Six common beliefs addressed, Part 267

1. Is glucose worse when it has fructose, like sugar does? Would this mean that potatoes are less bad than sugar?

Sugar is particularly obesogenic compared to any other carb because of two things - its sweet taste and it's half fructose. In fact, the fructose is what causes the sweet taste, so it's the fructose that is the main culprit.

• Fructose has a sweet taste and the state of sweet disrupts blood glucose homeostasis through its affects on dopamine/serotonin. Antidepressants like serotonin re-uptake inhibitors (SSRIs) have long been known to affect weight because of this.
• Fructose is a hepatotoxin like alcohol, and creates liver fat. This liver fat exacerbates and perpetuates metabolic conditions.

But glucose all by itself without the fructose, as is the case with potatoes, still impacts blood glucose because it adds extra glucose to a system that likes to keep its blood glucose under strict control. Anything that disrupts blood glucose homeostasis will result in metabolic dysfunction over time.

So you don't want to look for items that are "less bad" because there is no such thing as "less diabetes". You either have it or you don't.

2. My wife recently had a terrible bout of non-stop seizures. She was in intensive care for three weeks. She has always had seizures but they were well controlled until this set back. What I found interesting is that her morning blood glucose would always be in the 60s mg/dL. I have read on your blog that blood sugar this low is not normal. Could this be contributing to her recent health problems?

I am not a doctor so I cannot tell you what could have caused your wife's recent bout of seizures. It could have been a number of things. I have migraine with aura. I can sometimes detect triggers but most times cannot.

What I can tell you is that blood glucose dysregulation plays a very critical role in controlling conditions like migraine, seizures and other neurological issues. This is because the brain suffers first when there is a lack of blood glucose homeostasis. There are certain cells in our body that require glucose to remain alive and functioning. Some of those cells are in the brain. 

Disturbances to blood glucose homeostasis causes an energy crisis in the brain exacerbating neurological conditions. When I was able to better control my blood glucose, my migraines subsided. Insulin plays a vital role in getting glucose into these glucose dependent cells. Insulin resistance interferes with this process. Improving insulin sensitivity through the stabilization of blood glucose should be priority number one if you want to better control neurological conditions.

You are correct that a fasting blood glucose of 66 mg/dL is not normal. It is hypoglycemia and it will be very difficult for your wife to control her seizures if her blood glucose is on a roller coaster. I do not know why her blood glucose is dropping this low. It can be for a number of reasons, including seizure medications.

So I suggest you talk to her doctor about your concern and see if he has any answers for this. Other than that, your wife is going to have to diligently watch her diet and exercise routine. Lifestyle factors are the main contributor to blood glucose abnormalities.

3. I am sick of slim people talking about "junk food", "preservatives" and "additives". Is it true that people are obese because of preservatives in food?

No. I have spoken about this in other posts.

I feel your frustration because I am also sick and tired of this misconception. Obesity is not the result of preservatives, additives, chemicals or anything else found in conventional food. You can become obese off completely natural and organic, whole grain and fermented wheat products.

People start going through a rabbit hole of nonsense when they follow this type of advice but the diet sphere has always been ripe with this type of foolery. There are plenty of thin people eating Doritos and pizza boats daily. Just visit your local university's dorm room. It will be very difficult for you to find an 400 lbs. person on campus. There are many athletes that eat sheer "junk" on the daily and are perfectly slim. There are many people who are extremely picky with their food and only want the healthiest choices available and are still 400 lbs.

Obesity is the result of blood glucose dysregulation. Nothing else. It doesn't matter what food you eat as long as it doesn't interfere with blood glucose. The reason that "junk food" has gotten a bad rap is because it is usually filled with sugar, grains and plant based oils which all further contribute to blood glucose dysregulation.

No one knows for how long any individual can retain their blood glucose control while eating so called "junk". Look at low carb people. They eat clean and are still obese and unable to take control of their blood glucose. So controlling blood glucose and keeping it under control is dependent on a lot more than just food. Many individualized factors are at play here.

4. I want a real hack that I can use and it be effective. I LOVE McDonald's breakfast and I want to be able to eat it daily without it causing me obesity or diabetes. I know that's a lot to ask for but it's not like I'm asking for money and it's not every meal. I just want my breakfast! It's so convenient and delicious!

I know you think I'm going to reply that I can't help you and have no hack. But I actually do. In fact, it is the only real hack that exists.

If you understand that obesity/diabetes is rooted in blood glucose dysregulation, then the only thing you have to do is keep your blood glucose control and you will be free of developing either condition. But how? McDonald's and other fast food is notorious for interfering with blood glucose control and this is why everyone knows these foods are very obesogenic. But they are also very delicious. Is there such a thing as having your cake and eating it too?

Well, there is no magic pill you can take that can help you preserve your blood glucose regulation after eating biscuits and pancakes at McDonald's but there is a magical thing you can DO. All you have to do is walk five miles to the McDonald's, eat your breakfast and as you take the last bite, get up and walk five miles back home. The exercise will prevent your postprandial blood glucose from ever rising in a significant enough way to later cause hypoglycemia from prolonged insulin release. It's not even using insulin to clear the blood glucose!

This shows the actual curative mechanism of exercise rather than just the palliative mechanism of diet. With diet you are always hiding and avoiding but exercise causes an actual mechanical, quantifiable effect. This effect has been exploited by athletes, the world over, and this is how they can have McDonald's endorsements, and actually eat their food, with no adverse effects.

There is your hack, which will actually work. It would work if you are diabetic as well, it just depends on how well controlled it is, how many medications are being taken and what stage it's currently at.

But like all short cuts in life, you can run into problems. Walking a total of ten miles a day, everyday, can become unpredictable. Weather, illness, injury, age, work and other responsibilities can all get in the way of having the stamina and time to put into this endeavor. Remember, you can never fail one time or you will lose control of your blood glucose as you're basically walking on a tight rope to maintain it. You would need a lot of dedication and determination to be consistent with this hack. Even athletes eventually retire and become diabetic.

5. I usually like to go to the Dunkin' Donuts before work. I really like their coffee. While there I also get a breakfast sandwich, because I cannot have the dougnuts. I have to modify the sandwich so it's low carb by telling them to remove the bread and double the egg. The egg now becomes the "bread" so I can hold the sandwich. There is just one issue. They double the price. Low carb followers always talk about the modifications you can do at any restaurant but they leave out how pricey it can get. Prices have gone up anyway and this diet is going to break the bank.

Yes. That's why you want to avoid eating out as much as possible because you are already going to be spending more on food regardless. Might as well get more bang for you buck buying food you can prepare at home.

With low carb you can go to any restaurant and modify the food to fit your diet but prepare to pay more. Restaurants have always used carbs as filler. Carbs are cheap and create the illusion of a large portion. This makes you believe you got your money's worth, when you have to unzip your pants just to stay seated after a plate full of bread, pasta and salad. It is all smoke and mirrors though. When you remove all those carbs, you realize you are eating a plate of air and being robbed.

At the Dunkin' Donuts, tell them to ring each item of the sandwich separately. For example, they can ring up 2 eggs, one sausage patty and one cheese individually, rather than the whole sandwich and it will come out cheaper. Whether they are willing, or aware they can ring up the order that way, is another story.

All you have to do is just shop smarter when you do have to eat out. Stay away from fast food. It is not a bargain and usually ends up costing you more than a real restaurant, because you have to modify the menu and buy triple to make up for what's taken away.

6. Why does eating rice and beans or potatoes cause the feeling of being so full but it wears off so quickly?

Rice, beans, potatoes, pasta, all of this starch, causes a rise in blood glucose which makes insulin follow suit and this tells the body that enough food was eaten so hunger subsides and the feeling of being full increases. The problem is that excess insulin release to clear all of that glucose, continues dropping blood glucose while fasting causing the hunger to return in order to prevent hypoglycemia.

Blood glucose is what the body uses to determine its nutrient availability and whether it needs to be hungry or not. Not calories, not buffets, not portions, not micronutrients but blood glucose's influences on insulin. That is the main and sole determiner of how hungry and how fat you get.

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 122

1. Fructose is a liver and brain toxin.

A better way to say this is that fructose adversely effects the liver and brain, but it is not, in itself, a "toxin". Like a lot of other things, it can become toxic.

The obesity that is acquired from fructose is, unfortunately, usually intractable. Surprisingly, if fructose is eliminated from the diet, the fat that the liver acquired from it easily disappears, in a matter of weeks, reversing any fatty liver disease that the person may have had and improving metabolic markers. Unfortunately, the fat mass itself becomes impossible to get rid of, keeping the person at high risk for future metabolic problems and diabetes. 

This is usually the result of hypothalamic damage, where leptin is simply no longer communicating, the body's fat stores, to the brain. That fat is then never burned, as the brain can’t "see" it. The person continues to be a soft pile of fat, even with no significant visceral or entoptic fat remaining. You would think that, at least, some of the battle was won and the person can simply remain visibly fat, while maintaining metabolic health, but it doesn’t work that way. Because the safe subcutaneous fat storage space is full, the person easily regains visceral and entoptic fat, so they remain constantly teetering at the edge of metabolic dysfunction. This is aside from the fact that this excess subcutaneous fat interferes with immune and stress hormone function which affects blood glucose. 

There is no known treatment for this, but leptin's function in the brain is being closely studied and hopefully there will be some kind of treatment in the future. In the meantime, most doctors simply blame these patients because of their past dietary decisions and they are constantly being advised one diet after the other, to no avail. This is why you need to stay away from sweet things. The saying usually goes that "the dose makes the poison", but when it comes to sweet "the sweetness makes the poison". 

2. People with metabolic syndrome/obesity have a bad relationship with carbohydrates. 

People with metabolic syndrome/obesity have poor blood glucose regulation, which makes their relationship with all macronutrient "bad".

3. If you continue with the "keto" diet, improved metabolic numbers will not change. If they do, it's because you are consuming too much protein. 

Diabetes is not a "disease of numbers". It is a condition of poor blood glucose regulation. You do not obtain blood glucose regulation by having "improved numbers". Stop chasing symptoms with macronutrients. 

Metabolic numbers are usually improved, in the beginning, because when less dietary glucose comes in, there is an improvement in insulin expression/release. This occurs with all diets, not just "keto". The only advantage "keto" has is that it can be followed for a longer period of time, affecting blood glucose more profoundly. These diets will also not reinforce the starvation adaptation like calorie centered diets do. 

 

But we know that all diets have a dismal long term efficacy. This is because for most people, even though blood glucose lowers in the beginning, its proper regulation is never acquired. Until proper blood glucose regulation can be sustained, the condition will progress. This is why a diet that can be followed for a long period of time is the ideal as it gives you a better chance of continuing to affect blood glucose long enough for insulin expression/release to follow suit. 

So, no. Deteriorating metabolic numbers have nothing to do with "too much protein". They have to do with the inability to stabilize blood glucose homeostasis, even while adhering to a proper diet. Other issues that can be at play, which affect blood glucose regulation, is caffeine intake, not enough exercise, too much fasting, erratic meal and sleep times.

4 - 100 grams of carbohydrates a day, is not low enough for "some people". 

100 grams of carbs a day is a low carb diet. If you do not see results with 100 grams of carbs a day, you won’t see results with anything less than that. This is because the differences between 100 grams of carbs a day and 10 grams of carbs a day, to the body, are negligible if the carbs are not coming from sugar or grains. So, when we speak about carbs, we are talking about whole, non-starchy vegetables only. 

Continuously driving carbs down will not get you anywhere, except for temporary changes in numbers. As I stated above, diabetes is not a "disease of arithmetic". There are no "some people" who can’t tolerate 100 grams of carbs a day. There is no one who can tolerate sugar or grains. Usually people begin to notice this and they end up eliminating sugar and grains from their diet. Then, when they start seeing results, they claim that 100 grams of carbs a day is too much. It wasn’t the amount of carbs, it was the quality of carbs, that made the difference. 

5. Low carb/"keto"/carnivore cannot be "cures" if the person goes back to being a diabetic when they return to their "normal" diet.

 

This is all mental gymnastics and word play. First, there is a no "cure" for obesity/metabolic syndrome/diabetes. All three are chronic and progressive. They can only be "reversed" at their starting stages or put into "remission" at their end stages. 

 

The only way they can be reversed or put into remission is through obtaining and sustaining proper blood glucose regulation. The best diets for affecting blood glucose are low carb/"keto"/carnivore. The moment you lose your blood glucose control, you will return to obesity/metabolic syndrome/diabetes. This can occur while still adhering to low carb/"keto"/carnivore diets, as described in the above post. 

6. Having lots of fat in the diet, helps you maintain a fast. 

Eating large amounts of energy, to then be able to not eat, cancels itself out. All you’re doing is eating everything you would have eaten during your fast, before it begins. Not only is this dumb and useless, it causes a doubling down of the metabolic adaptation that enhances fat storage, over time.

Six common beliefs addressed, Part 102

1. Fruit has too much sugar.

Some do, some don't. It depends on the type of fruit. 

• Tomatoes, eggplants, zucchini and basically all other nightshades are low sugar fruits. They can be eaten with no restriction at mealtimes. 
• Berries and stone fruits are less likely to be hybridized, so they are fine to eat on occasion and as a garnish to your main meal. 
• Tropical fruits and other common fruits, like apples and grapes, are highly hybridized to contain much more sugar than they would have naturally and for this reason they are eliminated from the diet. 

Questions about fruit are very common, but this only places focus on food items that are not important, nor relevant to this diet, such as fruit. This diet is not about trying to incorporate what you used to eat into it, it's about eliminating what you used to eat from it. 

2. Fructose is "toxic" to humans. 

Fructose is a liver toxin, just like alcohol, when it is consumed in excess. "Excess" is not well defined, anywhere, as there seems to be a genetic variability in tolerance among individuals. Certain ancestries can better metabolize fructose than others. This is also the case for alcohol. 

For this reason, on this blog, we stay away from fructose, which basically means sugar. Sugar is half glucose and fructose. There is no established "safe" amount of sugar consumption and for that reason, no amount should be consumed. It's really that simple.

People tend to take a hot topic and sensationalize it by giving it properties such as "poisonous" or "toxic", to try and convince themselves to not consume it. But in reality, the only reason it should not be consumed, is not because of its "toxicity", but because it makes and keeps you fat.

3. Calories in/calories out (CICO) is useless because you never know how many calories are in a given food. 

Knowing the exact calories in food is irrelevant. Knowing the exact calories you are burning is also irrelevant. 

CICO is useless because it is a short term weight loss method that does not address blood glucose dysregulation. Overweight/obesity requires a long term fat loss method that consistently addresses blood glucose dysregulation. That's really all you need to know about CICO and why it fails as a treatment for obesity. 

Overweight/obese people misuse both the calories that come in and the ones that go out, irrespective of their amounts. 

4. You can consume all of the heavy whipping cream you want and still be successful on low carb.

You can consume it, until you are unsuccessful. Outcomes are completely individualized. 

If you are an obesity resistant person, you can get away with in taking quite a bit of heavy whipping cream until you become nauseous from it but you will not become obese because it does not affect blood glucose. Because of this, obesity resistant people have great leptin sensitivity which they sustain. They can go all the way up to 150 grams of fat a day, while on low carb, and be just fine. Sometimes they can even go upwards of that. 

Most obese people have terrible leptin sensitivity and they can't consume that amount of fat without stalling or gaining weight. They need to keep their fat intake on the low end of about 50 grams a day, but no less than that. Their blood glucose control is very poor and the storage of fat, which they don't burn, stimulates insulin which further contributes to blood glucose irregularities, reinforcing the problem.

 

If the goal is fat loss, there is really no reason to be using heavy whipping cream at all, unless it is required for a specific recipe. All heavy whipping cream will do is take up most of your fat macros, for the day, and you will be skimping out on more important food items, like meat, which also contains fat. 

Protein should be your priority, not items that are mostly fat. That is why dairy is to be used as a garnish and meat is the meal. Do not base your meal on liquid fat calories, as that's not a proper meal. 

5. You cannot "overeat" if your snacks are low carb. 

You should not be snacking. Period. Not because it's "overeating", but because it's obesogenic. 

6. It is very difficult to think about food in any other context that is not calories. It is also very difficult thinking of body composition, rather than just "weight".

On this blog, we do not chase symptoms, calories or the scale because neither of those work. You will have to get use to thinking of obesity in a different way or you will never be able to tackle it successfully.

Six common beliefs addressed, Part 75

1. I was told that body mass index (BMI) charts are not reliable.

I am sure that many obese people want you to believe that, but belief doesn't make things true. I have spoken about the BMI chart before and it's potential issues. This chart should not be used alone and requires context. 

The BMI chart is generally correct and the results only begin to skew for bodybuilders and/or athletes that have a significant amount of muscle mass. But, that's not the people we target on this blog. If you are reading this, then chances are you are just the average overweight/obese person. Common sense will take you a long way when interpreting your BMI chart results.

For example, if you are a healthy athlete and your BMI chart results indicate you are obese, you can pretty much guess that something is off. If you are a diabetic that looks like the Kool Aid Man and your BMI chart results indicate that you are obese, you can pretty much take it to the bank that it's correct. The mirror tells you everything you need to know.

So, using common sense is vital when dealing with a not so perfect measurement, such as the BMI chart. For this reason, I have a post that explains the proper way of measuring body fat here.

2. Protein negatively affects a diabetics gluconeogenesis.

People with metabolic syndrome/diabetes have over expressed gluconeogenesis, which is one of the main drivers of the disease, and is referred to as hyperglucagonemia. Unhealthy gluconeogenesis does not allow the body to regulate its blood glucose properly, so repairing not suppressing this important metabolic function, is vital for obtaining remission. Because of this inability of gluconeogenesis to function properly, diabetics are very efficient at breaking down their bodies, and everything they eat, into glucose. This means further loss of lean muscle mass and a continuous high insulin demand, which further deteriorates blood glucose homeostasis. For this reason, people with metabolic syndrome/diabetes require more protein, as they lose significant amounts from this heightened stress response. Protein also helps regulate gluconeogenesis, so it can begin functioning normally.

The protein itself does not cause hyperglucagonemia, nor does it make it worse. It simply unmasks it, exacerbating symptoms, which were always present to begin with. But this is transient and as the condition goes into remission, the symptoms disappear. People who "chase symptoms" immediately have the knee jerk reaction of restricting protein, because their blood glucose goes higher than it should, postprandial. Unfortunately, this will not solve anything, as eventually even breathing will cause high blood glucose if it is not properly treated.  

Protein restriction is not a proper treatment for metabolic abnormalities. Divide your daily protein requirement, into several small meals, instead of restricting it.

3. Should low carb diets be primarily plant based?

This is extremely common in diet advice. You would be surprised how many low carb proponents are ex vegans/vegetarians, that almost killed themselves on their plant based diets, and now want to "save the world" with low carb diets, which include meat. Actually they want to fill their wallets much more than they want to save the world, but let's give them the benefit of the doubt, for the sake of this reply.

Most of these ex vegans/vegetarians feel guilt for having left their "pure diet" and succumbing to eating animal products, so they insist that you must follow the diet with mostly plant foods. You don't have to do that. That's BS. Don't let someone else's guilt trip affect your health.

There was a time when the only "salad" that a human being would have, was found in the stomachs of ruminants, already partially digested, so the bounty of man-made, hybridized "plant foods", found at the farmer's market, is not going to save you. When trying to choose what to eat, keep in mind that:

• Meat = whole food
• Eggs = whole food
• Dairy = whole, fermented food
• Fruits = man-made, hybridization
• Vegetables = man-made, hybridization
• Grains = processed, man-made, hybridization

Which foods seem more natural to you?

4. The body's stress response has nothing to do with metabolic abnormalities. Blood glucose control is completely determined by diet alone.

The body's stress response is something that is often ignored and/or misunderstood, but is at the center of metabolic abnormalities. It irks me that no one explains this to people who have metabolic syndrome/diabetes. Low carb advocates ignore it completely and keep their focus, exclusively, on what's on your plate. The American Diabetes Association (ADA) makes no mention of it, even though that's why they ignore, exclusively, what's on your plate. This does not help the person who is trying to reverse their pathological metabolic adaptation.

Even though I sometimes refer to metabolic problems as "diseases", for simplicity's sake, I want everyone to get use to the idea of thinking about their condition as an adaptation, not a true disease. Metabolism has adapted to the hypo/hyperglycemic events, caused by an improper diet. This adaptation is pathological, meaning that it causes disease and eventually morbidity.

One of the main hallmarks of this pathological adaptation is an unregulated and exaggerated stress response by the body. This is caused by many decades of erratic blood glucose regulation of which hyperinsulinemia is at the forefront. When your blood glucose is unnaturally and chronically high, along with high insulin, any dip in it, even if by a little, causes the body to overreact with exaggerated adrenal (fight or flight/stress hormones) and pancreatic (glucagon) counter regulation. The gut also has a stake in this, as glucagon producing cells exist in the stomach, as well. Basically, the body has now "adapted" to high blood glucose and even dropping glucose levels to normal is seen as "hypoglycemia". This stress response is more complicated, as it doesn't just cause exaggerated glucose production, but it also down regulates insulin's effect, requiring even more insulin.

Chronic hyperglycemia adapts metabolism to live off its stress response. This is why I like describing it as a "metabolic adaptation to starvation" response. The body's metabolism is now set for increasing body fat, not losing it, as this starvation response goes hand in hand with the stress response, preserving and sparing fat mass at the expense of muscle.

This is why I always say that metabolic syndrome/diabetes is much more complicated than what some low carb person describes it as. Just because your diet is on point, does not mean you have taken control of this adaptation and its symptoms. This is what the ADA knows and why they don't put too much credence on dietary interventions. Too bad they don't explain this to anyone, so that the person with metabolic syndrome/diabetes understands what they are truly dealing with. This is also why low carb has been seen as "quackery", since it does not address this stress response at all. Low carb only addresses one part of the problem, the easy part (symptoms), which respond to what's on your plate, for the most part. But the problem has many parts. If it was so simple, it would have been cured back when it was discovered.

5. You will not gain weight eating "keto" ice cream. It's only 65 grams of fat, for the whole pint, and hardly has any carbs.

You will soon realize this is false if you do the math correctly, using the obesity algorithm, not what an obese "keto" person told you:

• 65 grams of fat + plus the taste of sweet = 6500 grams of stored fat.

That type of math is not present by simply turning over the carton and "glancing" at the fat and carb grams per serving. Glancing doesn't cure diabetes.

Remember to keep your dietary fat intake between 50 - 150 grams a day. The more fat you have to lose, the closer to 50 grams a day you should stay. Stop allowing for obese low carbers online, to advise you on what to eat. If their advice hasn't worked for them, it won't work for you.

The fat you consume should be from whole foods, that are not sweet and are nutrient dense. You are wasting your fat allotment by eating a pint of high energy junk, that will basically take up 70% of your daily fat intake and cause hypothalamic malfunction.

6. It is easier to lose fat gained from eating fat than from fructose. 

Fat is fat. I was obese once and I know people try to negotiate with their fat mass, all the time, but it doesn't work that way. Though the chronic taste of sweet causes permanent damage to hypothalamic function, making fat loss nearly impossible, the actual fat mass on your body is the same regardless of where it came from.

The fat that accumulates in the liver, due to fructose consumption, is extremely easy to get rid of. This is why fatty liver disease can be reversed by abstaining from fructose intake for about 7 days. The body is quick to get rid of this fat, because it doesn’t want it and will get rid of it any chance it gets.

The fat that is stored directly into fat tissue, from excess fat and/or carbohydrate consumption, is extremely hard to get rid of because you need intact and proper leptin expression to do so. If you are accumulating a lot of this fat, then you can pretty much guess leptin is not doing its job anymore. This means that fat stores in adipose tissue is extremely difficult to get rid of.

The body doesn't want to let this fat go, because it has adapted to withhold it for protection. Remember, the body is experiencing an exaggerated stress and starvation response, so it always finds a way to spare fat mass, not get rid of it. You can see this clearly in many people who have lost weight, but continue having excess "flab" fat (not skin). They have lost their visceral fat, but are left with a large "soft" fat mass, which they find impossible to lose. This is a sign that their metabolism continues to be abnormally adapted for obesity, not leanness. These people can gain weight at a drop of a dime, because their fat mass is just sitting there, waiting for any chance to expand and/or grow further.

This is a problem, because it will only take a very small push for them to start accumulating fat in the visceral, once again, since they are exceeded subcutaneously. For this reason, you don't want any excess body fat, regardless of what made you fat to begin with, because exceeding your fat stores is a sign of metabolic abnormality.

Six common beliefs addressed, Part 46

1. Sugar does not make anyone fat, as overweight people always avoid dessert.

Most of the obesity epidemic is being driven by added sugar. You do not have to eat dessert to have had several desserts, throughout the day, from products that are savory.

Sugar sales have declined in recent years, while obesity has increased exponentially. This is because no one needs to buy sugar anymore, to add to anything, as it's already been added for them by the food manufacturers.

2. 'Whole 30' is a great diet to follow for carbohydrate restriction. 

Whole 30 is a diet that emphasizes whole foods and is moderately carbohydrate restricted. It's sort of like Paleo, but without the "natural" sugars. This diet eliminates sugar, alcohol, grains, legumes, soy and dairy for 30 days. So, its emphasis is more on "food allergies" than obesity.

I never added Whole 30 to my list of recommended diets, because it makes too many concessions for people to continue eating foods they shouldn't. The elimination of dairy is also asinine, as that would have no effect on obesity, unless the dairy eliminated had added sugar.

3. Fructose cannot be harmful as it has no effect on some people.

This is dependent on how much fructose is being consumed, for how long and individual ability to metabolize it, which is genetically determined. Some people have a much harder time metabolizing fructose than others. This should not be surprising as we see this same variability in alcohol tolerance, since it's metabolized in the same way.

This genetic component can be commonly seen in certain ancestries. For example, Native Americans and people of South American ancestry, appear to be especially susceptible to fructose induced fatty liver disease.

4. If a person is strictly adhering to their diet, they will lose weight. 

We know that yo-yo dieting and starvation protocols can negatively affect metabolism and eventually cause for the person to become unable to lose weight. This is caused by poor leptin expression, which can cause hypothalamic damage in the long term. But, there is another situation that can cause intractable obesity and it has not been well studied, so the exact mechanisms behind it are unknown - fructose consumption.

We have long known that there is something particularly obesogenic about sugar, which is not found in any other saccharide. Fructose is a known liver toxin and its effects, when combined with glucose, are not entirely known. The liver is at the center of metabolic function, so for interventions to work, the liver must be responsive to them. It has long been observed that people who became obese/diabetic, specifically from fructose consumption, develop the most intractable forms of obesity and insulin resistance. This is related to leptin expression and since we know that the taste of sweet, affects the brain, we know that something unique occurs when obesity is the result of sugar consumption.

The consumption of fructose mainly comes in the form of sweetened beverages. Most of these beverages are fruit juices, smoothies, shakes, coffees and sodas. Desserts, candy, fruit and savory food items, containing added sugar, come in second. People who became obese from fructose consumption usually have a similar obesity pattern:

• They become obese earlier in life, often in childhood. Their children also tend to be obese.
• They gain large amounts of weight, usually of 100 + lbs. or more. These people are not just simply overweight, they are morbidly obese. In fact, they can pack on an incredible amount of body fat, before they show any abnormal metabolic markers. This is indicative of extreme insulin sensitivity of the fat mass. Again, this goes back to leptin dysregulation.
• They usually do not develop any of the symptoms of metabolic syndrome or show abnormal blood work. Surprisingly, a lot of these people do not display the symptoms of common metabolic disease that we would associate with having such massive body fat. Many have normal HbA1C's, do not display hyperlipidemia, nor develop high blood pressure or a blood glucose within the diabetic range. This causes them to live with morbid obesity for a longer time period. Obesity is a time dependent disease, so the longer you have it, the harder it is to reverse.

Having such incredible body fat and not displaying any abnormality, is a sign of impending disaster. The longer the person is obese, the harder it is to reverse and by the time these people suffer from health problems, which make it imperative for them to lose the weight, they simply can't.

There is a "quiet storm" occurring with these people's metabolism, which is not normal by any stretch of the imagination. Because these people have this uncanny ability to maintain "health" at such an extreme level of body fat, it's led to the creation of the "metabolically healthy obese" myth. But, these people are not metabolically healthy. In fact, they may have the most severe form of metabolic disease, as they simply cannot lose weight and must resort to drastic interventions like bariatric surgery, to keep from eventually dying.

The ability to accumulate such massive fat mass is a sign of severe metabolic dysfunction, that goes well beyond insulin abnormalities, but is directly correlated with leptin malfunction. The more their fat mass gains insulin sensitivity, the more every other tissue, in their body, becomes resistant. Not only can these people not lose weight, but when they do, they can regain weight quickly and a greater amount than they started with.

Though much still has to be learned about this type of obesity, we know that fructose consumption is at the center of it. It appears that fructose damages metabolism, in a permanent way, most likely at the hypothalamus and so it doesn't respond to treatment. This is precisely why we tell readers, of this blog, to refrain from sugar and sweeteners, as sugar affects the body and sweetness affects the brain. If you end up with hypothalamic damage, your body will never be able to regulate its weight.

The course of intervention, for these people, will be dependent on their lifestyle and habits. We know that they first must abstain, 100%, from any type of fructose and/or any sweeteners. From that point, carbohydrate restriction along with caloric restriction, must be implemented, as most of these people have severe disordered eating patterns and require caloric restriction in order to abstain from excess food consumption.

5. There should be one intervention for addressing obesity and not so much confusing and conflicting information.

The confusion comes from a simple fact, that most people are ignorant of or choose to conveniently ignore, - there is a major difference between weight gain and obesity. You will not find any obesity experts, online, selling books or pushing weight loss programs. This is mostly because obesity is very different from weight gain and cannot be treated the same way. It also has no known cure so writing a book about it is not going to be very helpful out of academia.

There is something peculiar going on in the bodies of the obese. You can see this clearly, by just observing people in public places. You can’t tell who’s a few pounds overweight, but you certainly can tell who is obese. Obesity is an entirely different metabolic state. This poses a huge problem in the health and diet sphere, because you are left with many people offering weight loss advice, to the obese, that’s not going to work. The obese don't need to simply lose weight, they need to lose enough weight to resolve their obesity.

It’s ridiculous to tell an obese person to go get fit at the gym. They have no muscle mass and their bodies aren't capable of producing any significant muscle mass to bypass their ever expanding fat mass. It’s also ridiculous to tell an obese person to just restrict calories, as this does not address their body's caloric mismanagement. The obese person's metabolism is working in a completely different way, than a person who just simply gained some weight and is now upset that their jeans are getting tight.

There is no doubt that the metabolism of someone who needs to lose 20 pounds is very different from someone who needs to lose 100 pounds. The metabolic dysfunction that accompanies obesity changes the rules, as to what will work for addressing it. Not to mention the long term metabolic effects of an obese person who loses weight. There is a big difference between the metabolism of someone who lost 20 lbs. and someone who lost 100 lbs. I wrote in detail about this here.

Most studies on weight loss have been done on metabolically healthy individuals, who are not obese, but more than likely "obesity resistant". The majority of studies done on the truly obese have been limited to the effects of bariatric surgery. But, the fact that the obese commonly end up needing bariatric surgery is telling in of itself. It means that what works for simple weight loss, never worked for the obese.

All animals have the capacity of gaining weight. Weight fluctuates and is never static, in any animal. This type of weight gain is not pathological. Only in industrialized societies do we see obesity, both in humans and their pets. This means that obesity is not exclusively a "human" problem. Weight gain is observed in animals and hunter/gatherers, while in there natural environment, but never obesity. There is something unique about modernity that results in the state of obesity. I suspect it has to do with the ability to sustain blood glucose abnormalities chronically, which just cannot be done in a hunter/gatherer environment. 

So far, most interventions have not curbed obesity nor gotten the obese to lean. We know this, because the most common difference between modern man and hunter/gatherer tribes is energy availability. But, when energy is reduced in modern man, weight loss occurs, but obesity doesn’t budge and when energy is increased in hunter/gatherers, weight gain occurs, but obesity does not. So, though simple interventions like "eat less/move more" help reduce weight, it does nothing for obesity.

I’m not yet completely convinced enough to claim that obesity is a “disease”, though many do. I see it more as an adapted metabolic state, caused by certain lifestyle choices, that can lead to pathology. So, the cure for obesity is not to lose weight, exactly, but rather to change this abnormal metabolic adaptation through lifestyle interventions, as many behaviors are implicated in it. The natural consequence, of a multifactorial intervention, will be weight loss.

6. People with metabolic syndrome/diabetes should restrict protein, unless they are trying to grow muscle. 

The only people who believe this, are people that know nothing about obesity and have very limited knowledge of diabetes.

People with metabolic syndrome/diabetes better be "trying to grow muscle", because if they aren't growing muscle, they are only growing fat, since growth doesn't stop at will. So, growing muscle is not optional.

Muscle loss goes hand in hand with diabetes. Diabetics have very high body fat and very low muscle mass. If they lose even more muscle, they get fatter by volume. For this reason, diabetics need to lose body fat, while preserving their muscle mass, because muscle mass is extremely important for a diabetic. Muscle mass drives metabolism for you to be leaner. Fat mass drives metabolism for you to be fatter. You choose who you want your driver to be, but the body always has a driver.

Muscle mass is so important for a diabetic, that you can be an obese diabetic and gain, just a little, muscle and your diabetes will improve. That's how vital muscle mass is. The diabetic wants to give their insulin something better to do than just grow fat mass. They need to divert its attention to growing muscle mass instead. Muscle helps regulate blood glucose. 

If you are following fad dietary protocols, which achieve weight loss mostly through the loss of lean muscle mass, you are not getting better, regardless of what the scale says. Protocols that cause weight loss, through the diminishment of muscle mass, are starvation protocols like caloric restriction (deficits), extended fasting and protein restricted diets. None of these protocols can sustain metabolic health and weight loss.

The followers of these protocols lose some scale weight from the direct loss of lean muscle mass. In the end, they put all that weight back on, and then some, as fat. So, in essence, their fad diet just made them fatter. They swapped out muscle mass for more fat mass. You are either muscle or fat. One or the other, since no one is made of rainbows and glitter, unless you're a unicorn. Becoming more fat, worsens metabolic outcomes. Fat people only get fatter. The more body fat you put on, the fatter your future self will be.

The older you get, the more this fact affects you. Children grow organs, tissues, bones, muscle and fat, but adults only grow muscle and fat. The older you get the more that scale tilts towards fat growth, as you lose the ability to synthesize protein efficiently, making it harder to grow muscle. This is why the older you become, the more at risk you are for metabolic dysfunction.

Six common beliefs addressed, Part 19

1. I don't get enough greens, but I don't like eating them.

If you don't like them, don't eat them. No where has it ever been proven that greens are needed. I understand that many hundreds of years ago people wanted to sell their crops and came up with the whole "you need your greens" mantra, but don't let agricultural marketing ploys control what's on your plate today. The only thing you need is to breathe. If you prefer a diet without greens, then eat only animal products.

2. Stable blood glucose is not important, because diabetes is a disease of insulin.

Diabetes is a disease of poor blood glucose regulation which eventually affects insulin release, function and expression (insulin resistance). Therefore, stabilizing blood glucose is extremely important to correct diabetes, because these erratic blood glucose fluctuations continue driving the insulin resistance. Everything else that occurs is always downstream from poor blood glucose regulation. 

Stabilizing blood glucose, in the context of pharmaceutical medications, is a fool's errand. Diabetes is a chronic and progressive disease, because the medications that "treat" it, only work to lower blood glucose, not to properly regulate it. This is why these medications do not "cure" diabetes, since they never reverse insulin resistance. 

3. Is taking magnesium and potassium enough to correct an electrolyte imbalance?

There are seven important electrolytes, which the body requires, and all of them work in unison - sodium, potassium, calcium, magnesium, chloride, phosphorus and sulfur.

If only one of them is too low or too high, it can affect how all of the others work. For this reason, concentrating on only sodium, magnesium or potassium is not enough to correct electrolyte imbalances. Consuming salt in isolation can also cause more dehydration,  furthering electrolyte imbalances. Salt needs to accompany the correct amount of fluid.

You need to replenish and balance electrolytes with a good quality electrolyte supplementation. These supplements can be found in health food stores or vitamin shops. Make sure the product you choose does not contain sugar. Also avoid products that are labeled electrolytes but contain other vitamins, minerals and "antioxidants" as fillers. You want electrolytes, not anything else. 

Discuss electrolyte concerns with your healthcare provider, so you can get the appropriate testing required to have a better understanding of what might be going on. This is especially true if you are symptomatic.

4. Since low carb diets will always work, I can just go back to them after binging and cheating.

No. 

Yo-yo dieting has extremely negative effects on metabolism and can eventually dysregulate leptin function, thyroid function, stress hormones, etc. This is because with yo-yo dieting you end up disrupting blood glucose even more, over time. 

Poor leptin expression can cause the inability to lose weight, unless extreme measures are taken. The more extreme, the less sustainable and the higher the failure rate. This is why a diet that worked once, might not work a second time.

This is why practicing a consistent dietary, fasting and exercise protocol is so important. You have to stick with it, so you can develop a healthy circadian rhythm, that your body will respond to. You do not want to stress your metabolism into no longer responding to anything.

5. I was told sugar is bad, but fructose is fine, since it does not raise my blood glucose.

Fructose does not raise blood glucose, because it is metabolized in the liver like alcohol, and becomes liver fat. Liver fat only perpetuates metabolic dysfunction further. 

The sweet taste of fructose interferes with incretin hormones, insulin and hypothalamic function. 

For this reason, you have to stay way from fructose as it is particularly obesogenic. 

6. Is coconut water good for electrolyte imbalances?

Coconut water contains all of the electrolytes needed, but if you are symptomatic, this is not enough. The more fluids you intake, the more you urinate and this causes more electrolyte loss. Electrolyte supplementation will be your best course of action, not drinking more.