Six common beliefs addressed, Part 242

1. What are some reasons that the body would produce so much of its own glucose?

The body produces glucose for many different reasons. It uses a series of feedback loops in order to retrieve information on when and how much glucose to produce. In the context of metabolic syndrome/diabetes this process is always over and under expressed. This means too much glucose is produced when not needed and too little is produced when needed. This makes sense as all of the metabolic hormones that control blood glucose are functioning poorly, and the feedback loops are broken.

In metabolic syndrome/diabetes the biggest influences for unregulated blood glucose production are:

• To counteract insulin. High insulin, low insulin, poorly functioning insulin all contribute to excess or not enough glucose production.
• To counteract the inability to burn fat for energy. It is very difficult to burn fat for fuel when leptin is not working properly, and this causes for more short-term energy (glucose) to be released into the blood stream instead. This is typically why overweight/obese people have a hard time "keeping their energy up" regardless of how much short-term energy they produce.
• To counteract starvation. Metabolic syndrome and all of its pathologies from overweight/obesity to diabetes are adaptations to starvation. The best way to stop starvation is to release enormous amounts of blood glucose into the bloodstream, not only for fuel but to increase fat mass at the expense of muscle mass.

Other things also influence and contribute to this glucose production like certain common deficiencies seen in people with metabolic problems and imbalances in electrolytes which is also common in metabolic conditions.

2. Should I hire a "low carb/fasting coach"?

There is no such thing. Low carb is simply keeping your carb intake to less than 100 grams per day and fasting simply means not eating anything. You don't need a "coach" to do that. You would need a coach to help you exercise but not to keep you from eating carbs or food.

Now you can go ahead and hire one if you want but you should do so knowing that you are wasting your money. You're basically giving away money to have someone hold your hand through something you should be doing all on your own by determination, will and need alone. The minute someone tells me they need a "coach" to follow a simple diet, I become leery in believing they are serious about anything.

3. I drink a lot of bubbly water. I buy the kind that has zero of everything. Zero sweeteners, calories and caffeine. I'm sure you are familiar with them as they have sprung up everywhere and are very popular with low carb/"keto" dieting. Anyway, I was wondering if their taste has anything to do with my recent weight gain but even more strangely, my recent high blood glucose.

I have discussed before that constantly tasting anything, especially things on the sweet side, will further disrupt your already damaged hypothalamic/pituitary/adrenal axis (HPA). I have also discussed how carbonated drinks effect ghrelin, the hunger hormone. Any of these two effects, on their own, can contribute to weight gain and it's why all of these "zero of everything" drinks haven't done a thing to curb obesity. They have had zero success, aside from zero of everything else. This is why the only thing you should be drinking is water.

But in your case, you aren't only experiencing weight gain but also a rise in blood glucose to boot, which takes us now into an entirely different direction.

CO2, the stuff that makes these waters "bubbly", is acidic. High acidity lowers potassium. Low potassium makes less insulin. Less insulin increases blood glucose. Increased blood glucose contributes to obesity. Imbalances in electrolytes always cause stress in the body and stress always makes more glucose. These waters not only have zero sweeteners, calories, caffeine and success but they also have zero electrolytes, unless it's Perrier which contains some minerals.

Stop drinking like you are at an endless birthday party. Bubbly, fizzy, carbonated, whatever you want to call it, drinks are party novelties. Drink what you were intended to drink in nature - plain water.

4. My blood glucose is fine when I wake up but then it starts rising as time passes. Is this "Dawn Phenomenon" (DP) and how do I stop it?

High blood glucose upon waking is DP which is basically an adverse reaction to the overnight fast. Rising blood glucose later is caused by a secondary spike in cortisol, which is dysregulated in people with metabolic syndrome/diabetes.

You can go out for a walk to lower your blood glucose but the main thing that will prevent this from happening is eating breakfast. Eating when you wake up helps that second cortisol spike to be much lower.

If you're on medications like insulin, you should speak with your doctor as they can adjust it for you to better control this as well.

5. Why does the American Diabetes Association (ADA) target an HbA1C of 7 for diabetics? Isn't that too high?

I've spoken about this before, but I'll quickly recap here.

This has to do with blood glucose lowering medications, which include insulin. Insulin dependent diabetics are extremely susceptible to deadly hypoglycemia. For this reason, it is recommended that their blood glucose remains higher than it would be if they were healthy, so that if their medications cause a blood glucose drop, it won't drop to deadly levels. A drop from an average blood glucose of 170 mg/dl is much safer than a drop from a blood glucose of 85 mg/dl.

So, the goal for this stage of diabetes is to try to keep blood glucose lower (not necessarily normal or low) and stable, which is more important than just "low". Remember diabetes is not a disease of high blood glucose. There are genetic abnormalities that cause for certain people to sustain higher than normal blood glucose and they have none of the complications that diabetics develop over time.

Diabetes is a multifactorial syndrome of which insulin resistance is at the core. Insulin resistance abnormalizes the function of multiple glucoregulatory/metabolic systems which end in the pathologies associated with diabetes and its ultimate morbidity. High blood glucose is only one of those pathologies. It's not the end all/be all. This is why diabetes is still a chronic and progressive condition, even with well controlled low blood glucose and at an HbA1C much lower than 7. The "disease" continues onward.

I really get a kick of low carb advocates who are so focused on blood glucose that they miss the forest for the trees and are always hung up over the ADA. I have said before how the ADA, despite its misgivings, knows way more about the mechanism of diabetes than these low carb people do. These low carb advocates only see one thing - high blood glucose from diet. Well, that's only a very myopic viewpoint of what this complicated syndrome really is. It's not the high blood glucose, it's the blood glucose roller coaster of ups and downs, with large disparities between the two, that is the root of the condition. 

6. Is it true that a diabetic can stop their use of insulin if they follow low carb?

It has been shown that about 50% of diabetics can reduce or completely eliminate their need for exogenous insulin if they follow a low carb diet. This shouldn't be surprising as going low carb eliminates a significant load of exogenous glucose from the blood stream depending on how many carbs, and from what sources, are being consumed. So, the highest carb consumers will see the most benefits from going low carb.

But the reality is that once you get to that level of carb consumption, any change in the diet which lowers carbs, including reduction of overall calories, would make an impact on insulin requirements. This is because most of the insulin these people are taking is to control exogenous glucose from their dietary choices.

When you're diabetic at any stage, you already have an excess amount of glucose being produced by your own body, so you certainly don't need more exogenous glucose adding to it. This is why low cab would be the way to go. But the real magic in low carb is the halting of erratic large disparities in blood glucose that occur from the high postprandial blood glucose carbs cause and then the ensuing chronic release of insulin which drives fasting blood glucose to drop too low. That's the engine that drives the metabolic adaptation known as metabolic syndrome/diabetes and results in insulin resistance.

In that sense low carb is powerful indeed but having said that, you have to remember that any diet is only palliative for diabetes. Diet works really well at the beginning stages of the condition and then not so much. This is because the middle and end stages are being driven by other factors which aren't diet specific.

Reducing or eliminating the need for insulin does not mean you aren't diabetic. There are many diabetics who do not require insulin. In fact, most don't. As you can see, once they put you on insulin, you are pretty far along into the "disease" and low carb will only get you so far.

Six common beliefs addressed, Part 202

1. All weight loss and gain is mitigated through calories but yet they can never get you to overweight or slim.

When we speak about “weight”, we are referring to muscle, water and fat. Your entire body's make up. Calories affect muscle, water and fat because they have a short term effect on insulin. Insulin is an anti diuretic so when it lowers, you lose weight from the loss of water. Caloric deficits also induce stress in the body which causes some muscle break down. These effects usually do not go beyond 5 - 20 pounds.

This is why all weight loss and gain is mitigated through calories because calories always cause this effect on insulin. So you could use calories if you want to fit into your pants before the next high school reunion or you need to make weight requirements for the next wrestling match. You could also use calories to see some gains at the gym. Calories are fantastic when some “weight” is all you need to lose or gain.

You need a much more profound effect on insulin in order to go beyond this "body weight" loss and get to body fat loss. The reason that calories never get to the fat of things is because calories do not effect insulin long term or profoundly enough for this to occur. So what does? Blood glucose regulation. After all, it is abnormal blood glucose regulation that causes insulin's proper function to deteriorate.

When you restrict over all calories, you are not addressing blood glucose regulation to the extent you have to. This is because, half a doughnut still effects blood glucose. Not eating also effects blood glucose as it breaks down muscle into sugar and further reinforces the sparing of fat. Therefore, the elimination of the doughnut all together and eating enough to reduce the break down of muscle would effect blood glucose regulation more severely, impacting insulin more profoundly.

This is why macronutrients are king for addressing obesity, rather than just calories. After all obesity is high body fat, not high body weight. You don't want to burn "calories", you want to burn fat. Obesity can only be addressed through a long term, sustained effect on blood glucose regulation so that insulin can be profoundly affected. Until insulin is profoundly affected, other metabolic hormones will not follow suit. The premise is that this profound effect on insulin function will cause leptin expression to improve and body fat loss to occur. There is no body fat loss without proper functioning leptin.

2. Calories can be used to help regulate blood glucose.

Not in any meaningful way.

Like I wrote above, calories have a short term effect on insulin, more than they do on blood glucose. For instance, if you eat an entire doughnut your postprandial blood glucose may reach 200 mg/dL and then your fasting blood glucose may drop to 75 mg/dL. If you were to eat a doughnut hole instead, in order to keep with your caloric goals, your postprandial blood glucose may reach 130 mg/dL and then your fasting blood glucose may drop to 70 mg/dL.

Just because blood glucose did not reach as high as 200 mg/dL does not mean it's well regulated so you will begin to see weight slowly creeping up again, after an initial loss, even while diligently following your diet for some time. This is why calorie restricted diets are now recommending you stay away from doughnuts all together, well just because. They will never explain to you why because they themselves don’t know and they certainly don’t want your attention to go away from calories.

This weight stall or regain will automatically cause you to restrict calories even further in order to achieve the initial results. Unfortunately, this tactic will fail even more now because leptin will under express further in response to the chronic caloric restriction and your blood glucose regulation will continue to have large disparities as you swap the doughnut hole for "heart healthy" oatmeal instead. You are systematically reducing calories but not addressing the blood glucose dysregulation which is causing the weight gain to persist. You're merely rearranging chairs in the Titanic.

This is why we do not recommend the use of calories to manage blood glucose regulation because they do a very poor job at it. It is best to have a macronutrient composition that prevents/minimizes blood glucose dysregulation instead. The best diet for that is low carb, moderate fat and adequate protein.

People who already have metabolic syndrome have problems with their insulin to glucagon ratio, making them very sensitive to postprandial blood glucose highs. This occurs even when they don't "overeat" but it can be worse when they do. Overeating is defined as eating beyond satiation which differs between individuals. In order to prevent this, calories can come in handy and can be used alongside your individualized macros. Calories can be used effectively to prevent overeating, rather than sustaining a deficit, which means that caloric goals would be different for everyone. This is especially useful for individuals with disordered eating habits which also includes under eating, another problem the obese have.

Calories should always be used alongside your macros. Do not attempt to use calories on their own or you will return to the doughnut hole problem I described above. Remember calories allow any macronutrient as long as your daily caloric allotment is followed. Carbs are a macronutrient that will not allow you to properly regulate your blood glucose, irrespective of calories. You would have to go to starvation levels for carbs to not disrupt your blood glucose too much but then starvation itself, will disrupt your blood glucose as the disparities between fasting and postprandial numbers continue to increase.

3. The program 'Optivia' (Medifast) is not a "healthy" program to follow because it is very low in calories, comes with prepackaged soy-based "fuelings" and exercise is discouraged. The necessity for prepackaged "fuelings" is explained “to keep your metabolism going”. The only positives is that each participant has a coach and there's a support page. They claim to be "science based" and some have had success but I think it's nonsense. 

First, let me address the concern over whether this program is "healthy" or not. There is nothing "unhealthy" about any "diet plan", unless you go into the fringes of weight loss circles. Of course, those techniques are not monetized and sold to anyone as a "diet plan".

So, it really all boils down to results and as I've stated before, all diets work and all diets fail. There is no diet that doesn't work because all weight loss is mitigated through calories due to their short term effect on insulin. This is why all diet plans have some sort of caloric restriction in place. For some, this effect on insulin goes beyond it and actually effects leptin, which is what the premise of caloric restriction, and any diet, is really all about. But, when this occurs it's because these people were already leptin sensitive to begin with and they only needed to normalize their blood glucose enough to effect their insulin and magically their leptin followed suit. But again, like I've stated before, this is not the norm. These are exceptions.

This is why I describe all diets as shams because whether they work or not is completely dependent on your leptin sensitivity but that's not how they are marketed. They are marketed to appear as if they will work for everyone, across the board, as long as you follow them correctly. If they don't work, it is assumed you "cheated" or "gave up" due to lack of "self control". Though there are people who simply cannot commit to anything, that is not the case for 90%. Most people are just simply not leptin sensitive enough to get any real benefits from these type of diets. That is why we don't recommend them as you will likely be more successful staying away from calorically based diets, particularly if you are obese and have already tried caloric restriction before to no avail. So it's not about whether something works or not, it's about what is most likely to work.

Now about the things you found to be questionable in this diet plan:

• Most diet plans are about caloric restriction because they have an immediate effect on insulin which will make you think they are working. This is precisely why so many people continue trying new caloric restriction plans because they always have initial success. This is why they all promise, at least a five pound loss in one week.
• The packaged garbage is just another way to restrict calories further while making you think you're eating. The soy is irrelevant. Your metabolism will never "keep going" unless you are intaking suffice calories and protein. So again, the packaged garbage is just a way to make you think you're not starving and of course it's a way for them to make you have to buy something else other than just a "program".
• They discourage exercise because they know the caloric restriction is putting the body through stress and they do not want you to break down your muscle mass into more glucose than it already is by following the program itself. The more lean muscle mass you lose, the more you're up %^& creek.

As far as the "positives" are concerned. I don't see any. The coaches are a rip off and so is the support page. Unless the coach and support page can increase leptin sensitivity, they are basically just another way to make you think you are getting a lot for your money. Unfortunately, these tactics sell as most people, who jump from diet to diet, like the hand holding and these are the people making up the bulk of their clientele. The "science" they are talking about is most likely calories in/calories out (CICO), which is outdated but standard flim-flam.

Finally, as I have said before, the successes are not surprising. If you are leptin sensitive, you will succeed with just about any caloric restriction diet plan simply because they all effect insulin. So, the leptin sensitive can pretty much lose weight on the Twinkie Diet. In fact, the Twinkie Diet has been pretty successful. Depending on the amount of weight loss, which is truly just a measure of how deeply your metabolism has been affected, metabolic syndrome conditions can be reversed in just about anyone.

As you can see, the argument is not over success, it's over unsuccess. That's what we deal with here - people who simply cannot lose weight or keep it off. We help them know what's going on and what will help them address it. For those that have never dieted before, they can try whatever diet they want because they have no clue if they can lose body fat or not. Obesity does not automatically make you leptin resistant, it just makes you more likely to be leptin resistant. Whether you are or not is dependent on multiple factors. So we don't discourage any method that might cause you to lose body fat. We only discourage these failed methods for the people who it has failed for before since they no longer need to continue trying them. The more they do, the more their metabolisms will suffer.

4. I read a post by the American Diabetes Association (ADA) that stated: "Are Grapes Good for People with Diabetes? Yes; the ADA recommends that people with diabetes eat fruit, including green and purple grapes. Despite the fact that carbohydrates can raise blood sugar, the body still needs this important macronutrient." How does this make sense?

It doesn't make sense because it was horribly written. The main problem with associations like the ADA is that they try to over simplify their information, to the point where it becomes bad information. They are horrified of having to write essays on their posts, like I do, because they know no one will read them. I get it. It's difficult to be thorough in written explanations but if you aren't, then this horrible statement gets released and all the low carb bozos will run miles with it. The miles they refuse to actually walk with their feet, they will run on the internet, while sitting on their behinds and leaving comments with even more bad information. Let me fill in the blanks on the point the ADA was trying to make but failed miserably at.

The ADA deals with both Type I and Type II diabetes. They assume that people who are diagnosed with either condition are on blood glucose lowering medications which may or may not include insulin. For this reason, the general consensus stands that these medications make carbohydrates a requirement, hence the statement - "the body still needs this important macronutrient".

Actually, the body doesn't "need" it but those on medications usually do. When it comes to diabetes medications, carbohydrates become necessary in order to prevent blood glucose drops which can cause dangerous hypoglycemia. This is a huge problem in the treatment of diabetes because these drops in blood glucose are not always caused by over-medication but rather by the body's inability to regulate its own blood glucose properly alongside medication.

Type II diabetics are more at risk because Type I diabetics can avoid this complication with stringent insulin doses. Remember a Type I diabetic can regulate their blood glucose, without an issue, as long as they are dosing insulin correctly. Type II diabetics cannot, regardless of the medications used, so it is not uncommon for their blood glucose to be on a roller coaster even while medicated. This is why the ADA does not want to discourage grapes. Grapes are sort of like sugar cubes which prevent hypoglycemia.

The ADA also deems it a win if a diabetic eats a calorically restricted serving of grapes rather than a bucket of French fries. That is a very important missing piece of information here. Grapes, or any recommended food, are suppose to be part of a calorically restricted diet plan. People always seem to conveniently miss that fact for some odd reason. Recommending you eat something, does not mean recommending you eat it ad libitum.

Having said that, let's get to the nitty-gritty. Grapes, or any fruit for that matter, will not allow you to regulate your blood glucose properly. Remember, the disease is not high blood glucose and this is most likely why the ADA is dismissing the rise in blood glucose caused by grapes because they are also aware that's not the problem. The problem is blood glucose regulation. This means that any food, which contains glucose, whether in the form of sugar or starch, will cause the body to struggle further with its glucose regulation. You are putting in more of what it cannot efficiently handle.

So all diabetics should stay away from not only grapes, but all fruits and also not replace them with some other carb junk (French fries). The ADA will never say this though because they know that is impossible to adhere to and the only thing that will occur is that the diabetic will start ignoring all recommendations. But I am not the ADA so I said it and I will say it again. Stay away from grapes and all fruit as it will interfere with proper blood glucose regulation especially when they are being eaten just because. Eat proper meals instead and leave the fruit as a garnish.

If your medications are causing hypoglycemia, tell your doctor so the doses can be tweaked or the medication can be changed because disrupting blood glucose further, through the dosing of dietary sugar, is not the answer. That's akin to self medicating. If you stay away from things that disrupt blood glucose regulation, your medications will work much better and you will minimize the blood glucose roller coaster. This is why you need to check your blood glucose often, throughout the day, in order to have a clearer picture of what your blood glucose is doing and what affects it.

So no, the ADA did not put out this statement because they have stock in prosthetic limbs and they want everyone on insulin. Instead, they just have dumb, and most likely unpaid, writers posting on Facebook for them.

5. I read studies that say high triglycerides (trigs) cause leptin resistance. Everyday something changes...

Yes, everyday something changes when you nitpick everything that is found in research. This causes you to miss the forest for the trees. This is why I keep the information, on this blog, focused on what's actually important instead of on minutia.

Research has indicated that an increase in triglyceride level is partially responsible for "leptin resistance". These studies have concluded that trigs are implicated in leptin resistance as they impair leptin transport across the blood brain barrier.

But when you read research studies on "one thing", you have to be careful to not have a knee jerk reaction into thinking that "one thing" is the cause for a condition already in progress since these complicated metabolic processes rely heavily on reverse feedback loops. This means that once one process malfunctions, so do all the others.

This is the conundrum of - What came first, the chicken or the egg? For example, let's take diabetes and high body fat. Because most diabetics display high body fat, it is automatically assumed that high body fat directly causes diabetes. In reality, the pathological metabolic profile that causes an increase in body fat occurs decades before diabetes is diagnosed. Afterwards, this high body fat perpetuates diabetes and further advances the condition. Therefore, you can say that an increase in body fat is the “canary in the coalmine”, signaling that impending future diabetes is most likely but the fat increase is not the root cause. The root cause is the blood glucose dysregulation that caused a metabolic profile which begins to spare and accumulate body fat. Diabetes is the end stage of this process, blood glucose dysregulation is the beginning and everything else happens in between.

Therefore, body fat is a symptom, not the disease itself. This is why diabetics who lose body fat, even by a little, see improvement in their condition, since they moved the goal post back some. Unfortunately, this improvement reverses after a short time. This is because the metabolic profile persists and the fact that they stop losing weight, and can never get to lean, is the symptom of this. But body fat loss is still pushed as the "cure" for diabetes, even when it's not. The ability to lose body fat is the "cure" for diabetes because that means the metabolic profile that got you to fat, to begin with, is being reversed.

So, are high trigs causing the leptin resistance or is the leptin resistance causing the high trigs? Leptin is a starvation hormone. It burns body fat. If it does not burn body fat, then you would assume trigs would rise. After all, trigs are a measure of unused fat energy in the blood. Fat that is not burned, remains floating around in the serum, just like unburned glucose does.

Do these high trigs perpetuate the disease further and interfere in leptin signaling? Most likely yes. If there is plenty of fat energy in the blood, then leptin would naturally be under expressed. After all, why burn more of what already appears to be abundant? As you can see, we arrive again to a viscous circle as most metabolic processes do. This is why metabolic conditions are so difficult to reverse regardless of a quack telling you otherwise.

The most important thing you need to know, in order to nip this in the bud, is to preserve your leptin signaling. This is done through controlling your blood glucose and by control I don't mean keeping it low. I mean actually controlling its highs and lows by following a lifestyle that reduces large blood glucose disparities.

6. I am diabetic. I have to get better before I can eat bread again.

You can never eat bread again. I want people to be clear that when they start a protocol for metabolic health, it is never stopped. It's life long. You can never eat bread again, not because you are a diabetic, but because bread interferes with proper blood glucose regulation, diabetic or not.

I don't know why people continue with the fallacy that they have to follow a no sugar and grain free diet "because they are sick". It's not because of "sickness", it’s because a diet of no sugar or grains is the correct diet for a human being. Your dog has a diet it has to follow. So does your cat. Your reptile and bird do too. You don't feed bird seeds to a cat or a live rat to a bird, unless you're into falconry. Well, sugar and grains cannot be in a human diet as humans aren't designed to eat them.

Six common beliefs addressed, Part 183

1. People should be educated on "low carb" and "fasting".  

There is no "education" to low carb. There is only education about obesity and what it's doing to your body. Unfortunately, low carb advocates do not teach anything about obesity because they don't understand it themselves. They look at the world through the myopic lens of carbs = bad. 

Low carb is very easy. Keep your carbs under 100 grams a day. Fasting is very easy. Don't eat. Class dismissed.

2. Is it very surprising that people are able to fast for 72 hours?

It’s actually surprising that anyone would be surprised they couldn't. The overweight/obese are the main people who can fast effortlessly. They make such an enormous amount of blood glucose, from the break down of their own lean muscle mass and ketones from their liver fat, that they can literally fast for days on end, with no hunger. Add to that their leptin expression, which has hit rock bottom, and they are doubly not hungry.

I have said it many times before, the overweight/obese are the least hungry people on the planet. That's why they don't like eating meals. They live off novelties because they are never truly hungry for real food. They have endless "cravings", not hunger. The overweight/obese don't even wake up hungry after a night long fast. The overweight/obese just want to eat. Hunger and wanting to eat are two very different things.

3. A low carb doctor wrote on his website that - "Conventional medicine will not cure your diabetes but you should consult with your doctor about any advice which can." What do they mean? 

This one made me laugh. It is ironic that these people claim your doctor doesn't know what they’re doing and won’t treat your diabetes correctly but then tell you to consult with them in the same breath. Well, what can they do? They are trying to cover their own behind from the quackery they are selling you.

4. Autophagy peaks at hour 72. 

Perhaps. No one cares. The only thing you want is to peak at burning body fat and who knows how long that will take. Certainly not 72 hours since these obese people can fast for weeks and still be just as obese as when they started.

5. Goals can be achieved through meal timings and diet alone.

Absolutely not. It takes much more than just diet to achieve "goals". You have to achieve proper blood glucose regulation. Diet will only get you so far as many things effect blood glucose regulation.

6. Is there an alternative to the American Diabetes Association's (ADA) diet and medications?

First, the ADA doesn't have a specific “diet”. I don't know where these low carb people get that from or what "diet" they are referring to. The ADA pretty much lets you eat whatever you want as long as it’s calorically restricted. They are trying to effect blood glucose regulation through calories. Any "diet" can fall under caloric restriction. All you have to do is eat what you want and restrict calories. 

The ADA also does not give out medications. Your doctor does. These medications are absolutely necessary for the uncontrolled diabetic. If it wasn't for these medications there would be a lot of dead diabetics out there. A diabetics blood glucose can easily reach 1K mg/dL without medications. Diet is only a palliative treatment for diabetes as is the medications. They both play around with your blood glucose numbers but the syndrome is still there. There is no known cure for diabetes. There is no known cure for overweight/obesity either. Basically there are no known cures for a metabolic adaptation towards starvation. Once your metabolism is on that track, it takes monumental effort to halt it. Notice I said halt, not reverse.

Six common beliefs addressed, Part 181

1. On “keto” you have to stay under a certain amount of protein macros and you should do the same on carnivore. 

On a classic ketogenic protocol, for the treatment of intractable epilepsy or neurodegenerative conditions, protein macros are monitored and kept under a certain amount to minimize the body converting protein into glucose, a completely natural and normal process that is highly regulated. Since chronic ketone presence is a strong signal to the body that it is "starving", it tends to ramp up its stress response and convert itself and everything that's eaten into glucose at a higher rate than normal. This stress response will reduce ketone production.

The people on classic ketogenic diets need ketones because that's what they are forcing their brain to use for fuel in order to prevent symptoms. This is precisely why classic ketogenic protocols need to be monitored by a healthcare provider to ensure that the person does not lose lean body mass, develop a deficiency and/or gain weight. Classic ketogenic protocols are not only protein restricted but calorically restricted as well. They are very difficult diets to follow without professional guidance.

Ketogenic protocols for the treatment of overweight/obesity and/or metabolic dysfunction do not restrict protein. These diets induce ketosis through the severe restriction of carbohydrate. Protein macros are followed to ensure you are getting enough protein, since most people do not.

The reason protein does not have to be restricted is because protein is not a macronutrient of concern as it is not the cause of overweight/obesity and/or metabolic dysfunction. Having chronic ketone presence is also not the goal of these protocols because lack of ketones is not the cause of overweight/obesity and or metabolic dysfunction so their presence is not the cure.

Now a lot of people tend to take this information to mean they can eat all the meat they want, since it’s "protein" but meat is not just protein. It is also fat. For this reason, though protein on its own is not restricted, protein as meat is, since you can easily go over your fat macros depending on the type and cut of meat you are consuming. You have to calculate the protein to fat content in your chosen cut of meat when following carnivore, to ensure you are getting enough protein and not too much fat.

2. Too much protein will stall weight loss.

There is no such thing as "too much protein" but there is such a thing as too much fat, which usually comes with the protein. For this reason, you have to make sure you track your macros carefully and stick to your fat macro allotment.

People with metabolic syndrome who have hyperglucagonemia make a lot of sugar after eating anything, including protein, which could stall their weight loss for a period of time until this condition normalizes. This condition only normalizes once you can regain insulin/leptin sensitivity and function. Restricting protein achieves neither.

3. Red meat "stays in your system" for 2 weeks.

False. The body uses protein to build itself, so technically meat "stays in your system" until you are dead.

4. Some low carb doctors discuss cancer because some of their patients have gone into remission. 

No one knows exactly what causes cancer to go into remission or why remission occurs to some people and not others. So far, studies suggest that a person’s initial immune response, to the cancer, has a lot to do with their remission outcome.

Many conventional doctors have had their patients go into remission. In fact, the bulk of cancer patients in remission have done so using conventional treatments. Anyone can go into cancer remission and anyone can also die from cancer. Like I mentioned above, your immune response appears to be the main determiner of this and you have no control over it.

As of this post, no cure for cancer has been discovered. We know of some risk factors for certain cancers but, again, they have not been proven to be linearly causative. So a low carb doctor boasting that he has some cancer patients in remission is completely meaningless as any doctor can boast that.

5. "Certain bacteria” causes obesity.

No. What causes obesity is not a mystery. It is well known that obesity is caused by metabolic dysfunction through blood glucose dysregulation which ultimately deteriorates insulin function and leptin expression. This not only leads to overweight/obesity but eventually to diabetes. The accumulation of high body fat, caused by metabolic syndrome, is the result of a complex hormonal interplay exacerbated by certain lifestyle factors, of which there are many.

So, the debate as to what causes obesity has long been settled but for some odd reason, it appears to not have reached the masses. Very few people understand obesity, which is a shame considering that obesity is now at epidemic levels. You can not treat what you don’t understand. I believe it is this lack of understanding that has allowed obesity to spread, unabated, and made it easier for charlatans to sell you “magical cures”.

What hasn't been settled with obesity is its treatment. This is because of the complex hormonal interplay, which I mentioned above, which is extremely difficult to reverse. This is because obesity is a metabolic adaptation and not a real “disease” so there technically is nothing to "cure". Your body is doing exactly what it's suppose to do under the conditions it's been subjected to.

There are microbiome changes seen in the overweight/obese and this is mostly related to diet type and immune function. High body fat affects the immune system. But no, bacteria itself does not make you obese. To be obese you need poor functioning and abnormal insulin which affects leptin expression and in turn deteriorates proper metabolic function over time.

6. The American Diabetes Association (ADA) refuses to tell people that they can “reverse their diabetes”.

This is because, as of this writing, there is no “cure” for diabetes. The ADA has a lot of issues in its organization but quackery isn't one of them. The most the person with diabetes can hope for is remission but long term remission has still been difficult to acquire for most.

I am sure that you may have heard a low carb doctor say he can "reverse your diabetes" but he simply cannot. He can only lower your blood glucose but so can I. On this blog, low blood glucose is not reversal of diabetes. That is the mistake conventional medicine makes when they diagnose diabetes with simply high blood glucose. Their treatment, which is to lower your blood glucose, hasn't really made much of a difference has it? Of course not. That is because diabetes is not a disease of high blood glucose. This means diabetes reversal is not acquired through lower blood glucose.

We stay away from the blood glucose seesaw on this blog. Diabetes is a very complex metabolic dysfunction that involves multiple energy regulating systems in the body. It is extremely difficult to put into remission so avoiding getting diabetes, in the first place, should always be the first course of action. This is why you are never too healthy to follow a healthy lifestyle.

Six common beliefs addressed, Part 99

1. If you have "sweet cravings", you should negotiate with sweet things by limiting the amounts you eat and using only artificial sweeteners. 

And for that reason you will not be able to lose a pound. You are following the same sweet centered diet that you always were. You just shuffled its macronutrient composition and that's not enough. 

This is a complicated situation and you will not like the answer, but there is no other answer to give. People that are going through "sweet cravings", will not be able to achieve total remission. This is precisely why we do not deal with this type of problem, on this blog, as it would be a total waste of time. I only provide information and protocols for people who are able to follow them. The ones that are constantly "falling off the wagon", require hand holding or throw constant pity parties cannot be helped. Their problems go well beyond the scope of what a dietary intervention can achieve. 

This problem is caused by dopamine dysregulation and it is seen in people who developed their obesity/diabetes through the consumption of fructose. Many researchers make the claim that this is the same mechanism as addiction (alcohol/drugs). I won't debate that part of it, as it is full of contention and not very well understood, for me to hold a solid position on either way. Regardless, the success rates for people with this problem are absolutely dismal and no, their health will not eventually get bad enough for them to finally "do something about it". Many rather die. 

This is because what is required to break this dopamine malfunction is the complete and total abstinence of any sweet taste and these people simply can't do it. Leptin enhances the taste of sweet via taste receptors. This is a product of starvation. The more a sweet taste is sought after, the fatter you become. So, people with leptin/dopamine dysregulation require more sweetness to be stimulated. You will notice this effect when you go on a 0 sweet diet and then, a few months later, eat a blueberry. The sweetness would knock you out, while the person who had leptin/dopamine issues will taste bitterness in the blueberry instead. 

So, I apologize, but this blog does not provide any help with this. 

2. "Plant butter" is a good alternative.  

Absolutely not. There is no such thing as "plant butter". Plants don't nurse their young, so they can't produce milk that can be churned into butter. Butter is always derived from animals. Mammals to be exact. 

"Plant butter" is made from plant fats that have been processed to look like butter. We were not meant to eat large amounts of plant fats. They disrupt fatty acid metabolism, contribute to obesity, alter lipid composition and interrupt the use of Omega 3 fatty acids found in saturated animal foods. 

3. It is normal for a "severely obese" person to have hypoglycemic symptoms with a blood glucose of 75 mg/dL.  

This is because metabolic syndrome is when the blood glucose set point is high and the body has an adverse reaction to any falling blood glucose level. It wants to keep its blood glucose as high as possible, so the excess insulin does not dip it too low. 

Unfortunately, because of your large fat mass, insulin is doing an excellent job at helping to clear blood glucose, causing for the body to struggle to keep glucose high. This means that your threshold for normal blood glucose is becoming higher and higher with time. In others words, your body deems a blood glucose of 75 mg/dL, as hypoglycemia and reacts as such. Your body wants its blood glucose to be about 300 mg/dL to match its insulin demand. Soon this is exactly what will occur, as insulin starts losing its effect and your body loses its ability to produce enough of it.

4. The American Diabetes Association (ADA) recommends ADA approved junk food.

Yes. This is because that's what the people want. If the ADA only recommended meat and vegetables, like this blog does, it would lose all its donors, go extinct and diabetics would die quicker. 

I know that the low carb world wants to make this into a conspiracy, of some sort, but they can't even follow their own diets without including chaffles and "keto" desserts, so they really need to leave the ADA alone. 

5. You need to find something that will stop "cravings for sweet". 

No, you don't. You only need to stop consuming sweets. 

6. You can not do "keto" if you can't tolerate dairy or eggs. 

Yes, you can. You do not need to consume dairy or eggs on a ketogenic diet. You just need to consume very little carbohydrates.

Six common beliefs addressed, Part 69

1. Chimps do not eat meat.

I have absolutely no clue, as to why chimp diets have made their way into low carb conversations, but for the record, chimpanzees are omnivores. There was a time when it was thought that chimps had a similar diet to early hominids and other primates like orangutans and gorillas, who were/are herbivores, but that's not the case. Chimps basically eat whatever they can find and/or hunt. It's the classic "see food" diet, which is also followed by all hunter/gatherer humans.

But, this is a metabolism blog, not a primatology blog. Chimp diets are mostly irrelevant to what diet humans need to follow in civilization. Though chimps are our closest cousins, there are huge differences between us. Chimps don't have to worry about low carb. They are eating the food they adapted to, in their natural environment. It's modern humans that have to concentrate on their own diets, as they are the ones eating abnormal foods in an unnatural environment.

2. There is no root cause for metabolic "disease".

There is only one root cause for metabolic syndrome, aside from rare, genetic abnormalities, and that is - blood glucose dysregulation. Once blood glucose homeostasis is disrupted enough, pathology follows.

There are many things that contribute to the disruption of normal blood glucose regulation, for this reason there is no one cure for metabolic disease. A lifestyle approach is the best course of treatment.

3. There should be no hunger during fasting, regardless of its length.

There is a lot of nuance when it comes to hunger. In some cases it can be healthy and in others it is not. Hunger can mean that enough energy is being burned and so it needs more or that not enough energy is being burned so it needs more. It all depends on your hormonal state.

You should be able to go through a 16 - 18 hour fast with minimal to no discomfort. Most days you should experience no hunger, during such short fasts, but there will be days where you might have more hunger than usual. Respect your fasting times and pull through it. This hunger should occur less and less, as your circadian clock adjusts to your feeding/fasting routine. That’s why it’s so important to keep consistency, in your fasting regimen, so you can avoid hunger during fasts. Do not break your fast due to hunger, as these fasts are too short to require any intervention.

For longer fasts of 24 - 32 hours, it’s normal to have hunger. There are positive and negative causes for this hunger, depending on many things, as explained above.

The bottom line is, shorten your fasts to lengths that do not cause hunger. There are no metabolic benefits to going hungry. The only thing it will cause, in the long term, is metabolic slow down.

4. I am obese because I eat too much.

You are obese because of poor blood glucose regulation. Now the only question is what is poor blood glucose regulation and what causes it. 

Poor blood glucose regulation is when there are large disparities between postprandial and fasting blood glucose levels, more than 40 points. 

Many things can contribute to this including diet, improper exercise, medications, disruptions in circadian rhythms, certain hormonal states and age. "Eating too much" and eating too little also disrupts blood glucose regulation.

"Eating too much" is a complex interplay between biology and psychology and it manifests differently in everyone. You have to do the homework to figure out how it is manifesting in you, so you can work on resolving it. It's going to take much more than just a dietary intervention to address this, though diet should tackle the biological factors. 

Determining just what "eating too much" even is, is a challenge in itself. Sometimes people think they are eating too much but they are instead not eating enough and vice versa. There is no one size fits all to how much you should be eating. You would have to calculate your individual macros, based on goals and current body fat, in order to have a baseline idea of just how much you should be eating and of what. I have a tutorial on how to determine your macros on the right side bar of the blog, under the label 'Quick Guides'.

5. Drinking LaCroix will not impede weight loss because it has no added sweeteners or chemicals.

There is obviously some flavor, in that "water", and it's most likely leaning towards sweetness. If it had no flavor, then Pellegrino or Perrier would do, not LaCroix, so regardless of what's in it, if you can taste it, it's triggering dopamine.

This is lethal for the obese. You do not want to taste anything that chronically stimulates dopamine, just like sugar does. This affects hypothalamic function and causes the storage of fat. On a low carb diet, this effect is quick, as fat is stored much more easily than carbohydrate, so you are giving your fat storage system steroids, every time you pick up a can of any "flavored drink". Do not drink flavored liquids.

On this blog, we advise you to drink water. If you want bubbly water, make sure it has no flavor, regardless of what they are labeled as, because that's irrelevant. It's the flavor that's making you fatter.

6. The head of the American Diabetes Association (ADA) says she was able to discontinue her prescribed insulin, for Type II diabetes, following a low carb diet. This mean that there is now "proof" these diets cure diabetes.

Oh boy. This is a very loaded topic and the response is very complex, so bare with me.

I know that this news has been circling around, low carb groups and pages, for awhile now, and it's really revving up the base. But, this only proves how ignorant mainstream low carb advocates are of what exactly diabetes is and how metabolism actually works. In this sense, they are similar to the ADA in their ignorance, but the ADA actually has better information, because they have an extensive research database that isn't as cherry picked and based on pseudoscience and anecdotal evidence as low carb's is.

First, diabetes is not a "disease" per say. It is best described as a metabolic adaptation to starvation that manifests as a syndrome. A syndrome is not one disease, but a cluster of associated symptoms or abnormalities that occur together. This is why not everyone manifests metabolic syndrome in the same way. Some become obese, some become diabetic, some develop fatty liver disease, some just have high blood pressure. Others drop dead of heart attacks and still others develop dementia.

As of this post, conventional medicine (based on the Cleveland Clinic) makes a diagnosis of diabetes, when one of the following occurs:

• Your blood sugar level is equal to or greater than 126 mg/dl (7 mmol/l).
• You have two random blood sugar tests over 200 mg/dl (11.1 mmol/l) with symptoms.
• You have an oral glucose tolerance test with results over 200 mg/dl (11.1 mmol/l).

Your doctor may also give you a diabetes diagnosis when you develop an HbA1C level of 6.5 percent or higher on two separate tests.

This, dear readers, is just the tip of the iceberg. Diabetes is the end stage of metabolic syndrome. This means you have had metabolic abnormalities for decades, before you reach this stage. It also means that you haven't died from any complications caused by those metabolic abnormalities, so you have lived long enough to experience what is described as "diabetes".

It is completely normal and even expected for a diabetic to discontinue their prescribed insulin if they go low carb. This is a no brainer. The high blood glucose in diabetes is caused by excess glucose production coming from inside the body, which is then exacerbated by excess glucose coming from outside the body (diet). If you remove the glucose that comes from the diet, the exacerbation seizes and blood glucose lowers. It may lower enough to where there is no longer a need for exogenous insulin to lower it for you.

This does not mean that low carb cured your diabetes, since you have only addressed one half of the problem. You took away the exacerbatory effect, but you didn't take away the "disease". The excess glucose production coming from inside the body continues. The blood glucose disparities which caused the problem to begin with, persists. This is why these positive, initial effects, soon reverse and the person begins to see their blood glucose creep up, with time, and no amount of carb restriction works any longer. The person is basically hiding the most obvious symptom of the disease (high blood glucose), while it continues progressing right under their watch. This is why dietary solutions for "curing" diabetes are not generally accepted. We already knew, for a very long time, that carb restriction effects diabetes symptoms, but chasing symptoms does not cure the disease. Just like taking antacids does not cure acid reflux disease. Though it may seem like a miracle, at first, the condition is persisting. You simply masked the symptoms.

So, we can more accurately describe what the head of the ADA is doing by saying that she is addressing her diabetes symptoms, through a dietary intervention. From there she must adopt certain lifestyle changes in order to have a more effective and complete treatment. The wrong description is that she found the "cure for her diabetes". She did not. In order to be cured of diabetes you must obtain and sustain proper blood glucose regulation. This means the body does not over produce glucose when it's not needed, nor under produce it when it does. I can guarantee you, that she has not obtained that through low carb, or any dietary intervention, nor will she.

In order to obtain and sustain proper blood glucose regulation, she has to reverse her metabolic adaptation to starvation. That is very difficult to do and takes monumental effort that must include exercise, adequate protein and normalizing her circadian clocks (stress response). Even after addressing all that, she still has to maintain this effect through proper hormonal homeostasis which would allow her to burn and not spare body fat. Only then, can it be said that she is no longer diabetic. Until then, she might have dropped her insulin, but she probably will continue, or soon require, Metformin or Victoza, until the disease gets to the point to where insulin is once again needed.

Six common beliefs addressed, Part 26

1.The American Diabetes Association (ADA) is recommending a "low carb" diet, but it's not low enough in carbohydrates.

The ADA does not have a specific dietary protocol, that they endorse, for the treatment of diabetes. They have implied the benefits of caloric restriction, low fat diets, Mediterranean style diets, vegetarian diets, etc., without committing to any one of them. Dietary options are pretty much left to the diabetic, along with the vague caveat of choosing a "healthy" diet of "moderation", with plenty of "fruits and vegetables" and the replacement of sugar with artificial sweeteners. No other solid definition, of what constitutes a "healthy diet", has ever been given by the ADA.

As far as carbohydrate restriction is concerned, in December 2008, the ADA issued its 'Clinical Practice Recommendations', with an option for following a low carbohydrate diet for controlling blood glucose levels and weight loss. The difference from their previous recommendation is that, this one, has actual recommended values for guidance. The recommendation for the United States, at that time, was for daily caloric intake from carbohydrates to be less than 45%. They consider this to be a "moderate" amount of carbohydrate. They keep the option to go lower in carbs open and at the discretion of your healthcare provider.

In December 2018, the ADA issued its new 'Standards of Medical Care in Diabetes', including its 'Lifestyle Management Standards of Care', which again, included the use of a low carbohydrate diet, for the lowering of blood glucose and medications, in the management of Type II diabetes. They used the one year study data by Virta Health, along with two other studies, as the basis for this decision.

Again, no hard values are given to guide yourself by, but there is a range for carbohydrate restriction, which can be anywhere below 130 grams a day and less than 26% of daily caloric intake. If you eat 3 meals a day, that is up to 43 grams of carbohydrate, per meal. They do not claim that any benefit in blood glucose control will go beyond one year following this diet. On the contrary, they mention that blood glucose control begins to decline with time, while still remaining on a low carbohydrate protocol and, once again, the Mediterranean Diet takes the trophy for its long term benefits in glucose control.

The ADA also makes its usual statement that the ability to adhere to a dietary protocol is much more important than the protocol itself and some people are able to adhere to a low carbohydrate diet, while others are not. I suspect they are being generous, on this front, because I can almost guarantee that most cannot, but let's continue to keep it vague. The ADA loves vagueness. They hate to be held accountable for any solid advice, so they know how to cover their ass very well. Vagueness permits them to never be brought to task on anything they say.

Other than this tiny section on diet, with no specific recommendations for any one of them, the rest of the paper consists primarily of information on medication management. I don't blame them. Patients want that magic pill and certainly don't want to put in the work, if they don't have to. Any doctor can attest to that.

So, what's wrong with all of this? Nothing. Absolutely nothing. First, limiting carbohydrates to 130 grams a day, and to no more than 26% of your daily caloric intake, is low carbohydrate considering that the typical Standard American Diet (SAD) consists of 300 - 400 grams of carbohydrates a day and more than half of daily caloric intake. If you want to restrict carbohydrates further, that's your prerogative, but to claim that anything that's higher, than a ketogenic percentage of carbohydrates, is not low carbohydrate is utterly asinine.

The ADA does not have to, nor should it, make a ketogenic diet recommendation, as they have to take into account a patient's medications, which are already bringing down blood glucose to very low levels, and the patients that are Type I diabetics on insulin. The ADA's shenanigans have nothing to do with its dietary recommendations.

Rather, the problems with the ADA is exclusively limited to its lack of accountability, both for itself and diabetics. It continues to spout the mantra of "you can still have dessert, if you are diabetic." and "you can eat anything you want, even with diabetes." This is a disservice to diabetics everywhere. The ADA continues to stand behind the position that you can just "hide" your bad dietary choices with medications. This doesn't promote a lifestyle change for the management of diabetes. This promotes complacency. When you think of the ADA, you think of desserts, pastries and junk food. Its insistence on caring more about its donors, mainly Big Pharma and Big Food, than the people with diabetes, it claims to be trying to help, is the true problem with the ADA.

2. Does "excess protein" turn into body fat?

You will hear many people repeat this and find it written in multiple mediums. Even legitimate sources will repeat this fallacy, from dietitians to nutritionists to doctors, etc. But, like I have stated before, repetition does not make things true. The available research does not support this claim.

Biochemically, the body has the capacity of turning protein into fat, but it never does. Just like biochemically, the body has the capacity to live to 130, but it never does. No one has yet seen protein being converted to fat, in any human study, even when protein was overfed by 4 to 5 times the recommended daily values. So, no one yet knows how high protein must go for this biochemical process to kick in. The only thing that was seen in people, who were overfed protein, was an increase in weight due to an increase in lean body mass. Body fat never increased. In fact, the more protein, the leaner people get.

Having said that, people with metabolic syndrome experience hyperglucagonemia after eating protein. This can disrupt blood glucose homeostasis and this disruption can cause more weight gain. This is due to insulin resistance and avoidance of protein does not solve this. Rather, daily protein intake should be divided as follows per Dr. Bernstein's recommendations:

• Breakfast: 6 grams carbohydrate, 3 ounces protein
• Lunch: 12 grams carbohydrate, 4 ounces protein
• Dinner: 12 grams carbohydrate, 5 ounces protein

Also, remember that protein comes with fat, so if you are purposely choosing fatty cuts of meat and adding even more fat to them, basal insulin levels will begin to rise. This will  disrupt blood glucose homeostasis and this disruption will cause more weight gain. So watch the type of meats you eat and how much fat you add to them. Fat is not a free food. 

3. Does fat really burn in the flame of carbohydrate?

This goes into the weeds of biochemistry and beyond the scope of this blog. There are many great blogs, out there, that are run by real biochemists and even some keyboard ones, but that's not the goal of this one.

Having said that, as you make your rounds on the internet, you might come across this statement and it's usually used as a way to try and "disprove" the fact that carbohydrates inhibit fat burning. So, for the sake of newbies that might become confused, I will explain where this statement goes wrong, as simply as I can, without getting too deep into the technical jargon.

First, let's go through some basic knowledge, before we continue. Anything that the body burns, whether it's glucose or fat, is burned to produce adenosine triphosphate (ATP); the energy currency used by our cells. There are many metabolic cycles involved, all run through different feedback loops, to produce ATP from the foods we eat.

The term "fat burns in the flame of carbohydrate" would be better described as "fat burns in the flame of oxaloacetate (OAA)". Oxaloacetate is a metabolic intermediate that is formed from pyruvate; a metabolite that can be derived from many different sources. Glucose is just one of those sources, as glucose can be converted to pyruvate. But, amino acids from proteins also convert to pyruvate, either from the use of their substrates or from their conversion to glucose.

So, you don't need to consume carbohydrate to light your fat burning flame. Your body can produce all the glucose it needs from protein, for pyruvate synthesis, and create all the OAA it needs to burn fat. This is why there is no essential, exogenous carbohydrate. You do not need them for any metabolic cycle.

4. I was told that unless I have high ketone levels, I am not burning fat.

This statement is better described as "unless you can keep your basal insulin low, you are not burning fat." Again, this is quite technical, so I will keep it as simple as possible.

Ketones are a byproduct of fat burning, but they are the result of incomplete oxidation of fatty acids. In other words, your liver is exporting unburned fat as ketones, into the bloodstream, for use by other cells in the body, mainly the brain. If ketones are low, it doesn't mean that you aren't burning fat, it just means that you have less unburned fat. As long as you have enough OAA (see above), you will be burning fat and you will not have any fat "spillover" to convert to ketones.

5. I am getting older, so I don't need much protein.

If you are getting older, you definitely need protein. In fact, you would need more protein, since the older you become the harder it is for the body to utilize proteins. This is why there is a marked decline in lean muscle mass, as you get older.

Older people are frail and weak, because of lean muscle mass loss. Young people are strong, because their muscle mass is intact. The main differences in the young and the old is visceral fat accumulation and lean muscle mass loss. Both go hand in hand. The less lean mass you have, the more fat you are.

6. Can I eat all of my macronutrient requirements in one meal?

You will not be able to obtain or sustain proper blood glucose regulation eating one meal a day. Not only would you have to eat too much in one sitting, which disrupts insulin/glucagon ratios, but you will end up fasting for an extended period of time daily. This is a recipe for blood glucose disaster. Aside from that, you also will not be able to consume your daily requirement of protein this way. 

For this reason one meal a day (OMAD) protocols are not recommended on this blog.