Six common beliefs addressed, Part 40

1. Are there any treatments for obesogenic behaviors?

Common obesogenic behaviors are disordered eating and obesogenic eating habits. They are very difficult to treat, but treatments still exist.

Disordered eating should be addressed with caloric restriction in order to take control of the excessive eating. There really is no other way to stop these people from eating themselves to obesity, as hyperphagia is oftentimes, a symptom of obesity. No diet can help with this, because no matter what diet is implemented, the excessive eating follows. These people have absolutely no satiety signaling, whatsoever. They also have no ability to gauge what a normal meal looks like.

Many people dismiss caloric restriction as not having any part to play in obesity treatment. On the other hand, some people believe that it is the only thing that matters. Both stances are BS. Caloric restriction absolutely has a part to play for controlling weight, in some people, but it should never be used as a primary intervention and/or the only intervention, especially in obesity. It really should be recommended on a case by case basis, as it will be required for some and not for others. This is why the "one size fits all diet" strategy does not work. Obesity is very individualized. There is no one cause for it. Many things can contribute to excess body fat.

Caloric restriction has also been followed incorrectly, especially in obesity. This has caused it to be, not only an epic fail, but an intervention that can make matters worse, not better. When we think of caloric restriction, we automatically think of a "sustained caloric deficit", but that is starvation to the body. Starvation protocols sabotage weight loss, as they make obesity intractable, because of their effect on leptin. Caloric restriction should only be used to prevent excess, not sustain a deficit, as the body will never accept a sustained deficit. This is why caloric restriction is best applied to correct behavioral issues, rather than to obesity as a whole. Calorically restricted diets should also be primarily carbohydrate restricted, as that is truly what causes the fat loss, through more stable blood glucose, once the excess has been controlled.

Obesogenic practices, on the other hand, might not require caloric restriction, but re-education instead. Many of these people are unaware that their practices are contributing to their obesity. They might ask for advice, but the advice given does not specifically let them know what they are doing wrong, as many recommendations are vague or just plain wrong.

Snacking, carb counting, eating while fasting, choosing foods that continue to disrupt blood glucose and continuing to believe low carb myths surrounding protein and insulin are some examples of obesogenic practices that can be corrected with the proper information.

2. Waiting before eating breakfast is the only way to address high morning blood glucose. 

High blood glucose, in the morning, is known as Dawn Phenomenon (DP) and it's caused by an overexpression of the adrenal response (stress hormones) to lowering blood glucose during the over night fast. This is the result of insulin dysfunction from prolonged release/overexpression.

People often mitigate this symptom by either waiting a few hours for blood glucose to lower, before eating, or eating something in order to raise insulin and lower the stress response. Either method can help you mitigate DP and the one you choose, depends on what is most sustainable for you. Some people like to eat breakfast and some don't. Eating or waiting, will both result in lower blood glucose.

But, the goal is to correct DP, not mitigate it. So, whichever one of these two methods you choose, for controlling morning blood glucose, you must continue monitoring your DP, to see if it is getting better with time. DP is usually a long lasting symptom, which takes time to improve, but should never display a worsening trend.

If your diet and exercise regimen is truly addressing insulin resistance, then DP should begin to correct itself, over time, and you will see lower and lower morning blood glucose. If this doesn't occur, then your protocol is not working and you will have to make changes.

3. If a protocol is being followed correctly, it will improve metabolic syndrome.

Some people have been on a legitimate protocol, which they have followed consistently, for a long time, and have still not seen much improvement to their metabolic condition. This is because, unlike what low carb advocates are trying to sell you, the truth is that diet is only palliative. It helps you control symptoms so that you can start treating the root cause and doesn't further exacerbate the condition.

When you have exhausted dietary interventions, then you have to work alongside your healthcare provider for the integration of conventional medicine alongside your dietary protocol. Do not ignore your metabolic abnormalities, as they will only worsen with time and result in complications. The combination of lifestyle and medications is often necessary, especially for people who have progressed so far, into their condition, that they can no longer acquire pancreatic beta cell response to dietary based treatments. Other people have conditions, which further aggravate metabolic dysfunction like kidney, liver, thyroid and/or cardiovascular diseases.

Believing that all conditions/diseases can be stomped out by a "good diet", is a dangerous precedent to follow and is basically quackery. Following a diet, without obtaining results is futile. It will only leave you wondering why you have the bad luck of doing all the right things, yet experience no progress. This can quickly turn into hopelessness and the abandonment of any treatment. Metabolic conditions will progress if they are not treated.

4. Fasting will always lower blood glucose.

Many people fast and see a rise in blood glucose, not a lowering. High blood glucose, caused by fasting, is called "Dawn Phenomenon" (DP). DP does not just occur in the mornings, though the word "dawn" makes it appear as though it's related to the time of day. Instead, it is best described as "Fasting Phenomenon", since it's basically an adverse reaction to fasting. Mornings are just the most common time it's experienced, as it's a result of the night time fast.

DP is caused by an overexpression of counter regulatory hormones in order to keep blood glucose from dropping too low. As this condition worsens it prevents blood glucose from dropping at all. DP is triggered by abnormalities in blood glucose regulation, which affect insulin function over time. Prolonged insulin release and overexpression, interferes with fasting blood glucose, lowing it too rapidly or too much. The body starts counteracting this by creating a high blood glucose set point. This is when the body actively fights against any drop in blood glucose, even if its to normal levels. DP is experienced differently between individuals, but it eventually leads to diabetes. Diabetes is when metabolism sustains and preserves a high blood glucose, insulin and body fat set point.

Some people will experience very high blood glucose, from a short overnight fast, but their blood glucose will begin to lower if the fast continues. Others see their blood glucose continue to rise, the longer the fast goes on. For some, blood glucose lowers once they eat, but for others, eating only causes blood glucose to go even higher. This is because glucagon is also a counter regulatory hormone, which is stimulated by the presence of insulin, as a result of food intake. So, now you basically gave the body a double whammy - DP caused by the absence of insulin and hyperglucagonemia caused by its presence. This reveals an unnatural metabolic response, by the body, where both of these counter regulatory states are mismatched and do not respond properly to fluctuating insulin levels.

This is why it's important to listen to your body, gauge its reaction to certain protocols and act accordingly. If fasting is causing your blood glucose to rise, stop fasting. Shorten your fasts until they produce benefits, not detriments.

5. Metabolic syndrome/diabetes is caused by fat accumulation in the muscles. 

No. Metabolic syndrome/diabetes are conditions caused by improper blood glucose regulation. Everything else occurs downstream from this including fat accumulation in the muscles. 

People with metabolic syndrome/diabetes have abnormal fat accumulation in musculoskeletal tissue and organs. This is because they are insulin resistant and insulin resistance causes dyslipidemia, lower muscle glycogen synthesis and a slew of other abnormalities. None of these are the cause of metabolic syndrome/diabetes. They are just many of the abnormalities that these conditions produce. It's not smart to focus on any one effect of insulin resistance, as its effects are many and you end up missing the forest for the trees. This is why lifestyle intervention treatments are the most efficacious.

This muscle fat accumulation phenomenon likes making its rounds on the internet, especially in vegan circles. This is because vegans like to associate this excess fat accumulation to dietary fat, but in Western societies, this fat accumulation is actually coming from excess dietary carbohydrate instead. Yes, the body turns dietary carbohydrates into fat, when blood glucose homeostasis is chronically disrupted. 

6. If you are eating low carbohydrate, your blood glucose will never go up, because high blood glucose is only caused by diet.

If you have high blood glucose and it's not coming from the outside, then it can only be coming from the inside. If this high blood glucose occurs while fasting, then it's being caused by an over expression of adrenal counter regulation (stress hormones). If it's caused after eating, then it's hyperglucagonemia.

Hyperglucagonemia is not the same as normal gluconeogenesis, which is a tightly regulated, demand driven process. This is more like "gluconeogenesis gone wild" and that’s why it’s referred to as hyperglucagonemia, not gluconeogenesis. It irks me every time low carb advocates mix these two up. Gluconeogenesis is normal, hyperglucagonemia is not.

In hyperglucagonemia, glucagon is breaking down your body and everything you eat into glucose and ketones, causing for your blood glucose to remain high, even while following low carb. This basically means that glucagon is no longer responding to insulin and cannot be controlled by it.

This does not occur to everyone. Some people are able to eat bacon and eggs and obtain, and maintain, normal blood glucose, but others cannot. Others will eat bacon and eggs and turn it all into glucose from this exaggerated and unmitigated glucagon response to the presence of insulin. This is caused by insulin resistance of multiple tissues and exacerbated by high body fat. I have written before, that glucagon producing cells are present in other tissues, besides the pancreas, and if those tissues remain insulin resistant, then you will continue having the same problem.

Hyperglucagonemia is a very complicated metabolic state and difficult to treat. The body is slowly losing its ability to stop catabolism as more and more tissues become insulin resistant. Glucagon is responsive to the proper pulsatile function of postprandial (bolus) insulin, rather than by its fasting levels (basal). So, lowering fasting insulin levels does not automatically correct this problem. Proper pulsatile insulin function can only be obtained when you are no longer insulin resistant in any tissue of the body. In other words, when you achieve metabolic homeostasis and your neuroendocrine system responds properly to insulin. This is a very long process, as different tissues gain and lose insulin sensitivity at different rates.