1. You speak a lot about exercise but I can’t exercise because of other health issues.
I speak on ways to obtain metabolic health and exercise is absolutely vital for doing so. Nothing can replace exercise. Unfortunately, if you cannot do it, that's a "you problem" with no solution. My recommendations remain the same. They don't change because someone can’t do it. If you can’t do it, you won’t obtain full metabolic health. Use the information you can and what you can’t leave behind, but this blog does not make concessions.
2. I am obese and have 0 energy most times. This makes me hate exercise but I also hated it even when I was young and slim. I just hate sweating and exerting myself. I wish I can retrain my dopamine to enjoy walking for exercise.
First, I like that you phrased the statement in the context of "walking for exercise" because a lot of people are under the impression that walking to the mailbox or strolling through Walmart counts as "walking". Though everyone walks, unless they are in a wheelchair, and all walking adds to your step goals, not all walking produces benefits. You have to actually "walk for exercise", which means walking at a steady state, moderate pace, for a long duration (1 hour or more). You should "feel" your walk afterwards, with mild aches, pains or tiredness. As your health improves, you will feel physically better afterwards instead. Now back to your "wish", which is very interesting.
Walking with a goal in mind, like reaching a landmark or completing a task, will affect dopamine. You can walk to a neighborhood store for something you need or you can hold off on podcasts/audio books and only listen during your walk. Anything that will motivate you by causing an anticipation to walk will work. If you do this often enough, you might start enjoying your walking routine because of its effects on dopamine. In other words, you are retraining your brain with a reward associated to a specific activity (walking).
This, of course, is all in theory even though it's based on what we scientifically know about dopamine and how it works. This is why I always recommend walking outside and not at a gym or closed "work out room". Dopamine reacts to seasons. Walking out in nature, experiencing different temperatures and smells, while watching greenery is beneficial for you to start enjoying your walking. Sometimes I walk through neighborhoods to get gardening ideas, browse seasonal decorations or to pick pine cones.
Walk with purpose. Give yourself a goal for walking because "walking for health" is not enough. Dopamine doesn't care about logic. It only evolved for you to meet a goal and "health" is too abstract and long term of a goal to motivate anyone. You need a short term, immediate goal for dopamine to react when you succeed in acquiring it.
3. High cortisol is due to the dopamine acquired by more glucose in the blood stream.
This is another interesting statement about dopamine and metabolic adaptations. Basically, if I understand you correctly, you are stating that your body is creating more glucose, through high cortisol, in order for the brain to receive a "dopamine hit" since it’s no longer acquiring it from dietary glucose.
I suppose that if you could somehow change metabolic adaptations, to work primarily through dopamine rather than insulin/leptin, the premise might work. Though we know that the hypothalamic/pituitary/adrenal (HPA) axis is involved in metabolic adaptations, and dopamine is a part of that axis, it has not been shown to work the way you're suggesting.
When dopamine is spoken about in the context of glucose, it is in the taste of sweet, not sugar in the blood. So even though glucose in the blood has an effect on the HPA axis, this effect is from a signal of anti starvation. High blood glucose is a mechanism of protection against starvation, not a true "dopamine hit". The only dopamine hit associated with anti starvation would be chocolate cake.
4. I know someone who lost 200 lbs. but I can’t even lose 50.
This is the result of leptin sensitivity. Just like money - some people have it and some people don't. Again, just like money, there are way more people who don't have it, than who do. Though everyone can "lose weight" most aren't able to lose enough, particularly body fat, to get to lean. That's why it is so fascinating to us when a person is able to lose enough fat to no longer be obese. They are the anomalies.
But surprisingly, there are still quite a large number of anomalies. This is why you can’t assume that all obese people are leptin resistant. Though most are, some actually aren't. For the ones who aren't leptin resistant, the moment they normalize their blood glucose/insulin, their leptin begins doing what it’s suppose to - burn excess body fat. For others, they either cannot ever normalize their blood glucose/insulin, to regain leptin sensitivity, or even when they do their leptin does not follow suit. No one knows the exact mechanism of why this occurs. This is why obesity is a "condition with no known cure".
Now the hurdle is long term success. Not only is getting to lean rare, but staying lean is even rarer. So many people who are able to obtain short term leptin sensitivity, enough to break their weight set point, are unfortunately unable to retain it. In fact, the ones who get to lean are the ones most vulnerable to weight regain. So super leptin sensitivity comes at a cost because it causes an even greater leptin resistance in the future. This of course happens to most, not all.
5. I have a friend who is always complaining about some health issue or another. They spend their days going from doctor to doctor but when they are given answers and possible solutions, they always doubt and question them so nothing is ever resolved. They have always been trying to "lose weight" but instead of following practical advice, like exercising for instance, they have instead always leaned towards fad/tabloid diets. I don't know what to tell them anymore but it's affecting my own journey since I'm getting caught up in their troubles.
I have unfortunately come across this often when dealing with the overweight/obese. I have noticed it is much more common in middle aged women.
Some people like to be "sick". I know that's a controversial statement but it's just a fact. For some people, dealing with "health issues" and "weight loss" is a hobby. They are lonely, bored and unsatisfied in their lives so they take it out on their body, instead of realizing it's their mind. Doctors give them the attention they crave and as long as they have "something to work on" they feel as though they have something to do. This is why they are drawn into short term fad diets and "miracle cures" instead of actually doing the work that it takes to reverse obesity. Short term protocols allow them to bond with others, who are in the same boat as them, and achieve immediate trivial "changes" disguised as results. Doing the actual work is far too difficult and long term. It is also a journey that has to be taken alone, not hand holding someone else. Worse still, if they actually succeed, what will they have left to do? A lot of these people don't want solutions, that's why they ignore the ones given.
There are people who are genuinely striving to improve themselves while getting bogged down by someone else who has this pseudo-Munchausen. A lot of people may not agree with the advice I am about to give you but it's solid advice none the less - the obese really need to stay away from the obese. Fat farms don't work. This is precisely why I don't allow comments recounting sob stories and new food lists to follow or avoid. Those don't help anybody and can be found in other blogs.
You are much better off making new friends at the gym, who are lean and active, than continuing to fraternize with people who have nothing to contribute but excuses, gripes, victim hood and coupons for the local buffet. Your active friends will be an encouragement, rather than a hindrance. In fact, I can tell you from experience, that the more success you obtain, the more you will realize you have nothing in common with these people any longer. It will become clear to you how obesity is rooted in behaviors and beliefs that you didn't even notice before but become very obvious as you get leaner. It's these behaviors and beliefs that will keep you obese.
So you can start dropping some weight, right now, by dropping them. It will be more than the five pounds their fad diets promise.
6. Because of the upcoming holidays, I was given a recipe by my endocrinologist for stuffed acorn squash. It was described as "low carb". All of these "low carb" people online would be horrified by this vegetable so I haven't wanted to share it in the groups I follow.
That's why you have to stay away from "low carb people online".
A cup of cooked acorn squash has about 22 grams of carbs. That falls within the parameters of a low carb diet as low carb is anything below 100 grams of carbs a day. So depending on how much acorn squash you eat, or what other carbs you have that day, it would fall in line with low carb as long as you don't go over 100 grams in a day. Of course, a cup of cooked acorn squash is practically starvation but would be fine as a side dish. This is something that has to be kept in mind when counting carbs in this manner. It is impossible to negotiate not starving while eating carbs at a benign level.
On this blog, we do not focus on the carbs of individual food items because 22 grams of carbs from bread are very different than from acorn squash as not all carbs are the same, just like not all calories are the same. This is because carbs are not just glucose, whether sugar or starch, but fiber as well. What you want to say away from is the glucose (sugar and starch). The fiber is irrelevant.
We also don't believe that a 0 carb diet is any better than a moderate carb one. We only believe in one thing - blood glucose regulation. The most profound effect to blood glucose regulation is obtained through carb elimination and restriction. To make this as easy as possible, we eliminate all sugar and grains while restricting everything else. Carb restricted diets can fall anywhere between "keto" to Mediterranean and your chosen one should be primarily based on how it affects your blood glucose regulation, not on how low it keeps carbs.
So instead of just giving you a "low carb" recipe, your endocrinologist should have advised you to monitor the effects this recipe has on your blood glucose regulation. To know that, you would need to measure your fasting blood glucose that morning and then your postprandial blood glucose, two hours after eating the squash. Then you would have to measure it again the following morning in order to see how you reacted to that meal. It's not enough to just check blood glucose after eating the squash. Remember, the goal is not to see that your blood glucose rose or not. The goal is to see how your blood glucose regulation is effected within a 24 hour period.
Just because the squash may not rise your blood glucose into the danger zone, it might rise it enough to cause large dips during the night which cause high blood glucose the next morning. Or if you are not diabetic yet, your blood glucose might not rise at all because your body is still able to control hyperglycemia through the release of enormous amounts of insulin, masking your blood glucose dysregulation. You will be able to tell this is occurring by seeing a postprandial dip in blood glucose instead of a high. You need to get off that roller coaster because dips in blood glucose means your insulin is being negatively affected due to blood glucose dysregulation.
You need to take your focus away from the squash and apply it to your blood glucose regulation instead. Putting focus on anything else means you are focusing on the wrong thing.
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