Six common beliefs addressed, Part 268

1. What evolutionary advantage is there to blood glucose shifts to cause the body to go into a starvation response? I much rather be the person who can maintain their blood glucose regulation intact while eating doughnuts and pizza.

I know that when I speak of "proper blood glucose regulation" it seems as though you have to constantly walk a tight rope because your body is against you but it actually is not. It is doing exactly what it is suppose to do. Shifts in blood glucose homeostasis help the body determine what the food environment is like. It helps the body know how much and what type of nutrient availability there is. It uses this information to determine if it needs to get fat for survival or not.

Of course there is an evolutionary advantage for the body to kick into starvation mode the moment it senses a disruption in blood glucose. This is why most people get fat and very few are able to sustain staying lean well into old age. The person whose metabolism is resistant to respond to blood glucose shifts might be blessed in an industrial modern setting but they would be toast in a hunter/gatherer setting. How would they survive a famine or even times of general food scarcity? They wouldn't fare very well at all. It's the one who can get fat that survives and that's why there are so many of us left since we were the ones who didn't die off. Evolution has made the decision that anti starvation mechanisms like the propensity for overweight/obesity, is a good thing in general.

So when I speak about "proper blood glucose regulation", you can think of it more as avoiding its disruption as much as possible.

2. I watch a YouTube doctor, who has millions of subscribers, but the advice he gives is really generic, simplistic and kind of vanilla. It's like a public relations team writes his content for him. He tried to do a "keto" diet one time and complained about how much fat he had to eat and how boring and inconvenient it was. Then he said he had to drop the diet because his "cholesterol went up". I doubt that was even true. I think it was a gimmick to make people not want to try the diet out through fear mongering.

YouTube doctors are like daytime TV, full of sh%t. They are there to gate keep the status quo, push a narrative/agenda and virtue signal to their audience. I actually believe that you might be right and this doctor did make up that his cholesterol went up following this diet because he knows that is a common problem people face. He wanted to make sure you stick with the standard dietary advice without question, and if you attempt to veer off, well then bad things will happen to you.

Look, we know who the target audience for these young, scrub wearing, obesity resistant, athletic, feminized, male doctors are - middle aged, overweight women who are bored with their lives and their "health" has now become their only hobby. They are ready to follow any fool who makes the claim they can "save" them from whatever is ailing them. It also doesn't hurt that these doctors are easy on the eyes and relatable while doing so. Sorry for whoever I triggered.

Stay away from this type of nonsense. It will not help you lose one pound. Why this doctor decided to eat that much fat on "keto" is beyond my understanding because as a doctor, he should know that you can go naturally into ketosis through carbohydrate reduction exclusively, but who knows. He might not even be a real doctor. These people will do anything for views except state facts.  

3. I love pudding and I saw a "keto pudding" online which I ordered, thinking it was truly "keto". When I looked at the ingredients though, it is 100% starch. It doesn't say what type of starch. Isn't regular pudding made of corn starch? So what's the difference between this keto pudding and the real thing? Is starch even "keto"?

Anything that does not disrupt ketosis is "keto". I have said before that "keto" is not a set of ingredients, it is simply a metabolic state where you primarily burn fat for fuel and produce ketones. The more efficient you become at burning fat, the less ketones you will produce. This has zero to do with metabolic health. If you are here because you want to treat your overweight/obesity/diabetes, then your main concern should not be ketones but your blood glucose regulation. So I will reply to this question as if you are dealing with overweight/obesity/diabetes since you did not specify why you are on a "keto" diet.

Do not get duped by these "keto" and "low carb" labels. Manufacturers are using these labels in order to sell their junk to a new wave of customers who are following these fad diets. The reason that this pudding was most likely labeled as "keto" is because it does not contain granulated sugar but some sort of artificial sweetener instead. They know their customers are dumb enough (with all due respect) to not even know that starch is simply a chain of glucose molecules bound together. Basically, glucose. Glucose disrupts blood glucose homeostasis. So it doesn't matter if this product is "keto", it is obesogenic.

They most likely didn't use corn starch in order to not alarm any potential customers as many of these "keto" followers are leery of corn and avoid any product that has corn in their ingredients. Corn sounds too much like high fructose corn syrup. This means the starch used is most likely cheap tapioca instead, which is believed to be lower in carbs, though no specific number exists or even a comparison to corn starch. I can almost guarantee tapioca is either higher in carbs than corn or about the same. In fact, I actually prefer the corn. You can become 700 lbs on tapioca or any other type of starch. Remember starch is just a fancy term for glucose as described above.

Real "keto" pudding is not only sugar free but starch free. This means you have to go online and find a starch free pudding recipe. You will need to actually buy other ingredients, to replace the starch, and do some cooking and it will not be "instant pudding". In other words, it will be a pain in the a$$ to make and the results are not guaranteed to be the consistency or texture you are accustomed to. I have become convinced that a lot of these substitutions simply do not hold up to the real thing. You can't reinvent the wheel. The wheel is perfect as is and it can't be made any better.

For this reason, I do not recommend any of this "find a substitution" practice. You need to become accustomed to your new diet and this is best done by accepting it as it is instead of trying to make it something that it's not. You will have to live with the fact that some of your favorite foods will just have to remain in the past so you can move forward. Find some other "keto" dessert that is not a mock recreation of the usual high carb fare.

4. I know someone who had bariatric surgery and it was successful. They changed their lifestyle and kept the weight off. It has been three years since their surgery and their weight is still off but they are having serious health issues which have not been easy to diagnose. This isn’t the first time I’ve heard of this. I have read multiple stories online of people who have lost their weight, kept it off, only to be plagued by multiple, mysterious health issues that have ruined their quality of life. What is going on?

I don't know and I doubt anyone else does. Health issues are individualized and we simply don't know what is going on with this person, who had bariatric surgery. If their doctors haven't been able to figure it out, I doubt we will. It could be the result of such an invasive surgery. It could be the complications that occur afterwards. It could be something totally unrelated that just so happened to occur after the surgery. We can only speculate at this point.

What I can tell you is that obesity has long term health consequences even after it is resolved. Body fat is the largest endocrine organ in the body, aside from the thyroid, by sheer surface area and distribution. Challenges to this body fat can pose potential long lasting, metabolic effects. Bariatric surgery does not just cause body fat loss, but mostly muscle mass and water loss. Loss of muscle mass is implicated in shorter lifespans and disease. This is not even considering the effects of abnormal insulin expression on tissues and organs. Insulin is what gets all nutrients, energy and electrolytes into cells. Insulin resistance basically starves various tissues and organs, to varying degrees, of these nutrients and the long term effects of starvation are pretty dire. Because bariatric surgery can induce weight loss without the need of insulin normalization, for the most part, the metabolic problems continue which often lead to weight regain and inability to regain muscle mass. These insulin abnormalities will continue inducing pathology over time.

As you can see, the cure for obesity is not weight loss. The condition and the metabolic abnormalities that result in it, persist regardless of weight loss.

5. I was controlling my blood glucose with a low carb diet but I moved to a more rural area and am now having allergies that I never had before. This has disrupted my blood glucose control. I don't understand how allergies can affect blood glucose and cause me to start gaining weight again. I thought that as long as my diet remained low carb, I wouldn't have these issues any longer.

This is the fallacy of the low carb community. They keep promoting this myopic idea that carbs are the only influence on blood glucose but they are wrong. Many things can negatively affect blood glucose control and if this negative affect continues for a prolonged period of time, insulin will start to abnormalize and metabolic conditions will ensue. They say you can't get fat from air but in your case, that is exactly what's happening.

There is a bidirectional relationship between histamine and blood sugar, with each influencing the other's levels and contributing to metabolic dysregulation.

• Histamine can stimulate the release of insulin, which can lead to hypoglycemia.
• Histamine can increase glucose uptake in muscles and adipose tissue, further contributing to hypoglycemia. In the case of the already overweight/obese, who have super insulin sensitivity of their fat mass, most of that glucose is going into their fat mass rather than their insulin resistant muscle.
• Histamine can suppress the release of glucagon which can also contribute to hypoglycemia.
• For individuals with certain chronic conditions, like mastocytosis, histamine can lead to hyperglycemia.
  

Anyway you put it and through whatever mechanism, histamine affects blood glucose and metabolic conditions require for blood glucose to not be disrupted in order to regain its proper regulation. For this reason, it is not surprising that your new found allergies are affecting you in this way. You need to work with your doctor in order to ensure you can take control of this situation before it gets worse.

6. Can dehydration cause blood glucose issues? Low carb groups always say to consume salt in order to increase sodium intake.

Salt and sodium are not the same things. 1 tsp salt is made up of 5 grams of salt and 2.3 grams of sodium. The rest is chloride.

Sodium in an essential mineral. It is found in your blood serum and the extra cellular fluid that surrounds all of your cells. Your kidneys and adrenal glands help keep sodium balanced in your body. When you consume too much salt, your kidneys simply excrete more of it. If you eat too little, then your adrenals cause your kidneys to conserve it through the action of aldosterone. This causes the side effect of potassium waste, which you don't want. When sodium is reduced the adrenals release cortisol and adrenaline which interferes in blood glucose.

So yes, dehydration can cause blood glucose abnormalities through stress hormone release. The proper way of addressing this is by making sure you are intaking suffice electrolytes. It is not resolved through drinking more water or consuming more salt. Either one of these, can cause more dehydration.

Six common beliefs addressed, Part 167

1. No one had an issue when I was eating cookies and cereals but they have an issue now that I eat "real food".

Oh, they would have had an issue with your cookies and cereal if they saw how you really ate them. Guaranteed. Obese people like to hide things so that they appear normal to others. If these same people that are having this issue with you eating real food, saw you eat an entire package of cookies and a whole box of cereal, they would have had an issue with that as well.

The reason medical professionals didn't have an issue with you eating cookies and cereals is because they didn't see you eating that entire box either. They thought you were following a calorically restricted diet. Like I have said before, caloric restriction is the antidote to a high carb diet.

People conveniently misunderstand things, just like they misunderstand the Dietary Guidelines and American Diabetes Association's (ADA) advice. No one has an issue when a person eats real food. It's not the real food that's in contention. It's the stick of butter over the rib eye. It's the unnecessary block of cream cheese over the dozen eggs. Or what about that carton of heavy cream that's downed, on its own? My personal favorite is the bottle of ghee, that sits on the kitchen table so the person can eat a spoonful, just because. That's the issue. Butter, steak, eggs, ghee and even cream cheese are all real food, but the person who's eating them that way is a freak and people recognize absurdity when they see it.

If "keto" people would sit down to eat, like normal human beings, there would no issue whatsoever. No one would have an issue if someone sat down with a plate of steak and broccoli with a pat of butter over it and an after dinner coffee with some heavy cream in it. No one. They wouldn't even notice. I have sat in front of many people, who follow the Standard American Diet (SAD), and ate my meal with no issue whatsoever. None. In fact, they all have commented on how healthy it looks. But if I sit down with a cup of coconut oil and a whole ham, then they might make a comment. People speak on things that are bizarre. I know I would. I would at least tell them to give me a call after they poop tomorrow.

2. Some people can up their fat intake and still lose weight.

One of the benefits of having super leptin sensitivity is that when you increase energy nutrients, like fat or carbs, body fat is lost. Leptin simply senses enough nutrients coming in and signals to the brain to begin burning fat as it's not necessary to keep so much of it in storage since there is no starvation.

The body complies with leptin's demands by increasing basal metabolic rate for work, not storage, but work. I make that distinction because people who are actively storing fat can also display a high basal metabolic rate as it takes energy to store energy. When leptin is working properly, the person will feel more energy to be more active. Basically the body is now honed to expend energy rather than spare it.

Obese people do not experience this. They can eat large amounts of fat or carbs and receive no benefits from leptin whatsoever because they do not have proper leptin expression. The only time that obese people lose weight when eating large amounts of fat, is when they drop their carbs to very low levels and they momentarily experience some weight loss as their insulin lowers and their metabolism is no longer competing with glucose. It now only has one fuel to use - fat. But the effects are short lived and soon their weight stalls, while still overweight/obese, and the benefits come to a halt. In many cases, they begin gaining weight as now their previous fat consumption is too high for their new lower weight. This is why we often see that the obese who benefit momentarily from this excess fat consumption are the morbidly obese.

3. If you had lap band surgery, and cannot eat much, you will not be able to consume enough protein. 

You will have to supplement with a good quality whey protein shake in the meantime. I am sure your doctor discussed this with you and might have even prescribed special meal replacement products for you to use.

4. You do not have to worry about an LDL of 152 if your HDL is 71.

You can't use blunt tools to perform precise work. Your LDL of 152 tells me nothing about your LDL function. Your HDL of 71 tells me nothing about your HDL function. Total lipid numbers say nothing about lipid health. If you have heart disease in your family, that might give you a clearer picture of your risk.

You can obtain more information with an advanced lipid panel, omega 3 to omega 6 ratio and oxidized LDL number, but again, none of these tests can predict cardiovascular disease. You would have to see a lipidologist and have advanced genetic testing done for specific lipid related cardiovascular risks.

5. Gastroparesis occurs from eating eggs.

No. Indigestion might occur from eating anything that doesn't sit well with you but gastroparesis is a condition that is usually the result of vagal nerves disruption. This is common in people who have metabolic problems, particularly Type I diabetics.

6. I lost weight very quickly. I am down to 120 lbs. I need to now eat more fat in order to gain muscle.

When the body is able to lose body fat, it might lose a lot of it quickly. Usually, you will eventually begin to gain weight back though and it will be mostly muscle, but the body also likes to put on some fat. You gain the muscle by eating adequate protein and exercising. Not by eating fat. The body will gain fat on its own by suppressing leptin. Every time you lose body fat, the body will put a halt to it through the down regulation of leptin expression. You do not need to consume fat to do this. Your body will do it on its own so do not expect to stay at 120 lbs.

Now all you have to do is recalculate your macros for your new lower body fat percentage. The lower your body fat percentage, the more leeway you have for dietary fat intake but remember, that is just a rule of thumb not necessarily a rule for you. It all depends on your leptin sensitivity.