Six common beliefs addressed, Part 269

1. Why do low carb advocates only concentrate on carbs and protein but not fat intake? They act as if fat is benign to their condition.

Because low carb advice online is all about postprandial blood glucose numbers. Fat is the only macronutrient that does not cause a rise in blood glucose after consuming it so they assume this means fat does not affect their condition. They do not understand obesity or diabetes.

Obesity and diabetes are conditions of poor blood glucose regulation. Disparities in blood glucose are the seed that allow the condition to begin but insulin response is ultimately what allows the condition to take root.

Carbs and protein only affect your short term insulin response but it's your high body fat that puts a high insulin demand on your body in both the short and long term. Dietary fat affects long term insulin because it must be stored, so while you are fasting, your insulin is still being stimulated, both by the fat on your body and the fat you just ate. This is pathological for blood glucose regulation. You cannot control your blood glucose properly in the presence of higher than normal insulin release and expression. It will only drive your fasting blood glucose too low.

For this reason, on this blog, we do not chase postprandial blood glucose numbers alone. We look at overall blood glucose regulation and that can only be obtained by eating a diet that does not affect blood glucose and insulin homeostasis. That diet is low in carbs, moderate in fat and adequate in protein.

2. Do low carb diets work because you can't store fat while being in ketosis and ketosis causes no hunger?

Negative. You absolutely can store fat while being in ketosis. Ketosis makes it less likely but it absolutely can occur, particularly if you are leptin resistant and are consuming too much dietary fat. This is why some ketogenic protocols cause weight gain, rather than weight loss. When people are starving they have complete access to their body fat and are in ketosis, yet they experience extreme hunger.

The advantage of low carb is that it allows the body to lower its weight set point through the stabilization of blood glucose which lowers the insulin demand. This in turn helps the central nervous system allow leptin signaling to communicate fat stores to the brain and maintain healthy body fat levels. Proper leptin expression is what induces satiety through the burning of body fat.

3. If carbs are what causes my blood glucose to rise, then why is it that protein, without any carbs, also causes my blood glucose to rise?

I have touched on this before but I will do it again since there is so much misinformation on what this is from the low carb community. I think it is the most asked question and the one least replied to correctly. To put it simply, this is caused by "hyperglucagonemia".

People who are diabetic have insulin resistance of the pancreatic alpha cells. Their alpha cells have lost sensitivity to blood glucose concentration. For this reason, they lack sufficient first phase insulin release (spike) to properly suppress glucagon. When they eat carbs, their liver constantly releases glucose because they cannot properly regulate glucagon.

This experiment has been done on Type II diabetic animals in laboratories. The result has been consistent across the board - their insulin spike is missing, yet they still have higher than normal insulin levels. You cannot suppress glucagon without a sufficient insulin spike. Now they have both high insulin and high glucagon. Their ratio is less than 1:0. This causes for the liver to not store incoming glucose and to keep producing glucose as it deems you are starving, regardless of the meal you just ate.

Aside from that, diabetics have also impaired incretin function. This means that their gut hormones do not respond properly by releasing insulin and lowering glucagon as needed. People with metabolic syndrome and prediabetes have a similar experience, just not as severe but the mechanism is the same.

Because all of these failing glucoregulatory systems, blood glucose rises postprandial whether you eat carbs or protein. Both require bolus insulin and insulin resistance does not allow for blood glucose to be cleared properly and it also causes for other hormones to release even more glucose in its presence. The only solution to this is improvement in insulin sensitivity through proper blood glucose regulation. You do this by remaining low carb and dividing your daily protein intake into three meals. That way you are not consuming too much protein at once, disrupting insulin to glucagon ratios further.

4. I have never heard my doctor use the term "diabetes reversal" but yet low carb people keep repeating it on all their groups and pages. Are they really reversing diabetes?

No. The reason you have never heard this term anywhere else is because it doesn't exist. It's a scam. They created it so now they get to define it anyway they see fit. For example, for them diabetes reversal is "getting off insulin" or "lowering your blood glucose" or "lowering your HbA1C". None of that means a thing. None of it.

Until you can properly regulate your blood glucose, meaning you do not release glucose when you don't need it and release it when you do, you have not put your diabetes into remission. You also have to be able to maintain a healthy body fat percentage because that is the proof that you are regulating your blood glucose properly. Everything else is nonsense.

5. I have been low carb for a while but it seems like I am slowly but surely losing control over my blood glucose. My postprandial blood glucose keeps rising, ever so slowly but surely. What is going on with me?

Glucagon. Glucagon usually increases over time in insulin resistance. The alpha cells of your pancreas become resistant to the inhibitory effects of insulin and they continue to produce glucagon, when they shouldn't. Basically hyperglucagonemia.

This is very similar to what occurs to Type 1 diabetics who also cannot stop producing glucagon simply because they have no insulin. Their glucagon "goes wild" and so is yours. Glucagon breaks down stored glycogen into glucose which is then released into the blood stream and you can measure it with your meter. Glucagon is only suppose to release glucose from the liver, when your blood glucose is low but with metabolic syndrome/diabetes, glucagon does this all the time, particularly in the presence of insulin and lowering of blood glucose.

Metformin works by suppressing this hepatic glucose output. Why is yours continuing to rise? Because you are still insulin resistant. Your low carb diet has never affected your blood glucose regulation profoundly enough to regain insulin sensitivity. As long as you are insulin resistant, you will continue to experience these issues. You might want to revisit your diet and your overall lifestyle, in order to try and pinpoint exactly what is contributing to your blood glucose dysregulation.

I am inclined to think it's the fat content of your diet since usually when people mention "low carb", it's because they are following the fad low carb diet they find online which encourages the intake of astronomical amounts of fat. Excess dietary fat will continue to stimulate a prolonged insulin release which affects fasting blood glucose. You will never be able to regulate your blood glucose if this continues.

6. Why is my antidepressant causing me to gain weight? Almost everyone who has been prescribed these drugs, refuses to take them because of this side effect. How can a medication cause weight gain? Does it have calories?

Basically drugs that increase serotonin without increasing dopamine will lead to weight gain. Like I have said before, dopamine is a powerful metabolic regulator. It is involved in the seasonal adaptation of energy conservation. Basically, dopamine signals to the body when it is time to store for winter. This is why dopamine levels fluctuate with the seasons and can affect your mood.

The mechanisms of action dopamine has on blood glucose are very complex and go beyond the scope of this blog as I try to keep the information on here as reader friendly as possible and I do not want to get into a lot of technical jargon that will be tuned out or become difficult to understand. This is not a biochemistry blog. Let's just say that dopamine is involved in signalling starvation to the body and this affects fat storage/burning.

For this reason, it is imperative to keep dopamine levels normal and balanced so metabolism is better regulated. Staying away from sweet taste is a good start but you also have to talk to you healthcare professional about any psychotropic drugs you may be taking that could be affecting your serotonin/dopamine ratios as this will eventually degrade your insulin function over time.

Six common beliefs addressed, Part 268

1. What evolutionary advantage is there to blood glucose shifts to cause the body to go into a starvation response? I much rather be the person who can maintain their blood glucose regulation intact while eating doughnuts and pizza.

I know that when I speak of "proper blood glucose regulation" it seems as though you have to constantly walk a tight rope because your body is against you but it actually is not. It is doing exactly what it is suppose to do. Shifts in blood glucose homeostasis help the body determine what the food environment is like. It helps the body know how much and what type of nutrient availability there is. It uses this information to determine if it needs to get fat for survival or not.

Of course there is an evolutionary advantage for the body to kick into starvation mode the moment it senses a disruption in blood glucose. This is why most people get fat and very few are able to sustain staying lean well into old age. The person whose metabolism is resistant to respond to blood glucose shifts might be blessed in an industrial modern setting but they would be toast in a hunter/gatherer setting. How would they survive a famine or even times of general food scarcity? They wouldn't fare very well at all. It's the one who can get fat that survives and that's why there are so many of us left since we were the ones who didn't die off. Evolution has made the decision that anti starvation mechanisms like the propensity for overweight/obesity, is a good thing in general.

So when I speak about "proper blood glucose regulation", you can think of it more as avoiding its disruption as much as possible.

2. I watch a YouTube doctor, who has millions of subscribers, but the advice he gives is really generic, simplistic and kind of vanilla. It's like a public relations team writes his content for him. He tried to do a "keto" diet one time and complained about how much fat he had to eat and how boring and inconvenient it was. Then he said he had to drop the diet because his "cholesterol went up". I doubt that was even true. I think it was a gimmick to make people not want to try the diet out through fear mongering.

YouTube doctors are like daytime TV, full of sh%t. They are there to gate keep the status quo, push a narrative/agenda and virtue signal to their audience. I actually believe that you might be right and this doctor did make up that his cholesterol went up following this diet because he knows that is a common problem people face. He wanted to make sure you stick with the standard dietary advice without question, and if you attempt to veer off, well then bad things will happen to you.

Look, we know who the target audience for these young, scrub wearing, obesity resistant, athletic, feminized, male doctors are - middle aged, overweight women who are bored with their lives and their "health" has now become their only hobby. They are ready to follow any fool who makes the claim they can "save" them from whatever is ailing them. It also doesn't hurt that these doctors are easy on the eyes and relatable while doing so. Sorry for whoever I triggered.

Stay away from this type of nonsense. It will not help you lose one pound. Why this doctor decided to eat that much fat on "keto" is beyond my understanding because as a doctor, he should know that you can go naturally into ketosis through carbohydrate reduction exclusively, but who knows. He might not even be a real doctor. These people will do anything for views except state facts.  

3. I love pudding and I saw a "keto pudding" online which I ordered, thinking it was truly "keto". When I looked at the ingredients though, it is 100% starch. It doesn't say what type of starch. Isn't regular pudding made of corn starch? So what's the difference between this keto pudding and the real thing? Is starch even "keto"?

Anything that does not disrupt ketosis is "keto". I have said before that "keto" is not a set of ingredients, it is simply a metabolic state where you primarily burn fat for fuel and produce ketones. The more efficient you become at burning fat, the less ketones you will produce. This has zero to do with metabolic health. If you are here because you want to treat your overweight/obesity/diabetes, then your main concern should not be ketones but your blood glucose regulation. So I will reply to this question as if you are dealing with overweight/obesity/diabetes since you did not specify why you are on a "keto" diet.

Do not get duped by these "keto" and "low carb" labels. Manufacturers are using these labels in order to sell their junk to a new wave of customers who are following these fad diets. The reason that this pudding was most likely labeled as "keto" is because it does not contain granulated sugar but some sort of artificial sweetener instead. They know their customers are dumb enough (with all due respect) to not even know that starch is simply a chain of glucose molecules bound together. Basically, glucose. Glucose disrupts blood glucose homeostasis. So it doesn't matter if this product is "keto", it is obesogenic.

They most likely didn't use corn starch in order to not alarm any potential customers as many of these "keto" followers are leery of corn and avoid any product that has corn in their ingredients. Corn sounds too much like high fructose corn syrup. This means the starch used is most likely cheap tapioca instead, which is believed to be lower in carbs, though no specific number exists or even a comparison to corn starch. I can almost guarantee tapioca is either higher in carbs than corn or about the same. In fact, I actually prefer the corn. You can become 700 lbs on tapioca or any other type of starch. Remember starch is just a fancy term for glucose as described above.

Real "keto" pudding is not only sugar free but starch free. This means you have to go online and find a starch free pudding recipe. You will need to actually buy other ingredients, to replace the starch, and do some cooking and it will not be "instant pudding". In other words, it will be a pain in the a$$ to make and the results are not guaranteed to be the consistency or texture you are accustomed to. I have become convinced that a lot of these substitutions simply do not hold up to the real thing. You can't reinvent the wheel. The wheel is perfect as is and it can't be made any better.

For this reason, I do not recommend any of this "find a substitution" practice. You need to become accustomed to your new diet and this is best done by accepting it as it is instead of trying to make it something that it's not. You will have to live with the fact that some of your favorite foods will just have to remain in the past so you can move forward. Find some other "keto" dessert that is not a mock recreation of the usual high carb fare.

4. I know someone who had bariatric surgery and it was successful. They changed their lifestyle and kept the weight off. It has been three years since their surgery and their weight is still off but they are having serious health issues which have not been easy to diagnose. This isn’t the first time I’ve heard of this. I have read multiple stories online of people who have lost their weight, kept it off, only to be plagued by multiple, mysterious health issues that have ruined their quality of life. What is going on?

I don't know and I doubt anyone else does. Health issues are individualized and we simply don't know what is going on with this person, who had bariatric surgery. If their doctors haven't been able to figure it out, I doubt we will. It could be the result of such an invasive surgery. It could be the complications that occur afterwards. It could be something totally unrelated that just so happened to occur after the surgery. We can only speculate at this point.

What I can tell you is that obesity has long term health consequences even after it is resolved. Body fat is the largest endocrine organ in the body, aside from the thyroid, by sheer surface area and distribution. Challenges to this body fat can pose potential long lasting, metabolic effects. Bariatric surgery does not just cause body fat loss, but mostly muscle mass and water loss. Loss of muscle mass is implicated in shorter lifespans and disease. This is not even considering the effects of abnormal insulin expression on tissues and organs. Insulin is what gets all nutrients, energy and electrolytes into cells. Insulin resistance basically starves various tissues and organs, to varying degrees, of these nutrients and the long term effects of starvation are pretty dire. Because bariatric surgery can induce weight loss without the need of insulin normalization, for the most part, the metabolic problems continue which often lead to weight regain and inability to regain muscle mass. These insulin abnormalities will continue inducing pathology over time.

As you can see, the cure for obesity is not weight loss. The condition and the metabolic abnormalities that result in it, persist regardless of weight loss.

5. I was controlling my blood glucose with a low carb diet but I moved to a more rural area and am now having allergies that I never had before. This has disrupted my blood glucose control. I don't understand how allergies can affect blood glucose and cause me to start gaining weight again. I thought that as long as my diet remained low carb, I wouldn't have these issues any longer.

This is the fallacy of the low carb community. They keep promoting this myopic idea that carbs are the only influence on blood glucose but they are wrong. Many things can negatively affect blood glucose control and if this negative affect continues for a prolonged period of time, insulin will start to abnormalize and metabolic conditions will ensue. They say you can't get fat from air but in your case, that is exactly what's happening.

There is a bidirectional relationship between histamine and blood sugar, with each influencing the other's levels and contributing to metabolic dysregulation.

• Histamine can stimulate the release of insulin, which can lead to hypoglycemia.
• Histamine can increase glucose uptake in muscles and adipose tissue, further contributing to hypoglycemia. In the case of the already overweight/obese, who have super insulin sensitivity of their fat mass, most of that glucose is going into their fat mass rather than their insulin resistant muscle.
• Histamine can suppress the release of glucagon which can also contribute to hypoglycemia.
• For individuals with certain chronic conditions, like mastocytosis, histamine can lead to hyperglycemia.
  

Anyway you put it and through whatever mechanism, histamine affects blood glucose and metabolic conditions require for blood glucose to not be disrupted in order to regain its proper regulation. For this reason, it is not surprising that your new found allergies are affecting you in this way. You need to work with your doctor in order to ensure you can take control of this situation before it gets worse.

6. Can dehydration cause blood glucose issues? Low carb groups always say to consume salt in order to increase sodium intake.

Salt and sodium are not the same things. 1 tsp salt is made up of 5 grams of salt and 2.3 grams of sodium. The rest is chloride.

Sodium in an essential mineral. It is found in your blood serum and the extra cellular fluid that surrounds all of your cells. Your kidneys and adrenal glands help keep sodium balanced in your body. When you consume too much salt, your kidneys simply excrete more of it. If you eat too little, then your adrenals cause your kidneys to conserve it through the action of aldosterone. This causes the side effect of potassium waste, which you don't want. When sodium is reduced the adrenals release cortisol and adrenaline which interferes in blood glucose.

So yes, dehydration can cause blood glucose abnormalities through stress hormone release. The proper way of addressing this is by making sure you are intaking suffice electrolytes. It is not resolved through drinking more water or consuming more salt. Either one of these, can cause more dehydration.

Six common beliefs addressed, Part 267

1. Is glucose worse when it has fructose, like sugar does? Would this mean that potatoes are less bad than sugar?

Sugar is particularly obesogenic compared to any other carb because of two things - its sweet taste and it's half fructose. In fact, the fructose is what causes the sweet taste, so it's the fructose that is the main culprit.

• Fructose has a sweet taste and the state of sweet disrupts blood glucose homeostasis through its affects on dopamine/serotonin. Antidepressants like serotonin re-uptake inhibitors (SSRIs) have long been known to affect weight because of this.
• Fructose is a hepatotoxin like alcohol, and creates liver fat. This liver fat exacerbates and perpetuates metabolic conditions.

But glucose all by itself without the fructose, as is the case with potatoes, still impacts blood glucose because it adds extra glucose to a system that likes to keep its blood glucose under strict control. Anything that disrupts blood glucose homeostasis will result in metabolic dysfunction over time.

So you don't want to look for items that are "less bad" because there is no such thing as "less diabetes". You either have it or you don't.

2. My wife recently had a terrible bout of non-stop seizures. She was in intensive care for three weeks. She has always had seizures but they were well controlled until this set back. What I found interesting is that her morning blood glucose would always be in the 60s mg/dL. I have read on your blog that blood sugar this low is not normal. Could this be contributing to her recent health problems?

I am not a doctor so I cannot tell you what could have caused your wife's recent bout of seizures. It could have been a number of things. I have migraine with aura. I can sometimes detect triggers but most times cannot.

What I can tell you is that blood glucose dysregulation plays a very critical role in controlling conditions like migraine, seizures and other neurological issues. This is because the brain suffers first when there is a lack of blood glucose homeostasis. There are certain cells in our body that require glucose to remain alive and functioning. Some of those cells are in the brain. 

Disturbances to blood glucose homeostasis causes an energy crisis in the brain exacerbating neurological conditions. When I was able to better control my blood glucose, my migraines subsided. Insulin plays a vital role in getting glucose into these glucose dependent cells. Insulin resistance interferes with this process. Improving insulin sensitivity through the stabilization of blood glucose should be priority number one if you want to better control neurological conditions.

You are correct that a fasting blood glucose of 66 mg/dL is not normal. It is hypoglycemia and it will be very difficult for your wife to control her seizures if her blood glucose is on a roller coaster. I do not know why her blood glucose is dropping this low. It can be for a number of reasons, including seizure medications.

So I suggest you talk to her doctor about your concern and see if he has any answers for this. Other than that, your wife is going to have to diligently watch her diet and exercise routine. Lifestyle factors are the main contributor to blood glucose abnormalities.

3. I am sick of slim people talking about "junk food", "preservatives" and "additives". Is it true that people are obese because of preservatives in food?

No. I have spoken about this in other posts.

I feel your frustration because I am also sick and tired of this misconception. Obesity is not the result of preservatives, additives, chemicals or anything else found in conventional food. You can become obese off completely natural and organic, whole grain and fermented wheat products.

People start going through a rabbit hole of nonsense when they follow this type of advice but the diet sphere has always been ripe with this type of foolery. There are plenty of thin people eating Doritos and pizza boats daily. Just visit your local university's dorm room. It will be very difficult for you to find an 400 lbs. person on campus. There are many athletes that eat sheer "junk" on the daily and are perfectly slim. There are many people who are extremely picky with their food and only want the healthiest choices available and are still 400 lbs.

Obesity is the result of blood glucose dysregulation. Nothing else. It doesn't matter what food you eat as long as it doesn't interfere with blood glucose. The reason that "junk food" has gotten a bad rap is because it is usually filled with sugar, grains and plant based oils which all further contribute to blood glucose dysregulation.

No one knows for how long any individual can retain their blood glucose control while eating so called "junk". Look at low carb people. They eat clean and are still obese and unable to take control of their blood glucose. So controlling blood glucose and keeping it under control is dependent on a lot more than just food. Many individualized factors are at play here.

4. I want a real hack that I can use and it be effective. I LOVE McDonald's breakfast and I want to be able to eat it daily without it causing me obesity or diabetes. I know that's a lot to ask for but it's not like I'm asking for money and it's not every meal. I just want my breakfast! It's so convenient and delicious!

I know you think I'm going to reply that I can't help you and have no hack. But I actually do. In fact, it is the only real hack that exists.

If you understand that obesity/diabetes is rooted in blood glucose dysregulation, then the only thing you have to do is keep your blood glucose control and you will be free of developing either condition. But how? McDonald's and other fast food is notorious for interfering with blood glucose control and this is why everyone knows these foods are very obesogenic. But they are also very delicious. Is there such a thing as having your cake and eating it too?

Well, there is no magic pill you can take that can help you preserve your blood glucose regulation after eating biscuits and pancakes at McDonald's but there is a magical thing you can DO. All you have to do is walk five miles to the McDonald's, eat your breakfast and as you take the last bite, get up and walk five miles back home. The exercise will prevent your postprandial blood glucose from ever rising in a significant enough way to later cause hypoglycemia from prolonged insulin release. It's not even using insulin to clear the blood glucose!

This shows the actual curative mechanism of exercise rather than just the palliative mechanism of diet. With diet you are always hiding and avoiding but exercise causes an actual mechanical, quantifiable effect. This effect has been exploited by athletes, the world over, and this is how they can have McDonald's endorsements, and actually eat their food, with no adverse effects.

There is your hack, which will actually work. It would work if you are diabetic as well, it just depends on how well controlled it is, how many medications are being taken and what stage it's currently at.

But like all short cuts in life, you can run into problems. Walking a total of ten miles a day, everyday, can become unpredictable. Weather, illness, injury, age, work and other responsibilities can all get in the way of having the stamina and time to put into this endeavor. Remember, you can never fail one time or you will lose control of your blood glucose as you're basically walking on a tight rope to maintain it. You would need a lot of dedication and determination to be consistent with this hack. Even athletes eventually retire and become diabetic.

5. I usually like to go to the Dunkin' Donuts before work. I really like their coffee. While there I also get a breakfast sandwich, because I cannot have the dougnuts. I have to modify the sandwich so it's low carb by telling them to remove the bread and double the egg. The egg now becomes the "bread" so I can hold the sandwich. There is just one issue. They double the price. Low carb followers always talk about the modifications you can do at any restaurant but they leave out how pricey it can get. Prices have gone up anyway and this diet is going to break the bank.

Yes. That's why you want to avoid eating out as much as possible because you are already going to be spending more on food regardless. Might as well get more bang for you buck buying food you can prepare at home.

With low carb you can go to any restaurant and modify the food to fit your diet but prepare to pay more. Restaurants have always used carbs as filler. Carbs are cheap and create the illusion of a large portion. This makes you believe you got your money's worth, when you have to unzip your pants just to stay seated after a plate full of bread, pasta and salad. It is all smoke and mirrors though. When you remove all those carbs, you realize you are eating a plate of air and being robbed.

At the Dunkin' Donuts, tell them to ring each item of the sandwich separately. For example, they can ring up 2 eggs, one sausage patty and one cheese individually, rather than the whole sandwich and it will come out cheaper. Whether they are willing, or aware they can ring up the order that way, is another story.

All you have to do is just shop smarter when you do have to eat out. Stay away from fast food. It is not a bargain and usually ends up costing you more than a real restaurant, because you have to modify the menu and buy triple to make up for what's taken away.

6. Why does eating rice and beans or potatoes cause the feeling of being so full but it wears off so quickly?

Rice, beans, potatoes, pasta, all of this starch, causes a rise in blood glucose which makes insulin follow suit and this tells the body that enough food was eaten so hunger subsides and the feeling of being full increases. The problem is that excess insulin release to clear all of that glucose, continues dropping blood glucose while fasting causing the hunger to return in order to prevent hypoglycemia.

Blood glucose is what the body uses to determine its nutrient availability and whether it needs to be hungry or not. Not calories, not buffets, not portions, not micronutrients but blood glucose's influences on insulin. That is the main and sole determiner of how hungry and how fat you get.

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.