Six common beliefs addressed, Part 110

1. Low carbohydrate diets are too expensive to follow.  

Not in the First World. Low carb is not expensive when you know what and where to buy. The only difference is more trips to the grocery store, since the food you are buying does not have a long shelf life. All of that pasta, rice and beans you could buy, once every six months to store in your pantry, are now gone. Fresh vegetables cannot keep for weeks on end. This means you have to go to the farmer's market or the grocery store, several times a week, to buy fresh vegetables for side dishes. Meat is not a problem, as it keeps in the freezer for months, so can be purchased during sales. 

Concentrate on spending your money on fresh meat and vegetables. Skip the expensive condiments and specialty dairy products. You should not be eating a diary centric diet. Fresh meat can always be found on sale and vegetables are extremely cheap if you know where to buy them. Aldi’s seems to be the cheapest so far, at least, in my area. So, if you could afford that expensive tub of Ben & Jerry's, you can afford to buy meat and vegetables. All you have to do is stop buying so much other stuff that you shouldn't be eating anyway. 

2. Can you be vegetarian and still be "keto"?

I have touched upon this before, but I will clarify again. I apologize for the inconvenience, but this blog will not be of much help if you insist on being vegetarian. "Vegetarian low carb" is an oxymoron. Vegetarian diets are by definition high carb diets. That’s what vegetables are. Carbs with fiber. Fiber is another type of carb that you just can’t digest. 

So, if you have to be vegetarian because of religious reasons, ethical reasons, whatever reasons or because you live in a part of the world where animal foods are impossible to obtain and/or are ridiculously expensive, then you have to abandon this "low carb" fantasy and instead, seek the help of a professional dietitian that specializes in vegetarian diets and is knowledgeable of human metabolism. That would be the only way to address the main things that must be included when following vegetarian/vegan diets. Those are: 

• Caloric restriction - You must be on caloric restriction with these diets. Carbohydrates are only benign in starvation and they are extremely easy to over consume. Over consuming carbs is not like over consuming fats or protein. They will interfere with your blood glucose regulation.
  
• Supplementation - You must make sure you are getting adequate vitamins and minerals, on these diets, as they are very nutrient poor. Vitamin B12 supplementation is a must.
  
• Adequate protein - You must make sure you are getting adequate protein on these diets, as they are very protein poor because they contain a lot of incomplete amino acids. 
• Tracking of metabolic markers - It is vital to track your metabolic markers, as they tend to deteriorate with time on these diets. This is why diabetic vegetarians have such terrible HbA1C's, but they simply cannot keep it low enough, so they settle with simply not getting it higher. That's not good enough.
• Tracking of body fat - Because protein is so difficult to acquire from these diets, you can lose a significant amount of lean muscle mass, making you fatter by default. You don’t just lose muscle mass and replace it with air. You replace it with fat, as the body assumes you are under some form of starvation. 
• Tracking of lean muscle mass - The lower lean muscle mass goes, the higher your fat mass grows. You have to avoid becoming a ball of fat, especially in the visceral. 

If the above list of concerns is not properly addressed, than you are not following a vegetarian diet correctly and you will encounter failure and metabolic deterioration over time. 

There are many ways of being ketogenic. You can calorically restrict yourself into ketosis, while eating potatoes daily, but that’s not the type of ketogenic protocols that we advise on here, as this blog's focus is healthy metabolism, not just being in ketosis for the hell of it. The goal here is always better metabolic function. For that reason, the ketogenic protocols we advise are solely acquired through carbohydrate restriction. This means low carb diets.

3. Conventional doctors purposely promote the Standard American Diet (SAD). 

That is a fallacy. Doctors don’t promote any type of diet. The standard advice is to simply eat less. The only diet advice you will receive is from a dietitian or nutritionist. You will usually be sent to these people if you are given a diabetes diagnosis. The type of diet they will recommend is not "SAD". It’s a calorically restricted diet where you can have SAD items, as long as you remain within your calorie goals. That’s the way all calorie restricted diets work. The reason that this is done is to gain compliance. Some compliance is better than no compliance as the goal is not to reverse overweight/obesity, since it has no known cure. The goal is to simply not get fatter. 

The reason that nursing homes, hospitals and other institutions also follow this type of misguided dietary protocol is because if doughnuts and oatmeal are removed from these places, they will be burned down by the patients. People do not like being in places where their favorite foods are not available. There are some people, reading this blog, who cannot get their own children to give up their junk, so it is unreasonable to expect a nursing home or other facility, which houses adults, to be able to do what you yourself cannot even do with a child. So, it’s not about “promoting”, it’s about having no other choice. You cannot force someone to adopt a low carb protocol. You simply can’t. I know low carb advocates believe they can, but their own followers can’t even stick to low carb themselves. 

4. The relationship with carbohydrates is "ruined" for diabetics. 

Carbs are not the problem. Poor blood glucose regulation is the problem. Carbs are just the easiest and quickest way to disrupt proper blood glucose regulation.

5. If you are "keto" and your blood glucose drops very low, into the 50's - 60's mg/dL, it's not a problem as your body can compensate with its fat burning. 

That is incorrect and a load of BS. When it comes to blood glucose, "the lower the better" is not the right approach. The normal the better. The body likes to keep its blood glucose under a very tight range, regardless of whether you are burning fat for fuel or not. That is irrelevant. 

The range for normal blood glucose is around 84 mg/dL. We know this from extensive studies that have been done on the blood glucose control of metabolically healthy individuals and hunter/gatherer tribes. Keep in mind that 84 mg/dL is an average, not a hard line number. If you have excess body fat, your blood glucose might run slightly higher, but that's not the true problem. It’s lows into the 50's and 60's mg/dL that destroy glucose counter regulation and will eventually make you diabetic, if you aren’t already. 

A lot of people who follow these low carb advocates are not aware that diabetes is not just high blood glucose after doughnuts. That’s actually a completely normal reaction to eating doughnuts. It’s the abnormal high blood glucose after fasting (Dawn Phenomenon) and high blood glucose after steak (hyperglucagonemia) that is indicative of diabetes. The fact that blood glucose is dipping very low, with no symptoms, means you have serious metabolic disease that can turn dangerous. Most diabetics die in their sleep from low blood glucose, not from high blood glucose after ice cream. These low dips in blood glucose are slowly adapting your body to keep its blood glucose set point high and those readings of 90 mg/dL will soon turn into 120 mg/dL, then 180 mg/dL, then 200 mg/dL and finally Victoza. 

You need to keep your blood glucose steady and not allow it to take such low dips. These low dips are caused by a counter regulatory system that is not responding to lowering insulin, during a fast, and so it’s not making glucose when it should be. Even though insulin is "lower" during fasts, it is not lowering enough, as it was already too high to begin with. This means that the higher than normal insulin levels are clearing too much glucose, during your fast, and your body is not compensating. People with metabolic syndrome have under expressed glucagon during a fast, yet they have over expressed glucagon after a meal. For some, this becomes a very obvious symptom, but for others it’s not, even though all people with metabolic disease exhibit this same glucagon abnormality to some degree. 

Diabetes is much more complicated than just getting blood glucose to go down after a meal. Blood glucose running high after a meal is just a symptom of a much deeper problem. The problem is an adaptation towards hyperglycemia and these lows are exactly what will reinforce this. This adaptation requires long term adherence to a proper dietary, exercise and lifestyle protocol in order to reverse it. 

6. Low carb doctors do not recommend an oral glucose tolerance test for a pregnant woman. 

I do not give any advice or recommendations for pregnant or breastfeeding women. These people need to seek the advice of their healthcare professional. Glucose tolerance tests for pregnant women are part of the ‘Standard of Care’ in conventional medicine and there are important reasons for this.