1. I eat the same foods daily, but I continue to be overweight. I have chronic and severe irritable bowel syndrome (IBS) so my diet is always the same daily.
Once you are low carb and following your protocol consistently, we don't nitpick it because whatever is going on is not diet related. Changing one little thing in your diet, here and there, is not going to make much of a difference. So, you would have to revisit your diet, which you did not describe, and identify other factors that could be contributing to your overweight.
2. I think that all those who started on that fat-chugging "keto" diet will never stop because it was their ticket out of Type II diabetes. They used the fat as a replacement for medications. Soon it will fail for them, and they will be right back to where they were before. I was also very strict when I started a low carb diet, many years ago, because I lost 60 pounds on it. I followed it religiously and then I gained everything back and I am now diabetic. No matter how strict I followed it, I still ended up here. Is this the case for all diets?
Well, let me break this down a little because there are a few misconceptions here.
First, the fat-chugging "keto" crowd never got a "ticket out of their diabetes". They only got a ticket to continue eating in a disordered way. The vast majority of these people have eating disorders and fad "keto" simply allows them to eat as much as they want as long as it's from the "allowed foods" list and that's basically one food - fat. They won't leave their fad diet because they are using fat as a replacement for carbs, not medications. The most they ever achieved was lower postprandial blood glucose.
Second, they won't "soon fail". They already failed. The most these people have been able to do is lower the dose of their exogenous insulin or get rid of it all together since insulin is basically an end-stage medication for the management of diabetes so any improvement in the condition will do away with insulin injections first. Some have been able to reduce other medications they were on because they were on a slew of them. Again, any improvement in their condition will have to eliminate some of those medications or they will have a deadly drop in blood glucose. Most of those medications were being taken to counteract the dietary glucose they were consuming. Get rid of that dietary glucose and you get rid of those extra medications, but the diabetes remains.
Just because you are off a medicine cabinet full of medications and your blood glucose meter reads 170 mg/dL instead of 300 mg/dL and your doctor tells you your HbA1C is "below what would constitute a diabetes diagnosis", does not mean you aren't diabetic any longer. It just means the high glucose symptom of the condition is not showing up as much as it was before.
Diabetes is not a disease of high blood glucose. It is a condition that tries to keep your blood glucose high so that is only one symptom of it. By the time it gets to that, you're at its end stage. Most of these people don't get that. They are following buffoons that only like throwing out scary words at them like "amputation", "fatty liver disease" and "dialysis". It's a cult where the leader must always espouse dooms day scenarios to keep their flock.
Like I have said many times before - diet is only a palliative treatment for metabolic disorders. It helps reduce symptoms and allows you time to take some control over your lifestyle and try and put the condition under remission, but it doesn't cure anything. The disease continues. So, you can be strict all you want with your diet, the disease is still looming if you aren't addressing other lifestyle factors that contribute and put you at risk for its progression. One of those lifestyle factors is following quackery. Quackery puts you at risk for the condition's progression.
That's what happened to you. You thought that strict diet adherence was all that was needed to cure your "diabetes" and you now had a very rude wake up call. This is precisely what I'm trying to prevent with this blog.
3. I lost enough weight to get to lean in the beginning, but I gained some back and I am now overweight. I have not been able to lose weight again, but I am also not gaining. I just hate that I couldn't remain lean. I have come to the conclusion that I will never be lean again, no matter what I do. Can I remain healthy even while being overweight? I don't want to have the same fate my parents did.
I've addressed this question before, but I will reply to it again since it's so common.
Overweight/obesity are only markers for metabolic problems. Canaries in the coalmine. They are symptoms of an underlying problem as overweight/obesity are not anymore normal than cachexia/anorexia. When you start putting on excessive body fat and sparing it, it means that your metabolism is under some type of stress. This is usually the first symptom of an impending problem. The stress is blood glucose dysregulation.
People can be overweight for a very long time without developing any other metabolic pathology. Once it gets to obesity then things do not stay benign for long. Hence the term "morbid obesity".
But overweight/obesity are not the be all/end all of metabolic dysfunction. If you are doing what you are supposed to do to address your health problems and you have gotten below obesity, but are still overweight, you can remain relatively healthy for a very long time. No one knows just how long but you aren't in any immediate danger.
What we do know is that the metabolic issues causing the overweight/obesity do not halt there. They continue to progress towards pathology. This is especially true with increasing age as metabolic dysfunction is a time dependent disease. It's not so much that your body is failing because you are old but rather the older you are the longer you have lived with this abnormality and so it had plenty of time to progress to its end-stage while you are still alive to witness it.
For this reason, always keep in mind that as long as you're overweight, your metabolism is abnormal, and you aren't 100% healthy. You have to be more vigilante with your diet, exercise and lifestyle choices as it's a very easy hop from overweight to obesity. Don't be like these fools online that try to tell you that you can be healthy while obese. You can't. There is no such thing as a "healthy obese person". There is only an obese person who isn't yet showing clinical symptoms of diabetes, fatty liver disease or cardiovascular disease but these pathologies are well under way.
That's why we don't see healthy obese people in their sixties or a healthy obese eighty-year-old. Obese people start developing a slew of health conditions in their fifties and sixties, if not earlier, and succumb to them way before they hit eighty. Obese people have an average of 14 years less of lifespan. That doesn't even take into consideration the loss of quality of life which begins decades before death.
4. Should I be tested for familial hypercholesterolemia (FH) if I have high LDL?
Your doctor will let you know if this test is required for you so you should have a discussion with them about this.
High LDL is not FH. It is simply hypercholesterolemia. FH is a specific genetic condition that limits the liver's ability to regulate low density lipoprotein (LDL), among other lipid abnormalities related to the body's ability to handle LDL. This condition is serious and will lead to early onset cardiovascular disease (CVD) if not treated properly. Though one of the signs of FH is high LDL cholesterol, this condition presents other signs and symptoms as well such as:
- Fatty skin deposits called xanthomas over parts of the hands, elbows, knees, ankles and around the cornea of the eye.
- Cholesterol deposits in the eyelids (xanthelasmas).
- Chest pain (angina) or other signs of coronary artery disease which may be present at a young age.
- Cramping of one or both calves when walking.
- Sores on the toes that do not heal.
- Sudden stroke-like symptoms such as trouble speaking, drooping on one side of the face, weakness of an arm or leg, and loss of balance.
Because of how serious FH is, do not allow your doctor to diagnose you with this condition simply because you have "high LDL". Many people have high LDL and do not have FH. Like I said above, FH is not simply high LDL. It is a complex condition that can result in early death from CVD. This is not always the case with simple high LDL. High LDL can be a marker of improper lipid management by the body, but this is not true in every case. You can have high LDL and remain completely healthy your entire life. It all boils down to how your body is managing its lipoproteins and that is very difficult to know since lipid function is so complex.
Lipid testing is very expensive, not generally available and the results are up for multiple interpretations depending on what lipidologist/cardiologist views it. This is why these tests are usually confined to the area of research, not general everyday medical practice. Usually, you become aware of your lipid function once you develop CVD, if the CVD is lipid related, and this is why doctors are quick to label high LDL as a risk factor for CVD from the get-go. It makes things easier even if it can result in some people receiving unnecessary treatments. They figure the treatment wouldn't hurt you, even if you don't need it, and it's best to be safe than sorry.
Most people can know immediately if they have FH, with no testing required. They just have to look at their family history. If you have a family history of early onset CVD, and you yourself have high LDL cholesterol, then you might have FH. A way to know you don't have it is if you are already 60 years old, with high LDL cholesterol, but no signs of CVD and neither do any of your family members. But the absolute best way to know is through testing. The testing is not a total cholesterol panel. The testing is genetic.
Genetic testing for FH looks for inherited genetic changes in three different genes (LDLR, APOB, and PCSK9) known to cause FH. This test can also include a study of cells called fibroblasts to see how the body absorbs LDL cholesterol. People who get only one copy of the defective gene, from their parents, may do well with diet changes and medications. People who have a more severe form of the disorder will require more invasive treatments.
This is why you need to talk to your doctor and become informed on which treatment option is appropriate for you. All you need to know is that if you are diagnosed with FH, you will require treatment or you will develop CVD. So, ignore whatever these low carb quacks tell you about statins or other cholesterol managing drugs because the least of your concerns are their possible side effects or how much money the pharmaceuticals are making from them. Your main concern is the impending heart attack or stroke in your near future. There is no way to "prevent" FH. You either have it or you don't. FH is a genetic condition, not a lifestyle result. All you can do is reduce your risk of developing CVD, if you have FH, through proper treatments.
FH is not the only marker of poor management of lipids. It is only one. There is actually a whole class of FH related conditions. These conditions are all as complex as lipid management itself. Some families do not have a history of early onset development of CVD but later onset instead. Some forms of FH do not even develop into any disease at all. This is usually the case for people who have a family history of high LDL with no CVD.
My family for instance has extremely high LDL, on my father's side, but none develop CVD. They all live well into their nineties. This is why you should take family history of CVD so seriously because it affects you. Family history of CVD carries more weight than just the total numbers of any lipoproteins.
5. What's the difference between glycogenolysis and gluconeogenesis? I hear these terms talked about a lot but always get confused as to what they are.
The liver converts glycogen into glucose through a process called glycogenolysis. The liver also can manufacture necessary glucose by converting amino acids, waste products and fat byproducts through gluconeogenesis.
Both of these are interesting, and I am sure you have heard them mentioned many times in low carb spaces, but you don't need to get bogged down remembering what they are as they are both completely out of your control. A lot of people get caught up in things that are neither here nor there. These things can help explain a little about metabolic function, but they aren't practical in any way whatsoever to its treatment. There is also a lot of nuance and context missing in these definitions.
So, keep focused on what you can control yourself and that's lifestyle factors.
6. Does a high fat diet cause fatty liver disease?
The only diet known to reverse fatty liver disease is a ketogenic diet, which is a very low carb diet. The magic seems to come from the elimination of carbs, particularly sugar, rather than the addition of fat as low carb diets alone improve fatty liver disease.
This makes sense as fatty liver disease can be caused by three things:
- A high sugar diet
- High alcohol consumption
- Viral infections
There is no "high fat diet" in that list anywhere. Certain hunter/gatherers who eat extraordinarily high fat diets do not ever develop fatty liver disease and neither do hunter/gatherers who eat a very high carb diet. This is why I made clear that a high sugar diet causes fatty liver, not a high carb diet alone.
Fructose seems to be the culprit for the disease and sugar is half fructose. Fructose is metabolized in the liver the same way as alcohol and this seems to be the catalyst for poor liver function. This is why sugar can be considered a hepatotoxin.
It would not be surprising if certain high fat diets can very well be complicit in the development of fatty liver disease as plant-based oils, particularly vegetable oils, have been implicated in dysregulating the liver's ability of managing fat within itself. Vegetable oils, seem to not be released from the liver as readily as animal-based fats with the exception of coconut oil. These oils also seem to contribute to more subcutaneous fat accumulation which will eventually affect visceral and ectopic fat.
So the make up of the fatty acids in different fats can effect liver function. For this reason, use oils sparingly and stick to saturated fats in moderation.
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