1. It seems like everyone who was able to lose a significant amount of weight always stall 20 -25 lbs. from goal weight.
Yes. It's called leptin.
It is actually more difficult for a person who is a little overweight to lose some weight than a person who is significantly overweight. But it is nearly impossible for the significantly overweight to ever reach leanness, even though they lose weight easier than the person who is only a little overweight.
The significantly overweight usually stall before they reach leanness. Some stall while still being very overweight and others stall 20 - 25 pounds from reaching leanness. Notice that I am describing the result as "leanness" not "goal weight". "Goal weight" doesn't mean anything because your goals might not be realistic or correct. Furthermore "weight" is not what's causing your health issues. What you want is the loss of excess body fat and that results as leanness when you succeed.
The problem is that overweight/obesity is not simple weight gain. It's an adaptation towards starvation so the body has compensatory mechanisms in place to prevent the loss of body fat and/or preserve a higher-than-normal weight set point. This is why people stall while still overweight or they stall before ever reaching leanness, even when they lose a significant amount of weight and are no longer considered obese.
This is because leptin resistance is common in the overweight/obese as leptin is the main hormone to under express if you want to preserve fat mass. You can't burn fat without leptin. So, if the body is under a starvation adaptation, it makes sense to under express leptin.
Let me make clear that this occurs to everyone, not just the overweight/obese. A healthy person will also see an under expression of leptin when their fat mass is challenged but the difference is that this under expression only occurs when body fat mass drops to levels that are too low. That's why the person who's not significantly overweight, and only wants to lose a few pounds, finds it so difficult to do. Leptin prevents starvation. The difference is that leptin under expression occurs in the overweight/obese while there is still plenty of body fat to safely lose.
2. Obesity is "inflammatory".
Anything that triggers the immune system is inflammatory. Most diseases/conditions, trigger the immune system so most diseases/conditions are inflammatory. Therefore, our immune system causes most of the problems we suffer from, but it is also what keeps us alive.
Overweight/obesity is a condition that results from a metabolism that is adapted towards starvation. This trajectory begins with blood glucose abnormalities which interfere with its proper regulation. If you are starving, it would be a good thing to become very fat and spare that fat, so it never gets burned. That's what the overweight/obese metabolism is doing. It's getting very fat, from whatever nutrient availability there is, and spares that fat so that it cannot be burned. It uses complex compensatory mechanisms to achieve this.
The only thing "inflammatory" about this process is at the adipocytes (fat cells) themselves. Many of these adipocytes simply "explode", for lack of a better term, from the excess fat that is being shoved into them. This causes an immune reaction at the fat mass. In fact, this fat mass is full of inflammatory cytokines and other immune cell activity because of the dead and dying, "exploded" fat cells. This further affects their normal function and response to metabolic demands. The fat mass behaves a little like cancer, where it no longer functions properly and grows uncontrollably.
3. My friend was slightly overweight and decided to go on a fad "keto" diet she found online. Now she looks like a skeleton. Everyone is very concerned about her, but she seems to think everything is all right. I know that people tend to exaggerate when someone loses weight, so to put it in perspective for you, she basically looks exactly like Maria Emmerich. I have noticed several people, online, who this has happened to. It is not common, but it happens, and I wonder why.
People that are only a little overweight or become overweight/obese later in life, for a short time, usually preserve their leptin expression and they respond very well to diet, causing weight loss that allows them to reach leanness. It is not common because usually people who have only a little weight to lose, do not seek much help in doing so since not much help is needed, and you never hear about their stories. It's the 300 pounder that continues with their struggle for all to see.
Some people have super leptin sensitivity and will lose more weight than intended because abnormal leptin expression can make you obese or make you very thin. It is blind to a proper weight set point. In fact, the very obese who become very thin are the ones most likely to have weight regain. Their leptin should have stopped their body fat loss earlier than it did. This adapts adipose tissue in the long run, to simply get better at sparing fat. That way, the next time fat is challenged, it will certainly not budge.
Someone who is as thin as you describe your friend to be, is basically cachexic. The fad "keto" diet is notorious for wasting muscle mass and that's basically the hallmark of cachexia. But, as to what exactly is going on, we won't ever know unless your friend tells you.
Some people have eating disorders and you would never know it because they hide it very well. There are certain illnesses that cause "wasting" and some people do not want to tell their loved ones about it. All I can tell you is that something else is going on with your friend because even if this fad "keto" diet had the ability to waste someone away like that, they would notice it and do something about it. So, the fact that you say your friend appears to think "everything is all right" might indicate that something else besides diet is going on.
4. What do you do when your "diet is over"?
On this blog your protocol is never "over".
5. I read that diabetics have high serum amino acids, and this is why they developed diabetes.
I don't know where you read this but let's talk about what is truly known.
We know that people with diabetes are "insulin resistant". They aren't insulin resistant in their entire body. Their tissues and organs are resistant to insulin to varying levels and degrees. Because of this, they have high serum blood glucose, high serum ketones, high serum fats, high serum amino acids, high serum everything. You need insulin to deliver all of these nutrients into cells and diabetics are... well, insulin resistant. So, everything is just left to float around in the serum until it can be converted to sugar and then stored as fat.
So, it wouldn't be surprising that diabetics would have high serum amino acids since they have high of everything else in the serum. Nothing new to see here. It's not like diabetics are known for building muscle mass, which is what amino acids would be great for. Unfortunately, that requires insulin.
Diabetes is not a mystery. We know exactly what causes it so whatever quack comes along and tells you that some "new thing" has been discovered that causes diabetes, you can tell them that there is an older thing that was discovered, decades ago, that truly causes diabetes - lifestyle.
Diabetes is a lifestyle choice. It's caused by choices in diet and exercise and the behaviors that effect both. That's it. That is why the only thing that has been shown to put diabetes into remission are lifestyle changes. Not blood glucose lowering medications. Not insulin pumps. Not triglyceride medications or statins. And certainly not amino acid clearance. In fact, you can put diabetes into remission using lifestyle changes, even before you fully reverse overweight/obesity. Lifestyle. You have to change your lifestyle.
6. I have a drastic drop in blood glucose when I walk after eating. In other words, I can bring a 200 mg/dL postprandial reading, down to double digits by just going for a long walk. This made me wonder if I can use walking to lower blood glucose instead of diet as it technically achieves the same thing.
I know you thought your premise would be laughed at and dismissed, but no. What you are describing is actually better at regulating blood glucose than trying to do it through eating fat or not eating at all. In other words, exercise works better than "keto" and certainly better than fasting.
The reason is because this drop in blood glucose, while exercising, is non-insulin mediated so you are actually addressing your insulin sensitivity while lowering your blood glucose. You are also truly lowering your blood glucose, not hiding its rise and you are not using extra insulin or glucose lowering medications to do so, so you don't have to be worried about hypoglycemia later on. This is what keeps a high carbohydrate, agrarian society, so healthy. All that workload after a bowl of rice is a good thing.
Anything that controls postprandial blood glucose is a good thing because postprandial highs effect blood glucose regulation over time, which will eventually induce diabetes and the sparing of body fat. But using walking as a way of keeping postprandial blood glucose low, chronically, is not truly the correct way of treating metabolic syndrome/diabetes, once you have it, though it's a cool hack and a great prevention.
The potential problems though, are numerous. The amount of walking needed to do this may not always be possible so you will still have some days where your blood glucose will make that rise and then dip when fasting which is what wrecks metabolism. It doesn't take many dips to start pathology. One dip has been shown to be enough in getting the ball rolling. So, unless you have a very strict, routine that never changes, you might not always be consistent with this little hack. Worse, what happens if you can't walk because of some health reason or injury? Certain seasons might make it difficult for you to go out walking. Some long-term diabetics will actually experience blood glucose highs after exercising. Also, this hack will never help you learn how to eat properly. If you don't eat properly, diabetes will always be around the corner and if you already have it, it will only worsen.
So, it's a cool hack that actually addresses the problem, and you don't see many hacks doing that often, but it's not going to work for the long term. You truly need a long term treatment in order to properly address diabetes. So proper diet, along with walking, is the best course of action.
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