Six common beliefs addressed, Part 211

1. My coach told me that I don't have to be fearful of "good carbs" as long as I follow their diet. "Good carbs" for them are "complex carbs" which include "whole grains". I am still hesitant to include grains in my meals. 

LOL I apologize for laughing but I just get so many questions with all kinds of crazy stuff in them. Some of the most asinine stuff I receive are advice from coaches and trainers.

You really don't have to be scared of any carb when you're following a starvation protocol, so I have no clue why these coaches have gotten into the habit of labeling carbs "good" or "bad". It goes against the premise of their protocols. Let me give you the reality. There is no such thing as a "good carb". In fact, there is no such thing as a good anything. The "goodness" in anything you eat stops at whether it disrupts your blood glucose homeostasis or not. 

Let me clarify what glucose homeostasis is. It's not when your blood glucose goes up after eating. It's when it goes up so high that insulin remains in the serum and expressed in tissues for a prolonged period of time, disrupting fasting blood glucose levels. This disruption breaks the tight regulation (homeostasis) the body has with its glucose. This isn't a one day event. This happens chronically unbeknownst to the person it's happening to.

The "carbs" that coaches are defining as "good" are carbs that contain a much higher glucose content (starch), than above ground vegetables. Things such as roots, tubers and squashes, which are perfectly fine occasionally, can remain within your macros and you will continue seeing results, if you can tolerate them well. Your coach has also lumped in grains along with these. Basically "good carbs", to a coach, is any carb that isn't a Snickers bar or Wonder Bread. Snickers bar and Wonder Bread = bad carbs to them.

Again, there is no purpose in differentiating between "good" or "bad" carbs, when a protocol is completely calorically based. If a Snickers bar and a slice of Wonder Bread fits your calories, then I don't see what the problem is, unless they are admitting that all calories are not the same, but still insist on holding onto their calorie theory none the less.... hmm. In other words, lots of double talk and not a pound lost.

My recommendation to you is that if you want to lose a few pounds, be unable to continue on the protocol and go right back to finding some other "treatment", then follow what your coach says and incorporate some "good carbs" into your diet. But if you are serious about losing weight and keeping it off, following a protocol that you can continue on for life and achieve long term weight management, then stay away from your coach's list of "good carbs". "Good carbs" interfere with blood glucose homeostasis, the same as "bad carbs".

2. You can’t get fat off what you "don’t eat".

Negative. There is no such thing as "not eating". For instance, you can get fat off your own muscle mass. All your body has to do is break it down into glucose and then store that glucose as fat. So technically you're eating. You're eating yourself. Worse, you're getting fatter doing so. This is why all obesity is sarcopenic because that's exactly what the obese metabolism is doing. It eats muscle and builds fat with it.

Now if we are talking about eating with your mouth, then you can only get fat off some of what you eat, most of what you eat or all of what you eat. That is not determined by how much you eat but by what you eat and how your metabolic state is allocating its calories. In other words, your neuroendocrine state determines how fat you become because it decides how much of what you eat is burned or stored.

3. If fat people make so much glucose, why can’t they run marathons constantly? They are technically full of energy.

Obese people are "full of energy" but it is only being used to build more body fat. All of the sugar circulating in an obese person's blood is being converted to fat and not used for working energy. Not only are there not enough marathons they can run to reverse this, but they simply have no usable energy to do so. This is why energy is subjective. For instance, it takes a lot of energy to get and remain fat. This is why a lot of fat people have high metabolic rates and pseudo hyperthyroidism. 

Surprisingly, most of the energy that a person uses is not while running marathons but while doing nothing at all. That is when the most fat is burned. Unfortunately, the obese also do not use energy while doing nothing at all. They are in a metabolic state that spares energy instead, whether they are active or inactive. In other words - starvation. Their metabolism is doing the exact same thing that a starving person's metabolism would do - conserve energy to become fatter. This is why obesity is an adaptation towards starvation. That is the definition of active obesity in a nutshell.

The person who is obesity resistant does not experience this. Their metabolism responds perfectly to energy in/energy out requirements even when using the simplest and most basic energy information input, such as calories.

Calories are the smallest denominator that the body uses to check its energy status and has the least long-term effect on body fat and metabolic function. But yet, the obesity resistant person can maintain their weight, for quite a long time, even while eating Snickers bars, through the counting of calories. Of course, the caveat is that this will only continue to work as long as the lean person is able to control their blood glucose regulation.

Unfortunately, calories are a poor way to control blood glucose regulation for the long-term, so the lean always end up expanding over time regardless of their calorie counting. Blood glucose regulation reigns supreme over calories for the body to determine its energy status and what to use that energy for.

So, yes you can be full of energy and have none to spare. "Water, water everywhere but not a drop to drink."

4. I am never hungry. I don't feel like I should eat anyway.

You need to eat at your mealtimes. Schedule convenient mealtimes and keep to them. You can choose two to three mealtimes a day. Make sure you schedule them so they can be followed consistently, daily. Do not snack in between.

I know that people say they are "never hungry", but I have yet to see those same people simply not eat anything for weeks at a time. In fact, most of those people do not even go one day without eating. Most of this "never hungry" stuff is really just "never hungry for a proper meal" because they can certainly live of snacks and novelties. If you can eat a Snickers bar, you can eat a meal.

Consistent mealtimes will help regulate satiety signaling and appetite. Once your body begins to burn some fuel, it will naturally become hungry and you want it to be hungry at your mealtimes, specifically.

5. I have a cheat meal at Burger King, once a week. I have still dropped pounds and inches. I only notice that my appetite changes a bit after that meal, but I am still seeing results. I think I should just work out more, after that cheat meal, to prevent it from catching up to me.

This would be fine if weight loss and/or maintenance is all you care about but the name of this blog is 'Journey to Metabolic Health'. This means that we strive to give the best advice for you to maintain or acquire metabolic health even at a normal weight. This is not a weight loss blog. The advice we give is to help treat obesity, not weight loss. This means that your "cheat meal" is detrimental to your metabolic health.

It takes very little time for disparities in blood glucose, ups and downs, to cause metabolism to change in detrimental ways. Because your cheat meal is from Burger King, I can assure that you are experiencing disparities in your blood glucose on that day. That's all it takes for things to take a turn downhill for you. Soon, you will adapt your body to store more fat and that one meal will be enough for you to start seeing changes in your body composition.

No amount of exercise is going to stop this snowball from going downhill because it's not being caused by lack of exercise. It's caused by disparities in blood glucose, directly caused by what you eat. How does this happen?

• Eat calorically restricted meal at Burger King.
• Blood glucose rises above a normal range due to the macronutrient composition of the meal, not its calories. Let's say 167 mg/dL.
• Because blood glucose rose above normal, the body releases a larger amount of insulin, than it would normally, in order to help facilitate the clearance of this abnormally high glucose.
• Because a larger amount of insulin had to be released, for an extended period of time, it remains in circulation and expressed in tissues for longer than it normally would. Now it's driving down fasting blood glucose too low. Let's say to 70 mg/dL. That's a 97-point drop. This signals to the body that you are now starving. The body is averse to drops in blood glucose of this magnitude.
• The body reacts to this extreme lowering in fasting blood glucose (starvation) by ramping up glucose release through adrenal stress hormone activation and under expressing insulin in various tissues and organs. In other words, the body now goes into anti-starvation mode. Anti-starvation mode is code word for sparing fat mass, building more fat mass and keeping blood glucose and weight set point high.

It is important to note that the starvation mode above, wasn't caused by "lack of food". It wasn't caused by calories. It was caused by large blood glucose disparities.

The above series of events will become a vicious cycle that will be extremely difficult to reverse. This cycle drives obesity/diabetes. This is why we don't believe in "cheat meals". It has been shown that metabolism adapts to erratic blood glucose fluctuations with just one meal. When you have been eating those meals for days, weeks, months, decades, what do you think will happen? Well, we have seen the end result, right? People crying that nothing helps their obesity and diabetes. After they have adapted their metabolisms to behave this way, they expect for someone else to wave a magic wand on them and make it all go way. It doesn't work that way. Don't be one of those people.

You must be consistent with your diet and stay away from cheats. If you are going to cheat, once a week, make sure the cheat meal is in line with your diet and it's not Burger King.

6. I have been having horrific stomach pains since I began eating large amounts of vegetables. I am trying to ignore it but can hardly get sleep at night because of the bloating, gas and pains. 

I have no idea why you are eating large amounts of vegetables, but I suggest you stop. You should never ignore serious digestive problems and continue to eat things that are obviously not settling well with your body.

When you change diets, there is a small period of time where your body adjusts, and you might experience some gas, diarrhea, constipation or acid reflux. These should all be mild and temporary. When they are severe and persistent, it's time to revise your diet and see your doctor.

A lot of people cannot tolerate above ground vegetables. This is understandable. Vegetables are new to us as they are a concoction of modern agriculture. We were never meant to eat large amounts of plant matter. Our digestive systems are not evolved to handle indigestible fiber. Some people can get away with it and have no issues. The body will accept all sorts of unnatural conditions and survive in spite of them.

But if you aren't thriving and only surviving, get rid of the plants. Focus on smaller meals that are protein prioritized instead.

Six common beliefs addressed, Part 204

1. I've started to notice that a lot of "low carb doctors", who push carnivore or "keto", are obsessed with eggs. They are now pushing eggs over meat. 

You have to understand that for most of these "doctors", “keto” and low carb are not their first rodeo. These people have been peddling one failed diet or another, for many years, before they got here. Most of the ones pushing eggs and greens, as a “keto” protocol, were once pushers of plant based protocols so they continue pushing a "less meat" agenda, even when they have been forced to include meat.

Stay away from “keto/low carb doctors" and stay focused on what's really going on with you. You cannot treat what you don't understand. Obesity is not caused by following the wrong food lists or buying the wrong diet book. Obesity is the chronic under expression of leptin due to metabolic abnormalities caused by blood glucose dysregulation. Blood glucose dysregulation ends in metabolic syndrome/diabetes which are starvation adaptations that further perpetuate obesity. In fact, the only commonality found in obesity research, between patients, is blood glucose dysregulation. Obese people vary in gender, age, health, pathologies, diets, lifestyles, appetites, etc. but they don't vary in blood glucose dysregulation. 

So in essence, all you have to worry about is obtaining/maintaining proper blood glucose regulation. Everything else is flim-flam. It doesn't matter if you can achieve proper blood glucose regulation through eggs or filet mignon. No one individual food item is going to achieve proper blood glucose regulation anyway. Only the right macronutrient composition of low carb, moderate fat and adequate protein can.

2. A family member was recently hospitalized for severe dehydration and has not been released from the hospital because they developed rhabdomyolysis. Doctors told them they would need dialysis if it continues. This reminded me of diabetes, for some reason. 

Rhabdomyolysis (rhabdo) is a potentially life-threatening syndrome resulting from the rapid breakdown of skeletal muscle which leaks muscle contents into the blood. The most common causes are crush injury, overexertion, alcohol abuse and certain medicines and toxic substances. Rhabdo can cause damage to the kidneys because they become overworked trying to eliminate this muscle waste. Rhabdo is not directly associated with diabetes but any chronic disease, like diabetes, can put you at more risk for developing this condition after any injury or illness. When the body loses resilience through one chronic condition, it affects how it handles all other conditions.

I think that the reason you thought of diabetes when you heard about rhabdo is because diabetics also break down their lean muscle mass, at an exaggerated rate, and eventually develop kidney disease. This is because their kidneys are also overworked as they try to eliminate this excess waste. The excess waste from a diabetic's muscle break down is mostly sugar. So rhabdo can damage kidneys in a few days and diabetes can take a decade, but their end result is the same - dialysis.

There are also other factors in diabetes that cause kidney damage as well, which include the chronic inflammation and excess water retention caused by hyperinsulinemia itself. This water retention causes high blood pressure and high blood pressure, especially in the small vessels, damages the kidneys over time. So even though these conditions are not connected, they both overwork the kidneys, eventually damaging them.

3. Low carb advocates always talk about insulin resistance or insulin sensitivity, but they never fully explain either. 

I have used the term insulin resistance and insulin sensitivity before but I refrain from doing so as much as possible. This is because low carb advocates blame insulin resistance for a slew of ailments that have nothing to do with insulin. It is such a misused and overused term that it has lost most of its meaning. Insulin sensitivity is also too general a term to use since diabetics are very insulin sensitive, at the fat mass only, so without nuance the term is mostly meaningless.

So since there is no such thing as being completely insulin resistant or completely insulin sensitive, I like to use insulin function instead because ultimately that's what’s deteriorated in metabolic problems. Insulin serum levels are chronically high, insulin is over expressed at the fat mass and it’s under expressed in other tissues and organs, at varying rates. That's poor overall insulin function.

4. My friend is on a traditional diet that's calorically restricted and I am following a "keto" protocol. Once a week, we both allow ourselves to have a dessert. I make myself a "keto" dessert, which complies with my macros, and she has a "cheat day" where she eats something she usually can’t, like a brownie. I think my "keto" dessert is a better option than hers but she thinks it equates to the same thing for us both.

Your "keto" dessert is definitely better because you are not going off protocol just to have a dessert. More importantly, a day of higher fat does not disrupt blood glucose regulation but a day of higher glucose does.

Of course, your friend is seeing this through the lens of calories so she assumes, both desserts are a wash at the end of the day but if you have been reading my posts, you know better. Just one episode of "dietary induced hypoglycemia", meaning that your postprandial blood glucose was disrupted enough to cause a prolonged insulin release/expression which then drops blood glucose while fasting, is enough to get the ball rolling towards metabolic disaster. You have to understand that our blood only has about one gram of glucose, at any given time. This means anything over that is technically overload.

Now this doesn't mean that your friend will drop dead instantly from a piece of pie. After all, there are hunger/gatherers who are forced to eat honey, for weeks on end, just to survive. Our metabolism is pretty resilient, particularly when there is nothing wrong with it at the moment. It just means that your friend is setting the stage for future problems.

On average, we live longer than hunter/gatherers so we have a future to worry about it. Most hunter/gatherers do not have to worry about losing a leg at 60 years old. Because we can live such long lives, we have more time for things to go wrong and things will go wrong. If your friend is already overweight/obese and/or suffering from other metabolic dysfunction, then things will go wrong much more quickly for her.

5. There is no way to reduce systemic stress.

The best ways to reduce systemic adrenal stress are the following:

• Take control of any chronic underlying conditions - Chronic conditions like metabolic syndrome, auto immune or any other inflammatory disease will cause your body to be in a persistent state of stress. It is very difficult to regulate blood glucose under stress. You need to discuss with your doctor effective ways of gaining control of any chronic condition you may have. A lot of people just go to routine doctor visits and find no real improvement in symptoms. They are either misdiagnosed or given ineffective treatments. You have to take control of your healthcare. Make sure you aren't just going through the motions when you visit your physician. If they can’t help you, find one who can.
• Take control of medications - You have to make sure you aren't being over medicated with drugs that effect blood glucose regulation. A lot of people don't realize that lower doses of medications are still effective in treating their condition. Others don't realize that the medication they are on is actually useless and not helping them at all. So make sure you discuss with your doctor your medications, particularly if you have been on them for a very long time and the dose has not been changed nor has your condition been recently re-tested. Some people are still taking medications for conditions they no longer even have. Others are taking over the counter medications, at their own discretion, when a better prescription medication may be available which can be better monitored.
• Exercise daily in a predictable routine - Exercise helps regulate inflammation by directly affecting inflammatory hormones like cortisol. You should have a predictable and consistent exercise routine you follow daily so the body becomes primed on when to burn energy and when to store it.
• Eat two to three meals a day in a predictable routine - Eat real meals, not novelties or "snacks". Meals should be protein prioritized, low in carbs and moderate in fat. Make sure your meal timings are consistent every day. Do not go long stretches without eating. Make sure you eat enough at each meal.
• Fast in a predictable routine - If your meal timings are consistent, then this would automatically make your fasting times consistent as well. 12 -18 hours is the only daily fasting schedule that we recommend on this blog. Choose the schedule within that time frame that prevents hunger and/or any other symptoms.
• Sleep in a predictable routine - Go to sleep at the same time nightly. Not only will this allow you to sleep better and wake up naturally, without the alarm clock, but it will help you get enough sleep. Sleep induces the lowest insulin state you will have in a 24 hour period.
• Get rid of any caffeine - You will never be able to control your blood glucose until caffeine, in every form, is removed from your diet. Blood glucose dysregulation is the main cause of adrenal stress. 
  

As you can see most of the above recommendations are focused on normalizing circadian rhythms. Your circadian clock is the way your body communicates with its environment. It's not enough to just be conscious. To help keep your circadian rhythms healthy, keep a schedule and do things according to it. Do not be willy-nilly with your time because that will throw off your eating, fasting and sleeping schedules. Take your time more seriously. Remember, we only have a finite amount of time. Make the most of it. 

Following circadian rhythms reduce systemic stress through their affect on cortisol and other stress hormones. All animals follow circadian rhythms. Dopamine plays a crucial role in regulating circadian rhythms. Dopamine affects metabolism profoundly as it regulates metabolic hormones seasonally for fat storage and burning. So living erratically and unpredictably is not good for metabolism. This is particularly true for people with current metabolic syndrome.

6. They will never tell us the truth about obesity. 

This is because they don't have effective ways of treating obesity since it has no cure. For this reason, they want to place responsibility on you to keep it "under control". The advice that is currently given to the obese, only works for the lean as it can reduce their risk of future obesity. For the already obese, it is mostly useless.

It is reprehensible the way obesity is discussed in medical circles. It is akin to malpractice in my opinion. To tell an obese person to "aim for a healthy body mass index (BMI)" and "increase their exercise" in order to "cure" a condition without any known cure is abusive.

Obesity is a leptin condition, not a diet condition. You can not achieve a healthy BMI without leptin. I find it impossible to believe that a medical doctor would not know this as this information is not hidden in a mysterious vault that only warlocks can view. This is actually consistent in obesity medical literature.

So I am with you on your outrage. I just don't have any answers for you. The only thing I can think of is that they want people to continue “being mindful of their weight” and they don't want to give them any excuse to not be.