Six common beliefs addressed, Part 273

1. I was diagnosed with diabetes some years ago and back then they tested me for fatty liver. My results were negative. Recently, they tested me again and they are now positive. I don't understand how this is possible if I have been eating low carb since before I even developed diabetes. Is there a way I can reverse fatty liver? Will eating low fat help?

It is not enough to just "eat low carb". I don't even know what you mean by "low carb" as this has different meanings depending on who you ask. You would have had to let me know what your exact protocol is.

Either way, the purpose of eating low carb is to be able to regulate your blood glucose properly. If low carb has not accomplished this, either because it hasn't been followed correctly or consistently or because of some other issue that's interfering with your blood glucose, then the condition will progress unabated. Metabolic syndrome, like diabetes, is chronic and progressive unless it is treated properly to achieve reversal or remission.

If you had been eating low carb since before you developed diabetes and now you have fatty liver disease, it means that you have not been treating the condition effectively. Your blood glucose regulation was never normalized and the pathologies associated with metabolic syndrome have occurred (i.e. diabetes, fatty liver disease).

Fatty liver disease is caused by alcohol, a viral infection or fructose consumption. Low fat diets do not treat fatty liver disease. The only diet that has been shown to reverse fatty liver disease is a ketogenic diet (no sugar) but you are now diabetic and unless you can regulate your blood glucose correctly, a ketogenic diet is not going to help you.

Diabetics will develop fatty liver disease over time because the liver is converting the glucose, released from their own body, into fat which it then stores within itself. It is very difficult to reverse this once you are diabetic unless you can be on a medication that can keep your blood glucose well regulated, 24/7, for the long term. A lot of diabetics are refusing medications because they think they can resolve this themselves. They can't. In many cases, particularly once the person is diabetic, low carb is a supportive treatment alongside diabetes medications.

2. I am still fat even though I eat very low carb. I have not been able to lose a single pound.

Fatness is determined by how well you can regulate your blood glucose not by how you eat, what you eat or how much of it. In other words, the amount of fat on your body is a direct reflection of your blood glucose control. This is why anything that affects blood glucose will cause body fat to increase or decrease.

Like I explained above, eating low carb is not enough. You have to make sure that your low carb diet is actually effective by monitoring your blood glucose. When you monitor your blood glucose, you can't be complacent with a simple postprandial "lower reading". Lowering your blood glucose is not going to cut it. You need to make sure your body is regulating its blood glucose correctly. This means it doesn't make excess glucose when its not needed and it makes enough when it is. You have to take fasted and postprandial readings, watching the disparities between the two closely.

3. I am a 70 year old diabetic. I am in the beginning stages of the disease and have no complications. But I have very intense gut issues. The doctors have not been able to help me nor have they even figured out what it could be regardless of the amount of tests they run. The only thing that relieves my symptoms is eating bread. I am following low carb though so I don't know what to do. I have developed a paranoia of carbs.

At 70 years old, you shouldn't be stressing this much over this. It is impressive that you made it to 70 with no diabetes complications.

Low carb is an umbrella term that covers many different types of diets. At your age, you would be fine following a simple Atkins style diet where bread is allowed as long as you don't go over 100 grams of carbs a day.

You have to decide how you want to live the rest of your years - obsessing over carbs or reducing these gut symptoms. I would be focused on reducing the gut symptoms because they will make the years you have left a nightmare. Diabetes is slow and you can slow it further by simply reducing carbs. You will be long gone by the time diabetes becomes a significant problem.

4. What do you think of 'Panera Bread'? I'm always told it's healthy. Can I eat low carb there?

"Healthy" is subjective. At this juncture, healthy is generally believed to be anything that isn't a candy bar so take the word "healthy" with a grain of salt. On this blog, the true definition of healthy is something that does not disrupt your blood glucose. As long as it does not disrupt your blood glucose, we don't care if its made by Kellogg's or Whole Foods.

You can eat low carb at just about any restaurant in existence. I suppose the only place low carb would not work is at a candy store, unless its a candy store that only uses artificial sweeteners. Other than that, you can modify your meals to be low carb anywhere. So the only question left for your chosen place is - "Is it worth it?" At Panera Bread it is most certainly not.

Panera Bread sells, well mostly bread and other baked goods. Other than that it's really a soup and salad place that happens to also serve coffee. Almost every soup they sell has carbs in the form of sugar, grains or starch. Salads are basically air. Air is starvation. So the food at Panera Bread can be described as starvation with a side of sugar. This is detrimental for the obese because it will be very difficult to regulate blood glucose while starving and eating sugar at the same time.

Another issue with Panera Bread is that their protein is served in child portions. In fact, it's hard to find another place that is more protein restrictive than Panera Bread. You can try and double the protein on a salad but expect to pay a lot for not very much, as even doubling the protein still leaves you with a pretty small portion since they started at such small portions to begin with.

So Panera Bread will not give you much bang for your buck. It's expensive and you will be left hungry. This means you will end up spending double because you will have to go eat somewhere else later and you will probably be hypoglycemic by then.

5. Is it true that all grains have gluten?

Gluten is irrelevant for the regulation of blood glucose as gluten in grains is not what disrupts your blood glucose. Their starch is the culprit, since starch is technically glucose. 

But this whole gluten hysteria is the same thing that occurs with low carb. It goes like this - "Some people have an immune response to gluten. Gluten is found is certain grains. Therefore all grains are bad and if you eat them, you will die instantly. Not eating them will also cure all the diseases you currently have." In low carb it goes this way - "Eating carbs make it very difficult to regulate your blood glucose. Therefore all carbs are the devil and if you eat them, you will die instantly. Not eating them will also cure all the diseases you currently have." Conflation and hyperbole at its finest. Why the human psyche makes these leaps is unknown but at the end of the day, it won't help you one bit. All of this conflation and hyperbole is causing you to lose site of the initial factual statement, which could actually help you solve what ails you.

When the word gluten is used, it is referring to gliadin specifically. Gliadin is a protein component of certain grains like wheat, barley and rye. Other grains such as rice, corn and oats contain other types of proteins which are not gluten. People who are sensitive to gliadin (gluten) may or may not be sensitive to these other plants proteins as well. In fact, people who are sensitive to gluten may be sensitive all plant proteins. This is something the person has to determine through nutritional testing and symptom triggers.

6. Is McDonald's really as evil as people make it out to be?

When a corporation becomes as large as McDonald's has, it is going to rack up quite a number of enemies along the way. McDonald's has been blamed for just about everything, from questionable employment practices, environmental assaults, poverty, small business destroyer and of course, obesity. The obesity blame is mostly due to the fact that their main selling product is burgers and burgers are beef and fat. Vegans and animal rights activists absolutely hate beef and animal fat. So McDonald's is personal non-grata on earth. Well, at least in the First World where everyone likes to think of First World problems.

But McDonald's is simply a meat and potatoes fast-food restaurant. They sell burgers and fries. Can this be blamed for obesity? Well, it certainly contributes to it when the burgers and fries are being served the "fast-food way". The "fast-food way" is not so much fast as it is cheap, or rather cheaper than a diner. McDonald's gives you a sliver of beef on top of a mountain of bread and a bucket of fries. This makes the meal cheaper but ultra high carb. Add a soda to that, particularly from a fountain machine which adds more sugar to it, and you are on the road to becoming 500 lbs. Don't forget the sugar-laden condiments and sauces to top it all off.

So the problem with McDonald's is not any activist's or interest group's gripes or that they serve "junk food" but that McDonald's interferes with proper blood glucose regulation due to the carb content in their foods. That is all. This is also not exclusive to McDonald's. All fast food places are the same and so are diners and restaurants. The only place that will prioritize protein, eliminate carbs and control fat is the food served at home, where you are in control.

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 245

1. I eat the same foods daily, but I continue to be overweight. I have chronic and severe irritable bowel syndrome (IBS) so my diet is always the same daily.

Once you are low carb and following your protocol consistently, we don't nitpick it because whatever is going on is not diet related. Changing one little thing in your diet, here and there, is not going to make much of a difference. So, you would have to revisit your diet, which you did not describe, and identify other factors that could be contributing to your overweight.

2. I think that all those who started on that fat-chugging "keto" diet will never stop because it was their ticket out of Type II diabetes. They used the fat as a replacement for medications. Soon it will fail for them, and they will be right back to where they were before. I was also very strict when I started a low carb diet, many years ago, because I lost 60 pounds on it. I followed it religiously and then I gained everything back and I am now diabetic. No matter how strict I followed it, I still ended up here. Is this the case for all diets?

Well, let me break this down a little because there are a few misconceptions here.

First, the fat-chugging "keto" crowd never got a "ticket out of their diabetes". They only got a ticket to continue eating in a disordered way. The vast majority of these people have eating disorders and fad "keto" simply allows them to eat as much as they want as long as it's from the "allowed foods" list and that's basically one food - fat. They won't leave their fad diet because they are using fat as a replacement for carbs, not medications. The most they ever achieved was lower postprandial blood glucose.

Second, they won't "soon fail". They already failed. The most these people have been able to do is lower the dose of their exogenous insulin or get rid of it all together since insulin is basically an end-stage medication for the management of diabetes so any improvement in the condition will do away with insulin injections first. Some have been able to reduce other medications they were on because they were on a slew of them. Again, any improvement in their condition will have to eliminate some of those medications or they will have a deadly drop in blood glucose. Most of those medications were being taken to counteract the dietary glucose they were consuming. Get rid of that dietary glucose and you get rid of those extra medications, but the diabetes remains.

Just because you are off a medicine cabinet full of medications and your blood glucose meter reads 170 mg/dL instead of 300 mg/dL and your doctor tells you your HbA1C is "below what would constitute a diabetes diagnosis", does not mean you aren't diabetic any longer. It just means the high glucose symptom of the condition is not showing up as much as it was before.

Diabetes is not a disease of high blood glucose. It is a condition that tries to keep your blood glucose high so that is only one symptom of it. By the time it gets to that, you're at its end stage. Most of these people don't get that. They are following buffoons that only like throwing out scary words at them like "amputation", "fatty liver disease" and "dialysis". It's a cult where the leader must always espouse dooms day scenarios to keep their flock.

Like I have said many times before - diet is only a palliative treatment for metabolic disorders. It helps reduce symptoms and allows you time to take some control over your lifestyle and try and put the condition under remission, but it doesn't cure anything. The disease continues. So, you can be strict all you want with your diet, the disease is still looming if you aren't addressing other lifestyle factors that contribute and put you at risk for its progression. One of those lifestyle factors is following quackery. Quackery puts you at risk for the condition's progression.

That's what happened to you. You thought that strict diet adherence was all that was needed to cure your "diabetes" and you now had a very rude wake up call. This is precisely what I'm trying to prevent with this blog.

3. I lost enough weight to get to lean in the beginning, but I gained some back and I am now overweight. I have not been able to lose weight again, but I am also not gaining. I just hate that I couldn't remain lean. I have come to the conclusion that I will never be lean again, no matter what I do. Can I remain healthy even while being overweight? I don't want to have the same fate my parents did.

I've addressed this question before, but I will reply to it again since it's so common.

Overweight/obesity are only markers for metabolic problems. Canaries in the coalmine. They are symptoms of an underlying problem as overweight/obesity are not anymore normal than cachexia/anorexia. When you start putting on excessive body fat and sparing it, it means that your metabolism is under some type of stress. This is usually the first symptom of an impending problem. The stress is blood glucose dysregulation.

People can be overweight for a very long time without developing any other metabolic pathology. Once it gets to obesity then things do not stay benign for long. Hence the term "morbid obesity".

But overweight/obesity are not the be all/end all of metabolic dysfunction. If you are doing what you are supposed to do to address your health problems and you have gotten below obesity, but are still overweight, you can remain relatively healthy for a very long time. No one knows just how long but you aren't in any immediate danger.

What we do know is that the metabolic issues causing the overweight/obesity do not halt there. They continue to progress towards pathology. This is especially true with increasing age as metabolic dysfunction is a time dependent disease. It's not so much that your body is failing because you are old but rather the older you are the longer you have lived with this abnormality and so it had plenty of time to progress to its end-stage while you are still alive to witness it.

For this reason, always keep in mind that as long as you're overweight, your metabolism is abnormal, and you aren't 100% healthy. You have to be more vigilante with your diet, exercise and lifestyle choices as it's a very easy hop from overweight to obesity. Don't be like these fools online that try to tell you that you can be healthy while obese. You can't. There is no such thing as a "healthy obese person". There is only an obese person who isn't yet showing clinical symptoms of diabetes, fatty liver disease or cardiovascular disease but these pathologies are well under way.

That's why we don't see healthy obese people in their sixties or a healthy obese eighty-year-old. Obese people start developing a slew of health conditions in their fifties and sixties, if not earlier, and succumb to them way before they hit eighty. Obese people have an average of 14 years less of lifespan. That doesn't even take into consideration the loss of quality of life which begins decades before death.

4. Should I be tested for familial hypercholesterolemia (FH) if I have high LDL?

Your doctor will let you know if this test is required for you so you should have a discussion with them about this.

High LDL is not FH. It is simply hypercholesterolemia. FH is a specific genetic condition that limits the liver's ability to regulate low density lipoprotein (LDL), among other lipid abnormalities related to the body's ability to handle LDL. This condition is serious and will lead to early onset cardiovascular disease (CVD) if not treated properly. Though one of the signs of FH is high LDL cholesterol, this condition presents other signs and symptoms as well such as:

• Fatty skin deposits called xanthomas over parts of the hands, elbows, knees, ankles and around the cornea of the eye.
• Cholesterol deposits in the eyelids (xanthelasmas).
• Chest pain (angina) or other signs of coronary artery disease which may be present at a young age.
• Cramping of one or both calves when walking.
• Sores on the toes that do not heal.
• Sudden stroke-like symptoms such as trouble speaking, drooping on one side of the face, weakness of an arm or leg, and loss of balance.

Because of how serious FH is, do not allow your doctor to diagnose you with this condition simply because you have "high LDL". Many people have high LDL and do not have FH. Like I said above, FH is not simply high LDL. It is a complex condition that can result in early death from CVD. This is not always the case with simple high LDL. High LDL can be a marker of improper lipid management by the body, but this is not true in every case. You can have high LDL and remain completely healthy your entire life. It all boils down to how your body is managing its lipoproteins and that is very difficult to know since lipid function is so complex.

Lipid testing is very expensive, not generally available and the results are up for multiple interpretations depending on what lipidologist/cardiologist views it. This is why these tests are usually confined to the area of research, not general everyday medical practice. Usually, you become aware of your lipid function once you develop CVD, if the CVD is lipid related, and this is why doctors are quick to label high LDL as a risk factor for CVD from the get-go. It makes things easier even if it can result in some people receiving unnecessary treatments. They figure the treatment wouldn't hurt you, even if you don't need it, and it's best to be safe than sorry.

Most people can know immediately if they have FH, with no testing required. They just have to look at their family history. If you have a family history of early onset CVD, and you yourself have high LDL cholesterol, then you might have FH. A way to know you don't have it is if you are already 60 years old, with high LDL cholesterol, but no signs of CVD and neither do any of your family members. But the absolute best way to know is through testing. The testing is not a total cholesterol panel. The testing is genetic.

Genetic testing for FH looks for inherited genetic changes in three different genes (LDLR, APOB, and PCSK9) known to cause FH. This test can also include a study of cells called fibroblasts to see how the body absorbs LDL cholesterol. People who get only one copy of the defective gene, from their parents, may do well with diet changes and medications. People who have a more severe form of the disorder will require more invasive treatments.

This is why you need to talk to your doctor and become informed on which treatment option is appropriate for you. All you need to know is that if you are diagnosed with FH, you will require treatment or you will develop CVD. So, ignore whatever these low carb quacks tell you about statins or other cholesterol managing drugs because the least of your concerns are their possible side effects or how much money the pharmaceuticals are making from them. Your main concern is the impending heart attack or stroke in your near future. There is no way to "prevent" FH. You either have it or you don't. FH is a genetic condition, not a lifestyle result. All you can do is reduce your risk of developing CVD, if you have FH, through proper treatments.

FH is not the only marker of poor management of lipids. It is only one. There is actually a whole class of FH related conditions. These conditions are all as complex as lipid management itself. Some families do not have a history of early onset development of CVD but later onset instead. Some forms of FH do not even develop into any disease at all. This is usually the case for people who have a family history of high LDL with no CVD.

My family for instance has extremely high LDL, on my father's side, but none develop CVD. They all live well into their nineties. This is why you should take family history of CVD so seriously because it affects you. Family history of CVD carries more weight than just the total numbers of any lipoproteins.

5. What's the difference between glycogenolysis and gluconeogenesis? I hear these terms talked about a lot but always get confused as to what they are.

The liver converts glycogen into glucose through a process called glycogenolysis. The liver also can manufacture necessary glucose by converting amino acids, waste products and fat byproducts through gluconeogenesis.

Both of these are interesting, and I am sure you have heard them mentioned many times in low carb spaces, but you don't need to get bogged down remembering what they are as they are both completely out of your control. A lot of people get caught up in things that are neither here nor there. These things can help explain a little about metabolic function, but they aren't practical in any way whatsoever to its treatment. There is also a lot of nuance and context missing in these definitions.

So, keep focused on what you can control yourself and that's lifestyle factors.

6. Does a high fat diet cause fatty liver disease?

The only diet known to reverse fatty liver disease is a ketogenic diet, which is a very low carb diet. The magic seems to come from the elimination of carbs, particularly sugar, rather than the addition of fat as low carb diets alone improve fatty liver disease.

This makes sense as fatty liver disease can be caused by three things:

• A high sugar diet
• High alcohol consumption
• Viral infections

There is no "high fat diet" in that list anywhere. Certain hunter/gatherers who eat extraordinarily high fat diets do not ever develop fatty liver disease and neither do hunter/gatherers who eat a very high carb diet. This is why I made clear that a high sugar diet causes fatty liver, not a high carb diet alone.

Fructose seems to be the culprit for the disease and sugar is half fructose. Fructose is metabolized in the liver the same way as alcohol and this seems to be the catalyst for poor liver function. This is why sugar can be considered a hepatotoxin.

It would not be surprising if certain high fat diets can very well be complicit in the development of fatty liver disease as plant-based oils, particularly vegetable oils, have been implicated in dysregulating the liver's ability of managing fat within itself. Vegetable oils, seem to not be released from the liver as readily as animal-based fats with the exception of coconut oil. These oils also seem to contribute to more subcutaneous fat accumulation which will eventually affect visceral and ectopic fat.

So the make up of the fatty acids in different fats can effect liver function. For this reason, use oils sparingly and stick to saturated fats in moderation.

Six common beliefs addressed, Part 195

1. You need protein to build muscle and carbs to keep them. 

If you are working out beyond your glycogen stores, because you are an athlete, you will begin to break down muscle into glucose in order to keep up the demand for glucose driven activity. This is not the case for the average person.

The average sedentary to moderately active person has enough glycogen stores for the minimal glucose fuel driven activity they do. Fat fuel takes care of the rest. Fat is the main fuel used by the body for everything, except running from a bear or training for the Olympics.

So if you are an athlete, then you will have to incorporate some type of carb into your diet in order to have the energy to continue with these types of unnatural activities. Everyone else is fine on fat and minimal carbs. You will not lose muscle. The only threat of muscle loss, that a sedentary and/or diabetic person has, is the wasting away from non usage and uncontrolled catabolism.

2. I have been “keto” for several years and am now noticing "discomfort" in my liver from fatty deposits. 

I can’t imagine how it wouldn't be. When you do "keto", as it is is recommended online for 2 years, I would be surprised your liver wouldn't be packed with fat. After all, the astronomical amount of fat in these failed protocols will cause the deposit of fat into the liver since it has no where else to go. All other stores would be full and you aren't burning what you already have. You first tried to kill yourself with glucose and now you are trying to kill yourself with fat. You are still on the trajectory towards death. You are just acquiring it through different means.

Having said that, "discomfort" doesn't truly mean anything. You have to go to your healthcare professional so they can order the appropriate testing for a true diagnoses. That would be the only way to know what’s really going on.

3. You shouldn't eat fat if you "need to lose weight". 

"Keto" pages always make stupid over simplified statements like these, without context whatsoever, because they are scams. The correct way to say this is that you shouldn't eat fat to excess if you want to lose body fat.

"Excess" is individualized and relative but a good rule of thumb is to stay around 50 grams of fat a day if you are obese. For everyone else, you should never go over 150 grams of fat a day. The absolute best way to determine your individual numbers are to calculate your macros.

4. You can use heavy whipping cream in coffee and you also cannot overeat meat. 

There is no reason to use heavy whipping cream in coffee if you are obese. Save your heavy whipping cream for recipes or to whip up at home and avoid the added sugar found in store bought whipped creams. Use half and half or milk in your coffee instead.

Yes, you can overeat meat. If you are carnivore and begin gaining body fat, then you have overeaten meat. Meat comes with fat. If you overeat certain fatty cuts of meat, you will end up going over your fat threshold and begin gaining body fat.

5. "Keto” is safe for diabetics with high cholesterol.

It is very difficult to predict how anyone will react to any diet when they have preexisting metabolic conditions. This is especially true if they are on medications for these conditions. For this reason, you should consult with your doctor about any changes in your diet.

Ketogenic protocols can drop blood glucose to very low levels. If you are on diabetes medications, this can be very dangerous.

Some people with certain genetic lipid abnormalities can have an adverse change in their cholesterol composition due to diet, putting them at a higher risk for heart disease. This is why you should have your cholesterol tested with an advanced lipid panel, a few months after beginning your diet, in order to see what fats have to be changed so that you don't have an adverse reaction.

All of this takes patience, testing and an open dialogue with your doctor.

6. "Keto” has no effect on cholesterol.

“Keto” diets can lower cholesterol or raise it depending on your genetic variability. For some, the rise in total cholesterol is from a rise in HDL or a rise in LDL or a rise in both. For most people it does nothing. There's a small segment of the population that see astronomical rises in cholesterol, particularly LDL, but all of these ups and downs in total cholesterol do not determine if you are having an adverse reaction or not. It is only a marker. Sometimes it can correlate with an adverse reaction and sometimes not.

There are some people who experience a very adverse reaction in the composition of their LDL cholesterol when they eat saturated fats. These people become high risk for heart disease. You can guess who these people are by looking at their family history for heart disease and any previous or current heart conditions. There is also genetic testing available to determine this with more accuracy.

So you cannot assume that "keto" will not adversely effect your lipids. It can. You need the proper testing done in order to determine if you are one of those people. Total cholesterol is not enough so you need an advanced lipid panel that checks particle size. This test is not fool proof but it can give you a better idea as to what may be going on with your lipids.

So if you have a history of or current heart disease in your family, you should refrain from following a saturated fat based ketogenic protocol. Use monounsaturated fats instead.

Six common beliefs addressed, Part 188

1. Sugar causes hair loss. 

No. Protein deficiency can cause hair loss. Certain thyroid conditions and/or age can cause hair loss. Gender can cause hair loss, which many men can attest to. Other medical conditions and/or medications can also cause hair loss but not sugar.

Sugar causes diabetes/overweight/obesity. Diabetes can cause protein deficiency since you need proper working insulin to get protein into cells. But sugar itself never directly decreases anything, including hair, except for overall health.

2. Diabetics who start "keto" can stop taking their medications. 

Do not stop any medication that you are on as it can cause serious health problems, especially as a diabetic.

Diets are only complimentary to conventional treatments. They are a way of eventually, hopefully, not needing anymore medications with time. But you do not stop your medications and just follow a diet. It doesn't work that way. You don't even know if this diet will help you or not.

Make sure that you tell your doctor the diet you are following and track your blood glucose closely so that medications can be reduced if the diet does begin working for you.

3. There is no confirmation that "keto" will cure fatty liver disease. 

Ketogenic protocols are the only known cure for fatty liver disease. Virta Health is a good resource for these published papers on fatty liver disease treatment which they have posted on their website. 

Of course, this dietary protocol would only work if your fatty liver disease was caused by fructose consumption, not alcohol. 

4. In order to get the benefits from the fat in meat, you have to consume it even if you don't like it. 

You don't have to eat the fat if you don't like it. The benefits come from the protein in the meat, not from its fat. Fat is a necessary nutrient but a little goes a long way. Eat the natural fat in foods you enjoy like dairy. You can keep meat lean.

5. There is no good way of reducing uric acid.

Elimination of all forms of fructose. I recently wrote about gout so you might want to reference my past posts.

In summary, people who consume a lot of fructose have metabolic syndrome. Metabolic syndrome causes chronically and abnormally high insulin levels (hyperinsulinemia). Hyperinsulinemia impairs kidney function which does not allow for the proper elimination of waste, including excess uric acid. For this reason, gout can be described as a sign of impending kidney disease from metabolic abnormalities.

After you eliminate all fructose from your diet, you need to discuss with your doctor, a better treatment plan to control your gout flare ups.

6. My doctor never told me to stay away from processed foods. He just told me to work on "losing weight".

Doctors really don't have to state the obvious, but they do anyway, even when it falls on deaf ears. You very well know that your doctor telling you to "stay away from processed foods", was not going to keep you from them. Let's be realistic here.

But aside from that, "processed foods" is too vague a term and leaves too much up for interpretation from the patient. What your doctor should have told you is that you need to normalize your blood glucose regulation and that can be tracked using a blood glucose meter. After all, if Twinkies keep your blood glucose under control, then it really doesn't much matter if they are processed or not.

Six common beliefs addressed, Part 155

1. Low carb people told me I could "fix" my fatty liver disease in a few weeks, but I still have had no improvement with my liver in more than a year of following low carb.

You'd be surprised what some people claim is low carb. There are folks who believe coconut sugar and cassava flour is "low carb". For this reason, I don't know what you mean by "low carb" so I cannot address your diet as you did not detail your protocol. I can only address the claims being made online by low carb advocates which bamboozled you into following a diet, that is obviously not working for your particular problem, and you have wasted valuable time.

Always take any claim of this sort with a grain of salt because you simply don't know what your individual outcome will be. The only intervention that has ever reversed fatty liver disease, in about two weeks, has been the elimination of all sugar from the diet. This has been done with a ketogenic style protocol. The same effect has also been seen by simply removing soda and other sugared beverages from the diet but mostly in children. Of course, these approaches are only true if the fatty liver disease was caused by excess sugar consumption to begin with.

So when you read about the "reversal of fatty liver disease" in a low carb platform, it is usually in the context that sugar was the culprit for the disease. If you take away the sugar, then the disease is cured, but fatty liver disease is not solely caused by sugar intake.

Aside from excess carbohydrate consumption in the form of sugar, fatty liver disease can also be caused by excess alcohol intake, viral infections, certain drug treatments and consumption of high dietary fat, particularly from vegetable oils. This means that if you don't follow low carb correctly and you begin consuming abnormal amounts of dietary fat, you will contribute to your disease progression and will see no improvement in it.

This is because abnormal lipid metabolism leads to ectopic liver fat accumulation. Trying to metabolize an extraordinary amount of dietary fat is abnormal lipid metabolism. In other words, you have too much energy stored in your liver and you are trying to add more. That's why swapping one high energy diet, like a high carb diet, for another high energy diet, like a high fat diet, will not work to improve your condition. So if this is the case, you have to address it immediately. Stop following charlatans and get on a true low carbohydrate protocol.

Aside from this, disorders in genes involved in fatty acid uptake, hepatic triacylglycerol secretion, choline deficiency and fatty acid oxidation also lead to fatty liver disease. The pathogenesis of fatty liver disease involves multiple pathways, including fatty acid uptake, de novo lipogenesis, mitochondrial fatty acid oxidation and lipoprotein secretion. So if you have genetic issues, in any of these pathways, you can develop fatty liver disease and if it's not addressed, the disease will progress and not improve. As you can see, there are multiple ways of acquiring fatty liver disease and multiple things that will contribute to it.

I know that your doctor will not give your fatty liver disease a second thought as conventional medicine believes that fat accumulation in the liver is benign until inflammation or scarring occurs. The problem with this is that inflammation and scaring is the end stage of fatty liver disease and that's when irreparable damage to the liver occurs. For this reason, it is up to you to figure out what is causing your fatty liver disease and address it. You have to force your doctor to not sleep on this and find out what is causing it through a proper investigation.

You also need to stop waiting for a low carb miracle to occur because you are wasting valuable time that could be spent finding a way to properly treat this problem rather than waiting for low carb to finally "kick in" and "cure" it for you. It's obviously not happening.

2. Blood glucose rises with exercise. 

This is caused by an exaggerated stress response, which is typical of people with full diabetes. Blood glucose rises with any injury or illness for these people as well.

As metabolic health improves, this effect tends to disappear. The length of time that takes depends on many factors, so it's highly individualized. You just have to focus on continuing what you have to do in order for things to improve with time. Do not do strenuous or prolonged exercises and never exercise fasted. That might help in the interim.

3. Even when consistently following "clean keto" for 2 years, my HbA1C has been creeping up.

You are still having blood glucose regulation issues. Like I have said many times before - "keto" and low carb are only palliative treatments for metabolic conditions. That means that they treat symptoms, not the actual condition itself. The actual condition is the result of poor blood glucose regulation. The canary in the coalmine, which signals this is the case, is not necessarily your increasing HbA1C but how much body fat you still have. As long as "keto" and low carb doesn't cause you to lose weight, specifically body fat, you will continue to be at the threshold of metabolic dysfunction.

When you first start "keto"/low carb, you lose some body fat because your blood glucose regulation improves. This in turn helps lower your blood glucose, HbA1C and insulin levels. You feel as though you have found the cure to your ailments but because you never fully correct your blood glucose regulation, you never lose enough body fat. The problem continues and not only do you not lose enough body fat, but you also begin piling more on and your metabolic numbers begin to rise. For some people this happens sooner and for others later, depending on their overall lifestyle but it will happen. As long as you are overweight/obese, it will happen again. You are simply moving the goal post further away but you're headed right to it.

This is why these diets have to be accompanied by lifestyle changes that are anti obesogenic. The diet alone will only get you so far.

4. Calories don't count if you are carnivore, unless you're diabetic and need to lose weight.

It depends on where the calories are coming from. Excess protein calories only build lean muscle mass. Excess fat calories only build fat mass. So, instead of tracking all of your calories, make sure that you track your fat calories instead. Everything else is irrelevant and this goes for both diabetics and non diabetics.

Fat and protein macros are individualized but the rule of thumb for fat grams is to always stay between 50 - 150 grams a day. The more body fat you have to lose, the more you should lean towards 50 grams.

5. I have transitioned to "keto" but feel hypoglycemic.

"Feeling" hypoglycemic and being hypoglycemic are two different things. The clinical definition for hypoglycemia is:

• A blood sugar level below 70 mg/dL (3.9 mmol/L) is too low and can cause harm.
• A blood sugar level below 54 mg/dL (3.0 mmol/L) is a cause for immediate action.

Lower blood glucose does not equal better in this blog. The goal is to obtain and maintain normal blood glucose regulation, not lower blood glucose. Lower blood glucose does not solve the complicated pathology of metabolic syndrome.

If your blood glucose is higher than 70 mg/dL then you are not clinically hypoglycemic and so your symptoms are being caused by "pseudo hypoglycemia". This is actually very common, especially in people who aren't full diabetics yet but are on their way there. Pseudo hypoglycemia is a state where the body actively tries to elevate blood glucose, even if it's at a normal level, by causing you symptoms that will make you eat or rev up the body's stress response. Ignore this. It will go away with time. Feeding into it will only cause for you to never get off this merry go round. Allow the body to learn how to regulate its blood glucose on its own, without your intervention.

If your blood glucose is lower than 70 mg/dL then you have to reformulate your diet so that this does not occur. If this means switching from "keto" to moderate low carb, do so. You want to keep your blood glucose steady. Unsteady blood glucose will deteriorate your counter glucoregulatory response further and soon you will be dumping out incredible amounts of glucose to prevent any lowering of it to normal.

If your blood glucose is lower than 70 mg/dL without symptoms, then you have a very big problem and you need to address it with a healthcare provider as some diabetics do not experience any symptoms when their blood glucose reaches clinical definitions of hypoglycemia. This is a problem with the autonomic nervous system causing a failure of the counter glucoregulatory response. It can be life threatening as your blood glucose can drop low enough to put you in a coma without you being none the wiser to it.

So anytime you have symptoms of hypoglycemia, check your blood glucose to determine what's really going on and then act accordingly.

6. If you are on "keto". you should reduce the units of insulin you are currently on. 

You need to talk with your healthcare provider. We cannot advise you on how to reduce injected insulin or any other type of prescription medication. Even if I could advise on this, I wouldn't because the internet is not a surrogate for proper healthcare. Any low carb advocate that allows this type of advice to be shared on their platform is immoral.

Altering your prescription medication, either on your own or with the advice of some fool online, is very dangerous and irresponsible. Monitor your blood glucose and discuss changes with your doctor so they can help you reduce or eliminate any medications you might be currently on.

Six common beliefs addressed, Part 126

1. Fatty liver and diabetes are easily reversed.

Fatty liver can be reversed in about two weeks on an absolutely 0 sugar diet, if the disease was the result of fructose consumption. Diabetes can take years to go into full remission, even though you can lower blood glucose rather quickly on a low carbohydrate diet. 

2. “Keto Chow" are good products to have when following "keto". 

The only “keto chow” that I recommend is meat and vegetables with a side of body fat. 

3. If your blood glucose readings are stable from following low carb, you can go off insulin. 

This needs to be discussed with a doctor. People who aren't doctors cannot prescribe insulin nor un-prescribe it. You need to take your blood glucose readings to your healthcare professional, along with your current diet, and discuss this with them. Then they can tell you what would be the best way to proceed with your glucose lowering medications, including any insulin you might be taking. This is precisely why you should discuss any dietary changes with your doctor before you begin. 

Low carbohydrate diets effect blood glucose, almost immediately, so do not start any protocol without discussing it with your doctor first. Especially if you are taking medications that already lower your blood glucose. You can die from hypoglycemia. It’s basic common sense. 

4. Can you go on carnivore after gastric bypass surgery?

Gastric bypass shrinks the stomach and doesn’t allow you to eat much. This means that you have to be on a special post-surgery diet to ensure you are getting enough nutrients. You need to discuss your diet changes with your doctor and see what supplementation you require. You might not be able to do carnivore, at the moment, and will have to wait. 

In the meantime, you are under calorie restriction by proxy, since your stomach won’t allow you to eat enough, much less in excess. You will have to sustain this for a while, until you can actually eat normally again. Then you can shift to a more long term protocol like carnivore. 

5. Is it normal to lose ten pounds on carnivore and not be hungry?

As long as you’re losing weight, not being hungry is good. It means you are getting enough energy from burning your own body fat. Of course, ten pounds is very little weight and mostly water based, so you will have to monitor this and see if you continue losing weight beyond these ten pounds, as the goal is to lose body fat, not body weight. It takes a while to get to the fat.

If you aren’t hungry and you stop losing weight or worse, start gaining, then you are up poop creek, because this lack of hunger is a sign of active obesity. Your metabolism is simply not burning enough energy to cause hunger and is actively sparing its fat mass. That means something is going wrong with your dietary protocol. 

6. Going on a hiatus from the ketogenic diet only causes for my aches, pains and allergies to return. 

Ketogenic diets are not a pill, like aspirin, that you take when you are feeling symptoms and then drop when you are better again. These diets are very powerful metabolic interventions for the treatment of metabolic dysfunction, including obesity. They require commitment and consistency in order to work properly because when they don’t work properly, they can create a metabolic nightmare. Their goal is to improve blood glucose regulation and that takes time.

I suggest you go to your allergist or rheumatologist if you are having "allergies and pains", so they can offer you a better treatment, for these conditions, that you can actually adhere to. They have medications for these ailments, which require no commitment except going to the pharmacy and picking them up. You don’t have to struggle through a ketogenic protocol, which you obviously cannot sustain, just to feel some temporary relief from these conditions. You can have 100%, long term, relief with a medication.

Six common beliefs addressed, Part 116

1. Cells refuse glucose entry because they are already filled with fat. Fat is what causes diabetes. 

This statement seems like it could be commented on easily, in one sentence, but it is actually the most difficult aspect to explain to people about metabolism. This statement is at the core of understanding what's happening to you, so you can treat it properly. 

The exact mechanism of metabolic syndrome/diabetes still remains hotly debated. This is because these conditions affect many systems of the body. In other words, many system wide abnormalities must occur for the conditions to exist and progress. For this reason, there are many arguments over what occurs when and downstream or upstream from what. Some believe the cells are filled with sugar (low carb advocates) and others believe they are filled with fat (low fat/calorie restriction advocates). It depends on the narrative you are trying to push.

Do not get caught up in the pedantic ramblings of all of these blogs and pages that try to break down studies, they themselves don't fully understand. Most of them are just trying to push their own agendas. 

 

The only thing you need to know is what will get you closer to reversing your condition and that is your blood glucose regulation because the only thing that tracks linearly with obesity and the eventual development of diabetes is your blood glucose regulation. Chronic disruptions in blood glucose homeostasis eventually deteriorate its proper regulation. Poor blood glucose regulation causes improper insulin release/expression, which further deteriorates blood glucose. This will cause an adaptation towards starvation which is when the body actively prevents any lowering of blood glucose as it deems it as hypoglycemia. Now your blood glucose, insulin and body fat set points are set high and the body will actively prevent any them from lowering. 

 

So in essence, we can describe that cells refuse glucose entry in order to spare it to make more fat. Glucose turns into fat. This is why there is insulin resistance in tissues and organs but insulin super sensitivity at the fat mass. So it doesn't much matter what your cells are "filled with". The only thing that matters is that your fat mass is getting filled with more fat and the lever is your blood glucose regulation.

2. High triglycerides are meaningless. Only high blood glucose is a problem. 

When the body converts glucose into fat, at an exponential rate, serum trigs rise. Trigs are the metric used to measure fat in the blood, just like your glucose meter measures glucose in the blood. High trigs and high glucose are caused by the same thing - metabolic syndrome, which basically sets your blood glucose, insulin and body fat points to high. 

People with high trigs are experiencing metabolic syndrome and their glucose might also be high, either after meals or while fasting as well. Just because trigs are fat, doesn't mean they are caused by dietary fat. They are actually caused by the conversion of glucose into fat through de novo lipogenesis in the liver. 

Interestingly, there is a small segment of the population that is obese and/or has metabolic syndrome, but continue to exhibit low trigs. This is usually because their liver is absorbing all of the fat into itself, rather than dispersing a large amount into the bloodstream. So being obese, with low trigs can be the first signs of being at very high risk for future liver disease. 

3. If your insulin levels are low, but you are still obese, you need to eliminate any foods that may still be effecting your insulin. 

Many things effect insulin. This is why we mainly focus on insulin expression, not insulin levels, on this blog. It is obvious that your insulin, regardless of its level, is not functioning as it should. It is building fat instead of anything else. This means you have not normalized your blood glucose regulation and your insulin is still being affected.

4. Do I have "sarcopenic" obesity?

All obesity is sarcopenic. Sarcopenic obesity simply means that the body is breaking down its lean muscle mass to create more glucose in order to convert it into even more body fat. Obesity eats at your muscle mass making you fatter by default. 

5. "Low carb doctors" like for liver enzymes to be in the teens. If you are over, then you have to cut back further on carbohydrates. 

This is why you have to be careful with "low carb doctors". There are no such things as "low carb doctors". You are either a doctor, with an MD, or you're not. I suggest that you go to a conventional, real doctor to get your liver enzymes assessed properly. Then you can apply a low carb treatment to address any issues depending on their cause. 

If you are already zero carb, then it's obvious you are not generating liver fat from your diet. This means that eliminating carbs is not working. This is because your generating liver fat from the breakdown of your own lean muscle mass. In other words, the glucose is not coming from the outside, it's coming from the inside. This is mainly driven by adrenal over expression and being zero carbs might be triggering it further as it could be a stressor for the body. 

I recommend you ditch the "zero carb diet" and go moderate low carb to see if it improves your liver enzymes. If it doesn't, then the problem is being caused by some abnormality within the liver itself. It could be a virus or alcohol consumption. You will have to work with your doctor in order to determine what's going on and address it. Even though fatty liver disease is most commonly caused by alcohol and/or fructose consumption, there are other conditions that can also cause disease in the liver. 

6. Do you need to eat fat to become "fat adapted"?

No. This is just nonsense. If any people on earth are "fat adapted", it's the obese. The obese are adapted to get fatter.

 

The premise this is based on is that you become "fat adapted" by lowering the consumption of carbohydrates enough to where glucose is no longer displacing fat oxidation. Basically this is a state where there is very little blood glucose and glycogen stores to burn for energy, so the body burns fat instead. Therefore, there technically is no "adaptation", there is only "allowance". 

 

Of course, that is only a premise. When you have metabolic syndrome, these systems do not work so efficiently. You need proper insulin and leptin expression for any of this to actually work.

Either way, you want to burn body fat, not just fat. So, dietary fat also has to be low enough so the body can do just that. 

Six common beliefs addressed, Part 70

1. You need carbohydrates to build muscle.

No. Only protein builds muscle.

2. The "fast/feast cycle" will protect you from muscle loss.

The "fast/feast cycle" is a marketing term and it protects you from nothing.

There is no “fast/feast cycle”. You are either eating or not eating and there’s no mysterious “cycle” involved in it. The body knows how to recognize anabolic/catabolic states, through nutrient availability. It does this every night, as you sleep. 

This has nothing to do with "protection" from muscle loss, as the person with metabolic syndrome/diabetes is exceptionally good at muscle breakdown, since these are conditions of adaptation to starvation. Eating again after a short fast, allows muscle mass to grow, but long fasts diminish it again and you never grow as much as you lose, so you don’t even break even. You know what grows exceptionally well, when you eat after a long fast? Fat. You grow fat mass very, very well.

It’s very simple - Fast for a short duration and there’s no muscle loss. Fast for a long duration and there’s always muscle loss. This is not unknown. This is a well documented fact. It’s one of those rare facts that has actually been seen consistently in experiments. So no, the magical “fast/feast cycle”, whatever that is, will not save your muscle mass, it will only spare your fat mass.

3. Is there a cure for fatty liver disease?

Fortunately, fatty liver disease is much easier to treat than diabetes. The only known method of reversal, which does not require a liver transplant, is a very low carb/ketogenic style diet.

4. Is there anything that can be done about excessive hunger after a fast?

Yes. Shorten your fast, until that doesn’t occur.

Excessive hunger after fasting, while still obese, is a sign of active obesity. The body is making you eat more in order to increase fat storage. This is specifically triggered by fasting for long periods. There is no metabolic advantage to going hungry.

5. Hyperinsulinemia is the main driver of obesity.

It’s one of the drivers of obesity. The main driver is your entire neuroendocrine system. Remember insulin is not an obesity hormone, but it’s necessary to grow fat. Being hyperinsulinemic simply means that you are in a hormonal state, which is powerfully contributing to your obesity. Remove the hyperinsulinemia and you greatly improve your chances of controlling and reversing obesity. It’s actually the simplest obesogenic driver to take control of, as it responds to dietary changes relatively quickly and well.

But, it’s certainly not the main driver, nor is it the only driver. There are many drivers in obesity and that’s why you have to focus on an anti-obesity lifestyle, which addresses all drivers.

6. Hyperinsulinemia is the same as insulin resistance.

Hyperinsulinemia (HI) is a direct result of a high insulin demand on the body. This high insulin demand is being driven primarily by a combination of four things:

• Too much glucose in - The body must handle the tsunami of glucose that’s coming in from the diet, by raising insulin levels to disperse it out of the blood.
• Too much glucose out - The body is producing an enormous amount of glucose from itself, through the breakdown of lean muscle mass, which further stimulates insulin release from chronically high blood glucose.
• Too much fat in - Any dietary fat that is not burned, is stored and the storage of fat requires insulin. This raises basal insulin, further contributing to blood glucose dysregulation. 
  
• Too much body fat - The body requires a high basal insulin level to keep fat in storage, as that fat cannot be released into the bloodstream. Insulin is like a dam, keeping body fat in place, and this is actually where the bulk of high basal insulin is coming from. 

All of this leads to insulin resistance (IR) of certain organs and tissues, but not of the fat mass. If the fat mass became insulin resistant, it could not hold all that fat inside, nor store more of it. So, the fat mass requires high insulin sensitivity.

So, when people group all of these effects together and simply describe them as “Mah’ bad insulin resistance”, they are not truly understanding insulin’s effect on the body. Yes, it’s IR and HI, but they work in specific ways, which you need to understand, to be able to tackle the condition long term. Just viewing it under general IR will not allow you to address it fully.