Why is Blood Sugar Sometimes Higher Than Expected on Keto?

We have a numbers problem in the keto community. 

We place too much stock in numbers without a good understanding of what they mean. 

We measure the level of every little molecule without an appreciation for the myriad feedback mechanisms and overlapping biochemical pathways that govern the systemic regulation that determines those levels. We assign way too much meaning to single measurements taken at single points in time rather than looking at longer term trends and patterns. It’s like seeing one frame of a movie—one isolated, frozen frame—and making wild guesses as to what the movie is about. It’s ridiculous. 

Allow me to tell you a story. Sometime in the early 1980s, when I was a little girl, my family took a trip to Disney World in Florida one winter. We lived in New York, so Florida was a way for me and my sister to see Disney World and for us to spend a few days away from the freezing cold and bask in the warmth of the Sunshine State. Well, a freak cold front happened while we were there. Yes, a freak, unexpected cold snap in Florida. Sea World was closed because some of the water was frozen. We had to buy winter coats down there, because who packs winter coats to go on vacation in Florida? 

Imagine if we knew nothing about Florida and based our assessment of Florida’s climate on the short-term weather of those few days. We would have assumed Florida was a bitterly cold place, rather than the hot, steamy swamp it usually is. The lesson here is, don’t mistake an acute occurrence for a general pattern, trend, or tendency. 

What does this have to do with blood glucose? 

(If you’re pressed for time and you want an abbreviated version of my take on this topic, watch this video. If you have a minute or two to read, the first part of this post will give you a brief synopsis of the most salient points. But if you have some extra time to spare and you want the juicy details, cozy up, settle in, and happy reading.) 

A New Look at Insulin, Glucagon & the Pancreas (a.k.a. ITIS part 9)

“Contrary to popular belief, insulin is not needed for glucose uptake and utilization in man.” (Source)

What? Insulin is not needed for glucose uptake? Did I just blow your mind a little?  If so, hang on to your hat. Lots more of that to come.

As I mentioned in my previous post on the personal fat threshold concept, what I enjoy most about writing my blog is that I get to share with you the fascinating and surprising things I learn. And one thing I can say with certainty is, the more I learn, the less I know. It seems like I barely hit publish on a new blog post before coming across a bunch of papers that teach me even more about the subject in question, or make me rethink what I wrote about it in the past.

One subject I’ve learned more about since I last wrote about it is insulin. If you’re new here, I recommend digging into my 8-part series on insulin. If I do say so myself, it’s some of the most important and educational stuff I’ve written.  But you don’t need to have read that to understand today’s post.

If you’re accustomed to thinking about insulin as a “blood sugar hormone,” you’re about to have your world turned upside down.  What I’ve learned about insulin over the past couple of years makes me think that lowering blood glucose might be one of the least important and impressive things it does.

Another very long post coming your way here, so grab a coffee or some pork rinds, and happy reading!

Before you dive in, though, I recommend scrolling way down to the bottom of this post where it says “End.” You might want to spend a while reading the whole thing, or you might not…that will help you decide. 

Keto & ApoE4

Hey All!

  

If you’ve been around the low carb and keto communities for a while, you might’ve run across the term “ApoE4.” ApoE4 is a gene that increases risk for cardiovascular disease and even more so for Alzheimer’s disease. In fact, if you’re homozygous for ApoE4 (meaning that you have 2 copies of the gene), you have between a 50-90% chance of developing Alzheimer’s. YIKES! That is not something to take lightly, so what’s the deal here? What is ApoE4 and why does it make people so much more susceptible to this frightening form of cognitive decline & impairment? And what are the implications for people following low-carb, high-fat diets? ApoE4 carriers are often cautioned to go lower in dietary saturated fat, but why? Is this truly warranted? Do you have to give up your beloved butter & cheese if you're E4?  

If you’ve heard of the ApoE4 gene and you’re curious about what it is and what it means, or if you know you carry one or two copies of ApoE4, you’ll want to check out my latest video. I cover the basics on what the gene is (it codes for the epsilon-4 [ε4] variant of the apoE protein, short for apolipoprotein E), why this matters, and what to do about it to potentially reduce your risk for Alzheimer’s and the other issues E4s are at greater risk for.

Most of what I know about ApoE4 is in relation to Alzheimer’s, owing to research I did for my book, The Alzheimer’s Antidote, which is about using a ketogenic or LCHF diet as a nutritional intervention for Alzheimer’s and other forms of cognitive impairment. (Didja know they regularly call Alzheimer's "type 3 diabetes" or "brain insulin resistance?" Now you know why it might be wise to adopt such a dietary approach to support healthy cognitive function.) But I would say that even if you don’t have any ApoE4 genes (the other forms are ApoE2 and ApoE3), or you’re not concerned about Alzheimer’s disease, I encourage you to watch the video anyway, because you might learn something that helps someone you know, and there’s a lot of information in the video that applies to everyone, regardless of your genetics.  

For those of you who prefer to read rather than watch videos, stay tuned. I’ll have a blog post on this in a few weeks. It won’t be a transcript of the video, but it’ll include all the same pertinent information and links to relevant research. But in the meantime, if you can’t wait to learn more and you’d really like to get some clarity on the whole ApoE4 “thing,” hop on over to my YouTube channel and watch the video.

For other videos and podcasts I’ve done on Alzheimer’s, covering issues far beyond ApoE4, you might enjoy these: 

• Video: Alzheimer’s talk at Low Carb Houston (October 2018)
• Video: Alzheimer’s talk at KetoCon (June 2018)
• Podcast: Interview on Ketovangelist (one of my best & most informative ever!)

Disclaimer: Amy Berger, MS, CNS, NTP, is not a physician and Tuit Nutrition, LLC, is not a medical practice. The information contained on this site is not intended to diagnose, treat, cure, or prevent any medical condition and is not to be used as a substitute for the care and guidance of a physician. Links in this post and all others may direct you to amazon.com, where I will receive a small amount of the purchase price of any items you buy through my affiliate links.

The Personal Fat Threshold Concept

Hey Kids!

It’s been ages since I’ve posted what I would call a “real” blog post. Something meaty and educational. Something you can really sink your teeth into. The last one was way back in August, when I wrote about whether protein is bad for the kidneys. (Hint: it’s not.) I’ve posted a few things since then, but nothing all that substantial. I’m glad to say today’s post makes up for lost time, because it is LONG. So grab yourself a cup of coffee or tea (or...*gag*...broth, if you must), put your phone on silent, and dig in.

I’m excited to share this with you. So excited, in fact, that I’ve been procrastinating on writing this for no less than 6 months. In looking at the folder of blog post drafts on my computer, I started jotting down notes for this in July 2018. The reason I kept putting it off is that I knew this was going to be a LONG post—massively long, even for me. But then I gave a talk on this topic at a keto event in Canada in December, so I finally had to organize my thoughts and put them together coherently. Once that was done, I figured it would be easier to get this written, since I could just flesh out the details of what was on the slides. Don’t kid yourselves, though. This still took four days to write and edit. (It’s much faster to talk and show images on slides than it is to type everything out in detail in a blog post!) Nevertheless, I’ve wanted to write this for a long time, so here we finally are. And the benefits a blog post has over a talk is that you can read this at your leisure, click on whatever links you’d like to explore further, and go as deeply down any of those rabbit holes as your heart desires. And to any of you who are happy at such a long post and who prefer reading to watching videos, I’m with you. I started my YouTube channel to bring my message of Keto Without the Crazy™ to a wider audience, but I, myself, prefer reading.    

One of the things I love most about writing my blog is sharing with you, my beloved readers, the fascinating and important things I learn as I deepen my understanding of human metabolism and physiology. The reason they call it “commencement” when you graduate with a degree in something is that it’s the start of your education, rather than the end of it. This has certainly proven true for me since getting my M.S. in nutrition.

One of the most intriguing things I’ve come across recently is the concept of the personal fat threshold. I don’t know who first coined this term, but it appears to have been Roy Taylor and Rury Holman, in their 2015 paper, Normal weight individuals who develop type 2 diabetes: the personal fat threshold. Other researchers wrote about the concept long before this paper, but I think Taylor & Holman were the first to use the phrase personal fat threshold. (Their paper is the first place I ever saw it in print, anyway. A researcher named Keith Frayn wrote some outstanding papers on the same topic years before without using the term. I cite his work liberally throughout this post. If you’d like to read the full text of any of the key papers I cite here, feel free to email me and I’ll send you a copy.)

I Started a YouTube Channel!

I started a YouTube channel!

Yes, dear readers, if you enjoy my writing, you can now go a step further and see and hear me. You can get “the real thing,” instead of trying to picture my voice or demeanor in your head. Some of you will be happy about this development; others might be thinking, “Why would I ever watch videos of her?” If you prefer reading blog posts, stay here on the blog. If you like videos too, please subscribe to the channel and keep reading the blog. Definitely don’t abandon the blog! (More on this later.)

Why did I start a channel?

People are hungry for a voice of reason, sanity, and simplicity.

I see people making keto so complicated. I see people convincing folks who are new to this that they need powdered MCT oil for their coffee, or that they have to use exogenous ketones to transition to keto. I see people pricking their fingers and peeing on test strips without the slightest clue of how to interpret what they see. (Okay, I don’t actually witness people peeing on strips, like, in person, but you know what I mean.) I see people plugging in their anthropometric data and getting “macros” spit out to them by calculators that have no idea how much body fat they carry (as opposed to total weight), or whether they have a thyroid problem. I see people following arbitrary macro percentages and loading up their food with extra butter and oil because some app told them to, not because they’re hungry for more fat.  

I see people who are confused and overwhelmed, and they’re not getting the results they want. They’re either so confused that they never even start a low carb way of eating, or they do what they think is the kind of low carb or keto diet they need, but they’ve been given so much inaccurate and potentially harmful information that whatever they were looking to accomplish, they’re actually going backward.

I see people misguidedly emphasizing “keto” instead of low carb. I see people bashing the Atkins diet, as if that isn’t a perfectly effective option for most of us. (And as if “keto” isn’t really just the 46-year-old Atkins induction phase wrapped up in a shiny new bow.)

For a long time, I’ve been trying to figure out who I am in the low carb scene. What do I have to contribute? Do I offer anything unique? Anything valuable? Am I saying anything a zillion other people aren’t already saying, and saying it better than I am?

Well, I think I’ve finally found my niche. After having been at this for a few years now (I published my first blog post way back in 2012), it’s happened organically – my “voice” has emerged over time, as the writing has grown. I want to help people see how simple this is—when we let it be. I’m the one who says, no, you don’t have to eat exclusively grassfed meats and organic vegetables. No, you probably don’t need to measure your ketones (but some people do benefit from it). No, you’re not going to die immediately if you use regular store-bought salad dressing, made with soybean oil. And no, you don’t have to have a PhD in calculus to figure out what and how much to eat.

In a world—including the keto community—that is increasingly polarized with warring factions shouting at each other from their entrenched camps, I’m okay with NOT being a zealot. I understand that there’s more than one way to get healthy, more than one way to lose weight, more than one way to lower blood sugar, and more than one way to be a decent human being who enjoys his or her food. I think I’ve gotten a reputation for being low-carb and keto-oriented, but also open minded and accepting of other ways of doing things that work for people. Maybe it’s only my perception, but I think I’m getting this reputation, and I like it. I think it’s needed. I look forward to new people finding me and my message of sanity and simplicity. I sincerely hope it helps them navigate low carb/keto as calmly and effortlessly as it should be navigated.

Now, about the videos:

As you know quite well if you’ve been around the blog awhile, brevity is not my strong suit. My posts tend to be really long. I plan to keep the videos short: aiming for about 10 minutes, give or take a few minutes. Some might be a little shorter; others will likely be longer (the first two already are, but they are intros to me and the channel, and are not typical of what I plan to be talking about in future videos), but I plan to make them all short enough that anyone who clicks on the links won’t be put off by the length.

I have friends and colleagues who have their own channels and put out lots of video content regarding LCHF/keto. And while I respect them and agree with most of what they say, I’ve found myself taking issue with a few things here and there. And I realized that if I’m not satisfied with how other people are explaining keto, then I need to get in the driver’s seat and do it myself.

So I have.

Please join me and subscribe to the channel, if you are so inclined.

As I’ll explain in my second video (in which I share my own history and how I got into low carb and eventually transitioned to being a nutrition professional), I am nearly helpless with technology. I’m an embarrassment to my alma mater, Carnegie Mellon University. It’s one of the top computer engineering schools in the world, but I’m lucky if I can even figure out how to plug in my laptop. It’s a bit of a miracle that I have a blog, a Twitter account, and now, a YouTube channel. See, I majored in creative writing, not computer engineering, or anything else having to do with 1s and 0s. So that’s why the writing here is kinda-sorta okay, but the site itself is a disaster. (Working on getting help with this soon! Planning a major overhaul of the site over the next several months. Yay!)

So bear with me as I learn how to improve the quality of my videos. I’d like to learn how to embed links and add images and text to the background. I know there are programs and apps that make it easy to do this. On the other hand, I’ve gotten feedback from people that simple is best. No need for anything fancy & flashy. If I’m saying something valuable, something people need to hear, then that’s enough. (Still, when I refer to blog posts I’ve written or to relevant scientific papers, I’d like for people to be able to click right on the link. That seems like the least I can do.)

And in case you’re wondering, yes, yes, YES, I will most definitely still be writing blog posts. Writing is, always has been, and likely always will be my first love. I’m adding YouTube to the mix only because it seems like you kind of “have to” be there to make a dent in things these days. Many people who are put off by the length of my posts would be happy to watch a 15-minute video (never mind that it would take them less than that to read even some of my longest posts). And some old-school folks (like me!) prefer reading and would sooner read a long post than watch a short video. So now I can reach more people, both the readers and the viewers, and everyone’s going to get pretty much the same message: keto doesn’t have to be complicated, confusing, or expensive. You can enjoy absolutely delicious food while improving your health and/or losing weight, and your way of eating doesn’t have to become an adventure in theoretical physics. You don’t need an advanced degree to lose weight, lower your blood sugar, get rid of your acid reflux, improve your PCOS, and say goodbye to joint pain, migraines, and gout. You just need to ditch the carbs.

See you on the screen!

P.S. Do you have any preference as to the frequency of new videos? I’m thinking twice a week, maybe every 4 days or so. I haven’t dived into YouTube analytics yet to see if there’s a “best” day to post, when more people are likely to watch. I’ll probably do what I do on the blog, which is follow my heart: write what I want to write, in the way I want to write it, and post it when I want to post it. It’s worked so far. I’m happy with the loyal readership I have here, and I’ve built it honestly and genuinely: no gimmicks, no false promises, no emphasis on whatever’s trendy just for more likes & shares. I plan to do the same with YT. Here’s hoping the people who need it find it.

P.P.S. Sorry for the decrease in blog posting frequency over the past several months. I have 2 or 3 long posts in the works, all in various stages of completion. I’ve had a bunch of speaking engagements the past few months and have 3 more coming up before the end of November. Once those are done, I’ll be able to focus on finishing these posts and hopefully resume putting out sarcastic and snarky educational content here. (And I'll publish shorter posts before then if I can.)

Disclaimer: Amy Berger, MS, CNS, NTP, is not a physician and Tuit Nutrition, LLC, is not a medical practice. The information contained on this site is not intended to diagnose, treat, cure, or prevent any medical condition and is not to be used as a substitute for the care and guidance of a physician. Links in this post and all others may direct you to amazon.com, where I will receive a small amount of the purchase price of any items you buy through my affiliate links.

Is There a Male Equivalent to PCOS? (a.k.a. The Detrimental Effects of Hyperinsulinemia on Men's Health)

 

Insulin has gotten a bad reputation in the low carb and keto communities. But insulin isn’t a bad thing. Too much insulin, too often, is a bad thing. If you ask people whose homes are threatened by wildfires whether lots of rain would be a good thing, you’ll probably get a very different answer than if you ask people whose homes have just been destroyed by hurricane floods. Water is not a problem; too much or too little water is a problem, and it’s the same with insulin.

So I’m not trying to demonize insulin. I wrote an 8-part blog series detailing the gnarly and nefarious effects of chronically elevated insulin (soon to be 9 or 10 parts -- new posts coming soon!), but the operative phrase there is chronically elevated. In and of itself, insulin isn’t a problem. (Just ask a type 1 diabetic.) The bad stuff happens only when insulin is too high, too often. Now that that’s out of the way, on with the show!

We know for certain that PCOS (polycystic ovarian syndrome)—which is “is the most common endocrinopathy of reproductive aged women affecting 6-10% of the population,”—is driven primarily by chronic hyperinsulinemia. (Incidence may be as high as 18% among certain cohorts when different diagnostic criteria are used, putting the number of women affected worldwide at around 10 million.)

“Hyperinsulinemia associated with insulin resistance has been causally linked to all features of the syndrome, such as hyperandrogenism, reproductive disorders, acne, hirsutism and metabolic disturbances.” (De Leo et al., 2004)

In fact, the causal link (not just an association!) between hyperinsulinema and PCOS is so well-known (and so powerful) that metformin—best known as a diabetes drug—is among the frontline pharmaceutical interventions for PCOS. Keep this in mind as you read about the men’s issues here.

Facial hair, acne, oily skin, mood swings, weight gain, menstrual irregularities, and infertility are not the only signs and symptoms of PCOS. These signs & symptoms are driven by the underlying hormonal disturbances, which include: elevated insulin, increased adrenal androgen synthesis (more testosterone and/or DHEA), decreased sex hormone binding globulin (SHBG), increased luteinizing hormone (LH), and decreased follicle stimulating hormone (FSH). And while the stereotypical PCOS patient is overweight or obese, as many as 50% of women with PCOS are not overweight or obese. (Remember, chronic hyperinsulinemia leads to obesity in some people, but not all. There are millions of people walking around with a “normal” body weight, but sky-high insulin levels.)

Since men produce all of these hormones as well, could there be a male equivalent of PCOS?

You bet your bald spot there is!

Let’s take a look at three different areas where chronic hyperinsulinemia has adverse effects on men:

• Early onset androgenetic alopecia (a.k.a. male-pattern baldness)
• Erectile dysfunction
• Benign prostatic hypertrophy (BPH) – enlargement of the prostate gland 

Let's Talk About Thyroid -- My Personal Story (Pt. 3/3...for now)

The first post in this 3-part series explored thyroid function in general, including what the different thyroid-related hormones are, the signs & symptoms of hypo- and hyperthyroidism, and what should be included when you have your thyroid hormones measured. (Reminder: TSH and T4 are not enough!) In part 2, we looked at the potential effects of low carb diets on thyroid function. As promised, here in part 3, we’ll do a deep-dive into my own personal experience with hypothyroidism. 

We’ll get into the gory details soon. But as Sam Beckett said in the final episode of one of the greatest TV shows of all time, Quantum Leap, “Instead of ‘once upon a time,’ let’s start with the happy ending.’” I started thyroid medication in January 2017 and here’s what’s happened since then: I’ve lost 17 pounds. My chronic constipation is gone. My hair no longer falls out in alarming clumps daily. My severe, longstanding, and unremitting depression is 89% gone.

This medication has been nothing short of life-changing for me. I still have a ways to go in several respects, but let’s just say that the reason I’m writing about thyroid at all is because, having gone through this experience, it is now almost like a religious mission to me to provide whatever information and help I can to people who are currently, right this minute, feeling as awful as I felt until recently. And I kind of hate saying that. I am as far from a religious (and low carb) zealot as a person can be. And yet, I now feel a compulsion to educate people so they can help themselves. As passionate as I am about the myriad benefits of low carb, and as much as I sometimes want to grab people at the grocery store and talk some sense into them, that is now far eclipsed by my fervor for proper thyroid assessment and treatment.

There’s so much to cover, I don’t know where to start. If you come to my blog for sensible information on low carb and ketogenic diets and don’t give two hoots (or even one hoot) about my thyroid odyssey, skip the rest of this post and wait until next time, when I’ll be back to posting my usual fare. On the other hand, if you suspect you have a thyroid problem, or you know you do and your medication is not getting you where you want to be, this is for you, my dears. You’re not alone.

Let's Talk About Thyroid -- Intro: Thyroid Function & Testing (Pt. 1/3)

Long time readers of this blog know that I have been dealing with a low functioning thyroid for quite some time. Even longer than I, myself, realized, now that I look back and think about how long I’ve been plagued by the signs and symptoms. It’s been about five years that things were noticeable, including two and a half during which they were downright unbearable, but in evaluating back even further, individual symptoms popped up here and there going back longer than that. (Why did I let things go on for five years? Details on that in part 3.)

Being that I have far more personal experience with this than I wish I did, and being that I’ve had several clients with thyroid issues, it’s time for me to write in detail about thyroid function. I’ll start off with a general overview of thyroid function and how to properly assess the various hormone levels. In part 2, we’ll look at the potential effects of low carb or ketogenic diets on thyroid function, and in part 3, I’ll talk specifically about my own history and what I’m doing now. Those of you with no interest in any of this, move along; nothing to see here. (I do feel like I write too much about myself, but I think sharing my personal experience can be informative for those who are dealing with similar problems and who’d like to see the struggles and stumbling blocks I encountered, and how I emerged on the other side feeling much better. So yeah, part 3 will be about me, but my hope is that it will be helpful for others.)

On with the show!

Ketogenesis, Measuring Ketones, and Burning Fat vs Being in Ketosis

This post is long overdue.

I cannot tell you how many emails I get from people fretting over their ketone levels. It’s time to set the record straight on this issue. I wish there was someplace I could refer people for reliable information on this subject, but I haven’t come across a blog post or podcast interview that explains things satisfactorily. At least, not to my satisfaction. And that is and always has been my goal in writing my blog: I explain things the way I would want someone to explain them to me, if I were new to all this. And since no one—as far as I know, anyway—has tackled this subject the way I would, I finally had to just sit down and write this. If you feel it’s educational, please share it in the low carb and/or ketogenic circles you frequent, because I know this issue comes up all the time in ketogenic forums and Facebook groups. (And if you know of other good resources on this topic, feel free to provide a link in the comments, and I’ll update this post to include it.)

Okay, here goes.

There are few issues more controversial regarding ketogenic diets than whether you should measure your ketones. There are valid reasons to measure, but there are also a lot—a lot—of misconceptions about measuring ketones and how to interpret the data. So let’s get into when and why it’s a good idea to measure, who doesn’t need to measure, and most important, what the numbers mean. (I said who “doesn’t need to” measure rather than who shouldn’t measure because if you want to measure, then go ahead. There’s really no should or shouldn’t here. But if you choose to measure, you need to understand how to interpret and understand the numbers so you don’t jump to illogical and false conclusions.)     

I will also be covering the difference between being fat adapted versus in ketosis. I tried to do it in a few posts awhile back, but I think I the way I explain it here is much better because I will show you the biochemical pathways involved so you will be able to see how it actually works. My hope is that this will go from a vague concept in your mind to, “Oh! NOW I get it!” And you will understand very clearly how you can absolutely, positively have a fat-based metabolism and lose body fat even if you’re not in ketosis. 

More Than You Ever Wanted to Know About Protein & Gluconeogenesis

My dear readers, the website/blog update has run into some snags. Rather than continuing to keep you waiting, though, I’m going to publish new posts and I’ll worry about transitioning them over later on. And since it’s been a few months since I last posted anything of substance, I’ve decided to drop this enormous, enormous post on you to make up for that lost time—and it might take you equally long to read it. Sorry about that, but hey, I haven’t written anything meaningful since May, so, depending on your point of view, this post is either a gift or a punishment. As I’ve said in the past, if you’re an insomniac or a cubicle dweller with lots of time to kill, you’re welcome. (The rest of you, go get yourself a cup of coffee or tea, come back, and get comfy.)

I’ve been meaning to write this post for over a year, but it’s such a big topic and so much can go wrong that the thought of tackling it all was enough to make me not write it. But it’s gotten to the point that I’m tired enough of seeing the same questions asked and the same myths propagated over and over on various keto and low carb forums that I’ve decided this needs to be done, no matter how painful I might find it. Because seeing nonsense and fearmongering regarding the role of protein in low carb or ketogenic diets is even more painful. So if finally managing to organize my thoughts into some kind of coherent prose means I never have to read the phrase, “too much protein turns into sugar” ever again, it will be worth it.

So that’s what’s on tap today, kids: Gluconeogenesis.

That’s right, friends, it’s time to do some myth-busting surrounding the whacked-out notion that protein—lean protein, in particular (like a skinless chicken breast, or tuna canned in water)—is the metabolic equivalent of chocolate cake. (Or cotton candy, or gummy bears, or any other insanely sugary thing that might raise your blood glucose and insulin far more than protein does.) 

Break Nutrition - A New (and GOOD!) Blog & Podcast

Hey Everyone,

To get the word out about the release of my book, The Alzheimer’s Antidote, I’ve been making the rounds on several podcasts. I’ll post something soon with links to all of them in case you’d like to give a few of them a listen. (Yes, it’s true! You can get your fix of me ranting [and occasionally sharing nifty information] even when there’s no new blog post, haha! And you get to hear it all in my real voice! [For better or worse…ugh…])

Before I get to that, though, there’s a particular show I’d like to tell you about. My friend Raphael has started a new podcast and website called Break Nutrition. Raphi is very darn smart. He’s doing graduate work in molecular biology, with a research focus on cancer. (He is quite familiar with all we’ve covered in the cancer series – the Warburg effect, Dr. Thomas Seyfried’s work, the role of damaged mitochondria, etc. Recall that I picked his brain a bit for one of the posts on hypoxia.) If you’re on Twitter, you’ll want to follow him.

Break Nutrition is brand new, but it looks to be a good source for some pretty intense, intelligent, and science-based arguments covering a lot of what you all love: evolutionary theory informing modern diets, how low carb/ketogenic diets might affect nutrient requirements, fat loss mistakes, and more. Raphi is not the only one writing for Break Nutrition. He’s already had guest posts from some low-carb heavy-hitters. If you’re getting a bit bored with your blog or podcast “routine” and are looking to change things up a little—and are especially seeking things that really make you think, question what you think you know, and go hmmm…, then this is for you.

The podcast is pretty advanced sometimes. I’ve listened to a couple episodes and have more to get to. Raphi has had his friend and colleague Gabor Erdosi on a few times, and they’ve talked about some very interesting theories and mechanisms regarding type 2 diabetes and obesity – things you are not learning about anywhere else, including my blog. (I’ve been reading some papers on these ideas, though, and it’s fascinating stuff! I’ll have a post or two on it in the not-too-distant future. Sneak peek: it’s becoming more and more obvious to me why some people do horribly on keto when they focus on the “high fat” part more than the low carb part.) These episodes might be a bit advanced for some people, but others might soak them up like sponges.

One particular episode you will not need a PhD to understand and enjoy is the one I was on. Raphi and I had a great time talking about Alzheimer’s pathology and possible treatments, but the stuff we chatted about after that was even better. We got into gluconeogenesis (LOADS of misinformation on this all over the ketowebs), exogenous ketones, and why the whole calorie “thing” is almost useless in discussions of fat loss, satiety, energy balance, and body weight regulation. Useless! (Details in this post I wrote. One of my favorites!) You will hear me say I’ve lost 14 pounds since starting thyroid medication in December. The crippling depression that had me sidelined for over two years is about 91% gone as well—for real this time! (Post coming soon on that, too, my darlings!)

Raphi and I had a great conversation and I think you’ll enjoy listening. (Bonus: you get to hear what my favorite Chinese food was, back in the day.)  ;-)

So check out Break Nutrition and download the podcast. (And check out the other shows, too! Available on iTunes, too.)

Disclaimer: Amy Berger, MS, CNS, NTP, is not a physician and Tuit Nutrition, LLC, is not a medical practice. The information contained on this site is not intended to diagnose, treat, cure, or prevent any medical condition and is not to be used as a substitute for the care and guidance of a physician. Links in this post and all others may direct you to amazon.com, where I will receive a small amount of the purchase price of any items you buy through my affiliate links.

My Top 10 Favorite Posts

I missed my four year blogversary!

My blog has existed since August 2012. I would have celebrated sooner, but August 2016 blew right past me. (Probably because I was mired in a deep and longstanding depression, which I thought I was starting to come out of, but which is actually back in full force and only lifted temporarily.)  As of this writing, there are 242 posts. I don’t think I hit my stride until sometime mid-2013, but there are a couple of gems going back as far as September 2012.

For those of you who found me a few years into my blathering blogging, and since new people stumble upon my blog every week, I thought it would be nice to start the new year by sharing a selection of my personal favorite posts for those of you who have only recently tuned in, as well as for any of you who are wondering what the “must read” posts are. (In my opinion, anyway.) I tried to purge all my low carb and keto-related anger in a few posts prior to the close of 2016 so that I could start 2017 on a more positive note. I can’t promise I won’t post any more rants in the future (I think we can all agree I’m not physically capable of holding it in), but I am going to try to stick to things that are a little more scientific, as well as posting tips and insights that are helpful for following these types of diets in the real world.

With no further ado, here are my top ten favorites, in no particular order, except that the first one is probably nearest and dearest to my heart and resonates with me, personally, the most deeply:

Metabolic Theory of Cancer: Speculation on the Causes of Cancer -- and How to Mitigate Them (Pt.5B)

Okay!

I left off last time saying that we have two big issues to address with regard to hypoxia as a cause or exacerbating factor in cancer: 

1. What causes tissue to become hypoxic?
2. Is there a role for hyperbaric oxygen therapy in fighting cancer?

  

Let’s tackle them in order.

To be honest with you, I still don’t know which comes first: low oxygen, or mitochondrial dysfunction. The fact is, even when there’s plenty of oxygen available, if the mitochondria are malfunctioning, they can’t use it. But what if what’s causing the mitochondria to malfunction is insufficient oxygen? (I told you last time this stuff is complicated!)

It almost doesn’t matter, right? The bottom line is, whether the tissue is hypoxic or not, the mitochondria are not using whatever oxygen might be present. (Well, they’re using some of it. Remember, kids, when it comes to biology and biochemistry, there are very rarely any absolutes, yes or no, on or off. Things aren't binary, but rather, there's a balancing act. Even cancer cells have some mitochondria that are okay; it’s just that the majority of them are messed up.)

I just have a hard time wrapping my head around it all. Think about angiogenesis: the creation of blood vessels specifically so that the cancerous tissue ensures it has a steady supply of fuel and nutrients. But what does blood carry besides fuel and nutrients? OXYGEN. So you would think that angiogenesis would give cancer cells more oxygen, not less. So going one step further, this being the case, it seems like the mitochondrial dysfunction comes first, because theoretically, there should be sufficient oxygen delivery to the cancer cells, what with all those blood vessels they created for their own nefarious purposes. So there is sufficient oxygen (“normoxia”), yet we have hypoxia-inducible factors out the yin-yang upregulating all sorts of nasty pathways and reactions in these cells to keep themselves alive because they think they’re hypoxic. And the reason they think they’re hypoxic is because the mitochondria aren’t using the oxygen. (That’s my logic, anyway. I told you there was going to be a lot of wild speculation here, and so it begins.)

Metabolic Theory of Cancer: Speculation on the Causes of Cancer -- and How to Mitigate Them (Pt.5A)

Graphic adapted from Seyfried et al., 2015

OH. EM. GEE!!!!!

It’s baaa-aaaaack!

Today is June 1, 2016. Looking back through the blog archives, I saw that the previous post in this series on the metabolic theory of cancer was published on June 1, 2015. Yes, kids, it’s been a year. A full year! An entire year to the day. If you have been waiting and waiting (and waiting!) for me to get back to this and address some key concepts we haven’t gotten to yet, believe me, nobody wanted me to get back to this more than I did. I absolutely did not plan on it taking a year. But alas. Hopefully, in that time, you’ve learned a thing or two about insulin, stubborn fat loss, and the use of ketogenic diets for Alzheimer’s disease and other neurological conditions. In fact, I am in the process of adding a new installment to the “ITIS/It’s the Insulin, Stupid” series, but when I saw that I was coming up on the one-year anniversary of neglecting the cancer series, I knew I had to get my rear in gear and just DO IT. I really wanted to do the insulin post first, but considering the date, I thought it would be apropos for me to do this one instead.

Also, just to let you know, since the writing of that last post, I have had the honor of meeting Drs. Seyfried, D’Agostino, and Poff in person. {Squee!!}  I also got to meet Dr. Cunnane, Dr. Newport, Dr. Rho, and Dr. Maffetone. Holy moly…it was a nonstop conference of metabolism rock stars.

I am most definitely going to get to the mamma-jamma, granddaddy of all topics we’ve been waiting for in this cancer series—the ketogenic diet—but please be patient. I’ve very recently had more work stuff come up (in a good way), and I am feeling a bit overwhelmed. I will write about ketosis. I can’t promise when, exactly, that will happen, but I promise it won’t take a year. (Maybe just a couple weeks, considering I’m already working on it.)  ;-)

If you’re new to my blog and have no idea what’s going on right now, the series I’ve written on the metabolic theory of cancer is a “fan favorite” – at least, among the people who like to geek out on the science with me. The cancer series is representative of when my blog becomes a free course in (very basic) biochemistry and physiology, and is peppered with links and quotes from the scientific literature. If you prefer my rants, shakedowns of food labels, and other casual-type posts, no prob! Whatever floats your boat. But for those of you who need to kill lots of time at your desk job, or who perhaps need help falling asleep, you might want to start way back at the beginning and work your way toward today’s post. (Actually, that’s sarcasm. The truth is, I think this stuff is fascinating, and perhaps some of my best work. I swear, that hexokinase 2 stuff STILL blows my mind.)

Since it has been a year (!!) since the last installment, I’ll make it easy for you and list all the posts in order, from first to most recent: 

1. Introduction
2. Cells Behaving Badly
3. Cellular Energy Generation 1 - Glycolysis
4. Cellular Energy Generation 2 - Mighty Mitochondria (Krebs Cycle, Electron Transport Chain)
5. Mitochondrial Dysfunction 1
6. Mitochondrial Dysfunction 2 - They ARE Broken
7. Glycolysis Run Amok & Mutant Hexokinase
8. Aerobic Fermentation (a.k.a. "The Warburg Effect")
9. Cancer Cells are Sugar Junkies
10. Mutations vs. Mitochondria
11. Cancer as a Protective Mechanism
12. Speculation on the Causes of Cancer (Pt.1)
13. Video Lesson! (Thomas Seyfried, PhD)
14. Speculation on the Causes of Cancer -- and How to Mitigate Risk (Pt.2)
15. Speculation on the Causes of Cancer -- and How to Mitigate Them (Pt.3 - Viruses)
16. Speculation on the Causes of Cancer -- and How to Mitigate Them (Pt.4 - Carcinogens)

Buckle up and hang on tight, everyone. HERE WE GO!

Podcast Interview - Ketogenic Diets for Neurological Health

For those of you who don’t follow me on Twitter or Facebook and missed the announcement last week, I’ve recorded another episode of the Real World Paleo Podcast with Christine Lehmann, the Reverse Diabetes Coach, and a fellow Nutritional Therapy Practitioner. (In fact, Christine and I met when we were in the same class for our NTP training.) You can check out the details here, and the show is available on iTunes and Stitcher.

You may recall I was on this show a few months ago, talking about ketogenic diets for Alzheimer’s disease. This time, we expanded the discussion to other neurological conditions, including Parkinson’s, ALS, epilepsy, and multiple sclerosis. We briefly touched upon the potential efficacy of ketogenic approaches for psychological conditions as well, such as schizophrenia, anxiety, and bipolar disorder. We also spent a few minutes talking about intermittent fasting and how it might be an additional tool in the arsenal to combat neurological and neurodegenerative conditions.

Being Fat Adapted Versus "In Ketosis" (Pt.3/3)

Now that the issues of fat adaptation and fat loss versus ketosis—or the lack thereof—have been clarified, let’s move on to a related issue that drives me crazy: newbie low-carbers freaking out if they eat something that not only takes away that beloved purple, but—gasp!—causes the scale to go up a few pounds.

When a low-carber who doesn’t understand some basics about human physiology gains weight after indulging in a pile of something sweet or starchy, they go absolutely apoplectic. Not knowing any better, they step on the scale the next day, see that their weight has gone up a few pounds, and they Just. Freak. Out. I can’t count how many times I’ve seen people post to forums and message boards either in tears or in a raging anger, because they ate a donut, or a bagel, or two slices of pizza, and gained, say, four pounds the next day. They then fall into thinking that their body is so fundamentally carbohydrate intolerant that after indulging in one carbohydrate-laden meal, they gained, overnight, four pounds of fat. (Never mind that the total weight of the amount of food they consumed for the entire day probably didn't even weigh four pounds, let alone that one bit of carb splurge, so I don't see any logic to how they think this works, but I digress.)

I’m not really sure how to talk about this without expressing grave concern over these well-intentioned folks’ ignorance as to the inner workings of their own bodies. (And by “expressing grave concern,” I mean, “shaking my head at the utter lunacy out there.”)

Time for a quick lesson in glycogen storage. 

Being Fat Adapted Versus "In Ketosis" (Pt.2/3)

In the previous post, we established the difference between fat adaptation and ketosis. Now, let’s revisit the “got kicked out of ketosis” thing. 

People new to low-carbing—and also people not-so-new, but who just don’t understand how this all works—will utter that dreaded phrase when they pee on a ketostick and don’t see their beloved dark purple, or—gasp!—not even a little pink. No color change at all. They will then assume that whatever they ate sometime prior to testing “kicked them out of ketosis,” and they will summarily cross that food item off their menu forever, banishing it to their ever-growing list of forbidden foods. (They will also spread tales of woe on forums far and wide, thereby terrifying other newbie low-carbers into avoiding these foods as well.)

But here’s the thing: ketostix are fickle things. Elevated ketones in the blood, urine, and breath, are fickle things. What else was going on before testing? Was this person very acutely stressed? Did they do an intense workout? Both of these can cause a temporary rise in blood glucose (albeit a smallish one), which might trigger a temporary rise in insulin, which could put a temporary stop to ketosis. Temporary. Note: it will not put a stop to being fat-adapted; only to having excess acetoacetate in the urine or elevated beta-hydroxybutyrate in the blood at that particular moment in time.

Being Fat Adapted Versus "In Ketosis" (Pt.1/3)

UPDATE!! (9/20/2017)
I have a new post that explains how and why the body produces ketones, It will help you understand much better the difference between burning fat and having a fat-based metabolism, versus being "in ketosis." It's very long, but I think it's worth reading if you'd really like to understand this -- and if you want to stop freaking out about your ketone levels. (If you click over to that post and want to read only the section that explains the difference between ketosis and running on fat, scroll way down to where it says Ketogenesis: How and Why Do We Make Ketones? Also: Fat Adaptation versus Ketosis.) Happy reading!

“I got kicked out of ketosis.”

If I never hear or read those six words, in that order, ever again, I’ll be one happy individual.

Based on what I come across on low-carb forums, blogs, and videos, there is a lot of confusion about the correct use of urine ketone test strips (which I’ll sometimes refer to as ketostix, since “ketone test strips” is a mouthful, even when you’re only reading). So allow me to ‘splain a little bit about how to interpret these things, and what role they should play—if any—in your low-carb life.

First and foremost is the most important thing you will read in today’s post. (And it is so important that I will likely repeat it in all the posts to follow in this little series. Plus, you can tell it’s important because it’s red, bold, in italics, and all caps, hehheh.)

You can be in ketosis and not lose body fat, 

and you can lose body fat without being in ketosis.

  

Podcast Interview: Lyme Ninja Radio

In case anyone out there isn’t completely sick yet of hearing me talk about the etiology of Alzheimer’s disease and the potential therapeutic role of very low-carb diets, I wanted to let you know about my latest podcast interview.

Hop on over to Lyme Ninja Radio, where I had a great conversation with the head ninja himself, Mackay Rippey. You can also find it on iTunes, but I’m not sure if this episode has been posted there yet. (I’m on episode 70.)

Some of it will be old news if you’ve listened to my previous podcast interviews on this subject, but Mackay was super fun to talk to, and we get into a couple of other low-carb and “real food” issues beyond Alzheimer’s. We recorded this one by phone, so there’s no static like when I was on Robb Wolf’s show, but I do kind of sound like I’m talking from inside a tin can. Not really sure why that happened, but you should be able to understand me just fine. (Except that I talk way too fast, just like my mother used to tell me, hehheh.)

And for those of you who are particularly interested in the notion of Alzheimer’s as “type 3 diabetes,” or “diabetes of the brain,” I’ve compiled links to my blog posts, journal articles, and podcast interviews, plus some of my favorite scientific papers, in a new tab on my website.

Enjoy!

Remember: Amy Berger, M.S., NTP, is not a physician and Tuit Nutrition, LLC, is not a medical practice. The information contained on this site is not intended to diagnose, treat, cure, or prevent any medical condition and is not to be used as a substitute for the care and guidance of a physician. Links in this post and all others may direct you to amazon.com, where I will receive a small amount of the purchase price of any items you buy through my affiliate links.