Six common beliefs addressed, Part 254

1. I have recently been very sick and I am amazed that I didn't lose weight. I would have thought sickness would cause weight loss. Everything I ate went right through me!

Fecal matter is not body fat so unless body fat went right through you, I can understand why you never lost a pound.

Sickness usually does not cause "weight loss" unless it causes cachexia (wasting). This is when the body simply breaks down all of its muscle and it can include body fat but not necessarily. Cachexia is usually a sign that impending death is near. The fact that cachexia "does not necessarily" include body fat in this breakdown is incredible in itself. It's amazing how the body will hold on to its body fat even when facing death.

Other than that, there is no sickness that increases leptin expression so you can lose body fat normally. You can lose a few pounds if you get a really bad flu, for example, as viral infections can cause dehydration through various mechanisms but that won't make you lean.

2. I have digestive problems and the only things that calm it are starch based foods. I am diabetic.

What may be good for your digestion is not good for your diabetes and vice versa. You would have to weigh what condition is more important to address or find alternative treatments for your digestive issues.

3. Why is the medical industry reluctant to say that the root cause of obesity/diabetes is blood glucose dysregulation even when they know this is a fact and is in their own literature? Your blog encouraged me to do my own research and I was appalled at what I found. What was found in these studies is not what's being told to the patients or even considered in their treatments.

The medical industry is reluctant to name anything as a "root cause" when it comes to chronic conditions that have a wide array of factors involved. The research is usually left up to interpretation and is muddied because what's being studied is "pathology in progress" which is already affecting multiple body wide systems.

Dr. Joseph Kraft studied metabolic syndrome before it became diabetes in order to see what changes occurred in metabolism which eventually led to pathology. What he found were abnormalities in insulin release in response to blood glucose dysregulation. So even in his study the focus became insulin rather than what insulin was responding to - abnormal blood glucose.

Doctors want to avoid conflicting recommendations. For instance, many patients who have been on long term blood pressure medications start developing conditions with their kidneys and intestinal lining. They go to the doctor for these symptoms and the doctor begins to treat these conditions with ineffective protocols. They never mention that these conditions are the result of long term side effects from these medications even when they know about them. After all, they can never actually prove this is what is occurring to this one individual patient and stopping the medication carries a greater risk than continuing to try and treat the conditions its causing.

Doctors want to avoid complications. Even though blood glucose dysregulation is what occurs before disease onset, your doctor will be reluctant to make that claim even if he agrees. After all, many things interfere with blood glucose regulation, including certain medications. This means many patients will be reluctant to take their medications if they knew it put them at risk for future diabetes. 

Blood glucose dysregulation is also the result of the "heart healthy diet" that is commonly recommended. Doctors certainly don't want to discourage people from conventional diet advice as they believe it will put them all at cardiovascular risk. Certain diseases also disrupt blood glucose regulation and no one wants to add another burden to someone who is already tackling one condition by telling them it is causing another.

To further complicate the matter, no one is in full agreement over what proper blood glucose regulation even is. How is it measured? What is the criteria being used? Can it be applied across the board? After all, a teenager will regulate blood glucose differently than a senior. We already know for a fact that high blood glucose cannot be confidently used as a blood glucose regulation marker as it doesn't always manifest this way. There are people with "diabetes in situ" or "occult diabetes". These people do not have postprandial highs. They have postprandial norms or lows because of the massive insulin they are releasing in response to blood glucose disparities.

It all becomes too complicated to be applied in mass. It takes close individual monitoring which cannot be done as there isn't enough healthcare staff and time to do so. For this reason, diabetes is often explained away to the diabetic as some sort of mysterious "pancreatic malfunction" or the result of "insulin resistance". This is why you have to be involved in your health care. You cannot leave it all in the hands of your doctor. You have to be your own advocate. You have to care about what no doctor will care about which is your blood glucose regulation.

4. What is happening to the low carb community? All of the people that were here in the beginning, when I first started following it, are either gone or have changed up their entire approach and hardly speak on obesity or diabetes anymore. Now they seem to only speak on supplements, junk food and other conditions. I would have thought the movement would have grown astronomically by now, not dwindled away.

If the charlatans that participated in this movement didn't leave or change their approach, they would have gone bankrupt or worse. Staying long only increases their risk of being sued or losing whatever medical license they are still holding on to, as their "patients" become liabilities over time. You have to understand that the people who were promised miracle cures are now ready to cash in on that promise and they are finding out the checks are bouncing right off their still expanded bellies. This makes them highly litigious.

So, people in this circa do not stay around for long. They have to move on and take their magic show to another unsuspecting town. People in this business know the importance of diversifying their quackery. So yes, a lot of the people who where around some years ago are either gone, switched to some other scam or are hiding behind paywalls where no one can see their shenanigans except for their hardcore, paying followers.

5. What is the rule of thumb for protein consumption for a female?

A recommended daily, minimum consumption of 1.0 grams of protein, per pound of ideal body weight is the rule of thumb for an adult.

The best way to get a more personalized recommendation is to calculate your macros which take into consideration sex, goals and activity levels. You can do so here.

6. I heard someone on YouTube say that "you're fat because you got fat". Is this true?

That's horribly worded. Basically this is just a terrible way of saying that fat people get fatter. This is because once you start hoarding and sparing body fat, getting fatter only perpetuates the effect further.

Six common beliefs addressed, Part 252

1. Is "nutrient availability" related to micronutrients? Is this what leptin is looking for?

No. I know that a lot of different people are on the bandwagon of obesity, from athletes to diet mongers to holistic nutritionists but none of them will help you. All they do is muddy up the waters and cause more confusion.

When I speak about leptin, I talk about long term nutrient availability. This is exclusively related to MACROnutrient availability, not MICROnutrient availability. Macronutrients are the energy handling (metabolic) nutrients - carbohydrates, fat and protein. Micronutrients are vitamins and minerals.

Macronutrients are what tell your body how to allocate energy and this affects body composition and metabolic homeostasis. Leptin doesn't care about your micronutrients. This is why you can lose weight on the micronutrient void Twinkie Diet. All leptin cares about is how many calories are coming in. All insulin cares about is where these calories are coming from. Leptin is a slave to insulin so at the end of the day where these calories are coming from reigns supreme for obesity treatment.

So your nutritionist can save you from beriberi but not from obesity.

2. If I gain weight, does it mean I am headed towards obesity?

Weight gain is no more obesity than cell growth is cancer. Unregulated, exponential growth of cells that refuse to die is cancer. Unregulated, exponential growth of body fat that refuses to be burned is obesity. The operative word here is body fat. Obesity is excess body fat, not excess body weight. Weight gain and obesity may appear similar because they both affect the scale and how tight your pants fit, but they are very different and that’s why what affects one does not affect the other (i.e.: calorie input).

So no, gaining weight is not obesity and losing weight is not slimness. The body naturally goes up and down in weight. These are normal changes in water, muscle and fat composition. A fluctuation in weight, up or down, of about 20 pounds is normal.

3. I have a friend who is having digestive issues and swears up and down that it's being caused by so many years of low carb dieting. They insist that others who follow low carb are always having issues as well. Is there something in low carb that causes health problems after a while?

No. Low carb diets are not anything special or new. They consist of real food - meat and vegetables. If real food is causing disease, then I don't know what to tell you. I do know that there is nothing in pizza and bagels that preserves digestive health. If meat and vegetables cause you digestive issues, then you have major problems as pizza and bagels will cause you even worse issues.

I don't take any of these claims seriously because most of the people who follow low carb are very sick and very old. Like I have said before, most people resort to an elimination diet when they have reached the end of their rope and by then, it is usually too late. Sick and old people suffer from many ailments and instead of blaming the obvious complexities of their age, health status and long term medication use, they seek to blame some simple external source. A lot of times this is just an excuse to go back to their previous diet.

When someone does have an issue with low carb it is because they are not following the protocol correctly. They are either:

• Not eating enough - living by salad
• Eating processed "low carb" junk - living by "keto" snacks
• Ignoring their electrolytes - what are those?

The first two can occur with any diet and people who have issues with low carb, have also had these same issues in the past with other diets. Electrolytes are different. Remember that low carb lowers insulin rapidly and this releases large amounts of water. This causes electrolyte imbalances so you have to keep your electrolytes in mind when following low carb to avoid the symptoms that this can cause. This is why some people have such a hard time specifically with low carb diets. Dehydration affects blood glucose regulation.

Other than that, there are some exceptions which can be considered:

• Vegetables - Some people have a very difficult time with vegetables. Low carb diets automatically increase the amount of above ground vegetables consumed as they are now replacing grains and starchy vegetables. This can be problematic for many. Vegetables can cause serious digestive issues for some. Gas, heartburn, bloating and diarrhea are not uncommon ailments when vegetables are increased. The simple solutions are to decrease vegetable servings, find the problematic ones and avoid them or eliminate all vegetables all together.
• Meat - There are some digestive issues that can be exacerbated through the breakdown of protein. This means that eating meat can cause severe digestive issues for these folks but this usually occurs when enzymes are taken along with food or when too much meat is consumed at once. Some meat is harder to digest than others so simply avoid the problematic ones.
• Dairy - Some individuals have an adverse reaction to dairy and since many low carb protocols introduce dairy into the diet, these individuals may develop digestive issues. This can be resolved by opting for lactose-free dairy and/or grass fed dairy which has a different protein composition. Lastly, they can simply eliminate the dairy all together. Dairy is not required. It is complimentary, not necessary.

4. I am diabetic and my doctor told me that grass fed meat is healthier than grain fed meat because it has "less saturated fat". They said that if I can't afford grass fed meat to simply eat less meat overall and eat more vegetables like avocados instead. Is this a good idea?

I received several questions this week pertaining to medical foolery. Let's start with this one.

If your doctor is telling you to eat avocados instead of meat then he doesn't care about saturated fat as avocados are very high in saturated fat. Saturated fat is saturated fat so why are they only concerned with the saturated fat in meat? Don't let them gaslight you.

What's different in grass versus grain fed meat is the composition of the fatty acids not the amount of saturated fat. Grass fed meat simply has a healthier fatty acid profile than grain fed meat and this makes a difference in how the liver processes this fat. Research has shown that there is more liver fat accumulation with grain fed meat consumption than grass fed but there are a lot of other factors involved in this rather than just a linear cause and effect. But let's stick to the fact that the fat composition is absolutely different between these meats and that does have a metabolic effect.

I would never recommend you swap protein (meat) for carbs (vegetables). Vegetables do not have enough calories or protein to keep you from starvation. This only reinforces the metabolic profile you already have. Remember, diabetes is a starvation adaptation. More starvation only makes it worse.

What your doctor should have told you instead is that if you can't afford grass fed meat, to diversify your meats between red meat, poultry and fish. You can also buy leaner grain fed meat and add your own fat at home during cooking. The most important thing is to remain low carb.

Little by little you will have more grass fed meat options at cheaper prices if the demand continues to increase and the United States Department of Agriculture (USDA) continues to cooperate in helping to increase the grass fed industry. Right now, it's in its infantile stages but you can already see how grass fed options are slowly becoming more mainstream and you can even find them at Walmart.

5. My endocrinologist told me that honey, agave syrup, coconut sugar and maple syrup are all sugar and they shouldn't be eaten because they all raise blood glucose just like regular table sugar would.

This one is only half foolery.

Yes, all of those sugars are sugar. Sugar by any other name..... They all need to be eliminated, not because they "raise blood glucose", but because they interfere with proper blood glucose regulation. I want people to get out of viewing diabetes through the lens of high blood glucose. That is not going to help you in the long run. What will help you is to look at it through the lens of what it truly is - poor blood glucose regulation. These means BOTH the highs and lows in blood glucose are abnormal.

Many things can lower your blood glucose and not resolve your diabetes one iota. In fact, the low carb world is plagued with obese people who now have lower blood glucose while still on Metformin. As time passes, their blood glucose again begins to rise. This is because lower blood glucose does not mean your diabetes is in remission, proper blood glucose regulation does.

Many other things raise blood glucose like exercise, the overnight fast and protein consumption but all three are necessary for obtaining proper blood glucose regulation in the long term so you don't stop them because they raise blood glucose in the short term.

Still, there are some people who have "diabetes in situ". Dr. Joseph Kraft coined the phrases "diabetes in-situ" and "occult diabetes", occult meaning “hidden” . The diabetes is hidden or "masked" because the blood glucose is being driven down by high insulin. This causes for blood glucose to actually drop after meals due to the massive insulin released in response to abnormal blood glucose. This is also diabetes even though it's marked by very low blood glucose rather than high. In fact, these drops in postprandial blood glucose reinforce the condition more than if glucose went high. These people are at a greater risk of becoming Type I diabetics in the future as their beta cells stop functioning.

You can't miss the forest for the trees. Focusing on individual blood glucose readings is doing just that. You need to look at the long term effect on blood glucose regulation.

6. My endocrinologist told me that my blood glucose rises during fasting because my liver is "blind" to insulin and "dumps out too much glucose". He also said that once my liver glycogen is depleted (9 - 12 hours of fasting) I will begin to burn body fat as the body has to continue "burning something". Is this true?

That is a lie. A cruel lie at that because it makes people think they have just been given the weight loss secret they had been waiting for their entire life since it sounds so "sciency" and was said by a doctor. I swear these doctors either act dumb or they are dumb for real. If they are dumb for real, we are in serious trouble.

First, if that were true, then the cure for diabetes would have already been found. All people with diabetes would simply have to fast long enough to deplete liver glycogen. This would cause them to loose their body fat and their diabetes would go into remission as if by magic. Unfortunately, we are aware that's not what happens and that's why there is no cure for diabetes. Ask your endocrinologist how many of his patients have gone into remission from fasting overnight for 9 hours? Not a one.

Instead, when liver glycogen is depleted, the diabetic simply breaks down their lean muscle mass to create more glucose and their fat stores remain safely in place. Remember diabetes is the end stage of a metabolic adaptation towards starvation. This means fat reserves are never accessed because they protect from starvation. Fat would be the last thing a starving body tries to burn. Fasting reinforces that there is true starvation and this fat is necessary. This is why you should never fast for too long since the depletion of liver glycogen will do nothing for you and the drop in blood glucose only reinforces the adaptation.

Your liver is also not "blind" to anything. It's just doing what it should under starvation - keeping blood glucose high. Insulin resistance is a natural process in order for the body to not only make as much glucose as it can but also spare it for creating more fat. So the diabetic is not "burning glucose". They are using glucose to make more body fat. Many metabolic systems in the body become insulin resistant in order to keep this glucose production efficient and its conversion to fat uninterrupted.

It's not just the liver implicated in this either. This glucose is being produced through the hypothalamic/pituitary/adrenal axis (HPA) as well. It is not solely the result of liver glycogen release.