Six common beliefs addressed, Part 264

1. I've decided to stop taking collagen. I'm trying to determine if protein is contributing to my "leptin resistance".

Protein has nothing to do with "leptin resistance". Collagen is not even a complete protein....SMH

Poor leptin expression is very complex and still being studied as very little is known of its exact mechanism. What we do know is what contributes to it. It occurs through metabolic dysregulation, mainly the cross-talk with insulin, as leptin is a slave to insulin. Hypothalamic dysfunction caused by chronic obesity and excess "sweet taste", not to mention the effects of being sedentary on adipocytes (fat cells) through leptin/adiponectin ratios, all affect leptin expression.

So we know metabolic hormones, the brain and adipocytes are all involved in leptin function. Unlike insulin, leptin is completely regulated by the state of your neuroendocrine system, not by any one external force. This is why there is no "leptin diet". The closest we have to a "leptin diet" is a protein sparing modified fast and a good enough amount of exercise because both of these affect your neuroendocrine state. There is also no "leptin pill" as serum leptin levels have nothing to do with its expression on the adipocytes and brain.

Aside from that, what makes you think you are "leptin resistant" anyway? Just because you are overweight/obese does not automatically make you "leptin resistant". You could just have temporary under expressed leptin until you correct the lifestyle factors that are contributing to your poor metabolic state. Intractable obesity would be more commonly considered as "leptin resistance".

Ugh, the low carb world just went from insulin to leptin, got them both wrong, and not one pound lost.

2. I go out shopping daily so I "make my steps" while walking around Walmart. Does this count as walking?

No. "Making steps" is not exercising.

You would be surprised how many steps an overweight/obese person can make from walking a very short distance. In fact, they can make 10K steps from just walking from their car to the front door of the Walmart. I remember when I started walking, I hit a milestone of 35K steps from walking a route I now make only 12K steps on. How is this possible, if it's the same route?

Because people who are in generally poor health, have a very short stride. They simply take more steps to cross the same distance compared to a healthy person. It has been harder for my husband JC, to improve his health compared to me and I can see this clearly in his stride. As we walk, he takes two additional steps for every one of mine. When we are both done walking and compare our pedometers, he always has about 900 more steps than me, though we both walked the same route together. So pedometers can be deceiving and must be used as a rough guide only. Just because you are "making your steps" doesn't mean you are exercising enough or as frequently as you should.

As my health improved, it started becoming harder and harder to make 10K steps on the routes that would give me 20+K steps before. I have been unable to surpass or even duplicate those 35K steps. For this reason, counting steps are great for a beginner but you can't remain there and they certainly won't work very well for a healthier person. A healthier person must change their walking goals to miles, rather than steps. You can also use "hours active" to monitor daily activity levels.

You have to "walk for exercise", which means exertion. Your walking routine should increase heart rate and make you feel as though you're getting a work out. Walking for exercise is not a stroll and it's non-stop until the goal is reached. Make your steps count.

3. I have a friend who was recently diagnosed as diabetic. They are not overweight/obese and have a history of working out. They suddenly ended up in the hospital last week with kidney problems from diabetes. How could diabetes do this to them so quickly and suddenly?

This is the unfortunate reality of Type II diabetes. It is quite insidious.

First, many diabetes cases are diagnosed late. This means that the person has had serious blood glucose abnormalities for a very long time before the diagnosis is made. This is because diabetes really does not have any symptoms, or just a few common mild symptoms, until a complication arises.

I have mentioned before how my husband's coworker had blurry vision for years. They complained constantly that none of the glasses they ever bought helped. They then passed out one day, on the job, and were taken to the hospital to find out they were a full blown diabetic and nearly went into a coma from a sudden rise in blood glucose. Once their diabetes was treated, their vision was no longer blurry. Of course, the damage the diabetes has caused on their body cannot be reversed.

The same happened to my friend, who also passed out at her job from a dangerous rise in blood pressure. Turns out that blood pressure rise was associated to uncontrolled diabetes, which she was unaware she had.

Even if you go to the doctor and have a yearly physical, understand that the metabolic panel ordered, only tests for fasting blood glucose which is many times low for diabetics. In fact, a lot of diabetics will have incredibly low blood glucose numbers while fasting. Diabetes is a syndrome. It does not manifest the same for any two individuals, even if there are some common symptoms. For some diabetics, their blood glucose is always high but for others, that rise is not constant and there is an equal sudden low.

This is what happened to my husband's best friend's brother. He died in his car from a drop in blood glucose because he was an undiagnosed diabetic. He simply felt sleepy, pulled over to take a nap and never woke up. This was a young man in his twenties who was not overweight/obese.

This is why I tell my readers, over and over, that diabetes is not high blood glucose so lowering your blood glucose, will not help. Diabetes is the result of abnormal blood glucose regulation. That means blood glucose can go very high or very low but it's never normal. These highs and lows are dangerous and cause pathology. The lows are particularly malignant because they not only reinforce the condition and continue making blood glucose set points too high, but they can cause sudden death to boot as most metabolic syndrome/diabetes sufferers do not feel hypoglycemic symptoms.

What does this all mean for your friend? This means that this erratic blood glucose is causing abnormal insulin expression because insulin is a slave to blood glucose. Hyperinsulinemia is extremely pathological to the kidneys. High blood glucose is pathological to the kidneys as well by overworking them. All of this sets the stage for kidney disease, a very common diabetes complication and it doesn't take long for this to occur. You can already experience impaired kidney function while simply having metabolic syndrome.

Metabolic syndrome causes high blood pressure and this is detrimental to the kidneys as well. Certain ethnicities are more susceptible to this. Native Americans and other Native Peoples of Central and South America are experiencing an epidemic of kidney disease caused by diabetes. For genetic reasons, they manifest very high insulin resistance in response to blood glucose abnormalities and as I've stated before, insulin resistance is notorious for causing renal disease. So diabetes even manifests differently in different genetic lineages.

Everyone has to understand that abnormalities in blood glucose regulation is a silent killer. By the time you are diagnosed with diabetes, you are at the end stage of metabolic disease. You will also most likely be diagnosed during a serious health crisis caused by the syndrome.

Do you want to be diagnosed sooner? Buy a blood glucose meter. You no longer need a prescription to get one in the United States. You just have to pay out of pocket for it but they are quite inexpensive now. Check your morning fasting blood glucose and then check your postprandial blood glucose, two hours after the largest meal. Do this for ten days straight and see your results. High disparities between fasting and postprandial blood glucose of more than 40 points, even without hyper/hypoglycemic numbers, means you are at risk for developing diabetes. Now you can do something about it rather than waiting for it to happen.

4. Should I restrict protein to get rid of eye floaters? I am on "keto" and was told that the restriction of protein could help with this.

This question has nothing to do with metabolic health but again, I am going to address it because it is in the context of diet. Unfortunately, low carb diets are riddled with this type of nonsense. Like I have stated many times before, low carb diets are only a palliative treatment for metabolic syndrome. They are not meant to "cure" anything. They don't even cure metabolic syndrome!

Ketogenic protocols for the treatment of metabolic syndrome, fall under the umbrella of low carb diets. Often described online as "keto" diets, there are several iterations of them but the only legitimate ones are ones that do not restrict protein. There is no need to restrict protein on ketogenic protocols whose goal is better metabolic function.

Eye floaters are spots in your vision. They may look like black or gray dots but can also look like strings or cobwebs. They drift when you move your eyes and dart away when you try to look at them directly. Most eye floaters are caused by changes that occur as the jelly-like substance (vitreous) inside your eyes liquefies and contracts. Scattered clumps of collagen fibers form within the vitreous and can cast tiny shadows on your retina. The shadows you see are called "floaters".

This has nothing to do with dietary protein unless you plan on making your vitreous out of some other material that is not protein. Your body is already made of fat and protein and your diet will not change that. Eating water bottles will not make you into plastic. Not eating fat and protein will not turn you into gold or some other material. You will still be fat and protein. This is pretty much common sense. Even if you were to restrict all protein, your body will break down its own lean muscle mass and so the floaters will continue.

Some people see more floaters than others. I have high myopia and will occasionally have bouts of many floaters. Usually the more vigilant of them you are, the more you are apt to see them. Age greatly affects the amount of floaters you will experience so the older you get, the more floaters you will see.

Sometimes floaters can be a sign of a retinal tear so if you see many of them and they are accompanied by flashing lights, it's time to see a doctor. Particularly if you have had a recent head/face trauma. Protein restriction will not repair or reattach your retina. You would need emergency surgery instead.

5. I am trying to eat healthier so I bought a "healthy" butternut squash soup that tasted like sewer water. It had wholesome ingredients though. Why do healthy things taste like %^&*?

Yes.......yes they do taste like that. They either taste like crap or have the wrong texture or simply don't hold up to the real thing. This is usually what occurs when you take something that has been perfected already and try to make it out of something else.

I always laugh at these health zealots when they claim there are "so many delicious healthy" foods. I am sure there are but none of them are fried chicken and waffles. This means you have to leave the chicken and waffles behind because they won't taste the same made "healthy". Just enjoy naturally delicious healthy foods like baby back ribs. I'm sorry, but that's just how it is.

It's hard to find creamy soups like butternut squash in the "healthy aisle" as that usually means low fat and/or low carb. Butternut squash soup is neither. Even if you make it yourself at home to avoid the fillers, gluten and MSG, it still requires butternut squash (carb) and coconut milk or cream (fat). For some, the seasoning for it is brown sugar and/or maple syrup (more carbs). You probably found an iteration made with bone broth instead in order for it to be healthy. Well, you just found out there's nothing like the real thing, baby because fake stuff sucks.

I recommend you stay away from constantly trying to recreate items you can no longer eat. A lot of these "healthy" soups or other food items remove the ingredients that make the original so good. If you take away a model's beautiful long hair, fit body, young age and symmetrical facial structure, you end up with me. Can you truly say I'm still a model? No. Not if you're being honest.

So when you take away the sugar, dairy, wheat and MSG from your favorite staples, can you truly say they are the same? No. They aren't.

6. Can I drink mineral water instead of electrolytes?

All water, except for distilled water, contains electrolytes. Mineral water generally has more electrolytes than tap water so you can consume it if you wish, since it is cheaper than electrolyte mixes.

We get most of our electrolytes from food. The body usually keeps its electrolytes tightly regulated. There are some exceptions though and this is why we emphasize the importance of electrolytes on this blog.

When you follow low carb/"keto" diets, your insulin naturally lowers. Changes in insulin levels have an impact on serum electrolyte levels. This is why they usually mix sugar in with electrolytes. You see this in the electrolyte IVs they give at the hospital and also in many "sports drinks". Sugar facilitates electrolyte entry into cells by raising insulin. On a side note, many diabetics are in a constant state of mild "dehydration" because of insulin resistance.

Insulin is also an anti-diuretic so when it lowers, you will naturally release more water from your body and this can cause imbalances in electrolyte levels which make you feel generally unwell. This can occur with any diet, since all diets affect insulin, but because low carb/keto diets can be sustained for a longer term, the effect is worse as the imbalance increases over time. Whenever you hear people complain that low carb makes them "feel like crap" so they "need carbs", it's because of this effect. 99% of the time this unwell feeling is caused by electrolyte imbalances.

For this reason, you have to keep your electrolytes in mind always. Not only should you supplement 400 IU of magnesium daily, you should drink an electrolyte mix after exercising, working in the heat or if you begin to just feel unwell on your new diet. Make sure the mix you use, does not contain sugar. Though sugar helps cells intake electrolytes, it is not a requirement. Taking electrolytes should make you start feeling better again but if you don't, then you have to stop the diet and see your doctor.

Unless you have certain medical conditions, like renal disease, that requires careful monitoring/restriction of potassium intake, you should not have any issues consuming electrolytes, since the body balances them for you. If you do have a condition where potassium can be problematic, speak to your doctor first.

Six common beliefs addressed, Part 203

1. You speak a lot about exercise but I can’t exercise because of other health issues. 

I speak on ways to obtain metabolic health and exercise is absolutely vital for doing so. Nothing can replace exercise. Unfortunately, if you cannot do it, that's a "you problem" with no solution. My recommendations remain the same. They don't change because someone can’t do it. If you can’t do it, you won’t obtain full metabolic health. Use the information you can and what you can’t leave behind, but this blog does not make concessions.

2. I am obese and have 0 energy most times. This makes me hate exercise but I also hated it even when I was young and slim. I just hate sweating and exerting myself. I wish I can retrain my dopamine to enjoy walking for exercise. 

First, I like that you phrased the statement in the context of "walking for exercise" because a lot of people are under the impression that walking to the mailbox or strolling through Walmart counts as "walking". Though everyone walks, unless they are in a wheelchair, and all walking adds to your step goals, not all walking produces benefits. You have to actually "walk for exercise", which means walking at a steady state, moderate pace, for a long duration (1 hour or more). You should "feel" your walk afterwards, with mild aches, pains or tiredness. As your health improves, you will feel physically better afterwards instead. Now back to your "wish", which is very interesting.

Walking with a goal in mind, like reaching a landmark or completing a task, will affect dopamine. You can walk to a neighborhood store for something you need or you can hold off on podcasts/audio books and only listen during your walk. Anything that will motivate you by causing an anticipation to walk will work. If you do this often enough, you might start enjoying your walking routine because of its effects on dopamine. In other words, you are retraining your brain with a reward associated to a specific activity (walking).

This, of course, is all in theory even though it's based on what we scientifically know about dopamine and how it works. This is why I always recommend walking outside and not at a gym or closed "work out room". Dopamine reacts to seasons. Walking out in nature, experiencing different temperatures and smells, while watching greenery is beneficial for you to start enjoying your walking. Sometimes I walk through neighborhoods to get gardening ideas, browse seasonal decorations or to pick pine cones.

Walk with purpose. Give yourself a goal for walking because "walking for health" is not enough. Dopamine doesn't care about logic. It only evolved for you to meet a goal and "health" is too abstract and long term of a goal to motivate anyone. You need a short term, immediate goal for dopamine to react when you succeed in acquiring it.

3. High cortisol is due to the dopamine acquired by more glucose in the blood stream.

This is another interesting statement about dopamine and metabolic adaptations. Basically, if I understand you correctly, you are stating that your body is creating more glucose, through high cortisol, in order for the brain to receive a "dopamine hit" since it’s no longer acquiring it from dietary glucose.

I suppose that if you could somehow change metabolic adaptations, to work primarily through dopamine rather than insulin/leptin, the premise might work. Though we know that the hypothalamic/pituitary/adrenal (HPA) axis is involved in metabolic adaptations, and dopamine is a part of that axis, it has not been shown to work the way you're suggesting.

When dopamine is spoken about in the context of glucose, it is in the taste of sweet, not sugar in the blood. So even though glucose in the blood has an effect on the HPA axis, this effect is from a signal of anti starvation. High blood glucose is a mechanism of protection against starvation, not a true "dopamine hit". The only dopamine hit associated with anti starvation would be chocolate cake.

4. I know someone who lost 200 lbs. but I can’t even lose 50. 

This is the result of leptin sensitivity. Just like money - some people have it and some people don't. Again, just like money, there are way more people who don't have it, than who do. Though everyone can "lose weight" most aren't able to lose enough, particularly body fat, to get to lean. That's why it is so fascinating to us when a person is able to lose enough fat to no longer be obese. They are the anomalies.

But surprisingly, there are still quite a large number of anomalies. This is why you can’t assume that all obese people are leptin resistant. Though most are, some actually aren't. For the ones who aren't leptin resistant, the moment they normalize their blood glucose/insulin, their leptin begins doing what it’s suppose to - burn excess body fat. For others, they either cannot ever normalize their blood glucose/insulin, to regain leptin sensitivity, or even when they do their leptin does not follow suit. No one knows the exact mechanism of why this occurs. This is why obesity is a "condition with no known cure".

Now the hurdle is long term success. Not only is getting to lean rare, but staying lean is even rarer. So many people who are able to obtain short term leptin sensitivity, enough to break their weight set point, are unfortunately unable to retain it. In fact, the ones who get to lean are the ones most vulnerable to weight regain. So super leptin sensitivity comes at a cost because it causes an even greater leptin resistance in the future. This of course happens to most, not all.

5. I have a friend who is always complaining about some health issue or another. They spend their days going from doctor to doctor but when they are given answers and possible solutions, they always doubt and question them so nothing is ever resolved. They have always been trying to "lose weight" but instead of following practical advice, like exercising for instance, they have instead always leaned towards fad/tabloid diets. I don't know what to tell them anymore but it's affecting my own journey since I'm getting caught up in their troubles.

I have unfortunately come across this often when dealing with the overweight/obese. I have noticed it is much more common in middle aged women.

Some people like to be "sick". I know that's a controversial statement but it's just a fact. For some people, dealing with "health issues" and "weight loss" is a hobby. They are lonely, bored and unsatisfied in their lives so they take it out on their body, instead of realizing it's their mind. Doctors give them the attention they crave and as long as they have "something to work on" they feel as though they have something to do. This is why they are drawn into short term fad diets and "miracle cures" instead of actually doing the work that it takes to reverse obesity. Short term protocols allow them to bond with others, who are in the same boat as them, and achieve immediate trivial "changes" disguised as results. Doing the actual work is far too difficult and long term. It is also a journey that has to be taken alone, not hand holding someone else. Worse still, if they actually succeed, what will they have left to do? A lot of these people don't want solutions, that's why they ignore the ones given.

There are people who are genuinely striving to improve themselves while getting bogged down by someone else who has this pseudo-Munchausen. A lot of people may not agree with the advice I am about to give you but it's solid advice none the less - the obese really need to stay away from the obese. Fat farms don't work. This is precisely why I don't allow comments recounting sob stories and new food lists to follow or avoid. Those don't help anybody and can be found in other blogs.

You are much better off making new friends at the gym, who are lean and active, than continuing to fraternize with people who have nothing to contribute but excuses, gripes, victim hood and coupons for the local buffet. Your active friends will be an encouragement, rather than a hindrance. In fact, I can tell you from experience, that the more success you obtain, the more you will realize you have nothing in common with these people any longer. It will become clear to you how obesity is rooted in behaviors and beliefs that you didn't even notice before but become very obvious as you get leaner. It's these behaviors and beliefs that will keep you obese.

So you can start dropping some weight, right now, by dropping them. It will be more than the five pounds their fad diets promise.

6. Because of the upcoming holidays, I was given a recipe by my endocrinologist for stuffed acorn squash. It was described as "low carb". All of these "low carb" people online would be horrified by this vegetable so I haven't wanted to share it in the groups I follow.

That's why you have to stay away from "low carb people online".

A cup of cooked acorn squash has about 22 grams of carbs. That falls within the parameters of a low carb diet as low carb is anything below 100 grams of carbs a day. So depending on how much acorn squash you eat, or what other carbs you have that day, it would fall in line with low carb as long as you don't go over 100 grams in a day. Of course, a cup of cooked acorn squash is practically starvation but would be fine as a side dish. This is something that has to be kept in mind when counting carbs in this manner. It is impossible to negotiate not starving while eating carbs at a benign level.

On this blog, we do not focus on the carbs of individual food items because 22 grams of carbs from bread are very different than from acorn squash as not all carbs are the same, just like not all calories are the same. This is because carbs are not just glucose, whether sugar or starch, but fiber as well. What you want to say away from is the glucose (sugar and starch). The fiber is irrelevant.

We also don't believe that a 0 carb diet is any better than a moderate carb one. We only believe in one thing - blood glucose regulation. The most profound effect to blood glucose regulation is obtained through carb elimination and restriction. To make this as easy as possible, we eliminate all sugar and grains while restricting everything else. Carb restricted diets can fall anywhere between "keto" to Mediterranean and your chosen one should be primarily based on how it affects your blood glucose regulation, not on how low it keeps carbs.

So instead of just giving you a "low carb" recipe, your endocrinologist should have advised you to monitor the effects this recipe has on your blood glucose regulation. To know that, you would need to measure your fasting blood glucose that morning and then your postprandial blood glucose, two hours after eating the squash. Then you would have to measure it again the following morning in order to see how you reacted to that meal. It's not enough to just check blood glucose after eating the squash. Remember, the goal is not to see that your blood glucose rose or not. The goal is to see how your blood glucose regulation is effected within a 24 hour period.

Just because the squash may not rise your blood glucose into the danger zone, it might rise it enough to cause large dips during the night which cause high blood glucose the next morning. Or if you are not diabetic yet, your blood glucose might not rise at all because your body is still able to control hyperglycemia through the release of enormous amounts of insulin, masking your blood glucose dysregulation. You will be able to tell this is occurring by seeing a postprandial dip in blood glucose instead of a high. You need to get off that roller coaster because dips in blood glucose means your insulin is being negatively affected due to blood glucose dysregulation.

You need to take your focus away from the squash and apply it to your blood glucose regulation instead. Putting focus on anything else means you are focusing on the wrong thing.