Six common beliefs addressed, Part 264

1. I've decided to stop taking collagen. I'm trying to determine if protein is contributing to my "leptin resistance".

Protein has nothing to do with "leptin resistance". Collagen is not even a complete protein....SMH

Poor leptin expression is very complex and still being studied as very little is known of its exact mechanism. What we do know is what contributes to it. It occurs through metabolic dysregulation, mainly the cross-talk with insulin, as leptin is a slave to insulin. Hypothalamic dysfunction caused by chronic obesity and excess "sweet taste", not to mention the effects of being sedentary on adipocytes (fat cells) through leptin/adiponectin ratios, all affect leptin expression.

So we know metabolic hormones, the brain and adipocytes are all involved in leptin function. Unlike insulin, leptin is completely regulated by the state of your neuroendocrine system, not by any one external force. This is why there is no "leptin diet". The closest we have to a "leptin diet" is a protein sparing modified fast and a good enough amount of exercise because both of these affect your neuroendocrine state. There is also no "leptin pill" as serum leptin levels have nothing to do with its expression on the adipocytes and brain.

Aside from that, what makes you think you are "leptin resistant" anyway? Just because you are overweight/obese does not automatically make you "leptin resistant". You could just have temporary under expressed leptin until you correct the lifestyle factors that are contributing to your poor metabolic state. Intractable obesity would be more commonly considered as "leptin resistance".

Ugh, the low carb world just went from insulin to leptin, got them both wrong, and not one pound lost.

2. I go out shopping daily so I "make my steps" while walking around Walmart. Does this count as walking?

No. "Making steps" is not exercising.

You would be surprised how many steps an overweight/obese person can make from walking a very short distance. In fact, they can make 10K steps from just walking from their car to the front door of the Walmart. I remember when I started walking, I hit a milestone of 35K steps from walking a route I now make only 12K steps on. How is this possible, if it's the same route?

Because people who are in generally poor health, have a very short stride. They simply take more steps to cross the same distance compared to a healthy person. It has been harder for my husband JC, to improve his health compared to me and I can see this clearly in his stride. As we walk, he takes two additional steps for every one of mine. When we are both done walking and compare our pedometers, he always has about 900 more steps than me, though we both walked the same route together. So pedometers can be deceiving and must be used as a rough guide only. Just because you are "making your steps" doesn't mean you are exercising enough or as frequently as you should.

As my health improved, it started becoming harder and harder to make 10K steps on the routes that would give me 20+K steps before. I have been unable to surpass or even duplicate those 35K steps. For this reason, counting steps are great for a beginner but you can't remain there and they certainly won't work very well for a healthier person. A healthier person must change their walking goals to miles, rather than steps. You can also use "hours active" to monitor daily activity levels.

You have to "walk for exercise", which means exertion. Your walking routine should increase heart rate and make you feel as though you're getting a work out. Walking for exercise is not a stroll and it's non-stop until the goal is reached. Make your steps count.

3. I have a friend who was recently diagnosed as diabetic. They are not overweight/obese and have a history of working out. They suddenly ended up in the hospital last week with kidney problems from diabetes. How could diabetes do this to them so quickly and suddenly?

This is the unfortunate reality of Type II diabetes. It is quite insidious.

First, many diabetes cases are diagnosed late. This means that the person has had serious blood glucose abnormalities for a very long time before the diagnosis is made. This is because diabetes really does not have any symptoms, or just a few common mild symptoms, until a complication arises.

I have mentioned before how my husband's coworker had blurry vision for years. They complained constantly that none of the glasses they ever bought helped. They then passed out one day, on the job, and were taken to the hospital to find out they were a full blown diabetic and nearly went into a coma from a sudden rise in blood glucose. Once their diabetes was treated, their vision was no longer blurry. Of course, the damage the diabetes has caused on their body cannot be reversed.

The same happened to my friend, who also passed out at her job from a dangerous rise in blood pressure. Turns out that blood pressure rise was associated to uncontrolled diabetes, which she was unaware she had.

Even if you go to the doctor and have a yearly physical, understand that the metabolic panel ordered, only tests for fasting blood glucose which is many times low for diabetics. In fact, a lot of diabetics will have incredibly low blood glucose numbers while fasting. Diabetes is a syndrome. It does not manifest the same for any two individuals, even if there are some common symptoms. For some diabetics, their blood glucose is always high but for others, that rise is not constant and there is an equal sudden low.

This is what happened to my husband's best friend's brother. He died in his car from a drop in blood glucose because he was an undiagnosed diabetic. He simply felt sleepy, pulled over to take a nap and never woke up. This was a young man in his twenties who was not overweight/obese.

This is why I tell my readers, over and over, that diabetes is not high blood glucose so lowering your blood glucose, will not help. Diabetes is the result of abnormal blood glucose regulation. That means blood glucose can go very high or very low but it's never normal. These highs and lows are dangerous and cause pathology. The lows are particularly malignant because they not only reinforce the condition and continue making blood glucose set points too high, but they can cause sudden death to boot as most metabolic syndrome/diabetes sufferers do not feel hypoglycemic symptoms.

What does this all mean for your friend? This means that this erratic blood glucose is causing abnormal insulin expression because insulin is a slave to blood glucose. Hyperinsulinemia is extremely pathological to the kidneys. High blood glucose is pathological to the kidneys as well by overworking them. All of this sets the stage for kidney disease, a very common diabetes complication and it doesn't take long for this to occur. You can already experience impaired kidney function while simply having metabolic syndrome.

Metabolic syndrome causes high blood pressure and this is detrimental to the kidneys as well. Certain ethnicities are more susceptible to this. Native Americans and other Native Peoples of Central and South America are experiencing an epidemic of kidney disease caused by diabetes. For genetic reasons, they manifest very high insulin resistance in response to blood glucose abnormalities and as I've stated before, insulin resistance is notorious for causing renal disease. So diabetes even manifests differently in different genetic lineages.

Everyone has to understand that abnormalities in blood glucose regulation is a silent killer. By the time you are diagnosed with diabetes, you are at the end stage of metabolic disease. You will also most likely be diagnosed during a serious health crisis caused by the syndrome.

Do you want to be diagnosed sooner? Buy a blood glucose meter. You no longer need a prescription to get one in the United States. You just have to pay out of pocket for it but they are quite inexpensive now. Check your morning fasting blood glucose and then check your postprandial blood glucose, two hours after the largest meal. Do this for ten days straight and see your results. High disparities between fasting and postprandial blood glucose of more than 40 points, even without hyper/hypoglycemic numbers, means you are at risk for developing diabetes. Now you can do something about it rather than waiting for it to happen.

4. Should I restrict protein to get rid of eye floaters? I am on "keto" and was told that the restriction of protein could help with this.

This question has nothing to do with metabolic health but again, I am going to address it because it is in the context of diet. Unfortunately, low carb diets are riddled with this type of nonsense. Like I have stated many times before, low carb diets are only a palliative treatment for metabolic syndrome. They are not meant to "cure" anything. They don't even cure metabolic syndrome!

Ketogenic protocols for the treatment of metabolic syndrome, fall under the umbrella of low carb diets. Often described online as "keto" diets, there are several iterations of them but the only legitimate ones are ones that do not restrict protein. There is no need to restrict protein on ketogenic protocols whose goal is better metabolic function.

Eye floaters are spots in your vision. They may look like black or gray dots but can also look like strings or cobwebs. They drift when you move your eyes and dart away when you try to look at them directly. Most eye floaters are caused by changes that occur as the jelly-like substance (vitreous) inside your eyes liquefies and contracts. Scattered clumps of collagen fibers form within the vitreous and can cast tiny shadows on your retina. The shadows you see are called "floaters".

This has nothing to do with dietary protein unless you plan on making your vitreous out of some other material that is not protein. Your body is already made of fat and protein and your diet will not change that. Eating water bottles will not make you into plastic. Not eating fat and protein will not turn you into gold or some other material. You will still be fat and protein. This is pretty much common sense. Even if you were to restrict all protein, your body will break down its own lean muscle mass and so the floaters will continue.

Some people see more floaters than others. I have high myopia and will occasionally have bouts of many floaters. Usually the more vigilant of them you are, the more you are apt to see them. Age greatly affects the amount of floaters you will experience so the older you get, the more floaters you will see.

Sometimes floaters can be a sign of a retinal tear so if you see many of them and they are accompanied by flashing lights, it's time to see a doctor. Particularly if you have had a recent head/face trauma. Protein restriction will not repair or reattach your retina. You would need emergency surgery instead.

5. I am trying to eat healthier so I bought a "healthy" butternut squash soup that tasted like sewer water. It had wholesome ingredients though. Why do healthy things taste like %^&*?

Yes.......yes they do taste like that. They either taste like crap or have the wrong texture or simply don't hold up to the real thing. This is usually what occurs when you take something that has been perfected already and try to make it out of something else.

I always laugh at these health zealots when they claim there are "so many delicious healthy" foods. I am sure there are but none of them are fried chicken and waffles. This means you have to leave the chicken and waffles behind because they won't taste the same made "healthy". Just enjoy naturally delicious healthy foods like baby back ribs. I'm sorry, but that's just how it is.

It's hard to find creamy soups like butternut squash in the "healthy aisle" as that usually means low fat and/or low carb. Butternut squash soup is neither. Even if you make it yourself at home to avoid the fillers, gluten and MSG, it still requires butternut squash (carb) and coconut milk or cream (fat). For some, the seasoning for it is brown sugar and/or maple syrup (more carbs). You probably found an iteration made with bone broth instead in order for it to be healthy. Well, you just found out there's nothing like the real thing, baby because fake stuff sucks.

I recommend you stay away from constantly trying to recreate items you can no longer eat. A lot of these "healthy" soups or other food items remove the ingredients that make the original so good. If you take away a model's beautiful long hair, fit body, young age and symmetrical facial structure, you end up with me. Can you truly say I'm still a model? No. Not if you're being honest.

So when you take away the sugar, dairy, wheat and MSG from your favorite staples, can you truly say they are the same? No. They aren't.

6. Can I drink mineral water instead of electrolytes?

All water, except for distilled water, contains electrolytes. Mineral water generally has more electrolytes than tap water so you can consume it if you wish, since it is cheaper than electrolyte mixes.

We get most of our electrolytes from food. The body usually keeps its electrolytes tightly regulated. There are some exceptions though and this is why we emphasize the importance of electrolytes on this blog.

When you follow low carb/"keto" diets, your insulin naturally lowers. Changes in insulin levels have an impact on serum electrolyte levels. This is why they usually mix sugar in with electrolytes. You see this in the electrolyte IVs they give at the hospital and also in many "sports drinks". Sugar facilitates electrolyte entry into cells by raising insulin. On a side note, many diabetics are in a constant state of mild "dehydration" because of insulin resistance.

Insulin is also an anti-diuretic so when it lowers, you will naturally release more water from your body and this can cause imbalances in electrolyte levels which make you feel generally unwell. This can occur with any diet, since all diets affect insulin, but because low carb/keto diets can be sustained for a longer term, the effect is worse as the imbalance increases over time. Whenever you hear people complain that low carb makes them "feel like crap" so they "need carbs", it's because of this effect. 99% of the time this unwell feeling is caused by electrolyte imbalances.

For this reason, you have to keep your electrolytes in mind always. Not only should you supplement 400 IU of magnesium daily, you should drink an electrolyte mix after exercising, working in the heat or if you begin to just feel unwell on your new diet. Make sure the mix you use, does not contain sugar. Though sugar helps cells intake electrolytes, it is not a requirement. Taking electrolytes should make you start feeling better again but if you don't, then you have to stop the diet and see your doctor.

Unless you have certain medical conditions, like renal disease, that requires careful monitoring/restriction of potassium intake, you should not have any issues consuming electrolytes, since the body balances them for you. If you do have a condition where potassium can be problematic, speak to your doctor first.

Six common beliefs addressed, Part 235

1. I love Starbucks drinks. Is there a way to enjoy the caramel macchiato without all the sugar?

I'm glad you describe these as "drinks" and not coffees. If anything, they are liquid desserts and they are loaded with sugar filled syrups.

What a lot of people don't know, is that you can actually get them "sugar free" even if it's not posted on the menu. This means that you can get a sugar free caramel macchiato, if you order it that way. I believe they use Splenda as the sugar alternative, but you will have to double check to be sure. Also, you would probably not be able to use your own sweetener as the Splenda is in the syrup.

Look, this type of stuff are novelties that shouldn't be staples in your diet. You definitely don't ever want to buy a sugar filled caramel macchiato but if you want to have a sugar free one, once a week or once a month, that's fine as long as your overall diet composition remains anti obesogenic with minimal sweet taste.

2. I don't understand why more people do not follow your blog. You are mostly unknown but the information you provide is spot on. I have cross checked it extensively.

I don't mind being unknown. I don't want to be known, especially in the diet and health sphere. They have too many charlatans and I don't want to be lumped in with them. This is not a career or business for me. This is a hobby. I like to write and make things simple. I am doing what anyone on here can do. I gather information from legitimate obesity research and post it so anyone can find and understand it.

Most people simply do not like the information I provide because I don't promise the "magic pill" they seek or I am not spouting the narrative they want. I am upfront and honest about overweight/obesity. I don't hand-hold, placate, coddle or give alternatives so the person can continue with the lifestyle that caused their obesity to begin with. People dislike the fact that I point out obesogenic behaviors as they want to believe that what's happened to them is not their fault in anyway, but it's someone else's instead.

As of this post, there is no known cure for overweight/obesity. So, anyone who tells you they're selling one, lies. My blog is for those that are sick and tired of being lied to. So, the information that I provide is simply so that people can better manage their body fat and health using the truth. In other words, things that might actually work, not feel-good nonsense and slogans.

3. I heard that exercise is not effective for weight loss. Is this true?

It's "true" but it is also shenanigans as are most things you will come across when dealing with overweight/obesity. A lot of the stuff you will read about diet, overweight/obesity and exercise is based on word play and half-truths. This is one of them. I'll explain why.

The study that concluded exercise was ineffective for weight loss was based on calories. Again, people keep equating "calorie burning" with weight loss. That's not the case. You can burn a lot of calories and still be uber fat. In fact, people who are obese burn a lot of calories. This study basically concluded that not only can you not burn enough calories, during a workout, to make a difference in your weight, but active hunter/gatherers burn about the same calories as the common person in the United States.

Why is this surprising to anyone? It shouldn't be. The study was based on a false premise to begin with. It's like me conducting a study to prove that trolls really don't live under bridges. Trolls don't exist so my study was a bust to begin with. (Well, they do kind of exist but on the internet, not under bridges.)

We have long known that calories in/calories out (CICO) does not equate to any significant weight gain or loss and does 0 for body fat gain or loss. We know this from the countless calorie deficit diets and starvation research that have been studied for more than a century now. This is not new. So, the only thing this proved was what we already know. The type of weight loss that an overweight/obese person is trying to achieve cannot be obtained through calories. It's obtained through metabolic homeostasis and that can only be done through lifestyle changes which include exercise.

If you want to improve your blood glucose regulation so that your metabolism can balance its own energy, you need to exercise. You won't get to lean without it, at least not in any ethical and healthy way. I can lock you in a basement and might be able to starve you into leanness, if you don't die of malnutrition first, but that's not addressing your obesity, regardless of any pounds lost. What you want to do though is reverse overweight/obesity and that is only done through a sustainable diet and exercise routine.

4. My mother doesn't do anything but talk about diet all of the time but yet she is still obese. She will even talk about diet to strangers. It seems like she is endlessly dieting. Why hasn't she become slim yet?

"Serial dieters" are always talking about diet. These people believe that diet will help just about anything, but it hasn't helped them lose a pound. These people go through all kinds of "fad" diets and then end up right back at the usual "healthy diet" of no "junk food" and also no results. It's all nonsense. Food lists after food lists but not one pound lost, yet they want to help everyone else with their diet. 

Like I have said many times before, the only intervention that works for addressing obesity is a lifestyle one. Not a diet one. Lifestyle. Diet is a very small part of your overall lifestyle. In fact, you sleep for longer periods of time than you eat. You also sit for longer periods of time than you eat. You sit while you eat. This means that movement should be priority number one as that's what you mostly don't do.

People want to only address diet because it's easy, fun and familiar. Addressing obesity through food intake is like addressing alcoholism through alcohol intake. How has that worked for alcoholics so far? Serial dieters aren't ready to do the hard work that it takes to change their entire obesogenic lifestyle. So, it's not surprising that your mother is still obese after all these decades of following "diets" which is basically equivalent to following food. She will most likely continue to be obese. Until an obese person can stop making food the center of their existence, they will continue with their problem.

5. I have a friend who used low carbohydrate dieting to better their health and drop some weight. They swear up and down that they are completely healthy because they can lift a lot of heavy weights at the gym, but they are still 200 lbs., and it isn't muscle. Does lifting heavy stuff mean you are metabolically fit?

No. That is ridiculous. I don't know where the heck this idea is coming from. I swear, the low carb world has just given up on losing body fat. Literally. I don't know why people equate "lifting things" to having more muscle mass. You can lift a lot of things and still be mostly fat.

I have discussed this before. Lifting heavy things does not mean you are fit or healthy. It doesn't mean you have a lot of lean muscle mass either. Lifting heavy things just means you can lift heavy things. Fat people lift heavy things all the time. For example, they lug around their own body weight all day long. When you are constantly carrying around 200+ lbs. of weight, you tend to be pretty strong. This is why overweight/obese people can lift heavy things and they can also knock you out. Having a large body mass, means you naturally have more muscle but that doesn't mean you are mostly lean muscle mass. You are still mostly fat.

Your ratio of lean muscle mass to fat mass is what truly determines your fitness and health. Being a 200 lb. person that can bench press 400 lbs. doesn't mean anything, except that you are a 200 lb. person that can bench press 400 lbs. You will still develop the complications of diabetes.

This has happened to body builders who haven't maintained low body fat. I had spoken about a body builder I knew, who did it professionally, and now has diabetes. His muscle mass did not save him from his growing fat mass. Building muscle is not enough. You have to get rid of body fat because if your body is piling on excess body fat, then it means your metabolism is broken from chronic blood glucose dysregulation.

6. Is it true that the Wahls Protocol cured Wahls of multiple sclerosis (MS)?

This question may be irrelevant on this blog, but I will answer it anyway as this is the type of stuff seen all the time in low carb/obesity/diabetes circles. A warning to the sensitive - you will be triggered.

Look, with all due respect to Dr. Wahls, she hasn't been recognized as having discovered the cure for MS. Unless she is hiding her Nobel Prize very well, we can safely assume she hasn't received it. We don't even know if she had true MS to begin with. Just because you have all of the clinical manifestations of a disease, does not necessarily mean you have that particular disease. You are simply diagnosed with the most common denominator. No diagnosis is set in stone. They are simply approximations done mostly through the process of elimination.

MS is a potentially disabling disease of the brain and spinal cord. In MS, the immune system attacks the protective sheath that covers nerve fibers and causes communication problems between your brain and the rest of your body. Eventually, the disease can cause permanent damage or deterioration of these nerves. The course of this disease is different with each individual. Some people deteriorate rather quickly, while others go into remission for years with no new symptoms or significant progression.

To make matters even more confusing, in rare cases progression simply halts and actually reverses for no apparent reason. This has also been documented in confirmed amyotrophic lateral sclerosis (ALS) patients. These events are known as "spontaneous reversals or resolutions". No one knows how or why they occur. They aren't linked to any specific "thing". The body simply stops doing whatever was causing the pathology, correcting itself. This is not surprising in a universe governed by chaos. Chaos can be either good or bad, depending on the results. The same effort it took to grow a brain tumor is the same effort it takes to dissolve it. It is just not a common occurrence, but it can happen and has.

Other things besides MS can also cause a deterioration in nerve communication, mimicking MS. We don't have to go through all the different toxins and conditions that can cause "pseudo-MS", so let's just focus on Wahls herself and what we do know about her. The main thing that stands out to me in Wahls case was her being a vegan for a prolonged period of time before her condition developed and further deteriorated. Severe B12 deficiency mimics MS. It is extremely coincidental that the moment Wahls began eating meat, she gets up from her chair. She claims, "meat cured her" and technically, it most likely did.

So instead of debating whether this woman found a magical cure for MS or not, the more important take away message here is that fad diets are very dangerous. There have been multiple cases of people ending up paralyzed and with brain legions from severe B12 deficiency because they have dabbled in unnatural diets like veganism and not bothered to monitor their nutritional status or supplement accordingly. Wahls was lucky as prolonged B12 deficiency damage can oftentimes not be reversed.

Six common beliefs addressed, Part 234

1. Can chronic calorie restriction be sustained? If it can, does it override the body's compensatory systems?

Yes. When true starvation is forced, it can be sustained, and it will override the body's compensatory systems. External forces like famine or other conditions, where food availability is not consistent, uncertain or non existent, causes a sustained state of chronic starvation.

In this state, the body compensates but this compensation never results in overweight/obesity because the person will die of malnutrition before any metabolic adaptation, resulting in metabolic syndrome, can take place. Metabolic syndrome is starvation without the death.

2. You can't predict who would get fatter and sicker on protocols like extended fasting and fad "keto".

Those type of programs are detrimental for people who:

• Have been overweight/obese for most of their life.
• Have metabolic syndrome/diabetes.
• Have dieted frequently using some sort of starvation (most diets).

It's these people who will suffer the most in the long run as these protocols will cause their metabolism to double down its starvation adaptation increasing body fat over time and worsening metabolic outcomes regardless of any initial improvements. You can find multiple in vivo case studies of this online, in the fasting/"keto" community.

3. I recently left a protocol I had been following for some months. I didn't really lose much weight, but I did drop some inches and then stalled. I left the program because there was too much strenuous exercise involved and I'm a senior who can't keep up. I felt like I was being blamed for not being able to lose more weight than I did. I feel lost as to what to do now.

It's sad to see people get duped, over and over again, by these weight loss programs, usually run by fit body building trainers. These people cannot help you. These people can help someone in their twenties achieve muscle tone and drop 20 lbs. but they cannot help someone in their sixty's reverse overweight/obesity and their metabolic syndrome. It's not going to happen.

Calorie centered protocols that work using deficits and a large amount of energy "output" is just not going to tackle the "disease" known as obesity. People on these programs will end up blaming you, when the protocol does not work. They are true believers that go into a rage when reality shows them otherwise. For them, if it's supposed to work, then it simply cannot fail. Their logic is that if it works for 30-year-old Debbie who is 30 lbs. overweight, then it must work for 50-year-old Sarah who is 100 lbs. obese. It doesn't. Being a few pounds over your "ideal weight" is not obesity.

This is why we focus on meal composition, sustainable exercise and behavior modification in order to get long term results. In other words, a lifestyle approach. Overweight/obesity and metabolic syndrome only respond to long term, consistent, lifestyle interventions.

4. Are there fasting protocols which are not based on calorie restriction?

Intermittent fasting protocols like 16/8 and 20/4 are not based on calorie restriction because the person can eat all of their required calories in the 2 - 3 meals they would have during their 8- or 4-hour eating period. Once the fasting protocol becomes longer like one meal a day (OMAD) or less, then it produces an overall calorie deficit.

Doing an OMAD or up to 72 hours of fasting, once a week, is not a prolonged enough calorie deficit to cause adverse metabolic side effects for the overweight/obese who are generally otherwise healthy, but not everyone responds the same way. The more obese the person, the less chances of negative side effects to these longer intermittent fasting protocols but, metabolic syndrome puts you at high risk for these protocols to become detrimental.

5. I’m Asian and in good health. I’m slim and do not have metabolic syndrome. I consume my traditional Cambodian diet which consists mainly of rice and vegetables. I’m considering giving up my diet because of all the anti-carb info I’ve been reading online.

No. If it's not broken, don't fix it. You’re not in any danger and you shouldn’t change your diet. As long as you continue consuming your traditional low to no sugar diet, without any Standard American Diet (SAD) processed items, you will continue to be fine.

Low to zero carb diets are the recommended diets for people tackling metabolic syndrome and overweight/obesity. They can no longer negotiate with carbs. Traditional Asian diets for healthy Asians are the best diets they can follow as it's their original diets which they genetically evolved with. Asian diets combined with the SAD diet is deadly. So, as long as your healthy, don’t change anything.

6. I have heard you mention "obesity mindset" before and I would like for you to elaborate on what that means. I have never heard anyone else mention this.

We don't see obesity as solely a biological or a behavioral problem, on this blog. Obesity is both. Both biology and psychology play a role in obesity, and one cannot exist without the other as they depend on each other. There must be fertile ground for obesity to take hold and that's where mindset, which influences behavior, plays its role. Obesity is a lifestyle choice. This means that the person must be living a lifestyle that promotes obesity (obesogenic) and this goes well beyond dietary choices.

There are certain behavioral characteristics that are similar, across the board, in most obese. These behaviors existed long before the person ever reached obesity. This is why obesity is a time dependent condition, on all levels, because it begins long before excess fat accumulation becomes visible.

To put it in perspective athletes are never obese. Now you could chop this up to simple calories in/calories out (CICO) theory, but you can also look at an athlete's mindset, long before they became an athlete. Athletes are known to be persistent, tenacious, consistent and determined. The person that gets up at  5 am to go jogging whether it's cold, hot, raining or snowing, is never obese and will most likely never develop obesity in their lifetime. Hint: It's not just because of the jogging.

Obesity characteristics are not as simple as just "gluttony and sloth", though you can see how this stereotype took hold, since many of these characteristics below mimic just that. The most common characteristics that I have experienced in the obese are:

• Entitlement - They feel they have a "right" to things. "I have the right to eat what I want and shouldn't be kept from it". "Because I am older, fatter, weaker and sicker, I have a right to not be expected to eat or move like others". "Because I am stressed, I have a right to this cookie. I deserve it".
• Avoidance - They will address the problem without ever doing what it takes to resolve it even when the resolution is known. They avoid difficulties and address "the issue" in a way that's comfortable, both physically and mentally for them, even if it provides no results.
• Excuses - Usually these excuses are part of the avoidance. Excuses come in dozens for the obese. From social gatherings to holidays to "I only ate a little bit" to once again, stating how old, sick and fat they are.

I notice this clearly in aging. For instance, in my Cuban culture the elderly are very entitled. They basically are not required to move while the young are obligated to do everything for them. Well, what this has caused is a very sick elderly population in our community. They become immobile younger and develop serious health conditions sooner. In contrast, American elderly people are out jogging, golfing, swimming, traveling and remain active for longer while older. This is because loss of mobility and knowing you can't really depend on the young to do for you, keeps them active by force. Invalids don't just use crutches, crutches make invalids.

Most obese use their mindset as a crutch to perpetuate and justify their obesity in one way or another. Once you are obese, biology will not make it easier to become lean. It will only make it easier to become more obese. So, this mindset has to be changed and preferably, not allowed to take hold early on in a person's life because it will make them obese later on. The ones who succeed in becoming lean, don't just change what they do, they change how they think.

Six common beliefs addressed, Part 232

1. The hormones in food are the cause of children looking older and developing quicker.

Hormones are actually very expensive and usually not used in foods. There are certain foods like soy that mimic human sex hormones and can alter development but for the most part, sexual development is determined by body fat. The higher the body fat, the sooner you develop as the body believes the environment is abundant and offspring are more likely to survive. Body fat speeds things up including your own demise.

2. People who are doing everything right on "keto" still gain weight over time. A lot of doctors say that it works initially but then it creates "issues".

Okay there are several assumptions being made here.

First "doing everything right" is up for debate. I don't know what that means because I don't know what type of "keto" these people are following. If they are doing the fad "keto", found online, then it's wrong. Just because it's on Facebook, doesn't mean it's right. If you are on a "keto" protocol that allows you to eat astronomical amounts of fat, you are doing "keto" wrong and so therefore, you will gain weight.

What "issues" are being described? That these people regain weight? Well, I already explained before that if they are doing "keto" wrong, they will gain weight but if they are doing "keto" right and still gaining weight, that's not a "keto" issue, that's an obesity issue. That occurs with all diets, not just "keto". All diets cause weight regain with time. 

You have to be careful when following diet promoting "doctors". You need to understand that all diets are only palliative treatments for obesity as overweight/obesity has no known cure. So, when you see a doctor talking down on other diets, it's because they are trying to sell their own as all diets have the same success rate for "treating" obesity.

3. Calorie advocates disagree that some medicines cause weight gain since it's all about calories.

"Calorie people" don't know what to think anymore. That's what happens when you try to serve two masters - calories and some other mysterious, unknown, agent. Of course, that "agent" are metabolic hormones, but they refuse to admit this so let's just call the agent elves instead. That should make them feel better.

Most calorie people will agree that some medicines come with elves which cause weight gain, but this is only because of the presences of calories. This is fundamentally, at its very basic level, true since if you were in a gulag, you wouldn't be gaining any weight regardless of what medicines you were on, but this doesn't help you in the real world. No one here is in a gulag.

Some medicines affect blood glucose homeostasis and so they end up causing overweight/obesity. This can be minimized by following an appropriate diet containing the correct macronutrient composition to prevent further blood glucose disruption. This should better help you not gain so much weight while on certain medications.

4. I have done all kinds of calorie restriction, low carb, "keto", carnivore, Paleo and fasting but I haven't lost a single pound. Actually, all I do is lose five or ten pounds and then regain them. I have been this way for years. Will I ever lose weight?

I don't know. I like to approach things with the mindset that the person can lose weight but that's never guaranteed. We can't be defeatists but we also have to be realists. The reality you have to face is that you, like everyone else, can only be as thin as how much leptin expression you can regain and most importantly sustain. Period. It's not the calories. It's not nitpicking diets. It's leptin.

People who have/had insulin dysfunction, like metabolic syndrome and/or diabetes, can’t seem to regain or sustain their leptin expression for long or at all. This is because leptin is a slave to insulin function and some people are just unable to regulate their blood glucose enough to normalize insulin expression.

So, all I can tell you is that at least you're not gaining weight. Even if you don't lose any, you are still managing your weight. Instead of hopping around from diet to diet, trying to figure out what works, stick to one because you will achieve the same results with all. Follow the diet you are most comfortable with so that you can continue on it for the long term.

5. My HbA1C has lowered with Metformin. It is no longer in the diabetes range and my doctor is very pleased by this. He tells me he wishes all of his diabetic patients can lower their HbA1C to my level of 5.2. I think that eating low carb has helped with this. I was told by low carb advocates that I am no longer diabetic.

No. You are still diabetic. You are still on Metformin. 

I don't want to rain on your parade because sustaining an HbA1C level of 5.2 while being diabetic is a good thing, so you can be proud of that since most diabetics simply aim for an HbA1C below 9. Usually that is based on their doctor's advice.

Unfortunately, diabetes is not a disease of high HbA1C. It is also not a disease of any one isolated, blood glucose reading. Surprisingly, it is also not a disease of insulin, per say. At least, not directly. It is a syndrome of large disparities in blood glucose regulation which deteriorates insulin function over time, causing a high HbA1C. This causes metabolism is adapt to a "starvation mode" that is extraordinarily difficult to reverse as it affects multiple glucoregulatory systems in the body.

This is why diabetes medications, whose goal is to lower HbA1C, do not stop the progression and the ultimate complications of diabetes. The disease continues on. This lowering of HbA1C is not indicative of proper blood glucose regulation. Let me explain.

You can have very high postprandial readings and then the abnormal drop in blood glucose during fasting, creates a pseudo "lower HbA1C". Just because your HbA1C can indicate an "average blood glucose" does not mean that you actually sustain blood glucose at that average number. It's simply taking your highest and lowest blood glucose reading to determine the average. In other words, if your HbA1C indicates that your average blood glucose is 120 mg/dL, it doesn't mean that's your actual reading at any given time. You can be anywhere well above or below that consistently.

This is why patients on diabetes medications have to be very careful during fasting and they are recommended to never fast. This is because that's when the medications can cause a very low drop in blood glucose, much more so than it would ever drop normally. This is sort of like how diet lowers cholesterol. It does that through the lowering of HDL but the pathology of oxidized and dysfunctional LDL persists, and heart disease still occurs regardless of total cholesterol number. These interventions are just altering numbers, not the disease.

Diabetes medications are basically trying to prevent blood glucose from going so high that you end up in a diabetic coma. They are not treating the disease or normalizing blood glucose regulation. They are actually not helping it at all. In fact, and this is going to be controversial to say, if you take what the pathology of diabetes is, which is large disparities in blood glucose, you can say that the medications are making this worse. Medications drop blood glucose lower than it would ever drop during fasting causing an even greater disparity, since they never really halt blood glucose from rising above normal after meals.

I'm not suggesting a stop to medications, as they actually will keep you living longer with the condition than if you didn't take them. I am just saying that at least they aren't helping to achieve remission and at most, they are enabling its progression. Remember you are living longer with the condition. Not without it. After all, the body doesn't care what your "average blood glucose" is. It only cares about the 190 mg/dL after meals and the 60 mg/dL while fasting. That's all it sees.

So, keep this in mind and continue with an anti-diabetic lifestyle as these medications are only going to take you so far. You have been able to keep your HbA1C in check due to your diet as it would be much higher if you just lived life like you weren't a diabetic, which is what the American Diabetes Association (ADA) pushes for. That's really the most dangerous message that the ADA puts out, by the way. You can never live life like you aren't diabetic. Ever. At least, I wouldn't recommend it as that would be certain death.

6. Diet is more important than exercise.

I like to emphasize that both diet and exercise work in conjunction to achieve the best outcome but if I absolutely had to make a hard line choice, between one or the other, I would pick exercise.

Many people are surprised by this, especially the obese since they love to focus on anything that doesn't make them have to move an inch, so diet is always their main target. But the results are clear and have been proven over and over again - exercise is the most metabolically protective thing that you can follow even in lieu of diet.

This has been seen time and time again in metabolic studies. Diabetics have been able to improve their metabolic markers and even get off medications, through exercise alone, without an iota of diet change. Athletes also prove this daily. You can be an athlete with a piss poor diet and still remain protected from obesity and metabolic dysfunction for most of your life span. That's how protective and far reaching the effects of exercise are. Humans can adapt to just about any diet, but they cannot adapt to being sedentary.

This can even be seen in aging. Someone who was an athlete when young, has better outcomes as they age. You can tell, just by looking at them, that they were mostly active throughout their life. These people can delay their diabetes until they are age 80 rather than age 50. This is seen in overweight/obesity as well. Athletes may eventually succumb to diabetes in their older years, but they sure do never succumb to overweight/obesity. Exercise wards off body fat and keeps it off.

Why would this be important if they still succumb to metabolic dysfunction? Because it is much easier to achieve remission of diabetes if you are not overweight/obese.

Of course, eventually, your metabolism will cave under the strain of a bad diet, whether you exercise or not. Athletes have also proven this often as their health deteriorates with age, but you can certainly delay these outcomes significantly through exercise and if they do occur, you can reverse them easier. The same can't be said with a bad diet without exercise. That causes metabolism to rapidly fail.

So as far as metabolism is concerned - exercise is king as it addresses both insulin and leptin.

Six common beliefs addressed, Part 230

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.

Six common beliefs addressed, Part 210

1. Bariatric surgery should never be pursued.

I never remove any treatment from the table because obesity is very difficult to treat, and many different approaches can be successful for addressing it. There is no one treatment for obesity. Well, actually that is a fib. There is one treatment for obesity - proper leptin expression. In theory, that can be achieved by the normalization of insulin through better blood glucose control, but success usually means the person already had it.

All obesity should be deemed difficult until it proves to be impossible. But surgery should not be the first course of action. It should be the last. There are two common types of intractable obesity but only one of them has a true biological cause:

• Disordered eating habits - The person simply fails at every dietary and exercise intervention they try because they are unable to sustain it. Inability to sustain a protocol is different from the protocol simply not working. Instead of the protocol not working, these people just always revert back to disordered eating and sedentary habits. Even when following a proper dietary protocol, they change it to fit their disordered eating habits taking away any effectiveness. This is all psychological and behavioral in nature. It can be something as simple as refusing to cook proper meals or as complex as the inability to even identify what a proper meal looks like. A lot of these people require "hand holding" to keep "motivated" or someone diligently watching over them for "accountability". Of course, all of this is futile. No one can do for you, what you can't do for yourself.
• Hypothalamic damage - This is a true biological issue that is caused by a defect in hypothalamic cross talk between leptin/dopamine and the fat cells. This usually occurs from obesity that was sustained from fructose (sugar) consumption, particularly soda, among other factors. These are the people who simply cannot lose weight regardless of the protocol used or their strict adherence to it.

Both of these conditions usually cause for your doctor to recommend bariatric surgery, as everything else has been tried and failed. But how successful is bariatric surgery for these conditions? Well, not very much considering what weight loss surgery is targeting. It’s targeting the ability to intake food. Basically calories. Calories do not address disordered eating habits or the malfunction of leptin. For this reason, most weight loss surgeries fail to produce long term weight management for these individuals, and they soon put on weight again.

I still don’t remove surgery from the table because there is a small segment who do have beneficial results after going through such an invasive treatment. Even if they are unable to reverse their obesity, they do lose enough weight to at least delay the onset of associated pathologies.

2. I recently started following a protocol and I lost about five pounds. I also lost ten inches. Then I gained back three pounds, but the inches remain lost. Are these lost inches fat loss?

Fat loss occurs over time. This is why you shouldn't concern yourself with anything that happened "recently". You will know you are losing body fat, when you are becoming slim. This is why we don't deal with such small weight fluctuations on this blog. They don't show anything other than the body's natural ups and downs in water retention.

Water bloat causes an increase in inches. This is why it's hard to button up your pants when you are bloated. When water bloat is reduced, inches are obviously going to be lost. These inches lost may not return if your current diet prevents water retention. That is not fat loss.

3. I keep losing and gaining the same four to five pounds while getting nowhere with fasting and "keto". I have been doing this for years. 

Like I wrote above, this is why we don't deal with such small weight fluctuations on this blog.

The body compensates to whatever it's exposed to and continues on its trajectory of dysfunction as long as the underlying cause is not addressed. We see this with seizures for example. The person takes medication to stop seizures in one area of the brain and eventually develops seizures in another. Calories are another example. Calories coming in are reduced and the body simply reduces calories going out to match what's coming in. Soon you can't eat any less.

Obesity is an adaptation to starvation. Period. Until that metabolic state is changed, it will continue on. You can't change this adaptation through more starvation. Fasting and chronic ketosis are two states of starvation. All you have done these years is train your body to spare fat and build more of it from everything you eat.

What I don't understand is why people continue with protocols, for this long, which prove to not be working. It should not have taken "years" for you to realize that this wasn't treating your condition. It should have only taken a few months. Six months max is what any protocol should be given to prove itself. A protocol is not a failure because it doesn't work in the first month, but it is also not successful when it still hasn't worked in the sixth.

Yo-yoing up and down such small amounts of weight is the first indication that the protocol you are on is an epic failure. Your weight can fluctuate this way on no protocol whatsoever. If fact, dump the protocol and watch it for yourself. The body naturally goes up and down in water weight on any diet it's on. This means that your fasting and "keto" protocol has addressed nothing, all of the years you have been following it.

I understand that you want to believe in an "ancient miracle cure" but that promise, in itself, is full of lies. First, obesity is not "ancient". It is a modern condition, so there is no "ancient cure" for it. Only the adaptation that causes it is ancient. That adaptation is not a disease, so there is no "cure" for it. I'll let you believe in "miracles" if you want but I can tell you from experience that when it comes to weight loss, there are no miracles. There are only interventions that achieve results or do not.

4. I was told that boredom causes "nibbling and snacking" so I should eat a huge meal in order to prevent this. The huge meal should be composed of "large amounts of vegetables".

That is total hogwash. We have all heard about these "large amounts of vegetables" protocols before, haven't we?

First, boredom doesn't cause "nibbling and snacking". Disordered eating habits do. You will be bored many times in life since the majority of us do not live lives of consistent excitement. Life is mostly boring, unless some calamity occurs. Then when the calamity occurs, you will end up blaming it for the "nibbling and snacking".

People with disordered eating habits are always blaming external events and conditions for their bad behavior. The advice you were given is only reinforcing the fallacy that your bad behavior is not your fault but it's instead being caused by something outside of you, that's out of your control. That will only make you a slave to your unfortunate circumstances. Life's unfortunate circumstances will only increase as you get older so you will never be free.

Eating a "huge meal", especially one based on carbs, is not going to help with this. Vegetables are carbs which are low in glucose but high in air. Air is starvation. Starvation interferes with blood glucose regulation. Also, huge meals do not take away this mysterious "boredom". Huge meals are usually finished in about thirty minutes. The day is 24 hours long. This means, you now are left with 23 hours of boredom, if you eat twice a day.

Instead, be disciplined and eat appropriate, protein centric, meals during mealtimes only. Eat them at consistent times daily to adapt your satiety hormones and ward off hunger. If you are serious about treating your obesity, this should not be difficult. It's a no brainer. You have to do what you have to, in order to get the results, you want.

Lastly, find a hobby if you are bored. The hobby should be done with your hands or feet, not your mouth. A great hobby for people with metabolic syndrome/diabetes is walking.

5. I was told that I have to exercise in order to have the "luxury of eating higher protein". 

You have to exercise in order to have the luxury of better leptin expression which helps you burn body fat. Exercise also promotes the luxury of muscle preservation/building.

You must have gotten the above advice from a calorie centric protocol. Because people who are trying to build muscle must intake enough protein calories, often times at a surplus, they try to match their training to their intake in order to keep with their caloric goals. On this blog, we do not recommend those types of protocols for the obese. Those protocols are great for obesity resistant people who are training for muscle gain or some athletic competition. The obese metabolic state is different.

The obese should eat adequate protein, without caloric restriction, regardless of exercise, because they are wasting away daily into glucose from hyperglucagonemia. It is very difficult for them to build muscle for various reasons, aside from that.

The calories of protein are used for preserving lean body mass. That is why the body expends a lot of calories to metabolize protein. This is released as heat or the "thermic effect of food". Protein has the highest thermic effect.

The body doesn't directly store protein as fat. Instead, it converts it into glucose and that is stored as fat. This is the process of gluconeogenesis. Most of the protein converted into glucose is from your own lean muscle mass, not from the protein you eat, though it tends to ramp up postprandially due to a rise in insulin. This is a very controlled process in the healthy but over expressed in metabolic syndrome/diabetes due to abnormalities in insulin/glucagon ratios (hyperglucagonemia).

But for the person who is trying to address these conditions, this alone is not significant enough to cause a progression in these pathologies, if the diet is low in carbs and moderate in fat. This breakdown of protein into glucose will taper off with time as insulin sensitivity improves. So, it's a worthwhile trade off in the short term.

6. I decided to take your advice and increase my meals to three a day, rather than just two, as I have been stalled for a while and decided f** it. What harm could it do? Keep me stalled? Well, it didn't do any harm at all. In fact, I started losing weight rapidly! I can now see a gap between my thighs, when I hold them together, and my clothing is falling off. How could eating more cause me to lose this much weight?

Leptin. There are many overweight/obese people who can easily obtain proper leptin expression and they are being duped into eating less by calories in/calories out (CICO) programs, causing them to remain obese. Eating less under expresses leptin and the person simply does not burn any body fat. Just because you are overweight/obese does not automatically make you permanently "leptin resistant". Many obese people are, but some aren't.

People who have:

• Not been overweight/obese in childhood, or who...
• Recently became overweight/obese, or who...
• Became obese from starch consumption rather than sugar (soda) and sedentary behaviors, are the most likely ones to regain leptin sensitivity when these issues are corrected.

Leptin sensitivity will allow you to lose weight from body fat and keep it off. You just have to eat enough and exercise sufficiently to kick start this. You did the right thing is incorporating an extra meal to your day. Now that you are no longer "starving", your body has agreed to burn body fat.

Six common beliefs addressed, Part 207

1. My trainer told me to not worry about high blood glucose or insulin because most overweight people have those issues and they go away when they become lean.

Ask your trainer why "most" overweight people have these issues but not all. That's the key question that reveals their BS. Outliers don't make the rules but they certainly break them.

Everyone knows what reverses insulin resistance and diabetes - body fat loss. I know that these coaches and trainers want to make statements like these in order to appear confidant in their protocol but the reality is that everyone knows this. What is not known is how to achieve it. We know that proper blood glucose regulation is the key but we simply don't know how to regain and sustain it long enough to affect body fat in everyone.

So, yes you have to worry about your high blood glucose and insulin because that's what's driving your condition. These issues do not go away because you become lean, instead you become lean because these issues go away.

2. A coach told me that loosing fat and gaining muscle is the key to reversing insulin resistance.

Like I said above, everyone knows what reverses insulin resistance and diabetes but no one yet knows how to achieve it, especially in the long term. There are many different treatments but they have all failed so far. You need a properly working metabolism to lose fat and build muscle. The key to this is proper blood glucose regulation. It doesn't happen through magic.

The overweight/obese metabolism doesn't want to lose fat and it breaks down all its muscle. It’s very difficult to reverse this, once it begins, and many different lifelong approaches have to be implemented together in order to have a chance to.

3. My neighbor was recently walking and suddenly had a heart attack. They discovered she had a 99% blockage in a main artery. She had started doing "keto" a while back, was doing great with weight loss, and then this happened. 

Heart disease is mostly genetic. I am pretty sure that there was heart disease in your neighbor’s family history. Having said that, people who have a genetic predisposition for heart disease have to be very careful of their lifestyle choices and keep in mind that some of these choices can put them at greater risk for developing this disease. Lifestyle choices like smoking, for example, puts everyone at risk for heart disease but it is especially malignant for the people who already have a genetic predisposition for it.

A lot of genetic heart disease is caused by poor lipid management in the body. Lipids are very complex but basically these people have LDL and apolipoproteins that do not function as they should. Certain lifestyles can effect the function of these proteins but for the most part their function is genetic. That's why these people have long family histories of heart disease. For some of these people, consumption of saturated fats has an adverse effect on their lipid profiles. "Keto", as is followed online by buffoons, is an ultra high saturated fat diet. If your neighbor was one of the people who have these genetics, then yes, she very well could have exacerbated her disease by eating all that fat. It doesn't mean she wouldn't have developed it anyway, it just means that she sped it up.

You should never follow a diet willy-nilly because you saw someone online recommend it since the odds are that the diet is not correct. Even a diet like veganism which is toted as benign is everything but. It can cause you serious health problems. Your neighbor should have gone to her doctor and had the proper testing done in order to see how this diet was affecting her lipids. You cannot guide yourself by simply having "low cholesterol". That's not enough to know how the diet is affecting you. Your cholesterol could be low and doing nothing but building plaque in your arteries, just like your insulin could be low and doing nothing but building fat around your middle. Having less or more of something doesn't make it good or bad. What it's doing is what determines this.

4. My friend was obese. His diet is carb based because in his culture it’s a tradition to eat bread, beans and other carbs. About a year ago he started making YouTube walking videos, giving tours of his city. These walking tours take anywhere from two to three hours of walking every day to every other day. I recently visited him and when I saw him, I nearly fell over. I didn’t recognize him. This man is in perfect shape now. He looks athletic! He said he was surprised himself as he never could have guessed making these videos would cause this to happen. He never changed his traditional diet either but he reversed his prediabetes anyway. 

This is not surprising as exercise has long been known to reign supreme when it comes to metabolic health. Diet is only a palliative treatment for metabolic syndrome/diabetes but exercise actually reverses the pathologies associated with this condition.

Many studies have consistently shown this in diabetics. Without any diet changes, diabetics can make significant and long lasting improvements to their condition with exercise alone. We have also seen this in athletes. Athletes can have the worse diets in the world and still be in perfect metabolic health, as long as they can continue exercising. Exercise is great at preventing metabolic conditions.

The profound effects that exercise has on glucose regulation is what sets these metabolic benefits into motion. These effects go well beyond glucose control and actually changes the way insulin functions. To compound the benefits, exercise affects leptin in a positive way, more than any diet can. Add to that mitochondrial energy balance and improvements to body composition and you have a system wide metabolic effect that cannot be matched by any diet. Exercise goes where no diet can.

5. Everyone is always arguing over one diet or another but does it truly matter when it comes to obesity? There is no diet that is best for obesity. 

Diets are all shim-sham when it comes to obesity because no diet can promise a restoration of leptin expression. Leptin expression is all that matters. This is why you cannot expect much from any diet but you also can't take any diet off the table, unless it hasn't worked for you before. If it didn't work once, it won't work twice. The premise is that your chosen diet will improve blood glucose regulation enough to enhance leptin expression.

The diet you choose affects your overall health and certain diets have to be followed due to allergies or other conditions that are exacerbated by the consumption of certain foods. But when it comes to obesity, diets are only palliative since obesity has no known cure. In fact, exercise reigns superior in its beneficial effects on obesity than any diet.

The path to restoring leptin expression, for the obese, is paved in blood glucose regulation. So the only diet that is best for obesity is one that helps preserve and/or stabilize blood glucose regulation. Proper blood glucose regulation simply means that the body is able to keep its blood glucose steady, without large disparities between highs and lows. A healthy body makes glucose when needed and not when it doesn't.

The best diets for achieving this are low in carb, moderate in fat and adequate in protein. This is because these diets have three very important benefits:

• They don't interfere further in the body's ability to regulate its blood glucose through the introduction of dietary glucose, whether in the form of sugar or starch.
• They minimize the storage of fat by no longer converting dietary glucose into fat. This is good since leptin under expression is not allowing for the burning of stored fat, so you don't want to add to it. Getting fatter only causes a further disruption in blood glucose regulation through an increased insulin demand.
• They allow the body to preserve and rebuild the lean muscle mass it's losing through excessive catabolism, restoring insulin/glucagon ratios and insulin's pulsatile function.
• They reduce systemic stress through the consumption of suffice calories, helping to break the starvation adaptation which is metabolic syndrome.

So even though you can affect blood glucose through multiple avenues, including caloric restriction, and they all can have some benefits, the most profound effect occurs from low carb diets because they target multiple glucoregulatory systems and they can be sustained for the long term. Obesity can only be treated with a long term solution that does not reinforce starvation.

6. If blood sugar rises too high, after a meal, it means you ate too much or ate the wrong thing.

You ate too much and you ate the wrong thing if what you ate is pizza. In that case, it’s not the amount of pizza that caused this but the pizza itself.

You can try to negotiate with the pizza and only have one bite so there isn't such a large abnormal rise in your postprandial blood glucose, but you will have some abnormal rise regardless. This will cause your insulin function to continue to deteriorate over time and this will further effect your blood glucose regulation. Soon you won’t need the pizza at all to see high blood glucose. You would just wake up in the mornings and see it. That can’t be solved by negotiating with your sleep and sleeping for just an hour a night.

Postprandial (two hours after a meal) blood glucose should technically be back to fasting levels. Of course, people with metabolic syndrome cannot achieve this so the rule of thumb is for blood glucose to not go over 140 mg/dL postprandial. You would be better off if you can keep it below 100 mg/dL. You want to avoid a blood glucose fluctuation of more than 40 points, whether up or down, but this is all very difficult to do when you are already insulin resistant. A healthy person would be able to control this much better in order to avoid becoming insulin resistant. Once you are already there, everything falls apart. The center does not hold.

A lot of people blame these postprandial blood glucose rises on what they ate or how much they ate, but I don't want you to focus too much on that. As long as you are eating a proper low carb diet and maintaining your macros, what or how much you ate becomes irrelevant. You can be on a zero carb diet and throw in caloric restriction to boot and still have high postprandial blood glucose.

This is because the high postprandial blood glucose, that a person with metabolic syndrome experiences, has mostly to do with their insulin function, not with what or how much they ate at any one single meal. These people simply do not have the correct first phase insulin response to stop glucagon's catabolism of their own body.

Insulin is not only anabolic. It is also anti-catabolic. So every time these people eat, whether it's doughnuts or rocks, they will have a rise in insulin which causes a rise in glucagon but their insulin does not rise high enough to stop glucagon’s action. The more glucagon breaks down their body into glucose, in an uncontrolled manner, the higher the glucose in their bloodstream rises. This problem exists with or without the doughnuts presence. That's why many people who are strict carnivores still see rises in their blood glucose, even with no carb consumption whatsoever.

Diabetes is not a carb disease. It is a blood glucose regulation condition caused most commonly by an improper diet. The malignancy in the doughnuts is not necessarily that they cause blood glucose to rise after eating them but that this rise causes a prolonged insulin release/expression which will then drop blood glucose 100 points or more, during the night time fast. It's this drop that begins the adaptation process.

Erratic and large disparities in blood glucose, postprandial and then fasting, deteriorate insulin function and blood glucose regulation over time, increasing the body’s propensity to store and preserve body fat. This is because these drops in blood glucose signal starvation and sparing fat is anti-starvation. This wasn't caused by any single blood glucose reading. This is something that occurs chronically in the long term. I'm talking decades.

So, the purpose of taking a dietary approach to control this effect is not to focus on single blood glucose readings in the short term but to improve insulin function in the long term. The improper diet is what caused this "insulin resistance" and that's what you want to reverse. For this reason, stay away from doughnuts. They interrupt the body’s glucose homeostasis whether you eat one or a dozen.

You also need to stop obsessing over single blood glucose readings and begin to reverse insulin resistance. You can develop advanced diabetes while twiddling with your postprandial blood glucose. We see this all the time with "low carb diabetics". They carry around their meters constantly and end up dying of diabetes complications regardless. Blood glucose meters give you important information about how diabetes medications are affecting you. That’s why you need to check your blood glucose often as blood glucose medications, including injectable insulin, can drop your blood glucose rapidly and without symptoms, which can possibly kill you. You need to make sure you are dosing diabetes medications properly. That's what the meter is for, not to see how onions or a tomato affects you.

For people who are not diabetic but are simply overweight/obese and/or have metabolic syndrome, the meter can show them in real time how doughnuts are not helping them. Some people need to see actual proof that pizza is unhealthy, in any quantity, before they even consider giving it up. Most people think that pizza just causes them to gain a few pounds a year but isn't actually killing them. Well a blood glucose meter can help convince them otherwise.

Six common beliefs addressed, Part 203

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.

Six common beliefs addressed, Part 175

1. Drinking diet sodas will prevent you from going into ketosis. 

No. It will just prevent you from getting lean.

2. "Keto" can cure asthma.

"Keto" does not cure asthma. The cure for asthma has not yet been found or rather, it has not been able to be successfully implemented in a large group of people with the same positive results. That's really the issue with many diseases. They know what causes them so they theoretically know how to solve them but the supposed "solution" doesn't work across the board in significant enough numbers to be claimed as a cure.

"Keto" is a palliative dietary treatment for metabolic dysfunction. It is to be used alongside any medication that your doctor has prescribed, after discussing your dietary changes with them.

"Keto" may relieve your symptoms because of a lowering of inflammation. It is already known that asthma is an abnormal inflammatory response. When your insulin levels are very high, you retain a lot of water. Water retention inflames tissues in the body further, since it has to be stored somewhere, and this is why it causes high blood pressure and exacerbates certain inflammatory conditions like auto immune disease or arthritis. This water retention can also make asthma symptoms worse as the lungs are impaired further from the pressure.

"Keto" diets, or any diet, that lowers insulin levels will cause a release of water and improve symptoms from conditions that are directly affected by inflammation, like asthma. The symptoms of these conditions may be temporarily relieved but the condition is still there as it hasn't been cured.

3. If you just get rid of sugar, it will cure acid reflux disease. 

It depends on what's causing your acid reflux disease. If it's being caused by doughnuts, then you might see an improvement or "cure" if you eliminate them. If it's being caused by all the other numerous things that can cause acid reflux, then no, there will be no difference.

4. You should only use butter, tallow or lard. Oils like olive and avocado are not "healthy fats".

People have used the term "healthy fat" ad nauseum and it has become absolutely annoying now. The only reason that the term "healthy fat" was coined, to describe these plant based oils, is because these oils have very little saturated fat and they aren't animal based. They are also less processed than seed/vegetable oils. This means that "healthy fat" is vegan/vegetarian propaganda. It is simply meaningless.

All fats are unhealthy if they are eaten beyond your macronutrient allotment as they will change the composition of your meals and that will change the composition of your body. You are what you eat.

You should be cooking only in saturated animal fats as they are much more stable when heated than any plant oil but you can still use plant oils for cold preparations or certain recipes. You have to keep your fat macros in mind when using any fat, especially added fat. Everything else is BS.

5. They say low carb diets are very delicious, but all people eat are plates of liver pate, runny raw looking eggs, cod liver with a brick of salt, all fried in bacon. I rather remain obese than have to eat like that. 

I get complaints like this constantly and my advice is always the same - stop following charlatans.

I totally understand that there are some low carb pages that feature the nastiest plates on planet earth so the world can toss their cookies. All of that is for shock value. A page will get attention if you post photos of yourself eating calf heart, rather than if you are just ate a normal plate of food. There are just so many diet pages that you need some type of con to get yours noticed and nasty food is a great sham that many low carb pages are now using. That's great for the growth of these pages, as all publicity is good publicity, but it won't help you one bit.

The problem with this is that the people who eat goose hearts and monkey brains are the ones that end up "falling off the wagon" and constantly trying to go back to their plate of horse testicles. When you have to eat frozen crickets, it's a given that you will end up at Denny's. And when you get there, you will binge. This is why we do not promote extreme, ridiculous protocols, as none of them are serious treatments for metabolic conditions.

You need to find a true low carb diet that is sustainable and prepare your foods the way you enjoy them. If you do not, you will not be able to consistently adhere to your protocol in the long term. Overweight/obesity and metabolic syndrome/diabetes are conditions that only respond to long term treatments, not gimmicks. You know if you are eating the right diet when you actually prefer to cook your own foods at home because you enjoy them more than what can be delivered by Door Dash.

6. There is no exercise that can reduce a stress response.

Low to moderate intensity, steady state, long duration exercise is the best stress reliever. This is the type of exercise that is low impact, improves cardiovascular health and also builds muscle. Walking about 8 - 10K steps or 5 miles a day is a great daily exercise regimen and if you can split that into two sessions, or if you can do more, then that is fantastic.

There is only so much weight lifting, running or high intensity exercise you can do before you max out its benefits and they become adverse but you can never do too much walking. The body does not react nor does it adapt to walking in the same way it does to other forms of exercises. So you can do as much walking as you want to do in a day and it will always be beneficial, even if you walk the same way, everyday.

So if you can walk an hour in the morning and another hour in the afternoon, it would be an ideal scenario. This is because you don't allow your body to remain sedentary for long but you also rest in between. Being sedentary for long periods is adverse to health. This is especially true when you suddenly introduce exercise to a sedentary body. That causes stress. This is why the worse form of exercise is being a "weekend warrior". All that exercise you are pushing yourself to do, on the weekends only, is causing nothing but a stress response in the body. So not allowing the body to be sedentary for long periods of time is key in your exercise regimen.

Six common beliefs addressed, Part 168

1. I never feel satiated with fat but the tiniest bit of protein makes me fill up immediately.

Fat is not a satiating macronutrient for the obese any more than carbs are. That's why we see all these obese "keto" followers drinking bacon fat right off the pan. This is because the leptin of the obese does not respond to dietary fat intake. They are momentarily satiated, but only after eating astronomical amounts of fat, and then they are hungry again a few hours later, just like with carbs.

Protein is different. Protein is the true satiating macronutrient that works better than fat. It is not foolproof but it does work better.

2. Weight training tightens loose skin.

Weight training may tighten your loose skin but this all depends on genetics and age. Some people just have looser skin than others and age has a big impact on that. The younger you are, the tighter your skin will be.

3. You can use actual weight or goal weight to calculate your required protein amount.

It depends on the formula you are using. Some use actual weight and others use desired (goal) weight. I have a tutorial for proper macro calculation here.

4. Cream cheese is acceptable on low carb.

Yes, it is.

5. I feel terrible on carnivore. I am tired, weak and I feel slumped like I'm having "sugar crashes" as if I was on high carb again.

In order to know what's happening with your blood glucose, you would need to actually check it and not just assume that these symptoms are caused by it. Since it's making you feel terrible then I suggest you drop carnivore.

If you are following the diet correctly, as recommended here, you should have no reason to feel any of these side effects, unless you are either not eating enough protein or you are having an issue metabolizing protein or your electrolytes are off.

Switch to a low carb diet instead.

6. Exercise is not needed to lose weight.

Nothing is needed to lose weight except for caloric restriction but we don't deal with "weight loss" on this blog. You can address weight loss with Weight Watchers. We deal with overweight/obesity and metabolic dysfunction. Overweight should really be changed to "overfat" as what you should be trying to lose is body fat, not body weight.

In order to treat overfat/obesity and metabolic dysfunction, you need to exercise. This is because weight loss is temporary but the treatment for obesity must be long term and it has to target multiple hormones. Hormones that you need to target, with your long term treatment, like leptin/adiponectin, respond profoundly to exercise. This is why exercise has been shown to produce the most important benefit when it comes to metabolic health - long term weight management. Diet alone does not do that.

I understand that the "keto" advocates don't want to nor care if you exercise since they aren't in the exercise business, they are in the diet business, but on this blog we approach these problems with whole lifestyle interventions as I run no business.