Six common beliefs addressed, Part 226

1. My coach said that she used to use macros but had to switch to calories because people never followed it. She finds that "women" seem to follow food lists and calories better than macros, but she said that you can't just count calories, you have to count them within certain groups of food. I thought a calorie was a calorie.

This coach is basically making women appear like idiots. The reality is that most diets are followed by women. Men get fat and either stay that way, without complaining, or just do what they have to in order to fix it. They don't need any guidance or hand holding to get it done. They just guide themselves by results. They aren't in denial as to what is making them fat and they don't make excuses. I suppose I am now making women appear like idiots.... Well, it is what it is.

There is no denying that some gender differences can be advantageous and others not so much. Men definitely are at an advantage when it comes to dealing with their weight issues simply because of behavior and approach. Because of this, I can imagine most of the people in your coach's program are women. After all, women are the ones who seem to require more "help" to deal with their weight issues.

Aside from the gender wars, calorie centered protocols have always been much easier to follow. They are also user friendly because there is no elimination of any particular food. This is why people are more likely to follow them. This is not new. This is why they are highly recommended by everyone, from your doctor to your neighbor, and they make up 99% of the diet industry. If your coach wanted to keep clients and make new ones, it is not surprising that she had to change her protocol to a calorie centered one.

Tsk, tsk though. She is sending out the message that calories are king, when it comes to weight loss, but still telling you that you have to count the calories within certain macronutrients. That's not a true calorie centered protocol. It's a hybrid and those whining women will be none the happier when they see they can't count out the calories in cookies but will be forced to eliminate them. "I have to eliminate foods and count calories too? I don't think so. Either or."

Oh well, to each his own, but this goes to show you the type of shenanigans that go on in the diet industry. This coach knows that calories are not enough but yet she hides the reality behind the excuse that "people will not follow my program on macros". Basically, her profit margin is more important than addressing the problem. This is why you have to be leery of diet programs because they will never advise on legitimate protocols. It's just not profitable.

Of course, a calorie is a calorie when it comes to weight loss, but a calorie is not a calorie when tackling overweight/obesity.

2. Men stay leaner longer and can lose weight quicker.

Testosterone is the hormone of leanness. Testosterone helps keep fat away from the subcutaneous and builds muscle instead. This process remains in equilibrium as long as there is sufficient testosterone, no disruption in blood glucose regulation and none of these:

• An imbalance of sex hormones because of childhood onset of obesity. Males that become obese before sexual development tend to become estrogen dominant and will have an obesity pattern similar to females with the development of "man boobs", hips, butt and large subcutaneous fat reserves.
• Getting older causes a decline in testosterone and this slowly tilts the axis towards estrogen dominance. Older males will now develop the "man boobs", hips, butt and large subcutaneous fat reserves typical of women.
• Obesity alongside testosterone is very dangerous. Testosterone forces fat to go into the visceral causing a large, hard, extended stomach, known as a "beer belly" but in actuality it's a "fat liver". The extremities will continue to be thin and there won't be much subcutaneous soft fat. This usually occurs in middle age men when there is still enough testosterone for the effect to take place.

If a man is still producing enough testosterone, they will quickly achieve results from diet and exercise. This will occur much more quickly than it would for a woman. Estrogen prevents women from losing fat easily. Men that are estrogen dominant, either from early onset obesity or from just being older, will have a much more difficult time losing weight.

Aside from that, men tend to stick to their diet due to the gender differences in behavior that I mentioned in my previous reply. Men who want to lose weight tend to be more committed and use less excuses. They do not require "support" or "hand holding", so they are less susceptible to falling for quackery and fad diets. They are also willing to do more exercise and sacrifice more foods. Their competitive nature and respect for self-accountability works to their advantage when it comes to dieting. This is why you see less men in "diet programs" and more men at the gym, while still achieving the most results. Again, this shows the behavioral aspect of obesity.

3. Body mass index (BMI) is "old school" and not reliable.

BMI is a pretty solid guide. Yes, it's old school and that's a good thing because it has stood the test of time. Of course, it is not one hundred percent accurate but that's only the case for body builders or other athletes that have crazy muscle mass. For the average person, BMI works pretty well.

But I have said it before and I will say it again - standing naked in front of a mirror tells you everything you need to know about your body, without the fancy calculations.

4. My coach calls vegetables "carbs".

Because they technically are but this is also a misnomer, since the "carb" in vegetables is fiber, not glucose. Fiber is not usable by the body, so the only carb of concern is glucose.

Coaches just want to sound cute calling vegetables "carbs" because they want to push back on the idea that "carbs" are "bad". If "carbs" are "bad" then where does that leave wholesome "veggies"? But this is all just a gimmick. It's no different than when "keto" people push back on the Dietary Guidelines by eating sticks of butter. It's not funny or "smart". It's asinine and it doesn't help you understand how to eat better.

The carb that is detrimental is glucose. Glucose is found in fruits and starchy vegetables. Starch turns into glucose in the body. Fibrous vegetables, which are basically all, above ground, non-starchy vegetables are carbs in the form of unusable fiber. This is why potatoes can raise your blood glucose but not cauliflower, even though they are both carbs. Not all carbs are created equal.

So, why would you have to watch out for these fibrous vegetables if they aren't a detrimental carb and are also low in calories? For several reasons.

• They can replace protein. Any food that displaces protein is detrimental in the diet. Protein is always the priority, but some people rather have a bowl of mashed cauliflower than a steak.
• They can become conduits for excess fat. Bacon fried green beans and mayonnaise drenched coleslaw have to be monitored. A lot of people like their vegetables because they can add a stick of butter to them or a tub of sour cream. Be careful with the preparation of your vegetables.
• They can become a conduit for sugar. Sweet and sour broccoli and honey coated asparagus are not proper ways to eat your vegetables.
• They are air, which is basically starvation. Be careful you aren't eating too much of them.

There is no such thing as a "good carb". The only "good carb" is the one your body makes itself through glycogenolysis and gluconeogenesis.

5. How does a person develop large disparities in blood glucose? Does it happen from getting fat? I know you have said that is the root of metabolic syndrome/diabetes, but I don't understand how this occurs.

This is a good question. These large disparities in blood glucose regulation are most commonly triggered by diet. This is the timeline of how this occurs:

• At 10 years old eating pizza. Blood glucose goes to 120 mg/dL post postprandial and 84 mg/dL fasting. Everything still appears normal even though the higher postprandial number makes 84 mg/dL fasting appear to be an abnormal drop in blood glucose to metabolism. Since a child is still growing, insulin expression is harder to adapt to these blood glucose abnormalities so everything continues to appear normal.
  
• At 20 years old eating pizza. Blood glucose goes to 140 mg/dL postprandial and 70 mg/dL fasting – Large disparities between postprandial and fasting blood glucose are much more apparent. This will only widen over time. Overweight begins to creep in, usually for a female.
• At 30 years old eating pizza. Blood glucose goes to 170 mg/dL postprandial and 60 mg/dL fasting – Postprandial hyperglycemia and fasting hypoglycemia. Obesity rears its ugly head, and it also becomes noticeable on males. That testosterone won't save you forever.
• At 40 years old eating pizza. Blood glucose goes to 200 mg/dL postprandial and 120 mg/dL fasting – Active hyperglycemia all of the time while the body believes the fasting number is still hypoglycemia. It will only double down in trying to keep fasting blood glucose as high as the highest postprandial number.
• At 50 years old eating pizza. Diagnosed as diabetic.
• At 60 years old eating pizza. On dialysis and missing a leg.

Keep in mind, the above timeline can differ depending on how the syndrome manifests in the individual. You can be on dialysis and missing a leg at a much younger age than 60 and you can absolutely become obese at age 10.

Notice how the pizza got the ball rolling by significantly raising postprandial blood glucose. This causes a large drop in fasting blood glucose, even when the body is just going back to baseline normal. The body doesn't like this and will actively fight these large drops in blood glucose as this is a signal to it that it is starving. Because it thinks it's starving, it starts sparing fat. This is the beginning of overweight/obesity.

As time goes on and insulin function deteriorates, you can see how the postprandial blood glucose keeps going higher and higher, while eating the same pizza. Fasting blood glucose never goes back to normal but remains high, even though a significant drop continues to occur, in comparison to the postprandial number.

What is occurring is that fasting blood glucose is trying desperately to catch up and match postprandial blood glucose, so that blood glucose is basically always high, and the large drop never occurs. The body is adapting to high blood glucose because it likes to keep blood glucose within a very controlled range. That is what diabetes is - an adaptation towards high blood glucose.

By 50 years old, fasting blood glucose is the same as postprandial blood glucose. The fasting blood glucose finally caught up and now blood glucose is always high, whether fasting or not, in other words diabetes. This adaptation causes for the body to do anything to keep blood glucose high and it does this through an over expression of gluconeogenesis and adrenal output, irrespective of diet. The 60-year-old that is now on dialysis and missing a leg had been showing signs of illness, since their 20's when they started becoming overweight/obese.

Like I said above, the onset of disease can be much earlier depending on how frequently these highs and lows in blood glucose occur. If this pizza eating person also eats ice cream, cookies and cakes, then this roller coaster in blood glucose occurs at every mealtime and the adaptation happens quicker, making them a diabetic at 30 years old, blind at 40 and on dialysis at 50.

You can see why overweight/obesity and diabetes are considered time dependent conditions. They don't occur over night. There is a decade span between each progression of the disease. So, this doesn't occur from "getting fat". Getting fat is the canary in the coalmine. It is telling you that something is wrong. Your metabolism is under stress.

Most people do not see this disease process occur because it happens so slowly and blood glucose is only checked while fasting, during your yearly physical. So, you never see these large disparities occurring. Some of those drops in fasting blood glucose can go well into the 50 mg/dL and 60 mg/dL during the overnight fast because of prolonged insulin release due to high postprandial blood glucose. It takes time to clear that glucose and insulin will remain in circulation during it. It then takes time to clear that insulin but by then, your blood glucose just keeps dropping.

Most prediabetics and diabetics develop a resistance to these drops in blood glucose and manifest no symptoms of hypoglycemia, even when their blood glucose becomes dangerously low. This is why many diabetics die in their sleep. This is also why many individuals with metabolic syndrome experience pseudo hypoglycemic symptoms even when their blood glucose is completely normal or even higher than normal.

These disparities will make you uber fat as the body continues to think it is starving because blood glucose is so erratic. You see, the body doesn't just use calories for nutrient availability information. It uses blood glucose as well. Nothing tells the body it is starving, more than a sudden drop in blood glucose. It's not the calories in the pizza. It's not the fat in it. It's not that it's junk food. It's the carbs that disrupt blood glucose regulation.

This is precisely why some people are at a loss as to why they are so fat. They don't seem to eat much and many times they don't even eat often enough. This is because what they are eating is reinforcing this adaptation, irrespective of portion sizes and calories. This is also why overweight/obesity cannot be treated using calories as that is not what caused the "disease". Yes, pizza has a lot of calories and that will cause you to gain weight, but you will only become obese because of the blood glucose disparities. This is why the younger you are, the better you can "handle" this pizza load even though the calories in that pizza are the same for a 20-year-old as for a 50-year-old, but the hormonal state of a 20-year-old is very different than a 50-year-old. The 50-year-old is more susceptible to blood glucose abnormalities.

How can all of this be avoided? Eat foods that do not disrupt your postprandial blood glucose. Disruptions in postprandial blood glucose will set the stage for this process to occur and once it begins, diet is only a palliative treatment.

6. A friend told me that she eats baked potato with plenty of butter in order to prevent blood glucose from rising too much.

You are either low carb or you're not. If you're not, then I recommend calorie restriction as this will at least ward off the "disease" for some time.

Mixing carbs with fat creates a high carb/high fat diet. Basically, that's the Standard American Diet (SAD), the most fattening diet on the planet. Just because the fat displaces glucose temporarily, and you don't see it rising on your blood glucose meter, it's not doing a thing to treat your condition. You're still getting fatter and sicker over time.