Six common beliefs addressed, Part 269

1. Why do low carb advocates only concentrate on carbs and protein but not fat intake? They act as if fat is benign to their condition.

Because low carb advice online is all about postprandial blood glucose numbers. Fat is the only macronutrient that does not cause a rise in blood glucose after consuming it so they assume this means fat does not affect their condition. They do not understand obesity or diabetes.

Obesity and diabetes are conditions of poor blood glucose regulation. Disparities in blood glucose are the seed that allow the condition to begin but insulin response is ultimately what allows the condition to take root.

Carbs and protein only affect your short term insulin response but it's your high body fat that puts a high insulin demand on your body in both the short and long term. Dietary fat affects long term insulin because it must be stored, so while you are fasting, your insulin is still being stimulated, both by the fat on your body and the fat you just ate. This is pathological for blood glucose regulation. You cannot control your blood glucose properly in the presence of higher than normal insulin release and expression. It will only drive your fasting blood glucose too low.

For this reason, on this blog, we do not chase postprandial blood glucose numbers alone. We look at overall blood glucose regulation and that can only be obtained by eating a diet that does not affect blood glucose and insulin homeostasis. That diet is low in carbs, moderate in fat and adequate in protein.

2. Do low carb diets work because you can't store fat while being in ketosis and ketosis causes no hunger?

Negative. You absolutely can store fat while being in ketosis. Ketosis makes it less likely but it absolutely can occur, particularly if you are leptin resistant and are consuming too much dietary fat. This is why some ketogenic protocols cause weight gain, rather than weight loss. When people are starving they have complete access to their body fat and are in ketosis, yet they experience extreme hunger.

The advantage of low carb is that it allows the body to lower its weight set point through the stabilization of blood glucose which lowers the insulin demand. This in turn helps the central nervous system allow leptin signaling to communicate fat stores to the brain and maintain healthy body fat levels. Proper leptin expression is what induces satiety through the burning of body fat.

3. If carbs are what causes my blood glucose to rise, then why is it that protein, without any carbs, also causes my blood glucose to rise?

I have touched on this before but I will do it again since there is so much misinformation on what this is from the low carb community. I think it is the most asked question and the one least replied to correctly. To put it simply, this is caused by "hyperglucagonemia".

People who are diabetic have insulin resistance of the pancreatic alpha cells. Their alpha cells have lost sensitivity to blood glucose concentration. For this reason, they lack sufficient first phase insulin release (spike) to properly suppress glucagon. When they eat carbs, their liver constantly releases glucose because they cannot properly regulate glucagon.

This experiment has been done on Type II diabetic animals in laboratories. The result has been consistent across the board - their insulin spike is missing, yet they still have higher than normal insulin levels. You cannot suppress glucagon without a sufficient insulin spike. Now they have both high insulin and high glucagon. Their ratio is less than 1:0. This causes for the liver to not store incoming glucose and to keep producing glucose as it deems you are starving, regardless of the meal you just ate.

Aside from that, diabetics have also impaired incretin function. This means that their gut hormones do not respond properly by releasing insulin and lowering glucagon as needed. People with metabolic syndrome and prediabetes have a similar experience, just not as severe but the mechanism is the same.

Because all of these failing glucoregulatory systems, blood glucose rises postprandial whether you eat carbs or protein. Both require bolus insulin and insulin resistance does not allow for blood glucose to be cleared properly and it also causes for other hormones to release even more glucose in its presence. The only solution to this is improvement in insulin sensitivity through proper blood glucose regulation. You do this by remaining low carb and dividing your daily protein intake into three meals. That way you are not consuming too much protein at once, disrupting insulin to glucagon ratios further.

4. I have never heard my doctor use the term "diabetes reversal" but yet low carb people keep repeating it on all their groups and pages. Are they really reversing diabetes?

No. The reason you have never heard this term anywhere else is because it doesn't exist. It's a scam. They created it so now they get to define it anyway they see fit. For example, for them diabetes reversal is "getting off insulin" or "lowering your blood glucose" or "lowering your HbA1C". None of that means a thing. None of it.

Until you can properly regulate your blood glucose, meaning you do not release glucose when you don't need it and release it when you do, you have not put your diabetes into remission. You also have to be able to maintain a healthy body fat percentage because that is the proof that you are regulating your blood glucose properly. Everything else is nonsense.

5. I have been low carb for a while but it seems like I am slowly but surely losing control over my blood glucose. My postprandial blood glucose keeps rising, ever so slowly but surely. What is going on with me?

Glucagon. Glucagon usually increases over time in insulin resistance. The alpha cells of your pancreas become resistant to the inhibitory effects of insulin and they continue to produce glucagon, when they shouldn't. Basically hyperglucagonemia.

This is very similar to what occurs to Type 1 diabetics who also cannot stop producing glucagon simply because they have no insulin. Their glucagon "goes wild" and so is yours. Glucagon breaks down stored glycogen into glucose which is then released into the blood stream and you can measure it with your meter. Glucagon is only suppose to release glucose from the liver, when your blood glucose is low but with metabolic syndrome/diabetes, glucagon does this all the time, particularly in the presence of insulin and lowering of blood glucose.

Metformin works by suppressing this hepatic glucose output. Why is yours continuing to rise? Because you are still insulin resistant. Your low carb diet has never affected your blood glucose regulation profoundly enough to regain insulin sensitivity. As long as you are insulin resistant, you will continue to experience these issues. You might want to revisit your diet and your overall lifestyle, in order to try and pinpoint exactly what is contributing to your blood glucose dysregulation.

I am inclined to think it's the fat content of your diet since usually when people mention "low carb", it's because they are following the fad low carb diet they find online which encourages the intake of astronomical amounts of fat. Excess dietary fat will continue to stimulate a prolonged insulin release which affects fasting blood glucose. You will never be able to regulate your blood glucose if this continues.

6. Why is my antidepressant causing me to gain weight? Almost everyone who has been prescribed these drugs, refuses to take them because of this side effect. How can a medication cause weight gain? Does it have calories?

Basically drugs that increase serotonin without increasing dopamine will lead to weight gain. Like I have said before, dopamine is a powerful metabolic regulator. It is involved in the seasonal adaptation of energy conservation. Basically, dopamine signals to the body when it is time to store for winter. This is why dopamine levels fluctuate with the seasons and can affect your mood.

The mechanisms of action dopamine has on blood glucose are very complex and go beyond the scope of this blog as I try to keep the information on here as reader friendly as possible and I do not want to get into a lot of technical jargon that will be tuned out or become difficult to understand. This is not a biochemistry blog. Let's just say that dopamine is involved in signalling starvation to the body and this affects fat storage/burning.

For this reason, it is imperative to keep dopamine levels normal and balanced so metabolism is better regulated. Staying away from sweet taste is a good start but you also have to talk to you healthcare professional about any psychotropic drugs you may be taking that could be affecting your serotonin/dopamine ratios as this will eventually degrade your insulin function over time.

Six common beliefs addressed, Part 260 - Soda Edition

1. What makes soda so detrimental for metabolism? Every time we think of obesity and diabetes, the first thing everyone mentions is soda. Does soda really deserve such a bad rap?

I really do not like to over dramatize the ill effects of any one food item but even I can agree that soda is the most obesogenic form of sugar known. It truly does deserve the bad rap, and then some. Unfortunately, most of the bad rap it receives is misdirected. When people think of soda, they think of "fast food", "high calories" or "empty calories" without truly understanding just how much soda can negatively impact their health irrespective of any of these. 

Soda is particularly harmful for blood glucose regulation through three different mechanisms. The trifecta is - sugar, caffeine and sweet taste. All three things work in conjunction to ensure you develop intractable obesity through hypothalamic damage. One thing is to consume something that disrupts your blood glucose regulation and another thing is to consume something that will disrupt every single glucoregulatory system in your body, even when you no longer consume it.

Sugar

This one is pretty self explanatory. We have discussed the effects of sugar extensively on this blog. Dietary sugar will disrupt your blood glucose regulation which in turn will abnormalize insulin expression over time. This effect promotes a metabolic adaptation that chronically under expresses leptin and purposely keeps blood glucose, insulin and body fat set points to high. This is the mechanism of metabolic syndrome and once it begins, it is very difficult to reverse as multiple systems in the body, now work together in feed back loops, to continue its progression.

But soda doesn't just contain sugar. It contains a special type of sugar - high fructose corn syrup. Don't worry about the "corn" or the "syrup" in that name. Don't concern yourself with how it's highly processed or who subsidizes it to make it cheap. Only focus on the "high fructose" part because that's all that matters. 

Sugar is a disaccharide, which consists of a glucose and fructose molecule linked together. This gives sugar a composition of 50% glucose and 50% fructose. This is the composition of honey and regular table sugar. High fructose corn syrup also consists of glucose and fructose, but the composition is varied to be about 55% fructose and 42% glucose. Fructose is what provides the sweet taste in sugar. High fructose corn syrup is sweeter as it has a higher concentration of fructose.

Fructose is metabolized in the liver, like alcohol, and is a hepatotoxin. Do not let them gaslight you into thinking that because alcohol is also metabolized in other tissues and organs, including the brain, and it's a depressant, that it is somehow metabolized differently than fructose. It is not. It is metabolized in the liver, just like fructose, and results in the same liver damage. Its effects on the liver are absolutely toxic. Everything else is pedantic word play. Consuming liquid fructose, such as high fructose corn syrup, can lead to a more rapid absorption of fructose into the bloodstream, which can exacerbate liver damage and metabolic alterations.

Some of the damage that fructose causes to the liver are:

• The development of non-alcoholic fatty liver disease (NAFLD), a condition characterized by the accumulation of fat in the liver.
• Promoting the storage of fat in the liver and increasing the production of insulin which dysregulates blood glucose through hypoglycemia.
• Damage to liver mitochondria, leading to impaired fat metabolism and increased liver fat storage.
• Inhibits the liver’s ability to properly metabolize fat, leading to an increase in the synthesis of fatty acids in the liver and an inhibition of lipid oxidation.

You would think that all of this is pretty bad, but the problems don't stop there.

Caffeine

Caffeine is a stimulant which is naturally found in coffee bans, tea leaves, certain seeds and nuts and chocolate. It is also added to other foods such as energy drinks, energy bars, sodas and some flavored waters. You will never be able to obtain proper blood glucose regulation as long as you are consuming caffeine. You would be surprised how many diabetics caffeine has made. It can give sugar a run for its money.

Caffeine stimulates the nervous system via the hypothalamus and hormones via the adrenal glands, activating the hypothalamic/pituitary/adrenal axis (HPA) and releasing catecholamines. Catecholamines are a group of hormones/neurotransmitters which play a crucial role in the body’s stress response. These "stress hormones" disrupt blood glucose regulation and insulin expression when chronically released. Studies have consistently shown that caffeine increases the levels of catecholamines in the body.

The catecholamines are:

• Epinephrine (Adrenaline): Released in response to intense stress. Epinephrine increases heart rate, blood pressure, and energy levels, preparing the body for immediate action.
• Norepinephrine (Noradrenaline): Released in response to chronic stress. Norepinephrine helps regulate blood pressure, heart rate, and energy levels, and is involved in the body’s “fight or flight” response.
• Cortisol: Released in response to chronic stress. Cortisol helps regulate metabolism, immune response, and energy levels, and is involved in the body’s response to stress and its regulation of inflammation.
• Dopamine: Released in response to various stimuli, including sweet taste. Dopamine is a very powerful metabolic regulator, involved in reward, motivation, and movement which we will discuss in the following segment.  
  

The exact mechanisms by which caffeine affects catecholamine levels are not fully understood, but several theories have been proposed:

• Caffeine may stimulate the release of catecholamines from the adrenal glands, leading to increased levels in the bloodstream.
• Caffeine may also increase the activity of enzymes involved in the synthesis of catecholamines, leading to increased production.
• Caffeine may also have a direct effect on the brain, stimulating the release of catecholamines from neurons.

Whatever the mechanism, the end result is still the same - blood glucose dysregulation. Some of the effects that catecholamines have on the body are:

• Catecholamines can directly stimulate the liver to release glucose into the bloodstream, increasing blood glucose levels. This is achieved by stimulating the breakdown of glycogen to glucose, a process known as glycogenolysis. This release of glucose impacts insulin release/expression.
• Catecholamines stimulate the release of other hormones, such as glucagon, which further increases blood glucose levels by stimulating glycogenolysis and inhibiting glucose uptake by muscles and adipose tissue. This again impacts insulin release/expression.
• Catecholamines can worsen blood glucose control in individuals with diabetes by stimulating the release of glucose from the liver and inhibiting insulin secretion worsening hyperglycemia. Insulin is once again impacted.
  
• Catecholamines can contribute to stress hyperglycemia, a common complication in critically ill patients, by stimulating the release of glucose from the liver and inhibiting insulin secretion causing extreme and deadly hyperglycemia.
• Catecholamines break down lean muscle mass into glucose, disrupting blood glucose regulation further and shifting body composition to more fat than muscle. A body composition of more fat than muscle further progresses blood glucose dysregulation. 
  

Some people are much more sensitive to caffeine than others. Aside from blood glucose dysregulation, caffeine affects blood pressure through the same mechanism of catecholamine release and through its anti diuretic properties. Like diabetes, you would be surprised how much hypertension caffeine has caused.  

This adrenal stress response continues long after the offending food is removed and is the driving force behind diabetes and its progression. Everything now causes this stress response from the night time fast, to exertion, to the common cold, to one night of insomnia. With each incident, the metabolic adaptation causing it is further reinforced. This is why it is vital to eliminate all caffeine from the diet because it will take a very long time to stop this vicious circle once it is.

By now, you would think it's gotten pretty bad but there's more.

Sweet Taste

When a person tastes something sweet, the brain produces huge surges of dopamine. With time, this chronic release of dopamine dysregulates it. Just like all other hormones, dopamine was made to work in pulses and not to be released chronically. Sweet taste was very hard to come by during our history as hunter/gatherers. It was limited to particular seasons and only in certain regions. It is a taste that tells the body to store for winter and dopamine obliges in sending that signal.

Dopamine, which is also a neurotransmitter, plays a crucial role in regulating metabolism, particularly in the context of food intake and energy balance. The relationship between dopamine and its effects on blood glucose homeostasis is complex and multifaceted. Dysregulation of dopamine signaling has been linked to obesity and metabolic disorders, as chronic release of dopamine profoundly disrupts blood glucose regulation.

Some of dopamine's effects on metabolism are:

• Chronic exposure to dopamine can lead to insulin resistance, which can impair glucose uptake in peripheral tissues and contribute to hyperglycemia.
• Dopamine can stimulate the release of glucagon, a hormone that promotes glucose production in the liver, which can lead to hyperglycemia.
• Dopamine can also suppress appetite, which can lead to reduced food intake and potentially lower blood glucose levels (hypoglycemia).
• Dopamine dysregulation has been implicated in the development of Type II diabetes, as it can lead to insulin resistance and impaired glucose metabolism.
• Dopamine also plays a role in regulating hunger and satiety. It has been shown that when dopamine levels lower, individuals will experience increased hunger and cravings particularly for more sweet tasting foods.
  

Dopamine dysregulation has been found to be implicated in the following:

• Studies have shown that obese individuals have fewer dopamine receptors in their brains. This reduced dopamine receptor density can lead to decreased insulin sensitivity, making it more challenging to regulate blood sugar levels and maintain a healthy weight.
• Research suggests that dopamine dysregulation may contribute to the development of obesity. For example, a study found that obese individuals had altered dopamine signaling in the brain, which may lead to overeating and poor food choices (seeking more sweet taste).
• Dopamine signaling dysregulation has been implicated in the development of  various metabolic disorders, including Type II diabetes, metabolic syndrome, and polycystic ovary syndrome (PCOS).

Because of these powerful metabolic effects, dopamine receptors have been targeted as potential therapeutic targets for the treatment of diabetes and related metabolic disorders. Since dopamine is stimulated by sweet taste, and impacts metabolism so profoundly, the introduction of artificial sweeteners has done nothing to curb the obesity/diabetes epidemic. You are now disrupting blood glucose through dopamine dysregulation instead of directly through dietary sugar.

It is not surprising that the obese, who usually have a "drinking problem", suffer from intractable obesity. They have succumbed to the trifecta of blood glucose dysregulation and it will be very difficult for them to reverse their condition. For this reason, on this blog, we tackle anything that disrupts proper blood glucose regulation, whether it's through dietary carbohydrates, the stress response or sweet taste.

Keep In Mind

• Decaffeinated coffee is not "caffeine free". It simply has less caffeine than regular coffee. So be careful of the amounts you drink a day as that caffeine adds up.
• It is even more difficult to find decaffeinated tea and it is also not" caffeine free". It simply has less caffeine that regular tea. Tea is not regulated the same as coffee so you don't know exactly what caffeine is in it, nor does it have to be labeled in any particular way. Be leery of any claims made.
• Diet soda does not mean "caffeine free". The soda must be marked as having 0 sugar and 0 caffeine.
• Diet soda or unsweetened tea at restaurants are usually not available decaffeinated so don't bother ordering them as the "diet" label will not save you.

Six common beliefs addressed, Part 203

1. You speak a lot about exercise but I can’t exercise because of other health issues. 

I speak on ways to obtain metabolic health and exercise is absolutely vital for doing so. Nothing can replace exercise. Unfortunately, if you cannot do it, that's a "you problem" with no solution. My recommendations remain the same. They don't change because someone can’t do it. If you can’t do it, you won’t obtain full metabolic health. Use the information you can and what you can’t leave behind, but this blog does not make concessions.

2. I am obese and have 0 energy most times. This makes me hate exercise but I also hated it even when I was young and slim. I just hate sweating and exerting myself. I wish I can retrain my dopamine to enjoy walking for exercise. 

First, I like that you phrased the statement in the context of "walking for exercise" because a lot of people are under the impression that walking to the mailbox or strolling through Walmart counts as "walking". Though everyone walks, unless they are in a wheelchair, and all walking adds to your step goals, not all walking produces benefits. You have to actually "walk for exercise", which means walking at a steady state, moderate pace, for a long duration (1 hour or more). You should "feel" your walk afterwards, with mild aches, pains or tiredness. As your health improves, you will feel physically better afterwards instead. Now back to your "wish", which is very interesting.

Walking with a goal in mind, like reaching a landmark or completing a task, will affect dopamine. You can walk to a neighborhood store for something you need or you can hold off on podcasts/audio books and only listen during your walk. Anything that will motivate you by causing an anticipation to walk will work. If you do this often enough, you might start enjoying your walking routine because of its effects on dopamine. In other words, you are retraining your brain with a reward associated to a specific activity (walking).

This, of course, is all in theory even though it's based on what we scientifically know about dopamine and how it works. This is why I always recommend walking outside and not at a gym or closed "work out room". Dopamine reacts to seasons. Walking out in nature, experiencing different temperatures and smells, while watching greenery is beneficial for you to start enjoying your walking. Sometimes I walk through neighborhoods to get gardening ideas, browse seasonal decorations or to pick pine cones.

Walk with purpose. Give yourself a goal for walking because "walking for health" is not enough. Dopamine doesn't care about logic. It only evolved for you to meet a goal and "health" is too abstract and long term of a goal to motivate anyone. You need a short term, immediate goal for dopamine to react when you succeed in acquiring it.

3. High cortisol is due to the dopamine acquired by more glucose in the blood stream.

This is another interesting statement about dopamine and metabolic adaptations. Basically, if I understand you correctly, you are stating that your body is creating more glucose, through high cortisol, in order for the brain to receive a "dopamine hit" since it’s no longer acquiring it from dietary glucose.

I suppose that if you could somehow change metabolic adaptations, to work primarily through dopamine rather than insulin/leptin, the premise might work. Though we know that the hypothalamic/pituitary/adrenal (HPA) axis is involved in metabolic adaptations, and dopamine is a part of that axis, it has not been shown to work the way you're suggesting.

When dopamine is spoken about in the context of glucose, it is in the taste of sweet, not sugar in the blood. So even though glucose in the blood has an effect on the HPA axis, this effect is from a signal of anti starvation. High blood glucose is a mechanism of protection against starvation, not a true "dopamine hit". The only dopamine hit associated with anti starvation would be chocolate cake.

4. I know someone who lost 200 lbs. but I can’t even lose 50. 

This is the result of leptin sensitivity. Just like money - some people have it and some people don't. Again, just like money, there are way more people who don't have it, than who do. Though everyone can "lose weight" most aren't able to lose enough, particularly body fat, to get to lean. That's why it is so fascinating to us when a person is able to lose enough fat to no longer be obese. They are the anomalies.

But surprisingly, there are still quite a large number of anomalies. This is why you can’t assume that all obese people are leptin resistant. Though most are, some actually aren't. For the ones who aren't leptin resistant, the moment they normalize their blood glucose/insulin, their leptin begins doing what it’s suppose to - burn excess body fat. For others, they either cannot ever normalize their blood glucose/insulin, to regain leptin sensitivity, or even when they do their leptin does not follow suit. No one knows the exact mechanism of why this occurs. This is why obesity is a "condition with no known cure".

Now the hurdle is long term success. Not only is getting to lean rare, but staying lean is even rarer. So many people who are able to obtain short term leptin sensitivity, enough to break their weight set point, are unfortunately unable to retain it. In fact, the ones who get to lean are the ones most vulnerable to weight regain. So super leptin sensitivity comes at a cost because it causes an even greater leptin resistance in the future. This of course happens to most, not all.

5. I have a friend who is always complaining about some health issue or another. They spend their days going from doctor to doctor but when they are given answers and possible solutions, they always doubt and question them so nothing is ever resolved. They have always been trying to "lose weight" but instead of following practical advice, like exercising for instance, they have instead always leaned towards fad/tabloid diets. I don't know what to tell them anymore but it's affecting my own journey since I'm getting caught up in their troubles.

I have unfortunately come across this often when dealing with the overweight/obese. I have noticed it is much more common in middle aged women.

Some people like to be "sick". I know that's a controversial statement but it's just a fact. For some people, dealing with "health issues" and "weight loss" is a hobby. They are lonely, bored and unsatisfied in their lives so they take it out on their body, instead of realizing it's their mind. Doctors give them the attention they crave and as long as they have "something to work on" they feel as though they have something to do. This is why they are drawn into short term fad diets and "miracle cures" instead of actually doing the work that it takes to reverse obesity. Short term protocols allow them to bond with others, who are in the same boat as them, and achieve immediate trivial "changes" disguised as results. Doing the actual work is far too difficult and long term. It is also a journey that has to be taken alone, not hand holding someone else. Worse still, if they actually succeed, what will they have left to do? A lot of these people don't want solutions, that's why they ignore the ones given.

There are people who are genuinely striving to improve themselves while getting bogged down by someone else who has this pseudo-Munchausen. A lot of people may not agree with the advice I am about to give you but it's solid advice none the less - the obese really need to stay away from the obese. Fat farms don't work. This is precisely why I don't allow comments recounting sob stories and new food lists to follow or avoid. Those don't help anybody and can be found in other blogs.

You are much better off making new friends at the gym, who are lean and active, than continuing to fraternize with people who have nothing to contribute but excuses, gripes, victim hood and coupons for the local buffet. Your active friends will be an encouragement, rather than a hindrance. In fact, I can tell you from experience, that the more success you obtain, the more you will realize you have nothing in common with these people any longer. It will become clear to you how obesity is rooted in behaviors and beliefs that you didn't even notice before but become very obvious as you get leaner. It's these behaviors and beliefs that will keep you obese.

So you can start dropping some weight, right now, by dropping them. It will be more than the five pounds their fad diets promise.

6. Because of the upcoming holidays, I was given a recipe by my endocrinologist for stuffed acorn squash. It was described as "low carb". All of these "low carb" people online would be horrified by this vegetable so I haven't wanted to share it in the groups I follow.

That's why you have to stay away from "low carb people online".

A cup of cooked acorn squash has about 22 grams of carbs. That falls within the parameters of a low carb diet as low carb is anything below 100 grams of carbs a day. So depending on how much acorn squash you eat, or what other carbs you have that day, it would fall in line with low carb as long as you don't go over 100 grams in a day. Of course, a cup of cooked acorn squash is practically starvation but would be fine as a side dish. This is something that has to be kept in mind when counting carbs in this manner. It is impossible to negotiate not starving while eating carbs at a benign level.

On this blog, we do not focus on the carbs of individual food items because 22 grams of carbs from bread are very different than from acorn squash as not all carbs are the same, just like not all calories are the same. This is because carbs are not just glucose, whether sugar or starch, but fiber as well. What you want to say away from is the glucose (sugar and starch). The fiber is irrelevant.

We also don't believe that a 0 carb diet is any better than a moderate carb one. We only believe in one thing - blood glucose regulation. The most profound effect to blood glucose regulation is obtained through carb elimination and restriction. To make this as easy as possible, we eliminate all sugar and grains while restricting everything else. Carb restricted diets can fall anywhere between "keto" to Mediterranean and your chosen one should be primarily based on how it affects your blood glucose regulation, not on how low it keeps carbs.

So instead of just giving you a "low carb" recipe, your endocrinologist should have advised you to monitor the effects this recipe has on your blood glucose regulation. To know that, you would need to measure your fasting blood glucose that morning and then your postprandial blood glucose, two hours after eating the squash. Then you would have to measure it again the following morning in order to see how you reacted to that meal. It's not enough to just check blood glucose after eating the squash. Remember, the goal is not to see that your blood glucose rose or not. The goal is to see how your blood glucose regulation is effected within a 24 hour period.

Just because the squash may not rise your blood glucose into the danger zone, it might rise it enough to cause large dips during the night which cause high blood glucose the next morning. Or if you are not diabetic yet, your blood glucose might not rise at all because your body is still able to control hyperglycemia through the release of enormous amounts of insulin, masking your blood glucose dysregulation. You will be able to tell this is occurring by seeing a postprandial dip in blood glucose instead of a high. You need to get off that roller coaster because dips in blood glucose means your insulin is being negatively affected due to blood glucose dysregulation.

You need to take your focus away from the squash and apply it to your blood glucose regulation instead. Putting focus on anything else means you are focusing on the wrong thing.

Six common beliefs addressed, Part 197

1. People who consume artificial sweeteners tend to be fatter than people who still use sugar.

I am not sure the statistics on this but if it’s true, it should not be surprising. When people consume real sugar, and are also health conscious, they tend to avoid it. This means they eat less sweet things over all, either because they are watching calories or sugar's effect on blood glucose. The people who use artificial sweeteners, tend to add them to everything, since they believe they are a "free food", as not only are they void of calories but also of any immediate effects on blood glucose.

There is just one caveat which they miss - There is no such thing as a "free food". The taste of sweet shifts the dopamine/leptin axis towards the conservation of fat, and the storing of more of it, irrespective of calories. This means that as long as there is a sweet taste more fat storage will occur, even on calorically restricted diets.

Many items which are sweetened with artificial sweeteners, like sodas, still have caffeine. Caffeine disrupts proper blood glucose regulation so the problem continues. 

2. Calorie restriction should no longer be recommended.

That will never occur. Over all calories are simply easier to track and the easier something is, the more it will be followed consistently. Calories are also easy to understand so it’s fool proof. Calorie restriction does not eliminate any food item so it's a much easier sell. This is why most programs take the calorie restriction route.

Aside from that, there are a lot of politics involved in advising people, especially from wealthy countries, to simply consume less of everything. There is a large group of people who believe in flogging as a means of achieving equity and relieving their psychotic level of guilt so ad libitum consumption of anything is always deemed a "moral flaw". 

3. If I’m already watching calories, why does my coach insist on prioritizing protein and empty foods like vegetables? Why would it matter where my calories came from?

Exactly. It wouldn’t matter one bit but calorie centered programs are well aware that calories don’t work so they pair calories with “healthy eating” to maximize their results. Of course, their healthy eating is usually nothing more than some iteration of a protein sparing modified fast.

They will insist this "healthy eating" is for "nutrients" but we all know what it is - a very effective way of manipulating the metabolic hormones responsible for muscle building, fat burning and appetite control through macronutrient composition, once again, since calories do not effect them at all. Macros still reign supreme in getting the body to loose fat and keep it off.

4. Meat based pizza crusts are a good low carb option.

You have to be very careful with these type of novelties as some of these recipes are extremely heavy on the fat content. Usually these crusts are mixed with cheese which is mostly fat, not protein. You must keep your macros in mind when consuming these items.

5. If a person is "eating healthy" they should not be obese.

Choosing "healthy" foods is an incorrect method of tackling obesity. This is because "eating healthy" does not resolve obesity as there are many "healthy" foods that still disrupt blood glucose regulation. For some people, "eating healthy" simply means avoiding fast food and candy. They don't deem something like oats, for instance, as unhealthy. There is much more to obesity than "unhealthy" foods.

So the solution does not lie in eating healthy or not. The solution lies in eating appropriately or not. These are two very different concepts. The only diet that is appropriate, is one that prevents/minimizes blood glucose dysregulation.

6. There must be a "cell" or hormone that causes people to prefer and seek out sweet tastes.

There is no particular "cell" that causes this. It’s mostly caused by exposure. The brain becomes trained to prefer the tastes it's exposed to over time. People who claim to have a "sweet tooth", have simply trained their brain to prefer sweet from eating it so much. They have also trained their brain to seek it out through a dysregulation of dopamine. So if you are going to single out any one hormone/chemical that would cause someone to "seek out sweet tastes", it would be dopamine.