Six common beliefs addressed, Part 273

1. I was diagnosed with diabetes some years ago and back then they tested me for fatty liver. My results were negative. Recently, they tested me again and they are now positive. I don't understand how this is possible if I have been eating low carb since before I even developed diabetes. Is there a way I can reverse fatty liver? Will eating low fat help?

It is not enough to just "eat low carb". I don't even know what you mean by "low carb" as this has different meanings depending on who you ask. You would have had to let me know what your exact protocol is.

Either way, the purpose of eating low carb is to be able to regulate your blood glucose properly. If low carb has not accomplished this, either because it hasn't been followed correctly or consistently or because of some other issue that's interfering with your blood glucose, then the condition will progress unabated. Metabolic syndrome, like diabetes, is chronic and progressive unless it is treated properly to achieve reversal or remission.

If you had been eating low carb since before you developed diabetes and now you have fatty liver disease, it means that you have not been treating the condition effectively. Your blood glucose regulation was never normalized and the pathologies associated with metabolic syndrome have occurred (i.e. diabetes, fatty liver disease).

Fatty liver disease is caused by alcohol, a viral infection or fructose consumption. Low fat diets do not treat fatty liver disease. The only diet that has been shown to reverse fatty liver disease is a ketogenic diet (no sugar) but you are now diabetic and unless you can regulate your blood glucose correctly, a ketogenic diet is not going to help you.

Diabetics will develop fatty liver disease over time because the liver is converting the glucose, released from their own body, into fat which it then stores within itself. It is very difficult to reverse this once you are diabetic unless you can be on a medication that can keep your blood glucose well regulated, 24/7, for the long term. A lot of diabetics are refusing medications because they think they can resolve this themselves. They can't. In many cases, particularly once the person is diabetic, low carb is a supportive treatment alongside diabetes medications.

2. I am still fat even though I eat very low carb. I have not been able to lose a single pound.

Fatness is determined by how well you can regulate your blood glucose not by how you eat, what you eat or how much of it. In other words, the amount of fat on your body is a direct reflection of your blood glucose control. This is why anything that affects blood glucose will cause body fat to increase or decrease.

Like I explained above, eating low carb is not enough. You have to make sure that your low carb diet is actually effective by monitoring your blood glucose. When you monitor your blood glucose, you can't be complacent with a simple postprandial "lower reading". Lowering your blood glucose is not going to cut it. You need to make sure your body is regulating its blood glucose correctly. This means it doesn't make excess glucose when its not needed and it makes enough when it is. You have to take fasted and postprandial readings, watching the disparities between the two closely.

3. I am a 70 year old diabetic. I am in the beginning stages of the disease and have no complications. But I have very intense gut issues. The doctors have not been able to help me nor have they even figured out what it could be regardless of the amount of tests they run. The only thing that relieves my symptoms is eating bread. I am following low carb though so I don't know what to do. I have developed a paranoia of carbs.

At 70 years old, you shouldn't be stressing this much over this. It is impressive that you made it to 70 with no diabetes complications.

Low carb is an umbrella term that covers many different types of diets. At your age, you would be fine following a simple Atkins style diet where bread is allowed as long as you don't go over 100 grams of carbs a day.

You have to decide how you want to live the rest of your years - obsessing over carbs or reducing these gut symptoms. I would be focused on reducing the gut symptoms because they will make the years you have left a nightmare. Diabetes is slow and you can slow it further by simply reducing carbs. You will be long gone by the time diabetes becomes a significant problem.

4. What do you think of 'Panera Bread'? I'm always told it's healthy. Can I eat low carb there?

"Healthy" is subjective. At this juncture, healthy is generally believed to be anything that isn't a candy bar so take the word "healthy" with a grain of salt. On this blog, the true definition of healthy is something that does not disrupt your blood glucose. As long as it does not disrupt your blood glucose, we don't care if its made by Kellogg's or Whole Foods.

You can eat low carb at just about any restaurant in existence. I suppose the only place low carb would not work is at a candy store, unless its a candy store that only uses artificial sweeteners. Other than that, you can modify your meals to be low carb anywhere. So the only question left for your chosen place is - "Is it worth it?" At Panera Bread it is most certainly not.

Panera Bread sells, well mostly bread and other baked goods. Other than that it's really a soup and salad place that happens to also serve coffee. Almost every soup they sell has carbs in the form of sugar, grains or starch. Salads are basically air. Air is starvation. So the food at Panera Bread can be described as starvation with a side of sugar. This is detrimental for the obese because it will be very difficult to regulate blood glucose while starving and eating sugar at the same time.

Another issue with Panera Bread is that their protein is served in child portions. In fact, it's hard to find another place that is more protein restrictive than Panera Bread. You can try and double the protein on a salad but expect to pay a lot for not very much, as even doubling the protein still leaves you with a pretty small portion since they started at such small portions to begin with.

So Panera Bread will not give you much bang for your buck. It's expensive and you will be left hungry. This means you will end up spending double because you will have to go eat somewhere else later and you will probably be hypoglycemic by then.

5. Is it true that all grains have gluten?

Gluten is irrelevant for the regulation of blood glucose as gluten in grains is not what disrupts your blood glucose. Their starch is the culprit, since starch is technically glucose. 

But this whole gluten hysteria is the same thing that occurs with low carb. It goes like this - "Some people have an immune response to gluten. Gluten is found is certain grains. Therefore all grains are bad and if you eat them, you will die instantly. Not eating them will also cure all the diseases you currently have." In low carb it goes this way - "Eating carbs make it very difficult to regulate your blood glucose. Therefore all carbs are the devil and if you eat them, you will die instantly. Not eating them will also cure all the diseases you currently have." Conflation and hyperbole at its finest. Why the human psyche makes these leaps is unknown but at the end of the day, it won't help you one bit. All of this conflation and hyperbole is causing you to lose site of the initial factual statement, which could actually help you solve what ails you.

When the word gluten is used, it is referring to gliadin specifically. Gliadin is a protein component of certain grains like wheat, barley and rye. Other grains such as rice, corn and oats contain other types of proteins which are not gluten. People who are sensitive to gliadin (gluten) may or may not be sensitive to these other plants proteins as well. In fact, people who are sensitive to gluten may be sensitive all plant proteins. This is something the person has to determine through nutritional testing and symptom triggers.

6. Is McDonald's really as evil as people make it out to be?

When a corporation becomes as large as McDonald's has, it is going to rack up quite a number of enemies along the way. McDonald's has been blamed for just about everything, from questionable employment practices, environmental assaults, poverty, small business destroyer and of course, obesity. The obesity blame is mostly due to the fact that their main selling product is burgers and burgers are beef and fat. Vegans and animal rights activists absolutely hate beef and animal fat. So McDonald's is personal non-grata on earth. Well, at least in the First World where everyone likes to think of First World problems.

But McDonald's is simply a meat and potatoes fast-food restaurant. They sell burgers and fries. Can this be blamed for obesity? Well, it certainly contributes to it when the burgers and fries are being served the "fast-food way". The "fast-food way" is not so much fast as it is cheap, or rather cheaper than a diner. McDonald's gives you a sliver of beef on top of a mountain of bread and a bucket of fries. This makes the meal cheaper but ultra high carb. Add a soda to that, particularly from a fountain machine which adds more sugar to it, and you are on the road to becoming 500 lbs. Don't forget the sugar-laden condiments and sauces to top it all off.

So the problem with McDonald's is not any activist's or interest group's gripes or that they serve "junk food" but that McDonald's interferes with proper blood glucose regulation due to the carb content in their foods. That is all. This is also not exclusive to McDonald's. All fast food places are the same and so are diners and restaurants. The only place that will prioritize protein, eliminate carbs and control fat is the food served at home, where you are in control.

Six common beliefs addressed, Part 267

1. Is glucose worse when it has fructose, like sugar does? Would this mean that potatoes are less bad than sugar?

Sugar is particularly obesogenic compared to any other carb because of two things - its sweet taste and it's half fructose. In fact, the fructose is what causes the sweet taste, so it's the fructose that is the main culprit.

• Fructose has a sweet taste and the state of sweet disrupts blood glucose homeostasis through its affects on dopamine/serotonin. Antidepressants like serotonin re-uptake inhibitors (SSRIs) have long been known to affect weight because of this.
• Fructose is a hepatotoxin like alcohol, and creates liver fat. This liver fat exacerbates and perpetuates metabolic conditions.

But glucose all by itself without the fructose, as is the case with potatoes, still impacts blood glucose because it adds extra glucose to a system that likes to keep its blood glucose under strict control. Anything that disrupts blood glucose homeostasis will result in metabolic dysfunction over time.

So you don't want to look for items that are "less bad" because there is no such thing as "less diabetes". You either have it or you don't.

2. My wife recently had a terrible bout of non-stop seizures. She was in intensive care for three weeks. She has always had seizures but they were well controlled until this set back. What I found interesting is that her morning blood glucose would always be in the 60s mg/dL. I have read on your blog that blood sugar this low is not normal. Could this be contributing to her recent health problems?

I am not a doctor so I cannot tell you what could have caused your wife's recent bout of seizures. It could have been a number of things. I have migraine with aura. I can sometimes detect triggers but most times cannot.

What I can tell you is that blood glucose dysregulation plays a very critical role in controlling conditions like migraine, seizures and other neurological issues. This is because the brain suffers first when there is a lack of blood glucose homeostasis. There are certain cells in our body that require glucose to remain alive and functioning. Some of those cells are in the brain. 

Disturbances to blood glucose homeostasis causes an energy crisis in the brain exacerbating neurological conditions. When I was able to better control my blood glucose, my migraines subsided. Insulin plays a vital role in getting glucose into these glucose dependent cells. Insulin resistance interferes with this process. Improving insulin sensitivity through the stabilization of blood glucose should be priority number one if you want to better control neurological conditions.

You are correct that a fasting blood glucose of 66 mg/dL is not normal. It is hypoglycemia and it will be very difficult for your wife to control her seizures if her blood glucose is on a roller coaster. I do not know why her blood glucose is dropping this low. It can be for a number of reasons, including seizure medications.

So I suggest you talk to her doctor about your concern and see if he has any answers for this. Other than that, your wife is going to have to diligently watch her diet and exercise routine. Lifestyle factors are the main contributor to blood glucose abnormalities.

3. I am sick of slim people talking about "junk food", "preservatives" and "additives". Is it true that people are obese because of preservatives in food?

No. I have spoken about this in other posts.

I feel your frustration because I am also sick and tired of this misconception. Obesity is not the result of preservatives, additives, chemicals or anything else found in conventional food. You can become obese off completely natural and organic, whole grain and fermented wheat products.

People start going through a rabbit hole of nonsense when they follow this type of advice but the diet sphere has always been ripe with this type of foolery. There are plenty of thin people eating Doritos and pizza boats daily. Just visit your local university's dorm room. It will be very difficult for you to find an 400 lbs. person on campus. There are many athletes that eat sheer "junk" on the daily and are perfectly slim. There are many people who are extremely picky with their food and only want the healthiest choices available and are still 400 lbs.

Obesity is the result of blood glucose dysregulation. Nothing else. It doesn't matter what food you eat as long as it doesn't interfere with blood glucose. The reason that "junk food" has gotten a bad rap is because it is usually filled with sugar, grains and plant based oils which all further contribute to blood glucose dysregulation.

No one knows for how long any individual can retain their blood glucose control while eating so called "junk". Look at low carb people. They eat clean and are still obese and unable to take control of their blood glucose. So controlling blood glucose and keeping it under control is dependent on a lot more than just food. Many individualized factors are at play here.

4. I want a real hack that I can use and it be effective. I LOVE McDonald's breakfast and I want to be able to eat it daily without it causing me obesity or diabetes. I know that's a lot to ask for but it's not like I'm asking for money and it's not every meal. I just want my breakfast! It's so convenient and delicious!

I know you think I'm going to reply that I can't help you and have no hack. But I actually do. In fact, it is the only real hack that exists.

If you understand that obesity/diabetes is rooted in blood glucose dysregulation, then the only thing you have to do is keep your blood glucose control and you will be free of developing either condition. But how? McDonald's and other fast food is notorious for interfering with blood glucose control and this is why everyone knows these foods are very obesogenic. But they are also very delicious. Is there such a thing as having your cake and eating it too?

Well, there is no magic pill you can take that can help you preserve your blood glucose regulation after eating biscuits and pancakes at McDonald's but there is a magical thing you can DO. All you have to do is walk five miles to the McDonald's, eat your breakfast and as you take the last bite, get up and walk five miles back home. The exercise will prevent your postprandial blood glucose from ever rising in a significant enough way to later cause hypoglycemia from prolonged insulin release. It's not even using insulin to clear the blood glucose!

This shows the actual curative mechanism of exercise rather than just the palliative mechanism of diet. With diet you are always hiding and avoiding but exercise causes an actual mechanical, quantifiable effect. This effect has been exploited by athletes, the world over, and this is how they can have McDonald's endorsements, and actually eat their food, with no adverse effects.

There is your hack, which will actually work. It would work if you are diabetic as well, it just depends on how well controlled it is, how many medications are being taken and what stage it's currently at.

But like all short cuts in life, you can run into problems. Walking a total of ten miles a day, everyday, can become unpredictable. Weather, illness, injury, age, work and other responsibilities can all get in the way of having the stamina and time to put into this endeavor. Remember, you can never fail one time or you will lose control of your blood glucose as you're basically walking on a tight rope to maintain it. You would need a lot of dedication and determination to be consistent with this hack. Even athletes eventually retire and become diabetic.

5. I usually like to go to the Dunkin' Donuts before work. I really like their coffee. While there I also get a breakfast sandwich, because I cannot have the dougnuts. I have to modify the sandwich so it's low carb by telling them to remove the bread and double the egg. The egg now becomes the "bread" so I can hold the sandwich. There is just one issue. They double the price. Low carb followers always talk about the modifications you can do at any restaurant but they leave out how pricey it can get. Prices have gone up anyway and this diet is going to break the bank.

Yes. That's why you want to avoid eating out as much as possible because you are already going to be spending more on food regardless. Might as well get more bang for you buck buying food you can prepare at home.

With low carb you can go to any restaurant and modify the food to fit your diet but prepare to pay more. Restaurants have always used carbs as filler. Carbs are cheap and create the illusion of a large portion. This makes you believe you got your money's worth, when you have to unzip your pants just to stay seated after a plate full of bread, pasta and salad. It is all smoke and mirrors though. When you remove all those carbs, you realize you are eating a plate of air and being robbed.

At the Dunkin' Donuts, tell them to ring each item of the sandwich separately. For example, they can ring up 2 eggs, one sausage patty and one cheese individually, rather than the whole sandwich and it will come out cheaper. Whether they are willing, or aware they can ring up the order that way, is another story.

All you have to do is just shop smarter when you do have to eat out. Stay away from fast food. It is not a bargain and usually ends up costing you more than a real restaurant, because you have to modify the menu and buy triple to make up for what's taken away.

6. Why does eating rice and beans or potatoes cause the feeling of being so full but it wears off so quickly?

Rice, beans, potatoes, pasta, all of this starch, causes a rise in blood glucose which makes insulin follow suit and this tells the body that enough food was eaten so hunger subsides and the feeling of being full increases. The problem is that excess insulin release to clear all of that glucose, continues dropping blood glucose while fasting causing the hunger to return in order to prevent hypoglycemia.

Blood glucose is what the body uses to determine its nutrient availability and whether it needs to be hungry or not. Not calories, not buffets, not portions, not micronutrients but blood glucose's influences on insulin. That is the main and sole determiner of how hungry and how fat you get.

Six common beliefs addressed, Part 266

1. My brother started with Type II diabetes. He had been drinking 21 sodas a day for several years before it began. He had a blood sugar of almost 1k mg/dL once and was hospitalized. Before then, he had had no symptoms. He wasn't even overweight or obese. During his hospitalization they discovered that his pancreas was no longer working as it should and couldn't make enough insulin anymore on its own. So he has basically progressed to Type I diabetes. He takes insulin injections daily and has had several bouts of keto acidosis which have nearly killed him. He is losing his sight and his liver and kidneys are failing. My brother cannot seem to get used to a healthy diet, which would help him tremendously. It's as if he doesn't understand what a healthy diet even is. For instance, he threw out the Debbie Snacks and Crispy Creme Donuts but kept the oatmeal with honey. For him that is a "healthy" choice. I don't know how to help him anymore.

Unfortunately, your brother is the victim of the pervasive misconception people have about diet and what's "healthy".

Oatmeal and honey are junk. But because oatmeal and honey are not a "highly processed", "fat loaded", "junk food", they are automatically put into the healthy category. I had written a post before stating that healthy is not "natural" nor "organic" nor "plant based" nor "low calorie". Healthy is only and exclusively a macronutrient profile that does not disrupt your blood glucose regulation. That's it. Blood glucose regulation is the only metric for what's healthy or not.

So the only way you can help your brother is by making him think of food in a completely different way. Healthy eating is not about "over consumption" or if food is "ultra processed" or "nutrient void". It's solely about how your blood glucose is affected because ultimately, that's all that matters.

2. I went on low carb in my forties and it caused me to lose my period for two months. I felt the best I have ever felt in my life. My period returned later and I have lost the energy and vitality I felt during that time. What happened?

I went through a four month bout of amenorrhea (loss of menstruation), when I started "keto", in my mid forties. Do not let the fact go over your head that the term "amenorrhea" starts with "amen". Amen indeed. I also felt better than I had ever felt before in my life. I had energy to spare. I even had certain lab markers, like my ANA (Antinuclear Antibody Test), which always would come back abnormal, completely normalize during this time. Unfortunately, my period returned and with it went my four month bliss streak and my normal ANA.

This is a controversial topic and I am not a doctor. I can only tell you what I know from what I have read and my own experience as a woman. Menstruating into your late forties and fifties is not a good thing. The toll hormonal imbalances cause on your body is dire to your well being. Perimenopause has caused me migraine with multiple different types of auras, cognitive issues and problems with my autonomic nervous system (dysautonomia). It's not fun and these issues can affect how you can treat your metabolic condition because they can very well impact your diet, exercise routine and systemic stress levels.

When you go on a low carb/"keto" diet and lose a large amount of body fat it can cause amenorrhea. Amenorrhea happens when the body goes through what it perceives as stress. Loss of body fat is stressful for the body. It doesn't want to lose it, particularly if you are a woman. Amenorrhea may be a bad thing for young women in their child bearing years but for many women like us, in our forties and fifties, it's a god send. Amenorrhea basically halts the hormonal onslaught that your body is going through during perimenopause. This is what causes an increase in energy and general well being. Once menstruation starts again, you can kiss those benefits goodbye.

There is nothing you can do about this. Your body was not going to keep losing body fat indefinitely. That was going to stop at some point and of course leptin was going to cause body fat to start increasing again. This makes the body feel safe to continue with menstruation and it will not stop until you finally reach menopause.

Menstruation is still considered the greatest thing that can happen to a woman so you will not find solutions for this in conventional medicine. If anything, they will try and pump you full of more hormones once menopause begins but for some women like us, menopause is the best thing that can happen to us. We just have to keep waiting for it.

3. I sometimes like to search diet and weight loss content on YouTube and I came across a channel where a fit guy was talking about "ultra processed" foods and giving stats on obesity and activity levels in Europe compared to the United States. Is any of this information relevant for weight loss?

History has told us it isn't.

First, lifestyle differences will absolutely affect a "lifestyle condition" like obesity so there are going to be regional differences in obesity statistics. That tells us nothing about the already obese. As long as you remain in the region, you are already in, you will most likely continue with the lifestyle you are accustomed to. The transit system, city planning, culture and amount of free time in your region are all designed to keep you in the same metabolic state you are already in. So these stats are useless for treatment. The only thing we know about the already obese, regardless of region, is that they remain obese.

Second, people like this fit athlete on YouTube have been expounding the dire effects of "processed foods", and now the new phrase "ultra processed" foods, to no avail. I only have one question for them - prove it. Prove that eating Twinkies has a worse outcome than eating yogurt. They can't because it was already done. People have lost weight on the Twinkie Diet and have remained obese on the yogurt one.

Obesity is not about processed foods, it's about blood glucose regulation. Like I have stated before, this is why someone can lose weight on the Twinkie Diet and someone can gain weight on yogurt. Blood glucose regulation reigns supreme as the determiner of what happens to your weight and many things affect it, including calorie restriction. So eating Twinkies, with enough calorie restriction, causes weight loss because it temporarily affects blood glucose, which lowers insulin and off comes all that water weight. But it takes a more sustained and prolonged effect on blood glucose to go beyond that and get to fat loss. That's why calorie restriction has been such a failure. It simply never reaches this sustained prolonged effect.

Eliminating "processed foods" is beneficial because it:

• Prevents snacking.
• Lowers fat and carb intake, particularly vegetable oils and sugar which are more detrimental to metabolism than other fats and carbs.
• Increases protein intake.

That's it. Those are the only three beneficial reasons, which by themselves mean nothing, but together help support healthy blood glucose control.

Not even the supposedly "nutrition void" claim of processed foods have been an issue since no one has developed beriberi from eating too many Snickers bars. There is nothing inherently evil in "ultra processed" foods. They simply negatively affect your overall eating habits and macronutrient composition which ultimately effects blood glucose regulation over time.

4. I buy plain, full fat yogurt but I wish I could eat it with granola. Is there a granola brand out there that's truly low carb friendly? I haven't found any at my store.

You will have to go to Amazon in order to find sugar free/grain free granola unless you have a specialty market in your area. As with all good quality products, it will be more expensive than conventional options. The best brand is Lakanto. They have several varieties of sugar free/grain free granola.

Stay away from cheap brands. Many cheaper choices advertise that they do not have any "added sugar" but no "added sugar" is very different from "sugar free". The brands with no added sugar do not add granulated sugar to their product but load it with dates or raisins instead, which is all sugar. Sugar by any other name..... You also want grain free granola because if the granola is loaded with whole wheat, oats or other cheap grains then you are still eating sugar by proxy.

When it comes to this type of stuff, price can tell you a lot. The cheaper it is, the more cheap ingredients it contains. Dried fruits and grains are very cheap so don't let the "organic", "healthy", "no added sugar", etc. label fool you. Low carb granola is sugar free and instead of cheap grains and dried fruits it's made of expensive nuts and seeds.

5. I'm sorry, this might be awkward because it's not really a question but I just need to get it off my chest. I was so disappointed and kind of depressed the other day when I went for coffee. I had forgotten to bring my special low carb nut bar with me, so I couldn't have anything with my coffee. I grabbed my plain, black, decaf coffee, because God forbid it be anything else, and put half and half in it. I was about to go and sit down when a woman behind me, slim as a rail, grabbed her specialty coffee and poured brown sugar into it. She then took her pastry and happily left with her coffee. She wasn't even a young woman. I sacrifice so much and still look like the average middle aged, slightly overweight woman who has the same health conditions as someone who goes to the Dunkin' Donuts daily. I don't look like Taylor Swift and I am certainly not slim nor healthy. Sometimes I swear the juice is not worth the squeeze.

All I can say is that I am sorry you are going through this or better yet, I am sorry you are realizing this because it was always there. The truth was just hidden from you because the diet/health industry is always selling you false treatments to what ails you. Not eating that cookie, will not make you slim, like the diet mongers promise you. Not eating it will simply not contribute to you getting fatter. You might still get fatter though, just not off the cookie. That is the hard truth. So the sacrifice gains you nothing. It simply removes one more thing from the table that can make you worse. The table is still full.

Nothing makes sense when it comes to obesity if you do not understand it's root cause. Until then, you will be forever left with the nagging and all to familiar questions - "Why do I sacrifice so much and get so little in return, while this brown sugar eating woman sacrifices nothing and has everything? If it's true what the diet/health industry is selling me, then how can a person like her even exist?" Because what they are selling you is not true. A perfect diet is not the potion for looking like Taylor Swift.

The truth only lies in blood glucose regulation. Who has it, who doesn't, who keeps it and who loses it. That's it. In all of obesity research its only consistent parameter, regardless of diet followed, is blood glucose regulation. Those who don't have it become obese and/or diabetic, those who do have it continue eating as they want while looking and feeling great. This means that in the vast majority of people diet is only a catalyst to an already existing hardwired problem.

Some people have a stress response that is honed and tuned to overreact to any dysregulation in their blood glucose, furthering its dysregulation over time. Chronic conditions, hormonal changes, systemic stress, age, injuries, metabolic shifts, etc. all cause them to create more glucose than normal and this slowly but surely deteriorates their insulin function over time. Certain lifestyle factors only exacerbate this further. This is why lifestyle factors can be corrected, but results are never guaranteed.

When you hear someone speak of obesity and "genetics" this is what they are referring to. It's in reference to the ability to retain your blood glucose regulation. Once it's lost, many systems in the body shift to accommodate its abnormality. This includes fat cells, mitochondrial function, glucoregulatory feedback loops, energy flux, etc. All these systems now work to make and keep you obese in response to your blood glucose. All of this doesn't even take into account how epigenetics affects insulin function, in the presence of blood glucose abnormalities, on such an individualized basis.

Lifestyle factors like diet are only palliative treatments for this condition. The condition persists through factors you can't control like simply becoming middle aged. The woman you saw was able to keep her blood glucose regulation intact for much longer than you were. Her insulin release/expression did not become abnormalized even if her blood glucose was not always in perfect homeostasis. Being middle aged has not affected this for her. Consuming brown sugar has not affected this for her. Whether she will ever be affected remains to be seen and only time will tell. She might die of something else well before we ever know for sure. As of right now, she is good to go. She didn't do anything magical and you didn't do anything wrong.

Now in order to determine if the "juice is worth the squeeze", you have to determine if what you are doing is effective and sustainable or not. Most importantly is it effective and sustainable for the long term. For example, if avoiding diet soda keeps my blood glucose under 140 mg/dL but drinking it keeps my blood glucose under 140 mg/dL then maybe the avoidance of diet soda is a hill that's not worth dying on. Some of these low carb people persist in thinking that the lower they can keep the carbs and the cleaner they can make the diet, then the better their outcomes will be but that's not true as they continue being obese and diabetic at 0 carbs. 'The Law of Diminished Returns' is always against us. There is only so much you can put into something until the returns become 0. That's when you start sacrificing a lot for nothing. That's what a lot of these low carb people do. They avoid the apple while still living off Metformin and remaining obese. Consuming the apple would have made 0 difference so they are torturing themselves for nothing. You very well could have found another bar or something else to eat with your coffee that would have also made 0 difference.

Don't make your life miserable because that will have you give up the lifestyle factors that are truly helpful in controlling the condition. Just because diet is palliative does not mean it's useless. Controlling your diet, controls the assault on your blood glucose regulation but only up to a certain point. You need to determine what that point is, so you don't burden yourself going beyond it. Revisit what you are doing and make sure that it is targeted and still effective.

6. My brother passed away last year at 715 lbs. He would eat massive amounts of food and would become aggressive if it was taken away. There would always be fast food bags littered all over the floor of his home. Two years before his death, he enrolled in a "fat farm" program which helped him lose 90 lbs. by eating mostly salads and vegetables. Once out of the program he gained 300 lbs. He lost his ability to move or take care of himself. Last year, he finally stopped breathing and died in my arms at only 26 years old. I read your blog in hopes of preventing his children from meeting this same fate. I am scared they are at risk since most of our family is overweight. No one is obese or as big as my brother had been but we tend to not be slim. Is my concern unfounded? What went wrong with my brother?

I am sorry for your loss.

Unfortunately, your brother was a victim of himself and the failed treatments they tried on him. They never really gave him a fighting chance because he never knew what was truly wrong with him. If you don't know what's wrong, then you can't treat it correctly.

"Fat farms" are notorious for using the failed calories in/calories out (CICO) approach for treating obesity. Hence all the salads and vegetables as they are "low calorie". We have seen this in popular shows like 'The Biggest Loser'. We have also seen how this practice has been the biggest failure, over and over again. Even the man who fasted for a year straight, and became slim under a blanket of skin, still died.

Basically using any starvation approach only causes the body to double down on its obesity over time and this is why your brother gained back 300 lbs. after only losing 90. This shows how his leptin was resistant to accept any starvation. Obesity is not an "in (eating) / out (burning)" problem. It is specifically an "out (burning)" problem. This is why obesity is a starvation adaptation and more starvation only reinforces it.

Of course your brother ate massive amounts of food. It takes a lot of energy to keep up with being 700+ lbs. This massive intake of food dysregulated his already abnormal blood glucose control. This is particularly true with the types of foods he was eating. Fast food is notorious for having a macronutrient profile that disrupts blood glucose.

I don't know what could have helped your brother because there is a lot of behavioral issues that had to be addressed and modified. No one could do those for him, but himself. What I can tell you is that it would have been extremely helpful for him to understand obesity and what caused it. Maybe it would have prevented him from feeling so helpless.

Most of the reluctance the obese have to diet modifications and/or other treatments is that they never work. They start feeling like nothing will ever work and they get scared of yet another failure. They start to give up. If your brother was given useful tools, like checking his blood glucose and targeting its regulation, rather than useless tools like targeting calories and checking their amounts, he would have had something to work with. If he would have been told that the weight he lost at that fat farm was mostly water and muscle and he would then gain back three times that amount as body fat, he would have understood that he needed to do much more than just eat salads to treat his condition. If he would have been helped to target the offending foods, rather than the calories in them, he would have been able to modify his diet effectively and without resistance. But he wasn't given any of these options. He was lied to.

His children are absolutely at risk for the development of intractable obesity. Not solely because they might have the same eating habits as your brother did but because fat cells are inherited from your parents and your brother's fat cells were particularly leptin resistant and insulin sensitive. They also seem to inherit their parent's insulin function. Children of obese parents start experiencing glucose abnormalities even at very young ages and fetuses of obese mothers are already producing higher than normal insulin while still in the womb. 

You are correct in being concerned. You have to be diligent in keeping the children's eating habits and their diet with foods that cause as little blood glucose dysregulation as possible. They have to keep a close eye on their blood glucose control. They also need to stay active to ensure their leptin keeps energy flux moving. They will simply have to do more than the average person to maintain a normal weight.

Six common beliefs addressed, Part 261

1. I am only able to control my weight when I control my calories.

This is because all weight loss and gain is mitigated through calories. All overweight/obesity is mitigated through blood glucose regulation (insulin/leptin).

If you are of normal weight and are trying to prevent an increase in some pounds, over time, then controlling calories should work well. People who control calories are usually referring to ups and downs in weight of 5, 10, 20 pounds. Once you go beyond that, calories won't cut it. So if you really want to prevent future obesity, you should start controlling your blood glucose.

2. I have diabetic and overweight/obese friends and the one thing that is common in them is their inability to eat real food. Even when they try to eat healthy, they still choose the "healthiest" junk. Why?

This is a complicated question because it is so individualized. In my experience, the main common denominator, I have seen in the overweight/obese, is their rejection of exercise. They seem to think they can control their condition through diet alone but diet is only a palliative treatment while exercise is an actual curative treatment. Yet, it is the thing they are least willing to do. This is because exercise is tiring and makes you sweat, while dieting is fun because you get to choose new junk to eat.

But I have also seen the eating of "junk" you are referring to. Your observation is not incorrect. Many overweight/obese people have a behavioral problem that perpetuates their condition further. They refuse to eat real meals, they live off novelties, they have an aversion to protein, they binge, they starve, etc. There are many different types of eating habits that contribute to obesity.

Many obese are in denial of this and refuse to address it. Instead, they just jump from diet to diet thinking that the next diet will be the solution but they only carry their bad behavior on to their new diet. It's not an easy fix because the solution is very individualized to what exactly that person is doing.

3. Why can some people fast and eat any way they want and never develop diabetes? If starvation can cause obesity/diabetes why can thin people fast with no issues?

The answer to this question is quite simple but 99% of people do not know it. Not even your doctor, coach, dietitian or so called "obesity expert" will answer this correctly. Certainly the low carb followers online can't either. This is why obesity/diabetes is so poorly treated because it's so poorly understood. People get caught up with the effects of calories on overall, temporary and minimal weight fluctuations and apply it to obesity/diabetes. This is why diet is still considered the main solution to these conditions and this is precisely why diet has not been able to solve neither of them. There are a lot of diets to choose from out there and they will all fail.

The path to obesity/diabetes is in blood glucose control. As long as your blood glucose is controlled, you can eat whatever you want and fast however you like with no problems. This is why healthy people can fast for days on end with no adverse health effects. This is why your healthy friend can eat a carton of Ben & Jerry's with no weight gain. Once blood glucose control deteriorates, then the stage is set for obesity.

So at the end of the day, it is blood glucose control that determines who gets sick and who doesn't. Of course there are lifestyles that help preserve blood glucose control and lifestyles that don't but in the end, it's how well your body can preserve its blood glucose control despite this. That is what's king.

No one knows why some people are more resilient in preserving their blood glucose regulation, even with less than healthy lifestyle habits, while others begin experiencing glucose dysregulation in childhood. It seems like some people are genetically wired to not experience an exaggerated adrenal stress response due to blood glucose disparities and they can preserve their insulin function despite blood glucose abnormalities, while others cannot. We see this in certain ethnicities which are more susceptible to developing obesity/diabetes at a lower body fat percentage. Other ethnicities experience massive body fat accumulation in response to blood glucose abnormalities but have a delay in becoming diabetic. So there is definitely a genetic/heritable factor in this issue.

No one yet has been able to pinpoint exactly what that is but certain studies have shown that it appears to be related to the intrinsic nature of certain individual's hypothalamic, pituitary, adrenal (HPA) axis. In other words, some people's stress response is very heightened, while others isn't. The ones with the heightened version, are more prone to developing diabetes over time, than the ones who aren't. 

Another factor involved in this is insulin function (release/expression). Some people have hyperinsulinemia without much expression at their fat mass (skinny diabetics). Others have a high insulin expression on the fat mass without serum levels becoming very high ("healthy" obese). So there is a lot of genetic diversity when it comes to the behavior of and cross-talk between insulin, fat cells and the HPA axis among individuals and this is why some become obese, some do not and others can reverse and others cannot.

4. Can cortisol cause diabetes?

Yes, kind of.

Cortisol is just one of the many pathways that perpetuates diabetes and allows it to progress through blood glucose disruption. As far as it causing diabetes, all on its own, is up for debate. Some people are more susceptible to pathological rises in cortisol than others but there has to be a combination of other factors or some catalyst to really end in diabetes. For example, caffeine.

Many do not realize just how much caffeine has played a role in the scourge of diabetes. Caffeine is lethal for blood glucose control. I would argue that the caffeine in soda is just as responsible for diabetes as its sugar content. This is why we do not recommend drinking tea or any other caffeinated drink because you cannot control your blood glucose as long as you are intaking caffeine, in any amount. Caffeine profoundly affects cortisol and other stress hormones like adrenaline.

So when we describe cortisol as being implicated in diabetes, we mean pathological cortisol dysregulation caused by metabolic stress from poor blood glucose control, an auto immune condition, caffeine consumption and inactivity. We do not mean everyday emotional stressors.

5. Are protein bars a good choice?

Because of the satiety it induces, protein is a very difficult macronutrient to keep at the recommended daily target. This is why oftentimes you will have to supplement. The best supplementation is whey protein alongside exercise. After all, if you don't use protein to build anything, the body will simply eliminate it. You can supplement with a whey protein drink or bar. Just make sure the ingredients are clean and no sugar is added.

But unfortunately, most obese/diabetics buy protein bars for snacks or to replace a meal while they sit all day. They are not truly supplementing anything but adding yet something else to their meals which wasn't needed. Worse, they usually choose the worst bars because those are the cheapest since they use inferior plant protein which is useless. They are also the ones that taste the best as they are all sugar.

So my general recommendation, to the obese/diabetic, is that protein bars are not a good choice. Eat real meals.

6. Is it true that they keep lowering blood pressure goals because of "Big Pharma"?

This has nothing to do with overweight/obesity/diabetes, but the answer is no. It would make a good conspiracy book though and it does make sense when you don't have all of the nuance and context behind it.

You would be surprised how easily blood pressure can be lowered without medications. This is especially true when most high blood pressure is caused by metabolic abnormalities and caffeine intake, which when corrected will drop blood pressure to normal levels rather rapidly. I used to have blood pressure in the 200 mm Hg range. It is now in the low 100s and has been for years. So, blood pressure can be easily reduced if there is no other underlying condition causing it to be high.

The reason they are lowering the recommendation for what normal blood pressure should be is because they are targeting more diseases that result from abnormal blood pressure, than just strokes and heart attacks. They have found that the current recommendation has not reduced or prevented the incidences of certain common ailments which a lower reading effectively can. In fact, they have found that healthy people have a much lower blood pressure reading than the current recommended 120/80 mm Hg. Like I said, mine is in the low 100s and has even dropped into the 90s.

It's sort of like blood glucose, right? 100 mg/dL doesn't sound too bad until you realize that a healthy person's blood glucose is around 84 mg/dL. All these low carb people do not have an issue with them lowering the recommendation of what a normal blood glucose should be, so they shouldn't have an issue with the lowering of blood pressure either.

For example, an elevated blood pressure of 130/85 mm Hg is not considered an emergency. Many people have blood pressure around this range and they do not keel over from strokes and heart attacks. In fact, your doctor will probably not even mention it to you. But that doesn't mean that this blood pressure will not cause pathology. After all, you don't just want to treat strokes and heat attacks, as that's end stage cardiovascular disease. Instead, you also want to treat micro vascular damage which can end in a array of different pathologies.

Chronically elevated blood pressure, even of 130/85 mm Hg, will damage the very small blood vessels on the periphery of your organs, over time. This can cause kidney disease and poor circulation in the extremities which can lead to wounds that do not heal. It can also cause retinal damage, dementia and other common ailments that could have been prevented by keeping your blood pressure normal to prevent micro vascular damage.

But if what's considered normal blood pressure is not low enough, then you would have developed these conditions without your knowledge. Most people will not concern themselves or try to lower a blood pressure of 130/85 mm Hg. They do not consider it an issue but it will become an issue over time. It is best to make people aware of that.

Six common beliefs addressed, Part 233

1. I have been following a protocol that has been able to get my weight to the lowest it's been in years, but I am still obese. I am also stalled. I need something to get me "over the hump" and "jump start" the weight loss again. 

There are no short cuts for getting "over the hump". The only way over it is to continue going.

When you find a protocol that has helped you lose weight, you have to stick to it and not jump around to something else. Jumping around will only reverse whatever progress you have made so far. Weight naturally stalls at intervals as it's being lost. This is the normal function of leptin. Doubling down will only cause this natural stall to be reinforced and become prolonged.

Also, small fluctuations in weight are not an indication of progress or failure. When losing weight, you have to look at overall, long term trends. This is why we don't recommend "daily weigh-ins". You check your progress once a month, at most.

2. I have lost weight following a calorie centered protocol but stalled. My coach told me to increase calories but that will only make me gain. I like the menu and don't want to change it, but I feel like I shouldn't add. I would feel safer "subtracting" instead. 

Usually, the coaches that run calorie centered protocols are full of BS but in this case, your coach is actually right on the money. As you lose weight, you should increase your calories to prevent weight regain. You cannot continue on the same calories that you started out with.

Calorie centered protocols, like all protocols, must change with weight change. Stalls can easily become weight regains on calorie centered protocols if these adjustments aren't made. Your coach seems knowledgeable about this effect and is trying to prevent it. That means they are aware of leptin and how it works. You don't need to "add or subtract" anything. What you need to do is trust the process and keep to the calorie goals that your coach has advised you on.

3. I was told that there is a way to increase lean muscle mass and lose body fat with no change in diet or lifestyle.

That's an obvious scam. When anyone tells you that you can achieve anything without putting in any work, they are obviously lying to you. If that was truly the case, then you would have already put on lean muscle mass and lost body fat doing what you are currently doing - nothing.

It’s hard to believe that with everything that’s currently known about overweight/obesity people are still being duped into "diet" and quack programs.

4. I had blood tests a week apart, from different doctors, and the first test had my triglycerides (trigs) at 133 and the other at 150. I am on a calorie centered protocol where my two main meals basically equate to about a quarter pound of meat and one pound of vegetables. I am still obese but have lost some inches and pounds. I am now fluctuating up and down the same pounds every week as I'm stalled.

Let's go through some issues I see here.

First, you need to tell, whichever doctor you see last, that the previous one already ordered the same blood tests for you so they can get the results from those. You never want to take the same blood tests back-to-back, because it will create conflicting results. This is especially true if each doctor uses a different lab and the tests being ordered are for things that naturally fluctuate on a daily basis like trigs, insulin and blood glucose. Take to your doctor the result of one blood test. It's ridiculous that they would make you go through the wringer twice for the same exact test. You're the one getting poked.

Aside from that, there isn't much of a difference between 133 and 150. It is totally irrelevant so there is no need to get caught up with minutia. The only relevancy in both of these readings is that your trigs are high. They aren't incredibly high, but they are higher than they should be. This is typical of high body fat but also the diet you are following.

One pound of vegetables is basically one pound of carbs. Carb centric diets tend to increase trigs. Since the protocol you are following is also calorie restricted, then I am sure it is low fat to boot. So, it should not be surprising that your trigs are higher than they should be. When you starve, you release trigs.

The only diets that drop trigs are very low carb diets like "keto". High carb/low fat diets increase trigs and decrease cholesterol while low carb/high fat diets decrease trigs and increase cholesterol. You can't win for losing so you are only left to mitigate your losses and focus on your goals. If a healthy metabolism is your goal, then it is more metabolically sound to have high cholesterol than high trigs. High trigs are really bad. High cholesterol, it depends.

High trigs are not indicative of weight loss on the type of protocol you are following. In fact, high trigs are generally not indicative of any weight loss. I lost all of my weight and my trigs never went up once. But if you were following "keto", then I would have advised you to keep an eye on the downward trend of your trigs if you were actively losing a significant amount of weight. Since then, you could make an argument that the temporary high trigs are caused by a liver dump of fat, but you aren't following "keto" and you aren't losing a significant amount of weight. So, neither applies to you.

Seesawing up and down a few pounds every week, is not significant weight loss. In fact, it's active obesity. You yourself admitted to being stalled.

So, I wouldn't worry about these trig results. They aren't astronomically high and the difference between the two readings is insignificant. The tests were also not properly done. You are obviously following a diet that you can sustain and has gotten you some results so just continue with what you're doing.

5. I have end stage kidney disease. My doctor told me to limit the amount of protein I consume but an online "low carb doctor" told me to eat all the protein I want. I don't know what to do.

You need to follow your doctor's orders. You are his patient. He has seen, examined and diagnosed you. No one online, even if they have a medical degree, can diagnose or treat you without seeing you in person. So whatever low carb doctor told you this, should have his license taken as what he is doing is unethical and illegal. Why you would even consider following the advice of someone online, who you haven't even met for a condition this serious, is beyond my comprehension.

Consumption of protein does not cause kidney disease but for people who already have kidney disease, protein consumption can add an extra burden on their already failing kidneys. There are studies that haven't shown any benefit in the reduction or elimination of protein for kidney patients but why take that risk when we know the biological mechanism of how the kidneys handle protein metabolism? I personally wouldn't. End stage kidney disease is nothing to play around with.

6. Sugar and "junk food" the only things that cause diabetes.

Wrong. Anything that disrupts proper blood glucose regulation can end in diabetes. What "causes" diabetes are large disparities between blood glucose highs and lows. In other words, between postprandial and fasting blood glucose. Postprandial blood glucose is affected by carbs in the diet and fasting blood glucose is dropped by an over expression of insulin in response to the postprandial blood glucose.

Sugar and junk food aren't the only things that can cause this disparity. "Healthy" foods like grains can cause it too, particularly in modernity where there is no forced, long term, chronic calorie restriction. Lack of exercise also eventually causes this disparity, because it disrupts metabolic homeostasis. Chronic conditions and medications can too. Sugar and junk food can accelerate the process, but as you can see, they aren't always the only cause.

Six common beliefs addressed, Part 8

1. Can I "hack" my way out of obesity?

There are no shortcuts and no "hacks". The only way out of obesity is through proper blood glucose regulation.

2. Should I only eat egg yolks and not the whites?

It is unnecessary to eat egg yolks on their own, just like it's unnecessary to eat egg whites on their own. Eat food whole, as nature intended and do not alter it.

3. Are carbohydrate restricted diets ineffective, because blood glucose rises when carbohydrates are reintroduced?

Only in the anti low carb world would this even be considered a logical expectation. Carbohydrates will always rise blood glucose. All foods rise blood glucose. Carbohydrates simply cause a higher and more prolonged rise. Carbohydrates rise blood glucose in the healthy as well but the healthy are able to sustain blood glucose regulation, in spite of these rises. Over time though, the rises eventually degrade insulin function and they become unhealthy too. 

The definition of effectiveness is the remission of metabolic abnormalities; no longer living under the threat of diabetes; prevention (not delay) of diabetic complications; maintaining a healthy weight and living a life free of health problems, treatments and loss of mobility. Carbohydrate restriction can achieve all of these, so it is completely effective. 

Effectiveness is not defined by eating a piece of cake and not seeing a rise in blood glucose. That is impossible. The purpose of carbohydrate restriction, as an intervention for metabolic dysfunction, it's not meant for you to be able to eat candy again. Candy is not food.

4. Will not eating carbohydrates make you insulin resistant?

Someone who has been on a low carbohydrate diet, for a very long time, can see their blood glucose rise abnormally when they eat carbohydrates. This is known as "physiological insulin resistance" and it's an extremely complex topic that goes well beyond the scope of my blog and of which little is understood. Low carbohydrate diets have simply not been studied long term, in a large population, to know every nuance associated with its effects.

A lot of people make the claim that having no exposure to glucose causes "intolerance of glucose", but gluconeogenesis negates this premise. The body makes its own glucose, so you are exposed to endogenous glucose daily and your body is not responding negatively to it. Furthermore, metabolic abnormalities have been reversed by restricting dietary glucose, so the disease process can be halted. Everything is going in the right direction and this blood glucose rise only seems to happen when a fattening carbohydrate (grain and sugar), which you shouldn't be eating anyways, is re-introduced. What's causing this physiological insulin resistance?

The widely accepted explanation is that this effect is caused by "adaptive glucose sparing". It is a protective response of the body, as it adapts to a limited supply of glucose, only acquired through gluconeogenesis, and spares any excess, exogenous glucose for the brain. In order to do this, the rest of the body refuses to accept the incoming glucose and you will see blood glucose temporarily rise.

Another explanation is that the enzymes used to metabolize glucose are temporarily low, from lack of exogenous glucose exposure. They need time to build back up, so the initial exposure leads to temporary high blood glucose levels, as there aren't sufficient enzymes to break glucose down. After a few days of carbohydrate exposure, this effect disappears. It is believed the same thing occurs when the diet becomes predominantly fat based. The "keto flu" would be the result of the body's lack of fat metabolizing enzymes, so the inability to break down this fat, causes unpleasant symptoms until you become "fat adapted".

Still another explanation is that the body is in a catabolic state of low insulin. It would be extremely easy for the body, in this state, to quickly break down dietary carbohydrates into glucose, causing temporary high glucose levels, until insulin "catches up" and slows down glucagon.

I don't favor any explanation over the other. For all I know, they are all true and physiological insulin resistance is a little bit of all three. What we do know is that this condition is not pathological. In other words, it is not a disease state and does not lead to disease.

Another thing we know, very well, is that carbohydrate centric diets, at least in the context of Western society, do and will lead to metabolic disease. That's a fact. Everything in between is left for interpretation by the blogosphere, but does nothing to better your health. So, it's best to stay focused on what's actually known.

5. I have reached goal weight, but believe I can lose more. My body refuses to continue cooperating though.

What we deem to be our ideal weight and what our bodies want to do can be completely different. The body knows how much weight it needs to loose.

As long as your waist measurements are healthy, there is little else you can do to force the body to continue losing fat. At this point, people are usually trying to lose subcutaneous fat, but this fat is protective and some people tend to have more of it than others. These differences are caused by gender, age and genetics.

You can certainly use exercise to tone and firm up, but once you reach your correct weight and waist size, let your body be. You don’t want to cause it undue stress by trying to become smaller. This can cause you to follow starvation diets or perform strenuous exercise, which can cause irreparable harm to the metabolism.

6. Can I eat junk food and desserts, as long as they are "keto" or "low carb"?

If your goal is to be as fat as the person giving you the recipe, then yes. If your goal is to be slim, then no. You can't eat junk and achieve better health. The Standard American Diet has already proven that.

Junk food, regardless of the diet, has a pathological effect on blood glucose homeostasis and this is what you want to avoid.