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.

Six common beliefs addressed, Part 117

1. You should eat as close to "zero carbs" as possible. 

No. That's not necessary. You eat up to your carb tolerance, which is solely measured by their affects on blood glucose. 

2. High ketones mean you are more "insulin sensitive". 

No. Ketones are the byproduct of fatty acid metabolism. When you mainly burn fat, you produce ketones, at least for a short while. Soon, the ketones become undetectable as the body better utilizes fat and less byproduct is produced. So, technically, if you are measuring ketones it's because you are less insulin sensitive. This is why diabetics can produce ketones very easily. Their insulin function is just not good enough to control ketone production very well. 

For this reason ketone measurement is useless as a marker for metabolic health or the treatment of obesity. 

3. Lean proteins "become sugar" in the body and block fat burning.

When you consume proteins, lean or not, it raises insulin and the body compensates by releasing blood glucose. Glucagon is the hormone responsible for this. In a healthy person this process is well regulated. In a person with metabolic syndrome/diabetes, they do not release enough first phase insulin to halt the overproduction of glucose by glucagon and this is referred to as hyperglucagonemia. 

This glucose is not coming solely from dietary protein. The dietary protein is not "becoming sugar in the body". That's silly. The glucose is coming primarily from the breakdown of your own lean body mass. If carbs are added to proteins, hyperglucagonemia is somewhat "hidden" because carbs cause a higher spike in insulin from the added glucose load. 

So, basically, the problem is not protein, it's metabolic syndrome. Lean protein has nothing to do with this. The halt in fat burning caused by hyperglucagonemia is temporary, unlike with carbs. It can be easily controlled by dividing your daily protein intake into three meals.

4. Is the yolk the best part of the egg?

The best part of the egg is the whole egg. 

5. You should select food with the highest fat content.

Yes, if you wish to remain fat. But, if you want to have a chance at being slim, you should select food by its protein content. 

6. You should "fat fortify" your food. 

Yes. If you want to join the person above, who wants to choose foods with the highest fat content, and remain fat or possibly get fatter, then go ahead and fortify at will.

Six common beliefs addressed, Part 8

1. Can I "hack" my way out of obesity?

There are no shortcuts and no "hacks". The only way out of obesity is through proper blood glucose regulation.

2. Should I only eat egg yolks and not the whites?

It is unnecessary to eat egg yolks on their own, just like it's unnecessary to eat egg whites on their own. Eat food whole, as nature intended and do not alter it.

3. Are carbohydrate restricted diets ineffective, because blood glucose rises when carbohydrates are reintroduced?

Only in the anti low carb world would this even be considered a logical expectation. Carbohydrates will always rise blood glucose. All foods rise blood glucose. Carbohydrates simply cause a higher and more prolonged rise. Carbohydrates rise blood glucose in the healthy as well but the healthy are able to sustain blood glucose regulation, in spite of these rises. Over time though, the rises eventually degrade insulin function and they become unhealthy too. 

The definition of effectiveness is the remission of metabolic abnormalities; no longer living under the threat of diabetes; prevention (not delay) of diabetic complications; maintaining a healthy weight and living a life free of health problems, treatments and loss of mobility. Carbohydrate restriction can achieve all of these, so it is completely effective. 

Effectiveness is not defined by eating a piece of cake and not seeing a rise in blood glucose. That is impossible. The purpose of carbohydrate restriction, as an intervention for metabolic dysfunction, it's not meant for you to be able to eat candy again. Candy is not food.

4. Will not eating carbohydrates make you insulin resistant?

Someone who has been on a low carbohydrate diet, for a very long time, can see their blood glucose rise abnormally when they eat carbohydrates. This is known as "physiological insulin resistance" and it's an extremely complex topic that goes well beyond the scope of my blog and of which little is understood. Low carbohydrate diets have simply not been studied long term, in a large population, to know every nuance associated with its effects.

A lot of people make the claim that having no exposure to glucose causes "intolerance of glucose", but gluconeogenesis negates this premise. The body makes its own glucose, so you are exposed to endogenous glucose daily and your body is not responding negatively to it. Furthermore, metabolic abnormalities have been reversed by restricting dietary glucose, so the disease process can be halted. Everything is going in the right direction and this blood glucose rise only seems to happen when a fattening carbohydrate (grain and sugar), which you shouldn't be eating anyways, is re-introduced. What's causing this physiological insulin resistance?

The widely accepted explanation is that this effect is caused by "adaptive glucose sparing". It is a protective response of the body, as it adapts to a limited supply of glucose, only acquired through gluconeogenesis, and spares any excess, exogenous glucose for the brain. In order to do this, the rest of the body refuses to accept the incoming glucose and you will see blood glucose temporarily rise.

Another explanation is that the enzymes used to metabolize glucose are temporarily low, from lack of exogenous glucose exposure. They need time to build back up, so the initial exposure leads to temporary high blood glucose levels, as there aren't sufficient enzymes to break glucose down. After a few days of carbohydrate exposure, this effect disappears. It is believed the same thing occurs when the diet becomes predominantly fat based. The "keto flu" would be the result of the body's lack of fat metabolizing enzymes, so the inability to break down this fat, causes unpleasant symptoms until you become "fat adapted".

Still another explanation is that the body is in a catabolic state of low insulin. It would be extremely easy for the body, in this state, to quickly break down dietary carbohydrates into glucose, causing temporary high glucose levels, until insulin "catches up" and slows down glucagon.

I don't favor any explanation over the other. For all I know, they are all true and physiological insulin resistance is a little bit of all three. What we do know is that this condition is not pathological. In other words, it is not a disease state and does not lead to disease.

Another thing we know, very well, is that carbohydrate centric diets, at least in the context of Western society, do and will lead to metabolic disease. That's a fact. Everything in between is left for interpretation by the blogosphere, but does nothing to better your health. So, it's best to stay focused on what's actually known.

5. I have reached goal weight, but believe I can lose more. My body refuses to continue cooperating though.

What we deem to be our ideal weight and what our bodies want to do can be completely different. The body knows how much weight it needs to loose.

As long as your waist measurements are healthy, there is little else you can do to force the body to continue losing fat. At this point, people are usually trying to lose subcutaneous fat, but this fat is protective and some people tend to have more of it than others. These differences are caused by gender, age and genetics.

You can certainly use exercise to tone and firm up, but once you reach your correct weight and waist size, let your body be. You don’t want to cause it undue stress by trying to become smaller. This can cause you to follow starvation diets or perform strenuous exercise, which can cause irreparable harm to the metabolism.

6. Can I eat junk food and desserts, as long as they are "keto" or "low carb"?

If your goal is to be as fat as the person giving you the recipe, then yes. If your goal is to be slim, then no. You can't eat junk and achieve better health. The Standard American Diet has already proven that.

Junk food, regardless of the diet, has a pathological effect on blood glucose homeostasis and this is what you want to avoid.