1. I started "keto" a few years ago. The consumption of saturated fat caused my LDL cholesterol to sky rocket so I took your advice and replaced all of the saturated fat from my diet with monounsaturated fats. My cholesterol dropped but for some reason, it has never lowered to what it was when I was consuming "vegetable oils". I don't understand this. Why would avocado and olive oils keep my cholesterol more elevated than corn or canola?
This is a very interesting question and I can relate to it as it has happened to me. For people who have genetic lipid profiles that are sensitive to diet, like myself, cholesterol can sky rocket when we consume saturated fats, particularly coconut oil.
When I started "keto" many years ago, my naturally high cholesterol of 210 rose to 650. I dropped the saturated fat from my diet and replaced it with monounsaturated fats and my cholesterol lowered but only to 320. After some years of only consuming monounsaturated fats, my cholesterol continues to consistently be in the 300+ range and never lowered to the 200+ range it was before when I was obese and consuming seed oils. What's going on?
Well, good luck finding the answer. No one will tell you as lipids are very complex and behave differently in everyone. Not only that, surprisingly so, we don't know much about lipids and their function. They are still quite mysterious. For this reason, the layman's usual answer is that it has to do with your HDL. A rise in HDL causes a rise in your total cholesterol and HDL levels rise dramatically with the intake of saturated fats. HDL also lowers significantly when saturated fats are restricted. But, the issue we are having is not totally explained by this phenomenon as it is not just total cholesterol that is being affected, we are talking specifically about LDL. Why doesn't LDL lower as much with avocado and olive oil, is it would with corn and canola?
I think I can give you an answer because your doctor won't give you a thing. Well except a statin, which you may or may not need. Now, I am not a doctor or lipidologist but I still kind of have a possible answer that explains this conundrum.
Many years ago, when I did extensive research on cholesterol, by going through many lipidology papers, I came across an interesting tidbit of information. Don't hold me as to what this paper was titled or who wrote it since, like I mentioned, this was years ago. I just know the information in it stood out because I found it quite fascinating and later on, saw the effects in myself. The lipidologist who wrote this paper stated that seed oils, didn't just keep your cholesterol from rising, they actively lowered it. How though? Well, he explained it was through smoke and mirrors. Basically, it's an issue with how LDL is measured in a lab.
Seed oils simply contribute to the oxidation of LDL and lipid panels do not measure oxidized LDL unless you do an actual oxidized LDL test. This means that this "lowering of cholesterol" is simply all of the oxidized LDL the test did not measure. Oxidized LDL is not good. The more LDL you produce, the more chances of it becoming oxidized so you want to prevent oxidative stress to your lipids by not smoking, not consuming "vegetable oils" and taking vitamin E. Vitamin E is a powerful lipid anti-oxidant and when taken in high doses, it has been shown to actually prevent heart disease. Nothing else has. This is why it's so surprising to me that cardiologists do not prescribe vitamin E to their cardiac patients and/or people at risk.
What does this all mean, though? It means that my cholesterol of 210 was never truly 210. It was always 320, it's just that the difference was oxidized and I had much lower HDL. That's a pretty large percentage of oxidized LDL. This was a ground breaking paper that of course, is never mentioned, but it shows how you can have very low cholesterol and still drop dead of a heart attack because most of it is oxidized LDL and poor levels of HDL.
So, your cholesterol will never be as low as it would be on canola oil but it doesn't matter because it is healthier than it would be on canola oil. The amount of cholesterol is not what matters. It's the health of your cholesterol that ultimately decides your fate.
2. A "keto" group I belong to says that if a person's insulin is 5.6 they don't need Metformin any more because they are cured of diabetes as long as they eat "keto". Is this true?
Insulin levels are not a marker of diabetes. Insulin function (insulin resistance) is and this does not always correlate to serum levels of insulin. Oftentimes, insulin will become high (hyperinsulinemia) due to this resistance but this is not always the case in all individuals. There are many diabetics with normal to low insulin levels but they still have resistance. I don't know what group is spreading this asinine information, but you need to stop going to it.
As far as Metformin is concerned, it is not prescribed for hyperinsulinemia. It is prescribed for the management of diabetes. Only your doctor can decide if you no longer need to be on Metformin but usually Metformin is the medication that is last to go, or never removed, as there is no known cure for diabetes. You can only manage the disease. If you are able to get off every medication and only stay on Metformin, that's still a win even if you aren't "cured" of diabetes. The better you can manage diabetes, the better your outcome because you delay or eliminate the onset of its pathologies.
3. I am vitamin B12 deficient and have been getting supplement shots but when I was recently tested it showed that my B12 serum levels were still on the low end and my intercellular B12 was non-existent. Basically I am still deficient even after months of getting shots. What's happening?
I am not a nutritionist nor a dietitian so you need to speak to a professional in order to get proper answers for your individual issues but I can throw in my two cents anyway so you have something further to discuss with your healthcare provider.
First, I am happy to see you are testing intercellularly. I am sure you are paying out of pocket for that test since it's usually not covered by insurance but it's truly the only way to know if your supplementation is getting into the cells where it's needed. You don't need B12 in your serum, you need it in the cell. Unfortunately, some labs are no longer even offering this type of test.
Second, B12 requires adequate amounts of vitamin B6. Without B6, B12 does not go into the cells. So if you are deficient in B12, you are probably deficient in B6 since usually being deficient in one B vitamin, means you are deficient in them all. You need to take 200 - 800 MG of vitamin B6 a day. Keep in mind there are two forms of vitamin B6. Pyridoxine HCL, which is the most commonly used version in over the counter vitamins, can become toxic as it accumulates in the body. This can cause issues over time so you want to take pyridoxal-5-phosphate which is safe to supplement with because it does not accumulate, even at very high doses.
Third, I hate to break this to you but the B12 shot your insurance pays for is not the bioavailable form of B12. The shot version is cyanocobalamin, a plant based B12. You only absorb a minuscule amount because it is not the animal based B12 we require which the body identifies. The best B12 supplementation is methylcobalamin, hydroxocobalamin or adenosylcobalamin in sublingual form. You should take 5k - 10k mcg a day or whatever your doctor recommends. You can get this form of B12 as a shot as well but it only comes in multi-use vials which cannot be used at the pharmacy or any other place that injects you. You would have to learn to inject yourself or have a private nurse inject you.
"Gina, how and why do you know all this crap?" Well, because I have high myopia and have been supplementing with B12 for a long time since the nerve in my eyes are abnormal and put me at risk for glaucoma. Also, JC has celiac disease and has to supplement with B12 as he has a deficiency. For this reason, we have had to do extensive research on this particular vitamin to ensure we are supplementing correctly. It is vitally important that if you are deficient in vitamin B12, that you supplement correctly because not addressing this deficiency can cause irreparable damage to your health.
4. My husband has been diagnosed with Type II diabetes. He had been feeling unwell for a very long time and then suddenly went blind for five minutes. He went to the ER and his blood glucose was 700+ mg/dL. His kidneys and liver had started to fail. He recovered and is now on insulin and has to check his blood glucose daily. My husband is not overweight or obese. We are still relatively young, in our 40's. He believes a healthy diet is low in meat and calorie restricted. We are Mexican so he is missing his traditional meat-based meals and complains often. His approach to his illness is to eat a doughnut if his blood glucose is "good". I don't know what to do.
I am sorry to say that their isn't much you can do but try to educate him on what diabetes is, its causes and its management. He either takes that information seriously, and implements it, or he doesn't.
A lot of what is occurring here has to do with simply misunderstanding the condition. This is not uncommon. Most diabetics are unable to make the lifestyle changes they require because they simply don't fully understand what's happening to them. They are either getting wrong or incomplete information from dietitians, nutritionists, their doctors and even the media. They are not asking the right questions nor seeking approaches outside of the Standard of Care.
Your husband's approach to his condition is pretty much the norm. I have seen many diabetics who check their blood glucose, see it's not as high as usual, so they reward themselves with a brownie. This myopic view of giving so much credence to isolated blood glucose readings is detrimental for the diabetic. The low carb people do something similar with their obsession over postprandial blood glucose readings. They also try to manage their diabetes with individual food items. That is not going to work.
Diabetes is not a disease of any single blood glucose reading or what food made that single reading go up or down. It is a condition of overall blood glucose regulation which includes what happens when you aren't eating. It is also not a disease of high blood glucose. Blood glucose lows are just as bad as the highs, if not worse, since it's the lows that set the stage for the condition.
You can give your husband the link to my blog so he does a little research and gets better information. This will help him make better decisions. There should be no reason he has to give up any meat-based Mexican recipes that he is used to. What he decides to do depends on how seriously he is taking his condition and how invested he is in trying to manage it. It also depends on how open he is to approaching his situation in a non-conventional way.
5. Why does caffeine in diet drinks help weight loss but is complicit in fat gain? How can it work both ways?
Because it depends on the metabolic state of who is taking it. Remember, fat gain or loss is completely at the mercy of your neuroendocrine state.
Caffeine is a stimulant that has long been used in diet products to increase metabolic rate before Fen-Phen was a thing. Many people have found benefits in it particularly if they just need to lose a few pounds. Our threshold for what is deemed overweight/obesity has certainly changed through the years. Seemingly slim women were binging on caffeine diet products in the 80s. Those same women are most likely obese today.
Chronic, long term use of caffeine always ends up in metabolic problems. You cannot regulate blood glucose properly as long as you're intaking caffeine. I have said before that you would be surprised to know how many diabetics caffeine has made, yet it always falls under the radar and people keep consuming it. Once you crossover to metabolic syndrome, caffeine becomes even more detrimental. Stimulants further interfere with the already failing blood glucose regulation of people with metabolic syndrome. This only sets the stage for further fat storage and sparing.
For this reason, we do not recommend any caffeine intake, from any source. You should be on a zero caffeine diet. Caffeine should be treated the same as sugar because they both have the same effect on your metabolism, so eliminating one and not the other will not work.
6. I have a cousin who has diabetes insipidus. Will going low carb reverse it? People in low carb groups seem to believe so.
Diabetes insipidus and diabetes mellitus (Type II diabetes) are two distinct conditions with different causes and treatments. They share the name “diabetes” because they both cause increased thirst and frequent urination but they are not related.
Diabetes insipidus is caused by problems with a hormone called vasopressin, which is the anti diuretic hormone that plays a key role in regulating the amount of fluid in the body. Disease or damage to the pituitary gland or hypothalamus, where this hormone is produced, can cause this condition. It can also be the result of heredity. This is a very rare condition but can be life threatening if not managed properly.
Your cousin needs to consult their doctor about any diet changes, particularly before going low carb since insulin is an anti diuretic and lowering it can result in the release of water from the body. This can result in complications if you have diabetes insipidus. This diuretic effect of lowering insulin can also interfere with any medications that your cousin is taking to manage this condition.
Diabetes insipidus cannot be "reversed" and has no known "cure" so be careful with whatever they are telling you in low carb groups. They might be confusing "diabetes in situ" or "occult diabetes" with diabetes insipidus. Diabetes in situ is simply a term coined by Dr. Joseph Kraft to describe the changes in insulin expression, he witnessed in his research, years before the onset of diabetes mellitus. These low carb groups are not very well versed in diabetes and often spew out misinformation about the condition. They are usually run by volunteers who have 0 knowledge of what they are talking about and they don't even do the research themselves to offer better help. Remember, anyone can open a Facebook group or page about any topic they want.
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