Six common beliefs addressed, Part 259

1. I have always had erratic meal timings because of my job. I am now diabetic even though I really do not like sugar or grains so I have never eaten them in any significant quantity making my diet relatively low carb. How could a low carb diet cause diabetes?

It wasn't the low carb diet. It was the erratic meal timings. Diabetes is not a carb disease. It is the end stage of a metabolic adaptation towards starvation. Diabetes is what occurs when you starve enough (blood glucose dysregulation) without ever dying. This starvation adaptation can occur from multiple factors. Anything that disrupts proper blood glucose regulation will eventually cause diabetes. This can be diet, medications, certain chronic conditions or also starvation.

You can't maintain proper blood glucose regulation when you have erratic meal timings. With erratic meal timings you can go an entire day without eating or not eat enough and then binge later. You need to have predictable meal timings daily in order to regulate blood glucose correctly. When you have predictable meal timings, you avoid going hungry and you avoid eating too much or not enough. That's why it's important to work with your circadian rhythms and eat properly.

Who knows how long you have been having blood glucose regulation issues and never knew about it until it became diabetes. As long as your fasting blood glucose and HbA1C levels are within the "normal" range, your doctor will not deem you as having any metabolic issue. This doesn't mean they don't exist.

Blood glucose disparities can only really be witnessed in real time. That means you would need a blood glucose meter and take readings yourself. People normally do not do this unless they are already diagnosed as diabetic. So the syndrome continues progressing from metabolic syndrome into diabetes, right under your nose.

So make sure you are following a truly low carb diet from now on, one that eliminates sugar and grains in their entirety and keep to your meal timings.

2. I was mortified to see that my endocrinologist now has a YouTube channel and is slowly subscribing to the whole "keto"/fasting fad. The last time I went to see him, he was in the office with me for about five minutes, gave me no answers and simply told me that "fasting is the best thing I can do". WTF?

Well, he won't be your doctor for long unless you're willing to dish out the big bucks when he opens his own quack practice and no insurance will accept him.

Unfortunately, a lot of doctors are realizing that the money is on YouTube, Patreon and their own subscription based websites. It certainly is not in taking insurance. So much for Medicare For All. In order for him to ask for people's money, he has to offer something different than what conventional medicine is so he must become a celebrity fasting quack.

As an endocrinologist, I am surprised he told you that the best thing you can do is fast. I am sure he knows about cortisol, glucagon, leptin, adrenaline, well.... who knows what he knows. It seems like he knows more about YouTube than anything else. All I know, and soon you will too, is that if you follow this crazy advice, your blood glucose regulation will start to fail. You can't starve blood glucose into submission just like you can't starve your fat mass to budge an inch. So I suggest you change endocrinologists pronto. Either way you will have to, when he quits his practice.

The fact that he only saw you for five minutes is another problem. You need to advocate for yourself and get better care from your doctor. You need a doctor that can keep his eyes off YouTube long enough to focus on his patients.

3. Is the science aware what obesity is? Why do they keep telling us to eat less?

The science knows but the science doesn't make good public policy so they hide and/or minimize it. Good public policy is to give people the impression they can lose weight by simply "not eating too much" because they fear the science will only give people an excuse to eat as much as they want since there is nothing they can do about their weight anyway.

This is the logic I consistently run across while researching obesity. In one sentence they will say that obesity is a leptin problem with no known cure and right after they will say they still want people to keep their "consumption" in mind. The truth is in the middle. Obesity is a leptin problem with no known cure and eating Ding Dongs, whenever you want, is not going to help it.

4. How does hyperglucagonemia help with starvation? Does the body purposely down regulate insulin release to keep blood glucose high?

It does not "down regulate insulin release", it under expresses insulin action in various tissues and organs to spare blood glucose for the brain since it believes you're under starvation. It's also sparing it to build more fat. It's simply keeping blood glucose high in circulation as you aren't truly starving but those dips in fasting blood glucose makes the body believe it is. This makes it averse to any lowering of blood glucose. Since insulin continues to be released in large amounts, it's only other option is to cause this under expression which is what insulin resistance is.

Hyperglucagonemia is simply a way of keeping blood glucose high, in the presence of insulin. It prevents insulin from lowering blood glucose to normal. Its real purpose, in a healthy human being, is to keep insulin from lowering blood glucose too low but in the person with metabolic syndrome it's just trying to keep blood glucose from lowering at all.

5. How would starvation affect blood glucose? I know that diet affects it but why would starvation?

Starvation causes an extended time in hypoglycemia. The body likes to keep its blood glucose very well regulated under a narrow range. When blood glucose goes up too high or drops down too low, outside of this tight range, the body reacts immediately. It has multiple glucoregulatory systems that will respond to any disruption in blood glucose and this system adapts. It learns. This learning causes it to proactively respond to any event that effects blood glucose. This is why you see people with metabolic syndrome/diabetes have blood glucose that goes haywire when they eat, when they fast, when they exercise, when they wake up in the morning, when they get sick or are under any stress.

Having chronic low blood glucose and/or being in a state where the body has to chronically create its own blood glucose, just to remain within a normal range, causes metabolism to up the ante on its glucose production. This will in turn rise insulin. This rise in insulin will cause more glucose to be made, as it is further reinforcing the need for more glucose. This feedback loop now feeds itself and metabolism goes into "starvation mode". This simply means it develops a high blood glucose, insulin and body fat set point to ward off starvation. This was all set into motion by the amount of "time in hypoglycemia".

This is why you have to be careful with fasting and make sure it is not extended as it will only reinforce this metabolic adaptation.

6. Can diabetes be prevented with vitamin D?

No. Diabetes is a syndrome caused when the body is no longer able to regulate its blood glucose properly. It cannot regulate its lows or its highs and this is why diabetes is not a disease of "high blood glucose". It is actually the lows that progresses the syndrome. The highs take decades to cause pathology, while the lows are pathological even when they occur once.

People with metabolic syndrome/diabetes oftentimes become low or even deficient in certain vitamins like vitamin C, D and all the Bs. This is the result of excess glucose metabolism which depletes these vitamins. Increasing these vitamins does not cure nor prevent diabetes. Only stable blood glucose regulation does.

Six common beliefs addressed, Part 258 - Snacking Edition

1. There is a lot of debate about snacking and most people do not even know what it is. What is snacking and how can I enjoy snack foods without it?

It is hard to believe how many misconceptions there are about snacking but this is typical with any aspect of diet. Most diets cannot define many of their tenets. Diets in general are a hot mess.

But this blog is different. I try to refrain from vague definitions and concessions that only confuse people further. Snacking, like fasting, has been one of those things that is always being redefined or not defined at all. Some people snack during their fast, so go figure. So let's be clear on what is meant by snacking on this blog:

• Snacking is eating out of mealtimes.

That is all. Simple and to the point. Anytime you have any food out of your mealtimes, it's snacking. Snacking is obesogenic. It doesn't matter what the snack consists of or its size. You should never eat out of meal times because it causes obesogenic eating habits.

Inconsistencies in meal times:

• Disrupt circadian rhythms which causes hunger when there shouldn't be.
• Fasts that last too long, extending your time in hypoglycemia.
• Lack of hunger when there should be, which only contributes to even longer fasting times and hunger later.

Unpredictable eating patterns are very common and most people do not think about them as being something negative but they set the stage for obesogenic behaviors such as eating the wrong foods, eating too much at once or eating too little. All of these disrupt metabolic homeostasis through improper blood glucose regulation. So no, snacking doesn't harm you because it adds calories to your day. It harms you through a chronic disruption of hormonal circadian rhythms.

You do not want to feel hungry when you shouldn't and not hungry when you should. The way to prevent this discomfort, which can ultimately affect how you eat, is by having predictable and consistent meal times. Decide a mealtime schedule that's convenient for you and fits with your daily activities. Choose between two or three meals - Breakfast and lunch or breakfast, lunch and dinner. You choose which of these you would like to be your largest meal, it doesn't matter which. Usually it's dinner but for me, for example, it's lunch.

There are many low carb "snack" foods such as olives, cheese, nuts, cold cuts, chocolate, berries and nut butters which you can incorporate into one of your meals or choose them for your smallest meal. For example you can have a charcuterie plate for lunch. This allows you to keep your favorite snack foods without actually snacking.

Six common beliefs addressed, Part 257

1. Why is some people's blood glucose so sensitive, while others aren't? For example, my friend can eat popcorn, when we go to the movies, but if I do my blood glucose takes a hit. I am not diabetic but was prediabetic at one time. I hate that I can't eat the simplest of things that others can.

Popcorn is mostly fiber, rather than glucose so it usually should not have much of an impact on blood glucose but, like I had said so many times before, blood glucose is pretty variable amongst individuals. What can cause a problem with one person, may not with another. 

This is determined by many factors such as insulin function and body composition. Once insulin function begins to deteriorate, due to blood glucose abnormalities, it becomes more difficult for the body to handle dietary glucose, even in minute amounts. When these abnormalities cause a metabolic disturbance which changes your body composition into more fat than muscle, this becomes even more difficult. The problems begin to compound until there is no one thing that is causing the issue but a combination of different things.

2. Why do some carbs not taste sweet even though they have "sugar" in them?

There are many different types of sugars. The differences are in their chemical composition. Sugars are found in all carbs. Fiber is also considered a carb but it is irrelevant.

Fructose is what tastes sweet. Glucose is what causes a rise in blood sugar. Their combinations vary, changing their ratios, depending on the food and this is what makes the difference in taste. For example, fruit has more fructose than bread. This is why fruit tastes sweet but bread does not, though they both cause a rise in blood glucose.

Sucrose, or regular table sugar, is composed of one molecule of glucose and one molecular of fructose. Like I stated above, fructose is what tastes sweet but causes no rise in blood glucose. Glucose, on the other hand, does not taste like anything but causes a rise in blood glucose. Sugar is the only food on the planet that is both a carb and a fat. This is because fructose does not rise blood glucose but causes fat accumulation in the liver. So every time you eat fructose, you are "eating" liver fat.

Both a rise in blood sugar from glucose and the accumulation of liver fat cause metabolic syndrome. This is what makes sugar particularly obesogenic, unlike any other food. That doesn't mean you cannot get metabolic disease from potatoes, which are mostly starch (glucose), or from agave syrup which is all fructose. Both of these chemical compounds, on their own, can cause metabolic syndrome just like they can together.

So, the carbs you want to avoid are both glucose and fructose, whether together or separate, not any other.

3. I have friend who has always been slim. It didn't matter how much they ate, which were enormous amounts by the way, they always remained slim regardless. I was always jealous as there was no way I could eat like they did. A few years ago they started having serious health problems and were finally diagnosed with lupus. They have ballooned to 300 lbs. during this interim. What in the world happened? I couldn't believe it when I saw them. I truly thought they would never be able to become overweight.

Blood glucose dysregulation. When the body cannot properly regulate its blood glucose, it will stop burning fat through a direct effect on leptin. Your super leptin sensitive friend just became obese, without changing a thing in their diet. This again shows how obesity is rooted in blood glucose homeostasis and not in how much you eat.

Many things can interfere with blood glucose regulation, besides diet. Chronic conditions like lupus put the body in a high state of stress. These adrenal stress hormones are trying to mitigate the uncontrolled inflammation caused by this type of auto immune condition. This puts the patient at a high risk for obesity as their body is releasing large amounts of glucose from the break down of their own muscle mass. This circulating glucose interferes with glucose homeostasis and insulin function. The person with lupus is eating chocolate cake 24/7, but from their own body rather than from the dessert bar.

Blood glucose dysregulation puts the body into starvation mode by default. In order to acquire starvation mode, the body has to down regulate leptin expression so it burns very little fat. After all, the body is trying to preserve fat in order to combat the starvation. Any increase in its metabolic rate is for the sole purpose of breaking down lean muscle mass into glucose, not the burning of body fat. The only way the body would now burn its body fat is through severe and permanent starvation, along side strenuous prolonged physical activity. Neither are recommended as they would put overall health at high risk, particularly if the person already has a condition like lupus. They would die of complications before they lost a pound.

The reason that I mention it though is to show how ridiculous eat less/move more is in the context of obesity. Instead of working harder, you have to work smarter. Do not eat less and move more, rather take control of your blood glucose regulation so you can reverse the starvation mode.

Now your friend has to take control of their lupus as best they can and watch their diet carefully in order to try and treat their obesity. After all, they don't want further blood glucose disruption through the introduction of dietary glucose. Aside from dietary glucose there are many other dietary components that can further exacerbate the immune response in certain people, compounding the effects they are already having from lupus. The more immune reactions, the more inflammation and the further stress the body will be in, making it impossible to control blood glucose.

Your friend has to be very precise so they can not only take control of their condition but also avoid the number of medications they would have to take as these also interfere in blood glucose regulation.

4. Is "keto" a good diet for hypothyroid?

We like to stick to discussions related to metabolic syndrome and not any other condition as they go beyond the scope of this blog. I don't want to be like all of these low carb advocates that are jacks of all trades and masters of none. I can only dedicate my time to researching one subject - obesity. I can help you get past the quackery though since this blog is dedicated to weeding through BS.

There are multiple factors that can cause hypothyroid. Some obese people naturally have a slow thyroid because of a hormonal profile which is dedicated to storing and sparing body fat. Others exhibit hyperthyroid instead because of a hormonal profile which is dedicated to storing and sparing body fat. This is because you can store and spare body fat by using no energy causing hypothyroid or by using a lot of energy, dedicated to storing fat, causing hyperthyroid. As you can see, obesity affects thyroid function in different ways.

This means "keto" will only help you depending on what's causing your hypothyroid. If it's an actual mechanical dysfunction of the thyroid caused by an auto immune condition or some other process, "keto" will not help you and instead possibly make your thyroid problems worse.

If your hypothyroid is being caused by active obesity, then "keto" might help you if it can halt or reverse this process, speeding up your thyroid naturally. So you have to discuss with your doctor what your actual diagnosis is so you can proceed with what's best for you.

5. Does fruit juice have vitamins and minerals?

Yes. All of them useless for you but great for the plant it came from. You can get all of your vitamins and minerals from meat without the added sugar load.

6. My fasting blood glucose always runs a bit high but my HbA1C is going down. I read on a low carb site that HbA1C was more important than blood glucose.

All markers work together in order to give you a metabolic profile. You cannot take any one individual marker and make a metabolic assessment from it. No one marker is better than any other. They all have to be used in conjunction to get the most information you can in order to assess your current metabolic state.

I don't know what "a bit high" is. I would need actual numbers. I don't know how low your HbA1C is or from how high it lowered. All I can tell you is that HbA1C is a measure of your average blood glucose in an approximate three month period. It is useful but it can also hide the fact that your blood glucose can be 300 mg/dL postprandial and then 50 mg/dL during the night time fast. After all, it's average blood glucose which takes the highest and the lowest readings to come up with a number. HbA1C also doesn't factor in red blood cell turnover rate, which tends to be slower in people following low carb causing a higher HbA1C.

This means you have to check your fasting and postprandial blood glucose at home to get a better picture of what may be going on.

Six common beliefs addressed, Part 256

1. Do you have "evidence" against the belief that the fiber in whole fresh fruit forms a barrier which causes the sugars to bypass the small intestine and instead go straight to the large intestine where it is eaten by the gut microbiome?

Yes. Eat fresh whole fruit and then use your blood glucose meter. Let me know if the sugar was eaten by your microbiome before it hit your blood stream.

2. If cigarettes and alcohol have warning labels, shouldn't candy, fruit juices and soda have them too?

You're asking the wrong person as I'm of the belief that nothing should have warning labels.

3. I read a book many years ago, that claimed "if you ate a diet of minimal fat and protein, with full complex carbs, the body would naturally reduce weight to its correct proportion for your individual needs". Is this true?

No. A correct way of saying this would be that "if you can acquire proper leptin expression, the body will naturally burn body fat to its correct proportion for your individual needs". Nothing else matters. Literally, nothing.

4. I have a friend who is lean having only 14% body fat. They have no gym membership and enjoy all of the fatty meat they can. I exercise and watch every morsel of food I intake but I cannot make any headway. My friend said that the solution is very simple - Just eliminate all sugar and grains and the problem will correct itself. Is this true?

Ask all of the people who have done just that and are also not making any headway. In fact, read the post below this one.

It is not that simple. People who are obesity resistant, meaning they have proper leptin expression, always want to make it appear very simple because it is for them. They can eat all the fat they want and remain at 14% body fat effortlessly because their set point was always 14% body fat to begin with. The lack of exercise will come back to haunt them in time but they will be able to keep their leptin expression in tact for a very long time if they can continue to preserve their blood glucose regulation. Staying away from sugar and grains is a good place to start in order to try and accomplish just that.

Unfortunately simply staying away from sugar and grains is not a magical cure for those that are already obese. The hope is that the avoidance of sugar and grains will normalize their blood glucose regulation enough to kick start their leptin but that's not guaranteed. It is the best way to go about it but it's not a magical cure. So tell your friend that the only thing that keeps them at 14% body fat is their leptin, not their simple solutions.

5. I went carnivore and have gained about 50 lbs. I have also developed neuropathy and I can't even exercise anymore because of the aches and pains. I am in the worst health of my life. I thought I was alone but I am quickly finding more people who have diligently followed this diet for several years and are facing the same issues. I am trying to find a doctor to solve this mess for me.

If you don't treat your metabolic syndrome properly, it will eventually lead to serious health complications and/or diabetes. Metabolic syndrome will not go away on its own. It is chronic and progressive, just like its end stage of diabetes.

You were sold a diet as a cure to a very complex metabolic adaptation and unfortunately, you fell for it. You were most likely not following the diet correctly and you were not monitoring your progress on it. If you are on a diet for six months and see no benefits and/or develop detriments instead, you need to stop it. Why people continue to be on the same failed protocol for years is mind boggling to me. People do this with calorie restriction all of the time as well. They keep chasing the dragon. The dragon were those initial few pounds you lost when you started which quickly reversed and were never lost again. Wake up. You will never catch the dragon.

You should have diligently researched the diet and tracked your results before you let this continue on for years on end. Most importantly, you should have researched obesity so that you would have known that your magical carnivore diet does not equate to proper blood glucose regulation or leptin expression. Unless a diet can promise you these, it is a roll of the dice. It might work or it might not or it might work for you and not for others or vice versa.

6. My endocrinologist told me that exercise was not important and it only equates to about a 3 pound loss a year. He also prescribed an injectable "weight loss" medication but when I researched it, the manufacturer clearly stated on their website that it was not intended for weight loss and worked similarly to Metformin. I am obese but not diabetic, not even prediabetic. He sent the medication to the wrong pharmacy as well and it was not even taken by my insurance, though he had verified both during my visit. It's like he's not paying attention. By the way, he emphasized fasting and is now selling supplements. I believe the pharmacy he sent the medication to is the same one making his supplements.

Good grief..... Going to the doctor lately has become akin to watching an episode of The Three Stooges. I don't know why I keep receiving these complaints lately but they seem to have become quite common. People are noticing that their doctors are becoming quacks right before their very eyes as they try to open their own "online" consultation services alongside their supplements. I don't know what's going on except that word is getting around that quackery simply pays more with less work, just like diet programs do. You will soon lose your doctor when they no longer take your insurance but will take your subscription to their website instead. Word to the wise - find another doctor ASAP. Don't let manure hit the fan before you do. At this point, you are no longer receiving adequate care.

Aside from that, I have no idea what your doctor is talking about or what his deal with exercise is. He is most likely practicing how to pander to obese clients, by promising them an easy "solution" that doesn't require them to rise their butts off their motorized carts. Who knows. All I know is that you will never obtain proper blood glucose regulation and energy flux without exercise. Period. You will not. Ever. Instead, you will forever be fiddling with your "diet" because it will forever stop working.

You can't treat a condition with incomplete protocols. Like I have said before, if you had to choose one thing because you couldn't choose both diet and exercise, then choose exercise. It just has a more overall metabolic affect than diet and research has shown this time and time again.

I can't second guess a physician over prescribed medications. I can only give you the facts, which you can also Google yourself, by the way. It seems like you already did and found out the medication is not for weight loss but for diabetes instead. The fact that you are not diabetic is most likely why your insurance will not cover it. Again, I have no clue why he described this as a "weight loss" medication, if it's not. We simply don't know what's in his mind except dollar signs. It appears that Big Pharma was more honest, in this case, than your own doctor. There is nothing you can inject to cause "weight loss". At least not while remaining healthy. Medications that play around with your insulin function will cause you further problems in the future, because you are not currently diabetic. Diabetics are at a stage where they have no choice, but you do.

I'm glad to see you are questioning everything and doing your own research because this is a perfect example of lazy medicine from a doctor who is begrudgingly at this office until he can make his escape into the profitable world of "low carb". Don't be a victim of his ambitions. Let him go down that path by himself because you need to focus on your own goals.