"Extended fasts and very low carb" is not an appropriate protocol for addressing obesity. But, if it's true that you have to do extended fasts and very low carb in order to lose weight, then you would have already reached "goal weight", since the protocol would have worked. If it worked, then I wouldn't be addressing this on here. So, obviously it doesn't work, (no surprise there), and the "weight loss" you are describing is simply water weight ups and downs. When something works, it gets you to slim, not just a few pounds lighter. A few pounds lighter doesn't address obesity.
So, what you are doing appears to be "working", but it's not doing a thing.
The fact that your fasting insulin is still 25, and you are unable to get to slim, on a real protocol, (not the one you are on), are all signs of active obesity. Your body simply doesn't want to lose weight and it's fighting you tooth and nail not to. You have to keep pushing that line on the sand, further and further, in order to get it to comply. Soon it will show you whose boss by not complying anymore, regardless of whether you start drawing the line in the ocean. This is not the proper way of addressing metabolic dysfunction and obesity. This is only a recipe to remain sick and fat.
Stop with the silly protocols and pseudo "weight loss" because they won't achieve long term weight maintenance. You need to start getting serious about addressing these issues for real, not for show. You can start by getting a little educated on what obesity and metabolic issues are by reading this blog. It's free.
2. Should you adjust macros for perimenopause and menopause?
There is no way to do that. Macro values are based on body fat since that's what you want to get rid of.
3. Can too much protein cause a stall?
No. Too much fat can cause a stall.
4. Is it more important to reach your fat goals than your protein?
Both. Macros work in conjunction. You want to hit your protein goals and you also don't want to overdo your fat. Either one of these can cause issues.
5. The American College of Cardiology said that saturated fat is fine to consume.
No. It actually said:
"Most recent meta-analyses of randomized trials and observational studies found no beneficial effects of reducing saturated fatty acid intake on cardiovascular disease (CVD) and total mortality, and instead found protective effects against stroke."
The entire study is basically a summary of Nina Teicholz and Gary Taubes book, put together, and this is not surprising since its funding came from 'The Nutrition Coalition', whose sole purpose of existence is to "change" the dietary guidelines. The "change" they want to make is not entirely clear, but they certainly aren't happy with the guidelines as they stand.
What we do know is that people aren't going to give up the junk food they love and if this junk food is changed into high saturated fat fare, there's going to be a lot of dead people out there. Remember, saturated fat is only benign in the context of a low carb diet. Not everyone in the United States cares to follow low carb. Of course, the zealots don't care about what you want.
The only thing you need to know is that if you eat too much fat, you will remain fat and/or get fatter. Everything else is irrelevant. So, make sure that you keep focused on your metabolic health, based on your results, and not these low carb "characters". They won't help you get to slim, as that's not what they care about, since they already know they can't make you lose a pound.
6. Every time I eat protein, my blood glucose drops to the 70s mg/dL and I start feeling lightheaded and weak. I have to eat fat in order to prevent my "symptoms".
First, a blood glucose drop into the 70s mg/dL is not true hypoglycemia. You did not provide the number it dropped from, so we don't know how big of a drop you're experiencing.
Regardless, this drop is caused by a rise in insulin, in response to protein. Normally, the counter regulatory hormone glucagon would kick in at that point, causing a rise in blood glucose in order to counter act this release of insulin. The body likes keeping a tight, narrow range for blood glucose, at all times, and prevents insulin from clearing too much glucose from the blood.
For people with metabolic syndrome, this counter regulation is usually over expressed, postprandial, and they see a spike in their blood glucose instead of a drop, which is described as hyperglucagonemia. This is because the person with metabolic syndrome does not have sufficient first phase insulin response to control glucagon.
In this case, this is not what's occurring. Rather, blood glucose is dropping to a lower level. This is usually caused by an under expressed glucagon response, which is also typical in people with metabolic syndrome. It can be described as a "hypoglucagonemia".
Aside from all of this, you should not be having hypoglycemic symptoms with a blood glucose in the 70s mg/dL. It would have to get a bit lower than that before symptoms occur. This means that whatever protocol you were on, did nothing to improve your condition.
The most interesting aspect of this problem is that the consumption of fat does nothing to improve hypoglycemic symptoms. Diabetics do not walk around with fat capsules in order to counteract the hypoglycemia caused by their injectable insulin. They walk around with sugar pills instead, as sugar is what halts hypoglycemia. So, biologically, what you are describing is impossible.
This further confirms these are not symptoms of true "hypoglycemia", as I stated above, since this is not very low blood glucose. Instead, this is a symptom of a body that is starving because it cannot access its fat stores. The minute that serum glucose lowers, the body has no more fuel to use. It is always running on empty. Feeding it dietary fat is not going to resolve the problem as it will, once again, do with the fat what it did with the carbs - use what's in the blood temporarily and store the rest.
You have to correct this problem by improving your leptin expression because dosing fat to stop your "pseudo hypoglycemia" is not going to help you resolve your metabolic issues. Eating excess fat causes a rise in basal insulin levels as the body stores it into your fat mass. Getting fatter will only put a higher insulin demand on the body and this disrupts leptin further. Leptin is a slave to insulin.
Stay on a true low carb protocol, which limits fat, and incorporate steady state exercises into your daily routine in order to improve leptin expression.
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