1. Even mild exercise causes for my blood glucose to rise very high. I am trying to incorporate exercise into my routine because I know I need it for metabolic health but even on insulin, I can't seem to control my blood glucose when I do.
You are an uncontrolled diabetic. Your doctor might have told you that everything is "under control" but it's not. If your blood glucose soars from mild exercise, then that's not control. It is also a recipe for worsening of diabetes over time since now you are left avoiding exercise in order to prevent high blood glucose. That's not the way to treat diabetes.
You do not treat diabetes by "avoiding" high blood glucose either through continuous diet modification or avoidance of exercise. As you can see, avoidance hasn't helped you one iota, or you wouldn't be complaining of high blood glucose from simply walking around. But sitting permanently does not treat diabetes.
This soaring of blood glucose also puts you at a very high risk of diabetes complications as any illness or injury can cause for your blood glucose to drive you into a coma. This is the most common cause of morbidity with diabetes and why so many "controlled" diabetics are suddenly no longer on this side of the ground, leaving everyone wondering what could have possibly happened. Well, what happened is exactly what you are describing, sudden uncontrolled spikes in blood glucose from any smidgen of perceived "stress" by the body.
You have to have a discussion with your doctor about the symptoms you are experiencing and explore other diabetes medications, besides just massive doses of insulin, to try and acquire better control of your blood glucose. Obviously exogenous insulin is not entirely effective in preventing this issue. Exogenous insulin is great for controlling postprandial blood glucose but it is not addressing the body's exaggerated adrenal stress response.
You are a prime example of why diabetes cannot be treated with diet alone, like the low carb zealots try to sell you. Once you are diabetic, diet is but a drop in the bucket as a treatment and this is why your doctor does not put much focus on it. Of course, I don't agree with them ignoring diet all together, but I also can appreciate their reluctance to give diet much credence as it simply doesn't have much to offer.
Diabetes causes the chronic, unregulated break down of the body (lean muscle mass specifically) into glucose and this occurs irrespective of diet. It is also a very complex adaptive mechanism where multiple hormonal driven systems are involved, particularly the hypothalamic/pituitary/adrenal axis (HPA). HPA dumps catecholamines (stress hormones) into the blood stream at an exaggerated rate in order to keep blood glucose high. Diabetes does not manifest exactly the same way in any two individuals, so each diabetic's needs are different as far as treatment goals are concerned.
Do not sit idly by while your doctor solely takes the reigns because HbA1C is not going to save you and that's all they are focused on. Let them know that you need to incorporate exercise into your lifestyle, not anything strenuous just simple walking, and you need something to control your blood glucose when doing so as it is not under control now. Teeter tottering at extreme hyperglycemia's edge is not control.
2. I have a carbohydrate allotment of 20 grams a day. There is a bar I like which is 16 grams total carbs, but they are from sugar in the form of dried dates. Is this still okay, since I am eating to my macros?
If you are slim and healthy, then you can eat to your macros and your 20 carb a day allotment can come from any source you wish. This is because 20 carbs a day is still within a carb restricted diet and as long as carbs are restricted (starving the body of dietary glucose) you can maintain metabolic health. Remember, carbs are only benign in the context of starvation.
The best way to cause this starvation is not through the restriction of total calories but the restriction of the offending calories. Carbs are the offending calories, and they cannot be eaten ad libitum just because you are healthy as they will ruin your metabolic health over time irrespective of total calories, through the dysregulation of blood glucose. So, restricting them to 20 grams a day is a good thing.
But, once you cross over the threshold and are overweight/obese with metabolic problems, then the source of your carbs becomes just as important as your carb allotment. This means that those 20 grams of carbs better come from broccoli and not sugar. The overweight/obese are particularly sensitive to sugar, no matter what form it comes in. So even though dates are not granulated Dixie Crystals, they still have a high sugar load, especially when dried, and do not belong in the diet of someone who has metabolic issues.
3. How is leptin affected by insulin?
Leptin is affected by long term nutrient availability, whether it's surpluses or deficits. This hormone takes its cues from different metabolic signals, insulin being one of them. Insulin is affected by blood glucose levels and blood glucose levels signal nutrient availability. For this reason, leptin is described as being a "slave to insulin". After all, leptin doesn't have eyes and sits next to you at the dinner table, watching what you eat. It gets its cues from other metabolic information, which lets it know your nutrient availability. Nutrient availability is not just how much food is available (leptin) but also what type (insulin; macronutrient composition).
When you are metabolically healthy, it goes something like this:
- If insulin is high, that's a cue for leptin to burn body fat because there's enough nutrients coming in to safely do so.
- If insulin is low, that's a cue for leptin to burn body fat because there aren't enough nutrients coming in and the body has to tap into its reserves.
As you can see, insulin works in pulses. These pulses are driven by blood glucose levels and the effects it has on insulin release/expression.
High and low insulin also causes leptin to under express temporarily, in order to halt too much body fat loss. This toggle system works in balance in order to manage weight in the long term by determining weight set points for different environments and metabolic states. This is why simple calorie restriction, for the healthy, fluctuates their weight up or down easily.
The problem comes in when things become chronic and no longer work in pulses. When you are metabolically unhealthy, it goes something like this:
- If insulin is chronically high, leptin will under express chronically since there would be no point of burning body fat if plenty of fuel is coming in from the diet. This becomes "leptin resistance" over time which makes it easier to build and spare body fat.
- If insulin is chronically low, then once again leptin under expresses chronically in order to not burn through fuel stores as there isn't enough fuel coming in from the diet and so preserving those stores now becomes necessary. This becomes "metabolic slow down" making it easier to build and spare body fat. This is how calorie restriction causes weight regain and stalls.
Leptin is produced and signals to the brain from the fat cells themselves. It's basically the messenger between the brain and the body's fat stores. Fat cells respond to ups and downs in insulin due to blood glucose fluctuations and this affects leptin expression as described above.
As you can see every metabolic function is intertwined. Everything effects everything else, positively or negatively, depending on your neuroendocrine state which is determined mainly by your macronutrient composition (nutrient availability) and activity level (lifestyle).
4. Is abdominal fat the cause of diabetes? I was in a low carbohydrate group, and they were discussing this, but I couldn't get clear answers. It seemed like they were just repeating someone else but didn't really know the details of how this actually occurs.
Typical of low carb circles. They talk a lot but say nothing.
Abdominal fat is a marker for metabolic syndrome. It is not the "cause of diabetes". Instead, it's simply a common manifestation of diabetes as the result of metabolic syndrome which causes for fat to be accumulated around the middle. This is not surprising.
Diabetes is a syndrome that causes the excess storage and sparing of body fat. That's why reduction of body fat has to be high on your target list for achieving remission as body fat only helps diabetes progress further. Body fat is diabetes' fuel because it puts a further high insulin demand on the body and does not allow for the proper disbursement of energy, leaving you tired while it keeps building itself. The burning of body fat means you are actually reversing this process.
Diabetes is the end stage of a metabolic adaptation caused by poor blood glucose control. The root cause of diabetes is the erratic ups and down in blood glucose, with large disparities between the two, caused primarily by lifestyle factors. It takes decades for this abnormal blood glucose regulation to develop into the syndrome we call diabetes. This syndrome causes many symptoms - high blood glucose, poor insulin function (insulin resistance), visceral fat, over expression of the stress response, under expression of leptin, dysregulated glucagon, among many other things. Improving or resolving any one of these does not affect the trajectory of the syndrome. We know this because modern medicine has a slew of very effective ways to control any one of these symptoms but hasn't been able to prevent the eventual morbidity of diabetes.
"Why is that, Gina?" Because if you lose your visceral fat and it helps lower your blood glucose you still have to contend with the over expression of the stress response and/or fasting blood glucose that dips too low and/or poor insulin function, etc. These all contribute to impending diabetes. Remember diabetes is a metabolic adaption where multiple systems are now geared towards keeping a high blood glucose set point. These systems work together to keep diabetes progressive. Even when all symptoms are addressed, you are still left with tissues and organs which might not regain their full insulin sensitivity and still develop pathologies related to that fact, as insulin expression continues in certain tissues and organs, long after serum insulin lowers/normalizes.
So, stay away from people who try to reduce the cause of diabetes to any one of its common obvious symptoms because what wasn't obvious (blood glucose disparities) was the root cause of the adaptation and this occurred long before the abdominal fat was accumulated.
Now I understand that there are two common debates you will see on low carb pages, and they go something like this:
- 1. You accumulate excess fat in the viscera, and this develops diabetes over time.
That is false. We know this because healthy metabolic function never accumulates fat in the viscera. It accumulates it subcutaneously which is the proper storage for fat and it has a strict threshold. When metabolism begins accumulating fat in the viscera it's because something pathological is occurring to cause it to do this. This is why fat accumulation in the viscera is so malignant. It is a symptom of a much larger and serious problem.
- 2. You become diabetic and for this reason you become fat. In other words, you are fat because you are diabetic.
That is also false. Not only are there plenty of diabetics that never become overweight/obese but there are many people who are overweight/obese and not diabetic. Diabetes does not "cause" you to become fat. Your abnormal metabolic function makes it easier to become fat and diabetic.
The cause of diabetes is the erratic blood glucose disparities described above. Those erratic blood glucose disparities deteriorate metabolic function so that it becomes easier to get and stay fat and eventually develop diabetes.
Overweight/obesity and diabetes are not mutually exclusive to each other though they are related. They can exist separately. This is because they are both time dependent and so they don't always occur at the same time. You can become overweight/obese first and then eventually develop diabetes or vice versa. It all depends on how your metabolism deals with the stress these blood glucose disparities cause it and how insulin adapts.
Everyone manifests metabolic syndrome differently and that's why it's called a "syndrome", not a disease. Metabolic syndrome is a group of similar symptoms which do not always occur together or at the same time for everyone. Genetics, epigenetics, dietary habits, activity levels, gender, age, hormonal status, co-morbid conditions, etc. all influence how this syndrome manifests in you.
5. A low carbohydrate follower sent me information on Dr. Bernstein. I am new to this. Is this a good doctor to "follow"?
I have an automatic negative reaction when someone describes themselves as "following" a doctor online. I hate to say it but that sounds kind of crazy. I don't know why low carbers follow these "personalities" on the internet as if they were a boy band.
A doctor online is not your doctor. They don't know you; they haven't examined you and they haven't diagnosed you so they can't provide you with any treatment for your individual condition. Therefore, you shouldn't be "following" anyone. Following doesn't treat diabetes. Doing does.
What I can tell you is that Dr. Bernstein is not on my Quack List, but he specializes in Type I diabetes. Type I and Type II diabetes are similar but different in very important ways. For this reason, though you can apply a low carb diet to both, their method of treatment ends there. On this blog, I feature Dr. Bernstein's dietary protocol in my 'Recommended Diets' list because it is a legitimate protocol that can be followed and be beneficial for Type II diabetics. But again, it ends there.
All you need to know from any "online doctor" is what protocol to follow and then you put them to the side. There's nothing else they can do for you. Listening to them regurgitate the same basic information and cliches, over and over again, while also trying to sell you crap from their sponsors, is not in any way going to make you slim. The only one that can follow the protocol is you. Following them does not magically give you results. Stop following and start doing.
6. I can't lose weight, no matter how strictly I follow "keto". An "alternative medicine doctor" told me to switch to a high carb diet instead. I am scared of doing this. What should I do and why would they suggest this?
I become very leery when I sense desperation to lose weight. Desperation causes for the person to jump from protocol to protocol and consume a large amount of snake oil in the interim. Snake oil is very fattening. Some of the fattest people on earth are the ones constantly desperate to lose weight. Desperation doesn't cause weight loss. Doing does.
There can be multiple things happening here. You could be following a "keto" protocol that prevents fat loss because of a high intake of dietary fat, too much fasting and inadequate protein intake (starvation). This causes the body to double down its efforts to spare its body fat. You should stop the "keto" and follow a normal, low to moderate carb diet. We have several featured on this blog, on the right hand side column, under 'Recommended Diets'. Choose one.
As far as your "alternative medicine doctor" is concerned - be careful. They are recommending a high carb diet in order to manipulate leptin, which I have discussed extensively in my prior posts. Manipulation of leptin is a diet hack that has been around since the beginning of time, so your alternative medicine doctor is not presenting anything new to the table though they are banking it's new to you. They could be right, and you might take the bait. After all, if you do and it works in their favor, you will swear up and down they worked a miracle on you, and you will then recommend them to your friends.
Diets that manipulate leptin are double edged swords. Though they can produce a benefit in the short term, they end up sabotaging you in the long term. The best way to effect leptin is to keep your insulin function normal by keeping your blood glucose control stable. High carbs won't allow you to do this. So, you are better off revisiting your low carb diet and changing whatever could be causing your issues.
You also did not mention any exercise routine. Get one if you don't have one already. Diet alone will not lead you to the promised land so stop solely banking on it. Remember to eliminate any caffeine consumption.
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