Six common beliefs addressed, Part 270

1. Do I have to "adapt" to ketones in order to use them?

No. Ketones are a quick energy source and are created to primarily replace glucose so people who are the most glucose dependent will be the easiest to get into ketosis. This is why it is not difficult for diabetics to go into ketosis. It is quite easy for them to produce ketones. It is the people who can use free fatty acids directly that tend to have lower ketosis.

2. Is insulin resistance always the cause of too much glucagon expression or can other things be implicated as well?

Glucagon overproduction is the outcome of low or insufficient leptin which is the direct result of abnormal insulin release/expression (hyperinsulinemia/insulin resistance). Leptin helps regulate glucagon. Abnormal insulin release/expression always results in a starvation adaptation which destroys leptin expression in tissues like the liver as well as the brain.

This is why, on this blog, we describe the timeline of obesity/diabetes as blood glucose dysregulation first, insulin degradation second and finally leptin resistance as the end result.

3. Does glucagon only release glycogen from the liver or does it also convert protein into glucose?

Glucagon releases stored glycogen into glucose which is then released into the blood stream. It also breaks down protein into glucose energy. Leptin resistance always ensures that protein is wasted into glucose due to hyperglucagonemia. So basically glucagon is responsible for glycogenolysis and gluconeogenesis.

Now, I often make the statement on this blog that glucagon will "break down everything you eat into glucose" simply because this is the easiest and most simplified way of describing the process above, to someone who has zero understanding of metabolism and how it works. But, we know that there are a lot of pedantic people out there that get caught up in the minutia of semantics, as though I am giving a dissertation at a medical conference, rather than just simplifying metabolic processes for the layman on a blog.

So for the sake of these people's sanity, and prevent any comments "correcting" me, I will be more precise and mention on this post that glucagon itself does not have the ability to directly convert protein into glucose. It simply regulates the breakdown of glycogen and the synthesis of new glucose molecules, in order to maintain blood glucose levels. Protein is not a direct substrate for glucose production. Amino acids can be used as substrates for gluconeogenesis, but this process is indirect and occurs through the action of other enzymes and metabolic pathways, not directly mediated by glucagon.

But at the end of the day, on this blog, the only thing that matters to YOU is that glucagon will break down everything you eat into glucose, due to insulin resistance. Period. The details do not matter. Glucagon does this irrespective of the nuance. This is not a blog for medical students or biochemists. This is a blog for the average obese person, who is struggling with their symptoms, to try and gain some understanding of what's happening to them so they can have a better chance of correcting it. For this reason, it makes zero difference for them to know the exact, complicated pathways of glycogenolysis and gluconeogenesis. All they need to know is that glucagon is the cause and it is regulated through insulin and leptin, both of which are malfunctioning in them. This gives them something they can target to better address their condition. So it doesn't matter how it happens, it just matters that it happens and it's happening to you.

4. I read on a weight loss group that ghrelin is responsible for over eating and so it causes weight gain. Does lowering ghrelin truly cause weight loss and should that be the target to achieve my goals?

Ghrelin is often referred to as the "hunger hormone" but the research on this has not been straightforward. There has been contradictory findings in studies. Studies show that ghrelin is actually low in the obese and in binge eaters compared to healthy individuals. Yet, ghrelin is released by the stomach to stimulate appetite so it would make sense that its reduction would result in lower appetite. How can one hormone do two different things?

This is actually very common in the many systems of the body. Hormones can have the opposite effects depending on their concentrations and cross talk with other chemicals and systems in the body. This is why I am so leery of blaming any one hormone for any one process as the body uses redundancies for many of its functions. Why make multiple hormones to do many things, when the same one can do all these things depending on the information it receives from the individual's overall neuroendocrine state? You can think of hormones as traffic cops. They can either stop, speed up or redirect traffic flow depending on the road/driving conditions.

So the only thing you need to concentrate on is your blood glucose regulation. None of this other flim-flam will help. It might be fascinating. It might be interesting. But it is not useful. The diet industry always has a new culprit for overweight/obesity every single day and this can be seen on tabloid magazines everywhere. At the end of the day, the only true mitigator of overweight/obesity/diabetes is blood glucose regulation. In that context, ghrelin has been shown to stimulate both cortisol and growth hormone, both of which cause hyperglycemia so at least we know that over production of ghrelin will disrupt blood glucose.

Don't target anything except your blood glucose regulation.

5. How is leptin a "slave to insulin"? You have mentioned this many times before but I am curious to know the mechanism behind it.

If insulin is low, leptin will also be low. Usually, when leptin is high, it means insulin is also high or the fat cells are highly insulin sensitive. For the overweight/obese, the former is the case. 

This is why sometimes insulin levels do not correlate with the level of obesity. Some obese do not display hyperinsulinemia through serum insulin levels but their insulin expression is always high at the fat cells. Some thin people have hyperinsulinemia but their insulin expression is not very high at the fat cells. This is the case with certain ethnicities who develop diabetes at much lower body fat percentages.

So leptin always tracks closely with insulin and it is affected by insulin release/expression. Normalizing insulin is enough to normalize leptin and weight.

6. Does calorie restriction really cause a longer life span?

Sort of.

When calories and protein are chronically restricted, it down regulates the sympathetic nervous system (SNS). This leads to lower blood pressure, heart rate, glucose release and thyroid hormone conversion. Basically everything slows down. These effects have been shown to increase life span in test animals.

We don't know what the implications of this are for humans. When humans are starved, their health is significantly impaired regardless of any increase in life span. This most likely has to do with our large brains which require a significant amount of nutrients and calories. It is easy to starve a mouse and increase its lifespan, without any health consequences, since mice do not live long anyway. Humans on the other hand have a median life expectancy of about 72 years. That's a lot of time for things to go wrong. Increasing that time through starvation only makes more things go wrong.

Six common beliefs addressed, Part 248

1. I was sent a video that claimed the early signs of prediabetes are depression, belly fat, irritability, hunger after meals, polycystic ovary syndrome (PCOS), nigricans/acne/skin tags, worsening vision, frequent urinary infections, slow healing cuts, thirst, burning/numbness in feet, fatigue and an HbA1C of 5.6 - 6.4. They insisted that you only need to have your HbA1C checked, and they also claimed that the "cure" for prediabetes was "very easy" - to just follow "keto" or carnivore. Is this all true?

Where do you guys get this nonsense from? Really? There's a lot of bull to process here so bear with me. This is called throwing as much crap as possible around to see what sticks. None of that crap is prediabetes. In fact, worsening vision, frequent urination, slow healing cuts and burning/numbness in feet are possible signs of full-blown diabetes, not "pre" anything.

The only correct sign of prediabetes on that list is an HbA1C of 5.6 - 6.4. Period. The only sign of metabolic dysfunction on that list is belly fat.

HbA1C is a blood test which is usually ordered by your doctor during your yearly physical. It's part of the Comprehensive Metabolic Panel. Most doctors order it, but it appears that some don't. Some insurances cover it, but some don't. For some, it depends on your fasting blood glucose result. If your fasting blood glucose is normal, they might not cover it and/or your doctor might not order it. Insurances change frequently and what was once covered, may no longer be unless a specific diagnosis is made to justify the testing.

I don't know why this person is insisting on you having your HbA1C checked as it is pretty much a useless marker for prediabetes considering that you would have to already have prediabetes in order for it to be useful. By then it's too late. But I bet whoever made that video is selling HbA1C test kits, aren't they? They are all so predictable. If only the roulette table in Vegas was this predictable, I wouldn't be sitting here but enjoying my winnings in Hawaii instead.

Anyway, if you want to know whether you truly are prediabetic, before you become prediabetic, get a blood glucose meter. They are available at Walmart, with no prescription needed, and they have become very inexpensive. I also don't sell them. This way you can check your fasting and postprandial blood glucose readings at home, which are much more telling if you are at risk of prediabetes than an HbA1C test. You have to check for large disparities in blood glucose between your fasting numbers and your postprandial numbers. You should aim for no more than a 40 point difference between the two. That's all that's needed.

I also can make a bet that whoever made that video is also "selling" the diets they are recommending, right? That's why they have the easy "cure" for your prediabetes. They create the problem and sell you the cure. The only thing that will reverse prediabetes or reduce your risk of developing prediabetes is to follow a diet, any diet, that prevents large disparities between fasting and postprandial blood glucose. In other words, any diet that preserves normal blood glucose regulation.

Carb restricted diets work very well for this but there are other factors involved that have nothing to do with diet at all. Quantity of food in one sitting can disrupt glucagon function which can raise postprandial blood glucose abnormally high, contributing to large disparities. Fasting for long periods of time can do the same. Type and frequency of exercise can contribute as well. Any of these can result in a compromised metabolic system which is very difficult to "reverse" but can certainly be "managed" and prevented from worsening.

Lastly, I'm always leery of anyone that says anything is "easy". There is nothing easy about reversing metabolic adaptations.

2. I have heard of "amylase" on some low carb websites. What is it and why should I be concerned over it?

You shouldn't be concerned over it. It's nonsense.

Low carb advocates are always bringing up some elusive and irrelevant biological function to cause confusion and have something to talk about. They are constantly trying to find what to focus on rather than focusing on what the real problem is. This of course is strategic on their part as they need to have something else to blame as a backup for when their protocol fails.

Amylase is an enzyme that helps you digest food. Particularly, it breaks down starch into sugars. Amylase is mostly made in the pancreas and salivary glands. A larger or smaller amount may mean that you have a serious disorder of the pancreas, such as pancreatitis. This can result from an infection, alcoholism or some other medical condition. Your doctor would suspect if you were having problems with your pancreas by assessing your symptoms and ordering the appropriate tests of which amylase could be a part of.

Who knows what this has to do with low card but anything that has to do with sugar metabolism is immediately honed in on by these clowns as their foolery knows no bounds. I'm guessing that since amylase helps break down starch, they figure the less of it you produce, the better, as it would theoretically mean less blood sugar? Who knows. That's how imbecilic and simpleton their train of thought is. To the layman, it would make perfect sense though.

Don't be taken in by this nonsense. Amylase doesn't cause nor prevent diabetes. Diabetes is a syndrome which is multifactorial and lifestyle driven. In fact, the pancreatic conditions that result in an abnormal amylase test do not even include diabetes or even high blood glucose. So whatever effect amylase has on blood glucose is insignificant and completely irrelevant.

3. Is it true that carnivore does not work for women?

It is impossible to know whether a diet will "work" for you or not, as an individual. Results are dependent on a lot of factors, most notably how well it can help you regain and sustain proper blood glucose regulation.

All diets work a lot better for men than women. This is not particular to carnivore. This is simply because a man's body is made for leanness so it will always prefer its natural state. The only men who have a difficult time losing weight, are the ones who are estrogen dominant. But normally, a man's higher muscle mass and testosterone always works to keep them lean. Leanness is their default state. This is why men tend to stay lean for longer and become lean faster than women.

Women's bodies are not made for leanness. Leanness for a child bearing hunter/gatherer means probable death. For this reason, estrogen causes for women to store and spare fat. We even have specialized areas on our bodies - hips, thighs, buttocks, breasts in order to carry this extra fat without reducing our mobility. A woman's body rejects low fat percentages and easily resorts to a starvation response to prevent it so I always tell women to be realistic with their weight loss goals. The younger you are and the less years you have been marinating in estrogen, the easier it is to become lean but as you get older, watch out.

Though humans have always had the capability to live for a very long time, it usually didn't ever occur. Child delivery could easily kill off half the women in a tribe. So, we now live longer in estrogen and this is obvious by how we begin to expand as we get older. Some women are lucky and have great leptin expression which keeps them lean forever as it is perfectly balanced with estrogen but the reality is that they are anomalies and wouldn't have survived very well in the wild. That's why they are not common. The vast majority of us become fatter with age. We do not retain our youthful figures.

So when finding a diet, find one that keeps you under obesity and preserves as much metabolic health as possible.

4. I was told to forget about fat loss and focus on "health gain". Will that ward off diabetes?

No. Fat loss is health gain. In fact, that's the first sign that you are gaining health. Without fat loss, you have gained nothing.

The first sign that your metabolism is failing, is the gain of excess body fat. That's the canary in the coalmine. Losing it is the first sign that your metabolism is normalizing. This is because body fat determines how profoundly you are affecting your metabolism. Everything else that happens to your metabolic panel may show you are headed in the right direction but it's ultimately the loss of body fat that signifies you have reversed the starvation adaptation which stores and spares it.

Because it is so difficult to affect metabolism profoundly enough to lose body fat, people simply give up. Since there is no one dietary protocol that can promise the loss of body fat, the ones selling you it will try to divert your attention elsewhere when they fail. Don't let people's failures redefine what you need to do to get healthy.

Targeting body fat is always the goal, period. The only ones who can reverse and ward off diabetes are the ones who lose body fat. Everyone else is constantly at the brink of diabetes, and will develop the same pathologies as a diabetic with time, from chronic metabolic syndrome. Having excess body fat will deteriorate your health. There are no healthy, vibrant, 400 lbs. 60 year old's. You will lose your mobility and you will be on a slew of medications to prevent death, even without having full blown diabetes. Diabetes is not the worse thing that happens to people with metabolic syndrome.

5. Is diabetes having "too much insulin in the body"?

No. This is why the insulin-carbohydrate hypothesis is null and void.

Diabetes is the result of abnormal blood glucose regulation. This abnormality results in metabolic pathologies that include excess fat storage and sparing, high body fat/blood glucose set points, exaggerated adrenal stress responses and a malfunction in insulin expression. Insulin is under expressed in tissues and organs but over expressed at the fat mass. Insulin malfunction contributes to everything from kidney disease to cardiovascular disease. All of these conditions are common in diabetics and even in people with simple metabolic syndrome.

This insulin malfunction is commonly referred to as "insulin resistance" and it can sometimes manifest as higher than normal fasting insulin serum levels but often times it doesn't. After all, insulin can malfunction at any serum level. Sometimes the body doesn't compensate for this malfunction by producing more insulin at all. This is why there is a percentage of overweight/obese/diabetic people who have completely normal insulin levels. This is also why insulin is usually not a metric that is measured in people with Type II diabetes. It's too imprecise and very variable. Also addressing its levels will not magically "fix" its malfunction.

This is why you shouldn't think of diabetes as having "too much insulin in the body" but having abnormal insulin expression instead.

6. Are carbohydrates "toxins"?

No. Carbohydrate is a macronutrient.

Anything in excess is toxic from water to oxygen. The dose makes the poison. The problem is that no one can determine what the proper "dose" for anything is until it kills you. Macronutrients do not kill you. This is why their "excess" is subjective.

People have tried to determine macronutrient excess through the counting of calories but that has been a total bust. People have tried to define excess through "moderation" but no one knows how to quantify that. So no one knows what exactly "excess" is.

In this blog, when we speak about excess, we are only speaking of what your individual macros have determined is excess. We do not use calories and we do not use "moderation". We only use your body fat, gender and goals to determine what excess would be for you. You can calculate your individual macros here. 

As far as carbohydrates are concerned, they aren't toxins. They are simply useless. This is great news because for someone who is trying to control their blood glucose, they can completely eliminate carbs without any adverse effects. Since carbohydrate is the macronutrient that most effects blood glucose homeostasis it's a good idea to do just that.

Six common beliefs addressed, Part 227

1. It seems like everyone who was able to lose a significant amount of weight always stall 20 -25 lbs. from goal weight.

Yes. It's called leptin.

It is actually more difficult for a person who is a little overweight to lose some weight than a person who is significantly overweight. But it is nearly impossible for the significantly overweight to ever reach leanness, even though they lose weight easier than the person who is only a little overweight.

The significantly overweight usually stall before they reach leanness. Some stall while still being very overweight and others stall 20 - 25 pounds from reaching leanness. Notice that I am describing the result as "leanness" not "goal weight". "Goal weight" doesn't mean anything because your goals might not be realistic or correct. Furthermore "weight" is not what's causing your health issues. What you want is the loss of excess body fat and that results as leanness when you succeed.

The problem is that overweight/obesity is not simple weight gain. It's an adaptation towards starvation so the body has compensatory mechanisms in place to prevent the loss of body fat and/or preserve a higher-than-normal weight set point. This is why people stall while still overweight or they stall before ever reaching leanness, even when they lose a significant amount of weight and are no longer considered obese.

This is because leptin resistance is common in the overweight/obese as leptin is the main hormone to under express if you want to preserve fat mass. You can't burn fat without leptin. So, if the body is under a starvation adaptation, it makes sense to under express leptin.

Let me make clear that this occurs to everyone, not just the overweight/obese. A healthy person will also see an under expression of leptin when their fat mass is challenged but the difference is that this under expression only occurs when body fat mass drops to levels that are too low. That's why the person who's not significantly overweight, and only wants to lose a few pounds, finds it so difficult to do. Leptin prevents starvation. The difference is that leptin under expression occurs in the overweight/obese while there is still plenty of body fat to safely lose.

2. Obesity is "inflammatory".

Anything that triggers the immune system is inflammatory. Most diseases/conditions, trigger the immune system so most diseases/conditions are inflammatory. Therefore, our immune system causes most of the problems we suffer from, but it is also what keeps us alive.

Overweight/obesity is a condition that results from a metabolism that is adapted towards starvation. This trajectory begins with blood glucose abnormalities which interfere with its proper regulation. If you are starving, it would be a good thing to become very fat and spare that fat, so it never gets burned. That's what the overweight/obese metabolism is doing. It's getting very fat, from whatever nutrient availability there is, and spares that fat so that it cannot be burned. It uses complex compensatory mechanisms to achieve this.

The only thing "inflammatory" about this process is at the adipocytes (fat cells) themselves. Many of these adipocytes simply "explode", for lack of a better term, from the excess fat that is being shoved into them. This causes an immune reaction at the fat mass. In fact, this fat mass is full of inflammatory cytokines and other immune cell activity because of the dead and dying, "exploded" fat cells. This further affects their normal function and response to metabolic demands. The fat mass behaves a little like cancer, where it no longer functions properly and grows uncontrollably.

3. My friend was slightly overweight and decided to go on a fad "keto" diet she found online. Now she looks like a skeleton. Everyone is very concerned about her, but she seems to think everything is all right. I know that people tend to exaggerate when someone loses weight, so to put it in perspective for you, she basically looks exactly like Maria Emmerich. I have noticed several people, online, who this has happened to. It is not common, but it happens, and I wonder why.

People that are only a little overweight or become overweight/obese later in life, for a short time, usually preserve their leptin expression and they respond very well to diet, causing weight loss that allows them to reach leanness. It is not common because usually people who have only a little weight to lose, do not seek much help in doing so since not much help is needed, and you never hear about their stories. It's the 300 pounder that continues with their struggle for all to see.

Some people have super leptin sensitivity and will lose more weight than intended because abnormal leptin expression can make you obese or make you very thin. It is blind to a proper weight set point. In fact, the very obese who become very thin are the ones most likely to have weight regain. Their leptin should have stopped their body fat loss earlier than it did. This adapts adipose tissue in the long run, to simply get better at sparing fat. That way, the next time fat is challenged, it will certainly not budge.

Someone who is as thin as you describe your friend to be, is basically cachexic. The fad "keto" diet is notorious for wasting muscle mass and that's basically the hallmark of cachexia. But, as to what exactly is going on, we won't ever know unless your friend tells you.

Some people have eating disorders and you would never know it because they hide it very well. There are certain illnesses that cause "wasting" and some people do not want to tell their loved ones about it. All I can tell you is that something else is going on with your friend because even if this fad "keto" diet had the ability to waste someone away like that, they would notice it and do something about it. So, the fact that you say your friend appears to think "everything is all right" might indicate that something else besides diet is going on.

4. What do you do when your "diet is over"?

On this blog your protocol is never "over".

5. I read that diabetics have high serum amino acids, and this is why they developed diabetes.

I don't know where you read this but let's talk about what is truly known.

We know that people with diabetes are "insulin resistant". They aren't insulin resistant in their entire body. Their tissues and organs are resistant to insulin to varying levels and degrees. Because of this, they have high serum blood glucose, high serum ketones, high serum fats, high serum amino acids, high serum everything. You need insulin to deliver all of these nutrients into cells and diabetics are... well, insulin resistant. So, everything is just left to float around in the serum until it can be converted to sugar and then stored as fat.

So, it wouldn't be surprising that diabetics would have high serum amino acids since they have high of everything else in the serum. Nothing new to see here. It's not like diabetics are known for building muscle mass, which is what amino acids would be great for. Unfortunately, that requires insulin.

Diabetes is not a mystery. We know exactly what causes it so whatever quack comes along and tells you that some "new thing" has been discovered that causes diabetes, you can tell them that there is an older thing that was discovered, decades ago, that truly causes diabetes - lifestyle.

Diabetes is a lifestyle choice. It's caused by choices in diet and exercise and the behaviors that effect both. That's it. That is why the only thing that has been shown to put diabetes into remission are lifestyle changes. Not blood glucose lowering medications. Not insulin pumps. Not triglyceride medications or statins. And certainly not amino acid clearance. In fact, you can put diabetes into remission using lifestyle changes, even before you fully reverse overweight/obesity. Lifestyle. You have to change your lifestyle.

6. I have a drastic drop in blood glucose when I walk after eating. In other words, I can bring a 200 mg/dL postprandial reading, down to double digits by just going for a long walk. This made me wonder if I can use walking to lower blood glucose instead of diet as it technically achieves the same thing. 

I know you thought your premise would be laughed at and dismissed, but no. What you are describing is actually better at regulating blood glucose than trying to do it through eating fat or not eating at all. In other words, exercise works better than "keto" and certainly better than fasting.

The reason is because this drop in blood glucose, while exercising, is non-insulin mediated so you are actually addressing your insulin sensitivity while lowering your blood glucose. You are also truly lowering your blood glucose, not hiding its rise and you are not using extra insulin or glucose lowering medications to do so, so you don't have to be worried about hypoglycemia later on. This is what keeps a high carbohydrate, agrarian society, so healthy. All that workload after a bowl of rice is a good thing.

Anything that controls postprandial blood glucose is a good thing because postprandial highs effect blood glucose regulation over time, which will eventually induce diabetes and the sparing of body fat. But using walking as a way of keeping postprandial blood glucose low, chronically, is not truly the correct way of treating metabolic syndrome/diabetes, once you have it, though it's a cool hack and a great prevention.

The potential problems though, are numerous. The amount of walking needed to do this may not always be possible so you will still have some days where your blood glucose will make that rise and then dip when fasting which is what wrecks metabolism. It doesn't take many dips to start pathology. One dip has been shown to be enough in getting the ball rolling. So, unless you have a very strict, routine that never changes, you might not always be consistent with this little hack. Worse, what happens if you can't walk because of some health reason or injury? Certain seasons might make it difficult for you to go out walking. Some long-term diabetics will actually experience blood glucose highs after exercising. Also, this hack will never help you learn how to eat properly. If you don't eat properly, diabetes will always be around the corner and if you already have it, it will only worsen.

So, it's a cool hack that actually addresses the problem, and you don't see many hacks doing that often, but it's not going to work for the long term. You truly need a long term treatment in order to properly address diabetes. So proper diet, along with walking, is the best course of action.

Six common beliefs addressed, Part 220

1. I ate potatoes and some hours later my blood glucose was 78 mg/dL. It’s never been under 100 mg/dL. I am a diabetic on Metformin. 

One blood glucose reading in isolation is not enough to determine what happened. Blood glucose readings are meant to detect patterns in metabolic function so multiple readings should be taken, across a span of time, in order to get a more complete picture of how the body is regulating its blood glucose. It would have been nice to know what your blood glucose was an hour and then two hours, after your meal, for example.

We can only guess why your blood glucose dropped to such low levels without you having done a very long fast. Usually, blood glucose will drop into the 70's mg/dL, for people with metabolic syndrome/diabetes after fasts of more than 18 hours. Blood glucose should never drop this low though as the body always keeps its blood glucose around 84 mg/dL, if it’s healthy.

Your blood glucose most likely went up high after eating the potatoes and this flood of extra insulin, plus the Metformin, dropped your blood glucose into the 70's mg/dL while fasting. That's why people on blood glucose medications are told to eat regularly and not fast for long periods.

2. I have been on "keto" for some years. I have been able to keep my blood glucose pretty stable, even though I am a diabetic on Metformin. Since I have heard "keto" people say that this diet can "cure" diabetes, I decided to give it a test and see if it "cured" me. I checked my blood glucose before eating at 10:45 am and it was 113 mg/dL. I ate a plain boiled potato and an hour later it was 193 mg/dL. Two hours later it was 250 mg/dL. It's 3 pm now and it's dropped to 97 mg/dL. I didn't eat anything else since, because I feel full and not hungry at all. It doesn't seem like I have been "cured".

You are correct. The reason it seems like you haven't been cured is because you haven't been "cured". Worse, you have been lied to. There is no known cure for diabetes as of this post. I get a lot of people asking me these types of question because of the quacks online who have fed them lies. "Keto" is not a cure for diabetes. All diets are only palliative treatments for the syndrome known as diabetes. What you are experiencing is diabetes. Diabetes is the inability to regulate blood glucose properly.

The problem is that when you are a diabetic, any glucose from diet, including glucose in the form of starch in potatoes, causes for blood glucose regulation to deteriorate. This can never be "cured". You can only manage your blood glucose with diet and medications. It will only remain managed as long as you don't veer from either. You want to keep your diabetes under control because it is chronic and will progress if not treated properly.

The goal is to prevent your blood glucose from taking these swings up and down. It's these large disparities in highs and lows that will worsen your condition and eventually lead to the complications of diabetes.

Stay away from carbs. Not because staying away from them will "cure" you or keep your blood glucose low, but because staying away from them will help minimize these erratic ups and downs in blood glucose which will eventually ruin your health and end in death.

As far as feeling full and not hungry is concerned, that's called "starvation mode". It's just like when you become less and less hungry, the longer you extend your fast. Contrary to popular belief, the potato didn't simply fill you up, keeping you satiated, so you eat less calories during the day. It actually disrupted your blood glucose homeostasis and your body simply interpreted that as starvation. Your metabolic rate dropped and your leptin under expressed, sparing your fat mass further. There is no need to be hungry if energy is being conserved. Inability to burn fat signals starvation. You are getting fatter as I write this.

You can't solve this by eating fat, like these "keto" people claim. That only hides the problem and makes you even doubly fat because there is nothing worse than consuming fat with poor leptin expression. You will store it all and then some. You need to eat a proper meal, even if you aren't hungry, to see if you can stabilize your blood glucose and halt this starvation mode. When you start getting your appetite back, then it's because you are headed in the right direction.

3. I was told by "keto" people that when you have metabolic syndrome/diabetes, it means that your insulin "doesn't work".

If your insulin "didn't work", you would have the same symptoms as a Type I diabetic. The insulin of Type II diabetics is "working" just fine. There are studies that even show that the "lock and key" mechanism between insulin and cells is working properly and not "broken", as it was once thought to be.

The problem is that insulin doesn't just do one thing. It is a hormone that is responsible for many processes in the body and basically, it's these processes that are not functioning properly. They aren't responding to insulin as they should, hence the term "insulin resistance". So, it's not that insulin "doesn't work", it's that diabetics have poor insulin function (release/expression) as a whole. They require more and more insulin to get the job done.

The mechanism behind this is very complicated and involves multiple metabolic systems that have deteriorated in the diabetic. So, to avoid complexity, which won't solve anything, let's just say that the body already has too much glucose and it's no longer able to control it, so it is no longer accepting more. That at least will help you target something, like not putting any more glucose in and getting what you have out.

4. How can my HbA1C have dropped to 5.2 from 5.9 but I checked my postprandial blood glucose, and it was 190 mg/dL. My fasting blood glucose never drops below 100 mg/dL. I have been on Metformin for about 8 months.

Because if your blood glucose drops very low during fasting, your HbA1C lowers but you still aren't regulating your blood glucose properly. HbA1C is a measurement of average blood glucose during a three-month period. You can have a seemingly normal HbA1C if your very high blood glucose readings cancel out your very low blood glucose readings. Basically, large disparities in highs and lows can still produce a lower HbA1C but you are getting sicker with time. In fact, HbA1C has the tendency to be the last marker to finally become abnormal. Your doctor will notice your high fasting blood glucose before he notices a high HbA1C. This is why lowering of HbA1C has not been shown to be very beneficial to diabetics in the long run and they still succumb to the progression of the "disease".

The same goes for low fasting blood glucose. If your blood glucose is 80 mg/dL while fasting, that's fantastic but if it rises to 200 mg/dL postprandial, you will eventually get diabetes, and if you already have it, those readings show you don't have it under control. That's really the crux of the problem. While a diabetic puts all of his focus on low fasting blood glucose and a lowering of their HbA1C, their blood glucose regulation continues to deteriorate.

Diabetes is not a disease of high blood glucose nor of a high HbA1C, though those are the diagnostic tools used to determine if you are diabetic or not. The syndrome itself is large disparities between highs and lows in blood glucose of which the lows drive the condition's progression. That's the engine driving all of the associated pathologies called diabetes, including overweight/obesity. You must avoid large disparities in blood glucose because that's the "disease". These disparities only deteriorate your insulin function and exacerbate overweight/obesity through a "starvation adaptation". Continuing to be overweight/obese does not improve diabetes outcomes. It only worsens them. High body fat is fertilizer for diabetes.

5. A person can have poor blood glucose regulation and not be diabetic. This poor blood glucose regulation will not cause overweight/obesity.

Diabetes is a syndrome which is the result of end stage metabolic dysfunction. Diabetes is not the beginning of your problems. It is the end.

A person can be in a perpetual state of appearing "healthy" while still having pathological metabolic function, for years, until they eventually succumb to diabetes. Remember, the engine that drives the syndrome known as diabetes are large disparities between blood glucose highs and lows. This disparity does not ever have to go into a "diabetic range". For example, a low fasting blood glucose of 70 mg/dL and a postprandial blood glucose of 150 mg/dL will eventually cause overweight/obesity and diabetes. This person will pass all of their annual blood work. They will have a normal HbA1C and a normal fasting blood glucose, all while slowly putting on body fat and having undetected, erratic blood glucose regulation. This is why diabetes is a syndrome that can take decades to develop.

The culprit is most commonly diet. It is these high postprandial blood glucose readings that drop fasting blood glucose to very low levels. It is then the low fasting blood glucose levels that push the body towards a starvation adaptation which spares body fat and deteriorates insulin function causing an "energy crises" in certain tissues and an "energy toxicity" at the fat mass. This occurs over a long period of time. It is actually mostly occurring while the person is seemingly still considered "healthy".

I once had an acquaintance who was in pretty good health. They had only put on a few pounds, through the years, and had recently started developing a bit of high blood pressure. All of their other health markers were prefect and their doctor was not concerned. Normally, the person will assume that these common and insignificant health issues are simply the normal result of getting older. Well, my blood glucose meter proved otherwise. Their postprandial blood glucose clocked in at 176 mg/dL. This was the result of eating two slices of pizza, three hours before.

This abnormality would have gone undetected, for decades, if it hadn't been for them wanting to check their blood glucose at that moment. Two seemingly benign slices of pizza were enough to cause havoc on metabolism and why not? It shouldn't be surprising, as pizza is the world's most obesogenic food. Pizza is a very high carb food, that is also very high in fat, and poor in protein. Pizza is the embodiment of the Standard American Diet (SAD). You can also see how watching calories would not prevent weight gain or diabetes. Two slices of pizza would fit a daily calorie budget, while still taking you towards obesity and diabetes through blood glucose dysregulation.

All diabetes usually begins at the mouth, and it ends everywhere else on the body. You can still control it at the mouth stage, but once it metastasizes from there, it's a roll of the dice whether it can be put into remission or not. This is why following a healthy diet, that keeps blood glucose stable and under control, is of vital importance because all of these seemingly "healthy" people, who believe they are immune to eating pizza, are simply not. No one is.

6. If my diet is under control, overweight/obesity should not worsen my diabetes. Diabetes solely a diet induced disease.

Diabetes is a lifestyle choice because multiple lifestyle factors, including behavior, activity level and diet, contribute to it. So how does overweight/obesity factor into this? Why would it make diabetes worse or even cause it?

Overweight/obesity is the right hand of diabetes and is usually the first stage of it. Overweight/obesity further deteriorates insulin function over time. High body fat (overweight/obesity) puts a high insulin demand on the body because it takes a lot of insulin to keep fat trapped in fat cells. So, once again we get that "compounding" effect where one thing piles on top of another and collapses metabolic function:

• A bad diet that interrupts the proper regulation of blood glucose, deteriorates insulin function plus,
• Overweight/obesity puts a high insulin demand on the body, further deteriorating blood glucose control and insulin function.

As you can see, diabetes and overweight/obesity work hand in hand, in a vicious circle, to progress the condition. If diet doesn't topple your health fast enough, overweight/obesity will finish the job. It's a double assault.

This is why diet is not enough. Diet is only palliative. It will never address the root cause of the syndrome. Diet was only the root, at the beginning stages of the syndrome, but not once the ball gets rolling. Now the ball has momentum and needs no further dietary assistance to keep rolling downhill. It has all the glucose it needs, coming from the inside, to continue the progression of the condition. Once you finally get diabetes, and make no mistake you most likely will, the condition itself will make it doubly hard for you to get rid of body fat, when you most need to, as diabetes is a fat sparing mechanism and makes it very difficult to regain blood glucose homeostasis enough to allow body fat loss to begin with. Again, diabetes is the right hand of overweight/obesity.

So, you can't be fooled by these "keto" people who weigh 500 pounds and think they are doing just fine because their insulin happens to be low. That's pure quackery and has no scientific foundation. That's simply someone who can't lose body fat and doesn't want the diet they are promoting to be blamed for it.

Six common beliefs addressed, Part 207

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Six common beliefs addressed, Part 206

1. I have lost a lot of weight and eat two meals a day. Lately, I have found it works even better for my schedule to eat my two meals, very early in the day as I have a long work commute. I am basically done eating by 10:30 AM. I then won’t eat anything else until the following day. I am finding that I am slowly gaining weight. I don't understand. I have not veered off of my initial diet which helped me lose all of the weight and kept me in maintenance.

Your fasting times have increased and it seems like your body is not very happy with that. Remember, any treatment for obesity is in itself obesogenic. I know that's a terrible nightmare reality, but it’s true. Any challenge to fat mass only makes the body double down and try to hoard and store more of it.

You lost a significant amount of weight so you challenged your body’s fat mass as much as it will allow you to, especially if you reached leanness. It’s had enough and won’t accept more fasting. It has now shifted into active obesity mode and you are simply storing more fat than you should be from your two meals.

I suggest you either space out your two meals further apart or add a third one a bit later in the day. You have to make sure you keep your leptin expression going and not have it stall on you. The best way to do that is to increase your nutrient availability.

2. It is a “keto” myth that I can eat as much fat as I want and lose weight instead of gain.

Yes. At least, it becomes a myth at some point in your journey. It doesn't happen right away. 

Going "keto" helps regulate blood glucose better. This normalizes insulin function allowing the body to increase its leptin expression and burn body fat. Usually the fatter you are, the better this works. Unfortunately, the fatter you are the quicker it stops working because it's not enough to break the starvation adaptation. That can only occur from sustaining long term proper blood glucose regulation. 

"Keto", as it is followed online, never sustains proper blood glucose regulation in the long term. The diet is too low in protein, too high in fat and restricts the intake of carbs through "carb counting" individual food items, which is not the proper way to restrict carbs. It also usually incorporates "fasting" which is unnecessary as ketogenic protocols already mimic starvation. The massive amounts of fat eaten on this bastardized version of the diet, simply levels out with your weight set point and you remain less obese but obese none the less. This weight stall is when you can see your leptin is under expressed and does not react to the amount of fat you are consuming at all. Instead, it purposely under expresses further from the initial loss of body fat which occurred in the beginning. Worse. This stall also confirms that your blood glucose is not properly regulated. 

I am going to elaborate on this just a little because it is easy to believe two common fallacies when this weight stalling effect takes place:

• Fallacy 1 - The person is consuming too many calories and now they are stalling or regaining weight.
• Fallacy 2 - This shouldn't be happening at all because the thinner the person is becoming, the more fat they should be able to eat as their leptin is improving and their metabolic rate should be increasing.

Well, neither are correct. Fallacy 1 is not what’s occurring for the obvious reasons I have discussed throughout this blog. Fallacy 2 is much more interesting but it is unfortunately not the case for the overweight/obese. In fact, the opposite occurs to them. Weight loss is not making their metabolism work as a healthy person’s would. It is actually doubling down on their tendency to be obese.

Obesity is a starvation adaptation and any challenge to the fat mass reinforces this. This means that their leptin expression continues to be reduced or reduces further as they become lean. Their metabolism will not react positively to dietary fat like you would expect since that's what occurs to a healthy, lean person. Remember how difficult it is for the lean to become fat, especially from dietary fat intake. Well, your weight loss does not make you suddenly obesity resistant like the lean. This is why obesity is a life long problem, even after you become less obese.

This is why concentrating on proper blood glucose regulation, not eating fat, should supersede any other goal because abnormal blood glucose regulation is what set the adaptation in motion. 

3. You should "overeat" protein for extra energy.

The energy in protein is only used for the building of muscle mass. This is why people train for muscle building in a caloric surplus. The overweight/obese, who are not doing any significant training, should stick to their macros.

This is particularly true because most, who aren't athletes, do not know how to consume protein correctly and believe they can get “extra protein energy” by eating rib eyes. That’s not how it works. Protein comes with fat. This is why body builders use protein supplements not rib eyes, so they can avoid the fat.

4. They told me I shouldn't use coconut oil in coffee because it adds extra calories that I might not burn off.

"They" always get it wrong. 

You shouldn't consume coconut oil in coffee because we never evolved to do so. It has nothing to do with calories. The proper way to think about this is as follows - You don't want too much added fat because you most likely do not have suffice leptin expression to burn body fat in response to it. If you don't burn enough body fat, then the added dietary fat will just add to your fat stores.

5. Calories matter especially to an overweight person.

I want everyone to start thinking about obesity in a different way because the traditional way of thinking about it will not help you.

Where calories are coming from matters most, especially to an overweight/obese person because the "where" is what affects blood glucose regulation. You are better able to tackle obesity when you target methods that aren't generalized like calories are but instead target methods that improve blood glucose homeostasis. What, how and when you eat are better strategies for building a proper diet. Remember obesity is not a simple "in/out problem". It’s a very complicated "out" problem. Many factors effect this, not simply the availability of what’s going in and out. You must burn fat, not calories, in order to reverse obesity.

6. I was told that "insulin resistance" will reverse when I become lean. Overweight people have "insulin resistance" due to weight gain.

This is half true. I have explained before how the overweight/obese have a high insulin demand and so they tend to have high insulin levels in order to keep their fat mass locked down. This is only half their problem though as many people who are overweight/obese do not have high insulin levels at all. So it's not insulin levels but insulin function.

Sometimes insulin levels correlate with this dysfunction but not always. The insulin function of the overweight/obese deteriorated first, due to the blood glucose dysregulation most commonly caused by an inappropriate diet. It is this deterioration that now keeps the weight set point high because their body becomes adapted at hoarding fat and preventing the lowering of blood glucose. Now it's like a vicious circle. Diet started the problem and now body fat helps maintain it.

Six common beliefs addressed, Part 204

1. I've started to notice that a lot of "low carb doctors", who push carnivore or "keto", are obsessed with eggs. They are now pushing eggs over meat. 

You have to understand that for most of these "doctors", “keto” and low carb are not their first rodeo. These people have been peddling one failed diet or another, for many years, before they got here. Most of the ones pushing eggs and greens, as a “keto” protocol, were once pushers of plant based protocols so they continue pushing a "less meat" agenda, even when they have been forced to include meat.

Stay away from “keto/low carb doctors" and stay focused on what's really going on with you. You cannot treat what you don't understand. Obesity is not caused by following the wrong food lists or buying the wrong diet book. Obesity is the chronic under expression of leptin due to metabolic abnormalities caused by blood glucose dysregulation. Blood glucose dysregulation ends in metabolic syndrome/diabetes which are starvation adaptations that further perpetuate obesity. In fact, the only commonality found in obesity research, between patients, is blood glucose dysregulation. Obese people vary in gender, age, health, pathologies, diets, lifestyles, appetites, etc. but they don't vary in blood glucose dysregulation. 

So in essence, all you have to worry about is obtaining/maintaining proper blood glucose regulation. Everything else is flim-flam. It doesn't matter if you can achieve proper blood glucose regulation through eggs or filet mignon. No one individual food item is going to achieve proper blood glucose regulation anyway. Only the right macronutrient composition of low carb, moderate fat and adequate protein can.

2. A family member was recently hospitalized for severe dehydration and has not been released from the hospital because they developed rhabdomyolysis. Doctors told them they would need dialysis if it continues. This reminded me of diabetes, for some reason. 

Rhabdomyolysis (rhabdo) is a potentially life-threatening syndrome resulting from the rapid breakdown of skeletal muscle which leaks muscle contents into the blood. The most common causes are crush injury, overexertion, alcohol abuse and certain medicines and toxic substances. Rhabdo can cause damage to the kidneys because they become overworked trying to eliminate this muscle waste. Rhabdo is not directly associated with diabetes but any chronic disease, like diabetes, can put you at more risk for developing this condition after any injury or illness. When the body loses resilience through one chronic condition, it affects how it handles all other conditions.

I think that the reason you thought of diabetes when you heard about rhabdo is because diabetics also break down their lean muscle mass, at an exaggerated rate, and eventually develop kidney disease. This is because their kidneys are also overworked as they try to eliminate this excess waste. The excess waste from a diabetic's muscle break down is mostly sugar. So rhabdo can damage kidneys in a few days and diabetes can take a decade, but their end result is the same - dialysis.

There are also other factors in diabetes that cause kidney damage as well, which include the chronic inflammation and excess water retention caused by hyperinsulinemia itself. This water retention causes high blood pressure and high blood pressure, especially in the small vessels, damages the kidneys over time. So even though these conditions are not connected, they both overwork the kidneys, eventually damaging them.

3. Low carb advocates always talk about insulin resistance or insulin sensitivity, but they never fully explain either. 

I have used the term insulin resistance and insulin sensitivity before but I refrain from doing so as much as possible. This is because low carb advocates blame insulin resistance for a slew of ailments that have nothing to do with insulin. It is such a misused and overused term that it has lost most of its meaning. Insulin sensitivity is also too general a term to use since diabetics are very insulin sensitive, at the fat mass only, so without nuance the term is mostly meaningless.

So since there is no such thing as being completely insulin resistant or completely insulin sensitive, I like to use insulin function instead because ultimately that's what’s deteriorated in metabolic problems. Insulin serum levels are chronically high, insulin is over expressed at the fat mass and it’s under expressed in other tissues and organs, at varying rates. That's poor overall insulin function.

4. My friend is on a traditional diet that's calorically restricted and I am following a "keto" protocol. Once a week, we both allow ourselves to have a dessert. I make myself a "keto" dessert, which complies with my macros, and she has a "cheat day" where she eats something she usually can’t, like a brownie. I think my "keto" dessert is a better option than hers but she thinks it equates to the same thing for us both.

Your "keto" dessert is definitely better because you are not going off protocol just to have a dessert. More importantly, a day of higher fat does not disrupt blood glucose regulation but a day of higher glucose does.

Of course, your friend is seeing this through the lens of calories so she assumes, both desserts are a wash at the end of the day but if you have been reading my posts, you know better. Just one episode of "dietary induced hypoglycemia", meaning that your postprandial blood glucose was disrupted enough to cause a prolonged insulin release/expression which then drops blood glucose while fasting, is enough to get the ball rolling towards metabolic disaster. You have to understand that our blood only has about one gram of glucose, at any given time. This means anything over that is technically overload.

Now this doesn't mean that your friend will drop dead instantly from a piece of pie. After all, there are hunger/gatherers who are forced to eat honey, for weeks on end, just to survive. Our metabolism is pretty resilient, particularly when there is nothing wrong with it at the moment. It just means that your friend is setting the stage for future problems.

On average, we live longer than hunter/gatherers so we have a future to worry about it. Most hunter/gatherers do not have to worry about losing a leg at 60 years old. Because we can live such long lives, we have more time for things to go wrong and things will go wrong. If your friend is already overweight/obese and/or suffering from other metabolic dysfunction, then things will go wrong much more quickly for her.

5. There is no way to reduce systemic stress.

The best ways to reduce systemic adrenal stress are the following:

• Take control of any chronic underlying conditions - Chronic conditions like metabolic syndrome, auto immune or any other inflammatory disease will cause your body to be in a persistent state of stress. It is very difficult to regulate blood glucose under stress. You need to discuss with your doctor effective ways of gaining control of any chronic condition you may have. A lot of people just go to routine doctor visits and find no real improvement in symptoms. They are either misdiagnosed or given ineffective treatments. You have to take control of your healthcare. Make sure you aren't just going through the motions when you visit your physician. If they can’t help you, find one who can.
• Take control of medications - You have to make sure you aren't being over medicated with drugs that effect blood glucose regulation. A lot of people don't realize that lower doses of medications are still effective in treating their condition. Others don't realize that the medication they are on is actually useless and not helping them at all. So make sure you discuss with your doctor your medications, particularly if you have been on them for a very long time and the dose has not been changed nor has your condition been recently re-tested. Some people are still taking medications for conditions they no longer even have. Others are taking over the counter medications, at their own discretion, when a better prescription medication may be available which can be better monitored.
• Exercise daily in a predictable routine - Exercise helps regulate inflammation by directly affecting inflammatory hormones like cortisol. You should have a predictable and consistent exercise routine you follow daily so the body becomes primed on when to burn energy and when to store it.
• Eat two to three meals a day in a predictable routine - Eat real meals, not novelties or "snacks". Meals should be protein prioritized, low in carbs and moderate in fat. Make sure your meal timings are consistent every day. Do not go long stretches without eating. Make sure you eat enough at each meal.
• Fast in a predictable routine - If your meal timings are consistent, then this would automatically make your fasting times consistent as well. 12 -18 hours is the only daily fasting schedule that we recommend on this blog. Choose the schedule within that time frame that prevents hunger and/or any other symptoms.
• Sleep in a predictable routine - Go to sleep at the same time nightly. Not only will this allow you to sleep better and wake up naturally, without the alarm clock, but it will help you get enough sleep. Sleep induces the lowest insulin state you will have in a 24 hour period.
• Get rid of any caffeine - You will never be able to control your blood glucose until caffeine, in every form, is removed from your diet. Blood glucose dysregulation is the main cause of adrenal stress. 
  

As you can see most of the above recommendations are focused on normalizing circadian rhythms. Your circadian clock is the way your body communicates with its environment. It's not enough to just be conscious. To help keep your circadian rhythms healthy, keep a schedule and do things according to it. Do not be willy-nilly with your time because that will throw off your eating, fasting and sleeping schedules. Take your time more seriously. Remember, we only have a finite amount of time. Make the most of it. 

Following circadian rhythms reduce systemic stress through their affect on cortisol and other stress hormones. All animals follow circadian rhythms. Dopamine plays a crucial role in regulating circadian rhythms. Dopamine affects metabolism profoundly as it regulates metabolic hormones seasonally for fat storage and burning. So living erratically and unpredictably is not good for metabolism. This is particularly true for people with current metabolic syndrome.

6. They will never tell us the truth about obesity. 

This is because they don't have effective ways of treating obesity since it has no cure. For this reason, they want to place responsibility on you to keep it "under control". The advice that is currently given to the obese, only works for the lean as it can reduce their risk of future obesity. For the already obese, it is mostly useless.

It is reprehensible the way obesity is discussed in medical circles. It is akin to malpractice in my opinion. To tell an obese person to "aim for a healthy body mass index (BMI)" and "increase their exercise" in order to "cure" a condition without any known cure is abusive.

Obesity is a leptin condition, not a diet condition. You can not achieve a healthy BMI without leptin. I find it impossible to believe that a medical doctor would not know this as this information is not hidden in a mysterious vault that only warlocks can view. This is actually consistent in obesity medical literature.

So I am with you on your outrage. I just don't have any answers for you. The only thing I can think of is that they want people to continue “being mindful of their weight” and they don't want to give them any excuse to not be.

Six common beliefs addressed, Part 194

1. I lost a lot of weight on "keto" but now I have an iron deficiency.

Iron deficiencies can be caused by numerous things. You need to discuss this with your doctor and get the appropriate testing in order to determine what could be the cause.

2. There are fasting mimicking diets for those who can't tolerate strict extended fasting.

Ketogenic protocols are fasting mimicking diets. This is why they produce ketones. Ketones are a signal to the body that there is some form of starvation occurring.

You should not be doing any extended fasting unless you want to remain fat and become fatter. Extended fasting would be perfect for that as it further down regulates leptin very well.

I have a great way of gaining a lot of fat and keeping it on. You fast for about fourteen days and then eat "keto" bread and ice cream for the next seven. Keep doing that for about six months and you won't fit through the door by the end of it. Guaranteed results.

3. "Insulin is fattening". This is why type I diabetics become thin if they stop dosing exogenous insulin. 

This is part of the dangerous quackery surrounding the low carb community. They just can't shake the nonsense off to save their own life or anyone else's. They are the ones solely responsible of why low carb diets are not taken seriously by anyone. But let's be realistic here. All diet mongers claim to know the "one thing" that's to blame for obesity, which they magically have the easy "cure" for. The problem is that they always get it wrong. There is only one thing to blame for obesity - blood glucose dysregulation which results in insulin dysfunction and causes a chronic under expression of leptin. There is no known "cure" for it.

Insulin is not an obesity hormone. We all know it helps regulate blood glucose but it also stimulates the uptake of amino acids into cells and protein synthesis in muscle tissue. This means that you cannot have proper lean muscle mass without insulin. But aside from these anabolic properties, insulin is also an anticatabolic hormone. In other words, insulin prevents your body from breaking itself down into sugar and ketones through its regulation of glucagon. Leptin also regulates glucagon and leptin is a slave to insulin.

Type I diabetics do not "become thin" when they stop taking their exogenous insulin. They waste away to nothing and then eventually die from "glucagon gone wild". Leanness and wasting are two very different things, just like weight gain and obesity are two very different things. It doesn't matter that they both make the scale go up or down. Insulin surely does not make body builders obese and some inject it exogenously for gains. So it takes very different metabolic profiles to become lean, obese, muscular or emaciated. All of these metabolic profiles use metabolic hormones, like insulin, to acquire the end result but insulin in of itself is not the problem. The problem is the metabolic profile that it's in.

Insulin in a metabolic profile that does nothing but store fat is bad but so is insulin that doesn't build muscle or that breaks you down into sugar. All metabolic hormones are a slave to whatever metabolic profile you put them in. When you deteriorate insulin function from blood glucose dysregulation, then you will get insulin that stores fat and doesn't build muscle.

4. Coconut does not raise LDL cholesterol.

There are two important issues that are not correctly understood in the fad "keto" world - ketosis and lipids. 

The first one, ketosis, is easy. The type of ketosis that a person with metabolic issues wants to be in, is the ketosis produced from the burning of their own body fat. Not the burning of coconut oil, a dietary fat. Burning coconut oil means nothing. It just means you are alive and can produce heat. Being able to burn your own body fat means a lot. It is an indication that your metabolism is on the road to correcting itself. You need properly working leptin to burn body fat and that's not achieved through the consumption of coconut oil, but through the normalization of insulin expression.

Now comes the hard part, lipids. Coconut oil absolutely raises total cholesterol in some individuals more than others. This rise includes both HDL and LDL (lipoproteins) and the rise between the two depends on genetic variability. Coconut oil is composed of a variety of fatty acids but it's the lauric, myristic and palmitic acids which produce the main effects on LDL. What does that mean? We don't know. The reason we don't know is because rise and fall in lipoproteins do not tell us a thing about whether their function is benign or malignant. We usually discover this when you drop dead of a heart attack, not before.

Unfortunately, lipoprotein function is extremely complicated and science has not caught up with what exactly causes lipoprotein pathology. For this reason, the go-to "treatment" is to lower all lipoproteins (total cholesterol). The premise is that lowering them might cause some good and certainly no harm. That has not panned out for the majority of people but it has for a small segment.

There is a small segment of the population that has an LDL abnormality which puts them at high risk for heart disease and no, it's not simply hypercholesterolemia though it falls under that umbrella. There are actually many forms of hypercholesterolemia, many which are benign. After all, hypercholesterolemia simply means "high cholesterol". Instead, this malignant form of hypercholesterolemia is an actual LDL malfunction which is not fully understood as it is not known if the malfunction is in the LDL itself or in various apolipoproteins or both or what. What is known is that these people benefit significantly from an aggressive reduction of LDL. For this reason, we know that LDL is implicated in the atherosclerotic process but no one knows exactly how it becomes pathological.

To make matters even more complicated, many people have LDL malfunction with absolutely no rise in its levels. In fact, that is the most common form of LDL malfunction. This is why the vast majority of people suffer from heart disease or die of heart attacks with low to normal total cholesterol. I am no even taking into account all of the cardiovascular disease that is not lipid related at all.

I tried to keep the above explanation as simple as possible because it's an extremely complex topic and goes way beyond the scope of this blog. It is so complex than even lipidologists, who have dedicated their entire lives researching this, have differing opinions on what has been found so far. Worse, this is not only complex, it is not helpful to you. It's interesting. It's fascinating. But it's not helpful, particularly for those trying to resolve their metabolic syndrome. This is what irks me about "low carb doctors". They are trying to act as if they know about a subject matter that is so incredibly difficult, and goes way beyond the scope of their practice and knowledge, that they shouldn't be advising on it at all. All they want to do is find an excuse for you to continue taking their snake oil, even if it's at your detriment. Well, I don't sacrifice people in order to push an agenda.

For this reason, the best approach that someone should take with their cholesterol is that of caution. That's how we deal with this subject matter on this blog – very cautiously, because unlike "low carb doctors", I do not claim to know everything and I am certainly not a lipidologist.

Use common sense and stay away from coconut oil if it's raising your LDL cholesterol. In fact, you should stay away from coconut oil even if it's not, particularly if you have a family history of heart disease. This is because you can be one of those people that simply cannot metabolize these fatty acids well and end up with early onset heart disease. No one will be able to tell you in advance if you are that person or not until you have heart disease, unless you are able to perform extremely expensive genetic lipid testing that has to be interpreted by a lipidologist. If your doctor has issues prescribing you an insulin test, you can only imagine how they will feel about a rare genetic test, that they might not have even heard of before. Don't wait for your doctor and don't wait for a heart attack to get answers. You also don't want your answers coming from a low carb bozo. You have to advocate for yourself. Stop putting your health in someone else's hands.

The vast majority of us are of ancestry that did not evolve consuming coconut oil. Particularly not out of a hunter/gatherer environment. Coconuts are quite rare. They are only available in very specific regions. This means you can easily swap out coconut oil for ghee and not eat gallons of it. If your lipids are particularly sensitive, you can swap out all saturated fats for monounsaturated fats and still be in ketosis. Like I said before, ketosis is only beneficial if it's coming from the burning of your own body fat and that is achieved through very low carbohydrate intake.

5. I want to follow this diet but I get tired of eating the same foods.

I am assuming that "this diet" is referring to low carb diets as you never specified. 

Every time someone comes with this type of complaint, I know they are full of BS. On planet earth, food only comes in two forms - meat and vegetables. This means that there isn't much variety on what to eat except by preparing and combining these items in different ways with varying spices and herbs. What you are truly tired of eating is food. You want junk and I can't help with that.

I have said before, that on this blog, we do not coddle obesity by giving credence to excuses. You either follow the diet properly, or you don't. You always have a choice. You can choose to remain obese.

6. I am struggling with staying carnivore. I just think my “addiction” is very strong.

This is a blog for advice on metabolic health. We are not a sobriety group so we do not recognize “addiction”, in the context of food, as a legitimate condition. Here, we only recognize habits, excuses and negligence.

Changing your diet is a very difficult thing to do as all living things are creatures of habit and seek to continue with familiar norms. But if you are truly concerned with your health and lifespan, then you would do whatever it takes to correct it. This should take precedence over the desire to keep old habits.

Six common beliefs addressed, Part 164

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

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

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

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

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

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

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

3. Is glaucoma early insulin resistance?

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

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

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

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

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

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

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

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

6. You should count total carbs not net carbs.

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

Six common beliefs addressed, Part 163

1. I have a family member who was overweight and prediabetic. They went on "keto" and they now look sick. I can see all of their bones and even their tendons. They appear frail too. Is this the result of too low protein and not enough exercise?

Some people lose a lot of weight and their family and friends swear up and down that they look "sick" when they are just slim. We are so used to seeing people who are overweight that they begin to appear normal to us and slim people appear abnormal. But, I don't believe that is what you are describing. You are describing someone who has lost too much body mass.

I have seen this occur a few times before but it is rare. Yes, there are cases where this can be the result of a very low protein diet and lack of muscle building exercise but not always. This is actually the result of obesity and its long term effects on insulin and leptin expression.

There are some overweight/obese people, who experience temporary super leptin sensitivity when they treat their metabolic dysfunction through diet and exercise but it can also occur after bariatric surgery. The hormonal changes which induce the weight loss are like a "shock" to metabolism and the person loses a significant amount of weight. In fact, they lose so much weight that they end up going well below their body mass threshold and might appear gaunt and boney, even cachexic. This is because they aren't just losing body fat but they are losing a good amount of muscle as well as this sudden shift in metabolism causes stress, which in turn causes muscle wasting. For those who were once obese, this muscle wasting can be quite exaggerated.

After some time, this super leptin sensitivity usually reverses without any changes made to lifestyle. The reversal is caused by a shift in leptin, once again, where the sensitivity is lost and this can result in a return to obesity. As you can see, the metabolism of the obese is "blind" to its threshold. They gain weight well beyond their threshold and they lose it well beyond their threshold as well. This shows that weight loss is not the cure for obesity as obesity is not just "being fat", it's a metabolic dysfunction. In fact, weight loss can cause a doubling down effect of obesity.

This effect is the consequence of leptin resistance which is not fully understood. No one knows what the long term effects of leptin resistance are for weight management in the ones who can achieve sensitivity. The outcomes do not look good.

The very few who are able to sustain this sensitivity continue to have very low weight and it doesn't reverse. This low weight continues to be the result of an abnormal body composition. When they were obese, they had high body fat and low lean muscle mass. Now they have low body fat and low lean muscle mass. It is like they can sustain super leptin sensitivity, while still being insulin resistant and the resistance has finally spread to their fat mass.

But this will not be the case for the vast majority of these people. Most will simply return to obesity. Why? Because losing weight below your threshold would cause what? A reinforcement of the starvation response. What is overweight/obesity? A starvation adaptation. So once again, leptin sabotages your weight loss. It causes so much weight loss that the body panics and the starvation response is heightened causing an exaggerated under expression of leptin and weight regain once again over time.

So your family member has to monitor this carefully. People tend to become very happy with their weight loss but it can be a Trojan horse. Remember, the cure for obesity is not weight loss, it's acquiring metabolic homeostasis instead.

2. My father is in his 70's. He has never been overweight/obese. Instead he has been slim his whole life. He has blood glucose issues, which he has controlled very well and has never reached the stage of diabetes, but yet he has developed kidney disease which causes him blood pressure issues. His blood glucose is the reason for his kidney problems, according to his doctor. I don't understand how someone without diabetes or obesity can still develop the same pathologies as a full diabetic.

Your father is suffering the consequences of long term metabolic syndrome.

Metabolic syndrome does not always end in diabetes but it always ends in pathology. Diabetes is simply the stage of metabolic syndrome, when blood glucose remains chronically and abnormally high. This commonly occurs at the end stage of metabolic syndrome but not for everyone. There are a few who simply do not ever develop diabetes. Remember, metabolic syndrome/diabetes are syndromes. This means they only manifest similar related symptoms which can vary between individuals. Not only do the symptoms vary but the progression and prognosis varies as well.

This has been researched extensively and there still isn't a consensus as to what causes these differences between individuals. Some claim it's the fat cells. The more fat cells you have, or can expand, the longer you can ward off diabetes as metabolism begins accumulating fat in order to protect you from its dysfunction. Your father proved that's not necessarily the case as he's slim and still was protected from diabetes regardless. We do know that fat is somewhat protective but obviously doesn't always live up to its purpose.

Some say it's genetics. Still others say it's the ectopic fat accumulation that ultimately decides your fate. Who knows because the reality is that no one does as there have been conflicting results with the studies that have looked into this. What we do know is that metabolic syndrome/diabetes are extraordinarily complex and everything I have mentioned so far is implicated in its progression in some way or form.

What this tells us though, is what I have been saying on this blog for a long time. We see it In vivo with your father. Metabolic syndrome/diabetes are not "diseases" of high blood glucose. They are adaptations towards high blood glucose and this begins with improper blood glucose regulation. Instead of just high blood glucose, the most likely culprit for these differences between individuals is related to insulin expression over time and how it adapts to disruptions in blood glucose. How much insulin sensitivity can you maintain, in the presence of abnormal blood glucose control, and for how long and how does it effect other hormones (leptin) in the long run? This ultimately determines how adaptable your metabolism becomes to starvation (high weight, insulin and blood glucose set points) which in turn effects how much blood glucose regulation you lose over time.

Your blood glucose does not have to be very high for insulin function to deteriorate. Just like lower blood glucose will not magically cause you to regain insulin function. It all has to do with blood glucose disparities. These disparities can happen at any blood glucose range. It appears that some are more sensitive to these fluctuations than others.

The kidneys are exceptionally vulnerable to insulin dysfunction and this is why kidney disease is so prevalent with metabolic conditions, especially in diabetes. Hyperinsulinemia impairs kidney function. Impaired kidney function does not allow for the proper elimination of waste, including excess uric acid. You can see this kidney failure begin to occur decades before diabetes sets in with the presence of gout. Gout is an early marker for kidney disease. These gout "flare ups" are the first sign of what's to come. High blood pressure, as well, is one of the markers of metabolic syndrome and extremely common. It is also a sign of compromised kidney function as insulin is anti diuretic, damaging the kidneys over time. In fact, high blood pressure medications are most commonly diuretics. They work on your kidneys to lower blood pressure and they themselves will cause the development of kidney disease.

All of this tells us that you have to protect proper insulin function long before you develop diabetes and preferably before you even develop metabolic syndrome. The best way to retain your insulin function is to follow a diet that does not cause disparities in blood glucose because those disparities are a snowball effect for your metabolism to begin going down hill.

3. Ever since I lost weight and my blood glucose and insulin levels lowered, I have noticed a terrible stress response to just about everything. If I get even the slightest bit nervous or upset, I have a surge of stress hormone release that causes shaking and headaches. 

If you have been checked out by a doctor and no condition was found that might be causing this, then this may be the body's reaction to lower blood glucose and insulin levels.

People assume that the "cure" to their "disease" will be a very positive experience, where they will feel great and all their previous ailments will magically disappear. That is not the case. In many instances, the cure is worse than the disease. At least, it will feel that way in the short term. Why? Because losing weight is only half of the problem. That's why weight loss is not the cure.

When metabolism adapted over time, to be in a state of hyperglycemia, all hormones were primed and honed for just this very outcome. When blood glucose drops to normal levels and insulin no longer remains chronically high, the body must re adapt to its "new normal". This will not occur painlessly. The body will use any situation, including emotional stress, for the release of stress hormones. It is trying to ramp up glucose release for higher blood glucose. The problem is that little by little it will have less and less of an ability to do this. You might then feel a release of adrenaline, more than anything else. Every system of the body does not adjust at once. Adjustment occurs in stages, just like the adaptation process itself, occurred in stages. Each system broke down with time and now each system corrects itself with time.

This is why metabolic syndrome/diabetes are not true diseases but adaptations described as "syndromes". It takes a long time for the body to adjust and in the interim you will feel symptoms you might not have noticed before. I know that I, personally, went through the worse time of my life while I was losing weight and lowering my blood glucose. I had poor health when I was 300 lbs. but I really went through the wringer while losing them. I had never even been to the ER at 300 lbs. and I went five times during their loss. I had all kinds of symptoms. Good thing that I stuck to it because I believed nothing bad could be happening if I was losing body fat and stabilizing blood glucose. It's difficult to believe you can feel great while going through hell but that's precisely what happened to me.

I suggest that you also keep an eye on your electrolytes and make sure that you are supplementing adequately. This is one the main reasons people feel terrible when their insulin lowers. Losing control of your electrolytes can not only make you feel awful but it can put you in the hospital. Recommendations for electrolyte supplementation can be found here.

4. I started fasting and at first, it seemed to be working, but I have actually been gaining weight and my body has increased its set point. Now it's become impossible to lose any weight and when I do, I just simply go down to that set point and no more. Fasting caused this.  

Yes. Unfortunately, it did.

Most people don't understand how this can be true since they are still holding on to the notion that calories drive obesity so if you are fasting, and no calories are coming in, how in the world can you possibly gain weight and become even more obese from calories that were never eaten?

This is because calories are not what drives obesity. Blood glucose dysregulation does and food is not the only thing that dysregulates blood glucose. Starvation does too. Starvation prolongs your time in hypoglycemia. Like I have mentioned before, its the lows in blood glucose that drive the condition. Metabolic syndrome/obesity/diabetes are all adaptations to starvation (hypoglycemia). When you starve for real (fasting), these adaptations double down in order to make you fatter and "protect" you. This is why you have to be very careful that the fasting protocol you are using is not contributing further to this process as it would make you fatter.

Choose a real intermittent fasting protocol. Do not fast for longer than 72 consecutive hours, once a week, and only choose that protocol if you are morbidly obese - over 50+ lbs.

5. Are low fat diets unhealthy?

No. Low fat diets are just as healthy as any other diet and can be metabolically sound if they are followed correctly. You just have to make sure that when you reduce fat, you do not replace it with carbs, which is usually how these diets are followed.

The reason that we do not include low fat diets in our list of recommended protocols is because carbohydrates disrupt blood glucose homeostasis more than any other macronutrient, so it makes sense to make it your main target. Low carb diets also eliminate junk and fast food, when followed correctly, and this automatically lowers the fat in your diet. The Standard American Diet (SAD) is a high carb/high fat diet. When you eliminate the carbs, you reduce the fat since they usually come together in SAD fare.

6. All symptoms of insulin resistance are the result of carbohydrate intake.

No. You can develop insulin resistance in other ways. Any condition that disrupts blood glucose homeostasis, preventing your insulin from working in pulses, will cause insulin resistance over time. So, just being overweight/obese will cause insulin resistance since having excess body fat puts a high insulin demand on the body. You also become insulin resistant naturally as you get older since insulin is no longer needed for "growth".

Carbohydrates are simply the most common contributor of excess body fat, in the modern diet, because they make the bulk of the food we eat. Carbohydrates disrupt blood glucose homeostasis and this ultimately causes insulin malfunction and the accumulation/preservation of body fat.