Considering all of the examples we have of obese people, who fast regularly, in the low carb community, you can pretty much guess this is a false statement. Fasting is no more effective for weight loss than exercise and calorie counting. You might lose some weight, but never enough body fat to stop metabolic abnormalities because fasting does not improve blood glucose regulation. Just like exercise and calorie restriction, you also can't counteract the effects of metabolic slow down. Fasting is only beneficial for weight and metabolic management. It’s terrible as a weight loss tool, even though it’s marketed as such for monetary reasons.
Obesity changes the rules of many intuitive beliefs we have about food. The obese have a pathological starvation and refeeding response. Their whole metabolism is honed and primed to preserve and increase body fat at an exponential rate. This is because their blood glucose is easily affected in a negative way by eating habits and macronutrient composition.
Obesity effects the neuroendocrine system, which is interplay between the brain and hormones. What works for simple weight loss, does not put a dent on obesity. This is what "weight loss" programs do not understand and why they fail every time. Obesity is its own monster. This is why starvation doesn't work to address it, even if it's gulag style. The obese will die of malnutrition before they lose enough body fat to no longer be obese.
2. The P:E Diet is low fat "keto".
The P:E Diet is not low fat "keto". It's a protein to energy diet, similar to a protein sparing modified fast, but fat is not kept low, it's instead used as a lever. The more fat on your body, the less fat on your plate. If weight loss stalls, the less fat should be on the plate. Fat is used to gauge results. Protein is prioritized and carbohydrates remain low. If you are eating the right amount of fat, you lose weight.
3. Blood glucose rises after meals because of gluconeogenesis.
This is the most common fallacy that is heard over and over again in low carb and I have touched on it multiple times before. But, this time around, I want to clear the confusion in using the term 'gluconeogenesis' to describe something that it is not.
Gluconeogenesis is an on demand driven process that happens to everyone. It is a very important part of metabolic regulation and there is nothing negative about it. Gluconeogenesis allows for the body to regulate its blood glucose by not over producing glucose, when it's not needed, or under producing glucose when it is. This system is counterregulatory and is driven by a series of hormones that work together in complex feedback loops, to insulin, to help the body maintain its blood glucose steady and within a narrow range.
Type I diabetics experience "gluconeogenesis gone wild", because they have no insulin to regulate it, so the feedback loop is broken. This causes for gluconeogenesis to break down their bodies, and everything they eat, into glucose and ketones, uncontrollably. Their body has no ability to stop this catabolism and they must dose exogenous insulin, according to what they eat, in order to prevent this catabolism from persisting, as it can result in death.
Type II diabetics experience an exaggerated gluconeogenesis, which is best described as hyperglucagonemia. This is caused by a combination of the loss of sufficient first phase insulin response, insulin resistance of the glucagon producing alpha cells of the pancreas and chronic abnormalities in other hormone levels like leptin. The feedback loop is faulty and results in a pathological "gluconeogenesis", which is not resolved with protein restriction or fasting or any of these other ludicrous and asinine interventions, since none of these correct the root causes of hyperglucagonemia, described above.
If you have metabolic syndrome/diabetes, you will notice that on this blog, we do not describe your after meal high blood glucose as simply "gluconeogenesis". We describe it as hyperglucagonemia, which is descriptive of what it really is. Using different terminologies to differentiate these processes, helps prevent the pathologizing of a completely normal and necessary metabolic function. So, remember, gluconeogenesis is when everything is normal, hyperglucagonemia is when it's not.
4. Diabetes has nothing to do with lifestyle.
I remember some years ago, Dr. Perlmutter made a video and said something, everyone already suspected was true, but had never heard anyone say before - "Diabetes is a lifestyle choice". I have to admit, my jaw dropped at that one. I couldn't believe that a doctor had just said that out loud. Many others couldn't believe it either, because he got one hell of a backlash for it. How he survived through that, is unknown, but I hear he's still out there, alive and kicking.
Claiming that Type II diabetes is a lifestyle choice is not a very popular stance and is quite controversial, but we know that this is true, since only lifestyle interventions have reversed it. Nothing else has. There are no medications or treatments that "cure" diabetes, aside from bariatric surgery and even that is short term. You can pop a pill, every morning, and manage diabetes, but the diabetes is still there, under your nose, progressing with each day that passes. Diabetes is considered a chronic condition, because there are no "cures" that a doctor can offer you.
Only lifestyle interventions reverse metabolic syndrome, overweight, obesity, fatty liver disease and Type II diabetes. This is because lifestyle choices are what cause these conditions, and yes, they are "choices", since no one forces you to follow any specific lifestyle.
On this blog, we don't get too bogged down blaming The Dietary Guidelines for lifestyle choices. Those guidelines have portion and calorie controls, as well they should, since you can't eat high carb diets without some form of starvation. Everyone followed the high carb part, but conveniently forgot all about the starvation part.
So, no matter how controversial it is, on this blog, diabetes considered a lifestyle choice made by each individual. Period. That's actually a good thing, because it means you have complete control in choosing to reverse it.
I don't consider any blog reader a victim of some "unknown" condition, bad luck, "very bad insulin resistance", bad genetics or any other vague and mysterious condition or circumstance. There are direct causes for what you are experiencing. That's why you never see sob stories or pity parties being shared on this blog. I am simply here to tell you why this is happening and what you can do that might help stop it.
5. You should fast for weight loss.
As stated above, on this blog, intermittent fasting, is advised to balance the body's anabolic/catabolic states exclusively. Balancing these two states is not for Zen purposes but because it helps to better regulate blood glucose. Fasting is not used as a primary weight loss method. Instead, we emphasize lifestyle interventions for addressing obesity. Lifestyle interventions include diet as primary, exercise and systemic stress reduction (circadian homeostasis). All of these help regulate blood glucose.
It is not difficult to understand why we don't use fasting as a weight loss tool. And, it has nothing to do with the countless of obese fasters, out there, that can't lose a pound, though they do make a good case for me. But rather, and more importantly, the person with metabolic syndrome/obesity/diabetes has a fasting kryptonite in place called 'Dawn Phenomenon' (DP) and hyperglucagonemia. Both are stress induced counter regulatory responses, which are overexpressed in people with metabolic abnormalities. It's as if their metabolism is in a chronic state of starvation. This state makes fasting detrimental, for the metabolically abnormal individual, not hormetic. This overexpressed counter regulation to insulin further disrupts blood glucose and insulin function.
The person believes fasting is helping them, but their body is actually ramping up this stress induced anti-starvation mechanism to make itself, and everything that's eaten later, into glucose and store it as more fat. Because this results in more loss of lean muscle mass and more sparing of fat mass, it makes metabolic abnormalities worse, not better. In the long term, chronic extended fasting only helps, both DP and hyperglucagonemia, get worse. We want to avoid that happening, to our readers, so we don't advise dumb interventions that only focus myopically on one factor of metabolic conditions, as diet only addresses one part of it.
6. Diabetes is simple. All you have to do is keep blood glucose low through diet.
Diabetes is not a disease of high blood glucose, it is a disease of poor blood glucose regulation.
Once the person is a full-blown diabetic, diet alone, will not control their blood glucose regulation, as they are experiencing counter regulatory abnormalities which result in hyper/hypoglycemic episodes. Though diet can help the person reduce the severity and frequency of these episodes, eventually helping them get off some or all, of the medications that contribute to this rollercoaster, diet alone will not result in the elimination of this effect. In other words, eating a donut will exacerbate counter regulatory abnormalities, but not eating a donut will not eliminate them. Most of the glucose that is being produced by a person with diabetes, is coming from the inside (glucagon), not the outside (diet).
Hyper/hypoglycemic episodes can be dangerous. Logging blood glucose, throughout the day and night, and sharing those logs during doctor visits, is vital. The time these episodes occur, can be indicative of what counter regulatory hormones are responsible, which will help with treatment options. Your doctor might also have to adjust medications, if you are following a carbohydrate restricted diet.
Hyper/hypoglycemic episodes can be dangerous. Logging blood glucose, throughout the day and night, and sharing those logs during doctor visits, is vital. The time these episodes occur, can be indicative of what counter regulatory hormones are responsible, which will help with treatment options. Your doctor might also have to adjust medications, if you are following a carbohydrate restricted diet.
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