Six common beliefs addressed, Part 260 - Soda Edition

1. What makes soda so detrimental for metabolism? Every time we think of obesity and diabetes, the first thing everyone mentions is soda. Does soda really deserve such a bad rap?

I really do not like to over dramatize the ill effects of any one food item but even I can agree that soda is the most obesogenic form of sugar known. It truly does deserve the bad rap, and then some. Unfortunately, most of the bad rap it receives is misdirected. When people think of soda, they think of "fast food", "high calories" or "empty calories" without truly understanding just how much soda can negatively impact their health irrespective of any of these. 

Soda is particularly harmful for blood glucose regulation through three different mechanisms. The trifecta is - sugar, caffeine and sweet taste. All three things work in conjunction to ensure you develop intractable obesity through hypothalamic damage. One thing is to consume something that disrupts your blood glucose regulation and another thing is to consume something that will disrupt every single glucoregulatory system in your body, even when you no longer consume it.

Sugar

This one is pretty self explanatory. We have discussed the effects of sugar extensively on this blog. Dietary sugar will disrupt your blood glucose regulation which in turn will abnormalize insulin expression over time. This effect promotes a metabolic adaptation that chronically under expresses leptin and purposely keeps blood glucose, insulin and body fat set points to high. This is the mechanism of metabolic syndrome and once it begins, it is very difficult to reverse as multiple systems in the body, now work together in feed back loops, to continue its progression.

But soda doesn't just contain sugar. It contains a special type of sugar - high fructose corn syrup. Don't worry about the "corn" or the "syrup" in that name. Don't concern yourself with how it's highly processed or who subsidizes it to make it cheap. Only focus on the "high fructose" part because that's all that matters. 

Sugar is a disaccharide, which consists of a glucose and fructose molecule linked together. This gives sugar a composition of 50% glucose and 50% fructose. This is the composition of honey and regular table sugar. High fructose corn syrup also consists of glucose and fructose, but the composition is varied to be about 55% fructose and 42% glucose. Fructose is what provides the sweet taste in sugar. High fructose corn syrup is sweeter as it has a higher concentration of fructose.

Fructose is metabolized in the liver, like alcohol, and is a hepatotoxin. Do not let them gaslight you into thinking that because alcohol is also metabolized in other tissues and organs, including the brain, and it's a depressant, that it is somehow metabolized differently than fructose. It is not. It is metabolized in the liver, just like fructose, and results in the same liver damage. Its effects on the liver are absolutely toxic. Everything else is pedantic word play. Consuming liquid fructose, such as high fructose corn syrup, can lead to a more rapid absorption of fructose into the bloodstream, which can exacerbate liver damage and metabolic alterations.

Some of the damage that fructose causes to the liver are:

• The development of non-alcoholic fatty liver disease (NAFLD), a condition characterized by the accumulation of fat in the liver.
• Promoting the storage of fat in the liver and increasing the production of insulin which dysregulates blood glucose through hypoglycemia.
• Damage to liver mitochondria, leading to impaired fat metabolism and increased liver fat storage.
• Inhibits the liver’s ability to properly metabolize fat, leading to an increase in the synthesis of fatty acids in the liver and an inhibition of lipid oxidation.

You would think that all of this is pretty bad, but the problems don't stop there.

Caffeine

Caffeine is a stimulant which is naturally found in coffee bans, tea leaves, certain seeds and nuts and chocolate. It is also added to other foods such as energy drinks, energy bars, sodas and some flavored waters. You will never be able to obtain proper blood glucose regulation as long as you are consuming caffeine. You would be surprised how many diabetics caffeine has made. It can give sugar a run for its money.

Caffeine stimulates the nervous system via the hypothalamus and hormones via the adrenal glands, activating the hypothalamic/pituitary/adrenal axis (HPA) and releasing catecholamines. Catecholamines are a group of hormones/neurotransmitters which play a crucial role in the body’s stress response. These "stress hormones" disrupt blood glucose regulation and insulin expression when chronically released. Studies have consistently shown that caffeine increases the levels of catecholamines in the body.

The catecholamines are:

• Epinephrine (Adrenaline): Released in response to intense stress. Epinephrine increases heart rate, blood pressure, and energy levels, preparing the body for immediate action.
• Norepinephrine (Noradrenaline): Released in response to chronic stress. Norepinephrine helps regulate blood pressure, heart rate, and energy levels, and is involved in the body’s “fight or flight” response.
• Cortisol: Released in response to chronic stress. Cortisol helps regulate metabolism, immune response, and energy levels, and is involved in the body’s response to stress and its regulation of inflammation.
• Dopamine: Released in response to various stimuli, including sweet taste. Dopamine is a very powerful metabolic regulator, involved in reward, motivation, and movement which we will discuss in the following segment.  
  

The exact mechanisms by which caffeine affects catecholamine levels are not fully understood, but several theories have been proposed:

• Caffeine may stimulate the release of catecholamines from the adrenal glands, leading to increased levels in the bloodstream.
• Caffeine may also increase the activity of enzymes involved in the synthesis of catecholamines, leading to increased production.
• Caffeine may also have a direct effect on the brain, stimulating the release of catecholamines from neurons.

Whatever the mechanism, the end result is still the same - blood glucose dysregulation. Some of the effects that catecholamines have on the body are:

• Catecholamines can directly stimulate the liver to release glucose into the bloodstream, increasing blood glucose levels. This is achieved by stimulating the breakdown of glycogen to glucose, a process known as glycogenolysis. This release of glucose impacts insulin release/expression.
• Catecholamines stimulate the release of other hormones, such as glucagon, which further increases blood glucose levels by stimulating glycogenolysis and inhibiting glucose uptake by muscles and adipose tissue. This again impacts insulin release/expression.
• Catecholamines can worsen blood glucose control in individuals with diabetes by stimulating the release of glucose from the liver and inhibiting insulin secretion worsening hyperglycemia. Insulin is once again impacted.
  
• Catecholamines can contribute to stress hyperglycemia, a common complication in critically ill patients, by stimulating the release of glucose from the liver and inhibiting insulin secretion causing extreme and deadly hyperglycemia.
• Catecholamines break down lean muscle mass into glucose, disrupting blood glucose regulation further and shifting body composition to more fat than muscle. A body composition of more fat than muscle further progresses blood glucose dysregulation. 
  

Some people are much more sensitive to caffeine than others. Aside from blood glucose dysregulation, caffeine affects blood pressure through the same mechanism of catecholamine release and through its anti diuretic properties. Like diabetes, you would be surprised how much hypertension caffeine has caused.  

This adrenal stress response continues long after the offending food is removed and is the driving force behind diabetes and its progression. Everything now causes this stress response from the night time fast, to exertion, to the common cold, to one night of insomnia. With each incident, the metabolic adaptation causing it is further reinforced. This is why it is vital to eliminate all caffeine from the diet because it will take a very long time to stop this vicious circle once it is.

By now, you would think it's gotten pretty bad but there's more.

Sweet Taste

When a person tastes something sweet, the brain produces huge surges of dopamine. With time, this chronic release of dopamine dysregulates it. Just like all other hormones, dopamine was made to work in pulses and not to be released chronically. Sweet taste was very hard to come by during our history as hunter/gatherers. It was limited to particular seasons and only in certain regions. It is a taste that tells the body to store for winter and dopamine obliges in sending that signal.

Dopamine, which is also a neurotransmitter, plays a crucial role in regulating metabolism, particularly in the context of food intake and energy balance. The relationship between dopamine and its effects on blood glucose homeostasis is complex and multifaceted. Dysregulation of dopamine signaling has been linked to obesity and metabolic disorders, as chronic release of dopamine profoundly disrupts blood glucose regulation.

Some of dopamine's effects on metabolism are:

• Chronic exposure to dopamine can lead to insulin resistance, which can impair glucose uptake in peripheral tissues and contribute to hyperglycemia.
• Dopamine can stimulate the release of glucagon, a hormone that promotes glucose production in the liver, which can lead to hyperglycemia.
• Dopamine can also suppress appetite, which can lead to reduced food intake and potentially lower blood glucose levels (hypoglycemia).
• Dopamine dysregulation has been implicated in the development of Type II diabetes, as it can lead to insulin resistance and impaired glucose metabolism.
• Dopamine also plays a role in regulating hunger and satiety. It has been shown that when dopamine levels lower, individuals will experience increased hunger and cravings particularly for more sweet tasting foods.
  

Dopamine dysregulation has been found to be implicated in the following:

• Studies have shown that obese individuals have fewer dopamine receptors in their brains. This reduced dopamine receptor density can lead to decreased insulin sensitivity, making it more challenging to regulate blood sugar levels and maintain a healthy weight.
• Research suggests that dopamine dysregulation may contribute to the development of obesity. For example, a study found that obese individuals had altered dopamine signaling in the brain, which may lead to overeating and poor food choices (seeking more sweet taste).
• Dopamine signaling dysregulation has been implicated in the development of  various metabolic disorders, including Type II diabetes, metabolic syndrome, and polycystic ovary syndrome (PCOS).

Because of these powerful metabolic effects, dopamine receptors have been targeted as potential therapeutic targets for the treatment of diabetes and related metabolic disorders. Since dopamine is stimulated by sweet taste, and impacts metabolism so profoundly, the introduction of artificial sweeteners has done nothing to curb the obesity/diabetes epidemic. You are now disrupting blood glucose through dopamine dysregulation instead of directly through dietary sugar.

It is not surprising that the obese, who usually have a "drinking problem", suffer from intractable obesity. They have succumbed to the trifecta of blood glucose dysregulation and it will be very difficult for them to reverse their condition. For this reason, on this blog, we tackle anything that disrupts proper blood glucose regulation, whether it's through dietary carbohydrates, the stress response or sweet taste.

Keep In Mind

• Decaffeinated coffee is not "caffeine free". It simply has less caffeine than regular coffee. So be careful of the amounts you drink a day as that caffeine adds up.
• It is even more difficult to find decaffeinated tea and it is also not" caffeine free". It simply has less caffeine that regular tea. Tea is not regulated the same as coffee so you don't know exactly what caffeine is in it, nor does it have to be labeled in any particular way. Be leery of any claims made.
• Diet soda does not mean "caffeine free". The soda must be marked as having 0 sugar and 0 caffeine.
• Diet soda or unsweetened tea at restaurants are usually not available decaffeinated so don't bother ordering them as the "diet" label will not save you.

Six common beliefs addressed, Part 242

1. What are some reasons that the body would produce so much of its own glucose?

The body produces glucose for many different reasons. It uses a series of feedback loops in order to retrieve information on when and how much glucose to produce. In the context of metabolic syndrome/diabetes this process is always over and under expressed. This means too much glucose is produced when not needed and too little is produced when needed. This makes sense as all of the metabolic hormones that control blood glucose are functioning poorly, and the feedback loops are broken.

In metabolic syndrome/diabetes the biggest influences for unregulated blood glucose production are:

• To counteract insulin. High insulin, low insulin, poorly functioning insulin all contribute to excess or not enough glucose production.
• To counteract the inability to burn fat for energy. It is very difficult to burn fat for fuel when leptin is not working properly, and this causes for more short-term energy (glucose) to be released into the blood stream instead. This is typically why overweight/obese people have a hard time "keeping their energy up" regardless of how much short-term energy they produce.
• To counteract starvation. Metabolic syndrome and all of its pathologies from overweight/obesity to diabetes are adaptations to starvation. The best way to stop starvation is to release enormous amounts of blood glucose into the bloodstream, not only for fuel but to increase fat mass at the expense of muscle mass.

Other things also influence and contribute to this glucose production like certain common deficiencies seen in people with metabolic problems and imbalances in electrolytes which is also common in metabolic conditions.

2. Should I hire a "low carb/fasting coach"?

There is no such thing. Low carb is simply keeping your carb intake to less than 100 grams per day and fasting simply means not eating anything. You don't need a "coach" to do that. You would need a coach to help you exercise but not to keep you from eating carbs or food.

Now you can go ahead and hire one if you want but you should do so knowing that you are wasting your money. You're basically giving away money to have someone hold your hand through something you should be doing all on your own by determination, will and need alone. The minute someone tells me they need a "coach" to follow a simple diet, I become leery in believing they are serious about anything.

3. I drink a lot of bubbly water. I buy the kind that has zero of everything. Zero sweeteners, calories and caffeine. I'm sure you are familiar with them as they have sprung up everywhere and are very popular with low carb/"keto" dieting. Anyway, I was wondering if their taste has anything to do with my recent weight gain but even more strangely, my recent high blood glucose.

I have discussed before that constantly tasting anything, especially things on the sweet side, will further disrupt your already damaged hypothalamic/pituitary/adrenal axis (HPA). I have also discussed how carbonated drinks effect ghrelin, the hunger hormone. Any of these two effects, on their own, can contribute to weight gain and it's why all of these "zero of everything" drinks haven't done a thing to curb obesity. They have had zero success, aside from zero of everything else. This is why the only thing you should be drinking is water.

But in your case, you aren't only experiencing weight gain but also a rise in blood glucose to boot, which takes us now into an entirely different direction.

CO2, the stuff that makes these waters "bubbly", is acidic. High acidity lowers potassium. Low potassium makes less insulin. Less insulin increases blood glucose. Increased blood glucose contributes to obesity. Imbalances in electrolytes always cause stress in the body and stress always makes more glucose. These waters not only have zero sweeteners, calories, caffeine and success but they also have zero electrolytes, unless it's Perrier which contains some minerals.

Stop drinking like you are at an endless birthday party. Bubbly, fizzy, carbonated, whatever you want to call it, drinks are party novelties. Drink what you were intended to drink in nature - plain water.

4. My blood glucose is fine when I wake up but then it starts rising as time passes. Is this "Dawn Phenomenon" (DP) and how do I stop it?

High blood glucose upon waking is DP which is basically an adverse reaction to the overnight fast. Rising blood glucose later is caused by a secondary spike in cortisol, which is dysregulated in people with metabolic syndrome/diabetes.

You can go out for a walk to lower your blood glucose but the main thing that will prevent this from happening is eating breakfast. Eating when you wake up helps that second cortisol spike to be much lower.

If you're on medications like insulin, you should speak with your doctor as they can adjust it for you to better control this as well.

5. Why does the American Diabetes Association (ADA) target an HbA1C of 7 for diabetics? Isn't that too high?

I've spoken about this before, but I'll quickly recap here.

This has to do with blood glucose lowering medications, which include insulin. Insulin dependent diabetics are extremely susceptible to deadly hypoglycemia. For this reason, it is recommended that their blood glucose remains higher than it would be if they were healthy, so that if their medications cause a blood glucose drop, it won't drop to deadly levels. A drop from an average blood glucose of 170 mg/dl is much safer than a drop from a blood glucose of 85 mg/dl.

So, the goal for this stage of diabetes is to try to keep blood glucose lower (not necessarily normal or low) and stable, which is more important than just "low". Remember diabetes is not a disease of high blood glucose. There are genetic abnormalities that cause for certain people to sustain higher than normal blood glucose and they have none of the complications that diabetics develop over time.

Diabetes is a multifactorial syndrome of which insulin resistance is at the core. Insulin resistance abnormalizes the function of multiple glucoregulatory/metabolic systems which end in the pathologies associated with diabetes and its ultimate morbidity. High blood glucose is only one of those pathologies. It's not the end all/be all. This is why diabetes is still a chronic and progressive condition, even with well controlled low blood glucose and at an HbA1C much lower than 7. The "disease" continues onward.

I really get a kick of low carb advocates who are so focused on blood glucose that they miss the forest for the trees and are always hung up over the ADA. I have said before how the ADA, despite its misgivings, knows way more about the mechanism of diabetes than these low carb people do. These low carb advocates only see one thing - high blood glucose from diet. Well, that's only a very myopic viewpoint of what this complicated syndrome really is. It's not the high blood glucose, it's the blood glucose roller coaster of ups and downs, with large disparities between the two, that is the root of the condition. 

6. Is it true that a diabetic can stop their use of insulin if they follow low carb?

It has been shown that about 50% of diabetics can reduce or completely eliminate their need for exogenous insulin if they follow a low carb diet. This shouldn't be surprising as going low carb eliminates a significant load of exogenous glucose from the blood stream depending on how many carbs, and from what sources, are being consumed. So, the highest carb consumers will see the most benefits from going low carb.

But the reality is that once you get to that level of carb consumption, any change in the diet which lowers carbs, including reduction of overall calories, would make an impact on insulin requirements. This is because most of the insulin these people are taking is to control exogenous glucose from their dietary choices.

When you're diabetic at any stage, you already have an excess amount of glucose being produced by your own body, so you certainly don't need more exogenous glucose adding to it. This is why low cab would be the way to go. But the real magic in low carb is the halting of erratic large disparities in blood glucose that occur from the high postprandial blood glucose carbs cause and then the ensuing chronic release of insulin which drives fasting blood glucose to drop too low. That's the engine that drives the metabolic adaptation known as metabolic syndrome/diabetes and results in insulin resistance.

In that sense low carb is powerful indeed but having said that, you have to remember that any diet is only palliative for diabetes. Diet works really well at the beginning stages of the condition and then not so much. This is because the middle and end stages are being driven by other factors which aren't diet specific.

Reducing or eliminating the need for insulin does not mean you aren't diabetic. There are many diabetics who do not require insulin. In fact, most don't. As you can see, once they put you on insulin, you are pretty far along into the "disease" and low carb will only get you so far.

Six common beliefs addressed, Part 241

1. Is it true that there is no money in keeping people healthy?

The people who commonly make this association, are making just as much money from sick people as the ones they are pointing their finger at.

There is money everywhere. It's a supply and demand economy so anything can be used to make money. In fact, trainers, gyms, fitness equipment, exercise programs, supplements, specialty restaurants/foods, fitness wear/books and "bio hacks" are generally purchased and used by the already healthy like athletes and others who have been invested in their health for most of their lives. Most of this stuff is quite expensive and the healthy are all too willing to buy it.

So healthy people make others just as much money as the sick do. In fact, there is a case to be made that the healthy can make you much more money since the overhead is low as healthy people do not have to be taken cared of so more profit can be made from them instead of dumped back on them. Healthy people also have more disposable income as they usually make their own money instead of living off the state because they can no longer work due to their health.

2. I watched a video that talked about fasting and blood glucose control for diabetics. It discussed how blood glucose sometimes rises while fasting, instead of lowering. It explained the technical stuff pretty well, but it still didn't explain how fasting could resolve this. It seemed incomplete somehow because I still have the same question I did when I started watching - How can fasting improve this problem if it seems to be causing it?

It can't.

The reason that a lot of information was skipped is because incomplete information helps dupe people into believing nonsense. If the video is trying to sell you fasting, then it can't give you information that will negate its benefits. That would make no sense. For this reason, it will only focus on information that will keep fasting in a good light.

Insulin helps regulate stress hormones, as the video most likely explained to you, but if your insulin is functioning poorly, meaning that it is not very effective at doing its job, then these stress hormones will not function properly either. Fasting will not help insulin regulate these hormones any better. That little bit of information was probably left out of the video. If anything, fasting will deteriorate insulin function further as more glucose production by stress hormones, will only continue to effect insulin's behavior. Insulin is a slave to blood glucose. If fasting is rising your blood glucose, then your insulin will follow suit and the resistance will continue as if you ate chocolate cake without ever enjoying it.

This is why the American Diabetes Association (ADA) never says to not eat cake, since not eating it will not cure this problem. The reason we don't recommend cake is because cake will further disrupt blood glucose even if not eating it will not "cure" you. If you can't be cured, you can at least not make things worse.

Remember, you cannot resolve starvation through more starvation. Overweight/obesity/metabolic syndrome, at every stage, is an adaptation towards starvation. Metabolism is trying to keep blood glucose, insulin and body fat at high set points. You are only facilitating this process through fasting. Worse, when blood glucose does lower during fasting, it can drop to extremely low levels, furthering the disparities between low (fasting) and high (postprandial) blood glucose. This is a recipe for more diabetes as this is exactly what causes metabolic dysfunction to begin with.

You have to fight obesity with proper eating. Just like you fight fire with a controlled, targeted fire, you fight obesity with controlled, targeted eating. Where does fasting come into play then? Fasting is supposed to lower insulin. That is the goal. You want to have specific times in the day where your insulin is very low, in order to try and improve its function by "breaking the resistance" and helping it to be released in pulses, rather than chronically. But this doesn't work if fasting rises your blood glucose through an exaggerated adrenal stress response and this is what usually happens to diabetics. This is why you have to have specific, consistent eating patterns and not fast erratically or for too long. The goal is to keep blood glucose steady and that can only occur through eating and fasting homeostasis.

3. I have been following low carb and fasting for some years now. I just found your blog so I'm kind of relearning everything. Before, I was just following the popular "low carb doctors" and "fasting groups" online. Well, my HbA1C is now 9.0. My blood glucose goes anywhere from 231 to 115 mg/dL throughout the day, sporadically and without any apparent cause. Basically, I am worse now than I was when I started low carb and fasting. I started it to control my prediabetes but now I am fully diabetic. Though low carb and fasting helped lower my blood glucose initially, particularly after eating, there seems to have been no benefit in the long run. I don't know what to do anymore.

There was a benefit in the long run - a delay in the diabetes that you would have ultimately still gotten. I apologize but this stuff makes me pissed because it's actually quite common and could have been avoided if you would have avoided the quacks. You know what they say about "if it's too good to be true, it probably is"? Well.... welcome to the probably is.

I hate to be the bearer of bad news, but you were just another person duped by all of this low carb and fasting BS. You paid the price with your health, and they just walked away unscathed, still promoting the same BS that will cause others to end up like you. You were basically misled into thinking that lower blood glucose, primarily postprandial, was a sign that you were being "cured". You were not. You were delaying the inevitable.

I have said it a million times on this blog, and I will continue to say it - diabetes is not a disease of high blood glucose. It is a syndrome of a metabolic adaptation towards starvation. It is chronic and progressive when it is not treated properly. Keeping a pseudo low blood glucose, after your meals, is not the proper treatment for diabetes. Lower blood glucose is not the "cure" for diabetes, any more than lower weight is the "cure" for obesity. Walking is not the "cure" for paralysis. I can put a paralyzed person in a mechanical walking machine that moves their limbs for them, but they are still paralyzed. Maybe a magician or snake oil salesman can claim that the person is no longer paralyzed and now "cured", but you know better. They are artificially walking by a machine. You were artificially keeping your blood glucose low by a simple dietary hack that has been known for as long as they have known about diabetes. You were gas lighted. Plain and simple.

This is why the American Diabetes Association (ADA) does not stand behind this BS because regardless of how incompetent they may be, they know better. They have quite an extensive library of diabetes research. We have to give the devil his due.

It takes a whole lot more than just "low carb and fasting" to put metabolic syndrome into remission, much less full-blown diabetes which is the end stage of metabolic syndrome. Remission requires:

• A proper dietary protocol, not just "low carb".
• A proper fasting regimen, not just "fasting".
• A proper exercise regimen, not just lifting boulders.

Aside from these three things you have to:

• Implement a lifestyle that reduces systemic stress so that you can lower the body's stress response. This means you have to keep consistent and predictable timing and frequency of meals, fasting, exercise and sleep.
• You need to address any underlying co-morbid conditions (autoimmune, cardio-vascular, fatty liver, etc.) which contribute to the body's stress response. 

This means that sitting around is not the proper treatment for arthritis and eating bread is not the proper treatment for gallbladder disease. Going to the carnival to eat elephant ears is not the proper treatment for menopausal symptoms. You need proper treatments for these conditions so that they can be truly under control and not interfere in the above four goals.

Finally, you need to have a long, honest talk with your doctor about actually taking control of your blood glucose regulation with the right, targeted treatment. Not everyone's diabetes is the same, so your doctor has to actually look at your blood glucose patterns, your insulin levels, your C peptide results, cortisol levels, inflammatory markers, etc. in order to put you on the right medication at the correct dose. That way you aren't over medicated or under medicated or medicated for some crap that isn't even an issue. You need medication that will work to enhance your lifestyle changes and vice versa, not work against them.

You have to overhaul your entire lifestyle and set up a new one and then you have to stick to it for the long term (forever). That is way more complicated and super less fun than going to the market and trying to find "keto" versions of ice cream and then talking about insulin all day in a group full of fat people who constantly track how many points their blood glucose goes up and down in an hour. In other words, you need a plan, not magic tricks.

4. Is it true that the body never uses protein for fuel? If this is the case, why do calories in/calories out (CICO) protocols limit the calories of protein?

The body always uses the two energy macronutrients (fat and carbs) for fuel. It technically can use protein for fuel as well, but it never does, except for one exception - during stress. Of course, that's only half the story.

During stress, the body can break down amino acids (the building blocks of muscle) for fuel. It uses the catabolic hormone cortisol for this breakdown. This mechanism evolved so that if you are being chased by a predator, the body could temporarily acquire extra energy, converting the protein in muscle into glucose, to help you sprint on out of there. Glucose is a great fuel for sprinting and since the body does not keep a large reserve of it as glycogen, because those stores are very limited, it can use this mechanism to tap into a hidden added reserve. Muscle is very valuable to the body, but energy is much more so it will sacrifice muscle to gain energy.

Even though things were meant to work this way, in metabolic syndrome, they don't. The body is in a constant level of high systemic stress from metabolic malfunction, mainly any lowering of blood glucose. This causes for this mechanism to be over expressed through chronically elevated cortisol levels. This depletes muscle mass continuously and the "fuel" derived from this breakdown is not used for any energy requirements as no one needs to sprint anywhere or enough, it's simply shuffled back into storage as fat. This causes low lean body mass and high body fat which is a body composition that further deteriorates metabolic function and adds to this stress. Your muscle mass is feeding the growth of your fat mass and it doesn't even taste as good as ice cream.

Aside from metabolic stress, there are other conditions that effect this catabolism to muscle mass that worries certain individuals, like athletes. Stress from strenuous and demanding exercise regimens will break down the muscle that they are trying to build. It's a constant battle for athletes to replenish what is lost and build a bit more of it with each work out.

As you can see, the body breaks down protein to use as fuel but not from diet, rather it's from its own muscle instead. It also doesn't use it for any energy output but for the further building of fat mass. That's why I always keep it simple and say that the body does not use protein for "fuel" because in the context of the subject matter of this blog - it truly doesn't. That's why protein is not a nutrient of concern, except if you aren't getting enough of it.

CICO protocols limit all calories, including "protein" calories because there is no food that is pure protein. Meat is what's described as protein and that comes with fat and water. So, with CICO you are inadvertently limiting fat calories when you limit protein as it's the fat in protein foods that would make you fat, not the protein.

5. Is protein never a nutrient of concern or can it become problematic at some point?

The only times that protein becomes problematic is when:

• It's carb based - Plant based proteins are inferior and come with an added load of glucose to boot. You have to eat a wider variety of carbs in order to make up for the incomplete or inadequate amounts of protein found in plants. This basically means you end up eating more carbs just to get enough protein. For example: beans and rice.
• It's fat based - Trying to hit your daily protein goals by consuming dairy products or rib eyes, is not the way to go. Hunter/gatherers eat lean proteins. Lean proteins are wild game. Even though farmed meat can be labeled "lean" it is still quite fatty compared to wild game. Lean meats give you more bang for your buck than fatty ones because they have more protein. You want to hit your protein goals, without surpassing your fat goals. A lot of people have issues acquiring this balance and that is why supplementation might be the only recourse to fix this. Protein supplements have all the protein, minus the fat.
• It's not adequate - A lot of people do not track their protein intake and are actually eating less than their required daily recommendation. People seem to have a hard time calculating how much protein their cut of meat contains. They keep making the mistake of thinking that the entire cut of meat is all pure protein. It isn't. Meat contains protein, it isn't protein itself. There's fat and water in meat so when you weigh your chosen cut of meat, you have to determine how much protein it contains. Protein amount varies by cut and animal source.

Finally, there is end stage metabolic syndrome. This is when protein becomes a dire necessity while becoming totally useless at the same time. I know it's hard to imagine these two realities existing at once, but they do. Two things can be true at the same time. Let me explain.

Once you reach a stage of diabetes where you are breaking down muscle mass, at such an uncontrolled and exaggerated rate, you can't eat enough protein to replace what you are losing. Worse, as you build it, you destroy it. The more you build, the more you destroy. It's almost as if the protein is now "feeding the fire", so to speak. Add to that insulin resistance, and you end up hardly using the amino acids in your serum. You need properly working insulin to use protein and build muscle. Aside from the liver, insulin resistance is most prominent in muscle cells. You know you are at this diabetic stage when:

• Your blood glucose is uncontrolled and high all of the time, irrespective of lifestyle changes. By high I'm talking a blood glucose in the 200+ range.
• Blood glucose goes high enough to require hospitalization from any injury or illness.
• Blood glucose runs high with any physical activity, fasting, sleep pattern disturbance or any change in daily routine that disrupts circadian rhythms.

This is caused by a complete breakdown of the hypothalamic/pituitary/adrenal axis (HPA). It usually occurs in very late-stage diabetes or in non-compliant patients, like the ones who do not take their diabetes medications properly and/or refuse to drop certain stressors like caffeine from their diet.

Regardless, these people should continue striving to meet their daily protein goals because it's better than not. Protein based foods are always better than carbohydrates regardless of disease stage.

6. I am "addicted" to coffee and it's the only thing I am unwilling to give up. At least it's better than the bread I use to be "addicted" to, right?

No "addiction" is better than another so you can't compare addictions, though people like to think that to make themselves feel better. But anything that controls you means you are still under the control of something.

Coffee and bread are both the same unless the comparison is being made with decaf coffee. Why is that? Well, bread makes your condition worse by disrupting your blood glucose regulation and so does caffeinated coffee. They both feed the "disease". Anything that feeds the "disease" is a problem because the result will be the same - more "disease".

If you are "addicted" to decaf coffee, and only have two cups a day, then you should be good. But this word "addicted" usually means you can't control how much coffee you have. You are most likely not drinking just two cups and you aren't drinking it only during mealtimes. You are drinking it just like you use to eat bread. This is why "diet" is simply not enough for some people and why I am sick and tired of people giving it so much importance. Some people just bring their bad habits to their new diet because their root problem was not diet related to begin with. It was their behavior.

Obesity is just as much a behavior driven condition as it is a dietary one. That's why we describe obesity as a lifestyle choice, because it's caused by much more than just diet. Aside from the word "addicted", the phrase "unwilling to give up" and "at least it's better" are prime examples of common obesogenic beliefs that contribute to obesogenic behaviors. These behaviors keep people fat and that's perfectly fine if they just remain fat and accept it instead of remaining fat and seeking from others a "fix" for it.

I can only advise people who can actually do what they need to in order resolve their problems. Addiction requires professional intervention so I can't be of much help.

Six common beliefs addressed, Part 238

1. Even mild exercise causes for my blood glucose to rise very high. I am trying to incorporate exercise into my routine because I know I need it for metabolic health but even on insulin, I can't seem to control my blood glucose when I do.

You are an uncontrolled diabetic. Your doctor might have told you that everything is "under control" but it's not. If your blood glucose soars from mild exercise, then that's not control. It is also a recipe for worsening of diabetes over time since now you are left avoiding exercise in order to prevent high blood glucose. That's not the way to treat diabetes.

You do not treat diabetes by "avoiding" high blood glucose either through continuous diet modification or avoidance of exercise. As you can see, avoidance hasn't helped you one iota, or you wouldn't be complaining of high blood glucose from simply walking around. But sitting permanently does not treat diabetes.

This soaring of blood glucose also puts you at a very high risk of diabetes complications as any illness or injury can cause for your blood glucose to drive you into a coma. This is the most common cause of morbidity with diabetes and why so many "controlled" diabetics are suddenly no longer on this side of the ground, leaving everyone wondering what could have possibly happened. Well, what happened is exactly what you are describing, sudden uncontrolled spikes in blood glucose from any smidgen of perceived "stress" by the body.

You have to have a discussion with your doctor about the symptoms you are experiencing and explore other diabetes medications, besides just massive doses of insulin, to try and acquire better control of your blood glucose. Obviously exogenous insulin is not entirely effective in preventing this issue. Exogenous insulin is great for controlling postprandial blood glucose but it is not addressing the body's exaggerated adrenal stress response.

You are a prime example of why diabetes cannot be treated with diet alone, like the low carb zealots try to sell you. Once you are diabetic, diet is but a drop in the bucket as a treatment and this is why your doctor does not put much focus on it. Of course, I don't agree with them ignoring diet all together, but I also can appreciate their reluctance to give diet much credence as it simply doesn't have much to offer.

Diabetes causes the chronic, unregulated break down of the body (lean muscle mass specifically) into glucose and this occurs irrespective of diet. It is also a very complex adaptive mechanism where multiple hormonal driven systems are involved, particularly the hypothalamic/pituitary/adrenal axis (HPA). HPA dumps catecholamines (stress hormones) into the blood stream at an exaggerated rate in order to keep blood glucose high. Diabetes does not manifest exactly the same way in any two individuals, so each diabetic's needs are different as far as treatment goals are concerned.

Do not sit idly by while your doctor solely takes the reigns because HbA1C is not going to save you and that's all they are focused on. Let them know that you need to incorporate exercise into your lifestyle, not anything strenuous just simple walking, and you need something to control your blood glucose when doing so as it is not under control now. Teeter tottering at extreme hyperglycemia's edge is not control.

2. I have a carbohydrate allotment of 20 grams a day. There is a bar I like which is 16 grams total carbs, but they are from sugar in the form of dried dates. Is this still okay, since I am eating to my macros?

If you are slim and healthy, then you can eat to your macros and your 20 carb a day allotment can come from any source you wish. This is because 20 carbs a day is still within a carb restricted diet and as long as carbs are restricted (starving the body of dietary glucose) you can maintain metabolic health. Remember, carbs are only benign in the context of starvation.

The best way to cause this starvation is not through the restriction of total calories but the restriction of the offending calories. Carbs are the offending calories, and they cannot be eaten ad libitum just because you are healthy as they will ruin your metabolic health over time irrespective of total calories, through the dysregulation of blood glucose. So, restricting them to 20 grams a day is a good thing.

But, once you cross over the threshold and are overweight/obese with metabolic problems, then the source of your carbs becomes just as important as your carb allotment. This means that those 20 grams of carbs better come from broccoli and not sugar. The overweight/obese are particularly sensitive to sugar, no matter what form it comes in. So even though dates are not granulated Dixie Crystals, they still have a high sugar load, especially when dried, and do not belong in the diet of someone who has metabolic issues.

3. How is leptin affected by insulin?

Leptin is affected by long term nutrient availability, whether it's surpluses or deficits. This hormone takes its cues from different metabolic signals, insulin being one of them. Insulin is affected by blood glucose levels and blood glucose levels signal nutrient availability. For this reason, leptin is described as being a "slave to insulin". After all, leptin doesn't have eyes and sits next to you at the dinner table, watching what you eat. It gets its cues from other metabolic information, which lets it know your nutrient availability. Nutrient availability is not just how much food is available (leptin) but also what type (insulin; macronutrient composition).

When you are metabolically healthy, it goes something like this:

• If insulin is high, that's a cue for leptin to burn body fat because there's enough nutrients coming in to safely do so.
• If insulin is low, that's a cue for leptin to burn body fat because there aren't enough nutrients coming in and the body has to tap into its reserves.

As you can see, insulin works in pulses. These pulses are driven by blood glucose levels and the effects it has on insulin release/expression.

High and low insulin also causes leptin to under express temporarily, in order to halt too much body fat loss. This toggle system works in balance in order to manage weight in the long term by determining weight set points for different environments and metabolic states. This is why simple calorie restriction, for the healthy, fluctuates their weight up or down easily.

The problem comes in when things become chronic and no longer work in pulses. When you are metabolically unhealthy, it goes something like this:

• If insulin is chronically high, leptin will under express chronically since there would be no point of burning body fat if plenty of fuel is coming in from the diet. This becomes "leptin resistance" over time which makes it easier to build and spare body fat.
• If insulin is chronically low, then once again leptin under expresses chronically in order to not burn through fuel stores as there isn't enough fuel coming in from the diet and so preserving those stores now becomes necessary. This becomes "metabolic slow down" making it easier to build and spare body fat. This is how calorie restriction causes weight regain and stalls.

Leptin is produced and signals to the brain from the fat cells themselves. It's basically the messenger between the brain and the body's fat stores. Fat cells respond to ups and downs in insulin due to blood glucose fluctuations and this affects leptin expression as described above.

As you can see every metabolic function is intertwined. Everything effects everything else, positively or negatively, depending on your neuroendocrine state which is determined mainly by your macronutrient composition (nutrient availability) and activity level (lifestyle).

4. Is abdominal fat the cause of diabetes? I was in a low carbohydrate group, and they were discussing this, but I couldn't get clear answers. It seemed like they were just repeating someone else but didn't really know the details of how this actually occurs.

Typical of low carb circles. They talk a lot but say nothing.

Abdominal fat is a marker for metabolic syndrome. It is not the "cause of diabetes". Instead, it's simply a common manifestation of diabetes as the result of metabolic syndrome which causes for fat to be accumulated around the middle. This is not surprising.

Diabetes is a syndrome that causes the excess storage and sparing of body fat. That's why reduction of body fat has to be high on your target list for achieving remission as body fat only helps diabetes progress further. Body fat is diabetes' fuel because it puts a further high insulin demand on the body and does not allow for the proper disbursement of energy, leaving you tired while it keeps building itself. The burning of body fat means you are actually reversing this process.

Diabetes is the end stage of a metabolic adaptation caused by poor blood glucose control. The root cause of diabetes is the erratic ups and down in blood glucose, with large disparities between the two, caused primarily by lifestyle factors. It takes decades for this abnormal blood glucose regulation to develop into the syndrome we call diabetes. This syndrome causes many symptoms - high blood glucose, poor insulin function (insulin resistance), visceral fat, over expression of the stress response, under expression of leptin, dysregulated glucagon, among many other things. Improving or resolving any one of these does not affect the trajectory of the syndrome. We know this because modern medicine has a slew of very effective ways to control any one of these symptoms but hasn't been able to prevent the eventual morbidity of diabetes.

"Why is that, Gina?" Because if you lose your visceral fat and it helps lower your blood glucose you still have to contend with the over expression of the stress response and/or fasting blood glucose that dips too low and/or poor insulin function, etc. These all contribute to impending diabetes. Remember diabetes is a metabolic adaption where multiple systems are now geared towards keeping a high blood glucose set point. These systems work together to keep diabetes progressive. Even when all symptoms are addressed, you are still left with tissues and organs which might not regain their full insulin sensitivity and still develop pathologies related to that fact, as insulin expression continues in certain tissues and organs, long after serum insulin lowers/normalizes.

So, stay away from people who try to reduce the cause of diabetes to any one of its common obvious symptoms because what wasn't obvious (blood glucose disparities) was the root cause of the adaptation and this occurred long before the abdominal fat was accumulated.

Now I understand that there are two common debates you will see on low carb pages, and they go something like this:

• 1. You accumulate excess fat in the viscera, and this develops diabetes over time.

That is false. We know this because healthy metabolic function never accumulates fat in the viscera. It accumulates it subcutaneously which is the proper storage for fat and it has a strict threshold. When metabolism begins accumulating fat in the viscera it's because something pathological is occurring to cause it to do this. This is why fat accumulation in the viscera is so malignant. It is a symptom of a much larger and serious problem.

• 2. You become diabetic and for this reason you become fat. In other words, you are fat because you are diabetic.

That is also false. Not only are there plenty of diabetics that never become overweight/obese but there are many people who are overweight/obese and not diabetic. Diabetes does not "cause" you to become fat. Your abnormal metabolic function makes it easier to become fat and diabetic.

The cause of diabetes is the erratic blood glucose disparities described above. Those erratic blood glucose disparities deteriorate metabolic function so that it becomes easier to get and stay fat and eventually develop diabetes.

Overweight/obesity and diabetes are not mutually exclusive to each other though they are related. They can exist separately. This is because they are both time dependent and so they don't always occur at the same time. You can become overweight/obese first and then eventually develop diabetes or vice versa. It all depends on how your metabolism deals with the stress these blood glucose disparities cause it and how insulin adapts.

Everyone manifests metabolic syndrome differently and that's why it's called a "syndrome", not a disease. Metabolic syndrome is a group of similar symptoms which do not always occur together or at the same time for everyone. Genetics, epigenetics, dietary habits, activity levels, gender, age, hormonal status, co-morbid conditions, etc. all influence how this syndrome manifests in you.

5. A low carbohydrate follower sent me information on Dr. Bernstein. I am new to this. Is this a good doctor to "follow"?

I have an automatic negative reaction when someone describes themselves as "following" a doctor online. I hate to say it but that sounds kind of crazy. I don't know why low carbers follow these "personalities" on the internet as if they were a boy band.

A doctor online is not your doctor. They don't know you; they haven't examined you and they haven't diagnosed you so they can't provide you with any treatment for your individual condition. Therefore, you shouldn't be "following" anyone. Following doesn't treat diabetes. Doing does.

What I can tell you is that Dr. Bernstein is not on my Quack List, but he specializes in Type I diabetes. Type I and Type II diabetes are similar but different in very important ways. For this reason, though you can apply a low carb diet to both, their method of treatment ends there. On this blog, I feature Dr. Bernstein's dietary protocol in my 'Recommended Diets' list because it is a legitimate protocol that can be followed and be beneficial for Type II diabetics. But again, it ends there.

All you need to know from any "online doctor" is what protocol to follow and then you put them to the side. There's nothing else they can do for you. Listening to them regurgitate the same basic information and cliches, over and over again, while also trying to sell you crap from their sponsors, is not in any way going to make you slim. The only one that can follow the protocol is you. Following them does not magically give you results. Stop following and start doing.

6. I can't lose weight, no matter how strictly I follow "keto". An "alternative medicine doctor" told me to switch to a high carb diet instead. I am scared of doing this. What should I do and why would they suggest this?

I become very leery when I sense desperation to lose weight. Desperation causes for the person to jump from protocol to protocol and consume a large amount of snake oil in the interim. Snake oil is very fattening. Some of the fattest people on earth are the ones constantly desperate to lose weight. Desperation doesn't cause weight loss. Doing does.

There can be multiple things happening here. You could be following a "keto" protocol that prevents fat loss because of a high intake of dietary fat, too much fasting and inadequate protein intake (starvation). This causes the body to double down its efforts to spare its body fat. You should stop the "keto" and follow a normal, low to moderate carb diet. We have several featured on this blog, on the right hand side column, under 'Recommended Diets'. Choose one.

As far as your "alternative medicine doctor" is concerned - be careful. They are recommending a high carb diet in order to manipulate leptin, which I have discussed extensively in my prior posts. Manipulation of leptin is a diet hack that has been around since the beginning of time, so your alternative medicine doctor is not presenting anything new to the table though they are banking it's new to you. They could be right, and you might take the bait. After all, if you do and it works in their favor, you will swear up and down they worked a miracle on you, and you will then recommend them to your friends.

Diets that manipulate leptin are double edged swords. Though they can produce a benefit in the short term, they end up sabotaging you in the long term. The best way to effect leptin is to keep your insulin function normal by keeping your blood glucose control stable. High carbs won't allow you to do this. So, you are better off revisiting your low carb diet and changing whatever could be causing your issues. 

You also did not mention any exercise routine. Get one if you don't have one already. Diet alone will not lead you to the promised land so stop solely banking on it. Remember to eliminate any caffeine consumption.

Six common beliefs addressed, Part 204

1. I've started to notice that a lot of "low carb doctors", who push carnivore or "keto", are obsessed with eggs. They are now pushing eggs over meat. 

You have to understand that for most of these "doctors", “keto” and low carb are not their first rodeo. These people have been peddling one failed diet or another, for many years, before they got here. Most of the ones pushing eggs and greens, as a “keto” protocol, were once pushers of plant based protocols so they continue pushing a "less meat" agenda, even when they have been forced to include meat.

Stay away from “keto/low carb doctors" and stay focused on what's really going on with you. You cannot treat what you don't understand. Obesity is not caused by following the wrong food lists or buying the wrong diet book. Obesity is the chronic under expression of leptin due to metabolic abnormalities caused by blood glucose dysregulation. Blood glucose dysregulation ends in metabolic syndrome/diabetes which are starvation adaptations that further perpetuate obesity. In fact, the only commonality found in obesity research, between patients, is blood glucose dysregulation. Obese people vary in gender, age, health, pathologies, diets, lifestyles, appetites, etc. but they don't vary in blood glucose dysregulation. 

So in essence, all you have to worry about is obtaining/maintaining proper blood glucose regulation. Everything else is flim-flam. It doesn't matter if you can achieve proper blood glucose regulation through eggs or filet mignon. No one individual food item is going to achieve proper blood glucose regulation anyway. Only the right macronutrient composition of low carb, moderate fat and adequate protein can.

2. A family member was recently hospitalized for severe dehydration and has not been released from the hospital because they developed rhabdomyolysis. Doctors told them they would need dialysis if it continues. This reminded me of diabetes, for some reason. 

Rhabdomyolysis (rhabdo) is a potentially life-threatening syndrome resulting from the rapid breakdown of skeletal muscle which leaks muscle contents into the blood. The most common causes are crush injury, overexertion, alcohol abuse and certain medicines and toxic substances. Rhabdo can cause damage to the kidneys because they become overworked trying to eliminate this muscle waste. Rhabdo is not directly associated with diabetes but any chronic disease, like diabetes, can put you at more risk for developing this condition after any injury or illness. When the body loses resilience through one chronic condition, it affects how it handles all other conditions.

I think that the reason you thought of diabetes when you heard about rhabdo is because diabetics also break down their lean muscle mass, at an exaggerated rate, and eventually develop kidney disease. This is because their kidneys are also overworked as they try to eliminate this excess waste. The excess waste from a diabetic's muscle break down is mostly sugar. So rhabdo can damage kidneys in a few days and diabetes can take a decade, but their end result is the same - dialysis.

There are also other factors in diabetes that cause kidney damage as well, which include the chronic inflammation and excess water retention caused by hyperinsulinemia itself. This water retention causes high blood pressure and high blood pressure, especially in the small vessels, damages the kidneys over time. So even though these conditions are not connected, they both overwork the kidneys, eventually damaging them.

3. Low carb advocates always talk about insulin resistance or insulin sensitivity, but they never fully explain either. 

I have used the term insulin resistance and insulin sensitivity before but I refrain from doing so as much as possible. This is because low carb advocates blame insulin resistance for a slew of ailments that have nothing to do with insulin. It is such a misused and overused term that it has lost most of its meaning. Insulin sensitivity is also too general a term to use since diabetics are very insulin sensitive, at the fat mass only, so without nuance the term is mostly meaningless.

So since there is no such thing as being completely insulin resistant or completely insulin sensitive, I like to use insulin function instead because ultimately that's what’s deteriorated in metabolic problems. Insulin serum levels are chronically high, insulin is over expressed at the fat mass and it’s under expressed in other tissues and organs, at varying rates. That's poor overall insulin function.

4. My friend is on a traditional diet that's calorically restricted and I am following a "keto" protocol. Once a week, we both allow ourselves to have a dessert. I make myself a "keto" dessert, which complies with my macros, and she has a "cheat day" where she eats something she usually can’t, like a brownie. I think my "keto" dessert is a better option than hers but she thinks it equates to the same thing for us both.

Your "keto" dessert is definitely better because you are not going off protocol just to have a dessert. More importantly, a day of higher fat does not disrupt blood glucose regulation but a day of higher glucose does.

Of course, your friend is seeing this through the lens of calories so she assumes, both desserts are a wash at the end of the day but if you have been reading my posts, you know better. Just one episode of "dietary induced hypoglycemia", meaning that your postprandial blood glucose was disrupted enough to cause a prolonged insulin release/expression which then drops blood glucose while fasting, is enough to get the ball rolling towards metabolic disaster. You have to understand that our blood only has about one gram of glucose, at any given time. This means anything over that is technically overload.

Now this doesn't mean that your friend will drop dead instantly from a piece of pie. After all, there are hunger/gatherers who are forced to eat honey, for weeks on end, just to survive. Our metabolism is pretty resilient, particularly when there is nothing wrong with it at the moment. It just means that your friend is setting the stage for future problems.

On average, we live longer than hunter/gatherers so we have a future to worry about it. Most hunter/gatherers do not have to worry about losing a leg at 60 years old. Because we can live such long lives, we have more time for things to go wrong and things will go wrong. If your friend is already overweight/obese and/or suffering from other metabolic dysfunction, then things will go wrong much more quickly for her.

5. There is no way to reduce systemic stress.

The best ways to reduce systemic adrenal stress are the following:

• Take control of any chronic underlying conditions - Chronic conditions like metabolic syndrome, auto immune or any other inflammatory disease will cause your body to be in a persistent state of stress. It is very difficult to regulate blood glucose under stress. You need to discuss with your doctor effective ways of gaining control of any chronic condition you may have. A lot of people just go to routine doctor visits and find no real improvement in symptoms. They are either misdiagnosed or given ineffective treatments. You have to take control of your healthcare. Make sure you aren't just going through the motions when you visit your physician. If they can’t help you, find one who can.
• Take control of medications - You have to make sure you aren't being over medicated with drugs that effect blood glucose regulation. A lot of people don't realize that lower doses of medications are still effective in treating their condition. Others don't realize that the medication they are on is actually useless and not helping them at all. So make sure you discuss with your doctor your medications, particularly if you have been on them for a very long time and the dose has not been changed nor has your condition been recently re-tested. Some people are still taking medications for conditions they no longer even have. Others are taking over the counter medications, at their own discretion, when a better prescription medication may be available which can be better monitored.
• Exercise daily in a predictable routine - Exercise helps regulate inflammation by directly affecting inflammatory hormones like cortisol. You should have a predictable and consistent exercise routine you follow daily so the body becomes primed on when to burn energy and when to store it.
• Eat two to three meals a day in a predictable routine - Eat real meals, not novelties or "snacks". Meals should be protein prioritized, low in carbs and moderate in fat. Make sure your meal timings are consistent every day. Do not go long stretches without eating. Make sure you eat enough at each meal.
• Fast in a predictable routine - If your meal timings are consistent, then this would automatically make your fasting times consistent as well. 12 -18 hours is the only daily fasting schedule that we recommend on this blog. Choose the schedule within that time frame that prevents hunger and/or any other symptoms.
• Sleep in a predictable routine - Go to sleep at the same time nightly. Not only will this allow you to sleep better and wake up naturally, without the alarm clock, but it will help you get enough sleep. Sleep induces the lowest insulin state you will have in a 24 hour period.
• Get rid of any caffeine - You will never be able to control your blood glucose until caffeine, in every form, is removed from your diet. Blood glucose dysregulation is the main cause of adrenal stress. 
  

As you can see most of the above recommendations are focused on normalizing circadian rhythms. Your circadian clock is the way your body communicates with its environment. It's not enough to just be conscious. To help keep your circadian rhythms healthy, keep a schedule and do things according to it. Do not be willy-nilly with your time because that will throw off your eating, fasting and sleeping schedules. Take your time more seriously. Remember, we only have a finite amount of time. Make the most of it. 

Following circadian rhythms reduce systemic stress through their affect on cortisol and other stress hormones. All animals follow circadian rhythms. Dopamine plays a crucial role in regulating circadian rhythms. Dopamine affects metabolism profoundly as it regulates metabolic hormones seasonally for fat storage and burning. So living erratically and unpredictably is not good for metabolism. This is particularly true for people with current metabolic syndrome.

6. They will never tell us the truth about obesity. 

This is because they don't have effective ways of treating obesity since it has no cure. For this reason, they want to place responsibility on you to keep it "under control". The advice that is currently given to the obese, only works for the lean as it can reduce their risk of future obesity. For the already obese, it is mostly useless.

It is reprehensible the way obesity is discussed in medical circles. It is akin to malpractice in my opinion. To tell an obese person to "aim for a healthy body mass index (BMI)" and "increase their exercise" in order to "cure" a condition without any known cure is abusive.

Obesity is a leptin condition, not a diet condition. You can not achieve a healthy BMI without leptin. I find it impossible to believe that a medical doctor would not know this as this information is not hidden in a mysterious vault that only warlocks can view. This is actually consistent in obesity medical literature.

So I am with you on your outrage. I just don't have any answers for you. The only thing I can think of is that they want people to continue “being mindful of their weight” and they don't want to give them any excuse to not be.

Six common beliefs addressed, Part 196

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

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

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

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

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

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

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

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

3. Cancer “feeds on sugar”.

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

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

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

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

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

To be obese you must have:

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

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

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

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

5. An exaggerated stress response cannot damage the liver.

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

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

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

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

Six common beliefs addressed, Part 174

1. People say they love "keto" because they can "eat as much as they want". 

I hate to be sarcastic but that's not surprising. Like I have said before, behavioral issues go hand in hand with obesity as much as biological issues do. Obesity is a mind/body problem.

That is not the correct way of following the diet or any diet for that manner. You cannot solve obesity with the same behaviors that got you to it but the reality is that many of these people will remain obese on "keto" and they won't care because their HbA1C dropped three points.

2. My blood glucose is still in the 200 mg/dL on carnivore but I fast for 16 hours. Does this mean I need to fast longer?

No. If you fast longer you will increase this problem over time, regardless of any short term benefits you might see. You are a full blown diabetic and your blood glucose is being driven primarily by an adrenal stress response, not the individual foods you eat.

The only thing you can do is mitigate this stress response by getting rid of every little thing that can contribute to it, incrementally, in order to try and get it under control. Each little thing you address will help cause a cumulative effect to try and drive down this stress. At least, that's the goal.

I recommend you drop carnivore. It is exacerbating the stress response but since I don't know your exact protocol, I can't tell you why. There are a multitude of ways you could be doing this diet incorrectly. Carnivore diets are very difficult to follow. For that reason, you shouldn't follow them at all, if they aren't producing significant results. 

• Go to a basic, low carb diet, Atkins style instead.
• Stop the fasting. Ditch the 16 hours and go to a 12 hour fasting schedule instead. This means you should be eating three meals a day. Do not snack.
• Make sure you do not over exercise but you still exercise. Exercises that are steady state, low to moderate intensity, like walking, are best as it helps to mitigate stress hormones.
• Also, keep your eating, fasting and exercise schedules consistent daily, with no deviation.

3. I am very cold when I fast. The longer I fast, the colder I get. 

Your metabolic rate is dropping and you aren't burning any body fat. You are only further disrupting leptin expression and thyroid function. And no, iodine will not save you.

It is mind boggling how people will insist on doing something, that is not only failing, but making them feel like crap to boot.

Shorten your fasts to only 12 hours a day, basically an overnight fast. Eat three meals a day with no snacks in between. See if that helps.

4. "Keto" will help change your relationship with food.

No. Your relationship with food has nothing to do with what foods you eat, but how you eat. Many people bring the same eating habits into their new diet which they carried over from the past one. "Keto" is a protocol that helps address the symptoms caused by metabolic syndrome. It addresses the biology but not the behavior.

5. The body will get use to a consistent fasting schedule and this will cause a weight loss stall. You should always "change it up" instead.

The body always compensates to calories coming in. This is why you need to avoid long fasts as they technically cause the same problems as caloric restriction since that's basically what long fasts are - a method of restricting calories (starvation). "Changing it up" is not the solution for this.

The body does not "get used to your fasting schedule". It gets used to fasting, period. That is why fasts have to be of short duration so that this adaptation does not occur.

6. Stress responses do not change over time.

They absolutely can. Losing a lot of body fat can trigger an abnormal stress response while keeping it on does the same thing. We usually only think of stress responses in the context of diabetes and metabolic syndrome but the cure to these problems can induce a stress response as well.

Some people see their blood glucose begin to rise as they lose more and more body fat. They might also feel jittery. They might even begin to gain weight, after they have lost a significant amount, due to a change in leptin and cortisol expression. Their energy levels might drop as well.

Unfortunately, nothing can be done about this. The body simply does not like a challenge to its body fat, especially if it has always had excess body fat. For chronically obese people, certain hormonal functions cause for their weight set point to always be higher than it should be. So, you just have to continue with the protocol that got you to lean and move forward.

Six common beliefs addressed, Part 172

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Six common beliefs addressed, Part 163

1. I have a family member who was overweight and prediabetic. They went on "keto" and they now look sick. I can see all of their bones and even their tendons. They appear frail too. Is this the result of too low protein and not enough exercise?

Some people lose a lot of weight and their family and friends swear up and down that they look "sick" when they are just slim. We are so used to seeing people who are overweight that they begin to appear normal to us and slim people appear abnormal. But, I don't believe that is what you are describing. You are describing someone who has lost too much body mass.

I have seen this occur a few times before but it is rare. Yes, there are cases where this can be the result of a very low protein diet and lack of muscle building exercise but not always. This is actually the result of obesity and its long term effects on insulin and leptin expression.

There are some overweight/obese people, who experience temporary super leptin sensitivity when they treat their metabolic dysfunction through diet and exercise but it can also occur after bariatric surgery. The hormonal changes which induce the weight loss are like a "shock" to metabolism and the person loses a significant amount of weight. In fact, they lose so much weight that they end up going well below their body mass threshold and might appear gaunt and boney, even cachexic. This is because they aren't just losing body fat but they are losing a good amount of muscle as well as this sudden shift in metabolism causes stress, which in turn causes muscle wasting. For those who were once obese, this muscle wasting can be quite exaggerated.

After some time, this super leptin sensitivity usually reverses without any changes made to lifestyle. The reversal is caused by a shift in leptin, once again, where the sensitivity is lost and this can result in a return to obesity. As you can see, the metabolism of the obese is "blind" to its threshold. They gain weight well beyond their threshold and they lose it well beyond their threshold as well. This shows that weight loss is not the cure for obesity as obesity is not just "being fat", it's a metabolic dysfunction. In fact, weight loss can cause a doubling down effect of obesity.

This effect is the consequence of leptin resistance which is not fully understood. No one knows what the long term effects of leptin resistance are for weight management in the ones who can achieve sensitivity. The outcomes do not look good.

The very few who are able to sustain this sensitivity continue to have very low weight and it doesn't reverse. This low weight continues to be the result of an abnormal body composition. When they were obese, they had high body fat and low lean muscle mass. Now they have low body fat and low lean muscle mass. It is like they can sustain super leptin sensitivity, while still being insulin resistant and the resistance has finally spread to their fat mass.

But this will not be the case for the vast majority of these people. Most will simply return to obesity. Why? Because losing weight below your threshold would cause what? A reinforcement of the starvation response. What is overweight/obesity? A starvation adaptation. So once again, leptin sabotages your weight loss. It causes so much weight loss that the body panics and the starvation response is heightened causing an exaggerated under expression of leptin and weight regain once again over time.

So your family member has to monitor this carefully. People tend to become very happy with their weight loss but it can be a Trojan horse. Remember, the cure for obesity is not weight loss, it's acquiring metabolic homeostasis instead.

2. My father is in his 70's. He has never been overweight/obese. Instead he has been slim his whole life. He has blood glucose issues, which he has controlled very well and has never reached the stage of diabetes, but yet he has developed kidney disease which causes him blood pressure issues. His blood glucose is the reason for his kidney problems, according to his doctor. I don't understand how someone without diabetes or obesity can still develop the same pathologies as a full diabetic.

Your father is suffering the consequences of long term metabolic syndrome.

Metabolic syndrome does not always end in diabetes but it always ends in pathology. Diabetes is simply the stage of metabolic syndrome, when blood glucose remains chronically and abnormally high. This commonly occurs at the end stage of metabolic syndrome but not for everyone. There are a few who simply do not ever develop diabetes. Remember, metabolic syndrome/diabetes are syndromes. This means they only manifest similar related symptoms which can vary between individuals. Not only do the symptoms vary but the progression and prognosis varies as well.

This has been researched extensively and there still isn't a consensus as to what causes these differences between individuals. Some claim it's the fat cells. The more fat cells you have, or can expand, the longer you can ward off diabetes as metabolism begins accumulating fat in order to protect you from its dysfunction. Your father proved that's not necessarily the case as he's slim and still was protected from diabetes regardless. We do know that fat is somewhat protective but obviously doesn't always live up to its purpose.

Some say it's genetics. Still others say it's the ectopic fat accumulation that ultimately decides your fate. Who knows because the reality is that no one does as there have been conflicting results with the studies that have looked into this. What we do know is that metabolic syndrome/diabetes are extraordinarily complex and everything I have mentioned so far is implicated in its progression in some way or form.

What this tells us though, is what I have been saying on this blog for a long time. We see it In vivo with your father. Metabolic syndrome/diabetes are not "diseases" of high blood glucose. They are adaptations towards high blood glucose and this begins with improper blood glucose regulation. Instead of just high blood glucose, the most likely culprit for these differences between individuals is related to insulin expression over time and how it adapts to disruptions in blood glucose. How much insulin sensitivity can you maintain, in the presence of abnormal blood glucose control, and for how long and how does it effect other hormones (leptin) in the long run? This ultimately determines how adaptable your metabolism becomes to starvation (high weight, insulin and blood glucose set points) which in turn effects how much blood glucose regulation you lose over time.

Your blood glucose does not have to be very high for insulin function to deteriorate. Just like lower blood glucose will not magically cause you to regain insulin function. It all has to do with blood glucose disparities. These disparities can happen at any blood glucose range. It appears that some are more sensitive to these fluctuations than others.

The kidneys are exceptionally vulnerable to insulin dysfunction and this is why kidney disease is so prevalent with metabolic conditions, especially in diabetes. Hyperinsulinemia impairs kidney function. Impaired kidney function does not allow for the proper elimination of waste, including excess uric acid. You can see this kidney failure begin to occur decades before diabetes sets in with the presence of gout. Gout is an early marker for kidney disease. These gout "flare ups" are the first sign of what's to come. High blood pressure, as well, is one of the markers of metabolic syndrome and extremely common. It is also a sign of compromised kidney function as insulin is anti diuretic, damaging the kidneys over time. In fact, high blood pressure medications are most commonly diuretics. They work on your kidneys to lower blood pressure and they themselves will cause the development of kidney disease.

All of this tells us that you have to protect proper insulin function long before you develop diabetes and preferably before you even develop metabolic syndrome. The best way to retain your insulin function is to follow a diet that does not cause disparities in blood glucose because those disparities are a snowball effect for your metabolism to begin going down hill.

3. Ever since I lost weight and my blood glucose and insulin levels lowered, I have noticed a terrible stress response to just about everything. If I get even the slightest bit nervous or upset, I have a surge of stress hormone release that causes shaking and headaches. 

If you have been checked out by a doctor and no condition was found that might be causing this, then this may be the body's reaction to lower blood glucose and insulin levels.

People assume that the "cure" to their "disease" will be a very positive experience, where they will feel great and all their previous ailments will magically disappear. That is not the case. In many instances, the cure is worse than the disease. At least, it will feel that way in the short term. Why? Because losing weight is only half of the problem. That's why weight loss is not the cure.

When metabolism adapted over time, to be in a state of hyperglycemia, all hormones were primed and honed for just this very outcome. When blood glucose drops to normal levels and insulin no longer remains chronically high, the body must re adapt to its "new normal". This will not occur painlessly. The body will use any situation, including emotional stress, for the release of stress hormones. It is trying to ramp up glucose release for higher blood glucose. The problem is that little by little it will have less and less of an ability to do this. You might then feel a release of adrenaline, more than anything else. Every system of the body does not adjust at once. Adjustment occurs in stages, just like the adaptation process itself, occurred in stages. Each system broke down with time and now each system corrects itself with time.

This is why metabolic syndrome/diabetes are not true diseases but adaptations described as "syndromes". It takes a long time for the body to adjust and in the interim you will feel symptoms you might not have noticed before. I know that I, personally, went through the worse time of my life while I was losing weight and lowering my blood glucose. I had poor health when I was 300 lbs. but I really went through the wringer while losing them. I had never even been to the ER at 300 lbs. and I went five times during their loss. I had all kinds of symptoms. Good thing that I stuck to it because I believed nothing bad could be happening if I was losing body fat and stabilizing blood glucose. It's difficult to believe you can feel great while going through hell but that's precisely what happened to me.

I suggest that you also keep an eye on your electrolytes and make sure that you are supplementing adequately. This is one the main reasons people feel terrible when their insulin lowers. Losing control of your electrolytes can not only make you feel awful but it can put you in the hospital. Recommendations for electrolyte supplementation can be found here.

4. I started fasting and at first, it seemed to be working, but I have actually been gaining weight and my body has increased its set point. Now it's become impossible to lose any weight and when I do, I just simply go down to that set point and no more. Fasting caused this.  

Yes. Unfortunately, it did.

Most people don't understand how this can be true since they are still holding on to the notion that calories drive obesity so if you are fasting, and no calories are coming in, how in the world can you possibly gain weight and become even more obese from calories that were never eaten?

This is because calories are not what drives obesity. Blood glucose dysregulation does and food is not the only thing that dysregulates blood glucose. Starvation does too. Starvation prolongs your time in hypoglycemia. Like I have mentioned before, its the lows in blood glucose that drive the condition. Metabolic syndrome/obesity/diabetes are all adaptations to starvation (hypoglycemia). When you starve for real (fasting), these adaptations double down in order to make you fatter and "protect" you. This is why you have to be very careful that the fasting protocol you are using is not contributing further to this process as it would make you fatter.

Choose a real intermittent fasting protocol. Do not fast for longer than 72 consecutive hours, once a week, and only choose that protocol if you are morbidly obese - over 50+ lbs.

5. Are low fat diets unhealthy?

No. Low fat diets are just as healthy as any other diet and can be metabolically sound if they are followed correctly. You just have to make sure that when you reduce fat, you do not replace it with carbs, which is usually how these diets are followed.

The reason that we do not include low fat diets in our list of recommended protocols is because carbohydrates disrupt blood glucose homeostasis more than any other macronutrient, so it makes sense to make it your main target. Low carb diets also eliminate junk and fast food, when followed correctly, and this automatically lowers the fat in your diet. The Standard American Diet (SAD) is a high carb/high fat diet. When you eliminate the carbs, you reduce the fat since they usually come together in SAD fare.

6. All symptoms of insulin resistance are the result of carbohydrate intake.

No. You can develop insulin resistance in other ways. Any condition that disrupts blood glucose homeostasis, preventing your insulin from working in pulses, will cause insulin resistance over time. So, just being overweight/obese will cause insulin resistance since having excess body fat puts a high insulin demand on the body. You also become insulin resistant naturally as you get older since insulin is no longer needed for "growth".

Carbohydrates are simply the most common contributor of excess body fat, in the modern diet, because they make the bulk of the food we eat. Carbohydrates disrupt blood glucose homeostasis and this ultimately causes insulin malfunction and the accumulation/preservation of body fat.