Six common beliefs addressed, Part 80

1. It's best to fast while traveling. 

People pull these "rules", out of their behind, with no rhyme or reason to them. Why anyone would advise this is beyond me. First, you shouldn't be doing long fasts, unless your are trying to increase body fat. So, if you are traveling, for days, you should not be fasting through them. That is asinine and plain dumb. Worse still, it's so unnecessary that it's ridiculous.

Traveling, already puts the body under stress because of circadian rhythm disruption. Every traveler can attest to this. Fasting will just add more stress to the mix, making your situation worse, especially if you already have metabolic problems.

While traveling, eat your carbohydrate restricted meals, as usual, and use common sense when choosing your restaurants. You will be hard pressed to find a restaurant you can't eat at. You can find something to eat, that is carb restricted, everywhere. So, why you would need to fast is beyond me.

Do not pile stress on top of stress. Your body will only double down on its stress response.

2. I have reached goal weight and maintained it for more than year. Can I now "indulge" during "special occasions", without having issues?

The goal of this blog is not "weight loss" or "dieting". I don't offer a protocol that can be followed, until you reach "goal weight" and then add back foods that interfere with blood glucose "in moderation". That's what the diet industry promises with their thousands of "weight loss hacks". But, I don't make silly promises that can't be kept. This is especially true of someone, like me, who was once obese and now has lost the weight. I suggest you read my article, Night Of The Living Fat Cell, so you understand that your past overweight/obesity has long lasting effects that can contribute to weight regain very easily.

Understand this, very clearly, whether it's unpopular or not: you will forever be overweight/obese, regardless of what the scale says. This is because your fat mass will always respond as such. Having been overweight/obese once, is enough to put you at a very high risk of becoming overweight/obese again.

That is why the goal of this blog is to teach lifelong appropriate dietary habits to address metabolic problems, not to lose 15 pounds in time for bikini season. We focus on an anti-obesity lifestyle and "indulging" on "special occasions" is not anti-obesity behavior. It's pro-obesity behavior, so we stay clear of this type of practice. It is not conducive to metabolic health.

We don't discriminate between the obese and the lean, on this blog. The advice to eat, as if your life depended on it, is the same for everyone whether they are 100 lbs or 600 lbs. Leanness does not give you a pass for abusing your metabolism, as leanness is easily lost.

3. I cannot eat much protein, as I have a hard time digesting it and cannot metabolize it properly, because of a genetic condition. 

Some people have genetic abnormalities that make the metabolizing, utilization and/or digestion of protein problematic. This is not to be confused with a diabetic's inability to do the same. Diabetics simply need to put their diabetes under remission in order to solve their protein issues and that's not done through protein restriction.

Genetic issues are handled differently and your doctor will most likely advise you to restrict protein. That's fine, as long as you don't restrict it to ridiculously low amounts and/or replace it with junk, like carbohydrate. So, if you have this type of medical condition you can better deal with your problem by keeping these things in mind:

• The minimum recommended daily allowance (RDA) for protein is 0.8 g/kg of current weight. But, a more appropriate value would be 1.2 g/kg of current weight, since it has been shown that the RDA recommendation is too low and can cause future health issues.
• You can divide your daily protein allotment into several meals, rather than try to eat it all at once. Three meals a day is a good way to prevent overwhelming the enzyme requirement for proper protein metabolism. Most of these genetic issues have to do with insufficient enzyme production.
• Digestive enzymes, specifically made for protein digestion, can also be supplemented.
• Have your doctor check your vitamin B6 status, as it's required for the break down and utilization of certain amino acids.
• Make sure that you have enough stomach acid to break down protein properly. Supplement with betaine hydrochloride with pepsin, as needed, if apple cider vinegar taken with meals is not suffice.

You want to find the sweet spot between consuming adequate protein and not exacerbating your symptoms. That will take a lot of tweaking, until you find what works for you.

4. I have noticed that I no longer have a desire for certain foods, that I thought I couldn't live without before starting low carb. For instance, I no longer care much for coffee.

This usually occurs when you can no longer add what was driving your desire for a particular food item to begin with. Coffee without added sugar, becomes completely unappealing, for many people, and they find they can now live without it. On the other hand, many people new to low carb, find they are suddenly coffee lovers, when they never were before. This is because they dump a carton of heavy cream, into their coffee, to make up for the missing sugar. In both cases, it's not the coffee they love, it's the added energy. Take away the sugar, and the fat, and very few true coffee lovers remain.

So, it's not that you couldn't live without coffee before, you just couldn't live without the added junk in it. No junk, no coffee. The same thing will happen at restaurants and parties. Once the palate porn is removed, having that particular food, in your life, becomes unnecessary and this is a good thing because the more you eliminate, the better. You want to end up with a meat and vegetable centric diet.

5. When following low carb, if you lower your fat consumption, blood glucose will increase.

You are still a diabetic if you have to eat enormous amounts of fat to not see your blood glucose go up. You are simply masking your symptoms using a pretty simple and well established fact about metabolism: fat metabolism displaces glucose metabolism and vice versa.

Dietary fat has now replaced, and taken over, dietary sugar not allowing it to show on your blood meter. But, if there was a 'fat blood meter', instead of a 'glucose blood meter', you would be shocked at your numbers. Your body is doing the same thing with fat, as it was doing with glucose - using it to increase its fat mass. Your metabolism is still suffering under the weight of a very high energy diet. You have lowered your blood glucose, but have not reversed your metabolic dysfunction. It is unmasked the moment you lower your dietary fat intake and realize your body is still making as much glucose as it was before. A healthy metabolism regulates itself and is not dependent on abnormal dietary protocols. Consuming enormous amounts of added fat, to keep blood glucose low, is not normal. That is not seen in any ancestral diet, that has ever existed, nor any metabolically healthy person on the planet.

Since diabetes is conventionally treated, solely through the lowering of blood glucose, of course you would be off your medications, but the diabetes is still there. For that reason, on this blog, we do not give much credence to the reduction or elimination of medications or a doctor's removal of a diabetic diagnosis. High blood glucose is the end stage of diabetes. Not the beginning, but the end. This means that metabolic abnormalities existed decades before blood glucose finally becomes significantly high.

6. Blood glucose should be checked 2 hours after the first bite of food. 

There is a lot of debate about this. Most diabetics will check their blood glucose two hours after their last bite, but officially, it is generally recommended that you start counting two hours from your first bite. Most of the food you consume will be digested and will raise blood glucose in one to two hours, so to capture the peak level of your blood glucose, it is best to test one to two hours after your first bite.

But, all of this is just technical mumbo-jumbo. At the end of the day, if your blood glucose is high two hours after your meal, whether measured from the first bite or the last, you are metabolically malfunctioning. In fact, the longer your blood glucose remains high, the more certain you can be of the malfunction, so if you check your blood glucose three hours after a meal and it's still high, your metabolic health is even worse. The same goes from four hours or five hours later. This is because you want the body to clear blood glucose, not keep it marinating in the bloodstream. The longer high blood glucose remains in your bloodstream, the worse your outcome as it places a high demand on insulin release and expression which will lower fasting blood glucose too low.

Six common beliefs addressed, Part 76

1. Soft, body fat is easy to lose and is not indicative of metabolic problems. 

I touched a little on this in my previous post. This soft excess subcutaneous fat is extremely difficult to get rid of, when metabolism is in active obesity mode or once was. I still have some of this fat myself. I know it's not very visible in my photos, because of clothing, but trust me, I still have some. This is caused by having a large number of fat cells.

Metabolic syndrome is an adaptation to the assault of chronic, large disparities in blood glucose due to higher than normal insulin. It's this soft fat mass that protects the organs from this assault and buffers fat storage to keep it away from where it doesn't belong. So, even though you have changed your diet and may no longer be gaining weight, it doesn't mean that the body is ready to give up its fat mass. On the contrary, it's sparing that fat mass at the expense of muscle mass.

Metabolic adaptation is very difficult to reverse. The very things that become abnormal - over expressed insulin and high body fat are the very things that keep it in motion. It becomes a vicious circle. This is a long term battle that requires consistent nutrient availability and avoidance of any protocol that mimics starvation. So, 0 long fasts and 0 protein restriction. Your diet has to be carb restricted with moderate fat intake. You need to do plenty of exercise to try and boost leptin/adiponectin expression and decrease systemic stress. Until the body feels safe to let go of that fat, it won't do so.

2. Eating too much protein will sabotage your weight loss. 

When you eat very lean meat, like wild game, you can eat pounds of it and not gain any body fat, but if you eat pounds of rib eye, pork belly, bacon, or any other "farm animal", you will begin gaining body fat. This is due to the higher fat content of these meats.

Farm animals are deliciously insulin resistant. Even when their meat is labeled as "lean", it is not truly very lean. It still contains a significant amount of fat and is not anywhere near the leanness of wild game. So, don't let that "lean" or "extra lean" sticker fool you. Add to that the stupidity of the low carb world who pushes bacon, instead of sirloin and you have a recipe for disaster.

You have to make sure that your diet is truly protein rich and not a fat fest. So, if you enjoy protein, stick to wild game or very lean muscle meat cuts because if you don't, the accompanying fat will cause weight gain.

3. Will going low carb cure skin tags?

Skin tags are benign tumors that appear on the surface of the skin. It is not clear exactly what causes skin tags, but it may happen when clusters of collagen and blood vessels become trapped inside thicker layers of skin. This is why skin tags are more commonly found in skin creases or folds. Any area where there is skin rubbing against skin, appears to be at a higher risk for the development of skin tags.

When you go low carb, or any diet that causes weight loss, you might experience a decrease in skin tags, since there will be less rubbing of excess skin. A decrease in insulin levels also reduces the risk of developing areas of thicker skin, which promotes skin tag growth.

So, you might see a decrease in skin tags or not. The important thing is that you will see a decrease in metabolic pathology.

4. Even if you hunt your own meat, you don't have to add fat to it. 

Hunting your own meat, most likely means, you are eating game animals, which are already extremely lean. You can’t live off of their muscle meat alone. You must eat their fatty organs or cook their meat in added fat. If you don’t, you will develop “rabbit starvation” from the lack of fat. Remember, the body not only refuses to use protein for fuel, but you need fat for the delivery of important vitamins and proper fuel storage. If you don’t get enough of it, the body will die, as it won't be able to regulate its metabolism properly or have enough lipids to repair certain tissues.

For people who don’t hunt and are consuming farm animals, they don’t have to worry about this, as that meat already contains plenty of fat.

5. We must show people what "real food" is.

People who wish to follow a proper diet will seek that information out for themselves. There are countless healthy diets being promoted by many popular media outlets. Long gone are the days of heavily processed "low fat diet" advice. Everyone is pretty much aware of what processed and junk food is. People understand that when they go to a fast food place, they are eating junk. People are aware that vending machine "food" is processed. Even if you are completely ignorant on diet, everyone still knows cookies, cakes, candy, soda and the like is unhealthy.

For many decades, people have been aware that bread makes you fat. This is why there are so many "alternative" breads available. From "low calorie", to paper thin versions, to dry crispy slices, everyone who has ever been on a diet has had to exchange regular bread for one of these alternatives. Why did they exchange rather than eliminate? Because they don't want to live without their bread. This is why calories in/calories out (CICO) is still the standard advice for weight control, even though it doesn't work. The hope is that if you can't eliminate, you can at least reduce. People are much more open to reducing than eliminating.

Most people do not want to change their diets or give up the items they know and love. It's not that they don't know what "real food" is, it's that they don't care. I was at a restaurant, one time, and ordered a steak with a side of broccoli. When my food came to the table, the obese people sitting near me commented that my plate looked "very healthy". They still ordered a mountain of fries, burgers and desserts. People know what it takes, they just don't want to do what it takes and that's their prerogative.

So, if someone asks you, then you can share, but don't become that annoying person that is constantly going up to obese people and telling them what they need to do. The only thing anyone needs to do is keep breathing.

6. If you can lift heavy, then you are healthy and no longer diabetic. 

If you are still obese, no.

The ability to "lift things" is not a measure of health, especially if you are obese. The obese have much more body mass, in general, so they are always going to be stronger, especially in the legs. Their legs are constantly carrying a large amount of weight - their own body. So, it's not surprising that an obese person's legs would be particularly strong.

A better measure of health, at the gym, is stamina and endurance. I have said this before and I'll say it again - the person who can do 25 push ups, non-stop, is in superior health to the person who can dead lift a refrigerator.

So, don't measure your health through weight lifting. Measure it through waist size and actual fitness.

Six common beliefs addressed, Part 64

1. The taste of sweet causes "insulin release".

The science has shown inconsistent results in incretin hormone release, and their stimulation of insulin, when it comes to the taste and/or smell of food. 

But, what has been very consistent is that the taste of sweet affects the brain. It causes dopamine abnormalities and dopamine is a metabolic regulator. Dopamine abnormalities will affect fat storage and burning. Leptin influences the dopamine system and vice versa.

This is why the taste of sweet should be avoided, as we never evolved to taste sweet 365 days a year.

2. You do not have to be so strict with your diet. 

The people who make these suggestion are usually obese themselves. But, you will not get that type of advice here. In here, you are encouraged to be very strict with your diet. After all, if you're serious about tackling a very complicated disease, like metabolic disease is, that's how it should be. You will most likely not see results with anything less than very strict adherence.

The person with obesity/metabolic have several issues that are working against them on their path to better health:

• No satiety signaling - Most people who are overweight/obese, have no satiety signaling, so they cannot trust their bodies to prevent them from overeating or eating too often. This is why many people must track macros and have a daily intermittent fasting protocol in order to control the onslaught. Others must include calorie tracking to avoid excess. You cannot stabilize blood glucose eating constantly.
• No hunger signaling - It sounds ludicrous, but many obese people do not have proper hunger signaling, either. They can go a long time without eating, pushing themselves into extended fasting territory. This is detrimental for the obese, because it's only causing their metabolism to double down its thrift response, encouraging their fat cells to store even more fat, once they do eat. You cannot stabilize blood glucose through starvation. 
• Dopamine abnormalities - Ah, the never ending search for the dragon of sweet. This constant hit of dopamine, from the sweetener pipe, dysregulates the body's metabolic circadian rhythm, pushing it into more fat storage. 
• Behavioral issues - Years of biological drives, as a result of metabolic dysfunction, cause for many obese people to develop habits and beliefs, around food, that further perpetuate obesity. They must constantly struggle with these habits, so they can take control of their relationship with food. Ironically, one of these beliefs is that "you shouldn't be strict with your diet", since being half-assed and lazy has worked so well so far.
• Excess body fat - The battle of the bulge is real. Excess fat mass is a driver for becoming more fat. Everything that is eaten, is allocated to these hungry fat cells, before it can reach any other cell. This means that food quality is of utmost importance, because the obese are simply better at storing more fat. You will continue storing fat until you stabilize blood glucose.
• Exaggerated response to conditions of fat mass growth - Caloric restriction, extended fasting, low protein with high carbs and fat, sedentary lifestyles, sex hormone status and heck, even pregnancy are all conditions that spare fat mass and grow more of it. The obese are exceptionally sensitive to any condition that will grow more fat.
• Exaggerated metabolic thrift response - The metabolism of the obese is honed and prepared to react to any inkling of starvation, so that it can store more fat and not release any of it for fuel.

As you can see, the obese person must be very cautious with the signals their bodies receive from the food they eat, as their bodies respond abnormally to practices that would not be of significant detriment to an otherwise healthy person. This is why simple caloric restriction works for a metabolically healthy person, but not for the significantly overweight or obese. The obese are long past following a diet casually. They have to follow a lifestyle that is as intense, as their bodies dysfunction. You can’t fight a wildfire the same way you would a campfire. The obese has to take out the big guns to tackle the huge problem (no pun intended) that they have.

3. Fat intake from a previous meal can set your metabolic table. 

(Fall asleep here.) This statement pertains to a very complex biochemical mechanism, which has been known for a very long time, of how fat consumption from a previous meal, will displace glucose oxidation of the next meal, decreasing fat storage due to a complex interplay between insulin, enterocytes, chylomicrons, blah, blah, blah. (Start snoring here.)

I see a lot of this stuff going around the internet. People get caught up on individual metabolic mechanisms, as they occur biochemically, and then run with them, proposing all kinds of diets, hacks and protocols based on completely useless nonsense. Detailed metabolic mechanisms are very interesting, but cannot win the battle against obesity. This is because it doesn't really matter what occurs at the micro level, on any one isolated aspect of a complex system, because what we truly care about is what occurs at the macro level to the entire system.

(Wake up here.) Obesity is not responsive to what occurs in the short term from individual meals. For this reason, the obese can follow a diet consistently, for a month or six months, and see no significant changes with their weight. It may appear to be a "long time" for them, but six months is a drop in the bucket when it comes to reversing the metabolic adaptation of the obese. For this reason, it doesn't matter what biochemical effects supposedly occur from one macronutrient in a meal, since what ultimately dictates where your next meal goes is your blood glucose. People get caught up on what's on their plate, but ignore how it affects their blood glucose. But, it's blood glucose that ultimately decides where the macronutrients on their plate go. The more disruption in blood glucose, the more you store food as fat, whether it's carbohydrate or fat based. If it's energy, the obese will store it.

So, this statement is fun research for first year biochemistry students with insomnia, who are also lean and want to experiment with "The Croissant Diet", but it is completely useless for the treatment of the overweight/obese.

4. Alanine aminotransaminase activity (ALT) should always be kept low.

ALT is a biomarker that is generally used to detect hepatic disease. It is expected to be low if the liver is healthy, but recent new research has associated this biomarker with overall health. Low levels seem to be correlated with frailty, cardiovascular disease amongst other issues. ALT is influenced by many things, including viruses, medications, etc. (basically anything that affects the liver) and it has recently been linked to metabolic abnormalities as well, so the "normal ranges" for ALT have been updated.

ALT is just another part of metabolic function. It's part of the alanine cycle. The problem seems to generate from the ALT enzyme, which is found mainly in the liver, but also in various other tissues, including kidney, skeletal muscle and myocardium. Interestingly those are all the organs that seem to be most susceptible to metabolic dysfunction.

This is a complex part of metabolic function, at the biochemical level, so the only thing thing a  person can actually do is follow a proper diet and exercise protocol to decrease their risk, but risk is never eliminated.

5. You cannot prioritize protein if you eat a lot of vegetables. 

The vegetable content of the diet does not displace protein. You can eat a large amount of vegetables, as long as you also eat plenty of meat. The problem only occurs when meat is reduced or replaced with vegetables, but eating plenty of both is not an issue.

6. There aren't any "low carb doctors" who promote a proper diet.

Most are charlatans, but both Dr. Naiman and Dr. Bernstein's dietary protocols are the most metabolically and scientifically correct regimens, I have seen, from the low carb community. These are the only two doctors I would recommend following.

Six common beliefs addressed, Part 60

1. It's okay to go off protocol, every once in a while. Our ancestors, and even hunter/gatherers today, also have short term access to high carb foods, like honey, and it raises their blood glucose without damaging their metabolism permanently.

The rise in blood glucose, after a high carbohydrate meal, is not what causes metabolic issues. It's the drop in blood glucose that occurs later. By drop, I don't mean that blood glucose ever goes into a medical definition range of hypoglycemia. I mean a drop from 200 mg/dL, after a high carb meal, to 120 mg/dL some hours later. A blood glucose of 120 mg/dL is not anywhere near hypoglycemia, but metabolism responds like it is because it dropped from such a high rise. 

This is not surprising, since the body always keeps a tight and narrow range in its blood glucose. It does not like large disparities between highs and lows. There is an 80 point drop from 200 mg/dL to 120 mg/dL. That is huge and would never occur under normal and natural circumstances. We did not evolve to handle drops in blood glucose of that proportion. The body is extremely sensitive to drops in blood glucose, not rises. It's the drops that adapt metabolism. The excess insulin release in response to such high postprandial blood glucose means insulin will be circulating in the serum long after blood glucose lowers, causing it to lower even further. This causes an aversion to any lowering of blood glucose over time. The body begins dosing blood glucose to counter balance the high insulin, keeping blood glucose abnormally high all of the time.

The difference between us and our ancestors, or hunter/gatherers today, is that they do not experience these disparities in blood glucose frequently enough or for any significant amount of time that would cause a pathological adaptation to occur. 

2. Should protein always be kept very low?

We don’t concern ourselves with protein, on this blog, except to ensure you are getting an adequate amount. Therefore, we don't have hardline numbers for protein consumption, as it's dependent on the individual. Protein is the macronutrient of leanness, since it doesn’t contribute to obesity, making it the macronutrient of least concern. You can eat it to satiety, as it is also the macronutrient of satiation.

But, to ensure you are getting adequate amounts of protein, you might need to track it. Our recommended values are as follows:

• General - We use Dr. Naiman's recommendation - A recommended, daily minimum consumption of 1.0 grams of protein, per pound of desired body weight.
• Fat loss - We use Dr. Naiman's recommendation - Keep protein grams over your desired body weight (in pounds) and keep non-protein energy (fat + net carbs) under same target.
• Hyperglucagonemia (high postprandial blood glucose) - We use Dr. Bernstein's recommendation - A recommended minimum daily consumption of 1.0 - 1.2 grams of protein, per kilogram of desired body weight, divided into three meals as follows: Breakfast: 3 ounces protein, Lunch: 4 ounces protein, Dinner: 5 ounces protein.
• Genetic protein metabolism issues - We use the generic minimum recommended daily allowance (RDA) - A daily recommended minimum consumption of 0.8 grams per kilogram of current weight. But, a more appropriate value would be 1.2 grams per kilogram of current weight, since it has been shown that the RDA recommendation is too low and can cause future health issues. Remember to divide your daily protein allowance into two or three meals in order to reduce the stress on your enzymes, as most genetic issues with protein metabolism are the result of enzyme abnormalities.

Keep in mind that "protein" is not just meat. Meat also comes with fat, so you must know how many grams of actual protein is in your chosen cut of meat. If you stall or begin gaining weight, it's not the protein, it's the fat content in your chosen meats, so choose leaner cuts of meat and don't add excess fat to them.

3. Coffee should always contain an unlimited amount of butter. 

If you don’t like cream or milk, you can use butter, as long as you don’t go over 150 grams of fat a day. If you’re stalled drop your fat intake closer to 50 grams a day, but no lower. Make sure you aren’t drinking coffee during your fasting times.

4. "Keto creamers" are best to use in coffee to maintain "ketosis".

The only “keto creamers” that exist are butter, coconut oil or cream, so do not buy any product labeled "keto creamer". Remember that the best "keto creamer" in the world is body fat.

5. Why are weight loss coaches suddenly experts in diabetes treatments?

A "culture of diabetes" has taken over weight loss circles. These people do nothing, but talk about metabolic syndrome, diabetes and insulin resistance constantly and mostly incorrectly.

Diabetes is increasing at epidemic rates, and all weight loss programs are aware of this, so they know the potential financial benefit in adding "diabetes reversal” to their weight loss claims. For this reason, most weight loss programs are now involved in some kind of "diabetes treatment". This is especially true of low carb weight loss programs. Obsession over "lower glucose" is their bread and butter, so this is something they will continue to do because it pays.

It's up to you to do your due diligence when researching any claim. Not treating metabolic problems correctly can cause worsening of the disease and push you back years from remission.

6. The low carb community is now saying that water is bad. 

Drinking too much water can flush your electrolytes to low levels, worsening dehydration. But, I am pretty sure these low carb people are most likely discussing water intake in the context of "weight gain". They know drinking water causes weight to increase.

It’s a known hack that reducing water intake will drop your weight. Athletes practice this unhealthy "hack", all the time, in order to “meet weight requirements”. So, I suppose, the new low carb diet scam is to discourage people from drinking water, so it appears like the diet protocol is working. That's the same thing they did by extending fasting, to ridiculous lengths, in order to make it appear as though you are losing weight, while only getting fatter.

Don’t fall for this. It's dangerous. Drink to thirst, but don’t go thirsty.

Six common beliefs addressed, Part 46

1. Sugar does not make anyone fat, as overweight people always avoid dessert.

Most of the obesity epidemic is being driven by added sugar. You do not have to eat dessert to have had several desserts, throughout the day, from products that are savory.

Sugar sales have declined in recent years, while obesity has increased exponentially. This is because no one needs to buy sugar anymore, to add to anything, as it's already been added for them by the food manufacturers.

2. 'Whole 30' is a great diet to follow for carbohydrate restriction. 

Whole 30 is a diet that emphasizes whole foods and is moderately carbohydrate restricted. It's sort of like Paleo, but without the "natural" sugars. This diet eliminates sugar, alcohol, grains, legumes, soy and dairy for 30 days. So, its emphasis is more on "food allergies" than obesity.

I never added Whole 30 to my list of recommended diets, because it makes too many concessions for people to continue eating foods they shouldn't. The elimination of dairy is also asinine, as that would have no effect on obesity, unless the dairy eliminated had added sugar.

3. Fructose cannot be harmful as it has no effect on some people.

This is dependent on how much fructose is being consumed, for how long and individual ability to metabolize it, which is genetically determined. Some people have a much harder time metabolizing fructose than others. This should not be surprising as we see this same variability in alcohol tolerance, since it's metabolized in the same way.

This genetic component can be commonly seen in certain ancestries. For example, Native Americans and people of South American ancestry, appear to be especially susceptible to fructose induced fatty liver disease.

4. If a person is strictly adhering to their diet, they will lose weight. 

We know that yo-yo dieting and starvation protocols can negatively affect metabolism and eventually cause for the person to become unable to lose weight. This is caused by poor leptin expression, which can cause hypothalamic damage in the long term. But, there is another situation that can cause intractable obesity and it has not been well studied, so the exact mechanisms behind it are unknown - fructose consumption.

We have long known that there is something particularly obesogenic about sugar, which is not found in any other saccharide. Fructose is a known liver toxin and its effects, when combined with glucose, are not entirely known. The liver is at the center of metabolic function, so for interventions to work, the liver must be responsive to them. It has long been observed that people who became obese/diabetic, specifically from fructose consumption, develop the most intractable forms of obesity and insulin resistance. This is related to leptin expression and since we know that the taste of sweet, affects the brain, we know that something unique occurs when obesity is the result of sugar consumption.

The consumption of fructose mainly comes in the form of sweetened beverages. Most of these beverages are fruit juices, smoothies, shakes, coffees and sodas. Desserts, candy, fruit and savory food items, containing added sugar, come in second. People who became obese from fructose consumption usually have a similar obesity pattern:

• They become obese earlier in life, often in childhood. Their children also tend to be obese.
• They gain large amounts of weight, usually of 100 + lbs. or more. These people are not just simply overweight, they are morbidly obese. In fact, they can pack on an incredible amount of body fat, before they show any abnormal metabolic markers. This is indicative of extreme insulin sensitivity of the fat mass. Again, this goes back to leptin dysregulation.
• They usually do not develop any of the symptoms of metabolic syndrome or show abnormal blood work. Surprisingly, a lot of these people do not display the symptoms of common metabolic disease that we would associate with having such massive body fat. Many have normal HbA1C's, do not display hyperlipidemia, nor develop high blood pressure or a blood glucose within the diabetic range. This causes them to live with morbid obesity for a longer time period. Obesity is a time dependent disease, so the longer you have it, the harder it is to reverse.

Having such incredible body fat and not displaying any abnormality, is a sign of impending disaster. The longer the person is obese, the harder it is to reverse and by the time these people suffer from health problems, which make it imperative for them to lose the weight, they simply can't.

There is a "quiet storm" occurring with these people's metabolism, which is not normal by any stretch of the imagination. Because these people have this uncanny ability to maintain "health" at such an extreme level of body fat, it's led to the creation of the "metabolically healthy obese" myth. But, these people are not metabolically healthy. In fact, they may have the most severe form of metabolic disease, as they simply cannot lose weight and must resort to drastic interventions like bariatric surgery, to keep from eventually dying.

The ability to accumulate such massive fat mass is a sign of severe metabolic dysfunction, that goes well beyond insulin abnormalities, but is directly correlated with leptin malfunction. The more their fat mass gains insulin sensitivity, the more every other tissue, in their body, becomes resistant. Not only can these people not lose weight, but when they do, they can regain weight quickly and a greater amount than they started with.

Though much still has to be learned about this type of obesity, we know that fructose consumption is at the center of it. It appears that fructose damages metabolism, in a permanent way, most likely at the hypothalamus and so it doesn't respond to treatment. This is precisely why we tell readers, of this blog, to refrain from sugar and sweeteners, as sugar affects the body and sweetness affects the brain. If you end up with hypothalamic damage, your body will never be able to regulate its weight.

The course of intervention, for these people, will be dependent on their lifestyle and habits. We know that they first must abstain, 100%, from any type of fructose and/or any sweeteners. From that point, carbohydrate restriction along with caloric restriction, must be implemented, as most of these people have severe disordered eating patterns and require caloric restriction in order to abstain from excess food consumption.

5. There should be one intervention for addressing obesity and not so much confusing and conflicting information.

The confusion comes from a simple fact, that most people are ignorant of or choose to conveniently ignore, - there is a major difference between weight gain and obesity. You will not find any obesity experts, online, selling books or pushing weight loss programs. This is mostly because obesity is very different from weight gain and cannot be treated the same way. It also has no known cure so writing a book about it is not going to be very helpful out of academia.

There is something peculiar going on in the bodies of the obese. You can see this clearly, by just observing people in public places. You can’t tell who’s a few pounds overweight, but you certainly can tell who is obese. Obesity is an entirely different metabolic state. This poses a huge problem in the health and diet sphere, because you are left with many people offering weight loss advice, to the obese, that’s not going to work. The obese don't need to simply lose weight, they need to lose enough weight to resolve their obesity.

It’s ridiculous to tell an obese person to go get fit at the gym. They have no muscle mass and their bodies aren't capable of producing any significant muscle mass to bypass their ever expanding fat mass. It’s also ridiculous to tell an obese person to just restrict calories, as this does not address their body's caloric mismanagement. The obese person's metabolism is working in a completely different way, than a person who just simply gained some weight and is now upset that their jeans are getting tight.

There is no doubt that the metabolism of someone who needs to lose 20 pounds is very different from someone who needs to lose 100 pounds. The metabolic dysfunction that accompanies obesity changes the rules, as to what will work for addressing it. Not to mention the long term metabolic effects of an obese person who loses weight. There is a big difference between the metabolism of someone who lost 20 lbs. and someone who lost 100 lbs. I wrote in detail about this here.

Most studies on weight loss have been done on metabolically healthy individuals, who are not obese, but more than likely "obesity resistant". The majority of studies done on the truly obese have been limited to the effects of bariatric surgery. But, the fact that the obese commonly end up needing bariatric surgery is telling in of itself. It means that what works for simple weight loss, never worked for the obese.

All animals have the capacity of gaining weight. Weight fluctuates and is never static, in any animal. This type of weight gain is not pathological. Only in industrialized societies do we see obesity, both in humans and their pets. This means that obesity is not exclusively a "human" problem. Weight gain is observed in animals and hunter/gatherers, while in there natural environment, but never obesity. There is something unique about modernity that results in the state of obesity. I suspect it has to do with the ability to sustain blood glucose abnormalities chronically, which just cannot be done in a hunter/gatherer environment. 

So far, most interventions have not curbed obesity nor gotten the obese to lean. We know this, because the most common difference between modern man and hunter/gatherer tribes is energy availability. But, when energy is reduced in modern man, weight loss occurs, but obesity doesn’t budge and when energy is increased in hunter/gatherers, weight gain occurs, but obesity does not. So, though simple interventions like "eat less/move more" help reduce weight, it does nothing for obesity.

I’m not yet completely convinced enough to claim that obesity is a “disease”, though many do. I see it more as an adapted metabolic state, caused by certain lifestyle choices, that can lead to pathology. So, the cure for obesity is not to lose weight, exactly, but rather to change this abnormal metabolic adaptation through lifestyle interventions, as many behaviors are implicated in it. The natural consequence, of a multifactorial intervention, will be weight loss.

6. People with metabolic syndrome/diabetes should restrict protein, unless they are trying to grow muscle. 

The only people who believe this, are people that know nothing about obesity and have very limited knowledge of diabetes.

People with metabolic syndrome/diabetes better be "trying to grow muscle", because if they aren't growing muscle, they are only growing fat, since growth doesn't stop at will. So, growing muscle is not optional.

Muscle loss goes hand in hand with diabetes. Diabetics have very high body fat and very low muscle mass. If they lose even more muscle, they get fatter by volume. For this reason, diabetics need to lose body fat, while preserving their muscle mass, because muscle mass is extremely important for a diabetic. Muscle mass drives metabolism for you to be leaner. Fat mass drives metabolism for you to be fatter. You choose who you want your driver to be, but the body always has a driver.

Muscle mass is so important for a diabetic, that you can be an obese diabetic and gain, just a little, muscle and your diabetes will improve. That's how vital muscle mass is. The diabetic wants to give their insulin something better to do than just grow fat mass. They need to divert its attention to growing muscle mass instead. Muscle helps regulate blood glucose. 

If you are following fad dietary protocols, which achieve weight loss mostly through the loss of lean muscle mass, you are not getting better, regardless of what the scale says. Protocols that cause weight loss, through the diminishment of muscle mass, are starvation protocols like caloric restriction (deficits), extended fasting and protein restricted diets. None of these protocols can sustain metabolic health and weight loss.

The followers of these protocols lose some scale weight from the direct loss of lean muscle mass. In the end, they put all that weight back on, and then some, as fat. So, in essence, their fad diet just made them fatter. They swapped out muscle mass for more fat mass. You are either muscle or fat. One or the other, since no one is made of rainbows and glitter, unless you're a unicorn. Becoming more fat, worsens metabolic outcomes. Fat people only get fatter. The more body fat you put on, the fatter your future self will be.

The older you get, the more this fact affects you. Children grow organs, tissues, bones, muscle and fat, but adults only grow muscle and fat. The older you get the more that scale tilts towards fat growth, as you lose the ability to synthesize protein efficiently, making it harder to grow muscle. This is why the older you become, the more at risk you are for metabolic dysfunction.

Six common beliefs addressed, Part 43

1. Is fiber helpful for diabetics?

Research into fiber has been going on for decades and it has been touted as the miracle antidote for everything from diabetes to cancer to heart disease. I hate to be the bearer of bad news, but that's all BS.

Diabetics will benefit from swapping pop tarts for fiber rich oats, but this is not correcting their disease. They basically rearranged the chairs on the Titanic and the disease will persist and eventually get worse. This fact means nothing to the people conducting these fiber studies, since they already know this and are of the mindset that diabetes has no viable treatment for remission, so that's not their goal. Too bad the diabetic will take no solace in that premise.

The only first course of action that can lead to the remission of diabetes and its prevention is not in trading one carbohydrate for another, but by the elimination of carbohydrate all together. Especially when that carbohydrate comes in the form of sugar or grains. 

I have said it before, on this blog, oats are for horses, meat is for humans. Just because you can put it in your mouth, chew it and have it come out the back end, does not make it food.

2. Is diabetes is caused by nutrient deficiencies?

Diabetes is a disease of poor glucose regulation, not under-nutrition.

Though diabetics are deficient in many vitamins, such as vitamin D and the B vitamins, which are important for the Krebs Cycle for cells to produce energy (ATP), these deficiencies are not the cause of the problem. In other words, you didn't acquire diabetes, because you are deficient in these vitamins. Instead, you are deficient in these vitamins, because you have diabetes. Glucose metabolism competes and/or depletes many vitamins and minerals.

If you have a diagnosis of diabetes, in the United States, insurance will cover testing for common diabetic vitamin deficiencies. So, if your doctor has not ordered these tests for you, request them. Even though normalizing the level of these vitamins will not reverse your diabetes, it certainly causes no harm to know your status and begin addressing these deficiencies.

3. Protein is fattening, that's why you should restrict it if you want to lose weight.

This is a well known weight loss hack and it's used often.

Protein foods like dairy and meat are actually very high in fat. These foods are described as "proteins", but that protein comes accompanied with a high fat content. Even "lean meats" are surprisingly high in fat if they are from farmed animals.

This is why bodybuilders drink protein shakes, rather than eat dairy or meat. The shakes allow them to bypass the fat load, that comes with protein rich foods, and only keep the protein, as the protein doesn't contribute to body fat.

For this reason, it is easy to control fat intake when you restrict protein and that's why it's commonly advised. So, it's not "the protein" that is causing the weight gain, it's the fat that comes with it.

But, instead of restricting these protein rich foods, which are the most nutrient dense, it's better to restrict added fats and carbohydrates instead.

4. You will gain weight if you go over your carbohydrate allotment once.

In order to gain weight from eating carbohydrates, you have to be consistent. This means, that not only do you have to be chronically consuming a high carbohydrate diet, but you have to include specific carbohydrates like sugar and grains, which begin disrupting blood glucose homeostasis. 

Going over your carbohydrate allotment, because you accidentally had too many nuts, a piece of fruit or a glass of milk does not cause weight gain. The accumulation of body fat is a long process, believe it or not. I know some people think they can gain weight overnight, because they step on the scale and see fluctuations in water retention, but water is not fat. You have to work at gaining body fat. If you are already fat, it is easier for you to put on more fat, but not so easy that one sweet potato would cause you to tip the scales into obesity. It doesn't work that way.

5. Should you eat "balanced" meals?

You may have heard the asinine advice that you must have "balanced meals". The people giving this advice have no explanation for why this is the case. They offer no proof, whatsoever, as to why this "balance" is important or even what the "balance" means. It's as if "balance" just sounds good, seems reasonable and so it's prudent to advise. Well, it's BS.

But, how do I know it's BS? Well, don't take my word for it. Let's look at biology and how the body actually uses macronutrients. That's when you see that the body does not "balance" their usage.

• The body runs on mostly fat, not glucose.
• The body uses glucose so sparingly, that even when carbohydrates are in excess, it rather store them as fat, than use them for more energy. This is because the body only has a very narrow window to use glucose for energy, like for instance, when you are running away from a bear. Now there's something that doesn't happen very often in modernity.
• The body requires protein and it is constantly using it. This is why it doesn't store protein as anything, instead it always uses it for rebuilding and repairing. 

This gives you an idea that not all macronutrients are considered the same, to the body, and so they should not be represented the same on your plate. Your plate should contain macronutrients in the order they are used and needed by the body instead. Protein first, fat second and carbohydrates last.

6. Can you be on a ketogenic diet forever?

Ketogenic diets, used for the treatment of metabolic disease, can be followed forever if they have produced and continue to produce results for you. The last thing you want to do is change a dietary strategy that has reversed your metabolic issues and is keeping you in remission.

Well formulated ketogenic diets, that do not restrict protein nor include the consumption of excess fat and diligently keep electrolytes balanced, allow the body to naturally go in and out of ketosis regularly. The body does this through gluconeogenesis, which is a vitally important part of metabolic regulation and should never be feared. Gluconeogenesis allows the body to regulate its blood glucose properly and the body's anabolic/catabolic states.

It's utterly ridiculous that gluconeogenesis has become a curse word, in the low carb community, because it's not. If you know anything about metabolism, you would know its importance. Just because your metabolism is dysfunctional and cannot regulate its catabolic state properly, doesn't mean it's the fault of gluconeogenesis. It's the fault of diabetes. Diabetes is not gluconeogenesis, nor is it caused by it.

Trying to artificially keep yourself in ketosis chronically can lead to problems with metabolic hormones that regulate the starvation response. Forget all of the other dumb reasons people have come up with for why you shouldn't be in chronic ketosis. The starvation response is truly the only reason why chronic ketosis should not be sustained if you already have a metabolic condition.

Six common beliefs addressed, Part 25

1. Should you take a break from low carbohydrate dieting and reintroduce carbohydrates for thyroid health?

This is complete crock, as the main things that damages the thyroid, during "dieting", is chronic caloric restriction, extended fasting, not getting enough protein and/or electrolyte imbalances. All of these are hallmarks of badly formulated diets. If you are following a properly formulated protocol, you should not experience any thyroid problems.

Trying to avoid these issues by adding carbohydrates back in, for a "break", is simply another excuse to resume eating carbohydrates again. Humans are at their most creative when trying to justify their actions, but just like with any other excuse, that sounds almost believable, this one also fails.

If you want to do this, keep in mind, you will have to go back to restricting calories, so you can avoid gaining weight. Carbohydrates are only benign in the context of starvation, so that they cause as little interference to blood glucose regulation as possible. So, you will end up doing one of the very things that is associated with thyroid dysfunction.

2. I restricted protein and started losing weight. How come?

You have definitely lost weight - from all the wrong places.

Restricting protein does not cause the loss of body fat. It just makes you lose everything else, that also has scale "weight" and prevents you from rebuilding it. Just because the body can break itself down, reducing its weight, does not get you to your goals faster, unless your goal is a specific number on the scale. You can cut limbs off to achieve that goal as well.

You don't want to lose weight, you want to lose fat. Fat accumulation is the pathology of metabolic disease. Protein restriction will not help you reduce it.

People who have metabolic syndrome experience hyperglucagonemia after eating protein, due to insulin resistance. This can interfere with blood glucose control. When they restrict protein, they see a reduction in weight, due to a temporary effect on blood glucose but this doesn't last. Metabolic syndrome is the inability to sustain blood glucose regulation so it will deteriorate once again, as it was never truly fixed, and the weight will begin to increase. 

Treatments that only deliver temporary results are not recommended as this will only cause metabolism to double down on its trajectory to pathology. You need to stabilize blood glucose for the long term, not the short term. 

3. Can you target another macronutrient, besides carbohydrate, to lose weight?

There are multiple ways of addressing metabolic disease and lose weight. If anyone tells you that there is only one way, they lie. If they tell you that carbohydrate restriction is not the best way, they also lie.

Below are some common reasons why carbohydrate is the best macronutrient to restrict, in no particular order:

• Carbohydrate is not essential. The body produces its own glucose, so you are not restricting a necessary macronutrient that might cause hunger or loss of energy.
• The foods that contain carbohydrate are not essential, as they are nutrient void and only add excess energy and bulk to the diet.
• Carbohydrates are not needed to metabolize any vitamins or minerals, so you are not inadvertently tampering with any necessary micronutrients, which might cause a deficiency. In fact, carbohydrates deplete micronutrients through different mechanisms.
• Carbohydrates are very easily consumed, so even though they have less calories than fat, you end up eating more calories when you consume them. It's easy to over consume calories as bread, but much harder to do so as steak.
• Carbohydrate intake displaces the other two important and essential macronutrients, protein and fat, disrupting hormonal balance and causing an obesogenic hormonal state that promotes fat storage instead of fat burning.
• Carbohydrate competes with fatty acid oxidation and always wins.
• Carbohydrate increases junk food consumption, since most junk food is carbohydrate based. This causes more hunger and frequent eating, as the body continues to demand its daily nutrient requirements.
• Carbohydrates are a conduit for excess energy intake, since they alone are not satisfying, nor palatable, and must be accompanied by fat. This leaves you with the very obesogenic carbohydrate + fat combination.
• Carbohydrate restriction eliminates the one carbohydrate that is the most harmful: sugar. Everything that is consumed along side sugar is more fattening than when eaten on its own. Even insulin becomes benign without sugar. This is true, irrespective of the amount of sugar consumed or the amount of calories the diet has overall. The presence of sugar, alone, is enough to generate a metabolic state that promotes weight gain, even if you only eat kale.
• Carbohydrate is the only macronutrient that is seasonal and our metabolisms evolved to take special notice of it. Carbohydrate directly signals metabolism to store energy or burn it, depending on future nutrient availability. In simple terms, the presence of carbohydrates is telling your body to store fat, in preparation for the upcoming winter famine, as the fattest will survive it. You want to avoid this type of hormonal signaling and avoid carbohydrates, so the body thinks winter is never coming.
• Carbohydrate is stored as glycogen (glucose), in the body, and consuming it will continue to create an excess in glycogen stores, which is a pathology of obesity and diabetes. The person with metabolic disease is already shuffling their glycogen stores, rather than depleting them, and does not need another method of adding more to them.
• Carbohydrate affects proper blood glucose homeostasis, which is the most important reason for eliminating them. 

The energy burning hierarchy, in the body, is as follows:

• First alcohol
• Then simple carbohydrates
• Next complex carbohydrates
• Eventually glycogen
• Finally fat (And only if blood glucose regulation is healthy enough for insulin to function properly and allow proper leptin expression.)

All of the simple and complex carbohydrates have to be first absorbed and utilized, from the gut, before the body even touches its glycogen stores. Unless you're an endurance athlete, you're in trouble. If you rid yourself of the alcohol, simple and complex carbohydrates, you can reduce glycogen so you can get to the fat. Everything above fat is interfering in the ability for it to be burned because everything above it interferes with blood glucose. 

As you can see, through simple carbohydrate restriction you address what the other weight loss strategies do not - long term blood glucose control. 

Until your blood glucose is normalized, weight gain is right around the corner,  regardless of how much you lose at first. Carbohydrates have a direct effect on blood glucose, irrespective of caloric intake. For this reason, it makes sense to target this specific macronutrient when trying to reverse metabolic dysfunction.

4. Insulin isn't fattening, because bodybuilders use it, all the time, and they are lean and mean, muscle building machines.

When insulin is dosed alongside other drugs that help stimulate the sympathetic nervous system, regulate the metabolic/endocrine system and sex hormone levels, you get the ultra muscular and super lean body of a bodybuilder. In this context, the injected insulin is used to act specifically on muscle mass, while the other drugs suppress its effect on the fat mass. That's the best situation to be in: very insulin sensitive at the muscle cell, but insulin resistant at the fat cell. This is the opposite of obesity. This effect requires pharmaceuticals that prime the neuroendocrine system to direct insulin in this way.

The average person does not see this effect, with high insulin, because they are not taking other drugs to counteract the effect of it on fat cells. Insulin just makes the average person fat as it disrupts fasting blood glucose rather than build muscle. 

As a side note, bodybuilders usually see a decline in this effect, as they get older or stop treatments, and there are plenty of metabolically impaired and diabetic bodybuilders, out there, that can attest to that.

5. Is protein intake just as fattening as carbohydrates and fat?

• Carbohydrates stimulate both bolus (after a meal) and basal (fasting) insulin levels to store glucose as fat from erratic blood glucose fluctuations.
• Fat stimulates basal insulin levels for storage and prevents further fat loss.
• Protein stimulates bolus insulin to build lean body mass, not body fat.

The fat contained in high protein foods is the culprit of weight stalling or weight gain. This is precisely why low fat diets, restrict protein containing foods. When you restrict protein containing foods you can acquire temporary weight loss. This weight loss is mostly the result of water and lean muscle mass loss. Whatever small amount of fat loss occurs, is directly the result of restricting the fat that accompanies the protein foods you are trying to avoid. The weight is then regained from the consequences of a chronically low protein diet, which causes edema and greater body fat storage in the long term.

Again, what insulin does, in your body, is at the discretion of your entire neuroendocrine system, not at the discretion of its mere stimulation or presence.

6. If the restriction of protein caused harm, the person would have serious symptoms.

The body adapts to low protein intakes by breaking itself down. Just because it adapts and learns to live in a low protein state, does not mean it is an optimal state to be in or conducive to long term health.

In some cases the symptoms of low protein are mistaken for other conditions, as no one ever thinks of protein deficiency (hypoproteinemia) as a real problem in modern society, but it is actually very rampant, as modern food does not contain adequate amounts, nor a bioavailable form, of protein.

The symptoms of hypoproteinemia can vary from mild to severe and include:

• Fatigue, weakness
• Frequent infections
• Thinning or falling out hair
• Loss of lean muscle mass
• Brittle nails and dry skin
• Cravings and constant hunger
• Poor thyroid function
• Feeling cold or inability to regulate body temperature
• Edema

These symptoms can be caused by other health conditions as well, but low protein should not be dismissed as a possible cause and must be diagnosed through medical testing. This is especially true if you have a tendency of disliking meat, have followed a vegan or vegetarian diet long term, have followed quack "keto" diets online, have practiced extended fasting or have been on a low fat, calorically restricted diet long term.