Six common beliefs addressed, Part 262

1. I read that they are not fully accepting that obesity is a starvation adaptation because there are so many factors involved that contribute to it.

This is word play and nonsense. The science is pretty clear. The metabolism of the overweight/obese is doing the exact same thing that it would normally do under starvation conditions. For this reason, obesity is not truly a "disease" as nothing is "malfunctioning". It is more of an adaptation than a pathology.

The only factor that tracks linearly as causal for overweight/obesity is blood glucose. Nothing else has and obesity has been studied ad nauseum. For this reason, obesity is a lifestyle condition because multiple lifestyle choices, whether made willingly or not, affect blood glucose regulation. This is why some people can reverse obesity and others cannot. Those that can take control of their blood glucose regulation see reversal and those who don't remain obese. This is also why obesity is so difficult to tackle once diabetes sets in. Diabetics cannot control their blood glucose any longer. If the condition is treated correctly, early enough, they have a better chance at remission through the stabilization of blood glucose.

Be careful of guidelines. They don't follow the science at all. There are many outdated guidelines out there that are still being actively pushed, like lowering of total cholesterol to prevent heart disease, lowering of blood glucose to manage diabetes, lowering of calories to reverse obesity, lowering of all dietary fat for weight loss and vaccinating children against COVID. All of these are just common examples of guidelines that do not follow the current science at all.

So of course you are going to read that obesity is not entirely a starvation adaptation because they still want to hang on to calories even when the science has proven otherwise. They will use fancy tricks to prove their position, like asking "who gets obesity at a concentration camp"? But I have explained all of this in depth in my posts before. It's all BS.

You control obesity by controlling blood glucose regulation and you can do that multiple ways. The most common ways are controlling diet, exercise, chronic conditions, medications, stress (circadian rhythms) and intake of caffeine.

2. Is diabetes truly a "diet disease"? I see so many doctors claiming that they can "cure" diabetes through diet and nothing else is needed. If this is true, what diet would "cure" diabetes?

Diabetes is the end stage of metabolic syndrome. Metabolic syndrome is a condition triggered by large disparities in blood glucose which affects its proper regulation. The most common culprit for this in modernity is diet. Specifically a high carb diet of which sugar is predominant. That is basically any Western Diet but the Standard American Diet (SAD) is the most cited one. As you can see, though diet can trigger this metabolic abnormality through blood glucose dysregulation, diabetes is not a "diet disease".

Many things affect blood glucose regulation besides diet. Chronic conditions, sex hormones, medications, genetics, aging, stimulants and lack of exercise all affect blood glucose regulation. They not only affect how well you can regulate your blood glucose but most importantly, how long you can sustain its proper regulation. This is why all these things affect what outcomes will be had from treatment.

These online doctors want to focus on diet alone because that's where the money is and they unfortunately, do not even understand what diabetes is. People are much more wiling to listen to someone blame diet than blame blood glucose regulation. Diet is easy and fun and blood glucose regulation sounds complicated and technical. Blood glucose regulation also sounds like something you have little control over and can't be "cured" with a magical pill or by picking out fun "healthy" snacks. Well, your diet is a completely useless pill. At most, it's a placebo. Like I have said many times before, treatments do not work when they are incorrect and/or incomplete. This is why diet interventions alone have been utter failures as treatments for metabolic syndrome/obesity/diabetes.

Having said that, the clue as to what would treat metabolic syndrome/diabetes is right in its definition. God is in the details, not the devil. If metabolic syndrome/diabetes are conditions caused by blood glucose dysregulation, then the best treatment is to eliminate/minimize blood glucose dysregulation. A low carb diet works very well at doing this because it stops the introduction of dietary glucose. Dietary glucose disrupts blood glucose homeostasis. This makes low carb diets a good starting point for reducing the disparities in blood glucose which continue exacerbating the problem.

Then you can also focus on other things that dysregulate blood glucose, like all the ones I listed above, to cause a compounding effect where blood glucose is as controlled as it can possibly be. This can not only prevent metabolic syndrome/diabetes but help put it in remission if you already have it.

3. Is it true that stevia is the only good artificial sweetener (AS)? Some health gurus have been fear mongering now about artificial sweeteners. They don't like any of them. I even heard one of them recommend you can use sugar, in small amounts, instead.

This is precisely why I never follow "diet news" especially from health nuts who have a new book out weekly they are trying to peddle. Diets have been studied ad nauseum and everything we need to know about them, is already known. We also know a lot about food additives, including AS. Artificial sweeteners are well, artificial. You can take from that what you will and that's about all you need to know to make a decision about them.

Artificial sweeteners became popular as more and more people watched their calories and AS are 0 calories (sort of). Then they slowly made another fan base with diabetics as all that calorie watching did nothing to prevent the scourge of diabetes from rearing its ugly head. So both people who watch calories and those who watch their glucose meters use AS liberally. And when I say liberally, I mean on everything. People will sweeten a steak, if they have the opportunity to. Don't believe me? Look at the numerous sweet sauces that can be slathered on everything, including steak.

There are numerous types of AS, some with warnings (saccharin), some with questionable health effects (aspartame/sucralose), some not quite studied enough (stevia) and some cause unpleasant side effects, mostly gastrointestinal (sugar alcohols). Some of these sugar alcohols also convert back into sugar in the body.

I know that a lot of these diet and health nuts find an issue with anything that people enjoy. Their idea of utopia is people flogging themselves constantly over their dinner table. It's almost with a religious fervor that they squash any type of enjoyment you can ever have from what you eat and they take great delight in it. So it was only a matter of time before they went for AS. They saw people had an option now and their job is to take that away immediately. No options. Comply or die. On this blog, I don't care about public shaming parades. I look at every thing through the lens of metabolic health because if you are here reading this, then I suppose that's what you care about as well. You are here to help solve your metabolic issues and I'm here to give you the information that would be most pertinent to accomplishing just that.

Artificial sweeteners do not help your metabolic health. If metabolic syndrome/diabetes are the result of blood glucose dysregulation, then intaking something that interferes with hypothalamic function via the dopamine/serotonin interaction, is not helping. How? Although studies have not proven a definitive correlation between dopamine and blood glucose levels, the answer lies with insulin.

The relationship between insulin and dopamine is fraught with contradictory findings but recent research has indicated that insulin modulates dopamine release in the striatum, which affects brain activity and connectivity. It's been concluded that the striatum plays a pivotal role in regulating glucose metabolism throughout the body. Dopamine has long been known to regulate metabolism, particularly seasonally, and it has been linked to metabolic syndrome/diabetes. But most importantly, we have seen how sugar has caused hypothalamic damage. A damaged hypothalamus can no longer respond to leptin properly so you will be obese forever.

It's believed that the taste of sweet itself is what begins deteriorating metabolic homeostasis through the hypothalamic pathway. After all, taste is metabolic information. It's not just there to make you want to eat, though that's one of its functions but nature is quite efficient. It uses one pathway for many functions rather than having to find many different pathways for each function. The taste of sweet directly affects dopamine as well as other metabolic hormones because sweet taste usually means store fat as winter is coming.

Artificial sweeteners are sweet. In fact, they usually are much more sweeter than sugar. Even with 0 calories, they have done nothing but increase obesity as more people use them quite liberally, on everything, simply because they are "better" than calorie ridden sugar. But the effects on the brain, particularly the part of the brain that's needed for metabolic homeostasis, is basically the same. After all sugar by any other name..... well you know the rest.

As for this idea of recommending the use of sugar "in small amounts", should not be entertained. How well did that work before AS was introduced into the food supply? There has been no established "safe dose" of sugar discovered as of this post. Sugar always affects blood glucose regulation, with individual variability. This means that the amount of sugar which may be benign for one person is not for the other and this changes over time as metabolism changes, age progresses, hormones decline, etc.  People need to stay away from sugar, particularly people with metabolic syndrome/diabetes.

Artificial sweeteners are a good alternative. Whether they help or hinder all has to do with the person consuming them. Some can eat like normal people and some simply cannot but staying obese while delaying diabetes (AS) is better than becoming more obese and developing diabetes sooner (sugar).

4. I heard on the news that caffeine is "neuroprotective" and since I have Alzheimer's in my family, I was thinking of drinking expresso, as they suggested. But I have also read your posts which say caffeine is detrimental for diabetes, which I have. What should I do?

Not listen to quacks. The single most important thing you can do for your health is not listen to quackery and daytime TV is full of quackery. This is why people who watch a lot of daytime TV score lower on intelligence tests than those who don't. Now there could be other factors for this. After all, if you have a lot of time to watch daytime TV to begin with, there might be other things going on with you. We can at least say people who watch daytime TV tend to be more misinformed than those who get their news elsewhere.

The reason I bring this is up is because I have seen this "neuroprotective" claim about caffeine make its rounds before. It always pops up every so often. A neurologist is given two minutes to tell you this half true information until they skedaddle him on out so their ads can begin playing. So, let's see where this idea comes from because quackery is usually birthed from truth. In fact, we can say quackery is as its core, bastardized truth.

• Caffeine is a stimulant. It raises blood glucose through adrenal over expression. This rise in blood glucose causes for cells that use glucose to have more access to uptake it. Neurons use glucose. If your neurons are impaired, such as with Alzheimer's, this extra glucose makes it easier for this uptake to occur so it appears as though the neurons are now working better.
• Glucose is an excitotoxin. It excites neurons. Remember the whole insulin nasal spray for Alzheimer's patients which showed an "improvement" in their symptoms? It's the same thing. More insulin, more glucose uptake and so more excited neurons that work harder and better.

There is just one problem. Exciting neurons kills them faster. So this temporary improvement has shown dismal long term results. This is why any neurologist, worth his salt, will tell you to stay away from caffeine if you have migraines. That temporary relief in pain, only causes your symptoms to become worse over time. The best thing a migraine patient can do, is get off caffeine. This will lessen the overall frequency of their migraine attacks.

So when you listen to claims of this sort, please be careful and do further research on your own about what is being claimed. All of this stuff you hear is just click bait to get your attention. This caffeine for Alzheimer's thing slowly became a claim that caffeine can prevent Alzheimer's which is not true. It's like a game of telephone. One person says one thing and as it goes down the line it becomes something else entirely. That's what mainstream news has become. A game of telephone. It puts a seed out there and lets it grow. The problem is that you pay the price.

5. If calories don't matter then why is it that when people "let themselves go" they gain weight? There is no denying that this happens and that's why everyone recommends for you to watch how much you eat, so you don't get fatter.

This is an excellent question and one that is always misunderstood.

The problem with eating ad libitum (letting yourself go) is not due to calories, it's due to blood glucose dysregulation. For instance, if I throw down on a huge serving of food, until I am stuffed, my blood glucose is going to be affected afterwards due to insulin/glucagon ratios. Though food is available for hunter/gatherers, the quantity eaten is always limited due to many factors. We were never designed to starve, but we were also not designed to eat at buffets daily.

Worse yet, if the meal I am stuffing myself with is from the typical Standard American Diet (SAD) menu, then the buffet will be mostly biscuits, pasta and bread rolls. That means I am not only disrupting insulin/glucagon homeostasis, through a huge pile of food, but I am consuming quite a load of dietary glucose to boot. This will further disrupt my blood glucose and affect my insulin for the next 12 - 24 hours. This isn't good because disruption in blood glucose homeostasis causes what? That's right - overweight/obesity/diabetes. So when you begin putting on the pounds, because of this habit, people will automatically assume it was all those calories. Well, it wasn't. It was all that blood glucose dysregulation.

The body can handle its calories but it can't handle disruptions to blood glucose. Not even in the short term. I need for people to understand this. Even in the short term, it's going to become a long term problem.

Eat to satiety. That means you don't leave the table hungry but you don't have to unbutton your pants to do so. This is why buffet style restaurants are never a good idea. Watch your portions through satiety, not because of calories, but because of your blood glucose.

6. I hear that "carnivore" can prevent or "drastically reduce" heart disease from occurring via it's reduction of "inflammatory substances". I totally believe that and am onboard but as someone with current cardiovascular disease (CVD), I am still concerned.

I hear that eating shark fins can make me live to 150. We all hear a lot of things but where is the evidence? I guarantee you found none before you "totally believed" and "got onboard". What if you got onboard the Titanic? People will believe just about anything nowadays and that's sad, considering there's this thing called the internet. All it takes is a little research to debunk the nonsense.

CVD is very complicated and has many causes. I don't know what type of CVD you have. If you believe that CVD is caused by some type of "inflammatory substance" then an anti-inflammatory medication would basically cure you. Unfortunately, NSAIDS have not yet been recognized as the cure for CVD. This means that CVD is much more complex than "inflammation". After all, many things cause inflammation, including arthritis but arthritis is not recognized as a risk factor for CVD. Well, unless it's rheumatoid arthritis, but there are other complexities with that condition.

Now that we have gotten past the nonsense, let's talk about what we do know. Metabolic syndrome is a risk factor for CVD and it's not because of its inflammatory effect though I'm sure that could contribute. It's because of a complex hormonal interplay that interferes with blood pressure regulation and other stress hormones that affect the cardiovascular system as a whole. It's a very complicated process that I will not go into here as I am sure people think I'm pedantically long winded as is.

Metabolic syndrome is caused by improper blood glucose control. Carbohydrates are notorious for interfering in blood glucose homeostasis. Carnivore eliminates all carbs. So carnivore would be beneficial for people with metabolic syndrome. If you can improve your metabolic syndrome, then you would lower your CVD risk. That's it. That's all that carnivore does. No where in that explanation is there a claim for "preventing or drastically reducing" heart disease.

Now the best thing you can do for yourself, is discuss your diet with your doctor. You need to know the results of certain tests, like an advanced lipid panel which measures individual lipoproteins, so that you can figure out what fats would be best for you to use. There are certain genetic profiles that would make the use of saturated fats detrimental for CVD. This means you should be tested regularly when you start your diet to make sure your markers do not take a negative turn. You also have to follow a legitimate carnivore protocol. If you do that, I don't see any issues with you following this type of diet and you shouldn't have any concerns.

Six common beliefs addressed, Part 221

1. I have a trainer who likes to use oat bran for "lifting heavy". It seems to work well for her, but I don't see how a carb like that would make someone "muscular".

It absolutely can. If the person is also eating adequate protein, the carb will spike insulin which builds muscle. This is why a body builder's favorite food is meat and potatoes. The protein in the meat alongside the prolonged insulin released, caused by the potatoes action on your blood glucose, behaves like an antigen would on your immune system. It's just a way of achieving a more prolonged insulin release so it acts on muscle mass longer. Of course, this only works if the person has proper insulin function that is actually building muscle rather than fat. You also would have to be quite a heavy trainer.

2. The diet program I am on, has desserts but they aren't recommended for "fat people". I feel like I am being signaled out on not being able to enjoy what the others are eating. Why would a calorie centered program care if I am eating dessert or not if it's within my daily calorie budget?

For the same reason that I have explained before. A lot of calorie centered programs are not fully calorie centered. They try to sneak in macronutrient (macros) composition in order to achieve better outcomes. This is because they are fully aware that a calorie is not a calorie. The calories of different macros are allocated differently in the body.

They most likely want you to stay away from dessert because, even if the dessert is within your calorie allotment, most of those calories are coming from some sort of carb. They want you to avoid the carbs because they know carbs disrupt blood glucose and this will cause further weight gain or the inability to lose weight. Sneaky, sneaky but I know all their tricks.

3. Will a diet program that keeps a calorie target between 1500 - 1800 a good one to follow?

That is very hard to say. I can say that, at least, that's not a ridiculous calorie goal like some other programs have. I am sure you will lose "weight" though. At least, initially. How far you can go and how long your results will last, are another story.

4. I am following a program that is heavy on the artificial sweeteners (AS). Will this interfere with my weight loss goals? Also why are diet programs so loaded with AS?

Because they are loaded with BS.

Most programs are loaded with AS because they know this is what will entice people to continue following the protocol. People like to eat novelties. They are used to it because that's what makes up most of the Standard American Diet's (SAD) fare. Removing these and having to eat real meals is extremely difficult for most. So, junk has to be included in any diet program.

I can't say if it will interfere with your goals or not. You would have to try it and see. What I can say is that chronic consumption of AS effects overweight/obesity in a negative way through hypothalamic dysfunction. So, if you want to have a greater chance of meeting your goals, you will want to eliminate AS from the diet.

5. I am helping people to lose weight and recommend eating protein to prevent sarcopenia, but a lot of my clients seem scared of protein because it raises their blood glucose. They do seem okay with the protein shakes though.

This is because most protein shakes are everything but. Shakes labeled as "protein", found at the supermarket, are really just carb laden smoothie desserts. Unless the person is actually consuming good quality whey protein, that contains no added sugar or fillers, they aren't really supplementing protein seriously. They are supplementing sugar, regardless of whether the shake actually contains it or not. This is why they like drinking shakes but not eating steaks.

Unfortunately, because of the internet, a lot of these people are going around with their little blood glucose meters chasing their symptoms so when they see their blood glucose rise after protein intake, they start panicking as they don't understand what's happening. It's a shame but all you can do is try to explain to them what's going on and emphasize the importance of protein. Since you have been reading my blog, you understand how to do just that.

6. How can I stop my clients from eating so much fat? They seem scared to eat any other macronutrient.

You won't be able to stop them. Like the question above, there are a lot of symptom-chasing people, who don't understand what's happening to them. They only see what their blood glucose meter reads, and their blood glucose barely budges when they eat fat. For them, this is a "miracle", of some sort, since they have no clue how metabolism works. They will continue to insist on eating fat because of this and eventually their diabetes will worsen with time and their weight will continue going up.

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 197

1. People who consume artificial sweeteners tend to be fatter than people who still use sugar.

I am not sure the statistics on this but if it’s true, it should not be surprising. When people consume real sugar, and are also health conscious, they tend to avoid it. This means they eat less sweet things over all, either because they are watching calories or sugar's effect on blood glucose. The people who use artificial sweeteners, tend to add them to everything, since they believe they are a "free food", as not only are they void of calories but also of any immediate effects on blood glucose.

There is just one caveat which they miss - There is no such thing as a "free food". The taste of sweet shifts the dopamine/leptin axis towards the conservation of fat, and the storing of more of it, irrespective of calories. This means that as long as there is a sweet taste more fat storage will occur, even on calorically restricted diets.

Many items which are sweetened with artificial sweeteners, like sodas, still have caffeine. Caffeine disrupts proper blood glucose regulation so the problem continues. 

2. Calorie restriction should no longer be recommended.

That will never occur. Over all calories are simply easier to track and the easier something is, the more it will be followed consistently. Calories are also easy to understand so it’s fool proof. Calorie restriction does not eliminate any food item so it's a much easier sell. This is why most programs take the calorie restriction route.

Aside from that, there are a lot of politics involved in advising people, especially from wealthy countries, to simply consume less of everything. There is a large group of people who believe in flogging as a means of achieving equity and relieving their psychotic level of guilt so ad libitum consumption of anything is always deemed a "moral flaw". 

3. If I’m already watching calories, why does my coach insist on prioritizing protein and empty foods like vegetables? Why would it matter where my calories came from?

Exactly. It wouldn’t matter one bit but calorie centered programs are well aware that calories don’t work so they pair calories with “healthy eating” to maximize their results. Of course, their healthy eating is usually nothing more than some iteration of a protein sparing modified fast.

They will insist this "healthy eating" is for "nutrients" but we all know what it is - a very effective way of manipulating the metabolic hormones responsible for muscle building, fat burning and appetite control through macronutrient composition, once again, since calories do not effect them at all. Macros still reign supreme in getting the body to loose fat and keep it off.

4. Meat based pizza crusts are a good low carb option.

You have to be very careful with these type of novelties as some of these recipes are extremely heavy on the fat content. Usually these crusts are mixed with cheese which is mostly fat, not protein. You must keep your macros in mind when consuming these items.

5. If a person is "eating healthy" they should not be obese.

Choosing "healthy" foods is an incorrect method of tackling obesity. This is because "eating healthy" does not resolve obesity as there are many "healthy" foods that still disrupt blood glucose regulation. For some people, "eating healthy" simply means avoiding fast food and candy. They don't deem something like oats, for instance, as unhealthy. There is much more to obesity than "unhealthy" foods.

So the solution does not lie in eating healthy or not. The solution lies in eating appropriately or not. These are two very different concepts. The only diet that is appropriate, is one that prevents/minimizes blood glucose dysregulation.

6. There must be a "cell" or hormone that causes people to prefer and seek out sweet tastes.

There is no particular "cell" that causes this. It’s mostly caused by exposure. The brain becomes trained to prefer the tastes it's exposed to over time. People who claim to have a "sweet tooth", have simply trained their brain to prefer sweet from eating it so much. They have also trained their brain to seek it out through a dysregulation of dopamine. So if you are going to single out any one hormone/chemical that would cause someone to "seek out sweet tastes", it would be dopamine.

Six common beliefs addressed, Part 166

1. I eat almost no carbs but my blood glucose still runs high. I have only lost about 10 lbs.

This is because you have just discovered what we have been saying on this blog for a long while now - what you eat has a limited effect on blood glucose as most of the high blood glucose in metabolic syndrome/diabetes is coming from the inside.

I don't know what type of diet you are on and I don't know what other lifestyle changes you have made but running high blood glucose, while eating low carb, is indicative of an adrenal stress response. The 10 lbs. you lost, were most likely water weight and lean muscle mass as the body must break down it's lean muscle mass in order to continue running blood glucose at high levels. Stop the nonsense. Instead of eating "almost no carbs" try a proper low carb diet instead to try and reduce this stress issue.

2. Statins can lower triglycerides (trigs).

Statins are used to lower cholesterol in people with high total cholesterol. That is usually the reason they are prescribed. You would need a very high dose of a strong statin to lower trigs only by about 50% and also help raise HDL cholesterol.

For this reason, trigs are normally not treated with statins, as there are trig lowering medications available like Fibrates, Nicotinic Acid and high, prescription strength, doses of Omega 3.

3. I started doing "keto" and my kidney started hurting. I had to stop and now I'm wondering what diet I should follow.

How do you know your "kidney started hurting"? Did you seek medical attention? Do you have current kidney disease?

It's mind boggling to me when people begin a diet and then suddenly start feeling aches, pains, etc. and immediately attribute it to the diet they are following. All a ketogenic protocol is, is a diet that is very low in carbohydrates. That's it. Are you saying that pizza and pasta prevented kidney pain? That's one for the record books.

Listen, I know there are many iterations of "keto" online, some of which can negatively affect your health and cause problems but that is not the case with a legitimate ketogenic protocol. So, I suggest you follow the ketogenic protocol that we recommend, found here and drop all of the dumb "keto" you found online. See if it makes a difference.

Also get yourself checked out by a doctor, if you haven't already, as kidney pain can be the symptom of a serious problem. I cannot believe you actually waited for a reply on my blog about this. It takes me weeks to get to everyone's questions and/or comments.

4. Diabetics are always told to eat a candy bar or drink soda to treat low blood glucose even though they shouldn't eat these items.

This is because eating a candy bar or drinking soda treats low blood glucose. It works perfectly for that, as dietary sugar raises blood sugar. It doesn't treat diabetes, it just treats the low blood glucose symptom.

That is always the case when you try to hide a symptom of a much more complex underlying problem. The same goes for eating bacon and eggs to treat high blood glucose and think you will be all right. That also is not treating the diabetes. You are just hiding a symptom.

5. Statin medications can be beneficial for people who do not want to change their diet. 

Yes. Conventional medicine is excellent at keeping you alive, even in the most dire of conditions. In fact, that is what they do best. For example, I know of someone who has colon cancer, advanced heart disease and diabetes and they are still alive and kicking. They have had several close calls and have been brought back from death's door multiple times. My own mother in law, remained alive for decades with diabetes and fatty liver disease due to pharmaceuticals and "treatments". In fact, she went into a coma once from a blood glucose over 1K mg/dL and they were able to bring her back. Conventional medicine allows you to continue living your worst life. All of these people would have been dead a long time ago if it wasn't for conventional medicine.

So yes, for a person who refuses to do anything to better their health, as diet is not the only thing they need to do, taking a statin might be beneficial for them. It's certainly worth it as there are certain lipid conditions that do not respond to diet alone and require pharmaceuticals.

You don't want someone who refuses to help themselves, to also start refusing someone else's help. Statins have been shown to have benefits in people with current heart disease. So these people need to continue working with their doctor to remain alive and avoid further complications.

6. The Cleveland Clinic still encourages artificial sweeteners and bread.

Artificial sweeteners and bread are not poison. The Cleveland Clinic doesn't encourage gasoline or arsenic as part of a healthy diet. Just because artificial sweeteners and bread are detrimental to metabolic health in the long term, and do not allow for people who already have metabolic issues to get better, these reasons are not enough for them to remove these items from their dietary advice.

Aside from that, they technically don't have to get rid of these items, since their dietary advice is calorically restricted. Caloric restriction is the antidote to a high carb diet. Carbohydrates in the context of starvation help stave off metabolic disease for quite a long while, especially if you are young, obesity resistant and still healthy.

Six common beliefs addressed, Part 140

1. Blood glucose will rise with artificial sweeteners (AS). 

Most AS are mixed with sugars and/or are converted back into sugar, once in the body. This means that your blood glucose could be going up because of that fact. It could also be going up from insulin slowly rising in response to a sweet taste and counter regulatory systems dumping glucose to counteract it. Who knows. This can be quite complex and studies are conflictive. 

The only thing that is known is that the taste of sweet it detrimental to the overweight/obese and should be eliminated in all of its forms, irrespective of caloric content or source. 

2. Artificial sweeteners (AS) stimulate insulin, but there is no real glucose to lower.  

The body reacts to insulin release by dumping out its own glucose. Basically any insulin fluctuation, up or down, can cause the release of glucose. That's what counter regulatory systems are in place for. In people with metabolic syndrome/diabetes, this process is over expressed and a very large, abnormal, amount of glucose is released in response to just about anything. This is because insulin is already higher than normal, chronically, so the body is dosing glucose to match it. This is one of the ways that AS can make you fatter. AS is doing nothing, but increasing and reinforcing the body's stress response. 

3. Autophagy "dips", rather than stops, with a small amount of calories. 

Autophagy is irrelevant for metabolic health and fat loss. Autophagy is something the body always does, so it never truly stops. It's only under or over expressed. No system in the body ever truly stops, unless you're dead. 

It doesn't matter if autophagy dips or rises. It does this multiple times in a 24 hour period in response to all kinds of stimuli. 

4. Ketones should be higher than .1 after 41 hours of fasting. 

Ketone levels are irrelevant for metabolic health and fat loss. Ketone levels do not tell you what your metabolism is truly doing. For instance: 

• Low ketones could mean that the body is more efficient at burning fat, so it produces little byproduct of this process (ketones) or it could mean that the body is not burning enough fat. 
• High ketones could mean that the body is simply burning fat, but you don't know if this fat is coming from the diet or your own body fat. 

As you can see, there are negatives and positives to both low or high ketones and they can mean completely different things. Your overall metabolic state and results are the only things that can determine what a low or high ketone reading means. 

5. Tea cannot cause weight stalls.  

Yes it can. Any caffeinated drink can cause weight stalls and even weight gain because caffeine is absolutely detrimental for the overweight/obese and/or those with metabolic syndrome. This is because caffeine exacerbates the stress response, since it's a stimulant, causing an inability to regulate and stabilize blood glucose. 

Aside from that, any drink with a taste has been known to interfere in weight loss. Even without any sweeteners, whether artificial or not, tea always has a taste. Constant taste is detrimental for the hypothalamic/pituitary adrenal axis, disrupting metabolic function further. 

You can try several things to see if there is improvement: 

• Restrict the amount of tea you drink to no more than three cups a day. 
• Change the way you drink the tea and only drink it during or right after your meal instead of in between meals or during fasting times. This is the also the proper way to drink coffee. 
• Stop the tea all together. You would have to completely stop it for six months or more to see if there is any difference. 

6. Are there other resources that can help me understand my lab results better?

Yes. Your doctor. 

Any type of question or concern that you have about your blood work, needs to be discussed with the physician who ordered it. They will be able to tell you why they ordered the test, what is the test looking for and why your particular results were considered normal or abnormal. Becoming involved and active in your medical care will go a long way in getting you the right treatment. 

What you don't want to do is cherry pick information about your blood work from quacks online. That will not help you decide what's the best course of action to take. The only thing that can help you is an open dialogue and honest communication with your doctor.

Six common beliefs addressed, Part 131

1. The Mediterranean Diet can help achieve a new low weight set point, so it works better than "keto". 

This is true and it's primarily because most people follow the fad "keto" diet, found online, which contains an astronomical amount of fat, sabotaging their results over time. The Mediterranean Diet lowers the fat load and causes some weight loss. But, let's pretend that this isn't the case at all. Let's say the person was following a proper ketogenic protocol. Then a more complex situation occurred. 

Ketogenic diets fool the body into "starvation" through the presence of ketones. People with metabolic syndrome/diabetes produce ketones rather easily because of their poor insulin function. This causes for the body to assume it is starving for a long period of time, as you aren't truly starving and can follow the diet indefinitely. A metabolism that is already adapted for starvation, is now being convinced that is exactly what's occurring because of ketone presence. This dysregulates blood glucose further through the stress response.

When you switch to a Mediterranean diet, which drops ketone levels and allows the body to go in and out of ketosis naturally, it simply up regulates leptin expression and causes the burning of body fat as the brain becomes aware that it had body fat to burn. This is the classic example of how leptin can be manipulated through nutrient availability and why there are such fad diets as "Eat more and lose weight!" or "Eat more frequently and lose weight!". This is also why fasting advocate's favorite saying is "Switch it up!" if you are stalled. All of these gimmicks are just temporarily effecting leptin, causing temporary weight loss. 

The problem is that leptin, once again, down regulates its expression once body fat is challenged, significantly enough, and you remain obese. I know that people don't like to hear this because they want to hold onto hope, but this is the reality that the diet industry will not tell you or come up with some snake oil to try and combat it. Leptin always under expresses when body fat is lost and it stalls weight loss, causing weight regain over time. This means that diet alone is not enough for you to lose enough body fat and keep it off. You need to have an overall lifestyle that is anti obesogenic which includes predictable meal timings and most importantly of all, exercise. Anti obesogenic lifestyles are ones that reduce and/or eliminate all interference with blood glucose regulation.

2. Even though calorie restriction feels like starving, "keto" is too difficult to follow because it does not allow grains.  

"Starving" on caloric restriction is basically the reality of this protocol. Caloric restriction is starvation. The body then responds as it should. It's trying to prevent starving by ramping up hunger. The body is starvation resistant and though many metabolic functions will fail, with time, its anti starving mechanism will remain in tact until the very end. Literally. That's why all diets fail. 

As far as everything else goes, there's not much that can be done. If you can't follow "keto", leaving you to resort to caloric restriction, then there isn't really much left for you to do, except basic low carb. Of course, basic low carb will not work in the long term because it still includes sugar and grains, just in smaller amounts, which continue to dysregulate blood glucose. But maybe that's as far as you can go. If there is no commitment, there are no results. If you can't do any diet, then maybe you shouldn't be dieting. You might not be ready to commit to what you have to do in order to get to where you want to be. 

3. I don't know why they assume that the grains used to fatten livestock would make humans thin. 

This is ridiculous. They feed livestock grains ad libitum. They don't assume that humans would "feed" that same way. So, basically they are basing grain consumption on caloric restriction through calorie tracking, portion control and the reduction of fat intake, so it doesn't compete with carb intake. The most fattening diet in the world is one that is both high in fat and carbs, just ask the Pima Tribe. The Standard American Diet (SAD) is both high in fat and carbs and this is why it's so very fattening. 

The solution then is to eliminate one of the energy macronutrients in order to make the overall diet reduced in calories. So, the logic works as follows - Reduce the fat in the diet and that only leaves the carb. Now the diet is restricted in calories by default because one energy macronutrient has been significantly reduced, giving the other one more leeway. The premise is correct. Whether you reduce fat or carbs, the overall diet is now less in energy. Unfortunately, that's not where the story ends. If only it did, obesity would have been resolved decades ago. 

The problem with this premise is it surmises that overweight/obesity is solely the result of overall calorie intake, especially fat calories. That is incorrect. Weight gain or loss is the sole result of overall calories. Overweight/obesity is much more complex and it is driven by blood glucose abnormalities caused primarily by carbohydrate calories. So, they have kept the wrong macronutrient in the diet. 

Carbs cause pathological abnormalities in gluconeogenesis, blood glucose regulation and the stress response. This easily turns carbs into body fat and you in turn acquire a hormonal profile that spares this body fat and builds more of it, irrespective of overall caloric intake. In other words, you can restrict carb calories alone to begin reversing these pathologies, but this same reversal is not seen in the restriction of all calories.

For this reason, you get much better results increasing protein calories, dropping the carb calories, all together, and moderating fat calories. 

4. Cereal should not be labeled "heart healthy".  

But they are because they do not raise cholesterol. Cholesterol and smoking are the most commonly used metrics, that conventional medicine relies on, to ascertain heart disease risk. Cereals do not effect cholesterol and when they do, it's to lower it. This is mainly achieved through the lowering of HDL, making your total cholesterol appear lower. For this reason, cereals are labeled "heart healthy". 

Of course, they aren't. They usually contribute to heart disease because people who buy these type of "foods", generally follow a bad diet over all. In other words, what makes cereals so unhealthy, is not the cereal itself, but the fact that its a staple of the Standard American Diet (SAD). People who eat cereal, eat SAD. 

5. If your HbA1C has not lowered, it's because you're using artificial sweeteners. 

Nope. At least, not directly. There are some artificial sweeteners that turn back into sugar in the body, but a high HbA1C is caused by one of three things: 

• Dawn phenomenon - High blood glucose in the morning 
• Hyperglucagonemia - High blood glucose after eating 
• Both - High blood glucose all the time, basically diabetes 

Once your HbA1C is 6.5% or higher, it means you are diabetic and your doctor will inform you of this. This means that diet will have some effect on bringing your blood glucose down, but it might not bring it down enough as your body will continue producing excess glucose, regardless of the glucose you eliminate from the diet. Your metabolism is adapted to keep blood glucose as high as possible and by any means necessary. This will continue, until insulin expression/release is normalized. Diet might help it normalize with time, but that's never guaranteed. 

What I do know is that artificial sweeteners have nothing to do with this directly. The taste of sweet contributes to obesity, indirectly, through the disruption of the hypothalamic axis. This will contribute to your body fat. Body fat heavily contributes to further blood glucose abnormalities because body fat puts a high insulin demand on the body. 

6. Your arteries should be healthy if you have low to normal cholesterol.

Total cholesterol is not the culprit of heart disease. It's more complex than that. Remnant cholesterol and LDL function are better metrics when it comes to heart disease. If serum LDL is high, it can be an indicator that LDL is not functioning and/or clearing properly, but that's not always the case. LDL clearance and function is mostly determined by apolipoproteins and this is mostly genetic with some epigenetics thrown in for good measure. In other words, lipids are very complicated and are effected by many things. 

Your arteries can be damaged by other things that are not lipid related. High blood pressure and hyperinsulinemia are known to cause endothelial damage to the arteries. In other words, cholesterol can be perfectly normal and you can still acquire heart disease.

Six common beliefs addressed, Part 121

1. You do not need to count calories if you eat to satiety. 

If you have to eat beyond your macros in order to achieve satiety, then you are eating in excess and your satiety point is set too high. In this case, you either scrap eating to satiety and follow your macros diligently or you can also include calories, along with your macros, to make sure you are keeping to them. 

Calories are great for monitoring overall nutrient intake, which is useless for addressing obesity and body fat in particular, as different nutrients affect body composition in different ways. But calories can be included, to macronutrient tracking, if the person has absolutely no satiety signaling and/or certain 'disordered eating' habits, which cause them to veer off their macros. This can go both ways, by the way. They can be eating to excess, but they also may not be eating enough. Tracking calories would help you know if you are eating too little, which a lot of obese people tend to do. 

2. If you do One Meal A Day (OMAD) and can get about 1K calories, then you are okay if you have no symptoms of metabolic slowdown. 

We never advise OMAD, on this blog, especially if you are overweight/obese. It is very difficult to get enough food in one meal, particularly protein, and trying to do so will only cause you to overeat in one sitting, aggravating glucagon to insulin ratios. OMADs also push you into too long of a fast, increasing your time in hypoglycemia, which only reinforces the starvation adaptation.

 

You should be having two to three meals a day. The number of calories needed a day, varies by individual and metabolic state. OMADs might not have an immediate negative effect. In fact, they might have a temporary beneficial one, but treating obesity is not temporary. Temporary solutions do not reverse this condition. Obesity only responds to long term treatments and OMAD is not a proper, long term treatment. 

3. There is no way to tell if you are temporarily stalled or have just stopped losing weight.

If you are still overweight/obese and stopped losing weight, you are stalled. If you are of normal weight, then you simply stopped losing weight. Overweight/obese people have a very high weight set point, so they will lose up to that set point and then won't lose anymore. This is why, though they lose weight, they remain overweight/obese. This is all caused by leptin. I recommend you read my article on leptin.

4. "Keto" is the correct diet for children.

The advice we provide, on this blog, is solely for adults with obesity/metabolic syndrome/diabetes. We do not provide advice for children, pets, athletes, pregnant women or breastfeeding women. Our advice also is not for any other condition or disease that is not metabolic in nature. 

 

Talk to your healthcare provider or seek alternative, licensed dietitians/nutritionists for advice on low carb children’s diets. 

5. The only cannabidiol (CBD) available is in gummy form, but its still okay to take.  

I recommend you start smoking it or using it in oil form, as gummies are not recommended. It's best to take your CBD without the added sugar or sweetness. 

6. Your diet should be working, even if you use artificial sweeteners. 

Artificial sweeteners interfere with fat loss, by adversely affecting hypothalamic dopamine/leptin cross talk. 

 

Even though artificial sweeteners do not have calories, they cause for the body to store everything else that does. This is why calories are such an incomplete way of addressing obesity, as many other things influence the body's storage and burning of fuel besides its amount. The taste of sweet is one of those things. You have to stop tasting sweet things or your body will continue storing for winter.

Six common beliefs addressed, Part 120

1. Is Crystal Light okay to consume because it has 0 sugar?

Just like with last week's post about diet sodas and sugar free Jell-O, Crystal Light is not okay to consume just because it has 0 sugar. 0 sugar does not give things a pass for consumption. The battle is not against sugar, per say. It is against blood glucose dysregulation. There are many things besides dietary sugar that affect proper blood glucose regulation. For example, endogenously produced "sugar" also affects proper blood glucose regulation.

Negative effects to hypothalamic function, caused by sweet taste, is obesogenic because it causes a dysregulation of blood glucose homeostasis. Just drink water. 

2. Should you drink bullion cubes or bone broth?

Bullion cubes are usually consumed when you need sodium. Some people use bullion to up their electrolytes, but you should really track and supplement electrolytes in a more precise way than this. 

You can't make a meal out of bone broth, so that means you would be consuming it between meals and that's snacking. Snacking is not recommended on this blog. Bone broth can be used in recipes, etc. Other than that, you shouldn't be drinking your calories, in any way shape or form. That means that you shouldn't drink Pepsi, but you should also not drink olive oil or bone broth. 

 

Teeth are anti obesogenic. Use them. 

3. Will artificial sweeteners help you transition away from sugar?

No. The only thing that artificial sweeteners do is replace sugar. You don't want to replace sugar. You want to eliminate it. 

The only thing that helps you transition from sugar is stopping the taste of sweet, in all of its forms. Replacing sugar with artificial sweeteners is what the calories in/calories out (CICO) advocates believe in. After all, if the artificial sweetener has no calories, then it becomes benign. Well, we know that's not true because obesity is a metabolic adaptation, not a calories condition. The taste of sweet drives obesity, irrespective of caloric content. It does this through dopamine expression.

 

Metabolism is not fooled. It can't store the artificial sweetener, so it just waits for the calories to come in from elsewhere and stores those instead. You cannot out run, out fast or out smart obesity. You can only treat it effectively or not. 

4. You can "control" high morning blood glucose by eating breakfast later. 

You can control not seeing your high morning blood glucose by eating breakfast later. The high morning blood glucose is still there, whether you choose to see it or not. 

High morning blood glucose is indicative of metabolic syndrome and/or diabetes, depending on how high it actually gets. Metabolic syndrome is the first sign of impending diabetes. You probably are already aware of that and I am sure your doctor is too, as they use fasting blood glucose to determine a diabetes diagnosis. 

 

High morning blood glucose is referred to as Dawn Phenomenon (DP), which I have covered extensively in my past blog posts. It's basically an adverse response to dropping blood glucose during the overnight fast. When blood glucose begins to drop when fasting, in the presence of higher than normal insulin levels, the body overreacts and adrenal counter regulation kicks in to release blood glucose and prevent hypoglycemia. Cortisol is the hormone that is responsible for DP as this is the hormone that naturally wakes you from sleep.

This problem will persist, as long as you have metabolic problems. You can try things to manipulate this effect, but none of them will correct the problem. They will only "mask" it. For instance, you can exercise, the moment you wake up, and that might drop your blood glucose. For others, it actually rises it further. You can eat breakfast, as soon as you wake up, and it might drop your blood glucose, as the stress response lowers but again, for others it makes their blood glucose even worse. 

The reason there are so many variables between individuals and there are no remedies is because chasing symptoms like DP is not correcting the root problem. You can spend years on this roller coaster of ups and downs every morning, as diabetes keeps progressing right under your nose. 

 

The only solution to this problem is proper blood glucose regulation. Keeping blood glucose as steady as possible, through the proper and consistent implementation of a diet, fasting and exercise routine is the first step in combating this problem. Consistency in your protocol is what will lower this stress response over time. 

 

Don’t flip flop between diets. Don’t fast for three days straight and then binge for a week, to then fast again for another week. Don’t take a month off from your exercise routine. All that BS will only make DP worse. 

5. Exercise can have an adverse effect on blood pressure, so it must be avoided. 

This is caused by an exaggerated stress response. Just like above, the stress response is kicked on due to any effect that is deemed stressful for the body, like lowering blood glucose during the overnight fast and/or exercise. Exercise lowers blood glucose, just like fasting does. Well, metabolic syndrome/diabetes are conditions that prevent the lowering of blood glucose as it wants to be kept at a high set point. People with metabolic problems have a dysregulation of their catecholamines, which are also released by the adrenals just like cortisol is. 

When you exercise blood glucose lowers and since metabolic syndrome is a condition that tries to keep blood glucose high, your stress hormones respond by releasing more blood glucose and also raising your blood pressure and/or not allowing it to lower. I don’t know what type of exercise you may be doing, but I recommend that you downgrade it. Steady state exercises like walking are what’s recommended on this blog. Stay away from anything strenuous, until your body can take control of this response. 

6. You cannot "overeat" real food. 

I try to stay away from the term "overeating" on this blog, unless absolutely necessary. This is because it is very difficult to quantify what "overeating" is. Nutrient recommendations are very individualized and must be determined on an individual basis. This is why we like to use macros instead of any other metric. Remember, the target here is obtaining proper blood glucose regulation and macros are a more precise metric to affect blood glucose than calorie counting or special "small" plates. So when the term "overeating" is used, I usually think of disordered eating habits which usually do not manifest in the quantity or quality of food. 

 

For example, I could be eating salads for breakfast, lunch and dinner. That would be overeating salads and their calorie totals or quantity wouldn't much matter as I am not getting adequate protein or fat due to this disordered eating habit. Eating salads is basically starvation reinforcing blood glucose dysregulation. 

 

I could be drinking "keto" coffees for dinner, instead of a real meal, again affecting adequate protein intake and making me go over moderate fat intake. Once fat goes over 150 grams a day, it becomes much easier to store, particularly if I am leptin resistant.

 

I could be eating rib eyes, fried in butter, for dinner, going over the recommended moderate intake for fat, once again. 

 

Salads, "keto" coffee and rib eyes with butter are all real food but yet, my eating habits have made them all obesogenic. So in essence, I would be overeating them and affecting my blood glucose regulation, regardless of the calories consumed. 

For others, disordered eating habits do fall into quantity. For example, if I am able to eat a pound of burgers with a block of cheese and a jar of mayo, poured over them, plus a bucket of "keto" ice cream for dessert, I have a problem. I am disrupting my insulin/glucagon ratio just by the massive workload I am putting on my digestion. How long will it take me to digest all of that? How much insulin will I release in response to it? How much glucagon will follow? All of this disrupts blood glucose regulation, irrespective of calories. 

So, we have to be very precise when we speak of overeating. Overeating what and how? None of the information needed can be obtained through the calorie or quality metrics of the overeating.

Six common beliefs addressed, Part 87

1. Is there is a persistent stress response with low carb and/or fasting?

There are some people who cannot get over an exaggerated stress response, which interferes with their ability to follow low carb or adopt a fasting regimen. This is simply a problem of the central nervous system, which was affected by years of metabolic stress and it causes over expression of the adrenal stress hormones.

Metabolic stress is caused by erratic highs and lows in blood glucose, with large disparities between the two. This in turn stimulates chronically high insulin, which loses its pulsatile function. Chronically high insulin exacerbates this glucose roller coaster further, doubling down the counter regulation response, which then further effects insulin. As you can see, it's a vicious circle. A "death spiral", as each effect contributes to the other.

This spiral chronically stimulates the body's "flight or fight" response (stress hormones) in a pathological way. This abnormality in the body's stress response can persist, even after insulin levels have lowered. Insulin is a hormone that has persistent action on certain tissues of the body, long after it's cleared or is at lower levels

Normalizing stress hormones is particularly difficult, depending on the time length of metabolic dysfunction and other hormone status, such as sex hormone and thyroid. All of these are impaired in people with metabolic dysfunction and further exacerbate the problem. Metabolic dysfunction is a "disease" of the neuroendocrine system. Notice the word neuro in there. In other words, it's not just hormones, but it also includes the brain and the nervous system and how they interact and respond to endocrine signals.

Unfortunately, for some people, they cannot take control of their stress response, no matter what their diet looks like. This means they continue having Dawn Phenomenon and/or hyperglucagonemia. This is why these people are recommended a low to moderate carb diet, that eliminates all sugar and grains, but does not go so low in whole carbs that it induces long periods of ketosis. The person must consume adequate protein, track their electrolytes, keep their fasts short (no longer than 16 -18 hours), avoid OMAD (one meal a day protocols) and not over exercise. One of the greatest regulators of the stress response is exercise if it's steady state and not strenuous. All of these, combined, eliminate and/or help reduce the stress response for people who have persistent stress issues.

2. Is allulose sweetener "keto" friendly?

All artificial sweeteners are "keto" friendly because they usually do not affect blood glucose enough to kick you out of ketosis. But all artificial sweeteners are "obesity unfriendly" because they cause adverse long term effects to the hypothalamic-pituitary-adrenal axis (HPA). They do this through taste. The taste of sweet is detrimental to metabolism and the ability to lose body fat.

So, if you are on a ketogenic diet for the treatment of epilepsy, you can use any artificial sweetener you want. After all, you are under a doctor's care, who will monitor your weight, while on this protocol. But if you are ketogenic for the treatment of obesity and/or metabolic disorders, you should be having 0 artificial sweeteners.

3. You can get enough protein from a one meal a day (OMAD) protocol.

Extremely unlikely. I can't even imagine it, unless you are downing some serious protein shakes, which should not be your primary method of obtaining protein anyway. "Shakes" are not real food. You must eat real food first and then if you have to supplement protein, that's fine, but you shouldn't be using shakes just to eat an OMAD.

Eat two to three meals a day.

4. Not all nuts are "keto". 

Ketosis is a metabolic state where you primarily burn fat for fuel through the breakdown of fatty acids. This breakdown causes a byproduct called ketone bodies, which are primarily used by the brain. Some will say this occurs in the "absence of glucose", but there is never an "absence of glucose" because if there was, you would be dead. The body still makes its own glucose.

What do nuts have to do with this? Nothing. All nuts are "keto", if you are able to sustain the burning of fat for fuel, while eating them. All nuts are not "keto", if you are unable to sustain the burning of fat for fuel, while eating them.

5. Foods that "spike insulin" cause a plateau.

That is complete nonsense from people that are either truly ignorant of how obesity works or they just pretend to be, in order to dupe you. Plateaus are solely caused by leptin. I explain this mechanism in this article.

Insulin is not an obesity hormone. It’s a growth hormone and what it grows is at the discretion of your neuroendocrine system, which is influenced primarily by the macronutrient composition of your plate and secondarily by other lifestyle factors.

People who are pre- or full diabetic do not have sufficient "insulin spikes" to cause anything, except the inability to halt glucagon expression, thereby releasing enormous amounts of glucose postprandial. So, "spiking insulin" is the least of their worries and their main concern should be eating to properly regulate their metabolism, not "control insulin spikes".

6. Does "keto" causes preventricular contractions (PVCs)?

PVCs are quite common and can be triggered by all kinds of things, from exercise to emotional stress to hormones to gastroesophageal reflux disease (GERD). PVCs are tightly correlated to an over excited/stimulated autonomic nervous system. Some people have issues regulating their autonomic nervous system and can suffer for months from non-stop PVC attacks.

Always get checked out by a doctor, but if the PVCs are correlated to "keto" then one of three things can be going on - inadequate electrolytes or a heightened stress response or both. I suggest you follow this electrolyte recommendation.

You also may want to ditch "keto", if this is stress related, and follow a low carb diet instead, as the benefits are the same.

Six common beliefs addressed, Part 73

1. "Keto" diets are complicated.

They sure can be. There are many diets, which fall under the umbrella of "ketogenic". The ketogenic diet is not just one diet. There are many. The one you choose to follow will depend on what your goals are and what you’re trying to treat. I’m not talking about nonsense like “dirty keto” or "keto carnivore". There are no such things. I’m talking about true ketogenic diets. They differ in their ability to sustain ketosis, the types of fats used and what they are restricting. All low carbohydrate diets are ketogenic, because they all mobilize fatty acid metabolism.

You can achieve ketosis many different ways: fasting, exercise, calorie restriction, protein sparing and carbohydrate restriction. These all induce ketotic states, to varying degrees, but their long term effects are different.

To keep it simple and in the scope of metabolic treatments only, a ketogenic diet is completely determined by carbohydrate restriction. You must maintain a low carbohydrate intake to obtain ketosis, but just how low you need to go, is very individualized. This sounds pretty simple, but it can get very complicated depending on the person's current metabolic state, habits, preferences, adherence and side effects.

Badly formulated ketogenic diets can cause weight gain, new health problems and/or make current metabolic problems worse. For this reason, I only recommend the Virta ketogenic protocol on this blog. Their protocol can be found here.

2. Will fasting always result in lower insulin levels?

Not in the long term. To properly address metabolic dysfunction, all treatments must be implemented for the long term, since metabolism only responds to long term treatments. How far along you are in the disease, determines the effect treatments will have on insulin. Fasting will not accomplish this, in the long term, because insulin levels aren't affected solely by food intake. Therefore, fasting needs to be combined with other strategies.

People who have the wrong information about low carb assume that because nothing is coming in, through the mouth, then it's completely logical for blood glucose and insulin levels to lower in response. You are, after all, technically "starving" them into submission. This is complete stupidity. This comes from the false belief that diabetes and metabolic syndrome are completely and solely controlled by diet alone. That is false. These conditions may have started with the diet, 30 years ago, but it is now driven by an adapted metabolic state.

This means that you don't have to consume glucose anymore, to continue producing it at an exaggerated rate, driving insulin levels high and keeping them that way, furthering blood glucose abnormalies. Triggers that raise the body's compensatory stress response, like long fasts and chronic caloric deficits, only make this worse. The further along you are in your condition, the harder it will be for you to lower insulin levels through any one treatment alone. Insulin levels are strongly determined by body fat. The more body fat you have, the higher you will drive your insulin, as it is the "dam" keeping all that fat in storage. Body fat puts a high insulin demand on the body, regardless of diet.

For these reasons, in order to truly lower insulin levels you have to consume the right diet, mitigate the body's stress response and lower body fat. Fasting is nowhere in that equation.

3. Metabolic "disease" is a nightmare. I am now more scared than ever.

Metabolic syndrome is only a nightmare when it's not treated properly, as it's progressive. It won't go away on its own. It only gets worse with time.

The information I provide is so people are aware that treatment requires a lifestyle intervention with personalized tweaks, depending on how the condition is manifesting in them, as an individual. There are no one size fits all treatments and there are no magic pills. I stay away from presenting treatments based on fads, gimmicks and pseudoscience, which is what the low carb community seems to be very adept at doing. They have a simplistic, short term, "symptom chasing" protocol for the "treatment" of metabolic dysfunction, which is absolutely wrong, regardless of how much money it might be making them. That is why I debunk myths, inconsistencies and just plain nonsense on this blog. If you don't understand what's happening to you, you won't be able to treat it effectively. You might end up treating it incorrectly, causing other serious issues to replace it or not treating it enough and end up right back where you started, in a few years.

Unfortunately, the rates of remission for obesity/diabetes are dismal, because of the inconsistencies, inaccuracies and confusion that the current information is providing. I like being straightforward and truthful in what metabolic syndrome is, the challenges it creates and what it takes to achieve true remission. I don't paint feel good, easy peasy BS about it, because that won't help you. It might help you feel relieved, but it won't treat your condition. Relief based on lies is just future panic in hiding.

4. Can artificial sweeteners raise insulin levels?

It depends. Some artificial sweeteners, like certain sugar alcohols, are converted back to sugar in the body. But, that’s not the primary reason you shouldn’t have artificial sweeteners. You shouldn’t have them because of their effects on dopamine and other hypothalamic functions. The taste of sweet affects the brain and obesity is not just a disorder of the body, but of the body's communication with the brain. That's why it's a condition of the neuroendocrine system. Neuro pertains to the brain and endocrine are hormones.

5. Is the P:E diet a good diet to follow for metabolic health?

Yes. Dr. Ted Naiman's P:E Diet is highly recommended on this blog. It's a whole foods based, low carb, ancestral diet that is great for reducing body fat, so it's targeted for the obese and those with metabolic disease. The best thing about this diet is that there is no "dogma" associated with it, nor pseudo science. It is based exactly on how our metabolisms actually works.

Dr. Naiman's "protein to energy diet" is specifically designed to burn body fat, through the normalization of blood glucose regulation, with none to minimal loss of lean muscle mass and no metabolic slowdown, as the diet prioritizes protein and uses fat as a lever. In other words, the more fat on your body to lose, the less fat on your plate. The thinner you become, the more leeway you have for dietary fat intake. This prevents prolonged weight stalls or too much weight loss. You can sort of think of it as a protein sparing modified fast, but designed to be followed for the long term, as you individualize it for your particular goals.

6. Low carb groups and pages always give out the same useless advice that does not cause a single pound to be lost.

This is because low carbers usually use a magical low carb eight ball that only has three outcomes, when they shake it: “Eat more fat”, “Fast longer”, “Stay away from nuts and dairy”. That’s it. That’s there reply for everything and if they are challenged further, then they pull out their three useless talking points: “Lower your insulin”, “Increase autophagy” and “Vegans suck”. That pretty much sums up low carb advice, as it stands on the internet today. When the going gets tough, they will have zero answers for you. Zero. I personally guarantee it, because I saw it happen, with my own eyes, for years. They can answer simple, silly questions like "How should I eat my eggs?" But, they have zero answers for the real questions, like "Why can't I lose weight on 'keto'?" That one is never answered, because they simply have no answers. The answer doesn't fit what they are trying to sell, so the person is simply ignored or they go back to the magic eight ball.

The sad reality is that the vast majority of the low carb community, as it is today, has zero clue of what obesity is or what truly causes metabolic syndrome and no, it's not potatoes. Low carb has become a fad that will never be taken seriously, by anyone in the medical field, and that has been solely caused by its advocates. You can't present information, at a real science convention, using junk science. That's why they create their own "low carb" conventions, where they aren't challenge or harassed by pesky and annoying facts.

For those that can't lose a pound on low carb, I suggest you go back, way back, to Atkins and start all over again, because following the low carb dogma of today will only make you uber obese.

Six common beliefs addressed, Part 48

1. "Keto" is a wonderful, fulfilling diet that is not difficult at all. 

Ketogenic style diets are not wonderful, they are extremely difficult diets to follow if you are doing them correctly and that is why you see so many people unable to sustain them consistently. But, if you are just sitting there eating buckets of "keto" branded junk and making "keto" recipes, then you will have a great time doing "keto", because you are not following a ketogenic diet correctly and it's showing at the fat mass (ass).

For you to be able to drop your carbohydrate grams to very low levels, on a daily basis, you need to give up traditional foods that you grew up on and are used to. Some of these foods may be a cultural custom, part of a religious doctrine, a family tradition, etc. Changing these dietary habits takes monumental effort and dedication, because dietary habits are one of the most intractable habits that a human being has. People can change just about anything in their lives, long term, except for dietary habits.

2. Can carbohydrate restriction help with infertility?

Unlike other blogs out there, I don’t overreach into subject matter that I’m not read thoroughly on. This blog is exclusively for metabolic health. Maybe if others took this same approach, better advice and information would be available instead of quackery.

Fertility issues should be discussed with a fertility expert. Improving your metabolic health through proper nutrition and taking control of conditions like metabolic syndrome/diabetes/obesity, will increase your chances of successfully combating fertility issues, since many of these issues are the direct result of metabolic conditions. But no, low carb is not the cure for infertility. It is only meant to be a metabolic treatment.

3. I can have any item that is sweetened, as long as the sweetener is artificial.

Studies have produced conflicting results when it comes to the release of incretins via taste, though I tend to believe there is a connection. On this blog, we side with caution as sweeteners have been shown to promote obesity rather than curb it, even in people who are carbohydrate restricted. This means something is going on with sweeteners and it hasn't been positive. It is unclear as to what that "something" is. There can be multiple issues that can be at play:

• Sweeteners may stimulate appetite causing the person to eat more overall, disrupting blood glucose further.
• Sweeteners may trigger cravings for more sweetened foods, so the person eats more often, disrupting blood glucose further.
• Sweeteners may interfere with hypothalamic function, because of the chronic taste of sweet, disrupting blood glucose further.
• Sweeteners may interfere with dopamine regulation, because of the chronic taste of sweet. This particular one has been well studied in research of how sugar affects the brain. Dopamine disruption, disrupts blood glucose further.
• Sweeteners may cause the body to go into a heightened fat storage mode, because of the taste of sweet. More fat storage, disrupts blood glucose further. This would explain why sugar is particularly obesogenic and why it causes weight gain irrespective of caloric intake, while other carbohydrates do not.

It could be all of these, some of these or just one of these. We don't really know for sure. What we do know is that all of the above disrupts proper blood glucose regulation. We also know that obese people are in the habit of using sweeteners, in all kinds of things. So, the taste of sweet tracts very closely with obesity, much more so than any other factor.

As of right now, the only positive thing artificial sweeteners have achieved is that they might allow a diabetic to live for another five years instead of just two. For this reason, on this blog, we advise on no sweeteners. Stop sweetening foods.

4. Insulin resistance causes fat cells to be less responsive to storage, making you lean not obese.

That is a misunderstanding of what insulin resistance is. Insulin is the "hormone of leanness" to a healthy, athlete or bodybuilder, who is using it to build lean muscle mass, along with help from drugs, but not for the insulin resistant.

Insulin resistance is not an overall body condition. It occurs in stages and different tissues and organs succumb to this resistance at different levels and rates. Usually, insulin resistance manifests as a condition that occurs at the organ, tissue, musculoskeletal level, not the fat mass. The fat mass does not become insulin resistant. It becomes super insulin sensitive instead.

No one yet knows exactly how this occurs but if your metabolism is under a starvation adaption, it would make sense for the fat mass to develop super insulin sensitivity, since it's trying to grow. 

We know, that in general, fat mass does not become more resistant to insulin, as the person ages, like other tissues and organs do, but this super sensitivity is not a part of normal aging. Some believe that this expanding fat mass is trying to protect the body from storing fat, where it doesn’t belong. So, as your entire body becomes insulin resistant, at different rates, fat mass becomes more insulin sensitive as a "protective mechanism". This causes an overexpression of fat storage at the fat cell. I personally believe it is simply a metabolism that is trying to protect the person from starvation. A starvation that is obviously not occurring but the body believes it is due to chronic abnormalities in blood glucose. That is why this adaptation is pathological. It is useful when needed but deadly when not. 

This is why fat people only get fatter. Once this process kicks in, it becomes easier and easier to accumulate more fat. The obese are also extremely sensitive to any metabolic state that promotes fat storage, such as metabolic thrift.

When the fat mass does not expand in this way, the person with insulin resistance becomes thin on the outside/fat on the inside (TOFI) and displays the most aggressive form of insulin resistance. People who are TOFI suffer serious disease faster than people who aren’t.

5. Can bread be eaten "seasonally"? 

"Seasonal" foods do not include items like grains and sugar. Those items should be eliminated from the diet.

Seasonal foods only include whole food items that require restriction like fruit and starches. Starches are tubers, squashes and roots.

6. If I mix carbohydrates with other macronutrients, can it improve my blood glucose readings?

The only carbohydrate that betters blood glucose readings, is the carbohydrate that is absent. You cannot "hack" your way to better blood glucose regulation. You can manipulate, hide and influence single blood glucose readings but your blood glucose regulation will continue spiraling downwards over time until a consistently adhered to protocol is followed.