Originally Posted by Greg Battaglia
1. First of all I think I addressed that quite clearly above, so i won't waste any time commenting on why he (probably) doesn't need to increase his carbohydrate intake. Secondly, Scott has made no indication that he is an "athlete". Saying that Scott is an "athlete engaged in a strength training program" is misleading and not an assumption that you could make based on his post. Suggesting that he is an athlete suggests that he is doing other vigorous sport-specific training on top of his strength program. That may be the case, but he didn't include those details in his post, so there is no way to come to that conclusion. Perhaps Scott could fill us in more on the specifics of his activity level to help clear that up. But until then, all we can assume is that Scott is an everyday guy who does some recreational strength training.
That being said, he should have plenty of glycogen from both dietary sources and gluconeogenesis (I never said he would get ALL of his glycogen from gluconeogenesis, as you've suggested). And that's not even to mention that he clearly stated that he eats cheat meals (which most likely are on the higher carb side) on the weekends.
Carbohydrates are indeed protein sparing, but so is fat, and Scott has an appropriately high fat intake given his lower carb intake.
2. Your critique of my response is completely misguided and out of context, especially considering that Scott has received blood results that indicate that he's low on hemoglobin, which is implicated in anemia. Combine that with the fact that he's presenting symptoms of anemia (you should know that heavy, stiff limbs can be a sign of B12 deficiency) and it becomes obvious that carb intake isn't the main factor here, if at all.
If the person was an athlete and those were the only symptoms, then yes, I would consider glycogen depletion, but they're not. I already stated the obvious: Scott has blood results to suggest anemia. His symptoms suggest anemia. He probably has anemia.
The reason I suggested a supplement was to help identify the problem. If the supplement corrected the problem then we would know that b-vitamins were the issue and use specific dietary changes to get him back to where he needs to be. If the supplements fail, then we know that it's something else.
Dr. G suggested lead poisoning. I'm not too familiar with lead poisoning and anemia, so I can't comment on that, but I'm sure Dr. G knows more about it than me. I offered my response to Scott in hopes that it may help him if it turns out that lead wasn't the issue. In that case he could look to his digestive system and check for stomach problems or h. pylori.
An interesting response Greg but you're not getting the point I'm trying to make; sure Scott is slightly anemic but that isn't his biggest problem, his biggest problem is his low energy diet.
If you look at the chart he posted you'll see that for the past two months his average daily calorie intake was just 2022 kcals/day and if you calculate his BMR (~1870 kcals/day) you'll see that he's only allowing himself 152 kcals/day for all other activities besides simply existing. The occasional cheat day meal of beer and pizza or whatever is never going to be enough to make up for such a chronic low energy intake so it's hardly surprising he's complaining that he's feeling fatigued.
If Scott can be persuaded to start eating more carbs in the form of fresh fruit and starchy root vegetables he'll see an immediate improvement in performance and as more food means more nutrients he'll start correcting any minor vitamin and mineral deficiencies he may have. If after a month or two he hasn't seen any improvement in performance that's when you should start doing further tests and if necessary prescribe any vitamin or mineral supplements he may need.