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.

Six common beliefs addressed, Part 144

1. It is not difficult to get rid of fat from around the waist because visceral fat is the first to go. 

The waist is usually where subcutaneous fat is also stored. The body doesn't like storing fat on its limbs as this reduces mobility. This means that the waist is up for grabs. We can all reach down and grab some fat from around our middle. This is the normal location for fat storage. 

Women also store fat along the hips, buttocks and thighs because women have a body that is designed for more fat storage. So even if you lose all of your visceral fat, you might still have the infamous muffin top.

2. My insulin is very high but my HbA1C is 5.4. 

Well, I don't know just how "high" your insulin is because you didn't provide a number. What I do know is that an HbA1C of 5.4 is on the high side. 

Your "high" insulin is controlling your blood glucose for the time being, but sooner or later your insulin to glucagon ratio will deteriorate and your blood glucose will begin to rise, regardless of your insulin levels. When your body can no longer produce enough insulin to control this rising blood glucose, your doctor will put you on exogenous insulin or medications that force the body to output even more insulin and/or eliminate more glucose. 

You have to take control of this impending train wreck as soon as possible by actively trying to lower both insulin levels and your HbA1C. 

3. Bad dietary protocols are continued to be advised, even though they don't work.

Because most dietary protocols are based on compliance, not reality. For this reason you see the same protocols, making their rounds every few decades, reinvented, renamed and revamped but at the end of the day they are all the same BS with a new name. 

Most dietary protocols are based on calorie in/calorie out (CICO) models, whether it's directly or indirectly, by using portion control or even time restricted eating. No protocol wants to recommend the elimination of anything. It's all reduction or replacement. 

Like I have said before, as long as "weight loss" protocols are profit driven, results are not necessary. Empty promises and temporary benefits are all they have to deliver to bait people in. Baiting people in, is very easy. Overweight/obesity is a common problem that many people want to "fix", so as long as there is a demand for a solution, more diet protocols will continue popping up. But the reality is that, as of the time of this post, there is no known cure for overweight/obesity. 

4. My insulin has lowered and my blood glucose is stable but I’m having a horrible "stress response" where I’m jittery, can't sleep and often hungry.  

Those are all signs of systemic stress. This is normal as your metabolism is primed to keep higher insulin levels and higher blood glucose in response and vice versa. Breaking that feedback loop will cause side effects as the body actively fights to keep its blood glucose set point. 

Give it some time and allow for your hormones to stabilize and follow suit to your insulin's new lows. It will stop fighting this with time. In the meantime make sure you get plenty of steady state exercise to help signal to the body that it needs to burn energy and that the new low insulin and blood glucose levels are normal. You also have to keep your electrolytes in mind and make sure you aren't going deficient. 

5. I began following a "conventional" diet and was able to lose weight and lower my weight set point.  

This is the case for any diet. As far as obtaining a new weight set point is concerned, wait to make that claim a year from now. It takes a long term dietary regimen to reduce weight set points, from overweight/obesity, and conventional diets can not be followed long term to achieve this. 

Also, "weight set points" are fluid and constantly changing with age, environment and metabolic status. They aren't written in stone. The set point you had at age 15 will not be the same at age 50. So weight set points can be modified, for a span of time, but not permanently. In normal metabolism weight set points will keep for about a decade and then slightly change to a higher or lower point. 

The reason that it might appear as though the diet has worked wonders, for the time being, is from an effect on leptin which can enhance its expression temporarily and cause weight loss. Maybe your diet has a different macronutrient composition that triggered this effect. For example, diets that include carbs can trigger a leptin effect because of their rise in insulin levels which signal to the body that there are enough nutrients. Carbs also cause the person to eat more often or more food in general and this also causes leptin to increase temporarily from a blood glucose rise. 

Like I have stated before, weight loss can occur from a caloric deficit as well as a caloric surplus. Both trigger different hormones. It's what occurs in the long term that effects the end results. Triggering leptin in this manner only has a temporary beneficial effect until insulin levels begin to rise and its function deteriorates once again causing overweight/obesity to follow. 

6. You should not supplement with Lite Salt for more potassium because it contains dextrose. 

A good alternative is Lo Salt, which is nothing but potassium bicarbonate with no fillers. It is a bit more difficult to find but you can order it off Amazon or find it at Whole Foods. 

Lite Salt is a low sodium salt that is used by people who are on some type of sodium restriction. Because it is mostly potassium bicarbonate, people who want to supplement potassium use it as well. It is the safest way to supplement potassium as potassium supplementation should be reviewed by a doctor. 

Lite Salt contains dextrose as its a conventional iodized salt mixed with potassium bicarbonate. This doesn't mean you have to stop using it if its a good way for you to increase your potassium safely and you can't find the alternative. You can use it on specific items rather than as your main salt. For example, on certain dishes or to mix an electrolyte drink with. Dextrose comprises very little of this salt so it's not enough to make a difference, especially when the rest of your diet is low carb.

 

Metabolic syndrome is the result of poor blood glucose regulation. It takes much more than some dextrose in salt to cause it. 

Six common beliefs addressed, Part 131

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Six common beliefs addressed, Part 51

1. Are bananas deadly?

People love to point at something and yell “Witch, burn at the stake!” But, being overly dramatic will only cloud your critical thinking skills.

Bananas are not the devil, nor the cause of obesity/diabetes. They are simply an unnecessary food, which disrupts proper blood glucose regulation. Modern bananas have been cultivated to contain more fructose than they otherwise would and they will only end up replacing much better food options, if you insist on including them in your diet.

So, if you have metabolic disease, put the banana down and if you are healthy make sure bananas are only part of an overall low sugar diet so you can keep blood glucose levels healthy.

2. Dietary cholesterol does not raise serum cholesterol.

You might have heard this before. Low carbers love to quote Ancel Keys, the father of the 'Diet Heart Hypothesis', admitting to this very fact. It makes them think they have discovered a "Gotcha!" moment, where Keys admits he was wrong.

But, there is no "Gotcha!" moment and no admittance of anything. It is absolutely true that dietary cholesterol does not raise serum cholesterol, because it’s dietary fat that raises cholesterol, not dietary cholesterol.

3. Medications have no role in treating metabolic disease.

For some people, lifestyle changes alone are enough to achieve remission, but for others they're not and they must resort to medications. Medications should only be complementary to lifestyle interventions, for individuals that have had no, or too little, results from dietary treatments alone. Medication should never be your sole course of treatment, because they will not be able to improve blood glucose regulation on their own. Do not think medications can do your job for you.

For people who must take medications, dietary and exercise interventions must be included, as part of their therapy, to avoid further deterioration of health.

4. Will fasting help lower my weight set point?

Weight set point is determined by leptin and leptin does not respond to fasting, except in one way - lower insulin levels.

Leptin is a slave to insulin and normalizing insulin levels helps normalize leptin, but fasting without a significant effect on insulin will not help regulate leptin. If anything it makes leptin worse. That’s why you need a fasting protocol that lowers insulin without adversely affecting leptin. That’s only achieved through fasts of short duration. 

5. The world is obese, so there is no more world hunger.

World hunger is on the decline. Some people have made the claim that it no longer even exists and the only hunger left is the one created by governments, since we have the ability to feed the world. But, this is a misnomer. One of those "half truths".

Yes, there are plenty of calories available, to feed the world and then some, but the entire planet is protein starved. Hunter/gatherers consume three times more protein than a Westerner on a typical modern diet. So, everyone has plenty of calories, but poor metabolic health to show for it. When it comes to nutrition, it’s not about quantity, it’s ultimately about quality.

6. If you fast for weight loss, drinking tea or coffee is fine, but if you fast for autophagy, then it should be water and salt only.

Fasting is when you consume nothing but water. Period. As long as you are consuming anything with taste or calories, you are by definition, no longer fasting. There is a more appropriate term for drinking while fasting, it's called liquid dieting. Consuming low liquid calories is not fasting, it’s caloric restriction juicing. Changing the definitions of things to fit a narrative won’t work.

Obesity is a condition of poor blood glucose regulation, so if you are tasting things and consuming calories, while fasting, you are stimulating blood glucose. You will not become adapted to not eating if you continue this annoying and very asinine practice. The path to correcting something is to change it, not coddle it.

Autophagy is a process that the body goes through daily. It has nothing to do with obesity. There are different levels of autophagy that the body performs and they are triggered by different conditions. Whether the body does it effectively or efficiently is based on metabolic status. You will not obtain a good metabolic status if you keep eating/drinking while fasting, which is basically snacking. Keep your focus on obesity and keep the silly marketing ploys for day time TV.

Six common beliefs addressed, Part 1

1. Are foods that cause an insulin spike "bad"?

All foods cause insulin "spikes" (release). A chronically high insulin level is what's "bad" because it drops fasting blood glucose too low. The most common cause of chronically high insulin levels are carbohydrates, which dysregulate blood glucose and cause prolonged insulin release postprandially.

The body is supposed to have insulin spikes after it eats. Insulin regulates how your body uses glucose and nutrients. If this doesn't occur, you die. Insulin also regulates glucagon. If it wasn't for this regulation, glucagon would eventually break down every part of your body into glucose and ketones. Insulin helps build muscle and muscle is the most metabolically active organ in your body. Muscle helps clear glucose from the bloodstream.

But, insulin was meant to be released by the body in pulses, not constantly. It is supposed to go up after eating (postprandial) and then come back down during periods of not eating (fasting). When you eat foods that do not disrupt blood glucose homeostasis, insulin is allowed to work in these pulses. So, the spike is not what matters, as long as insulin is allowed to come down again to very low levels when fasting, so it doesn't drop fasting blood glucose too low.

• The most insulinogenic foods, on the planet, are dairy proteins. When you drink a cup of milk, it causes an initial, very high, insulin spike, but it lowers shortly afterwards. Though it causes a large insulin spike, it does not cause prolonged insulin release. By the time your next meal comes around, your insulin has already lowered. You are able to maintain normal fasting blood glucose.
• When you drink a glass of orange juice, which is mostly sugar, the disruption to blood glucose causes for insulin levels to rise and remain that way, for a prolonged period of time, afterwards. In this case insulin must remain high, because it is desperately trying to clear out the high dose of glucose caused by the orange juice. By the time your next meal comes around, insulin is still high and will now go even higher after you eat again. All of this insulin will drop fasting blood glucose too low, overnight. You are unable to maintain normal fasting blood glucose.

The milk is not obesogenic, but the orange juice is because when you cannot maintain normal fasting blood glucose, the body will begin to store body fat. To control this obesogenic hormonal state you do not avoid insulin release, you avoid prolonged insulin release. The body disposes of insulin pretty quickly, but not when glucose continues to go high postprandial. Glucose is the signal, for the body, to keep its insulin levels elevated. Eat foods that do not cause abnormally and prolonged high glucose levels and you will automatically be on a low insulin diet.

2. Is milk better than cream?

Neither one is better than the other. Reduced fat or skim milk is what you should avoid.

When you take away the fat in milk, you concentrate its protein and carbohydrate, making it an unnatural, man made drink which can disrupt blood glucose homeostasis. Milk is naturally mostly fat and must be consumed in its whole form. If milk's naturally, high fat profile is something you wish to avoid, then avoid milk itself, but do not revert to drinking altered varieties.

A recent study has shown that the neuroprotective benefits of a ketogenic diet are not derived from the presence of ketones themselves, but from the metabolism of the fatty acids in MCTs (medium chain triglycerides). The vast majority of these beneficial MCTs are found in dairy fat, goat dairy having the highest concentrations of these fats like decanoic acid.

Whey protein, found in milk, which is highly insulinogenic, is the most powerful stimulator of glutathione. Glutathione is the most potent antioxidant in the body. This can be found in full fat cottage cheese.

There is no question that those of us who consumed dairy had an advantage. All dairy has benefits, not just cream. The dairy you choose just has to be full fat and preferably organic and grass fed, in order to obtain the maximum benefit from its fat and protein profile.

3. Can using a blood glucose meter help you lose weight?

Yes. 

A blood glucose meter can help you determine if you are on your way to metabolic dysfunction or already have it. This is because it allows you to view, in real time, changes in your blood glucose regulation and what could be causing it.

4. Are foods that contain the most fat, the best to eat?

No. 

The foods that do not disrupt your blood glucose are the best to eat. Because fat has a minimal effect on blood glucose, it is often perceived as the best choice but fatty foods come with their own negative metabolic effects, particularly if you have leptin resistance. Fat also has an effect on insulin, in the long term, because it still has to be stored.

5. Does how much you eat determine your body's weight set point?

Weight set point is determined by the communication between leptin, your fat cells and your brain. Leptin communicates how much stored fat you have and at what rate it's being used. It is the body's weight thermostat and it is controlled through insulin regulation. Two abnormalities occur in high weight set points and each one is a direct result of the other:

• Too Much Body Fat - The person has fat storage that goes well beyond their personal fat threshold. The more fat cells you have, the more leptin is created. Chronically elevated leptin develops "leptin resistance". This is especially true in a sedentary state.
• Chronically High Insulin (Hyperinsulinemia) - When insulin levels remain chronically high, they interfere with leptin signaling in the central nervous system and cause fat mass to remain set to high. This causes for the body to fight to preserve its fat mass, at this higher weight set point, regardless of the person's efforts to lower it or their current state of obesity. Even a trivial amount of weight loss is enough to trigger a metabolic reaction of slow down, when insulin levels remain elevated.

There is debate in the literature as to the sequence of events in this pathology. Some believe the problem lies primarily in leptin, some in the fat cells, some in the brain itself. As far as you're concerned, whatever the reason and whatever came first, the result is the same. The body is having a starvation response, when it shouldn't be having one, as it still has plenty of fat mass and is far from starving. The communication with leptin has obviously broken down, at some level. What is actually stored, is not being communicated to the brain, so it's not being burned and even further storage occurs instead.

More than likely, the miscommunication in leptin signaling is caused, primarily, by hyperinsulinemia and/or abnormal insulin expression at the fat mass. This chronically elevated/expressed insulin causes a metabolism that is set to conserve energy, not burn it, as all obesity is mitigated through insulin receptors at the fat tissue. Insulin resistance is always greater at the muscle and liver, than at the fat mass.

This means that you need to keep insulin normal and the only way to do that is to maintain proper blood glucose regulation. Blood glucose is the first domino that drops, causing a very complex, system-wide pathology afterwards. Stable blood glucose helps insulin normalize and improves leptin signaling, since insulin has a profound influence on leptin.

6. Should nutrient density be the main focus of a diet? 

Proper blood glucose regulation is the only metric of a good diet. 

If you have scurvy, beriberi or some other nutritional deficiency disease, then you would need to address those with the right supplementation. Obesity and metabolic dysfunction are not nutrient deficiency diseases. They are diseases of improper blood glucose control.

Metabolic dysfunction often leads to the inability to properly use certain vitamins, like B vitamins, but eating more does not solve this problem. You must correct the underlying metabolic dysfunction, which is the root cause, in order for the body to use these vitamins again.

Focusing on nutrient density, without a properly formulated diet, causes for two obesogenic dietary practices to occur:

• Incorporation of foods that are falsely labeled as being "nutrient dense", but which are really carbohydrate dense instead.
• Eating more than you need to in order to ensure you are getting enough nutrients.

The hunt for nutrients, in this way, will only help you find obesity. Only a doctor can perform the necessary tests required to determine if you have a nutrient deficiency. Do not assume that you are nutrient deficient and then attempt to eat your way to good health.