1. There is something seriously wrong with Maria Emmerich. She looks horrible. Niesha Berry, Dr. Berry's wife, seems to be going down that same road. Her recent photos are scary. All of these "keto" people either stay or become more obese or they become like skeletons.
I see this comment in many low carb forums so I will address it here.
First off, I don't know either of these women. I don't follow them or their work. I have never met them. I don't know their medical history so I don't even know if they might be suffering from some type of medical condition, at the current moment, which might be the cause for how they look.
Both of these women look cachexic, particularly Emmerich, but I can only reply in the context of what is known about them from their online public personas. What is known about Emmerich specifically, is that she pushes a very nutrient poor diet, based on her "cookbooks" and low carb rhetoric. Her meals are composed of endless, high fat, desserts. As far as Berry is concerned, she has little by little deteriorated into the world of fad dieting as well and doesn't fall far behind Emmerich in the low carb rhetoric and misinformation.
So since this public knowledge is the only thing I can take into consideration, because it's the only thing I know about these women, I can tell you that the way they look is a direct result of a nutrient poor, protein starved diet that has resulted in the massive loss of lean muscle mass, especially for Emmerich. This is particularly true because neither of them were morbidly obese at any time in their life.
Emmerich obviously has intact leptin expression and is obesity resistant. This is why the massive amount of fat she eats daily, if she really does eat it, does not cause weight gain. That of course, does not necessarily mean she is lean. Judging by her photos alone, you can tell that this person has such a low percentage of lean muscle mass that she very well can automatically be left with a high fat mass by ratio. You do not have to look fat to be fat. The moment that your fat mass surpasses your lean muscle mass, at any weight, you are obese by default.
We don't know what the true ratio of lean muscle mass to fat mass Emmerich has because she won't ever share that. We also don't know what her metabolic function is. We are just left with a person that looks very unhealthy. This is why you have to be very careful who you take dietary advice from. You can end up looking like these women or worse. Since you might not have their leptin expression, you can go in the opposite direction and end up at 500 lbs., following their mostly fat based diet.
Metabolic function is a double edged sword. It can either make you very obese or it can make you waste away. Remember, the metabolisms of both the obese and these women, is blind to its weight set point. This is why both extremes are dangerous states to be in.
That is why we do not believe you can be "healthy at any size". That does not exist. We do not promote that you remain obese as long as your blood glucose remains low or that you try to get to the lowest weight you possibly can as long as you can keep your blood glucose low. You are only truly healthy when you have the right lean muscle mass to fat ratio based on your gender, body frame and age.
Body fat is extremely important. It is the largest endocrine organ in the body. It regulates your thyroid function, your leptin expression, your insulin release, your glucose homeostasis and your reproductive hormones, amongst other functions. You cannot sustain a large, abnormal loss of body fat, for a prolonged period of time, and remain metabolically stable. You also cannot carry around a large amount of excess body fat and remain metabolically stable. Both are bad.
2. Any success in weight loss is due to leptin sensitivity.
Yes. There is no fat loss without proper leptin sensitivity. I happened to be an obese person that reacted to a dietary intervention, quite rapidly, and was able to lose weight. I only experienced two weight loss stalls, which I was able to surpass easily. This means that I was leptin sensitive throughout my weight loss. I was able to reach leanness.
This is not surprising to me as I have always been leptin sensitive throughout my life. I know this because I have been overweight, for most of my life, but have always been able to drop weight quickly and become lean, through small changes in my eating and/or exercise routine, particularly with eating more rather than less. I was never the type of person that purposely pursued weight loss though. These drops in weight I experienced, throughout my life, were the result of natural changes in my lifestyle and not the result of any dietary protocol purposely used for weight loss.
Of course, now that I dropped so much weight, it will be interesting to see if I can keep my leptin sensitivity. After all, it's not about what you can achieve but what you can keep.
It is not well understood what causes some people to have great leptin sensitivity and others not. It is also not well understood what changes leptin sensitivity over time. For instance, many people lose their leptin sensitivity as they get older. Substantial weight loss can also make you lose your leptin sensitivity. We know that profound changes in metabolic function and increases/decreases in fat mass affect leptin, but why some people are more affected than others is unknown. This is why it is a misnomer to assume that all fat people are "leptin resistant". That is not necessarily the case. Most are, but not all. Some fat people can lose weight rather rapidly when the conditions for weight loss are met. Yet, others cannot.
Many things seem to be correlated to poor leptin sensitivity. They include lack of exercise, chronic caloric restriction (crash/starvation diets), fructose consumption, early life onset of obesity and a highly insulin sensitive fat mass (poor insulin function). As you can see leptin function is dependent on many factors and is highly individualized. This is why diets don't work and the diet that may work for one, may not for another. Maybe, in the future, advances in obesity research will make leptin therapy a standard in obesity treatment and weight management. As of now, that is not the case as the correlation between leptin serum levels and obesity is not linear. This means that leptin function, just like insulin, is much more complicated than just measuring serum levels. Leptin's ability to interreact with the brain, regardless of serum levels, is the confounder.
3. Fasting can improve leptin sensitivity.
No. Starvation studies have consistently shown that leptin levels decline rapidly in response to fasting and this causes profound changes in energy balance and hormone levels. Low leptin levels induce overfeeding and suppress energy expenditure, thyroid and reproductive hormones, along with immunity. Aside from the decline of leptin levels, there appears to be a chronic suppression of leptin expression, which only keeps you fat and helps you get fatter.
This is precisely why fasting is not used as a treatment for obesity, by any serious obesity expert, even though we have known about fasting since we have known about eating. Believing in fasting and caloric restriction as treatments for obesity is akin to still believing in bloodletting.
4. I am on a Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and they give me a lot of cereal but very little eggs. I want to drop the cereal and feed my family more healthy.
Find someone who is willing to trade you eggs for cereal. More people like cereal than they do eggs as cereal requires no cooking time and many are on egg restricted diets anyway. So, just like people buy food stamps, they will also buy cereal, especially if WIC is giving you a lot of it.
5. Medium-chain triglycerides (MCT) oil will cause a weight stall as the body tries to burn through it before accessing its own fat stores. You should switch to another type of fat.
Though not all fats are metabolized the same way, all fats do the same thing when they are eaten beyond your macronutrient allotment and there isn't proper leptin expression - they get stored. Switching from one fat to another will not make a difference in this effect. You need to follow proper fat macros instead.
6. People who have trouble accessing body fat should eat more dietary fat or "they will feel terrible".
Negative. That would be like saying that if you have trouble metabolizing glucose (diabetes), you should eat more of it or you will feel terrible.
If you want to lose body fat, you have to burn it. In order to burn it, you need to force the body to do so. Making concessions based on false beliefs will not allow that to ever occur.
The only thing that causes the inability to access body fat is called obesity. The only thing that reverses obesity are long term protocols designed to acquire proper blood glucose regulation.
Feeling terrible on a protocol is not because you have "trouble accessing body fat". If you are obese, you already had that trouble since before you started your protocol. Feeling terrible on any protocol means that it is not appropriate and you are either running a deficit in protein, electrolytes, calories or all three.
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