Six common beliefs addressed, Part 228

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

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

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

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

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

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

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

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

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

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

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

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

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

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

5. Hormones do not impact energy expenditure.

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

Two major hormones that effect energy expenditure are:

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

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

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

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

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

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

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

Six common beliefs addressed, Part 174

1. People say they love "keto" because they can "eat as much as they want". 

I hate to be sarcastic but that's not surprising. Like I have said before, behavioral issues go hand in hand with obesity as much as biological issues do. Obesity is a mind/body problem.

That is not the correct way of following the diet or any diet for that manner. You cannot solve obesity with the same behaviors that got you to it but the reality is that many of these people will remain obese on "keto" and they won't care because their HbA1C dropped three points.

2. My blood glucose is still in the 200 mg/dL on carnivore but I fast for 16 hours. Does this mean I need to fast longer?

No. If you fast longer you will increase this problem over time, regardless of any short term benefits you might see. You are a full blown diabetic and your blood glucose is being driven primarily by an adrenal stress response, not the individual foods you eat.

The only thing you can do is mitigate this stress response by getting rid of every little thing that can contribute to it, incrementally, in order to try and get it under control. Each little thing you address will help cause a cumulative effect to try and drive down this stress. At least, that's the goal.

I recommend you drop carnivore. It is exacerbating the stress response but since I don't know your exact protocol, I can't tell you why. There are a multitude of ways you could be doing this diet incorrectly. Carnivore diets are very difficult to follow. For that reason, you shouldn't follow them at all, if they aren't producing significant results. 

• Go to a basic, low carb diet, Atkins style instead.
• Stop the fasting. Ditch the 16 hours and go to a 12 hour fasting schedule instead. This means you should be eating three meals a day. Do not snack.
• Make sure you do not over exercise but you still exercise. Exercises that are steady state, low to moderate intensity, like walking, are best as it helps to mitigate stress hormones.
• Also, keep your eating, fasting and exercise schedules consistent daily, with no deviation.

3. I am very cold when I fast. The longer I fast, the colder I get. 

Your metabolic rate is dropping and you aren't burning any body fat. You are only further disrupting leptin expression and thyroid function. And no, iodine will not save you.

It is mind boggling how people will insist on doing something, that is not only failing, but making them feel like crap to boot.

Shorten your fasts to only 12 hours a day, basically an overnight fast. Eat three meals a day with no snacks in between. See if that helps.

4. "Keto" will help change your relationship with food.

No. Your relationship with food has nothing to do with what foods you eat, but how you eat. Many people bring the same eating habits into their new diet which they carried over from the past one. "Keto" is a protocol that helps address the symptoms caused by metabolic syndrome. It addresses the biology but not the behavior.

5. The body will get use to a consistent fasting schedule and this will cause a weight loss stall. You should always "change it up" instead.

The body always compensates to calories coming in. This is why you need to avoid long fasts as they technically cause the same problems as caloric restriction since that's basically what long fasts are - a method of restricting calories (starvation). "Changing it up" is not the solution for this.

The body does not "get used to your fasting schedule". It gets used to fasting, period. That is why fasts have to be of short duration so that this adaptation does not occur.

6. Stress responses do not change over time.

They absolutely can. Losing a lot of body fat can trigger an abnormal stress response while keeping it on does the same thing. We usually only think of stress responses in the context of diabetes and metabolic syndrome but the cure to these problems can induce a stress response as well.

Some people see their blood glucose begin to rise as they lose more and more body fat. They might also feel jittery. They might even begin to gain weight, after they have lost a significant amount, due to a change in leptin and cortisol expression. Their energy levels might drop as well.

Unfortunately, nothing can be done about this. The body simply does not like a challenge to its body fat, especially if it has always had excess body fat. For chronically obese people, certain hormonal functions cause for their weight set point to always be higher than it should be. So, you just have to continue with the protocol that got you to lean and move forward.

Six common beliefs addressed, Part 134

1. You should use a scale that calculates metabolic rate. 

The only thing you should be tracking are results. Results are seen in inches lost and improved metabolic markers. Better yet, the results are seen when you stand naked in front of a mirror and are pleased. After all, if you are getting lean, then your metabolic rate is working to keep you that way and if you are obese, your metabolic rate is working to keep you that way. Your metabolism is always working to keep you in the state you are currently in. 

• Having a high metabolic rate, while being obese, means that your body is working hard at putting on the pounds. 
• Having a low metabolic rate, while being obese, means that your body is hardly working so it can keep those pounds on. 
• Having a high metabolic rate, while being lean, means that your body is working hard at keeping the pounds off. 
• Having a low metabolic rate, while being lean, means that your body is hardly working at putting on the pounds. 

At the end of the day, body fat determines what your metabolic rate is doing. What it's doing is ultimately all you care about. How fast or slow it is doing this, is irrelevant. Speed doesn't change the outcome. 

2. I can eat a whole steak and a pound of ground beef in one sitting. Though I have lost weight, I am now stalled at 20 pounds from "goal weight". 

It doesn't matter if you can eat a side of cow, if you are losing weight and/or keeping it off. How much you eat is irrelevant, in that context, but if you are stalled and/or gaining weight then you have to lay off on the amount of fat you are in taking, if you are already low carb. 

Dietary fat is the Achilles Heal of low carb diets. The carbs are gone, so they aren't the ones adding to the pounds. The fat remained or has increased and so that is definitely the culprit of a weight stall or gain. Eat leaner meats. Make sure your steak is sirloin and not rib eye. Make sure your ground beef is marked lean and not chuck. See if that makes a difference. Also, scan your diet for any other fat that you might be in taking in the form of dairy or added fats like butter or oils. Cut back on them. 

Check your diet for other culprits that can be interfering with your blood glucose, like too much fasting, erratic meal times, not enough exercise or the wrong kind of exercise, too much artificial sweeteners and in taking caffeine. All of these dysregulate blood glucose regulation and will sabotage your results.

I hate the term "goal weight". Your goal is not necessarily your body's goal. It is very common to stall 20 - 25 pounds from "goal weight" simply because the body refuses to go too low on its body fat. This is especially true of women. Let your body decide how much weight it wants to lose. Being 20 - 25 lbs. from "goal weight" is not stalling like it would be at 50 or 100 lbs. from it. I have seen people complain over being 5 lbs. from goal weight, if you can believe it. 

We only deal with serious overweight/obesity, on this blog, not vanity weight. Vanity weight can be reduced with simple caloric restriction. 

3. If you just eat rib eyes, you will be fine. 

Unfortunately there are two types of low carbers out there, that always want to throw in their two cents, when they should really just keep their coins to themselves. On this blog, there are no slots to put them in. The vending machine is closed. These two nickel and dimers are: 

• The low carber who is not truly overweight/obese, but wants to trail the bandwagon anyway - This type of person can basically eat rib eyes until the cows come home. Literally. They aren't stalled. They aren't gaining weight. Everything is happy in the Land of Obesity Resistance. Yet, they want to take their experience and pass it on to you, making you fatter in the end. 
• The low carber who was once a diabetic and now has "lower blood glucose" - This type of person is basically happier than a pea in a pod because their blood glucose runs at 120 mg/dL instead of their usual 200 mg/dL. They still suffer from morning and postprandial highs, but who cares when their HbA1C is now two points under the diabetic range and their doctor removed them from diabetes medications. Hint - Their still diabetic, but it hasn't gotten bad enough to require medications.... yet. Of course this person will tell you that rib eyes "cured" them and now wants you to do the same. 

Don't follow these fools or you will be going off the cliff with them. The reality is that your overall dietary composition is king in determining what you can eat. If all you eat are rib eyes and you never have dairy, nuts or use added cooking fats, then there is a possibility you will get results and you just might be able to sustain them. Of course, time will be the determining factor of that, but let's just assume you really could sustain results long term, for argument's sake. On the other hand, if you are eating rib eyes, adding a stick of butter to cook them in, frying up bacon and drinking half a carton of cream with your coffee, rib eyes are guaranteed to not get you sustained results long term. 

So, If you are truly serious about your metabolic health and the direction it will take, in the future, you would not guide yourself by temporary successes or failures, but rather by an overall progress that can be sustained. For this, you should be moderating the fat in your diet and making sure you are prioritizing protein. That is the only way to not end up like the failures we see daily, who follow low carb and remain semi sick and absolutely still obese. 

4. I have been trying to stick to "keto/carnivore", but I always end up sabotaging myself. The sugar and bread addiction is so hard to break. 

First, we don't believe in a "sugar and bread addiction" on this blog. Second, you need to find another type of diet. There are many different diets, out there, that address metabolic dysfunction, from caloric restriction to vegan/vegetarian to low fat. I don't know why you want to narrow down your choice of diet to only "keto/carnivore" if it's obvious you can't follow it. 

Low carb diets are elimination diets. Whoever tells you that's not true is because they are either lying to you on purpose, in order to sell you snake oil, or they simply don't know how to follow a proper low carb diet. With low carb diets you have to severely restrict and/or eliminate an entire macronutrient - carbohydrates. The least restrictive of all low carb diets is Atkins because that diet simply keeps carbs under 100 grams a day and they can come from any source you want, including sugar. Other than that, you will be completely eliminating sugar and grains, in all of their forms, and the only carbs left will be non starchy vegetables. This has to be sustained for the long term as metabolic/obesity treatments only work when followed for the long term. This means that low carb is not only restrictive, but it's a commitment to boot. This isn't a "7 day fat loss diet" like you read in a tabloid. Low carb is a lifestyle. 

Many people simply can't do it and so it's best they don't even try. I am going to elaborate as to why. If you follow low carb and are actually able to sustain it, for some months, and you end up losing a lot of weight, improving your metabolic makers, but end up eating sugar and bread again because of your "addiction", you will quickly regain all of the weight you lost and it will be twice as hard to get rid of again. Going up and down in weight (yo-yo dieting) is detrimental to metabolic function. You are better off remaining consistently obese than to lose weight to only become obese again. That only ends up training your fat cells to grow even larger with each subsequent weight regain and losing weight will start becoming impossible as you completely annihilate your leptin expression. So, instead of fooling around, you should find a diet that you can stick to and follow consistently. 

5. Will "keto" always correct triglyceride (trigs) levels?

Keep an eye on your trigs to see if they are on a downward trend. Sometimes it takes time for the liver to stop dumping fat, from within itself, into the bloodstream. That's a good thing because you want the fat out of your liver. 

But if your trigs stall and remain high, then lower your dietary fat intake and see if that makes a difference. Usually the type of "keto" that is followed advises on way too much dietary fat. Trigs are a measure of too much energy in the blood, whether from carbs or fat. Carbs have a more profound effect on trigs, but that doesn't mean fat is exempt. 

Other than that, there are certain genetic profiles that cause for some people to run very high trigs, even on a healthy diet. 

6. Insulin resistance is a precursor to diabetes. 

Diabetes is the end stage of poor blood glucose regulation. Once you develop diabetes, blood glucose remains high all of the time. There are people with poor blood glucose regulation that do not ever develop diabetes or will only develop it very late in life. Insulin resistance can be described as a condition of poor insulin function as a result of poor blood glucose regulation. This can result in diabetes if it reaches its end stage.

Six common beliefs addressed, Part 33

1. Why would the body not want to lose fat? It would make it healthier.

We see losing body fat as positive, because we hate the way we look naked and we know the long term health effects of excess body fat. But, the body doesn't look that far ahead. It only looks seasonally. It's just trying to survive the next winter, not trying to survive till it's 100 years old. This is why losing weight is so difficult, but gaining weight can become easier, especially with time.

The body is inclined to learn how to gain fat, but doesn't care so much about losing it. It loses fat only when its forced to. This is why all diets use some form of starvation (force) and why they all fail (results cannot be sustained). Why? Because tyranny is always doomed to failure.

Diets that use starvation to induce fat loss, are guaranteed to fail. This is because starvation has been the main evolutionary driver, for the body, to learn how to keep fat on, not off. The body is very good at adapting to starvation. This is why losing fat using starvation protocols only helps the body become more efficient at gaining it.

2. Why is it that the older you get, the fatter you become?

It's an unfortunate truth.

Getting older means insulin begins to put its focus on growing your fat mass, rather than on something much more useful like growing your muscle mass. This is because protein synthesis slows down with age and insulin is no longer invited to the muscles pool party. But, fat cells also like to party and insulin is always invited to those events. Now insulin has a new BFF - your fat mass. This is all fun, reality show drama for them, but disease for you, as the only reality show you end up in is "My 600 Lb. Life".

This is why it's so vital to prioritize protein, especially as you become older. This gives your insulin something more useful to do than to build more fat mass. You also have to do everything you can to preserve your blood glucose regulation as everything else occurs downstream from it.

3. Low carbohydrate diets are never recommended, because they make no money.

Many people believe that low carb diets are not promoted, because they don't make money. Really? Check the internet.

There are plenty of low carb programs, coaches, conventions, conferences, festivals, cruises, junk food, supplements, books, paywalls, merchandise, Patreon accounts and gurus who beg to differ, as they are raking in millions. Even conventional doctors are throwing in their stethoscopes to cash by setting up their own private "low carb" clinics. 

There is plenty of money to be made from low carb. In general, there's so much money in weight loss that there is plenty to go around. No one in the weight loss business is going to be destitute any time soon.

4. All obesity is caused by high insulin levels.

All obesity is caused by blood glucose abnormalities. which interfere in proper insulin function. This is irrespective of insulin levels but hyperinsulinemia can be a common marker. Downstream from this, there are a slew of abnormalities that continue to perpetuate obesity on their own. 

Insulin is variable amongst individuals. When studies have tested the insulin levels in a group of people, both obese and not, the results have been inconsistent. Obese people did not uniformly have high insulin levels and lean people did not have uniformly low insulin levels. This is precisely why the 'Insulin Hypothesis' is considered incomplete. Though we know that insulin plays an important role in obesity and metabolic dysfunction, most likely a primary role, it is unclear exactly how this occurs for each individual person. What we do know, is that abnormalities in proper blood glucose homeostasis is at the forefront. 

The inconsistencies are because insulin levels are not indicative of insulin function. Though levels can be measured, and they tell part of the story, function is more difficult to determine and does not always correlate with levels. The differences in the insulin sensitivity of various tissues, in the body, causes complexity for pinpointing a universal abnormality that applies to everyone equally, as everyone's insulin resistance is unique. The level of insulin that results in insulin resistance varies between tissues and individuals.

For people who are very insulin sensitive, at the fat mass, weight gain can continue to occur, even with insulin levels below hyperinsulinemic values. This is a dysfunction of the fat mass, itself, caused by chronically higher than tolerable insulin levels. Notice that I did not use the term "higher than normal", because normal, as far as insulin is concerned, is very subjective.

Just like we have an individual fat threshold, we also have an individual insulin threshold. Some people are much more sensitive to the effects of insulin than others. This is not surprising, as insulin was never designed to be static. It fluctuates and changes with metabolic adaptation. All of the tissues of your body must respond to these changes accordingly. For example, your fat mass must become more insulin sensitive during seasons of weight gain and other tissues must become resistant in order to spare energy for that fat mass. Other tissues, like bone and muscle must become insulin sensitive during growth, so fat mass becomes more resistant in order to spare that energy for this growth. The insulin required to halt catabolism is different from the insulin required for facilitating glucose into cells, etc. All tissues require different levels of insulin, at different times and develop resistance differently and at different rates in different people.

This is why there is no one fix for metabolic dysfunction, regardless of what you read online.

5. A high metabolic rate will always keep you lean.

Metabolic rate is an important part of metabolic function and it is mostly affected by the macronutrient composition on your plate, but it can be misleading, especially in the context of metabolic dysfunction. For this reason, you do not want to become overly concerned with your metabolic rate, as it is very difficult to precisely measure and it's not indicative of the whole story.

Because of a larger body mass, you would think that obese people have a higher metabolic rate. But, this is only true for some, not all. Many obese people, actually have very slow metabolic rates. This slower metabolic rate, in the context of obesity, is usually due to genetics and/or a metabolism that is prone to thrift (leptin dysregulation). Basically, metabolism has slowed to a crawl, in these people, from a history of improper blood glucose control caused by bad diets, crash dieting and/or chronic caloric deficits.

Having a "slow metabolism" and being obese is something we have all heard of before and most assume that it's the cause of obesity. So, why are the obese with high metabolic rates also fat?

Metabolic rate is dependent on context. Since we aren't simple calorimeters, with a linear relationship between available energy and energy burned, a "faster metabolism" does not always equate to leanness, since extra energy can be applied to all sorts of different tasks, at the discretion of your neuroendocrine system. Some of those tasks are ones that you may not want, like the preservation and growth of fat mass, for example. So, a higher metabolic rate, in the context of obesity, simply means more energy is being put into making more fat mass. If it wasn't, then you would be lean, not fat and getting fatter.

You must address your metabolic function in order to improve your energy flux, so you can get the most out of your metabolic rate.

6. Increasing human growth hormone is always positive.

Just like with metabolic rate, described above, context is everything.

People with human growth hormone deficiency have positive effects when they are administered growth hormone. Their muscle mass increases and they have some decline in their abdominal fat. Because of these benefits, it was assumed that if diabetics are administered growth hormone, they will also have these positive outcomes, as metabolic syndrome/diabetes causes a deficiency in human growth hormone, due to insulin resistance of the pituitary.

Well, it didn't happen. The obese who were administered growth hormone saw no difference in their body fat composition and some even grew more fat mass. Does this surprise anyone? It shouldn't.

Human growth hormone is a growth hormone, after all, and it stimulates insulin-like growth factor 1 (IGF-1). If there is one thing that the obese do not need, is more hormones that cause growth, since the only thing they grow well, is their insulin sensitive fat mass. There is a reason the pituitary becomes insulin resistant, in the obese. It's trying to stop more growth.

So, increasing the growth hormone of the obese will not make them lean or look like a bodybuilder; not even remotely. In fact, stimulating human growth hormone causes even more fat mass growth, especially in the context of a low protein and excess fat diet, like the fad "keto" diets being followed online or the people who are practicing extended fasting.

Six common beliefs addressed, Part 17

1. The sick are the only ones who should eat healthy.

Everyone needs to eat healthy, because you never want to get sick and then try to fix the problem. Prevention is worth a pound of cure. If you want to keep your good health, then you have to begin implementing the lifestyle that will help you acquire it now. We were all healthy once.

2. Can fat turn into glucose? 

If needed, the body can turn fat into glucose through gluconeogenesis. It does not just use protein to do this. Excess fat is stored and is only converted to glucose in a tightly regulated way. This is demand driven, not supply driven. That is always the case for gluconeogenesis.

Triglycerides are derived from the foods we eat and the glycerol in triglycerides can be converted back to glucose. So, even though fat cannot be directly converted into glycogen, it is possible for stored fats to be broken down into glucose, which can then be converted into glycogen.

3. Can weight loss, by fasting, reduce loose skin?

Natural weight loss is what reduces the risk of loose skin. When weight loss occurs very rapidly and unnaturally, it tends to develop large amounts of loose skin. I never had loose skin during my weight loss, because I did it naturally and at the pace that my body wanted it. Little by little, my body "ate" all of it.

There has not been any proof that fasting will prevent the development of loose skin, but there has been studies that have proven fasting has no affect on it. Though there is protein catabolism, from fasting, most of these proteins are broken down from the musculoskeletal system, not the skin. Skin proteins appear to be preserved during fasting, so it doesn't reduce.

We can see this, in real time, with the results of bariatric surgery patients. All of them have been basically put through a forced fast, from their surgery, but they have all had issues with excessive loose skin. This extreme weight loss from rapid metabolic change is the most likely culprit. The body just cannot catch up with this unnatural rate of change.

The amount of loose skin you can have, after weight loss, is also dependent on age, fat cell health and genetics. Some of us just have looser skin than others and there are differences in the amount of subcutaneous fat that we all store. If you want tighter skin, exercise will be your best bet to get it. There are also several supplements available that can help with loose skin.

4. I automatically refuse any medication my doctor prescribes.

You have the right to refuse any treatment, including medication, that a doctor recommends, but it's vital to make an informed decision and not one based on something you read or saw on the internet. Medication should only be rejected after you do your research and have the appropriate discussion with your doctor.

Good topics to discuss are:

• Why is this medication being prescribed?
• How does the medication work?
• What are its side effects and long term effects?
• How long will you be expected to take it?
• What real benefits will you derive from it?
• What real risks will you have from not taking it?

Getting answers to these important questions will help you make a better decision, rather than just automatically rejecting treatments that can be beneficial for you.

5. Do I need to add resistant starch and fat to improve my diabetes?

Metabolic syndrome and diabetes are not caused by resistant starch or dietary fat deficiencies. It is caused by poor blood glucose regulation.

There is no magic pill, out there, that cures diabetes. The only thing that reverses it is obtaining and sustaining proper blood glucose regulation. 

6. Is leptin only responsible for raising metabolic rate?

When you have too much body fat, you make too much leptin and develop leptin resistance. This is the most common form of leptin dysregulation for people who are obese, but you can also have poor leptin signaling at the level of the fat cell itself or the brain, irrespective of leptin levels.

Leptin is not only responsible for satiety and the ability to increase basal metabolism, but it is also a very important regulator of glucagon.

If you are leptin resistant, then glucagon will automatically be over expressed and continuously release too much glucose from the liver, which in turn can raise insulin levels. High insulin levels will dysregulate blood glucose even further and the whole cycle begin again. This can be exacerbated further after eating, as glucagon rises to mitigate postprandial insulin levels. If glucagon did not do this, rising insulin would clear too much blood glucose and cause hypoglycemia. 

The problem is that now, glucagon is "running wild", with no control from leptin or insulin, because the metabolic dysfunction has left the person resistant and with inadequate expression of both hormones. When glucagon is left to do its bidding, with no control, blood glucose rises to very high levels as glucose is being dumped from the liver, in an exaggerated rate, and other substrates (proteins, lactate, glycerol) are also being converted to glucose, in response to the presence of insulin. That's why postprandial blood glucose is always the highest.

You must improve both insulin and leptin sensitivity to improve metabolism. Insulin sensitivity is improved with a carbohydrate restricted diet and an intermittent fasting regimen. This will help control blood glucose better and lower insulin levels to normal.

Leptin sensitivity is improved with the correction of body composition, which is done through exercise, avoidance of "starvation" and the right macronutrient profile of adequate protein, moderate fat and low carbohydrate. This will help leptin expression and the loss of body fat. If you have high body fat, you are particularly sensitive to excess dietary fat, as your leptin will not respond to it by increasing metabolic rate and you will end up storing it. Unlike insulin, leptin responds to food intake over the long term, so it takes time to correct its dysregulation. 

So, be careful how you address your insulin resistance. You do not want to swap one resistance for another. Leptin takes a very long time to regulate, is much more complicated to address and it's dysregulation can become permanent as it can lead to hypothalamic damage.