Six common beliefs addressed, Part 267

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

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

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

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

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

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

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

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

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

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

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

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

No. I have spoken about this in other posts.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Six common beliefs addressed, Part 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 226

1. My coach said that she used to use macros but had to switch to calories because people never followed it. She finds that "women" seem to follow food lists and calories better than macros, but she said that you can't just count calories, you have to count them within certain groups of food. I thought a calorie was a calorie.

This coach is basically making women appear like idiots. The reality is that most diets are followed by women. Men get fat and either stay that way, without complaining, or just do what they have to in order to fix it. They don't need any guidance or hand holding to get it done. They just guide themselves by results. They aren't in denial as to what is making them fat and they don't make excuses. I suppose I am now making women appear like idiots.... Well, it is what it is.

There is no denying that some gender differences can be advantageous and others not so much. Men definitely are at an advantage when it comes to dealing with their weight issues simply because of behavior and approach. Because of this, I can imagine most of the people in your coach's program are women. After all, women are the ones who seem to require more "help" to deal with their weight issues.

Aside from the gender wars, calorie centered protocols have always been much easier to follow. They are also user friendly because there is no elimination of any particular food. This is why people are more likely to follow them. This is not new. This is why they are highly recommended by everyone, from your doctor to your neighbor, and they make up 99% of the diet industry. If your coach wanted to keep clients and make new ones, it is not surprising that she had to change her protocol to a calorie centered one.

Tsk, tsk though. She is sending out the message that calories are king, when it comes to weight loss, but still telling you that you have to count the calories within certain macronutrients. That's not a true calorie centered protocol. It's a hybrid and those whining women will be none the happier when they see they can't count out the calories in cookies but will be forced to eliminate them. "I have to eliminate foods and count calories too? I don't think so. Either or."

Oh well, to each his own, but this goes to show you the type of shenanigans that go on in the diet industry. This coach knows that calories are not enough but yet she hides the reality behind the excuse that "people will not follow my program on macros". Basically, her profit margin is more important than addressing the problem. This is why you have to be leery of diet programs because they will never advise on legitimate protocols. It's just not profitable.

Of course, a calorie is a calorie when it comes to weight loss, but a calorie is not a calorie when tackling overweight/obesity.

2. Men stay leaner longer and can lose weight quicker.

Testosterone is the hormone of leanness. Testosterone helps keep fat away from the subcutaneous and builds muscle instead. This process remains in equilibrium as long as there is sufficient testosterone, no disruption in blood glucose regulation and none of these:

• An imbalance of sex hormones because of childhood onset of obesity. Males that become obese before sexual development tend to become estrogen dominant and will have an obesity pattern similar to females with the development of "man boobs", hips, butt and large subcutaneous fat reserves.
• Getting older causes a decline in testosterone and this slowly tilts the axis towards estrogen dominance. Older males will now develop the "man boobs", hips, butt and large subcutaneous fat reserves typical of women.
• Obesity alongside testosterone is very dangerous. Testosterone forces fat to go into the visceral causing a large, hard, extended stomach, known as a "beer belly" but in actuality it's a "fat liver". The extremities will continue to be thin and there won't be much subcutaneous soft fat. This usually occurs in middle age men when there is still enough testosterone for the effect to take place.

If a man is still producing enough testosterone, they will quickly achieve results from diet and exercise. This will occur much more quickly than it would for a woman. Estrogen prevents women from losing fat easily. Men that are estrogen dominant, either from early onset obesity or from just being older, will have a much more difficult time losing weight.

Aside from that, men tend to stick to their diet due to the gender differences in behavior that I mentioned in my previous reply. Men who want to lose weight tend to be more committed and use less excuses. They do not require "support" or "hand holding", so they are less susceptible to falling for quackery and fad diets. They are also willing to do more exercise and sacrifice more foods. Their competitive nature and respect for self-accountability works to their advantage when it comes to dieting. This is why you see less men in "diet programs" and more men at the gym, while still achieving the most results. Again, this shows the behavioral aspect of obesity.

3. Body mass index (BMI) is "old school" and not reliable.

BMI is a pretty solid guide. Yes, it's old school and that's a good thing because it has stood the test of time. Of course, it is not one hundred percent accurate but that's only the case for body builders or other athletes that have crazy muscle mass. For the average person, BMI works pretty well.

But I have said it before and I will say it again - standing naked in front of a mirror tells you everything you need to know about your body, without the fancy calculations.

4. My coach calls vegetables "carbs".

Because they technically are but this is also a misnomer, since the "carb" in vegetables is fiber, not glucose. Fiber is not usable by the body, so the only carb of concern is glucose.

Coaches just want to sound cute calling vegetables "carbs" because they want to push back on the idea that "carbs" are "bad". If "carbs" are "bad" then where does that leave wholesome "veggies"? But this is all just a gimmick. It's no different than when "keto" people push back on the Dietary Guidelines by eating sticks of butter. It's not funny or "smart". It's asinine and it doesn't help you understand how to eat better.

The carb that is detrimental is glucose. Glucose is found in fruits and starchy vegetables. Starch turns into glucose in the body. Fibrous vegetables, which are basically all, above ground, non-starchy vegetables are carbs in the form of unusable fiber. This is why potatoes can raise your blood glucose but not cauliflower, even though they are both carbs. Not all carbs are created equal.

So, why would you have to watch out for these fibrous vegetables if they aren't a detrimental carb and are also low in calories? For several reasons.

• They can replace protein. Any food that displaces protein is detrimental in the diet. Protein is always the priority, but some people rather have a bowl of mashed cauliflower than a steak.
• They can become conduits for excess fat. Bacon fried green beans and mayonnaise drenched coleslaw have to be monitored. A lot of people like their vegetables because they can add a stick of butter to them or a tub of sour cream. Be careful with the preparation of your vegetables.
• They can become a conduit for sugar. Sweet and sour broccoli and honey coated asparagus are not proper ways to eat your vegetables.
• They are air, which is basically starvation. Be careful you aren't eating too much of them.

There is no such thing as a "good carb". The only "good carb" is the one your body makes itself through glycogenolysis and gluconeogenesis.

5. How does a person develop large disparities in blood glucose? Does it happen from getting fat? I know you have said that is the root of metabolic syndrome/diabetes, but I don't understand how this occurs.

This is a good question. These large disparities in blood glucose regulation are most commonly triggered by diet. This is the timeline of how this occurs:

• At 10 years old eating pizza. Blood glucose goes to 120 mg/dL post postprandial and 84 mg/dL fasting. Everything still appears normal even though the higher postprandial number makes 84 mg/dL fasting appear to be an abnormal drop in blood glucose to metabolism. Since a child is still growing, insulin expression is harder to adapt to these blood glucose abnormalities so everything continues to appear normal.
  
• At 20 years old eating pizza. Blood glucose goes to 140 mg/dL postprandial and 70 mg/dL fasting – Large disparities between postprandial and fasting blood glucose are much more apparent. This will only widen over time. Overweight begins to creep in, usually for a female.
• At 30 years old eating pizza. Blood glucose goes to 170 mg/dL postprandial and 60 mg/dL fasting – Postprandial hyperglycemia and fasting hypoglycemia. Obesity rears its ugly head, and it also becomes noticeable on males. That testosterone won't save you forever.
• At 40 years old eating pizza. Blood glucose goes to 200 mg/dL postprandial and 120 mg/dL fasting – Active hyperglycemia all of the time while the body believes the fasting number is still hypoglycemia. It will only double down in trying to keep fasting blood glucose as high as the highest postprandial number.
• At 50 years old eating pizza. Diagnosed as diabetic.
• At 60 years old eating pizza. On dialysis and missing a leg.

Keep in mind, the above timeline can differ depending on how the syndrome manifests in the individual. You can be on dialysis and missing a leg at a much younger age than 60 and you can absolutely become obese at age 10.

Notice how the pizza got the ball rolling by significantly raising postprandial blood glucose. This causes a large drop in fasting blood glucose, even when the body is just going back to baseline normal. The body doesn't like this and will actively fight these large drops in blood glucose as this is a signal to it that it is starving. Because it thinks it's starving, it starts sparing fat. This is the beginning of overweight/obesity.

As time goes on and insulin function deteriorates, you can see how the postprandial blood glucose keeps going higher and higher, while eating the same pizza. Fasting blood glucose never goes back to normal but remains high, even though a significant drop continues to occur, in comparison to the postprandial number.

What is occurring is that fasting blood glucose is trying desperately to catch up and match postprandial blood glucose, so that blood glucose is basically always high, and the large drop never occurs. The body is adapting to high blood glucose because it likes to keep blood glucose within a very controlled range. That is what diabetes is - an adaptation towards high blood glucose.

By 50 years old, fasting blood glucose is the same as postprandial blood glucose. The fasting blood glucose finally caught up and now blood glucose is always high, whether fasting or not, in other words diabetes. This adaptation causes for the body to do anything to keep blood glucose high and it does this through an over expression of gluconeogenesis and adrenal output, irrespective of diet. The 60-year-old that is now on dialysis and missing a leg had been showing signs of illness, since their 20's when they started becoming overweight/obese.

Like I said above, the onset of disease can be much earlier depending on how frequently these highs and lows in blood glucose occur. If this pizza eating person also eats ice cream, cookies and cakes, then this roller coaster in blood glucose occurs at every mealtime and the adaptation happens quicker, making them a diabetic at 30 years old, blind at 40 and on dialysis at 50.

You can see why overweight/obesity and diabetes are considered time dependent conditions. They don't occur over night. There is a decade span between each progression of the disease. So, this doesn't occur from "getting fat". Getting fat is the canary in the coalmine. It is telling you that something is wrong. Your metabolism is under stress.

Most people do not see this disease process occur because it happens so slowly and blood glucose is only checked while fasting, during your yearly physical. So, you never see these large disparities occurring. Some of those drops in fasting blood glucose can go well into the 50 mg/dL and 60 mg/dL during the overnight fast because of prolonged insulin release due to high postprandial blood glucose. It takes time to clear that glucose and insulin will remain in circulation during it. It then takes time to clear that insulin but by then, your blood glucose just keeps dropping.

Most prediabetics and diabetics develop a resistance to these drops in blood glucose and manifest no symptoms of hypoglycemia, even when their blood glucose becomes dangerously low. This is why many diabetics die in their sleep. This is also why many individuals with metabolic syndrome experience pseudo hypoglycemic symptoms even when their blood glucose is completely normal or even higher than normal.

These disparities will make you uber fat as the body continues to think it is starving because blood glucose is so erratic. You see, the body doesn't just use calories for nutrient availability information. It uses blood glucose as well. Nothing tells the body it is starving, more than a sudden drop in blood glucose. It's not the calories in the pizza. It's not the fat in it. It's not that it's junk food. It's the carbs that disrupt blood glucose regulation.

This is precisely why some people are at a loss as to why they are so fat. They don't seem to eat much and many times they don't even eat often enough. This is because what they are eating is reinforcing this adaptation, irrespective of portion sizes and calories. This is also why overweight/obesity cannot be treated using calories as that is not what caused the "disease". Yes, pizza has a lot of calories and that will cause you to gain weight, but you will only become obese because of the blood glucose disparities. This is why the younger you are, the better you can "handle" this pizza load even though the calories in that pizza are the same for a 20-year-old as for a 50-year-old, but the hormonal state of a 20-year-old is very different than a 50-year-old. The 50-year-old is more susceptible to blood glucose abnormalities.

How can all of this be avoided? Eat foods that do not disrupt your postprandial blood glucose. Disruptions in postprandial blood glucose will set the stage for this process to occur and once it begins, diet is only a palliative treatment.

6. A friend told me that she eats baked potato with plenty of butter in order to prevent blood glucose from rising too much.

You are either low carb or you're not. If you're not, then I recommend calorie restriction as this will at least ward off the "disease" for some time.

Mixing carbs with fat creates a high carb/high fat diet. Basically, that's the Standard American Diet (SAD), the most fattening diet on the planet. Just because the fat displaces glucose temporarily, and you don't see it rising on your blood glucose meter, it's not doing a thing to treat your condition. You're still getting fatter and sicker over time.

Six common beliefs addressed, Part 220

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Six common beliefs addressed, Part 196

1. My doctor told me that “keto” is great for short term weight loss but not for the long term.

Your doctor is correct. "Keto" is great for short term "weight loss" and so are all other diets. So "keto" is no worse than any other diet in that sense. Once your body fat is challenged, leptin always under expresses to prevent further fat loss. This is why all diets fail. These fad “keto” protocols are particularly detrimental because they increase the adrenal stress response through starvation and adapt the body further to sparing fat mass.

For this reason, the target of a ketogenic protocol is to control blood glucose regulation so that the adaptation to starvation is broken.

2. Low carb protocols are a "lifestyle" and not just for fat loss.

That statement is always made by scammers. They want to take your focus away from what they can’t deliver - fat loss.

All diet's primary goal should be the loss of body fat because body fat is the main indicator of a pathological metabolic adaptation that leads to diabetes. It is the canary in the coalmine that blood glucose regulation is abnormal. "Weight" is not implicated in diabetes, body fat is. The loss or gain of body fat is an indicator of what your metabolism is doing. If you can lose body fat, then you are headed in the right direction. If you can’t, you are only rearranging chairs in the Titanic. Nothing matters, until body fat is lost. Nothing. 

I know a lot of people do not like to hear that but I'm not here to tell fairy tales so you feel good. That's what cake used to do and look where it got you. Metabolic health can only be obtained through the loss of body fat because this means you have regulated blood glucose enough that leptin is responding to treatment. If leptin does not respond, you will forever be stuck at diabetes' front door.

So yes, low carb protocols should be a lifestyle because it takes much more than just diet to address metabolic issues but the primary goal is always to get your body to start burning its own body fat. That's the first engine that must come on for the machine to begin working properly. The loss of body fat is the primary metabolic advantage.                                            

3. Cancer “feeds on sugar”.

I've addressed this statement before but I don't mind doing it again so it's clear and the nonsense can stop.

Cancer feeds on the same things your healthy cells feed on. This is why cancer hasn't been able to be successfully "starved" as you would have to starve yourself. Anything that is poisonous to you, is poisonous to cancer. That's why chemotherapy and radiation damage healthy cells along side cancerous ones.

So, cancer feeds on sugars, proteins and fats - just like you. This occurs to varying degrees depending on the type of cancer as all cancers are different. But let’s say, for the sake of argument, that cancer only feeds on sugar. Well, your body makes its own sugar so it will be feeding the cancer all by itself. In fact, the body especially likes to make sugar when it is sick (like having cancer) so it will be an open 24 hour buffet for it.

4. No one knows what obesity is or what causes it.

Obesity is the chronic under expression of leptin, caused by blood glucose dysregulation which abnormalizes insulin expression over time. This process doesn’t occur over night. You don’t wake up one morning with under expressed leptin and begin piling on the pounds of fat. It is a gradual occurrence. Obesity is not a line you cross, it’s steps you take, like a ladder. A series of things together cause a “compounding effect” and once they begin, they become a viscous circle, feeding off each other and progressing the condition further. 

To be obese you must have:

• Blood glucose dysregulation – Erratic fluctuations in blood glucose, with large disparities between highs and lows, which deteriorates insulin function over time causing “insulin resistance”. Insulin resistance affects all glucoregulatory systems, lipid metabolism and fat cell function. Leptin is a slave to insulin and is produced by fat cells so it becomes compromised and chronically under expressed.
• Obesity - That's right. Being obese makes you more obese, hence the viscous circle description above. The fatter you are, the fatter you will become because being fat itself interferes in proper insulin function as the obese have a very high insulin demand which dysregulates their blood glucose further. 
  

Many things can cause blood glucose dysregulation but some of the most common lifestyle factors are diet and exercise. Of course, there is a lot of nuance to both and this is why the generic advice of "eat less/move more" will not help you. It is much more complicated than that. The nuances are:

• Not moving enough – insufficient hours active
• Not moving the right way – strolling through stores or jogging
• Not moving at the right times – working out on the weekends only
• Eating too frequently or not enough – chronic snacking/extended fasting
• Eating the wrong things – too many energy based foods that are nutrient poor
• Eating the wrong way – eating as a reward, as consolation for a bad day or because of boredom
• Eating at the wrong times – eating too late at night or out of consistent meal times

The obvious habits of drinking sodas, eating fast food, sweet based snacks and processed foods all contribute to obesity but they aren't the only things. You could have eliminated all of these things, from your diet, and still be doing one or all of the things listed above. Age, gender, current metabolic profile and genetics will all compound the effects these habits cause.

5. An exaggerated stress response cannot damage the liver.

The uncontrolled catabolism experienced by diabetics can absolutely damage the liver causing inflammation and cirrhosis which further deteriorate their condition. Many diabetics experience an increase of this risk after illness or injury.

Eventually, there is also kidney damage as both the liver and kidneys are the organs that have to filter the byproducts of this excessive skeletal muscle catabolism. This is why only 30% of diabetes progression is due to diet but 70% is due to the effects of this exacerbated stress response.

6. You cannot make low carb work if the only vegetables your digestive system can tolerate are potatoes. 

You can have potatoes as long as you aren’t consuming sugar and grains and you stick to your carb macros. Make sure you use red potatoes or sweet potatoes, not “baking” or “Idaho” potatoes as those are hybrids with too much starch.

Six common beliefs addressed, Part 172

1. The body does not know how much glucose to make during stress.

This is correct, but only of people with metabolic syndrome/diabetes. 

Metabolic syndrome/diabetes is when you do not have proper blood glucose regulation. This means you make too much blood glucose when you don't have to and too little when you do. This causes erratic lows and highs in blood glucose, with large disparities between the two. 

When you have metabolic syndrome/diabetes and suffer from an injury, illness, dehydration, strenuous exercise, hormonal imbalances, etc. you will produce glucose at an exaggerated rate through an over expressed adrenal stress response. It is this response that eventually drives the condition and progresses it over time.

2. I use to be able to eat oregano but now if I try it, I get gastroparesis and it triggers my seizures. 

Stay away from oregano if it is causing you this type of distress.

Herbs can have some powerful compounds in them. They have been used medicinally for millennia so you have to be careful of what affect they may produce in you. These effects can change over time so just because something didn't cause you any harm in the past, does not mean it will remain that way in the future. Our body's chemistry changes over time, especially when your entire diet changes.

3. Only thin people should give recommendations and advice to the overweight/obese.

The problem with these overweight/obese low carb advocates is not their weight. The problem is their lies and the continuous promotion of misinformation just for the sake of making money. Those are two very different things. You can be overweight/obese and still talk about overweight/obesity. Remember, there is no known cure for overweight/obesity, so anyone who speaks about it is not suppose to be selling you a "cure". If they are, they are a scammer/quack. 

So their weight is not the problem, as long as they are not misguiding people for their own personal financial gain. The battle of the bulge is something we are all dealing with in this sphere. Just because you know what causes overweight/obesity, does not mean you can change it in yourself or anyone else. In fact, if you truly know what causes overweight/obesity you would know for certain that you can't change it in yourself or anyone else.

You can't say that only thin people can speak on overweight/obesity because we already have that. They are called the diet industry, which is completely overrun by thin, obesity resistant, athletic types that have no clue what obesity is or its mechanism. People who were once obese and then became thin are not the only ones who have dibs on speaking about this subject because that's saying that they have some "magical" cure, which they only know about. That's not true. They were at the mercy of their blood glucose regulation and how it reacted to treatment.

Again, there is no known cure for overweight/obesity. There are only interventions that might or might not work for each individual. The length of time that they might work will also vary. Overweight/obesity is a lifetime problem. Once the ball gets rolling, it's very difficult to stop it.

So you shouldn't discredit someone who is overweight/obese simply because they are overweight/obese. You discredit them when they are full of BS. You also cannot assume that their diet is incorrect either because many things besides diet contribute to overweight/obesity. In other words, you can't fault the person who is doing everything right and is still having an issue with body fat. But you can blame the person who insists on doing everything wrong and is still having an issue with body fat.

4. If someone eats a potato and their blood glucose does not rise, it means they have stabilized or "reversed" their Type II diabetes.

This false belief goes to show how the low carb community is misinforming their followers at the detriment of their health.

I have explained before how diabetes is not a "disease of high blood glucose" but a metabolic adaptation towards high blood glucose caused by abnormalities in insulin function. This means you can easily and temporarily manipulate your blood glucose numbers through the foods you eat. I want everyone to keep in mind that there is a window during the "disease" process when this is still able to be done but there comes a time when this is no longer possible and blood glucose will no longer respond to what you eat, as the dysfunction becomes primarily "stress hormone driven". You cannot reverse the metabolic adaptation of diabetes using temporary methods such as the "foods you eat". Diabetes is not controlled through individual food items, but by having an overall dietary protocol and lifestyle to match.

Eating a potato and not seeing blood glucose rise is not indicative of anything. It doesn't mean you do not have diabetes nor does it mean you do. Individual and singular blood glucose readings are meaningless when it comes to metabolic dysfunction. You can easily manipulate what the reading will be by simply eating a very small amount of potato or a red potato, rather than a baking potato, or a potato with butter on it, rather than plain, or a potato on its own instead of accompanied with other foods, etc. The effects of the potato are not indicative of the progression of your dysfunction. The abnormality continues, even with a minimal to no rise in blood glucose from a potato.

Diabetes is not a disease of what happens to your blood glucose after eating a potato. Diabetes is a disease of poor blood glucose regulation which deteriorates insulin function over time and under expresses leptin causing the storing and sparing of body fat. It is an adaptation towards starvation because metabolism starts to do everything as if it was starving, including the sparing of glucose for the creation of more fat (insulin resistance).

So instead of focusing on what your glucose reading is after eating a potato, you should focus on an over all anti obesogenic lifestyle that will stop the onslaught to your body and give it a chance at reversal.

5. If you go carnivore, it can change your microbiome in a way that would cause you to be unable to eat plant foods again if you ever decide to in the future.

No. A person's microbiome is very individualized, like a fingerprint. Our microbiomes are very difficult to change, as many factors contribute to which organisms thrive in us and which don't. Colonies of bacteria, temporarily increase and decrease due to diet changes and other factors but never enough to cause long term issues unless a very unusual circumstance occurs like being on a long term antibiotic, which can result in certain gastrointestinal disorders. Simply not eating vegetables is not enough to cause any major changes in a person's microbiome.

When I was a little kid, I was playing in a pool and decided that it was a good idea to drink pool water for about an hour straight. I had massive gastrointestinal issues but after a few weeks, my microbiome returned to what it had always been. We are the bacteria inside of us so just like we can't rearrange our face easily, as it would take an extreme intervention like surgery, our microbiomes are also resistant to change unless an extreme intervention occurs.

What can make you intolerant, to the reintroduction of vegetables, is a lack of enzymes to break them down but those are built back up in a short time.

6. The "keto" diet has been a failure for most people.

Because "keto", as it's been marketed, is exactly the same as the Standard American Diet (SAD).

SAD consists of a combination of carbs, salt, sugar and fat. "Keto" consists of a combination of salt, artificial sugar and fat. On "keto" carbs are dropped but they are replaced with even more fat. So, in the end, these diets cancel themselves out and become the exact same thing. When you do the same things, you acquire the same results.

Six common beliefs addressed, Part 157

1. Metabolic syndrome/diabetes can be described as "diseases of high body fat". 

Metabolic syndrome/diabetes and other related metabolic dysfunctions can be described as "diseases of high body fat" and often are because the people who suffer from these conditions have high body fat. All of them. Whether the body fat is invisible on the inside or very obvious on the outside. Any way you put it, body fat accompanies these syndromes. So it is not incorrect to describe them as "diseases of high body fat" since the fat to muscle ratio, in all these people, indicate high body fat. You can also say that the loss of body fat "reverses" these conditions but this is where the whole story is not being told.

Excess body fat is the canary in the coalmine. When your body begins piling on body fat and sparing it, you know you are headed up %$& creek. Not because soon you will no longer fit in your pants but because soon you will need injectable insulin. Putting on excess body fat is a sign that some metabolic abnormality is at play and it will progress if not stopped. That metabolic abnormality is blood glucose dysregulation.

The body puts on excess body fat and spares it when it is under starvation. That is its defense mechanism. This is why conditions like metabolic syndrome/diabetes/overweight/obesity are all metabolic adaptations towards starvation. This means that something occurs, before the body fat is put on, to cause this adaptation to take hold. We know this because normal weight gain, does not cause this. Like I have said many times before, weight normally fluctuates up and down and its gain does not cause obesity nor does its loss cause cachexia. A healthy metabolism regulates its weight very well and within tight parameters. Obesity is when the body goes well beyond these parameters and raises its weight set point, particularly body fat at the expense of lean muscle mass, to an abnormal level.

The cause for this abnormal blood glucose regulation and that is multifactorial and complex but we certainly know that two things are involved:

• Diet - A diet that causes large disparities between highs and lows in blood glucose sets the ball rolling for adapting metabolism to a high blood glucose, insulin level and body fat set point. This deteriorates proper metabolic function. Large disparities in blood glucose are a signal to metabolism that it is "starving". The trigger for this adverse reaction is the drop in fasting blood glucose after a very high postprandial rise (e.g. pizza eating).
• Exercise - A lifestyle where you are mostly sedentary dysregulates blood glucose control further and adversely effects leptin expression.
• Fasting (Starving) - Time spent in hypoglycemia is detrimental for this process to take hold and progress. Not eating regular meals at predictable times, eating low protein, chronic caloric restriction and simply not being hungry enough for a meal but certainly for a novelty are the primary causes for this. 
  

All three of these things cause for metabolism to begin piling on and sparing fat. This excess body fat further contributes to the downhill progression of the condition. When you follow a lifestyle that addresses blood glucose regulation and leptin function, you halt the adaptation and you begin seeing fat loss as the body allows for this fat to be lost. This in turn improves your condition. So, yes, technically the loss of body fat helped but what helped you lose the body fat was addressing your blood glucose regulation.

The problem comes in when the person simply can't regain and/or sustain proper blood glucose regulation to make a difference. This means that they simply didn't effect their insulin expression profoundly enough to correct their blood glucose, even when it is corrected postprandial. Body fat is at the mercy of your neuroendocrine system and the state it is in. When fat loss doesn't happen, it's because you didn't change that system enough to make a significant, long lasting difference. It doesn't mean this was necessarily your fault. Blood glucose regulation and leptin expression can only be affected so much by your actions. But this is why being fat is never okay. As long as you're fat, you have metabolic problems.

2. Intermittent fasting and caloric restriction are the same thing, if they both equate to the same caloric deficit at the end of the day.

In order to understand how this works you have to abandon the premise that total calories are the only marker the body uses to determine its nutrient status. We have discussed in previous posts how total calories determine body weight loss and gain but not obesity. Obesity is not simple weight gain anymore than cachexia is simple weight loss, even if it appears that way to the onlooker.

The mechanism in obesity that is piling on and sparing weight, particularly body fat, is hormonal driven and doesn't respond to calories in any significant way as it's getting the bulk of its nutrient availability information from your neuroendocrine state. So it doesn't matter if at the end of the day you ate less calories by fasting or caloric restriction because you will still be obese. You can kind of think of obesity as "calorie blindness" because what's driving it is blood glucose dysregulation. You can disrupt your blood glucose with low calories. After all, macronutrients affect blood glucose more than calories but starvation does too. So caloric restriction is actually doubly bad for treating obesity as it uses two mechanisms to adversely affect your blood glucose regulation.

A healthy metabolism responds primarily to caloric input which causes periodic, insignificant, weight fluctuations as it balances itself at its weight set point. An unhealthy one bypasses all of that and can care less as its sole purpose is to continue putting on fat, beyond its threshold, and by any means necessary.

So what matters is what effect these practices (fasting/caloric restriction) have on the metabolic adaptation towards starvation which is what obesity/diabetes is. What exactly does blood glucose dysregulation affect, that would cause body fat to be stored and spared? Though this is very complicated, let's just focus on one hormone - leptin, as we want to get to the "fat" of the problem.

Leptin is usually referred to as the "obesity hormone" but it is best described as the "starvation hormone". Leptin is very sensitive to nutrient availability and it doesn't just measure this through calories. It measures this through meal frequency and activity levels. How does it know? Through insulin release/expression which of course is determined by blood glucose levels. If obesity is sort of a "calorie blindness" then calories are the least relevant information that leptin will go by. You can see this in real time as calorie restricted diet after diet fails miserably in addressing it. This is particularly true for leptin resistant obesity, which is the most common form of obesity. The obese that are still leptin sensitive lose all of their weight effortlessly, following a legitimate protocol, and do not complain about their weight ever again....well, at least for a very long time. This is quite rare but it does happen. If you are on this blog, that's probably not you.

• Intermittent fasting (steady blood glucose) tells the body that there is plenty of food available, it just has to wait for it. This allows leptin to burn body fat during a fast because it knows that plenty of food will still be coming in a short while. This raises metabolic rate.
• Chronic caloric restriction (too much time in hypoglycemia) tells the body that there isn't enough food available no matter how long the wait. Some kind of famine is occurring and leptin prepares the body to deal with that famine by sparing fat mass during fasting times in order to preserve it. After all, this fat mass will be very beneficial if food becomes even more scarce. This lowers metabolic rate to boot.

The way these practices (fasting/caloric restriction) relay to the body this information is through blood glucose homeostasis. Leptin has been around for as long as we have been around and it has evolved to listen carefully to these queues. It is much smarter than we are. It has been through many famines in the past. I know that our bodies seem new to us because our individual consciousness just got here but our bodies are actually "hand me downs" from past generations. Everything that was learned before, is in us and our consciousness can't do a thing to change it.

Our metabolism regulates itself. We weren't meant to interfere with it. When it's not working properly it's because it's being conditioned to do something it's not suppose to, due to the inputs its receiving.

3. If you are "addicted" to diet soda, you should cut it with sparkling water in order to reduce the negative effects.

If you approach your lifestyle change under the premise that you are "addicted" to something, then you should find some other treatment plan besides diet. You do not cure "addiction" by reducing the amount of addictive substances you use. So that right there is a recipe for failure. After all, if you are a "victim" of some "addiction" process then you have no control over what happens. You need to go to rehab. You should never try to tackle an addiction on your own as it requires professional help.

Secondly, if you begin your low carb diet by reducing the same foods you already eat, then you might as well try another diet. In fact, there is already a diet out there that does just that. It's called caloric restriction.

People come up with all kinds of tricks to try and comply with their diet. This is precisely why they came up with caloric restriction in the first place. Caloric restriction is just like cutting your soda with sparkling water. In fact, it's literally the same thing. Both practices make things "less bad". If you eat half the Hershey's Kisses you ate before, then they are only half as bad as they were. If you only have one bite of chocolate cake, then you now made it only one bite bad. We all know none of this works. 

• Half the Hershey's Kisses is still disrupting your blood glucose through the introduction of dietary glucose. 
• Half a glass of soda is still disrupting your blood glucose through its effects on the hypothalamus from the sweet taste and the introduction of caffeine.

When you don't understand obesity and how it works, it would seem that this reduction should produce results but it doesn't. This is because your metabolic issues are not reacting to the "amount of bad". It's reacting to the "bad". Period. As long as the bad remains, in any amount, the issues will also remain. This is why caloric restriction only gets you to calorically restricted obesity. Making your food half bad keeps you less obese but obese none the less. Now some people are just fine being less obese but their metabolic markers will continue to deteriorate over time. After all, you may be able to be half obese but you can't be half diabetic.

Elimination is the only thing that works. Not negotiation, reduction, replacement or manipulation. Now you can fool yourself playing around with your food like this but you can't fool your obesity. People who do things like this never get anywhere. I have seen this time and time again through all the years I've been dealing with these issues.

The best way to eliminate diet soda, is to eliminate diet soda.

4. My husband had a plate of rice and his fasting blood glucose of 84 mg/dL, jumped to 180 mg/dL an hour later. This morning, his blood glucose is still high but when he ate breakfast, eggs only, it dropped to 73 mg/dL. Is rice the culprit for these crazy highs and lows?

Yes, but no. This is actually a very good question and if you ask any low carb advocate they will immediately tell you that the rice is unequivocally the culprit of your husband's problems. They will get on a pulpit and preach that you must simply remove the rice, do nothing else, and your husband's problems will magically go away. Of course, they will conveniently ignore the drop in blood glucose from the eggs. Well, I'm not that kind of low carb advocate, as I don't sell hogwash.

Your husband is having metabolic abnormalities and though I haven't seen him, I'm pretty sure this is evident by the accumulation of excess body fat he has acquired through the years. These large disparities in blood glucose highs and lows, you are witnessing, have been occurring for a very long time and they didn't begin with just the rice. The rice is allowing for you to see this happening in real time because rice is one of the contributors to this blood glucose roller coaster. It makes this abnormality more obvious, particularly with postprandial highs.

The rice alone did not get your husband to this. It only contributed to the process. That is why the removal of rice alone will not solve this. We know this because Asians have eaten bowls of rice, for millennia, and they never developed any blood glucose regulation abnormalities. Of course, this was back in the day when Asians ate their carbohydrates in the context of starvation and had no sugar. No one willingly starves themselves, unless they have an eating disorder. We weren't meant to live under chronic starvation.

This means that two things must be done to stop your husband from becoming diabetic:

• Yes, he must get rid of the rice and never eat it again. Simple.
• But, he must also stop the erratic ups and downs in blood glucose. Not so simple and requires more than just getting rid of rice. It requires a lifestyle change.

He can't just do one of these. He must do both because their combination are what's causing the problem. There is no room for rice in a Western diet. It is very obesogenic in modernity. It is not needed and it is not proper nutrition.

5. Every time I join a low carbohydrate group or page, I am either bombarded with scientific jargon, that I don't understand, or I am bombarded with recipes that are completely useless.

This is why I run my blog differently. I only tell you what you have to know and in layman's language. No jargon or complicated studies required. After all, a great way to hide the truth and muddy the waters is through complicated jargon and "studies". I don't jump at every little new "discovery" made. It's not needed. I also give people meal ideas, rather than recipes and I even limit those.

Low carb is not difficult. It does not require recipes. It only requires meat and vegetables. Unfortunately though, that's what people like to browse as their brain turns to toothpaste on Facebook. They like recipe after recipe that they won't make anyway. Low carb advocates concede in order to continue getting the clicks.

6. If you follow a low carbohydrate diet, the only potatoes you can eat should be raw. 

I often receive questions about what types of fruit are allowed or what are the best tubers or is white rice better than brown rice. Let me be clear about something. Carbohydrate restricted diets do not focus on any of these items, since none of these items should be included on the menu. For this reason, there are no recommendations for them. It is irrelevant which are better or how you should eat them.

The focus of carb restricted diets is on meat and vegetables. That's why they are "carb restricted". As ridiculous as this might sound, "meat and vegetables" has to actually be defined for some, so here goes:

• Meat - Any item that comes from an animal, whether muscle or organs or milk. All animals are on the menu, from farm animals to wild animals. Humans are the only animals that others might have an issue with, so don't share your human meatball recipes in public.
• Vegetables - All non starchy, above ground, edible plants. This includes low sugar fruit like nightshades and fungi like mushrooms. All leafy greens are included and cruciferous flowers as well. Do not try to eat elm trees or saw grass. Edible plants only.

It's not rocket science. There are a multitude of combinations for meat and vegetables. In fact, you can have a different meal, every day, and not repeat any for a whole year and then some. I have a page devoted to just that. Here is a list of 365 meal ideas, comprised of meat and vegetables, including an extra one for leap year.

Notice that items like dairy, seeds, nuts and fruit are only used as garnishes. A very limited amount of meals also use tubers and even legumes as garnishes. The priority is not given to these items but to the meat and vegetables instead.

With this meals list, you will no longer need to eat raw potatoes like a badger. I don't even think they had raw potatoes in the gulag, so I am sorry you have had to live this way. Throw your raw potatoes away and eat real food.

Six common beliefs addressed, Part 98

1. People who go low carb, will no longer need their eyeglasses.  

I think this is one of the dumbest things I have heard in awhile, but it's out there. I hate to break the news, but only laser surgery corrects eye problems. No one magically develops 20/20 vision after being myopic their entire lives, unless they found a really good faith healer. Just make sure your chosen faith healer isn't wearing eyeglasses themselves and neither is any of their congregation. 

High blood glucose and the inflammation caused by hyperinsulinemia can be culprits of near/farsightedness. If the person fixes their diet and lowers these two values it may affect their eyesight and they will magically assume that they have been "cured". But it's BS. I used to know a woman who wore eyeglasses, for many years, until she passed out from a blood glucose of over 400 mg/dL. When they put her on insulin, she ditched the eyeglasses. Do you think the prescribed insulin "cured" her eyesight? No. There was never anything wrong with her eyesight to begin with. She just needed to wipe all that glucose off the surface of her eyes and the prescribed insulin helped her do just that. So, if your eyesight gets "better on low carb", its because you were having symptoms of diabetes, not a true eye issue. 

2. Should diabetics track ketones?

No. It's absolutely a waste of time, unless they are monitoring for keto acidosis. On this blog, we do not track ketones, we track results. 

3. You will not be set back if you fall off the wagon. Just pick yourself back up again. 

When you "fall off the wagon" you are set as far back as when you first started the diet. This is because you obviously aren't taking the diet seriously and you cannot sustain it, in the long term, except by jumping on and off the wagon. So unfortunately, we do not deal with that type of behavior on this blog. We only recognize those making true lifestyle changes. 

But there are many other blogs out there that entertain this and were created specifically for people who do this. You are welcome to go vent there. 

4. Is meat inflammatory, even if I feel great eating it?

There is no "inflammatory" anything, including meat. There are only inflammatory states. Some are positive and some are negative. Hyperinsulinemia is a negative inflammatory state. So is obesity, metabolic syndrome, diabetes and autoimmune conditions, just to name a few. Exercise is a positive inflammatory state. So is the inflammation present in an injured or infected area. 

Inflammatory states are affected constantly by different external and internal conditions. So basically, if you have a preexisting inflammatory condition, you are pretty much continuously fighting against the effects of different processes, which can flare up your symptoms. There is no universal inflammatory "thing". It's inflammatory to you, if it aggravates your preexisting condition. The inflammatory response is between you and your disease, not between you and a specific thing. 

5. Do Type II diabetics need to take insulin to control their blood glucose?

I hear this often because a lot of sick people go to low carb pages and groups, where they are told that they can control their blood glucose through their diet alone and that is false. It is not only false, it is a very dangerous claim to make. 

The vast majority of diabetics will have to use a combination of diet and medications in order to take back control of their blood glucose. With time, medications can be reduced or eliminated, but that is not going to be the case for everyone. It all depends on: 

• How far their condition has progressed. 
• How strictly they adhere to their diet. 
• What other lifestyle changes they are willing to make and remain consistent with. (e.g.: exercise) 
• How much body fat they can lose. 

All of those depend on: 

• Age 
• Gender 
• Hormonal status (e.g.: menopause, premenopause, andropause) 
• Pre-existing/comorbid conditions (e.g.: thyroid disease, autoimmune disease) Current metabolic status (e.g.: diabetes) 
• Mindset (e.g.: commitment and consistency) 

You can see now why remission is so difficult to achieve for many people. That's a laundry list of things that can potentially go wrong. Remission is a gift that not everyone gets to open. For this reason, some diabetics must continue to take insulin and/or other glucose lowering medications, even after the implementation of an appropriate diet, since they simply cannot keep their blood glucose under control. Their metabolism has succumbed to its pathological state and they no longer produce enough insulin to stop the catabolic counter regulation that continues breaking down their lean body mass, and everything they eat, into glucose at an uncontrolled rate. This further deteriorates blood glucose control and insulin function.

This lets us know, that insulin is still effective for lowering their blood glucose, on some level. Even though many of their organs and tissues are rejecting insulin, others are still responding to it, but pharmacological doses are required to achieve this proper response. The control of glucagon is one of those processes that requires large amounts of insulin, in order to work properly, and the more insulin is given, the more of it will be needed with time. This is because diabetes and other metabolic issues are conditions of adaptation. This is why taking control of diet is so important, in order to reverse this adaptation and hopefully lower insulin requirements, until they are no longer needed. 

So, if you cannot control your blood glucose through diet alone, you will have to continue taking your medications and use diet as a lever. Eventually, you might be able to get off your medications. 

6. If you incorporate boiled potatoes to your low carb meals, it might trigger weight loss.  

If you are leptin sensitive, and have been following a low carb diet for a prolonged period of time, introducing carbs in the form of starch can ramp up weight loss, breaking a stall or your maintenance. 

Potatoes simply cause a rise in blood glucose. This rise is not pathological for people who are metabolically stable, but it is enough to signal to the body that there is plenty of nutrients available. The temporary decrease in ketones and rise in insulin, in response to this rise in blood glucose, is a strong signal to the body to burn body fat, as there is plenty of food available to do so. Leptin expression is stimulated and body fat is the targeted fuel. The body recognizes that there is no need to store anything, as the presence of glucose is a strong indicator of nutrient availability. 

It is this very mechanism that has driven a lot of weight loss protocols to focus on starch and make claims such as "Potatoes for weight loss!" or "Eat starch, become slim!". These claims are true, to a certain extent. The person simply must be aware of the true mechanism behind the weight loss, which is the stimulation of leptin, not that starch is a magic pill. The last thing a person wants to do is believe that the starch itself is causing the weight loss, as this can cause an excess of starch consumption and the person will begin seeing diminished gains, as they stimulate leptin at the expense of insulin. Soon leptin will under express in response to insulin over expression.

Manipulating leptin through diet is very difficult to do and quite a balancing act. For this reason, there are no "leptin diets", as leptin responds directly to nutrient availability and indirectly to macronutrient composition. All of the benefits of leptin are completely dependent on your leptin sensitivity, so not everyone will respond the same way. Another potential issue with this is that people tend to "carb creep". This means that they no longer just stick to adding potatoes to their meals, they begin adding all sorts of other crap to it as well, like bread, oats, rice or sweets. People like to take the good effects of one thing and run with it, until these effects top off and begin going in the opposite direction. 

So, be careful and make sure you are targeting the mechanism you want, which is leptin enhancement, and not targeting your tongue, which just wants french fries. 

Six common beliefs addressed, Part 93

1. There is no one thing that can reduce systemic stress.

There is - be consistent. Consistency is the body's main stress reliever. With consistency comes predictability and the body's ability to coordinate the pulsatile rhythms of its hormones. All hormones work in pulses. You have an internal, biological clock that drives this and it is very sensitive to the surrounding environment. So taking care of your circadian rhythms is the first step to reducing systemic stress.

For this reason, you want to be rhythmic and consistent in your diet, fasting and exercise protocol. There is nothing that disrupts the body's clocks and stress response like flip flopping from one diet to another or exercising one day and sitting the rest or fasting for five days to then binge for eight. Do not do that. People with metabolic problems already have a heightened stress response and it doesn't take much to tip them over the edge. 

2.  Do thyroid problems cause difficulty in losing weight?

Some people think that pseudo lows or highs in thyroid are a "problem" when they are only the result of their overall metabolic state. Being obese, being thin, losing fat, gaining fat - are all metabolic states that affect thyroid function. This does not equate to "thyroid problems". 

The thyroid is a master hormonal regulator and works alongside every metabolic hormone in the body. This means that when you have thyroid problems, you will automatically have metabolic issues and vice versa. These issues can vary by individuals because they are so dependent and intertwined with the person's overall metabolic state. People who have been obese their entire life almost unanimously exhibit thyroid "dysfunction". A lot of obese people think they are obese because of their thyroid problems, but the reverse is true - they have thyroid problems because they are obese. This is of course only true in the absence of any genetic or autoimmune thyroid condition. 

Taking control of your metabolic problems will help improve your thyroid function, but you will not be able to take control of your situation completely, unless you address any real thyroid disease you may have. You need to work closely with your healthcare provider in order to accomplish that. It's going to take some tweaking, as you find the right treatment for your particular case, but it will be well worth it. You want a thyroid that will be working with you, to better your condition, not against you. 

3. Is there a cure for obesity?

There is no known cure for obesity. There are only lifestyle interventions. This makes perfect sense, when you look at obesity through the lens of "adaptation", rather than "disease". 

4. Do "low leptin" levels causes hunger?

Leptin is a starvation hormone, not a hunger hormone. 

Leptin is best, and most simply, described as a fuel pump. If leptin is signaling properly and fat stores are being used for fuel it can either trigger hunger because the body needs to acquire more fuel or it can trigger no hunger because the body has fuel to spare and doesn't need more of it. What occurs is dependent on your overall metabolic state, as there is an interplay of many hormones, working in feedback loops, that determine this. There is no one sole hormone that is responsible for any one specific effect. 

5. If you soak potatoes for 30 minutes, it will get rid of their starch.

The way you get rid of starch from potatoes is to let them go down the drain with the water you rinsed them in. Potatoes themselves are starch. The starch doesn't just cling to the exterior of the potato like dust clung to people's clothing during the Dust Bowl. 

If the starch is only on the outside of the potato, then what is that white "meat" that is inside the peel? Solid fairy dust? I don't think so. Do not fall for advice like this. It will only make you eat an excess amount of potatoes, thinking that you are now "safe from the starch". Low carb diets do not focus on the consumption of potatoes. On these diets, potatoes are either eliminated, all together, or are very limited. 

6. Is it difficult for a person with diabetes or other metabolic problems to achieve ketosis?

It is actually very easy for them to because of their under expressed insulin function and over expressed catabolism, which easily breaks down the body into glucose and ketones. A person with diabetes and metabolic problems can go into measurable ketosis, relatively easy, with just some simple carbohydrate restriction.

Six common beliefs addressed, Part 88

1. A diabetic cannot control their stress response.

That is the core problem of diabetes and the day it's successfully controlled, then it would be the cure. Diet has a very minimal effect on the stress response. The majority of the blood sugar that diabetics make is coming directly from the inside, not the outside. It is extremely difficult to reverse this stress response adaptation. For some people, it’s much easier than others. Some people are just wired to have high stress responses. Consistency in eating, fasting, sleep and exercise is a good way of taking back control, as normalizing circadian rhythms has a profound effect on regulating the stress response.

For some people going very low carb, without enough protein, like is the case for “keto”, can result in the body doubling down on its stress response. This is why we recommend eating carbs to tolerance and from whole foods only. Remember, diabetes is primarily a starvation adaptation, hence the high stress response. You never want to aggravate that further.

2. Do people lose weight and lower blood glucose on starch diets because these diets are very low in animal products?

The absence of animal products is irrelevant to the efficacy of these diets.

In the short term, all diets cause weight loss and lower blood glucose. Why? Because all diets create some form of caloric deficit and this has a mild and short term effect on metabolism, mainly through the lowering of glucose which affects insulin. But all diets fail in the long term because in order to manage weight, you need profound and long term effects on metabolism, as a whole, which is mainly done through the proper regulation of blood glucose. 

Weight management cannot be achieved using short term treatments, which do not impact blood glucose enough. Bypassing proper blood glucose regulation for simply a lowering of blood glucose in order to temporarily affect insulin, will not achieve long term results. All you are doing is releasing water weight and breaking down muscle mass, not burning body fat.

So, anytime someone points to a diet and claims that people are "losing weight" and "lowering blood glucose" on it, they are not making any special claim, as both of these effects are true of every diet on the planet.

3. They say meat builds muscle, but you can get fatter on carnivore.

"Meat" does not build muscle. Protein builds muscle and that is only stimulated through exercise.

Meat is not just protein. It contains plenty of fat and that’s what can make you fatter on carnivore. Consume leaner cuts of meat. Remember, the only true lean meat is wild game.

If you can't make your protein goal for the day, because it will cause you to go over your fat goal, supplement with whey protein. Remember, you must also have an exercise regimen in place. You won’t build muscle if you don’t use them.

4. An occasional bag of potato chips is not enough to gain weight.

That is correct. Again, it's all about proper blood glucose regulation. If a bag of potato chips does not affect your blood glucose regulation, then you can eat them but if it does, you cannot. For people who already have problems regulating their blood glucose, it does not take much to see a negative affect to their blood glucose so for them, an occasional bag of potato chips is enough to affect their goals.

Potato chips are very obesogenic. The refined oil, that the potato chips are fried in, mixed with the high starch of “baking potatoes”, makes for a very obesogenic food item and the obese are particularly sensitive to any condition that facilitates the growth of body fat. Potato chips are just that condition.

As a rough example, potato chips for a healthy person will cause a 0.5 increase in body fat in a span of months. Potato chips for an overweight/obese person will cause 2 pounds of body fat in a span of weeks. This is why obese people often complain that “just looking at a cupcake" causes them to gain weight. Fat people are extremely efficient and perfectly adapted at growing body fat. They must stay away from anything that makes it easier for them to do just that. 

So stay away from any food that disrupts blood glucose, even "occasionally" because it only takes one occasional hypoglycemic event to reinforce the adaptation towards obesity.  

5. Ever since I went carnivore, my belly fat has increased.

This is due to a badly formulated carnivore diet. When eating carnivore you must:

• Watch the fat content of your meat. Stop slathering rib eyes with sticks of butter or fat based sauces. Farmed animal meat is already very high in fat, even when it's marked "lean".
• Watch your dairy intake. Carnivore is a protein centered diet, not a fat centered diet. Dairy is mostly fat. You can easily go over your daily fat goal eating plates of cheese with bacon and drinking cartons of heavy cream.
• Watch the type of meat you’re eating. Carnivore should be done using fresh meat not cold cuts, processed, pre-cooked, pre-seasoned, pre-prepared meats. Hot dogs and sausages are party food, not health food.
• Stay away from one meal a day (OMAD). Meat is very satiating and boring, so this can cause you to get into the habit of eating only once a day. Don’t. Eating once a day is not a good practice for people who are overweight/obese and/or have metabolic conditions. Eat two meals a day and divide your daily protein between them. Stuffing yourself once a day will only further disrupt your insulin to glucagon ratio and the inability to acquire your daily protein requirement.

6. Carnivore exacerbates autoimmune conditions.

Read the carnivore recommendation above and watch your calorie intake. It is very easy to not eat enough, while on carnivore without realizing it, because of satiety. This can cause a stress response, in the body, that can trigger an immune response for some people.

Also, talk to your healthcare professional about any non improving and/or worsening symptoms when it comes to autoimmune conditions. Carnivore is suppose to be a metabolic treatment, not an autoimmune treatment. Diet, exercise and other lifestyle interventions are only complimentary to proper medical care.