Six common beliefs addressed, Part 263

1. My ophthalmologist checked my intraocular pressure (IOP), 6 weeks ago. One eye had a pressure of 23 the other 17. He said these pressures were elevated and I needed eye drops for glaucoma. I went in yesterday to be rechecked and my pressures were 10 and 12. The doctor believed this was an error so they rechecked it again and got the same reading. He said this was not possible without medication. I started "ketovore" a month ago and believe this is what corrected this.

I don't think you are recalling this experience correctly or some dire piece of information is being left out. But if it happened exactly as you are describing, you need to find a new eye doctor ASAP.

Normal IOP is considered to be between 11 and 21 mmHg. This would mean that your first reading showed one eye slightly elevated and the other as normal. Your doctor suggesting that you needed "eye drops for glaucoma" is preposterous. He didn't even screen you for glaucoma to make that statement. There are individuals with higher than normal IOP who never develop glaucoma just like there are individuals with normal IOP who do develop glaucoma. Risk of glaucoma varies and that risk has to be assessed carefully before glaucoma medication is administered. Many other underlying factors could be affecting IOP. Why he jumped the gun to glaucoma, with a single eye pressure result, is mind boggling to me. This is why I believe you are not recalling this correctly.

IOP varies considerably during the 24-hour cycle so why he would say that your change in IOP is "not possible without medication" is ridiculous. It is totally possible. A single eye pressure measurement at any given time, on any given day, in the doctor's office is only a snapshot of what the eye pressure truly is on average. This is why your doctor would have had to take multiple readings before he could determine if you truly have elevated IOP, what's causing it and what risk does it pose. Then he could determine what course of treatment you should have. My husband has had high IOP in one eye before, multiple times, and then it would be normal by the next reading. He was never been told he needed "eye drops for glaucoma" before and he actually has a family history of glaucoma. They simply monitor his IOP fluctuations, but he doesn't have glaucoma... yet.

This is precisely why I never take these anecdotal experiences seriously but low carb pages and groups run rampant with them. These stories always have missing information, incorrect information or exaggerated information in order to prove whatever narrative they want you to believe. I understand you are excited with "ketovore" but putting out these stories, that don't make sense, is not going to help anyone. Like I said before, there are many factors involved in the regulation of IOP. The reason that "ketovore corrected this" is because there was nothing wrong to begin with.

2. I lost 140+ lbs. but now I have kidney issues and will be seeing a specialist next month. I'm pretty sure all my health issues are 100% stress. My HbA1C is now 4.5, thanks to low carb. I just don't understand why I am having kidney issues now that everything has improved.

And I don't understand what your kidney issues are. You left that part out.

There are many types of "kidney issues". Not all kidney issues are related to diabetes, overweight/obesity or metabolic syndrome. I can be on the best diet and exercise program and still drop dead of a heart attack because not all heart issues are caused by diet and exercise. Sometimes organs simply mechanically fail because of some other underlying reason or even genetics. Certain medications also, when taken for the long term, cause kidney disease like blood pressure medications.

So, I can only go by the information you gave me, not by what you didn't. The fact you lost 140+ lbs., means you were significantly obese at one time and I don't know how long you were that way. I also don't even know if the loss of 140 lbs. got you to lean because you didn't say.

You said that your "HbA1C is now 4.5 which makes me believe it was much higher before. This means you were possibly diabetic or prediabetic at one time, but you also didn't say. Dropping your HbA1C to 4.5, which is something I haven't even been able to accomplish, is quite impressive. Too impressive actually. You should check your blood glucose lows. People in the low carb world always hoot and holler at low blood glucose numbers and HbA1Cs. They make it seem as if there is no bottoming out for these numbers but there is. Too low means big problems. The person with too low of these values is just as diabetic as the one with two high of them so, it is not surprising to me that you are having kidney issues. "Everything improved" is up for interpretation.

Diabetes is not a disease of high blood glucose or high HbA1C. It is a syndrome caused by poor blood glucose regulation which deteriorates insulin function over time. Abnormal release and over expression of insulin (insulin resistance) is notorious for damaging the kidneys. It takes decades for this to happen, but it eventually does and that is why kidney disease is such a common complication for diabetics. You can still have abnormal insulin function with a low HbA1C. In fact, it could be that over expression of insulin dropping your blood glucose so low. I would have really liked to see your fasting and postprandial glucose readings. After all, you have to explain that low HbA1C and nope, low carb is not the explanation. Are you on some type of medication?

This is why you have to be ultra careful when you listen to low carb zealots. Their goal is to just lower your blood glucose, as low as it can go, and they simply ignore everything else. Well, your blood glucose certainly lowered but at what expense? It appears your syndrome was still continuing unabated. Overweight/obesity/diabetes/metabolic syndrome have long lasting effects on the body, even after your blood glucose seemingly lowered and the pounds came off. I certainly would have needed more information so I could have some context of your issues.

3. Is there a point where you need to stop eating "keto"?

A well formulated ketogenic diet does not ever have to be stopped.

4. Why do low carbohydrate/"keto" people keep pushing a diet that they can't even follow themselves? Yet they swear up and down it's the only way.

First, you can't be duped this easily. You should know the answer to this. The people who are pushing this stuff are people who get paid off it. It's their job to push it and minimize/hide when it doesn't work or people don't like following it. Of course they themselves can't follow it. The diet has no ravioli, pizza, biscuits, cinnamon buns, shakes, cakes and pies. When it does, they taste like &@^$. Nothing beats the real thing and there is nothing worse than searching constantly for alternatives to the junk you used to have, only to find out it doesn't live up to the hype. So yes, these people will always be unable to follow a diet where it is imperative that you stay away from junk.

I remember watching a video of a "low carb doctor" where he had the audacity to say that a "natural, low carb diet is full of delicious foods". He then listed nuts, spinach, berries.... WTF? Did he not think we knew those foods existed before? We never ate them for a reason. They taste like &@^$. Yes, I can eat broccoli but who wants to?

This is why I never patronize my readers. I tell them the truth so they know what to expect and don't become discouraged or disappointed later. The key to success is to know exactly what you're getting into beforehand and to understand why you're doing it and what happens if you don't. That's all you need as motivation.

Low carb diets, when followed correctly and not "a-la-carb counting", are restrictive, elimination diets that require diligent adherence and a high level of commitment. This is because tacos, cookies and brownies will be completely off the menu and so will 90% of all the other stuff you're used to eating. Good bye Italian restaurant unless you order the caprese salad only. The diet is only meat and vegetables. No shared desserts and of course, the cookie bar is gone too. You can't have your cake or eat it at all.

You can find delicious ways of preparing and seasoning your meat and vegetables but no, there are no French toasts or waffles or even French fries to go with it. There is no lemonade or corn dogs so your carnival visit might be hampered. At the movie theater you better bring your own bland nut tray or your bitter 90% chocolate bar because popcorn and Kit Kat bars are forbidden. You can go through your phase of trying to recreate these items to be "low carb" but you will soon learn that they aren't the same and not even worth the hassle of making. Those that cross that bridge, actually learn to live with their diet, enjoy it and they begin to obtain results. Those that don't, will continuously fall off the wagon and cry about it.

The goal of low carb is not calories or to fit into a bikini. The goal is proper blood glucose regulation. You are trying to fix the tree from the root upwards because trimming the branches is not solving the crooked trunk. This is why low carb diets are only beneficial for people who are ready for a metabolic intervention, not those simply trying to find a new diet to follow.

5. If blood glucose disparities set the stage for overweight/obesity/diabetes, how does fasting play into this? A lot of fat people do not seem to ever be hungry.

Fasting is detrimental for people who already have metabolic syndrome because it prolongs their "time in hypoglycemia". Basically this is lengthy exposure to low blood glucose. This further reinforces the metabolic adaptation towards high blood glucose, insulin and body fat. You cannot keep stable and proper blood glucose regulation when you fast for long stretches of time. Remember, if the person is overweight/obese, they already have a high insulin demand so prolonging the time in fasting blood glucose only drops their blood glucose lower than it normally would due to the presence of higher than normal insulin expression.

This is why people on exogenous insulin and/or blood glucose lowering medications are told to not fast for long stretches as this will only cause them more problems. Lows in blood glucose are the engine that drives the condition we know as metabolic syndrome/diabetes. Highs in blood glucose would be the transmission. This car is headed towards dialysis.

Some obese people are often hungry but there is a large percentage of them who are mostly not hungry. No hunger is usually a sign of "leptin resistance". This is why it's not surprising that the never hungry obese, are the ones with intractable obesity.

6. I've read that on "fasting days" it's okay to eat, you just have to keep calories under 500. I'm not sure if I have to worry about macros. Can I have a green tea?

I don't know what you're talking about. This must have come from some asinine protocol you were reading online but it's not reality. "Fasting days" while eating are called "eating days". "Eating days" under 500 calories are called "snacking days". Doing this for a prolonged period of time is called "starvation".

The only thing that's called "fasting" are 0 calories. Fasting is when you do not eat anything. Nothing at all. Not a thing. Well, except for your own body fat but if your leptin expression is through the floor, you won't be doing that either. So it's zero.

Also there is no such thing as "fasting days". You fast daily for a set number of hours. You don't "fast for days".

Six common beliefs addressed, Part 240

1. Can low carb "cure" glaucoma?

Low card can't "cure" anything. Low carb is a diet that is used, alongside other lifestyle changes, to control the progression of metabolic syndrome. It is a palliative treatment only.

As far as glaucoma is concerned, there are many different types of glaucoma and all of them are completely treatable in the modern world. In fact, glaucoma treatments are so effective in this day and age that you can describe this once blinding condition as technically "curable".

2. I've heard about a "documentary" called 'Reversed'. What do you think of it?

All this stuff is just another money grab by known low carb quacks. Many of these types of films are floating around out there. Once you have seen one, you have seen them all.

I have seen a snippet of this one and that was enough to see that it's just another emotionally driven documentary to grab at your heart strings since the "science" it's based on is plain incorrect. If you like watching this stuff, that's fine but don't expect to resolve your metabolic issues. The only thing this can do for you is deliver false hope, but some people are just fine with that.

3. I follow a "low carb doctor" and he measures ketone levels in his patients to determine if they are being "cured" or not. Is this a good strategy?

That is foolery. It's just a way to make the patient think that "something is happening" so therefore, "it must be working".

A diabetic has poor insulin function. Insulin does a lot more than just facilitate glucose into cells. It also controls ketones from fat burning. This means that diabetics can make ketones very easily as their insulin is not very good at regulating ketones or anything else. Measuring ketone levels in a diabetic is a waste of time. It simply shows you that they are burning fat. Whoopee! They are still fat and diabetic. Diabetes is not the inability to burn fat. It is the end stage of metabolic syndrome, a condition of poor blood glucose regulation.

A rise in ketone levels from eating low carb is expected in a diabetic as it's expected in anyone else. When insulin lowers, it makes you more prone to producing ketones. This means nothing. Literally, nothing. You can achieve the same thing with calorie restriction. It's the way the body is supposed to work. Ketones do not "cure" diabetes. The diabetic is still diabetic and will continue to be while producing ketones.

Diabetics burn fat, like everyone else. In fact, they have excess fat in their blood to burn. Diabetics burn glucose. They for sure have plenty of glucose in their blood to burn. Diabetics burn through their lean muscle mass too and they don't even have much of it to spare. Everyone burns fat and glucose, including diabetics. The difference is that diabetics don't burn enough stored fat and can't keep themselves from storing more. This isn't resolved with ketones. This is resolved by stopping the metabolic adaptation that keeps this cycle going.

It's really sad the way these low carb "doctors" take advantage of these desperate people who don't understand basic metabolic function or biology. They are duped by fancy and mysterious words like "ketones" and think that some magic is occurring in their bodies. Throw the word "insulin" in there, which is one they have heard their doctor mention before and they think they just found the Holy Grail. These people want to hold on to the belief that there are "easy quick fixes" out there, so they will take whatever these "doctors" tell them at face value since their own doctors haven't been able to "cure" them. At least, not easily nor quickly.

Once you get past how sad this is, it becomes rather disgusting that there are parasitic people that would do this to these sick people. These "low carb doctors", well the ones who are actual MD's, took an oath to do no harm and I suppose they justify their actions by telling themselves that they aren't really doing harm. They are just not telling these people the whole story and these people do get somewhat better so it can't be that bad. After all, they can't get any worse. The problem is that they do. They continue getting worse.

Not only are these people robbed of money, they could use for better food and walking shoes, a lot of them also stop their medications, ignore serious symptoms, follow diets that make their problems worse, all while living a lie. The worst part is that they don't even live long enough to realize it. By the time they wake up, it's too late.

4. How many carbs a day is still considered low carb?

This is subjective as there isn't an "official" number for what constitutes "low carb" that everyone agrees on. It really depends on who you ask but if you were to take all low carb diets and take a range from them, then you can say low carb diets fall anywhere between 30 - 200 grams of carbs a day. Remember, we are discussing low carb, not no carb. No carb would be 0 carbs a day.

Below 30 grams a day would be considered ketogenic. Above 200 grams a day would be considered moderate carb until it reaches the Standard American Diet (SAD) of well over 300+ grams of carbs a day, which would be considered high and/or ultra-high carb.

As a side note, people who advocate for the Dietary Guidelines, will swear up and down that SAD does not have such a high carb allotment but that's only true of people actually following the daily calorie recommendation, which none do because they can't. No one can. So, the way the diet is actually followed, not the fantasy, does push carbs way over 300 grams a day.

A good rule of thumb is to just use the Atkins model which defines true low carb as up to 100 grams of carbs a day. Just stay away from sugar and grains.

5. Is it true that things like red light therapy, saunas and "grounding" will help overweight/obesity?

Absolutely not. I don't want you to get caught up in nonsense because you won't get anywhere and people with metabolic problems do not have much time to waste on dead ends.

The only thing that has been shown to be successful in reversing and halting the progression of overweight/obesity/metabolic pathologies is lifestyle. Lifestyle comprises of diet, exercise and stress mitigation (sleep, fasting). None of these things work by themselves, except for exercise which is the only one that has been shown to have benefits irrespective of the others, but the best outcome is to incorporate all of them.

6. If sugar and carbohydrate consumption has decreased why is obesity still an issue?

I've answered this before and it's multi factorial. Sugar consumption has dropped in the past several decades because there is no need to add sugar to anything. It's already been added to the products being sold. So even though individual sugar consumption has decreased, food manufacturer usage has increased exponentially.

Foods like ice cream, soda, candy and deserts have been on the decline for several decades because of calories in/calories out (CICO) compliance, plus the "healthy foods" renaissance that has taken over the diet sphere. So obvious "junk foods" have been pushed to the side in lieu of "healthy fats", "healthy grains", "healthy sweeteners", "healthy fill-in-the-blank".

But "junk food" aren't the carbs that make people fat. Fat people have been passing on the dessert at restaurants since before they got fat. It's the grain based "healthy" products that are the main culprits for obesity. These foods are impossible to consume within CICO parameters as they are so nutrient void, and disrupt blood glucose so profoundly, that you would be unable to stick to calorie deficits without feeling uncomfortable enough to make it stop. So even when the overweight/obese person declines the dessert at a restaurant, it doesn't make a bit of difference when they just ate a basket of multi-grain bread and a plate full of whole grain pasta only to be ravenously hungry an hour later.

This is the main problem with CICO combined with a high carb diet. It becomes impossible to follow as the macronutrient composition keeps you hungry, due to a disruption in blood glucose homeostasis, they it truly only works in a perpetual state of starvation (chronic hypoglycemia). This prolonged time in hypoglycemia will eventually result in metabolic syndrome anyway. So, you can see diets, which are carb based, have made people fatter and this is why you see a linear increase in obesity alongside a decrease in sugar consumption. Decreasing sugar calories while still eating high carb, doesn't work.

Overweight/obesity are also time dependent conditions. It takes a chronic, long-term assault on blood glucose for weight gain to become overweight/obesity as it takes time for metabolism to adapt to the point to where it begins piling body fat exponentially while sparing it at the same time. The journey to obesity is just as slow as the journey to leanness. The only difference is that obesity is a guaranteed destination while leanness is not.

Six common beliefs addressed, Part 164

1. Calorie restriction forces you to go lower and lower in calories to achieve the same results.

Yes. The body always compensates when its calories are reduced and its fat mass is challenged. It then adapts and continues gaining body fat with the new lower caloric set point. The body does this when its starved in any way, including by extended fasting, which is a form of caloric restriction.

The only way around this is to fool the body into thinking that it is under caloric restriction by giving it calories it will not store, like protein and eliminating/restricting calories it does store like carbs and fat. That way the body is not under caloric restriction but it is at the same time. Though you may be in a surplus of calories from protein, the body will not store them but use them for the building of lean muscle mass or simply expel them.

2. There is no way to know if you are insulin resistance.

We only use the classic five criteria to determine insulin resistance, which are present in metabolic syndrome:

• Waist circumference over 40 inches (men) or 35 inches (women)
• Blood pressure over 130/85 mmHg
• Fasting triglyceride (TG) level over 150 mg/dl
• Fasting high-density lipoprotein (HDL) cholesterol level less than 40 mg/dl (men) or 50 mg/dl (women)
• Fasting blood sugar over 100 mg/dl

You do not have to have all of them. If you experience three or more of the conditions listed above, you are considered to have metabolic syndrome, unless they are the result of some other condition or medication. Metabolic syndrome is always indicative of poorly functioning insulin (insulin resistance).

3. Is glaucoma early insulin resistance?

Glaucoma is caused by the death of the ganglion cells of the eye. Period. Until is is definitively known what causes the death of these cells, then the disease can never be cured. You can't cure what you don't understand.

We know that whatever kills any cell, will kill ganglion cells as well. This includes chemicals, injury, infections, toxins, radiation, etc. That tells us nothing as to why ganglion cells, specifically, die in certain people causing glaucoma. So no, glaucoma is not "early insulin resistance". Glaucoma is simply the death of ganglion cells and though there are interventions which will reduce your risk of going blind and significantly reduce its symptoms and progression, the disease itself remains as there is no known cure for glaucoma.

Like with all other diseases, staying as healthy as possible, for as long as possible, can reduce your risk of glaucoma.

4. People are getting gout for the first time after starting "keto".

People are getting gout for the first time after starting vegan, vegetarian, low fat, carnivore, Standard American Diet (SAD), fruitarian, Mediterranean and just about any other diet under the sun because people are getting gout, for the first time, on a daily basis.

The best way to avoid gout is to avoid metabolic syndrome as gout can be best described as early stage kidney disease. The vast majority of kidney disease, in the Western world, is caused by metabolic abnormalities. Carbohydrate restricted diets can reduce your risk of metabolic syndrome.

5. If you don't check ketones you won't know if you are in ketosis.

You don't, but you are. We all go into ketosis every single night during the overnight fast. Our body's metabolism is a hybrid which uses both glucose and fatty acids. The metabolizing of fatty acids, produces ketones. If you are on a low carb diet, you will go in and out of ketosis naturally. If you are diabetic, you will go into ketosis even easier. 

6. You should count total carbs not net carbs.

It depends on the protocol you are following but you shouldn't be counting any carbs. Counting carbs is not necessary on an appropriate low carb protocol as you would only be eating the carbs found in above ground vegetables.