Six common beliefs addressed, Part 83

1. Low carb advocates claim that diabetes is "curable", but conventional doctors says it's "chronic and progressive". 

This is because they are both equal quacks.

• Diabetes is not curable because there is nothing to "cure". Like I have said before, diabetes and other metabolic abnormalities are not true "diseases", but adaptations. For this reason, they can only go into remission. (We refrain from using "cure" because of the lifelong effects these adaptations cause.) Remission is achieved by eliminating the condition which caused the adaptation to begin - blood glucose dysregulation.
  
• Diabetes is only chronic and progressive when it is not treated properly. This is because the adaptation will continue, relentlessly forward, unless there is an intervening treatment that halts its progress and achieves remission instead of just addressing its symptoms. Addressing symptoms is actually much easier to do than achieving true remission. After symptoms are addressed, the long, grueling road of sustaining remission must be taken or the diabetes will continue chronically and progress.

I don't know what low carb pages are peddling, but on this blog, we don't claim diabetes is "curable". Aside from the fact that it's not a true disease, the fat mass of a person, who was once obese and/or had metabolic dysfunction, remains abnormal long after all symptoms disappear. It is not known how long this abnormality continues, as fat cell turnover is still being researched and is highly individualized. It's as if the fat mass, itself, adapts to behave a certain way, because of exposure to specific environments, and continues to do so long after a change in that environment occurs. This fat mass is very insulin demanding and insulin will affect how blood glucose is regulated. So regaining proper blood glucose regulation can be extremely difficult. The same is true of hypothalamic function and, to some extent, thyroid function. So, we focus on remission and, of course, prevention.

2. Ketogenic diets are only needed for the sick, not for healthy people.

First, the metabolizing of fatty acids, as your primary fuel, is the natural state for our metabolism to be in, so there is nothing abnormal occurring by following a diet that promotes just that. You should not wait to follow a ketogenic diet once you are sick. You should have been ketotic from birth, in order to minimize the risk of metabolic illness, since ketosis is the consistent and natural state you would have been in, if you had been born during 99% of human history. This is precisely why we are able to burn fat, even while we rest. Fat fuel is extremely versatile and used for more energy requirements. Glucose is not. Glucose is very specific.

So, a healthy person would eat ketogenic in order to remain healthy by allowing their metabolism to function, as it was intended to. That's why this blog is also for healthy people, who want to follow an anti-obesity lifestyle and prevent diabetes in the future.

3. Have people with metabolic syndrome/diabetes lost their ability to metabolize carbohydrates?

That’s dumb ^%$^ery.

You never lose the "ability" to metabolize anything, unless you were born with a genetic enzymatic abnormality. But in people without these genetic conditions, enzymes are simply over or under expressed. If you do not intake much dietary carbs, especially in the forms of starch, the enzymes that break down carbohydrate are under expressed, since the body does not need them. The same thing occurs when you go from a "low fat" diet, to a "high fat" diet. The enzymes that help break down fats are under expressed and you may have digestive issues, at first, amongst other issues like the "keto flu". Slowly, with time, you build up these enzymes. This is why humans can survive on vastly versatile diets and can adapt to practically any diet.

The diabetic is still metabolizing carbs just fine. This is precisely how they are able to store them all as fat. The diabetic's tissues and organs are simply no longer accepting glucose, due to an under expression of insulin in these areas and an over expression of insulin at the fat mass. So, it’s not a lack of metabolizing, it’s the sparing of glucose in order to turn it into fat and the sparing of insulin so it expresses mostly on the fat mass and not anywhere else. 

4. Can a healthy person eat carbs because their blood glucose does not react to them like a diabetics?

A healthy person’s pancreas is still able to respond to blood glucose irregularities just fine. The body was designed to be able to respond to dietary glucose, even in large amounts, for short periods of time. We have been metabolizing glucose, since we were single-cell organisms. 

The healthy person's metabolism has simply not adapted negatively to chronic glucose assaults. This is most likely the result of how insulin is managed by their body. The younger you are and the more muscle mass you have, the better you can continue regulating your blood glucose, even through dietary assaults. There are also rare people who are obesity resistant and continue to be able to regulate their blood glucose, well into older ages.

The majority of people though, blood glucose regulation will deteriorate over time and depending on the type of dietary assault, for some it can even start in childhood. Once this deterioration occurs, insulin is affected and everything goes down hill from there. So, if you are healthy today, do not expect to continue being healthy tomorrow. We were all healthy once.

5. Carbs are not any different than other macronutrients, as a diabetic responds adversely to any insulin release and all macronutrients cause insulin release.

This is half correct, as is usually the case of almost everything in this "diet sphere". Carbs aren’t any different than other macronutrients, as far as insulin release goes. The only difference is that carbs continue contributing to the blood glucose irregularities that perpetuate the adaptation towards hyperglycemia. This is because carbs have a long-term effect on insulin release and function, through the disruption of blood glucose levels. Though this puts healthy people at risk, it is detrimental for the diabetic. Not only is the diabetic suffering from the glucose they make internally, but they just added a load of glucose externally, deteriorating blood glucose control further.

The reason that dietary carbs are targeted is mainly because of two very important reasons:

• Carbohydrates are uniquely toxic because of their interference with normal blood glucose regulation.
• Carbohydrates are uniquely obesogenic because of their ability to grow body fat. Body fat puts a further high insulin demand, on the body, perpetuating the interference with normal blood glucose regulation.

Carbohydrates do not just cause insulin release. Insulin release is normal. If you had none, you would be a Type I diabetic. On the Richter Scale of insulin spikes, carbs are actually not very formidable. Whey protein is top dog in this department. But carbohydrates cause the worse insulin function you can ever have - prolonged insulin release and expression. That’s the difference that makes all the difference.

It’s not the release of insulin, per say. You will always release insulin in response to any food, regardless of its composition. What you want to avoid is prolonged insulin release and expression. In order to achieve this you want to take away one of the main contributors of this compounding negative metabolic effect, from the table, which is the carbohydrate, as their interference in blood glucose regulation, causes them to effect insulin in a prolonged way. You don’t want prolonged anything, except prolonged fat burning.

You want an initial insulin spike, at meal times, and then low levels during fasting. You do not want an insufficient insulin spike, at meal times, and then higher than normal levels during fasting. This is the hallmark of a diabetic’s insulin function. Diabetics have lost their "insulin spike", first phase insulin response at meal times, and have also lost the ability to obtain very low insulin levels during fasting. They sort of linger in a chronically high insulin state, all of the time, known as hyperinsulinemia. Insulin was not meant to work that way. It needs to be pulsatile.

Carbohydrates interfere in insulin's pulsatile release because they cause blood glucose to rise too high, postprandial, and the insulin that is released in response to this, drops blood glucose too low during fasting. Metabolism now adapts towards hyperglycemia in order to avoid those drops in blood glucose. It's adapting in response to insulin expression. Your metabolism is basically "dosing glucose to match insulin", just like your doctor advises you to eat more carbohydrates, as your diabetes medications and/or prescribed insulin increases with time. Your doctor is trying to avoid hypoglycemia and so is your metabolism. Your body's "set point" for hypoglycemia continues to rise with time. It soon responds to a blood glucose of 200 mg/dL, as if it was hypoglycemia.

So, this is why carbs are removed, from the table, and other macronutrients can remain.

• Protein causes an insulin spike and then insulin lowers to very low levels during fasting.
• Fat causes very little insulin release and will only further stimulate fasting insulin if it is eaten to excess and then must be stored.

As you can see the prioritized macronutrient should be protein because it stimulates that spike in insulin, which is what you want, as that’s what controls glucagon and will eventually correct gluconeogenesis. The spike in insulin caused by protein is used for the building of lean muscle mass and delivery of nutrients into cells, not for building further fat mass, as is the case for carbs and fat. But this will only occur if carbohydrates are kept low and fat is kept moderate.

6. Do exercises that help burn glycogen "reverse" diabetes?

These type of assumptions are precisely why my advice is for people with metabolic syndrome/obesity/diabetes and not ultra-marathoners, martial arts competitors, football players, etc. The fuel requirement for athletes is completely different from the one for "ordinary" people.

You need to burn fat, specifically from fat stores. Not glycogen, but fat. If you keep tapping glycogen and ignore fat, you will end up like these diabetic ex-athletes. Body fat is toxic to metabolism in excess. What exactly excess is varies between individuals and is determined by age, gender, sex hormone/metabolic status and genetics.

Athletes love to burn glycogen because that’s where they get their "explosive" energy from, but obese diabetics do not have "explosive energy" requirements, nor is it required. They have the normal prolonged, steady state energy requirements that we evolved to have and are acquired through the burning of fat for fuel. Diets that stop contributing to the building of useless glycogen fuel and force the body to burn fat instead, are what helps achieve remission of diabetes.

Stop negotiating with your glycogen like these athletes do. You need to get rid of body fat. When you stop replenishing glycogen, it will naturally reduce with time, so you don’t need to "burn through it". A diabetic never uses their glycogen stores efficiently anyway. Their body just keeps right on producing excess glucose and glycogen continues to be stored in excess constantly. In fact, all of their muscle soon becomes glycogen. You need proper insulin sensitivity to synthesize glycogen, which diabetics lack.

Target body fat and leave glycogen alone. Glycogen corrects itself, as metabolism improves with time and body fat is allowed to lower.