca, Cassava (bitter) 55
Mustard (sugar added) 55
Papaya (fresh fruit) 55
Red rice 55
Sushi 55
Butter cookies, shortbread, spritz biscuit (flour, butter, sugar) 55
Japanese plum, loquat 55
Mango juice (unsweetened) 55
Manioc, mandioca, yucca, cassava (sweet) 55
Nutella® 55
Peaches (tin/can, with syrup) 55
Spaghetti (well cooked) 55
Tagliatelle (well cooked) 55
All Bran™ 50
Basmati rice 50
Bread with quinoa (approximately 65% of quinoa) 50
Cereal bar, energetic (no sugar added) 50
Cranberry juice (unsweetened) 50
Kiwifruit, monkey peach 50
Macaronis (durum wheat) 50
Muesli (no sweet) 50
Pineapple juice (unsweetened) 50
Wasa™ light rye 50
Whole wheat pasta 50
Apple juice (unsweetened) 50
Biscuit (whole flour, no sugar added) 50
Brown rice, unpolished rice 50
Chayote, chocho, pear squash, christophine 50
Jerusalem artichoke 50
Litchi (fresh fruit) 50
Mango (fresh fruit) 50
Persimmon, kaki-persimmon 50
Sweet potatoes 50
Whole couscous/semolina 50

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[learn_more caption=”Intermediate Glycemic Index Foods (GI 35-50)”]

Brown basmati rice 45
Coconut 45
Farro flour (integral) 45
Grapes, green and red (fresh fruit) 45
Jam (no sugar added, grapefruit juice sweetened) 45
Kamut flour (integral) 45
Orange juice (fresh squeezed and unsweetened) 45
Plantain/cooking banana/platano (raw) 45
Rye (integral; flour, bread) 45
Spelt, einkorn (integral) 45
Toasted integral bread 45
Whole bulgur wheat (cooked) 45
Whole couscous, whole semolina 45
Bananas (unripe) 45
Capellini pasta 45
Cranberry 45
Grapefruit juice (unsweetened) 45
Green peas (tin/can) 45
Kamut bread 45
Muesli Montignac 45
Pineapple (fresh fruit) 45
Plantain/cooking banana/platano (raw) 45
Sandard Pumpernickel bread 45
Spelt, einkorn (integral) 45
Tomato sauce (with sugar) 45
Whole cereals (no sugar added) 45
Bread, 100% integral flour with pure leaven 40
Buckwheat, kasha, saracen (integral; flour or bread) 40
Coconut milk 40
Dried plums/prunes 40
Falafel (fava beans) 40
Fava beans, broad beans, horse beans (raw) 40
Kidney/pinto beans (tin/can) 40
Matzo bread (integral flour) 40
Oat flakes (uncooked) 40
Peanut butter (no suger addes) 40
Quince (preserve/jelly, without sugar) 40
Shortbread, spritz biscuit (integral flour, no sugar added) 40
Tahin 40
Al dente spaghetti (5 min cook) 40
Brut cider 40
Carrot juice (unsweetened) 40
Dried fig 40
Egyptian wheat, kamut 40
Farro 40
Integral wheat pasta, al dente 40
Lactose 40
Montignac Pumpernickel 40
Oats 40
Pepino dulce, melon pear 40
Quinoa flour 40
Sorbet (unsweetened) 40
Adzuki/azuki bean 35
Amaranth, seeds 35
Apple stew, apple sauce 35
Cassoulet (meat and beans French dish) 35
Chick pea flour 35
Chinese noodles/vermicelli (hard wheat), noodles 35
Custard apple, cherimoya, sherbet fruit, soursop, guanabana 35
Dried apples 35
Dried tomatos 35
Falafel (chick peas) 35
Green peas (fresh) 35
Ice cream (with real fructose) 35
Kidney/pinto beans 35
Nectarines (fresh fruit) 35
Peaches (fresh fruit) 35
Pomegranate (fresh fruit) 35
Quinoa, hie 35
Sunflower seeds 35
Tomato sauce (natural, no sugar added) 35
White almond paste/puree (unsweetened) 35
Wild rice 35
Yoghurt 35
Ale strains 35
Apple (fresh fruit) 35
Black beans 35
Celeriac, knob celery, turnip rooted celery (raw) 35
Chick peas, garbanzo beans (tin/can) 35
Cranberry bean, borlotti bean, Roman bean 35
Dijon type mustard 35
Dried apricots 35
Essene/ezekiel bread (sprouted cereals bread) 35
Figs; Indian/barbary fig (fresh fruit) 35
Green peas (fresh) 35
Indian corn 35
Linum, sesame (seeds) 35
Oranges (fresh fruit) 35
Plums, prunes (fresh fruit) 35
Quince (fresh fruit) 35
Soy yogurt (fruit flavored) 35
Tomato juice 35
Wasa™ fiber (24%) 35
White beans, haricot beans, cannellini beans, faziola beans 35
Yeast 35

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[learn_more caption=”Low Glycemic Index Foods (GI <35)”]

Bread (Montignac integral bread) 34
Almond milk 30
Beet (raw) 30
Carrots (raw) 30
Chinese noodles/vermicelli (made from soy or mung beans) 30
Garlic 30
Marmalade (no sugar added) 30
Oat milk (non cooked) 30
Pears (fresh fruit) 30
Curd cheese 30
Soy milk 30
Tomatoes 30
Yellow lentils 30
Apricots (fresh fruit) 30
Brown lentils 30
Chick peas, garbanzo beans 30
French beans, string beans 30
Grapefruit, pummelo, shaddock (fresh fruit) 30
Milk 30
Passion fruit, maracuja, granadilla 30
Powdered/fresh milk 30
Scorzoneras 30
Tangerines, madarines, satsuma 30
Turnip (raw) 30
Blanched barley 25
Cherries 25
Flageolet beans, fayot beans 25
Green lentils 25
Mung beans, moong dal 25
Raspberry (fresh fruit) 25
Seeds (squash/marrow) 25
Split peas 25
Whole-almond paste/puree (unsweetened) 25
Blackberry, mulberry 25
Blueberry, whortleberry, bilberry 25
Dark chocolate (more than 70% of cocoa content) 25
Gooseberry 25
Hummus, homus, humus 25
Peanut paste/puree (unsweetened) 25
Redcurrant 25
Soy flour 25
Strawberries (fresh fruit) 25
Whole-hazelnut paste/puree (unsweetened) 25
Artichoke 20
Chocolate, plain (>85% of cocoa) 20
Heart of palm, cabbage palm 20
Lemon juice (unsweetened) 20
Montignac sugarless jam 20
Ratatouille 20
Soy “cream” 20
West Indian cherry, acerola 20
Bamboo shoot 20
Eggplant, aubergine 20
Lemon 20
Montignac Real fructose, fruit sugar 20
Powder cocoa (no sugar added) 20
Soy yogurt (unflavored) 20
Tamari sauce (unsweetened) 20
Almonds 15
Black currant 15
Broccoli 15
Cabbage 15
Cashew nut, acajou 15
Celery 15
Chicory, endive 15
Courgettes, zucchini 15
Fennel 15
Hazelnuts, filberts, Barcelona nuts 15
Mushroom, fungus 15
Onions 15
Pesto 15
Pickle 15
Pistachio, green almond 15
Rhubarb 15
Salad, lettuce 15
Shallot, echalot, Spanish garlic 15
Soya 15
Spinaches 15
Sweet peppers (red, green), paprika 15
Tofu, soybean curd 15
Wheat germ 15
Agave (syrup) 15
Asparagus 15
Bran (oat, wheat…) 15
Brussels sprouts 15
Carob powder 15
Cauliflower 15
Cereal shoots (soy or mung bean sprouts, etc.) 15
Chili pepper 15
Cucumber 15
Ginger 15
Leeks, scallions 15
Olives 15
Peanuts 15
Physalis, golden gooseberry, Cape gooseberry, Chinese lantern, husk tomato 15
Pine seed 15
Radish 15
Runner beans, Italian flat beans 15
Sauerkraut, sourcrout 15
Sorrel dock 15
Spinach beet, perpetual spinach 15
Sprouted seeds 15
Tempeh 15
Walnuts 15
Low GI Montignac pasta (spaghetti) 10
Avocado 10
Low GI Montignac spaghetti 10
Crustaceans 5
Vinegar 5
Spices (parsley, basil, oregano, cinnamon, vanilla, etc.) 5

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In general, refined grain products and potato have a high GI, exceeding that of table sugar by up to 50%, whereas most vegetables, fruits and legumes have a low GI.  Other factors including carbohydrate type, fiber, protein, fat, food form and method of preparation, determine the GI of a particular food.

According to data from the Department of Agriculture, >80% of the carbohydrate currently consumed by children ages 2–18 has a GI equal to or greater than that of table sugar.  Moreover, carbohydrate absorption rate (and therefore GI) is increased after a low fat meal because fat acts to delay gastric emptying.

The rapid absorption of glucose from the high GI meal results in a high insulin secretion; which promotes uptake of glucose in muscle, liver and fat tissue and inhibits fat breakdown (lipolysis).  In the post absorptive period, a transient hypoglycemia ensues, with blood sugars falling below normal due to high insulin, resulting in hunger and agitation.  In some individuals, this may cause tremendous anxiety, which may create a feedback loop of carbohydrate addiction. Experimental evidence also suggests that elevated insulin levels, even just for 48–72-h period (in the presence of normal or reduced blood sugar levels) decreases insulin sensitivity in healthy subjects creating a diabetic effect of insulin resistance.

Without a doubt, high GI foods elicit (calorie for calorie) higher insulin levels than low GI foods.  In humans, high acute insulin secretion after intravenous glucose tolerance tests predicts weight gain.  High insulin levels also reduce Growth Hormone levels, which may reduce metabolic rate. Hormonal responses to a high GI diet stimulate hunger and favor storage of fat, which promotes excessive weight gain.

 

The LiveHealthProtocol dietary recommendation is designed to lower the insulin response to ingested carbohydrate (low GI), which improves access to stored metabolic fuels, decreases hunger, and promotes weight loss. The LiveHealthProtocol recommends abundant quantities of vegetables, and fruits, moderate amounts of protein and healthful fats, and decreased intake of refined grain products, potato and concentrated sugars.

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  • Milk products (whey protein) have a GI which is low, but have paradoxic high insulinemic index (release high amounts of insulin).  Milk products appear insulinotropic as judged from 3-fold to 6-fold higher insulinemic indexes than expected from the corresponding glycemic indexes.  So even if you are consuming a low GI milk product, from the insulin standpoint it is a very high load.


  • Starchy fruits increase their Glycemic Index depending on ripeness.  Green bananas have low GI of 40 but when they are ripen it will raise to 65.


  • Glycemic Load [GL] relates the GI to the amount of carbohydrate eaten in a normal serving or in 100 grams.  It measures the total amount of carbohydrate, and is decreased by fiber consumption.

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Not all calories are the same.

Your brain and obesity.

Obese people have, on average, eight percent less brain tissue than people of normal weight, according to a new study published in the journal Human Brain Mapping.  Even overweight people have four percent less brain tissue than their normal-weight peers.   Obesity is independently associated with poor educational attainment and may be responsible for the cognitive deficiency manifested in lower intelligence test scores (IQ).  Excessive body weight gain has a shrinking and aging effect on the brain with a reduction in measureable IQ, in addition to the previously recognized increased risk of diabetes, high blood pressure, heart disease and stroke.  The terminology of obesity and ever weight is defined by using weight and height to calculate a number called the Body Mass Index (BMI).  Obesity is defined as a BMI greater than 30, and overweight is defined as a BMI of 25 to 29.9.

 

 

The new study showed that age, gender, and race don’t matter. MRI brain scans of obese people revealed that their brains are smaller (atrophy) and appeared to be 16 years older than brains of lean people. The brains of overweight people appeared to be 8 years older. The presence of brain shrinkage is associated with dementia and depletes cognitive reserves in later years, which puts you at greater risk of Alzheimer’s and other diseases that attack the brain.

Atrophy or shrinkage of brain tissue associated with obesity and Alzheimer's

 

The primary areas of the brain affected include the frontal and temporal lobes, which are responsible for planning and memory.

 

The mechanisms which links obesity to gray matter atrophy (brain shrinkage) include:

  • Reduced blood flow to brain due to blood vessel shrinkage
  • Reduced perfusion due to hypertension and loss of vessel elasticity
  • Toxic xenoestrogens released from excessive adipose tissue
  • Insulin resistance with chronically elevated blood glucose, leading to glycation, inflammation, and protein degradation
  • Expansion of the penumbra zones (enlargement of the stroke zone), possibly even with micro strokes or silent strokes.

 

 

This lack of blood flow to the brain causes cell and tissue death resulting in brain shrinkage. Interestingly, the research also showed that regular, vigorous exercise has the reverse effect. Physical activity can actually conserve brain tissue, which further supports the idea that blood flow is at least partly responsible for the maintenance or shrinkage of our brains. Of course, exercise also helps greatly in preventing obesity and its related conditions and risks.

 

According to the World Health Organization, a poor dietary habit with reliance on convenience and processed foods significantly contributes to obesity.  The lack of portion size control is a particular problem in the United States, where “Super Sizing” every restaurant meal has contributed to our expanding waistlines.  Additionally, food engineering and tremendous food diversity titillates our taste buds into over consumption.

 

These new study results highlight the importance of exercising regularly, eating a balanced diet of fresh, whole foods and limiting your portion sizes. Not only will these healthy habits go a long way towards maintaining your weight and reducing the risks associated with obesity, they can help you maintain a healthy brain – which will end up affecting much more than how you look.

Brain shrinkage and reduced IQ is associated with obesity. It may be reversible with appropriate diet and nutrition.

How does food become energy?

Optimizing fat burning while simultaneously building muscle should be the goal of any effective exercise program, the critical linkage between exercise and the food we eat is ATP.  This article describes the importance of understanding what ATP is, and how different foods are converted to ATP, and when different fuels (protein, carbohydrate, or fat) are used for energy.   Understanding these concepts provides the blueprint for the LiveHealthProtocol.com diet and exercise guidelines.

I frequently talk to patients about the foods they eat, and how it impacts their health.  I think its very important to understand that converting food to usable energy is far more than simply chewing big pieces of food, which are digested into small pieces, and used directly by the cells.   Your body does not directly take the food particles it consumes and transfers them to your cells for metabolism.  It converts these particles to fundamental substrates, which are then converted to ATP (adenosine triphosphate), which is the actual fuel for your cells.

 

(Other substrates are used for structural growth and for cofactors, as well as immune recognition purposes; but the apple you eat does not become a little apple that your cells consume, it instead converts to sugars, proteins, and fats which are metabolized to ATP, which power your cells.)

The universal currency for life is ATP, the energy-carrying molecule found in the cells of all living things.  ATP functions like a tiny battery debit card, an ATP molecule consists of adenosine and three negatively charged inorganic phosphate groups when it is fully charged and ADP (adenosine diphosphate) when it has released its energy and has only two phosphates.

 

 

Recharging ADP to ATP requires fuel substrates, which is the converted food that you eat, whether it be protein, carbohydrate, or fat.  The exact recharging is coupled to the molecular destruction of Carbon bonds, similar to gasoline combustion in your car.

The recharging of ADP to ATP is what couples the food you consume to usable energy, the discharging of ATP to ADP transfers energy to usable cellular function for either chemical or mechanical reactions.  Available ATP (and Phospho Creatine- a related Phosphate storage bank in muscle) is depleted within 15 seconds of vigorous exercise.

 

 

 

Substrate to ATP

There are three significant fuel sources or substrates of energy to reform ATP from ADP.

 

Carbohydrates

Carbohydrates are metabolized to glucose, which quickly regenerates ADP to ATP through a process called glycolysis.  Consumed carbohydrates are directly available as glucose, or excessive consumed carbohydrates are stored in muscle and liver as glycogen for later reconversion to glucose. (Excessive carbohydrates in the presence of insulin are also converted to fat in fat cells.) Use of carbohydrates for energy does not require large amounts of oxygen and can occur even during anaerobic conditioning.  Production of lactate and lactic acid occur with use of carbohydrates for fuel.  Available carbohydrates provide energy to recharge ATP for the first 45-60 seconds of high intensity therapeutic exercise.

Fat

Fat is a slow energy release form, typically stored in fat cells.  Lipolysis is the term used to describe the breakdown of fat (triglycerides) into the more basic units of glycerol and free fatty acids, which then undergo beta-oxidation. Combustion of fatty acid molecules produces significantly more ATP, compared to glucose molecules. However, because fatty acids consist of more carbon atoms than glucose, they require more oxygen for their combustion.  Fatty acids are oxidized by most of the tissues in the body; except, the brain, red blood cells, and the adrenal medulla.  It is a huge storage reservoir, but is too slowly released for immediate energy utilization.  Lipolysis provides energy after the first 60 seconds of exercise, but only effectively in the presence of large amounts of oxygen.

Protein

Protein can also be used as an energy source, but it must first be broken down to amino acids before being converted to glucose.  Protein is thought to make only a small contribution (< 5%) to energy production, but up to 18% of total energy requirements during long strenuous activity, sometimes characterized as rhabdomyolysis.