Six common beliefs addressed, Part 265

1. I started "keto" a few years ago. The consumption of saturated fat caused my LDL cholesterol to sky rocket so I took your advice and replaced all of the saturated fat from my diet with monounsaturated fats. My cholesterol dropped but for some reason, it has never lowered to what it was when I was consuming "vegetable oils". I don't understand this. Why would avocado and olive oils keep my cholesterol more elevated than corn or canola?

This is a very interesting question and I can relate to it as it has happened to me. For people who have genetic lipid profiles that are sensitive to diet, like myself, cholesterol can sky rocket when we consume saturated fats, particularly coconut oil.

When I started "keto" many years ago, my naturally high cholesterol of 210 rose to 650. I dropped the saturated fat from my diet and replaced it with monounsaturated fats and my cholesterol lowered but only to 320. After some years of only consuming monounsaturated fats, my cholesterol continues to consistently be in the 300+ range and never lowered to the 200+ range it was before when I was obese and consuming seed oils. What's going on?

Well, good luck finding the answer. No one will tell you as lipids are very complex and behave differently in everyone. Not only that, surprisingly so, we don't know much about lipids and their function. They are still quite mysterious. For this reason, the layman's usual answer is that it has to do with your HDL. A rise in HDL causes a rise in your total cholesterol and HDL levels rise dramatically with the intake of saturated fats. HDL also lowers significantly when saturated fats are restricted. But, the issue we are having is not totally explained by this phenomenon as it is not just total cholesterol that is being affected, we are talking specifically about LDL. Why doesn't LDL lower as much with avocado and olive oil, is it would with corn and canola? 

I think I can give you an answer because your doctor won't give you a thing. Well except a statin, which you may or may not need. Now, I am not a doctor or lipidologist but I still kind of have a possible answer that explains this conundrum.

Many years ago, when I did extensive research on cholesterol, by going through many lipidology papers, I came across an interesting tidbit of information. Don't hold me as to what this paper was titled or who wrote it since, like I mentioned, this was years ago. I just know the information in it stood out because I found it quite fascinating and later on, saw the effects in myself. The lipidologist who wrote this paper stated that seed oils, didn't just keep your cholesterol from rising, they actively lowered it. How though? Well, he explained it was through smoke and mirrors. Basically, it's an issue with how LDL is measured in a lab.

Seed oils simply contribute to the oxidation of LDL and lipid panels do not measure oxidized LDL unless you do an actual oxidized LDL test. This means that this "lowering of cholesterol" is simply all of the oxidized LDL the test did not measure. Oxidized LDL is not good. The more LDL you produce, the more chances of it becoming oxidized so you want to prevent oxidative stress to your lipids by not smoking, not consuming "vegetable oils" and taking vitamin E. Vitamin E is a powerful lipid anti-oxidant and when taken in high doses, it has been shown to actually prevent heart disease. Nothing else has. This is why it's so surprising to me that cardiologists do not prescribe vitamin E to their cardiac patients and/or people at risk.

What does this all mean, though? It means that my cholesterol of 210 was never truly 210. It was always 320, it's just that the difference was oxidized and I had much lower HDL. That's a pretty large percentage of oxidized LDL. This was a ground breaking paper that of course, is never mentioned, but it shows how you can have very low cholesterol and still drop dead of a heart attack because most of it is oxidized LDL and poor levels of HDL.

So, your cholesterol will never be as low as it would be on canola oil but it doesn't matter because it is healthier than it would be on canola oil. The amount of cholesterol is not what matters. It's the health of your cholesterol that ultimately decides your fate.

2. A "keto" group I belong to says that if a person's insulin is 5.6 they don't need Metformin any more because they are cured of diabetes as long as they eat "keto". Is this true?

Insulin levels are not a marker of diabetes. Insulin function (insulin resistance) is and this does not always correlate to serum levels of insulin. Oftentimes, insulin will become high (hyperinsulinemia) due to this resistance but this is not always the case in all individuals. There are many diabetics with normal to low insulin levels but they still have resistance. I don't know what group is spreading this asinine information, but you need to stop going to it.

As far as Metformin is concerned, it is not prescribed for hyperinsulinemia. It is prescribed for the management of diabetes. Only your doctor can decide if you no longer need to be on Metformin but usually Metformin is the medication that is last to go, or never removed, as there is no known cure for diabetes. You can only manage the disease. If you are able to get off every medication and only stay on Metformin, that's still a win even if you aren't "cured" of diabetes. The better you can manage diabetes, the better your outcome because you delay or eliminate the onset of its pathologies.

3. I am vitamin B12 deficient and have been getting supplement shots but when I was recently tested it showed that my B12 serum levels were still on the low end and my intercellular B12 was non-existent. Basically I am still deficient even after months of getting shots. What's happening?

I am not a nutritionist nor a dietitian so you need to speak to a professional in order to get proper answers for your individual issues but I can throw in my two cents anyway so you have something further to discuss with your healthcare provider.

First, I am happy to see you are testing intercellularly. I am sure you are paying out of pocket for that test since it's usually not covered by insurance but it's truly the only way to know if your supplementation is getting into the cells where it's needed. You don't need B12 in your serum, you need it in the cell. Unfortunately, some labs are no longer even offering this type of test.

Second, B12 requires adequate amounts of vitamin B6. Without B6, B12 does not go into the cells. So if you are deficient in B12, you are probably deficient in B6 since usually being deficient in one B vitamin, means you are deficient in them all. You need to take 200 - 800 MG of vitamin B6 a day. Keep in mind there are two forms of vitamin B6. Pyridoxine HCL, which is the most commonly used version in over the counter vitamins, can become toxic as it accumulates in the body. This can cause issues over time so you want to take pyridoxal-5-phosphate which is safe to supplement with because it does not accumulate, even at very high doses.

Third, I hate to break this to you but the B12 shot your insurance pays for is not the bioavailable form of B12. The shot version is cyanocobalamin, a plant based B12. You only absorb a minuscule amount because it is not the animal based B12 we require which the body identifies. The best B12 supplementation is methylcobalamin, hydroxocobalamin or adenosylcobalamin in sublingual form. You should take 5k - 10k mcg a day or whatever your doctor recommends. You can get this form of B12 as a shot as well but it only comes in multi-use vials which cannot be used at the pharmacy or any other place that injects you. You would have to learn to inject yourself or have a private nurse inject you.

"Gina, how and why do you know all this crap?" Well, because I have high myopia and have been supplementing with B12 for a long time since the nerve in my eyes are abnormal and put me at risk for glaucoma. Also, JC has celiac disease and has to supplement with B12 as he has a deficiency. For this reason, we have had to do extensive research on this particular vitamin to ensure we are supplementing correctly. It is vitally important that if you are deficient in vitamin B12, that you supplement correctly because not addressing this deficiency can cause irreparable damage to your health.

4. My husband has been diagnosed with Type II diabetes. He had been feeling unwell for a very long time and then suddenly went blind for five minutes. He went to the ER and his blood glucose was 700+ mg/dL. His kidneys and liver had started to fail. He recovered and is now on insulin and has to check his blood glucose daily. My husband is not overweight or obese. We are still relatively young, in our 40's. He believes a healthy diet is low in meat and calorie restricted. We are Mexican so he is missing his traditional meat-based meals and complains often. His approach to his illness is to eat a doughnut if his blood glucose is "good". I don't know what to do.

I am sorry to say that their isn't much you can do but try to educate him on what diabetes is, its causes and its management. He either takes that information seriously, and implements it, or he doesn't.

A lot of what is occurring here has to do with simply misunderstanding the condition. This is not uncommon. Most diabetics are unable to make the lifestyle changes they require because they simply don't fully understand what's happening to them. They are either getting wrong or incomplete information from dietitians, nutritionists, their doctors and even the media. They are not asking the right questions nor seeking approaches outside of the Standard of Care.

Your husband's approach to his condition is pretty much the norm. I have seen many diabetics who check their blood glucose, see it's not as high as usual, so they reward themselves with a brownie. This myopic view of giving so much credence to isolated blood glucose readings is detrimental for the diabetic. The low carb people do something similar with their obsession over postprandial blood glucose readings. They also try to manage their diabetes with individual food items. That is not going to work.

Diabetes is not a disease of any single blood glucose reading or what food made that single reading go up or down. It is a condition of overall blood glucose regulation which includes what happens when you aren't eating. It is also not a disease of high blood glucose. Blood glucose lows are just as bad as the highs, if not worse, since it's the lows that set the stage for the condition.

You can give your husband the link to my blog so he does a little research and gets better information. This will help him make better decisions. There should be no reason he has to give up any meat-based Mexican recipes that he is used to. What he decides to do depends on how seriously he is taking his condition and how invested he is in trying to manage it. It also depends on how open he is to approaching his situation in a non-conventional way.

5. Why does caffeine in diet drinks help weight loss but is complicit in fat gain? How can it work both ways?

Because it depends on the metabolic state of who is taking it. Remember, fat gain or loss is completely at the mercy of your neuroendocrine state.

Caffeine is a stimulant that has long been used in diet products to increase metabolic rate before Fen-Phen was a thing. Many people have found benefits in it particularly if they just need to lose a few pounds. Our threshold for what is deemed overweight/obesity has certainly changed through the years. Seemingly slim women were binging on caffeine diet products in the 80s. Those same women are most likely obese today.

Chronic, long term use of caffeine always ends up in metabolic problems. You cannot regulate blood glucose properly as long as you're intaking caffeine. I have said before that you would be surprised to know how many diabetics caffeine has made, yet it always falls under the radar and people keep consuming it. Once you crossover to metabolic syndrome, caffeine becomes even more detrimental. Stimulants further interfere with the already failing blood glucose regulation of people with metabolic syndrome. This only sets the stage for further fat storage and sparing.

For this reason, we do not recommend any caffeine intake, from any source. You should be on a zero caffeine diet. Caffeine should be treated the same as sugar because they both have the same effect on your metabolism, so eliminating one and not the other will not work.

6. I have a cousin who has diabetes insipidus. Will going low carb reverse it? People in low carb groups seem to believe so.

Diabetes insipidus and diabetes mellitus (Type II diabetes) are two distinct conditions with different causes and treatments. They share the name “diabetes” because they both cause increased thirst and frequent urination but they are not related.

Diabetes insipidus is caused by problems with a hormone called vasopressin, which is the anti diuretic hormone that plays a key role in regulating the amount of fluid in the body. Disease or damage to the pituitary gland or hypothalamus, where this hormone is produced, can cause this condition. It can also be the result of heredity. This is a very rare condition but can be life threatening if not managed properly.

Your cousin needs to consult their doctor about any diet changes, particularly before going low carb since insulin is an anti diuretic and lowering it can result in the release of water from the body. This can result in complications if you have diabetes insipidus. This diuretic effect of lowering insulin can also interfere with any medications that your cousin is taking to manage this condition.

Diabetes insipidus cannot be "reversed" and has no known "cure" so be careful with whatever they are telling you in low carb groups. They might be confusing "diabetes in situ" or "occult diabetes" with diabetes insipidus. Diabetes in situ is simply a term coined by Dr. Joseph Kraft to describe the changes in insulin expression, he witnessed in his research, years before the onset of diabetes mellitus. These low carb groups are not very well versed in diabetes and often spew out misinformation about the condition. They are usually run by volunteers who have 0 knowledge of what they are talking about and they don't even do the research themselves to offer better help. Remember, anyone can open a Facebook group or page about any topic they want.

Six common beliefs addressed, Part 259

1. I have always had erratic meal timings because of my job. I am now diabetic even though I really do not like sugar or grains so I have never eaten them in any significant quantity making my diet relatively low carb. How could a low carb diet cause diabetes?

It wasn't the low carb diet. It was the erratic meal timings. Diabetes is not a carb disease. It is the end stage of a metabolic adaptation towards starvation. Diabetes is what occurs when you starve enough (blood glucose dysregulation) without ever dying. This starvation adaptation can occur from multiple factors. Anything that disrupts proper blood glucose regulation will eventually cause diabetes. This can be diet, medications, certain chronic conditions or also starvation.

You can't maintain proper blood glucose regulation when you have erratic meal timings. With erratic meal timings you can go an entire day without eating or not eat enough and then binge later. You need to have predictable meal timings daily in order to regulate blood glucose correctly. When you have predictable meal timings, you avoid going hungry and you avoid eating too much or not enough. That's why it's important to work with your circadian rhythms and eat properly.

Who knows how long you have been having blood glucose regulation issues and never knew about it until it became diabetes. As long as your fasting blood glucose and HbA1C levels are within the "normal" range, your doctor will not deem you as having any metabolic issue. This doesn't mean they don't exist.

Blood glucose disparities can only really be witnessed in real time. That means you would need a blood glucose meter and take readings yourself. People normally do not do this unless they are already diagnosed as diabetic. So the syndrome continues progressing from metabolic syndrome into diabetes, right under your nose.

So make sure you are following a truly low carb diet from now on, one that eliminates sugar and grains in their entirety and keep to your meal timings.

2. I was mortified to see that my endocrinologist now has a YouTube channel and is slowly subscribing to the whole "keto"/fasting fad. The last time I went to see him, he was in the office with me for about five minutes, gave me no answers and simply told me that "fasting is the best thing I can do". WTF?

Well, he won't be your doctor for long unless you're willing to dish out the big bucks when he opens his own quack practice and no insurance will accept him.

Unfortunately, a lot of doctors are realizing that the money is on YouTube, Patreon and their own subscription based websites. It certainly is not in taking insurance. So much for Medicare For All. In order for him to ask for people's money, he has to offer something different than what conventional medicine is so he must become a celebrity fasting quack.

As an endocrinologist, I am surprised he told you that the best thing you can do is fast. I am sure he knows about cortisol, glucagon, leptin, adrenaline, well.... who knows what he knows. It seems like he knows more about YouTube than anything else. All I know, and soon you will too, is that if you follow this crazy advice, your blood glucose regulation will start to fail. You can't starve blood glucose into submission just like you can't starve your fat mass to budge an inch. So I suggest you change endocrinologists pronto. Either way you will have to, when he quits his practice.

The fact that he only saw you for five minutes is another problem. You need to advocate for yourself and get better care from your doctor. You need a doctor that can keep his eyes off YouTube long enough to focus on his patients.

3. Is the science aware what obesity is? Why do they keep telling us to eat less?

The science knows but the science doesn't make good public policy so they hide and/or minimize it. Good public policy is to give people the impression they can lose weight by simply "not eating too much" because they fear the science will only give people an excuse to eat as much as they want since there is nothing they can do about their weight anyway.

This is the logic I consistently run across while researching obesity. In one sentence they will say that obesity is a leptin problem with no known cure and right after they will say they still want people to keep their "consumption" in mind. The truth is in the middle. Obesity is a leptin problem with no known cure and eating Ding Dongs, whenever you want, is not going to help it.

4. How does hyperglucagonemia help with starvation? Does the body purposely down regulate insulin release to keep blood glucose high?

It does not "down regulate insulin release", it under expresses insulin action in various tissues and organs to spare blood glucose for the brain since it believes you're under starvation. It's also sparing it to build more fat. It's simply keeping blood glucose high in circulation as you aren't truly starving but those dips in fasting blood glucose makes the body believe it is. This makes it averse to any lowering of blood glucose. Since insulin continues to be released in large amounts, it's only other option is to cause this under expression which is what insulin resistance is.

Hyperglucagonemia is simply a way of keeping blood glucose high, in the presence of insulin. It prevents insulin from lowering blood glucose to normal. Its real purpose, in a healthy human being, is to keep insulin from lowering blood glucose too low but in the person with metabolic syndrome it's just trying to keep blood glucose from lowering at all.

5. How would starvation affect blood glucose? I know that diet affects it but why would starvation?

Starvation causes an extended time in hypoglycemia. The body likes to keep its blood glucose very well regulated under a narrow range. When blood glucose goes up too high or drops down too low, outside of this tight range, the body reacts immediately. It has multiple glucoregulatory systems that will respond to any disruption in blood glucose and this system adapts. It learns. This learning causes it to proactively respond to any event that effects blood glucose. This is why you see people with metabolic syndrome/diabetes have blood glucose that goes haywire when they eat, when they fast, when they exercise, when they wake up in the morning, when they get sick or are under any stress.

Having chronic low blood glucose and/or being in a state where the body has to chronically create its own blood glucose, just to remain within a normal range, causes metabolism to up the ante on its glucose production. This will in turn rise insulin. This rise in insulin will cause more glucose to be made, as it is further reinforcing the need for more glucose. This feedback loop now feeds itself and metabolism goes into "starvation mode". This simply means it develops a high blood glucose, insulin and body fat set point to ward off starvation. This was all set into motion by the amount of "time in hypoglycemia".

This is why you have to be careful with fasting and make sure it is not extended as it will only reinforce this metabolic adaptation.

6. Can diabetes be prevented with vitamin D?

No. Diabetes is a syndrome caused when the body is no longer able to regulate its blood glucose properly. It cannot regulate its lows or its highs and this is why diabetes is not a disease of "high blood glucose". It is actually the lows that progresses the syndrome. The highs take decades to cause pathology, while the lows are pathological even when they occur once.

People with metabolic syndrome/diabetes oftentimes become low or even deficient in certain vitamins like vitamin C, D and all the Bs. This is the result of excess glucose metabolism which depletes these vitamins. Increasing these vitamins does not cure nor prevent diabetes. Only stable blood glucose regulation does.

Six common beliefs addressed, Part 161

1. Diet is the only thing that determines if you will become obese. 

Obesity is caused by a disruption in blood glucose homeostasis which disrupts metabolic hormones. This can result from anything that interferes in normal blood glucose regulation. Certain diseases, medications, etc. can contribute to this dysfunction which leads to obesity. Anything that disrupts proper blood glucose regulation can be the culprit.

But for the most part, the most common disruption in blood glucose regulation is the result of diet. This is the case for all common metabolic conditions from metabolic syndrome to diabetes.

2. I recently had a wisdom tooth pulled. I have had wisdom teeth pulled before and the pain and recovery time has been horrendous. This time I suffered no pain and no inflammation. I even had antibiotics, along with a probiotic, with no issues whatsoever. 

When you better your metabolic health, you become much more resilient to other conditions that may present themselves. If you already have lower inflammation and better blood glucose control, then when the body experiences stress from illness or injury, it can better handle it and you lower your risk of complications. You have less reactions to antibiotics and if you have to consume a liquid meal or be on an IV, which may contain ingredients you wouldn't usually consume, you will experience less of a set back.

3. When Type I diabetics break down their body, and everything they eat, into glucose they become emaciated if it's not stopped but Type II diabetics can break down their body, and everything they eat too, but remain obese. 

Catabolism from glucagon "gone wild" should produce the same results in Type II as it does in Type I, because they are both suffering from the exact same thing. So why doesn't it? After all, Type IIs can run a blood glucose of 400 - 500 mg/dL and up, chronically, and not waste away to anything at all. What gives? The answer is in their insulin function commonly described as "insulin resistance".

Type Is have no insulin whatsoever, so they don't have insulin resistance. Type IIs have insulin, in some cases too much of it, but it doesn't function properly causing a condition referred to as insulin resistance. Because of this, in a Type I their entire body melts into glucose and ketones but in Type II their lean muscle mass alone, melts into glucose and ketones. Their fat mass is always spared as their insulin function spares their fat mass, above all else. This is a hallmark of insulin resistance. 

For a Type II insulin function is as follows:

• Under release of insulin to halt chronic catabolism into glucose and ketones (glucagon).
• Over expression of catabolic hormones on lean muscle mass (cortisol).
• Under expression of catabolic hormones on fat mass (leptin).
• Insulin action is over expressed in storing fat and preventing its loss.
• Insulin action is under expressed in getting glucose and nutrients into other tissues.
• Insulin action is under expressed in its anabolic effects on lean muscle mass.

As you can see, insulin function effects other hormones as insulin is sort of like the conductor in an orchestra.

So a Type II diabetic is not only a person who might have very high insulin but a person who always has abnormal insulin function. A Type II diabetic's insulin is primed and honed for only one specific task, at the expense of everything else, - the building and preserving of fat mass. So it doesn't matter how much the body catabolizes itself, it never catabolizes its fat mass. For this reason, a Type II diabetic will never lose a pound of fat from this exaggerated catabolic process unless their disease progresses to Type I from pancreatic beta cell failure.

4. Many people with lipedema and/or lymphedema frequent obesity discussions because they claim their conditions are a "type of obesity". 

Lipedema is not obesity nor is it "metabolic" in nature. No one knows its exact cause but it appears to be related to female hormonal changes and/or imbalances. Only about 11% of women are affected by this. For these reasons, it is not subject matter that I discuss on this blog. I know a lot of people like to jump on the bandwagon so people with lipedema are very active in obesity groups. This is where many of these groups begin to lose focus as people with this condition usually have a very difficult time exercising which is a necessary part of any protocol that treats obesity. That's where the concessions begin. 

So the best source of information on this condition is your doctor and/or specialist. There is nothing that I can advise on it as I can't make concessions for this particular ailment. The only thing I can recommend is to try to live a lifestyle that keeps female sex hormones in homeostasis. An anti obesogenic lifestyle would be a good start to achieve this. Having said that, I will briefly give an overview on these conditions for those who are curious. 

• Lipedema is a condition where fat is distributed in an irregular way, usually in the buttocks and legs, causing for the lower body to grow heavy, become tender and even bruise easily. Hence the female hormone suspect, as this is the main pattern of fat distribution in females. This large bottom half will obviously limit mobility.  
• Lymphedema develops when this excess fat blocks the lymphatic system and prevents proper drainage of lymph fluid. This can lead to complications such as infections and non healing wounds. This requires treatment with invasive procedures. 

Like I have said many times prior, just because someone appears "fat", doesn't mean they're obese. Just because someone "gains weight" doesn't mean they're obese. Obesity is an adaptive metabolic state where the body stores and spares body fat beyond its threshold, usually around the middle/central region. This is the result of metabolic syndrome. 

5. If you can't swallow pills, you should still never take gummy vitamins because they have carbs.

First, if your can't swallow pills, you will have a hard lot in life. Outlying situations like these, cannot make the rules for others, as I mentioned above in the question about lipedema. I do not make concessions on this blog. We give advice on the treatment of obesity/metabolic syndrome. There is nothing I can do if something hinders you from following the advice given. The advice does not change. 

Second, we don't "count carbs" either. It is a useless practice that does nothing to treat obesity/diabetes. What you need is an overall low carbohydrate, whole foods diet. Counting the carbs of single food items is not going to cut it. There are many items that have zero to low carbs and are still very obesogenic, depending on how they are eaten. So an anti obesogenic diet is not about carb counting but about overall macronutrient composition, food quality, meal timings and general eating practices. That gummy vitamin is not going to treat your metabolic condition but it is also not going to contribute to it. 

Third, and this part was unsolicited in the statement but I will add it anyway. "Gummy vitamins" are generally not good quality vitamins. You are basically paying for a bottle of "sugar in small doses". When you buy a vitamin you have to make sure that it is bioavailable so they should always be coenzymated. This means the vitamins are bound to the enzymes needed to break them down. This causes your body to actually absorb them, rather than just pee them out. The majority of deficiencies are not caused from "lack of vitamins" per say, but lack of the enzymes needed to get them into cells, either because of some genetic problem or some other chronic condition. 

All minerals should be chelated. Chelated minerals are bound to an amino or organic acid, so they don't require as much stomach acid to be efficiently digested. Most people are deficient in minerals because they cannot break them down due to low/insufficient stomach acid. 

You also have to make sure that you stay away from certain supplements such as "folic acid". Folic acid is a synthetic form of vitamin B9 (folate). It tends to build up in the body and cause issues over time. There are other supplements that pose this same issue because they are synthetic as well or they must be taken alongside other supplements to prevent issues. 

So research your supplements carefully and don't just go to the local pharmacy to pick up a bottle of whatever they have. At best, you will be wasting your money and possibly not treating your deficiency. At worse, you could be harming your health. 

6. I was following "keto" and lost 30 pounds. I felt great. I have now come across "The Proper Human Diet", which I am currently learning about, but my numbers keep going up.

First, I don't know what anyone means by "keto" but since you are now "learning" about "The Proper Human Diet", I can only imagine it was some type of fad protocol you found online. This tells me that you most likely jump from one diet to the next and aren't committed to any one of them. Of course, in this case, you might have done the right thing by dumping "keto". Unfortunately, you remained in the garbage pile and picked up yet some more junk. 

I have said it before that there is no "proper human diet". There are only marketing slogans and improper human diets of which there are only two - vegan and the Standard American Diet (SAD). That's it. Everything other than those two goes. In fact, humans are so adaptable, to any diet available, that they can make vegan and SAD work for them under strict conditions (i.e. supplementation, caloric restriction). These conditions can at least make these diets work for a very long time before they fail. So we have cleared that nonsense. 

Second, people who have overweight/obesity or any level of metabolic syndrome, including diabetes, do better on a carbohydrate restricted, clean diet of meat and above ground vegetables only. This doesn't mean that's the "proper human diet", it just means it's the best diet for someone who has metabolic dysfunction. This is because they can get a better handle on their blood glucose regulation when following this type of protocol. Blood glucose dysregulation is what causes metabolic issues to begin with. Diet has a huge effect on blood glucose regulation so it makes sense to target the problem with diet. 

There are no gimmicks to following a carb restricted diet. You simply eat meat and above ground vegetables. That's it. Meat and above ground vegetables basically becomes a low carb, moderate fat, adequate protein diet. This is the best macronutrient composition for the metabolically dysfunctional. There is no "learning" involved in this. 

Third, I recommend you get your mental health in order before you embark on any diet because you are displaying a very common behavioral issue of the obese - diet mongering. You just keep trying every single diet you come across and since there are multiple reasons for this, I won't guess what yours are. I will tell you this, metabolic dysfunction requires a long term treatment. For a treatment to be long term you must be committed and consistent with it. You shouldn't be looking for a protocol on every click bait title that comes across your screen. You need to actually think through a protocol and see how it fits your lifestyle and goals. 

Fourth, this isn't just about eating. You need to tackle other lifestyle issues that can interfere and hinder progress such as your behavior, described above, exercise regimen and systemic stress reduction.

Six common beliefs addressed, Part 156

1. Sugar and carbs are only not good in "excess". 

Sugar (fructose/glucose) is not "good" in any amount. Why? because it had been shown to be problematic and disruptive to liver and metabolic function irrespective of calories (amount). It does this through a disruption in blood glucose homeostasis. This means that there is no anti obesogenic amount of sugar that you can have. It is all obesogenic, in any amount.

Other carbs like starch, which is basically glucose, are not good in excess. Excess is difficult to determine but if they make up a good percentage of your overall diet, you will have a problem. If they replace protein, you will have a problem. If they are consumed alongside refined fats, you will have a problem. If they are consumed as processed foods, you will have a problem. If they taste sweet, you will have the biggest problem and soon you will be as big as all your problems. You must follow your macros and keep carbs low.

So, overall, carbs must be restricted. Carb restriction will help you maintain better control over your weight than if they were unrestricted.

2. Protein will not raise blood glucose if it's balanced with fats.

That is pseudo science. Avoidance of symptoms is not the proper way of treating metabolic problems.

If you have metabolic syndrome/diabetes, protein will most likely raise your blood glucose but this is not a pathological rise and will correct itself with time. The proper way to address this is by dividing your daily protein into several meals, not adding more fat to the mix. You already have plenty of fat on your behind. Use it.

3. Diabetics should take a lot of supplements. 

We do not recommend specific supplements but we do generally advise on magnesium 400 IU a day and a good quality multi vitamin. If you have been tested and are deficient in anything else, then follow your doctor's advice. Diabetics usually are low in B vitamins so if you want to add a coenzymated B complex supplement, then you can do so. If you are protein averse or simply cannot meet your daily protein goals, then a good quality whey protein supplement would be advised.

4. If you are prediabetic it means you are basically a full diabetic who has it under control enough to stay below the radar. 

Technically, this is correct. If you are watching your diet and incorporating other lifestyle habits, you can control the symptoms of your metabolic syndrome and even prevent it from progressing. But avoiding the metabolic states that contribute to the adaptation, like erratic blood glucose fluctuations, does help reverse the syndrome.

Unfortunately, this is not the case for everyone and that's why there is no cure for metabolic syndrome. I was able to reverse my prediabetes but many others have not, even when doing the same thing I did. Reversal is completely dependent on how much blood glucose control you can obtain and sustain, which will ultimately (hopefully) determine how much body fat you can lose and insulin sensitivity you can regain. Not everyone is capable of obtaining or sustaining their blood glucose regulation to a degree that will cause reversal or remission. The reasons for this are complex and have to do with how your metabolic hormones, fat cells and hypothalamus reacts to treatment.

5. Some people are able to put their diabetes into remission effortlessly, and remain thin, while the vast majority cannot, no matter what they do.

That is the most complicated issue with metabolic conditions, and why most will shy away from giving an answer for it since they have no answers, but it basically has to do with an individual's neuroendocrine response to treatment.

Just like with any other condition, some people respond to treatment and others do not. I have spoken before about the known culprits that can effect outcomes like age, length of disease, co morbid conditions, gender, sex hormone status, etc. Behavior is also a big one which effects the consistency and adherence to treatment. But at the end of this laundry list it all boils down to leptin. How much leptin sensitivity can you acquire and, most importantly, how much can you retain?

Some people can acquire leptin sensitivity very easily and retain it for a long time. Those are the ones that can reverse their condition rather "effortlessly". After all, leptin is the "starvation hormone" and since metabolic syndrome/diabetes/overweight/obesity are starvation adaptations, leptin is the target hormone that can reverse them. Unfortunately, most people cannot become leptin sensitive enough or retain this sensitivity for the long run. This is not good as obesity is a condition that requires a long term treatment.

Leptin function appears to be driven by genetics/epigenetics as leptin is produced by adipocytes (fat cells). Fat cells are unique to every individual and have some heritability. Fat cells also change with time depending on the "metabolic environment" they are exposed to. Add to that the hypothalamic damage, which many obese people end up with, and you are left with a recipe for failure. The hypothalamus is the area of the brain that communicates with leptin. This is why leptin resistance is so complicated since it's not fully understood where it develops (brain or fat cells or both?) or from what exact trigger (obesity alone or insulin resistance or both?). So far, it does not appear to be reversible in the long term for most individuals.

This is why a good sign that your treatment for metabolic syndrome is working is when there is body fat loss. Body fat loss is an indicator that leptin is responding to treatment and if leptin is responding then we can safely assume other hormones are reaching homeostasis as leptin is a slave to insulin, glucagon, etc. This is also why conventional diabetes treatments have such a dismal outcome because none of them induce body fat loss. This means metabolism is still damaged, regardless of how low your blood glucose goes. As long as you're obese, you're sick and have not obtained proper blood glucose regulation.

So when a former diabetic or obese person tells you that they "did all the right things" in order to "cure" themselves, don't buy it. The only right thing that happened to them was a proper leptin response, which they had no control over. This means that whatever they did, does not apply to you unless your leptin can do what theirs did.

6. If blood glucose is kept low, you should not be overweight. 

Well, you're still overweight because low blood glucose is not indicative of proper blood glucose regulation. Until you are able to obtain and sustain proper blood glucose regulation, you will not normalize insulin release/expression and so you will never become leptin sensitive enough to be slim. I explained that in the above question, but let's tackle how this relates to blood glucose as that's a bit more interesting.

The body doesn't see blood glucose "numbers", it only sees disparities. You see numbers because you have a blood glucose meter but the body only goes by homeostasis. Disparities disrupt homeostasis. A drop from a 220 mg/dL blood glucose, postprandial, to 90 mg/dL fasting is the same as if the blood glucose was 85 mg/dL and then dropped to 40 mg/dL. Blood glucose dropping in this manner signals starvation. The body will now actively try to prevent this by keeping blood glucose higher than it should. In fact, it will strive to keep blood glucose high all of the time in order to prevent any drops.

When you stop eating pizza and your postprandial blood glucose no longer goes to 220 mg/dL, your body will still react to your blood glucose lowering from a normal 90 mg/dL to a normal 80 mg/dL. Your metabolism has become adapted to react adversely to any lowering of blood glucose, regardless of its range.

This is why it's so difficult to reverse this metabolic adaptation because it tends to continue even at seemingly normal blood glucose levels. In other words, it doesn't matter how low someone can keep their blood glucose, they seem to never acquire proper blood glucose regulation. The body will continue actively trying to be in a state of hyperglycemia. It takes a very long time to normalize this depending on a multitude of factors, most importantly insulin expression which tends to remain abnormal in certain tissues, even after proper clearance, particularly in the fat mass. As long as insulin is abnormally expressed, blood glucose will continue to fluctuate erratically, even at supposedly normal levels. This is because insulin over expression always drops blood glucose too low during fasting and the body will continue to actively try to prevent this.

How does this relate to leptin and you still being overweight? Well, leptin is a slave to insulin. Obtaining leptin sensitivity so the body can lose body fat is extremely difficult and insulin/glucagon abnormalities do not make it any better. Metabolic dysfunction ultimately deteriorates leptin expression and it is not known if it can be regained. So far the data is dismal and this is why overweight/obesity are still considered conditions with no known cure. This is why the only thing you can do is be one step under obesity. Control works just as well as remission. Keep your blood glucose under control so things do not become worse and with time, everything might follow suit.

Six common beliefs addressed, Part 129

1. Will taking the proper supplements help treat obesity?

I don't sell supplements, so I don't push any. Supplements do nothing for obesity, so I suggest that you have proper testing done to see if you are deficient in any vitamins or minerals and then supplement accordingly. 

If you are diabetic your insurance will most likely cover testing for vitamin D and B deficiencies. If you are taking certain medications, such as a statin, your insurance might cover testing for CoQ10. The same applies to any other medication, you might be taking, that can interfere in the absorption of certain nutrients. Make sure that the testing is not just serum testing, but intercellular testing. After all, if the vitamins are not getting into the cell itself, then your serum values are meaningless. Intercellular testing may or may not be available at your preferred laboratory and/or covered by your insurance so if you are unable to test this way, keep in mind that you will not know if you have a true deficiency or not.

Things to consider about popular supplements: 

• Good quality multi vitamin - You can take one of these a day, since the food supply is lacking in nutrients due to soil depletion associated with agriculture. Make sure that the brand you choose uses co-enzymated vitamins and chelated minerals. That's what will ensure you will actually absorb them into the cells as many people lack the appropriate enzymes to break down vitamins and minerals, especially if they have a metabolic condition.
• Electrolytes - Very important to make sure that you treat your electrolytes as a fourth macro. This is vital for people on low carb diets, especially very low to zero carb diets. 
• Protein - If you can't meet your protein requirements for the day, from meat consumption, then you have to supplement with a good quality whey protein. This is especially true if you are trying to lose body fat and are consuming farmed animals. The only truly lean meat is wild game. That's the meat that gives you the most protein with the less fat. Other than that, you might start gaining weight if you try to eat your required protein from farmed animals as you can easily go over your daily fat allotment. Make sure you are taking whey protein, not soy or pea protein or individual proteins like collagen. Collagen alone does not count towards your daily protein requirement. You need complete protein. 
• Fish oil - People who do not include organ meats, as a staple in their diet, and also do not consume much grass fed meat or milk, should consider a fish oil supplement for their Omega 3. This is especially true if you have or are at risk for macular degeneration. 
• Magnesium - It doesn't hurt to take a 400 IU tablet of magnesium citrate a day if your multi vitamin does not contain it. Magnesium is one of the first minerals that is depleted quickly on low carb. 

Other than these, you don't need to consider any other supplement, unless you have been diagnosed deficient. 

2. When you crave something sweet, try a "keto" brand treat. 

We don't entertain "cravings" on this blog. Feeding a "craving" is feeding a disordered eating habit. This blog is serious about the treatment of metabolic conditions and/or obesity.  

3. I have been hesitant to try "low carb" because I have a crazy sweet tooth.  

Luckily you have two choices. Pull out your tooth or remain overweight. 

4. You should always calculate how long your eating window should be.  

You don't calculate how many hours of eating you should have. You calculate how many hours of fasting you should do. You should be doing 16 - 18 hour fasts daily. That's the basic, general recommendation. Now there are exceptions to this. Some people do not do well on 16 - 18 hour fasts. They simply cannot fast that long, so it is recommended for them to do a daily fast of no less than 12 hours. 

Your fasting routine should be based on results. During the hours that you aren't fasting, you should have two to three meals. This is why we don't like to describe this as an "eating window", though it is often referred to this way. It is not actually an "eating window". It is a time period when you consume your two to three meals. That time period occurs on the hours you aren't fasting. 

5. I need to drop 10 pounds, but I find it's impossible to do. 

You don't "need" to drop anything except that bagel, if you are still eating them. What you need is to not be obese and if 10 pounds is all you think you need to drop, then you are certainly not obese. This means that you need to stop focusing on your 10 pounds and instead focus on how to stay lean and not become or return to obesity. That's the real struggle ahead. 

6. I am considering low carb and what's winning me over is the fact that I don't have to track calories. 

A lot of people say this because they assume that since they don't have to track calories, they don't have to track anything and can eat limitlessly, as long as its "low carb". That's not how low carb works. 

There is a subset of people, like myself, who can eyeball their food, eat to satiety and not track anything while still achieving results. This is particularly true for people who never had disordered eating habits. For us, eyeballing the composition of the plate is enough to be at low carb, adequate protein and moderate fat, but this is simply not the case with everyone. There are many factors that play into this like eating habits and satiety signaling. 

For this reason, the majority of people will have to track their macros and tracking macros is much more complicated than tracking calories. You have to determine your macros using the right calculator. You might also require supplementation in order to hit your protein goals. Even after all of that, some people still require the tracking of calories in addition to their macros. The correct way of tracking macros can be found here.

A lot of people are really annoyed at having to do all of this and also not be able to eat pie and cake. With calorie tracking you get to at least keep your favorite foods as you track one simple number - calories. So, just because you aren't tracking calories doesn't mean it's going to be easier for you.

Six common beliefs addressed, Part 125

1. If you follow a protein sparing modified fast protocol (PSMF) for too long, it might damage the gallbladder or cause other health problems.

That is incorrect. Hunter/gatherers never used added fat on any of their food and they are perfectly healthy. PSMFs are low carb, low fat diets. It’s not a “no fat” diet. There is no such thing as a “no fat” diet. 

 

The only people who would have adverse effects, following these diets, for a prolonged period of time, are the ones who are only eating the muscle meat of very lean, wild game while having low body fat to begin with. So, if you are following a very low fat diet or PSMF, you are fine as long as you have excess body fat to lose.

2. The food industry continues to push grain products, which hurt people’s health.

This is because people want them. The operative word here is "industry". They make money selling products that people want. 

3. You should have your first meal at 12 noon. 

The problem with breakfast was never the breakfast. It was the breakfast foods. You would think that people would have figured this out by now. It's a no brainer. 

Like I have said before, it doesn’t matter what times you plan your meals or fasting. You can schedule it whichever way your circadian rhythm prefers. Just be consistent with your times and follow them daily. Do not be erratic. 

There is an advantage to earlier eating times, simply because of how insulin functions, coupled with the overnight fast. Not being hungry in the morning has always been associated with active obesity, but at the end of the day, it doesn’t much matter. Just be consistent and don’t deviate from your eating/fasting schedule. 

4. It is very dangerous to have low Vitamin D levels. 

Everyday a new quack is coming up with a new vitamin that they claim will save you from death and cure all your ailments. This seems to occur in cycles, like fashion designers who will periodically bring back bell bottoms. Sometimes its Vitamin C, other times its Vitamin E and I am sure we all remember the CoQ10 craze or the Vitamin K hysteria. It seems like Vitamin D is back in the mix of things. 

The bottom line is that the research hasn’t shown any significant difference in supplementing with Vitamin D or not, unless the person has rickets. No one knows exactly why this is the case. Genetics seems to play a big part on what your Vitamin D levels are and how its used in the body. Why some ancestries seem to maintain such low levels, while still being perfectly healthy, is not well understood. The only thing that is known, is that people with metabolic disease seem to deplete their B, C and D vitamins. It is very common for these individuals to have very low levels of these vitamins and that's due to metabolic dysfunction and the burden it puts on these specific vitamins. 

It also kind of explains why supplementing has not been shown to be effective. After all, if there is a hole in your sink and you are losing water, adding more water to the sink is not going to help. The more you add, the more you lose. Well if your metabolic function is depleting these vitamins, the more you supplement, the more the body will use and you are right back to square one again. You have to fix the hole in your sink, just like you have to fix what’s depleting your vitamins. So, you have to focus on fixing your metabolic dysfunction and if you want to supplement in the interim, go right ahead. 

We don’t discourage supplementation. We just don’t agree that these vitamins are the “cure all” of anything. They aren’t. Only a healthy metabolism improves your overall health significantly. 

5. If you follow "keto", you will not get diabetes. Especially if you keep carbohydrates below 20 grams a day and from above ground vegetables only. 

If you follow "keto" and it helps you obtain and sustain proper blood glucose regulation, you will not get diabetes. That is the only metric that matters - blood glucose. Nothing else does. It doesn't matter how you can obtain and sustain your blood glucose regulation. When it comes to metabolic health, the ends always justify the means.

6. A blood glucose level of 53 mg/dL is perfectly fine because your body is burning fat. That is why you have no symptoms of low blood glucose. 

That is hypoglycemia. Blood glucose should be around 84 mg/dL and not much lower than that. Unlike what “keto” advocates online say, having no symptoms from blood glucose that has dropped to hypoglycemic levels is not normal, as a blood glucose that low is not normal. 

It is not true that you are not having any symptoms because "you are running on fat". That is ridiculous and has nothing to do with what’s occurring because regardless of whether the body runs on fat or not, it likes to keep a very tight range of its blood glucose. That range is always around 84 mg/dL. So, even if you are running on 100% fat, your body will continue to keep its blood glucose at around 84 mg/dL, if it’s healthy. 

Having no symptoms of hypoglycemia is called ‘Hypoglycemia Associated Autonomic Failure’ or simply ‘Hypoglycemia Unawareness’. This is common in people with metabolic syndrome/diabetes, since their metabolism is adapted to the erratic highs and lows of blood glucose and their autonomic nervous system (ANS) no longer responds to drops in blood glucose levels by activating counter regulatory hormone action or any symptom of malaise. Many diabetics, unfortunately, die from this condition which tends to occur more often during the overnight fast. The exact mechanism of this phenomenon is still largely unknown. 

If you are experiencing this, you need to find out why your blood glucose is going so low. Get this checked out immediately by a healthcare professional in order to determine if your blood glucose is dropping because of some medication you might be on, while also following a low carbohydrate diet. Your medications might need to be changed, but you absolutely have to tell your doctor that you are experiencing no symptoms of this blood glucose drop.

Six common beliefs addressed, Part 107

1. Before wheat was hybridized, it was fine to eat.

Wheat was never “fine to eat”. It has always been a highly processed food. Just ask the people who ferment and grind their own non hybridized wheat. It is a very time-consuming process. This is because we were simply never meant to eat grains. It supplemented the food supply to prevent starvation, during times of scarcity, and it was much easier than hunting. People rather waste time than energy. 

Agriculture made food predictable and easy. Regardless of how it's processed or how ancient the seeds are, wheat is not the type of food that you want included in your diet. 

2. Are triglycerides a more important measure than blood glucose for determining metabolic health?

That depends. If you suffer from hyperglycemia, you do not want to neglect your blood glucose and only focus on triglycerides. Triglycerides allow you to get a glimpse of how much energy is in your body. They are a measure of blood fats and if you are fasting with a high concentration of them, it means that you are in a state of energy toxicity. But no one marker is good enough to tell you much of anything. You have to have a complete view of your metabolic state by tracking multiple markers. 

For instance, fasting blood glucose tells you nothing on its own. You want to know your insulin levels as well. The same applies vice versa. Knowing your HbA1C, alongside your insulin and blood glucose, also begins to paint a clearer picture of what can be going on in your body. There are very obese people, with extreme hyperinsulinemia, who have perfectly normal triglycerides. Their liver is simply not releasing many lipids into the bloodstream. It’s most likely hoarding them all within itself. So, context is everything. 

You need a complete metabolic panel, with multiple tests, along with body fat percentage, to really get a full picture of your metabolic state. 

3. When I wake up in the morning, I am nice and slim, but by the time evening comes, I look fat and bloated. 

This is normal and happens to everyone. You wake up dehydrated and that’s why your pants fit so nicely, but your busting out of them by nightfall. You even shrink an inch in height, as the day goes on, from the effects of gravity on the body. As you eat your meals during the day, water retention and digestion affects your waist circumference. 

For this reason, you should always measure in the mornings, while still fasting, to get a more accurate reading. 

4. Can supplementing vitamins help improve metabolic disease?

People with metabolic problems are usually deficient in the B vitamins and also in vitamin D, amongst other things. This could be because the person simply loses their ability to uptake these vitamins, due to enzyme depletion, or it could be the result of an overworked metabolism that depletes these vitamins quickly, due to high glucose. It could also be the consequence of insulin resistance. Insulin is required for the uptake of nutrients. The bottom line is that their metabolic problems were not caused by the deficiency. Instead, the deficiency was caused by the metabolic problems. The root cause is the metabolic problem. 

Once metabolism is healed, these deficiencies, slowly but surely, correct themselves unless the person has some other underlying condition, such as celiac disease. So, you can supplement to help your body along, but not with the expectation that it will resolve your metabolic issues. You must resolve your metabolic issues first, before the deficiencies are corrected. 

5. Should you take iodine if you have thyroid problems?

I do not make recommendations for supplements of this type. What I do recommend is that you find yourself a very good endocrinologist. Do your homework and make sure that who you choose is willing to listen to you and take your symptoms into consideration. Personalize your treatment, as much as possible with your doctor. Do not accept cookie cutter diagnosis or treatments. Your doctor should take into consideration your past and current metabolic status in order to determine the right treatment for you because this status changes the context of all treatments. Thyroid treatments that work for a metabolically healthy person, will not for a metabolically abnormal person. 

The thyroid is a major metabolic regulator and so your current metabolic state determines what treatments will be effective. For some people, no treatment is necessary as their thyroid numbers correct themselves when their metabolic state improves and the body adjusts to fat loss. This, of course, would not be the case for autoimmune related thyroid diseases. 

Do not take any type of supplement without discussing it with your doctor first. Certain thyroid diseases become worse with iodine supplementation or the iodine is simply not utilized, making it ineffective and supplementing useless. 

6. Low carb is as easy as just eating foods that are "high in fat and low in carbs".

Low carb is as easy as low carb. It is not more complicated than that. The macronutrient of concern is carbohydrate. Keep carbohydrates low and don’t add fat. Keep fat natural and moderate, as you have always consumed it before going low carb. Fat is not eaten purposely on true low carb diets.

Six common beliefs addressed, Part 78

1. You should not consume supplements during your fasting hours.

It depends on the supplements, but it's preferable to consume supplements with your meals, unless the supplement cannot be taken that way. Most supplements though, are best taken with food for better absorption.

2. Is vinegar okay to consume during fasting hours?

In this group, the only thing you can consume, while fasting, is water. Nothing else. After all, you are fasting.

3. Being overweight/obese does not automatically mean you are sick. 

Yes. Excess body fat is an indication that the body is under metabolic stress and has adapted a hormonal profile that is causing it to do, what you do not want it to: grow fat mass beyond its threshold and spare it.

For some people, this can cause pathology quickly, even before they appear overweight externally. For others, it can take years, to decades, before they develop any pathology, at all, and they can acquire an extremely large fat mass in the interim. For some of these people, the fat mass itself kills them before they develop pathology, due to the loss of mobility and crushing weight.

Excess body fat is the start stage of the condition. Diabetes is the end stage.

So, don't fall for what these obese, low carb advocates are trying to make you believe. I know that admitting their diet hasn't worked, and they are still sick (obese), is bad for business, but don't let that become your problem. That's their problem to deal with. You need to find a way to lose body fat, because until you do, you are still sick.

4. Only blood glucose determines if you are insulin resistant, so if you can keep it low, you have nothing else to worry about.

Lowering of blood glucose does not magically regain insulin sensitivity. This is because metabolic syndrome is not a condition of high blood glucose. It is a condition of poor blood glucose regulation. You can still have poor blood glucose regulation, at lower blood glucose levels. In fact, metabolic syndrome is insulin resistance at lower blood glucose levels than a diabetic. This is because the erratic and large disparities between postprandial and fasting blood glucose remains, driving the condition and finally progressing it to diabetes. Insulin's handling of this erratic blood glucose is what causes insulin resistance.

The pathology is actually driven by the lows in blood glucose, not the highs. It's these lows that cause metabolism to drive up the set points of blood glucose, insulin and body fat. So technically, trying to drive your blood glucose low worsens the problem, rather than solves it. You want to keep blood glucose steady, without the large disparities between highs and lows. You are much better off keeping blood glucose steady at higher levels, than driving it low and then watching it rise again after eating or exercising. 

5. The body is not so stupid that it will break down its lean muscle mass, while having plenty of stored fat to use.

Yes, it is. In fact, this stupidity is known as diabetes.

Diabetes is a disease of high body fat, while continuing to chronically catabolize lean muscle mass, at an exaggerated rate. Even the obese, without a diagnosis of diabetes, continue storing fat, even though they have plenty in storage to burn. Stupid indeed, but still reality. The body does a lot of stupid things, like attacking itself, growing old, failing for no apparent reason and finally dropping dead, though it's lived long enough to have gotten the gist of how to stay alive.

Intermittent fasting does not have a significant effect on this catabolic process because it is simply too short of a fast to make much of a difference. Extended fasting absolutely does have a negative effect and the more metabolic disease you have, the worse this effect is. All the benefits of fasting are seen with intermittent fasting only.

6. Athletes do not do well with fasting.

So far, it appears to be that they actually do. This is because athletes do not do extended fasting nor do they restrict protein, as they do not want to lose their lean muscle mass.

But, this is a metabolic health blog, not an athletes blog. I try to refrain from comparing athletes to non athletes, especially diabetics, as the context is completely different between the two. My advice is specifically for people with metabolic syndrome.

Six common beliefs addressed, Part 16

1. I am tempted by delicious fast food. Are there any quick "keto" meals?

No. The only quick "keto" meal that exists, is body fat.

2. I need a cheating day in order to continue this diet.

You are only cheating yourself. If you chose to commit to this new lifestyle, there is no such thing as cheating, except on your own health. If you are still needing to cheat, because this new lifestyle is too difficult to follow, or the benefits are not worth it, then you might not be ready for a change.

3. I am always hungry.

Hunger is subjective. A lot of people claim to be hungry, when in reality they are just craving a certain food item or wanting the experience of having something to eat.

That doesn't mean that there won't be times when you will be legitimately hungry. You may be hungry when you begin a new diet , because the body has not become hormonally adapted to it yet. You can become hungry during your fasting times, if your fasting regimen is occurring at the times that you use to eat. When circadian rhythms are changed, the body will still send out the same signals as it did before the change. If you always ate dinner and you don't any more, expect to be hungry around dinner time, until the body adjusts.

Hunger is not abnormal or an indication that your lifestyle is not working. It's a natural state for the body to be in and it's driven by all sorts of reasons. In the modern Western world there is only one reason it is not driven by - need.

4. Are "healthy fats" important?

Healthy fats or natural fats are superior to man made, industrial fats from "vegetable" oils. They are recognized well, by the body, so they are cleared efficiently and they transport needed vitamins properly. That's the only importance they have. They do not make any contribution to weight loss.

They are not a vehicle of satiety and should not be used as such. Protein is the macronutrient of satiety. Fat should also not be used as "fuel". The most important part of your diet, which contributes to weight loss, is carbohydrate restriction, so you can use your own body fat as fuel.

5. Are supplements necessary?

The only times supplements are necessary is when you are deficient in a particular vitamin or mineral. You need to discuss, with your healthcare provider, the appropriate tests required to determine if you have a true deficiency. You can guide yourself by conventional medicine values or you can get a second opinion from a functional medicine doctor. In conventional medicine, values that are deemed as "normal" do not necessarily reflect optimal. Conventional medicine uses, as normal values, the absolute minimum values that the body can have without showing signs of disease. You do not want to live just one point above disease, you want to live optimally.

You also want to make sure that you do not just check serum (blood) values. You need to know if the vitamin or mineral is actually getting into your cells. You might have a high serum value, of a particular vitamin or mineral, making it appear that you aren't deficient. In actuality, your serum values are high because the vitamin or mineral is not making it into the cell where it's needed. Your healthcare provider should be aware of this, and if they aren't, you need to remind them before they order your tests. Aside from, or instead of, serum values you need to check intracellular values, known as RBC values.

Another reason you do not want to supplement yourself, without professional advice, is because certain vitamins and minerals only work properly in the right environment. For instance, calcium supplementation has been found to increase mortality. This could be because calcium alongside high inflammation causes health issues, but calcium without inflammation is beneficial. In this context, there was a reason the body was keeping its calcium low. It was protecting itself from it. When a certain vitamin or mineral is low, there can be a biological reason for it and not necessarily a "deficiency". Vitamins and minerals also work alongside each other. You might be low in Vitamin D, because you're deficient in Vitamin K2 and/or K7, not necessarily because you need more Vitamin D.

People who are practicing a ketogenic lifestyle often times become deficient in Magnesium, because low insulin levels cause low water retention. Taking a 400 IU of Magnesium, is often recommended to ward off muscle cramps.

Electrolyte supplementation is a must for many people who follow carbohydrate restriction and intermittent fasting. Because electrolytes work together and too much of them can be as harmful as too little, you should consult with your healthcare provider to obtain a recommendation.

Modern food is often too low in vitamins and minerals, so if you are concerned with this, you can take a good quality, co-enzymated and chelated multivitamin.

Always consult with your healthcare provider about any supplements you intend on taking.

6. Is a plant based diet healthier?

There has never been any proof of this. The only proof available is that when you are mindful of what foods you eat, eliminate junk foods, exercise and implement other healthy practices into your lifestyle, it reduces the occurrence of the "diseases of civilization" and extends lifespan. You can do this eating only meat, if you wish.

Meat has all of the bioavailable vitamins and minerals, needed for a human being, complete protein and useable Omega 3 fats. It also has all of the fatty acids required for vitamins to be absorbed properly. The human body does not need anything else. It makes its own antioxidants, it does not have any need for fiber and it requires very little Vitamin C, in the absence of grains and sugar.