Six common beliefs addressed, Part 241

1. Is it true that there is no money in keeping people healthy?

The people who commonly make this association, are making just as much money from sick people as the ones they are pointing their finger at.

There is money everywhere. It's a supply and demand economy so anything can be used to make money. In fact, trainers, gyms, fitness equipment, exercise programs, supplements, specialty restaurants/foods, fitness wear/books and "bio hacks" are generally purchased and used by the already healthy like athletes and others who have been invested in their health for most of their lives. Most of this stuff is quite expensive and the healthy are all too willing to buy it.

So healthy people make others just as much money as the sick do. In fact, there is a case to be made that the healthy can make you much more money since the overhead is low as healthy people do not have to be taken cared of so more profit can be made from them instead of dumped back on them. Healthy people also have more disposable income as they usually make their own money instead of living off the state because they can no longer work due to their health.

2. I watched a video that talked about fasting and blood glucose control for diabetics. It discussed how blood glucose sometimes rises while fasting, instead of lowering. It explained the technical stuff pretty well, but it still didn't explain how fasting could resolve this. It seemed incomplete somehow because I still have the same question I did when I started watching - How can fasting improve this problem if it seems to be causing it?

It can't.

The reason that a lot of information was skipped is because incomplete information helps dupe people into believing nonsense. If the video is trying to sell you fasting, then it can't give you information that will negate its benefits. That would make no sense. For this reason, it will only focus on information that will keep fasting in a good light.

Insulin helps regulate stress hormones, as the video most likely explained to you, but if your insulin is functioning poorly, meaning that it is not very effective at doing its job, then these stress hormones will not function properly either. Fasting will not help insulin regulate these hormones any better. That little bit of information was probably left out of the video. If anything, fasting will deteriorate insulin function further as more glucose production by stress hormones, will only continue to effect insulin's behavior. Insulin is a slave to blood glucose. If fasting is rising your blood glucose, then your insulin will follow suit and the resistance will continue as if you ate chocolate cake without ever enjoying it.

This is why the American Diabetes Association (ADA) never says to not eat cake, since not eating it will not cure this problem. The reason we don't recommend cake is because cake will further disrupt blood glucose even if not eating it will not "cure" you. If you can't be cured, you can at least not make things worse.

Remember, you cannot resolve starvation through more starvation. Overweight/obesity/metabolic syndrome, at every stage, is an adaptation towards starvation. Metabolism is trying to keep blood glucose, insulin and body fat at high set points. You are only facilitating this process through fasting. Worse, when blood glucose does lower during fasting, it can drop to extremely low levels, furthering the disparities between low (fasting) and high (postprandial) blood glucose. This is a recipe for more diabetes as this is exactly what causes metabolic dysfunction to begin with.

You have to fight obesity with proper eating. Just like you fight fire with a controlled, targeted fire, you fight obesity with controlled, targeted eating. Where does fasting come into play then? Fasting is supposed to lower insulin. That is the goal. You want to have specific times in the day where your insulin is very low, in order to try and improve its function by "breaking the resistance" and helping it to be released in pulses, rather than chronically. But this doesn't work if fasting rises your blood glucose through an exaggerated adrenal stress response and this is what usually happens to diabetics. This is why you have to have specific, consistent eating patterns and not fast erratically or for too long. The goal is to keep blood glucose steady and that can only occur through eating and fasting homeostasis.

3. I have been following low carb and fasting for some years now. I just found your blog so I'm kind of relearning everything. Before, I was just following the popular "low carb doctors" and "fasting groups" online. Well, my HbA1C is now 9.0. My blood glucose goes anywhere from 231 to 115 mg/dL throughout the day, sporadically and without any apparent cause. Basically, I am worse now than I was when I started low carb and fasting. I started it to control my prediabetes but now I am fully diabetic. Though low carb and fasting helped lower my blood glucose initially, particularly after eating, there seems to have been no benefit in the long run. I don't know what to do anymore.

There was a benefit in the long run - a delay in the diabetes that you would have ultimately still gotten. I apologize but this stuff makes me pissed because it's actually quite common and could have been avoided if you would have avoided the quacks. You know what they say about "if it's too good to be true, it probably is"? Well.... welcome to the probably is.

I hate to be the bearer of bad news, but you were just another person duped by all of this low carb and fasting BS. You paid the price with your health, and they just walked away unscathed, still promoting the same BS that will cause others to end up like you. You were basically misled into thinking that lower blood glucose, primarily postprandial, was a sign that you were being "cured". You were not. You were delaying the inevitable.

I have said it a million times on this blog, and I will continue to say it - diabetes is not a disease of high blood glucose. It is a syndrome of a metabolic adaptation towards starvation. It is chronic and progressive when it is not treated properly. Keeping a pseudo low blood glucose, after your meals, is not the proper treatment for diabetes. Lower blood glucose is not the "cure" for diabetes, any more than lower weight is the "cure" for obesity. Walking is not the "cure" for paralysis. I can put a paralyzed person in a mechanical walking machine that moves their limbs for them, but they are still paralyzed. Maybe a magician or snake oil salesman can claim that the person is no longer paralyzed and now "cured", but you know better. They are artificially walking by a machine. You were artificially keeping your blood glucose low by a simple dietary hack that has been known for as long as they have known about diabetes. You were gas lighted. Plain and simple.

This is why the American Diabetes Association (ADA) does not stand behind this BS because regardless of how incompetent they may be, they know better. They have quite an extensive library of diabetes research. We have to give the devil his due.

It takes a whole lot more than just "low carb and fasting" to put metabolic syndrome into remission, much less full-blown diabetes which is the end stage of metabolic syndrome. Remission requires:

• A proper dietary protocol, not just "low carb".
• A proper fasting regimen, not just "fasting".
• A proper exercise regimen, not just lifting boulders.

Aside from these three things you have to:

• Implement a lifestyle that reduces systemic stress so that you can lower the body's stress response. This means you have to keep consistent and predictable timing and frequency of meals, fasting, exercise and sleep.
• You need to address any underlying co-morbid conditions (autoimmune, cardio-vascular, fatty liver, etc.) which contribute to the body's stress response. 

This means that sitting around is not the proper treatment for arthritis and eating bread is not the proper treatment for gallbladder disease. Going to the carnival to eat elephant ears is not the proper treatment for menopausal symptoms. You need proper treatments for these conditions so that they can be truly under control and not interfere in the above four goals.

Finally, you need to have a long, honest talk with your doctor about actually taking control of your blood glucose regulation with the right, targeted treatment. Not everyone's diabetes is the same, so your doctor has to actually look at your blood glucose patterns, your insulin levels, your C peptide results, cortisol levels, inflammatory markers, etc. in order to put you on the right medication at the correct dose. That way you aren't over medicated or under medicated or medicated for some crap that isn't even an issue. You need medication that will work to enhance your lifestyle changes and vice versa, not work against them.

You have to overhaul your entire lifestyle and set up a new one and then you have to stick to it for the long term (forever). That is way more complicated and super less fun than going to the market and trying to find "keto" versions of ice cream and then talking about insulin all day in a group full of fat people who constantly track how many points their blood glucose goes up and down in an hour. In other words, you need a plan, not magic tricks.

4. Is it true that the body never uses protein for fuel? If this is the case, why do calories in/calories out (CICO) protocols limit the calories of protein?

The body always uses the two energy macronutrients (fat and carbs) for fuel. It technically can use protein for fuel as well, but it never does, except for one exception - during stress. Of course, that's only half the story.

During stress, the body can break down amino acids (the building blocks of muscle) for fuel. It uses the catabolic hormone cortisol for this breakdown. This mechanism evolved so that if you are being chased by a predator, the body could temporarily acquire extra energy, converting the protein in muscle into glucose, to help you sprint on out of there. Glucose is a great fuel for sprinting and since the body does not keep a large reserve of it as glycogen, because those stores are very limited, it can use this mechanism to tap into a hidden added reserve. Muscle is very valuable to the body, but energy is much more so it will sacrifice muscle to gain energy.

Even though things were meant to work this way, in metabolic syndrome, they don't. The body is in a constant level of high systemic stress from metabolic malfunction, mainly any lowering of blood glucose. This causes for this mechanism to be over expressed through chronically elevated cortisol levels. This depletes muscle mass continuously and the "fuel" derived from this breakdown is not used for any energy requirements as no one needs to sprint anywhere or enough, it's simply shuffled back into storage as fat. This causes low lean body mass and high body fat which is a body composition that further deteriorates metabolic function and adds to this stress. Your muscle mass is feeding the growth of your fat mass and it doesn't even taste as good as ice cream.

Aside from metabolic stress, there are other conditions that effect this catabolism to muscle mass that worries certain individuals, like athletes. Stress from strenuous and demanding exercise regimens will break down the muscle that they are trying to build. It's a constant battle for athletes to replenish what is lost and build a bit more of it with each work out.

As you can see, the body breaks down protein to use as fuel but not from diet, rather it's from its own muscle instead. It also doesn't use it for any energy output but for the further building of fat mass. That's why I always keep it simple and say that the body does not use protein for "fuel" because in the context of the subject matter of this blog - it truly doesn't. That's why protein is not a nutrient of concern, except if you aren't getting enough of it.

CICO protocols limit all calories, including "protein" calories because there is no food that is pure protein. Meat is what's described as protein and that comes with fat and water. So, with CICO you are inadvertently limiting fat calories when you limit protein as it's the fat in protein foods that would make you fat, not the protein.

5. Is protein never a nutrient of concern or can it become problematic at some point?

The only times that protein becomes problematic is when:

• It's carb based - Plant based proteins are inferior and come with an added load of glucose to boot. You have to eat a wider variety of carbs in order to make up for the incomplete or inadequate amounts of protein found in plants. This basically means you end up eating more carbs just to get enough protein. For example: beans and rice.
• It's fat based - Trying to hit your daily protein goals by consuming dairy products or rib eyes, is not the way to go. Hunter/gatherers eat lean proteins. Lean proteins are wild game. Even though farmed meat can be labeled "lean" it is still quite fatty compared to wild game. Lean meats give you more bang for your buck than fatty ones because they have more protein. You want to hit your protein goals, without surpassing your fat goals. A lot of people have issues acquiring this balance and that is why supplementation might be the only recourse to fix this. Protein supplements have all the protein, minus the fat.
• It's not adequate - A lot of people do not track their protein intake and are actually eating less than their required daily recommendation. People seem to have a hard time calculating how much protein their cut of meat contains. They keep making the mistake of thinking that the entire cut of meat is all pure protein. It isn't. Meat contains protein, it isn't protein itself. There's fat and water in meat so when you weigh your chosen cut of meat, you have to determine how much protein it contains. Protein amount varies by cut and animal source.

Finally, there is end stage metabolic syndrome. This is when protein becomes a dire necessity while becoming totally useless at the same time. I know it's hard to imagine these two realities existing at once, but they do. Two things can be true at the same time. Let me explain.

Once you reach a stage of diabetes where you are breaking down muscle mass, at such an uncontrolled and exaggerated rate, you can't eat enough protein to replace what you are losing. Worse, as you build it, you destroy it. The more you build, the more you destroy. It's almost as if the protein is now "feeding the fire", so to speak. Add to that insulin resistance, and you end up hardly using the amino acids in your serum. You need properly working insulin to use protein and build muscle. Aside from the liver, insulin resistance is most prominent in muscle cells. You know you are at this diabetic stage when:

• Your blood glucose is uncontrolled and high all of the time, irrespective of lifestyle changes. By high I'm talking a blood glucose in the 200+ range.
• Blood glucose goes high enough to require hospitalization from any injury or illness.
• Blood glucose runs high with any physical activity, fasting, sleep pattern disturbance or any change in daily routine that disrupts circadian rhythms.

This is caused by a complete breakdown of the hypothalamic/pituitary/adrenal axis (HPA). It usually occurs in very late-stage diabetes or in non-compliant patients, like the ones who do not take their diabetes medications properly and/or refuse to drop certain stressors like caffeine from their diet.

Regardless, these people should continue striving to meet their daily protein goals because it's better than not. Protein based foods are always better than carbohydrates regardless of disease stage.

6. I am "addicted" to coffee and it's the only thing I am unwilling to give up. At least it's better than the bread I use to be "addicted" to, right?

No "addiction" is better than another so you can't compare addictions, though people like to think that to make themselves feel better. But anything that controls you means you are still under the control of something.

Coffee and bread are both the same unless the comparison is being made with decaf coffee. Why is that? Well, bread makes your condition worse by disrupting your blood glucose regulation and so does caffeinated coffee. They both feed the "disease". Anything that feeds the "disease" is a problem because the result will be the same - more "disease".

If you are "addicted" to decaf coffee, and only have two cups a day, then you should be good. But this word "addicted" usually means you can't control how much coffee you have. You are most likely not drinking just two cups and you aren't drinking it only during mealtimes. You are drinking it just like you use to eat bread. This is why "diet" is simply not enough for some people and why I am sick and tired of people giving it so much importance. Some people just bring their bad habits to their new diet because their root problem was not diet related to begin with. It was their behavior.

Obesity is just as much a behavior driven condition as it is a dietary one. That's why we describe obesity as a lifestyle choice, because it's caused by much more than just diet. Aside from the word "addicted", the phrase "unwilling to give up" and "at least it's better" are prime examples of common obesogenic beliefs that contribute to obesogenic behaviors. These behaviors keep people fat and that's perfectly fine if they just remain fat and accept it instead of remaining fat and seeking from others a "fix" for it.

I can only advise people who can actually do what they need to in order resolve their problems. Addiction requires professional intervention so I can't be of much help.