1. I follow my diet strictly, but I am still not seeing results. The only thing I don't like to do is exercise, but my diet is top notch. I don't understand how I am not having any success just because I don't exercise.
This reply is to remind everyone that - You will not reach your goals through diet alone! Metabolism is an input/output cycle. The body uses diet (input) to create energy for work (output). You can't just address one half of this cycle.
Metabolic hormones all work together to convert food into energy and then expend it. No matter how "healthy" your diet, you will not reach your weight loss or metabolic health goals without exercise. It just won't happen. You will not be able to reverse your metabolic dysfunction or get to lean sitting around. Everyone that I have seen fail in reaching their goals have all had one thing in common - refusal to exercise or improper exercise.
So, stop nitpicking your diet. The reason you aren't getting results is because you're not moving.
2. I was told by a "carnivore advocate" that protein sparing modified fasts (PSMFs) are "too extreme".
Absolutely not, but what do you expect a "carnivore advocate" to say? They have to say it's extreme, as they are pushing their own diet.
Protein sparing modified fasts are a low carb and low fat diet combined. Basically, they restrict the energy macronutrients (fat and carbs) while prioritizing protein. Some are also calorie restricted on top of that. But when these diets are implemented correctly, they are extraordinarily effective for the treatment of overweight/obesity, especially before bariatric surgery as these diets also aren't a "cure". They target two main hormones that are implicated in obesity - insulin (carbs) and leptin (fat).
Remember, there is no known cure for overweight/obesity. All diets are only palliative treatments but some work better than others. PSMFs work very well. PSMFs are reserved for people who are very overweight/obese as they will be the ones who will get maximum benefits with the least side effects.
So, there is nothing "extreme" about PSMFs. Overweight/obesity itself is extreme. It is the result of a very extreme diet filled with glucose and fat.
3. It is not possible for someone who is following "keto" to still have a fasting insulin of 20.
This could be the result of high body fat. The higher your body fat, the higher your fasting serum insulin, regardless of what you eat. This does not always correlate with every overweight/obese person as some are simply no longer producing enough insulin to have a very high serum level.
4. I was morbidly obese at over 250 lbs. I went on "keto" and dropped down to 110 lbs. I have found that I am slowly gaining weight even though I am still following my regimen diligently. I have gained about 30 pounds. I am going through menopause.
I get this question a lot and there's a few things to unpack here.
When you drop that much weight and get to lean, as 110 lbs. obviously is, it means that the diet was a success, and you have good leptin expression. It responded to your dietary intervention and got you to lean. Of course, this very low weight, is not realistic. You won't be able to sustain it. The fact that you were able to reach it, kind of shows your metabolism is a little wonky. It was blind to the fact you were losing that much body fat and it will now compensate. This is why I always say that the cure for obesity is not weight loss.
You will always gain some of your weight back as your weight set point cannot be that low if you were once over 250 lbs. That type of low weight set point is only realistic for those that have never been overweight/obese and that's their normal. So, you can't expect to be able to stay at that weight. It's a nice place to visit, but you won't stay there.
Menopause could be contributing to your weight gain but it's not the "reason" for it. You say you have continued with the same "keto" regimen that you started with and that can be problematic because as you lose weight, you have to change your protocol since the leaner you are, the more you can eat. Some people continue to fast too long or eat too little and that can cause the body to under express leptin, more than normal, the thinner they become. This can cause weight regain. In order to keep your leptin expression, you have to eat enough.
Aside from all of this, I want to remind you and everyone that there is no known cure for overweight/obesity. Remember,"losing weight" is not the cure. Overweight/obesity is a metabolic adaptation towards starvation and losing weight does not stop this process. It just addressees one of the most obvious symptoms of it. Just like lowering your blood glucose is not curing diabetes, lowering your weight is not curing overweight/obesity.
The only thing you can do is not to strive to reach your lowest weight again but to avoid going back to your highest.
5. Fasting blood glucose and insulin levels are enough to give an indication of insulin resistance.
Insulin resistance is determined by the presence of metabolic syndrome. We only use the classic five criteria, which are present in metabolic syndrome:
- Waist circumference over 40 inches (men) or 35 inches (women)
- Blood pressure over 130/85 mmHg, fasting
- Triglyceride (TG) level over 150 mg/dl
- Fasting high-density lipoprotein (HDL) cholesterol level less than 40 mg/dl (men) or 50 mg/dl (women)
- Fasting blood sugar over 100 mg/dl
Nothing else determines "insulin resistance" unless you are already diabetic, which would mean you are at the end stage of metabolic syndrome.
6. A fasting blood glucose of 95 mg/dL is normal.
Fasting blood glucose should be around 84 mg/dL, so 95 mg/dL is too high. It is not at the point where a diagnosis of prediabetes can be made but it's getting there. It's giving you a heads up that something is wrong.
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