Six common beliefs addressed, Part 92

1. Can blood glucose become very low when you don't eat?

This is from a lack of proper blood glucose regulation. I know that when we think of metabolic syndrome/diabetes, we tend to think of high blood glucose. This is only part of the problem. Metabolic syndrome/diabetes are conditions of improper blood glucose regulation. This means that blood glucose can become very high, but it can also drop to very low. The body is simply unable to keep its blood glucose in the narrow, normal range it's suppose to be in. 

A healthy metabolism does not allow for blood glucose to go very low. There are counter regulatory systems, in place, to prevent this from occurring. People with metabolic syndrome have an under expressed glucagon response to low blood glucose, during fasting, while having an over expressed glucagon response to insulin release postprandial. This is the hallmark of poor blood glucose regulation. 

2. Even a blood glucose in the 80s mg/dL range, can still cause symptoms of hypoglycemia. 

This is typical of metabolic syndrome, especially diabetes. Metabolic syndrome/diabetes are adaptations towards hyperglycemia. The body is actively trying to keep blood glucose high to match insulin levels and expression. This can cause symptoms of "hypoglycemia", even at normal blood glucose ranges like the 90s or 80s mg/dL. In fact, any drop in blood glucose can cause these pseudo hypoglycemic symptoms. 

I understand these symptoms are uncomfortable and annoying. You might feel lightheaded, hungry, irritable, sleepy and generally like crap. But, you must ignore it. If you keep reacting to it, you are only feeding the troll and enforcing it. A blood glucose in the 80s mg/dL is not hypoglycemia. It is actually completely normal. So, you have nothing to worry about. You won't go into a coma or pass out. You will just feel like you have been run over by a truck. It's the price you have to pay to get back metabolic control. 

Allow the body to adapt to lower blood glucose levels. Don't try to raise your blood glucose just to feel better. This will only cause for this problem to continue.

3. Tendonitis is a sign that the body is saying "enough". 

Negative. Tendonitis is a sign that you are doing something incorrectly. In the modern world the body never says "enough". It actually begs and pleads to keep going because it's never doing enough. 

Tendonitis is caused by abnormal movement and/or improper stretching, which then causes injury when the body is "worked". This is especially the case when there has been a previous injury. The body does not become "injured" when it is moving, as it was intended to, unless there is some underlying pathology. The body also resists injury when the proper stretching is done, before it's put to work. Stretching is a must to counteract the abnormal amounts of sedentary behavior, which is very common. 

The type of activity we do, in the modern world, is not the same as field plowing by hand, so you never have to worry about "overwork", unless you're an athlete, training for the Olympics, or some other competition of which you have a deadline. Then you are at risk of possibly pushing yourself beyond what your body can handle. But, the average person, does not have to worry about this, as the average person never pushes their body beyond what it takes to walk to the fridge. 

Sitting on a chair is not going to limit your risk for tendonitis. It will only increase it. Rather than avoiding being active, analyze exactly what you were doing when you had this flare up of tendonitis and see what you could have been doing wrong that perpetuated it. 

• Maybe you were playing a sport. Sports consist of swift, unnatural movements that significantly increase the risk of injury. 
• Maybe you were using the wrong equipment. Make sure you have running shoes for running and walking shoes for walking, etc. Wear the appropriate braces or other equipment that help prevent injuries, depending on your activity. 
• Maybe you didn't prepare properly. Before any activity - stretch, stretch, stretch. You must take 15 minutes to stretch, before you embark on any physical activity. You should also stretch after activity. If you don't, you significantly increase your chances for injury. 
• Maybe you were mildly dehydrated. Inadequate hydration increases injury risk. 
• Maybe you were on a medication that increases your risk for tendon injuries. Certain antibiotics are known to cause this, so speak to your doctor if that's your case. 

4. Vegetarian diets only cause muscle loss, instead of fat loss, in the absence of exercise. 

You can exercise all you want, but without protein, you won't be building any muscle mass and yes, you will lose what you have through cortisol action. In fact, the stress of exercise will cause even more muscle loss, without adequate protein. This means that vegetarian diets can absolutely cause the loss of muscle instead of fat. 

This doesn't mean that there isn't a way to prevent this and still remain vegetarian. I have said before that vegetarian diets are difficult diets to follow because they require special supplementation, as they are very nutrient poor and not natural to humans. But, if you find a knowledgeable dietitian that is well versed in the issues pertaining to vegetarian diets, you can bypass these risks or at least be aware of them, so they can be addressed before they become a problem. 

5. Can high leptin cause leptin resistance?

Leptin plays a significant role in the homeostasis of the insulin-glucose axis. In other words, there is a constant complex feedback loop between blood glucose, insulin and leptin. They do not work independently of each other. They are slaves to one another. Where your glucose goes, insulin will follow and where insulin goes, leptin will follow. The higher the body fat, the higher the insulin and the more leptin produced. The more leptin produced, the more chances of "resistance". 

But "leptin resistance" is really a description of poor leptin expression. Meaning that it is much more complex than just having chronically high leptin levels and the body eventually ignoring it, due to a developed "resistance". That's a very simplistic explanation that stops midway through the whole story. It may have started that way, but it ends up being much more complicated with time. Simple things usually become more complex, when left to their own devices. So, what started at the fat mass, ends in the brain. 

"Leptin resistance" is described by several definitions. Here is a simplified version of each: 

• Leptin resistance is impaired leptin transport across the blood brain barrier. If leptin cannot enter the brain, then the brain cannot "see" its own fat stores. Leptin transport across the blood brain barrier has been shown to be impaired in obesity. 
• Leptin resistance is impaired leptin signal transduction in neurons. If leptin crosses the blood brain barrier, but is impaired in signaling the right neurons, then it's as if it never entered the brain to begin with. The brain will still not "see" its own fat stores. 
•  Leptin resistance is damage to the hypothalamus itself resulting in inflammation, endoplasmic reticulum stress and defective autophagy, which are a result of the above leptin impairments. Hypothalamic damage is no joke. This is the part of the brain that regulates weight according to nutrient availability and body fat status. If it is damaged, it won't ever be able to do this. 

This is what is currently known about leptin, as of this post, and how it "functions" in the obese and impairs weight loss. There are many "theories" out there, as to how exactly this begins, but what we know for sure is that excess body fat, and all of the ways its acquired, is the main driver of setting this into motion. This is why you need to keep body fat under control by addressing your blood glucose regulation.

6. Diabetes cannot be a "metabolic adaptation to starvation", since the person is always in a caloric surplus. 

You can describe metabolic adaptations to starvation, as a misuse of calories. In other words, the overweight/obese, redirect all of their calories, whether in excess or not, primarily to the growth of their fat mass. It is "starvation" because the growth of fat mass is a way to prevent starvation. This is why these adaptations cannot be treated through the manipulation of "calories in" alone, since the calories themselves are not being allotted correctly within the body. 

Another mechanism that occurs with this adaptation is sparing of the fat mass. This means that the body actively tries to stop any challenge to its fat mass by purposely under expressing leptin signaling and reducing metabolic rate. This is why these adaptations cannot be treated through the manipulation of "calories out" alone, since the body will not ever burn sufficient energy to make a difference. 

As you can see, a caloric surplus or a caloric deficit does not affect the root cause of the problem at hand. The type of calorie has a more profound effect to this process, than their amounts since this process is driven by disparities in blood glucose. Calories do not have much of a profound effect on blood glucose but type of calories does.