Six common beliefs addressed, Part 131

1. The Mediterranean Diet can help achieve a new low weight set point, so it works better than "keto". 

This is true and it's primarily because most people follow the fad "keto" diet, found online, which contains an astronomical amount of fat, sabotaging their results over time. The Mediterranean Diet lowers the fat load and causes some weight loss. But, let's pretend that this isn't the case at all. Let's say the person was following a proper ketogenic protocol. Then a more complex situation occurred. 

Ketogenic diets fool the body into "starvation" through the presence of ketones. People with metabolic syndrome/diabetes produce ketones rather easily because of their poor insulin function. This causes for the body to assume it is starving for a long period of time, as you aren't truly starving and can follow the diet indefinitely. A metabolism that is already adapted for starvation, is now being convinced that is exactly what's occurring because of ketone presence. This dysregulates blood glucose further through the stress response.

When you switch to a Mediterranean diet, which drops ketone levels and allows the body to go in and out of ketosis naturally, it simply up regulates leptin expression and causes the burning of body fat as the brain becomes aware that it had body fat to burn. This is the classic example of how leptin can be manipulated through nutrient availability and why there are such fad diets as "Eat more and lose weight!" or "Eat more frequently and lose weight!". This is also why fasting advocate's favorite saying is "Switch it up!" if you are stalled. All of these gimmicks are just temporarily effecting leptin, causing temporary weight loss. 

The problem is that leptin, once again, down regulates its expression once body fat is challenged, significantly enough, and you remain obese. I know that people don't like to hear this because they want to hold onto hope, but this is the reality that the diet industry will not tell you or come up with some snake oil to try and combat it. Leptin always under expresses when body fat is lost and it stalls weight loss, causing weight regain over time. This means that diet alone is not enough for you to lose enough body fat and keep it off. You need to have an overall lifestyle that is anti obesogenic which includes predictable meal timings and most importantly of all, exercise. Anti obesogenic lifestyles are ones that reduce and/or eliminate all interference with blood glucose regulation.

2. Even though calorie restriction feels like starving, "keto" is too difficult to follow because it does not allow grains.  

"Starving" on caloric restriction is basically the reality of this protocol. Caloric restriction is starvation. The body then responds as it should. It's trying to prevent starving by ramping up hunger. The body is starvation resistant and though many metabolic functions will fail, with time, its anti starving mechanism will remain in tact until the very end. Literally. That's why all diets fail. 

As far as everything else goes, there's not much that can be done. If you can't follow "keto", leaving you to resort to caloric restriction, then there isn't really much left for you to do, except basic low carb. Of course, basic low carb will not work in the long term because it still includes sugar and grains, just in smaller amounts, which continue to dysregulate blood glucose. But maybe that's as far as you can go. If there is no commitment, there are no results. If you can't do any diet, then maybe you shouldn't be dieting. You might not be ready to commit to what you have to do in order to get to where you want to be. 

3. I don't know why they assume that the grains used to fatten livestock would make humans thin. 

This is ridiculous. They feed livestock grains ad libitum. They don't assume that humans would "feed" that same way. So, basically they are basing grain consumption on caloric restriction through calorie tracking, portion control and the reduction of fat intake, so it doesn't compete with carb intake. The most fattening diet in the world is one that is both high in fat and carbs, just ask the Pima Tribe. The Standard American Diet (SAD) is both high in fat and carbs and this is why it's so very fattening. 

The solution then is to eliminate one of the energy macronutrients in order to make the overall diet reduced in calories. So, the logic works as follows - Reduce the fat in the diet and that only leaves the carb. Now the diet is restricted in calories by default because one energy macronutrient has been significantly reduced, giving the other one more leeway. The premise is correct. Whether you reduce fat or carbs, the overall diet is now less in energy. Unfortunately, that's not where the story ends. If only it did, obesity would have been resolved decades ago. 

The problem with this premise is it surmises that overweight/obesity is solely the result of overall calorie intake, especially fat calories. That is incorrect. Weight gain or loss is the sole result of overall calories. Overweight/obesity is much more complex and it is driven by blood glucose abnormalities caused primarily by carbohydrate calories. So, they have kept the wrong macronutrient in the diet. 

Carbs cause pathological abnormalities in gluconeogenesis, blood glucose regulation and the stress response. This easily turns carbs into body fat and you in turn acquire a hormonal profile that spares this body fat and builds more of it, irrespective of overall caloric intake. In other words, you can restrict carb calories alone to begin reversing these pathologies, but this same reversal is not seen in the restriction of all calories.

For this reason, you get much better results increasing protein calories, dropping the carb calories, all together, and moderating fat calories. 

4. Cereal should not be labeled "heart healthy".  

But they are because they do not raise cholesterol. Cholesterol and smoking are the most commonly used metrics, that conventional medicine relies on, to ascertain heart disease risk. Cereals do not effect cholesterol and when they do, it's to lower it. This is mainly achieved through the lowering of HDL, making your total cholesterol appear lower. For this reason, cereals are labeled "heart healthy". 

Of course, they aren't. They usually contribute to heart disease because people who buy these type of "foods", generally follow a bad diet over all. In other words, what makes cereals so unhealthy, is not the cereal itself, but the fact that its a staple of the Standard American Diet (SAD). People who eat cereal, eat SAD. 

5. If your HbA1C has not lowered, it's because you're using artificial sweeteners. 

Nope. At least, not directly. There are some artificial sweeteners that turn back into sugar in the body, but a high HbA1C is caused by one of three things: 

• Dawn phenomenon - High blood glucose in the morning 
• Hyperglucagonemia - High blood glucose after eating 
• Both - High blood glucose all the time, basically diabetes 

Once your HbA1C is 6.5% or higher, it means you are diabetic and your doctor will inform you of this. This means that diet will have some effect on bringing your blood glucose down, but it might not bring it down enough as your body will continue producing excess glucose, regardless of the glucose you eliminate from the diet. Your metabolism is adapted to keep blood glucose as high as possible and by any means necessary. This will continue, until insulin expression/release is normalized. Diet might help it normalize with time, but that's never guaranteed. 

What I do know is that artificial sweeteners have nothing to do with this directly. The taste of sweet contributes to obesity, indirectly, through the disruption of the hypothalamic axis. This will contribute to your body fat. Body fat heavily contributes to further blood glucose abnormalities because body fat puts a high insulin demand on the body. 

6. Your arteries should be healthy if you have low to normal cholesterol.

Total cholesterol is not the culprit of heart disease. It's more complex than that. Remnant cholesterol and LDL function are better metrics when it comes to heart disease. If serum LDL is high, it can be an indicator that LDL is not functioning and/or clearing properly, but that's not always the case. LDL clearance and function is mostly determined by apolipoproteins and this is mostly genetic with some epigenetics thrown in for good measure. In other words, lipids are very complicated and are effected by many things. 

Your arteries can be damaged by other things that are not lipid related. High blood pressure and hyperinsulinemia are known to cause endothelial damage to the arteries. In other words, cholesterol can be perfectly normal and you can still acquire heart disease.

Six common beliefs addressed, Part 110

1. Low carbohydrate diets are too expensive to follow.  

Not in the First World. Low carb is not expensive when you know what and where to buy. The only difference is more trips to the grocery store, since the food you are buying does not have a long shelf life. All of that pasta, rice and beans you could buy, once every six months to store in your pantry, are now gone. Fresh vegetables cannot keep for weeks on end. This means you have to go to the farmer's market or the grocery store, several times a week, to buy fresh vegetables for side dishes. Meat is not a problem, as it keeps in the freezer for months, so can be purchased during sales. 

Concentrate on spending your money on fresh meat and vegetables. Skip the expensive condiments and specialty dairy products. You should not be eating a diary centric diet. Fresh meat can always be found on sale and vegetables are extremely cheap if you know where to buy them. Aldi’s seems to be the cheapest so far, at least, in my area. So, if you could afford that expensive tub of Ben & Jerry's, you can afford to buy meat and vegetables. All you have to do is stop buying so much other stuff that you shouldn't be eating anyway. 

2. Can you be vegetarian and still be "keto"?

I have touched upon this before, but I will clarify again. I apologize for the inconvenience, but this blog will not be of much help if you insist on being vegetarian. "Vegetarian low carb" is an oxymoron. Vegetarian diets are by definition high carb diets. That’s what vegetables are. Carbs with fiber. Fiber is another type of carb that you just can’t digest. 

So, if you have to be vegetarian because of religious reasons, ethical reasons, whatever reasons or because you live in a part of the world where animal foods are impossible to obtain and/or are ridiculously expensive, then you have to abandon this "low carb" fantasy and instead, seek the help of a professional dietitian that specializes in vegetarian diets and is knowledgeable of human metabolism. That would be the only way to address the main things that must be included when following vegetarian/vegan diets. Those are: 

• Caloric restriction - You must be on caloric restriction with these diets. Carbohydrates are only benign in starvation and they are extremely easy to over consume. Over consuming carbs is not like over consuming fats or protein. They will interfere with your blood glucose regulation.
  
• Supplementation - You must make sure you are getting adequate vitamins and minerals, on these diets, as they are very nutrient poor. Vitamin B12 supplementation is a must.
  
• Adequate protein - You must make sure you are getting adequate protein on these diets, as they are very protein poor because they contain a lot of incomplete amino acids. 
• Tracking of metabolic markers - It is vital to track your metabolic markers, as they tend to deteriorate with time on these diets. This is why diabetic vegetarians have such terrible HbA1C's, but they simply cannot keep it low enough, so they settle with simply not getting it higher. That's not good enough.
• Tracking of body fat - Because protein is so difficult to acquire from these diets, you can lose a significant amount of lean muscle mass, making you fatter by default. You don’t just lose muscle mass and replace it with air. You replace it with fat, as the body assumes you are under some form of starvation. 
• Tracking of lean muscle mass - The lower lean muscle mass goes, the higher your fat mass grows. You have to avoid becoming a ball of fat, especially in the visceral. 

If the above list of concerns is not properly addressed, than you are not following a vegetarian diet correctly and you will encounter failure and metabolic deterioration over time. 

There are many ways of being ketogenic. You can calorically restrict yourself into ketosis, while eating potatoes daily, but that’s not the type of ketogenic protocols that we advise on here, as this blog's focus is healthy metabolism, not just being in ketosis for the hell of it. The goal here is always better metabolic function. For that reason, the ketogenic protocols we advise are solely acquired through carbohydrate restriction. This means low carb diets.

3. Conventional doctors purposely promote the Standard American Diet (SAD). 

That is a fallacy. Doctors don’t promote any type of diet. The standard advice is to simply eat less. The only diet advice you will receive is from a dietitian or nutritionist. You will usually be sent to these people if you are given a diabetes diagnosis. The type of diet they will recommend is not "SAD". It’s a calorically restricted diet where you can have SAD items, as long as you remain within your calorie goals. That’s the way all calorie restricted diets work. The reason that this is done is to gain compliance. Some compliance is better than no compliance as the goal is not to reverse overweight/obesity, since it has no known cure. The goal is to simply not get fatter. 

The reason that nursing homes, hospitals and other institutions also follow this type of misguided dietary protocol is because if doughnuts and oatmeal are removed from these places, they will be burned down by the patients. People do not like being in places where their favorite foods are not available. There are some people, reading this blog, who cannot get their own children to give up their junk, so it is unreasonable to expect a nursing home or other facility, which houses adults, to be able to do what you yourself cannot even do with a child. So, it’s not about “promoting”, it’s about having no other choice. You cannot force someone to adopt a low carb protocol. You simply can’t. I know low carb advocates believe they can, but their own followers can’t even stick to low carb themselves. 

4. The relationship with carbohydrates is "ruined" for diabetics. 

Carbs are not the problem. Poor blood glucose regulation is the problem. Carbs are just the easiest and quickest way to disrupt proper blood glucose regulation.

5. If you are "keto" and your blood glucose drops very low, into the 50's - 60's mg/dL, it's not a problem as your body can compensate with its fat burning. 

That is incorrect and a load of BS. When it comes to blood glucose, "the lower the better" is not the right approach. The normal the better. The body likes to keep its blood glucose under a very tight range, regardless of whether you are burning fat for fuel or not. That is irrelevant. 

The range for normal blood glucose is around 84 mg/dL. We know this from extensive studies that have been done on the blood glucose control of metabolically healthy individuals and hunter/gatherer tribes. Keep in mind that 84 mg/dL is an average, not a hard line number. If you have excess body fat, your blood glucose might run slightly higher, but that's not the true problem. It’s lows into the 50's and 60's mg/dL that destroy glucose counter regulation and will eventually make you diabetic, if you aren’t already. 

A lot of people who follow these low carb advocates are not aware that diabetes is not just high blood glucose after doughnuts. That’s actually a completely normal reaction to eating doughnuts. It’s the abnormal high blood glucose after fasting (Dawn Phenomenon) and high blood glucose after steak (hyperglucagonemia) that is indicative of diabetes. The fact that blood glucose is dipping very low, with no symptoms, means you have serious metabolic disease that can turn dangerous. Most diabetics die in their sleep from low blood glucose, not from high blood glucose after ice cream. These low dips in blood glucose are slowly adapting your body to keep its blood glucose set point high and those readings of 90 mg/dL will soon turn into 120 mg/dL, then 180 mg/dL, then 200 mg/dL and finally Victoza. 

You need to keep your blood glucose steady and not allow it to take such low dips. These low dips are caused by a counter regulatory system that is not responding to lowering insulin, during a fast, and so it’s not making glucose when it should be. Even though insulin is "lower" during fasts, it is not lowering enough, as it was already too high to begin with. This means that the higher than normal insulin levels are clearing too much glucose, during your fast, and your body is not compensating. People with metabolic syndrome have under expressed glucagon during a fast, yet they have over expressed glucagon after a meal. For some, this becomes a very obvious symptom, but for others it’s not, even though all people with metabolic disease exhibit this same glucagon abnormality to some degree. 

Diabetes is much more complicated than just getting blood glucose to go down after a meal. Blood glucose running high after a meal is just a symptom of a much deeper problem. The problem is an adaptation towards hyperglycemia and these lows are exactly what will reinforce this. This adaptation requires long term adherence to a proper dietary, exercise and lifestyle protocol in order to reverse it. 

6. Low carb doctors do not recommend an oral glucose tolerance test for a pregnant woman. 

I do not give any advice or recommendations for pregnant or breastfeeding women. These people need to seek the advice of their healthcare professional. Glucose tolerance tests for pregnant women are part of the ‘Standard of Care’ in conventional medicine and there are important reasons for this.

Six common beliefs addressed, Part 44

1. You cannot stop losing weight on a ketogenic diet. 

You will continue losing fat, as long as the body has excess fat to lose.

In the beginning, you might appear "gaunt" because the body does not exclusively lose fat, but also loses a significant amount of lean muscle mass, as well. But, once the body loses all of the excess body fat, it will begin to put the lost lean muscle mass back on and weight will go up. This is why having adequate protein and staying away from long fasts, is so important. The body must rebuild itself again in order to be healthy.

It's during this "gaunt" stage, that people around you might start worrying, but they need to place all that worry on their own obesity instead of your weight loss. Also, a lot of people think gauntness is indicative of their own impending demise. News flash! - Pizza and donuts are not proper nutrition for the body. Just because these items make you fat, doesn't mean they are nutritious. It just means they are fattening. Fatness is not indicative of health. On the contrary. It's indicative of a metabolism that is not in balance and not healthy.

So, unless you have cancer, advanced HIV or some other malignant disease, the body will stop losing weight when it's ready to. No one dies of famine, while still eating.

2. If you are on a ketogenic diet, you can never have high blood glucose.

Yes you can. Whoever tells you, that it's impossible to have abnormal blood glucose on "keto" is either a liar or a bumbling fool. It's hard to tell which one is worse, since the damage they both cause is the same.

Ketogenic diets are not a magic "cure" for metabolic disease. Ketogenic diets and all diets only affect the glucose coming in, but most of the high glucose, that a metabolically ill person experiences, is glucose coming out. This means that their body is breaking itself down, and everything eaten, into glucose in an exaggerated and unregulated way. This is not halted exclusively through diet. This is halted over time with consistent blood glucose control so that insulin function improves. 

But, this is not the case for everyone. Some people are unable to properly regulate their blood glucose enough to normalize insulin function, regardless of their diet. This is caused by many other factors that have nothing to do with diet such as age, gender, chronic conditions, medications, and other stressors. Also caffeine intake is a big one. 

Insulin is very complex. It affects many organs and regulates many functions in the body. For people who are unable to achieve remission through diet alone, medications will be required, alongside a proper diet. This will help them take better control and halt the disease from becoming progressively worse.

3. A blood glucose of 80 mg/dl, after a meal, is hyperglycemia.

No. That's ridiculous. Two hours after eating, your blood glucose should return to fasting levels. A healthy fasting blood glucose level is around 84 mg/dL.

Since this issue has been brought up, I am going to go on a small tangent about blood glucose. Some people seem to be obsessed with their blood glucose and are having panic attacks when they see their blood glucose fluctuate a couple of points. This is probably do to the sensationalism displayed over blood glucose by the low carb community. They continue this hype around blood glucose, while ignoring their expanding waistlines. So, let me surgically remove this heap of BS, before it metastasizes.

There is no hard line number for blood glucose. A healthy range is around 84 mg/dL. We know this because this is the average range of blood glucose in healthy people. We also know that the average range of blood glucose in diabetics, is much higher. From this information, we make a calculated guess as to what healthy blood glucose should look like. That's really the only way we can determine what a healthy range might look like.

If blood glucose dips too far under that range, then it may be problematic. If blood glucose goes too far above that range, then it may be problematic. There are no certainties here. It all depends on just how far up or down you are going and how chronically it does this. We know how far up blood glucose can go to kill you, the same for how far down it can go, but normal is very subjective. That number is not so clear, as a person can still be healthy at any point within a certain range. The body is an imprecise machine, which does not use exact numbers. It can still be healthy under a wide range of factors.

What is known is that blood glucose rarely goes below 70 or above 100 mg/dl in healthy people. These people are able to keep their blood glucose, tightly regulated, around 84 mg/dL with no issues or effort. So, if your blood glucose is dipping below 70 mg/dL or rising above 100 mg/dL, then you have to monitor when and why this occurs, so you can have a better picture of what may be going on.

Type I diabetics can control their blood glucose very well, following carbohydrate restriction. They can keep it at a steady 84 mg/dl, because they don't have insulin resistance, of any organ or tissue, and they administer their own insulin.

But, people with metabolic disease have a very difficult time keeping their blood glucose steady or keeping it in the 80's mg/dl. Their blood glucose can rise to the 90's mg/dL and the low 100's mg/dL. This is because insulin resistance tends to create more blood glucose fluctuations and it's harder to keep it steady at one number. Don't panic. The goal is to continue working at keeping blood glucose steady. Period.

Stick to your diet. Continue your exercise. Relax with the blood glucose meter. If you aren't dosing insulin or eating donuts, you only need to check your blood glucose twice a day and your HbA1C every three to six months.

• Blood glucose should be taken first thing in the morning. This helps you know your adrenal glucose (stress response to low insulin) release status.
• Then it should be taken two hours after your largest meal. This helps you know your pancreatic glucose (glucagon response to high insulin) release status.

The end. No more. Those are the only two times you need to use your blood glucose meter, because they are the only two times that will give you all of the information you need to know. Do not keep pricking your fingers every hour, on the hour, to see how your blood glucose fluctuates a million ways, during the day. This will not help you find out a thing about your disease. It will only show you, what you already know - that you have a disease.

Control your blood glucose, don't obsess. Obsession is not control. Obsession is chaos under the disguise of control. That's not going to better your health.

4. The Standard American Diet (SAD) diet is high in carbohydrate.

The SAD diet is both a high carb and a high fat diet. The carbohydrate of choice is sugar and the fat is vegetable oils.

5. Chia seeds are very healthy and necessary.

Chia seeds, at best, are completely unnecessary. At worst, they can exacerbate digestive issues. Chia seeds are not proper human food. Feed seeds to birds and meat to humans.

6. Fasting allows the body to "rest". 

I hate to say that is silly, but there really is no other way to describe it. The body never rests. It only rests when it dies.

When you are fasting, the only thing that rests is your digestive system, since it's empty. Your esophagus, stomach and intestines are all muscles that can "rest" if they aren't pushing solid food around. But the body continues its metabolic process, since it has no choice. If it stops, you die.

The body still requires proteins, fats, glucose, oxygen, vitamins, minerals, etc. It must continue being metabolically active, to acquire all of these needs, so it shifts from an anabolic state (fed/storage) to a catabolic state (fasted/burning). Now it acquires everything it needs from itself. It basically breaks itself down for energy. The body doesn't like to do this and does so through the release of "stress hormones". So, catabolism (fasting) is not "resting". If anything, it's quite the opposite. It's a stressor.

Now just because the body is under stress does not necessarily mean it's an unhealthy state. Some stress is healthy. It's only when the stress becomes chronic or it's compounded on top of other stressors, that causes problems. This is especially true of people with metabolic diseases, as they do not have the metabolic flexibility to handle stressors very well. Most stressors for them are detrimental rather than hormetic.

That's why on this blog we focus on beneficial fasting and beneficial diets. We stay away from silly beliefs like this one, which are just lies.

Six common beliefs addressed, Part 11

1. Did the Standard American Diet (SAD) make me fat?

The Standard American Diet (SAD) is known for having a very obesogenic macronutrient profile of being high in carbohydrate, high in fat (in the form of "vegetable" oils) and low in protein. What makes this macronutrient profile obesogenic? This profile interferes with blood glucose homeostasis. 

This means that you have a higher chance of becoming obese consuming the SAD diet, but this isn't a guarantee. It all depends on how long you can preserve proper blood glucose regulation and this varies in individuals. We can safely say that the vast majority of people's blood regulation will succumb to the SAD diet's assault, so never assume you will be one of the lucky ones that can preserve it. 

2. I have been on a low carbohydrate diet and a fasting regimen, for a while, and my hair is falling out.

This is why it's so important to follow a well formulated diet. A lot of people will restrict calories during their meal times, consume isolated fats as a "meal", fast for extended periods of time or severely restrict protein. If you eat this way, you will experience a slew of problems and one of the main ones is thyroid related.

Living in a chronic state of "starvation", will shut down thyroid function, as the body goes into adaptive energy conservation. This is basically a chronic slow down of metabolism. The thyroid is crucial for proper regulation of metabolism. Metabolic slow down can cause fatigue, palpitations, hair loss and/or a low body temperature, amongst other symptoms.

Many times thyroid tests will not detect this problem, because it's not a problem with the thyroid gland itself, but with the liver's conversion of T4 to T3. Dr. Atkins recommended for his patients to take their core temperature, for three days straight, and if it was below 97.8 degrees, then it was presumed the thyroid was being affected.

Restructure your diet and make sure you are getting enough calories during your meal times, that you are not fasting for extended periods of time and that you are eating whole foods, not any isolated macronutrients. If you are eating two meals a day and water fasting for the rest, there is no need to restrict protein at meal times. Proper nutrition is extremely important, regardless of the diet being followed.

3. I was told that low carb diets are very complicated.

Low carb diets are the simplest diets in the world. They are just meat and above ground vegetables. That is how all your meals should look like. Ham and eggs. Steak and broccoli. Chicken and zucchini. Etc. That is all. 

4. If I didn't have to work, I would be able to eat better.

Where there's a will, there's a way. Working outside the home is not an excuse to eat badly. If you had better health, you would have more energy to prepare meals properly. 

If you work outside the home, use a slow cooker. You can make a variety of low carb meals, while you sleep at night using a slow cooker. In the morning, you just separate your portion to take to work with you, and your family's portion can be saved for dinner. When you get home from work, you reheat your family's portion. You won't have to eat, because you already ate yours at work. You can use that time to start preparing the next days meal to cook through the night.

Buy all of the ingredients you need for the week, on your days off, when you do your shopping. It takes the same amount of time to cash out a bag of chips as it does to cash out a pound of beef. There are many frozen vegetables like sliced peppers and diced onions, which make seasoning meats easier than having to chop them yourself. 

Eggs can be baked in a muffin tray with sausage and/or bacon inside so they can be easily frozen and heated up for a quick breakfast. 

5. Do glycogen stores need to be depleted for my blood glucose to remain very low?

First, target blood glucose should be around 83 mg/dl. This means it should never "remain very low". Postprandial (2 hours after a meal) blood glucose should never go higher than 100 mg/dl and the closer to 83 mg/dl, the better. Target HbA1C should be 4.5. “The lower the blood glucose, the better”. False. "The more normal the blood glucose, the better."

Glycogen storage is a complicated subject, when it comes to people with metabolic syndrome. This is because, diet and fasting will only deplete liver glycogen, but muscle glycogen can only be depleted with exercise. So, if you want to get anywhere near lowering your glycogen levels, you must exercise so you can burn it off. It doesn't just magically evaporate into thin air. You also need insulin to synthesize muscle glycogen and people with insulin resistance, have a very difficult time doing so.

People with diabetes and metabolic syndrome do the "glycogen shuffle", rather than depletion. They have an enormous, excess amount of glycogen, stored in their muscles, and if they aren't moving, it's not going anywhere. It just sits there, sort of like they are doing. This is why it can take years for them to lower blood glucose to normal, while sitting in front of a computer.

To achieve metabolic health, not only are you supposed to not put more glucose in; you are supposed to get the glucose you already have OUT. Sitting all day is not going to accomplish this. Exceeding glycogen storage capacity, is only an avenue for exceeding fat storage capacity. This is the pathology of metabolic disease: Exceeding all storage capacity.

Your muscles can hold way more glycogen than your liver can. For this reason, liver glycogen is depleted fairly quickly and replenished just as fast. Your muscles on the other hand, can store a lot of glycogen and it takes longer to deplete it, as they are very metabolically active, if they are being used. This is why diabetics and people with metabolic syndrome have such a hard time "depleting" their glycogen stores. Even though they are rigorously following a fasting and dietary regimen, glucose continues to pour out of them. Not only is their glucagon converting everything to glucose, at an exaggerated rate due to insulin resistance, this glucose has simply no where to go. The main storage unit, the muscles, are already full, so this glucose goes right back to the liver to start the shuffle once again and serum blood glucose continues to remain high.

Anyone, that talks to you about metabolism, and how it works, should know that exercise is fundamental for hormonal regulation and homeostasis. They should know that exercise improves the muscle cells insulin sensitivity, because they are being depleted of excess glucose and regain the capacity to store glucose, once again. This is the first thing that is lost in diabetes. In diabetes, the muscles become insulin resistant and the fat cells become highly insulin sensitive. 

Exercise, isn't about calories or being beneficial "for many other things" besides weight loss. No, this is exercise directly playing a role in blood glucose metabolism and weight loss. These benefits of exercise are just not being acquired through the burning of calories. They are being acquired through metabolic hormonal regulation.

You MUST exercise if you want to improve your metabolic health.

6. Is the goal of a ketogenic diet to have as many ketones as possible, because ketones are "beneficial"?

The goal of the ketogenic diet, and why it's beneficial, is because of the mobilization and burning of fatty acids from your own body fat. This is done by maintaining steady and normal blood glucose levels which in turn cause better insulin function. Better insulin function allows access to stored body fat. A low glucose diet, allows for fat to become the dominant fuel, for the body, because it no longer has to compete with glucose metabolism.

Ketones are a byproduct of this process and they are used as an alternative fuel, mainly for the brain. Everything else in the body is primarily fueled by fatty acids, which can now be mobilized.

The body prevents ketoacidosis, because insulin moderates ketone levels. As long as you are able to secrete insulin, you prevent this dangerous condition from occurring. So, ketones stimulate insulin release. If you purposely consume excess fat, on a ketogenic diet, you will have higher ketone levels, but they will also be stimulating basal insulin, in order to keep them under control. This effects fasting blood glucose homeostasis. The excess fat that can not be mobilized will go into storage. This is why you can get fat, while maintaining high ketone levels. Ketogenic diets have been used to gain weight as well as lose weight.

The only thing you need to be concerned about, when on a ketogenic diet for weight loss and metabolic health, is the mobilization of fatty acids through better blood glucose control, so you can burn body fat. Ketone levels are irrelevant. If you are losing weight, then the benefit is occurring.