Six common beliefs addressed, Part 217

1. There is no difference between a macronutrient centered protocol and a calorie centered protocol.

On this blog, we only recommend macronutrient centered protocols. These protocols restrict the calories of individual macronutrient (macros), to varying degrees, in order to create a specific macronutrient composition, irrespective of total calories. There is no total calorie deficit goal because these protocols usually do not restrict total calories. Don't get me wrong, some do, but not any that are recommended here.

With our recommended protocols you track your macros instead of total calories. This is completely individualized depending on the protocol chosen, current metabolic state, activity level, goals and body fat percentage.

Calorie centered protocols restrict total calories from all sources. These protocols are not proper treatments for overweight/obesity, and this is why they aren't recommended here. These protocols require calorie tracking, mostly through the weighing of food, as that's a more precise way of calculating calories. These programs do not focus on what macronutrient composition is used, as long as the "calorie budget" for the day is met. Calories and only calories are the metric used for weight loss. The metric that the overweight/obese need to use though, is blood glucose homeostasis and that's best achieved through macros.

Keep in mind, that some of these calorie centered protocols will sneak in macronutrient tracking as well. They mostly do this by recommending that you acquire your "calorie budget" from specific macronutrients, making them a pseudo version of a macronutrient protocol. This is because calorie centered protocols have had such a dismal success rate that they have tried to merge macronutrient tracking, along with calorie tracking, for better outcomes or they would go out of business. It's a way of admitting their protocol is a fail, while still saving face. After all, they can always chalk up their macronutrient recommendation to the fact that "you should be eating healthier anyway". It's smoke and mirrors though. If the protocol has added macronutrient recommendations, then that's what's causing any benefits obtained, not the total calories, unless the person has an eating disorder.

For this reason, do not pay an arm and a leg for calorie centered protocols because regardless of how fancy they are packaged, they are all basically the same thing. You shouldn't pay an arm and leg for any protocol but especially calorie based ones because they can be given to you free, by your dietitian or doctor. You can also find them everywhere online. Instead of that trainer or coach, get on Weight Watchers and Silver Sneakers. The result is the same and it's cheaper. The American Diabetes Association will even give you a program and menu to follow for free as well.

When choosing a protocol, you should first identify and determine what your goals are. Are you overweight/obese or do you just want to lose some weight to fit your bikini after a pregnancy? Do you have metabolic syndrome/diabetes, or do you just want to get in shape with muscle tone? Your goals and what your current issues are will determine what protocol would be best to follow.

Simple weight loss, muscle toning and/or muscle gain can be easily achieved through a calorie centered protocol, along with weight training. These protocols are easy, non-restrictive, only for the short term and can achieve your goals quickly when you are otherwise healthy. This is why they really don't require any true commitment unless you want to body build professionally.

But if you are tackling serious overweight/obesity/diabetes issues then you need a much more restrictive, long-term protocol, that will profoundly affect how your metabolism works. You need to give your metabolism way more information, in order to make this change, than just calorie input. This is because calories won't even scratch the surface of your problems. I think everyone reading this can attest to that from experience.

2. I don't understand what's going on. I was losing weight, and everything was going great until I started eating low calorie pre-prepared foods. I am staying under my recommended calories for the day but yet I am gaining weight. 

This is the reason we recommend macronutrient centered protocols rather than calorie ones. An overweight/obese person can have the same calorie meals as their thin counterpart and remain overweight/obese or even gain weight. They have to be in a perpetual state of starvation just to not tip the scales further, but this starvation never gets them to lean. In fact, it causes them to be more susceptible to further weight gain over time. This is because the overweight/obese are particularly sensitive to macronutrient composition, irrespective of calories because certain macronutrients interfere with their already failing blood glucose regulation. Calories do not affect blood glucose the same way.

Items marked low calorie like bars, chips, frozen foods, desserts, etc. all have the same macronutrient composition regardless of their calorie content. This composition usually goes like this – high in carbs, high in fats and low in protein. When they do contain protein, it is inferior plant-based protein. Technically more carbs. This equates to disruptions in blood glucose homeostasis, irrespective of total calories.

This macronutrient composition is the most obesogenic of all because it has prolonged effects on blood glucose and insulin expression. In fact, if you were to take the moniker - "you are what you eat" literally, then you can see you are actually becoming what you are eating. You are becoming mostly glucose (high carbs), body fat (high fat) and no muscle (low protein). You are also mimicking your favorite snack's calorie content as well. It has low calories, and you use no calories. You are becoming the living embodiment of your favorite low calorie snack.

Stay away from "low calorie" foods. Meeting your calorie goals for the day will not get you to slim. Millions have already tried that. You need to make sure you truly become what you eat by eating the macronutrient composition, you would like your body composition to mimic – mostly muscle (adequate protein), low body fat (moderate fat) and no glucose (low carb). Then your body will actually use its calories for you. So, when you sit down to a meal, make sure your plate looks like how you want to look.

3. What can I do to minimize the chance of getting Alzheimer's/dementia? It runs in my family.

Alzheimer's/dementia are beyond the scope of this blog but maintaining metabolic health will help you with all other conditions.

Some people have genotypes that cause them to have a predisposition for dementia. The best thing you can do help reduce your susceptibility is to keep your metabolic health on point. Metabolic syndrome, even in its infancy stage, begins to deteriorate how the brain uses its energy and increases oxidative stress which profoundly effects the brain. This is why glutathione, the most powerful antioxidant the body produces, has been shown to decrease the symptoms of neurodegenerative conditions when given in high doses.

Do not deplete your glutathione through the oxidative stress of metabolic syndrome because the more of it you deplete, the less your brain will have for its everyday requirements. Keep your metabolism functioning correctly.

4. My C-Peptide has been slowly dropping with time while on low carb. In fact, it is now being flagged red. My blood glucose is perfect and so is my HbA1C. I feel great. 

I cannot interpret lab results for you. Only your healthcare professional can diagnose you and offer a treatment plan. On this blog, we can only give general information on metabolic panels. For this reason, I am going to reply to this question with general information for you to discuss with your doctor.

C-Peptide is a gauge of how much insulin is being produced in the body and so it can help you determine how your body is handling its blood glucose. C-Peptide is usually ordered by an endocrinologist, either because they suspect an issue, or you have been already diagnosed with Type I or Type II diabetes or are at risk for either one.

A low C-Peptide can mean that your body is not making enough insulin either because of Type 1 diabetes, Addison's disease or a disorder of the adrenal glands. But it can also mean that your body does not have much need for insulin because your blood glucose is always normal. This is why, you have to discuss your results with your doctor because they can be either negative or positive, depending on other factors. Numbers are meaningless without context and nuance.

I can only give you general information on Type I diabetes. If you have been having regular medical screenings, you would have already been diagnosed with Type I diabetes. Especially if your C-Peptide has been lowering over time. You would have very high blood glucose, a very high HbA1C and high ketones. All of these would have been easily seen during routine blood work. You would also have other nasty symptoms, including significant and unexplained weight loss.

Type I diabetes is the result of an autoimmune condition, but it can also occur after long term Type II diabetes. If you have none of the blood markers or symptoms of Type I diabetes, then this low C-Peptide is the result of something else and I am sure your healthcare provider will explain this further to you or screen you for different conditions if he suspects it's warranted.

In the absence of any preexisting condition, a low C-Peptide can simply be the result of a low carb diet. Low carb diets help keep your blood glucose low, so you do not require much insulin. This means that a low C Peptide would mean your body is doing exactly what it is supposed to do. It is not producing much insulin so that your blood glucose does not drop too low.

5. I keep thinking that I’m losing weight, then it feels like I gained weight. All of this because of my clothes. Sometimes they are tight, sometimes they are loose. I’m going crazy.

This has to do with water retention causing bloat. It can be caused by multiple things from digestion, hydration, hormonal fluctuations, being sedentary, etc. This water retention can be very significant and can affect the way your clothes fit.

6. "Keto" is right for lipedema.

It can be if it’s done correctly, but "keto" is not a protocol specifically for this condition. It is primarily a metabolic intervention. Because of its benefits to metabolic health, you may see secondary benefits in other conditions.

Six common beliefs addressed, Part 161

1. Diet is the only thing that determines if you will become obese. 

Obesity is caused by a disruption in blood glucose homeostasis which disrupts metabolic hormones. This can result from anything that interferes in normal blood glucose regulation. Certain diseases, medications, etc. can contribute to this dysfunction which leads to obesity. Anything that disrupts proper blood glucose regulation can be the culprit.

But for the most part, the most common disruption in blood glucose regulation is the result of diet. This is the case for all common metabolic conditions from metabolic syndrome to diabetes.

2. I recently had a wisdom tooth pulled. I have had wisdom teeth pulled before and the pain and recovery time has been horrendous. This time I suffered no pain and no inflammation. I even had antibiotics, along with a probiotic, with no issues whatsoever. 

When you better your metabolic health, you become much more resilient to other conditions that may present themselves. If you already have lower inflammation and better blood glucose control, then when the body experiences stress from illness or injury, it can better handle it and you lower your risk of complications. You have less reactions to antibiotics and if you have to consume a liquid meal or be on an IV, which may contain ingredients you wouldn't usually consume, you will experience less of a set back.

3. When Type I diabetics break down their body, and everything they eat, into glucose they become emaciated if it's not stopped but Type II diabetics can break down their body, and everything they eat too, but remain obese. 

Catabolism from glucagon "gone wild" should produce the same results in Type II as it does in Type I, because they are both suffering from the exact same thing. So why doesn't it? After all, Type IIs can run a blood glucose of 400 - 500 mg/dL and up, chronically, and not waste away to anything at all. What gives? The answer is in their insulin function commonly described as "insulin resistance".

Type Is have no insulin whatsoever, so they don't have insulin resistance. Type IIs have insulin, in some cases too much of it, but it doesn't function properly causing a condition referred to as insulin resistance. Because of this, in a Type I their entire body melts into glucose and ketones but in Type II their lean muscle mass alone, melts into glucose and ketones. Their fat mass is always spared as their insulin function spares their fat mass, above all else. This is a hallmark of insulin resistance. 

For a Type II insulin function is as follows:

• Under release of insulin to halt chronic catabolism into glucose and ketones (glucagon).
• Over expression of catabolic hormones on lean muscle mass (cortisol).
• Under expression of catabolic hormones on fat mass (leptin).
• Insulin action is over expressed in storing fat and preventing its loss.
• Insulin action is under expressed in getting glucose and nutrients into other tissues.
• Insulin action is under expressed in its anabolic effects on lean muscle mass.

As you can see, insulin function effects other hormones as insulin is sort of like the conductor in an orchestra.

So a Type II diabetic is not only a person who might have very high insulin but a person who always has abnormal insulin function. A Type II diabetic's insulin is primed and honed for only one specific task, at the expense of everything else, - the building and preserving of fat mass. So it doesn't matter how much the body catabolizes itself, it never catabolizes its fat mass. For this reason, a Type II diabetic will never lose a pound of fat from this exaggerated catabolic process unless their disease progresses to Type I from pancreatic beta cell failure.

4. Many people with lipedema and/or lymphedema frequent obesity discussions because they claim their conditions are a "type of obesity". 

Lipedema is not obesity nor is it "metabolic" in nature. No one knows its exact cause but it appears to be related to female hormonal changes and/or imbalances. Only about 11% of women are affected by this. For these reasons, it is not subject matter that I discuss on this blog. I know a lot of people like to jump on the bandwagon so people with lipedema are very active in obesity groups. This is where many of these groups begin to lose focus as people with this condition usually have a very difficult time exercising which is a necessary part of any protocol that treats obesity. That's where the concessions begin. 

So the best source of information on this condition is your doctor and/or specialist. There is nothing that I can advise on it as I can't make concessions for this particular ailment. The only thing I can recommend is to try to live a lifestyle that keeps female sex hormones in homeostasis. An anti obesogenic lifestyle would be a good start to achieve this. Having said that, I will briefly give an overview on these conditions for those who are curious. 

• Lipedema is a condition where fat is distributed in an irregular way, usually in the buttocks and legs, causing for the lower body to grow heavy, become tender and even bruise easily. Hence the female hormone suspect, as this is the main pattern of fat distribution in females. This large bottom half will obviously limit mobility.  
• Lymphedema develops when this excess fat blocks the lymphatic system and prevents proper drainage of lymph fluid. This can lead to complications such as infections and non healing wounds. This requires treatment with invasive procedures. 

Like I have said many times prior, just because someone appears "fat", doesn't mean they're obese. Just because someone "gains weight" doesn't mean they're obese. Obesity is an adaptive metabolic state where the body stores and spares body fat beyond its threshold, usually around the middle/central region. This is the result of metabolic syndrome. 

5. If you can't swallow pills, you should still never take gummy vitamins because they have carbs.

First, if your can't swallow pills, you will have a hard lot in life. Outlying situations like these, cannot make the rules for others, as I mentioned above in the question about lipedema. I do not make concessions on this blog. We give advice on the treatment of obesity/metabolic syndrome. There is nothing I can do if something hinders you from following the advice given. The advice does not change. 

Second, we don't "count carbs" either. It is a useless practice that does nothing to treat obesity/diabetes. What you need is an overall low carbohydrate, whole foods diet. Counting the carbs of single food items is not going to cut it. There are many items that have zero to low carbs and are still very obesogenic, depending on how they are eaten. So an anti obesogenic diet is not about carb counting but about overall macronutrient composition, food quality, meal timings and general eating practices. That gummy vitamin is not going to treat your metabolic condition but it is also not going to contribute to it. 

Third, and this part was unsolicited in the statement but I will add it anyway. "Gummy vitamins" are generally not good quality vitamins. You are basically paying for a bottle of "sugar in small doses". When you buy a vitamin you have to make sure that it is bioavailable so they should always be coenzymated. This means the vitamins are bound to the enzymes needed to break them down. This causes your body to actually absorb them, rather than just pee them out. The majority of deficiencies are not caused from "lack of vitamins" per say, but lack of the enzymes needed to get them into cells, either because of some genetic problem or some other chronic condition. 

All minerals should be chelated. Chelated minerals are bound to an amino or organic acid, so they don't require as much stomach acid to be efficiently digested. Most people are deficient in minerals because they cannot break them down due to low/insufficient stomach acid. 

You also have to make sure that you stay away from certain supplements such as "folic acid". Folic acid is a synthetic form of vitamin B9 (folate). It tends to build up in the body and cause issues over time. There are other supplements that pose this same issue because they are synthetic as well or they must be taken alongside other supplements to prevent issues. 

So research your supplements carefully and don't just go to the local pharmacy to pick up a bottle of whatever they have. At best, you will be wasting your money and possibly not treating your deficiency. At worse, you could be harming your health. 

6. I was following "keto" and lost 30 pounds. I felt great. I have now come across "The Proper Human Diet", which I am currently learning about, but my numbers keep going up.

First, I don't know what anyone means by "keto" but since you are now "learning" about "The Proper Human Diet", I can only imagine it was some type of fad protocol you found online. This tells me that you most likely jump from one diet to the next and aren't committed to any one of them. Of course, in this case, you might have done the right thing by dumping "keto". Unfortunately, you remained in the garbage pile and picked up yet some more junk. 

I have said it before that there is no "proper human diet". There are only marketing slogans and improper human diets of which there are only two - vegan and the Standard American Diet (SAD). That's it. Everything other than those two goes. In fact, humans are so adaptable, to any diet available, that they can make vegan and SAD work for them under strict conditions (i.e. supplementation, caloric restriction). These conditions can at least make these diets work for a very long time before they fail. So we have cleared that nonsense. 

Second, people who have overweight/obesity or any level of metabolic syndrome, including diabetes, do better on a carbohydrate restricted, clean diet of meat and above ground vegetables only. This doesn't mean that's the "proper human diet", it just means it's the best diet for someone who has metabolic dysfunction. This is because they can get a better handle on their blood glucose regulation when following this type of protocol. Blood glucose dysregulation is what causes metabolic issues to begin with. Diet has a huge effect on blood glucose regulation so it makes sense to target the problem with diet. 

There are no gimmicks to following a carb restricted diet. You simply eat meat and above ground vegetables. That's it. Meat and above ground vegetables basically becomes a low carb, moderate fat, adequate protein diet. This is the best macronutrient composition for the metabolically dysfunctional. There is no "learning" involved in this. 

Third, I recommend you get your mental health in order before you embark on any diet because you are displaying a very common behavioral issue of the obese - diet mongering. You just keep trying every single diet you come across and since there are multiple reasons for this, I won't guess what yours are. I will tell you this, metabolic dysfunction requires a long term treatment. For a treatment to be long term you must be committed and consistent with it. You shouldn't be looking for a protocol on every click bait title that comes across your screen. You need to actually think through a protocol and see how it fits your lifestyle and goals. 

Fourth, this isn't just about eating. You need to tackle other lifestyle issues that can interfere and hinder progress such as your behavior, described above, exercise regimen and systemic stress reduction.

Six common beliefs addressed, Part 158

1. Lean protein "spikes" insulin more than fatty protein.

On this blog, we do not focus on insulin "spikes". People with metabolic syndrome/diabetes do not have a sufficient insulin spike, as they have impaired first phase insulin release. For this reason, their insulin never spikes high enough to stop catabolism and they end up releasing an enormous amount of glucose after eating (hyperglucagonemia), which affects their insulin expression further. For this reason, we care about obtaining proper insulin expression, which is what corrects this abnormality.

All proteins spike insulin the same. The fat in fatty meat simply makes this effect less obvious and causes for insulin to be released for a prolonged period of time afterwards, as insulin is required to store fat. You never want prolonged insulin release especially when the only part of your body that is insulin sensitive is your fat mass. You want an initial high spike and then low insulin levels while fasting. In order to obtain proper insulin function, you need for insulin to work as it was intended - in pulses. High insulin when eating and low insulin when fasting. Not chronically higher than normal insulin, that never gets high enough or low enough when it's suppose to.

So if you have excess fat on your body, lower your dietary fat intake to no less than 50 grams a day. You want to prevent insulin from continually acting on your fat mass. You want to divert its action to your lean body mass instead. That's acquired through protein intake and proper exercise, not fat intake and sitting around. Protein builds muscle and fat builds fat.

2. I eat low carb but I keep having a "low blood glucose feeling" a few hours after I eat.

This is the body's way of preventing blood glucose from lowering.

Metabolic syndrome/diabetes are adaptations towards hyperglycemia. As long as your blood glucose is above 70 mg/dL, there is no need to intervene. If you continuously respond to these feelings by trying to raise your blood glucose, you will never be able to obtain normal blood glucose regulation.

3. You can do a 16/8 fast and instead of two meals, have one meal and a few snacks during your eating window. This is better than one meal a day (OMAD).

People always want a definitive answer on eating habits but there are none. It all depends on your hormonal reaction to them. We know for sure that OMAD is not a good protocol for the obese because it prolongs your time in hypoglycemia (fasting). You can't treat starvation with more starvation. But, if you want to swap out one of your two meals, for one or two smaller meals, then the outcome is not certain. It all depends on how this would affect your blood glucose regulation. For some, having one meal and a couple of small meals, during their eating window, works better than two meals because their leptin sensitivity responds to this and can even improve. But there are issues you should keep in mind when doing this.

"Snacks" usually consist of novelties. In the low carb world this means a bunch of low carb "junk" like seeds and/or nuts, nut butters or some silly "keto" sweet recipe or bar. There is no room for any of that in a proper protocol. All meals/snacks should be protein prioritized.

So instead of the typical "snacks", I suggest you have one meal and one or two smaller meals, during your eating window. A small meal can be a salad with some tuna or a can of sardines or a couple of boiled eggs. That would be perfectly fine but "a couple of small snacks" is not how you should be eating.

4. Will "keto" cure leg edema?

First of all, no one knows what is causing your leg edema except for you and your doctor. I am pretty sure that your doctor must have given you some explanation as to why your legs are swelling. If they haven't, then you have to have a discussion with them for answers or get a second opinion. Until the issue that is causing the edema is addressed, the edema will continue.

"Keto" diets will only help with edema if the edema is being caused by very high insulin levels/over expression, which retains a lot of fluid. It cannot address any other type of edema like the ones caused by congestive heart failure, kidney failure, lymphatic system dysfunction, etc. Those require additional treatments.

5. If the person is carnivore, the body will never choose to burn protein instead of fat.

The only time the body will burn protein instead of fat is during starvation. Obesity is starvation. Diabetes is starvation. Both conditions prevent you from accessing the body fat you already have, and are continuously putting on, so you burn muscle (protein) instead. This is why obesity is sarcopenic. You're being starved of your body fat and you're being starved of your glucose because it's only using it to make more fat that can't be used.

The more metabolic issues you have, the more exaggerated this effect will be since metabolic issues are starvation adaptations. Metabolic syndrome is a condition where the body spares its fat mass and burns through everything else. It doesn't even burn it for fuel, it simply converts it all into more fat for further storage like I described above. This occurs primarily through leptin under expression amongst many other things.

This is precisely why we don't believe that "the body is not stupid enough to burn its muscle while having plenty of fat around". The body does just that. Daily. The body under expresses leptin during starvation because fat is extraordinarily valuable for it. Leptin is fat's keeper. So conditions like diabetes, metabolic syndrome and obesity are conditions that always under express leptin as these conditions are body fat sparing.

This process contributes to obesity and it doesn't occur primarily from the protein you eat, but from the constant conversion of the protein already in your body. This always results in storing more fat than you're burning as you don't really have access to what's stored. 

• The more lean muscle mass and dietary protein you break down into sugar, the fatter you become by volume. You are not building nor repairing the little muscle you do have left and this directly affects calories in.
• The more your body holds on to its fat mass and instead burns glucose, the less effective metabolism runs and the fatter you become by proxy. This is what causes the lack of energy and directly affects calories out.

The first instinct is to reduce or eliminate dietary protein so that the body stops converting it into glucose and the symptoms can be hidden. But like I stated above, the conversion into glucose itself is not the problem. It's that the body continues to do this, in an unregulated way - that's the problem. People with metabolic syndrome/diabetes actually need more protein so they don't continue losing so much lean muscle mass and they need to correct the underlying problem which is basically caused by poor insulin function.

So if this is happening to you, make sure the carnivore diet you are following is not causing starvation. Follow legitimate protocols only. Here is the carnivore protocol we recommend.

6. There are no supplements that can help lower high triglycerides naturally.

Omega 3s. A fish oil capsule can help naturally lower trigs but it's not guaranteed as some people genetically have higher than normal trigs.