Six common beliefs addressed, Part 180

1. I am 110 lbs. at 5'4 and still considered overweight according to "waist measurements and ratios".

Body mass index (BMI) is a measurement of relative body weight, not body composition. Because lean mass weighs far more than fat some people are incorrectly classified as obese based on BMI. This is particularly true for athletes and body builders. Skin fold testing provides a more accurate body fat assessment than BMI for those individuals.

Since it is not specified how you are determining your "waist measurements and ratios" I can only guess why you are being classified as obese. It can be because you have an oddly shaped body or maybe your 110 lbs. is all fat around your middle, which is not good. 

This is why there is no one marker to determine if your metabolic health is at risk. You need to know multiple markers, taken in the context of what your current issues are, including how fat is distributed on your body.

2. If sugar is truly "addictive", then why weren't people "addicted" to it 500 years ago?

Precisely! Sugar has been around for a very long time and though it does create changes in the balance between catecholamines and hypothalamic function, it is not considered a truly addictive substance. For this reason, we do not describe sugar as "addictive" on this blog.

Instead, we recommend anti obesogenic approaches in lifestyle in order to combat overweight/obesity. Considering yourself a victim of "addictive sugar" is a very pro obesogenic stance to have. After all, if sugar is addictive, and food companies put it everywhere, then you aren't to blame for your predicament. If you aren't to blame, then you can't do a thing about it. This will only keep you obese.

We not only tackle diet and exercise, but we also challenge the beliefs and behaviors that perpetuate overweight/obesity.

3. Many people, who have been successful on their new way of eating, still end up with gastrointestinal issues.

Aside from diet changes, which are the main cause for gastrointestinal issues, there are also other culprits. One of them is lower insulin levels. Low insulin levels usually cause gastroparesis.

4. You wrote before, in one of your posts, that: "If you are not losing weight or are gaining instead, then the body is in active obesity mode and the reduction of appetite is coming from a thrifty metabolism that is not burning any fuel and so does not require any more of it." So tell me again why I need to not fast longer?

Because fasting, short or long, does not address a thrifty metabolism, which is the operative word in my post. Just because the body does not require more fuel, does not mean that it will respond positively if you don't give it any.

What you need to address instead is its fuel management so it burns what it has. That is caused by improving leptin expression which is not done through fasting but through normalizing blood glucose control in order to improve insulin sensitivity. That cannot be done through fasting, as fasting disrupts blood glucose homeostasis.

5. All diets should include "carb cycling".

"Carb cycling", sometimes also referred to as "carb loading", involves going back and forth between high carb days and low carb days. You would usually have a high carb day when you plan on doing intense exercise. Supposedly, on those days, your body would require more fuel so you would need more carbs. No one who is treating their metabolic dysfunction, should be doing any exercise that would require primarily carbs for fuel as that would exacerbate their condition. So intense exercise should go out the door.

Aside from that, carb cycling is a topic that should never be under discussion when it comes to overweight/obesity and or metabolic health since it does not pertain to either. Carb cycling is a topic that belongs in athletic forums. This is not an athletic forum.

6. Nothing proves that "keto" would be better than a "clean vegan" diet.

Trying to "prove" anything of this sort is above my pay grade and a waste of time since people are usually not motivated by "what’s better for them" but by what they want to do instead. I recently wrote a post explaining what the issues are with vegan/vegetarian diets. You can read it here.

You would have to do your own research and try both diets to see which one is actually better for you, depending on the goals you have for your own health. You have to do the work. I'm not a salesperson so I don’t try to sell anyone anything.

Six common beliefs addressed, Part 132

1. Can lowering LDL cause health problems?

That is still being researched and there are no clear answers as of yet. We know that people who have certain genetic conditions, which cause low to almost zero detectable LDL, have no health problems whatsoever. They also have no heart disease. So far, when they have lowered LDL in people, without this genetic anomaly, to nearly undetectable levels, they have also had no adverse health effects. So far. But no one knows what occurs long term or if this would be the case for absolutely everyone as PCSK9 inhibitors are a fairly new introduction to Big Pharma. 

What we do know is that LDL is implicated in neuro function, as it does cross the blood brain barrier, and it also has some immune system function, so I personally, wouldn't radically lower it unless there is a specific reason to. Discuss with your doctor the pros and cons of any prescribed medication, especially one that will be administered for the long term. 

2. They continue insisting on limiting saturated fat intake for no reason. 

The main reason is because saturated fat raises total cholesterol, in individuals whose cholesterol is sensitive to diet. Total cholesterol is still seen as a risk factor for heart disease. 

Another reason is because of caloric restriction. The standard dietary advice is based on a calorie centered protocol, that restricts the calories of all macronutrients, but particularly tends to mostly effect protein and fat calories, since the diet's goal is to be carb centric. So, you are left with a diet that is predominantly carbohydrate, while still being calorically restricted. 

In other words, the dietary guidelines do not recommend "high carb" as in "eat all the donuts you want". They recommend for your diet to be calorically restricted and composed of mainly "complex" carbs. Of course "complex" for them includes grains, not just tubers or roots. Saturated fat simply has no role to play in this type of diet. 

3. Do people gain weight on "keto" because their carbs remain too high and they eat too often?

No. People gain weight on "keto" because their fat intake is too high and they eat too little. 

4. Vegetables cannot cause stomach problems. 

Diet changes can result in stomach upset. Changes in gut flora and enzyme activity can cause this. If vegetables are not sitting well with you, don't eat them or cook them thoroughly. 

5. Can drinking ice cold water help you burn more calories?

No. It helps you have stomach issues though. You would be surprised how many people with chronic acid reflux have not figured out yet that the culprit is their iced drink, rather than their burrito. 

Drink normal temperature water. You can never burn enough calories to trick the body into doing anything, except burn less calories over time. 

6. Should you include "carb days" into your regimen?

People are full of ridiculous ideas and unlimited BS. There are many reasons why people would do this and the excuses run the gamut of the idiocrasy. The real reason though, which is the one excuse that is never given, is that they simply want to eat bread or whatever other form they like their carb to come as. But instead of saying the truth they make up stuff like:

• Carb days help replenish glycogen - This is mainly used by athletes who seem to always have their two cents in the slot of obesity discussions as if they had a seat at the table. They don't. Athletes don't have anything to contribute to the treatment of obesity. Not a single thing. In fact, the only thing that athletes have contributed, so far, is the importance of building lean muscle mass which is very difficult for the obese to do, leaving them at square one. 
• Carb days help your thyroid and reduce the stress response - The presence of ketones can exacerbate the stress response and interfere with thyroid function because the body believes it is starving. This kicks in counter regulatory responses which can cause annoying symptoms. This is not resolved with "carb days". This is resolved with an overall low to moderate carb diet that does not sustain long periods of ketosis. Having carb days actually makes this situation worse as the blood glucose fluctuations from eating high carb only causes a doubling down of the stress response over time. 
• Carb days help you lose weight - This one is true! This is the only one on here that is true. Unfortunately it's only temporary. When the body has been in starvation mode for a while, as is the case with caloric restriction, badly formulated "keto" diets or inappropriate fasting protocols, adding carbs into the diet can cause temporary weight loss. This is because leptin expression increases when the body detects a surplus in nutrient availability. Carbs trick the body into thinking there is plenty of nutrients available because of how they effect blood glucose and insulin. Of course, leptin is a slave to insulin and once insulin demand becomes abnormal, leptin once again under expresses and you stall or start gaining weight. 

So, "carb days" are nothing but crock. They are only a way of having your cake and eating too, but with cake comes diabetes.

Six common beliefs addressed, Part 10

1. Some people are lucky, because they can eat sweets without consequences.

This is because these people are able to maintain proper blood glucose regulation for a longer period of time. This is most common in the young and there are many complicated factors for why this is the case. 

Some of it all has to do with insulin and its function over time. The older you become, you naturally become more resistant to insulin, affecting your ability to maintain proper blood glucose homeostasis. 

Some of it has to do with the fat cells themselves and their response to blood glucose abnormalities. There are a myriad of lifestyle and genetic factors that contribute to who maintains their blood glucose regulation and who does not. 

2. Is worrying about what you eat worse than eating badly?

Approach anyone trying to sell you a diet and you might hear this load of crock.

Worrying about what you eat is a great thing and doesn’t cause diabetes. Not worrying and eating whatever and whenever you want, is what causes diabetes. You're always better off worrying about what you eat than eating badly. Those that worry about what they eat have better health outcomes.

Of course you don't want to worry in vain. When you worry about what you eat, you should be worried in the context of your blood glucose regulation. Which foods will affect it and which ones won't. 

3. I’m an adult, so I can eat whatever I want.

Adults make decisions based on what they need. Children make decisions based on what they want. So, the adult decision is to not eat whatever you want, but to eat what you need. Just because you can, doesn't mean you should.

4. Do I need a "carb load" or refeed after or before working out?

This is completely dependent on your goals and reasons for carbohydrate restriction.

If you are playing a competitive sport and want to ensure that you do not crash out on the field, then carbohydrates might be the only way to go. An athlete that must compete and push their body to abnormal levels, either for payment or glory, must follow whatever athletic protocol is recommended for them.

If you are obese, have metabolic dysfunction or are diabetic, the benefits of working out are to be able to burn your own endogenous glucose and fat, turn over your own proteins and improve leptin/adiponectin ratios. You do not need any "carb loading" to accomplish this. 

5. I have high ketones, does this means I have low insulin levels?

Low insulin levels are not a requirement for ketone production. Ketones are not indicative of low insulin levels at all, in the context of metabolic syndrome, as poor insulin function also creates ketones.

The most common cause of ketones in Type I diabetes is insulin deficiency. Without insulin, glucose builds up in the bloodstream, as insulin facilitates glucose entry into cells and halts glucose production through the suppression of catabolic hormones like glucagon. If you have no insulin, neither process is occurring. This unregulated catabolic state doesn't just break down proteins, it also breaks down fat. The break down of fatty acids results in the release of ketones, which enter the bloodstream and eventually spill into the urine. For Type I diabetics this can result in ketoacidosis, since there is no insulin to mitigate either glucose or ketones and they both reach very high levels, disrupting the bodies PH and resulting in death.

This extreme condition of having no insulin, gives us a glimpse as to what may be happening in Type II diabetes, as the end result of uncontrolled catabolism, in the body, is the SAME for both forms of diabetes.

The most common cause of ketone production in Type II diabetes is insulin inefficiency, which causes similar symptoms as deficiency. Inefficient insulin causes for the same two processes, of glucose clearance and catabolic suppression, to be impaired. This means an elevation of glucose production from hyperglucagonemia and unregulated fatty acid break down. Insulin inefficiency causes the liver to be primed for ketogenesis, as it activates the appropriate enzymes for this process. This accelerated fat breakdown results in the liver pouring out ketones in the same way it's pouring out glucose. So, insulin inefficiency causes glucose and ketone over-production.

For this reason, Type II diabetics can absolutely make ketones, and very easily in fact, no matter how high their insulin levels are, as their insulin cannot regulate their rate of catabolism. The only difference is that for Type II diabetics, this catabolic state rarely results in ketoacidosis, except in cases of severe infection or illness, as they still have some insulin mitigation left for both glucose and ketones.

This is why chasing ketones is a fool's errand. They are meaningless in the context of metabolic health. Ketones simply mean you are burning fatty acids. You can burn fatty acids in an advanced diseased state. Anyone can burn fatty acids. The body burns fatty acids daily, whether you are 100 lbs. or 1000 lbs. Ketones should never be your sole reference point for monitoring metabolic health. Lower fasting insulin levels and loss of body fat are the only markers that indicate you are headed in the right direction.

6. Is obesity a disease?

Though obesity has many pathologies and it absolutely is not normal weight gain, I am still on the fence about calling it a "disease". After all, metabolism is doing exactly what its supposed to do under the conditions it's been put in.