A lot of people who read about metabolic syndrome/diabetes often ask questions like why aren’t leptin or insulin or cortisol or "name hormone here" targeted with prescription medications for the treatment of diabetes.
The answer is because metabolic conditions are more complicated than any one hormone. This is why you have to stay away from quacks who like to reduce the complexity of any condition to one cause and then tell you they have the cure for it without ever delivering the goods.
Diabetes and other metabolic conditions are syndromes. Syndromes are always multifactorial. On this blog, I have broken down what each hormone contributes to these pathologies but I do not blame any one of them for the entirety of the pathology.
Though it is well established that people suffering from metabolic dysfunction and diabetes have issues with their hypothalamic/pituitary/adrenal axis (HPA) function, studies have not been able to determine whether this is correlation or causation. These studies have shown conflictive results with cortisol levels, for example. Some have only seen an abnormal rise in serum cortisol levels after certain diabetic complications develop, most commonly retinopathy. Basically, it seems like serum level rises, in these hormones, occur at the very late stages of the disease.
The same has been seen with insulin as there are many diabetics walking around with absolutely normal insulin levels even though it has been proven that poor insulin function plays a very important role in the development of diabetes. Leptin is another hormone whose function does not always correlate with serum levels even though "leptin resistance" is a well established fact in intractable obesity.
For this reason, no drug has been developed to "treat" serum levels of these hormones, for metabolic dysfunction, as serum levels do not always reflect their function. In other words, these hormones can poorly function at any serum level as all these hormones are at the mercy of your entire neuroendocrine system. That is why you can still become fat with low insulin. There are no medications that "fix" metabolic hormone function as it appears that the malfunction is coming from alterations in their very complicated feedback loops. So the standard treatment for diabetes is still blood glucose lowering medications as those are readily available, very effective and targeted to what will eventually cause mortality.
This is why, on this blog, we speak on hormonal function, not serum levels. We don't treat numbers. Sometimes serum levels can give you an insight as to what may be occurring metabolically, and they can be a target of treatment, but we don't assume that someone who is diabetic or overweight/obese, automatically has high serum levels of anything unless they have been tested and this has shown to be the case.
2. I you lose weight, can you begin putting it back on as cortisol levels begin to rise?
Your weight loss caused your weight gain. That's why there is no known cure for obesity as of this post. The cure for obesity is not "lower weight".
You lost weight and your body went into panic mode. Your metabolism was adapted to store and spare fat mass and a change to this caused systemic stress from a change in metabolic function. This can produce very high cortisol as the body fights to keep its blood glucose, insulin levels and body fat at very high set points.
Your weight loss to a normal weight was deemed by the body as starvation and it will break itself down into glucose in order to stop this.
That's why obesity is not simple "weight gain" and why "weight loss", doesn't cure it. Obesity is when the body purposely stores and spares fat mass well beyond its threshold, irrespective of calories. Weight gain is simply caused by a surplus in calories which results in temporary added water, fat and muscle that can be reversed in two weeks max with a caloric deficit. It's not a big deal. It's not a lifelong struggle. A healthy metabolism mitigates its weight on its own by gaining a little and then refusing to continue. Just like it loses a little and then refuses to continue.
Of course, we all know obesity certainly doesn't work that way. Obesity continues on and on unabated and irrespective of nutrient availability. It's as if there is no ceiling for obesity. The weight set point is not determined and it can continue rising limitlessly. As long as any nutrient is available, in any amount, the obese will continue expanding. When all nutrients stop, the expansion continues from muscle mass breakdown. This is why you see many obese people, especially older ones, walking around looking somewhat "thin" underneath mountains of hanging globs of "skin". It's not skin. It's subcutaneous fat that refuses to be lost and the "thinness" underneath is caused by the loss of muscle. If they are sent to a gulag, they will die of malnutrition before they lose any of that fat.
All of this causes hormonal chaos as every single hormone is primed and honed for fat sparing and storage. So aside from over expressed cortisol, obesity also under expresses leptin to make sure no fat is burned as the body is struggling for an increase of its fat stores, not a decrease.
Elevated cortisol results in the following:
- It slows digestion from an interference with the parasympathetic nervous system.
- It decreases muscle size as it's catabolic to muscle.
- It increases blood glucose from the breakdown and conversion of muscle, disrupting its regulation.
- It stores body fat from this increase in blood glucose.
- It adversely effects lipid profiles through fat displacement from glucose overproduction.
- It interrupts sleeping patterns from an interference with the parasympathetic nervous system.
- It increases heart rate from an interference with the parasympathetic nervous system.
- It lowers testosterone as testosterone interferes in fat storage and muscle breakdown.
- It weakens the immune system as you lose the beneficial inflammation that cortisol is suppose to produce.
The palliative treatments of diet, exercise and systemic stress reduction (lifestyle) are the only "treatments" that are known for now, to stop and in some instances reverse this adaptation. This is always the goal, never a guarantee.
Like I mentioned in my previous cortisol post, you can try lowering your cortisol levels by using ashwagandha, an herbal supplement you can find over the counter which has been shown to help reduce cortisol levels, but you should discuss its use with your doctor. In fact, you should discuss this high cortisol with your doctor and insist on a treatment as it's interfering with your weight management. Just don't let the treatment be more cortisol.
3. Even if you eat low carb, blood glucose will still rise when you eat if you are a diabetic.
That's because you are diabetic and diabetes is not "carbetes". Everything a diabetic eats causes their blood glucose to rise to high because there isn't enough first phase insulin release to halt glucagon and their glucagon producing cells have also become mostly insulin resistant. Basically glucagon is out of control, breaking down everything into glucose which spills into the blood stream. Type I diabetes is similar to Type II diabetes in this regard. This effect is irrespective of carb intake as there is an insulin response to everything you eat and glucagon follows suit.
The purpose of eating low carb is not to keep blood glucose low postprandial. Keeping blood glucose low postprandial is not the way to obtain proper blood glucose regulation. It is only a pseudo effect because a lowering of blood glucose occurs immediately in many people. It makes you think you are getting your "disease" under control but you aren't. Diabetes is a syndrome of many abnormalities. They all persist until an effective treatment is followed.
The true purpose of eating low carb is to keep blood glucose stable. Preventing blood glucose from rising too high after meals, prevents it from diving to low while fasting. You are trying to shorten the disparities between the highs and lows in blood glucose, in order to halt the progression of the syndrome by breaking the metabolic adaptation that drives it. Shortening blood glucose disparity will help normalize insulin levels over time. That's it. That's the whole purpose of eating low carb and that's all it's effective for.
If you think your blood glucose is still high while on low carb, you should see it after eating a doughnut. This is why, regardless of whether your blood glucose goes as low as you want it to or not, do not stop your low carb diet. Low carb diets work in conjunction to other diabetes treatments, such as blood glucose lowering medications. If your diabetes is not under control with the treatment that your doctor has you on, you need to have a discussion with them about it. Do not depend on palliative treatments to take effect while your blood glucose continues to rise.
4. Should I be worried about oxalates?
Oxalates are a natural substance found in many foods. They bind to calcium during digestion in the stomach and intestines and leave the body in the stool. Oxalate that is not bound to calcium travels as a waste product from the blood to the kidneys where it leaves the body in the urine.
That is to the extent that we deal with oxalates on this blog.
This is a metabolic health blog. Metabolic dysfunction like obesity and metabolic syndrome, is the leading cause of numerous common conditions that people are suffering from in the modern world. Some of these conditions can be life threatening like cardiovascular disease and diabetes. There is an obesity epidemic, not an oxalate epidemic.
5. Blood glucose should not still be between 95 mg/dL and 120 mg/dL if you eat less than 20 grams of carbs a day.
Metabolic syndrome is not "carb syndrome". Once again, a lot of people are being duped by low carb advocates into thinking that their high blood glucose is solely caused by dietary glucose. That is incorrect.
Your high blood glucose is being caused by your own body. Your metabolism is driven to keep you in a state of hyperglycemia, so it breaks down everything in your body into glucose in order to meet that goal. Dietary glucose has a very small effect on this process. That is why diabetes is a chronic and progressive disease because the body itself is breaking down everything it can find to make more glucose, driving the abnormalities that we see in diabetes.
The reason that carbs are dialed down and even eliminated is to prevent the erratic blood glucose fluctuations that reinforce the condition. Carb restriction is not meant to be a cure. It is meant as a palliative treatment in order to take back some control since it's the sole thing you are in control of. Palliative means that it reduces symptoms but does not cure the "disease".
So you need much more than carb restriction. You need an exercise regimen, a fasting protocol and a routine that reduces systemic stress. Your diet can't just be "low carb" either. That's not good enough. It's quality has to be top notch. Lots of things have to work together in order to reverse the adaptation that your metabolism is in.
6. You cannot reverse prediabetes following "keto".
That is technically correct but reversing prediabetes is much easier than putting full diabetes into remission. "Keto" is definitely a step in the right direction but you can't put all your eggs into that basket.
"Reversal" is a wild claim to make but even I use it because it is so difficult to find the right word of what exactly occurs. This is why I put it in quotes. Remission is a much better description of what takes place, especially with full diabetes.
You can absolutely try "keto". If you follow it correctly, consistently and you use a legitimate protocol, you can most certainly "reverse" your prediabetes. I did and I had pretty advanced prediabetes. Just make sure that you remember to incorporate other lifestyle changes into your new diet because any low carb diet is only palliative for metabolic syndrome.
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