Six common beliefs addressed, Part 169

1. People who have lost a lot of weight are susceptible to weight regain.

Yes. This is the result of fat cell adaptation which affects leptin expression/sensitivity. This is precisely why, I describe people who have lost a lot of weight and are now thin, as still being obese, like myself. I am still obese, and forever will be, even though I lost all of the weight and hit rock bottom at 117 lbs. at one time.

The fat cells of a once obese person, remain honed and primed for expansion and proliferation, long after they have shrunk and decreased. Women are more susceptible to this than men because it appears that their fat cells have a longer "memory". This makes sense because women are much more "anti starvation" than men. They have to be, since they can get pregnant. This means they need added protection against famine.

Fat cell turnover varies and it can take anywhere from five to ten years for these fat cells to completely be replaced. Even when they are replaced, it is uncertain if they ever truly lose their "memory" as they are a product of previous fat cell division. I wrote a more detailed article about this here.

So, do not expect to remain at your lowest weight. Your weight will start going up again after a short time. You will never get back to morbid obesity, as long as you continue following your diet, but you also won't remain at your lowest weight either. The body has mechanisms in place to fight that.

2. If diet and exercise are enough to reverse overweight/obesity, it should always work. 

Correct, but it doesn't because that premise is false. Diet and exercise are not enough to reverse overweight/obesity. That is why it doesn't always work or will work for a while and then stop.

The only thing that reverses overweight/obesity and keeps it reversed is proper blood glucose regulation. How much of it can be regained and sustained is very individualized and this is why you see such varied outcomes in different people, even on the same treatment.  

How much blood glucose control you can regain and sustain is determined by genetics/epigenetics, which affects how the hypothalamic/pituitary/adrenal axis and fat cells function and adapt under certain conditions. Some people have a metabolism that simply does not adapt rapidly to blood glucose disparities. These people remain insulin and leptin sensitive for most of their life, if not all. They are obesity resistant. But the vast majority of people are highly adaptable and their metabolisms adapt quickly to blood glucose disparities, causing an adaptation towards starvation.

That's why, on this blog, we make no promises about diet and exercise. You can only use them in an effective way to keep you as healthy as you can be for as long as you can.

3. I see all kinds of reasons given for weight plateaus but they don't seem right to me. I've seen everything blamed from diary to nuts to meat itself. It's actually very confusing.

That's because it's all crock or rather BS. True plateaus are caused by leptin. Leptin is a starvation hormone. The way it works is a little counter intuitive and this is why there is so much misinformation surrounding it.

Leptin responds to long term nutrient availability. The way it detects this is through several mechanisms, including levels of certain metabolic hormones, primarily insulin. Leptin is suppressed in people who are overweight/obese. Because their metabolism is behaving as if they were starving, leptin expression is down regulated so that it doesn't burn stored fat, but spares it instead. This is why overweight/obese people tend to lose some weight but never get to slim as their weight set point is set to high on purpose. It is set to match their insulin function and glucose regulation. The body is actively preventing fat stores from lowering.

The next question is - Why would the body do this? Because it is simply reacting to dips in blood glucose. Dips in blood glucose signal starvation so the body is sparing fat mass to not starve. The pathology in blood glucose regulation is not in the hyperglycemia, per say, but the adaptation to it, which makes any dip in blood glucose adverse to the body.

So all those silly lists you see claiming to be causes of plateaus and how to "fix it", are total BS. The only thing the items in those lists do is, once again, effect insulin through blood glucose which in turn effects leptin but never profoundly enough to get you to slim. Getting to slim is not done with lists. It's done through a long term, consistent protocol that reverses the pathological adaptation towards obesity by primarily targeting blood glucose regulation.

4. Many people are slim in their arms and legs but have a large belly as if they are putting all of their weight on their mid section only.

This is the typical male pattern obesity. Slim in the extremities and a large, hard belly. This can also be seen in some menopausal women. Accumulation of fat around the mid section is common in metabolic syndrome.

Unless the male is estrogen dominant, testosterone will keep him slim for a long time but once it starts dropping with age, it will diverts fat into the viscera instead of the subcutaneous stores which is where it is suppose to go. That hard belly is simply ectopic fat, which is the most pathological.

5. A lot of low carb followers only focus on a few markers on their blood tests but ignore how fat they still are. They claim that weight can be ignored in lieu of "lower insulin levels" or "lower blood glucose".

Because they are full of BS. On this blog, we do not believe in that. As long as you have excess fat on your body, you are metabolically dysfunctional and at diabetes's door if you aren't already there. Markers such as insulin levels and blood glucose help you determine if you are heading in the right direction but they are not very meaningful as long as you are overweight/obese.

6. My doctor refuses to give me a C Peptide test.

C Peptide tests are usually ordered by an endocrinologist (endo). If you are diabetic, you should be seeing an endo already. If you have thyroid issues, you would be seeing an endo too and they sometimes order a C Peptide test, when you are a first time patient.

It's an interesting test to have but if you were already diagnosed as diabetic, there usually is no need to repeat it as the problem is already known. Many times the person is a full diabetic and still comes back with a normal C Peptide test. For this reason, HbA1C is the test that is most relied on as it's the most accurate for a diagnosis. Everything else is just extra information that cannot be interpreted on its own.