Six common beliefs addressed, Part 57

1. Incretin hormones play no part in metabolic disease. Only insulin matters. 

Incretins are metabolic hormones secreted when you eat. These hormones augment the release of insulin and glucagon, from the pancreas, to regulate your blood glucose levels, after a meal. They are also involved in gastric emptying and appetite control. Studies have shown that incretin hormones are impaired in Type II diabetes.

There has been conflicting research findings on whether incretins are also stimulated by the smell and/or taste of food. Some studies have shown a correlation, but others have not. 

This is why we always emphasize how metabolic abnormalities, affect a wide range of hormonal systems, which are difficult to normalize afterwards, as they all depend on each other through complex feedback loops. This means that many hormones are affected downstream from insulin. 

2. Are coffee and bone broth good "fasting aids"?

A healthy metabolism is the only fasting aid.

When metabolism is healthy, the person can fast for appropriate periods of time, because they can properly mobilize fatty acids, to use for fuel, and make their own blood glucose as needed. You achieve this healthy metabolism through a proper diet and exercise protocol that helps normalize blood glucose control. There is no other “fasting aid”. Any other "aid", while fasting, is called eating and therefore is no longer fasting.

Because you should require no aid, during a fast, it is very important that you start with short fasts and then slowly prolong them in increments, as your metabolism becomes healthier, until you can easily do a daily 16 - 18 hour, water only fast.

3. Carbohydrates are only bad when they are overeaten and they are easy to overeat. 

Whether the interference in weight management is caused by carbohydrates being "easy to overeat" or not, is irrelevant to the end result, which is obesity. It also does not take away the negative impact that carbohydrates have on blood glucose, even when they aren't overeaten. So, regardless of the exact cause of carbohydrates being a problem, the solution is always elimination.

4. If a diabetic eliminates ice cream, from their diet, can they keep the whole wheat bread?

Both ice cream and bread have negative effects on blood glucose homeostasis, so a diabetic who is still eating bread, might as well add in the ice cream as well, since the difference in lifespan between eating ice cream and not is null, as long as bread remains on the menu.

5. I had a coronary artery calcium (CAC) score of 0. This means I have no cardiovascular disease (CVD).

I have mentioned this before, but many people still bring it up. The consensus amongst cardiologists/lipidologists is as follows.

CAC scores of 0 are pretty much the norm, because you have to have pretty advanced atherosclerosis for plaque to be measurable on this test. Atherosclerosis develops decades before there is visible plaque, through changes in the arterial wall, which this type of scan will not detect. So, basically, a CAC score of 0 means nothing, as it’s not telling you anything that you don’t already know - you don’t have advanced CVD, at the moment. Maybe you are still too young to have developed significant plaque that can be measurable on a CAC test. That doesn't mean there isn't arterial thickening present and other abnormalities of the endothelium that will eventually lead to plaque formation.

Don't become complacent because of a 0 CAC score. Nearly everyone receives a 0 CAC score. Include an ultrasound of your arteries and other, more important, CVD screenings if you truly want to know about your heart health.

6. Can going carnivore "cure" all of my health ailments?

Some people have turned to an all meat diet and experience a reversal of certain health conditions. There can be many reasons for this. A main one is that eliminating plant foods can be extremely beneficial for people who have autoimmune, allergic conditions and/or digestive issues. Plants have been known to exacerbate these ailments and so their total elimination will obviously be very helpful.

 

Another one is that eating only meat keeps meals very predictable and consistent, which can lead to better blood glucose control. Protein induces satiety so keeping to meal times also becomes more manageable and this in turn further regulates blood glucose better. 

But none of this is indicative that an all meat diet is best and everyone should follow it as these benefits vary by individuals. It’s just one diet, amongst many other appropriate ancestral diets, that you can try to see if it helps you.

Six common beliefs addressed, Part 28

1. Hyperglycemia is the only blood glucose abnormality in metabolic syndrome/diabetes.

Blood glucose dysregulation is the most common and obvious symptom of metabolic syndrome/diabetes, but not solely because of hyperglycemia. It's the roller coaster ups and down of blood glucose that ultimately sink the ship. Large disparities in blood glucose, at any given time of the day, begin to dysregulate insulin, which in turn dysregulates the counter regulatory response, which in turn dysregulates the fat mass. Fixing one thing, does not mean a fix for everything, as all of these things malfunction at different rates and stages.

2. Metabolic syndrome/diabetes is easily "cured" with diet alone, if the diet is adhered to.

It is very easy to lie and manipulate the vulnerable and the desperate with outlandish claims. Unfortunately, people with serious diseases, like diabetes, fall into the category of being easily taken advantage of. You have been lied to by the diabetes guidelines, but you have also been lied to by the quacks online. In fact, anyone that makes the following claims is basically a liar:

• Metabolic syndrome/diabetes is easily "cured" through carbohydrate restriction alone.
• If your blood glucose lowers, you are now "cured" of metabolic syndrome/diabetes.
• Once your insulin, "the fat storing hormone", is low, you will no longer gain weight and your blood glucose will be normal.

All of this is hogwash. We know that none of the above statements are true, because we know what happens in practice.

• There are many people who follow a carbohydrate restricted diet and have had no improvement of their metabolic syndrome. For many, after the one year mark, no significant difference has been seen in blood glucose regulation. This is most likely due to other factors affecting blood glucose aside from diet. 
• There are people who suffer from rare genetic disorders like inactivating glucokinase mutations, which keeps their HbA1C's in the prediabetic/diabetic level. These people are in a chronic state of hyperglycemia, but have none of the complications that diabetics have. So, high blood glucose in isolation, does not a diabetic make.
• There are people who have naturally high insulin levels with absolutely no evidence of insulin resistance, insulin toxicity or the development of diabetes. So, high insulin levels, in isolation, does not a diabetic make.

This all means that metabolic syndrome/diabetes is not a one cause problem. Metabolic syndrome is a disease of the fat mass, leptin, adiponectin, glucagon, adrenal counter regulation, ceramide flux, mitochondria, etc. It effects the anabolic and catabolic processes of the body. It is not just a disease of high blood glucose, high insulin or obesity. It's all of that and then some.

Controlling diet, blood glucose and insulin is just the tip of the iceberg. It's not a magic pill or the answer and certainly not a guarantee of outcome.

3. If your calcium score is 0, then you are free and clear of heart disease and it means your LDL cholesterol levels are benign.

Atherosclerosis progresses very slowly and can take decades to appear. High LDL will not produce any short term cardiovascular changes, so unless calcium scores were already high to begin with, there should be no difference. This is not proof that LDL is benign, this is just proof of no current disease state. It says nothing of the future. Calcium is end stage cardiovascular disease. It means that you have had the disease for a very long time. Changes in the epithelium of the arteries, which is the beginning stage of the disease, will not show up in a calcium scan.

This doesn't mean that calcium scans are useless. They can certainly be part of your tool box of diagnostic tests. It just means that they are not 100% reliable nor indicative of 0 heart disease.

4. Calories always affect weight gain or loss, so they are the only thing that matters.

Weight and fat are two different things when it comes to body composition. Calories always affect weight, but fat is all that matters, since fat is part of the pathology, not weight. Since calories always target total weight and not specifically fat, they are an irrelevant measurement that should only be used under certain circumstances, but never as the primary or sole intervention for obesity.

It is much better to target macronutrient composition, so you can target body composition, which is all that truly matters. You want to starve the fat mass, not yourself. Using calories is like nonspecific chemotherapy, but using macronutrient composition is like targeted immunotherapy.

5. If I lost weight, am I free and clear of obesity?

You want long term sustained weight management. Weight loss is not indicative of proper weight management. Weight management is very difficult.

People selling you diets and programs promise you the easy part of lowering blood glucose and losing weight, but dump you at the hard part of proper blood glucose regulation and weight management. Just like any fool can lower blood glucose, any fool can lose weight. This is why you have to be leery of "success stories". Yes, there are many legitimate ones, but they mostly aren't, as “success” wanes after the first year of weight loss. This is why most published studies, showing success, stop at the first year mark and mums the word on anything after.

Weight loss protocols that do not produce long term weight management, are useless, regardless of their initial effectiveness.

6. Metabolic syndrome/diabetes can be "cured" with exogenous insulin or if insulin levels are lowered.

Type I diabetes (child onset) is a terrible disease, but they actually have it easier than a Type II. This is because with Type I diabetes you can successfully obtain and maintain normal blood glucose regulation by implementing two simple treatments - proper insulin dosing and a low carbohydrate diet. Unfortunately, these interventions are usually not enough for Type II diabetics.

How do we know this? Because exogenous insulin is commonly prescribed to Type II diabetics, as part of the 'Standard Of Care', and it has been an utter and dismal failure, as it makes their condition worse over time, not better. For Type I diabetics, the appropriate administration of insulin does not make their disease worse, it corrects it.

Because Type I diabetics had no insulin, to begin with, all of their metabolic systems, which depend on insulin, are not resistant to it from decades of chronic insulin dysfunction. A Type I diabetic's metabolism works great, once the proper administration of insulin is given.

A Type II diabetic cannot claim the same success, as administered insulin does nothing to treat their disease. Even the lowering of their insulin levels does not necessarily produce results either, since lower insulin is not indicative of restored insulin sensitivity. Even at lower insulin levels, it still takes time for insulin resistance to correct. Insulin sensitivity is also not acquired, equally throughout the body, because different tissues have different levels of resistance. All of the other metabolic hormones, also do not respond immediately to lower insulin levels. Hormones, like leptin, take a long time to sync with new lower insulin levels. This means that lowering insulin levels is just the beginning of a very long journey for the Type II diabetic.

Many dietary protocols have been used for Type II diabetics and they have also been, pretty much, a hit or miss, as far as long term efficacy is concerned. This is why the American Diabetes Association (ADA) refuses to stand behind any particular dietary protocol, especially after the first year. This is most likely due to the fact that even though insulin responds pretty quickly to dietary interventions, other hormones, like leptin, do not.

As you can see, Type II diabetes is not such a straightforward disease as Type I, though they share many similarities. Type II is more of a syndrome than a disease. Syndromes are very complex, as they can have multiple causes and progress in multiple different ways, depending on individual biodiversity. Modern medicine has been able to find cures for many diseases, but has yet to cure one syndrome. Metabolic syndrome/diabetes is a neuroendocrine/mitochondrial disorder that is multifactorial and affects multiple systems.

This is why the treatment of metabolic syndrome/diabetes requires a lifestyle intervention that addresses multiple factors, not just one.