Six common beliefs addressed, Part 208

1. I am following a program which has a diet that is mostly veggies and protein with no added fats. It consists of two to three meals a day and a 1500 calorie "budget". 

I know your program director is patting themselves on the back and telling you this is some type of "miracle diet", they discovered, but it’s simply a protein sparing modified fast (PSMF). Any diet that prioritizes protein, while strictly restricting carbs and fat is a PSMF. Now, don't get me wrong, I'm not knocking this approach. PSMFs, whatever their iteration, are legitimate protocols that have been shown to be very effective for the reduction of body fat. They can also be used for training or for other health goals, besides weight loss, depending on how they are modified.

PSMFs target insulin and leptin. They stabilize blood glucose by restricting dietary carbs which lowers bolus (postprandial) insulin. The restriction of dietary fat lowers basal (fasting) insulin. Ultimately this affect on insulin allows for better blood glucose regulation and the preservation of insulin function. The premise is that this would regain proper leptin expression, since leptin is a slave to insulin. These diets obviously accomplish this since they are used successfully, in multiple settings, for the reduction of body fat, specifically. The overweight/obese need to lower body fat, specifically.

PSMFs are just hard to follow long term and if you have ever followed one correctly, you would know why, but I can break it down easily for you. If you think a low fat or a low carb or a caloric restricted diet is difficult to follow for the long term, then imagine a low fat, low carb and calories restricted diet combined. That's a PSMF. That's why they are usually not recommended for the long term. That is aside from the fact that the lower your body fat already is, the more problematic these diets can become, unless you watch your protein intake carefully and train properly.

I keep all options on the table for the overweight/obese because there is no one protocol for obesity with guaranteed results. That's why I have multiple recommended protocols which can all be combined in different ways to create your own. I prefer for you to be informed about your choices because most weight loss protocols are sold as the "miracle cure". Snake oil is not hard to sell to the desperate.

This is why it irks me when people bring up old methods, put them in a new shiny package and sell them to you as a new item. This is what happened with the whole "fasting" fad, remember? Well, just like fasting, PSMFs are not new either. They have been used by body builders forever. They are an old method of tricking the body into burning body fat. How long you can keep this up is completely individualized and results will vary, since it all depends on much proper blood glucose regulation you can regain and sustain. The healthier and leaner you are, the better the results because you already have proper leptin expression. The sicker and fatter you are the more varied results because you are trying to kick start proper leptin expression and that doesn't always happen. The long term results are unknown.

I would personally try it. This is because PSMFs have a very good track record of effecting leptin expression positively so you don't loose anything by giving it a go. You might actually lose some body fat. Just keep in mind, this isn't something exclusive to the program you are in. This is a very well known diet and you really don't have to pay for it. There are many free PSMF plans online.

2. I am currently on a weight loss journey and I refuse to let go of my "fat clothing". I don't know why exactly. I feel an extreme and unusual anxiety about throwing any of them out or giving them away. 

I haven't touched on the emotional and psychological stress related to overweight/obesity. That doesn't mean that it doesn't exist, it's just that it goes beyond the scope of this blog and the knowledge I have. I am not very familiar with this but I can give you my non-expert opinion.

Tackling overweight/obesity is extremely difficult. Many people's entire lives have been devoted to trying treatment after treatment, to try and reverse this condition, to no avail. It is very frightening to have to deal with something you have little control over and that will cause you expensive and serious health problems in the future. In fact, overweight/obesity is the main contributor to an early death, in some form or another.

Some people have become so paralyzed with the fear of yet another failure, that they simply have grown to accept their overweight/obesity and no matter what treatment they follow, they have the mindset that they will remain or return to being overweight/obese regardless. This is probably why you don't want to let go of your "fat clothing". It's scarier to fail and have to buy "fat clothing" all over again, which only makes the failure a more solid reality, than to fail and already have these clothes as if you never even intended to lose weight to begin with.

Fear of failure can result in many additional problems including eating disorders. You have to watch this carefully as people with current mental health issues like anxiety, depression and/or obsessive compulsive disorders are more at risk for developing these problems. Eating disorders are very serious and there are a lot of "fad diets" that only help perpetuate them by giving them legitimacy.

I suggest that if you are already experiencing severe anxiety, and exhibiting behaviors, like keeping "fat clothing", that doesn't fit you anymore, you should seek professional help. Being able to talk to someone can be very valuable in helping you address this issue before it gets worse.

3. I was told to eat between 150 - 200 grams of fat a day for maintenance but that seems like a lot to me. 

This recommendation is the standard for legitimate ketogenic protocols used for the treatment of overweight/obesity and metabolic disorders. Just keep in mind that it doesn't matter how legitimate and science based a protocol is, all protocols have had dismal long term success rates. Don't let the word "legitimate" fool you. Legitimate simply means that the protocol is not a "crash diet" or "fad diet" which can further harm your metabolism's function.

Will it work? That is very hard to say even for a legitimate protocol. Like I said above, all protocols have not only had dismal long term success rates, the successes and failures have not been well studied nor understood. It is very difficult to follow people around for the long term. It is also very difficult to know exactly what they did during that long term span of time. What people say and what they actually do, do not always coincide.

The premise of this recommendation is based on that, if you lost all the weight and are now lean and ready to be in maintenance, your insulin resistance is resolved and proper leptin expression has been restored. That's a pretty big premise to have since that's not really known. Remember, the cure for obesity is not weight loss. There is no known cure for obesity.

What we do know is that the fat cells of the once obese are not the same as the fat cells of the always lean but that's the assumption that is being made with this premise. They are assuming that you are now "cured" and your metabolism should perform as a healthy person's would. You increase fat intake for maintenance because it is being assumed you now have proper leptin expression and you wouldn't want to eat less than you should because this would cause a reversal and you would enter into starvation mode (low leptin expression) once again, storing fat and not burning it.

A healthy person can eat an astronomical amount of fat and hardly gain 25 lbs. Their leptin expression is intact and it simply won't allow for their weight to increase to any significant amount as they have a low weight set point. Their metabolic rate simply increases as their dietary fat does and they burn it all off. They will then get to the point where they simply cannot eat that much fat and they will naturally reject it. So they cannot eat astronomical amounts of fat chronically. The body has tight controls over its weight set point. It will increase metabolic rate, increase activity, decrease appetite, whatever it takes, to remain in weight homeostasis. For the overweight/obese things do not function quite like that. Instead, they have a very high weight set point and the body is doing everything it takes to maintain it.

So the only thing you can do is to try and see. Will your body burn enough stored body fat so the 200 grams of dietary fat simply replace what's being burned and you remain in homeostasis? Can you even keep up eating 200 grams of fat chronically without a large reduction in appetite? We don't know. Only you can find out.

Rarely overweight/obese people are able to acquire their leptin expression easily and keep it. Some will acquire it for a short time and then lose it again. Most will never acquire it at all. It all depends on how your individual fat cells are behaving and how your hypothalamus is reacting. How did the effects of overweight/obesity change both fat cells and hypothalamic function, for the long term, in you? You will soon find out. Keep us posted. I'm actually curious to know.

4. My triglycerides have doubled and my cholesterol has gone significantly up, within a six month period. I have never had these issues before. I already eat low carb and have been for many years. The only thing that has changed is that I am on Metformin. My doctor told me he put me on it for "insulin resistance". I am a Type II diabetic with pretty well controlled blood glucose. This is why I am only on a low dose of Metformin for now.

It is unusual for metabolic markers to change this quickly for absolutely no reason. This is why I am very leery when someone comes to me with this type of problem. This is because they usually tell their side of the story and not the whole story.

People will say they are “low carb” but I have no clue what that means. Low carb means different things for different people. I also take the claims that "nothing has changed" or "the only thing that changed is" with a grain of salt. People will swear up and down that “nothing has changed” but that's because they like to omit what actually changed. I am not accusing you of this but my personal experience has shown that most people lie when it comes to describing their diets. This is why I prefer hard numbers. I need actual macros in order to determine if you are truly low carb or not.

But for the sake of being able to answer this question, I am going to take it at face value and assume you are on a legitimate low carb protocol that has truly not changed at all, except for your use of Metformin. Let's unpack this piece by piece.

High cholesterol can either be a rise in HDL, LDL or both. You never said if yours was a rise in total cholesterol or in a specific lipoprotein. Most people experience no changes in their cholesterol due to saturated fat in the diet but a small segment does. Why this would be occurring to you now though, is unknown. This is usually seen immediately the moment you begin consuming saturated fats. You say you have been low carb "for years", so you would have seen this rise in cholesterol years ago, not six months ago. Cholesterol rises from diet occur within a few days.

High trigs are usually a sign of metabolic syndrome and as the condition progresses, they tend to increase further. It is not uncommon to see a diabetic with trigs in the 1K or more. This occurs slowly over time so if your increase was sudden, then something else could be going on. I am assuming you do not drink alcohol so fructose consumption would be the only thing that would rise trigs quickly. You would have to see if any products you are using, might contain fructose. Fructose does not cause a rise in blood glucose so it is usually used in diabetes products as it has a sweet taste without the “sugar”. Check your products for fructose, including any medications.

Both cholesterol and trigs are handled by the liver. You know what else is handled by the liver? Metformin. Metformin works with the liver to control glucose production causing a pseudo lowering of blood glucose. The effects this has in the liver remains unclear. Metformin is not considered intrinsically hepatotoxic but there has been conflicting evidence on its lipid-lowering effects and other claimed benefits, such as a treatment for fatty liver disease. In fact, The American Association for the Study of Liver Diseases, the American College of Gastroenterology, and the American Gastroenterological Association state that Metformin has “no significant effect on liver histology and is not recommended as a treatment for liver disease in adults with non-alcoholic steatohepatitis (fatty liver disease)”.

Though Metformin reduces insulin dependency in Type II diabetics it is unclear if this effect continues beyond the first year. No significant improvements in HbA1C are noted with Metformin use. I'm telling you all of this so that you can be a bit more critical when reading how great Metformin is. The truth is that they simply don't know because the long term studies have not been done as of this post.

You would need to look further into this and discuss it with your doctor. When you do, do not be gaslighted. Do not let your doctor tell you that "Metformin cannot possibly cause hyperlipidemia" because he doesn't know. You should also review other medications that you are taking as they might interfere with how Metformin works. I suggest you review your medications with your doctor and explain how this hyperlipidemia correlates with your Metformin usage. Your doctor should have a history of your previous blood work so he can note changes through a certain time period. Demand personalized health care, after all, you're paying for it.

On another note, I don't know why your doctor said he prescribed you Metformin for "insulin resistance". Instead, he should have told you that he prescribed you Metformin to lower your blood glucose. There is no pill that addresses "insulin resistance".

5. Some artificial sweeteners (AS) have calories.

Some AS have an effect on insulin. Others are converted back into sugar by the body. Most are mixed with fillers that have calories in the form of glucose. All of it is irrelevant. Whatever the case, the calories are so trivial that they can still label the product as having 0 calories. None of these are what make AS problematic.

Like I have stated before, the real problem with AS is in the sweet taste information they are giving your metabolism via the hypothalamus. Sweet taste means store more. This means that everything you eat, accompanied by AS, will be stored more than if AS was not included. This is most likely the reason why the introduction of AS, to the food supply, has done nothing to curb obesity or the incidents of diabetes. In fact, both have only increased.

6. I am never hungry and that's why I can fast so much but I have noticed that a lot of fasters are never hungry. Some of them are not even obese.

The obese are usually never hungry because they aren’t burning any fat due to poor leptin expression. You don't have to be obese to ruin your leptin expression. You can absolutely fast it away. The more you expose the body to starvation, the less willing it will be to burn body fat.

Thin fasters are simply training their body to under express leptin. That is why first-time fasters are very hungry in the beginning and then, over time, they find out they can fast forever. Soon these thin fasters will join their obese counterparts. Instead of body fat loss, they are simply losing leptin expression along with their muscle mass. Lack of hunger is a sign of things to come.

Six common beliefs addressed, Part 138

1. You should ask for a complete thyroid panel in order to know exactly what my thyroid function is. 

Yes. If you are having some type of issue, your doctor suspects can be related to thyroid disease, then the proper blood work will be ordered by them to confirm this. 

But, I don't want you to get too caught up with your thyroid numbers as the thyroid is at the mercy of your overall metabolic state and for this reason you have to take into consideration many other things before you can conclude your thyroid health from just numbers. For instance, a person who is losing weight will have hypothyroid numbers without there being a pathological reason for it. This is just the result of a normal, perfectly healthy thyroid responding to the loss of fat mass. You don't want to end up on thyroid medication that will disrupt this normal process and possibly cause a weight stall or weight regain. 

Do not treat numbers. Treat disease. 

2. Going carnivore can cause depression and other emotional issues.  

This may occur with any diet that restricts carbohydrates. It doesn't happen to everyone, but there are some people who are sensitive to this. 

When you consume a meal that's heavy in carbohydrates, it disrupts your blood glucose and your body responds by over releasing insulin. Insulin lowers the concentration of most amino acids. The one amino acid that doesn't decrease in response to insulin is tryptophan, which is converted in the brain to serotonin. When insulin lowers the concentrations of other amino acids, tryptophan is then able to pass into the brain more readily. The body adapts to this condition, especially when this has been happening for decades. Any changes to this hormonal state will result in side effects. 

When insulin levels suddenly drop, because of carbohydrate restriction and fasting, serotonin levels can be affected and this can cause multiple side effects like mood changes, sleep disturbances, etc. It can also aggravate pre-existing conditions like depression and anxiety. Usually these effects, though uncomfortable, are transient and will decrease as the body adapts to its new state, but for others, this can become a serious problem. This is especially true if prescription medications are involved. 

These symptoms need to be discussed with a healthcare professional if they persist. If you are on prescription medication, for the treatment of any psychological condition, you must discuss any diet change with your doctor prior to implementation. 

3. Blood glucose can remain high, hours after a meal, while on carnivore. 

That's hyperglucagonemia. You should divide your daily protein requirement into three meals, so you don't eat so much at once. You have to give the body a chance to properly regulate its counter regulatory system. That will take some time, but you can help by dividing meals. 

4. You should make your child eat "keto", even if they are reluctant to try it. 

The advice we give is for people who can follow it themselves and voluntarily. This is what ensures compliance and consistency as this type of metabolic therapy must be followed long term. This is why I cannot give advice for children or anyone else that is under another person's care. 

I suggest you talk to your child's doctor about healthy diets for children. The diets recommended in this group are a metabolic intervention for adults only. 

5. Cheese can cause a weight stall.  

Only if it's replacing the protein in the diet. You can't expect to eat a wheel of cheese and lose weight. Cheese is only a garnish to your meals. It's not a snack or a meal in itself. 

6. If you don't want to cook meat, try lunch meat. 

Lunch meat should not be a staple in your diet. Lunch meat is a staple of the Standard American Diet (SAD) because you don't have to cook or prepare it and you can make sandwiches out of it, but lunch meat is not proper nutrition. It is a processed meat that does not have the right fat and protein content or in the right ratios. It is fine to use as hors d'oeuvre at a party because it's better than eating crackers, but it should not be part of your everyday meals. 

So whether you can find it clean or not is irrelevant. Lunch meat is not appropriate "food". 

Six common beliefs addressed, Part 5

1. Are cravings a sign that something is wrong with my diet?

People assume that their cravings and/or desire to eat certain foods means that somehow the diet is not working for them or they haven't been "cured" yet. Obesity is a lifestyle choice that is influenced by environment and this is one of the effects of that environment.

We live in a society where we are constantly being bombarded with food. It's everywhere. It's in the media, in every corner and at every event. There is no escape from it. Of course, you will want to eat these foods, as you come across them. The temptations are everywhere and it has nothing to do with your state of metabolic health. It's a natural, biological effect. It doesn't matter if you have been on a ketogenic diet for 50 years, if you see ice cream, you will more than likely, want it.

Craving, wanting, desiring something does not mean you have to react to it. You will have to find a way to live with these feelings and bypass them or you will not be able to live in society at all. You can not expect for something else to control these feelings, besides yourself. Avoidance and "getting cured" are not going to come to the rescue. You are your only rescuer. Society is not going to change for you. It is not going to provide a soft cushion and censor its food porn, so that you are no longer tempted. Following a ketogenic diet is not going to magically erase the part of your brain that knows these junk foods are delicious. You have to make the decision, each and every time, to not eat things that don't belong in your body. Nothing else is going to make this decision for you.

With time, you might lose interest in 90% of the foods you used to enjoy, because there are other foods now that have taken their place, but this will never be a 100%. Some interest and desire will always remain. You have to learn to live with it and realize that it's just a mental desire and not a physical need, that requires acting upon.

2. I was told that coconut nectar and syrup are healthier than sugar.

The food industry is now hiding the sugar in their junk food by giving it special names like "coconut nectar", "coconut sugar", "coconut syrup", "turbinado sugar", "date sugar", "muscovado sugar", etc. All of these unfamiliar names make it appear as if they are healthy ingredients and that they have nothing to do with sugar. 

NEWS FLASH! - These are all still sugar and your blood glucose  doesn't give an iota of care about where it from or in what stage of refinement it's in. Sugar, regardless of its name or refinement will affect blood glucose homeostasis negatively. 

You must read ingredients and not be fooled by fancy terminology. Any "nectar" or "syrup", regardless of where it comes from, is sugar to the body. The body doesn't make a distinction if the sugar comes from cane, beets, dates or a rock. It doesn't matter if it's honey or maple syrup. It's all metabolized in the exact same way as plain old, white Dixie Crystals from a sugar bowl.

Don't let the food industry fool you and take your hard earned money by selling you roadkill labeled as mink. It's still roadkill. In the end, you are being robbed, while they get rich. Their wealth won't benefit you at all, since it won't help pay your medical bills.

3. My '23&Me' results say I can’t eat a high fat diet.

This is the default result of 23&Me, when it comes to diet. I have not come across a single person who has gotten a result that recommends a low carbohydrate diet, much less a high fat diet. If the DNA they receive is human, the diet they will recommend will magically mirror the dietary guidelines. Not surprising. They might get in big trouble if it didn't.

Do not use this test to determine what diet you should follow, because it's not reliable. Your health goals and results should be your only determining factor for choosing a diet.

4. My depression/anxiety has increased, since I began restricting carbohydrates and fasting.

When you consume a meal that's heavy in carbohydrates, your blood glucose rises abnormally and your body responds by releasing excess insulin. Insulin not only lowers glucose, but it also lowers the concentration of most amino acids. The one amino acid that doesn't decrease, in response to insulin, is tryptophan, which is converted in the brain to serotonin. When insulin lowers the concentrations of other amino acids, tryptophan is able to pass into the brain more readily. The body adapts to this condition, especially when this has been happening for decades. Any changes to this hormonal adaptation will result in side effects.

When insulin levels suddenly drop, because of carbohydrate restriction and fasting, serotonin levels can be affected and this can cause multiple side effects like mood changes, sleep disturbances, etc. It can aggravate pre-existing conditions like depression and anxiety. It's similar to what happens if you suddenly stop a psychotropic medication, because, technically, it is similar.

Usually these effects, though uncomfortable, are transient and will decrease as the body adapts to its new metabolic state, but for others, this can become a serious problem. This is especially true if prescription medications are involved. These symptoms need to be discussed with a healthcare professional, if they persist. If you are on prescription medication, for the treatment of any psychological condition, you must discuss any diet change with your doctor, prior to implementation.

5. Does having an energy drink break a fast?

A lot of people will ask the question of whether an energy drink, diet drink, chewing gum, etc. will break their fast. If you feel the need to ask, then you might already know the answer: YES.

Anything that you can taste, breaks a fast, regardless of caloric content. Incretin hormones, released from the small intestine, have been found to respond to chewing, taste and smell and not just to the presence of food in the digestive tract. They actually begin working before food reaches the stomach. Your mouth is the first part of your digestive tract.

Incretins stimulate the release of insulin. In people with diabetes and other metabolic abnormalities, the insulin stimulation of incretin hormones has been found to be upregulated. So, chewing and tasting stimulates even more insulin in people with these metabolic pathologies.

When you fast, fast. When you eat, eat. Shorten your fasts until you can do a water only fast. Long fasts while eating, are not fasting. Fasting is by definition, not eating. There is a word for eating while fasting, it’s called snacking.

Drink coffee and tea during your eating window only. The clearer the definition of fasting becomes, the clearer the action required is.

6. Is the purpose of a ketogenic diet to be in a caloric deficit?

The purpose of being in nutritional ketosis is to burn your own body fat through the better regulation of blood glucose which in turns causes a reduction of insulin levels/expression.

The reason there is no caloric deficit, when insulin levels are low, is because you are still eating, even while you're fasting. You're eating from your own body fat. The low insulin allows the body to make up for any dietary caloric deficit, through the break down of body fat. Rump roast is on the menu, from your own behind, and it's an all you can eat buffet that's open 24 hours.