1. I have always had erratic meal timings because of my job. I am now diabetic even though I really do not like sugar or grains so I have never eaten them in any significant quantity making my diet relatively low carb. How could a low carb diet cause diabetes?
It wasn't the low carb diet. It was the erratic meal timings. Diabetes is not a carb disease. It is the end stage of a metabolic adaptation towards starvation. Diabetes is what occurs when you starve enough (blood glucose dysregulation) without ever dying. This starvation adaptation can occur from multiple factors. Anything that disrupts proper blood glucose regulation will eventually cause diabetes. This can be diet, medications, certain chronic conditions or also starvation.
You can't maintain proper blood glucose regulation when you have erratic meal timings. With erratic meal timings you can go an entire day without eating or not eat enough and then binge later. You need to have predictable meal timings daily in order to regulate blood glucose correctly. When you have predictable meal timings, you avoid going hungry and you avoid eating too much or not enough. That's why it's important to work with your circadian rhythms and eat properly.
Who knows how long you have been having blood glucose regulation issues and never knew about it until it became diabetes. As long as your fasting blood glucose and HbA1C levels are within the "normal" range, your doctor will not deem you as having any metabolic issue. This doesn't mean they don't exist.
Blood glucose disparities can only really be witnessed in real time. That means you would need a blood glucose meter and take readings yourself. People normally do not do this unless they are already diagnosed as diabetic. So the syndrome continues progressing from metabolic syndrome into diabetes, right under your nose.
So make sure you are following a truly low carb diet from now on, one that eliminates sugar and grains in their entirety and keep to your meal timings.
2. I was mortified to see that my endocrinologist now has a YouTube channel and is slowly subscribing to the whole "keto"/fasting fad. The last time I went to see him, he was in the office with me for about five minutes, gave me no answers and simply told me that "fasting is the best thing I can do". WTF?
Well, he won't be your doctor for long unless you're willing to dish out the big bucks when he opens his own quack practice and no insurance will accept him.
Unfortunately, a lot of doctors are realizing that the money is on YouTube, Patreon and their own subscription based websites. It certainly is not in taking insurance. So much for Medicare For All. In order for him to ask for people's money, he has to offer something different than what conventional medicine is so he must become a celebrity fasting quack.
As an endocrinologist, I am surprised he told you that the best thing you can do is fast. I am sure he knows about cortisol, glucagon, leptin, adrenaline, well.... who knows what he knows. It seems like he knows more about YouTube than anything else. All I know, and soon you will too, is that if you follow this crazy advice, your blood glucose regulation will start to fail. You can't starve blood glucose into submission just like you can't starve your fat mass to budge an inch. So I suggest you change endocrinologists pronto. Either way you will have to, when he quits his practice.
The fact that he only saw you for five minutes is another problem. You need to advocate for yourself and get better care from your doctor. You need a doctor that can keep his eyes off YouTube long enough to focus on his patients.
3. Is the science aware what obesity is? Why do they keep telling us to eat less?
The science knows but the science doesn't make good public policy so they hide and/or minimize it. Good public policy is to give people the impression they can lose weight by simply "not eating too much" because they fear the science will only give people an excuse to eat as much as they want since there is nothing they can do about their weight anyway.
This is the logic I consistently run across while researching obesity. In one sentence they will say that obesity is a leptin problem with no known cure and right after they will say they still want people to keep their "consumption" in mind. The truth is in the middle. Obesity is a leptin problem with no known cure and eating Ding Dongs, whenever you want, is not going to help it.
4. How does hyperglucagonemia help with starvation? Does the body purposely down regulate insulin release to keep blood glucose high?
It does not "down regulate insulin release", it under expresses insulin action in various tissues and organs to spare blood glucose for the brain since it believes you're under starvation. It's also sparing it to build more fat. It's simply keeping blood glucose high in circulation as you aren't truly starving but those dips in fasting blood glucose makes the body believe it is. This makes it averse to any lowering of blood glucose. Since insulin continues to be released in large amounts, it's only other option is to cause this under expression which is what insulin resistance is.
Hyperglucagonemia is simply a way of keeping blood glucose high, in the presence of insulin. It prevents insulin from lowering blood glucose to normal. Its real purpose, in a healthy human being, is to keep insulin from lowering blood glucose too low but in the person with metabolic syndrome it's just trying to keep blood glucose from lowering at all.
5. How would starvation affect blood glucose? I know that diet affects it but why would starvation?
Starvation causes an extended time in hypoglycemia. The body likes to keep its blood glucose very well regulated under a narrow range. When blood glucose goes up too high or drops down too low, outside of this tight range, the body reacts immediately. It has multiple glucoregulatory systems that will respond to any disruption in blood glucose and this system adapts. It learns. This learning causes it to proactively respond to any event that effects blood glucose. This is why you see people with metabolic syndrome/diabetes have blood glucose that goes haywire when they eat, when they fast, when they exercise, when they wake up in the morning, when they get sick or are under any stress.
Having chronic low blood glucose and/or being in a state where the body has to chronically create its own blood glucose, just to remain within a normal range, causes metabolism to up the ante on its glucose production. This will in turn rise insulin. This rise in insulin will cause more glucose to be made, as it is further reinforcing the need for more glucose. This feedback loop now feeds itself and metabolism goes into "starvation mode". This simply means it develops a high blood glucose, insulin and body fat set point to ward off starvation. This was all set into motion by the amount of "time in hypoglycemia".
This is why you have to be careful with fasting and make sure it is not extended as it will only reinforce this metabolic adaptation.
6. Can diabetes be prevented with vitamin D?
No. Diabetes is a syndrome caused when the body is no longer able to regulate its blood glucose properly. It cannot regulate its lows or its highs and this is why diabetes is not a disease of "high blood glucose". It is actually the lows that progresses the syndrome. The highs take decades to cause pathology, while the lows are pathological even when they occur once.
People with metabolic syndrome/diabetes oftentimes become low or even deficient in certain vitamins like vitamin C, D and all the Bs. This is the result of excess glucose metabolism which depletes these vitamins. Increasing these vitamins does not cure nor prevent diabetes. Only stable blood glucose regulation does.
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