1. I recently opened a Facebook diet and exercise page which focuses on low carb dieting. The problem is that most of the memberships it's gained so far appears to be seniors. That is not exactly the type of crowd I wanted to attract as I don't believe I can be of much help. Why does "low carb" attract so many elderly and/or very obese people? If my page would have been focused on mostly exercise or conventional dieting, I am sure I would have attracted younger and more motivated people. These elderly/obese people are on dozens of other "low carb" pages, aside from mine, and I don't see many positive outcomes. Am I wrong for feeling this way?
This is the result of several things. First, Facebook is a platform that has been attracting an older crowd for a while now so if your page is being hosted on there, then you might want to go elsewhere if that's not your target audience.
I don't believe you are wrong for feeling how you do. I understand your concern. You might feel as if you are wasting your time trying to help such sick, obese and older people, especially if you are doing this for free to just get info out there. A lot of these people are into "page surfing" but won't really put in any work to gain results. They are just searching "feel good" information that helps ease their anxiety about their failing health. As long as they feel there is "something out there" that can "help" they think they have done something.
I have discussed many times how overweight/obesity/diabetes are time dependent conditions. The longer the person lives with these issues, the less likely they are to reverse them. They might be able to improve some things, but they won't be able to achieve true remission. There are just too many obstacles they will face - natural insulin resistance, hormones, loss of muscle mass, inability to do enough exercise, co-morbid conditions, intractable metabolic adaptation, etc.
In other words, if you want to maximize the rate of success, your target followers should ideally be between 30 - 55 years old. Once you start going beyond that, the rate of success drops significantly. Younger than 30 years old is a breeze unless there is some underlying eating disorder. Of course, prevention has the best outcomes but yet is often neglected.
Aside from the biology, there's the old adage of "you can't teach an old dog new tricks" and nothing can be truer when it comes to lifestyle changes. A lot of these older people are just looking for a magic pill, so they gravitate to protocols that replace carbs with fat or don't push them to get up from their recliners. We know that doesn't work. Elimination diets that require movement are very difficult for them to adhere to as they are inclined to continue with what they are familiar with. They are also reluctant to give up certain habits or food items they are used to, so they insist on keeping them in their new diet despite the hindrance in results. It's very frustrating.
All I can advise you is to either leave the Facebook platform or present a protocol that will naturally cause those who can't follow to drop it on their own and go elsewhere. That will happen automatically with your first exercise post or at the first mention of moderating fat intake. When someone asks you a question, just be upfront and honest with the answer instead of trying to find ways to "please" them. This will automatically thin the herd for you. Remember the majority of these people just want hand holding, excuses and sympathy. If there are none of those available, they will leave and seek it elsewhere which is exactly what you want.
2. My endocrinologist spoke about protein spiking glucose, and he said it was due to gluconeogenesis. He was very vague in his explanation, and I didn't quite understand it. He said that the amount of protein eaten in the US is "astronomical" and that the best way to handle this is through "portion control" but didn't specify how. He also showed a chart of blood glucose slowly creeping up with protein intake, hours after eating, which isn't what's happening to me. My protein spikes right after eating protein like it would carbs. Can you give more insight on this?
I have mentioned this before, many times, but I will address some key problems you mentioned.
Your doctor is correct. This is caused by gluconeogenesis "gone wild" known as hyperglucagonemia. In other words, the Type II diabetic does not have enough of a postprandial insulin spike to halt the catabolic effects of glucagon, so it breaks down too much glucose into the bloodstream. This can cause postprandial hyperglycemia for some hours after eating.
The same effect occurs to Type I diabetics because they have no insulin to halt glucagon so they must dose exogenous insulin to match carb and protein intake. Type I diabetics cannot resolve this without exogenous insulin. Their bodies will not magically correct this problem with diet over time. Type II diabetics can reverse this with diet over time as they regain insulin sensitivity which corrects their first phase insulin response.
But there are some issues with what your doctor said. First, the amount of protein eaten in the US is not "astronomical" at all. In fact, the US is protein deficient in its diet as is the rest of the world. The Standard American Diet (SAD) is not even adequate in protein, much less astronomical in it. But it is astronomically high in carbs and fat.
Second, your doctor is describing hyperglucagonemia as if it is a protein induced condition because of the "astronomical amounts" of protein eaten in the US. That's simply hogwash and will only cause his patients to become further protein averse causing increased protein deficiency and worsening of diabetes. He needs to get his stats correct.
Hyperglucagonemia is the result of metabolic syndrome/diabetes, period. In other words, poor insulin function due to insulin resistance. It is not a "protein disease" or a "carb disease". It is a pathological metabolic adaptation which was initially, most commonly triggered by the postprandial hyperglycemia of a high carb diet, not protein.
The chart he showed you of blood glucose slowly rising hours after protein intake is a little strange. Hyperglycemia occurs pretty quickly postprandial as you described it's happening to you. The person eats protein and when they check their blood glucose, two hours later, it's high. The effect is the same as with carbs. The only difference is that blood glucose usually does not rise as high with protein as with carbs and tends to lower sooner than it would with carbs as carbs interfere with blood glucose regulation for a longer period of time due to the added glucose load. That's why Type I diabetics dose insulin when they eat. They don't dose it hours later. They need to halt glucagon postprandial.
So, the chart he is showing you seems to be the effects of stress hormones during fasting, or what would be considered "Dawn Phenomenon". This has nothing to do with protein intake. This is counter regulatory hormones, mainly adrenals (stress), being triggered by a natural lowering of blood glucose in the presence of insulin. It's basically an adverse reaction to fasting.
Remember, metabolic syndrome/diabetes is a condition where the body actively tries to stop the lowering of blood glucose. So, the minute that begins to happen, during fasting, stress hormones pump out more blood glucose. I have no clue why your doctor is attributing that to protein, but you know how it is. Protein gets blamed for just about everything. But these are two different counter regulations to insulin.
Third, this "portion control" he's talking about is very vague and it's no wonder you were left confused. "Portion control" doesn't have anything to do with controlling diabetes. Ice cream is still ice cream, even at the right portion. I get the feeling that this is the type of doctor that blames overall calories for diabetes which is usually the case in conventional medicine. It's just not true.
Diabetes is poor glucose regulation of which carb calories are the culprit. If it wasn't for the disparities in blood glucose highs and lows caused by carb calories, there would be no diabetes. High insulin alone doesn't cause diabetes. High blood glucose alone doesn't cause diabetes. High body fat alone doesn't cause diabetes. Disparities in blood glucose highs and lows results in diabetes and that leads to high insulin, high blood glucose and high body fat which in turn exacerbate the condition and keeps it going.
Portion control will help you maintain a good insulin to glucagon ratio reducing disparities in blood glucose highs and low but not portion control of everything. You need portion control of only certain things. Like I said above, ice cream is still ice cream, and it will cause disparities in blood glucose even at the right portion. So, you want to eliminate ice cream and all carbs. There is no right portion for them. Then you want to divide your protein intake in order to not disrupt your insulin to glucagon ratio. I use Dr. Bernstein recommendation for this, which is:
- A recommended minimum daily consumption of 1.0 - 1.2 grams of protein, per kilogram of ideal body weight, for adults. You divide that amount into three meals as follows:
- Breakfast: 6 grams carbohydrate, 3 ounces protein.
- Lunch: 12 grams carbohydrate, 4 ounces protein.
- Dinner: 12 grams carbohydrate, 5 ounces protein.
3. Is Paleo a good protocol to follow? My mother-in-law follows Paleo and was able to drop her diabetes medications. I was thinking of doing the same thing to try and better my own health.
Yes. Paleo is a good protocol if followed correctly and without the concessions. Unfortunately, like most diets, many iterations of Paleo try to appease their followers with substitutions, recreations, alternatives, etc. of Standard American Diet (SAD) staples.
Stay away from "dessert centered Paleo". You never want to follow any protocol that makes excuses for its followers and allows them an exit. It may help them make more money, but it will only help you remain fat.
If you look at "paleolithic" art on cave walls, it tells you exactly what to eat. In fact, those cave paintings are basically a recipe book. This has caused for naysayers to criticize Paleo for not truly being "paleo". Paleo is just the name of the protocol and doesn't mean you will be eating truly as a caveman would since those times are long gone. Instead, Paleo is basically a meat and vegetables diet that eliminates all sugar and grains, but it is not exactly a "low carb" protocol. This is why I don't feature it in 'Recommended Diets'.
Paleo is primarily focused on whole, unprocessed foods, sort of like "going back to basics". So, what are the pitfalls of Paleo?
- Paleo allows honey and/or maple syrup which is a no-no. You never want to incorporate either, in any amount or form, into your diet. Sugar by any other name is still sugar. A lot of Paleo protocols use these sugars way too often simply to entice people to try the diet. Don't fall for that trick. Anyone who is trying to treat overweight/obesity/diabetes or does not want to have to treat them in the future, should not be consuming honey and/or maple syrup, no matter how "natural" they are.
- Paleo also allows root vegetables. If you are diabetic, you might have issues controlling your blood glucose if you include these so you should eliminate them until your health improves. Even then, they should always be restricted and never the main meal. All vegetables are only complimentary to meat. Keep your focus on protein.
4. Is it true that being fat by itself does not cause diabetes?
This is another "word play" type of question. I can understand how people become confused. This word play is used to keep the confusion going. Let me explain.
Being fat puts you at risk for diabetes because excess body fat is a signal/marker that there is something interfering with your metabolic homeostasis, and this will eventually lead to pathology. This is why the reduction of body fat is vital for remission as it means that metabolism is finally doing what it's supposed to. It's not the loss of body fat itself that causes benefits, instead it's the ability for your body to do so. Being able to lose body fat, means your metabolism is improving.
This is true whether the excess body fat can be seen externally or not. Some people appear thin on the outside but are actually very fat on the inside. This is because having a high body fat percentage does not always translate into the appearance of "fat". You can appear thin and still be mostly fat. This is why there are skinny Type II diabetics. But things are not quite that simple as there is more to this story. It's all about why you are getting fat rather than just being fat.
Diabetes is the end result of poor blood glucose regulation. Basically, the body can no longer properly control its blood glucose. This is most commonly the result of a poor diet that interferes with proper blood glucose regulation, but other things can also interfere with blood glucose homeostasis like certain chronic medical conditions and/or medications. Also, let's not forget caffeine. This stimulant is notorious for interfering with blood glucose, and it is hidden in many things that are consumed liberally in the modern diet.
Improper blood glucose regulation is the machine that causes weight gain through the increase and sparing of body fat specifically. Having high body fat further disrupts blood glucose regulation because it places a high insulin demand on the body. If your insulin is running too high and/or is over expressed, you will not be able to control your blood glucose properly.
So being fat, per say, does not cause diabetes. It is a marker that metabolism is headed in the direction of diabetes, and this is why being overweight/obese tracks closely with an increased risk of diabetes. Also, this is why lowering blood glucose, while remaining fat, will not stop diabetes. The only way to actually know you are fixing your damaged metabolism is when you start losing body fat.
So, don't let anyone tell you that being fat does not cause diabetes because it is actually the beginning stage of diabetes. But also, don't let anyone tell you that being fat alone causes diabetes because the actual culprit is the blood glucose dysregulation which is triggering the accumulation of fat to begin with. Do not miss the forest for the trees.
5. I have heard you mention that metabolic syndrome/diabetes are not "carbohydrate diseases" but yet carbs are what caused this process to occur.
I am reluctant to describe metabolic syndrome/diabetes as "carbohydrate diseases" because it is hyperbolic and doesn't help solve the problem one iota. In fact, it causes more harm than good. All you will get from it is obese people talking about how "Kellogg's is the devil" while still not losing a pound. Blaming carbs in this way causes several misconceptions which we see rampant in the low carb community today:
- It gives the impression that carb elimination will magically cure diabetes. It doesn't.
- It causes the belief that fat is benign and can be eaten ad libitum, safely replacing carbs. It can't.
- It creates the false assumption that nothing else has to be done besides the elimination of carbs from the diet. That's wrong.
All three of these notions set the stage for failure and worsening of overweight/obesity/diabetes over time without the person even being aware as their nose is plastered to their postprandial blood glucose after consuming one pound of bacon. That's why we see so many obese diabetics counting the carbs in a pimento or continually struggling to keep their hyperglucagonemia and Dawn Phenomenon under control to no avail. That's when they turn to protein restriction as well until there is nothing else left to restrict but fat and that doesn't help either. Back to Victoza.
But you are correct. Carbohydrate consumption is the most common cause of the initial condition (blood glucose dysregulation) which resulted in these pathologies, but it wasn't all carbs. Chronic and high consumption of sugar and grain based carbs specifically, are the true culprit.
When I say "high" consumption, I am not talking about "excess calories". I am talking about a macronutrient profile where carb calories dominate all other macronutrients irrespective of total calorie amounts. In other words, you can remain at your daily caloric requirement and still have a high carb diet because it is a diet where carb calories make up most of those total required calories. This causes illness over time unless some form of strict and chronic starvation is applied. You can be aware of all of this while also still being aware that metabolic syndrome/diabetes are much more complex conditions than just carbs as the story does not simply stop there.
Once this metabolic adaptation begins, the elimination of carbs is only a palliative treatment and much more than that has to be done to achieve remission.
6. Is it true that if you eat too much fat, you won't burn your own body fat causing a weight stall?
Ugh.... yes, but no. I know that these statements are repeated often but there's important nuance absent from them.
You cannot burn body fat without proper leptin expression regardless of whether you eat 0 fat a day. No leptin, no fat burning. Thin, obesity resistant (leptin sensitive) people can consume astronomical amounts of fat and burn it in a day and then some. Why am I saying this? Because I want people to understand that all body fat is mitigated by the state of your neuroendocrine system, not through nitpicking your diet constantly.
So, the correct idea is that if you are overweight/obese, you are most likely "leptin resistant". This is especially true if you cannot lose weight and/or suffer weight stalls and/or weight regains. You want to avoid excess dietary fat because you don't have enough leptin expression to burn it. That's the sole reason why you want to avoid it not because "eating too much fat prevents your body from burning its own". That's not correct. Fat consumption isn't what's "preventing" this. Poor leptin expression is, so you end up storing dietary fat on top of what you already have stored. It's Leptin. Only leptin.
"Gina, why is this so important to point out?" Because overweight/obese people will begin lowering their dietary fat to zero and still be fat. Then they will wonder what's happening, once again. It seems like overweight/obese people are constantly being directed into these endless mazes, by diet mongers, where they are told to eliminate this, restrict that, all to no avail. It doesn't matter how much they run in the maze, they never achieve results because they are being led wrong. The maze has no exits. It's a trick bag.
Yes, the thinner you are the more fat calories you can consume. Yes, the fatter you are the less fat calories you can consume but this is mitigated by leptin. What improves leptin expression? Not low fat, I can tell you that much. But these things do:
- Exercise. If you are overweight/obese and aren't eating excess dietary fat but still can't lose a pound it's because of poor leptin expression due to the fact that you aren't moving. Without exercise there is no leptin/adiponectin homeostasis.
- Insulin. Leptin is a slave to insulin. If you have not yet been able to properly regulate your blood glucose, then your insulin expression is also abnormal. This will only allow metabolism to continue on its trajectory of storing and sparing excess fat.
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