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. 

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.

Book Review: The Case Against Sugar

Gary Taubes wrote another book.

Gary Taubes! (*Fangirl squee!*)

Do I really need to say more?

I don’t, but since this is my blog, I will.

TL;DR: I loved this book and you will too. READ IT.

If you don’t read a lot of blogs and websites outside the low carb bubble, then allow me to tell you that there’s a large contingent of people who loathe Taubes. He takes a boatload of criticism, as does anyone who writes something that condemns or exonerates something other people love or hate (e.g., red meat and saturated fats, refined carbohydrates, and raw milk). But put me squarely in the camp that loves his work and is grateful for his meticulous research. (The endnotes and bibliography of Good Calories, Bad Calories are almost as large as my entire book.) I’m not saying he’s right about everything, nor that I agree with him on everything. I’m only saying I’m a big fan and have been for several years.

I had the pleasure of meeting Gary in spring 2017, first at a reading and book signing in Washington, DC, and then a few weeks later at a literary event in Charlottesville, VA. I actually drove him from Charlottesville back up to Dulles airport in my neck of the woods, so we had some time to chat and shoot the low carb breeze. Let me tell you, folks: I read GCBC during my deployment in Iraq, circa 2008. Having always been a sucker for salt & pepper hair, intellect, and a wry and somewhat dark sense of humor, I developed an immediate nerd crush on Gary. Never in my wildest imagination—and mine is pretty wild—did I think nine years later, I’d have him all to myself on the road for two hours.

Get your minds out of the gutter. Nothing happened except good conversation and Gary being an exceptionally good sport about the fact that my decade-old car has seen better days. (He assured me that his car is older and in even worse disrepair. We writers don’t exactly break the bank; not even ones like Gary, who garner big advances and have multiple bestsellers to their names.) Without revealing too much, I’ll say that it was really nice to talk with a writer of Gary’s caliber, and to find out that many of the emotional demons that plague me are not unique to me. Gary deals with his by throwing himself into work; I deal with mine by avoiding work. Neither strategy is all that healthy, long term. But I can look to Gary as someone with a lot of dark thoughts and inner turmoil who still manages to get shit done produce great work. It helps that he has a wife and two sons depending on him, so he sort of has to bring home the proverbial (and literal) bacon. 

As an aside, Gary has spent time in France, and he longs for it. As he talked about it, his desire to be there—and, maybe, to be the person he was when he was there—was palpable. He has also written and spoken a lot about his history as a smoker. I could totally see him as the quintessential ex-pat, sitting at a roadside café in Paris, sipping coffee and reading poetry, complete with a black turtleneck and a cigarette.  

But enough about Gary. On to the book!

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. 

New Perspectives on Low Carb Diets for Weight Loss

As I wrote about in a recent post, I’ve finally gotten active in a few Facebook groups dedicated to low carb and ketogenic diets. There’s a world of good being done there, and heaps upon heaps of great information being shared—life-changing and life-saving information people aren’t hearing from their doctors. But there’s also a lot—and I mean a lot—of stuff that makes me want to: a) grab people tightly by the upper arms and shake some sense into them (because that’s more humane than ramming them head-first into a brick wall, which is what I’d really like to do in some cases), or b) wrap them in a long, warm hug, and help them feel better about things. I got all my keto-related anger out in the epic end-of-year rant I posted in December, so today, let’s focus on the kinder, gentler side of things.

I am paraphrasing, but here are a few examples of what I routinely read in various FB groups and blog comments:

1. “I’ve been following a strict ketogenic diet for two months and have only lost 10 pounds. What am I doing wrong?”   
2. “I’ve been doing strict keto for three months. I’m off my blood pressure medication and have reduced my insulin dose by half. I feel fantastic and have tons of energy, but I haven’t lost any weight. Why isn’t this working for me?” 
3. “I’m doing a keto diet and I lost four pounds the first week, three the second week, then only two the third week, and now I’m up a pound. What did I do wrong?” 

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!

"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?

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.

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.

  

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.5 - The Little Things)

We’ve covered several big concepts so far in the past few posts on stubborn fat loss. You might not think they’re big, but assessing the kinds of food you eat and how much, addressing nutrient insufficiencies and digestive efficiency, optimizing thyroid function, and getting out of your comfort zone and into your discomfort zone can go a long way toward getting your body to finally start releasing some of the excess adipose tissue it’s so desperately clinging to.

But what happens when you’ve already done all that, and the weight still won’t budge? You’re at the point where you honestly don’t know what else to do. Your diet’s better than ever. You’re pushing yourself hard, physically. You’re getting many hours of deep, restorative sleep every night. Your bloodwork looks great. You’re off most of—or maybe even all of—your meds, and your doctor is thrilled. Everything’s peachy! Except, that is, for your belly, your chin, your upper arms, your hips, your thighs, or your backside, all of which are exactly the same size as when you started putting things into high gear.

WHAT GIVES?!

Well, when it seems like there’s really nothing left to do, there are, in fact, a few more things to try. We’ve gotten all of the big things out of the way, so now, let’s look at the little things. To be honest, I don’t think these are huge roadblocks for weight loss, but who can really say? If you’re really, truly, doing everything else and the weight still isn’t moving, then it’s worth looking into these issues to see if they’re standing in your way. Again, I don’t think these are anyone’s primary obstacles to fat loss, but when you have well and truly exhausted all other possibilities, and you’re still struggling, then quizás, quizás, quizás…

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?