Six common beliefs addressed, Part 265

1. I started "keto" a few years ago. The consumption of saturated fat caused my LDL cholesterol to sky rocket so I took your advice and replaced all of the saturated fat from my diet with monounsaturated fats. My cholesterol dropped but for some reason, it has never lowered to what it was when I was consuming "vegetable oils". I don't understand this. Why would avocado and olive oils keep my cholesterol more elevated than corn or canola?

This is a very interesting question and I can relate to it as it has happened to me. For people who have genetic lipid profiles that are sensitive to diet, like myself, cholesterol can sky rocket when we consume saturated fats, particularly coconut oil.

When I started "keto" many years ago, my naturally high cholesterol of 210 rose to 650. I dropped the saturated fat from my diet and replaced it with monounsaturated fats and my cholesterol lowered but only to 320. After some years of only consuming monounsaturated fats, my cholesterol continues to consistently be in the 300+ range and never lowered to the 200+ range it was before when I was obese and consuming seed oils. What's going on?

Well, good luck finding the answer. No one will tell you as lipids are very complex and behave differently in everyone. Not only that, surprisingly so, we don't know much about lipids and their function. They are still quite mysterious. For this reason, the layman's usual answer is that it has to do with your HDL. A rise in HDL causes a rise in your total cholesterol and HDL levels rise dramatically with the intake of saturated fats. HDL also lowers significantly when saturated fats are restricted. But, the issue we are having is not totally explained by this phenomenon as it is not just total cholesterol that is being affected, we are talking specifically about LDL. Why doesn't LDL lower as much with avocado and olive oil, is it would with corn and canola? 

I think I can give you an answer because your doctor won't give you a thing. Well except a statin, which you may or may not need. Now, I am not a doctor or lipidologist but I still kind of have a possible answer that explains this conundrum.

Many years ago, when I did extensive research on cholesterol, by going through many lipidology papers, I came across an interesting tidbit of information. Don't hold me as to what this paper was titled or who wrote it since, like I mentioned, this was years ago. I just know the information in it stood out because I found it quite fascinating and later on, saw the effects in myself. The lipidologist who wrote this paper stated that seed oils, didn't just keep your cholesterol from rising, they actively lowered it. How though? Well, he explained it was through smoke and mirrors. Basically, it's an issue with how LDL is measured in a lab.

Seed oils simply contribute to the oxidation of LDL and lipid panels do not measure oxidized LDL unless you do an actual oxidized LDL test. This means that this "lowering of cholesterol" is simply all of the oxidized LDL the test did not measure. Oxidized LDL is not good. The more LDL you produce, the more chances of it becoming oxidized so you want to prevent oxidative stress to your lipids by not smoking, not consuming "vegetable oils" and taking vitamin E. Vitamin E is a powerful lipid anti-oxidant and when taken in high doses, it has been shown to actually prevent heart disease. Nothing else has. This is why it's so surprising to me that cardiologists do not prescribe vitamin E to their cardiac patients and/or people at risk.

What does this all mean, though? It means that my cholesterol of 210 was never truly 210. It was always 320, it's just that the difference was oxidized and I had much lower HDL. That's a pretty large percentage of oxidized LDL. This was a ground breaking paper that of course, is never mentioned, but it shows how you can have very low cholesterol and still drop dead of a heart attack because most of it is oxidized LDL and poor levels of HDL.

So, your cholesterol will never be as low as it would be on canola oil but it doesn't matter because it is healthier than it would be on canola oil. The amount of cholesterol is not what matters. It's the health of your cholesterol that ultimately decides your fate.

2. A "keto" group I belong to says that if a person's insulin is 5.6 they don't need Metformin any more because they are cured of diabetes as long as they eat "keto". Is this true?

Insulin levels are not a marker of diabetes. Insulin function (insulin resistance) is and this does not always correlate to serum levels of insulin. Oftentimes, insulin will become high (hyperinsulinemia) due to this resistance but this is not always the case in all individuals. There are many diabetics with normal to low insulin levels but they still have resistance. I don't know what group is spreading this asinine information, but you need to stop going to it.

As far as Metformin is concerned, it is not prescribed for hyperinsulinemia. It is prescribed for the management of diabetes. Only your doctor can decide if you no longer need to be on Metformin but usually Metformin is the medication that is last to go, or never removed, as there is no known cure for diabetes. You can only manage the disease. If you are able to get off every medication and only stay on Metformin, that's still a win even if you aren't "cured" of diabetes. The better you can manage diabetes, the better your outcome because you delay or eliminate the onset of its pathologies.

3. I am vitamin B12 deficient and have been getting supplement shots but when I was recently tested it showed that my B12 serum levels were still on the low end and my intercellular B12 was non-existent. Basically I am still deficient even after months of getting shots. What's happening?

I am not a nutritionist nor a dietitian so you need to speak to a professional in order to get proper answers for your individual issues but I can throw in my two cents anyway so you have something further to discuss with your healthcare provider.

First, I am happy to see you are testing intercellularly. I am sure you are paying out of pocket for that test since it's usually not covered by insurance but it's truly the only way to know if your supplementation is getting into the cells where it's needed. You don't need B12 in your serum, you need it in the cell. Unfortunately, some labs are no longer even offering this type of test.

Second, B12 requires adequate amounts of vitamin B6. Without B6, B12 does not go into the cells. So if you are deficient in B12, you are probably deficient in B6 since usually being deficient in one B vitamin, means you are deficient in them all. You need to take 200 - 800 MG of vitamin B6 a day. Keep in mind there are two forms of vitamin B6. Pyridoxine HCL, which is the most commonly used version in over the counter vitamins, can become toxic as it accumulates in the body. This can cause issues over time so you want to take pyridoxal-5-phosphate which is safe to supplement with because it does not accumulate, even at very high doses.

Third, I hate to break this to you but the B12 shot your insurance pays for is not the bioavailable form of B12. The shot version is cyanocobalamin, a plant based B12. You only absorb a minuscule amount because it is not the animal based B12 we require which the body identifies. The best B12 supplementation is methylcobalamin, hydroxocobalamin or adenosylcobalamin in sublingual form. You should take 5k - 10k mcg a day or whatever your doctor recommends. You can get this form of B12 as a shot as well but it only comes in multi-use vials which cannot be used at the pharmacy or any other place that injects you. You would have to learn to inject yourself or have a private nurse inject you.

"Gina, how and why do you know all this crap?" Well, because I have high myopia and have been supplementing with B12 for a long time since the nerve in my eyes are abnormal and put me at risk for glaucoma. Also, JC has celiac disease and has to supplement with B12 as he has a deficiency. For this reason, we have had to do extensive research on this particular vitamin to ensure we are supplementing correctly. It is vitally important that if you are deficient in vitamin B12, that you supplement correctly because not addressing this deficiency can cause irreparable damage to your health.

4. My husband has been diagnosed with Type II diabetes. He had been feeling unwell for a very long time and then suddenly went blind for five minutes. He went to the ER and his blood glucose was 700+ mg/dL. His kidneys and liver had started to fail. He recovered and is now on insulin and has to check his blood glucose daily. My husband is not overweight or obese. We are still relatively young, in our 40's. He believes a healthy diet is low in meat and calorie restricted. We are Mexican so he is missing his traditional meat-based meals and complains often. His approach to his illness is to eat a doughnut if his blood glucose is "good". I don't know what to do.

I am sorry to say that their isn't much you can do but try to educate him on what diabetes is, its causes and its management. He either takes that information seriously, and implements it, or he doesn't.

A lot of what is occurring here has to do with simply misunderstanding the condition. This is not uncommon. Most diabetics are unable to make the lifestyle changes they require because they simply don't fully understand what's happening to them. They are either getting wrong or incomplete information from dietitians, nutritionists, their doctors and even the media. They are not asking the right questions nor seeking approaches outside of the Standard of Care.

Your husband's approach to his condition is pretty much the norm. I have seen many diabetics who check their blood glucose, see it's not as high as usual, so they reward themselves with a brownie. This myopic view of giving so much credence to isolated blood glucose readings is detrimental for the diabetic. The low carb people do something similar with their obsession over postprandial blood glucose readings. They also try to manage their diabetes with individual food items. That is not going to work.

Diabetes is not a disease of any single blood glucose reading or what food made that single reading go up or down. It is a condition of overall blood glucose regulation which includes what happens when you aren't eating. It is also not a disease of high blood glucose. Blood glucose lows are just as bad as the highs, if not worse, since it's the lows that set the stage for the condition.

You can give your husband the link to my blog so he does a little research and gets better information. This will help him make better decisions. There should be no reason he has to give up any meat-based Mexican recipes that he is used to. What he decides to do depends on how seriously he is taking his condition and how invested he is in trying to manage it. It also depends on how open he is to approaching his situation in a non-conventional way.

5. Why does caffeine in diet drinks help weight loss but is complicit in fat gain? How can it work both ways?

Because it depends on the metabolic state of who is taking it. Remember, fat gain or loss is completely at the mercy of your neuroendocrine state.

Caffeine is a stimulant that has long been used in diet products to increase metabolic rate before Fen-Phen was a thing. Many people have found benefits in it particularly if they just need to lose a few pounds. Our threshold for what is deemed overweight/obesity has certainly changed through the years. Seemingly slim women were binging on caffeine diet products in the 80s. Those same women are most likely obese today.

Chronic, long term use of caffeine always ends up in metabolic problems. You cannot regulate blood glucose properly as long as you're intaking caffeine. I have said before that you would be surprised to know how many diabetics caffeine has made, yet it always falls under the radar and people keep consuming it. Once you crossover to metabolic syndrome, caffeine becomes even more detrimental. Stimulants further interfere with the already failing blood glucose regulation of people with metabolic syndrome. This only sets the stage for further fat storage and sparing.

For this reason, we do not recommend any caffeine intake, from any source. You should be on a zero caffeine diet. Caffeine should be treated the same as sugar because they both have the same effect on your metabolism, so eliminating one and not the other will not work.

6. I have a cousin who has diabetes insipidus. Will going low carb reverse it? People in low carb groups seem to believe so.

Diabetes insipidus and diabetes mellitus (Type II diabetes) are two distinct conditions with different causes and treatments. They share the name “diabetes” because they both cause increased thirst and frequent urination but they are not related.

Diabetes insipidus is caused by problems with a hormone called vasopressin, which is the anti diuretic hormone that plays a key role in regulating the amount of fluid in the body. Disease or damage to the pituitary gland or hypothalamus, where this hormone is produced, can cause this condition. It can also be the result of heredity. This is a very rare condition but can be life threatening if not managed properly.

Your cousin needs to consult their doctor about any diet changes, particularly before going low carb since insulin is an anti diuretic and lowering it can result in the release of water from the body. This can result in complications if you have diabetes insipidus. This diuretic effect of lowering insulin can also interfere with any medications that your cousin is taking to manage this condition.

Diabetes insipidus cannot be "reversed" and has no known "cure" so be careful with whatever they are telling you in low carb groups. They might be confusing "diabetes in situ" or "occult diabetes" with diabetes insipidus. Diabetes in situ is simply a term coined by Dr. Joseph Kraft to describe the changes in insulin expression, he witnessed in his research, years before the onset of diabetes mellitus. These low carb groups are not very well versed in diabetes and often spew out misinformation about the condition. They are usually run by volunteers who have 0 knowledge of what they are talking about and they don't even do the research themselves to offer better help. Remember, anyone can open a Facebook group or page about any topic they want.

Six common beliefs addressed, Part 242

1. What are some reasons that the body would produce so much of its own glucose?

The body produces glucose for many different reasons. It uses a series of feedback loops in order to retrieve information on when and how much glucose to produce. In the context of metabolic syndrome/diabetes this process is always over and under expressed. This means too much glucose is produced when not needed and too little is produced when needed. This makes sense as all of the metabolic hormones that control blood glucose are functioning poorly, and the feedback loops are broken.

In metabolic syndrome/diabetes the biggest influences for unregulated blood glucose production are:

• To counteract insulin. High insulin, low insulin, poorly functioning insulin all contribute to excess or not enough glucose production.
• To counteract the inability to burn fat for energy. It is very difficult to burn fat for fuel when leptin is not working properly, and this causes for more short-term energy (glucose) to be released into the blood stream instead. This is typically why overweight/obese people have a hard time "keeping their energy up" regardless of how much short-term energy they produce.
• To counteract starvation. Metabolic syndrome and all of its pathologies from overweight/obesity to diabetes are adaptations to starvation. The best way to stop starvation is to release enormous amounts of blood glucose into the bloodstream, not only for fuel but to increase fat mass at the expense of muscle mass.

Other things also influence and contribute to this glucose production like certain common deficiencies seen in people with metabolic problems and imbalances in electrolytes which is also common in metabolic conditions.

2. Should I hire a "low carb/fasting coach"?

There is no such thing. Low carb is simply keeping your carb intake to less than 100 grams per day and fasting simply means not eating anything. You don't need a "coach" to do that. You would need a coach to help you exercise but not to keep you from eating carbs or food.

Now you can go ahead and hire one if you want but you should do so knowing that you are wasting your money. You're basically giving away money to have someone hold your hand through something you should be doing all on your own by determination, will and need alone. The minute someone tells me they need a "coach" to follow a simple diet, I become leery in believing they are serious about anything.

3. I drink a lot of bubbly water. I buy the kind that has zero of everything. Zero sweeteners, calories and caffeine. I'm sure you are familiar with them as they have sprung up everywhere and are very popular with low carb/"keto" dieting. Anyway, I was wondering if their taste has anything to do with my recent weight gain but even more strangely, my recent high blood glucose.

I have discussed before that constantly tasting anything, especially things on the sweet side, will further disrupt your already damaged hypothalamic/pituitary/adrenal axis (HPA). I have also discussed how carbonated drinks effect ghrelin, the hunger hormone. Any of these two effects, on their own, can contribute to weight gain and it's why all of these "zero of everything" drinks haven't done a thing to curb obesity. They have had zero success, aside from zero of everything else. This is why the only thing you should be drinking is water.

But in your case, you aren't only experiencing weight gain but also a rise in blood glucose to boot, which takes us now into an entirely different direction.

CO2, the stuff that makes these waters "bubbly", is acidic. High acidity lowers potassium. Low potassium makes less insulin. Less insulin increases blood glucose. Increased blood glucose contributes to obesity. Imbalances in electrolytes always cause stress in the body and stress always makes more glucose. These waters not only have zero sweeteners, calories, caffeine and success but they also have zero electrolytes, unless it's Perrier which contains some minerals.

Stop drinking like you are at an endless birthday party. Bubbly, fizzy, carbonated, whatever you want to call it, drinks are party novelties. Drink what you were intended to drink in nature - plain water.

4. My blood glucose is fine when I wake up but then it starts rising as time passes. Is this "Dawn Phenomenon" (DP) and how do I stop it?

High blood glucose upon waking is DP which is basically an adverse reaction to the overnight fast. Rising blood glucose later is caused by a secondary spike in cortisol, which is dysregulated in people with metabolic syndrome/diabetes.

You can go out for a walk to lower your blood glucose but the main thing that will prevent this from happening is eating breakfast. Eating when you wake up helps that second cortisol spike to be much lower.

If you're on medications like insulin, you should speak with your doctor as they can adjust it for you to better control this as well.

5. Why does the American Diabetes Association (ADA) target an HbA1C of 7 for diabetics? Isn't that too high?

I've spoken about this before, but I'll quickly recap here.

This has to do with blood glucose lowering medications, which include insulin. Insulin dependent diabetics are extremely susceptible to deadly hypoglycemia. For this reason, it is recommended that their blood glucose remains higher than it would be if they were healthy, so that if their medications cause a blood glucose drop, it won't drop to deadly levels. A drop from an average blood glucose of 170 mg/dl is much safer than a drop from a blood glucose of 85 mg/dl.

So, the goal for this stage of diabetes is to try to keep blood glucose lower (not necessarily normal or low) and stable, which is more important than just "low". Remember diabetes is not a disease of high blood glucose. There are genetic abnormalities that cause for certain people to sustain higher than normal blood glucose and they have none of the complications that diabetics develop over time.

Diabetes is a multifactorial syndrome of which insulin resistance is at the core. Insulin resistance abnormalizes the function of multiple glucoregulatory/metabolic systems which end in the pathologies associated with diabetes and its ultimate morbidity. High blood glucose is only one of those pathologies. It's not the end all/be all. This is why diabetes is still a chronic and progressive condition, even with well controlled low blood glucose and at an HbA1C much lower than 7. The "disease" continues onward.

I really get a kick of low carb advocates who are so focused on blood glucose that they miss the forest for the trees and are always hung up over the ADA. I have said before how the ADA, despite its misgivings, knows way more about the mechanism of diabetes than these low carb people do. These low carb advocates only see one thing - high blood glucose from diet. Well, that's only a very myopic viewpoint of what this complicated syndrome really is. It's not the high blood glucose, it's the blood glucose roller coaster of ups and downs, with large disparities between the two, that is the root of the condition. 

6. Is it true that a diabetic can stop their use of insulin if they follow low carb?

It has been shown that about 50% of diabetics can reduce or completely eliminate their need for exogenous insulin if they follow a low carb diet. This shouldn't be surprising as going low carb eliminates a significant load of exogenous glucose from the blood stream depending on how many carbs, and from what sources, are being consumed. So, the highest carb consumers will see the most benefits from going low carb.

But the reality is that once you get to that level of carb consumption, any change in the diet which lowers carbs, including reduction of overall calories, would make an impact on insulin requirements. This is because most of the insulin these people are taking is to control exogenous glucose from their dietary choices.

When you're diabetic at any stage, you already have an excess amount of glucose being produced by your own body, so you certainly don't need more exogenous glucose adding to it. This is why low cab would be the way to go. But the real magic in low carb is the halting of erratic large disparities in blood glucose that occur from the high postprandial blood glucose carbs cause and then the ensuing chronic release of insulin which drives fasting blood glucose to drop too low. That's the engine that drives the metabolic adaptation known as metabolic syndrome/diabetes and results in insulin resistance.

In that sense low carb is powerful indeed but having said that, you have to remember that any diet is only palliative for diabetes. Diet works really well at the beginning stages of the condition and then not so much. This is because the middle and end stages are being driven by other factors which aren't diet specific.

Reducing or eliminating the need for insulin does not mean you aren't diabetic. There are many diabetics who do not require insulin. In fact, most don't. As you can see, once they put you on insulin, you are pretty far along into the "disease" and low carb will only get you so far.

Six common beliefs addressed, Part 238

1. Even mild exercise causes for my blood glucose to rise very high. I am trying to incorporate exercise into my routine because I know I need it for metabolic health but even on insulin, I can't seem to control my blood glucose when I do.

You are an uncontrolled diabetic. Your doctor might have told you that everything is "under control" but it's not. If your blood glucose soars from mild exercise, then that's not control. It is also a recipe for worsening of diabetes over time since now you are left avoiding exercise in order to prevent high blood glucose. That's not the way to treat diabetes.

You do not treat diabetes by "avoiding" high blood glucose either through continuous diet modification or avoidance of exercise. As you can see, avoidance hasn't helped you one iota, or you wouldn't be complaining of high blood glucose from simply walking around. But sitting permanently does not treat diabetes.

This soaring of blood glucose also puts you at a very high risk of diabetes complications as any illness or injury can cause for your blood glucose to drive you into a coma. This is the most common cause of morbidity with diabetes and why so many "controlled" diabetics are suddenly no longer on this side of the ground, leaving everyone wondering what could have possibly happened. Well, what happened is exactly what you are describing, sudden uncontrolled spikes in blood glucose from any smidgen of perceived "stress" by the body.

You have to have a discussion with your doctor about the symptoms you are experiencing and explore other diabetes medications, besides just massive doses of insulin, to try and acquire better control of your blood glucose. Obviously exogenous insulin is not entirely effective in preventing this issue. Exogenous insulin is great for controlling postprandial blood glucose but it is not addressing the body's exaggerated adrenal stress response.

You are a prime example of why diabetes cannot be treated with diet alone, like the low carb zealots try to sell you. Once you are diabetic, diet is but a drop in the bucket as a treatment and this is why your doctor does not put much focus on it. Of course, I don't agree with them ignoring diet all together, but I also can appreciate their reluctance to give diet much credence as it simply doesn't have much to offer.

Diabetes causes the chronic, unregulated break down of the body (lean muscle mass specifically) into glucose and this occurs irrespective of diet. It is also a very complex adaptive mechanism where multiple hormonal driven systems are involved, particularly the hypothalamic/pituitary/adrenal axis (HPA). HPA dumps catecholamines (stress hormones) into the blood stream at an exaggerated rate in order to keep blood glucose high. Diabetes does not manifest exactly the same way in any two individuals, so each diabetic's needs are different as far as treatment goals are concerned.

Do not sit idly by while your doctor solely takes the reigns because HbA1C is not going to save you and that's all they are focused on. Let them know that you need to incorporate exercise into your lifestyle, not anything strenuous just simple walking, and you need something to control your blood glucose when doing so as it is not under control now. Teeter tottering at extreme hyperglycemia's edge is not control.

2. I have a carbohydrate allotment of 20 grams a day. There is a bar I like which is 16 grams total carbs, but they are from sugar in the form of dried dates. Is this still okay, since I am eating to my macros?

If you are slim and healthy, then you can eat to your macros and your 20 carb a day allotment can come from any source you wish. This is because 20 carbs a day is still within a carb restricted diet and as long as carbs are restricted (starving the body of dietary glucose) you can maintain metabolic health. Remember, carbs are only benign in the context of starvation.

The best way to cause this starvation is not through the restriction of total calories but the restriction of the offending calories. Carbs are the offending calories, and they cannot be eaten ad libitum just because you are healthy as they will ruin your metabolic health over time irrespective of total calories, through the dysregulation of blood glucose. So, restricting them to 20 grams a day is a good thing.

But, once you cross over the threshold and are overweight/obese with metabolic problems, then the source of your carbs becomes just as important as your carb allotment. This means that those 20 grams of carbs better come from broccoli and not sugar. The overweight/obese are particularly sensitive to sugar, no matter what form it comes in. So even though dates are not granulated Dixie Crystals, they still have a high sugar load, especially when dried, and do not belong in the diet of someone who has metabolic issues.

3. How is leptin affected by insulin?

Leptin is affected by long term nutrient availability, whether it's surpluses or deficits. This hormone takes its cues from different metabolic signals, insulin being one of them. Insulin is affected by blood glucose levels and blood glucose levels signal nutrient availability. For this reason, leptin is described as being a "slave to insulin". After all, leptin doesn't have eyes and sits next to you at the dinner table, watching what you eat. It gets its cues from other metabolic information, which lets it know your nutrient availability. Nutrient availability is not just how much food is available (leptin) but also what type (insulin; macronutrient composition).

When you are metabolically healthy, it goes something like this:

• If insulin is high, that's a cue for leptin to burn body fat because there's enough nutrients coming in to safely do so.
• If insulin is low, that's a cue for leptin to burn body fat because there aren't enough nutrients coming in and the body has to tap into its reserves.

As you can see, insulin works in pulses. These pulses are driven by blood glucose levels and the effects it has on insulin release/expression.

High and low insulin also causes leptin to under express temporarily, in order to halt too much body fat loss. This toggle system works in balance in order to manage weight in the long term by determining weight set points for different environments and metabolic states. This is why simple calorie restriction, for the healthy, fluctuates their weight up or down easily.

The problem comes in when things become chronic and no longer work in pulses. When you are metabolically unhealthy, it goes something like this:

• If insulin is chronically high, leptin will under express chronically since there would be no point of burning body fat if plenty of fuel is coming in from the diet. This becomes "leptin resistance" over time which makes it easier to build and spare body fat.
• If insulin is chronically low, then once again leptin under expresses chronically in order to not burn through fuel stores as there isn't enough fuel coming in from the diet and so preserving those stores now becomes necessary. This becomes "metabolic slow down" making it easier to build and spare body fat. This is how calorie restriction causes weight regain and stalls.

Leptin is produced and signals to the brain from the fat cells themselves. It's basically the messenger between the brain and the body's fat stores. Fat cells respond to ups and downs in insulin due to blood glucose fluctuations and this affects leptin expression as described above.

As you can see every metabolic function is intertwined. Everything effects everything else, positively or negatively, depending on your neuroendocrine state which is determined mainly by your macronutrient composition (nutrient availability) and activity level (lifestyle).

4. Is abdominal fat the cause of diabetes? I was in a low carbohydrate group, and they were discussing this, but I couldn't get clear answers. It seemed like they were just repeating someone else but didn't really know the details of how this actually occurs.

Typical of low carb circles. They talk a lot but say nothing.

Abdominal fat is a marker for metabolic syndrome. It is not the "cause of diabetes". Instead, it's simply a common manifestation of diabetes as the result of metabolic syndrome which causes for fat to be accumulated around the middle. This is not surprising.

Diabetes is a syndrome that causes the excess storage and sparing of body fat. That's why reduction of body fat has to be high on your target list for achieving remission as body fat only helps diabetes progress further. Body fat is diabetes' fuel because it puts a further high insulin demand on the body and does not allow for the proper disbursement of energy, leaving you tired while it keeps building itself. The burning of body fat means you are actually reversing this process.

Diabetes is the end stage of a metabolic adaptation caused by poor blood glucose control. The root cause of diabetes is the erratic ups and down in blood glucose, with large disparities between the two, caused primarily by lifestyle factors. It takes decades for this abnormal blood glucose regulation to develop into the syndrome we call diabetes. This syndrome causes many symptoms - high blood glucose, poor insulin function (insulin resistance), visceral fat, over expression of the stress response, under expression of leptin, dysregulated glucagon, among many other things. Improving or resolving any one of these does not affect the trajectory of the syndrome. We know this because modern medicine has a slew of very effective ways to control any one of these symptoms but hasn't been able to prevent the eventual morbidity of diabetes.

"Why is that, Gina?" Because if you lose your visceral fat and it helps lower your blood glucose you still have to contend with the over expression of the stress response and/or fasting blood glucose that dips too low and/or poor insulin function, etc. These all contribute to impending diabetes. Remember diabetes is a metabolic adaption where multiple systems are now geared towards keeping a high blood glucose set point. These systems work together to keep diabetes progressive. Even when all symptoms are addressed, you are still left with tissues and organs which might not regain their full insulin sensitivity and still develop pathologies related to that fact, as insulin expression continues in certain tissues and organs, long after serum insulin lowers/normalizes.

So, stay away from people who try to reduce the cause of diabetes to any one of its common obvious symptoms because what wasn't obvious (blood glucose disparities) was the root cause of the adaptation and this occurred long before the abdominal fat was accumulated.

Now I understand that there are two common debates you will see on low carb pages, and they go something like this:

• 1. You accumulate excess fat in the viscera, and this develops diabetes over time.

That is false. We know this because healthy metabolic function never accumulates fat in the viscera. It accumulates it subcutaneously which is the proper storage for fat and it has a strict threshold. When metabolism begins accumulating fat in the viscera it's because something pathological is occurring to cause it to do this. This is why fat accumulation in the viscera is so malignant. It is a symptom of a much larger and serious problem.

• 2. You become diabetic and for this reason you become fat. In other words, you are fat because you are diabetic.

That is also false. Not only are there plenty of diabetics that never become overweight/obese but there are many people who are overweight/obese and not diabetic. Diabetes does not "cause" you to become fat. Your abnormal metabolic function makes it easier to become fat and diabetic.

The cause of diabetes is the erratic blood glucose disparities described above. Those erratic blood glucose disparities deteriorate metabolic function so that it becomes easier to get and stay fat and eventually develop diabetes.

Overweight/obesity and diabetes are not mutually exclusive to each other though they are related. They can exist separately. This is because they are both time dependent and so they don't always occur at the same time. You can become overweight/obese first and then eventually develop diabetes or vice versa. It all depends on how your metabolism deals with the stress these blood glucose disparities cause it and how insulin adapts.

Everyone manifests metabolic syndrome differently and that's why it's called a "syndrome", not a disease. Metabolic syndrome is a group of similar symptoms which do not always occur together or at the same time for everyone. Genetics, epigenetics, dietary habits, activity levels, gender, age, hormonal status, co-morbid conditions, etc. all influence how this syndrome manifests in you.

5. A low carbohydrate follower sent me information on Dr. Bernstein. I am new to this. Is this a good doctor to "follow"?

I have an automatic negative reaction when someone describes themselves as "following" a doctor online. I hate to say it but that sounds kind of crazy. I don't know why low carbers follow these "personalities" on the internet as if they were a boy band.

A doctor online is not your doctor. They don't know you; they haven't examined you and they haven't diagnosed you so they can't provide you with any treatment for your individual condition. Therefore, you shouldn't be "following" anyone. Following doesn't treat diabetes. Doing does.

What I can tell you is that Dr. Bernstein is not on my Quack List, but he specializes in Type I diabetes. Type I and Type II diabetes are similar but different in very important ways. For this reason, though you can apply a low carb diet to both, their method of treatment ends there. On this blog, I feature Dr. Bernstein's dietary protocol in my 'Recommended Diets' list because it is a legitimate protocol that can be followed and be beneficial for Type II diabetics. But again, it ends there.

All you need to know from any "online doctor" is what protocol to follow and then you put them to the side. There's nothing else they can do for you. Listening to them regurgitate the same basic information and cliches, over and over again, while also trying to sell you crap from their sponsors, is not in any way going to make you slim. The only one that can follow the protocol is you. Following them does not magically give you results. Stop following and start doing.

6. I can't lose weight, no matter how strictly I follow "keto". An "alternative medicine doctor" told me to switch to a high carb diet instead. I am scared of doing this. What should I do and why would they suggest this?

I become very leery when I sense desperation to lose weight. Desperation causes for the person to jump from protocol to protocol and consume a large amount of snake oil in the interim. Snake oil is very fattening. Some of the fattest people on earth are the ones constantly desperate to lose weight. Desperation doesn't cause weight loss. Doing does.

There can be multiple things happening here. You could be following a "keto" protocol that prevents fat loss because of a high intake of dietary fat, too much fasting and inadequate protein intake (starvation). This causes the body to double down its efforts to spare its body fat. You should stop the "keto" and follow a normal, low to moderate carb diet. We have several featured on this blog, on the right hand side column, under 'Recommended Diets'. Choose one.

As far as your "alternative medicine doctor" is concerned - be careful. They are recommending a high carb diet in order to manipulate leptin, which I have discussed extensively in my prior posts. Manipulation of leptin is a diet hack that has been around since the beginning of time, so your alternative medicine doctor is not presenting anything new to the table though they are banking it's new to you. They could be right, and you might take the bait. After all, if you do and it works in their favor, you will swear up and down they worked a miracle on you, and you will then recommend them to your friends.

Diets that manipulate leptin are double edged swords. Though they can produce a benefit in the short term, they end up sabotaging you in the long term. The best way to effect leptin is to keep your insulin function normal by keeping your blood glucose control stable. High carbs won't allow you to do this. So, you are better off revisiting your low carb diet and changing whatever could be causing your issues. 

You also did not mention any exercise routine. Get one if you don't have one already. Diet alone will not lead you to the promised land so stop solely banking on it. Remember to eliminate any caffeine consumption.

Six common beliefs addressed, Part 231

1. I am so tired of reading about insulin levels in these low carbohydrate groups.

They are pushing BS. On this blog, we focus on insulin function which deteriorates over time when insulin demand is abnormal.

What would cause abnormal insulin demand? When your post postprandial blood glucose reaches 200 mg/dL, from a slice of pizza, and then insulin has to help clear this astronomically high blood glucose. Not only does this put a high insulin demand on the body, but blood glucose continues dropping after fasting, due to this high insulin output, which not only takes time to clear in the serum but continues its expression on certain organs and tissues after it does leading to insulin resistance over time. This erratic blood glucose and abnormal insulin expression sets the stage for a metabolic adaptation that chronically under expresses leptin leading to the storage and sparing of body fat.

Insulin resistance does not always correlate with insulin serum levels as insulin can be rather erratic, especially after meals. Fasting insulin levels are a better indicator of insulin function, but that also doesn't always match up in everyone. The best way to determine how your insulin is functioning, in the context of metabolic syndrome, is whether you are overweight/obese or not.

2. If the carbohydrate insulin hypothesis (CIH) is not true, then why are carbs still being blamed for overweight/obesity?

Because CIH is not true, but the Carbohydrate Obesity Hypothesis (COH) is. Remember insulin is not an obesity hormone. It is simply an anabolic/anticatabolic hormone. That is all. Obesity is a metabolic adaptation to starvation not an "insulin disease". It takes a lot of metabolic dysfunction to create this adaptation and insulin is only one hormone in that conveyor belt of abnormality.

Carbs cause a pathology in blood glucose regulation setting the stage for this adaptation to occur. So, carbs directly impact obesity just not through insulin, but through blood glucose disparities instead, which eventually deteriorates insulin function over time. This deterioration in function takes many forms. From insulin resistance in various tissues, to varying degrees, to not enough first phase insulin output to stop catabolism to adrenal over expression. This affects many systems in the body. It's like a domino effect that becomes more complex as more glucoregulatory systems are affected.

But it all begins with postprandial blood glucose abnormalities of which carbs are the culprit. This doesn't mean that there aren't other mechanisms that can cause this metabolic adaptation towards obesity. After all, anything that affects proper blood glucose regulation will eventually drive this adaptation. There are many things, other than diet, which can dysregulate blood glucose. Diet is just the most common culprit in modern obesity.

3. Most of the low carbohydrate doctors seem to have moved away from "keto" or disappeared altogether. I hardly hear them speak on fasting anymore.

A lot of them have disappeared to desperately try and find another shtick. It's been some years since fasting and "keto" have been thrown around and the overweight/obese are still the same as when they started. Most of the ones who did see improvement, are slowly seeing their numbers revert back to diabetic status. This means that their movement has slowly lost momentum because still being fat and sick after five years of "keto" is certainly not a good business model.

A lot of these doctors are cutting their losses and moving on to the next gimmick. Many of them jumped from low carb to "keto", then fasting and then carnivore but that's basically the last straw. There's nowhere else to go from there except somewhere else.

4. Some people fast with great success and others seem to get fatter.

"Great success" is up for interpretation......

In the end, all diets and other obesity interventions like fasting only work as well as your leptin expression allows. No one yet knows the exact mechanism of how leptin expression fails, though insulin is involved, or how to regain it. For this reason, there is no known cure for overweight/obesity. What we do know is that overweight/obesity interventions work best the earlier they are applied as obesity is a time dependent condition. The longer you have it, the more intractable it becomes. So, people who were overweight/obese for a short time in their lives, tend to respond to treatments better. The longer you have been obese, especially if you had childhood obesity, the less you will respond to treatments.

Overweight/obesity is an adaptation towards starvation and one of the main hormones that drive this is leptin. So, of course, if your leptin expression is already compromised, fasting will only make it worse causing for more body fat to be accumulated.

This is why there is no one intervention for obesity because your results are completely determined by how much proper blood glucose regulation you can regain and sustain. Results are not at the discretion of the treatment but of your metabolic response.

5. If I have urine ketones, it means I'm burning body fat.

No. It means you are burning dietary fat, if you are following "keto". The type of ketosis you want is when the ketones being produced are from the burning of your own body fat. Those are the only types of ketones that will treat overweight/obesity.

If you are treating another condition with ketosis, then it wouldn't matter where the ketones are coming from as you just need the ketones.

Overweight/obesity is treated through the burning of body fat. It's not treated by the presence of ketones. That's why we don't track any of that silly stuff on this blog. The best way to know if you are burning body fat is when the mirror, scale and the measuring tape reflects it.

6. If the person eats less food than the body requires, it causes the burning of body fat.

Fat is always being burned, whether you eat the body's requirement or not. This is because fat is the primary fuel that the body uses for everything, even while sleeping. The body never "stops" burning fat, unless you're dead.

How much fat is burned and where it's coming from (glucose conversion, dietary fat, body fat) is at the discretion of your neuroendocrine system, not whether you ate "less food than the body requires". Metabolism always compensates for nutrient availability. This is why an obese person can eat the same amount of food as a lean person but remain obese, while a lean person can eat the same amount of food as an obese person and remain lean.

All body fat loss and gain is at the discretion of your neuroendocrine system. If this system is healthy and working properly, you can just use a simple metric such as the body's daily energy requirements in calories and fluctuate your weight up or down. But when you are overweight/obese, you need to use more sophisticated nutrient information for this system to respond properly and not overcompensate.

Six common beliefs addressed, Part 230

1. I follow my diet strictly, but I am still not seeing results. The only thing I don't like to do is exercise, but my diet is top notch. I don't understand how I am not having any success just because I don't exercise.

This reply is to remind everyone that - You will not reach your goals through diet alone! Metabolism is an input/output cycle. The body uses diet (input) to create energy for work (output). You can't just address one half of this cycle.

Metabolic hormones all work together to convert food into energy and then expend it. No matter how "healthy" your diet, you will not reach your weight loss or metabolic health goals without exercise. It just won't happen. You will not be able to reverse your metabolic dysfunction or get to lean sitting around. Everyone that I have seen fail in reaching their goals have all had one thing in common - refusal to exercise or improper exercise.

So, stop nitpicking your diet. The reason you aren't getting results is because you're not moving.

2. I was told by a "carnivore advocate" that protein sparing modified fasts (PSMFs) are "too extreme".

Absolutely not, but what do you expect a "carnivore advocate" to say? They have to say it's extreme, as they are pushing their own diet.

Protein sparing modified fasts are a low carb and low fat diet combined. Basically, they restrict the energy macronutrients (fat and carbs) while prioritizing protein. Some are also calorie restricted on top of that. But when these diets are implemented correctly, they are extraordinarily effective for the treatment of overweight/obesity, especially before bariatric surgery as these diets also aren't a "cure". They target two main hormones that are implicated in obesity - insulin (carbs) and leptin (fat).

Remember, there is no known cure for overweight/obesity. All diets are only palliative treatments but some work better than others. PSMFs work very well. PSMFs are reserved for people who are very overweight/obese as they will be the ones who will get maximum benefits with the least side effects.

So, there is nothing "extreme" about PSMFs. Overweight/obesity itself is extreme. It is the result of a very extreme diet filled with glucose and fat.

3. It is not possible for someone who is following "keto" to still have a fasting insulin of 20.

This could be the result of high body fat. The higher your body fat, the higher your fasting serum insulin, regardless of what you eat. This does not always correlate with every overweight/obese person as some are simply no longer producing enough insulin to have a very high serum level.

4. I was morbidly obese at over 250 lbs. I went on "keto" and dropped down to 110 lbs. I have found that I am slowly gaining weight even though I am still following my regimen diligently. I have gained about 30 pounds. I am going through menopause. 

I get this question a lot and there's a few things to unpack here.

When you drop that much weight and get to lean, as 110 lbs. obviously is, it means that the diet was a success, and you have good leptin expression. It responded to your dietary intervention and got you to lean. Of course, this very low weight, is not realistic. You won't be able to sustain it. The fact that you were able to reach it, kind of shows your metabolism is a little wonky. It was blind to the fact you were losing that much body fat and it will now compensate. This is why I always say that the cure for obesity is not weight loss.

You will always gain some of your weight back as your weight set point cannot be that low if you were once over 250 lbs. That type of low weight set point is only realistic for those that have never been overweight/obese and that's their normal. So, you can't expect to be able to stay at that weight. It's a nice place to visit, but you won't stay there.

Menopause could be contributing to your weight gain but it's not the "reason" for it. You say you have continued with the same "keto" regimen that you started with and that can be problematic because as you lose weight, you have to change your protocol since the leaner you are, the more you can eat. Some people continue to fast too long or eat too little and that can cause the body to under express leptin, more than normal, the thinner they become. This can cause weight regain. In order to keep your leptin expression, you have to eat enough.

Aside from all of this, I want to remind you and everyone that there is no known cure for overweight/obesity. Remember,"losing weight" is not the cure. Overweight/obesity is a metabolic adaptation towards starvation and losing weight does not stop this process. It just addressees one of the most obvious symptoms of it. Just like lowering your blood glucose is not curing diabetes, lowering your weight is not curing overweight/obesity.

The only thing you can do is not to strive to reach your lowest weight again but to avoid going back to your highest.

5. Fasting blood glucose and insulin levels are enough to give an indication of insulin resistance.

Insulin resistance is determined by the presence of metabolic syndrome. We only use the classic five criteria, which are present in metabolic syndrome:

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

Nothing else determines "insulin resistance" unless you are already diabetic, which would mean you are at the end stage of metabolic syndrome.

6. A fasting blood glucose of 95 mg/dL is normal.

Fasting blood glucose should be around 84 mg/dL, so 95 mg/dL is too high. It is not at the point where a diagnosis of prediabetes can be made but it's getting there. It's giving you a heads up that something is wrong.

Six common beliefs addressed, Part 228

1. Fat calories matter more for a fat person so not all calories are equal. 

All calories are equal because they are just units of energy measurement but calories from different sources are compartmentalized differently in the body and effect metabolism in different ways. The calories of energy macronutrients like carbohydrates and fat are better targets for an overweight/obese person, for different reasons.

• Carbohydrates effect blood glucose homeostasis which helps contribute to body fat through insulin/leptin disruption.
• Fat is stored easily and not burned when leptin is under expressed. This only adds to more body fat and a greater insulin demand, further exacerbating the sparing of body fat.

2. What is the difference between basal metabolic rate and total daily energy expenditure? Basal metabolic rate is usually the most talked about in diets.

• Basal metabolic rate is the rate at which the body uses energy while at rest, just to keep vital functions going.
• Total energy expenditure consists of basal metabolic rate + the thermic effect of feeding + physical activity.

Diets usually talk about basal metabolic rate because it can make up to 50-70% of your total daily energy expenditure, making it very important for determining how much fuel you actually burn. Body fat is also the preferred fuel for basal metabolism and that is exactly what you want to burn off. This is why it is the most common target.

3. Diet coaches keep telling me that all calories are the same, but then say that all caloric sources do not affect energy expenditure in the same way. It's like they are double talking. Do calories in/calories out (CICO) advocates assume all calories are the same or not?

Because they are double talking. Actually, they are just nitpicking semantics. All calories are the same because they are just units of measurement for energy. Sort of like all digits on a clock are the same because they all measure time but there's a huge difference between a New York minute and a Mississippi one.

Usually when calories are being discussed, it is in the context of overweight/obesity, so knowing how calories from different sources effect our metabolism is important since not all caloric sources affect energy expenditure in the same way. After all, in order to lose body fat, you have to burn it, so you want to make sure that you are able to do just that. You want to burn more and store less.

There are multiple ways to achieve this, but you have to do it in a way where the body's compensatory mechanisms don't kick in and sabotage your progress. Also, achieving this is not the same as sustaining it. That's why you want to provide the body efficient calories, not just calories. Just like how I could get things done efficiently in New York City will be very different from how I could get things done efficiently in Mississippi, though the clock still reads the same times in both places.

In classic, run of the mill CICO, as it's practiced in calorie centered protocols, all calories are treated the same. It doesn't matter if you eat a Snickers bar or a leg of lamb, you must keep to your caloric goals. Because these programs have failed so dismally, and obesity research keeps evolving, a lot of calorie centered protocols do not practice this anymore. They now sneak in macronutrient tracking for better results. So many CICO advocates will now tell you that they do not believe that all calories are the same, sort of, kind of. They have also replaced "calorie deficits" with "calorie tracking" and "calorie goals" with "calorie budgets".

Surprisingly, many CICO advocates now also believe there is such a thing as "fat shaming" and "hormones". They used to just talk about "will power" and "effort". Go figure. You have to respect the hustle though. They are trying desperately to stay relevant and not give up on their theory. I salute them.

4. There a difference between the thermal effect of food between carbohydrates versus fat.

Not in any significant amount. The highest thermal effect of food is from protein metabolism.

5. Hormones do not impact energy expenditure.

There are many hormones that effect energy expenditure. No one hormone is responsible for any one thing in isolation. The body has a very complex series of feedback loop systems that effect the state of all hormones. When one hormone is out of whack, they all become out of whack, and they can no longer be treated effectively in isolation. In other words, you can't target one hormone and expect for things to magically correct themselves.

Two major hormones that effect energy expenditure are:

• Thyroid hormone, which can reduce basal metabolic rate by up to 25%.
• Leptin plays a role in basal metabolic rate regulation because it allows the burning of body fat or not.

6. If insulin levels are low, then you cannot get fat from dietary fat. This is why Type I diabetics are so thin.

Fat can be stored without an increase in insulin via acylation stimulating protein (ASP). This is really useless information even though some might find it interesting.

Every time someone comes across something interesting, they begin giving it too much importance and this only makes their body continue to put on fat. For example, the calories in/calories out (CICO) crowd loves bringing up ASP to try and discount insulin and emphasize how easily dietary fat is stored. But ASP is an adipogenic hormone which not only stimulates triglyceride synthesis but also glucose transport into fat cells. So, this hormone doesn't just help store fat, but also glucose. It also stimulates insulin secretion, so we are back to square one.

As you can see, the body has multiple interesting mechanisms for achieving the same result, as no one mechanism can be depended on solely. It always has a fail safe, especially for the storage of body fat as body fat is extraordinarily valuable to it.

So, none of this really matters and that's why I try to stay away from this type of stuff. It won't help you lose a pound. The only thing that matters is that you can absolutely get fat with low insulin levels, and this is precisely why we don't promote the carbohydrate insulin hypothesis on this blog. Insulin is not an obesity hormone. At what rate energy is burned or stored in your body is at the discretion of your entire neuroendocrine system. "System" being the operative word here. So instead of insulin levels, you need to think of insulin function and your entire metabolic state.

Type I diabetics become "wasted" because of uncontrolled catabolism. So, it's not so much that they can't store fat, like everyone else, it's that they can't keep it in storage, as their bodies and everything they eat are being broken down into glucose and ketones at a very rapid rate. Far more rapidly than they can store.

Six common beliefs addressed, Part 198

1. I was told that high insulin simply causes you to store "excess calories coming in".

Um, why would "high insulin" cause this to occur? If "excess calories" are coming in, wouldn't they be stored whether the insulin is high or low? After all, if all weight loss and gain is mitigated through calories, what does insulin have to do with it? So if I had "low insulin" I could eat whatever amount of calories I want and they wouldn't be stored?

Anyway, enough trying to make sense of nonsense. Insulin is an anabolic hormone, meaning that it "builds". It helps do this by transporting nutrients and energy into cells. In metabolism, generally speaking, insulin causes all calories to be allocated in some way or another, whether for storage or energy. The "whether for storage or energy" is what's important and this differs depending on your metabolic state. Your metabolic state is determined through your blood glucose homeostasis.

In a healthy person (leptin sensitive), most excess calories are not "stored". They are burned for energy through an increase in the metabolic rate. This energy is used for physical activity, the building of muscle, etc. In a person with metabolic syndrome/obesity most calories are stored with no increase in metabolic rate. When metabolic rate does increase, it is only for the building of new body fat. The calories do not have to be in "excess" for this to occur. Their body simply uses most of its calories for the growth of more body fat, excess or not.

The obese person is just like a body builder except that they build fat, not muscle. A body builder uses most of their calories to build more muscle. This is why they eat at a caloric surplus to increase gains. The overweight/obese use most of their calories to build more fat. They do so even at a caloric deficit.

So, we can say that all weight loss and gain is mitigated through insulin's response to disruptions in blood glucose, irrespective of calories.

2. My coach told me that my high insulin is caused by being overweight, not by diet. 

That is half right. Being overweight/obese puts a high insulin demand on the body. Meaning that the more body fat you have, the higher your insulin will generally be as it's the dam that keeps fat locked inside of the cell. But you were lean once.

Your diet is what initially caused your insulin to become chronically high by losing its pulsatile function due to a disruption in proper blood glucose regulation. If you continue this type of diet, you will not see any change in your insulin level or function. This will only be compounded by packing on more body fat. So you have to follow an appropriate diet to address the issue and not just stay stagnant under the excuse that the issue exists because you're overweight/obese.

3. Snacking causes me to loose weight. When I stop, weight starts creeping up. 

This is caused by leptin. People who have intact leptin sensitivity tend to lose weight with frequent meals. Nutrient availability is a signal to the body that there is plenty of fuel coming in, so it is safe to burn what's stored. This can occur to anyone, but the only way to make sure it doesn't back fire on you over time, is by choosing protein based snacks, without a sweet taste.

Adequate exercise is also key as it is exercise that signals to the body that fuel must be burned. You can only acquire proper leptin expression with consistent exercise. People who consistently exercise have the best leptin to adiponectin ratios.

This "snacking effect" is not the case for everyone. Many overweight/obese people do not find any benefits in snacking, but rather they find it to be detrimental to their goals. They are simply not leptin sensitive and their body stores their snacks rather than use them as a signal to burn more fuel. For this reason, we do not generally advise snacking, on this blog, since the vast majority of overweight/obese people are not leptin sensitive. But if you happen to be leptin sensitive, then you can take advantage of the effects of snacking.

4. I have never been the type of person who cares for sweet foods. I rather eat a pickle than a cookie but yet I am still obese.

First, I want to say something before addressing this statement.

A lot of people who say they don't care for "sweet" foods are referring to cakes, pies, cookies and candy. But these same people are big consumers of sweet sauces, spices and beverages, so I always take these claims with a grain of salt.

Desserts are not the only sweet foods that exist. In fact, most of the "sweet", found in the typical American's diet, is not coming from the dessert they always pass on. It's coming from foods that you would deem to be savory but aren't because they have been prepared to not be. So yes, that sweet pumpkin casserole is still a dessert, even if you serve it as a side dish. So are the sweet chili meatballs, barbecue, maple bacon, apple sausages, etc.

Having said that, sweets aren’t the only foods that are fattening. Not all junk is sweet. Sweet foods are just particularly fattening because of their "sweet taste" and it's effects on the hypothalamic/pituitary/adrenal (HPA) axis, but sour and savory foods can be fattening as well, when they aren’t eaten correctly, like when you replace protein with a pickle.

5. Eating higher protein foods help me gain muscle and ward off obesity.

Eating higher protein foods is ideal because it helps curb obesity, but is not a cure. First, you can only make muscle through exercise. Protein alone won’t cut it. Protein helps raise insulin to build this muscle, but the insulin of the obese likes building fat instead. Protein foods at least won't give insulin much to store, so it’s protective in that sense, but it's not pixie dust.

I've seen a lot of coaches and trainers get caught up in "protein power", but the maximum benefits of this are seen in the obesity resistant who are also active. Like I’ve said before, the metabolism of the obese does not function as it should. This is why you shouldn’t put much credence on weight loss methods pushed by athletes or personal trainers. You have to use methods that target how obesity works.

6. My personal trainer told me that I shouldn't focus on hormones and just on my goals. 

Micromanaging hormones can keep you from your goals because you become bogged down with mostly useless information, that you can't do a thing about, and get caught up in quack experiments. Like I've said before, knowledge without action is useless. But knowing how obesity works and what is occurring in your body can help you fine tune your diet and activity routine in order to better obtain your goals. It can also prevent you from wasting time with protocols that will only work for the short term and/or possibly make things worse in the long term.

That is why this is not a "weight loss" blog. I am not a coach, program director or trainer. I don't offer any one type of treatment or protocol to "cure" your obesity as obesity has no known cure. The only thing I offer my readers is a better understanding of what's occurring in their body and the best ways to gain some leverage against it. I also help my readers become aware of quack and failed treatments, so they don't go down that much traveled road by other obese people, who are still obese to this day.

Six common beliefs addressed, Part 189

1. I want support for my low carb diet but I haven't been able to find a "low carb doctor" in my area.

Good. The last thing you want to do is go to a low carb quack who will pit you against your doctor and send you down dead end roads to nowhere. There is no such thing as a "low carb doctor" but those who have given themselves that fake title, hinder more than they help with their pseudo science and snake oil. You have to be careful to not fall into that trap. There are many obese people in there already. I have consistently followed my low carb diet with results, without the need of a "low carb doctor" whatsoever.

You do not need to see a "low carb doctor" to follow a low carb diet. Low carb diets are pretty simple. They are restricted in carbohydrates (less than 100 grams a day) and that's about it. You can reduce carbs further if you like, all the way to zero, depending on your results and/or preference.

There is a variety of ways to follow low carb and the choice is yours to find a suitable low carb diet that you can sustain and be consistent with. Some diets focus on carbs as a whole and others only eliminate specific carbs. Basically, you can make all kinds of modifications to the diet to suit your lifestyle and palette. On this blog, we recommend that carb sources should not include sugar or grains. The best thing is that information for low carb diets is free online. This blog is just one of the many resources for that information. 

What you don't need is a low carb doctor that doesn't emphasize the importance of a whole lifestyle change but only focuses on carbs. You need to focus on exercise, dietary fat and systemic stress reduction. It is also very important to work alongside your doctor and continue taking your prescribed medications so that you can get the most out of your lifestyle changes.

If there are tests you want done, which your doctor is refusing to order for you, find another doctor or order them yourself from a lab that doesn't require a doctor's prescription. Do some research on what the desired tests will actually show and what difference that would make. Quack low carb doctors tend to prescribe a slew of useless tests that do not help one iota in achieving results.

2. "Keto" ice cream can be a part of a low carb diet.

"Keto" ice creams like Rebel are very low in carbs and moderately high in fat. You just have to take into consideration any other fatty food you have consumed to make sure you stay around 35 - 80 grams of fat a day and never go over 150 grams. These dietary fat gram recommendations are determined by your weight loss status. If you are losing weight, you can get closer to 150 grams but if you are stalled, you need to remain closer to 35.

But that's not the problem with these type of foods. The problem is in how they effect eating habits over all. Consuming foods that are nutrient poor and energy rich is an obesogenic habit. It is also an obesogenic habit to consume items that are sweet. Ice cream is party food. It's a novelty. It has its place in the diet, on a special occasion, because it's better than conventional ice cream. Rebel ice cream is great for a holiday meal, birthday party or after Sunday dinner. It is not a great item to keep on hand as a staple in your freezer for consumption daily. Your freezer should be filled with meat and vegetables, not desserts and novelties.

People who are obese, bring their obesogenic eating habits into their new diet and decide that it's a good idea to eat a pint of Rebel ice cream, either as a meal on its own or after a pound of bacon. That is not the way we were intended to eat. Eating in disordered and obesogenic ways will only keep you obese regardless of the diet you choose to follow.

3. Type I diabetics do not have to worry about their diet because they have to take insulin anyway. 

This blog does not focus on Type I diabetes but the answer to this statement also pertains to Type II. This statement is in sync with the diabetes education that you will receive from your doctor. Basically the education goes as follows: Diabetes is a malfunction of the body. Give the body what it needs and the symptoms of the malfunction will decrease. 

Well, in the case of Type I diabetes, this is correct but it is not in the case of Type II as Type II diabetes is an adaptation to certain lifestyle factors. It is not a true "disease". Diet is a lifestyle factor that can effect both Type I and Type II diabetes control and diet is responsible for the development of Type II diabetes. The body was never made to handle doughnuts. The fact that the body cannot handle that onslaught is not a malfunction within it. The doughnuts are the malfunction.

If a Type I diabetic has to continue dosing insulin to counteract doughnuts, what will eventually occur is that they will lose control of their blood glucose, gain body fat and develop Type II diabetes (double diabetes). This is not to mention the high risk of over or under dosing insulin which can result in serious life threatening complications. I believe that this effect on Type I diabetics, who dose high amounts of insulin due to an improper diet, is the single most important proof we have, occurring in vivo, of how Type II diabetes develops. No need to debate studies or research papers. Once blood glucose regulation chronically fails, insulin begins to malfunction and Type II obesity/diabetes develops. This is why Type I diabetics refuse to take their insulin, in order to keep from gaining body fat, once they start becoming insulin resistant.

So there is the proof that Type II diabetes develops when there are large disparities in blood glucose requiring a high insulin demand. Though many things can interfere with proper blood glucose regulation, 90% of the Type II diabetes we experience is due to diet. This high insulin demand deteriorates its sensitivity and function, at different rates in various tissues and organs, over time. All of this helps build body fat which puts a further demand on insulin and the cycle never ends.

Whether insulin is being produced by your own body or being injected exogenously, a diet that interferes with proper blood glucose regulation, will require a high insulin demand and this will eventually lead to Type II diabetes.

4. If you went low carb and feel light headed and nauseous, it means your insulin levels are too high making your blood glucose drop too low. 

First, you need to actually check your blood glucose in order to know if it's really "too low". Without numbers, I am unable to give my opinion.

If you are diabetic or have metabolic syndrome, the symptoms you are describing may occur even with high blood glucose as both of these conditions are adaptations towards hyperglycemia so any drop in blood glucose, will cause "symptoms". Blood glucose does not have to drop to clinical hypoglycemic levels for symptoms to occur.

Other than that, this could be due to an electrolyte imbalance as this is very common with low carb. You have to make sure you're getting adequate electrolytes and are properly hydrated.

5. You do not have active obesity if you are obese but not gaining weight. 

Active obesity is the presence of obesity. The fact your body is sparing its fat mass and not allowing you to lose it, is active obesity.

6. I have a low carb recipe for a chocolate molten mug cake. I have gone through its macros and it's within the parameters of a low carb/"keto" diet. Everyone should be allowed an occasional dessert. 

I deal with people who have very serious health problems caused by metabolic abnormalities. They are usually full blown diabetics who have been overweight/obese their entire lives. They have tried endless dietary protocols that have simply not worked or worked for a short while and then failed. They are desperate to treat their problem and that is precisely why they have ended up here. The last resort a human being takes is an elimination diet. Humans will try to negotiate for a very long time before they resort to draconian options. Once they reach a draconian solution it's because they have reached the end of the line.

I have stated before how overweight/obesity is not just a biological abnormality. It co-morbidly exists with certain behavioral practices that enable it to continue and worsen with time. Most overweight/obese people put too much credence on excuses like "just a little bit", "in moderation" and "occasionally". They bank on these false ideas and perpetuate their condition. For this reason, we advise and practice total elimination, with no excuses, because concessions have never worked before for the overweight/obese and never will. Strict and total adherence is the only thing that the overweight/obese have not practiced, during their years of dieting, because no marketable diet encourages this since it wouldn't sell.

If you are the type of overweight/obese person that can stick with your diet and not let desserts overrun you, then you can have your dessert once a week but if you are the type of person that uses these desserts as an excuse to continue with obesogenic behaviors then you should not be having any.

Six common beliefs addressed, Part 165

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

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

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

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

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

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

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

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

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

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

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

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

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

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

4. Body builders use insulin for energy.

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

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

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

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

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

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

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

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

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

6. Can cholesterol be too low?

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

Six common beliefs addressed, Part 155

1. Low carb people told me I could "fix" my fatty liver disease in a few weeks, but I still have had no improvement with my liver in more than a year of following low carb.

You'd be surprised what some people claim is low carb. There are folks who believe coconut sugar and cassava flour is "low carb". For this reason, I don't know what you mean by "low carb" so I cannot address your diet as you did not detail your protocol. I can only address the claims being made online by low carb advocates which bamboozled you into following a diet, that is obviously not working for your particular problem, and you have wasted valuable time.

Always take any claim of this sort with a grain of salt because you simply don't know what your individual outcome will be. The only intervention that has ever reversed fatty liver disease, in about two weeks, has been the elimination of all sugar from the diet. This has been done with a ketogenic style protocol. The same effect has also been seen by simply removing soda and other sugared beverages from the diet but mostly in children. Of course, these approaches are only true if the fatty liver disease was caused by excess sugar consumption to begin with.

So when you read about the "reversal of fatty liver disease" in a low carb platform, it is usually in the context that sugar was the culprit for the disease. If you take away the sugar, then the disease is cured, but fatty liver disease is not solely caused by sugar intake.

Aside from excess carbohydrate consumption in the form of sugar, fatty liver disease can also be caused by excess alcohol intake, viral infections, certain drug treatments and consumption of high dietary fat, particularly from vegetable oils. This means that if you don't follow low carb correctly and you begin consuming abnormal amounts of dietary fat, you will contribute to your disease progression and will see no improvement in it.

This is because abnormal lipid metabolism leads to ectopic liver fat accumulation. Trying to metabolize an extraordinary amount of dietary fat is abnormal lipid metabolism. In other words, you have too much energy stored in your liver and you are trying to add more. That's why swapping one high energy diet, like a high carb diet, for another high energy diet, like a high fat diet, will not work to improve your condition. So if this is the case, you have to address it immediately. Stop following charlatans and get on a true low carbohydrate protocol.

Aside from this, disorders in genes involved in fatty acid uptake, hepatic triacylglycerol secretion, choline deficiency and fatty acid oxidation also lead to fatty liver disease. The pathogenesis of fatty liver disease involves multiple pathways, including fatty acid uptake, de novo lipogenesis, mitochondrial fatty acid oxidation and lipoprotein secretion. So if you have genetic issues, in any of these pathways, you can develop fatty liver disease and if it's not addressed, the disease will progress and not improve. As you can see, there are multiple ways of acquiring fatty liver disease and multiple things that will contribute to it.

I know that your doctor will not give your fatty liver disease a second thought as conventional medicine believes that fat accumulation in the liver is benign until inflammation or scarring occurs. The problem with this is that inflammation and scaring is the end stage of fatty liver disease and that's when irreparable damage to the liver occurs. For this reason, it is up to you to figure out what is causing your fatty liver disease and address it. You have to force your doctor to not sleep on this and find out what is causing it through a proper investigation.

You also need to stop waiting for a low carb miracle to occur because you are wasting valuable time that could be spent finding a way to properly treat this problem rather than waiting for low carb to finally "kick in" and "cure" it for you. It's obviously not happening.

2. Blood glucose rises with exercise. 

This is caused by an exaggerated stress response, which is typical of people with full diabetes. Blood glucose rises with any injury or illness for these people as well.

As metabolic health improves, this effect tends to disappear. The length of time that takes depends on many factors, so it's highly individualized. You just have to focus on continuing what you have to do in order for things to improve with time. Do not do strenuous or prolonged exercises and never exercise fasted. That might help in the interim.

3. Even when consistently following "clean keto" for 2 years, my HbA1C has been creeping up.

You are still having blood glucose regulation issues. Like I have said many times before - "keto" and low carb are only palliative treatments for metabolic conditions. That means that they treat symptoms, not the actual condition itself. The actual condition is the result of poor blood glucose regulation. The canary in the coalmine, which signals this is the case, is not necessarily your increasing HbA1C but how much body fat you still have. As long as "keto" and low carb doesn't cause you to lose weight, specifically body fat, you will continue to be at the threshold of metabolic dysfunction.

When you first start "keto"/low carb, you lose some body fat because your blood glucose regulation improves. This in turn helps lower your blood glucose, HbA1C and insulin levels. You feel as though you have found the cure to your ailments but because you never fully correct your blood glucose regulation, you never lose enough body fat. The problem continues and not only do you not lose enough body fat, but you also begin piling more on and your metabolic numbers begin to rise. For some people this happens sooner and for others later, depending on their overall lifestyle but it will happen. As long as you are overweight/obese, it will happen again. You are simply moving the goal post further away but you're headed right to it.

This is why these diets have to be accompanied by lifestyle changes that are anti obesogenic. The diet alone will only get you so far.

4. Calories don't count if you are carnivore, unless you're diabetic and need to lose weight.

It depends on where the calories are coming from. Excess protein calories only build lean muscle mass. Excess fat calories only build fat mass. So, instead of tracking all of your calories, make sure that you track your fat calories instead. Everything else is irrelevant and this goes for both diabetics and non diabetics.

Fat and protein macros are individualized but the rule of thumb for fat grams is to always stay between 50 - 150 grams a day. The more body fat you have to lose, the more you should lean towards 50 grams.

5. I have transitioned to "keto" but feel hypoglycemic.

"Feeling" hypoglycemic and being hypoglycemic are two different things. The clinical definition for hypoglycemia is:

• A blood sugar level below 70 mg/dL (3.9 mmol/L) is too low and can cause harm.
• A blood sugar level below 54 mg/dL (3.0 mmol/L) is a cause for immediate action.

Lower blood glucose does not equal better in this blog. The goal is to obtain and maintain normal blood glucose regulation, not lower blood glucose. Lower blood glucose does not solve the complicated pathology of metabolic syndrome.

If your blood glucose is higher than 70 mg/dL then you are not clinically hypoglycemic and so your symptoms are being caused by "pseudo hypoglycemia". This is actually very common, especially in people who aren't full diabetics yet but are on their way there. Pseudo hypoglycemia is a state where the body actively tries to elevate blood glucose, even if it's at a normal level, by causing you symptoms that will make you eat or rev up the body's stress response. Ignore this. It will go away with time. Feeding into it will only cause for you to never get off this merry go round. Allow the body to learn how to regulate its blood glucose on its own, without your intervention.

If your blood glucose is lower than 70 mg/dL then you have to reformulate your diet so that this does not occur. If this means switching from "keto" to moderate low carb, do so. You want to keep your blood glucose steady. Unsteady blood glucose will deteriorate your counter glucoregulatory response further and soon you will be dumping out incredible amounts of glucose to prevent any lowering of it to normal.

If your blood glucose is lower than 70 mg/dL without symptoms, then you have a very big problem and you need to address it with a healthcare provider as some diabetics do not experience any symptoms when their blood glucose reaches clinical definitions of hypoglycemia. This is a problem with the autonomic nervous system causing a failure of the counter glucoregulatory response. It can be life threatening as your blood glucose can drop low enough to put you in a coma without you being none the wiser to it.

So anytime you have symptoms of hypoglycemia, check your blood glucose to determine what's really going on and then act accordingly.

6. If you are on "keto". you should reduce the units of insulin you are currently on. 

You need to talk with your healthcare provider. We cannot advise you on how to reduce injected insulin or any other type of prescription medication. Even if I could advise on this, I wouldn't because the internet is not a surrogate for proper healthcare. Any low carb advocate that allows this type of advice to be shared on their platform is immoral.

Altering your prescription medication, either on your own or with the advice of some fool online, is very dangerous and irresponsible. Monitor your blood glucose and discuss changes with your doctor so they can help you reduce or eliminate any medications you might be currently on.

Six common beliefs addressed, Part 144

1. It is not difficult to get rid of fat from around the waist because visceral fat is the first to go. 

The waist is usually where subcutaneous fat is also stored. The body doesn't like storing fat on its limbs as this reduces mobility. This means that the waist is up for grabs. We can all reach down and grab some fat from around our middle. This is the normal location for fat storage. 

Women also store fat along the hips, buttocks and thighs because women have a body that is designed for more fat storage. So even if you lose all of your visceral fat, you might still have the infamous muffin top.

2. My insulin is very high but my HbA1C is 5.4. 

Well, I don't know just how "high" your insulin is because you didn't provide a number. What I do know is that an HbA1C of 5.4 is on the high side. 

Your "high" insulin is controlling your blood glucose for the time being, but sooner or later your insulin to glucagon ratio will deteriorate and your blood glucose will begin to rise, regardless of your insulin levels. When your body can no longer produce enough insulin to control this rising blood glucose, your doctor will put you on exogenous insulin or medications that force the body to output even more insulin and/or eliminate more glucose. 

You have to take control of this impending train wreck as soon as possible by actively trying to lower both insulin levels and your HbA1C. 

3. Bad dietary protocols are continued to be advised, even though they don't work.

Because most dietary protocols are based on compliance, not reality. For this reason you see the same protocols, making their rounds every few decades, reinvented, renamed and revamped but at the end of the day they are all the same BS with a new name. 

Most dietary protocols are based on calorie in/calorie out (CICO) models, whether it's directly or indirectly, by using portion control or even time restricted eating. No protocol wants to recommend the elimination of anything. It's all reduction or replacement. 

Like I have said before, as long as "weight loss" protocols are profit driven, results are not necessary. Empty promises and temporary benefits are all they have to deliver to bait people in. Baiting people in, is very easy. Overweight/obesity is a common problem that many people want to "fix", so as long as there is a demand for a solution, more diet protocols will continue popping up. But the reality is that, as of the time of this post, there is no known cure for overweight/obesity. 

4. My insulin has lowered and my blood glucose is stable but I’m having a horrible "stress response" where I’m jittery, can't sleep and often hungry.  

Those are all signs of systemic stress. This is normal as your metabolism is primed to keep higher insulin levels and higher blood glucose in response and vice versa. Breaking that feedback loop will cause side effects as the body actively fights to keep its blood glucose set point. 

Give it some time and allow for your hormones to stabilize and follow suit to your insulin's new lows. It will stop fighting this with time. In the meantime make sure you get plenty of steady state exercise to help signal to the body that it needs to burn energy and that the new low insulin and blood glucose levels are normal. You also have to keep your electrolytes in mind and make sure you aren't going deficient. 

5. I began following a "conventional" diet and was able to lose weight and lower my weight set point.  

This is the case for any diet. As far as obtaining a new weight set point is concerned, wait to make that claim a year from now. It takes a long term dietary regimen to reduce weight set points, from overweight/obesity, and conventional diets can not be followed long term to achieve this. 

Also, "weight set points" are fluid and constantly changing with age, environment and metabolic status. They aren't written in stone. The set point you had at age 15 will not be the same at age 50. So weight set points can be modified, for a span of time, but not permanently. In normal metabolism weight set points will keep for about a decade and then slightly change to a higher or lower point. 

The reason that it might appear as though the diet has worked wonders, for the time being, is from an effect on leptin which can enhance its expression temporarily and cause weight loss. Maybe your diet has a different macronutrient composition that triggered this effect. For example, diets that include carbs can trigger a leptin effect because of their rise in insulin levels which signal to the body that there are enough nutrients. Carbs also cause the person to eat more often or more food in general and this also causes leptin to increase temporarily from a blood glucose rise. 

Like I have stated before, weight loss can occur from a caloric deficit as well as a caloric surplus. Both trigger different hormones. It's what occurs in the long term that effects the end results. Triggering leptin in this manner only has a temporary beneficial effect until insulin levels begin to rise and its function deteriorates once again causing overweight/obesity to follow. 

6. You should not supplement with Lite Salt for more potassium because it contains dextrose. 

A good alternative is Lo Salt, which is nothing but potassium bicarbonate with no fillers. It is a bit more difficult to find but you can order it off Amazon or find it at Whole Foods. 

Lite Salt is a low sodium salt that is used by people who are on some type of sodium restriction. Because it is mostly potassium bicarbonate, people who want to supplement potassium use it as well. It is the safest way to supplement potassium as potassium supplementation should be reviewed by a doctor. 

Lite Salt contains dextrose as its a conventional iodized salt mixed with potassium bicarbonate. This doesn't mean you have to stop using it if its a good way for you to increase your potassium safely and you can't find the alternative. You can use it on specific items rather than as your main salt. For example, on certain dishes or to mix an electrolyte drink with. Dextrose comprises very little of this salt so it's not enough to make a difference, especially when the rest of your diet is low carb.

 

Metabolic syndrome is the result of poor blood glucose regulation. It takes much more than some dextrose in salt to cause it.