Six common beliefs addressed, Part 41

1. Low carbohydrate diets will always lead to remission of metabolic disease.

This is false. Remission depends on many factors, not just diet alone. Diet is a very important component for success, but it's not a magic pill. Remissions depends on:

• Age - The older you are the less insulin sensitive your tissues naturally become, except for your fat mass.
• Hormonal Status - An adequate balance of hormones helps metabolic function, while erratic hormones do not -menopause/andropause/thyroid disease.
• Gender - Women accumulate and preserve body fat more strongly than men. They also have less muscle mass and muscle is a main driver of metabolism. On the other hand, men tend to accumulate and preserve more visceral fat, which also significantly impedes the rate of remission.
• Time - The longer you have had metabolic syndrome, the longer your metabolism has adapted to starvation and the harder it is to correct. Metabolic syndrome is a time dependent disease. It took decades to acquire it, so it cannot be fixed overnight.
• Obesity - The longer you have lived with obesity, the harder it is to treat metabolic syndrome, as your fat mass would be very large and unresponsive to treatments (poor leptin expression). Obesity is a time dependent condition. It took decades to pile on the pounds, so they cannot be lost overnight.
• Will - What you are willing to do about it. Some people refuse to give up certain foods, practices, habits or incorporate exercise. How much you're willing to change, in your life, is reflective of how much this disease concerns you. If it was truly important, then you would be willing to do whatever it takes, to address it. Complaints and whining produce 0 results for obesity. Following gurus around the internet, will not produce results either. 

2. Nothing resolves high postprandial blood glucose, so it should just be ignored.

Controlling hyperglucagonemia (high postprandial blood glucose) requires two things:

• Normalizing insulin levels/function, so that other hormones follow suit and the assault is seized. The normalization of insulin levels/function will allow it to regain its pulsatile function over time.
• Following a diet and fasting regimen that does not interfere with leptin function, as leptin is a huge regulator of glucagon and the starvation response. 

Both of these require:

• Strict and consistent adherence to a low carbohydrate diet. This means following a low carbohydrate protocol 24/7, 365 days a year, 366 on leap year.
• Avoidance of any starvation protocols. Starvation makes hyperglucagonemia worse, as it stimulates further glucose production through counter regulatory hormone activation (glucagon), in order to spare fat mass further. In this context, glucagon acts like an anti-starvation hormone.
• Dividing daily protein intake into 2 - 3 meals, rather than restricting it. Some people do fine consuming their daily protein in 2 meals, but others need further division. The more you eat in one meal, of any macronutrient, the larger the blood glucose disruption furthering more insulin demand on the body. The more insulin, the more glucagon. This is one of the reasons why 'One Meal A Day' (OMAD) protocols are not advised for the metabolically sick. They place too much glucagon demand, on the body, in one sitting.
• Eliminating any obesogenic habits, such as snacking between or after meals. This includes the drinking of any flavored beverages.

Though none of these tactics are a magic pill, they are completely worth a try, as they have allowed numerous people to control their postprandial blood glucose over time.

3. Will eating fat keep my postprandial blood glucose low.

Fasting for extended time periods and/or eating globs of fat, to not see your postprandial blood glucose rise, is not the proper way of addressing hyperglucagonemia.

• Extended fasting will only trigger more leptin dysfunction, increasing the effects of hyperglucagonemia with time.
• Fat is not food and because it's not food, it doesn't stimulate much insulin, after eating, hiding the effects of hyperglucagonemia. But, dietary fat will only increase your fasting insulin levels. This will not help balance other metabolic hormones. It will only make things worse because increased fasting insulin levels disrupts fasting blood glucose. 

The more fat you store, the fatter you will become and body fat places a high insulin demand on the body. You should be trying to lose body fat, by stabilizing blood glucose, not grow more of it.

4. The Dietary Guidelines were a sham to benefit Big Food and Big Pharma. 

My take, on this repetitive lore about The Dietary Guidelines, is very simple and goes as follows:

• Something was found,  studied and misunderstood. That something was the "fat" accumulation in the arteries of people with cardiovascular disease.
• The government decided to enact a public policy, around this finding, before it was fully understood.
• This public policy was influenced by a slew of social, political and economic factors, as is always the case with all government mandated public policy.
• Now that the finding is better understood, we realize the public policy surrounding it was an utter failure.
• Just like with everything that is controlled by the government, this policy will not be easily or quickly reversed, as there are now too many chefs in the kitchen getting paid for continuing to cook the status quo gruel.

Period. That's what occurred, in a nutshell. No need to watch yet another docudrama depicting it. There's nothing mysterious or conspiratorial about what happened. It's just plain old fashioned stupidity by placing the carriage before the horse, because it made good politics.

The nuances, of these events, are obviously lost to history, since Ancel Keys, and the many others who were a part of it, are no longer alive to explain the details or their side. The ones who remain, like the government, food companies and health agencies will rewrite history in their defense, as is the case of all humans when they are confronted with the consequences of doing something stupid. Others will make money off of claims they found a way of "correcting these terrible mistakes".

As for the people who pout and complain that they are now sick, because they were "given the wrong information", I'm not buying it. Yes, the wrong information was given, but none of that information recommended the eating of chocolate cake and cookies, ad libitum. The information given had actual portion and calorie recommendations instead, but they were not followed.

Join any low carb group and you will see the sob stories of people "falling off the wagon" constantly, even when given the right information. These people "fell of the wagon" following The Dietary Guidelines and they will continue falling off it following low carb. So, no The Dietary Guidelines are not 100% to blame for failing.

What occurred with the dietary guidelines, is the same thing that is occurring in low carb right now:

• Recommendation: Carbohydrate restriction.
• Application: People don't follow it, so "low carb ice cream" and "keto cheesecake" are created to entice them.
• Result: Utter failure.

We know that people refuse to stick to dietary recommendations, unless those recommendations offer some kind of "free food". Of course, broccoli doesn't count. This is why so many gravitate to these fad "low carb" and "keto" diet versions, which make them precisely that promise with fat. Be careful of who promises you the world, as they usually never deliver.

5. The carbohydrate-insulin hypothesis completely explains insulin resistance. 

On this blog we follow the insulin hypothesis (IH), though we understand it is incomplete. We do not follow the carbohydrate-insulin hypothesis (CIH). CIH has been pretty much debunked, as carbohydrates aren't the only thing that can cause hyperinsulinemia because many things, besides carbs, can effect blood glucose. We do know that insulin has a primary involvement in the development of metabolic disease, but the exact mechanism of how this occurs is not fully understood, though research seems to point to blood glucose dysregulation. This is why IH is considered incomplete. But, even though IH is incomplete, it offers a much more complete treatment than CIH alone.

CIH can easily be dismissed, because there are multiple hunter/gatherer tribes and agrarian societies, which consume about 80% of their calories as carbohydrates. Neither of these groups have manifested metabolic dysfunction, while consuming their original diets. Now, we all know that both of these groups have one other thing in common, besides carbohydrate, and that's they "subsist". This means they live in a constant state of caloric deprivation. This chronic caloric restriction is not harmful to their metabolism, as they have never experienced obesity in the past, nor will they in the future, and many do not live long enough for it to matter.

Both of these often cited examples might make your eyes roll, as they do mine, since they do not pertain to the realities of Western societies in any way. But, they do show that carbohydrates, in of themselves, are not hyperinsulinemic alone, since these people's high carbohydrate intake is not enough to cause it. It actually shows that certain carbohydrates can be benign, but only in the context of starvation. Sugar is the only carbohydrate that is obesogenic irrespective of starvation levels, but hunter/gatherers do not use sugar. 

This occurs because starvation always has an effect on blood glucose, which does not appear to be pathological when metabolism is still healthy. Blood glucose always effects insulin expression/function. This allows the body the ability to continue burning body fat, even with glucose as a primary fuel, since there is no effect on blood glucose regulation, to halt fat burning. In simple terms - the metabolisms of hunter/gatherers do not have a chronic adaptation to starvation. They are healthy. 

What is even more important to consider is that other things, besides excess carbohydrates, have also been implicated in abnormal insulin expression/function. Dietary fat, for example, has been shown to produce metabolic abnormalities, especially when this fat comes in the form of vegetable oils. Dietary fat combined with carbohydrate produces the same effect. Sedentary lifestyles are implicated in metabolic dysfunction as well. Having high body fat, in general, perpetuates further insulin abnormalities due to the high insulin demand required to retain fat in storage.

So, the idea that carbohydrates are the only factor that affects insulin and eventually leads to metabolic disease has not been shown to pan out. For this reason, carbohydrate restriction alone, has not been shown to be "the cure". Remission can be acquired from any method that results in better blood glucose control which in turn normalizes insulin expression/function. Several interventions can accomplish this.

6. Some people eat whatever they want and live a long life without becoming overweight or diabetic. 

Because some people are able to retain and sustain proper blood glucose regulation long term irrespective of lifestyle factors. I have explained in other posts how this is mostly determined by genetics.