Psychobiotics are live organisms that, eaten in adequate amounts, produce a mental health benefit. They are a subset of probiotics defined by their effect on the brain, not on digestion. They work by making neuroactive (brain-active) compounds, shifting the immune signals that reach the brain and acting on the vagus nerve.
The bacteria in your gut are not passengers. They take part in mood control, immune signaling and glucose handling. The pathways linking them to the brain are more and more well described.
Is gut flora determined randomly?
No. Several things shape its makeup: how you were delivered at birth, early feeding, antibiotic exposure, diet over time and the chemical environment. Diet is the largest lever an adult has. The microbial population reflects what it is fed, and it changes measurably within days of a change in diet.
What are psychobiotics?
Psychobiotics are live organisms that, when swallowed in adequate amounts, produce a mental health benefit. They are a subset of probiotics. What defines them is their effect on the brain rather than on digestion. The proposed ways they work include making neuroactive compounds, modulating the immune signals that reach the brain, and effects on the vagus nerve.
Is serotonin made in the gut?
The overwhelming majority of the body’s serotonin is made in the gut, not the brain. Gut microbes influence that production directly. That raises the possibility of modulating serotonin signaling through the microbiome, not only through medication. The research is early and the enthusiasm often outruns it. But the mechanism is real.
Can gut problems cause anxiety and depression?
Anxiety can be driven or worsened by gut problems, and the relationship runs in both directions. Inflammatory signals that start in the gut reach the brain. Stress changes gut permeability (how leaky the gut wall is) and the mix of microbes. For that reason, studies of gut microbiomes are being used to investigate brain and mood disorders.
Diet takes part directly. A diet high in sugar and fat measurably affects cognition (thinking) and mood. It does so partly through the microbiome and partly through the inflammatory load it creates.
Alzheimer’s disease
Probiotics have been studied in Alzheimer’s disease. The hypothesis is that changing the microbes could influence progression by acting on inflammation and the gut-brain axis. Results are preliminary. It would be dishonest to call this established. It would be just as dishonest to dismiss a mechanism with this much biological plausibility.
Do artificial sweeteners affect blood sugar?
Artificial sweeteners can disrupt blood sugar control through their effect on gut bacteria, not through any direct calories. That is why a zero-calorie sweetener is not metabolically neutral. It is also why we say to avoid sugars and artificial sweeteners rather than swap one for the other.
Triclosan and the chemical environment
Triclosan is an antibacterial agent used widely in consumer products. It does not tell apart the bacteria you want from the bacteria you do not. Ongoing exposure to broad antibacterials in soaps, toothpastes and household products is a plausible contributor to microbial disruption. Its safety in that role is not as settled as its wide use implies.
Diabetes, gluten and the colon
Bacterial translocation (bacteria crossing the colon wall) has been investigated as a contributor to the inflammation behind type 2 diabetes. Separately, gluten can worsen autoimmune conditions in susceptible people. A gluten-free diet helps a subset of people with irritable bowel syndrome — not because gluten is harmful to everyone, but because each person responds in their own way. That is worth testing rather than assuming.
Frequently asked questions
How do you increase good bacteria in your gut naturally?
Start with diet, the largest lever an adult has. Your gut bacteria reflect what you feed them. The population changes measurably within days of a change in diet. Avoid sugars and artificial sweeteners rather than swapping one for the other. Broad antibacterials such as triclosan, found in soaps, toothpastes and household products, do not tell apart the bacteria you want from the ones you do not.
What foods are worst for gut health?
A diet high in sugar and fat measurably affects cognition and mood. It does this partly through the microbiome and partly through the inflammatory load it creates. Artificial sweeteners are not a safe swap. They can disrupt blood sugar control through their effect on gut bacteria. In susceptible people, gluten can worsen autoimmune conditions. The response is individual enough to test rather than assume.
How does the gut talk to the brain?
Through several routes. Gut bacteria make neuroactive compounds, shift the immune signals that reach the brain and act on the vagus nerve. Most of the body’s serotonin is made in the gut, and gut microbes influence that production directly. The traffic runs both ways. Inflammation from the gut reaches the brain, and stress changes gut permeability and the mix of bacteria.
Are gut bacteria linked to type 2 diabetes?
Yes. Bacteria crossing the wall of the colon have been investigated as a contributor to the inflammation behind type 2 diabetes. Gut bacteria also explain why artificial sweeteners can upset blood sugar control without adding a single calorie. What you feed your gut shows up in your glucose, not only in your digestion.
Related reading
Sources
- Dinan TG, Stanton C, Cryan JF. Psychobiotics: a novel class of psychotropic. Biological Psychiatry. 2013. PMID 23759244
Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP
Interventional pain physician, addiction medicine specialist and obesity medicine diplomate.
Licensed in Missouri and Illinois.
Last reviewed August 25, 2026
Important Points:
- Industrial Seed Oils
- Hydrogenated fat
- Omega 6
- Omega 3
- Linoleic acid
- Animal Fats
Are Vegetable and Seed Oils Bad for Your Health?
The consumption of vegetable oils has increased dramatically in the past century. We have been told otherwise, but industrial seed oils such as soybean, canola, and corn oils are not “heart healthy” at all. They do nothing good for our bodies and brains. In fact, plenty of research indicates that these oils are making us sick. Here we cover industrial seed oil history, the harm they do to your health, and what fats you should eat instead.
1. What Are Seed Oils?
Industrial seed oils are highly processed oils taken from soybeans, corn, rapeseed (the source of canola oil), cottonseed, and safflower seeds. They entered the American diet in the early 1900s.
2. How Are Industrial Seed Oils Made?
The way industrial seed oils are made is anything but natural. Oils from soybeans, corn, cottonseed, safflower seeds, and rapeseeds must be refined, bleached, and deodorized. Only then are they fit to eat.
- First, seeds are gathered from the soy, corn, cotton, safflower, and rapeseed plants.
- Next, the seeds are heated to extremely high temperatures. This makes the unsaturated fatty acids in the seeds oxidize (react with oxygen and break down). That creates byproducts that harm human and animal health.
- The seeds are then processed with a petroleum-based solvent, such as hexane, to squeeze out as much oil as possible.
- Next, industrial seed oil makers use chemicals to deodorize the oils, which smell very bad once extracted. This deodorizing step produces trans fats.
- Finally, more chemicals are added to improve the color of the industrial seed oils.
All in all, industrial seed oil processing makes an oil that is high in calories and low in nutrients. It contains chemical residues, trans fats, and oxidized byproducts.
3. Why are they bad for you?
Linoleic Acid Could be Increasing Our Risk of Obesity and Related Health Problems
In experiments in mice, raising linoleic acid intake from 1% to 8% may trigger brain signals that drive more eating and promote body fattening. Eating more linoleic acid seems to mask the feeling of fullness. It also seems to increase the size of fat cells.
- Vegetable Oils Contain an Unnatural Amount of Omega-6 Fats
When it comes to omega-6, quality matters. Industrial seed oils are high in omega-6. But plenty of whole, fresh foods also contain omega-6 fatty acids naturally. These include nuts, poultry, and avocados.
Essential fatty acids are polyunsaturated fats (PUFA) that humans cannot make. So we must get them from food. They come in two kinds: omega-6 fatty acids and omega-3 fatty acids. Once eaten, omega-6 fatty acids turn into arachidonic acid and strong byproducts that mostly drive inflammation. These include prostaglandin E2 and leukotriene B4. Omega-3 fatty acids such as ALA, EPA, and DHA, on the other hand, turn into byproducts that fight inflammation.
A delicate balance between omega-6 and omega-3 fatty acids must be maintained in the body to promote optimal health. Eating a lot of omega-6 and little omega-3 throws your inflammation signals out of balance. The signals that fan inflammation outweigh the ones that calm it. That produces a state of chronic inflammation that contributes to numerous chronic disease processes.
- Vegetable Oils are Unnaturally Produced, Highly Refined, and Extracted Using Heat and Chemicals
Factory-made PUFA oils are produced with high heat and extreme pressure. This exposes the oil to all sorts of oxidative damage (damage from oxygen). Then the makers dump in chemical solvents to get every last drop of profitable oil out of the seeds, corn, or soy. Some of the chemical (usually hexane) stays in. Then yet another chemical is added to cover the stench of the rancid PUFA oil. In that process, the small amount of omega-3 in oils like canola actually turns into trans fatty acid. Last, BHT and BHA are added as chemical preservatives. Both are carcinogenic (cancer-causing). Why add them? Because processing wipes out the natural preservatives the food once had, such as the antioxidant vitamin E.
- Vegetable Oils Contribute to Excess Inflammation and Free Radical Damage.
Polyunsaturated fats are very fragile and oxidize very easily. Heat, light, or oxygen makes the PUFA oxidize and form free radicals (unstable molecules that damage cells). That is hard to avoid when you are cooking with these fragile oils. And most restaurants use only these oils, not just for cooking but for extreme high-heat frying.
PUFAs cause too much inflammation in the body because of free radicals. These free radicals form when industrial oils (like vegetable and canola) are processed, and they make the oils rancid. Free radicals are loose and need a place to land. They attack cell membranes and red blood cells. They also damage DNA and RNA strands, which leads to cell mutations in the body’s tissues. In skin, it causes wrinkles and early aging. In blood vessels, they cause plaque to build up. In tissues and organs, it can set the stage for tumors to form. You get the idea. Free radicals are bad, bad news, and industrial PUFA oils are full of them.
- Many Vegetable Oils are Hydrogenated and Can Be Filled with Trans Fats.
PUFAs are at their very worst when they are partially or fully hydrogenated. This chemical process takes place in factories. It is used to make PUFAs solid at room temperature and more “shelf stable”. Trans fat is the artery-clogging fat formed when vegetable oils are hardened. That is how margarine, vegetable shortening, and often vegan butters and cheeses are made. Trans fats block the making of prostacyclin, which your body needs to keep your blood flowing. When your arteries cannot make prostacyclin, blood clots form, and you may die suddenly.
4. What Health Conditions are Linked to Industrial Seed Oils?
- Asthma: Eating industrial seed oils may raise your risk of asthma. Industrial seed oils are high in omega-6 fatty acids. Eating a lot of these compared with omega-3 fatty acids raises the inflammation signals associated with asthma.
- Autoimmune Disease: Industrial seed oils may promote autoimmunity, where the immune system attacks the body. They do it by raising the body’s omega-6-to-omega-3 ratio. They also add to oxidative stress and chronic inflammation.
- Cognition and Mental Health: Industrial seed oils are especially harmful to the brain. A high omega-6-to-omega-3 fatty acid ratio sets people up for depression, anxiety, cognitive decline (loss of thinking skills), and dementia. Eating canola oil is linked to worse memory and weaker learning in Alzheimer’s disease. Trans fats end up in industrial seed oils in two ways. Some form by accident from chemical and heat processing. Others are made on purpose through hydrogenation. Trans fats are associated with higher risks of dementia and, oddly enough, aggression.
- Diabetes and Obesity: Linoleic acid is the main fatty acid in industrial seed oils. Research in mice indicates that eating a lot of it changes nerve signaling in the brain. In the end, that increases eating and weight gain. In mice, a diet high in soybean oil causes obesity, insulin resistance, diabetes, and fatty liver disease. Some animal research also suggests that canola oil may cause insulin resistance.
- Heart Disease: Researcher James DiNicolantonio has put forward a theory. He calls it the “oxidized linoleic acid theory of coronary heart disease”. It links eating industrial seed oils rich in linoleic acid with heart and blood vessel disease (cardiovascular disease).
- IBS and IBD: Research suggests that industrial seed oils may harm gut health. This may contribute to conditions such as irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). In one study, mice fed a diet high in omega-6 fatty acids from corn oil had more gut bacteria that drive inflammation. These changes favor gut disease, among many other chronic diseases.
- Inflammation: A high omega-6 intake from industrial seed oils promotes chronic inflammation. Eating partially hydrogenated industrial seed oils is associated with higher C-reactive protein, TNF-alpha, and interleukin-6. So is eating plain soybean oil that is not hydrogenated. These are blood markers of body-wide inflammation.
- Infertility: About 9 percent of men and 11 percent of women in the United States have trouble having children. Many factors are driving soaring rates of infertility. One overlooked cause may be the large amount of industrial seed oils we eat. Infertile men have a significantly higher omega-6-to-omega-3 ratio than fertile men. In animal studies of female mammals, eating a lot of omega-6 fats causes poor reproductive results.
- Macular Degeneration: Industrial seed oils may be harmful to the eyes. A high intake of omega-6 fatty acids increases the risk of age-related macular degeneration. This eye disease causes vision loss that gets worse over time and ends in blindness. Too much omega-6 may contribute to eye problems in two ways. It promotes inflammation. It also pushes out the omega-3 fatty acid DHA, which is crucial for vision.
- Osteoarthritis: In people with osteoarthritis, there is an association between omega-6 fatty acids and synovitis. Synovitis is inflammation of the lining of the joint. On the other hand, MRI scans show that more omega-3 intake goes with less cartilage loss in the knee. Industrial seed oils add a large amount of omega-6 fatty acids to the diet. So avoiding these oils may be beneficial for those with or at risk of osteoarthritis.
5. Which Oils Should You Use for Cooking?
- Coconut Oil
- Tallow/ Suet (beef fat)
- Lard/Bacon Fat (pork fat)
- Butter
- Ghee
- Goose, Duck or Chicken Fat
- Extra-Virgin Olive Oil*
- Avocado Oil*
- Palm Oil
- Other fats (not always for cooking, but essential to good health) come from meats, eggs, dairy, and fish. Nuts are also good in moderation, since they are high in polyunsaturated fats.
* Olive oil and avocado oil are both high in monounsaturated fats, which are fairly stable. So they are best used with no heat or low heat. Avoid extreme high-heat cooking with them. They are also great in salad dressings, homemade mayonnaise, for drizzling, etc.
Note:
You can tell if an oil is chemically processed just by reading the label.
AVOID all fats and oils, and any products that contain them, if you see these processing terms ANYWHERE on ANY food label:
- Refined
- Hydrogenated
- Partially-Hydrogenated
- Cold-PROCESSED (do not confuse this trick phrase with Cold-PRESSED)
INSTEAD, look for these safer processing terms on your fat/oil labels:
- Organic
- First-cold pressed or Cold-Pressed Expeller-Pressed
- Unrefined
- Extra Virgin
6. The Bottom Line
If top health is your goal, then industrial seed oils have no place in your diet. Instead, cook with traditional animal fats. Get your omega-6s from whole foods such as nuts and poultry. Balance them out with omega-3 fatty acids from seafood, shellfish, and fish oil.
Related reading
- Conjugated Linoleic Acid: Is It Good for You?
- Heart Healthy Oils: Which Oils to Use
- 10 Types of Saturated Fats
- Why Vegetable Oil Seemed Healthy
- Omega-6 Vegetable Oils, Obesity and Insulin Resistance
Sources
- Ramsden CE, Zamora D, Leelarthaepin B, et al. Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis. BMJ. 2013. PMID 23386268
- Ramsden CE, Zamora D, Majchrzak-Hong S, et al. Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73). BMJ. 2016. PMID 27071971
Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP
Interventional pain physician, addiction medicine specialist and obesity medicine diplomate.
Licensed in Missouri and Illinois.
Last reviewed June 18, 2026
Important Points:
- Sugar
- Behavior
- Learning
- Brain
- Memory
Sugar: Is it bad for kids’ learning and behavior?
Yes. Excess sugar hurts children’s learning. It inflames the hippocampus, the brain’s memory center. It slows communication between brain cells. It raises cortisol, which makes it harder to pay attention and sit still in class. In the short term, the memory effect reverses when sugar comes down.
How sugar affects children’s behavior is a hotly debated topic in pediatrics. Parents and teachers often say sugar and other carbs can dramatically impact children’s behavior, especially how active they are. Doctors, on the other hand, have looked at controlled studies of sugar intake. They have not found hypoglycemia or other blood sugar problems in children who eat large amounts of sugar. So how do sugar and behavior go together?
What effects of sugar make it harmful?
Diets high in refined sugar and saturated fat not only contribute to weight gain and associated health issues. They also have a profoundly detrimental impact on brain function.
Eating too much sugar is known to damage parts of the brain that are key for learning and memory. Neurons (brain cells) that encode memories, in regions including the hippocampus, no longer work efficiently. This leads to poorer learning.
Recent research in rodents has shown that the teen brain is at higher risk of diet-induced cognitive dysfunction. Teenage rats that drank sugary drinks were less able to remember a specific spot that led to an escape hatch. They were compared with adult rats drinking sugary drinks, and with teenage rats on low-sugar diets.
The brains of the teen rats on the sugar diet also showed more inflammation in the hippocampus. That inflammation disrupted learning and memory. Inflammation in the brain can contribute to cognitive decline and dementia.
What effect does sugar have on learning?
- Sugar slows down the brain
A 2012 study on rats by UCLA researchers found that a diet high in fructose (a form of sugar) hinders learning and memory. It does this by literally slowing down the brain. Rats that ate too much fructose had damaged synaptic activity in the brain. That means communication among brain cells was impaired.
Heavy sugar intake caused the rats to develop resistance to insulin. Insulin is a hormone that controls blood sugar levels. It also regulates how brain cells work. Insulin strengthens the synaptic connections (links) between brain cells. This helps them communicate better and form stronger memories. So when insulin levels in the brain are lowered as a result of excess sugar, cognition (thinking) can be impaired.
- Sugar Decreases Attention Span and Memory
It’s well documented that sugar activates the brain’s pleasure response. But scientists are finding that it affects the brain in many other ways too.
When people eat a lot of sugar and then try hard tasks, like math problems, the brain’s hypothalamus lets the body release a lot of cortisol, the stress hormone, which impedes memory. When children’s bodies are flooded with cortisol at school, they struggle to pay attention to their lessons. They find it hard to sit quietly. When their attention is elsewhere, they find it hard to retain what they are taught.
- Chronic Sugar Consumption Might Permanently Impair Memory Functions
In the short term, sugar will only harm memory for a while. So if children eat less sugar, they should find that they can reach their actual academic potential. Some studies suggest that overindulging in sugar early may have a long-lasting effect.
Researchers from the University of Southern California gave adult and teen rats drinks as sugary as ordinary sodas. After a month, the adults showed normal brain function. But the teen rats showed weaker memory and learning. Along with weaker memory, these rats also had inflamed hippocampi. This part of the brain is key for forming, organizing and storing memories.
If sugar can impact young rats in this way, what’s it doing to your child?
- Sugary Foods Crowd Out Brain Food
When sugar moves into the digestive tract, it signals the brain that the body is full. So it makes sense what researchers from Pennsylvania State University found. The more added sugar children eat, the less likely they are to eat healthy brain foods like grains, vegetables, fruits, and dairy products.
Sugar and moods in children
Extreme levels of sugar in children can interfere with neurotransmitters (chemical messengers in the brain) that are responsible for keeping moods stable. This often leads to depression and anxiety in children. High sugar levels can also cause inflammation of cells in a part of the brain called the hippocampus. This area plays a key role in organizing and storing memories. It also connects senses and emotions to those memories.
This topic is still controversial, but sugar has an addictive effect on children and adults alike. Like drugs, sugar floods the brain with dopamine, a feel-good chemical. In this way, it interferes with normal brain function. A study at Yale University found that just the sight of a milkshake activated the same reward centers of the brain that cocaine does in addicts. In fact, another study done in 2007 found that study subjects (rats) preferred sugar water to cocaine.
If you notice behavior changes or mood swings in your child, consider keeping a food journal. Track what they eat and when they show concerning behavior. Try cutting out suspect foods to see if the behavior changes. Food isn’t the cause of all behavioral issues and conditions. Still, it’s important to make sure your child is not suffering from something that can be easily remedied.
The teenage brain and sugar
The teenage brain goes through major changes in structure and function as it develops. Brain-imaging studies show that the prefrontal cortex doesn’t fully mature until the early 20s. A major job of the prefrontal cortex is executive function. That includes behavioral control, attention and decision-making.
Eating too much sugar in the teen years could derail the way the brain normally matures. It may also change the normal path of development and lead to lasting behavioral predispositions (tendencies).
Poor control of the prefrontal cortex in the teen years can explain the increased risk-taking in teenagers. This includes dangerous driving, drug use, and binge drinking.
Brain changes caused by eating too many sugary foods in the teen years can show up later in life. They show up as trouble experiencing reward. Research has shown that male rats that drank sugar water as teens showed reduced motivation and less enjoyment of rewards as adults. These behaviors are core features of mood disorders, including depression. Importantly, this shows that how we eat as teens can affect brain function as adults.
How much sugar is OK?
Limiting your child’s sugar intake is essential for helping them achieve their academic potential. The American Heart Association recommends that children have no more than four teaspoons of sugar a day. Children younger than 2 years should have no sugar at all.
When you add up sugar intake, note that every 4 grams of sugar equals 1 teaspoon. Also watch for hidden sugars in unexpected places like sauces, dried fruits, and flavored yogurts.
A recent study supports this idea: a breakfast with less sugar may improve short-term memory and attention span at school. So give your child a real-food breakfast (eggs, plain yogurt, berries, bananas, etc.) instead of loads of refined sugar. Skip refined grains such as cereal, pancakes and white bread. This should keep adrenaline levels more steady. It should also make the school day more wondrous and productive. Pack her/his lunch box with tasty fiber-containing treats (peaches, grapes, a myriad of other fresh fruits, etc.). That may turn afternoons at home into a delight.
References
- The Conversation (2016): Why sugar is so much worse for teenagers’ brains. Retrieved from
https://theconversation.com/why-sugar-is-so-much-worse-for-teenagers-brains-67238
- Arizona Ob Gyn Associates (2015): How Sugar Affects a Child’s Brain. Retrieved from
- The Center for Parenting Education (2019): Sugar and our children…What’s the deal? Retrieved from
- Huffpost (2015): This Is What Sugar Does To Your Brain. Retrieved from
- Verywell Mind (2017): Negative Impact of Sugar on the Brain. Retrieved from
https://www.verywellmind.com/how-sugar-affects-the-brain-4065218
- Learning Liftoff (2016): The Effects of Sugar on a Child’s Academic Performance. Retrieved from
https://www.learningliftoff.com/the-effects-of-sugar-on-a-childs-academic-performance/
- Dr. Greene (2018): The Relationship between Sugar and Behavior in Children. Retrieved from
https://www.drgreene.com/relationship-sugar-behavior-children/
Related reading
Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP
Interventional pain physician, addiction medicine specialist and obesity medicine diplomate.
Licensed in Missouri and Illinois.
Last reviewed June 18, 2026
The Carnivore Diet: Starting Pointers
Expect an adaptation period. Nearly everyone starting the carnivore diet gets symptoms such as brain fog, headache, sugar cravings and digestive upset. These come while the body adjusts to carbohydrate restriction. Eating more meat, staying hydrated and replacing electrolytes gets you through it. Replacing electrolytes starts with generous salt on your meat.
The carnivore diet – also known as the all meat diet or the carnivorous diet – means eating almost nothing but meat for every meal, every day. That means a lot of protein, a lot of fat, and almost zero carbs. This drastic shift in eating is bound to leave your body reeling. So let’s talk about whether there are bad symptoms and how you can manage them. In this article we’ll walk you through what to expect, and the tips and tricks that will get you through it.
The Carnivore Diet Symptoms
You may have significant symptoms while adapting to The Carnivore Diet. Nearly everyone has bad symptoms and side effects when they start the Carnivore Diet. These symptoms are your body’s natural response to carbohydrate restriction. They are also a response to removing addictive agents and chemicals. Common Symptoms Include:
- Brain fog
- Headache
- Chills
- Sore throat
- Digestive issues
- Dizziness
- Irritability
- Bad breath/smells
- Bad taste in mouth (metallic)
- Dry mouth
- Cravings (sugar!)
- Muscle soreness
- Jaw soreness
- Nausea
- Diarrhea
- Poor focus and concentration
- Decreased performance, energy, and drive
- Cramping
- Rapid heart rate
- Insomnia
- Night sweats
- Nocturia (peeing a lot at night)
- Feeling hot or cold
Coming from a ketogenic (keto) or high fat/low carb diet (HFLC)? Then the switch is generally easier (but there are still symptoms you need to understand!) than for someone coming from a Standard American Diet that is high in carbohydrates. These symptoms come from the significant metabolic and hormonal changes your body is going through.
The 3 Major Adaptations
If you decide to start The Carnivore Diet, your body is going to go through three major adaptations. 1. Fluid Rebalancing: Because you are eating fewer carbs, your insulin levels drop. That signals the kidneys to release sodium from the body. Water follows sodium out of the body, so losing 10 lbs. of water in a couple days is not uncommon. Glycogen (stored sugar) is then turned into glucose. This is the last energy source used before you switch to mainly fatty acids. 2. Transitioning from Sugar to Fat for Energy Your body will start switching from burning mainly sugar to burning fat for energy. Depending on your metabolic flexibility, your symptoms might be milder or more severe. Metabolic flexibility is your body’s ability to adapt to different fuel sources. It depends on a number of factors, including genetics, and especially your diet before this change. If you are used to eating a lot of high carbohydrate foods, it can feel a lot like going into withdrawal. 3. Hormone Response and Rebalancing Some hormones in your body will respond to the diet by rebalancing. Let’s look at thyroid and cortisol hormones. T3 thyroid hormone levels may drop. That is because T3, a hormone made by the thyroid, is closely connected with dietary carbohydrates. It plays a major role in controlling body temperature, metabolism, and heart rate.
Cures for the Carnivore Adaptation Symptoms
You can sharply lessen, and perhaps even eliminate, most of the suffering in the “trough” by using some tricks. They help bridge your body to the adapted state of bliss. Here are some tricks: 1. Eat more meat. Under-eating is the number one reason people suffer when they don’t have to. Early on, it’s common to feel extremely hungry. As your body is getting used to the diet, eat, eat, and eat again. Do not try to restrict calories or track macros. Don’t worry about gaining fat. 2. Hydrate Make sure you are drinking water. Do not overdo it, because you will make things worse, but you need to stay hydrated. After adapting, you drink to thirst (no need to measure or track). But if you are feeling like crap during adaptation – make sure you are hydrating. 3. Electrolytes Replace your electrolytes. As you lose a lot of extra water, you also lose a lot of electrolytes: sodium, potassium, magnesium, chloride. Salt, used generously on your meat, is the first step. For some people, this may be enough. Other people need some help in the potassium and magnesium department as well though… These tricks can help you replace potassium and magnesium:
- Drink Meaty Bone Broth – Besides water and sodium, this will give you some potassium. That will offset some of the discomfort at the level of your cells.
- It’s important that the bones have some meat on them because that’s where the potassium is.
- Supplement – the three electrolytes below:
- Potassium K+: 500 – 3500 mg/day (start with 1g – K+ chloride)
- Magnesium Mg: 250-500 mg/day (magnesium citrate)
- Sodium Na: 2-7g/day (5g is a good starting point – I like this brand)
Solving GI Problems
Gastrointestinal (GI) issues are extremely common, especially if you are coming from a low-fat diet. Your gallbladder and pancreas might not be ready for the extra fat, even if you are. When first starting, you may not have enough bile and lipase to digest the extra fat. That can lead to diarrhea and other kinds of GI distress. To help manage this, you can eat less fat by choosing leaner cuts of meat. A better solution is to supplement for 2-4 weeks. You could take some lipase supplement a few minutes before meals. You can start with one tablet, and if you still have some discomfort, take two. If you still have GI issues, especially if they are GERD/acid reflux related, take a Betaine HCl supplement. Many people make too little stomach acid for good digestion and proper metabolic signaling. This is a main cause of GERD, heartburn and acid reflux. Don’t take this supplement with anti-inflammatories, because it could result in ulcers. It should automatically include pepsin, but check to make sure. Common doses range between 3-5g/meal. Important note: Supplements are a bridging strategy and not designed for long term use; the goal is to be off all of these after the first month. They are meant to let your body catch up. It might also be important to eliminate rendered fats, because they could make the problem worse. It is normal to have fewer bowel movements. That is because your body absorbs and uses meat very efficiently, and not a lot goes to waste.
Sleep
Insomnia is common during adaptation. And since you are purging water, nocturia is also an interrupter. A few hacks that help: Keep your room pitch black (blackout curtains, cover LEDs) and COOL. Start winding down 2 hours before bed (no screens, or at least put them in night mode)
- Don’t eat within a few hours of sleep if you can help it
- Be conscious of how much you are drinking later in the day
- Be asleep before 11 (a cortisol spike happens if you are not asleep around this time)
Sweat
Sweating is a natural detox mechanism. You are finally giving your body the nutrition it has been craving. So you give it the chance to expel toxins. Give your body a hand and help it detox by getting some exercise and sweating.
Killing cravings and addictions – “Brain Changes”
Besides the metabolic and hormonal changes mentioned, you may also notice what I call “Brain Changes.” They occur along the “brain-body highway”, a signaling control system between the gut and the brain. This communication highway affects everything from hormones to neurotransmitters like dopamine, serotonin, and GABA. These play huge roles in mood, cravings, and addiction. Much like many drug addictions, you may go through withdrawal symptoms from foods or other substances (especially sugar). Your body has become physically and neurologically addicted to them. Cravings are common, and the best solution is to make sure you are eating enough fatty meat. Not eating enough meat and eating meat that is too lean are the top mistakes.
You’re Ready to Start
Most people have adaptation symptoms, which can range from annoying to a certainty that you are going to die. I’ll be the first to admit that they aren’t all that pleasant. But with the above information to help identify and deal with them, your first attempt should be much easier. Yes, your bowel movements will change, and you will have some early fatigue and brain fog. But in my opinion, the benefits certainly outweigh these temporary symptoms, especially if your goal is to lose weight fast. Be committed, don’t let them deter you and give it a try. References
- Meat Health (2018):The Carnivore Diet – Symptoms and Cures. Retrieved from
- Mike Fishbein (2019):The Carnivore Diet: How to Survive the First Month. Retrieved from
- Carnivore Style (2018): Carnivore Diet Side Effects What Are the Symptoms, Risks & Dangers? Retrieved from
Related reading
Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP
Interventional pain physician, addiction medicine specialist and obesity medicine diplomate.
Licensed in Missouri and Illinois.
Last reviewed June 18, 2026
Important Points:
- Obesity
- Malnourished
- Nutrient intake
- Vitamin deficiency
- Starvation
Malnutrition is Both Obesity and Starvation
Yes, you can be obese and malnourished at the same time. Malnutrition means poor nutrition in either direction: too few nutrients, or more calories than you need. A diet of pizza, fries, pasta and cakes gives plenty of calories but few vitamins and minerals.
We usually link the word malnutrition with the tragically thin people in TV news reports of third world famines. In fact, it’s a shockingly common problem all over the world. Not at starvation level, but millions of patients aren’t getting enough calories, protein, vitamins, and minerals.
Doctors say we lean more and more on fast food, and binge-drinking rates keep rising. Because of that, many people lack the vitamins and minerals they need for health. In the most extreme cases, the result is pot-bellies, wasted limbs and emaciated (very thin) bodies. These are all conditions more often associated with famine victims in the developing world. Malnutrition can be fatal. In milder forms, it can cause a host of symptoms that affect everyday life, from hair loss and muscle wasting to food cravings and lethargy (low energy). It is possible to be obese and still be malnourished.
1. What is Malnutrition?
Malnutrition is a serious condition. It happens when a person’s diet doesn’t have the right amount of nutrients. Malnutrition means “poor nutrition” and can refer to:
- undernutrition – when you don’t get enough nutrients
- overnutrition – when you get more nutrients than you need
2. Who is Affected by Malnutrition?
Malnutrition is a common health problem. An estimated 3 million people in the UK are malnourished at any time, and many more are at risk. Around one in three people admitted to hospital or care homes in the UK are found to be malnourished or at risk of it.
Malnutrition is caused by a poor diet or by a problem absorbing nutrients from food. That can come from reduced mobility, a long-term health condition, or a low income.
3. What are the Signs of Malnutrition?
The most common symptom of undernutrition is weight loss you did not plan (losing 5-10% or more of your body weight over three to six months). Other signs include weak muscles, fatigue, low mood, and more illnesses or infections.
The main sign of overnutrition is being overweight or obese. But people with undernutrition can also be overweight if they eat a diet high in energy (calories) but low in other nutrients.
4. Why are so many obese people undernourished?
The number of people who are malnourished despite being obese is shocking, a leading weight loss surgeon said today. A recent study showed that despite high levels of obesity in the U.S., many people are undernourished.
A diet of pizza, fries, chips, pasta, rice, cookies, cakes leaves many people eating a lot of calories but few nutrients. So says Dr. Sally Norton, an NHS consultant who specializes in weight loss and upper gastrointestinal surgery.
Drug companies push sales of expensive drugs that treat the symptoms of the disease but not the cause. The multi-million-dollar drug industry encourages doctors to use expensive drugs, not healthier food. It wants them to treat type 2 diabetes, high cholesterol, heart disease and other conditions tied to poor nutrition that way.
Hippocrates, the father of medicine, was so right when he said, over 2,000 years ago: ‘let food be thy medicine’. And yet, jump to the 21st century. A recent study shows that many Americans, despite their access to plenty of food, are undernourished.
5. Can obese people really be malnourished?
Picture a malnourished hospital patient…..
The person you’re picturing probably doesn’t weigh 300 pounds, does she? Yet obese patients can develop malnutrition before or during a hospital stay. They have worse outcomes because of it.
In fact, a recent study found that malnutrition cancels out the “obesity paradox,” the idea that, among the critically ill, heavier patients do better than normal- or underweight patients. Researchers looked specifically at malnourished obese patients. They had a higher risk of death than well-nourished patients of similar body mass index. The results were published in the January issue of Critical Care Medicine.
Yet experts say hospital clinicians often miss these patients’ nutritional deficiencies. “We as physicians don’t necessarily have a great handle on who is malnourished,” said Kenneth B. Christopher, MD, co-author of the study. “You can always tell if someone’s profoundly malnourished, because they start appearing to be cachectic, but it’s less severe degrees of malnutrition that are actually harder to see.”
Judging by looks is one problem. A number of other factors can also make it hard to diagnose or prevent malnutrition in obese hospital patients. These include gaps in history taking, limits of lab testing, and challenges in getting nutrition to patients. Experts say hospitalists can help close these gaps. They can do this if they raise their own level of suspicion and work with the health care team to focus on patients’ nutritional status.
Malnutrition can be fatal. In milder forms, it can cause a host of symptoms that affect everyday life. How many nutrients do you get in cookies, pieces of cake, chips, fries, pizza, white rice, pasta and bread? Not a whole lot. Foods like these are harmful, refined grains most of all, so cut them out. Get your nutrients from real, fresh, whole foods instead.
6. How is malnutrition diagnosed in someone with obesity?
Accurate screening for malnutrition starts with knowing you can’t see it with your eyes or even a scale. “Nutritional status is not body mass index,” summed up Dr. Christopher, a nephrologist (kidney doctor) and critical care specialist at Brigham and Women’s Hospital in Boston. For one thing, extra weight may not be body fat.
Obesity could also hide recent weight loss, an important marker of malnutrition. “Somebody could be obese but have a gastrointestinal problem and have been losing weight. Even though they’ve lost a considerable amount of weight, they started off so obese that they’re still technically obese,” said Dr. Mechanick.
“Because our society has so much stigma around overweight and obesity, when many obese people lose weight, however they lose it, they get more positive feedback,” said Charlene W. Compher, PhD, a professor of nutrition science at the University of Pennsylvania in Philadelphia. If a patient lost weight from bariatric surgery, he is at special risk for malnutrition. “The odds of having vitamin deficiencies are very high with patients with gastric bypass, especially if they do not take all of the vitamin and mineral supplements that they are instructed to,” said Dr. Compher. An obese person could be getting enough calories but not enough protein or other nutrients, because of an unhealthy diet.
7. How Can You Tell if You’re Malnourished?
“There’s no lab test for malnutrition,” said Dr. Kirkland. “People rely on albumin. It’s not helpful for malnutrition. Albumin just reflects the acuity of illness or the duration of malnutrition, but not the severity of it or the presence of it.”
Whatever your weight, always eat well balanced, healthy meals, with regular supplements where needed. That matters because malnutrition could potentially lead to other chronic illnesses such as type 2 diabetes, heart issues and others.
Frequently asked questions
What does severe malnourishment look like?
In its most extreme form, malnutrition shows up as pot-bellies, wasted limbs and emaciated bodies, the look most people link with famine. Doctors call a profoundly malnourished person cachectic (wasted). Milder malnutrition is much harder to see. In a person with obesity, it can hide completely behind their weight.
What problems can malnutrition cause?
Mild malnutrition causes everyday symptoms such as hair loss, muscle wasting, food cravings and lethargy. Undernutrition also brings weak muscles, fatigue, low mood and more illnesses and infections. Over time, poor nutrition can lead to chronic illness, including type 2 diabetes and heart problems. And malnutrition can be fatal.
Can you be malnourished and not know it?
Yes. You cannot see malnutrition with your eyes or a scale, and there is no single lab test for it. Albumin, the blood test many people rely on, does not show whether malnutrition is present. Someone who is still obese after losing a lot of weight, or who has had gastric bypass, can be malnourished without anyone noticing.
Related reading
- Food Addiction and Hyperpalatable Food: How It Works
- The Secret to a Healthy Weight: Insulin, Not Calories
References:
- International Journal of Obesity (2019): Overfed but undernourished: recognizing nutritional inadequacies/deficiencies in patients with overweight or obesity. Retrieved from
https://www.nature.com/articles/s41366-018-0143-9
- NCBI (2012): The Malnutrition of Obesity: Micronutrient Deficiencies That Promote Diabetes. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3313629/
- ACP Hospitalist (2015): Obesity and malnutrition are not mutually exclusive. Retrieved from
https://acphospitalist.org/archives/2015/02/nutrition.htm
- Critical Care Medicine (2015): The True Obesity Paradox
Obese and Malnourished? Retrieved from
- NHS Inform (2019): Malnutrition. Retrieved from
https://www.nhsinform.scot/illnesses-and-conditions/nutritional/malnutrition
Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP
Interventional pain physician, addiction medicine specialist and obesity medicine diplomate.
Licensed in Missouri and Illinois.
Last reviewed June 18, 2026
Is there a solution to rising insulin prices?
The solutions on the table are laws and oversight. One is transparent pricing that forces drug companies to reveal how they set insulin prices. The other is federal enforcement. The American Medical Association has urged the Federal Trade Commission and the Department of Justice to do it. Until then, open talk between patient and clinician is what prevents deaths from rationing.
The rising cost of insulin has been a heated topic of public policy debate. But the human struggle of patients trying to cope has gotten less attention. Some patients tried rationing their insulin to make it last longer. Their struggles include hospital stays and even death.
Besides rationing, some patients cut back on carbohydrates just to lower their insulin dose. Others saved money by reusing insulin needles and blood glucose test strips. All of this risks wrong readings and infection.
Despite this alarming news, no one knows the exact number of people who died or were harmed by rationing. That is most likely because patients and family members are too embarrassed to report it.
Because of these struggles, grassroots advocacy groups formed. They include the campaign hashtag #Insulin4all, backed by the nonprofits T1International and Pendsey Trust. Most #Insulin4all supporters are very critical of the people who make policy, especially politicians. They go as far as accusing the drug industry of making diabetics an underclass.
The claimed reason for sky-high insulin prices is a monopoly. Three companies have a chokehold on setting the price of insulin.
The idea behind preventing deaths from rationing is that more open talk between patients and the clinician is the key. Many times, this talk is cut short because of how patients feel. They feel like failures. They fear not being seen as independent. They are embarrassed that they cannot afford their own medicine.
One expected result of rising prices is a push to go back to older human insulins called NPH and Regular. This is harder for the patient because it takes a syringe and a needle. Modern insulin comes in prefilled pens. Without them, the patient could get the wrong dose or struggle to work out the right dosing schedule.
Given this problem, the solution may lie in making laws. Some experts favor transparent pricing. That would require drug companies to reveal in detail how they set insulin prices. Groups like the American Medical Association have strongly urged the US Federal Trade Commission and the Department of Justice to closely watch insulin pricing and to take action when they can.
Note that the brands Novo Nordisk, Sanofi, and Eli Lilly promised ways to keep insulin affordable for patients. But trusting company promises may not be the best answer to this serious problem either.
Source: Diabetes Patients Beg, Ration Insulin in Deepening Crisis (Medscape).
Related reading
Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP
Interventional pain physician, addiction medicine specialist and obesity medicine diplomate.
Licensed in Missouri and Illinois.
Last reviewed June 18, 2026
Important Points:
- whole grains
- refined grains
- Western dietary pattern
- diabetes
- obesity
Refined Grains: The Good, the Bad, the Ugly
Refined grains are grains stripped of their bran and germ, such as white flour and white rice. Refining removes about a quarter of the protein. It also removes half or more of many nutrients, and enrichment puts back only a fraction. Two slices of wheat bread raise blood sugar higher than six teaspoons of table sugar.
Flour is all around us. It tempts us at every meal. Breakfast means toast, bagels, cereal and pancakes. Lunch means sandwiches, wraps, pasta and pizza. Refined grains have been blamed as one of the leading causes of poor health. Is that true? Should we toss all refined grain products off our tables? Here we take a close look at the good, the bad and the ugly of refined flour, so you know what is on your plate.
What are Refined Grains?
A refined grain is not whole because it is missing one or more of its three key parts: the bran, the germ or the endosperm. White flour and white rice are refined grains, for instance, because both have lost their bran and germ. Only the endosperm is left. Refining strips out about a quarter of a grain’s protein. It also strips out half to two thirds or more of a score of nutrients. What is left is a mere shadow of the original grain.
More refining steps include mixing, bleaching and brominating. Makers also often add thiamin, riboflavin, niacin and iron back in to enrich the product. Because the added nutrients are only a fraction of what was removed, refined grains are considered nutritionally worse than whole grains. Still, for some grains, losing the fiber and grinding fine makes slightly more of the grain’s energy available to the body.
Grain refining led to disastrous and widespread health problems. Among them were the deficiency diseases pellagra and beri-beri. In response, many governments recommended or required that refined grains be “enriched.”
The Good: do refined grains have any benefits?
The federal government’s 2010 Dietary Guidelines for Americans give advice on grains. They say half of your daily grains should come from whole grains high in fiber, such as brown rice, oatmeal and whole-wheat bread. We do not follow that advice. We recommend no refined grains for our patients, and we do not build meals around grains.
One nutrition researcher, Julie Miller Jones, a professor emeritus at St. Catherine University, argues that refined grains have one benefit: the nutrients added back to refined flours. That does not make white flour a good food. It makes it a processed food with a patch.
Folic acid was added to bread, cereal and other grains in 1999. Since then, the rate of newborns with neural tube defects has dropped 46%. These defects are a known result of folic acid deficiency. Leafy greens supply folate without the blood sugar spike, and women planning a pregnancy should take a folic acid supplement rather than rely on white bread for it. In chronic pain, gluten and gliadin in wheat drive a leaky gut and autoimmune trouble, and no added vitamin fixes that.
The Bad: why is white flour bad for you?
As our national appetite for flour has inched up, so have diet-related ills such as obesity, heart disease and diabetes. Coincidence? Many nutrition experts don’t think so. When they weigh the evidence linking food choices and disease, they see the white, dusty fingerprints of flour everywhere.
Flour started out as a clever fix to a hard problem. Grass seeds were plentiful. But the tough outer shell (the husk) made the seeds hard to chew and digest. Early humans outsmarted the seeds by grinding them between stones. That crushed the outer layers to get at the goodness inside. The result, a coarse powder, was the first whole-grain flour.
The downside was spoilage. Crushing the germ released its oils, and those oils quickly turned rancid in the air. Then industrial milling arrived in the late 1800s. Machines began filtering out the germ. They ground the remaining endosperm into a fine, white powder that lasted on the shelf for months. And so all-purpose white flour was born, along with a host of health problems.
Whole-kernel grains have a rigid structure. Inside it, they hide an array of vitamins, minerals, phytonutrients and fiber. But when machines grind kernels into flour, even whole-grain flour, what is left is a starchy powder. That powder can wreak havoc on the body.
The Ugly
Eating too much flour can lead to a number of problems in the body, including:
- Food Allergies/Intolerances. Gluten intolerance has become a term tied to this generation. Wheat is one of the biggest food triggers of allergies and intolerances. The exact reason is unclear. Still, many experts blame the higher gluten content of modern wheat.
- Blood-Sugar Spikes. The difference between a whole-kernel grain and a processed grain all comes down to the glycemic index. That index measures how fast the body turns food into fuel, or glucose. Foods made with wheat flour are especially damaging. Wheat has a carbohydrate called amylopectin A. It turns into blood sugar more easily than just about any other carbohydrate. Two slices of bread made with whole-wheat flour raise blood sugar higher than six teaspoons of table sugar. They also raise it higher than many candy bars.
- Food Cravings. One of the biggest changes in modern wheat is a modified form of gliadin. Gliadin is a protein found in wheat gluten. It gives the brain a feel-good effect by changing into a substance that crosses the blood-brain barrier and binds to the brain’s opiate receptors. That makes you want to eat more.
- Caloric Overload. A refined grain packs more calories than a whole-kernel grain because it is more concentrated. Foods high in grains also tend to be high in sugar and industrial fats. These foods add a great deal to obesity and the diabetes epidemic.
- Metabolic Slowdown. Research shows that high-glycemic-index foods may push the body to store nutrients as fat instead of burning them in muscle. In 2004, Ludwig and his colleagues at Harvard ran a study, published in the journal Lancet. They fed rats diets with the same nutrients, except for the type of starch. By the end, rats in both groups weighed roughly the same. But the rats on the high-glycemic diet had 71 percent more fat than the low-glycemic-index group.
- Inflammation. A diet high in grains stokes inflammation. When blood sugar spikes, glucose builds up in the blood significantly. Glucose drifting in the blood sticks to nearby proteins. This chemical reaction is called glycation. It is a pro-inflammatory process that plays a role in a host of inflammatory diseases.
- GI Disorders. Studies show that the lectins in grains inflame the lining of the gut and open cracks between cells. Also, when whole-kernel grains are refined, 80 percent of the fiber is lost, and gut health suffers. Fiber also helps sweep debris out of the gut. It supports the body’s vital elimination and detox processes. Those processes also help keep high cholesterol and inflammation at bay.
- Acid-Alkaline Imbalance. The body has a detailed system of checks and balances to hold its pH at a steady 7.4. A diet high in acidic foods, such as grains, forces the body to pull calcium from the bones to stay balanced. Researchers looked at how the diets of more than 500 women affected their bone density. A diet high in refined grains, among other nutrient-poor foods, was linked to bone loss. A highly acidic diet also chips away at our cell health and immunity. That can leave us open to chronic disease. Grains are the only plant foods that make acidic byproducts. Wheat, in particular, is among the most potent sources of sulfuric acid. This powerful substance quickly overpowers the neutralizing effect of alkaline bases.
The Bottom Line….
Grains are not essential, and there is no nutrient in there that you can’t get from other foods.
Related reading
Sources
- Swaminathan S, Dehghan M, Raj JM, et al. Associations of cereal grains intake with cardiovascular disease and mortality across 21 countries in Prospective Urban and Rural Epidemiology study: prospective cohort study. BMJ. 2021. PMID 33536317
- Schwingshackl L, Hoffmann G, Lampousi AM, et al. Food groups and risk of type 2 diabetes mellitus: a systematic review and meta-analysis of prospective studies. European Journal of Epidemiology. 2017. PMID 28397016
Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP
Interventional pain physician, addiction medicine specialist and obesity medicine diplomate.
Licensed in Missouri and Illinois.
Last reviewed June 18, 2026
Prediabetes is a pre-diagnosis — a warning, not a disease in waiting. It is also reversible. The mistake built into standard practice is treating the diagnostic line as the point where harm begins.
When does prediabetes start causing damage?
Most doctors wait until HbA1c is above 6.5 before they act. But macrovascular damage (damage to the large blood vessels) is already happening between 5.7 and 6.5. The higher cardiovascular risk associated with type 2 diabetes does not start at the diagnostic cutoff. Microvascular and macrovascular (small and large blood vessel) risk runs along a continuum that extends well below it. (Hopper I, Billah B, Skiba M, Krum H. Prevention of diabetes and reduction in major cardiovascular events in studies of subjects with prediabetes: a meta-analysis of randomized controlled trials.)
It is also worth knowing that HbA1c has a significant tendency to miss cases compared with an oral glucose tolerance test. A normal HbA1c is weaker comfort than most patients are led to believe.
How common is prediabetes, and does it have symptoms?
In 2015 an estimated 84.1 million American adults had prediabetes — roughly one in three. Most did not know. Diabetes develops slowly, over years. During the prediabetic phase there may be no symptoms at all.
What people sometimes notice:
- Eating a standard American processed-food diet.
- Being hungrier than usual.
- Losing weight despite eating more, or gaining despite eating less.
- Increased thirst.
- Passing urine more frequently.
- Unusual fatigue.
What does an HbA1c test measure?
Glycation is a chemical reaction that happens on its own — a Maillard reaction. In it, a sugar molecule bonds tightly (covalently) to a protein or fat with no enzyme controlling it. It is random, and it harms the function of whatever it changes. Notably, fructose has roughly ten times the glycation activity of glucose. That is why the source of the sugar matters, not only the amount.
HbA1c measures the share of hemoglobin that has been glycated. That is why it reflects an average over the life of the red blood cell, not a single moment.
The economics of treating early
Delaying the move to type 2 diabetes is cost-effective even when it takes medication. Generic metformin costs well under five cents per 1,000 mg tablet — roughly six dollars for a thirty-day supply. Compare that with the later cost of insulin once beta-cell fatigue sets in (when the insulin-making cells tire out).
Metformin also has effects beyond glucose. In the prediabetic range it appears to protect the heart. Here is why. Insulin resistance is implicated in the development of left ventricular hypertrophy (a thickened main pumping chamber of the heart). That is one of the strongest independent predictors of cardiovascular outcome. Dysglycemia (abnormal blood sugar) is also common in patients with coronary artery disease. It is linked to insulin resistance.
How many carbohydrates do you actually need?
A patient once asked how many carbohydrates she should eat each day. She asked because her dietitian had told her to eat at least 250 grams or risk brain injury from hypoglycemia (low blood sugar). The USDA, the Institute of Medicine and the American Heart Association recommend that carbohydrates make up 45 to 65 percent of daily calories. On 2,000 calories, that is roughly 900 to 1,300 calories from carbohydrate.
Strictly speaking, the human need for dietary carbohydrate is zero. The body makes the glucose it needs through gluconeogenesis. That is not an argument for cutting out all carbohydrate. But it is a reason to treat the recommended range as a convention, not a body requirement.
Can prediabetes be reversed?
Obesity, prediabetes and type 2 diabetes are associated with most of the diseases of modern society. These include cardiovascular disease, cerebrovascular disease (disease of the brain’s blood vessels), cancer, and Alzheimer’s disease. All are metabolic dysfunctions tied to the malnutrition of overconsumption. That produces metabolic inflammation.
Reversing diabetes while it is still prediabetes is safe, cost-effective and disease-modifying. The best way to reverse diabetes is not to develop it. That is because the risk of heart disease, cancer and death is already raised in the prediabetic range. Treating the root cause rather than the symptom is the whole approach. Cutting out refined carbohydrates is where it starts.
Frequently asked questions
What happens if you are prediabetic?
Harm is already under way. Macrovascular damage (damage to the large blood vessels) happens at an HbA1c between 5.7 and 6.5, long before the diagnostic cutoff for type 2 diabetes. The risk of heart disease, cancer and death is already raised. Most people feel nothing. Roughly one in three American adults had prediabetes in 2015, and most did not know it.
What is the main cause of prediabetes?
Prediabetes is a metabolic dysfunction driven by the malnutrition of overconsumption. That means a diet heavy in refined carbohydrates and sugar, which produces metabolic inflammation. The source of the sugar matters, not only the amount. Fructose has roughly ten times the glycation activity of glucose. So it glycates (sugar-coats) proteins and fats far more readily.
What are the worst foods for prediabetes?
Refined carbohydrates come first, and cutting them out is where reversal starts. The standard American processed-food diet is the usual driver. Foods heavy in fructose deserve special caution, because fructose glycates proteins about ten times faster than glucose. Carbohydrate is not a body requirement. The body makes the glucose it needs through gluconeogenesis.
What is the fastest way to fix prediabetes?
Treat the root cause instead of waiting for an HbA1c of 6.5. Cutting out refined carbohydrates is where it starts. When medication is needed to delay progression, generic metformin costs roughly six dollars for a thirty-day supply. It also appears to protect the heart in the prediabetic range. Reversing it now is safe, cost-effective and disease-modifying.
Related reading
Sources
- Tabák AG, Herder C, Rathmann W, et al. Prediabetes: a high-risk state for diabetes development. Lancet. 2012. PMID 22683128
- Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine. 2002. PMID 11832527
- Tabák AG, Jokela M, Akbaraly TN, et al. Trajectories of glycaemia, insulin sensitivity, and insulin secretion before diagnosis of type 2 diabetes: an analysis from the Whitehall II study. Lancet. 2009. PMID 19515410
Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP
Interventional pain physician, addiction medicine specialist and obesity medicine diplomate.
Licensed in Missouri and Illinois.
Last reviewed August 25, 2026
The belief that vegetable oil is heart-healthy rests substantially on early data that was confounded (muddied by other factors). The trials done since have not been kind to it.
Where the confounding came in
Older data was confounded because it lumped omega-3 polyunsaturated fatty acid intake in with omega-6. That mix misrepresented the health benefits of omega-6 specifically. Other work found that omega-6 PUFA increased death and coronary heart disease compared with animal fat. That work includes the Anti-Coronary Club trial.
A meta-analysis of almost 10,000 patients confirmed it. High intake of omega-6 oils from vegetable oils and margarines increases the risk of death and heart disease compared with saturated fat.
The ratio
The Standard American Diet has a greater than 20:1 ratio of omega-6 to omega-3. That distortion is associated with a range of neuropsychiatric dysfunction (brain and mood problems). This includes profound anxiety. Restoring a healthier ratio nearer 4:1 — even by supplementing omega-3 rather than removing omega-6 — appears to reduce that anxiety. (Buydens-Branchey L, Branchey M, 2007.)
Seed oil and type 2 diabetes
Processed seed oil is associated with type 2 diabetes. In the opposite direction, cohort studies find that plasma (blood) saturated fatty acids from dairy sources such as cheese and yogurt are inversely related to the incidence of type 2 diabetes. That means more of them goes with fewer new cases.
Neuroinflammation, mood and attention
Processed food, and specifically where its fat comes from, is associated with several neuropsychiatric conditions — neuroinflammation, anxiety, depression and attention disorders among them. The fat in processed food is mostly industrial seed oil. That is what makes this more than a correlation with processed food in general.
The unholy trifecta
Sugar, vegetable oil and grain. In more than twenty years of practice, I have not seen a type 2 diabetes patient who did not have all three. The root cause of the obesity, prediabetes and type 2 diabetes epidemic is that combination. It is acellular carbohydrate, industrial seed oil and refined grain, arriving together in nearly everything ultra-processed.
Related reading
Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP
Interventional pain physician, addiction medicine specialist and obesity medicine diplomate.
Licensed in Missouri and Illinois.
Last reviewed August 25, 2026
Important Points:
- Fibromyalgia
- Chronic pain
- hemoglobin A1c
- insulin resistance
Is insulin resistance linked to chronic pain?
Yes, insulin resistance and chronic pain are linked. One study looked at 23 fibromyalgia patients. Their age-adjusted hemoglobin A1c, a measure of insulin resistance, ran significantly higher than in matched controls. Metformin reduced their pain.
An estimated 10 million adults in the United States live with fibromyalgia. It causes pain throughout the body, often to the point where it’s hard to function. Could insulin resistance be the key to understanding and treating fibromyalgia and other chronic pain? Here is some of what current research says.
So, what is Fibromyalgia?
Fibromyalgia brings chronic, widespread pain, more sensitivity to pain, and strong feelings of fatigue, brain fog, and more. It is still poorly understood. It is also hard to diagnose and hard to manage, and it lowers the quality of life for those who live with it. Reports put its global prevalence at an estimated 2.7%. Women outnumber men nearly three to one. In addition, a couple of studies have noted that fibromyalgia seems to be more common in people with Type 2 diabetes (T2D). That suggests a link between the two conditions that is worth more study. Experts agree that genes and environment play a part in fibromyalgia. But little is known about how and why it develops.
Doctors diagnose fibromyalgia using the American College of Rheumatology (ACR) guidelines. The Widespread Pain Index measures pain or tenderness felt in 19 different body regions in the week before the visit. The Severity Scale comes from the patient’s own rating of symptoms like fatigue and brain fog on a scale from 0 to 3. ACR guidelines combine these two measures on a scale from 0 to 31. By their standard, a score of 13 or higher means a diagnosis of fibromyalgia.
The global cost of FM is huge. In the United States alone, the healthcare cost is around $100 billion/year, similar to reports from European countries. Patients with FM also feel pain at lower levels. Because of that, they have more muscle, joint and spine problems with symptoms. Those problems add to the cost of managing this disorder.
Many theories try to explain its wide range of symptoms. They include inherited defects, problems in nerve signal pathways such as substance P, immune dysregulation (an immune system out of balance), and several others. Sadly, none of these ideas has led to real progress beyond treating symptoms. In fact, recent reviews of FM published in 2016 and 2017 concluded that there had been no real advances in our understanding of this disease.
2. What are the Similarities Between Fibromyalgia and Insulin Resistance?
Newer reviews of fibromyalgia research do not mention its suggested link to insulin resistance or diabetes. Even so, the two conditions affect brain vasculature (the brain’s blood vessels) in strikingly similar ways.
Miguel Pappolla, MD, PhD, is a professor of neurology at the University of Texas Medical Branch. He is also medical director of St. Michael’s Pain and Spine Clinics in Houston. He says insulin resistance is known to impair brain microcirculation (blood flow in tiny vessels). That leads to slowed blood flow and oxygen delivery (hypo-perfusion) in certain brain regions. “What is very interesting,” he said, “is that patients with fibromyalgia also have hypo-perfusion in several brain areas.” The question remains whether insulin resistance may be behind these similar drops in blood flow in people with fibromyalgia.
- Do people with fibromyalgia have higher A1c levels?
To look into this, Dr. Pappolla led a retrospective, cross-sectional study. The team reviewed medical records from 23 patients (21 females, 2 males; 11 White, 8 Hispanic, 4 African American; ages 35 to 60) at St. Michael’s Pain and Spine Clinics. All 23 patients met the ACR criteria for a fibromyalgia diagnosis.
To measure insulin resistance, the team chose the hemoglobin A1c. Values between 5.7 and 6.4 define prediabetes, and values of 6.5 or more mean diabetes. They compared the A1cs on record for the 23 patients with fibromyalgia to two separate control groups. One was the non-diabetic subset (1,350 people) from the Framingham Offspring Study with normal glucose tolerance (FOS NGT). The other was the non-diabetic subset (1,592 people) from the National Health and Nutrition Examination Survey (NHANES).
The team compared the A1c results of the people with fibromyalgia to controls of the same age. The people with fibromyalgia had significantly higher hemoglobin A1c levels. A1c is a measure of insulin resistance.
“[People with prediabetes] with slightly elevated A1c values carry a higher risk of developing central (brain) pain, a hallmark of fibromyalgia and other chronic pain disorders,” notes Dr. Pappolla. He points out that this link between insulin resistance and fibromyalgia has been around for a long time. Surprisingly, no one noticed it. “Considering the extensive research on fibromyalgia, we were puzzled that prior studies had overlooked this simple connection,” the first author says.
“The main reason for this oversight is that about half of fibromyalgia patients have A1c values currently considered within the normal range. However, this is the first study to analyze these levels normalized for the person’s age, as optimal A1c levels do vary throughout life,” the researcher continues.
“Adjustment for the patients’ age was critical in highlighting the differences between patients and control subjects,” he explains.
As part of the study, the team gave metformin to people with fibromyalgia and muscle or connective tissue pain. Metformin is a drug people typically take to treat insulin resistance.
Metformin reduced pain in this cohort. That led the researchers to suggest this common drug could be a workable, cheaper treatment for some people with this chronic pain condition.
“In the [U.S.] alone, the healthcare cost is around $100 billion [per] year; comparable to reports in European countries,” the researchers write in the study paper.
“Earlier studies discovered that insulin resistance causes dysfunction within the brain’s small blood vessels. Since this issue is also present in fibromyalgia, we investigated whether insulin resistance is the missing link in this disorder.”
First author Dr. Miguel Pappolla
“We showed that most — if not all — patients with fibromyalgia can be identified by their A1c levels, which reflects average blood sugar levels over the past 2 to 3 months,” Dr. Pappolla adds.
The A1c test is a blood test. It lets doctors measure a person’s blood sugar levels by looking at “hemoglobin A1c,” a blood cell protein that binds to the simple sugar glucose. Doctors use this test to diagnose prediabetes and type 2 diabetes.
To back up this finding, the team also checked pain scores over time. They looked at FM patients whose insulin resistance had been treated with drugs. This subgroup reported dramatic drops in their myofascial pain (muscle pain) after taking metformin.
- Can metformin help fibromyalgia pain?
This evidence is early, but it suggests a disease link between Fibromyalgia and Insulin Resistance. That may lead to better treatment plans. Metformin, a drug commonly used to treat diabetes by targeting insulin resistance, has also shown promise for fibromyalgia pain. It may lead not only to a radical paradigm shift for the management of [fibromyalgia] but may also save billions of dollars to healthcare systems around the world.
That said, more research is needed. We need to better understand how insulin resistance links to fibromyalgia and other kinds of chronic pain.
Frequently asked questions
Is fibromyalgia more common in people with diabetes?
It appears to be. A couple of studies have found fibromyalgia more often in people with type 2 diabetes. That points to a link between the two conditions. Insulin resistance and fibromyalgia also affect the brain’s blood vessels in strikingly similar ways. Both slow blood flow and oxygen delivery in several brain regions.
How is fibromyalgia diagnosed?
Doctors use American College of Rheumatology criteria. The Widespread Pain Index counts pain or tenderness in 19 body regions over the past week. The Severity Scale rates symptoms such as fatigue and brain fog from 0 to 3. The two combine into a score from 0 to 31. A score of 13 or higher corresponds to fibromyalgia.
Why was the link between insulin resistance and fibromyalgia missed?
About half of fibromyalgia patients have A1c values inside today’s normal range. So the pattern hid in plain sight. The Pappolla study was the first to adjust A1c for each patient’s age, because the best A1c levels change over a lifetime. Once the results were adjusted for age, the gap between patients and controls became clear.
What does an A1c test measure?
The A1c test reflects your average blood sugar over the past two to three months. It measures hemoglobin A1c, a blood protein that binds glucose. Doctors use it to diagnose prediabetes and type 2 diabetes. Values between 5.7 and 6.4 define prediabetes. A value of 6.5 or higher means diabetes.
How common is fibromyalgia?
An estimated 10 million adults in the United States live with fibromyalgia. It causes pain throughout the body, often to the point where it is hard to function. The estimated global prevalence is 2.7 percent. Women outnumber men nearly three to one.
Related reading
References
- NCBI (2016): A Correlative Relationship Between Chronic Pain and Insulin Resistance in Zucker Fatty Rats: Role of Downregulation of Insulin Receptors. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/26705975
- Science Daily (2019): Does insulin resistance cause fibromyalgia? Retrieved from
https://www.sciencedaily.com/releases/2019/05/190507145523.htm
- MedicalNewsToday (2019): Fibromyalgia: Is insulin resistance ‘the missing link?’ Retrieved from
https://www.medicalnewstoday.com/articles/325155.php#1
- Plos One (2019): Is insulin resistance the cause of fibromyalgia? A preliminary report. Retrieved from
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0216079
- Practical Pain Management (2019): Fibromyalgia and Insulin Resistance: Correlational or Causal Relationship? Retrieved from
- Healthline (2019): Drug Used to Treat Diabetes May Be Effective Against Fibromyalgia. Retrieved from
https://www.healthline.com/health-news/does-insulin-resistance-cause-fibromyalgia
Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP
Interventional pain physician, addiction medicine specialist and obesity medicine diplomate.
Licensed in Missouri and Illinois.
Last reviewed June 18, 2026