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.) 

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.)

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.) 

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:

A Word About Upcoming Posts

I try to be a voice of sensibility in the vast and overwhelming sea of information regarding low carbohydrate and ketogenic ways of eating. It even says so at the top of my homepage: “A source of sanity in the sea of nutritional madness.” What I know compared to what there is left to learn is like a thimble of water compared to the Pacific Ocean. There’s a lot more—a lot more—I don’t know than what I do know, but I try to share with you the small bits of knowledge I gain as I hang on for dear life while traversing these tumultuous waters. I’ve done it about digestion, cancer, insulin, fuel partitioning, and more. (My Alzheimer’s book has been completely rewritten and updated for a March 2017 release as a print book from a big name publisher, so I’ll continue do it about Alzheimer’s, too.)   

However, I am starting to worry that, due to my penchant for ranting about things that bother me about the low carb and ketogenic communities, I’m developing a reputation for being an angry, hateful, vicious, and vindictive person. I assure you, I am neither angry, nor hateful, nor vicious, nor vindictive. In fact, “in real life,” I am quiet, shy, and, I’d like to think, gentle and kind. Nevertheless, there’s no denying the fact that I do rant a lot. But what can I say? The utter madness being masqueraded as fact in certain spaces provides no shortage of material to rant about. Being a gentle and kind person, I assume the spreading of misinformation occurs as a result of plain ol’ ignorance, rather than deliberate malice and ill intent. Whatever the intent, the end result is that misinformation is being spread, and because of it, people are experiencing setbacks along their roads to better health, fat loss, better blood sugar control, and more.

Why do I care? Well, like I mentioned in my rant post about fasting, as a nutritionist working with clients, I deal with the consequences of what happens when people follow advice that is either straight-up false, or advice that is perfectly appropriate for a certain context, but which is not applicable to their context.

It’s getting old, folks. I’m tired of trying to respond politely to emails from people who are afraid to eat two ounces of carrots in a serving of mixed vegetables, but who think it’s completely normal to put five tablespoons of butter and coconut oil in a cup of coffee. (Or better yet, to drink that 500-calorie coffee in the morning and say they’re “fasting.”) I’m tired of trying to respond politely to emails from grown adults who are restricting themselves to 45 grams of protein a day because they’re afraid that if they eat more than that, they’ll be at less than 80% fat and they’ll mess up their “keto ratios,” and also because the excess protein will be turned immediately into glucose and cause a huge “spike” in their blood sugar. (No, it won’t. Really, it won’t. Seriously now, it won’t.) I’m tired of trying to respond politely to emails from people who are disappointed and frustrated because they’re not losing weight or are maybe even gaining weight, even though they’re listening to their trusted experts online and are eating more fat – adding lots of extra butter to things, eating fat bombs, and shunning anything that even hints at being lean or low in fat. They’re as afraid of skinless chicken breasts as they are of 64-ounce troughs of Mountain Dew. And I’m tired of trying to respond politely to emails from people who, for whatever reasons—and there are many—are convinced that they must, must be in ketosis at all times. I swear, if I read or hear “I got kicked out of ketosis” one more time…

I am frustrated, and good-hearted people out there trying to follow low carb or ketogenic diets are frustrated, too.

In this spirit, I have a few more rants planned (already written, in fact) about the problematic things I see in the carbohydrate restriction community. But I don’t want to be a one-trick pony. I don’t want to have a reputation as an angry person who only ever posts electronic versions of hissy fits. Nevertheless, now that I’m more active in a few Facebook groups, I am confronted with these problematic things every day, and I feel compelled to address them. Since I don’t want to address them over and over and over again, I am going to post these few rants and then be done with them. (For now. Heaven knows there will always be something else that gets a rise out of me, but I’ll try to keep the ranting to a minimum once these next few posts are out of my system.) And get them out of my system I must. I don’t have children. What I have instead are ideas to write about, and they nag me, metaphorically pulling on my pant leg, until I finally give them they attention they require and see to their care and feeding.

I have three such posts in the hopper. You will know them when you see them. One of them—the last one I’ll post—is a candidate for a spot in my top three longest posts ever (alongside the one about my mother and the one about vitamin J). I thought about breaking it up into three or four separate posts, but I’d rather just get it all out at once and be done with it. Plus, that way, if I ever need to respond to someone on social media, or someone who emails me directly, in regard to some of what that post includes, I can just send them a link and it will all be centrally located.

As for what I’m going to write about after that, I’ll continue with more Low Carb Cooking Class (LC3), and I have not forgotten about the series on the metabolic theory of cancer. I do plan to pick it up again, as we have finally, finally gotten to the point where we can talk about the ketogenic diet and have it make sense. And I have been saying for ages now that I’d like to write something about sodium, and how salt is not something to fear, but that’s going to take a while. Before that, I’m going to post a couple of things that I see a need for, if questions on Twitter and Facebook are any indication: a guide to dining out on a low carb or ketogenic diet, and breakfast ideas for people who either don’t like bacon and eggs, or who are “tired of them.” (Yes, apparently such a thing is possible, though I have yet to witness this rare phenomenon in person.) I’m also contemplating sharing my thoughts on “zero carb” diets, as well as my growing suspicion that a plethora of modern chronic illnesses are driven not just by hyperinsulinemia and hyperglycemia, which are both, of course, huge issues, but by chronic nutrient insufficiency. The more I learn about the nuances of certain biochemical processes and the modern food supply, the more I appreciate just how robust the human body is, because frankly, I’m actually surprised there aren’t even more very ill people in our midst. That there aren’t is a testament to the ability of the human body to adapt and overcome and keep on truckin’ even when all indicators suggest someone is about to keel over and die at any moment.  

That’s all. Just wanted to warn you let you know what’s in store for the next few posts. After that, I’ll get back to writing things that might be more helpful for people, and I’ll try to keep my anger out of things. (Although I have to say, while I don’t want a reputation for being angry, my sarcasm and snark seem to go over pretty well, and I’m totally okay with being known for that.)  ;-) 

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.

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!

"Calories Out" -- A Rant

I don’t like that I post so many rants, but what can I say? The nutrition world gives me lots to rant about. Lots. And if I may say, many of the emails I get from you, my beloved readers, specifically mention how much you enjoy my sass and snark. So, if sass and snark are what ye seek, then sass and snark are what ye shall receive! Especially when it comes to today’s topic.

I’ve written before about the complete and utter crapstorm that is the very concept of “calories.” (That post is from April 2014. I’ve acquired a lot of new readers since then, so if you’ve never read that one, do click on over and give it a whirl. It’s a good one, if I do say so myself.) 

Okay, so, calories.

When it comes to losing weight fat loss, we’ve heard over and over again that it comes down to one thing: calories in, calories out (CICO). (Or is that two things?) Or, rather, it comes down to weight loss reduced adiposity being the result when someone takes in fewer calories than they burn. People are so stubbornly wedded to this idea that “Woo” famously calls them CICOpaths, CICOphants, or CICOtards. (With apologies to the reader who took me to task for my “Don’t Be a Ketard” series title, which has been renamed “Being Fat Adapted Versus ‘In Ketosis.’”)

As you know, I try to be careful about how I phrase things. (Case in point: the crossed out stuff in the preceding paragraph.) Part of this comes from me being an English major and language nerd, and part of it comes from knowing that when we phrase things incorrectly, they may not even be relevant. For example, I try to say “accumulate adipose tissue” more often than I say “gain weight.” Because gaining weight and accumulating adipose are not the same thing. If you gain weight, that might be water, muscle, bone, or, for the truly crunchy/hippie among you, a pounds’ worth of leg and armpit hair. And I try to say lose body fat rather than lose weight, because you can lose water, muscle, bone, etc., and when the vast majority of us talk about “weight loss,” what we really mean—and what we really want—is fat loss.

The reason why I’m such a stickler for saying things a certain way is because saying them more precisely/accurately helps us frame discussions in a certain light. And the reason why I’m explaining to you why I’m such a stickler is because we are going to frame today’s discussion in a certain light. One that I don’t think gets anywhere near enough attention in the nutrition and health world (except from me). As far as I can tell, I am one of the only people writing about this particular thing in this particular way. (If I’m wrong, tell me in the comments and share links to relevant stuff you find.)

What the heck am I talking about? What is the point that’s taking me so much prep work and blathering to get to?

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.

Constitutional Obesity Resistance Vs. Constitutional Obesity Propensity

Although activity on my Facebook and Twitter accounts might suggest otherwise, I’m not a big fan of social media. I participate in it because I feel like I “have to,” not because I particularly enjoy it. Then again, as I am extremely introverted, it’s a great way to interact with people without having to really interact with them. I can unplug and disengage the second I start feeling uninterested, overwhelmed, or exhausted. That being said, one of the great things about Twitter is that I get to interact with some quite brilliant people whom I would never otherwise have “met,” and I am regularly presented with ideas that blow my mind. (That’s how I came across the stuff about Dr. Kraft’s insulin assays, which inspired the insulin series.) Often, these are ideas and concepts that should be pretty obvious to me, and the only reason they aren’t is that I’ve just never stopped to think about them. And not only are they pretty obvious, but they’re often put out there or tweeted about casually, as if the writer is saying something relatively simple. A one-off post or a couple of lines about something that seems like no big deal and is a total no-brainer to them, but which, upon reflection, turns out to be a huge deal to me.

For example: the registered nurse who goes by the online nickname “Woo” frequently drops knowledge bombs that send me into a hurricane of thoughts. She holds no punches and does not suffer fools. Her writing style takes some getting used to, but she is truly one of the most intelligent and insightful people currently writing about metabolism, endocrinology, calories, ketosis, fat adaptation, body weight regulation, PCOS, and lots of other things many of us are interested in. Time and time again, something she posts makes me see things in a new light. So much light, in fact, that she should buy stock in General Electric, Phillips, or some other company that manufactures lightbulbs, because that is how many of those things go on over my head when I read her work.

Case in point: a few days ago, Woo made the correct observation that, in many cases, children who are put on a ketogenic diet (KD) for epilepsy can actually stop the diet after a couple of years and remain seizure free for life. Something about staying on a KD for some period of time during one’s formative years seems to actually permanently correct the underlying problem, such that the diet can be abandoned later on and the seizures do not return.

Coupling this fact with some observations about people on low-carb and Paleo diets, she came to some rather fascinating conclusions, and proposed an observational study. First, I’ll tell you about the study, and then we’ll work through the rationale for it, via exploring some intriguing things about body weight, and why some of us are so incredibly prone to accumulating excess adipose tissue, while others are not.

The observational study would be intended to test the following hypothesis:

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.

Talk in West Virginia!

WEST VIRGINIA PEOPLE!

I’m giving a talk on Thursday, January 21^st at 6pm, at the Clarion Hotel in Shepherdstown. If you’re in the local area, come on out and say hello! There’s a $13.95 charge, but that covers your enjoyment of an all-you-can-eat low carb buffet. (I receive no speaking fee. Just doing this for fun and to help lots of low-carb newbies!)

The event is a meeting for a low-carb support group run by Mark Cucuzzella, MD. I reached out to Dr. Cucuzzella after hearing him on episode 1005 of Jimmy Moore’s Livin’ la Vida Low Carb Show. Listening to him talk with Jimmy, I felt like I was hearing a kindred spirit. Not only is he in the U.S. Air Force Reserve, but he’s a LCHF-fueled distance runner as well as a low-carb-friendly physician bringing the low-carb and real food message to the bigwigs who decide what recruits eat at basic training. Can you imagine the fighting force we’d have if more of these young people were eating low-carb? As if that weren’t enough to keep the guy busy, he’s also on a mission to transform the health of people in West Virginia (which has the sad distinction of being one of the most obese states in the nation).

Turns out, Dr. Cucuzzella heard me on Robb Wolf’s podcast, and had been planning to contact me as well. Go figure!

I’m told the group I’ll be addressing will be about 50/50 low-carb newbies and people who’ve already been doing it for a few months. So I’m planning to give a (funny and educational) general talk about why and how low-carb works. It'll be sort of the live version of my fuel partitioning series. (If you’ve read that, you’ll probably recognize some of my slides, hehheh.) So I probably won’t be saying anything you don’t already know, but if you’d like to come eat some yummy food, see me in person, and meet other low-carbers in your area, come join us! Plus, we’ll have a Q&A, so if you want to ask me something more advanced or off-topic from the talk, this is your chance.

See the flyer below, and if you’d like to attend, please RSVP to Melanie Miller, at melaniemillerconsulting@gmail.com.

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.

Why Am I Not Losing Weight on LCHF? (Pt.4 - Effect a Change, a.k.a. The DIScomfort Zone)

Since I might not have been clear about things in the previous posts in this series on stubborn fat loss, allow me to clarify something before we add another post to the pile:

When I talk about carb and caloric intake, nutrient deficiencies, and thyroid function as factors that may be interfering with body fat loss, please know that I’m writing for the folks with significant amounts of body fat to lose: 30, 50, 100 pounds, or more. This series isn’t really intended for people who are looking to get rid of “the last ten pounds” (or five!). Of course, some of the concepts I write about might well be applicable to people who are in the home stretch, and if so, great. But to be honest, getting those last few pounds off—and keeping them off—may require slightly different methods than those that led to an initial, much larger loss. (Most of us recognize it’s very hard to lose those last few pounds, so if that’s all you’re trying to lose in the first place, you might face an even tougher battle than someone who wants to lose 100 pounds, but for whom the first 75 melted off relatively quickly.)

That being said, some of the general principles I’m going to address today could apply to anyone who’s struggling to lose body fat. Those among us who are working very hard to lose weight, but who aren’t making any headway, sometimes claim we’ve “tried everything.” We’ve “done everything” to lose weight, and “nothing works.”

Really?

Really?

You’ve tried everything?

Every single thing under the sun?

Why Am I Not Losing Weight on LCHF? (Pt.3b - Thyroid)

Testing & Interpreting Thyroid Hormone Levels

If I really wanted to do justice to the topic of testing and evaluating lab values for thyroid and associated hormones, I could write approximately 85 posts and probably still not cover all the nuances. So we’re going to do the quick & dirty overview, and then I’ll point you toward some resources for more information.

Remember: the reason we’re taking some time to delve into thyroid function is because we’re exploring reasons for difficult (seemingly impossible) fat loss, even on a good LCHF diet. And thyroid dysfunction is very near the top of that list.  

It is a freaking travesty that so many doctors run one test, and one test only, when a patient requests a thyroid test. This is for thyroid stimulating hormone (TSH), which, as I mentioned in the previous post, is not a thyroid hormone at all, but rather, a signaling molecule produced by the pituitary gland. The reasoning behind testing TSH is, if TSH is elevated, then something is wrong with the thyroid gland, because if the thyroid gland were responding normally to TSH, then TSH wouldn’t be elevated.

If your TSH is high, a doctor might put you on some sort of thyroid hormone, without ever digging deeper to try and ascertain WHY your TSH is high, and without ever testing other hormones. They will give you medication without actually trying to solve the problem. (Modern medicine is profoundly excellent when it comes to trauma and emergency care. But when it comes to this stuff, it is somewhere in the realm of COMPLETELY USELESS.)

Why Am I Not Losing Weight on LCHF? (Pt.3a - Thyroid)

In the previous post in this series on stubborn weight loss, we talked about nutrient deficiencies as possible roadblocks to losing body fat, even when someone is faithfully following a low-carb, higher-fat diet. I left off saying that there are nutrients we typically associate with thyroid function, and thyroid function is a huge player, not just in fat loss, but in metabolism and energy generation as a whole. If your thyroid is on the fritz, or forces outside the thyroid gland are making it go on the fritz, fat loss will be very difficult. So this post and the next one will focus on nutritional factors that help the thyroid, as well as dietary and lifestyle factors that hurt the thyroid.

I have had many clients who were on thyroid medication of one kind or another. It was obvious to me, however, that whatever medication they were taking was not helping, because they were still overweight, depressed, fatigued, and had other signs and symptoms of low thyroid function. To my astonishment, these people were typically dumbfounded by my asking them, “Do you think the medication is working? Do you actually feel any better?” (Apparently, none of their physicians had ever bothered to inquire, and the clients had never stopped to ask themselves if they were feeling better.) The answer, which required no hesitation or deliberation on their part whatsoever, was an unqualified NO. Of course it was no. If they did feel better, and they were losing weight, they would not have sought my help in the first place. This isn’t rocket science, folks. If you are “on thyroid medication,” but you still feel like dog-poo, then either the dose is not optimal for you, or the type of medication is not right for you. Before we can get into detail on medication, though, we need to talk a little bit about thyroid function in general, and then we’ll see where nutrients and meds fit into the picture.

Why Am I Not Losing Weight on LCHF? (Pt.2 - Nutrients)

This is the second installment in a short-ish series looking at roadblocks to fat loss, even when it seems like you’re doing “all the right things.” If you missed part 1, you can check it out here, and here’s a link to a post about the complexity of weight loss in general.

Since we covered some of the “duh” stuff last time—the stuff that most of you are already aware of and were probably angry with me for even writing—this time, let’s get into some issues that might resonate with more of you, and, perhaps most importantly, provide you with information you can apply immediately if they do resonate.

In the series I wrote about insulin (which general consensus says totally kicked butt, by the way), I frequently used the word lipolysis. I explained that that’s just a fancy way to say “breaking down fat.” (“Lipo” for fat, and “lysis,” for splitting apart.) I further explained that lipolysis is the splitting of a triglyceride into its component pieces: a glycerol molecule and three fatty acids. The reason lipolysis is such an important process is that it is the method by which body fat is released from adipose tissue (fat cells), in order to travel through the blood to arrive at a destination where it can be burned for energy, such as in muscle cells. (10-second refresher: triglycerides are too large to pass through the cell membrane. In order for them to get out of the fat cell—which is what we want and need to happen in order to burn that fat—they have to be broken down into smaller pieces.)

As we also covered in the insulin posts, insulin gets in the way of lipolysis. (Scientifically speaking, insulin inhibits the enzyme hormone-sensitive lipase, which is what starts the lipolysis ball rolling.) This is one of the mechanisms by which low-carb diets work: keep insulin levels low, and lipolysis is free to proceed. Keep insulin levels high, and that fat ain’t goin’ nowhere, no-how.

But here’s the thing. And pay attention, because this is a very big thing:

Why Am I Not Losing Weight on LCHF? (Pt.1 - Calories & Carbs)

…Aaaaand, we’re back!

Based on the number of page views my post called “The Truth About Weight Loss” has gotten, people are far more interested in reading about losing weight than they are in cancer or the disastrous consequences associated with chronically elevated insulin. And, based on the comments that post garnered, right here on the blog as well as on various LCHF sites, this post and the next few in this mini-series are among the most hotly anticipated posts I’ve ever written. (Except for the next cancer post. I know, I know…I keep promising to get back to those, but then I get sidetracked by other equally fascinating things.) 

With that in mind, I’m feelin’ the pressure, everybody. I’ll try not to disappoint, but, the truth is, I don’t have any magical formulas for you. I don’t have the secret to THE ONE THING you’ve never, ever heard of for kick-starting fat loss or breaking a stall. I haven’t discovered the only unsullied superfruit with mystical fat-melting properties, found deep in the Amazon Rain Forest, and known only to me and one indigenous tribe untouched by Western civilization. (But if I ever do stumble upon that, it’ll be available through my website for just $39.99, and you’ll have to order it by clicking on the obnoxious pop-up window that flashes in your face immediately upon the site loading. [Don’t’cha just love those?] It’ll also be available for purchase through an affiliate link in the sidebar of every single other LCHF, Paleo, Primal, and real food site you frequent. [This is the part where you express silent thanks for how terrible I am at marketing. :D])

Okay, let’s get down to business: