From carbohydrate orthodoxy to low-carbohydrate eating

• Noakes's Lore of Running taught carbohydrate loading, while Waterlogged addressed excess drinking and exercise-associated hyponatremia. Dulaney began long-distance running using those guidelines. [1][2]
• A recent paper coauthored by Noakes and Andrew Koutnik centers the endurance benefit of carbohydrate on maintaining blood glucose during exercise, rather than replenishing depleted muscle glycogen; Dulaney subsequently changed her fueling. [3]
• Noakes grew up eating meat, fish, and farm foods in Zimbabwe, adopted the low-fat advice from his 1970s medical training, switched to grains, and subsequently gained weight and developed insulin resistance.
• Swedish muscle-biopsy research in 1967 shifted endurance physiology from liver glycogen and blood glucose toward muscle glycogen depletion; Noakes taught that model for decades. [4]
• Bruce Fordyce recovered his pace late in the Comrades Marathon after drinking Coca-Cola with added sugar; Noakes subsequently introduced glucose polymers to his regimen and helped develop an early endurance carbohydrate gel with Bernard Rose.
• Industry funding supported sports-drink research, while advice to drink heavily coincided with exercise-associated hyponatremia. Noakes's research connected dangerous cases with overhydration, preceding his departure from prevailing fueling and hydration guidance. [5]
• After an unusually exhausting short run, Noakes read The New Atkins for a New You, revised his nutrition advice after 33 years, and switched to a low-carbohydrate, high-fat diet in 2010. [6]
• Noakes has maintained that diet for about 16 years, identifies his type 2 diabetes as being in remission though not fully normalized, and connects his personal risk to his father's severe diabetes and early death.

Dulaney's parallel path through endurance sport and plant-based eating

• Dulaney expected that remaining lean through marathons, Ironman races, and ultramarathons would protect her from her family's diabetes and heart-disease history; abdominal fat and symptoms accumulated despite extensive running.
• Carbohydrates before running triggered recurring shakiness and sweating, while gels coincided with repeated energy highs, crashes, nausea, and difficulty continuing without additional sugar.
• She initially rejected Noakes's low-carbohydrate approach and adopted a low-fat plant-based diet based on the idea that removing dietary fat could prevent insulin resistance.

Banting, institutional resistance, and the hearing

• Two runners who traversed the Great Wall of China ate pork fat when food was scarce; their experience helped initiate The Real Meal Revolution, which popularized the high-fat, low-carbohydrate Banting diet in South Africa. [7]
• After a parliamentary official publicly requested Noakes's autograph, university leaders criticized his diet advocacy; Noakes connected their opposition with grain and nutrition interests.
• Dietitians objected as patients rejected low-fat advice. A general tweet recommending low-carbohydrate, high-fat eating for children became the basis of a professional-misconduct complaint, without individualized advice to a specific mother.
• Noakes's former colleagues and the Health Professions Council of South Africa assembled a case against him amid opposition to departures from established nutrition guidelines.
• With pro bono legal assistance, Noakes underwent a 28-day hearing, spent nine days giving evidence and three days under cross-examination, and was ultimately found not guilty; the defense involved two years of intensive nutrition research.
• Lore of Nutrition emerged from that research and disciplinary process; Nina Teicholz and Zoë Harcombe supported the defense, and Dulaney used Teicholz's The Big Fat Surprise to reexamine low-fat dietary advice based on observational studies, selective evidence, and entrenched assumptions. [8][9]

Changes in Dulaney's practice and nutrition

• After a difficult 50-km race fueled by gels, Dulaney completed another 50-km race using small, regularly timed carbohydrate amounts, maintained her pace without bonking, and experienced little soreness the following day; Koutnik linked the reduced soreness to less glucose-related inflammation.
• Koutnik's explanation of insulin as a storage hormone led her to investigate whether repeated gels and high-carbohydrate meals reduced access to stored body fat.
• Her wellness practice followed fewer than 200 patients and taught low-calorie plant-based cooking; some patients initially lost weight, but she did not achieve complete diabetes remission with that dietary approach.
• Lean patients also developed abdominal fat, rising HbA1c, frequent hunger, post-meal sleepiness, and digestive symptoms; thinness and the absence of heart attacks coexisted with other metabolic concerns.
• Reducing carbohydrate on a plant-based diet also reduced protein from legumes and grains, leading her to reintroduce eggs, fish, and other animal foods after family and practice consultations.
• After reading Michael Crawford's work on DHA and the brain, she measured omega-3 profiles in herself, relatives, and patients, found very low DHA, and introduced fish or supplements to address limited conversion from flax, chia, or hemp ALA.
• Dulaney initially used Noakes's Banting green/yellow/orange/red food lists as a starting guide for patients while her own approach developed.

CGM observations during running and ultramarathons

• Continuous glucose monitoring showed that Dulaney's shaky symptoms after carbohydrates began as glucose fell from a peak, without a measured glucose low.
• She completed 267 miles over 16 days, averaging about 17 miles daily, consuming almost no carbohydrate beyond traces in an electrolyte drink, with steady energy and little cumulative soreness.
• Despite years of extensive running, fasting glucose increased to roughly 103–105 mg/dL; HbA1c reached 5.9% with insulin of 4.9, and she eventually reduced carbohydrates to under 10 g daily.
• During a 100-mile race lasting 33 hours, she consumed some carbohydrate, including a cheeseburger bun, and CGM peaks increased from about 150 to above 200 mg/dL, returning toward baseline roughly eight hours after finishing.
• Without food, morning five- or six-mile runs elevated CGM glucose to 130–150 mg/dL, occasionally 180 at higher heart rates, with one to two hours to settle; heat and greater effort coincided with larger rises.

The liver, insulin resistance, and carbohydrate balance

• Exercise-associated glucose increases can result when liver glucose output exceeds muscle uptake; glucagon, cortisol, epinephrine, and exercise intensity are possible contributors.
• Slower exercise has reduced Noakes's glucose spikes; greater exertion can coincide with increased glucose in an insulin-resistant person, although the specific mechanism is unresolved.
• Ben Bikman's alpha-cell insulin-resistance hypothesis involves abnormal glucagon release, which could explain the glucose rises and can be tested through direct glucagon measurements.
• Noakes and Philip Prins are developing a carbohydrate-balance model: daily carbohydrate is oxidized or stored, and glycogen-filled muscles are associated with higher insulin, carbohydrate oxidation, and reduced fat oxidation; related hypotheses had existed in 1970s–1980s research.
• Muscle and liver glycogen are repeatedly used rather than permanently retained; Dulaney's very-low-carbohydrate intake and regular running make excess muscle glycogen an insufficient explanation for persistent glucose spikes.
• A recent randomized comparison of ketogenic, Mediterranean, and very-low-fat plant-forward diets found the largest reductions in liver fat, de novo lipogenesis, and impaired hepatic glucose regulation with ketogenic eating at comparable weight loss. [10]
• Years of high carbohydrate intake can increase liver fat production and insulin resistance, with ketogenic eating producing the greatest hepatic improvements among the three diets.
• Dulaney suspects that some very thin long-term plant-based advocates have elevated insulin and reduced muscle; Noakes concurs that normal-range HbA1c alone cannot settle this question.
• Brain activity and stress also affect glucose control: Noakes's fasting CGM readings rose from about 5.2 to 6.2 mmol/L during a stressful period, then returned over roughly a week.

Protein, dietary fat, and ketone responses

• Dulaney, weighing about 113 pounds, consumes roughly 100 g protein daily and questions whether her protein-to-fat ratio contributes to elevated glucose despite minimal carbohydrate intake.
• Noakes experiences gradual glucose rises after protein-rich meals and invokes the nearly all-fat diets used for type 1 diabetes before insulin availability as historical examples of dietary glucose control.
• Dulaney observes a steadier glucose trace with sardines packed in oil than with less-fatty foods and experiments with greater fat relative to protein.
• Dulaney's blood ketones are often around 0.4–0.5 mmol/L in the morning and sometimes about 1.4 later; Noakes links low readings during exercise to greater ketone use and experiences higher levels with fasting and exercise.
• An exogenous ketone drink lowered Noakes's glucose by roughly 1 mmol/L; Dulaney used exogenous ketones during her 100-mile race without her familiar shaky or sleepy symptoms and observed a downward afternoon glucose trend during later use.
• Both favor testing exogenous ketones when glucose remains elevated during carbohydrate restriction, with metabolic responses varying between individuals.

Body weight, ultramarathon fueling, and ongoing work

• Dulaney's calorie-restricted plant-based approach did not produce weight loss in her severely obese patients; some patients with previously stalled weight loss are now losing weight after dietary changes.
• Substantial weight-loss cases included approximately 100 pounds in one year and 80 kg in 28 weeks for a man in Cape Town, demonstrating the magnitude of the observed changes.
• For an upcoming 100-mile race, Noakes advises that dietary fat need not be carried as exercise fuel: stored body fat supplies muscle energy, while carbohydrate during prolonged exercise serves mainly to maintain brain-accessible blood glucose.
• Ketone adaptation can increase tolerance of lower glucose without symptoms, while eating during a race can also address hunger, comfort, and morale; Arthur Newton's mid-race meals and the runners' late-race meals serve as examples.
• Collaboration with Andrew Koutnik and Philip Prins sustained Noakes's research career and the Noakes Foundation's educational work, while the dietary change renewed Dulaney's clinical practice.

References

1. [00:00] Lore of Running — https://us.humankinetics.com/products/lore-of-running-4th-edition?variant=12335071690813
2. [00:00] Waterlogged: The Serious Problem of Overhydration in Endurance Sports — https://us.humankinetics.com/products/waterlogged-epub
3. [00:01] Carbohydrate Ingestion on Exercise Metabolism and Physical Performance — https://doi.org/10.1210/endrev/bnaf038
4. [00:04] Diet, Muscle Glycogen and Physical Performance — https://doi.org/10.1111/j.1748-1716.1967.tb03720.x
5. [00:07] Water Intoxication: A Possible Complication During Endurance Exercise — https://doi.org/10.1249/00005768-198506000-00012
6. [00:08] The New Atkins for a New You — https://www.simonandschuster.com/books/The-New-Atkins-for-a-New-You/Dr-Eric-C-Westman/Atkins/9781439190272
7. [00:14] The Real Meal Revolution — https://www.quivertreepublications.com/product/the-real-meal-revolution/
8. [00:21] Lore of Nutrition: Challenging Conventional Dietary Beliefs — https://thenoakesfoundation.org/lore-of-nutrition-out-now/
9. [00:22] The Big Fat Surprise — https://www.simonandschuster.com/books/The-Big-Fat-Surprise/Nina-Teicholz/9781451624434
10. [00:41] Effect of Diet Macronutrient Content on the Cardiometabolic Response to Weight Loss: A Randomized Clinical Trial — https://doi.org/10.1016/j.cmet.2026.07.020