Six common beliefs addressed, Part 244

1. I was on carnivore but couldn't lose any weight until I dropped the coffee. Once I got rid of it, I lost thirty pounds. I thought coffee had "no nutrition", so how can this be?

Well, if you were drinking the coffee black, with nothing added to it, then it would have "no nutrition" but if you were taking it with quarts of cream, or sticks of butter, or whatever else people put into it, then it would not be surprising that dropping it would cause weight loss.

If you were drinking it black, then it's the elimination of caffeine that caused the weight loss. I have said it many times before - until you drop the caffeine you will not be able to stabilize blood glucose. Stable blood glucose is the gateway to weight loss.

2. Do you recommend Dr. Shawn Baker?

We do not endorse nor recommend anyone in the low carb community. None of them. Our advice is solely based on biology by what we know about human metabolism and how it works in the context of overweight/obesity.

I have several diets listed on this blog, on the right side column under 'Recommended Diets', but we only recommend the protocol, not the "guru" who "came up" with it because they simply didn't. Low carb diets have been around since carbs have been around. None of these people discovered anything new. They simply put it in a book, marketed online and took credit for it as their own but it's all smoke and mirrors. Every diet that's out there currently, was already out there before. Just because it's new to you, and someone copy wrote it before you did, doesn't mean it's truly new.

Baker is simply a guy who made a book called 'The Carnivore Diet'. That's it. Humans have been carnivores to varying degrees since we first walked the planet. We have cookbooks painted on cave walls from when the woolly mammoth was still roaming the plains. Baker didn't discover a thing we didn't already know. So, you don't need to follow him to know how to eat meat and drink water.

3. Do "total carbs" include sugars too?

Yes. Total carbs are total carbs and sugar is a carb.

4. Is "keto" recommended for someone with hypothyroidism?

It depends on what's causing the hypothyroidism. Generally, starvation diets are not recommended for hypothyroidism. This means no calorie deficits, long fasts or low protein diets.

"Keto" diets are interpreted by the body as starvation because of the presence of ketones. People with hypothyroidism are particularly sensitive to any starvation signal. So, you can try "keto" and see what happens, as not everyone is affected by this, but if it does affect you negatively then you would have to drop the diet and find something else.

5. What is 'Intuitive Eating'? A lot of people are talking about this, and I want to try it out.

Another diet-con to sell books and get views. In fact, the con is in the inability to even define it so most of the book sales and website views are from people simply trying to figure out what the heck it is. After all, the more mysterious it's made to be, the more intrigued people become.

Well, I'll tell you for free. I will also tell you what it really is, compared to what it's being sold as. 'Intuitive Eating' is marketed as being comprised of "10 principals":

• Reject the "diet mentality".
• Honor your hunger.
• Make peace with food.
• Challenge the "food police".
• Discover the "satisfaction factor".
• Feel your fullness.
• Cope with your emotions with kindness.
• Respect your body.
• Movement - make the difference.
• Honor your health - gentle nutrition.

You may be asking yourself, WTF is all this? Well, the definitions are as vague as the principals themselves so there is no point of even describing them as it will be a total waste of time. These "principals" are just word salad to make you think that something important is being discussed when it's not. You know, like daytime TV.

When you peel away the marketing scam, what's left is a premise that's quite simple - reverse psychology. The theory of reverse psychology proposes that people respond to the reverse of what they actually want to do. In other words, the dietitians who created this 'Intuitive Eating' BS figured that preoccupation with diet itself leads to more overweight/obesity so if you are simply not preoccupied with diet, then you might lose weight. Essentially - "I lost weight because I stopped thinking about losing weight!"

Of course, you can't trick yourself into losing weight any more than you can trick your bank account into wealth. The overweight/obese have no intuition when it comes to food. None. That's what got them in this mess to begin with. You can certainly trick other people into doing what you want by telling them the opposite, but your fat mass isn't so easily fooled. "My fat mass wants all these Twix candy bars. Well, I'll show it by eating them all!"

The reason that diets perpetuate more overweight/obesity is not because the person is "preoccupied" with them. It's because all diets use some form of starvation (calorie deficit) and the metabolism of the overweight/obese is already under a starvation adaptation. This means their body will only double down when more starvation is applied.

The unfortunate part of this is that some overweight/obese people, with intact leptin sensitivity, will swear up and down that 'Intuitive Eating' caused them weight loss and "saved their life". BS. All that happened is that they ate all those Twix bars, after years of calorie restriction, and their leptin kicked in causing temporary weight loss. In the end, they will regain the weight all back as their blood glucose continues to become abnormal from the Twix, leading to weight regain. But their temporary success will put a notch on 'Intuitive Eating's' belt and lure more people into the con. This is the case with all diets, even the ones who claim to not be a diet.

The overweight/obese need a solid plan they can consistently follow for the long term and starvation isn't it. Neither are magic tricks. Instead, they need targeted elimination and behavioral modification in order to treat their condition more effectively. In other words - lifestyle changes, not psychobabble.

6. I have been seeing a "low carb doctor" who suggested carnivore and a 'one meal a day' (OMAD) protocol for me to follow. Though I started having good results, now I am seeing my blood glucose and HbA1C numbers slowly rising, and I am concerned. The doctor is too because he checked my BUN, creatinine and uric acid levels, and they are all rising to abnormal levels as well. I am thin with low insulin and C Peptide levels. I am also highly active, and I haven't deviated from my diet. The doctor "has no clue" what's happening.

I am dumbfounded when I receive questions like these. The reason is because I am not a doctor, not even remotely, but I actually can come up with a better answer as to what MIGHT be happening, other than "I have no clue". How can a doctor "have no clue" about something so obvious? He can't even make an educated guess? This just goes to show that these "low carb" doctors are mostly quacks. They are making recommendations which they pull out of their behind, because they read it online, and have no clue as to what the effects will be or what the hell they are even doing.

I will do what your doctor should have done. Let's analyze the problem and make an educated guess with the information we have and what we should all know about basic metabolism, especially a doctor.

The first clue we have is in the tests you say are coming out abnormal. Fasting blood glucose and HbA1C are tests to determine blood glucose regulation. You are obviously losing yours if these numbers are rising. Blood Urea Nitrogen (BUN), Creatinine and Uric Acid Blood Test are all tests that measure how well your kidneys are filtering out waste product from the body. Most of this waste product is the result of protein metabolism. Uric Acid tests are also commonly used to detect gout. Gout is basically the first stage of kidney impairment. This is usually why people with gout also have high blood pressure. The kidneys are simply not filtering uric acid and sodium effectively.

The second clue we have is from the diet you are following. OMAD and carnivore. Why you were recommended this diet, while also being highly active and lean, is unknown to me. But these quacks are always jumping on some bandwagon or other and then screwing their patients up in the interim.

Now the reason that your "doctor" has "no clue" as to what's going on, even though the clues are right in front of their face, is because they most likely believe that fasting for 22 hours a day is completely normal and benign. After all, they read this on Facebook. They also believe that if carnivore can improve blood glucose, then nothing can possibly go wrong since blood glucose is the only relevant marker of health according to what they were taught on YouTube. Low carb doctors are truly one trick ponies.

So, what have the clues told us that your doctor didn't understand? It told us that you are basically burning through your own lean muscle mass. You are breaking yourself down into glucose and this is why your blood glucose and HbA1C numbers are rising. As you break down your body, your protein metabolism waste goes up and this is why your BUN, creatinine and uric acid levels are also rising.

I suggest that you drop your dietary protocol. I don't necessarily mean the carnivore part as long as you are actually following carnivore correctly. Carnivore prioritizes protein, not fat, so you shouldn't be eating a plate of cheese instead of a steak. What you need to drop is the OMAD part. OMADs are generally not good protocols to follow chronically unless all you eat are pancakes. If you are a highly active person, this is something you should have known, especially if you are following a 0 carb diet. This is why athletes avoid 0 carb diets and OMADs. When they do them, they suffer the consequences in their performance, recovery and gains and this is why they don't stay on them for long.

We follow low carb so that we don't have to be under chronic starvation. Humans have never lived under chronic starvation. We have had periods of famine, where we have either lived or died, but we never remained living while chronically starved. That is why we were able to develop our large brains because we always had sufficient nutrients, for the majority of the time. Chronic starvation is a product of modern geo-political issues. Either you are living in a country were food production is unstable and has to be rationed and/or is not always available. You may be unable to leave a certain territory where there is food scarcity because you are not allowed entry elsewhere. You may be succumbing to the inconsistencies and fickleness of agriculture. It is interestingly ironic that the "breadbasket of the world" (agriculture), which helped increase human population to what it is today, is the same thing that has systematically starved us as you would be surprised how difficult, nutrient poor and wasteful it truly is.

Now these quack doctors are right in one thing - the body usually doesn't break down its muscle mass, but they are wrong to think this is based on how much fat there is available. The breakdown of the body is not determined by fat or glucose availability, it's determined by its access to both. In other words, rate of starvation (stress). The only time the body breaks itself down is during starvation. It's supposed to work as follows -

• Fasting/starvation = Glucagon (catabolic) is high, insulin (anabolic/anticatabolic) is low.
• Eating = Glucagon (catabolic) is low, insulin (anabolic/anticatabolic) is high.

That's the proper glucagon to insulin toggle function. If you are starving all the time, then glucagon is always high, and you are continuously breaking down your body. This constant breakdown will dysregulate insulin through its effect on blood glucose regulation.

Starvation does not only happen at the gulag. OMAD is starvation. Obesity is starvation. Diabetes is starvation. That is why a 500 lb. person has plenty of fat but still breaks down their muscle at an exponential rate. A diabetic has plenty of blood glucose but still breaks down their muscle chronically for even more glucose. You are starving because of the dumb OMAD protocol you were made to follow. You are simply not getting enough calories (glucose and fat) and/or protein which is always the case with OMADs and common with carnivore.

This high blood glucose and HbA1C, are affecting your insulin function and will cause metabolic syndrome over time, but you won't get gout or kidney damage from your high protein metabolism markers. That will happen later. What will happen now instead is that you will lose most of your lean muscle mass and have a very difficult time replacing it. This will further contribute to your metabolic syndrome and eventually end in diabetes. This is the result of your metabolism doubling down on its starvation adaptation which always results in obesity and diabetes. The diabetes is what will destroy your kidneys in the future.

Please find a real doctor and stop fooling around with your health because it's truly a sad state of affairs when a stranger online "has a clue" of what's happening to you, but your own doctor doesn't.

Six common beliefs addressed, Part 239

1. Can fasting be added to any diet?

Yes, but you won't obtain any metabolic benefits. Fasting by itself does nothing for the reversal of metabolic conditions and overweight/obesity. It is only complimentary to a proper diet and exercise regimen.

2. Are there any acceptable vegetables on carnivore?

Carnivore is an all-animal based diet. So, unless animals started growing plant parts I am not familiar with, aside from the eggplant emoji, then vegetables would not be acceptable on carnivore.

If a diet does not fit you, find another one but don't change it to fit your desires because then it loses its efficacy.

3. I have diverticulitis. My doctor told me to limit meat consumption. Could it have been caused by carnivore?

The only reason I'm answering this question is because it was made in the context of diet but, people please, don't bring me your medical problems. I am not a doctor.

This is a metabolic health blog, not an "I don't have insurance" and/or "I'm too lazy to contact my doctor right now so I'm asking around the internet for help" blog. The internet is not a surrogate for proper medical care. If you're second guessing your doctor, then find another doctor and get a second opinion. Don't get your second opinion from someone who is not a doctor and not your doctor.

The answer to your question is NO. Carnivore doesn't have anything to do with this condition. Anyone can get this. Diverticulitis is when small, bulging pouches develop in your digestive tract. When these pouches become inflamed or infected, the condition becomes diverticulitis. As you get older, your intestinal walls can become weaker putting you at risk for the development of these pouches. Also, certain chronic digestive issues can make you more susceptible to this. I'm sure your doctor has explained this to you already but I'm describing it for the reader.

This has nothing to do with carnivore. The reason your doctor most likely told you to stay away from meat is because it is slower to digest, as it's nutrient dense, causing for your digestive tract to work more and irritate these pouches further. At least, that would be the logic behind the recommendation, but we don't know if that really pans out in practice. It depends on where the pouches are. If they are in your colon then meat would be your best friend. If they are somewhere further up, then not so much.

Whatever the case, your doctor is the one who diagnosed you. Ask them to explain to you clearly why you would have to limit meat specifically and not anything else. See what answer they give you. I am sure you would be able to discern if the answer is justified and makes sense or if it's just pure BS. Usually "stay away from meat" is the go-to advice for anything from a broken leg to dandruff. This is why you should question your doctor until you get satisfactory answers because you are ultimately paying him to treat you. Don't leave the office with these types of doubts because going to the internet with them is not going to make things any clearer. You have probably already gotten 70 different answers to this before you got mine. Go back to your doctor.

4. Can you still lose weight and "regulate insulin" if you only eat potatoes one meal a day (OMAD) style?

The simple answer is no. For those that want the complicated answer, keep reading.

I don't know what you mean by "regulate insulin". Insulin can only be "regulated" through proper blood glucose regulation, unless you have a serious pancreatic condition. Eating only potatoes once a day does not acquire proper blood glucose regulation, particularly when you are already overweight/obese with bad blood glucose control to begin with.

The OMAD style is actually more detrimental for this than the potatoes. Overweight/obesity/diabetes are metabolic adaptations towards starvation. Doing OMAD will only reinforce this adaptation, not reverse it. This type of eating causes a prolonged time in hypoglycemia, which is a signal to the body that it is starving and must get its blood glucose up. That's when your hypothalamic/pituitary/adrenal axis (HPA) makes sure blood glucose goes up. Way up. Stimulating this stress response daily, causes further metabolic adaptation towards starvation.

5. I am a grazer and so don't eat "meals". What are good items to munch on?

Air. Oxygen. Breeze. Wind. Draft. All of these are good to "munch" on.

Now if you want to actually address your metabolic health, then you would first have to address your bad eating habits. Grazing is one of them. We aren't ruminants. Humans don't graze. You can't make a metabolically healthy diet fit in with your bad behaviors or it will lose its efficacy.

The way metabolically healthy diets work is when they are followed properly. When you eat is just as important as what you eat. You are supposed to be eating proper meals - two to three a day and fasting in between. That's how it works. If you can't do it, you can always remain fat. Remaining fat is always an option but wasting time is not.

6. I am going on vacation and need quick results to drop 20 pounds.

Join Jenny Craig.

There are many easy, cheap and effective weight loss programs out there for dropping 5 - 20 pounds. I've said this before. If you just want to drop some vanity weight to fit into your bikini, you can do so on a weekend liquid diet. Pick up a tabloid at the check out aisle of your local grocery store and follow whatever fad diet they recommend this week to drop weight fast. After all, the bikini doesn't care if the weight you dropped is from water, fat, muscle or bones. You can cut your leg off and drop 10 pounds instantly.

But this blog is for metabolic health. It's not a weight loss blog. You have clicked the wrong link.

Six common beliefs addressed, Part 158

1. Lean protein "spikes" insulin more than fatty protein.

On this blog, we do not focus on insulin "spikes". People with metabolic syndrome/diabetes do not have a sufficient insulin spike, as they have impaired first phase insulin release. For this reason, their insulin never spikes high enough to stop catabolism and they end up releasing an enormous amount of glucose after eating (hyperglucagonemia), which affects their insulin expression further. For this reason, we care about obtaining proper insulin expression, which is what corrects this abnormality.

All proteins spike insulin the same. The fat in fatty meat simply makes this effect less obvious and causes for insulin to be released for a prolonged period of time afterwards, as insulin is required to store fat. You never want prolonged insulin release especially when the only part of your body that is insulin sensitive is your fat mass. You want an initial high spike and then low insulin levels while fasting. In order to obtain proper insulin function, you need for insulin to work as it was intended - in pulses. High insulin when eating and low insulin when fasting. Not chronically higher than normal insulin, that never gets high enough or low enough when it's suppose to.

So if you have excess fat on your body, lower your dietary fat intake to no less than 50 grams a day. You want to prevent insulin from continually acting on your fat mass. You want to divert its action to your lean body mass instead. That's acquired through protein intake and proper exercise, not fat intake and sitting around. Protein builds muscle and fat builds fat.

2. I eat low carb but I keep having a "low blood glucose feeling" a few hours after I eat.

This is the body's way of preventing blood glucose from lowering.

Metabolic syndrome/diabetes are adaptations towards hyperglycemia. As long as your blood glucose is above 70 mg/dL, there is no need to intervene. If you continuously respond to these feelings by trying to raise your blood glucose, you will never be able to obtain normal blood glucose regulation.

3. You can do a 16/8 fast and instead of two meals, have one meal and a few snacks during your eating window. This is better than one meal a day (OMAD).

People always want a definitive answer on eating habits but there are none. It all depends on your hormonal reaction to them. We know for sure that OMAD is not a good protocol for the obese because it prolongs your time in hypoglycemia (fasting). You can't treat starvation with more starvation. But, if you want to swap out one of your two meals, for one or two smaller meals, then the outcome is not certain. It all depends on how this would affect your blood glucose regulation. For some, having one meal and a couple of small meals, during their eating window, works better than two meals because their leptin sensitivity responds to this and can even improve. But there are issues you should keep in mind when doing this.

"Snacks" usually consist of novelties. In the low carb world this means a bunch of low carb "junk" like seeds and/or nuts, nut butters or some silly "keto" sweet recipe or bar. There is no room for any of that in a proper protocol. All meals/snacks should be protein prioritized.

So instead of the typical "snacks", I suggest you have one meal and one or two smaller meals, during your eating window. A small meal can be a salad with some tuna or a can of sardines or a couple of boiled eggs. That would be perfectly fine but "a couple of small snacks" is not how you should be eating.

4. Will "keto" cure leg edema?

First of all, no one knows what is causing your leg edema except for you and your doctor. I am pretty sure that your doctor must have given you some explanation as to why your legs are swelling. If they haven't, then you have to have a discussion with them for answers or get a second opinion. Until the issue that is causing the edema is addressed, the edema will continue.

"Keto" diets will only help with edema if the edema is being caused by very high insulin levels/over expression, which retains a lot of fluid. It cannot address any other type of edema like the ones caused by congestive heart failure, kidney failure, lymphatic system dysfunction, etc. Those require additional treatments.

5. If the person is carnivore, the body will never choose to burn protein instead of fat.

The only time the body will burn protein instead of fat is during starvation. Obesity is starvation. Diabetes is starvation. Both conditions prevent you from accessing the body fat you already have, and are continuously putting on, so you burn muscle (protein) instead. This is why obesity is sarcopenic. You're being starved of your body fat and you're being starved of your glucose because it's only using it to make more fat that can't be used.

The more metabolic issues you have, the more exaggerated this effect will be since metabolic issues are starvation adaptations. Metabolic syndrome is a condition where the body spares its fat mass and burns through everything else. It doesn't even burn it for fuel, it simply converts it all into more fat for further storage like I described above. This occurs primarily through leptin under expression amongst many other things.

This is precisely why we don't believe that "the body is not stupid enough to burn its muscle while having plenty of fat around". The body does just that. Daily. The body under expresses leptin during starvation because fat is extraordinarily valuable for it. Leptin is fat's keeper. So conditions like diabetes, metabolic syndrome and obesity are conditions that always under express leptin as these conditions are body fat sparing.

This process contributes to obesity and it doesn't occur primarily from the protein you eat, but from the constant conversion of the protein already in your body. This always results in storing more fat than you're burning as you don't really have access to what's stored. 

• The more lean muscle mass and dietary protein you break down into sugar, the fatter you become by volume. You are not building nor repairing the little muscle you do have left and this directly affects calories in.
• The more your body holds on to its fat mass and instead burns glucose, the less effective metabolism runs and the fatter you become by proxy. This is what causes the lack of energy and directly affects calories out.

The first instinct is to reduce or eliminate dietary protein so that the body stops converting it into glucose and the symptoms can be hidden. But like I stated above, the conversion into glucose itself is not the problem. It's that the body continues to do this, in an unregulated way - that's the problem. People with metabolic syndrome/diabetes actually need more protein so they don't continue losing so much lean muscle mass and they need to correct the underlying problem which is basically caused by poor insulin function.

So if this is happening to you, make sure the carnivore diet you are following is not causing starvation. Follow legitimate protocols only. Here is the carnivore protocol we recommend.

6. There are no supplements that can help lower high triglycerides naturally.

Omega 3s. A fish oil capsule can help naturally lower trigs but it's not guaranteed as some people genetically have higher than normal trigs.

Six common beliefs addressed, Part 142

1. Diet advice is very confusing and doesn't seem to provide any one single answer to the problem of obesity. 

Obesity is very complex and once you are obese, many systems in the body are affected. Obesity is still a "disease without a known cure" as of this post. This means that whatever shenanigans they want you to follow, in order to "treat" or "cure" obesity, is a lie by default. 

The only thing you can do to better manage obesity and have a chance at reversing is to follow the actual data that is known about it. Abnormalities in blood glucose regulation has been the only metric that has tracked linearly with obesity in research. Nothing else. For this reason, blood glucose is what you should be addressing.

2. On "keto", my menstrual period stopped for several months and I felt better than I ever have in my entire life. With time, my menstruation returned back to normal and I started to feel run down again.

Hormonal imbalances, fluctuations and chronic release cause havoc in the body. I know that in modernity amenorrhea (lack of menstruation) is seen as something sinister and it can be, if it's being caused by an actual pathological condition or deficiency. Therefore, the 28 day cycle is considered "normal". But, hunter/gatherer women, who are completely healthy, do not menstruate every month because of their low body fat so in essence, this tells us that we never evolved to menstruate on a 28 day cycle chronically. 

When you start "keto" and your body fat takes a significant plunge, you feel the beneficial effects of not menstruating on a monthly basis, but as body fat goes back up, you once again fall into a 28 day cycle, which is the maximum ovulation cycle that a human female has. This constant marination in sex hormones, without a break, can cause side effects such as bloating, premenstrual syndrome, headaches and low energy. If you are going through peri/pre-menopause, you might experience even nastier side effects, such as migraines, allergies and auto immune activity. It is no wonder that women experience so many health conditions related to their sex hormone status and these conditions only become worse as their hormones become increasingly imbalanced. 

Menstruation is mainly driven by body fat and "stress". Even at a normal fat percentage, the body will have a 28 day cycle. It is only when body fat dips below a certain percentage or is actively being lost in large amounts that menstruation will halt. This is because a challenge to body fat is a stressor on the body. Stress is hormetic when it's controlled and occurs in low doses. When low body fat or the loss of body fat is the only stressor that the body is sensing, it becomes beneficial. 

The body will not sustain a body fat deficit in a modern environment so menstruation will eventually return to a 28 day cycle. You would literally have to go live with the hunter/gatherers if you want to avoid this hormonal chaos. The only thing you can do is mitigate these symptoms by actively trying to keep body fat within a normal range, continue a healthy diet and have an exercise regimen in place. The healthier you are metabolically, the better your body can handle this hormonal onslaught and keep sex hormones balanced. 

3. Will "keto" help resolve uncontrollable overeating?

Stabilization of blood glucose can have a direct effect on hunger because metabolic hormones follow suit. This addresses the biological causes for hunger and that can be enough to resolve overeating issues if there aren't any behavioral drivers. But unfortunately, most uncontrollable overeating is not driven by biology but by mental health issues. For this reason, a mental health professional would be most helpful, rather than diet.

4. On "keto" you usually "forget to eat", so it's okay to follow a 'one meal a day' (OMAD) protocol. 

If you are healthy and slim, this is not a problem. It simply means that your metabolism is working as it should and acquiring energy from fat storage. There is enough fat storage to do this without any unpleasant side effects like low energy. The body is in perfect balance between what it eats and what it stores and the energy it derives from each. A healthy metabolism balances energy all by itself without your interference. 

But if you are overweight or obese, and not actively losing weight, you shouldn't be "forgetting to eat". I know it's trendy to "forget to eat" in low carb circles but this practice only sabotages weight loss and blood glucose control over time. If forgetting to eat truly treated obesity then the caloric model would be fool proof as a treatment but we know that's not the case. You need to have set times for your meals and you should never do frequent OMADs. 

5. Do carnivore and "keto" use the same macros for protein?

Macros are highly individualized. As far as protein is concerned, if the diet is being used for the treatment of obesity and metabolic conditions, protein should be prioritized. The main difference between carnivore and "keto", when used for the treatment of obesity and metabolic conditions, is simply the carbohydrate amount and its source. 

Carnivore is a "0 plant" diet while "keto" still has a carb allotment of no more than 30 grams a day. The carbs in carnivore are coming from diary and the carbs on "keto" come from vegetables, primarily leafy greens. 

6. I cannot follow low carb dieting because "stress" makes me eat. 

"Stress" cannot "make you eat" because it doesn't have hands that bring food into your mouth. 

People often confuse their bad eating habits with "stress" since we tend to be stressed often. When people refer to "stress" they usually mean some kind of "emotional stress". But nothing stresses the body more than inappropriate eating, especially when that's coupled with inappropriate food. This only perpetuates metabolic stress, a real and dangerous stress, that eventually leads to disease if it hasn't already. 

You need to find a way of addressing your bad eating habits, without giving them an ambiguous cause such as "stress". The type of stress you are referring to cannot ever be resolved, so you are trapping yourself into a corner and basically blocking all of your own exits. When people do this, it usually means they simply aren't ready to make the lifestyle change necessary to tackle such a complex and long term issue as obesity and/or metabolic health. You need to revisit the diet again when you become truly ready.

Six common beliefs addressed, Part 121

1. You do not need to count calories if you eat to satiety. 

If you have to eat beyond your macros in order to achieve satiety, then you are eating in excess and your satiety point is set too high. In this case, you either scrap eating to satiety and follow your macros diligently or you can also include calories, along with your macros, to make sure you are keeping to them. 

Calories are great for monitoring overall nutrient intake, which is useless for addressing obesity and body fat in particular, as different nutrients affect body composition in different ways. But calories can be included, to macronutrient tracking, if the person has absolutely no satiety signaling and/or certain 'disordered eating' habits, which cause them to veer off their macros. This can go both ways, by the way. They can be eating to excess, but they also may not be eating enough. Tracking calories would help you know if you are eating too little, which a lot of obese people tend to do. 

2. If you do One Meal A Day (OMAD) and can get about 1K calories, then you are okay if you have no symptoms of metabolic slowdown. 

We never advise OMAD, on this blog, especially if you are overweight/obese. It is very difficult to get enough food in one meal, particularly protein, and trying to do so will only cause you to overeat in one sitting, aggravating glucagon to insulin ratios. OMADs also push you into too long of a fast, increasing your time in hypoglycemia, which only reinforces the starvation adaptation.

 

You should be having two to three meals a day. The number of calories needed a day, varies by individual and metabolic state. OMADs might not have an immediate negative effect. In fact, they might have a temporary beneficial one, but treating obesity is not temporary. Temporary solutions do not reverse this condition. Obesity only responds to long term treatments and OMAD is not a proper, long term treatment. 

3. There is no way to tell if you are temporarily stalled or have just stopped losing weight.

If you are still overweight/obese and stopped losing weight, you are stalled. If you are of normal weight, then you simply stopped losing weight. Overweight/obese people have a very high weight set point, so they will lose up to that set point and then won't lose anymore. This is why, though they lose weight, they remain overweight/obese. This is all caused by leptin. I recommend you read my article on leptin.

4. "Keto" is the correct diet for children.

The advice we provide, on this blog, is solely for adults with obesity/metabolic syndrome/diabetes. We do not provide advice for children, pets, athletes, pregnant women or breastfeeding women. Our advice also is not for any other condition or disease that is not metabolic in nature. 

 

Talk to your healthcare provider or seek alternative, licensed dietitians/nutritionists for advice on low carb children’s diets. 

5. The only cannabidiol (CBD) available is in gummy form, but its still okay to take.  

I recommend you start smoking it or using it in oil form, as gummies are not recommended. It's best to take your CBD without the added sugar or sweetness. 

6. Your diet should be working, even if you use artificial sweeteners. 

Artificial sweeteners interfere with fat loss, by adversely affecting hypothalamic dopamine/leptin cross talk. 

 

Even though artificial sweeteners do not have calories, they cause for the body to store everything else that does. This is why calories are such an incomplete way of addressing obesity, as many other things influence the body's storage and burning of fuel besides its amount. The taste of sweet is one of those things. You have to stop tasting sweet things or your body will continue storing for winter.

Six common beliefs addressed, Part 87

1. Is there is a persistent stress response with low carb and/or fasting?

There are some people who cannot get over an exaggerated stress response, which interferes with their ability to follow low carb or adopt a fasting regimen. This is simply a problem of the central nervous system, which was affected by years of metabolic stress and it causes over expression of the adrenal stress hormones.

Metabolic stress is caused by erratic highs and lows in blood glucose, with large disparities between the two. This in turn stimulates chronically high insulin, which loses its pulsatile function. Chronically high insulin exacerbates this glucose roller coaster further, doubling down the counter regulation response, which then further effects insulin. As you can see, it's a vicious circle. A "death spiral", as each effect contributes to the other.

This spiral chronically stimulates the body's "flight or fight" response (stress hormones) in a pathological way. This abnormality in the body's stress response can persist, even after insulin levels have lowered. Insulin is a hormone that has persistent action on certain tissues of the body, long after it's cleared or is at lower levels

Normalizing stress hormones is particularly difficult, depending on the time length of metabolic dysfunction and other hormone status, such as sex hormone and thyroid. All of these are impaired in people with metabolic dysfunction and further exacerbate the problem. Metabolic dysfunction is a "disease" of the neuroendocrine system. Notice the word neuro in there. In other words, it's not just hormones, but it also includes the brain and the nervous system and how they interact and respond to endocrine signals.

Unfortunately, for some people, they cannot take control of their stress response, no matter what their diet looks like. This means they continue having Dawn Phenomenon and/or hyperglucagonemia. This is why these people are recommended a low to moderate carb diet, that eliminates all sugar and grains, but does not go so low in whole carbs that it induces long periods of ketosis. The person must consume adequate protein, track their electrolytes, keep their fasts short (no longer than 16 -18 hours), avoid OMAD (one meal a day protocols) and not over exercise. One of the greatest regulators of the stress response is exercise if it's steady state and not strenuous. All of these, combined, eliminate and/or help reduce the stress response for people who have persistent stress issues.

2. Is allulose sweetener "keto" friendly?

All artificial sweeteners are "keto" friendly because they usually do not affect blood glucose enough to kick you out of ketosis. But all artificial sweeteners are "obesity unfriendly" because they cause adverse long term effects to the hypothalamic-pituitary-adrenal axis (HPA). They do this through taste. The taste of sweet is detrimental to metabolism and the ability to lose body fat.

So, if you are on a ketogenic diet for the treatment of epilepsy, you can use any artificial sweetener you want. After all, you are under a doctor's care, who will monitor your weight, while on this protocol. But if you are ketogenic for the treatment of obesity and/or metabolic disorders, you should be having 0 artificial sweeteners.

3. You can get enough protein from a one meal a day (OMAD) protocol.

Extremely unlikely. I can't even imagine it, unless you are downing some serious protein shakes, which should not be your primary method of obtaining protein anyway. "Shakes" are not real food. You must eat real food first and then if you have to supplement protein, that's fine, but you shouldn't be using shakes just to eat an OMAD.

Eat two to three meals a day.

4. Not all nuts are "keto". 

Ketosis is a metabolic state where you primarily burn fat for fuel through the breakdown of fatty acids. This breakdown causes a byproduct called ketone bodies, which are primarily used by the brain. Some will say this occurs in the "absence of glucose", but there is never an "absence of glucose" because if there was, you would be dead. The body still makes its own glucose.

What do nuts have to do with this? Nothing. All nuts are "keto", if you are able to sustain the burning of fat for fuel, while eating them. All nuts are not "keto", if you are unable to sustain the burning of fat for fuel, while eating them.

5. Foods that "spike insulin" cause a plateau.

That is complete nonsense from people that are either truly ignorant of how obesity works or they just pretend to be, in order to dupe you. Plateaus are solely caused by leptin. I explain this mechanism in this article.

Insulin is not an obesity hormone. It’s a growth hormone and what it grows is at the discretion of your neuroendocrine system, which is influenced primarily by the macronutrient composition of your plate and secondarily by other lifestyle factors.

People who are pre- or full diabetic do not have sufficient "insulin spikes" to cause anything, except the inability to halt glucagon expression, thereby releasing enormous amounts of glucose postprandial. So, "spiking insulin" is the least of their worries and their main concern should be eating to properly regulate their metabolism, not "control insulin spikes".

6. Does "keto" causes preventricular contractions (PVCs)?

PVCs are quite common and can be triggered by all kinds of things, from exercise to emotional stress to hormones to gastroesophageal reflux disease (GERD). PVCs are tightly correlated to an over excited/stimulated autonomic nervous system. Some people have issues regulating their autonomic nervous system and can suffer for months from non-stop PVC attacks.

Always get checked out by a doctor, but if the PVCs are correlated to "keto" then one of three things can be going on - inadequate electrolytes or a heightened stress response or both. I suggest you follow this electrolyte recommendation.

You also may want to ditch "keto", if this is stress related, and follow a low carb diet instead, as the benefits are the same.

Six common beliefs addressed, Part 26

1.The American Diabetes Association (ADA) is recommending a "low carb" diet, but it's not low enough in carbohydrates.

The ADA does not have a specific dietary protocol, that they endorse, for the treatment of diabetes. They have implied the benefits of caloric restriction, low fat diets, Mediterranean style diets, vegetarian diets, etc., without committing to any one of them. Dietary options are pretty much left to the diabetic, along with the vague caveat of choosing a "healthy" diet of "moderation", with plenty of "fruits and vegetables" and the replacement of sugar with artificial sweeteners. No other solid definition, of what constitutes a "healthy diet", has ever been given by the ADA.

As far as carbohydrate restriction is concerned, in December 2008, the ADA issued its 'Clinical Practice Recommendations', with an option for following a low carbohydrate diet for controlling blood glucose levels and weight loss. The difference from their previous recommendation is that, this one, has actual recommended values for guidance. The recommendation for the United States, at that time, was for daily caloric intake from carbohydrates to be less than 45%. They consider this to be a "moderate" amount of carbohydrate. They keep the option to go lower in carbs open and at the discretion of your healthcare provider.

In December 2018, the ADA issued its new 'Standards of Medical Care in Diabetes', including its 'Lifestyle Management Standards of Care', which again, included the use of a low carbohydrate diet, for the lowering of blood glucose and medications, in the management of Type II diabetes. They used the one year study data by Virta Health, along with two other studies, as the basis for this decision.

Again, no hard values are given to guide yourself by, but there is a range for carbohydrate restriction, which can be anywhere below 130 grams a day and less than 26% of daily caloric intake. If you eat 3 meals a day, that is up to 43 grams of carbohydrate, per meal. They do not claim that any benefit in blood glucose control will go beyond one year following this diet. On the contrary, they mention that blood glucose control begins to decline with time, while still remaining on a low carbohydrate protocol and, once again, the Mediterranean Diet takes the trophy for its long term benefits in glucose control.

The ADA also makes its usual statement that the ability to adhere to a dietary protocol is much more important than the protocol itself and some people are able to adhere to a low carbohydrate diet, while others are not. I suspect they are being generous, on this front, because I can almost guarantee that most cannot, but let's continue to keep it vague. The ADA loves vagueness. They hate to be held accountable for any solid advice, so they know how to cover their ass very well. Vagueness permits them to never be brought to task on anything they say.

Other than this tiny section on diet, with no specific recommendations for any one of them, the rest of the paper consists primarily of information on medication management. I don't blame them. Patients want that magic pill and certainly don't want to put in the work, if they don't have to. Any doctor can attest to that.

So, what's wrong with all of this? Nothing. Absolutely nothing. First, limiting carbohydrates to 130 grams a day, and to no more than 26% of your daily caloric intake, is low carbohydrate considering that the typical Standard American Diet (SAD) consists of 300 - 400 grams of carbohydrates a day and more than half of daily caloric intake. If you want to restrict carbohydrates further, that's your prerogative, but to claim that anything that's higher, than a ketogenic percentage of carbohydrates, is not low carbohydrate is utterly asinine.

The ADA does not have to, nor should it, make a ketogenic diet recommendation, as they have to take into account a patient's medications, which are already bringing down blood glucose to very low levels, and the patients that are Type I diabetics on insulin. The ADA's shenanigans have nothing to do with its dietary recommendations.

Rather, the problems with the ADA is exclusively limited to its lack of accountability, both for itself and diabetics. It continues to spout the mantra of "you can still have dessert, if you are diabetic." and "you can eat anything you want, even with diabetes." This is a disservice to diabetics everywhere. The ADA continues to stand behind the position that you can just "hide" your bad dietary choices with medications. This doesn't promote a lifestyle change for the management of diabetes. This promotes complacency. When you think of the ADA, you think of desserts, pastries and junk food. Its insistence on caring more about its donors, mainly Big Pharma and Big Food, than the people with diabetes, it claims to be trying to help, is the true problem with the ADA.

2. Does "excess protein" turn into body fat?

You will hear many people repeat this and find it written in multiple mediums. Even legitimate sources will repeat this fallacy, from dietitians to nutritionists to doctors, etc. But, like I have stated before, repetition does not make things true. The available research does not support this claim.

Biochemically, the body has the capacity of turning protein into fat, but it never does. Just like biochemically, the body has the capacity to live to 130, but it never does. No one has yet seen protein being converted to fat, in any human study, even when protein was overfed by 4 to 5 times the recommended daily values. So, no one yet knows how high protein must go for this biochemical process to kick in. The only thing that was seen in people, who were overfed protein, was an increase in weight due to an increase in lean body mass. Body fat never increased. In fact, the more protein, the leaner people get.

Having said that, people with metabolic syndrome experience hyperglucagonemia after eating protein. This can disrupt blood glucose homeostasis and this disruption can cause more weight gain. This is due to insulin resistance and avoidance of protein does not solve this. Rather, daily protein intake should be divided as follows per Dr. Bernstein's recommendations:

• Breakfast: 6 grams carbohydrate, 3 ounces protein
• Lunch: 12 grams carbohydrate, 4 ounces protein
• Dinner: 12 grams carbohydrate, 5 ounces protein

Also, remember that protein comes with fat, so if you are purposely choosing fatty cuts of meat and adding even more fat to them, basal insulin levels will begin to rise. This will  disrupt blood glucose homeostasis and this disruption will cause more weight gain. So watch the type of meats you eat and how much fat you add to them. Fat is not a free food. 

3. Does fat really burn in the flame of carbohydrate?

This goes into the weeds of biochemistry and beyond the scope of this blog. There are many great blogs, out there, that are run by real biochemists and even some keyboard ones, but that's not the goal of this one.

Having said that, as you make your rounds on the internet, you might come across this statement and it's usually used as a way to try and "disprove" the fact that carbohydrates inhibit fat burning. So, for the sake of newbies that might become confused, I will explain where this statement goes wrong, as simply as I can, without getting too deep into the technical jargon.

First, let's go through some basic knowledge, before we continue. Anything that the body burns, whether it's glucose or fat, is burned to produce adenosine triphosphate (ATP); the energy currency used by our cells. There are many metabolic cycles involved, all run through different feedback loops, to produce ATP from the foods we eat.

The term "fat burns in the flame of carbohydrate" would be better described as "fat burns in the flame of oxaloacetate (OAA)". Oxaloacetate is a metabolic intermediate that is formed from pyruvate; a metabolite that can be derived from many different sources. Glucose is just one of those sources, as glucose can be converted to pyruvate. But, amino acids from proteins also convert to pyruvate, either from the use of their substrates or from their conversion to glucose.

So, you don't need to consume carbohydrate to light your fat burning flame. Your body can produce all the glucose it needs from protein, for pyruvate synthesis, and create all the OAA it needs to burn fat. This is why there is no essential, exogenous carbohydrate. You do not need them for any metabolic cycle.

4. I was told that unless I have high ketone levels, I am not burning fat.

This statement is better described as "unless you can keep your basal insulin low, you are not burning fat." Again, this is quite technical, so I will keep it as simple as possible.

Ketones are a byproduct of fat burning, but they are the result of incomplete oxidation of fatty acids. In other words, your liver is exporting unburned fat as ketones, into the bloodstream, for use by other cells in the body, mainly the brain. If ketones are low, it doesn't mean that you aren't burning fat, it just means that you have less unburned fat. As long as you have enough OAA (see above), you will be burning fat and you will not have any fat "spillover" to convert to ketones.

5. I am getting older, so I don't need much protein.

If you are getting older, you definitely need protein. In fact, you would need more protein, since the older you become the harder it is for the body to utilize proteins. This is why there is a marked decline in lean muscle mass, as you get older.

Older people are frail and weak, because of lean muscle mass loss. Young people are strong, because their muscle mass is intact. The main differences in the young and the old is visceral fat accumulation and lean muscle mass loss. Both go hand in hand. The less lean mass you have, the more fat you are.

6. Can I eat all of my macronutrient requirements in one meal?

You will not be able to obtain or sustain proper blood glucose regulation eating one meal a day. Not only would you have to eat too much in one sitting, which disrupts insulin/glucagon ratios, but you will end up fasting for an extended period of time daily. This is a recipe for blood glucose disaster. Aside from that, you also will not be able to consume your daily requirement of protein this way. 

For this reason one meal a day (OMAD) protocols are not recommended on this blog.