Six common beliefs addressed, Part 269

1. Why do low carb advocates only concentrate on carbs and protein but not fat intake? They act as if fat is benign to their condition.

Because low carb advice online is all about postprandial blood glucose numbers. Fat is the only macronutrient that does not cause a rise in blood glucose after consuming it so they assume this means fat does not affect their condition. They do not understand obesity or diabetes.

Obesity and diabetes are conditions of poor blood glucose regulation. Disparities in blood glucose are the seed that allow the condition to begin but insulin response is ultimately what allows the condition to take root.

Carbs and protein only affect your short term insulin response but it's your high body fat that puts a high insulin demand on your body in both the short and long term. Dietary fat affects long term insulin because it must be stored, so while you are fasting, your insulin is still being stimulated, both by the fat on your body and the fat you just ate. This is pathological for blood glucose regulation. You cannot control your blood glucose properly in the presence of higher than normal insulin release and expression. It will only drive your fasting blood glucose too low.

For this reason, on this blog, we do not chase postprandial blood glucose numbers alone. We look at overall blood glucose regulation and that can only be obtained by eating a diet that does not affect blood glucose and insulin homeostasis. That diet is low in carbs, moderate in fat and adequate in protein.

2. Do low carb diets work because you can't store fat while being in ketosis and ketosis causes no hunger?

Negative. You absolutely can store fat while being in ketosis. Ketosis makes it less likely but it absolutely can occur, particularly if you are leptin resistant and are consuming too much dietary fat. This is why some ketogenic protocols cause weight gain, rather than weight loss. When people are starving they have complete access to their body fat and are in ketosis, yet they experience extreme hunger.

The advantage of low carb is that it allows the body to lower its weight set point through the stabilization of blood glucose which lowers the insulin demand. This in turn helps the central nervous system allow leptin signaling to communicate fat stores to the brain and maintain healthy body fat levels. Proper leptin expression is what induces satiety through the burning of body fat.

3. If carbs are what causes my blood glucose to rise, then why is it that protein, without any carbs, also causes my blood glucose to rise?

I have touched on this before but I will do it again since there is so much misinformation on what this is from the low carb community. I think it is the most asked question and the one least replied to correctly. To put it simply, this is caused by "hyperglucagonemia".

People who are diabetic have insulin resistance of the pancreatic alpha cells. Their alpha cells have lost sensitivity to blood glucose concentration. For this reason, they lack sufficient first phase insulin release (spike) to properly suppress glucagon. When they eat carbs, their liver constantly releases glucose because they cannot properly regulate glucagon.

This experiment has been done on Type II diabetic animals in laboratories. The result has been consistent across the board - their insulin spike is missing, yet they still have higher than normal insulin levels. You cannot suppress glucagon without a sufficient insulin spike. Now they have both high insulin and high glucagon. Their ratio is less than 1:0. This causes for the liver to not store incoming glucose and to keep producing glucose as it deems you are starving, regardless of the meal you just ate.

Aside from that, diabetics have also impaired incretin function. This means that their gut hormones do not respond properly by releasing insulin and lowering glucagon as needed. People with metabolic syndrome and prediabetes have a similar experience, just not as severe but the mechanism is the same.

Because all of these failing glucoregulatory systems, blood glucose rises postprandial whether you eat carbs or protein. Both require bolus insulin and insulin resistance does not allow for blood glucose to be cleared properly and it also causes for other hormones to release even more glucose in its presence. The only solution to this is improvement in insulin sensitivity through proper blood glucose regulation. You do this by remaining low carb and dividing your daily protein intake into three meals. That way you are not consuming too much protein at once, disrupting insulin to glucagon ratios further.

4. I have never heard my doctor use the term "diabetes reversal" but yet low carb people keep repeating it on all their groups and pages. Are they really reversing diabetes?

No. The reason you have never heard this term anywhere else is because it doesn't exist. It's a scam. They created it so now they get to define it anyway they see fit. For example, for them diabetes reversal is "getting off insulin" or "lowering your blood glucose" or "lowering your HbA1C". None of that means a thing. None of it.

Until you can properly regulate your blood glucose, meaning you do not release glucose when you don't need it and release it when you do, you have not put your diabetes into remission. You also have to be able to maintain a healthy body fat percentage because that is the proof that you are regulating your blood glucose properly. Everything else is nonsense.

5. I have been low carb for a while but it seems like I am slowly but surely losing control over my blood glucose. My postprandial blood glucose keeps rising, ever so slowly but surely. What is going on with me?

Glucagon. Glucagon usually increases over time in insulin resistance. The alpha cells of your pancreas become resistant to the inhibitory effects of insulin and they continue to produce glucagon, when they shouldn't. Basically hyperglucagonemia.

This is very similar to what occurs to Type 1 diabetics who also cannot stop producing glucagon simply because they have no insulin. Their glucagon "goes wild" and so is yours. Glucagon breaks down stored glycogen into glucose which is then released into the blood stream and you can measure it with your meter. Glucagon is only suppose to release glucose from the liver, when your blood glucose is low but with metabolic syndrome/diabetes, glucagon does this all the time, particularly in the presence of insulin and lowering of blood glucose.

Metformin works by suppressing this hepatic glucose output. Why is yours continuing to rise? Because you are still insulin resistant. Your low carb diet has never affected your blood glucose regulation profoundly enough to regain insulin sensitivity. As long as you are insulin resistant, you will continue to experience these issues. You might want to revisit your diet and your overall lifestyle, in order to try and pinpoint exactly what is contributing to your blood glucose dysregulation.

I am inclined to think it's the fat content of your diet since usually when people mention "low carb", it's because they are following the fad low carb diet they find online which encourages the intake of astronomical amounts of fat. Excess dietary fat will continue to stimulate a prolonged insulin release which affects fasting blood glucose. You will never be able to regulate your blood glucose if this continues.

6. Why is my antidepressant causing me to gain weight? Almost everyone who has been prescribed these drugs, refuses to take them because of this side effect. How can a medication cause weight gain? Does it have calories?

Basically drugs that increase serotonin without increasing dopamine will lead to weight gain. Like I have said before, dopamine is a powerful metabolic regulator. It is involved in the seasonal adaptation of energy conservation. Basically, dopamine signals to the body when it is time to store for winter. This is why dopamine levels fluctuate with the seasons and can affect your mood.

The mechanisms of action dopamine has on blood glucose are very complex and go beyond the scope of this blog as I try to keep the information on here as reader friendly as possible and I do not want to get into a lot of technical jargon that will be tuned out or become difficult to understand. This is not a biochemistry blog. Let's just say that dopamine is involved in signalling starvation to the body and this affects fat storage/burning.

For this reason, it is imperative to keep dopamine levels normal and balanced so metabolism is better regulated. Staying away from sweet taste is a good start but you also have to talk to you healthcare professional about any psychotropic drugs you may be taking that could be affecting your serotonin/dopamine ratios as this will eventually degrade your insulin function over time.