Six common beliefs addressed, Part 207

1. My trainer told me to not worry about high blood glucose or insulin because most overweight people have those issues and they go away when they become lean.

Ask your trainer why "most" overweight people have these issues but not all. That's the key question that reveals their BS. Outliers don't make the rules but they certainly break them.

Everyone knows what reverses insulin resistance and diabetes - body fat loss. I know that these coaches and trainers want to make statements like these in order to appear confidant in their protocol but the reality is that everyone knows this. What is not known is how to achieve it. We know that proper blood glucose regulation is the key but we simply don't know how to regain and sustain it long enough to affect body fat in everyone.

So, yes you have to worry about your high blood glucose and insulin because that's what's driving your condition. These issues do not go away because you become lean, instead you become lean because these issues go away.

2. A coach told me that loosing fat and gaining muscle is the key to reversing insulin resistance.

Like I said above, everyone knows what reverses insulin resistance and diabetes but no one yet knows how to achieve it, especially in the long term. There are many different treatments but they have all failed so far. You need a properly working metabolism to lose fat and build muscle. The key to this is proper blood glucose regulation. It doesn't happen through magic.

The overweight/obese metabolism doesn't want to lose fat and it breaks down all its muscle. It’s very difficult to reverse this, once it begins, and many different lifelong approaches have to be implemented together in order to have a chance to.

3. My neighbor was recently walking and suddenly had a heart attack. They discovered she had a 99% blockage in a main artery. She had started doing "keto" a while back, was doing great with weight loss, and then this happened. 

Heart disease is mostly genetic. I am pretty sure that there was heart disease in your neighbor’s family history. Having said that, people who have a genetic predisposition for heart disease have to be very careful of their lifestyle choices and keep in mind that some of these choices can put them at greater risk for developing this disease. Lifestyle choices like smoking, for example, puts everyone at risk for heart disease but it is especially malignant for the people who already have a genetic predisposition for it.

A lot of genetic heart disease is caused by poor lipid management in the body. Lipids are very complex but basically these people have LDL and apolipoproteins that do not function as they should. Certain lifestyles can effect the function of these proteins but for the most part their function is genetic. That's why these people have long family histories of heart disease. For some of these people, consumption of saturated fats has an adverse effect on their lipid profiles. "Keto", as is followed online by buffoons, is an ultra high saturated fat diet. If your neighbor was one of the people who have these genetics, then yes, she very well could have exacerbated her disease by eating all that fat. It doesn't mean she wouldn't have developed it anyway, it just means that she sped it up.

You should never follow a diet willy-nilly because you saw someone online recommend it since the odds are that the diet is not correct. Even a diet like veganism which is toted as benign is everything but. It can cause you serious health problems. Your neighbor should have gone to her doctor and had the proper testing done in order to see how this diet was affecting her lipids. You cannot guide yourself by simply having "low cholesterol". That's not enough to know how the diet is affecting you. Your cholesterol could be low and doing nothing but building plaque in your arteries, just like your insulin could be low and doing nothing but building fat around your middle. Having less or more of something doesn't make it good or bad. What it's doing is what determines this.

4. My friend was obese. His diet is carb based because in his culture it’s a tradition to eat bread, beans and other carbs. About a year ago he started making YouTube walking videos, giving tours of his city. These walking tours take anywhere from two to three hours of walking every day to every other day. I recently visited him and when I saw him, I nearly fell over. I didn’t recognize him. This man is in perfect shape now. He looks athletic! He said he was surprised himself as he never could have guessed making these videos would cause this to happen. He never changed his traditional diet either but he reversed his prediabetes anyway. 

This is not surprising as exercise has long been known to reign supreme when it comes to metabolic health. Diet is only a palliative treatment for metabolic syndrome/diabetes but exercise actually reverses the pathologies associated with this condition.

Many studies have consistently shown this in diabetics. Without any diet changes, diabetics can make significant and long lasting improvements to their condition with exercise alone. We have also seen this in athletes. Athletes can have the worse diets in the world and still be in perfect metabolic health, as long as they can continue exercising. Exercise is great at preventing metabolic conditions.

The profound effects that exercise has on glucose regulation is what sets these metabolic benefits into motion. These effects go well beyond glucose control and actually changes the way insulin functions. To compound the benefits, exercise affects leptin in a positive way, more than any diet can. Add to that mitochondrial energy balance and improvements to body composition and you have a system wide metabolic effect that cannot be matched by any diet. Exercise goes where no diet can.

5. Everyone is always arguing over one diet or another but does it truly matter when it comes to obesity? There is no diet that is best for obesity. 

Diets are all shim-sham when it comes to obesity because no diet can promise a restoration of leptin expression. Leptin expression is all that matters. This is why you cannot expect much from any diet but you also can't take any diet off the table, unless it hasn't worked for you before. If it didn't work once, it won't work twice. The premise is that your chosen diet will improve blood glucose regulation enough to enhance leptin expression.

The diet you choose affects your overall health and certain diets have to be followed due to allergies or other conditions that are exacerbated by the consumption of certain foods. But when it comes to obesity, diets are only palliative since obesity has no known cure. In fact, exercise reigns superior in its beneficial effects on obesity than any diet.

The path to restoring leptin expression, for the obese, is paved in blood glucose regulation. So the only diet that is best for obesity is one that helps preserve and/or stabilize blood glucose regulation. Proper blood glucose regulation simply means that the body is able to keep its blood glucose steady, without large disparities between highs and lows. A healthy body makes glucose when needed and not when it doesn't.

The best diets for achieving this are low in carb, moderate in fat and adequate in protein. This is because these diets have three very important benefits:

• They don't interfere further in the body's ability to regulate its blood glucose through the introduction of dietary glucose, whether in the form of sugar or starch.
• They minimize the storage of fat by no longer converting dietary glucose into fat. This is good since leptin under expression is not allowing for the burning of stored fat, so you don't want to add to it. Getting fatter only causes a further disruption in blood glucose regulation through an increased insulin demand.
• They allow the body to preserve and rebuild the lean muscle mass it's losing through excessive catabolism, restoring insulin/glucagon ratios and insulin's pulsatile function.
• They reduce systemic stress through the consumption of suffice calories, helping to break the starvation adaptation which is metabolic syndrome.

So even though you can affect blood glucose through multiple avenues, including caloric restriction, and they all can have some benefits, the most profound effect occurs from low carb diets because they target multiple glucoregulatory systems and they can be sustained for the long term. Obesity can only be treated with a long term solution that does not reinforce starvation.

6. If blood sugar rises too high, after a meal, it means you ate too much or ate the wrong thing.

You ate too much and you ate the wrong thing if what you ate is pizza. In that case, it’s not the amount of pizza that caused this but the pizza itself.

You can try to negotiate with the pizza and only have one bite so there isn't such a large abnormal rise in your postprandial blood glucose, but you will have some abnormal rise regardless. This will cause your insulin function to continue to deteriorate over time and this will further effect your blood glucose regulation. Soon you won’t need the pizza at all to see high blood glucose. You would just wake up in the mornings and see it. That can’t be solved by negotiating with your sleep and sleeping for just an hour a night.

Postprandial (two hours after a meal) blood glucose should technically be back to fasting levels. Of course, people with metabolic syndrome cannot achieve this so the rule of thumb is for blood glucose to not go over 140 mg/dL postprandial. You would be better off if you can keep it below 100 mg/dL. You want to avoid a blood glucose fluctuation of more than 40 points, whether up or down, but this is all very difficult to do when you are already insulin resistant. A healthy person would be able to control this much better in order to avoid becoming insulin resistant. Once you are already there, everything falls apart. The center does not hold.

A lot of people blame these postprandial blood glucose rises on what they ate or how much they ate, but I don't want you to focus too much on that. As long as you are eating a proper low carb diet and maintaining your macros, what or how much you ate becomes irrelevant. You can be on a zero carb diet and throw in caloric restriction to boot and still have high postprandial blood glucose.

This is because the high postprandial blood glucose, that a person with metabolic syndrome experiences, has mostly to do with their insulin function, not with what or how much they ate at any one single meal. These people simply do not have the correct first phase insulin response to stop glucagon's catabolism of their own body.

Insulin is not only anabolic. It is also anti-catabolic. So every time these people eat, whether it's doughnuts or rocks, they will have a rise in insulin which causes a rise in glucagon but their insulin does not rise high enough to stop glucagon’s action. The more glucagon breaks down their body into glucose, in an uncontrolled manner, the higher the glucose in their bloodstream rises. This problem exists with or without the doughnuts presence. That's why many people who are strict carnivores still see rises in their blood glucose, even with no carb consumption whatsoever.

Diabetes is not a carb disease. It is a blood glucose regulation condition caused most commonly by an improper diet. The malignancy in the doughnuts is not necessarily that they cause blood glucose to rise after eating them but that this rise causes a prolonged insulin release/expression which will then drop blood glucose 100 points or more, during the night time fast. It's this drop that begins the adaptation process.

Erratic and large disparities in blood glucose, postprandial and then fasting, deteriorate insulin function and blood glucose regulation over time, increasing the body’s propensity to store and preserve body fat. This is because these drops in blood glucose signal starvation and sparing fat is anti-starvation. This wasn't caused by any single blood glucose reading. This is something that occurs chronically in the long term. I'm talking decades.

So, the purpose of taking a dietary approach to control this effect is not to focus on single blood glucose readings in the short term but to improve insulin function in the long term. The improper diet is what caused this "insulin resistance" and that's what you want to reverse. For this reason, stay away from doughnuts. They interrupt the body’s glucose homeostasis whether you eat one or a dozen.

You also need to stop obsessing over single blood glucose readings and begin to reverse insulin resistance. You can develop advanced diabetes while twiddling with your postprandial blood glucose. We see this all the time with "low carb diabetics". They carry around their meters constantly and end up dying of diabetes complications regardless. Blood glucose meters give you important information about how diabetes medications are affecting you. That’s why you need to check your blood glucose often as blood glucose medications, including injectable insulin, can drop your blood glucose rapidly and without symptoms, which can possibly kill you. You need to make sure you are dosing diabetes medications properly. That's what the meter is for, not to see how onions or a tomato affects you.

For people who are not diabetic but are simply overweight/obese and/or have metabolic syndrome, the meter can show them in real time how doughnuts are not helping them. Some people need to see actual proof that pizza is unhealthy, in any quantity, before they even consider giving it up. Most people think that pizza just causes them to gain a few pounds a year but isn't actually killing them. Well a blood glucose meter can help convince them otherwise.

Six common beliefs addressed, Part 166

1. I eat almost no carbs but my blood glucose still runs high. I have only lost about 10 lbs.

This is because you have just discovered what we have been saying on this blog for a long while now - what you eat has a limited effect on blood glucose as most of the high blood glucose in metabolic syndrome/diabetes is coming from the inside.

I don't know what type of diet you are on and I don't know what other lifestyle changes you have made but running high blood glucose, while eating low carb, is indicative of an adrenal stress response. The 10 lbs. you lost, were most likely water weight and lean muscle mass as the body must break down it's lean muscle mass in order to continue running blood glucose at high levels. Stop the nonsense. Instead of eating "almost no carbs" try a proper low carb diet instead to try and reduce this stress issue.

2. Statins can lower triglycerides (trigs).

Statins are used to lower cholesterol in people with high total cholesterol. That is usually the reason they are prescribed. You would need a very high dose of a strong statin to lower trigs only by about 50% and also help raise HDL cholesterol.

For this reason, trigs are normally not treated with statins, as there are trig lowering medications available like Fibrates, Nicotinic Acid and high, prescription strength, doses of Omega 3.

3. I started doing "keto" and my kidney started hurting. I had to stop and now I'm wondering what diet I should follow.

How do you know your "kidney started hurting"? Did you seek medical attention? Do you have current kidney disease?

It's mind boggling to me when people begin a diet and then suddenly start feeling aches, pains, etc. and immediately attribute it to the diet they are following. All a ketogenic protocol is, is a diet that is very low in carbohydrates. That's it. Are you saying that pizza and pasta prevented kidney pain? That's one for the record books.

Listen, I know there are many iterations of "keto" online, some of which can negatively affect your health and cause problems but that is not the case with a legitimate ketogenic protocol. So, I suggest you follow the ketogenic protocol that we recommend, found here and drop all of the dumb "keto" you found online. See if it makes a difference.

Also get yourself checked out by a doctor, if you haven't already, as kidney pain can be the symptom of a serious problem. I cannot believe you actually waited for a reply on my blog about this. It takes me weeks to get to everyone's questions and/or comments.

4. Diabetics are always told to eat a candy bar or drink soda to treat low blood glucose even though they shouldn't eat these items.

This is because eating a candy bar or drinking soda treats low blood glucose. It works perfectly for that, as dietary sugar raises blood sugar. It doesn't treat diabetes, it just treats the low blood glucose symptom.

That is always the case when you try to hide a symptom of a much more complex underlying problem. The same goes for eating bacon and eggs to treat high blood glucose and think you will be all right. That also is not treating the diabetes. You are just hiding a symptom.

5. Statin medications can be beneficial for people who do not want to change their diet. 

Yes. Conventional medicine is excellent at keeping you alive, even in the most dire of conditions. In fact, that is what they do best. For example, I know of someone who has colon cancer, advanced heart disease and diabetes and they are still alive and kicking. They have had several close calls and have been brought back from death's door multiple times. My own mother in law, remained alive for decades with diabetes and fatty liver disease due to pharmaceuticals and "treatments". In fact, she went into a coma once from a blood glucose over 1K mg/dL and they were able to bring her back. Conventional medicine allows you to continue living your worst life. All of these people would have been dead a long time ago if it wasn't for conventional medicine.

So yes, for a person who refuses to do anything to better their health, as diet is not the only thing they need to do, taking a statin might be beneficial for them. It's certainly worth it as there are certain lipid conditions that do not respond to diet alone and require pharmaceuticals.

You don't want someone who refuses to help themselves, to also start refusing someone else's help. Statins have been shown to have benefits in people with current heart disease. So these people need to continue working with their doctor to remain alive and avoid further complications.

6. The Cleveland Clinic still encourages artificial sweeteners and bread.

Artificial sweeteners and bread are not poison. The Cleveland Clinic doesn't encourage gasoline or arsenic as part of a healthy diet. Just because artificial sweeteners and bread are detrimental to metabolic health in the long term, and do not allow for people who already have metabolic issues to get better, these reasons are not enough for them to remove these items from their dietary advice.

Aside from that, they technically don't have to get rid of these items, since their dietary advice is calorically restricted. Caloric restriction is the antidote to a high carb diet. Carbohydrates in the context of starvation help stave off metabolic disease for quite a long while, especially if you are young, obesity resistant and still healthy.

Six common beliefs addressed, Part 138

1. You should ask for a complete thyroid panel in order to know exactly what my thyroid function is. 

Yes. If you are having some type of issue, your doctor suspects can be related to thyroid disease, then the proper blood work will be ordered by them to confirm this. 

But, I don't want you to get too caught up with your thyroid numbers as the thyroid is at the mercy of your overall metabolic state and for this reason you have to take into consideration many other things before you can conclude your thyroid health from just numbers. For instance, a person who is losing weight will have hypothyroid numbers without there being a pathological reason for it. This is just the result of a normal, perfectly healthy thyroid responding to the loss of fat mass. You don't want to end up on thyroid medication that will disrupt this normal process and possibly cause a weight stall or weight regain. 

Do not treat numbers. Treat disease. 

2. Going carnivore can cause depression and other emotional issues.  

This may occur with any diet that restricts carbohydrates. It doesn't happen to everyone, but there are some people who are sensitive to this. 

When you consume a meal that's heavy in carbohydrates, it disrupts your blood glucose and your body responds by over releasing insulin. Insulin lowers the concentration of most amino acids. The one amino acid that doesn't decrease in response to insulin is tryptophan, which is converted in the brain to serotonin. When insulin lowers the concentrations of other amino acids, tryptophan is then able to pass into the brain more readily. The body adapts to this condition, especially when this has been happening for decades. Any changes to this hormonal state will result in side effects. 

When insulin levels suddenly drop, because of carbohydrate restriction and fasting, serotonin levels can be affected and this can cause multiple side effects like mood changes, sleep disturbances, etc. It can also aggravate pre-existing conditions like depression and anxiety. Usually these effects, though uncomfortable, are transient and will decrease as the body adapts to its new state, but for others, this can become a serious problem. This is especially true if prescription medications are involved. 

These symptoms need to be discussed with a healthcare professional if they persist. If you are on prescription medication, for the treatment of any psychological condition, you must discuss any diet change with your doctor prior to implementation. 

3. Blood glucose can remain high, hours after a meal, while on carnivore. 

That's hyperglucagonemia. You should divide your daily protein requirement into three meals, so you don't eat so much at once. You have to give the body a chance to properly regulate its counter regulatory system. That will take some time, but you can help by dividing meals. 

4. You should make your child eat "keto", even if they are reluctant to try it. 

The advice we give is for people who can follow it themselves and voluntarily. This is what ensures compliance and consistency as this type of metabolic therapy must be followed long term. This is why I cannot give advice for children or anyone else that is under another person's care. 

I suggest you talk to your child's doctor about healthy diets for children. The diets recommended in this group are a metabolic intervention for adults only. 

5. Cheese can cause a weight stall.  

Only if it's replacing the protein in the diet. You can't expect to eat a wheel of cheese and lose weight. Cheese is only a garnish to your meals. It's not a snack or a meal in itself. 

6. If you don't want to cook meat, try lunch meat. 

Lunch meat should not be a staple in your diet. Lunch meat is a staple of the Standard American Diet (SAD) because you don't have to cook or prepare it and you can make sandwiches out of it, but lunch meat is not proper nutrition. It is a processed meat that does not have the right fat and protein content or in the right ratios. It is fine to use as hors d'oeuvre at a party because it's better than eating crackers, but it should not be part of your everyday meals. 

So whether you can find it clean or not is irrelevant. Lunch meat is not appropriate "food". 

Six common beliefs addressed, Part 112

1. After starting “keto” blood glucose can go into the 50s and 60s mg/dL, but this is not dangerous. 

Yes. It absolutely can be, especially if you are diabetic. You have to put a halt to this because all it’s doing is adapting your body further to keeping its blood glucose set point too high. For this reason, the best way to approach a dietary change is to take it in stages. 

You should start with moderate low carb first and see what results you get. The results occur in the long term (6 months to a year), not the short term. Some people go low carb and see that their blood glucose lowers, so they decide that if they restrict carbs further, then their blood glucose will lower even more, and though this might be true in the short term, they are actually causing the body to double down on its insistence to keep blood glucose higher than normal. After some time, their blood glucose begins to rise again. 

So, you don’t want to ignore this like “keto” people tell you to do. Normal blood glucose does not dip this low in healthy people. Drop the “keto” and especially drop any fasting you might be doing alongside “keto”. 

2. "Zero carb" diets cannot cause weight gain.

Carbs are not the sole cause of obesity. There are many things that are done wrong on carnivore that you might not have done on "keto". If you want to make sure you are following carnivore correctly, you can read how to properly do so here.

3. Do low carbohydrate diets and intermittent fasting (IF) cause blood glucose to creep up?

Only if they are not properly regulating your blood glucose. If they are causing an extended time in hypoglycemia, your blood glucose will eventually begin to rise again. 

 

You have to shorten your fasts. A lot of people call all sorts of fasts "IF" when they aren’t. Keep your fasts between 12 -18 hours a day and no more. Continue shortening it, until you get to 12 hours if you can’t keep your blood glucose within a normal range. 

4. Is the “Snake Diet” a good protocol to follow?

Yes. If you are a snake. If you are a snake who has made this claim, then the snake diet is absolutely appropriate for you. Reptiles have a very slow digestive system because they are cold blooded animals. Depending on the species, some reptiles only have to eat once a month. 

 

But this blog is specifically for human metabolism, and the appropriate diet for humans, so you might want to search blogs dedicated to the Reptilians, as I cannot help you. 

5. "Keto" causes joint pain. 

This means that your body is under stress and you are losing your cortisol regulation, as you are releasing too much of it. When cortisol release becomes chronic, in the body, it loses its ability to regulate inflammation. Cortisol, like all other hormones, is meant to work in a pulsatile manner. Stop the “keto”. Go on moderate low carb. Low carb is any diet that is 100 grams of carbs or less a day. 

For a healthy person, this stress response would not be an issue. This is just something that people with metabolic abnormalities experience, as their bodies are "carb dependent" because of their adaptation to hyperglycemia. The body demands that its blood glucose be kept high all of the time. Carbs are a great way of accomplishing this, so their removal causes an exaggerated stress response in some. No, this isn’t "carb addiction" or the pain of not being able to eat bread. This is a physiological response to a metabolic adaptation. 

Removing the carbs removes the easiest way the body has of keeping its blood glucose high and so it’s reacting to it lowering. Usually this is temporary as the body, once again, adapts to lower blood glucose, over time, but for some people it’s not temporary and they continue having issues with their stress response. 

So, don’t jump to very low carb first. Reserve very low carb diets for when results are not obtained with moderate low carb. 

6. If you eat “too much protein” your blood glucose will increase. You must find the ideal "protein to fat ratio" in order to prevent this. 

No, no, no. There is no such thing as this. This is better phrased as "When your insulin levels do not rise enough, after eating, your blood glucose increases. You need to stop this uncontrolled catabolism through better blood glucose regulation.” Better blood glucose regulation will improve your insulin sensitivity and help you regain your first phase insulin response. Until then, you are not releasing enough insulin to stop glucagon. You are only releasing enough to activate 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 79

1. Virta Health appears to have taken the stance that fasting is a fad.

Because it is. It’s the new fad going around, in the diet world, like so many others that came before it. It seems to now be dying down some, along with "keto", thank goodness. A lot of people, who jumped on that money train, are going to have to find a new shtick or starve. Unfortunately, it won't be difficult for them, since the diet sphere makes a new promise, that it can’t deliver on, nearly everyday. Just scan the tabloid magazine covers, during your next check out at the grocery store.

Virta Health is a real, science based ketogenic protocol, and though they put too much emphasis on useless blood ketone levels, and their definition of “success” is up for interpretation, their approach is still true to metabolic function and has been proven to work.

2. Will going low carb help prevent or improve macular degeneration?

We read statements like these, all of the time, about low carb helping with everything from hair loss to ingrown toenails, but on this blog, carbohydrate restriction is a specific treatment for metabolic syndrome exclusively.

Studies have shown that there is an inverse relationship between the intake of omega 3, long chain polyunsaturated fatty acids, and age related macular degeneration. It appears that the eye requires omega 3, to be healthy, but will use omega 6, instead, if it's what’s mostly available. The fatty acid ratio of the modern diet is very high in omega 6 and deficient in omega 3, which is the case of all plant based diets. With time, this increases the risk for macular degeneration.

Some people appear to be more at risk for this disease than others, so there is a genetic component to the disease. This is most likely related to how the body handles omega polyunsaturated fats.

The only way that carbohydrate restriction would be beneficial, in addressing this condition, is through an increase of animal derived omega 3 fats and a decrease in omega 6. Many people have reduced the progression of this disease through omega 3 supplementation. It is always good to know your omega 3 to 6 ratios, if you are at risk or currently have macular degeneration.

3. The protocol "Delay Don't Deny" is appropriate for addressing overweight/obesity. 

Absolutely not. I do not recommend any gimmicks, as this blog deals with serious conditions like metabolic syndrome, obesity and diabetes.

"Delay Don't Deny" is just another useless protocol for weight loss. The sad part of it is, that the obese flock to this kind of garbage, as if it was a free doughnut stand, because in a way it is. In the end, they will realize that they were no better off, than if they would have continued tracking calories.

This intermittent fasting protocol is incomplete and incorrect, because it does not address diet. It promises weight loss, without the need to change what you eat. This is not new. This is actually an old trick. It's simply caloric restriction disguised as "intermittent fasting", since that term is now popular and attention grabbing. But, regardless of the catchy description chosen, you are simply restricting calories, throughout the entire day, rather than at each meal.

You're still eating the foods that disrupt proper blood glucose regulation. This means you're still preserving your obesogenic hormonal profile. You're still sparing your fat mass. You're just addressing calories through fewer meal times. This might help you see a benefit, in the short term, but you are doomed to fail in the long term. Remember, you cannot "out fast" a bad diet. Short term solutions do not reverse obesity. They make it worse.

Again, overweight/obesity are lifestyle conditions, so an entire lifestyle change must be made to address it. Don't fall for promises that are too good to be true. While this person makes money off of you, and travels the world on your dime, you are left to deal with your obesity.

You cannot address metabolic disease by not denying. Denial is vital for success. "Delaying" and not denying, only causes a delay to the inevitable outcome of diabetes.

4. Fasting is dangerous.

No. It's not dangerous, is just mostly ineffective because people do not do it properly. Obesity is dangerous, so if you use an ineffective protocol to treat it, or one that makes it worse, then I suppose you are doing something dangerous by proxy.

5. You must eat 0 carbs to keep your blood glucose low. Even berries will cause high blood glucose. 

"Chasing symptoms" through diet is not going to achieve remission. Once you eliminate foods that affect your blood glucose negatively, you have to put your focus on other things that could be affecting your blood glucose besides diet. The goal is for your body to begin regulating its own blood glucose. The goal is never for you to be attached to your meter, watching your blood glucose erratically go up and down and not do a thing about it.

The problem is large disparities in blood glucose. In other words, you don't want to measure your blood glucose, see that it's low and then wash your hands of the problem. You have to see just how low and how high your blood glucose goes in a 24 hour period. This is best done by measuring fasting blood glucose and then postprandial blood glucose. If you drop to 60 mg/dL, while fasting, and then go up to 120 mg/dL, after you eat, you have issues. This roller coaster will only exacerbate the stress response. You might feel complacent that your blood glucose is 120 mg/dL, instead of 300 mg/dL, but your body doesn't care. Complacency does not cure diabetes. Steady blood glucose control does. Avoid disparities in blood glucose of more than 40 points.

6. Is the 'Impossible Burger', full of "estrogen" and other "toxins"?

Who knows. If you are going to eat a burger, eat a real meat based burger. Real meat is from an animal. Do not eat man-made concoctions. What's in it is irrelevant. The only thing that counts is what's not in it: real meat.

Six common beliefs addressed, Part 67

1. There is no rule book for "keto".

There is. People who are ketogenic use the break down of fat as their primary fuel. There are two ways to do this and each depends on your goals and condition being treated:

• Ketogenic for a metabolically healthy, lean epileptic - fuel from the breakdown of dietary fat.
• Ketogenic for a metabolically unhealthy, obese patient - fuel from the breakdown of body fat.

That's it. That's the rule book. You must follow the above rule if you are ketogenic, not the made up rules you may have read online or the person who told you there were no rules at all.

Ketogenic diets are very low in carbohydrate. So, you must restrict your carbohydrates low enough, so that the body can mobilize fatty acids. Reread that sentence carefully. You are mobilizing fatty acids, not "ketones". Ketones are simply a by-product of this process and their presence does not differentiate between dietary fatty acid mobilization or body fat, making them a worthless metric. After all, the metabolic advantage is completely dependent on where these fatty acids are coming from. Having them come from your plate, will make a huge difference in outcome, than if they were coming from your behind. You want them to come from your behind.

The way you choose to restrict carbohydrates is left up to you, as the diet does not have a “restricted carbohydrates” list. The only requirement is to drop carbohydrate to very low levels. Of course, the easiest way to do this is to eliminate concentrated carbohydrates like grains and sugar. In the context of obesity, these refined, isolated and concentrated carbohydrates are detrimental.

The fake rules that have been added to this diet, by charlatans, such as eating gobs of fat and restricting protein are not real rules, but marketing schemes for money making attention.

You can read more about ketogenic diets in my blog post here.

2. If you follow low carb and still have blood glucose issues, you should lower your carbs further.

You might come across this type of advice often, from low carb advocates. This is because low carb advocates only talk about dietary glucose, since that's the easy and profitable part. They never talk about the glucose your own body is making, because that's the hard and non-profitable part. After all, not even conventional medicine has been able to control this except in pseudo ways using pharmaceuticals.

Uncontrolled creation of glucose by the body has to do with glucagon and adrenal counter regulation (stress hormones), which simply does not fit the low carb narrative of - "It's the carbs affecting insulin, stupid". No, stupid, it's not. That domino fell a long time ago and the diabetic is long past it. Now the diabetic has a slew of other issues going on, which will not normalize through diet alone, or by just "lowering insulin levels". They sure as hell won't normalize by lowering glucose levels either.

This is a very complicated "disease" that requires multi factorial treatments of which low carb in only one part of.

3. Whole fruit can spike blood glucose the same way as simple sugars.

I know that many low carb pages and groups, out there, like throwing around blanket mantras that keep their base stirred up, but we don't do that here. Why? Because it's false. Claiming that fruit spikes blood glucose the same as simple sugars is only true for people with metabolic syndrome. So, it's not the fruit, it's the condition caused by poor blood glucose regulation.

Certain foods are known to disrupt blood glucose homeostasis. Grains and added sugars are especially notorious for this effect. Consuming these products will make metabolic problems worse. Those that are still healthy, will be pushed towards disease with time. 

If you follow any dietary practice that dysregulates blood glucose, you will eventually become metabolically sick of which an increase of body fat is the first symptom. Increasing body fat will inevitably cause you to go beyond your fat threshold, with time, and place a high insulin demand on the body, furthering blood glucose dysregulation and perpetuating the disease. You are especially at risk for this as you become older, since older people grow fat much more efficiently than they do muscle due to a natural resistance to insulin with age. So, by default, the older you are, the fatter you can become.

As far as the effects of whole fruit is concerned, it all depends on how far along your disease is, what type of whole fruit you’re eating, how much if it you’re eating, how often and, most importantly of all, if it's dysregulating your blood glucose. I'll give you a hint: If you are already fat and/or getting fatter, you can make the educated guess that it is affecting your blood glucose. If your blood glucose continues to be dysregulated, there will come a time where even eggs will spike it. Eventually, breathing will spike it too and that’s when you will have high blood glucose all of the time, since it's now coming from the inside and it won't disappear just because you stopped it from the outside. That's when you are diabetic.

So, I don't want anyone who reads this blog to miss the forest for the trees. Anything that contributes to blood glucose dysregulation, will eventually lead to metabolic dysfunction, whether it's whole fruit or coconut oil. 

 
4. Insulin resistance only affects the liver and muscles.

Insulin is a master metabolic hormone. It not only facilitates glucose into cells, but it also delivers nutrients, regulates energy usage, regulates growth and regulates catabolic function through various hormones, amongst other things. When insulin is either insufficient or tissues/organs are resistant to its function, then many serious problems can arise, besides fatty liver disease and obesity. So no, liver and muscles are not the only organs affected. Many other organs and tissues are also affected downstream and upstream from these as well.

5. Should you eat mostly fat?

Yes. If you want to gain weight and/or continue to be obese, by all means, eat mostly fat.

6. Low carb can heal heartburn.

If carbs are what’s causing the heartburn, then their elimination would heal it. For example, some grains trigger heartburn because they cause excess acid production in the stomach. If you go low carb by avoiding grains, you will obviously reduce your heartburn. Other heartburn is due to low stomach acid, diet changes or gastroparesis, which all require other interventions besides low carb.

Six common beliefs addressed, Part 45

1. I am a very hard case that can't follow the diet consistently. I also can't fast and can't exercise.

I do not offer any miracles here. This blog is only for people who can still help themselves. Readers of this blog must be able to:

• Adhere to a proper carbohydrate restricted diet, consistently.
• Fast for an appropriate and beneficial period of time daily, minimally 12 hours.
• Exercise up to their limitations.

None of the above recommendations are easy or comfortable. The only thing that is easy and comfortable is going out to dinner and shopping.

• Adhering to a proper, low carbohydrate, whole foods diet removes from the table many of the familiar foods that you are use to. This means you have to retrain your palate. This can be grueling.
• Fasting does not allow you to partake in habitual fun behaviors, which you enjoyed in the past, like eating while watching TV or grabbing something from the fridge, just because you walked by it.
• Exercise is painful, tiring and exposes you to "icky" things like heat, sweat and sun. It takes time out of the day, which could have been otherwise spent reading, on the computer, sleeping and eating.

But, those are the only three things, which help with weight loss and metabolic health, aside from bariatric surgery. We cannot offer any other help besides these, because there is nothing else to offer. Anything that goes beyond these recommendations requires pharmaceuticals, which we do not provide nor can advise on. If you cannot do any of these three things, then you must talk to your healthcare provider and follow his instructions.

2. I tried a low carbohydrate approach and felt terrible, so I had to stop.

Many people who begin following a low carb diet, experience uncomfortable symptoms. They can have no energy, feel fatigued, have heart palpitations, hair loss, anxiety, feelings of being cold, etc. The list of symptoms is endless. For others, it worsens thyroid function and/or causes increased hunger, rather than a decrease.

99% of the time, these symptoms are being caused by electrolyte imbalances, so they can be corrected with the right supplementation. Make sure that when you begin any low carb diet, you treat electrolytes as a fourth macronutrient. You do not want to put all of your focus on carbohydrates at the expense of everything else.

An electrolyte guide can be found here.

Electrolyte imbalances can cause much more than just uncomfortable side effects. They can cause permanent adverse health effects if they are ignored. Electrolytes are required for proper thyroid and digestive function.

3. I am losing too much weight on a ketogenic diet. I should eat carbohydrates again.

Yes. If you wish to be fat, you must eat a fattening diet and carbohydrates are part of a very fattening diet. But, if you want to be lean and healthy, or remain that way, then you have to sustain a carbohydrate restricted diet.

The first thing you need to do is make sure that you are truly losing an abnormal amount of weight. Being thin, and staying that way, is not indicative of abnormal weight loss or that you are becoming unhealthy. Being fat is not a sign of good health. "Normal weight" has been clouded in an atmosphere of mostly obese people, so now anyone who is not coated in a layer of fat is deemed to be anorexic. So, make sure you are interpreting your weight loss correctly by making the proper measurements, not just eyeballing the mirror. Then you should discuss any weight loss concerns with your doctor.

While you wait for an appointment, you can take into consideration the following - The only time that a ketogenic diet would cause abnormal weight loss is when it is protein restricted and/or very low in calories. Other than that, abnormal weight loss is not a common occurrence and usually only happens to people who are obesity resistant. These people did not have a significant amount of body fat to lose, when they started the diet, and may have gone ketogenic for other reasons that were not weight related. Because they are not obese, they immediately lose weight quickly and can go below their usual, already lean, baseline body weight. This is why it's so important to have a well formulated ketogenic diet and not follow clowns online. It is very easy for ketogenic diets to become protein and calorie deficient, causing adverse health effects, or even become fattening.

To counteract this effect, up your protein and calories. Calories can be made higher by increasing dietary fat. Remember, the less body fat you have, the more dietary fat you can consume. You also need to make sure that you are doing the proper exercises to build muscle.

If you continue to lose a lot of weight, then you have to discuss it with your doctor, as this most likely has nothing to do with the diet and something else could be going on. This is especially the case if you have been a long term Type II diabetic. Any diabetic who experiences abnormal, persistent weight loss, needs to see their doctor immediately.

4. Can I ignore my high blood glucose because I am already on low carb?

There are people out there that will tell you to ignore your blood glucose, if it starts rising, while following a low carb/"keto" diet. They make excuses and caveats about how the diet is still working, even with high blood glucose because, to them, high blood glucose can be "normal" on low carbohydrate. They minimize effects like Dawn Phenomenon (DP) and physiological insulin resistance.

I have written extensively about DP, and though it’s a normal event that occurs to everyone, the DP diabetics experience is not normal, even if they are following low carbohydrate. If the DP is persistent, and does not improve with time, it must be addressed.

Physiological insulin resistance, also known as 'adaptive glucose sparing', is another occurrence that everyone on low carb experiences, to some degree, but if it persists, especially when consuming low carbohydrate items like above ground vegetables, then it is absolutely not normal.

The same goes for weight. Weight gain is not "health gains", it’s obesity. So, if weight is creeping up on you, it's indicative of a problem. Don’t listen to the excuses given by fanatics, who are so twisted by their absurd blind belief in their diet, that it causes you to harm your health.

If your blood glucose is still high on low carb/"keto" then you’re still sick. If high blood glucose did not indicate sickness you could have accepted high blood glucose on the Standard American Diet as well. The goal of the diet is to stabilize blood glucose within a normal range in order to improve its regulation, improve insulin and start losing body fat. 

5. Is there a macronutrient, which is best for people with metabolic syndrome?

There is. Protein.

Protein is the only macronutrient that will not contribute further to your fat mass. 

6. All symptoms of metabolic syndrome/diabetes will disappear once insulin levels lower.

Each organ in your body has a specific, independent and unique metabolic profile. The body is not a monolith, though everything must work in sync.

Lower insulin without improving its function only starves glucose dependent tissues more. Certain glucose dependent cells in the nervous system, retinas, kidneys and red blood cells cannot use fat. Lower insulin levels mean that these cells will struggle more to acquire the glucose they need. This can exacerbate certain conditions like retinopathy, neuropathy, anemia, etc. This is most likely the mechanism behind worsening of certain diabetic conditions, when following “keto” and extended fasting protocols.

Six common beliefs addressed, Part 44

1. You cannot stop losing weight on a ketogenic diet. 

You will continue losing fat, as long as the body has excess fat to lose.

In the beginning, you might appear "gaunt" because the body does not exclusively lose fat, but also loses a significant amount of lean muscle mass, as well. But, once the body loses all of the excess body fat, it will begin to put the lost lean muscle mass back on and weight will go up. This is why having adequate protein and staying away from long fasts, is so important. The body must rebuild itself again in order to be healthy.

It's during this "gaunt" stage, that people around you might start worrying, but they need to place all that worry on their own obesity instead of your weight loss. Also, a lot of people think gauntness is indicative of their own impending demise. News flash! - Pizza and donuts are not proper nutrition for the body. Just because these items make you fat, doesn't mean they are nutritious. It just means they are fattening. Fatness is not indicative of health. On the contrary. It's indicative of a metabolism that is not in balance and not healthy.

So, unless you have cancer, advanced HIV or some other malignant disease, the body will stop losing weight when it's ready to. No one dies of famine, while still eating.

2. If you are on a ketogenic diet, you can never have high blood glucose.

Yes you can. Whoever tells you, that it's impossible to have abnormal blood glucose on "keto" is either a liar or a bumbling fool. It's hard to tell which one is worse, since the damage they both cause is the same.

Ketogenic diets are not a magic "cure" for metabolic disease. Ketogenic diets and all diets only affect the glucose coming in, but most of the high glucose, that a metabolically ill person experiences, is glucose coming out. This means that their body is breaking itself down, and everything eaten, into glucose in an exaggerated and unregulated way. This is not halted exclusively through diet. This is halted over time with consistent blood glucose control so that insulin function improves. 

But, this is not the case for everyone. Some people are unable to properly regulate their blood glucose enough to normalize insulin function, regardless of their diet. This is caused by many other factors that have nothing to do with diet such as age, gender, chronic conditions, medications, and other stressors. Also caffeine intake is a big one. 

Insulin is very complex. It affects many organs and regulates many functions in the body. For people who are unable to achieve remission through diet alone, medications will be required, alongside a proper diet. This will help them take better control and halt the disease from becoming progressively worse.

3. A blood glucose of 80 mg/dl, after a meal, is hyperglycemia.

No. That's ridiculous. Two hours after eating, your blood glucose should return to fasting levels. A healthy fasting blood glucose level is around 84 mg/dL.

Since this issue has been brought up, I am going to go on a small tangent about blood glucose. Some people seem to be obsessed with their blood glucose and are having panic attacks when they see their blood glucose fluctuate a couple of points. This is probably do to the sensationalism displayed over blood glucose by the low carb community. They continue this hype around blood glucose, while ignoring their expanding waistlines. So, let me surgically remove this heap of BS, before it metastasizes.

There is no hard line number for blood glucose. A healthy range is around 84 mg/dL. We know this because this is the average range of blood glucose in healthy people. We also know that the average range of blood glucose in diabetics, is much higher. From this information, we make a calculated guess as to what healthy blood glucose should look like. That's really the only way we can determine what a healthy range might look like.

If blood glucose dips too far under that range, then it may be problematic. If blood glucose goes too far above that range, then it may be problematic. There are no certainties here. It all depends on just how far up or down you are going and how chronically it does this. We know how far up blood glucose can go to kill you, the same for how far down it can go, but normal is very subjective. That number is not so clear, as a person can still be healthy at any point within a certain range. The body is an imprecise machine, which does not use exact numbers. It can still be healthy under a wide range of factors.

What is known is that blood glucose rarely goes below 70 or above 100 mg/dl in healthy people. These people are able to keep their blood glucose, tightly regulated, around 84 mg/dL with no issues or effort. So, if your blood glucose is dipping below 70 mg/dL or rising above 100 mg/dL, then you have to monitor when and why this occurs, so you can have a better picture of what may be going on.

Type I diabetics can control their blood glucose very well, following carbohydrate restriction. They can keep it at a steady 84 mg/dl, because they don't have insulin resistance, of any organ or tissue, and they administer their own insulin.

But, people with metabolic disease have a very difficult time keeping their blood glucose steady or keeping it in the 80's mg/dl. Their blood glucose can rise to the 90's mg/dL and the low 100's mg/dL. This is because insulin resistance tends to create more blood glucose fluctuations and it's harder to keep it steady at one number. Don't panic. The goal is to continue working at keeping blood glucose steady. Period.

Stick to your diet. Continue your exercise. Relax with the blood glucose meter. If you aren't dosing insulin or eating donuts, you only need to check your blood glucose twice a day and your HbA1C every three to six months.

• Blood glucose should be taken first thing in the morning. This helps you know your adrenal glucose (stress response to low insulin) release status.
• Then it should be taken two hours after your largest meal. This helps you know your pancreatic glucose (glucagon response to high insulin) release status.

The end. No more. Those are the only two times you need to use your blood glucose meter, because they are the only two times that will give you all of the information you need to know. Do not keep pricking your fingers every hour, on the hour, to see how your blood glucose fluctuates a million ways, during the day. This will not help you find out a thing about your disease. It will only show you, what you already know - that you have a disease.

Control your blood glucose, don't obsess. Obsession is not control. Obsession is chaos under the disguise of control. That's not going to better your health.

4. The Standard American Diet (SAD) diet is high in carbohydrate.

The SAD diet is both a high carb and a high fat diet. The carbohydrate of choice is sugar and the fat is vegetable oils.

5. Chia seeds are very healthy and necessary.

Chia seeds, at best, are completely unnecessary. At worst, they can exacerbate digestive issues. Chia seeds are not proper human food. Feed seeds to birds and meat to humans.

6. Fasting allows the body to "rest". 

I hate to say that is silly, but there really is no other way to describe it. The body never rests. It only rests when it dies.

When you are fasting, the only thing that rests is your digestive system, since it's empty. Your esophagus, stomach and intestines are all muscles that can "rest" if they aren't pushing solid food around. But the body continues its metabolic process, since it has no choice. If it stops, you die.

The body still requires proteins, fats, glucose, oxygen, vitamins, minerals, etc. It must continue being metabolically active, to acquire all of these needs, so it shifts from an anabolic state (fed/storage) to a catabolic state (fasted/burning). Now it acquires everything it needs from itself. It basically breaks itself down for energy. The body doesn't like to do this and does so through the release of "stress hormones". So, catabolism (fasting) is not "resting". If anything, it's quite the opposite. It's a stressor.

Now just because the body is under stress does not necessarily mean it's an unhealthy state. Some stress is healthy. It's only when the stress becomes chronic or it's compounded on top of other stressors, that causes problems. This is especially true of people with metabolic diseases, as they do not have the metabolic flexibility to handle stressors very well. Most stressors for them are detrimental rather than hormetic.

That's why on this blog we focus on beneficial fasting and beneficial diets. We stay away from silly beliefs like this one, which are just lies.

Six common beliefs addressed, Part 41

1. Low carbohydrate diets will always lead to remission of metabolic disease.

This is false. Remission depends on many factors, not just diet alone. Diet is a very important component for success, but it's not a magic pill. Remissions depends on:

• Age - The older you are the less insulin sensitive your tissues naturally become, except for your fat mass.
• Hormonal Status - An adequate balance of hormones helps metabolic function, while erratic hormones do not -menopause/andropause/thyroid disease.
• Gender - Women accumulate and preserve body fat more strongly than men. They also have less muscle mass and muscle is a main driver of metabolism. On the other hand, men tend to accumulate and preserve more visceral fat, which also significantly impedes the rate of remission.
• Time - The longer you have had metabolic syndrome, the longer your metabolism has adapted to starvation and the harder it is to correct. Metabolic syndrome is a time dependent disease. It took decades to acquire it, so it cannot be fixed overnight.
• Obesity - The longer you have lived with obesity, the harder it is to treat metabolic syndrome, as your fat mass would be very large and unresponsive to treatments (poor leptin expression). Obesity is a time dependent condition. It took decades to pile on the pounds, so they cannot be lost overnight.
• Will - What you are willing to do about it. Some people refuse to give up certain foods, practices, habits or incorporate exercise. How much you're willing to change, in your life, is reflective of how much this disease concerns you. If it was truly important, then you would be willing to do whatever it takes, to address it. Complaints and whining produce 0 results for obesity. Following gurus around the internet, will not produce results either. 

2. Nothing resolves high postprandial blood glucose, so it should just be ignored.

Controlling hyperglucagonemia (high postprandial blood glucose) requires two things:

• Normalizing insulin levels/function, so that other hormones follow suit and the assault is seized. The normalization of insulin levels/function will allow it to regain its pulsatile function over time.
• Following a diet and fasting regimen that does not interfere with leptin function, as leptin is a huge regulator of glucagon and the starvation response. 

Both of these require:

• Strict and consistent adherence to a low carbohydrate diet. This means following a low carbohydrate protocol 24/7, 365 days a year, 366 on leap year.
• Avoidance of any starvation protocols. Starvation makes hyperglucagonemia worse, as it stimulates further glucose production through counter regulatory hormone activation (glucagon), in order to spare fat mass further. In this context, glucagon acts like an anti-starvation hormone.
• Dividing daily protein intake into 2 - 3 meals, rather than restricting it. Some people do fine consuming their daily protein in 2 meals, but others need further division. The more you eat in one meal, of any macronutrient, the larger the blood glucose disruption furthering more insulin demand on the body. The more insulin, the more glucagon. This is one of the reasons why 'One Meal A Day' (OMAD) protocols are not advised for the metabolically sick. They place too much glucagon demand, on the body, in one sitting.
• Eliminating any obesogenic habits, such as snacking between or after meals. This includes the drinking of any flavored beverages.

Though none of these tactics are a magic pill, they are completely worth a try, as they have allowed numerous people to control their postprandial blood glucose over time.

3. Will eating fat keep my postprandial blood glucose low.

Fasting for extended time periods and/or eating globs of fat, to not see your postprandial blood glucose rise, is not the proper way of addressing hyperglucagonemia.

• Extended fasting will only trigger more leptin dysfunction, increasing the effects of hyperglucagonemia with time.
• Fat is not food and because it's not food, it doesn't stimulate much insulin, after eating, hiding the effects of hyperglucagonemia. But, dietary fat will only increase your fasting insulin levels. This will not help balance other metabolic hormones. It will only make things worse because increased fasting insulin levels disrupts fasting blood glucose. 

The more fat you store, the fatter you will become and body fat places a high insulin demand on the body. You should be trying to lose body fat, by stabilizing blood glucose, not grow more of it.

4. The Dietary Guidelines were a sham to benefit Big Food and Big Pharma. 

My take, on this repetitive lore about The Dietary Guidelines, is very simple and goes as follows:

• Something was found,  studied and misunderstood. That something was the "fat" accumulation in the arteries of people with cardiovascular disease.
• The government decided to enact a public policy, around this finding, before it was fully understood.
• This public policy was influenced by a slew of social, political and economic factors, as is always the case with all government mandated public policy.
• Now that the finding is better understood, we realize the public policy surrounding it was an utter failure.
• Just like with everything that is controlled by the government, this policy will not be easily or quickly reversed, as there are now too many chefs in the kitchen getting paid for continuing to cook the status quo gruel.

Period. That's what occurred, in a nutshell. No need to watch yet another docudrama depicting it. There's nothing mysterious or conspiratorial about what happened. It's just plain old fashioned stupidity by placing the carriage before the horse, because it made good politics.

The nuances, of these events, are obviously lost to history, since Ancel Keys, and the many others who were a part of it, are no longer alive to explain the details or their side. The ones who remain, like the government, food companies and health agencies will rewrite history in their defense, as is the case of all humans when they are confronted with the consequences of doing something stupid. Others will make money off of claims they found a way of "correcting these terrible mistakes".

As for the people who pout and complain that they are now sick, because they were "given the wrong information", I'm not buying it. Yes, the wrong information was given, but none of that information recommended the eating of chocolate cake and cookies, ad libitum. The information given had actual portion and calorie recommendations instead, but they were not followed.

Join any low carb group and you will see the sob stories of people "falling off the wagon" constantly, even when given the right information. These people "fell of the wagon" following The Dietary Guidelines and they will continue falling off it following low carb. So, no The Dietary Guidelines are not 100% to blame for failing.

What occurred with the dietary guidelines, is the same thing that is occurring in low carb right now:

• Recommendation: Carbohydrate restriction.
• Application: People don't follow it, so "low carb ice cream" and "keto cheesecake" are created to entice them.
• Result: Utter failure.

We know that people refuse to stick to dietary recommendations, unless those recommendations offer some kind of "free food". Of course, broccoli doesn't count. This is why so many gravitate to these fad "low carb" and "keto" diet versions, which make them precisely that promise with fat. Be careful of who promises you the world, as they usually never deliver.

5. The carbohydrate-insulin hypothesis completely explains insulin resistance. 

On this blog we follow the insulin hypothesis (IH), though we understand it is incomplete. We do not follow the carbohydrate-insulin hypothesis (CIH). CIH has been pretty much debunked, as carbohydrates aren't the only thing that can cause hyperinsulinemia because many things, besides carbs, can effect blood glucose. We do know that insulin has a primary involvement in the development of metabolic disease, but the exact mechanism of how this occurs is not fully understood, though research seems to point to blood glucose dysregulation. This is why IH is considered incomplete. But, even though IH is incomplete, it offers a much more complete treatment than CIH alone.

CIH can easily be dismissed, because there are multiple hunter/gatherer tribes and agrarian societies, which consume about 80% of their calories as carbohydrates. Neither of these groups have manifested metabolic dysfunction, while consuming their original diets. Now, we all know that both of these groups have one other thing in common, besides carbohydrate, and that's they "subsist". This means they live in a constant state of caloric deprivation. This chronic caloric restriction is not harmful to their metabolism, as they have never experienced obesity in the past, nor will they in the future, and many do not live long enough for it to matter.

Both of these often cited examples might make your eyes roll, as they do mine, since they do not pertain to the realities of Western societies in any way. But, they do show that carbohydrates, in of themselves, are not hyperinsulinemic alone, since these people's high carbohydrate intake is not enough to cause it. It actually shows that certain carbohydrates can be benign, but only in the context of starvation. Sugar is the only carbohydrate that is obesogenic irrespective of starvation levels, but hunter/gatherers do not use sugar. 

This occurs because starvation always has an effect on blood glucose, which does not appear to be pathological when metabolism is still healthy. Blood glucose always effects insulin expression/function. This allows the body the ability to continue burning body fat, even with glucose as a primary fuel, since there is no effect on blood glucose regulation, to halt fat burning. In simple terms - the metabolisms of hunter/gatherers do not have a chronic adaptation to starvation. They are healthy. 

What is even more important to consider is that other things, besides excess carbohydrates, have also been implicated in abnormal insulin expression/function. Dietary fat, for example, has been shown to produce metabolic abnormalities, especially when this fat comes in the form of vegetable oils. Dietary fat combined with carbohydrate produces the same effect. Sedentary lifestyles are implicated in metabolic dysfunction as well. Having high body fat, in general, perpetuates further insulin abnormalities due to the high insulin demand required to retain fat in storage.

So, the idea that carbohydrates are the only factor that affects insulin and eventually leads to metabolic disease has not been shown to pan out. For this reason, carbohydrate restriction alone, has not been shown to be "the cure". Remission can be acquired from any method that results in better blood glucose control which in turn normalizes insulin expression/function. Several interventions can accomplish this.

6. Some people eat whatever they want and live a long life without becoming overweight or diabetic. 

Because some people are able to retain and sustain proper blood glucose regulation long term irrespective of lifestyle factors. I have explained in other posts how this is mostly determined by genetics. 

Six common beliefs addressed, Part 40

1. Are there any treatments for obesogenic behaviors?

Common obesogenic behaviors are disordered eating and obesogenic eating habits. They are very difficult to treat, but treatments still exist.

Disordered eating should be addressed with caloric restriction in order to take control of the excessive eating. There really is no other way to stop these people from eating themselves to obesity, as hyperphagia is oftentimes, a symptom of obesity. No diet can help with this, because no matter what diet is implemented, the excessive eating follows. These people have absolutely no satiety signaling, whatsoever. They also have no ability to gauge what a normal meal looks like.

Many people dismiss caloric restriction as not having any part to play in obesity treatment. On the other hand, some people believe that it is the only thing that matters. Both stances are BS. Caloric restriction absolutely has a part to play for controlling weight, in some people, but it should never be used as a primary intervention and/or the only intervention, especially in obesity. It really should be recommended on a case by case basis, as it will be required for some and not for others. This is why the "one size fits all diet" strategy does not work. Obesity is very individualized. There is no one cause for it. Many things can contribute to excess body fat.

Caloric restriction has also been followed incorrectly, especially in obesity. This has caused it to be, not only an epic fail, but an intervention that can make matters worse, not better. When we think of caloric restriction, we automatically think of a "sustained caloric deficit", but that is starvation to the body. Starvation protocols sabotage weight loss, as they make obesity intractable, because of their effect on leptin. Caloric restriction should only be used to prevent excess, not sustain a deficit, as the body will never accept a sustained deficit. This is why caloric restriction is best applied to correct behavioral issues, rather than to obesity as a whole. Calorically restricted diets should also be primarily carbohydrate restricted, as that is truly what causes the fat loss, through more stable blood glucose, once the excess has been controlled.

Obesogenic practices, on the other hand, might not require caloric restriction, but re-education instead. Many of these people are unaware that their practices are contributing to their obesity. They might ask for advice, but the advice given does not specifically let them know what they are doing wrong, as many recommendations are vague or just plain wrong.

Snacking, carb counting, eating while fasting, choosing foods that continue to disrupt blood glucose and continuing to believe low carb myths surrounding protein and insulin are some examples of obesogenic practices that can be corrected with the proper information.

2. Waiting before eating breakfast is the only way to address high morning blood glucose. 

High blood glucose, in the morning, is known as Dawn Phenomenon (DP) and it's caused by an overexpression of the adrenal response (stress hormones) to lowering blood glucose during the over night fast. This is the result of insulin dysfunction from prolonged release/overexpression.

People often mitigate this symptom by either waiting a few hours for blood glucose to lower, before eating, or eating something in order to raise insulin and lower the stress response. Either method can help you mitigate DP and the one you choose, depends on what is most sustainable for you. Some people like to eat breakfast and some don't. Eating or waiting, will both result in lower blood glucose.

But, the goal is to correct DP, not mitigate it. So, whichever one of these two methods you choose, for controlling morning blood glucose, you must continue monitoring your DP, to see if it is getting better with time. DP is usually a long lasting symptom, which takes time to improve, but should never display a worsening trend.

If your diet and exercise regimen is truly addressing insulin resistance, then DP should begin to correct itself, over time, and you will see lower and lower morning blood glucose. If this doesn't occur, then your protocol is not working and you will have to make changes.

3. If a protocol is being followed correctly, it will improve metabolic syndrome.

Some people have been on a legitimate protocol, which they have followed consistently, for a long time, and have still not seen much improvement to their metabolic condition. This is because, unlike what low carb advocates are trying to sell you, the truth is that diet is only palliative. It helps you control symptoms so that you can start treating the root cause and doesn't further exacerbate the condition.

When you have exhausted dietary interventions, then you have to work alongside your healthcare provider for the integration of conventional medicine alongside your dietary protocol. Do not ignore your metabolic abnormalities, as they will only worsen with time and result in complications. The combination of lifestyle and medications is often necessary, especially for people who have progressed so far, into their condition, that they can no longer acquire pancreatic beta cell response to dietary based treatments. Other people have conditions, which further aggravate metabolic dysfunction like kidney, liver, thyroid and/or cardiovascular diseases.

Believing that all conditions/diseases can be stomped out by a "good diet", is a dangerous precedent to follow and is basically quackery. Following a diet, without obtaining results is futile. It will only leave you wondering why you have the bad luck of doing all the right things, yet experience no progress. This can quickly turn into hopelessness and the abandonment of any treatment. Metabolic conditions will progress if they are not treated.

4. Fasting will always lower blood glucose.

Many people fast and see a rise in blood glucose, not a lowering. High blood glucose, caused by fasting, is called "Dawn Phenomenon" (DP). DP does not just occur in the mornings, though the word "dawn" makes it appear as though it's related to the time of day. Instead, it is best described as "Fasting Phenomenon", since it's basically an adverse reaction to fasting. Mornings are just the most common time it's experienced, as it's a result of the night time fast.

DP is caused by an overexpression of counter regulatory hormones in order to keep blood glucose from dropping too low. As this condition worsens it prevents blood glucose from dropping at all. DP is triggered by abnormalities in blood glucose regulation, which affect insulin function over time. Prolonged insulin release and overexpression, interferes with fasting blood glucose, lowing it too rapidly or too much. The body starts counteracting this by creating a high blood glucose set point. This is when the body actively fights against any drop in blood glucose, even if its to normal levels. DP is experienced differently between individuals, but it eventually leads to diabetes. Diabetes is when metabolism sustains and preserves a high blood glucose, insulin and body fat set point.

Some people will experience very high blood glucose, from a short overnight fast, but their blood glucose will begin to lower if the fast continues. Others see their blood glucose continue to rise, the longer the fast goes on. For some, blood glucose lowers once they eat, but for others, eating only causes blood glucose to go even higher. This is because glucagon is also a counter regulatory hormone, which is stimulated by the presence of insulin, as a result of food intake. So, now you basically gave the body a double whammy - DP caused by the absence of insulin and hyperglucagonemia caused by its presence. This reveals an unnatural metabolic response, by the body, where both of these counter regulatory states are mismatched and do not respond properly to fluctuating insulin levels.

This is why it's important to listen to your body, gauge its reaction to certain protocols and act accordingly. If fasting is causing your blood glucose to rise, stop fasting. Shorten your fasts until they produce benefits, not detriments.

5. Metabolic syndrome/diabetes is caused by fat accumulation in the muscles. 

No. Metabolic syndrome/diabetes are conditions caused by improper blood glucose regulation. Everything else occurs downstream from this including fat accumulation in the muscles. 

People with metabolic syndrome/diabetes have abnormal fat accumulation in musculoskeletal tissue and organs. This is because they are insulin resistant and insulin resistance causes dyslipidemia, lower muscle glycogen synthesis and a slew of other abnormalities. None of these are the cause of metabolic syndrome/diabetes. They are just many of the abnormalities that these conditions produce. It's not smart to focus on any one effect of insulin resistance, as its effects are many and you end up missing the forest for the trees. This is why lifestyle intervention treatments are the most efficacious.

This muscle fat accumulation phenomenon likes making its rounds on the internet, especially in vegan circles. This is because vegans like to associate this excess fat accumulation to dietary fat, but in Western societies, this fat accumulation is actually coming from excess dietary carbohydrate instead. Yes, the body turns dietary carbohydrates into fat, when blood glucose homeostasis is chronically disrupted. 

6. If you are eating low carbohydrate, your blood glucose will never go up, because high blood glucose is only caused by diet.

If you have high blood glucose and it's not coming from the outside, then it can only be coming from the inside. If this high blood glucose occurs while fasting, then it's being caused by an over expression of adrenal counter regulation (stress hormones). If it's caused after eating, then it's hyperglucagonemia.

Hyperglucagonemia is not the same as normal gluconeogenesis, which is a tightly regulated, demand driven process. This is more like "gluconeogenesis gone wild" and that’s why it’s referred to as hyperglucagonemia, not gluconeogenesis. It irks me every time low carb advocates mix these two up. Gluconeogenesis is normal, hyperglucagonemia is not.

In hyperglucagonemia, glucagon is breaking down your body and everything you eat into glucose and ketones, causing for your blood glucose to remain high, even while following low carb. This basically means that glucagon is no longer responding to insulin and cannot be controlled by it.

This does not occur to everyone. Some people are able to eat bacon and eggs and obtain, and maintain, normal blood glucose, but others cannot. Others will eat bacon and eggs and turn it all into glucose from this exaggerated and unmitigated glucagon response to the presence of insulin. This is caused by insulin resistance of multiple tissues and exacerbated by high body fat. I have written before, that glucagon producing cells are present in other tissues, besides the pancreas, and if those tissues remain insulin resistant, then you will continue having the same problem.

Hyperglucagonemia is a very complicated metabolic state and difficult to treat. The body is slowly losing its ability to stop catabolism as more and more tissues become insulin resistant. Glucagon is responsive to the proper pulsatile function of postprandial (bolus) insulin, rather than by its fasting levels (basal). So, lowering fasting insulin levels does not automatically correct this problem. Proper pulsatile insulin function can only be obtained when you are no longer insulin resistant in any tissue of the body. In other words, when you achieve metabolic homeostasis and your neuroendocrine system responds properly to insulin. This is a very long process, as different tissues gain and lose insulin sensitivity at different rates.

Six common beliefs addressed, Part 38

1. High morning blood glucose is not as bad as high blood glucose after meals.

Any disruption to blood glucose homeostasis will perpetuate the progression of the condition, so high morning blood glucose effects metabolism the same as high postprandial blood glucose. 

High morning blood glucose is indicative of excessive adrenal counter regulation to any lowering of blood glucose overnight. In other words, improper blood glucose regulation, related specifically to the interaction between stress hormones and lowering blood glucose. This process will never allow blood glucose to lower to normal. In essence - diabetes.

2. People with metabolic syndrome/diabetes can have carbohydrate if they fast long enough.

People with metabolic syndrome/diabetes need to avoid anything that further disrupts their blood glucose so they can increase their chances of achieving proper blood glucose regulation over time. Consuming carbohydrates disrupts blood glucose. Fasting for extended periods, disrupts blood glucose. So both of these practices will only further disrupt blood glucose and progress the condition. 

3. Do all obese people have high insulin levels?

The Insulin Hypothesis (IH) is incomplete, so it only tells us part of the story of metabolic dysfunction. It begins the story downstream from the actual initial trigger, which is chronic disruption in blood glucose regulation.

High insulin levels are not perfectly correlated with obesity. There are about 15% of obese people who don't have elevated insulin levels. This is most likely due to beta cell mass loss and/or dysfunction, alongside other abnormalities in insulin/fat mass function. A 'C-Peptide Test' is recommended, for these people, in order to see if they are still producing their own insulin and what function it still has.

Obesity is a condition between the complex interplay of blood glucose and hormones, not just one hormone, but many. The person who is experiencing active obesity, can become obese at low to normal levels of insulin, because of other hormonal abnormalities and the dysfunction of insulin expression in various tissues.

4. I follow "macro" recommendations and still cannot lose weight.

A lot of people are calling certain practices "following macros", when they really aren't.

Macronutrient recommendations, often referred to as simply "macros", are hardline numbers, which are followed for the tracking of daily macronutrient intake from every meal. These personalized recommendations are usually derived from an online calculator or through a dietitian/coach/program. Your goals, weight, gender, activity level and body fat percentage are all factored into the results. Sometimes, other factors like calories, are also included.

Tracking macros sometimes requires the need to weigh or measure food intake. You also need to know what the macronutrients are, within the food you eat, not the entire portion of food itself, since you aren't tracking portions, you are tracking macronutrients. For example, you need to know how much fat and/or protein, your chosen cut of meat has, not how much total meat you have.

Knowing your daily macronutrients in percentages, eyeballing your plate, simply being "low carb or "keto" and/or guessing, ARE NOT tracking of macros. You are also not following macros by simply repeating your favorite guru's mantra of "eating enough fat", "getting adequate protein" or "restricting carbs". There has to be numbers associated with those statements and every guru has their own recommendations as to what those are. That's why you have to follow one protocol and stick to it, rather than 20 different mixed approaches. Remember, tracking of macros is based on hardline numbers and requires knowledge of your chosen foods composition.

The only problem with "following macros" is that there is one metric which is left out of the equation and it's one that every person with metabolic dysfunction needs to know - their blood glucose control. In other words, the macros which are recommended for you, do not take into account how they may affect your blood glucose. So a person with metabolic dysfunction, should not only calculate their macros, but they need to monitor how these macros are affecting their blood glucose by using a blood glucose meter and checking their 2 hour postprandial readings. 

You will not accomplish anything by "eating to your macros" and ignoring your blood glucose. 

5. It doesn't matter what food your daily carbohydrate allotment comes from, even if it's sugar.

False. Not for the person with metabolic syndrome/diabetes.

Twenty grams of carbs from sugar and 20 grams of carbs from vegetables is only the same as far as energy goes, but energy intake is not the main cause of metabolic dysfunction and cannot be addressed by counting carbs or calories. Energy intake simply effects small up and down variations in total weight. Energy partitioning is the main cause of metabolic abnormalities, so we approach metabolic interventions, on this blog, from the perspective of their effect to blood glucose not Pepsi Co's perspective, as that hasn't worked.

As far as energy intake is concerned, 20 grams of carbs is 20 grams of carbs, regardless of where it comes from. This simplistic metric can be used if you are a calorimeter or need to lose vanity weight or make the team, while being otherwise healthy, but it doesn’t work for obesity or metabolic dysfunction. If it did work, there would be no reason to continue researching obesity and we would all be thin eating Snack Wells at a caloric deficit.

The processing and compartmentalization of macronutrients is detrimental for the obese. This is because there fat mass responds, in an exaggerated way, to any obesogenic stimuli and sugar is obesogenic. It disrupts blood glucose profoundly and for a prolonged period of time. Sugar only grows fat mass and the obese do not need anything stimulating their, already insulin sensitive, fat mass to continue growing. For this reason, your 20 grams of carbs needs to come from whole carbohydrates, not as added sugar.

6. I stalled 20 lbs. from my goal. I am having a weight plateau.

The people giving plateau advice, never ask the most important question of all: "How do you know you are experiencing a plateau?" Like I have said before, being 5 - 20 lbs. from your "goal weight" is not a true plateau.

Though the mechanisms for any plateau are basically the same, a down regulation of leptin expression, they differ in one very important key aspect - having to lose 5 - 20 lbs. is not pathological or detrimental to metabolism, nor is it obesity. It's vanity weight, plain and simple. We do not deal with vanity weight loss, on this blog, as vanity weight has nothing to do with obesity nor is it treated in the same way.