1. High cholesterol is the same as high blood glucose.
The disease of high blood glucose is diabetes, but there is no disease of "high cholesterol". When blood glucose is treated, you’re treating an actual disease; when cholesterol is treated, you are treating a number. This number is a scientifically unsupported “risk factor” for cardiovascular disease (CVD). Treatments should only be reserved for real conditions and diseases, not made up ones, because then you end up over-treating.
Over-treating affects your wallet and ultimately your health, because you divert focus to unimportant things, rather than targeting important ones. For example, your doctor will prescribe you a statin to "treat" your high cholesterol, but takes a "wait and see" approach for your high blood glucose. Your total high cholesterol is not affecting your health, but your high blood glucose absolutely is.
Glucose, like shards of glass, damages organs and causes decreased blood flow into the periphery of tissues, slowly killing them from lack of oxygen (hypoxia). This is why most of the damage caused by high blood glucose is seen in the periphery of organs and tissues. This is what’s described as glucose toxicity.
High total cholesterol is not damaging you, unless you have a genetic lipid abnormality. These abnormalities would cause you damage whether your total cholesterol is low or high. These apolipoprotein dysfunctions are very difficult to assess and require specific testing with a lipidologist to interpret the results. For these reasons, high total cholesterol is basically a useless marker.
2. Is stored glucose released when following a low carbohydrate diet?
To a certain extent it is, but the benefit of low carb is from allowing the body to release stored fat and use it for fuel, as it’s no longer competing with dietary glucose. It also allows the body to stop storing excess glucose as fat, but if glucose is no longer coming in through the diet, this would be a moot effect.
The premise is that if no glucose comes in, the body is allowed to get the glucose it has out, whether that glucose is in the form of intercellular excess or stored fat. Of course, this is completely dependent on the individual's hormonal response to the dietary intervention.
3. The release of stored glucose from following a low carbohydrate diet can cause blood glucose to be high.
This can cause a temporary rise in blood glucose, especially when the diet is first being followed. The problem occurs when an abnormal stress response is confused with the temporary release of stored glucose. Unfortunately, an abnormal stress response is usually the culprit for high blood glucose on low carb.
If high blood glucose is persistent and/or becomes worse with time, it may be indicative of this adverse stress response. This usually does not occur from low carb alone, but rather from extended fasting or excessive exercise. Certain badly formulated ketogenic diets can also cause an adverse stress response, but general carbohydrate restriction does not. So, you can say, that the worst protocol would be "fad keto", alongside extended fasting, alongside high intensity interval training (HIIT). That's a recipe for disaster.
Remember, dietary glucose is only half the battle for people with metabolic syndrome/diabetes. It’s the exaggerated release of internal glucose (stress response/counter regulation), that’s the other half.
4. Can diet resolve the body's abnormal stress response?
Diet has a very minimal effect on the stress response. The majority of the blood sugar that diabetics make is coming directly from the inside, not the outside. It is extremely difficult to reverse this stress response adaptation.
For some people it’s much easier than others. Some people are just wired to have high stress responses. Consistency in eating, fasting, sleep and exercise is a good way of taking control, because normalizing circadian rhythms have a profound effect on the stress response.
For some people, going very low carb without adequate protein and electrolytes, like is the case for “keto”, can result in the body doubling down on its stress response. This is why we recommend eating carbs to tolerance and from whole foods only. Remember, diabetes is primarily a starvation adaptation, hence the high stress response. You never want to aggravate that further.
5. Can adding starch to the diet help with diabetes?
These recommendations are usually given by people who are advocates of starch diets and/or fans of the "Potato Hack Diet”. Just like some vegans, they like spending time online chasing low carb advocates to make pro-potato comments on their posts.
Aside from helping the Potato Growers of America, they mostly like to make these comments to ruffle the feathers of some of the crazies in the low carb world. After all, it's funny to see people's heads explode at the mention of potatoes, so it can make for great entertainment. But, these potato people can become extremely annoying and muddy the waters of legitimate information.
Most low carb posts are intended for people who have insulin resistance, metabolic abnormalities and/or are obese. You know, all the conditions that these potato people don’t suffer from, nor ever have. So, they are right that potatoes are not the devil and you can certainly be in ketosis while eating them, but they are an unnecessary staple for people with metabolic issues. Protein is still king and starch should be kept in the back seat.
Remember, starch affects blood glucose and any disturbance to blood glucose further reinforces metabolic syndrome.
6. When you are “keto adapted” it means you are using ketones for fuel.
I have said before that there is no “adaptation”, there is only allowance. You allow the body to use fat for fuel, when you keep glucose low. The body then builds up the enzymes needed to break down fat, when you are consistent in keeping glucose low. The body doesn’t require "adaptation". It’s already adapted to using both glucose and fat as fuels. It adapted this through evolution when we were still single cell organisms.
Ketones are by products of fatty acid metabolism. Very few cells, in our bodies, use ketones and they are mainly in the brain. The rest are urinated out. As the body continues using fat more efficiently, ketones disappear from the urine. So, the body mainly runs on fatty acids, not ketones. Ketones are just spillover, so the statement that you "use ketones for fuel" is a misnomer. You use fatty acids for fuel.
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