Six common beliefs addressed, Part 266

1. My brother started with Type II diabetes. He had been drinking 21 sodas a day for several years before it began. He had a blood sugar of almost 1k mg/dL once and was hospitalized. Before then, he had had no symptoms. He wasn't even overweight or obese. During his hospitalization they discovered that his pancreas was no longer working as it should and couldn't make enough insulin anymore on its own. So he has basically progressed to Type I diabetes. He takes insulin injections daily and has had several bouts of keto acidosis which have nearly killed him. He is losing his sight and his liver and kidneys are failing. My brother cannot seem to get used to a healthy diet, which would help him tremendously. It's as if he doesn't understand what a healthy diet even is. For instance, he threw out the Debbie Snacks and Crispy Creme Donuts but kept the oatmeal with honey. For him that is a "healthy" choice. I don't know how to help him anymore.

Unfortunately, your brother is the victim of the pervasive misconception people have about diet and what's "healthy".

Oatmeal and honey are junk. But because oatmeal and honey are not a "highly processed", "fat loaded", "junk food", they are automatically put into the healthy category. I had written a post before stating that healthy is not "natural" nor "organic" nor "plant based" nor "low calorie". Healthy is only and exclusively a macronutrient profile that does not disrupt your blood glucose regulation. That's it. Blood glucose regulation is the only metric for what's healthy or not.

So the only way you can help your brother is by making him think of food in a completely different way. Healthy eating is not about "over consumption" or if food is "ultra processed" or "nutrient void". It's solely about how your blood glucose is affected because ultimately, that's all that matters.

2. I went on low carb in my forties and it caused me to lose my period for two months. I felt the best I have ever felt in my life. My period returned later and I have lost the energy and vitality I felt during that time. What happened?

I went through a four month bout of amenorrhea (loss of menstruation), when I started "keto", in my mid forties. Do not let the fact go over your head that the term "amenorrhea" starts with "amen". Amen indeed. I also felt better than I had ever felt before in my life. I had energy to spare. I even had certain lab markers, like my ANA (Antinuclear Antibody Test), which always would come back abnormal, completely normalize during this time. Unfortunately, my period returned and with it went my four month bliss streak and my normal ANA.

This is a controversial topic and I am not a doctor. I can only tell you what I know from what I have read and my own experience as a woman. Menstruating into your late forties and fifties is not a good thing. The toll hormonal imbalances cause on your body is dire to your well being. Perimenopause has caused me migraine with multiple different types of auras, cognitive issues and problems with my autonomic nervous system (dysautonomia). It's not fun and these issues can affect how you can treat your metabolic condition because they can very well impact your diet, exercise routine and systemic stress levels.

When you go on a low carb/"keto" diet and lose a large amount of body fat it can cause amenorrhea. Amenorrhea happens when the body goes through what it perceives as stress. Loss of body fat is stressful for the body. It doesn't want to lose it, particularly if you are a woman. Amenorrhea may be a bad thing for young women in their child bearing years but for many women like us, in our forties and fifties, it's a god send. Amenorrhea basically halts the hormonal onslaught that your body is going through during perimenopause. This is what causes an increase in energy and general well being. Once menstruation starts again, you can kiss those benefits goodbye.

There is nothing you can do about this. Your body was not going to keep losing body fat indefinitely. That was going to stop at some point and of course leptin was going to cause body fat to start increasing again. This makes the body feel safe to continue with menstruation and it will not stop until you finally reach menopause.

Menstruation is still considered the greatest thing that can happen to a woman so you will not find solutions for this in conventional medicine. If anything, they will try and pump you full of more hormones once menopause begins but for some women like us, menopause is the best thing that can happen to us. We just have to keep waiting for it.

3. I sometimes like to search diet and weight loss content on YouTube and I came across a channel where a fit guy was talking about "ultra processed" foods and giving stats on obesity and activity levels in Europe compared to the United States. Is any of this information relevant for weight loss?

History has told us it isn't.

First, lifestyle differences will absolutely affect a "lifestyle condition" like obesity so there are going to be regional differences in obesity statistics. That tells us nothing about the already obese. As long as you remain in the region, you are already in, you will most likely continue with the lifestyle you are accustomed to. The transit system, city planning, culture and amount of free time in your region are all designed to keep you in the same metabolic state you are already in. So these stats are useless for treatment. The only thing we know about the already obese, regardless of region, is that they remain obese.

Second, people like this fit athlete on YouTube have been expounding the dire effects of "processed foods", and now the new phrase "ultra processed" foods, to no avail. I only have one question for them - prove it. Prove that eating Twinkies has a worse outcome than eating yogurt. They can't because it was already done. People have lost weight on the Twinkie Diet and have remained obese on the yogurt one.

Obesity is not about processed foods, it's about blood glucose regulation. Like I have stated before, this is why someone can lose weight on the Twinkie Diet and someone can gain weight on yogurt. Blood glucose regulation reigns supreme as the determiner of what happens to your weight and many things affect it, including calorie restriction. So eating Twinkies, with enough calorie restriction, causes weight loss because it temporarily affects blood glucose, which lowers insulin and off comes all that water weight. But it takes a more sustained and prolonged effect on blood glucose to go beyond that and get to fat loss. That's why calorie restriction has been such a failure. It simply never reaches this sustained prolonged effect.

Eliminating "processed foods" is beneficial because it:

• Prevents snacking.
• Lowers fat and carb intake, particularly vegetable oils and sugar which are more detrimental to metabolism than other fats and carbs.
• Increases protein intake.

That's it. Those are the only three beneficial reasons, which by themselves mean nothing, but together help support healthy blood glucose control.

Not even the supposedly "nutrition void" claim of processed foods have been an issue since no one has developed beriberi from eating too many Snickers bars. There is nothing inherently evil in "ultra processed" foods. They simply negatively affect your overall eating habits and macronutrient composition which ultimately effects blood glucose regulation over time.

4. I buy plain, full fat yogurt but I wish I could eat it with granola. Is there a granola brand out there that's truly low carb friendly? I haven't found any at my store.

You will have to go to Amazon in order to find sugar free/grain free granola unless you have a specialty market in your area. As with all good quality products, it will be more expensive than conventional options. The best brand is Lakanto. They have several varieties of sugar free/grain free granola.

Stay away from cheap brands. Many cheaper choices advertise that they do not have any "added sugar" but no "added sugar" is very different from "sugar free". The brands with no added sugar do not add granulated sugar to their product but load it with dates or raisins instead, which is all sugar. Sugar by any other name..... You also want grain free granola because if the granola is loaded with whole wheat, oats or other cheap grains then you are still eating sugar by proxy.

When it comes to this type of stuff, price can tell you a lot. The cheaper it is, the more cheap ingredients it contains. Dried fruits and grains are very cheap so don't let the "organic", "healthy", "no added sugar", etc. label fool you. Low carb granola is sugar free and instead of cheap grains and dried fruits it's made of expensive nuts and seeds.

5. I'm sorry, this might be awkward because it's not really a question but I just need to get it off my chest. I was so disappointed and kind of depressed the other day when I went for coffee. I had forgotten to bring my special low carb nut bar with me, so I couldn't have anything with my coffee. I grabbed my plain, black, decaf coffee, because God forbid it be anything else, and put half and half in it. I was about to go and sit down when a woman behind me, slim as a rail, grabbed her specialty coffee and poured brown sugar into it. She then took her pastry and happily left with her coffee. She wasn't even a young woman. I sacrifice so much and still look like the average middle aged, slightly overweight woman who has the same health conditions as someone who goes to the Dunkin' Donuts daily. I don't look like Taylor Swift and I am certainly not slim nor healthy. Sometimes I swear the juice is not worth the squeeze.

All I can say is that I am sorry you are going through this or better yet, I am sorry you are realizing this because it was always there. The truth was just hidden from you because the diet/health industry is always selling you false treatments to what ails you. Not eating that cookie, will not make you slim, like the diet mongers promise you. Not eating it will simply not contribute to you getting fatter. You might still get fatter though, just not off the cookie. That is the hard truth. So the sacrifice gains you nothing. It simply removes one more thing from the table that can make you worse. The table is still full.

Nothing makes sense when it comes to obesity if you do not understand it's root cause. Until then, you will be forever left with the nagging and all to familiar questions - "Why do I sacrifice so much and get so little in return, while this brown sugar eating woman sacrifices nothing and has everything? If it's true what the diet/health industry is selling me, then how can a person like her even exist?" Because what they are selling you is not true. A perfect diet is not the potion for looking like Taylor Swift.

The truth only lies in blood glucose regulation. Who has it, who doesn't, who keeps it and who loses it. That's it. In all of obesity research its only consistent parameter, regardless of diet followed, is blood glucose regulation. Those who don't have it become obese and/or diabetic, those who do have it continue eating as they want while looking and feeling great. This means that in the vast majority of people diet is only a catalyst to an already existing hardwired problem.

Some people have a stress response that is honed and tuned to overreact to any dysregulation in their blood glucose, furthering its dysregulation over time. Chronic conditions, hormonal changes, systemic stress, age, injuries, metabolic shifts, etc. all cause them to create more glucose than normal and this slowly but surely deteriorates their insulin function over time. Certain lifestyle factors only exacerbate this further. This is why lifestyle factors can be corrected, but results are never guaranteed.

When you hear someone speak of obesity and "genetics" this is what they are referring to. It's in reference to the ability to retain your blood glucose regulation. Once it's lost, many systems in the body shift to accommodate its abnormality. This includes fat cells, mitochondrial function, glucoregulatory feedback loops, energy flux, etc. All these systems now work to make and keep you obese in response to your blood glucose. All of this doesn't even take into account how epigenetics affects insulin function, in the presence of blood glucose abnormalities, on such an individualized basis.

Lifestyle factors like diet are only palliative treatments for this condition. The condition persists through factors you can't control like simply becoming middle aged. The woman you saw was able to keep her blood glucose regulation intact for much longer than you were. Her insulin release/expression did not become abnormalized even if her blood glucose was not always in perfect homeostasis. Being middle aged has not affected this for her. Consuming brown sugar has not affected this for her. Whether she will ever be affected remains to be seen and only time will tell. She might die of something else well before we ever know for sure. As of right now, she is good to go. She didn't do anything magical and you didn't do anything wrong.

Now in order to determine if the "juice is worth the squeeze", you have to determine if what you are doing is effective and sustainable or not. Most importantly is it effective and sustainable for the long term. For example, if avoiding diet soda keeps my blood glucose under 140 mg/dL but drinking it keeps my blood glucose under 140 mg/dL then maybe the avoidance of diet soda is a hill that's not worth dying on. Some of these low carb people persist in thinking that the lower they can keep the carbs and the cleaner they can make the diet, then the better their outcomes will be but that's not true as they continue being obese and diabetic at 0 carbs. 'The Law of Diminished Returns' is always against us. There is only so much you can put into something until the returns become 0. That's when you start sacrificing a lot for nothing. That's what a lot of these low carb people do. They avoid the apple while still living off Metformin and remaining obese. Consuming the apple would have made 0 difference so they are torturing themselves for nothing. You very well could have found another bar or something else to eat with your coffee that would have also made 0 difference.

Don't make your life miserable because that will have you give up the lifestyle factors that are truly helpful in controlling the condition. Just because diet is palliative does not mean it's useless. Controlling your diet, controls the assault on your blood glucose regulation but only up to a certain point. You need to determine what that point is, so you don't burden yourself going beyond it. Revisit what you are doing and make sure that it is targeted and still effective.

6. My brother passed away last year at 715 lbs. He would eat massive amounts of food and would become aggressive if it was taken away. There would always be fast food bags littered all over the floor of his home. Two years before his death, he enrolled in a "fat farm" program which helped him lose 90 lbs. by eating mostly salads and vegetables. Once out of the program he gained 300 lbs. He lost his ability to move or take care of himself. Last year, he finally stopped breathing and died in my arms at only 26 years old. I read your blog in hopes of preventing his children from meeting this same fate. I am scared they are at risk since most of our family is overweight. No one is obese or as big as my brother had been but we tend to not be slim. Is my concern unfounded? What went wrong with my brother?

I am sorry for your loss.

Unfortunately, your brother was a victim of himself and the failed treatments they tried on him. They never really gave him a fighting chance because he never knew what was truly wrong with him. If you don't know what's wrong, then you can't treat it correctly.

"Fat farms" are notorious for using the failed calories in/calories out (CICO) approach for treating obesity. Hence all the salads and vegetables as they are "low calorie". We have seen this in popular shows like 'The Biggest Loser'. We have also seen how this practice has been the biggest failure, over and over again. Even the man who fasted for a year straight, and became slim under a blanket of skin, still died.

Basically using any starvation approach only causes the body to double down on its obesity over time and this is why your brother gained back 300 lbs. after only losing 90. This shows how his leptin was resistant to accept any starvation. Obesity is not an "in (eating) / out (burning)" problem. It is specifically an "out (burning)" problem. This is why obesity is a starvation adaptation and more starvation only reinforces it.

Of course your brother ate massive amounts of food. It takes a lot of energy to keep up with being 700+ lbs. This massive intake of food dysregulated his already abnormal blood glucose control. This is particularly true with the types of foods he was eating. Fast food is notorious for having a macronutrient profile that disrupts blood glucose.

I don't know what could have helped your brother because there is a lot of behavioral issues that had to be addressed and modified. No one could do those for him, but himself. What I can tell you is that it would have been extremely helpful for him to understand obesity and what caused it. Maybe it would have prevented him from feeling so helpless.

Most of the reluctance the obese have to diet modifications and/or other treatments is that they never work. They start feeling like nothing will ever work and they get scared of yet another failure. They start to give up. If your brother was given useful tools, like checking his blood glucose and targeting its regulation, rather than useless tools like targeting calories and checking their amounts, he would have had something to work with. If he would have been told that the weight he lost at that fat farm was mostly water and muscle and he would then gain back three times that amount as body fat, he would have understood that he needed to do much more than just eat salads to treat his condition. If he would have been helped to target the offending foods, rather than the calories in them, he would have been able to modify his diet effectively and without resistance. But he wasn't given any of these options. He was lied to.

His children are absolutely at risk for the development of intractable obesity. Not solely because they might have the same eating habits as your brother did but because fat cells are inherited from your parents and your brother's fat cells were particularly leptin resistant and insulin sensitive. They also seem to inherit their parent's insulin function. Children of obese parents start experiencing glucose abnormalities even at very young ages and fetuses of obese mothers are already producing higher than normal insulin while still in the womb. 

You are correct in being concerned. You have to be diligent in keeping the children's eating habits and their diet with foods that cause as little blood glucose dysregulation as possible. They have to keep a close eye on their blood glucose control. They also need to stay active to ensure their leptin keeps energy flux moving. They will simply have to do more than the average person to maintain a normal weight.

Six common beliefs addressed, Part 265

1. I started "keto" a few years ago. The consumption of saturated fat caused my LDL cholesterol to sky rocket so I took your advice and replaced all of the saturated fat from my diet with monounsaturated fats. My cholesterol dropped but for some reason, it has never lowered to what it was when I was consuming "vegetable oils". I don't understand this. Why would avocado and olive oils keep my cholesterol more elevated than corn or canola?

This is a very interesting question and I can relate to it as it has happened to me. For people who have genetic lipid profiles that are sensitive to diet, like myself, cholesterol can sky rocket when we consume saturated fats, particularly coconut oil.

When I started "keto" many years ago, my naturally high cholesterol of 210 rose to 650. I dropped the saturated fat from my diet and replaced it with monounsaturated fats and my cholesterol lowered but only to 320. After some years of only consuming monounsaturated fats, my cholesterol continues to consistently be in the 300+ range and never lowered to the 200+ range it was before when I was obese and consuming seed oils. What's going on?

Well, good luck finding the answer. No one will tell you as lipids are very complex and behave differently in everyone. Not only that, surprisingly so, we don't know much about lipids and their function. They are still quite mysterious. For this reason, the layman's usual answer is that it has to do with your HDL. A rise in HDL causes a rise in your total cholesterol and HDL levels rise dramatically with the intake of saturated fats. HDL also lowers significantly when saturated fats are restricted. But, the issue we are having is not totally explained by this phenomenon as it is not just total cholesterol that is being affected, we are talking specifically about LDL. Why doesn't LDL lower as much with avocado and olive oil, is it would with corn and canola? 

I think I can give you an answer because your doctor won't give you a thing. Well except a statin, which you may or may not need. Now, I am not a doctor or lipidologist but I still kind of have a possible answer that explains this conundrum.

Many years ago, when I did extensive research on cholesterol, by going through many lipidology papers, I came across an interesting tidbit of information. Don't hold me as to what this paper was titled or who wrote it since, like I mentioned, this was years ago. I just know the information in it stood out because I found it quite fascinating and later on, saw the effects in myself. The lipidologist who wrote this paper stated that seed oils, didn't just keep your cholesterol from rising, they actively lowered it. How though? Well, he explained it was through smoke and mirrors. Basically, it's an issue with how LDL is measured in a lab.

Seed oils simply contribute to the oxidation of LDL and lipid panels do not measure oxidized LDL unless you do an actual oxidized LDL test. This means that this "lowering of cholesterol" is simply all of the oxidized LDL the test did not measure. Oxidized LDL is not good. The more LDL you produce, the more chances of it becoming oxidized so you want to prevent oxidative stress to your lipids by not smoking, not consuming "vegetable oils" and taking vitamin E. Vitamin E is a powerful lipid anti-oxidant and when taken in high doses, it has been shown to actually prevent heart disease. Nothing else has. This is why it's so surprising to me that cardiologists do not prescribe vitamin E to their cardiac patients and/or people at risk.

What does this all mean, though? It means that my cholesterol of 210 was never truly 210. It was always 320, it's just that the difference was oxidized and I had much lower HDL. That's a pretty large percentage of oxidized LDL. This was a ground breaking paper that of course, is never mentioned, but it shows how you can have very low cholesterol and still drop dead of a heart attack because most of it is oxidized LDL and poor levels of HDL.

So, your cholesterol will never be as low as it would be on canola oil but it doesn't matter because it is healthier than it would be on canola oil. The amount of cholesterol is not what matters. It's the health of your cholesterol that ultimately decides your fate.

2. A "keto" group I belong to says that if a person's insulin is 5.6 they don't need Metformin any more because they are cured of diabetes as long as they eat "keto". Is this true?

Insulin levels are not a marker of diabetes. Insulin function (insulin resistance) is and this does not always correlate to serum levels of insulin. Oftentimes, insulin will become high (hyperinsulinemia) due to this resistance but this is not always the case in all individuals. There are many diabetics with normal to low insulin levels but they still have resistance. I don't know what group is spreading this asinine information, but you need to stop going to it.

As far as Metformin is concerned, it is not prescribed for hyperinsulinemia. It is prescribed for the management of diabetes. Only your doctor can decide if you no longer need to be on Metformin but usually Metformin is the medication that is last to go, or never removed, as there is no known cure for diabetes. You can only manage the disease. If you are able to get off every medication and only stay on Metformin, that's still a win even if you aren't "cured" of diabetes. The better you can manage diabetes, the better your outcome because you delay or eliminate the onset of its pathologies.

3. I am vitamin B12 deficient and have been getting supplement shots but when I was recently tested it showed that my B12 serum levels were still on the low end and my intercellular B12 was non-existent. Basically I am still deficient even after months of getting shots. What's happening?

I am not a nutritionist nor a dietitian so you need to speak to a professional in order to get proper answers for your individual issues but I can throw in my two cents anyway so you have something further to discuss with your healthcare provider.

First, I am happy to see you are testing intercellularly. I am sure you are paying out of pocket for that test since it's usually not covered by insurance but it's truly the only way to know if your supplementation is getting into the cells where it's needed. You don't need B12 in your serum, you need it in the cell. Unfortunately, some labs are no longer even offering this type of test.

Second, B12 requires adequate amounts of vitamin B6. Without B6, B12 does not go into the cells. So if you are deficient in B12, you are probably deficient in B6 since usually being deficient in one B vitamin, means you are deficient in them all. You need to take 200 - 800 MG of vitamin B6 a day. Keep in mind there are two forms of vitamin B6. Pyridoxine HCL, which is the most commonly used version in over the counter vitamins, can become toxic as it accumulates in the body. This can cause issues over time so you want to take pyridoxal-5-phosphate which is safe to supplement with because it does not accumulate, even at very high doses.

Third, I hate to break this to you but the B12 shot your insurance pays for is not the bioavailable form of B12. The shot version is cyanocobalamin, a plant based B12. You only absorb a minuscule amount because it is not the animal based B12 we require which the body identifies. The best B12 supplementation is methylcobalamin, hydroxocobalamin or adenosylcobalamin in sublingual form. You should take 5k - 10k mcg a day or whatever your doctor recommends. You can get this form of B12 as a shot as well but it only comes in multi-use vials which cannot be used at the pharmacy or any other place that injects you. You would have to learn to inject yourself or have a private nurse inject you.

"Gina, how and why do you know all this crap?" Well, because I have high myopia and have been supplementing with B12 for a long time since the nerve in my eyes are abnormal and put me at risk for glaucoma. Also, JC has celiac disease and has to supplement with B12 as he has a deficiency. For this reason, we have had to do extensive research on this particular vitamin to ensure we are supplementing correctly. It is vitally important that if you are deficient in vitamin B12, that you supplement correctly because not addressing this deficiency can cause irreparable damage to your health.

4. My husband has been diagnosed with Type II diabetes. He had been feeling unwell for a very long time and then suddenly went blind for five minutes. He went to the ER and his blood glucose was 700+ mg/dL. His kidneys and liver had started to fail. He recovered and is now on insulin and has to check his blood glucose daily. My husband is not overweight or obese. We are still relatively young, in our 40's. He believes a healthy diet is low in meat and calorie restricted. We are Mexican so he is missing his traditional meat-based meals and complains often. His approach to his illness is to eat a doughnut if his blood glucose is "good". I don't know what to do.

I am sorry to say that their isn't much you can do but try to educate him on what diabetes is, its causes and its management. He either takes that information seriously, and implements it, or he doesn't.

A lot of what is occurring here has to do with simply misunderstanding the condition. This is not uncommon. Most diabetics are unable to make the lifestyle changes they require because they simply don't fully understand what's happening to them. They are either getting wrong or incomplete information from dietitians, nutritionists, their doctors and even the media. They are not asking the right questions nor seeking approaches outside of the Standard of Care.

Your husband's approach to his condition is pretty much the norm. I have seen many diabetics who check their blood glucose, see it's not as high as usual, so they reward themselves with a brownie. This myopic view of giving so much credence to isolated blood glucose readings is detrimental for the diabetic. The low carb people do something similar with their obsession over postprandial blood glucose readings. They also try to manage their diabetes with individual food items. That is not going to work.

Diabetes is not a disease of any single blood glucose reading or what food made that single reading go up or down. It is a condition of overall blood glucose regulation which includes what happens when you aren't eating. It is also not a disease of high blood glucose. Blood glucose lows are just as bad as the highs, if not worse, since it's the lows that set the stage for the condition.

You can give your husband the link to my blog so he does a little research and gets better information. This will help him make better decisions. There should be no reason he has to give up any meat-based Mexican recipes that he is used to. What he decides to do depends on how seriously he is taking his condition and how invested he is in trying to manage it. It also depends on how open he is to approaching his situation in a non-conventional way.

5. Why does caffeine in diet drinks help weight loss but is complicit in fat gain? How can it work both ways?

Because it depends on the metabolic state of who is taking it. Remember, fat gain or loss is completely at the mercy of your neuroendocrine state.

Caffeine is a stimulant that has long been used in diet products to increase metabolic rate before Fen-Phen was a thing. Many people have found benefits in it particularly if they just need to lose a few pounds. Our threshold for what is deemed overweight/obesity has certainly changed through the years. Seemingly slim women were binging on caffeine diet products in the 80s. Those same women are most likely obese today.

Chronic, long term use of caffeine always ends up in metabolic problems. You cannot regulate blood glucose properly as long as you're intaking caffeine. I have said before that you would be surprised to know how many diabetics caffeine has made, yet it always falls under the radar and people keep consuming it. Once you crossover to metabolic syndrome, caffeine becomes even more detrimental. Stimulants further interfere with the already failing blood glucose regulation of people with metabolic syndrome. This only sets the stage for further fat storage and sparing.

For this reason, we do not recommend any caffeine intake, from any source. You should be on a zero caffeine diet. Caffeine should be treated the same as sugar because they both have the same effect on your metabolism, so eliminating one and not the other will not work.

6. I have a cousin who has diabetes insipidus. Will going low carb reverse it? People in low carb groups seem to believe so.

Diabetes insipidus and diabetes mellitus (Type II diabetes) are two distinct conditions with different causes and treatments. They share the name “diabetes” because they both cause increased thirst and frequent urination but they are not related.

Diabetes insipidus is caused by problems with a hormone called vasopressin, which is the anti diuretic hormone that plays a key role in regulating the amount of fluid in the body. Disease or damage to the pituitary gland or hypothalamus, where this hormone is produced, can cause this condition. It can also be the result of heredity. This is a very rare condition but can be life threatening if not managed properly.

Your cousin needs to consult their doctor about any diet changes, particularly before going low carb since insulin is an anti diuretic and lowering it can result in the release of water from the body. This can result in complications if you have diabetes insipidus. This diuretic effect of lowering insulin can also interfere with any medications that your cousin is taking to manage this condition.

Diabetes insipidus cannot be "reversed" and has no known "cure" so be careful with whatever they are telling you in low carb groups. They might be confusing "diabetes in situ" or "occult diabetes" with diabetes insipidus. Diabetes in situ is simply a term coined by Dr. Joseph Kraft to describe the changes in insulin expression, he witnessed in his research, years before the onset of diabetes mellitus. These low carb groups are not very well versed in diabetes and often spew out misinformation about the condition. They are usually run by volunteers who have 0 knowledge of what they are talking about and they don't even do the research themselves to offer better help. Remember, anyone can open a Facebook group or page about any topic they want.

Six common beliefs addressed, Part 264

1. I've decided to stop taking collagen. I'm trying to determine if protein is contributing to my "leptin resistance".

Protein has nothing to do with "leptin resistance". Collagen is not even a complete protein....SMH

Poor leptin expression is very complex and still being studied as very little is known of its exact mechanism. What we do know is what contributes to it. It occurs through metabolic dysregulation, mainly the cross-talk with insulin, as leptin is a slave to insulin. Hypothalamic dysfunction caused by chronic obesity and excess "sweet taste", not to mention the effects of being sedentary on adipocytes (fat cells) through leptin/adiponectin ratios, all affect leptin expression.

So we know metabolic hormones, the brain and adipocytes are all involved in leptin function. Unlike insulin, leptin is completely regulated by the state of your neuroendocrine system, not by any one external force. This is why there is no "leptin diet". The closest we have to a "leptin diet" is a protein sparing modified fast and a good enough amount of exercise because both of these affect your neuroendocrine state. There is also no "leptin pill" as serum leptin levels have nothing to do with its expression on the adipocytes and brain.

Aside from that, what makes you think you are "leptin resistant" anyway? Just because you are overweight/obese does not automatically make you "leptin resistant". You could just have temporary under expressed leptin until you correct the lifestyle factors that are contributing to your poor metabolic state. Intractable obesity would be more commonly considered as "leptin resistance".

Ugh, the low carb world just went from insulin to leptin, got them both wrong, and not one pound lost.

2. I go out shopping daily so I "make my steps" while walking around Walmart. Does this count as walking?

No. "Making steps" is not exercising.

You would be surprised how many steps an overweight/obese person can make from walking a very short distance. In fact, they can make 10K steps from just walking from their car to the front door of the Walmart. I remember when I started walking, I hit a milestone of 35K steps from walking a route I now make only 12K steps on. How is this possible, if it's the same route?

Because people who are in generally poor health, have a very short stride. They simply take more steps to cross the same distance compared to a healthy person. It has been harder for my husband JC, to improve his health compared to me and I can see this clearly in his stride. As we walk, he takes two additional steps for every one of mine. When we are both done walking and compare our pedometers, he always has about 900 more steps than me, though we both walked the same route together. So pedometers can be deceiving and must be used as a rough guide only. Just because you are "making your steps" doesn't mean you are exercising enough or as frequently as you should.

As my health improved, it started becoming harder and harder to make 10K steps on the routes that would give me 20+K steps before. I have been unable to surpass or even duplicate those 35K steps. For this reason, counting steps are great for a beginner but you can't remain there and they certainly won't work very well for a healthier person. A healthier person must change their walking goals to miles, rather than steps. You can also use "hours active" to monitor daily activity levels.

You have to "walk for exercise", which means exertion. Your walking routine should increase heart rate and make you feel as though you're getting a work out. Walking for exercise is not a stroll and it's non-stop until the goal is reached. Make your steps count.

3. I have a friend who was recently diagnosed as diabetic. They are not overweight/obese and have a history of working out. They suddenly ended up in the hospital last week with kidney problems from diabetes. How could diabetes do this to them so quickly and suddenly?

This is the unfortunate reality of Type II diabetes. It is quite insidious.

First, many diabetes cases are diagnosed late. This means that the person has had serious blood glucose abnormalities for a very long time before the diagnosis is made. This is because diabetes really does not have any symptoms, or just a few common mild symptoms, until a complication arises.

I have mentioned before how my husband's coworker had blurry vision for years. They complained constantly that none of the glasses they ever bought helped. They then passed out one day, on the job, and were taken to the hospital to find out they were a full blown diabetic and nearly went into a coma from a sudden rise in blood glucose. Once their diabetes was treated, their vision was no longer blurry. Of course, the damage the diabetes has caused on their body cannot be reversed.

The same happened to my friend, who also passed out at her job from a dangerous rise in blood pressure. Turns out that blood pressure rise was associated to uncontrolled diabetes, which she was unaware she had.

Even if you go to the doctor and have a yearly physical, understand that the metabolic panel ordered, only tests for fasting blood glucose which is many times low for diabetics. In fact, a lot of diabetics will have incredibly low blood glucose numbers while fasting. Diabetes is a syndrome. It does not manifest the same for any two individuals, even if there are some common symptoms. For some diabetics, their blood glucose is always high but for others, that rise is not constant and there is an equal sudden low.

This is what happened to my husband's best friend's brother. He died in his car from a drop in blood glucose because he was an undiagnosed diabetic. He simply felt sleepy, pulled over to take a nap and never woke up. This was a young man in his twenties who was not overweight/obese.

This is why I tell my readers, over and over, that diabetes is not high blood glucose so lowering your blood glucose, will not help. Diabetes is the result of abnormal blood glucose regulation. That means blood glucose can go very high or very low but it's never normal. These highs and lows are dangerous and cause pathology. The lows are particularly malignant because they not only reinforce the condition and continue making blood glucose set points too high, but they can cause sudden death to boot as most metabolic syndrome/diabetes sufferers do not feel hypoglycemic symptoms.

What does this all mean for your friend? This means that this erratic blood glucose is causing abnormal insulin expression because insulin is a slave to blood glucose. Hyperinsulinemia is extremely pathological to the kidneys. High blood glucose is pathological to the kidneys as well by overworking them. All of this sets the stage for kidney disease, a very common diabetes complication and it doesn't take long for this to occur. You can already experience impaired kidney function while simply having metabolic syndrome.

Metabolic syndrome causes high blood pressure and this is detrimental to the kidneys as well. Certain ethnicities are more susceptible to this. Native Americans and other Native Peoples of Central and South America are experiencing an epidemic of kidney disease caused by diabetes. For genetic reasons, they manifest very high insulin resistance in response to blood glucose abnormalities and as I've stated before, insulin resistance is notorious for causing renal disease. So diabetes even manifests differently in different genetic lineages.

Everyone has to understand that abnormalities in blood glucose regulation is a silent killer. By the time you are diagnosed with diabetes, you are at the end stage of metabolic disease. You will also most likely be diagnosed during a serious health crisis caused by the syndrome.

Do you want to be diagnosed sooner? Buy a blood glucose meter. You no longer need a prescription to get one in the United States. You just have to pay out of pocket for it but they are quite inexpensive now. Check your morning fasting blood glucose and then check your postprandial blood glucose, two hours after the largest meal. Do this for ten days straight and see your results. High disparities between fasting and postprandial blood glucose of more than 40 points, even without hyper/hypoglycemic numbers, means you are at risk for developing diabetes. Now you can do something about it rather than waiting for it to happen.

4. Should I restrict protein to get rid of eye floaters? I am on "keto" and was told that the restriction of protein could help with this.

This question has nothing to do with metabolic health but again, I am going to address it because it is in the context of diet. Unfortunately, low carb diets are riddled with this type of nonsense. Like I have stated many times before, low carb diets are only a palliative treatment for metabolic syndrome. They are not meant to "cure" anything. They don't even cure metabolic syndrome!

Ketogenic protocols for the treatment of metabolic syndrome, fall under the umbrella of low carb diets. Often described online as "keto" diets, there are several iterations of them but the only legitimate ones are ones that do not restrict protein. There is no need to restrict protein on ketogenic protocols whose goal is better metabolic function.

Eye floaters are spots in your vision. They may look like black or gray dots but can also look like strings or cobwebs. They drift when you move your eyes and dart away when you try to look at them directly. Most eye floaters are caused by changes that occur as the jelly-like substance (vitreous) inside your eyes liquefies and contracts. Scattered clumps of collagen fibers form within the vitreous and can cast tiny shadows on your retina. The shadows you see are called "floaters".

This has nothing to do with dietary protein unless you plan on making your vitreous out of some other material that is not protein. Your body is already made of fat and protein and your diet will not change that. Eating water bottles will not make you into plastic. Not eating fat and protein will not turn you into gold or some other material. You will still be fat and protein. This is pretty much common sense. Even if you were to restrict all protein, your body will break down its own lean muscle mass and so the floaters will continue.

Some people see more floaters than others. I have high myopia and will occasionally have bouts of many floaters. Usually the more vigilant of them you are, the more you are apt to see them. Age greatly affects the amount of floaters you will experience so the older you get, the more floaters you will see.

Sometimes floaters can be a sign of a retinal tear so if you see many of them and they are accompanied by flashing lights, it's time to see a doctor. Particularly if you have had a recent head/face trauma. Protein restriction will not repair or reattach your retina. You would need emergency surgery instead.

5. I am trying to eat healthier so I bought a "healthy" butternut squash soup that tasted like sewer water. It had wholesome ingredients though. Why do healthy things taste like %^&*?

Yes.......yes they do taste like that. They either taste like crap or have the wrong texture or simply don't hold up to the real thing. This is usually what occurs when you take something that has been perfected already and try to make it out of something else.

I always laugh at these health zealots when they claim there are "so many delicious healthy" foods. I am sure there are but none of them are fried chicken and waffles. This means you have to leave the chicken and waffles behind because they won't taste the same made "healthy". Just enjoy naturally delicious healthy foods like baby back ribs. I'm sorry, but that's just how it is.

It's hard to find creamy soups like butternut squash in the "healthy aisle" as that usually means low fat and/or low carb. Butternut squash soup is neither. Even if you make it yourself at home to avoid the fillers, gluten and MSG, it still requires butternut squash (carb) and coconut milk or cream (fat). For some, the seasoning for it is brown sugar and/or maple syrup (more carbs). You probably found an iteration made with bone broth instead in order for it to be healthy. Well, you just found out there's nothing like the real thing, baby because fake stuff sucks.

I recommend you stay away from constantly trying to recreate items you can no longer eat. A lot of these "healthy" soups or other food items remove the ingredients that make the original so good. If you take away a model's beautiful long hair, fit body, young age and symmetrical facial structure, you end up with me. Can you truly say I'm still a model? No. Not if you're being honest.

So when you take away the sugar, dairy, wheat and MSG from your favorite staples, can you truly say they are the same? No. They aren't.

6. Can I drink mineral water instead of electrolytes?

All water, except for distilled water, contains electrolytes. Mineral water generally has more electrolytes than tap water so you can consume it if you wish, since it is cheaper than electrolyte mixes.

We get most of our electrolytes from food. The body usually keeps its electrolytes tightly regulated. There are some exceptions though and this is why we emphasize the importance of electrolytes on this blog.

When you follow low carb/"keto" diets, your insulin naturally lowers. Changes in insulin levels have an impact on serum electrolyte levels. This is why they usually mix sugar in with electrolytes. You see this in the electrolyte IVs they give at the hospital and also in many "sports drinks". Sugar facilitates electrolyte entry into cells by raising insulin. On a side note, many diabetics are in a constant state of mild "dehydration" because of insulin resistance.

Insulin is also an anti-diuretic so when it lowers, you will naturally release more water from your body and this can cause imbalances in electrolyte levels which make you feel generally unwell. This can occur with any diet, since all diets affect insulin, but because low carb/keto diets can be sustained for a longer term, the effect is worse as the imbalance increases over time. Whenever you hear people complain that low carb makes them "feel like crap" so they "need carbs", it's because of this effect. 99% of the time this unwell feeling is caused by electrolyte imbalances.

For this reason, you have to keep your electrolytes in mind always. Not only should you supplement 400 IU of magnesium daily, you should drink an electrolyte mix after exercising, working in the heat or if you begin to just feel unwell on your new diet. Make sure the mix you use, does not contain sugar. Though sugar helps cells intake electrolytes, it is not a requirement. Taking electrolytes should make you start feeling better again but if you don't, then you have to stop the diet and see your doctor.

Unless you have certain medical conditions, like renal disease, that requires careful monitoring/restriction of potassium intake, you should not have any issues consuming electrolytes, since the body balances them for you. If you do have a condition where potassium can be problematic, speak to your doctor first.

Six common beliefs addressed, Part 263

1. My ophthalmologist checked my intraocular pressure (IOP), 6 weeks ago. One eye had a pressure of 23 the other 17. He said these pressures were elevated and I needed eye drops for glaucoma. I went in yesterday to be rechecked and my pressures were 10 and 12. The doctor believed this was an error so they rechecked it again and got the same reading. He said this was not possible without medication. I started "ketovore" a month ago and believe this is what corrected this.

I don't think you are recalling this experience correctly or some dire piece of information is being left out. But if it happened exactly as you are describing, you need to find a new eye doctor ASAP.

Normal IOP is considered to be between 11 and 21 mmHg. This would mean that your first reading showed one eye slightly elevated and the other as normal. Your doctor suggesting that you needed "eye drops for glaucoma" is preposterous. He didn't even screen you for glaucoma to make that statement. There are individuals with higher than normal IOP who never develop glaucoma just like there are individuals with normal IOP who do develop glaucoma. Risk of glaucoma varies and that risk has to be assessed carefully before glaucoma medication is administered. Many other underlying factors could be affecting IOP. Why he jumped the gun to glaucoma, with a single eye pressure result, is mind boggling to me. This is why I believe you are not recalling this correctly.

IOP varies considerably during the 24-hour cycle so why he would say that your change in IOP is "not possible without medication" is ridiculous. It is totally possible. A single eye pressure measurement at any given time, on any given day, in the doctor's office is only a snapshot of what the eye pressure truly is on average. This is why your doctor would have had to take multiple readings before he could determine if you truly have elevated IOP, what's causing it and what risk does it pose. Then he could determine what course of treatment you should have. My husband has had high IOP in one eye before, multiple times, and then it would be normal by the next reading. He was never been told he needed "eye drops for glaucoma" before and he actually has a family history of glaucoma. They simply monitor his IOP fluctuations, but he doesn't have glaucoma... yet.

This is precisely why I never take these anecdotal experiences seriously but low carb pages and groups run rampant with them. These stories always have missing information, incorrect information or exaggerated information in order to prove whatever narrative they want you to believe. I understand you are excited with "ketovore" but putting out these stories, that don't make sense, is not going to help anyone. Like I said before, there are many factors involved in the regulation of IOP. The reason that "ketovore corrected this" is because there was nothing wrong to begin with.

2. I lost 140+ lbs. but now I have kidney issues and will be seeing a specialist next month. I'm pretty sure all my health issues are 100% stress. My HbA1C is now 4.5, thanks to low carb. I just don't understand why I am having kidney issues now that everything has improved.

And I don't understand what your kidney issues are. You left that part out.

There are many types of "kidney issues". Not all kidney issues are related to diabetes, overweight/obesity or metabolic syndrome. I can be on the best diet and exercise program and still drop dead of a heart attack because not all heart issues are caused by diet and exercise. Sometimes organs simply mechanically fail because of some other underlying reason or even genetics. Certain medications also, when taken for the long term, cause kidney disease like blood pressure medications.

So, I can only go by the information you gave me, not by what you didn't. The fact you lost 140+ lbs., means you were significantly obese at one time and I don't know how long you were that way. I also don't even know if the loss of 140 lbs. got you to lean because you didn't say.

You said that your "HbA1C is now 4.5 which makes me believe it was much higher before. This means you were possibly diabetic or prediabetic at one time, but you also didn't say. Dropping your HbA1C to 4.5, which is something I haven't even been able to accomplish, is quite impressive. Too impressive actually. You should check your blood glucose lows. People in the low carb world always hoot and holler at low blood glucose numbers and HbA1Cs. They make it seem as if there is no bottoming out for these numbers but there is. Too low means big problems. The person with too low of these values is just as diabetic as the one with two high of them so, it is not surprising to me that you are having kidney issues. "Everything improved" is up for interpretation.

Diabetes is not a disease of high blood glucose or high HbA1C. It is a syndrome caused by poor blood glucose regulation which deteriorates insulin function over time. Abnormal release and over expression of insulin (insulin resistance) is notorious for damaging the kidneys. It takes decades for this to happen, but it eventually does and that is why kidney disease is such a common complication for diabetics. You can still have abnormal insulin function with a low HbA1C. In fact, it could be that over expression of insulin dropping your blood glucose so low. I would have really liked to see your fasting and postprandial glucose readings. After all, you have to explain that low HbA1C and nope, low carb is not the explanation. Are you on some type of medication?

This is why you have to be ultra careful when you listen to low carb zealots. Their goal is to just lower your blood glucose, as low as it can go, and they simply ignore everything else. Well, your blood glucose certainly lowered but at what expense? It appears your syndrome was still continuing unabated. Overweight/obesity/diabetes/metabolic syndrome have long lasting effects on the body, even after your blood glucose seemingly lowered and the pounds came off. I certainly would have needed more information so I could have some context of your issues.

3. Is there a point where you need to stop eating "keto"?

A well formulated ketogenic diet does not ever have to be stopped.

4. Why do low carbohydrate/"keto" people keep pushing a diet that they can't even follow themselves? Yet they swear up and down it's the only way.

First, you can't be duped this easily. You should know the answer to this. The people who are pushing this stuff are people who get paid off it. It's their job to push it and minimize/hide when it doesn't work or people don't like following it. Of course they themselves can't follow it. The diet has no ravioli, pizza, biscuits, cinnamon buns, shakes, cakes and pies. When it does, they taste like &@^$. Nothing beats the real thing and there is nothing worse than searching constantly for alternatives to the junk you used to have, only to find out it doesn't live up to the hype. So yes, these people will always be unable to follow a diet where it is imperative that you stay away from junk.

I remember watching a video of a "low carb doctor" where he had the audacity to say that a "natural, low carb diet is full of delicious foods". He then listed nuts, spinach, berries.... WTF? Did he not think we knew those foods existed before? We never ate them for a reason. They taste like &@^$. Yes, I can eat broccoli but who wants to?

This is why I never patronize my readers. I tell them the truth so they know what to expect and don't become discouraged or disappointed later. The key to success is to know exactly what you're getting into beforehand and to understand why you're doing it and what happens if you don't. That's all you need as motivation.

Low carb diets, when followed correctly and not "a-la-carb counting", are restrictive, elimination diets that require diligent adherence and a high level of commitment. This is because tacos, cookies and brownies will be completely off the menu and so will 90% of all the other stuff you're used to eating. Good bye Italian restaurant unless you order the caprese salad only. The diet is only meat and vegetables. No shared desserts and of course, the cookie bar is gone too. You can't have your cake or eat it at all.

You can find delicious ways of preparing and seasoning your meat and vegetables but no, there are no French toasts or waffles or even French fries to go with it. There is no lemonade or corn dogs so your carnival visit might be hampered. At the movie theater you better bring your own bland nut tray or your bitter 90% chocolate bar because popcorn and Kit Kat bars are forbidden. You can go through your phase of trying to recreate these items to be "low carb" but you will soon learn that they aren't the same and not even worth the hassle of making. Those that cross that bridge, actually learn to live with their diet, enjoy it and they begin to obtain results. Those that don't, will continuously fall off the wagon and cry about it.

The goal of low carb is not calories or to fit into a bikini. The goal is proper blood glucose regulation. You are trying to fix the tree from the root upwards because trimming the branches is not solving the crooked trunk. This is why low carb diets are only beneficial for people who are ready for a metabolic intervention, not those simply trying to find a new diet to follow.

5. If blood glucose disparities set the stage for overweight/obesity/diabetes, how does fasting play into this? A lot of fat people do not seem to ever be hungry.

Fasting is detrimental for people who already have metabolic syndrome because it prolongs their "time in hypoglycemia". Basically this is lengthy exposure to low blood glucose. This further reinforces the metabolic adaptation towards high blood glucose, insulin and body fat. You cannot keep stable and proper blood glucose regulation when you fast for long stretches of time. Remember, if the person is overweight/obese, they already have a high insulin demand so prolonging the time in fasting blood glucose only drops their blood glucose lower than it normally would due to the presence of higher than normal insulin expression.

This is why people on exogenous insulin and/or blood glucose lowering medications are told to not fast for long stretches as this will only cause them more problems. Lows in blood glucose are the engine that drives the condition we know as metabolic syndrome/diabetes. Highs in blood glucose would be the transmission. This car is headed towards dialysis.

Some obese people are often hungry but there is a large percentage of them who are mostly not hungry. No hunger is usually a sign of "leptin resistance". This is why it's not surprising that the never hungry obese, are the ones with intractable obesity.

6. I've read that on "fasting days" it's okay to eat, you just have to keep calories under 500. I'm not sure if I have to worry about macros. Can I have a green tea?

I don't know what you're talking about. This must have come from some asinine protocol you were reading online but it's not reality. "Fasting days" while eating are called "eating days". "Eating days" under 500 calories are called "snacking days". Doing this for a prolonged period of time is called "starvation".

The only thing that's called "fasting" are 0 calories. Fasting is when you do not eat anything. Nothing at all. Not a thing. Well, except for your own body fat but if your leptin expression is through the floor, you won't be doing that either. So it's zero.

Also there is no such thing as "fasting days". You fast daily for a set number of hours. You don't "fast for days".