Six common beliefs addressed, Part 273

1. I was diagnosed with diabetes some years ago and back then they tested me for fatty liver. My results were negative. Recently, they tested me again and they are now positive. I don't understand how this is possible if I have been eating low carb since before I even developed diabetes. Is there a way I can reverse fatty liver? Will eating low fat help?

It is not enough to just "eat low carb". I don't even know what you mean by "low carb" as this has different meanings depending on who you ask. You would have had to let me know what your exact protocol is.

Either way, the purpose of eating low carb is to be able to regulate your blood glucose properly. If low carb has not accomplished this, either because it hasn't been followed correctly or consistently or because of some other issue that's interfering with your blood glucose, then the condition will progress unabated. Metabolic syndrome, like diabetes, is chronic and progressive unless it is treated properly to achieve reversal or remission.

If you had been eating low carb since before you developed diabetes and now you have fatty liver disease, it means that you have not been treating the condition effectively. Your blood glucose regulation was never normalized and the pathologies associated with metabolic syndrome have occurred (i.e. diabetes, fatty liver disease).

Fatty liver disease is caused by alcohol, a viral infection or fructose consumption. Low fat diets do not treat fatty liver disease. The only diet that has been shown to reverse fatty liver disease is a ketogenic diet (no sugar) but you are now diabetic and unless you can regulate your blood glucose correctly, a ketogenic diet is not going to help you.

Diabetics will develop fatty liver disease over time because the liver is converting the glucose, released from their own body, into fat which it then stores within itself. It is very difficult to reverse this once you are diabetic unless you can be on a medication that can keep your blood glucose well regulated, 24/7, for the long term. A lot of diabetics are refusing medications because they think they can resolve this themselves. They can't. In many cases, particularly once the person is diabetic, low carb is a supportive treatment alongside diabetes medications.

2. I am still fat even though I eat very low carb. I have not been able to lose a single pound.

Fatness is determined by how well you can regulate your blood glucose not by how you eat, what you eat or how much of it. In other words, the amount of fat on your body is a direct reflection of your blood glucose control. This is why anything that affects blood glucose will cause body fat to increase or decrease.

Like I explained above, eating low carb is not enough. You have to make sure that your low carb diet is actually effective by monitoring your blood glucose. When you monitor your blood glucose, you can't be complacent with a simple postprandial "lower reading". Lowering your blood glucose is not going to cut it. You need to make sure your body is regulating its blood glucose correctly. This means it doesn't make excess glucose when its not needed and it makes enough when it is. You have to take fasted and postprandial readings, watching the disparities between the two closely.

3. I am a 70 year old diabetic. I am in the beginning stages of the disease and have no complications. But I have very intense gut issues. The doctors have not been able to help me nor have they even figured out what it could be regardless of the amount of tests they run. The only thing that relieves my symptoms is eating bread. I am following low carb though so I don't know what to do. I have developed a paranoia of carbs.

At 70 years old, you shouldn't be stressing this much over this. It is impressive that you made it to 70 with no diabetes complications.

Low carb is an umbrella term that covers many different types of diets. At your age, you would be fine following a simple Atkins style diet where bread is allowed as long as you don't go over 100 grams of carbs a day.

You have to decide how you want to live the rest of your years - obsessing over carbs or reducing these gut symptoms. I would be focused on reducing the gut symptoms because they will make the years you have left a nightmare. Diabetes is slow and you can slow it further by simply reducing carbs. You will be long gone by the time diabetes becomes a significant problem.

4. What do you think of 'Panera Bread'? I'm always told it's healthy. Can I eat low carb there?

"Healthy" is subjective. At this juncture, healthy is generally believed to be anything that isn't a candy bar so take the word "healthy" with a grain of salt. On this blog, the true definition of healthy is something that does not disrupt your blood glucose. As long as it does not disrupt your blood glucose, we don't care if its made by Kellogg's or Whole Foods.

You can eat low carb at just about any restaurant in existence. I suppose the only place low carb would not work is at a candy store, unless its a candy store that only uses artificial sweeteners. Other than that, you can modify your meals to be low carb anywhere. So the only question left for your chosen place is - "Is it worth it?" At Panera Bread it is most certainly not.

Panera Bread sells, well mostly bread and other baked goods. Other than that it's really a soup and salad place that happens to also serve coffee. Almost every soup they sell has carbs in the form of sugar, grains or starch. Salads are basically air. Air is starvation. So the food at Panera Bread can be described as starvation with a side of sugar. This is detrimental for the obese because it will be very difficult to regulate blood glucose while starving and eating sugar at the same time.

Another issue with Panera Bread is that their protein is served in child portions. In fact, it's hard to find another place that is more protein restrictive than Panera Bread. You can try and double the protein on a salad but expect to pay a lot for not very much, as even doubling the protein still leaves you with a pretty small portion since they started at such small portions to begin with.

So Panera Bread will not give you much bang for your buck. It's expensive and you will be left hungry. This means you will end up spending double because you will have to go eat somewhere else later and you will probably be hypoglycemic by then.

5. Is it true that all grains have gluten?

Gluten is irrelevant for the regulation of blood glucose as gluten in grains is not what disrupts your blood glucose. Their starch is the culprit, since starch is technically glucose. 

But this whole gluten hysteria is the same thing that occurs with low carb. It goes like this - "Some people have an immune response to gluten. Gluten is found is certain grains. Therefore all grains are bad and if you eat them, you will die instantly. Not eating them will also cure all the diseases you currently have." In low carb it goes this way - "Eating carbs make it very difficult to regulate your blood glucose. Therefore all carbs are the devil and if you eat them, you will die instantly. Not eating them will also cure all the diseases you currently have." Conflation and hyperbole at its finest. Why the human psyche makes these leaps is unknown but at the end of the day, it won't help you one bit. All of this conflation and hyperbole is causing you to lose site of the initial factual statement, which could actually help you solve what ails you.

When the word gluten is used, it is referring to gliadin specifically. Gliadin is a protein component of certain grains like wheat, barley and rye. Other grains such as rice, corn and oats contain other types of proteins which are not gluten. People who are sensitive to gliadin (gluten) may or may not be sensitive to these other plants proteins as well. In fact, people who are sensitive to gluten may be sensitive all plant proteins. This is something the person has to determine through nutritional testing and symptom triggers.

6. Is McDonald's really as evil as people make it out to be?

When a corporation becomes as large as McDonald's has, it is going to rack up quite a number of enemies along the way. McDonald's has been blamed for just about everything, from questionable employment practices, environmental assaults, poverty, small business destroyer and of course, obesity. The obesity blame is mostly due to the fact that their main selling product is burgers and burgers are beef and fat. Vegans and animal rights activists absolutely hate beef and animal fat. So McDonald's is personal non-grata on earth. Well, at least in the First World where everyone likes to think of First World problems.

But McDonald's is simply a meat and potatoes fast-food restaurant. They sell burgers and fries. Can this be blamed for obesity? Well, it certainly contributes to it when the burgers and fries are being served the "fast-food way". The "fast-food way" is not so much fast as it is cheap, or rather cheaper than a diner. McDonald's gives you a sliver of beef on top of a mountain of bread and a bucket of fries. This makes the meal cheaper but ultra high carb. Add a soda to that, particularly from a fountain machine which adds more sugar to it, and you are on the road to becoming 500 lbs. Don't forget the sugar-laden condiments and sauces to top it all off.

So the problem with McDonald's is not any activist's or interest group's gripes or that they serve "junk food" but that McDonald's interferes with proper blood glucose regulation due to the carb content in their foods. That is all. This is also not exclusive to McDonald's. All fast food places are the same and so are diners and restaurants. The only place that will prioritize protein, eliminate carbs and control fat is the food served at home, where you are in control.

Six common beliefs addressed, Part 272 - Seasoning Edition

1. I watch a nutritionist online that believes in low carb and "keto" diets. He sometimes recommends certain products, which he deems are the healthiest. He recently recommended the brand Siete. I tried their fajita seasoning mix but noticed that my postprandial blood glucose rose a bit more than usual. I checked the ingredients and didn't find any carbs. I saw no added sugar. What could have happened?

Quackery. Quackery is what happened and usually it's the only thing that happens consistently. A lot of these nutritionists/dietitians, who are online selling their supplements, programs and books, are focused on their agenda and not on the science. It seems that whatever gimmick this online nutritionist is selling, diabetes is not their forte.

I found the Siete brand Fajita Seasoning Mix you mentioned. Look closely at the ingredients and tell me what you see that shouldn't belong there. To make it easier for you, I actually circled what it is on my photo below - ground dates. Why would a savory seasoning mix, which is used on beef or chicken dishes, contain dates? In fact, all of their seasoning mixes contain dates.  

These supposedly "healthy" food manufacturers are very clever, if not cunning. They hide the sugar in their products by adding it as dates or syrup or fruit juice or honey, etc. etc. I even saw "fermented cane sugar" once, as if that made a difference. The circus left but the clowns remain. I have said it many times before - the obese will put sugar on a steak and this is the proof. This manufacturer knows that sugar sells.

This is why I always advise my readers to be very leery of products marked "low carb", "no added sugar" and/or "keto". You must look closely at the ingredients and do not expect to see the word "sugar", "high fructose corn syrup" or "fructose". They know you are looking for those trigger words, so they hide them now and quite clever ways.  Just look for any ingredient that contains sugar. This can be hidden with terms such as "fruit" or "starch". The consumer has to be smart and unfortunately paranoid.

The best thing you can do is not buy seasoning mixes. There is no need to. You can make your own seasoning blends. They also have many seasoning mixes in the seasoning aisle, in bottles, which do not contain extra ingredients like dates.

Six common beliefs addressed, Part 271

1. Why do so many low carb diets fail, even though you have explained how they would be the most beneficial treatment for metabolism?

Because most diets are fads and scams. Unfortunately, low carb diets have not been immune to this.

There are many iterations of low carb diets online which are full of junk foods (wrong macronutrient compositions), unrealistic/unsustainable protocols (bone broth fasts), floggings/binge eating (fast for a week/eat 3 pounds of bacon) and symptom chasing (postprandial blood glucose/gained five pounds). I have said before that the low carb community is full of frauds, scammers, snake oil salesmen and quacks. Low carb diets attract a lot of desperate, misinformed and serial dieters with eating disorders. All of these people are easy to manipulate, lie to and rob.

This is why I made this blog. In order for anyone to get the information they need, for free and simply explained so they have a better chance of reversing their condition.

2. What is the correct insulin to glucagon ratio?

Insulin in the pancreas is at its purest and most undiluted form. It is no coincidence that the alpha cells are right next to the beta cells in the pancreas. This close proximity causes for insulin to be potent enough to stop the secretion of glucagon, as its potency begins to reduce as it enters the liver and finally the peripheral tissues.

Insulin is released during the fed state so that's when glucagon should be properly suppressed. The fed state means no glucose should be produced as blood glucose naturally rises from the breakdown of the food we eat. The correct insulin to glucagon ratio at this point should be around 7 - 4.

3. I just watched a video on YouTube from a "low carb doctor" and he was basically saying that the dietary advice given on a national news network was wrong but he never said how exactly. He was just pissed at certain recommended items like fruit, barley and broccoli. He only seemed to agree with any item that was "low carb". I browsed through the comments and they were mostly of people saying they only had to take their insulin twice since going carnivore or how there is a war against meat. There wasn't a single dissenting voice in all of the comments. I remember, some years back, there would be challenges to these claims but now I see none.  

Because they most likely filter out comments. I remember when there would be a lot of unanswered questions in the comment sections of these charlatans but those are gone too. They know its bad for business to leave questions unanswered. Jimmy Moore was notorious for cleaning up his comment sections. He would ban people from his page, in a hot second.

Look, all of these people are frauds and scammers. Most of them have given up and moved on to something else but there are a few still holding on to their flock. They have just moved to another platform like YouTube instead of Facebook. Too many people from their past are still on Facebook so they look for a new audience elsewhere. I have said it many times before, snake old salesmen have to keep moving from town to town or their gig will be up.

Aside from that, all of these frauds are one trick ponies. They see dietary food choices from one myopic viewpoint - no carbs. For them, this is the "cure". Of course, they know its not but they peddle it because, just like you saw in the comments, someone will pipe up and say they were taken off their insulin or their HbA1C is lower than ever before. For these people, this signals that they have been miraculously "cured". They don't understand diabetes any more than the fool they are following. Of course your blood glucose lowers if you don't consume dietary glucose but the condition is still progressing. By the time your postprandial blood glucose shows a significant rise, you have been having blood glucose dysregulation for years. This is why these people will remove the carbs and then start complaining that now their blood glucose is going up from meat.

I hate to say this, but they are all dummies. Back in the day, when you could only get information from your doctor or some quack you met at the pharmacy, I could understand the ignorance but there is internet now. The same time they put into watching a clown on the low carb circus, is the same time they can put into reading some obesity medical journals. They are all free online, ready for viewing. They don't do it because they are lazy. It's easier to keep watching the clown comes out of the car than to do actual research so I don't feel sorry for them and you shouldn't either. Forget the ones that can't be saved and save yourself.

4. Why is it that a lot of carnivore proponents have become sick and had to leave their diets if this is the diet we evolved with?

Because they are quacks. Let's be real, the only "carnivore proponents" I have seen are just regular people who tried out a diet, found it beneficial and decided to write a book, make a website, create a program and charge for all of them. I hate to say it but they are grifters. They know where the money is at. It's at every single fad diet that can be thought of. These people did not take time to research the diet or its possible side effects.

We absolutely evolved eating meat. In fact, meat made us human, particularly when we learned how to cook it. Cooking meat extracts its nutrients exponentially. There is just one problem - we are not living in caveman days so the meat we have access to is very different from the meat hunter/gatherers have access to.

Hunter/gatherers have access to wild game. Wild game is very lean so it packs a much higher amount of protein per serving than farm raised animals. Eating lean meats for a long period of time can cause health problems (rabbit starvation) as you need fats to be able to metabolize certain nutrients. For this reason, hunter/gatherers eat nose to tail. This means they consume the entire animal, particularly the organ meats. Organ meats are where most of the nutrients, fats and electrolytes are found. It is also where you can find already digested and fermented plant matter which has beneficial bacteria.

In modernity, these "carnivore proponents" sit down to large plates of muscle meat and claim they are eating like their ancestors. They are not. Muscle meat is not as nutritious as organ meats and over time, you start experiencing electrolyte imbalances. This is particularly true on a diet that tends to keep your insulin very low. This can be detrimental in the long term because the more you deplete your electrolytes, the more difficult it is to replenish them and you end up in a state of chronic dehydration that's hard to reverse. This will cause all sorts of nasty health problems that can even become dangerous and in some instances not reversible.

Electrolyte imbalances are the worst case scenario of eating muscle meat carnivore but another problem is the fat in the meat. The muscle fat in farm raised animals is very different from the organ fat in wild game. Consuming too much dietary fat, over the long term, will only deteriorate your insulin function since fat keeps basal insulin levels higher than normal. This is why a lot of "carnivore proponents" end up seeing their metabolic markers deteriorate over time. This is particularly true if they already had some stage of metabolic syndrome. Farm raised meat packs quite a load of fat, especially when all you eat is cattle. Wild game is not cattle. It's a wide array of animals, including insects. Also this extra fat comes at the expense of protein. This means you can be carnivore and still suffer from not consuming adequate protein because that rib eye will fill you up before you can get the most protein out of it. Meat is very satiating so it is difficult to hit your protein goals without going over your fat goals.

All of this means that carnivore is the most difficult diet to follow out of all low carb diets. A lot of people do not like organ meats. They cannot become accustomed to their taste, they are difficult to find and you have to learn how to prepare and cook them. It is hard to have a Thanksgiving dinner table that features lamb hearts instead of turkey and fish eyeballs for hors d’oeuvres. For this reason, if you want to do carnivore using only muscle meat, you have to be knowledgeable in the right supplementation of electrolytes and possibly protein as well. You have to watch your fat intake through careful tracking of macros and choosing the right cuts of meat.

It's a science to do carnivore correctly in modernity because the carnivore of today is very different from the carnivore of the past. So don't follow "proponents", follow information. You must do the right research to ensure the diet you choose is right for you and will get you to your goals.

5. I keep hearing "fasting" people say that you can add fasting to any diet. Can fasting help with better blood glucose control.

I have touched on this before but it's been quite a while so I will recap in this reply. The term "fasting can be added to any diet" is a marketing slogan. Why limit your customers to only low carbers when you can have a wider audience covering all kinds of diets? These people are selling fasting. It's a business that's also a gimmick. They could care less about anything else except if its profitable at the end of the day. So they can't even explain how it works or why it should even work. We have already discovered it doesn't.

Fasting used in this fad way is a symptom chasing approach. Diabetes is not a symptom. It is a syndrome. There's a difference. If you want to have better blood glucose control, which is just another way of saying you want to obtain proper blood glucose regulation, then you can't try to resolve it using one method and destroy it with another. Every time you eat the wrong macronutrient composition, you are once again disrupting your blood glucose and fasting won't correct it. Instead, fasting would reinforce it because it lengthens your time in hypoglycemia after a bout of hyperglycemia. Hyperglycemia disrupts insulin function and hypoglycemia makes the disruption permanent.

The premise of fasting is to lower blood glucose so that insulin release/expression reduces. This helps normalize your fasting insulin levels, breaking the resistance and allowing for better leptin expression. This is done after a proper meal that does not disrupt blood glucose to begin with. The last thing you want to do is fast after very high postprandial blood glucose as you will release excessive insulin after. This insulin will not be cleared after fasting so fasting further will only cause a severe drop in blood glucose. This strengthens the disparities between postprandial and fasting blood glucose, allowing the condition to be reinforced and progress.

Remember, diabetes is caused by chronic, large disparities between postprandial and fasting blood glucose so that is what you want to avoid.

6. I was told that carnivore was not a good diet because our ancestor's diet varied greatly depending on region and climate. I was also told that a balanced diet would get you all the nutrients you need.

Yes. Our ancestor's diet varied wildly as humans are highly adaptable when it comes to diet. How this translates to carnivore not being a "good diet" is unknown.

As far as a "balanced diet" goes, that is a product of modernity. Like I mentioned above, humans are highly adaptable when it comes to diet and can thrive on many different types of diets. This means they can thrive on a modern "balanced diet", the same way they can thrive on a restrictive carnivore diet. A "balanced diet" is no better than a vegetarian diet or a ketogenic diet.

No one who recommends "balanced diets" can even define what that even means. I suppose they mean any diet that is not restrictive of any macronutrient. Why the restriction of a macronutrient would translate to the restriction of micronutrients is unknown.

Humans have evolved with and thrived with diets that fall anywhere between 100% animal based to 80% plant based. The only diets that humans have never evolved with are 100% plant based diets (vegan), "fat free" diets or "balanced diets". Just like "balanced diets", vegan diets are a concoction of modernity as well but even so, they can be followed successfully if done right. That means that humans are so adaptable that they can even thrive on diets they didn't even evolve with.

A "balanced diet" does not guarantee you will get all the nutrients you need. The Standard American Diet (SAD) is a "balanced diet" but it is still quite nutrient void. The nutrients in your diet are completely at the mercy of you including bioavailable nutrient rich foods and your body's ability to metabolize them. 

Six common beliefs addressed, Part 270

1. Do I have to "adapt" to ketones in order to use them?

No. Ketones are a quick energy source and are created to primarily replace glucose so people who are the most glucose dependent will be the easiest to get into ketosis. This is why it is not difficult for diabetics to go into ketosis. It is quite easy for them to produce ketones. It is the people who can use free fatty acids directly that tend to have lower ketosis.

2. Is insulin resistance always the cause of too much glucagon expression or can other things be implicated as well?

Glucagon overproduction is the outcome of low or insufficient leptin which is the direct result of abnormal insulin release/expression (hyperinsulinemia/insulin resistance). Leptin helps regulate glucagon. Abnormal insulin release/expression always results in a starvation adaptation which destroys leptin expression in tissues like the liver as well as the brain.

This is why, on this blog, we describe the timeline of obesity/diabetes as blood glucose dysregulation first, insulin degradation second and finally leptin resistance as the end result.

3. Does glucagon only release glycogen from the liver or does it also convert protein into glucose?

Glucagon releases stored glycogen into glucose which is then released into the blood stream. It also breaks down protein into glucose energy. Leptin resistance always ensures that protein is wasted into glucose due to hyperglucagonemia. So basically glucagon is responsible for glycogenolysis and gluconeogenesis.

Now, I often make the statement on this blog that glucagon will "break down everything you eat into glucose" simply because this is the easiest and most simplified way of describing the process above, to someone who has zero understanding of metabolism and how it works. But, we know that there are a lot of pedantic people out there that get caught up in the minutia of semantics, as though I am giving a dissertation at a medical conference, rather than just simplifying metabolic processes for the layman on a blog.

So for the sake of these people's sanity, and prevent any comments "correcting" me, I will be more precise and mention on this post that glucagon itself does not have the ability to directly convert protein into glucose. It simply regulates the breakdown of glycogen and the synthesis of new glucose molecules, in order to maintain blood glucose levels. Protein is not a direct substrate for glucose production. Amino acids can be used as substrates for gluconeogenesis, but this process is indirect and occurs through the action of other enzymes and metabolic pathways, not directly mediated by glucagon.

But at the end of the day, on this blog, the only thing that matters to YOU is that glucagon will break down everything you eat into glucose, due to insulin resistance. Period. The details do not matter. Glucagon does this irrespective of the nuance. This is not a blog for medical students or biochemists. This is a blog for the average obese person, who is struggling with their symptoms, to try and gain some understanding of what's happening to them so they can have a better chance of correcting it. For this reason, it makes zero difference for them to know the exact, complicated pathways of glycogenolysis and gluconeogenesis. All they need to know is that glucagon is the cause and it is regulated through insulin and leptin, both of which are malfunctioning in them. This gives them something they can target to better address their condition. So it doesn't matter how it happens, it just matters that it happens and it's happening to you.

4. I read on a weight loss group that ghrelin is responsible for over eating and so it causes weight gain. Does lowering ghrelin truly cause weight loss and should that be the target to achieve my goals?

Ghrelin is often referred to as the "hunger hormone" but the research on this has not been straightforward. There has been contradictory findings in studies. Studies show that ghrelin is actually low in the obese and in binge eaters compared to healthy individuals. Yet, ghrelin is released by the stomach to stimulate appetite so it would make sense that its reduction would result in lower appetite. How can one hormone do two different things?

This is actually very common in the many systems of the body. Hormones can have the opposite effects depending on their concentrations and cross talk with other chemicals and systems in the body. This is why I am so leery of blaming any one hormone for any one process as the body uses redundancies for many of its functions. Why make multiple hormones to do many things, when the same one can do all these things depending on the information it receives from the individual's overall neuroendocrine state? You can think of hormones as traffic cops. They can either stop, speed up or redirect traffic flow depending on the road/driving conditions.

So the only thing you need to concentrate on is your blood glucose regulation. None of this other flim-flam will help. It might be fascinating. It might be interesting. But it is not useful. The diet industry always has a new culprit for overweight/obesity every single day and this can be seen on tabloid magazines everywhere. At the end of the day, the only true mitigator of overweight/obesity/diabetes is blood glucose regulation. In that context, ghrelin has been shown to stimulate both cortisol and growth hormone, both of which cause hyperglycemia so at least we know that over production of ghrelin will disrupt blood glucose.

Don't target anything except your blood glucose regulation.

5. How is leptin a "slave to insulin"? You have mentioned this many times before but I am curious to know the mechanism behind it.

If insulin is low, leptin will also be low. Usually, when leptin is high, it means insulin is also high or the fat cells are highly insulin sensitive. For the overweight/obese, the former is the case. 

This is why sometimes insulin levels do not correlate with the level of obesity. Some obese do not display hyperinsulinemia through serum insulin levels but their insulin expression is always high at the fat cells. Some thin people have hyperinsulinemia but their insulin expression is not very high at the fat cells. This is the case with certain ethnicities who develop diabetes at much lower body fat percentages.

So leptin always tracks closely with insulin and it is affected by insulin release/expression. Normalizing insulin is enough to normalize leptin and weight.

6. Does calorie restriction really cause a longer life span?

Sort of.

When calories and protein are chronically restricted, it down regulates the sympathetic nervous system (SNS). This leads to lower blood pressure, heart rate, glucose release and thyroid hormone conversion. Basically everything slows down. These effects have been shown to increase life span in test animals.

We don't know what the implications of this are for humans. When humans are starved, their health is significantly impaired regardless of any increase in life span. This most likely has to do with our large brains which require a significant amount of nutrients and calories. It is easy to starve a mouse and increase its lifespan, without any health consequences, since mice do not live long anyway. Humans on the other hand have a median life expectancy of about 72 years. That's a lot of time for things to go wrong. Increasing that time through starvation only makes more things go wrong.