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 211

1. My coach told me that I don't have to be fearful of "good carbs" as long as I follow their diet. "Good carbs" for them are "complex carbs" which include "whole grains". I am still hesitant to include grains in my meals. 

LOL I apologize for laughing but I just get so many questions with all kinds of crazy stuff in them. Some of the most asinine stuff I receive are advice from coaches and trainers.

You really don't have to be scared of any carb when you're following a starvation protocol, so I have no clue why these coaches have gotten into the habit of labeling carbs "good" or "bad". It goes against the premise of their protocols. Let me give you the reality. There is no such thing as a "good carb". In fact, there is no such thing as a good anything. The "goodness" in anything you eat stops at whether it disrupts your blood glucose homeostasis or not. 

Let me clarify what glucose homeostasis is. It's not when your blood glucose goes up after eating. It's when it goes up so high that insulin remains in the serum and expressed in tissues for a prolonged period of time, disrupting fasting blood glucose levels. This disruption breaks the tight regulation (homeostasis) the body has with its glucose. This isn't a one day event. This happens chronically unbeknownst to the person it's happening to.

The "carbs" that coaches are defining as "good" are carbs that contain a much higher glucose content (starch), than above ground vegetables. Things such as roots, tubers and squashes, which are perfectly fine occasionally, can remain within your macros and you will continue seeing results, if you can tolerate them well. Your coach has also lumped in grains along with these. Basically "good carbs", to a coach, is any carb that isn't a Snickers bar or Wonder Bread. Snickers bar and Wonder Bread = bad carbs to them.

Again, there is no purpose in differentiating between "good" or "bad" carbs, when a protocol is completely calorically based. If a Snickers bar and a slice of Wonder Bread fits your calories, then I don't see what the problem is, unless they are admitting that all calories are not the same, but still insist on holding onto their calorie theory none the less.... hmm. In other words, lots of double talk and not a pound lost.

My recommendation to you is that if you want to lose a few pounds, be unable to continue on the protocol and go right back to finding some other "treatment", then follow what your coach says and incorporate some "good carbs" into your diet. But if you are serious about losing weight and keeping it off, following a protocol that you can continue on for life and achieve long term weight management, then stay away from your coach's list of "good carbs". "Good carbs" interfere with blood glucose homeostasis, the same as "bad carbs".

2. You can’t get fat off what you "don’t eat".

Negative. There is no such thing as "not eating". For instance, you can get fat off your own muscle mass. All your body has to do is break it down into glucose and then store that glucose as fat. So technically you're eating. You're eating yourself. Worse, you're getting fatter doing so. This is why all obesity is sarcopenic because that's exactly what the obese metabolism is doing. It eats muscle and builds fat with it.

Now if we are talking about eating with your mouth, then you can only get fat off some of what you eat, most of what you eat or all of what you eat. That is not determined by how much you eat but by what you eat and how your metabolic state is allocating its calories. In other words, your neuroendocrine state determines how fat you become because it decides how much of what you eat is burned or stored.

3. If fat people make so much glucose, why can’t they run marathons constantly? They are technically full of energy.

Obese people are "full of energy" but it is only being used to build more body fat. All of the sugar circulating in an obese person's blood is being converted to fat and not used for working energy. Not only are there not enough marathons they can run to reverse this, but they simply have no usable energy to do so. This is why energy is subjective. For instance, it takes a lot of energy to get and remain fat. This is why a lot of fat people have high metabolic rates and pseudo hyperthyroidism. 

Surprisingly, most of the energy that a person uses is not while running marathons but while doing nothing at all. That is when the most fat is burned. Unfortunately, the obese also do not use energy while doing nothing at all. They are in a metabolic state that spares energy instead, whether they are active or inactive. In other words - starvation. Their metabolism is doing the exact same thing that a starving person's metabolism would do - conserve energy to become fatter. This is why obesity is an adaptation towards starvation. That is the definition of active obesity in a nutshell.

The person who is obesity resistant does not experience this. Their metabolism responds perfectly to energy in/energy out requirements even when using the simplest and most basic energy information input, such as calories.

Calories are the smallest denominator that the body uses to check its energy status and has the least long-term effect on body fat and metabolic function. But yet, the obesity resistant person can maintain their weight, for quite a long time, even while eating Snickers bars, through the counting of calories. Of course, the caveat is that this will only continue to work as long as the lean person is able to control their blood glucose regulation.

Unfortunately, calories are a poor way to control blood glucose regulation for the long-term, so the lean always end up expanding over time regardless of their calorie counting. Blood glucose regulation reigns supreme over calories for the body to determine its energy status and what to use that energy for.

So, yes you can be full of energy and have none to spare. "Water, water everywhere but not a drop to drink."

4. I am never hungry. I don't feel like I should eat anyway.

You need to eat at your mealtimes. Schedule convenient mealtimes and keep to them. You can choose two to three mealtimes a day. Make sure you schedule them so they can be followed consistently, daily. Do not snack in between.

I know that people say they are "never hungry", but I have yet to see those same people simply not eat anything for weeks at a time. In fact, most of those people do not even go one day without eating. Most of this "never hungry" stuff is really just "never hungry for a proper meal" because they can certainly live of snacks and novelties. If you can eat a Snickers bar, you can eat a meal.

Consistent mealtimes will help regulate satiety signaling and appetite. Once your body begins to burn some fuel, it will naturally become hungry and you want it to be hungry at your mealtimes, specifically.

5. I have a cheat meal at Burger King, once a week. I have still dropped pounds and inches. I only notice that my appetite changes a bit after that meal, but I am still seeing results. I think I should just work out more, after that cheat meal, to prevent it from catching up to me.

This would be fine if weight loss and/or maintenance is all you care about but the name of this blog is 'Journey to Metabolic Health'. This means that we strive to give the best advice for you to maintain or acquire metabolic health even at a normal weight. This is not a weight loss blog. The advice we give is to help treat obesity, not weight loss. This means that your "cheat meal" is detrimental to your metabolic health.

It takes very little time for disparities in blood glucose, ups and downs, to cause metabolism to change in detrimental ways. Because your cheat meal is from Burger King, I can assure that you are experiencing disparities in your blood glucose on that day. That's all it takes for things to take a turn downhill for you. Soon, you will adapt your body to store more fat and that one meal will be enough for you to start seeing changes in your body composition.

No amount of exercise is going to stop this snowball from going downhill because it's not being caused by lack of exercise. It's caused by disparities in blood glucose, directly caused by what you eat. How does this happen?

• Eat calorically restricted meal at Burger King.
• Blood glucose rises above a normal range due to the macronutrient composition of the meal, not its calories. Let's say 167 mg/dL.
• Because blood glucose rose above normal, the body releases a larger amount of insulin, than it would normally, in order to help facilitate the clearance of this abnormally high glucose.
• Because a larger amount of insulin had to be released, for an extended period of time, it remains in circulation and expressed in tissues for longer than it normally would. Now it's driving down fasting blood glucose too low. Let's say to 70 mg/dL. That's a 97-point drop. This signals to the body that you are now starving. The body is averse to drops in blood glucose of this magnitude.
• The body reacts to this extreme lowering in fasting blood glucose (starvation) by ramping up glucose release through adrenal stress hormone activation and under expressing insulin in various tissues and organs. In other words, the body now goes into anti-starvation mode. Anti-starvation mode is code word for sparing fat mass, building more fat mass and keeping blood glucose and weight set point high.

It is important to note that the starvation mode above, wasn't caused by "lack of food". It wasn't caused by calories. It was caused by large blood glucose disparities.

The above series of events will become a vicious cycle that will be extremely difficult to reverse. This cycle drives obesity/diabetes. This is why we don't believe in "cheat meals". It has been shown that metabolism adapts to erratic blood glucose fluctuations with just one meal. When you have been eating those meals for days, weeks, months, decades, what do you think will happen? Well, we have seen the end result, right? People crying that nothing helps their obesity and diabetes. After they have adapted their metabolisms to behave this way, they expect for someone else to wave a magic wand on them and make it all go way. It doesn't work that way. Don't be one of those people.

You must be consistent with your diet and stay away from cheats. If you are going to cheat, once a week, make sure the cheat meal is in line with your diet and it's not Burger King.

6. I have been having horrific stomach pains since I began eating large amounts of vegetables. I am trying to ignore it but can hardly get sleep at night because of the bloating, gas and pains. 

I have no idea why you are eating large amounts of vegetables, but I suggest you stop. You should never ignore serious digestive problems and continue to eat things that are obviously not settling well with your body.

When you change diets, there is a small period of time where your body adjusts, and you might experience some gas, diarrhea, constipation or acid reflux. These should all be mild and temporary. When they are severe and persistent, it's time to revise your diet and see your doctor.

A lot of people cannot tolerate above ground vegetables. This is understandable. Vegetables are new to us as they are a concoction of modern agriculture. We were never meant to eat large amounts of plant matter. Our digestive systems are not evolved to handle indigestible fiber. Some people can get away with it and have no issues. The body will accept all sorts of unnatural conditions and survive in spite of them.

But if you aren't thriving and only surviving, get rid of the plants. Focus on smaller meals that are protein prioritized instead.

Six common beliefs addressed, Part 208

1. I am following a program which has a diet that is mostly veggies and protein with no added fats. It consists of two to three meals a day and a 1500 calorie "budget". 

I know your program director is patting themselves on the back and telling you this is some type of "miracle diet", they discovered, but it’s simply a protein sparing modified fast (PSMF). Any diet that prioritizes protein, while strictly restricting carbs and fat is a PSMF. Now, don't get me wrong, I'm not knocking this approach. PSMFs, whatever their iteration, are legitimate protocols that have been shown to be very effective for the reduction of body fat. They can also be used for training or for other health goals, besides weight loss, depending on how they are modified.

PSMFs target insulin and leptin. They stabilize blood glucose by restricting dietary carbs which lowers bolus (postprandial) insulin. The restriction of dietary fat lowers basal (fasting) insulin. Ultimately this affect on insulin allows for better blood glucose regulation and the preservation of insulin function. The premise is that this would regain proper leptin expression, since leptin is a slave to insulin. These diets obviously accomplish this since they are used successfully, in multiple settings, for the reduction of body fat, specifically. The overweight/obese need to lower body fat, specifically.

PSMFs are just hard to follow long term and if you have ever followed one correctly, you would know why, but I can break it down easily for you. If you think a low fat or a low carb or a caloric restricted diet is difficult to follow for the long term, then imagine a low fat, low carb and calories restricted diet combined. That's a PSMF. That's why they are usually not recommended for the long term. That is aside from the fact that the lower your body fat already is, the more problematic these diets can become, unless you watch your protein intake carefully and train properly.

I keep all options on the table for the overweight/obese because there is no one protocol for obesity with guaranteed results. That's why I have multiple recommended protocols which can all be combined in different ways to create your own. I prefer for you to be informed about your choices because most weight loss protocols are sold as the "miracle cure". Snake oil is not hard to sell to the desperate.

This is why it irks me when people bring up old methods, put them in a new shiny package and sell them to you as a new item. This is what happened with the whole "fasting" fad, remember? Well, just like fasting, PSMFs are not new either. They have been used by body builders forever. They are an old method of tricking the body into burning body fat. How long you can keep this up is completely individualized and results will vary, since it all depends on much proper blood glucose regulation you can regain and sustain. The healthier and leaner you are, the better the results because you already have proper leptin expression. The sicker and fatter you are the more varied results because you are trying to kick start proper leptin expression and that doesn't always happen. The long term results are unknown.

I would personally try it. This is because PSMFs have a very good track record of effecting leptin expression positively so you don't loose anything by giving it a go. You might actually lose some body fat. Just keep in mind, this isn't something exclusive to the program you are in. This is a very well known diet and you really don't have to pay for it. There are many free PSMF plans online.

2. I am currently on a weight loss journey and I refuse to let go of my "fat clothing". I don't know why exactly. I feel an extreme and unusual anxiety about throwing any of them out or giving them away. 

I haven't touched on the emotional and psychological stress related to overweight/obesity. That doesn't mean that it doesn't exist, it's just that it goes beyond the scope of this blog and the knowledge I have. I am not very familiar with this but I can give you my non-expert opinion.

Tackling overweight/obesity is extremely difficult. Many people's entire lives have been devoted to trying treatment after treatment, to try and reverse this condition, to no avail. It is very frightening to have to deal with something you have little control over and that will cause you expensive and serious health problems in the future. In fact, overweight/obesity is the main contributor to an early death, in some form or another.

Some people have become so paralyzed with the fear of yet another failure, that they simply have grown to accept their overweight/obesity and no matter what treatment they follow, they have the mindset that they will remain or return to being overweight/obese regardless. This is probably why you don't want to let go of your "fat clothing". It's scarier to fail and have to buy "fat clothing" all over again, which only makes the failure a more solid reality, than to fail and already have these clothes as if you never even intended to lose weight to begin with.

Fear of failure can result in many additional problems including eating disorders. You have to watch this carefully as people with current mental health issues like anxiety, depression and/or obsessive compulsive disorders are more at risk for developing these problems. Eating disorders are very serious and there are a lot of "fad diets" that only help perpetuate them by giving them legitimacy.

I suggest that if you are already experiencing severe anxiety, and exhibiting behaviors, like keeping "fat clothing", that doesn't fit you anymore, you should seek professional help. Being able to talk to someone can be very valuable in helping you address this issue before it gets worse.

3. I was told to eat between 150 - 200 grams of fat a day for maintenance but that seems like a lot to me. 

This recommendation is the standard for legitimate ketogenic protocols used for the treatment of overweight/obesity and metabolic disorders. Just keep in mind that it doesn't matter how legitimate and science based a protocol is, all protocols have had dismal long term success rates. Don't let the word "legitimate" fool you. Legitimate simply means that the protocol is not a "crash diet" or "fad diet" which can further harm your metabolism's function.

Will it work? That is very hard to say even for a legitimate protocol. Like I said above, all protocols have not only had dismal long term success rates, the successes and failures have not been well studied nor understood. It is very difficult to follow people around for the long term. It is also very difficult to know exactly what they did during that long term span of time. What people say and what they actually do, do not always coincide.

The premise of this recommendation is based on that, if you lost all the weight and are now lean and ready to be in maintenance, your insulin resistance is resolved and proper leptin expression has been restored. That's a pretty big premise to have since that's not really known. Remember, the cure for obesity is not weight loss. There is no known cure for obesity.

What we do know is that the fat cells of the once obese are not the same as the fat cells of the always lean but that's the assumption that is being made with this premise. They are assuming that you are now "cured" and your metabolism should perform as a healthy person's would. You increase fat intake for maintenance because it is being assumed you now have proper leptin expression and you wouldn't want to eat less than you should because this would cause a reversal and you would enter into starvation mode (low leptin expression) once again, storing fat and not burning it.

A healthy person can eat an astronomical amount of fat and hardly gain 25 lbs. Their leptin expression is intact and it simply won't allow for their weight to increase to any significant amount as they have a low weight set point. Their metabolic rate simply increases as their dietary fat does and they burn it all off. They will then get to the point where they simply cannot eat that much fat and they will naturally reject it. So they cannot eat astronomical amounts of fat chronically. The body has tight controls over its weight set point. It will increase metabolic rate, increase activity, decrease appetite, whatever it takes, to remain in weight homeostasis. For the overweight/obese things do not function quite like that. Instead, they have a very high weight set point and the body is doing everything it takes to maintain it.

So the only thing you can do is to try and see. Will your body burn enough stored body fat so the 200 grams of dietary fat simply replace what's being burned and you remain in homeostasis? Can you even keep up eating 200 grams of fat chronically without a large reduction in appetite? We don't know. Only you can find out.

Rarely overweight/obese people are able to acquire their leptin expression easily and keep it. Some will acquire it for a short time and then lose it again. Most will never acquire it at all. It all depends on how your individual fat cells are behaving and how your hypothalamus is reacting. How did the effects of overweight/obesity change both fat cells and hypothalamic function, for the long term, in you? You will soon find out. Keep us posted. I'm actually curious to know.

4. My triglycerides have doubled and my cholesterol has gone significantly up, within a six month period. I have never had these issues before. I already eat low carb and have been for many years. The only thing that has changed is that I am on Metformin. My doctor told me he put me on it for "insulin resistance". I am a Type II diabetic with pretty well controlled blood glucose. This is why I am only on a low dose of Metformin for now.

It is unusual for metabolic markers to change this quickly for absolutely no reason. This is why I am very leery when someone comes to me with this type of problem. This is because they usually tell their side of the story and not the whole story.

People will say they are “low carb” but I have no clue what that means. Low carb means different things for different people. I also take the claims that "nothing has changed" or "the only thing that changed is" with a grain of salt. People will swear up and down that “nothing has changed” but that's because they like to omit what actually changed. I am not accusing you of this but my personal experience has shown that most people lie when it comes to describing their diets. This is why I prefer hard numbers. I need actual macros in order to determine if you are truly low carb or not.

But for the sake of being able to answer this question, I am going to take it at face value and assume you are on a legitimate low carb protocol that has truly not changed at all, except for your use of Metformin. Let's unpack this piece by piece.

High cholesterol can either be a rise in HDL, LDL or both. You never said if yours was a rise in total cholesterol or in a specific lipoprotein. Most people experience no changes in their cholesterol due to saturated fat in the diet but a small segment does. Why this would be occurring to you now though, is unknown. This is usually seen immediately the moment you begin consuming saturated fats. You say you have been low carb "for years", so you would have seen this rise in cholesterol years ago, not six months ago. Cholesterol rises from diet occur within a few days.

High trigs are usually a sign of metabolic syndrome and as the condition progresses, they tend to increase further. It is not uncommon to see a diabetic with trigs in the 1K or more. This occurs slowly over time so if your increase was sudden, then something else could be going on. I am assuming you do not drink alcohol so fructose consumption would be the only thing that would rise trigs quickly. You would have to see if any products you are using, might contain fructose. Fructose does not cause a rise in blood glucose so it is usually used in diabetes products as it has a sweet taste without the “sugar”. Check your products for fructose, including any medications.

Both cholesterol and trigs are handled by the liver. You know what else is handled by the liver? Metformin. Metformin works with the liver to control glucose production causing a pseudo lowering of blood glucose. The effects this has in the liver remains unclear. Metformin is not considered intrinsically hepatotoxic but there has been conflicting evidence on its lipid-lowering effects and other claimed benefits, such as a treatment for fatty liver disease. In fact, The American Association for the Study of Liver Diseases, the American College of Gastroenterology, and the American Gastroenterological Association state that Metformin has “no significant effect on liver histology and is not recommended as a treatment for liver disease in adults with non-alcoholic steatohepatitis (fatty liver disease)”.

Though Metformin reduces insulin dependency in Type II diabetics it is unclear if this effect continues beyond the first year. No significant improvements in HbA1C are noted with Metformin use. I'm telling you all of this so that you can be a bit more critical when reading how great Metformin is. The truth is that they simply don't know because the long term studies have not been done as of this post.

You would need to look further into this and discuss it with your doctor. When you do, do not be gaslighted. Do not let your doctor tell you that "Metformin cannot possibly cause hyperlipidemia" because he doesn't know. You should also review other medications that you are taking as they might interfere with how Metformin works. I suggest you review your medications with your doctor and explain how this hyperlipidemia correlates with your Metformin usage. Your doctor should have a history of your previous blood work so he can note changes through a certain time period. Demand personalized health care, after all, you're paying for it.

On another note, I don't know why your doctor said he prescribed you Metformin for "insulin resistance". Instead, he should have told you that he prescribed you Metformin to lower your blood glucose. There is no pill that addresses "insulin resistance".

5. Some artificial sweeteners (AS) have calories.

Some AS have an effect on insulin. Others are converted back into sugar by the body. Most are mixed with fillers that have calories in the form of glucose. All of it is irrelevant. Whatever the case, the calories are so trivial that they can still label the product as having 0 calories. None of these are what make AS problematic.

Like I have stated before, the real problem with AS is in the sweet taste information they are giving your metabolism via the hypothalamus. Sweet taste means store more. This means that everything you eat, accompanied by AS, will be stored more than if AS was not included. This is most likely the reason why the introduction of AS, to the food supply, has done nothing to curb obesity or the incidents of diabetes. In fact, both have only increased.

6. I am never hungry and that's why I can fast so much but I have noticed that a lot of fasters are never hungry. Some of them are not even obese.

The obese are usually never hungry because they aren’t burning any fat due to poor leptin expression. You don't have to be obese to ruin your leptin expression. You can absolutely fast it away. The more you expose the body to starvation, the less willing it will be to burn body fat.

Thin fasters are simply training their body to under express leptin. That is why first-time fasters are very hungry in the beginning and then, over time, they find out they can fast forever. Soon these thin fasters will join their obese counterparts. Instead of body fat loss, they are simply losing leptin expression along with their muscle mass. Lack of hunger is a sign of things to come.

Six common beliefs addressed, Part 205

1. The diet industry seems to be unaware of leptin. 

Like all other metabolic hormones, leptin has had its “Fifteen Minutes of Fame”, in the diet sphere, for all the wrong reasons. This is a shame because leptin is central to obesity. These diet mongers are constantly focusing on targeting one metabolic system or the other in the exact same useless way – by eating less. So here are some basic things that are known about leptin, as of this post, without the BS:

• Leptin sends a signal to your brain that helps you feel full and less interested in food. Because of this you may hear leptin described as a "satiety hormone", in weight loss circles, though this is not a correct description. Inducing satiety is still believed to be the Holy Grail for combating obesity, since the consensus is that the obese are fat due to being "hungry all the time". But when you get away from the shenanigans, the reality is that leptin is better described as a “starvation hormone” because it determines how and when your body turns fat into energy. When leptin is working properly, it signals satiety through the burning of fat. It doesn't signal it just because it's present.
• Leptin is mostly made by your fat cells but your stomach also releases some when you eat. Leptin circulates in your bloodstream and travels to your brain where it delivers the message that you have enough fuel so you don't need more (satiation). But the real magic is that leptin now signals to the brain that it can burn the fat you have stored.
• Leptin suppresses appetite, in a healthy manner, when it burns fat for fuel. Again, the suppression of appetite is overly emphasized as it is believed the obese eat uncontrollably. The reality is that when you have proper leptin expression, it helps you maintain a healthy weight by balancing the amount of food you eat with how much fat you burn. The amount of food eaten is inconsequential to this process. The important process is in how much fat you burn. We know this from starvation studies where people were chronically over or under fed. The overfed simply burned more fat and refused to eat. They put on a capped amount of temporary weight and never became obese. We see this effect in healthy people who are struggling to put on weight and simply cannot, no matter how much they eat. The underfed simply burned less fat and their appetites tapered down with time. They lost a capped amount of temporary weight and then refused to lose more. We also see this effect in the overweight/obese who are struggling to lose weight and simply cannot, no matter how little they eat. So the real problem with obesity is not in how much you eat but in how little you burn.
• Fasting for several hours can cause your leptin levels to lower. The more you fast, the less hungry you become. This is the unhealthy way that leptin suppresses appetite. As you can see less hunger is not always a good sign so it shouldn't be a primary goal in weight loss. You could be hungry or not hungry and still not burn fat. Again, the problem is in how little you burn.
• Chronic inflammation and high levels of triglycerides can make it more difficult for leptin to cross the blood-brain barrier.
• People with leptin deficiency are prone to early onset obesity. They need daily doses of a leptin-like protein to control their weight. This same treatment cannot be given to people with "leptin resistance" as their problem is not insufficient leptin but poor leptin expression. It is still being researched whether this poor leptin expression occurs at the fat cell, the brain or both. Until this is known, leptin cannot be targeted with medications for the treatment of obesity.
• Leptin also works with other systems in the body, including immune cells. A strong immune response is a good thing when you’re sick, but chronic inflammation from an overactive immune system causes health problems. People who have obesity and high leptin serum levels often have chronic inflammation. This is linked to cardiovascular diseases, insulin resistance and cancer.
• There are no obesity treatments which use leptin at the current moment for the issues discussed above, but it has been used in obesity research. Over the counter "leptin" supplements are just caffeine riddled junk food. Remember, the problem is not leptin serum levels but its expression on fat cells and the brain. Supplements do not resolve this. If they did, the pharmaceutical companies would already have a leptin medication for the treatment of obesity but they do not. Obesity is still a condition with no known cure.

As you can see, leptin is quite complicated as are all systems in our bodies. Maybe in the future some breakthrough will be found where this hormone can be targeted for obesity treatments but as of today, there just isn't enough information on how or why it malfunctions to cause obesity. The research appears to be pointing towards the most likely explanation that leptin is not malfunctioning at all but acting in accordance to a metabolic profile of starvation which is set in motion by other factors, like blood glucose dysregulation.

2. Overeating eventually leads to obesity.

In a healthy person, "overeating", in of itself, cannot lead to obesity as their metabolism truly regulates the balance between what’s coming in and what’s going out. We do know that "overeating" does have an effect on the glucagon/insulin ratio of people who already have metabolic syndrome. This effects blood glucose homeostasis, progressing the condition further. So there is a clear and distinct difference when it comes to "overeating" between the healthy and the metabolically impaired.

We have evolved with mechanisms that prevent "overeating" so the conversation shouldn't be about "overeating" but about what you're burning. The path to obesity is set in motion through blood glucose dysregulation, not total calories (overeating). We have fail-safes to prevent "overeating" but there are no fail-safes to prevent blood glucose dysregulation. Blood glucose dysregulation stops the "burning" of fat.

This blood glucose dysregulation occurs from consuming a completely normal plate of pasta with no "overeating" required. The blood glucose dysregulation from the pasta will cause you to become overweight over time. In response, you will reduce the pasta in order to try to "control your weight". You think its calories but in reality, the less pasta you eat, the less blood glucose dysregulation you experience. This makes you not gain more weight and so you falsely believe that eating less, across the board, is helping you but in reality you're only reinforcing the starvation response that you already induced with the blood glucose dysregulation caused by the pasta. You haven't gained more weight but you also haven't lost a pound and you will gain more in time. This will cause you to double down on eating even less and your metabolism will double down on keeping you fat. You are on the road to diabetes, all while preventing "overeating" but ignoring your blood glucose dysregulation. You will go from overweight to obese rather rapidly.

This is why we refrain from throwing around ambiguous terms like "overeating". You have to be able to define what you mean by "overeating". What are you "overeating" and according to what criteria? The only criteria should be your macros, calculated by your body fat percentage and goals because the only thing you should be concerned with is "under burning" fat, instead of "overeating" calories.

3. I cannot lose weight. I have tried everything. I have been at this for decades with no headway. I am now a senior citizen and tired of struggling with my weight. I don’t want to spend the rest of my years like this anymore. I don’t want to be lied to anymore. I am at a time in my life where I can take the truth. Will I ever be able to lose weight?

I cannot make predictions of this sort with finality but I can say that you can safely assume you will never lose weight. At least, not body fat. For some, proper leptin expression will simply never occur. This is most likely the result of hypothalamic damage, which is still being researched in obesity.

At this point, you would have to take draconian actions in order to lose body fat. After all, everyone can lose weight. These actions would be unhealthy and not recommended on this blog. For instance, if you starved and physically worked yourself at concentration camp levels, you might lose weight, if you don't die of malnutrition/stress first, but you would be putting your health at risk. It’s simply not worth it, as the weight loss would not cure your obesity. It would only reinforce it.

You could also go through bariatric surgery, which is simply a way of making your stomach believe it’s in a concentration camp. I personally, wouldn't ever recommend this type of mutilation, especially for a senior. Remember, even bariatric surgery is temporary so you will eventually get out of the "concentration camp" and the only way you can lose weight and keep it off is by staying in there permanently.

The only thing you can do now is continue a healthy diet and lifestyle that is antiobesogenic so that you can minimize blood glucose disparities and ward off pathology for as long as you can. Obesity, in of itself, is not directly pathological. It is only a symptom of a metabolic abnormality that puts you at risk for pathology. But if you can control the abnormalities, eliminating them all, even if you have to remain overweight, is still success.

4. Losing inches means your losing body fat. 

No. The inches lost have to actually be body fat in order for them to count. Usually you can tell this is the case if you are losing inches consistently and not gaining them back. The inches that matter most are the ones around your middle. This loss occurs over time and in the long term. Fat is never lost in the short term.

If you lost inches rapidly, because you reduced your weight by four or five pounds, then those lost inches were only water weight bloat. When you reduce water weight bloating, you reduce inches but those don’t matter.

5. "Keto" ice cream has too much fat.

When it comes to novelties, you have to shift your focus from calories, carbs or fat to the taste of sweet itself. The taste of sweet is what’s harmful. That's why every diet on the planet allows desserts, in accordance to their macronutrient and/or caloric goals, and this has done nothing for the diet to succeed. In fact, a good predictor of whether a diet has the potential of being successful or not is in the amount of allowed desserts.

The amount of cream found in "keto” ice cream, or any ice cream for that matter, is not very significant. Ice cream is sort of like whipped cream, but the ice takes the place of air. If you actually melt a serving of ice cream, you will see it doesn't consist of much cream, so the fat content is not the problem. The problem with traditional ice cream is the sugar content. "Keto" ice cream contains no sugar. So why would it still be considered obesogenic? Where is the obesity coming from if not from its macronutrients? The obesity is in the sweet taste itself.

Overweight and obese people are particularly sensitive to gaining more body fat from any fat storing trigger that their body receives. Sweet taste is one of those triggers which works through dopamine. Dopamine is a very powerful metabolic regulator. So you have to be very careful when consuming these types of items as their sweet taste will cause you to store all of the fat in them and in everything else you eat that day.

Taste carries metabolic information. This evolved through the availability of certain foods at different times of the year. Sweet taste is information to store for winter. The winter that will never come. The sweet taste found in these novelties is also much stronger than any sweet taste we would have found as hunter/gatherers, aside from honey, so its effect on your dopamine is even greater than any natural food source would have. Also a sweet natural food source would not be accompanied by fat. The combination of sweet and fat, further disrupts dopamine and enhances fat storage.

So, be cautious when incorporating these desserts in your diet. You should really be limiting your exposure to sweet taste if you are serious about tackling your obesity. This is especially true if you also have disordered eating behaviors and cannot keep the consumption of these novelties under control.

6. I am never hungry. Because of this, I can fast for long stretches but I was told this was not a good practice. But I like to use my hunger as a signal to eat or not. 

Hunger is not the right way to gauge food intake for the overweight/obese. Overweight/obese people are either chronically hungry or chronically never hungry. Healthy people aren't chronically anything. Their hunger fluctuates normally, up and down, as their body maintains its weight homeostasis. The overweight/obese have a satiety signaling that is completely dysfunctional and shouldn't be taken seriously. Interestingly, the overweight/obese people who are never hungry, tend to have the most stubborn body fat and often have intractable obesity. This is not surprising if we again remember how obesity works.

Obesity is simply a starvation adaptation that perpetuates through chronic blood glucose dysregulation, which abnormalizes insulin and chronically under expresses leptin. The less hungry you are, the less frequently you eat and so the more you starve. The more you starve the more you "teach" your fat cells to store and hoard. You are adapting them towards obesity.

Unfortunately, because of the calories model of obesity, the overweight/obese person thinks that their ability to starve themselves, without hunger, is a great thing. They will deem themselves much luckier than the unfortunate obese person who's always hungry. Of course, they will constantly wonder how in the world can they still be so fat when they hardly ever eat. Well, chronic "hardly ever eating" makes the overweight/obese fatter over time. Everything they do eat, will be stored much more efficiently and at a greater rate than the always hungry fat person or the healthy person. I have said it before, the only starvation that works for the obese, is the starvation that ends in death. As long as something is coming in, they will remain fat.

This is why it's so very important to take control of this and eat at set meal times only. This practice is a very good control mechanism against the erroneous information you are receiving from your faulty "hunger" signals. Having consistent and predictable meal times will also help normalize your satiety hormones as you better control your glucose/insulin homeostasis through the reduction of the stress response. Taking control of your diet is not just choosing what to eat but also when to eat.

Six common beliefs addressed, Part 165

1. I keep reading on low carb pages that this is the "best diet in the world", with the "best foods", but everyone keeps "falling off the wagon". 

Because people like junk food and other man-made creations. They are fun, economical, easy to obtain and highly palatable. Few people can make a commitment to eat as if this was the 1800's because it's a new millennium.

Low carbohydrate diets are simply the best protocols to follow if you have metabolic syndrome because they help blood glucose homeostasis. But they aren't the "best diets in the world", nor do they promise the "best foods". They are just a diet, like any other, that consists of real food.

The people who make claims about low carb being best, can't even follow the diet properly for more than three days at a time. Low carbohydrate diets are restrictive and highly boring, until you get the hang of them and become accustomed to your daily fare. Some are able to do this better than others. This is why low carb is not the first diet recommendation you will get from a nutritionist or dietitian. They always start with caloric restriction first, as most people can stick with those protocols better and for longer.

2. I am struggling to stay within my macros because I am still hungry. 

Use protein as a lever. When it comes to hunger, protein can be increased to achieve satiation. Protein is the hunger lever and fat is the weight lever.

3. Insulin levels are very variable and can go up and down erratically, depending on your food intake. Because of this, it's advised to not give this marker any importance. 

This is somewhat true. Insulin is very variable and that is why it's not the only marker we focus on. But when we discuss insulin on this blog, we are specifically referring to basal insulin levels and primarily to insulin function (release/expression). Basal insulin levels, your fasting insulin, should be low. It should not be high as there is no need for it to be high if you are fasted. High basal insulin levels will interfere with your fasting blood glucose, by dropping it too low. This will reinforce the metabolic adaptation known as metabolic syndrome. There is a percentage of obese people who do not display high insulin levels, even while fasted. It is believed that these people are simply no longer making enough insulin due to beta cell dysfunction.

More importantly, you need to focus on insulin function. People who are overweight/obese and/or have metabolic syndrome have poor insulin function, regardless of its level:

• There insulin does not spike high enough to stop catabolism postprandial.
• There insulin does not trigger a proper counter regulatory response while fasting.
• There insulin is over expressed at the fat mass, diverting all energy to it and not allowing any out.
• There insulin is under expressed in their muscles, organs and tissues, basically "starving" them and sparing more glucose for more fat conversion.
  

This is the result of poor insulin function and may not be reflected in insulin levels. For example, a very obese person may have an insulin of only 12 and you might have expected 45 or more. Well, 12 is still quite high for basal insulin but it's not as high as you would have expected. So why is the person so incredibly obese? Because of poor insulin function.

It's good to know your basal insulin level but it's also good to not ignore what your body is telling you. If you are overweight/obese, your body is letting you know it is having poor insulin function.

4. Since obese people have poor insulin function, they should restrict protein.

No. That's the reason they should increase it. Because protein does not go into the fat mass for storage, it helps build and maintain the lean muscle mass that the obese have left.

4. Body builders use insulin for energy.

No. Bodybuilders use insulin for muscle growth, not for energy.

5. All "low carb" doctors seem to have differing opinions about how insulin works.

Because a lot of doctors do not like to stay in their lane. What ends up happening is they have a little bit of knowledge about a variety of things but not enough to complete the picture. In other words - jack of all trades and master of none.

Nearly all doctors have no understanding of obesity. They have an understanding of weight gain and the things that contribute to it but they have no clear understanding of obesity itself as a pathology. This is also true for the diet and exercise industry.

For example, you may continue to hear the following common fallacies from many of these doctors such as:

• The obese are very insulin sensitive because they are able to get and remain fat, which requires insulin.
• Insulin is not implicated in obesity because there are obese people who do not have very high insulin levels.
• Insulin cannot make you fat. It is a very slimming hormone. Just look at bodybuilders.

The people making these statements give themselves away as not having a clue as to what they are talking about. They have a complete misconception of insulin and how it works in the body. So, let's correct these statements:

• The obese are very insulin sensitive, but only at the fat mass. There is no such thing as being completely insulin sensitive or completely "insulin resistance". The body exhibits both at the same time. Insulin resistance occurs at different rates and to varying degrees in each organ and tissue of the body. It is believed this occurs in order to spare glucose for further fat conversion.
  
• The abnormality in insulin when it comes to the obese, is in its function, more than its level. By function we are talking about insulin release and expression. You can get a hint of this dysfunction, through basal insulin levels but that's not always 100% linear. Excess body fat and/or the presence of metabolic pathologies are the main indicators that insulin is malfunctioning, rather than just insulin levels on their own.
• Insulin is a very slimming hormone but not in the context of obesity. It is slimming in the context of obesity resistance. Athletes and body builders know how slimming insulin is when it is building muscle rather than fat. Over weight/obese people know how fattening insulin is when it is building fat rather than muscle. Insulin builds your body as it is an anabolic hormone. Rather, it is best described as an anticatabolic hormone. If the body is prevented from breaking itself down, then it can be left to build itself up. The body is always building. You are either building fat or muscle. So insulin is not anymore a slimming hormone than it is an obesity hormone. It's not either. It only does what it is allowed to do in the neuroendocrine environment it's working in.

So when you follow any of these doctors, be very careful of their information. None of them have it 100% right. There is a lot of BS mixed in with their message. Do not leave your health in the hands of anyone. Do your own research.

6. Can cholesterol be too low?

Only if there is a genetic abnormality that is causing hypocholesterolemia. Cholesterol is made by every cell in the body, so it is not an "essential nutrient". If you have a genetic abnormality that causes very low cholesterol it would have been detected very early in life as the result of most hypocholesterolemia wouldn't just be low cholesterol numbers, but other symptoms that would have resulted in serious health issues.

Six common beliefs addressed, Part 126

1. Fatty liver and diabetes are easily reversed.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Six common beliefs addressed, Part 123

1. I am not advanced enough, in my journey, to only eat real food. 

You are either taking the diet seriously or not. There is no "in between".

2. Does hunger tend to decrease as a fast progresses?

Yes. This is because your metabolism increases in the beginning, and that’s when you feel hunger, but then it plummets as the fast continues and hunger seizes. There is no need to feel hunger if your energy output has slowed to a crawl. This is why many obese people are usually never hungry. 

3. Can a diabetic restore their insulin sensitivity if they can keep their blood glucose low?

No, because you can keep blood glucose low and still have abnormal blood glucose regulation. Proper blood glucose regulation means the body produces its own glucose when needed and halts its production when not. That is the only way insulin sensitivity can be acquired.  

 

As long as blood glucose regulation remains abnormal, insulin expression/release will also be abnormal and this in turn, further deteriorates blood glucose. So do not be lulled to sleep by low numbers. Usually the only low numbers a diabetic experiences is postprandial. They continue having Dawn Phenomenon and hyperglucagonemia. 

4. Is it impossible to be able to lose excess body fat?

Yes. It is absolutely possible for a person to be unable to lose their excess body fat. This is called intractable obesity. This occurs when blood glucose regulation cannot be obtained and/or sustained for a long enough time to affect insulin and leptin expression/function.

There are multiple reasons for why this occurs. Some are:

• Hypothalamic damage - Leptin no longer communicates to the brain that there is excess body fat and so the brain never "sees" it. You can’t lose, what the brain can’t "see" because it simply won’t send the appropriate signal to the fat mass to burn it. There is some research being done on pharmaceuticals that might be able to treat this, but that is still in the future. 
• Age - The older a person becomes the more they resist lifestyle changes. This causes for them to be unable to obtain proper blood glucose regulation as diet is not enough. Exercise can be very difficult for people who have limited mobility, due to a lifetime of metabolic dysfunction and being overweight/obese. But these aren’t the only issues that older people have to face. Changes in hormonal states and the way insulin behaves, as you get older, works against them as well. 
• Habits - There are certain lifestyle factors that some people are unwilling to change such as stopping the intake of caffeine or the inability to eliminate sugar and grains. Keeping these items in the diet further interferes with proper blood glucose regulation.
  
• Length of metabolic dysfunction - Fat people only get fatter. Sarcopenic obesity, which simply means you are becoming more fat than muscle, makes you weaker by default and less able to build lean body mass due to insulin insensitivity. You need insulin to build muscle and synthesize glycogen. Insulin malfunction impedes both of these processes. Dysfunction of the thyroid and other hormonal axes effect metabolic rate and help further spare fat mass. All things that work against you. 

Aside from these, there are other factors such as certain chronic conditions which require medications that interfere in blood glucose regulation. Obesity is time dependent. The longer you have been obese, particularly if you were obese in childhood, and obesity that was the result of fructose (sugar) consumption is especially at risk for becoming intractable.

 

5. Type II diabetics should avoid whey protein because of the insulin response.

The spike caused by whey protein, and any other type of protein, is exactly what a diabetic needs in order to regain the pulsatile function of their insulin. This is especially true after insulin goes back to lower levels during the overnight fast. Spikes in insulin, control glucagon and eventually correct hyperglucagonemia if the person is controlling their blood glucose highs and lows with a low carb diet. So, the insulin spike caused by protein doesn’t have much of an effect on the insulin to glucagon ratio. 

Carbohydrates, on the other hand, do not allow insulin to function in this way because the extra dietary glucose disrupts blood glucose worse and causes a prolonged insulin release. This extra insulin continues to affect blood glucose into fasting times, dropping it too low. This is the engine that keeps the condition going.

6. There are no "best" dietary and exercise protocols for people with obesity/metabolic syndrome/diabetes.

Though there is no one protocol that will guarantee remission, there are protocols that are better than others. Long term protocols are the only proper protocols for addressing obesity and metabolic dysfunction because you need to have a prolonged affect on blood glucose homeostasis in order to affect insulin and leptin expression/release. Short term treatments do not work.

 

The best diets for this are low carb diets. Carbohydrate restriction from 100 grams to 0 grams per day work by not introducing dietary glucose to a system that is already unable to regulate its own internal glucose. This helps normalize insulin expression/release and eventually improve leptin sensitivity.  

Steady state exercise of long duration, like a 5 mile walk a day, does not contribute to the stress response and helps leptin/adiponectin ratios which help burn excess body fat. Exercise also helps you clear glucose without the need for insulin.

Six common beliefs addressed, Part 91

1. Even positive changes, like a healthy diet, are a stress for the body. 

All change is stressful for the body. Even something positive like the loss of body fat, is extremely stressful, because the body sees body fat as a positive. The best way to counteract this is primarily through consistency, rather than speed. Consistency is key, so that the body adapts to new changes, without stress. A constant back and forth is more damaging than the change itself. Making slow changes can help in adherence and so improve consistency. 

2. There will come a time when the low carb healthy diet, you started with, will no longer work to reverse obesity, no matter how consistent you are with it. 

Unfortunately, this is true in some cases. 

 

The long term effectiveness of any diet is whether it can regain and sustain proper blood glucose regulation. We have seen time and time again that it is very difficult to do this, particularly with diet alone since diet is not the only thing that affects blood glucose. Age, body composition, hormonal status (perimenopause, menopause), chronic conditions, injury, stress, etc. all affect blood glucose regulation. The normalization of blood glucose is the only thing that will affect insulin expression/release so you can regain insulin sensitivity. This in turn normalizes leptin expression so you can adequately burn body fat and maintain the balance of fat storage/burning, with what's coming in. That's a lot of multi-system juggling. 

 

Add to that the time dependency needed for this to actually work for the long term. This means you have to be able to consistently sustain this for a long enough duration that it actually makes a difference. For some people, they need a longer time than the life span they have left to live. This is particularly true if the steps to reverse this are started late in life. Remember, it took decades to develop the metabolic abnormalities that eventually lead to diabetes. You did not become obese overnight. It will take decades to correct it.

3. Even if you are still obese, as long as you are able to lower your HbA1C to 5.0, you have reversed your diabetes. 

No. HbA1C is not a good marker for determining disparities in blood glucose as it is only measuring average blood glucose within a three month period. This can easily include periods of very high blood glucose and very low blood glucose, which average out to a lower HbA1C. 

 

As long as you have excess body fat you are at diabetes's door. Excess body fat is the indicator that there is metabolic stress going on in your body. You have not normalized your blood glucose regulation. You have simply lowered the highs in blood glucose, while still having large disparities compared to the lows.

4. There is no difference between diabetes and hyperinsulinemia.

"Hyperinsulinemia" is a condition where basal insulin levels remain chronically high. But, this is not the only pathology that is occurring. It's simply the only one we can measure easily through a serum blood test. The more sinister aspect of hyperinsulinemia is what is not seen, which is abnormal insulin expression and action at the tissue level. 

Basically, with hyperinsulinemia, the pulsatile release of insulin seizes and the person simply sustains a higher than normal level all of the time. This completely disrupts metabolic function and further deteriorates proper blood glucose regulation. Certain tissues become insulin resistant, while others like the fat mass, remain and become highly sensitive to insulin action. This environment is the hallmark of what will become diabetes in the future. It's the beginning stage. 

Diabetes is the end stage, of this process, which occurs when glucose levels become chronically high in order to match insulin levels and function. The body adapts to being in a hyperglycemic state, so that the abnormal insulin cannot drop blood glucose too low. The set point for blood glucose continues to rise higher and higher with time, driving insulin demand higher as well. It is a vicious circle. Now you have high blood glucose, all of the time, and the body actively fights its lowering. This is what is described as diabetes. 

5. Can you be allergic to all meats?

You can be allergic to anything. The only one who would know for sure is a medical professional. You need to have the appropriate testing done, depending on the symptoms you are experiencing, so that proper treatment can be administered. Don't just assume and guess. Check and test. 

6. The appetite reduction on "keto" should always be of concern.  

An increase or decrease in appetite is only a concern, depending on context. Increases and decreases of anything, on their own, are meaningless. 

If you are losing weight, the reduction of appetite simply means that you are using fat stores for fuel and the body is currently not in need of additional dietary fuel. 

If you are not losing weight or are gaining instead, then the body is in active obesity mode and the reduction of appetite is coming from a thrifty metabolism that is not burning any fuel and so does not require any more of it. 

Six common beliefs addressed, Part 86

1. The hunger felt during a fast is "false".

Hunger is never “false”. Cravings are false and we can easily figure those out because no one “craves” a real meal. They crave specific junk food items or tastes.

Hunger is real hunger. The question is should you be hungry or not. A short fast of 18 hours or less is usually not enough time to cause hunger. You should be able to use your own body fat for fuel, during this time. Gluconeogenesis takes care of any glucose demands and helps regulate your blood glucose, while you fast. 

But being hungry is not necessarily a bad thing either. It can just mean that your using fuel and you need more to replenish. All hunger means something and that is determined by your neuroendocrine state so there is no one way of interpreting it. The only thing that matters is whether you are in active obesity or not. Hunger is mostly inconsequential.

2. Starvation is not the only thing that produces autophagy. "Normal fasting” can also produce it.

"Normal fasting" is starvation. I don’t understand why people think they are two different things. They are the same thing. The only difference is the length of time you starve for. You can starve for an hour or until you're dead. The starving are fasting. You can get all technical and wise by saying that the obese are starving without fasting, but that’s a completely different conversation. We are only discussing "not eating". All “not eating” is starvation. "Fasting" is just a fancy term for starvation that doesn’t end in death.

Autophagy is triggered constantly in the human body. It is triggered every night, during the night time fast, and for other reasons, such as exercising. Even caloric restriction increases autophagy. Autophagy is useless for the treatment of obesity. It is just something the body does on its own and will not reduce your body fat. You need to burn body fat in order to get rid of it.

3. Will fasting lower blood glucose?

High body fat puts a very high insulin demand on the body, so when your blood glucose should be lowering, your body kicks in its counter regulatory system to prevent this. This is because this system is responding to your basal insulin levels. Higher basal insulin levels require higher glucose production in order to avoid glucose from dropping too low. So, as long as you have high body fat, your fasting blood glucose will be very difficult to get into the normal range of about 83 mg/dL. It will always be slightly higher. Lower blood glucose does not automatically equate to normal blood glucose.

4. Will fasting help with autoimmune disease?

This blog's focus is general metabolic health information, not autoimmune diseases, which should be monitored by a healthcare professional. But I am going to make an exception for this statement, since I want to make clear that "fasting for autoimmune health" is complete quackery and utter nonsense.

When you fast, the body goes into a temporary anabolic state where it under expresses certain non-essential processes. Some of those processes are immune system related. If the immune system is being "suppressed", then it can reduce autoimmune symptoms. This does not occur in everyone. For many, their symptoms increase rather than decrease. So, these short-term symptom chasing treatments, like fasting, are futile and do not treat nor improve the disease itself. You are doing no better than taking an aspirin for a broken leg. The pain is reduced, but the leg stays broken and you’re also damaging your stomach lining in the interim.

Treat your autoimmune disease with a healthcare professional and use supportive lifestyle habits like proper diet, exercise and systemic stress reduction to increase your treatments effectiveness.

5. Can fasting cause diabetes?

The claim that fasting causes diabetes went viral, a while back, causing all the people who make money off of low carb and fasting to have a cow. They claim this is based off a study that "wasn’t peer reviewed" and "couldn't be read", as it wasn’t even published yet. You know, just like the studies they like using to try and "prove" their own nonsense. It’s a tit for tat of BS. But this does make you wonder. If the study supposedly "couldn’t be read", then why are they so sure nothing was found or if what was found was even false?

Either way, we don’t care about any of that here. A healthy metabolism is diabetes resistant. The body does not naturally want to be in a diabetic state. So, it takes much more than just intermittent fasting to cause diabetes. But, that doesn’t mean that fasting is completely benign to metabolic health. Remember, your metabolic state is never "diseased", it is adapted.

Starvation adapts the body to hoard and increase its fat mass. This is a very well understood metabolic process that has been studied multiple times, in multiple settings, and with multiple animals, including humans. If you starve yourself too much, you die. If you starve yourself a little, you tend to get fat over time, after some initial “weight loss”. That’s how the body protects itself from future death. It’s been doing this, since the beginning of time. This is what keeps you alive during a famine and makes you more robust to survive a second one. Our metabolisms are extraordinarily adaptable. You can begin to adapt metabolism, in a very short time, to just about anything. Though it takes decades to adapt into diabetes, it takes a few weeks to adapt into “starvation”.

So, whatever this study was, and whatever it found, it wasn’t anything new. We have always known that starvation spares and increases body fat. Any person who has followed caloric restriction, for a long while, can attest to that fact. Increasing body fat puts you at risk for diabetes because high body fat puts a high insulin demand on the body, which further dysregulates blood glucose. 

But why? Because remember, the only question that matters with metabolic conditions is - Is my blood glucose being disrupted? Fasting disrupts blood glucose, just like carbohydrates, so that can lead to the starvation adaptation described above. It does this though:

• Fast for too long.
• Not eating enough at meal times.
• Binging at meal times.
  

If you do what’s on the above list, fasting will only make you fatter, in the long run, regardless of what the scale says in the short run. This is precisely why fasting has never been used as a proper protocol to address obesity and we have known about fasting, since we have known about eating. Just because you see fasting now on Facebook and trending on Twitter does not mean it’s a new discovery. Books on fasting have been published, since books began being published and just like all other "weight loss" strategies, it's been an utter FAIL.

So, the takeaway message is that if fasting is done correctly, not the way these low carb advocates say, it can be beneficial as an addition to your dietary and exercise protocol. But if done incorrectly, it can increase your body fat over time, through its affects on blood glucose regulation, regardless of what you eat.

6. Does blood glucose go up during illness?

People who have diabetes, or any other type of metabolic syndrome, tend to run high blood glucose during any type of illness or injury. This is caused by an over expression of the adrenal stress hormones that over react to any type of stress in the body.

Six common beliefs addressed, Part 77

1. Reducing calories does not mean you will be hungry and you will lose weight. 

You cannot "out calorie" a bad diet. Calories do not have much of an effect on blood glucose regulation, so your metabolism does not change and continues on its trajectory towards obesity.

Hunger and further weight gain is a common effect of anyone who tries to be on a long term caloric deficit. Since the focus of the food that is being eaten, is calories, their affect on blood glucose goes ignored. So, you can still have a diet, which consists of "low calorie" yogurts, wheat thins, sugar free soda and 'Healthy Choice' TV dinners. This type of diet is obesogenic irrespective of calories because it is still disrupting proper blood glucose homeostasis. Macronutrient composition is still king when it comes to the effects on blood glucose.

Eat meat and vegetables. Why? Because those are the only two items in the food supply that will not disrupt your blood glucose. When eating a diet that is focused on blood glucose regulation, if you are still forced to track caloric intake, because you can't eat to satiety, then the calorie tracking will work as long as it's used to avoid excess and not to sustain a deficit. 

Why would you need to avoid excess if calories don't mater? Because excess disrupts insulin/glucagon ratios and that affects blood glucose but it is not determined through calories. It is a direct hormonal reaction of the digestive process. The same thing occurs if you eat all of the time, instead of an excess in one sitting. This is why we do not recommend snacking, of any kind, on this blog.

2. Pregnant and breastfeeding women require more carbohydrates. 

Children, pregnant women and/or breastfeeding women should follow their healthcare professional's recommended diet, since these people have specific requirements based on preexisting or newly developed conditions.

Having said that, humans are extremely adaptable and versatile when it comes to diet. In hunter/gatherer populations, women have successful pregnancies and breast feedings with diets that range anywhere between 80% carbs to 0% carbs. As long as the woman is eating enough nutrients, she should have no problems with less or no carbohydrates.

3. Does gastric bypass always work as a treatment for obesity?

Gastric bypass staples the stomach, but does not address blood glucose dysregulation. Gastric bypass can temporarily affect blood glucose through the restriction of total food consumed, which is the exact mechanism of calorie restriction. This effect on blood glucose can lower insulin levels and the person appears to lose weight but what they are really losing is mostly water and lean muscle mass. This is why you see many gastric bypass patients left as globs of fat. The fat is not being burned. It just sort of stays there until it is surgically removed.

Also, the person is not being properly taught what made them obese in the first place. They are still hanging on to the calories theory and they once again start regaining the weight as they focus on how much they are eating instead of what they are eating. The what is what affects blood glucose. These people will not only go right back to their usual eating habits, and regain the weight, stapling the stomach does not reverse the obesogenic adaptation of their metabolism. It actually make it worse so when they regain the weight, they regain it double. They continue having an obesogenic hormonal profile, but with a smaller stomach.

This doesn't mean that gastric bypass isn't beneficial for many. Some of these people are on death's door and this surgery bids them more time to try and get it together. It's just that, unfortunately, most never do.

4. Is hunger the main determiner of whether weight is lost and kept off?

The main determiner of whether weight is lost and kept off is how much proper blood glucose regulation you can regain and sustain. The premise is that if you can regain and sustain proper blood glucose regulation, you will regain insulin sensitivity and proper insulin expression. This in turn will break leptin resistance and body fat will be burned as leptin is a slave to insulin.  

Leptin effects hunger, but not always in a negative way. Sometimes hunger is a sign that the body is burning body fat and requires additional fuel. How can you know the difference? Easy - results.

• Hunger while losing weight - Leptin is working very well. Even though you are hungry, and eating in response, you aren't gaining weight as leptin knows nutrients are coming in and it is safe to burn body fat.
• Hunger while gaining weight or being stalled - Leptin is not working properly. It is signaling for fuel, even though there is plenty in storage for use.

So, no. Obesity cannot be broken down to such a myopic statement, which claims hunger determines anything. That only makes sense if you believe in "calories". There is too much being left out that basically makes the statement incorrect. Context determines everything and active obesity is the context that changes what things mean.

5. I was told that if you have issues with dairy, you should consume raw milk.

I know there is a huge debate about this and I don't wish to partake in it, as this blog is not about this type of nonsense, since it does not pertain to metabolism. So, my advice below is the only one I will give and then I'll move on from this topic.

I can only recommend that you use common sense. The selling of raw milk is illegal, in many states, and there is a reason for it. Milk is extremely perishable, since it is the most nutritious food on the planet. This means that every living thing is gunning for it, including bacteria and parasites that can make people very sick. The minute milk leaves the safety of the cow's immune system, it's up for grabs, so handling, transporting and storing raw milk is a delicate practice, which can turn deadly if it's not done properly. Even experienced dairy farms have had their share of contaminated milk. This is why pasteurization was created. It allows people access to safe milk, even if they don't live on or near a farm.

If you live on a farm and can drink the milk, as it's being squeezed directly from the cow's udder, you will be fine. If you don't, you take your chances. If you are having issues with dairy, stop consuming it. It makes no sense to trade in one potential issue for another. Though milk is the most nutritious food on the planet, you can live just fine without it. It is not essential for adults. It is only advantageous.

6. Is all weight loss healthy, regardless of how it's achieved, since weight loss is always the goal?

This is a very interesting question and the crux of long term weight management. Before I begin, let me clear something up in that statement in order to set up the context of my reply. Weight loss may be the goal, but how healthy it is depends on exactly what's being lost. Excess body fat is what's always healthy to lose. There is a difference between weight and body fat. It seems like people continue having a difficult time differentiating between the two. Weight is water, lean muscle mass and fat and body fat is well, just body fat. A healthy metabolism loses body fat, specifically. That's the "weight" you want to lose.

You may have heard this warning before, usually from mainstream medicine - "Don't lose weight in an unhealthy way." You will usually hear this if you tell your doctor that you are restricting carbohydrates or are fasting for a certain amount of time each day. Sometimes you might even hear it from a dietitian, if you tell them you are avoiding all sugar. They are correct. You can lose weight unhealthily, but unfortunately, these mainstream naysayers have it ass backwards. Their idea of why some weight loss methods are "unhealthy" is total BS.

Let's break this down to understand what's really unhealthy. Restricting carbs, fasting for a short duration and eliminating all sugar from the diet, will have 0 negative effects on metabolism, so all of the "weight loss", obtained from these protocols, is being lost in a healthy way.

But, let's say that someone decides to eat only 'one meal a day' (OMAD) and fast for the other 23 hours. They see they lose "weight" and continue doing this. Their one meal is restricted in carbohydrates, "keto style", because they found a "keto doctor" online and is taking their advice. Now they are part of the anecdotal charade, on the comments section of their favorite "low carb" page, since they lost more than 50 pounds doing this "keto/OMAD" diet.

A lone "troll" pipes up, in the comments, and makes the claim that this weight loss was achieved in a "unhealthy manner". The other obese commenters beat the troll right out of the page, since all they care about is that a fellow obese person lost a lot of weight, giving them hope for losing theirs. They don't need a Debbie Downer, at this party, taking that hope from them and telling them they are doing "something wrong". They all gear up for a 7 day "group fast". After all, if one of them lost more than 50 pounds on a 23 hour, daily fast, imagine all of the weight that will be lost if the fast is stretched for 7 whole days!

Then reality bites. None of them lose a pound, except for one, who loses a total of 3 pounds! Three years later the person who lost 50 pounds, gained 100 and disappears from the page. The troll who was mocked into hiatus, for saying the weight was lost unhealthily, silently smiles in the background, vindicated. The "doctor" that runs the page, keeps raking in the money and can care less about the personal plight of his followers. After all, there will be other anecdotal claims made, on his page, burying any "discrepancies", deep down under thousand of comments.

How did this happen? Because the troll who made the comment that this weight was being lost in an unhealthy way, was absolutely correct. I know to the obese "the ends justify the means", but the means always come back to haunt them. Losing weight through starvation methods, only causes metabolism to double down on its obesogenic adaptation, irrespective of the initial weight loss. There's a series of intertwined causes, which come together to create the perfect storm for this to occur.

• Too much loss of lean muscle mass - This is especially true if the obese person is also suffering from metabolic syndrome/diabetes. Hyperglucagonemia and over expression of the adrenal stress response helps break down the body, and everything that's eaten, into sugar and ultimately converted into more fat, at a rapid, unregulated rate. This means lean muscle mass is lost, while more body fat is gained, irrespective of the initial weight lost. The lost weight was mostly lean muscle mass, so the person is now fatter by volume and body fat is one the main catalysts that progresses the condition. This technically means they have more "disease" now, than when they started, but since they only care about what the scale says, they miss the forest for the trees.
• Doubling down on body fat gain - The obese person's fat mass is already adapted to over express a starvation response to any stimulus that signals to it a need to grow in number and size. Starvation is that perfect signal. Now the person can actually gain body fat easier. Now when their weight set point is challenged, below their starting point and no where near lean, they stall or begin gaining again, even more than before.

What contributes to this?

• Diets restricted in protein like online fad, "keto" diets.
• Fasting for excessive and chronic periods of time, which limits the ability to obtain enough nutrients and calories from only one meal. Technically calorie restriction because that's what fasts of long duration ultimately are.
  

What else contributes to this?

• Re-feeding after long stretches of fasting. That's the perfect time for the body to acquire more body fat, so it can prepare for the next long fast. It does this by under expressing leptin action, in the brain, and over expressing insulin action at the fat cell.
• High energy intake. This is especially true of people who fast for long stretches, while also eating "keto". Their re-feeding consists of nothing, but high energy (fat), which goes directly into their fat mass. 

These are the classic results of a metabolism that goes into "starvation mode", but starvation mode is an often cited phrase that is usually inappropriately used and not well understood. It's a misnomer when it comes to the obese, with metabolic syndrome/diabetes, as their metabolism is already in starvation mode, so they can't trigger it again. It has been in this mode for decades and it was triggered by erratic blood glucose fluctuations.

This is why diabetics gain weight, rapidly and easily, once they acquire the disease. Metabolic syndrome/diabetes sufferers already have hyperglucagonemia and an exaggerated adrenal stress response, which spares fat mass, rather than burn it. Their leptin is already under expressed in the brain through abnormalities/damage in the hypothalamus from chronic leptin resistance and the taste of sweet. They just made it all worse by forcing the body into a "fake famine".

So yes. You can certainly lose weight in an unhealthy way, because it's not about what you can lose, it's about what you can keep lost. If you can't keep body fat lost, then it's as if you lost nothing, because you are making your metabolism unable to lose it next time. There's going to come a time when you really need to lose body fat, and not because you want to be ready for bikini season, but because you are developing diabetes. When that time comes and you can no longer lose any fat.....well, you know what occurs then - neuropathy, retinopathy, nephropathy, anemia, sepsis, cardiovascular disease, fatty liver disease, Type I diabetes, dementia and finally death.