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 262

1. I read that they are not fully accepting that obesity is a starvation adaptation because there are so many factors involved that contribute to it.

This is word play and nonsense. The science is pretty clear. The metabolism of the overweight/obese is doing the exact same thing that it would normally do under starvation conditions. For this reason, obesity is not truly a "disease" as nothing is "malfunctioning". It is more of an adaptation than a pathology.

The only factor that tracks linearly as causal for overweight/obesity is blood glucose. Nothing else has and obesity has been studied ad nauseum. For this reason, obesity is a lifestyle condition because multiple lifestyle choices, whether made willingly or not, affect blood glucose regulation. This is why some people can reverse obesity and others cannot. Those that can take control of their blood glucose regulation see reversal and those who don't remain obese. This is also why obesity is so difficult to tackle once diabetes sets in. Diabetics cannot control their blood glucose any longer. If the condition is treated correctly, early enough, they have a better chance at remission through the stabilization of blood glucose.

Be careful of guidelines. They don't follow the science at all. There are many outdated guidelines out there that are still being actively pushed, like lowering of total cholesterol to prevent heart disease, lowering of blood glucose to manage diabetes, lowering of calories to reverse obesity, lowering of all dietary fat for weight loss and vaccinating children against COVID. All of these are just common examples of guidelines that do not follow the current science at all.

So of course you are going to read that obesity is not entirely a starvation adaptation because they still want to hang on to calories even when the science has proven otherwise. They will use fancy tricks to prove their position, like asking "who gets obesity at a concentration camp"? But I have explained all of this in depth in my posts before. It's all BS.

You control obesity by controlling blood glucose regulation and you can do that multiple ways. The most common ways are controlling diet, exercise, chronic conditions, medications, stress (circadian rhythms) and intake of caffeine.

2. Is diabetes truly a "diet disease"? I see so many doctors claiming that they can "cure" diabetes through diet and nothing else is needed. If this is true, what diet would "cure" diabetes?

Diabetes is the end stage of metabolic syndrome. Metabolic syndrome is a condition triggered by large disparities in blood glucose which affects its proper regulation. The most common culprit for this in modernity is diet. Specifically a high carb diet of which sugar is predominant. That is basically any Western Diet but the Standard American Diet (SAD) is the most cited one. As you can see, though diet can trigger this metabolic abnormality through blood glucose dysregulation, diabetes is not a "diet disease".

Many things affect blood glucose regulation besides diet. Chronic conditions, sex hormones, medications, genetics, aging, stimulants and lack of exercise all affect blood glucose regulation. They not only affect how well you can regulate your blood glucose but most importantly, how long you can sustain its proper regulation. This is why all these things affect what outcomes will be had from treatment.

These online doctors want to focus on diet alone because that's where the money is and they unfortunately, do not even understand what diabetes is. People are much more wiling to listen to someone blame diet than blame blood glucose regulation. Diet is easy and fun and blood glucose regulation sounds complicated and technical. Blood glucose regulation also sounds like something you have little control over and can't be "cured" with a magical pill or by picking out fun "healthy" snacks. Well, your diet is a completely useless pill. At most, it's a placebo. Like I have said many times before, treatments do not work when they are incorrect and/or incomplete. This is why diet interventions alone have been utter failures as treatments for metabolic syndrome/obesity/diabetes.

Having said that, the clue as to what would treat metabolic syndrome/diabetes is right in its definition. God is in the details, not the devil. If metabolic syndrome/diabetes are conditions caused by blood glucose dysregulation, then the best treatment is to eliminate/minimize blood glucose dysregulation. A low carb diet works very well at doing this because it stops the introduction of dietary glucose. Dietary glucose disrupts blood glucose homeostasis. This makes low carb diets a good starting point for reducing the disparities in blood glucose which continue exacerbating the problem.

Then you can also focus on other things that dysregulate blood glucose, like all the ones I listed above, to cause a compounding effect where blood glucose is as controlled as it can possibly be. This can not only prevent metabolic syndrome/diabetes but help put it in remission if you already have it.

3. Is it true that stevia is the only good artificial sweetener (AS)? Some health gurus have been fear mongering now about artificial sweeteners. They don't like any of them. I even heard one of them recommend you can use sugar, in small amounts, instead.

This is precisely why I never follow "diet news" especially from health nuts who have a new book out weekly they are trying to peddle. Diets have been studied ad nauseum and everything we need to know about them, is already known. We also know a lot about food additives, including AS. Artificial sweeteners are well, artificial. You can take from that what you will and that's about all you need to know to make a decision about them.

Artificial sweeteners became popular as more and more people watched their calories and AS are 0 calories (sort of). Then they slowly made another fan base with diabetics as all that calorie watching did nothing to prevent the scourge of diabetes from rearing its ugly head. So both people who watch calories and those who watch their glucose meters use AS liberally. And when I say liberally, I mean on everything. People will sweeten a steak, if they have the opportunity to. Don't believe me? Look at the numerous sweet sauces that can be slathered on everything, including steak.

There are numerous types of AS, some with warnings (saccharin), some with questionable health effects (aspartame/sucralose), some not quite studied enough (stevia) and some cause unpleasant side effects, mostly gastrointestinal (sugar alcohols). Some of these sugar alcohols also convert back into sugar in the body.

I know that a lot of these diet and health nuts find an issue with anything that people enjoy. Their idea of utopia is people flogging themselves constantly over their dinner table. It's almost with a religious fervor that they squash any type of enjoyment you can ever have from what you eat and they take great delight in it. So it was only a matter of time before they went for AS. They saw people had an option now and their job is to take that away immediately. No options. Comply or die. On this blog, I don't care about public shaming parades. I look at every thing through the lens of metabolic health because if you are here reading this, then I suppose that's what you care about as well. You are here to help solve your metabolic issues and I'm here to give you the information that would be most pertinent to accomplishing just that.

Artificial sweeteners do not help your metabolic health. If metabolic syndrome/diabetes are the result of blood glucose dysregulation, then intaking something that interferes with hypothalamic function via the dopamine/serotonin interaction, is not helping. How? Although studies have not proven a definitive correlation between dopamine and blood glucose levels, the answer lies with insulin.

The relationship between insulin and dopamine is fraught with contradictory findings but recent research has indicated that insulin modulates dopamine release in the striatum, which affects brain activity and connectivity. It's been concluded that the striatum plays a pivotal role in regulating glucose metabolism throughout the body. Dopamine has long been known to regulate metabolism, particularly seasonally, and it has been linked to metabolic syndrome/diabetes. But most importantly, we have seen how sugar has caused hypothalamic damage. A damaged hypothalamus can no longer respond to leptin properly so you will be obese forever.

It's believed that the taste of sweet itself is what begins deteriorating metabolic homeostasis through the hypothalamic pathway. After all, taste is metabolic information. It's not just there to make you want to eat, though that's one of its functions but nature is quite efficient. It uses one pathway for many functions rather than having to find many different pathways for each function. The taste of sweet directly affects dopamine as well as other metabolic hormones because sweet taste usually means store fat as winter is coming.

Artificial sweeteners are sweet. In fact, they usually are much more sweeter than sugar. Even with 0 calories, they have done nothing but increase obesity as more people use them quite liberally, on everything, simply because they are "better" than calorie ridden sugar. But the effects on the brain, particularly the part of the brain that's needed for metabolic homeostasis, is basically the same. After all sugar by any other name..... well you know the rest.

As for this idea of recommending the use of sugar "in small amounts", should not be entertained. How well did that work before AS was introduced into the food supply? There has been no established "safe dose" of sugar discovered as of this post. Sugar always affects blood glucose regulation, with individual variability. This means that the amount of sugar which may be benign for one person is not for the other and this changes over time as metabolism changes, age progresses, hormones decline, etc.  People need to stay away from sugar, particularly people with metabolic syndrome/diabetes.

Artificial sweeteners are a good alternative. Whether they help or hinder all has to do with the person consuming them. Some can eat like normal people and some simply cannot but staying obese while delaying diabetes (AS) is better than becoming more obese and developing diabetes sooner (sugar).

4. I heard on the news that caffeine is "neuroprotective" and since I have Alzheimer's in my family, I was thinking of drinking expresso, as they suggested. But I have also read your posts which say caffeine is detrimental for diabetes, which I have. What should I do?

Not listen to quacks. The single most important thing you can do for your health is not listen to quackery and daytime TV is full of quackery. This is why people who watch a lot of daytime TV score lower on intelligence tests than those who don't. Now there could be other factors for this. After all, if you have a lot of time to watch daytime TV to begin with, there might be other things going on with you. We can at least say people who watch daytime TV tend to be more misinformed than those who get their news elsewhere.

The reason I bring this is up is because I have seen this "neuroprotective" claim about caffeine make its rounds before. It always pops up every so often. A neurologist is given two minutes to tell you this half true information until they skedaddle him on out so their ads can begin playing. So, let's see where this idea comes from because quackery is usually birthed from truth. In fact, we can say quackery is as its core, bastardized truth.

• Caffeine is a stimulant. It raises blood glucose through adrenal over expression. This rise in blood glucose causes for cells that use glucose to have more access to uptake it. Neurons use glucose. If your neurons are impaired, such as with Alzheimer's, this extra glucose makes it easier for this uptake to occur so it appears as though the neurons are now working better.
• Glucose is an excitotoxin. It excites neurons. Remember the whole insulin nasal spray for Alzheimer's patients which showed an "improvement" in their symptoms? It's the same thing. More insulin, more glucose uptake and so more excited neurons that work harder and better.

There is just one problem. Exciting neurons kills them faster. So this temporary improvement has shown dismal long term results. This is why any neurologist, worth his salt, will tell you to stay away from caffeine if you have migraines. That temporary relief in pain, only causes your symptoms to become worse over time. The best thing a migraine patient can do, is get off caffeine. This will lessen the overall frequency of their migraine attacks.

So when you listen to claims of this sort, please be careful and do further research on your own about what is being claimed. All of this stuff you hear is just click bait to get your attention. This caffeine for Alzheimer's thing slowly became a claim that caffeine can prevent Alzheimer's which is not true. It's like a game of telephone. One person says one thing and as it goes down the line it becomes something else entirely. That's what mainstream news has become. A game of telephone. It puts a seed out there and lets it grow. The problem is that you pay the price.

5. If calories don't matter then why is it that when people "let themselves go" they gain weight? There is no denying that this happens and that's why everyone recommends for you to watch how much you eat, so you don't get fatter.

This is an excellent question and one that is always misunderstood.

The problem with eating ad libitum (letting yourself go) is not due to calories, it's due to blood glucose dysregulation. For instance, if I throw down on a huge serving of food, until I am stuffed, my blood glucose is going to be affected afterwards due to insulin/glucagon ratios. Though food is available for hunter/gatherers, the quantity eaten is always limited due to many factors. We were never designed to starve, but we were also not designed to eat at buffets daily.

Worse yet, if the meal I am stuffing myself with is from the typical Standard American Diet (SAD) menu, then the buffet will be mostly biscuits, pasta and bread rolls. That means I am not only disrupting insulin/glucagon homeostasis, through a huge pile of food, but I am consuming quite a load of dietary glucose to boot. This will further disrupt my blood glucose and affect my insulin for the next 12 - 24 hours. This isn't good because disruption in blood glucose homeostasis causes what? That's right - overweight/obesity/diabetes. So when you begin putting on the pounds, because of this habit, people will automatically assume it was all those calories. Well, it wasn't. It was all that blood glucose dysregulation.

The body can handle its calories but it can't handle disruptions to blood glucose. Not even in the short term. I need for people to understand this. Even in the short term, it's going to become a long term problem.

Eat to satiety. That means you don't leave the table hungry but you don't have to unbutton your pants to do so. This is why buffet style restaurants are never a good idea. Watch your portions through satiety, not because of calories, but because of your blood glucose.

6. I hear that "carnivore" can prevent or "drastically reduce" heart disease from occurring via it's reduction of "inflammatory substances". I totally believe that and am onboard but as someone with current cardiovascular disease (CVD), I am still concerned.

I hear that eating shark fins can make me live to 150. We all hear a lot of things but where is the evidence? I guarantee you found none before you "totally believed" and "got onboard". What if you got onboard the Titanic? People will believe just about anything nowadays and that's sad, considering there's this thing called the internet. All it takes is a little research to debunk the nonsense.

CVD is very complicated and has many causes. I don't know what type of CVD you have. If you believe that CVD is caused by some type of "inflammatory substance" then an anti-inflammatory medication would basically cure you. Unfortunately, NSAIDS have not yet been recognized as the cure for CVD. This means that CVD is much more complex than "inflammation". After all, many things cause inflammation, including arthritis but arthritis is not recognized as a risk factor for CVD. Well, unless it's rheumatoid arthritis, but there are other complexities with that condition.

Now that we have gotten past the nonsense, let's talk about what we do know. Metabolic syndrome is a risk factor for CVD and it's not because of its inflammatory effect though I'm sure that could contribute. It's because of a complex hormonal interplay that interferes with blood pressure regulation and other stress hormones that affect the cardiovascular system as a whole. It's a very complicated process that I will not go into here as I am sure people think I'm pedantically long winded as is.

Metabolic syndrome is caused by improper blood glucose control. Carbohydrates are notorious for interfering in blood glucose homeostasis. Carnivore eliminates all carbs. So carnivore would be beneficial for people with metabolic syndrome. If you can improve your metabolic syndrome, then you would lower your CVD risk. That's it. That's all that carnivore does. No where in that explanation is there a claim for "preventing or drastically reducing" heart disease.

Now the best thing you can do for yourself, is discuss your diet with your doctor. You need to know the results of certain tests, like an advanced lipid panel which measures individual lipoproteins, so that you can figure out what fats would be best for you to use. There are certain genetic profiles that would make the use of saturated fats detrimental for CVD. This means you should be tested regularly when you start your diet to make sure your markers do not take a negative turn. You also have to follow a legitimate carnivore protocol. If you do that, I don't see any issues with you following this type of diet and you shouldn't have any concerns.

Six common beliefs addressed, Part 259

1. I have always had erratic meal timings because of my job. I am now diabetic even though I really do not like sugar or grains so I have never eaten them in any significant quantity making my diet relatively low carb. How could a low carb diet cause diabetes?

It wasn't the low carb diet. It was the erratic meal timings. Diabetes is not a carb disease. It is the end stage of a metabolic adaptation towards starvation. Diabetes is what occurs when you starve enough (blood glucose dysregulation) without ever dying. This starvation adaptation can occur from multiple factors. Anything that disrupts proper blood glucose regulation will eventually cause diabetes. This can be diet, medications, certain chronic conditions or also starvation.

You can't maintain proper blood glucose regulation when you have erratic meal timings. With erratic meal timings you can go an entire day without eating or not eat enough and then binge later. You need to have predictable meal timings daily in order to regulate blood glucose correctly. When you have predictable meal timings, you avoid going hungry and you avoid eating too much or not enough. That's why it's important to work with your circadian rhythms and eat properly.

Who knows how long you have been having blood glucose regulation issues and never knew about it until it became diabetes. As long as your fasting blood glucose and HbA1C levels are within the "normal" range, your doctor will not deem you as having any metabolic issue. This doesn't mean they don't exist.

Blood glucose disparities can only really be witnessed in real time. That means you would need a blood glucose meter and take readings yourself. People normally do not do this unless they are already diagnosed as diabetic. So the syndrome continues progressing from metabolic syndrome into diabetes, right under your nose.

So make sure you are following a truly low carb diet from now on, one that eliminates sugar and grains in their entirety and keep to your meal timings.

2. I was mortified to see that my endocrinologist now has a YouTube channel and is slowly subscribing to the whole "keto"/fasting fad. The last time I went to see him, he was in the office with me for about five minutes, gave me no answers and simply told me that "fasting is the best thing I can do". WTF?

Well, he won't be your doctor for long unless you're willing to dish out the big bucks when he opens his own quack practice and no insurance will accept him.

Unfortunately, a lot of doctors are realizing that the money is on YouTube, Patreon and their own subscription based websites. It certainly is not in taking insurance. So much for Medicare For All. In order for him to ask for people's money, he has to offer something different than what conventional medicine is so he must become a celebrity fasting quack.

As an endocrinologist, I am surprised he told you that the best thing you can do is fast. I am sure he knows about cortisol, glucagon, leptin, adrenaline, well.... who knows what he knows. It seems like he knows more about YouTube than anything else. All I know, and soon you will too, is that if you follow this crazy advice, your blood glucose regulation will start to fail. You can't starve blood glucose into submission just like you can't starve your fat mass to budge an inch. So I suggest you change endocrinologists pronto. Either way you will have to, when he quits his practice.

The fact that he only saw you for five minutes is another problem. You need to advocate for yourself and get better care from your doctor. You need a doctor that can keep his eyes off YouTube long enough to focus on his patients.

3. Is the science aware what obesity is? Why do they keep telling us to eat less?

The science knows but the science doesn't make good public policy so they hide and/or minimize it. Good public policy is to give people the impression they can lose weight by simply "not eating too much" because they fear the science will only give people an excuse to eat as much as they want since there is nothing they can do about their weight anyway.

This is the logic I consistently run across while researching obesity. In one sentence they will say that obesity is a leptin problem with no known cure and right after they will say they still want people to keep their "consumption" in mind. The truth is in the middle. Obesity is a leptin problem with no known cure and eating Ding Dongs, whenever you want, is not going to help it.

4. How does hyperglucagonemia help with starvation? Does the body purposely down regulate insulin release to keep blood glucose high?

It does not "down regulate insulin release", it under expresses insulin action in various tissues and organs to spare blood glucose for the brain since it believes you're under starvation. It's also sparing it to build more fat. It's simply keeping blood glucose high in circulation as you aren't truly starving but those dips in fasting blood glucose makes the body believe it is. This makes it averse to any lowering of blood glucose. Since insulin continues to be released in large amounts, it's only other option is to cause this under expression which is what insulin resistance is.

Hyperglucagonemia is simply a way of keeping blood glucose high, in the presence of insulin. It prevents insulin from lowering blood glucose to normal. Its real purpose, in a healthy human being, is to keep insulin from lowering blood glucose too low but in the person with metabolic syndrome it's just trying to keep blood glucose from lowering at all.

5. How would starvation affect blood glucose? I know that diet affects it but why would starvation?

Starvation causes an extended time in hypoglycemia. The body likes to keep its blood glucose very well regulated under a narrow range. When blood glucose goes up too high or drops down too low, outside of this tight range, the body reacts immediately. It has multiple glucoregulatory systems that will respond to any disruption in blood glucose and this system adapts. It learns. This learning causes it to proactively respond to any event that effects blood glucose. This is why you see people with metabolic syndrome/diabetes have blood glucose that goes haywire when they eat, when they fast, when they exercise, when they wake up in the morning, when they get sick or are under any stress.

Having chronic low blood glucose and/or being in a state where the body has to chronically create its own blood glucose, just to remain within a normal range, causes metabolism to up the ante on its glucose production. This will in turn rise insulin. This rise in insulin will cause more glucose to be made, as it is further reinforcing the need for more glucose. This feedback loop now feeds itself and metabolism goes into "starvation mode". This simply means it develops a high blood glucose, insulin and body fat set point to ward off starvation. This was all set into motion by the amount of "time in hypoglycemia".

This is why you have to be careful with fasting and make sure it is not extended as it will only reinforce this metabolic adaptation.

6. Can diabetes be prevented with vitamin D?

No. Diabetes is a syndrome caused when the body is no longer able to regulate its blood glucose properly. It cannot regulate its lows or its highs and this is why diabetes is not a disease of "high blood glucose". It is actually the lows that progresses the syndrome. The highs take decades to cause pathology, while the lows are pathological even when they occur once.

People with metabolic syndrome/diabetes oftentimes become low or even deficient in certain vitamins like vitamin C, D and all the Bs. This is the result of excess glucose metabolism which depletes these vitamins. Increasing these vitamins does not cure nor prevent diabetes. Only stable blood glucose regulation does.

Six common beliefs addressed, Part 256

1. Do you have "evidence" against the belief that the fiber in whole fresh fruit forms a barrier which causes the sugars to bypass the small intestine and instead go straight to the large intestine where it is eaten by the gut microbiome?

Yes. Eat fresh whole fruit and then use your blood glucose meter. Let me know if the sugar was eaten by your microbiome before it hit your blood stream.

2. If cigarettes and alcohol have warning labels, shouldn't candy, fruit juices and soda have them too?

You're asking the wrong person as I'm of the belief that nothing should have warning labels.

3. I read a book many years ago, that claimed "if you ate a diet of minimal fat and protein, with full complex carbs, the body would naturally reduce weight to its correct proportion for your individual needs". Is this true?

No. A correct way of saying this would be that "if you can acquire proper leptin expression, the body will naturally burn body fat to its correct proportion for your individual needs". Nothing else matters. Literally, nothing.

4. I have a friend who is lean having only 14% body fat. They have no gym membership and enjoy all of the fatty meat they can. I exercise and watch every morsel of food I intake but I cannot make any headway. My friend said that the solution is very simple - Just eliminate all sugar and grains and the problem will correct itself. Is this true?

Ask all of the people who have done just that and are also not making any headway. In fact, read the post below this one.

It is not that simple. People who are obesity resistant, meaning they have proper leptin expression, always want to make it appear very simple because it is for them. They can eat all the fat they want and remain at 14% body fat effortlessly because their set point was always 14% body fat to begin with. The lack of exercise will come back to haunt them in time but they will be able to keep their leptin expression in tact for a very long time if they can continue to preserve their blood glucose regulation. Staying away from sugar and grains is a good place to start in order to try and accomplish just that.

Unfortunately simply staying away from sugar and grains is not a magical cure for those that are already obese. The hope is that the avoidance of sugar and grains will normalize their blood glucose regulation enough to kick start their leptin but that's not guaranteed. It is the best way to go about it but it's not a magical cure. So tell your friend that the only thing that keeps them at 14% body fat is their leptin, not their simple solutions.

5. I went carnivore and have gained about 50 lbs. I have also developed neuropathy and I can't even exercise anymore because of the aches and pains. I am in the worst health of my life. I thought I was alone but I am quickly finding more people who have diligently followed this diet for several years and are facing the same issues. I am trying to find a doctor to solve this mess for me.

If you don't treat your metabolic syndrome properly, it will eventually lead to serious health complications and/or diabetes. Metabolic syndrome will not go away on its own. It is chronic and progressive, just like its end stage of diabetes.

You were sold a diet as a cure to a very complex metabolic adaptation and unfortunately, you fell for it. You were most likely not following the diet correctly and you were not monitoring your progress on it. If you are on a diet for six months and see no benefits and/or develop detriments instead, you need to stop it. Why people continue to be on the same failed protocol for years is mind boggling to me. People do this with calorie restriction all of the time as well. They keep chasing the dragon. The dragon were those initial few pounds you lost when you started which quickly reversed and were never lost again. Wake up. You will never catch the dragon.

You should have diligently researched the diet and tracked your results before you let this continue on for years on end. Most importantly, you should have researched obesity so that you would have known that your magical carnivore diet does not equate to proper blood glucose regulation or leptin expression. Unless a diet can promise you these, it is a roll of the dice. It might work or it might not or it might work for you and not for others or vice versa.

6. My endocrinologist told me that exercise was not important and it only equates to about a 3 pound loss a year. He also prescribed an injectable "weight loss" medication but when I researched it, the manufacturer clearly stated on their website that it was not intended for weight loss and worked similarly to Metformin. I am obese but not diabetic, not even prediabetic. He sent the medication to the wrong pharmacy as well and it was not even taken by my insurance, though he had verified both during my visit. It's like he's not paying attention. By the way, he emphasized fasting and is now selling supplements. I believe the pharmacy he sent the medication to is the same one making his supplements.

Good grief..... Going to the doctor lately has become akin to watching an episode of The Three Stooges. I don't know why I keep receiving these complaints lately but they seem to have become quite common. People are noticing that their doctors are becoming quacks right before their very eyes as they try to open their own "online" consultation services alongside their supplements. I don't know what's going on except that word is getting around that quackery simply pays more with less work, just like diet programs do. You will soon lose your doctor when they no longer take your insurance but will take your subscription to their website instead. Word to the wise - find another doctor ASAP. Don't let manure hit the fan before you do. At this point, you are no longer receiving adequate care.

Aside from that, I have no idea what your doctor is talking about or what his deal with exercise is. He is most likely practicing how to pander to obese clients, by promising them an easy "solution" that doesn't require them to rise their butts off their motorized carts. Who knows. All I know is that you will never obtain proper blood glucose regulation and energy flux without exercise. Period. You will not. Ever. Instead, you will forever be fiddling with your "diet" because it will forever stop working.

You can't treat a condition with incomplete protocols. Like I have said before, if you had to choose one thing because you couldn't choose both diet and exercise, then choose exercise. It just has a more overall metabolic affect than diet and research has shown this time and time again.

I can't second guess a physician over prescribed medications. I can only give you the facts, which you can also Google yourself, by the way. It seems like you already did and found out the medication is not for weight loss but for diabetes instead. The fact that you are not diabetic is most likely why your insurance will not cover it. Again, I have no clue why he described this as a "weight loss" medication, if it's not. We simply don't know what's in his mind except dollar signs. It appears that Big Pharma was more honest, in this case, than your own doctor. There is nothing you can inject to cause "weight loss". At least not while remaining healthy. Medications that play around with your insulin function will cause you further problems in the future, because you are not currently diabetic. Diabetics are at a stage where they have no choice, but you do.

I'm glad to see you are questioning everything and doing your own research because this is a perfect example of lazy medicine from a doctor who is begrudgingly at this office until he can make his escape into the profitable world of "low carb". Don't be a victim of his ambitions. Let him go down that path by himself because you need to focus on your own goals.

Six common beliefs addressed, Part 250

1. Is it true that the American Heart Association (AHA) now recommends "keto" diets?

Don't let people gaslight you. A lot of low carb people will usually make the claim like the American Diabetes Association (ADA) or the AHA are now "recommending keto or low carb", but none of that is true.

The American Heart Association, just like the ADA, does not endorse any particular diet. It simply recommends for healthcare providers to develop individualized plans for their patients based on three concepts:

• A moderately reduced calorie diet.
• A program of increased physical activity.
• The use of behavioral strategies to help patients achieve and maintain a "healthy body weight".

That's it. This is precisely why you can never get clear answers from your doctor about what diet you should follow. They always fall back to these same vague recommendations and then refer you to a dietitian or nutritionist to help sort out the details. In a way, this is good because there is no one diet that is best for everyone.

On their websites, these associations always use generic recommendations for dieting such as "to eat a variety of fruits, vegetables, and grain products, particularly whole grains; choose fat-free and low-fat dairy products, legumes, poultry, and lean meats; and eat fish, preferably oily fish, at least twice a week".

These associations have leaned heavily on the Mediterranean style of eating for a long while now. That type of diet is not low fat. It is low in saturated fat which is the stance that these associations still hold. Even when they recommend a moderate fat diet, they emphasize that the focus be on "healthy fats" which for them simply means primarily monounsaturated plant fats, not animals fats, as monounsaturated plant fats are extremely low in saturated fat. So their stance on fat has not changed. They still want you to follow a low saturated fat diet.

The reason that the AHA is still holding on to a low saturated fat diet is because some people who have lipid abnormalities do not do well on diets which contain saturated fats. Study after study has shown this to be true. Should these studies have been used for recommending low saturated fat to everyone? No, but the recommendation does not hurt anyone either unless the saturated fat is replaced with sugar, which is what ended up happening. The AHA is aware of that now and has retracted their stamp of approval on high sugar foods.

"Keto" isn't mentioned anywhere here. It's a non factor. Can some people benefit from "keto"? Yes. If the "keto" can keep their diabetes and metabolic syndrome at bay, which contributes to certain cardiovascular conditions. Can some people have worsening cardiovascular outcomes on "keto"? Yes. If "keto" worsens lipid function and composition, it will certainly contribute to certain cardiovascular conditions.

By the way, if you want to get technical, a Mediterranean style diet can absolutely put you in ketosis so I suppose that in that respect, we can say these associations recommend "keto".

2. For some reason protein hates me. It makes my blood sugar and weight go up. I had to cut down on protein lately and increase my fat. Now my weight is stable and my blood glucose is better.

But your metabolic syndrome is getting worse. "Stable weight" while being obese is not a good thing and "better blood glucose", whatever that means, is meaningless. I need hard numbers.

Protein doesn't hate you. What hates you is your insulin function. You need proper insulin function to regulate glucagon and metabolize protein. When you can't do either properly, you have issues which aren't solved by decreasing protein and increasing fat, unless you want to get fatter and worsen this condition over time.

What you need to do is drop all that fat eating, then calculate your protein macros and divide them between three meals. Use common sense not reactionary dieting. Remember, you aren't simply "losing weight", you are trying to reverse a detrimental metabolic adaptation.

3. I can't fast and I’m slim.

That's a good thing. If you are slim and you can't fast, it means your leptin is working as it should and demanding nutrients so it can burn fat. If you are slim and can fast, that's also a good thing. It means your leptin is working as it should and burning body fat as long as it can until nutrients are available again.

Being slim or obese tells you what your metabolism is doing because it sets the context. In the context of slimness, we can assume everything is working well to keep you healthy. In the context of obesity, we can assume everything is working well to keep you obese.

4. Why do all "keto" doctors teach people how to cook replacement sweets?

Unfortunately most people desire that type of food and it's very hard to run a paid diet program without offering them.

5. I was told that statins are "toxic". Is this true?

I am not a chemist/pharmacist and this is not a blog about pharmaceuticals but this is a blog about common sense and fact based information. For this reason I only share what the data actually shows. The data on statins has been pretty clear. What we know for sure is this:

• Statins effectively lower total cholesterol but do not prevent heart disease. This means statins have not prevented a single heart attack through the lowering of total cholesterol. That makes sense since heart disease is multifactorial and it appears that "high cholesterol" is the least of those factors. Treating a number is not treating the problem. This is precisely why we don't consider preventing high blood glucose a proper treatment for diabetes.
• Statins have been beneficial in people with current heart disease. The exact mechanism as to how or why this is the case remains unclear but we can safely say that it is not related to the lowering of total cholesterol. This doesn't mean lowering total cholesterol is useless for everyone. In theory, there would be a beneficial effect in individuals with certain genetic lipid related problems which put them at risk for heart disease. This is because if total cholesterol lowers, so does their malfunctioning LDL. LDL is absolutely implicated in the atherosclerotic process but it appears that its number does not always correlate with its malfunction. Number tracks more closely with malfunction when LDL is significantly high, like over 300 mg/dL. Either way, these individuals are basically slowing down the inevitable by having less LDL through less total cholesterol.

That's all. Those are the facts.

All medications come with risks and benefits. There isn't a single one that doesn't cause some kind of side effect or even long term permanent damage. You can use blood pressure medications as a prime example of that. Blood pressure medications have long been implicated in the development of kidney disease. This could be the result of the medication itself or that blood pressure medication simply does not lower blood pressure enough to prevent future kidney disease. Even borderline high blood pressure damages the kidneys.

Regardless of the reason, what this means is that eventually you will develop kidney problems on these medications but this won't occur until 15 - 20 years later. Untreated high blood pressure, on the other hand, could have killed you in 6 months - 1 year and also damages kidneys more rapidly than the medication does. So, the question is, do you want to die now or later? The risks of treating your blood pressure vastly outweigh the risks of not treating it.

Now what quacks are trying to sell is that you can easily treat your blood pressure, all by yourself, and have 0 risks and nothing but benefits. Would you invest money with an investment firm that makes you this promise? Does it sound like a scam to you? It should, because it is. There are things you can proactively do which can better your treatment outcomes for any condition but most conditions are very complex. No matter how well you try to treat them on your own, you can never treat them enough to reduce your risks of dying from them. That's why there is medical intervention. Does medical intervention end up killing some? Of course. Any intervention can cause death or new problems to arise but medical intervention ends up helping most.

One of the best ways of helping yourself is staying away from quackery as that will prevent you from choosing a proper and effective treatment.

6. There are people who eat one brownie and are thin, but fasting "keto" people follow that "weird diet" and are still obese and sick. Why?

Once you develop metabolic syndrome all bets are off. That's when you begin to pile on body fat, exponentially, and this trajectory will not reverse unless something affects metabolism profoundly enough to halt this adaptation towards starvation. Adaptation towards starvation simply means a metabolism that keeps a high blood glucose, insulin and body fat set point. The body adapts to keeping its blood glucose and body fat high, by any means necessary. This is exactly what occurs during "classic starvation". Of course with classic starvation the body simply can not achieve the body fat and so the person eventually dies. But the mechanism itself, regardless of its success, is exactly the same. In a way, obesity can be described as what occurs when there is long term starvation with sufficient nutrients to prevent death.

The person who has not developed metabolic syndrome yet, can handle this brownie for as long as their body continues to retain its blood glucose regulation. How long the body can retain this is dependent on multiple factors of which the amount of brownie is the least of them. So trying to eat only a little bit of brownie is not going to cut it in the long run. The brownie will eventually break metabolic homeostasis 99% of the time. There are a rare few who can handle this brownie well into age 100 and beyond but don't bank on that being you. Especially if you are already overweight/obese and reading this.

These fasting obese "keto" people all have metabolic syndrome to some degree. That's why they resorted to this diet to begin with. They didn't willingly give up their doughnuts. It took disease and impending death to make them do so. Metabolic syndrome is anything from overweight/obesity to diabetes and everything in between. Their "weird diet" has simply not affected their metabolism profoundly enough to reverse this adaptation. There are multiple reasons for this, one of them being the "weird diet" itself.

This is why the goal is the reversal of this adaptation, not to follow a "weird diet". You have to be sure that the protocol you are following is actually addressing the issue at hand and the best way to know that is to see if it's lowering your body fat.

Six common beliefs addressed, Part 247

1. I recently had the flu, so I followed the advice in a fasting group to "fast it away". I ended up in the hospital with dehydration. The moment I ate again, my symptoms subsided, and I recovered quickly. My doctor told me I had done a dangerous thing. How do these people get away with giving this type of advice?

I hate to say it but if you play stupid games, you win stupid prizes.

Illnesses like the flu can cause serious dehydration and this in turn can result in electrolyte imbalances. You have to be well hydrated, but you also need proper nutrition because electrolytes are mostly controlled in the colon by what you eat. This is why you can get very sick when you fast, even if you drink suffice water. It's simply not enough.

Your immune system also needs protein to make antibodies and since stress causes for there to be a lot of lean muscle mass breakdown into sugar, you have to make sure you eat adequately to help your body fight off infection. In fact, access to nutrients has been a major factor in humans surviving infectious diseases like the flu. Malnutrition/not enough food is the main contributor of death in third world countries. The best and only support available for viral infections is proper electrolyte administration.

The reason these people get away with this type of advice is because others are foolish enough to follow. Don't blame the leaders, blame the followers. Anyone who goes online to seek medical advice, is basically a fool. I prefer for people to become educated and not follow idiots rather than censoring them. Let them give all of the advice they want but if no one follows, they will simply have to find another gimmick.

2. I have obesity and metabolic syndrome, so I have to be on a low carb diet in order to control these conditions. Unfortunately, I also have a genetic condition where I cannot metabolize fats very well, so I tend to get sick on a "high fat diet". The protocol for my particular condition recommends that I restrict fat to only 20 grams a day. When I remain low fat, I feel great. Is there a practical way of going low carb and low fat at the same time for the long term?

Yes. Low fat and low carb is basically a protein sparing modified fast protocol. You are restricting (fasting) the energy macros from your diet (fat and carbs) and keeping (sparing) the protein. There are multiple ways of applying this protocol because the macros can be modified depending on your goals. Hence the name of the diet.

But before I take a deep dive into your question, I want to address the "high fat diet" part. We do not recommend "high fat" protocols on this blog. Those are not legitimate protocols. This blog is all about low carbohydrate, not high of anything. I know there are some legitimate protocols out there that have unfortunately been described as "high fat" but those are false labels. The only "high fat diets" that exist are being followed by very obese, low carb advocates online that went rogue. No legitimate protocol endorses that way of eating.

When a protein sparing modified fast is being used for body fat loss, it is quite restrictive, making it very difficult to adhere to. It also cannot be used for the long term as it should no longer be followed once body fat goes below a healthy percentage.

• For a man, 2–5% fat is essential, 2–24% fat is considered healthy, and more than 25% classifies as obesity.
• For a woman, 10–13% fat is essential, 10–31% fat is healthy, and more than 32% classifies as obesity.

Of course, the obese will have a very difficult time getting to "essential" or "healthy" fat percentages, so they are pretty safe following protein sparing modified fasts for as long as they are still obese.

But of course, this diet can be modified. That's the operative word. It doesn't have to be so restrictive especially if you have to follow it for life. You can simply keep dietary fat up to 50 grams a day in order to give you some leeway. In your case, you can keep it at 20 grams a day so you feel your best. Keep your protein consumption adequate so that your body does not reinforce its starvation response. The carbs can go anywhere from 0 to 100 grams a day. Remember, the priority of this protocol is protein, not fat or carbs so they are irrelevant as long as they are kept low.

Practical ways of achieving this is avoiding dairy products, as they are very high in fat. If you wish to still consume them, you will have to get the 'low fat' or 'fat free' versions but watch your carbs if you do so. Buy 'lean' to 'extra lean' meats and add your own fat at home, if needed. Remember farm animals still contain a high amount of fat even when labeled lean. But adding your own fat to lean meats (preferably wild game) can help you control how much fat is in them without sacrificing protein which is your priority. Avoid unnecessary novelties like nut products and other "low carb" favorites which usually are more fat than anything else. Your priority is protein not fat.

Stay away from junk. Go for the naturally 'low fat', 'fat free' foods which are still whole and not processed or packaged. In other words, choose part-skim mozzarella and not fat free Oreo's. The premise of consuming whole foods still applies to low fat diets.

3. I was sitting at the grocery store and saw that nearly every obese person who passed by me, had a cart that was either empty or had very little food items in it. Yet, every single one of them went directly to the bakery to pick up a pie, cookies or a cake. The stereotype is always that a fat person would basically inhale the entire market, but their carts say otherwise. Strangely enough, every person who was slim bypassed the sweets and went to the bread aisle of the bakery instead. It was an eye-opening experience and I was wondering if you can opine on it.

You pretty much experienced the reality of the obese and why the calories in/calories out (CICO) approach as a treatment has failed so miserably. The obese are the least hungry people on earth. At least, for food. I will relay to you my own experience with this, and I have two examples.

Example 1: My husband's mother was morbidly obese and diabetic. When we would go out to eat, she would take two bites of her food and then stop. Then she would either bag it for the dogs or tell me I can have it. You would imagine, from simply looking at her, that she would wolf down the entire table of food but it never happened. She would blame her hiatal hernia for being unable to eat as it caused her to feel full prematurely but she would then order the dessert and eat it in its entirety by herself.

She would wake up in the morning with no hunger whatsoever and wouldn't eat a thing until almost evening. Of course her meal would consist of mango juice or a milk shake at the ice cream shop. I never saw her sit down to a real meal. Ever. Every time food was available, she was never hungry. She never even cooked. She lived off novelties.

This woman was well at or below her daily calories chronically but yet she was still obese. As you can see it wasn't the quantity of food she was eating that was causing her obesity but her disordered eating habits instead. She was on a high fat/high carb novelty diet and calories be damned.

Example 2: I had a friend who was overweight and diabetic. She did the exact same thing. Every time we would go out to eat, she would take two bites of the meal and then tell me to eat the rest. She blamed her missing gallbladder, but she always had room for dessert, the bread and the fries. She just could never stomach the meat and vegetables. She was never hungry but always had room for high carb "junk". Again, disordered eating habits.

This doesn't end at these Standard American Diet (SAD) followers. We also see this in the obese who follow "keto" or the fad low carb diets you find online. None of them ever sit down to a real meal. Their food always consists of fat. Cream cheese, butter, ice cream, fat bombs, bulletproof coffees, high fat sauces and novelties are considered "meals" for these people. They simply went from disordered eating habits which featured high carb foods to disordered eating habits which feature high fat foods, but the disordered eating habits remain. They were never changed and not even acknowledged.

So yes, I have also seen the very obese walking around the market with a skinless chicken breast, fat free milk and salt free broth in their cart, plus a package of brownies. I have also seen the obese live off salads and veggies because they refuse to eat a real meal. The obese have very strange eating patterns that go well beyond "overeating". Most of the time "overeating" isn't even on the docket. It's really overeating of sugar and under eating of real food or eating air. Real food is meat and vegetables. You know the type of stuff they consider boring and not fun. It's a chore to cook but a joy to open an Entenmann's Bakery box or drink of gallon of diet soda.

Of course, this is also a huge contentious topic with the obese as they do not like to be criticized for their eating habits. They rather blame someone else for their problems, like their doctors, fat free diet products or the Dietary Guidelines. Obesity is already very difficult to treat biologically, and this "victim" mentality and "don't fat shame me" attitude makes it all the more difficult. Behavior must be addressed when treating obesity or the condition will always return, no matter what amount of weight is lost. This is why "weight loss surgery" has been a failure as well.

Thin people heading to the bread aisle of the bakery is a much more complicated topic as bread is eaten around the world and obesity does not track with it. Obesity tracks with sugar intake, not bread. All cultures have their own bread recipes, and they are quite old, yet obesity is a modern condition.

Regardless, bread is a food item that is not recommended on this blog because it is very difficult for an overweight/obese/diabetic to control their blood glucose regulation while keeping bread in the diet. In fact, grains in general are to be avoided at all times. But we all know that bread is very different from doughnuts.

For a person who is still metabolically healthy, what will ward off disease is the overall macronutrient composition of their diet, eating habits and other lifestyle factors. A lot of these thin people, who are headed to the bread aisle of the bakery, are mostly using calorie restriction to maintain their metabolic health even though we know this will ultimately fail if they aren't watching their blood glucose as well. But they will be able to sustain their blood glucose regulation for longer if they continue to bypass the cupcakes and get a loaf of rye instead.

4. Are eggs and cream cheese a good meal to have? A lot of low carbers have told me it's really good.

Eggs and cream cheese are not a "meal". It's a novelty. This type of disordered eating will only make you fatter, especially if you have had a hard time losing weight since that is indicative of leptin resistance. Low carbers shouldn't be telling you that eggs and cream cheese are "really good". The only thing that's good is regaining and sustaining proper blood glucose regulation. That is the only lens you should be using to formulate your dietary choices because that is all that matters.

When you are leptin resistant, any fat you eat is stored and never burned. This causes for dietary fat to be extremely obesogenic as it only adds to your fat mass.

There is no reason to live off cream cheese. Low carb is not cream cheese. It's meat and vegetables. Eat a real meal.

5. Is it true that the purpose of "keto" is not weight loss?

The purpose of "keto" depends on your goals.

There are many iterations of a ketogenic diet. Each is designed for different goals. The classic ketogenic diet is for the treatment of cancer, seizures and other neurodegenerative conditions. There are ketogenic protocols for muscle gain, for weight gain, for the treatment of metabolic syndrome/diabetes and also for weight loss.

The fad "keto" protocol promoted online was marketed as a weight loss diet. This is what caused hordes of people to flock to it and give it a try. When it didn't work, suddenly the purpose was redefined.

Don't let these people gaslight you. This diet gained popularity as a weight loss tool, period. That is probably why you decided to follow it too. If it didn't work, dump it. No weight loss = no long term metabolic change. So who cares what it improves in the short term. Obesity can only be treated with long term changes.

6. Is it "healing" for the body to shift from burning glucose to fat and does this "cure" you of obesity?

As of this post, there is no known cure for overweight/obesity. There is nothing to "heal". Overweight/obesity is not a "disease" that requires "curing" or "healing". It is a metabolic state that requires changing.

Your obesity was not caused from "burning glucose". Your obesity was caused from not burning fat. Glucose burning can displace fat burning but that's meaningless in obesity. That happens to everyone. Our bodies are constantly burning both glucose and fat. It never does one or the other. It does them both at different rates.

For instance, athletes burn massive amounts of glucose all day and do not become obese from it even if it temporarily displaces fat burning. At the end of the day, when they reduce their glucose burning, they burn fat just fine and continue to do so while resting. The obese do not. They just simply don't burn enough fat to not be obese.

The obese also burn very little glucose. The glucose they have is turned into more fat instead. So, the obese are not burning much of anything. This is why they are constantly tired and growing fatter. In fact, most of the energy that the obese "burn", is from converting glucose into more fat. This is why some obese people have high metabolic rates but are still obese. It takes a lot of energy burning to be fat. Not only to they have to lug around gym weights in the form of body fat, but they have to keep converting glucose into more fat.

When the obese are starved of dietary glucose, they simply convert more lean muscle mass into glucose and continue expanding their fat mass from it. They do not magically start burning fat because there is no glucose in sight. There is always glucose. It never disappears just because it's not on your plate. The only thing that causes the obese to burn fat is an increase in leptin expression. This can occur through the normalization of other metabolic hormones but it's not guaranteed.

Six common beliefs addressed, Part 240

1. Can low carb "cure" glaucoma?

Low card can't "cure" anything. Low carb is a diet that is used, alongside other lifestyle changes, to control the progression of metabolic syndrome. It is a palliative treatment only.

As far as glaucoma is concerned, there are many different types of glaucoma and all of them are completely treatable in the modern world. In fact, glaucoma treatments are so effective in this day and age that you can describe this once blinding condition as technically "curable".

2. I've heard about a "documentary" called 'Reversed'. What do you think of it?

All this stuff is just another money grab by known low carb quacks. Many of these types of films are floating around out there. Once you have seen one, you have seen them all.

I have seen a snippet of this one and that was enough to see that it's just another emotionally driven documentary to grab at your heart strings since the "science" it's based on is plain incorrect. If you like watching this stuff, that's fine but don't expect to resolve your metabolic issues. The only thing this can do for you is deliver false hope, but some people are just fine with that.

3. I follow a "low carb doctor" and he measures ketone levels in his patients to determine if they are being "cured" or not. Is this a good strategy?

That is foolery. It's just a way to make the patient think that "something is happening" so therefore, "it must be working".

A diabetic has poor insulin function. Insulin does a lot more than just facilitate glucose into cells. It also controls ketones from fat burning. This means that diabetics can make ketones very easily as their insulin is not very good at regulating ketones or anything else. Measuring ketone levels in a diabetic is a waste of time. It simply shows you that they are burning fat. Whoopee! They are still fat and diabetic. Diabetes is not the inability to burn fat. It is the end stage of metabolic syndrome, a condition of poor blood glucose regulation.

A rise in ketone levels from eating low carb is expected in a diabetic as it's expected in anyone else. When insulin lowers, it makes you more prone to producing ketones. This means nothing. Literally, nothing. You can achieve the same thing with calorie restriction. It's the way the body is supposed to work. Ketones do not "cure" diabetes. The diabetic is still diabetic and will continue to be while producing ketones.

Diabetics burn fat, like everyone else. In fact, they have excess fat in their blood to burn. Diabetics burn glucose. They for sure have plenty of glucose in their blood to burn. Diabetics burn through their lean muscle mass too and they don't even have much of it to spare. Everyone burns fat and glucose, including diabetics. The difference is that diabetics don't burn enough stored fat and can't keep themselves from storing more. This isn't resolved with ketones. This is resolved by stopping the metabolic adaptation that keeps this cycle going.

It's really sad the way these low carb "doctors" take advantage of these desperate people who don't understand basic metabolic function or biology. They are duped by fancy and mysterious words like "ketones" and think that some magic is occurring in their bodies. Throw the word "insulin" in there, which is one they have heard their doctor mention before and they think they just found the Holy Grail. These people want to hold on to the belief that there are "easy quick fixes" out there, so they will take whatever these "doctors" tell them at face value since their own doctors haven't been able to "cure" them. At least, not easily nor quickly.

Once you get past how sad this is, it becomes rather disgusting that there are parasitic people that would do this to these sick people. These "low carb doctors", well the ones who are actual MD's, took an oath to do no harm and I suppose they justify their actions by telling themselves that they aren't really doing harm. They are just not telling these people the whole story and these people do get somewhat better so it can't be that bad. After all, they can't get any worse. The problem is that they do. They continue getting worse.

Not only are these people robbed of money, they could use for better food and walking shoes, a lot of them also stop their medications, ignore serious symptoms, follow diets that make their problems worse, all while living a lie. The worst part is that they don't even live long enough to realize it. By the time they wake up, it's too late.

4. How many carbs a day is still considered low carb?

This is subjective as there isn't an "official" number for what constitutes "low carb" that everyone agrees on. It really depends on who you ask but if you were to take all low carb diets and take a range from them, then you can say low carb diets fall anywhere between 30 - 200 grams of carbs a day. Remember, we are discussing low carb, not no carb. No carb would be 0 carbs a day.

Below 30 grams a day would be considered ketogenic. Above 200 grams a day would be considered moderate carb until it reaches the Standard American Diet (SAD) of well over 300+ grams of carbs a day, which would be considered high and/or ultra-high carb.

As a side note, people who advocate for the Dietary Guidelines, will swear up and down that SAD does not have such a high carb allotment but that's only true of people actually following the daily calorie recommendation, which none do because they can't. No one can. So, the way the diet is actually followed, not the fantasy, does push carbs way over 300 grams a day.

A good rule of thumb is to just use the Atkins model which defines true low carb as up to 100 grams of carbs a day. Just stay away from sugar and grains.

5. Is it true that things like red light therapy, saunas and "grounding" will help overweight/obesity?

Absolutely not. I don't want you to get caught up in nonsense because you won't get anywhere and people with metabolic problems do not have much time to waste on dead ends.

The only thing that has been shown to be successful in reversing and halting the progression of overweight/obesity/metabolic pathologies is lifestyle. Lifestyle comprises of diet, exercise and stress mitigation (sleep, fasting). None of these things work by themselves, except for exercise which is the only one that has been shown to have benefits irrespective of the others, but the best outcome is to incorporate all of them.

6. If sugar and carbohydrate consumption has decreased why is obesity still an issue?

I've answered this before and it's multi factorial. Sugar consumption has dropped in the past several decades because there is no need to add sugar to anything. It's already been added to the products being sold. So even though individual sugar consumption has decreased, food manufacturer usage has increased exponentially.

Foods like ice cream, soda, candy and deserts have been on the decline for several decades because of calories in/calories out (CICO) compliance, plus the "healthy foods" renaissance that has taken over the diet sphere. So obvious "junk foods" have been pushed to the side in lieu of "healthy fats", "healthy grains", "healthy sweeteners", "healthy fill-in-the-blank".

But "junk food" aren't the carbs that make people fat. Fat people have been passing on the dessert at restaurants since before they got fat. It's the grain based "healthy" products that are the main culprits for obesity. These foods are impossible to consume within CICO parameters as they are so nutrient void, and disrupt blood glucose so profoundly, that you would be unable to stick to calorie deficits without feeling uncomfortable enough to make it stop. So even when the overweight/obese person declines the dessert at a restaurant, it doesn't make a bit of difference when they just ate a basket of multi-grain bread and a plate full of whole grain pasta only to be ravenously hungry an hour later.

This is the main problem with CICO combined with a high carb diet. It becomes impossible to follow as the macronutrient composition keeps you hungry, due to a disruption in blood glucose homeostasis, they it truly only works in a perpetual state of starvation (chronic hypoglycemia). This prolonged time in hypoglycemia will eventually result in metabolic syndrome anyway. So, you can see diets, which are carb based, have made people fatter and this is why you see a linear increase in obesity alongside a decrease in sugar consumption. Decreasing sugar calories while still eating high carb, doesn't work.

Overweight/obesity are also time dependent conditions. It takes a chronic, long-term assault on blood glucose for weight gain to become overweight/obesity as it takes time for metabolism to adapt to the point to where it begins piling body fat exponentially while sparing it at the same time. The journey to obesity is just as slow as the journey to leanness. The only difference is that obesity is a guaranteed destination while leanness is not.

Six common beliefs addressed, Part 234

1. Can chronic calorie restriction be sustained? If it can, does it override the body's compensatory systems?

Yes. When true starvation is forced, it can be sustained, and it will override the body's compensatory systems. External forces like famine or other conditions, where food availability is not consistent, uncertain or non existent, causes a sustained state of chronic starvation.

In this state, the body compensates but this compensation never results in overweight/obesity because the person will die of malnutrition before any metabolic adaptation, resulting in metabolic syndrome, can take place. Metabolic syndrome is starvation without the death.

2. You can't predict who would get fatter and sicker on protocols like extended fasting and fad "keto".

Those type of programs are detrimental for people who:

• Have been overweight/obese for most of their life.
• Have metabolic syndrome/diabetes.
• Have dieted frequently using some sort of starvation (most diets).

It's these people who will suffer the most in the long run as these protocols will cause their metabolism to double down its starvation adaptation increasing body fat over time and worsening metabolic outcomes regardless of any initial improvements. You can find multiple in vivo case studies of this online, in the fasting/"keto" community.

3. I recently left a protocol I had been following for some months. I didn't really lose much weight, but I did drop some inches and then stalled. I left the program because there was too much strenuous exercise involved and I'm a senior who can't keep up. I felt like I was being blamed for not being able to lose more weight than I did. I feel lost as to what to do now.

It's sad to see people get duped, over and over again, by these weight loss programs, usually run by fit body building trainers. These people cannot help you. These people can help someone in their twenties achieve muscle tone and drop 20 lbs. but they cannot help someone in their sixty's reverse overweight/obesity and their metabolic syndrome. It's not going to happen.

Calorie centered protocols that work using deficits and a large amount of energy "output" is just not going to tackle the "disease" known as obesity. People on these programs will end up blaming you, when the protocol does not work. They are true believers that go into a rage when reality shows them otherwise. For them, if it's supposed to work, then it simply cannot fail. Their logic is that if it works for 30-year-old Debbie who is 30 lbs. overweight, then it must work for 50-year-old Sarah who is 100 lbs. obese. It doesn't. Being a few pounds over your "ideal weight" is not obesity.

This is why we focus on meal composition, sustainable exercise and behavior modification in order to get long term results. In other words, a lifestyle approach. Overweight/obesity and metabolic syndrome only respond to long term, consistent, lifestyle interventions.

4. Are there fasting protocols which are not based on calorie restriction?

Intermittent fasting protocols like 16/8 and 20/4 are not based on calorie restriction because the person can eat all of their required calories in the 2 - 3 meals they would have during their 8- or 4-hour eating period. Once the fasting protocol becomes longer like one meal a day (OMAD) or less, then it produces an overall calorie deficit.

Doing an OMAD or up to 72 hours of fasting, once a week, is not a prolonged enough calorie deficit to cause adverse metabolic side effects for the overweight/obese who are generally otherwise healthy, but not everyone responds the same way. The more obese the person, the less chances of negative side effects to these longer intermittent fasting protocols but, metabolic syndrome puts you at high risk for these protocols to become detrimental.

5. I’m Asian and in good health. I’m slim and do not have metabolic syndrome. I consume my traditional Cambodian diet which consists mainly of rice and vegetables. I’m considering giving up my diet because of all the anti-carb info I’ve been reading online.

No. If it's not broken, don't fix it. You’re not in any danger and you shouldn’t change your diet. As long as you continue consuming your traditional low to no sugar diet, without any Standard American Diet (SAD) processed items, you will continue to be fine.

Low to zero carb diets are the recommended diets for people tackling metabolic syndrome and overweight/obesity. They can no longer negotiate with carbs. Traditional Asian diets for healthy Asians are the best diets they can follow as it's their original diets which they genetically evolved with. Asian diets combined with the SAD diet is deadly. So, as long as your healthy, don’t change anything.

6. I have heard you mention "obesity mindset" before and I would like for you to elaborate on what that means. I have never heard anyone else mention this.

We don't see obesity as solely a biological or a behavioral problem, on this blog. Obesity is both. Both biology and psychology play a role in obesity, and one cannot exist without the other as they depend on each other. There must be fertile ground for obesity to take hold and that's where mindset, which influences behavior, plays its role. Obesity is a lifestyle choice. This means that the person must be living a lifestyle that promotes obesity (obesogenic) and this goes well beyond dietary choices.

There are certain behavioral characteristics that are similar, across the board, in most obese. These behaviors existed long before the person ever reached obesity. This is why obesity is a time dependent condition, on all levels, because it begins long before excess fat accumulation becomes visible.

To put it in perspective athletes are never obese. Now you could chop this up to simple calories in/calories out (CICO) theory, but you can also look at an athlete's mindset, long before they became an athlete. Athletes are known to be persistent, tenacious, consistent and determined. The person that gets up at  5 am to go jogging whether it's cold, hot, raining or snowing, is never obese and will most likely never develop obesity in their lifetime. Hint: It's not just because of the jogging.

Obesity characteristics are not as simple as just "gluttony and sloth", though you can see how this stereotype took hold, since many of these characteristics below mimic just that. The most common characteristics that I have experienced in the obese are:

• Entitlement - They feel they have a "right" to things. "I have the right to eat what I want and shouldn't be kept from it". "Because I am older, fatter, weaker and sicker, I have a right to not be expected to eat or move like others". "Because I am stressed, I have a right to this cookie. I deserve it".
• Avoidance - They will address the problem without ever doing what it takes to resolve it even when the resolution is known. They avoid difficulties and address "the issue" in a way that's comfortable, both physically and mentally for them, even if it provides no results.
• Excuses - Usually these excuses are part of the avoidance. Excuses come in dozens for the obese. From social gatherings to holidays to "I only ate a little bit" to once again, stating how old, sick and fat they are.

I notice this clearly in aging. For instance, in my Cuban culture the elderly are very entitled. They basically are not required to move while the young are obligated to do everything for them. Well, what this has caused is a very sick elderly population in our community. They become immobile younger and develop serious health conditions sooner. In contrast, American elderly people are out jogging, golfing, swimming, traveling and remain active for longer while older. This is because loss of mobility and knowing you can't really depend on the young to do for you, keeps them active by force. Invalids don't just use crutches, crutches make invalids.

Most obese use their mindset as a crutch to perpetuate and justify their obesity in one way or another. Once you are obese, biology will not make it easier to become lean. It will only make it easier to become more obese. So, this mindset has to be changed and preferably, not allowed to take hold early on in a person's life because it will make them obese later on. The ones who succeed in becoming lean, don't just change what they do, they change how they think.

Six common beliefs addressed, Part 231

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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