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 21

1. Insulin resistance is when cells are overfilled with fat, not sugar. For this reason, sugar is not to blame for obesity.

This statement is true, but it is describing something that occurs way downstream from what you can control. Insulin resistance is caused by poor blood glucose regulation, which you can control, but we can into the weeds a little bit. 

Once your adipose tissue (fat cells) reach their threshold, and can no longer hold any more fat, the fat spills into the bloodstream and other organs, causing metabolic abnormalities, which are obesity and metabolic syndrome, all of the hallmarks of insulin resistance and future diabetes.

The reason that the cells are described as being "filled with sugar" is because, in modern society, this fat is mostly coming from excess carbohydrate (sugar) consumption. Excess carbohydrate is converted into fat and then efficiently stored in the adipose (fat cells), once glycogen stores have exceeded their threshold. This view helps the person better understand the dietary approach they have to take to treat their obesity. They must put a shut off valve on the sugar intake. If they don't and take the approach of restricting dietary fat, instead, they will continue getting fat and be none the wiser as to why or how.

The average person is not aware that the body converts sugar into fat. It doesn't matter how inefficient it is at it. It doesn't matter how much it tries to avoid doing it. It doesn't matter what a pain in the ass it is, since it's so much easier to just shuffle fat into fat cells. It doesn't matter how far down the metabolic pathway it occurs. It's all irrelevant. Nothing matters except that it does do this. The body uses what it's given, not what it wishes for. If it's given a lot of carbohydrates, then it has no choice, but to stick it somewhere. It doesn't just evaporate into the surrounding air to feed the fairies.

Most people assume sugar stays as sugar and fat stays as fat, in the body, but it doesn't work that way. Sugar can turn into fat and vice versa. For this reason, it's very common for people to assume they are fat from too much dietary fat. This is why only going low fat, does not curb obesity since, the main culprit, sugar, is still pouring into the body.

In the modern world, carbohydrates like sugar and grains, are the primary cause of obesity, because they are abundant, cheap and easily accessible. The fear mongering and expense of animal fats and protein, has also made people turn to carbohydrate as their primary macronutrient. This does not mean that you cannot become obese on starch or dietary fat. You can get fat on any diet that causes an interference in proper blood glucose control. Carbohydrates are just the common culprit in modernity.

2. Do people get fat from "vegetable" oils, because they cause an increase in calories?

If controlling calories worked, it would have already worked, but once again, things are slightly more complicated than that.

Each fat cell is equipped with the ability to reject excess energy that's being delivered to it by becoming locally insulin resistant. This allows for the Reverse Electron Transport (RET) process to release energy, to the bloodstream, rather than the cell up taking it. This release of energy into the bloodstream causes the basal metabolic rate to respond by increasing, in order for this energy to be burned off. Linoleic fatty acids, from "vegetable" oils, interfere with this process by halting the RET pathway and overfilling adipose cells with energy. Now the cell has no way to stop intaking energy and it eventually reaches its threshold and overfills. After this, the process of the body becoming systemically insulin resistant, and eventually developing diabetes, is on a roll and is inescapable.

The cells reach their fat threshold, not because of a lot of calories from "vegetable" oils, but because the RET pathway has been inhibited by them. You can control all the calories from "vegetable" oils, you want, and you will still get fat. Until these oils are completely removed, this will continue to be the case. This is how "vegetable oils" interfere in the ability for the body to break down its fat stores and they are implicated in insulin resistance.

3. If it wasn't for grains, civilization wouldn't have ever gotten to this point.

Grains are the breadbasket of the world. If it wasn't for agriculture, population would have never made it to where it is now. Complex political, social systems, innovation and progress would have never occurred, because food uncertainty takes precedence over everything. The fact that people can now relax and come up with an iPhone is because of grains. The reason that famine is becoming less of a concern, around the world, is because of grains. More and more people are rising out of poverty, with each passing year, in poor countries, because of grains. Hunter/gatherers have not had the same success. You just cannot develop into a complex and advanced  civilization without the domestication of plants and animals (agriculture).

It can be debated that all of this progress is more about fossil fuel than grains, but that's another story, so for the sake of simplicity let's allow grains to keep their fifteen minutes of fame, since without them, the search for fossil fuels or any kind of fuel, for that matter, would have most likely not ever occurred. 

Regardless of the miracles created by agriculture, or not, they mean nothing to your blood glucose and your blood glucose is all you should be caring about because the one innovation, that grains have been late in producing, is the artificial pancreas. The other innovation, grains can take complete credit for, but you don't want to take advantage of, is the dialysis machine.

Grains are one of the largest contributors to obesity and general ill health, the world over. People are living longer, but sicker. The person that has to go to dialysis daily can care less about the geopolitical advancements caused by grains. They only care about how they are going to get through the day and what got them there. When you are obese and diabetic, you have to figure out how to avoid ending up at that dialysis center. Taking solace from the many world benefits of grain production is not going to help you. What will help you is to stop eating grains because grains profoundly interfere with blood glucose homeostasis. 

So, on this blog, I focus solely on grains and health, not on grains and world hunger, advancements or anything else.

4. There's hunter/gatherer tribes that consume plenty of fruit and honey and do not suffer from metabolic syndrome, therefore no one food can be blamed for the obesity epidemic.

This is correct. No one food or diet can be blamed for anything. The only thing to blame is poor blood glucose regulation. Poor blood glucose regulation can be the result of many lifestyle factors, of which diet is only one. But let's go down this rabbit hole anyway. 

Just like there is a big difference between the way an impoverished, agrarian society consumes plain, white rice, there’s a big difference between the way the Mbuti and Hadza peoples consume sugar. It is almost ridiculous to compare our Western society to these tribes, but these arguments are out there and make the rounds every so often. They do nothing, but get in the way of people making the decisions that will better their health.

These hunter/gatherer tribes do not add sugar to everything they eat. When non-hybridized fruits and honey are available to them, seasonally, they take advantage of them and make them the bulk of their already limited supply of food. During these times, carbohydrates can make up to 80% of their daily calories, while they continue being under a state of low grade starvation. These tribes aren't dipping their biscuits in honey, adding it to their coffee or their steak sauce, whenever they want. They aren't eating fruits as snacks, in a syrup laden container or topping their pancakes with them.

These tribes do not have agriculture, so they do not have access to crops like wheat and corn, to pair with their honey and fruit. Eating plain honey is not a very pleasant experience, especially when it's all you have to eat. But, these tribes do not have much of a choice. They have to take advantage of what's available or starve to death. Their environment is different from ours. Their activity level is different from ours. Their rationing of food is different from ours. Their metabolic adaptation is different from ours. Honey to a hunter gatherer = no death from famine. Honey to a Westerner = another way to get fatter. 

Thankfully, we have year round access to nutrient dense foods and we do not have to eat the plain white rice of the agrarian or the honey of the hunter gatherer. We do not live in conditions of low grade starvation, unless we purposely put ourselves there in order to have Oreos. But, since we can't sustain the starvation, we still end up getting fat. After all, it's purposeful starvation, not forceful starvation. Starvation is one of those funny things that works best when we aren't in control of it and its forced on us. This is because forced starvation only has two outcomes - death or it passes. These hunter/gatherers will not be eating honey forever. It will pass. 

5. Will sugar alcohols affect my blood glucose?

Sugar alcohols go by many names, just like sugar. Common ones are erythritol, maltitol, hydrogenated starch hydrolysates, isomalt, lactitol, mannitol, sorbitol and xylitol. These sugar substitutes are usually added to processed foods in order for manufacturers to make claims on their packaging like "Diabetes Friendly" or "No Sugar Added." A lot of these sweeteners are also being used in low carbohydrate diets like "keto" or Paleo.

It is true that they do not raise blood glucose. Only glucose raises blood glucose and sugar alcohols are not glucose, but many sugar alcohols are converted back into glucose by the body. Others require no conversion and are used, by the body, in the exact same way as it would glucose, causing the same hormonal effects and interference with fatty acid metabolism that glucose would.

You can do your own research on which sugar alcohols cause different effects, since they do not all work the same, but on this blog, sweeteners of any kind are not recommended.

6. Unprocessed, whole carbohydrates did not cause the obesity epidemic, so they shouldn't be restricted.

Just like with fat, whole food carbohydrates did not make you obese or diabetic, but they sure can keep you that way. Make no mistake, you can continue experiencing abnormal blood glucose eating starch and if you were sick before, they can help you get sick again. For this reason, it is best to eliminate carbohydrates like sugar and grains and restrict whole carbohydrates like starch, for life.

Remember, whole food carbohydrates disrupt proper blood glucose regulation, just like any other carbohydrate.