1. I have a family member who was overweight and prediabetic. They went on "keto" and they now look sick. I can see all of their bones and even their tendons. They appear frail too. Is this the result of too low protein and not enough exercise?
Some people lose a lot of weight and their family and friends swear up and down that they look "sick" when they are just slim. We are so used to seeing people who are overweight that they begin to appear normal to us and slim people appear abnormal. But, I don't believe that is what you are describing. You are describing someone who has lost too much body mass.
I have seen this occur a few times before but it is rare. Yes, there are cases where this can be the result of a very low protein diet and lack of muscle building exercise but not always. This is actually the result of obesity and its long term effects on insulin and leptin expression.
There are some overweight/obese people, who experience temporary super leptin sensitivity when they treat their metabolic dysfunction through diet and exercise but it can also occur after bariatric surgery. The hormonal changes which induce the weight loss are like a "shock" to metabolism and the person loses a significant amount of weight. In fact, they lose so much weight that they end up going well below their body mass threshold and might appear gaunt and boney, even cachexic. This is because they aren't just losing body fat but they are losing a good amount of muscle as well as this sudden shift in metabolism causes stress, which in turn causes muscle wasting. For those who were once obese, this muscle wasting can be quite exaggerated.
After some time, this super leptin sensitivity usually reverses without any changes made to lifestyle. The reversal is caused by a shift in leptin, once again, where the sensitivity is lost and this can result in a return to obesity. As you can see, the metabolism of the obese is "blind" to its threshold. They gain weight well beyond their threshold and they lose it well beyond their threshold as well. This shows that weight loss is not the cure for obesity as obesity is not just "being fat", it's a metabolic dysfunction. In fact, weight loss can cause a doubling down effect of obesity.
This effect is the consequence of leptin resistance which is not fully understood. No one knows what the long term effects of leptin resistance are for weight management in the ones who can achieve sensitivity. The outcomes do not look good.
The very few who are able to sustain this sensitivity continue to have very low weight and it doesn't reverse. This low weight continues to be the result of an abnormal body composition. When they were obese, they had high body fat and low lean muscle mass. Now they have low body fat and low lean muscle mass. It is like they can sustain super leptin sensitivity, while still being insulin resistant and the resistance has finally spread to their fat mass.
But this will not be the case for the vast majority of these people. Most will simply return to obesity. Why? Because losing weight below your threshold would cause what? A reinforcement of the starvation response. What is overweight/obesity? A starvation adaptation. So once again, leptin sabotages your weight loss. It causes so much weight loss that the body panics and the starvation response is heightened causing an exaggerated under expression of leptin and weight regain once again over time.
So your family member has to monitor this carefully. People tend to become very happy with their weight loss but it can be a Trojan horse. Remember, the cure for obesity is not weight loss, it's acquiring metabolic homeostasis instead.
2. My father is in his 70's. He has never been overweight/obese. Instead he has been slim his whole life. He has blood glucose issues, which he has controlled very well and has never reached the stage of diabetes, but yet he has developed kidney disease which causes him blood pressure issues. His blood glucose is the reason for his kidney problems, according to his doctor. I don't understand how someone without diabetes or obesity can still develop the same pathologies as a full diabetic.
Your father is suffering the consequences of long term metabolic syndrome.
Metabolic syndrome does not always end in diabetes but it always ends in pathology. Diabetes is simply the stage of metabolic syndrome, when blood glucose remains chronically and abnormally high. This commonly occurs at the end stage of metabolic syndrome but not for everyone. There are a few who simply do not ever develop diabetes. Remember, metabolic syndrome/diabetes are syndromes. This means they only manifest similar related symptoms which can vary between individuals. Not only do the symptoms vary but the progression and prognosis varies as well.
This has been researched extensively and there still isn't a consensus as to what causes these differences between individuals. Some claim it's the fat cells. The more fat cells you have, or can expand, the longer you can ward off diabetes as metabolism begins accumulating fat in order to protect you from its dysfunction. Your father proved that's not necessarily the case as he's slim and still was protected from diabetes regardless. We do know that fat is somewhat protective but obviously doesn't always live up to its purpose.
Some say it's genetics. Still others say it's the ectopic fat accumulation that ultimately decides your fate. Who knows because the reality is that no one does as there have been conflicting results with the studies that have looked into this. What we do know is that metabolic syndrome/diabetes are extraordinarily complex and everything I have mentioned so far is implicated in its progression in some way or form.
What this tells us though, is what I have been saying on this blog for a long time. We see it In vivo with your father. Metabolic syndrome/diabetes are not "diseases" of high blood glucose. They are adaptations towards high blood glucose and this begins with improper blood glucose regulation. Instead of just high blood glucose, the most likely culprit for these differences between individuals is related to insulin expression over time and how it adapts to disruptions in blood glucose. How much insulin sensitivity can you maintain, in the presence of abnormal blood glucose control, and for how long and how does it effect other hormones (leptin) in the long run? This ultimately determines how adaptable your metabolism becomes to starvation (high weight, insulin and blood glucose set points) which in turn effects how much blood glucose regulation you lose over time.
Your blood glucose does not have to be very high for insulin function to deteriorate. Just like lower blood glucose will not magically cause you to regain insulin function. It all has to do with blood glucose disparities. These disparities can happen at any blood glucose range. It appears that some are more sensitive to these fluctuations than others.
The kidneys are exceptionally vulnerable to insulin dysfunction and this is why kidney disease is so prevalent with metabolic conditions, especially in diabetes. Hyperinsulinemia impairs kidney function. Impaired kidney function does not allow for the proper elimination of waste, including excess uric acid. You can see this kidney failure begin to occur decades before diabetes sets in with the presence of gout. Gout is an early marker for kidney disease. These gout "flare ups" are the first sign of what's to come. High blood pressure, as well, is one of the markers of metabolic syndrome and extremely common. It is also a sign of compromised kidney function as insulin is anti diuretic, damaging the kidneys over time. In fact, high blood pressure medications are most commonly diuretics. They work on your kidneys to lower blood pressure and they themselves will cause the development of kidney disease.
All of this tells us that you have to protect proper insulin function long before you develop diabetes and preferably before you even develop metabolic syndrome. The best way to retain your insulin function is to follow a diet that does not cause disparities in blood glucose because those disparities are a snowball effect for your metabolism to begin going down hill.
3. Ever since I lost weight and my blood glucose and insulin levels lowered, I have noticed a terrible stress response to just about everything. If I get even the slightest bit nervous or upset, I have a surge of stress hormone release that causes shaking and headaches.
If you have been checked out by a doctor and no condition was found that might be causing this, then this may be the body's reaction to lower blood glucose and insulin levels.
People assume that the "cure" to their "disease" will be a very positive experience, where they will feel great and all their previous ailments will magically disappear. That is not the case. In many instances, the cure is worse than the disease. At least, it will feel that way in the short term. Why? Because losing weight is only half of the problem. That's why weight loss is not the cure.
When metabolism adapted over time, to be in a state of hyperglycemia, all hormones were primed and honed for just this very outcome. When blood glucose drops to normal levels and insulin no longer remains chronically high, the body must re adapt to its "new normal". This will not occur painlessly. The body will use any situation, including emotional stress, for the release of stress hormones. It is trying to ramp up glucose release for higher blood glucose. The problem is that little by little it will have less and less of an ability to do this. You might then feel a release of adrenaline, more than anything else. Every system of the body does not adjust at once. Adjustment occurs in stages, just like the adaptation process itself, occurred in stages. Each system broke down with time and now each system corrects itself with time.
This is why metabolic syndrome/diabetes are not true diseases but adaptations described as "syndromes". It takes a long time for the body to adjust and in the interim you will feel symptoms you might not have noticed before. I know that I, personally, went through the worse time of my life while I was losing weight and lowering my blood glucose. I had poor health when I was 300 lbs. but I really went through the wringer while losing them. I had never even been to the ER at 300 lbs. and I went five times during their loss. I had all kinds of symptoms. Good thing that I stuck to it because I believed nothing bad could be happening if I was losing body fat and stabilizing blood glucose. It's difficult to believe you can feel great while going through hell but that's precisely what happened to me.
I suggest that you also keep an eye on your electrolytes and make sure that you are supplementing adequately. This is one the main reasons people feel terrible when their insulin lowers. Losing control of your electrolytes can not only make you feel awful but it can put you in the hospital. Recommendations for electrolyte supplementation can be found here.
4. I started fasting and at first, it seemed to be working, but I have actually been gaining weight and my body has increased its set point. Now it's become impossible to lose any weight and when I do, I just simply go down to that set point and no more. Fasting caused this.
Yes. Unfortunately, it did.
Most people don't understand how this can be true since they are still holding on to the notion that calories drive obesity so if you are fasting, and no calories are coming in, how in the world can you possibly gain weight and become even more obese from calories that were never eaten?
This is because calories are not what drives obesity. Blood glucose dysregulation does and food is not the only thing that dysregulates blood glucose. Starvation does too. Starvation prolongs your time in hypoglycemia. Like I have mentioned before, its the lows in blood glucose that drive the condition. Metabolic syndrome/obesity/diabetes are all adaptations to starvation (hypoglycemia). When you starve for real (fasting), these adaptations double down in order to make you fatter and "protect" you. This is why you have to be very careful that the fasting protocol you are using is not contributing further to this process as it would make you fatter.
Choose a real intermittent fasting protocol. Do not fast for longer than 72 consecutive hours, once a week, and only choose that protocol if you are morbidly obese - over 50+ lbs.
5. Are low fat diets unhealthy?
No. Low fat diets are just as healthy as any other diet and can be metabolically sound if they are followed correctly. You just have to make sure that when you reduce fat, you do not replace it with carbs, which is usually how these diets are followed.
The reason that we do not include low fat diets in our list of recommended protocols is because carbohydrates disrupt blood glucose homeostasis more than any other macronutrient, so it makes sense to make it your main target. Low carb diets also eliminate junk and fast food, when followed correctly, and this automatically lowers the fat in your diet. The Standard American Diet (SAD) is a high carb/high fat diet. When you eliminate the carbs, you reduce the fat since they usually come together in SAD fare.
6. All symptoms of insulin resistance are the result of carbohydrate intake.
No. You can develop insulin resistance in other ways. Any condition that disrupts blood glucose homeostasis, preventing your insulin from working in pulses, will cause insulin resistance over time. So, just being overweight/obese will cause insulin resistance since having excess body fat puts a high insulin demand on the body. You also become insulin resistant naturally as you get older since insulin is no longer needed for "growth".
Carbohydrates are simply the most common contributor of excess body fat, in the modern diet, because they make the bulk of the food we eat. Carbohydrates disrupt blood glucose homeostasis and this ultimately causes insulin malfunction and the accumulation/preservation of body fat.
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