Six common beliefs addressed, Part 222

1. My sister has always been overweight, but she recently had gallbladder surgery and she has lost a lot of weight in the four months after. I think she secretly had bariatric surgery. It is not possible to lose weight rapidly without weight loss surgery.

It is absolutely possible to lose an enormous amount of weight when going through a stressful health crisis. Surgeries, illnesses and accidents can all cause a rapid deterioration of muscle mass particularly in people with metabolic issues. In fact, people with diabetes are at an exceptionally high risk of damaging their liver/kidneys from rapid lean muscle mass loss during and after a serious illness.

This is caused by the exaggerated adrenal stress response that metabolically compromised people experience and which I have discussed before. Diabetics can break down everything on their bodies, extremely quickly, except their fat mass. The fat mass is always spared. It is this sparing that causes the rapid loss of everything else.

This would make it seem like the person has lost "weight" but in reality, the weight they lost was mostly lean muscle mass. This is why it becomes so obvious to the onlooker as the person might appear gaunt in the upper body and extremities but still have a large amount of soft fat covering their body.

This rapid "weight loss" is not good. Loss of muscle mass worsens the outcomes of recovering from serious illnesses, and it negatively effects overweight/obesity in the future. After all, if you lose a lot of muscle while fat mass is mostly spared, you are now fatter by volume than you were before, no matter how "thin" you may look or what the scale says.

Nutrition is vitally important during this time, especially adequate protein. Unfortunately, a desire to eat protein is usually lost when appetite reduces and people tend to seek novelties in order to stimulate their appetite, worsening the problem. Protein supplementation should be discussed with a healthcare professional for this issue.

2. Fat people always lie. They lie about "why" they are fat. They never blame themselves. It's always some "stress" or illness. My mother ballooned up to 225 lbs. and says it was "because of COVID".

There are a lot of fat people who are in denial and often "lie" about why they are fat but the vast majority of them simply don't know. They don't associate their behaviors, particularly their food choices, to being fat because they have been on countless "diets" and seen little to no results. This makes them start doubting that their condition could be related to food and they are correct for the most part.

Because of this it's easy for quacks online to tell them it's "stress" or parasites or viruses. Most of these quacks aren't misinforming them on purpose. They also can't figure out what it is because they don't understand obesity any more than their obese patients do.

Your mother didn't reach 225 lbs. "because of COVID". Putting on that much weight does not occur overnight. I am sure she wasn't slim and trim before getting sick. She reached that weight due to blood glucose dysregulation. This is mostly the result of lifestyle, which diet and exercise are a large part of. Of course, it would be very difficult to explain this to her as she most likely doesn't want to give up her diet or she believes she never "ate enough" to make her 225 lbs. After all, if it's all about calories, she would assume she had to eat an enormous number of pancakes to make that big of a difference in her weight. Of course, we know that's not true. It only takes one pancake, believe it or not, as carbohydrates profoundly incline metabolism towards obesity, even at low calories, through their effect on blood glucose regulation. One pancake is enough to disrupt blood glucose.

COVID doesn't make you fat. It makes you sick. An illness like COVID, which effects your respiratory system and gives you flu like symptoms, tends to make you not want to eat, as food loses its appeal when you're coughing, running a fever, can't breathe and may even lose your sense of smell and taste.

Of course, this doesn't mean that illnesses or injuries cannot contribute to weight gain. If I break my leg and can only sit in front of the TV for the next six months, while taking solace eating cookies all day, then I can say the broken leg contributed to my weight gain. But it only made a contribution, it wasn't the direct cause. You don't gain weight from unfortunate circumstances. You gain weight from blood glucose dysregulation due to sitting around all day while eating cookies, broken leg or not. Cookies disrupt your blood glucose regulation. Certain inflammatory conditions which require prescribed steroids will also interfere with blood glucose regulation. But these things can be circumvented to prevent or minimize their effects.

For those who already have blood glucose dysregulation, they will only experience more of it after COVID as illnesses cause a prolonged and exaggerated stress response in them. So in that sense, you can say COVID contributes to further dysregulation of blood glucose which will cause more weight gain but it doesn't work alone. There had to have already been an issue with metabolism to begin with. 

Overweight/obesity are lifestyle choices and, aside from diet and exercise, one of those choices is victim hood. If you are a victim of unfortunate circumstances and this is why you are overweight/obese, then there is nothing you can do about it. You will continue being helplessly overweight/obese while making absolutely zero efforts to change it. There are a lot of overweight/obese people who take this approach. They address everything except what's causing their overweight/obesity.

3. If you aren't counting calories and skip a meal, then that equates to less calories. That's what's really achieving any benefits.

This premise has been debated a million times over and the beliefs surrounding it are always incomplete or incorrect. There are a couple of assumptions being made here:

• Assumption One - Skipping a meal equates to less calories. That's not necessarily true. A person can eat an enormous number of calories in just one meal, depending on what the meal consists of. So, skipping a meal doesn't always equate to "less calories". It depends on what the meals being eaten are and what the meal being skipped was. Then the person has to accurately track their calories in order to know exactly how much they are consuming and how much they aren't. People are notoriously imprecise doing this. But you know what they are even more imprecise at? Calculating how many calories they burn.
  
• Assumption Two - Eating less calories, is what's achieving results. That's also not true. Again, it depends on what exactly is being eaten and what's being defined as "results". All short term weight loss and gain is mitigated through calories. If stepping on the scale and being ten pounds lighter is considered "results", then you can easily achieve that with calories. If the results you need are to get 50 lbs.+ off, then calories won't affect your metabolism profoundly enough to get the job done.

To expand on this question further, what's ultimately being debated here is whether fasting is the same as calorie restriction and the answer to that is yes and no. Like I mentioned above, fasting very well can result in a reduction of overall caloric intake but that's not where the benefits are coming from. If it was, then caloric restriction would achieve the same results but it doesn't. Why?

Because there is a big difference in restricting calories at "mealtimes" and restricting them "overall". The body doesn't respond the same way to these two forms of "calorie restriction". Calorie restriction at mealtimes results in increased hunger because the person couldn't eat to satiety and had to leave the table hungry. After all, they have to purposely refrain from eating because they can go over their calorie budget. The body reacts to this practice, if done chronically, by going into "starvation mode". It simply believes there isn't enough food available and for that reason, it must conserve energy and spare fat mass. Soon, all of the calorie restricted food that's eaten, will be stored as fat and no body fat will be burned. That's basically what "starvation mode" is - An under expression of leptin so the body doesn't burn its body fat. This ancient mechanism prevents starvation.

But if the person practices no caloric restriction during mealtimes and simply eats to satiety, without leaving the table hungry, the body will not react to a missed meal. This is why it is much easier for someone to drop one meal and keep two, than it is for them to eat three "small" calorie restricted meals. Dropping one meal does not signal to the body that there isn't enough food available. It simply signals to it that it must wait for its next meal.

Starvation mode is the Achilles heel of dieting and why all diets fail. You should practice eating habits that prevent this mechanism from kicking in before it's suppose to. The only time this mechanism should kick in, is when body fat drops to a critical point. Not before. If it does it before, you remain fat.

4. A person who only eats 500 calories a day will lose weight.

They will lose the typical water weight, everyone loses at first, and then the body fights back. It does this through increased hunger, reduction in energy expenditure from metabolic slow down, catabolism of lean muscle mass through an increased adrenal stress response and an under expression of leptin to stop any burning of body fat. The body will continue this trajectory until one of two things occur:

• #1 - The person gives up because they feel so unwell. They resume eating normally and they start feeling better, but their body insists that starvation is right around the corner, so it purposely stores all of their food as fat and continues to limit metabolic output. The person now easily becomes fatter than they were before while not increasing food intake.
• #2 - The person continues on 500 calories a day and ignores everything that's happening to them. This usually can only occur in a controlled situation like a prison camp or during famine but can also be seen in certain eating disorders. The person continues to burn through their lean muscle mass. The person can become a human skeleton but continue living. It is very difficult to starve to death as long as some food is coming in. This is because the body has extremely efficient, fail-safe mechanisms to prevent starvation. It will continue eating itself, down to the bones, if need be, in order to preserve the little fat that's left. If the person wavers from this, the same thing that happened to the person in scenario #1, will happen to them upon eating again.

Chronic calorie restriction adapts the body to becoming fatter. It will become fatter faster, better and become even more resistant to leanness than it was before the restriction. This is why calorie restriction is a terrible, unhealthy way of addressing obesity.

5. You can have "as much insulin as you like" and not gain weight, if you aren't eating excess calories.

The premise of this statement is incorrect. Insulin doesn't cause "weight gain". It is not an "obesity hormone". It causes for either primarily muscle to grow or primarily fat to grow. It's an anabolic hormone. It makes things grow. It is also anticatabolic but that's another discussion. Let's just concentrate on insulin's anabolic properties for the time being as that's the context of the statement.

If your insulin is being directed to build muscle, you will technically gain weight as muscle is very heavy. This is why some body builders inject insulin. They aren't worried about "having too much insulin". After all, the insulin is causing their muscle mass to grow. Of course, they take other things besides insulin to redirect insulin's action to their muscle mass and suppress it from taking action on their fat mass, but you get the gist.

If your insulin is being directed to build fat mass, then you will also gain weight, but it won't seem to be much since fat is not as heavy as muscle. If you were to inject the same insulin as a body builder, you will get even fatter.

As you can see, it doesn't much matter how much insulin there is. The only thing that matters is what it's doing. Insulin is always building something. Muscle or fat. Leanness or obesity.

What this statement assumes is that you can have high insulin and not gain body fat because you aren't eating excess calories. That is semi-correct. You can have high insulin and not gain body fat, irrespective of calories, excess or not. Remember, this isn't about having "high insulin" or "excess calories". It's about insulin expression. What is insulin primarily acting on in your body? You can be eating an excess of calories and your insulin could be building muscle with it. You can be eating a deficit of calories and your insulin could be building fat mass with it.

Insulin is sort of like a traffic director. It tells calories where to go and what to do in your body, regardless of amount. It doesn't care if it's Sunday morning or rush hour. The cars (calories) will all be directed to do the same thing depending on your insulin expression which is determined by your neuroendocrine state.

6. Fasting is an ancient practice that has become popular again today. It should have always remained popular. 

Fasting is an ancient practice that is still practiced today but usually in religious observations and customs. It was once thought to work as a weight loss method but failed miserably. This is why it lost popularity, quite quickly and became taboo.

The reason that it became taboo is because of its long-term negative effects on metabolism, when it's not practiced correctly. Basically, it can cause intractable obesity through chronic leptin under expression (starvation mode). This is the same thing that occurs with chronic calorie restriction. In fact, fasting became popular for weight loss when calories gained popularity for weight loss. Funny how calorie restriction is still practiced and condoned while fasting became taboo, even though they both cause the same metabolic dysfunction.

The only difference between the two seems to be that fasting causes this metabolic dysfunction quicker than calorie restriction as most people cannot sustain calorie restriction for long but they can surprisingly stretch fasting for longer and longer periods of time. This is most likely due to the body's ability to adapt quickly to the starvation mode caused from fasting than it does from calorie restriction. After all, calorie restriction still has some food coming in but fasting rapidly convinces the body it is starving for real.

So, that's why fasting fell from grace and didn't catch on. Of course, now it has made a comeback and all of those people practicing it, will eventually come to the same realization that all of the people who came before them did. By then though, it will be too late.

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 77

1. Reducing calories does not mean you will be hungry and you will lose weight. 

You cannot "out calorie" a bad diet. Calories do not have much of an effect on blood glucose regulation, so your metabolism does not change and continues on its trajectory towards obesity.

Hunger and further weight gain is a common effect of anyone who tries to be on a long term caloric deficit. Since the focus of the food that is being eaten, is calories, their affect on blood glucose goes ignored. So, you can still have a diet, which consists of "low calorie" yogurts, wheat thins, sugar free soda and 'Healthy Choice' TV dinners. This type of diet is obesogenic irrespective of calories because it is still disrupting proper blood glucose homeostasis. Macronutrient composition is still king when it comes to the effects on blood glucose.

Eat meat and vegetables. Why? Because those are the only two items in the food supply that will not disrupt your blood glucose. When eating a diet that is focused on blood glucose regulation, if you are still forced to track caloric intake, because you can't eat to satiety, then the calorie tracking will work as long as it's used to avoid excess and not to sustain a deficit. 

Why would you need to avoid excess if calories don't mater? Because excess disrupts insulin/glucagon ratios and that affects blood glucose but it is not determined through calories. It is a direct hormonal reaction of the digestive process. The same thing occurs if you eat all of the time, instead of an excess in one sitting. This is why we do not recommend snacking, of any kind, on this blog.

2. Pregnant and breastfeeding women require more carbohydrates. 

Children, pregnant women and/or breastfeeding women should follow their healthcare professional's recommended diet, since these people have specific requirements based on preexisting or newly developed conditions.

Having said that, humans are extremely adaptable and versatile when it comes to diet. In hunter/gatherer populations, women have successful pregnancies and breast feedings with diets that range anywhere between 80% carbs to 0% carbs. As long as the woman is eating enough nutrients, she should have no problems with less or no carbohydrates.

3. Does gastric bypass always work as a treatment for obesity?

Gastric bypass staples the stomach, but does not address blood glucose dysregulation. Gastric bypass can temporarily affect blood glucose through the restriction of total food consumed, which is the exact mechanism of calorie restriction. This effect on blood glucose can lower insulin levels and the person appears to lose weight but what they are really losing is mostly water and lean muscle mass. This is why you see many gastric bypass patients left as globs of fat. The fat is not being burned. It just sort of stays there until it is surgically removed.

Also, the person is not being properly taught what made them obese in the first place. They are still hanging on to the calories theory and they once again start regaining the weight as they focus on how much they are eating instead of what they are eating. The what is what affects blood glucose. These people will not only go right back to their usual eating habits, and regain the weight, stapling the stomach does not reverse the obesogenic adaptation of their metabolism. It actually make it worse so when they regain the weight, they regain it double. They continue having an obesogenic hormonal profile, but with a smaller stomach.

This doesn't mean that gastric bypass isn't beneficial for many. Some of these people are on death's door and this surgery bids them more time to try and get it together. It's just that, unfortunately, most never do.

4. Is hunger the main determiner of whether weight is lost and kept off?

The main determiner of whether weight is lost and kept off is how much proper blood glucose regulation you can regain and sustain. The premise is that if you can regain and sustain proper blood glucose regulation, you will regain insulin sensitivity and proper insulin expression. This in turn will break leptin resistance and body fat will be burned as leptin is a slave to insulin.  

Leptin effects hunger, but not always in a negative way. Sometimes hunger is a sign that the body is burning body fat and requires additional fuel. How can you know the difference? Easy - results.

• Hunger while losing weight - Leptin is working very well. Even though you are hungry, and eating in response, you aren't gaining weight as leptin knows nutrients are coming in and it is safe to burn body fat.
• Hunger while gaining weight or being stalled - Leptin is not working properly. It is signaling for fuel, even though there is plenty in storage for use.

So, no. Obesity cannot be broken down to such a myopic statement, which claims hunger determines anything. That only makes sense if you believe in "calories". There is too much being left out that basically makes the statement incorrect. Context determines everything and active obesity is the context that changes what things mean.

5. I was told that if you have issues with dairy, you should consume raw milk.

I know there is a huge debate about this and I don't wish to partake in it, as this blog is not about this type of nonsense, since it does not pertain to metabolism. So, my advice below is the only one I will give and then I'll move on from this topic.

I can only recommend that you use common sense. The selling of raw milk is illegal, in many states, and there is a reason for it. Milk is extremely perishable, since it is the most nutritious food on the planet. This means that every living thing is gunning for it, including bacteria and parasites that can make people very sick. The minute milk leaves the safety of the cow's immune system, it's up for grabs, so handling, transporting and storing raw milk is a delicate practice, which can turn deadly if it's not done properly. Even experienced dairy farms have had their share of contaminated milk. This is why pasteurization was created. It allows people access to safe milk, even if they don't live on or near a farm.

If you live on a farm and can drink the milk, as it's being squeezed directly from the cow's udder, you will be fine. If you don't, you take your chances. If you are having issues with dairy, stop consuming it. It makes no sense to trade in one potential issue for another. Though milk is the most nutritious food on the planet, you can live just fine without it. It is not essential for adults. It is only advantageous.

6. Is all weight loss healthy, regardless of how it's achieved, since weight loss is always the goal?

This is a very interesting question and the crux of long term weight management. Before I begin, let me clear something up in that statement in order to set up the context of my reply. Weight loss may be the goal, but how healthy it is depends on exactly what's being lost. Excess body fat is what's always healthy to lose. There is a difference between weight and body fat. It seems like people continue having a difficult time differentiating between the two. Weight is water, lean muscle mass and fat and body fat is well, just body fat. A healthy metabolism loses body fat, specifically. That's the "weight" you want to lose.

You may have heard this warning before, usually from mainstream medicine - "Don't lose weight in an unhealthy way." You will usually hear this if you tell your doctor that you are restricting carbohydrates or are fasting for a certain amount of time each day. Sometimes you might even hear it from a dietitian, if you tell them you are avoiding all sugar. They are correct. You can lose weight unhealthily, but unfortunately, these mainstream naysayers have it ass backwards. Their idea of why some weight loss methods are "unhealthy" is total BS.

Let's break this down to understand what's really unhealthy. Restricting carbs, fasting for a short duration and eliminating all sugar from the diet, will have 0 negative effects on metabolism, so all of the "weight loss", obtained from these protocols, is being lost in a healthy way.

But, let's say that someone decides to eat only 'one meal a day' (OMAD) and fast for the other 23 hours. They see they lose "weight" and continue doing this. Their one meal is restricted in carbohydrates, "keto style", because they found a "keto doctor" online and is taking their advice. Now they are part of the anecdotal charade, on the comments section of their favorite "low carb" page, since they lost more than 50 pounds doing this "keto/OMAD" diet.

A lone "troll" pipes up, in the comments, and makes the claim that this weight loss was achieved in a "unhealthy manner". The other obese commenters beat the troll right out of the page, since all they care about is that a fellow obese person lost a lot of weight, giving them hope for losing theirs. They don't need a Debbie Downer, at this party, taking that hope from them and telling them they are doing "something wrong". They all gear up for a 7 day "group fast". After all, if one of them lost more than 50 pounds on a 23 hour, daily fast, imagine all of the weight that will be lost if the fast is stretched for 7 whole days!

Then reality bites. None of them lose a pound, except for one, who loses a total of 3 pounds! Three years later the person who lost 50 pounds, gained 100 and disappears from the page. The troll who was mocked into hiatus, for saying the weight was lost unhealthily, silently smiles in the background, vindicated. The "doctor" that runs the page, keeps raking in the money and can care less about the personal plight of his followers. After all, there will be other anecdotal claims made, on his page, burying any "discrepancies", deep down under thousand of comments.

How did this happen? Because the troll who made the comment that this weight was being lost in an unhealthy way, was absolutely correct. I know to the obese "the ends justify the means", but the means always come back to haunt them. Losing weight through starvation methods, only causes metabolism to double down on its obesogenic adaptation, irrespective of the initial weight loss. There's a series of intertwined causes, which come together to create the perfect storm for this to occur.

• Too much loss of lean muscle mass - This is especially true if the obese person is also suffering from metabolic syndrome/diabetes. Hyperglucagonemia and over expression of the adrenal stress response helps break down the body, and everything that's eaten, into sugar and ultimately converted into more fat, at a rapid, unregulated rate. This means lean muscle mass is lost, while more body fat is gained, irrespective of the initial weight lost. The lost weight was mostly lean muscle mass, so the person is now fatter by volume and body fat is one the main catalysts that progresses the condition. This technically means they have more "disease" now, than when they started, but since they only care about what the scale says, they miss the forest for the trees.
• Doubling down on body fat gain - The obese person's fat mass is already adapted to over express a starvation response to any stimulus that signals to it a need to grow in number and size. Starvation is that perfect signal. Now the person can actually gain body fat easier. Now when their weight set point is challenged, below their starting point and no where near lean, they stall or begin gaining again, even more than before.

What contributes to this?

• Diets restricted in protein like online fad, "keto" diets.
• Fasting for excessive and chronic periods of time, which limits the ability to obtain enough nutrients and calories from only one meal. Technically calorie restriction because that's what fasts of long duration ultimately are.
  

What else contributes to this?

• Re-feeding after long stretches of fasting. That's the perfect time for the body to acquire more body fat, so it can prepare for the next long fast. It does this by under expressing leptin action, in the brain, and over expressing insulin action at the fat cell.
• High energy intake. This is especially true of people who fast for long stretches, while also eating "keto". Their re-feeding consists of nothing, but high energy (fat), which goes directly into their fat mass. 

These are the classic results of a metabolism that goes into "starvation mode", but starvation mode is an often cited phrase that is usually inappropriately used and not well understood. It's a misnomer when it comes to the obese, with metabolic syndrome/diabetes, as their metabolism is already in starvation mode, so they can't trigger it again. It has been in this mode for decades and it was triggered by erratic blood glucose fluctuations.

This is why diabetics gain weight, rapidly and easily, once they acquire the disease. Metabolic syndrome/diabetes sufferers already have hyperglucagonemia and an exaggerated adrenal stress response, which spares fat mass, rather than burn it. Their leptin is already under expressed in the brain through abnormalities/damage in the hypothalamus from chronic leptin resistance and the taste of sweet. They just made it all worse by forcing the body into a "fake famine".

So yes. You can certainly lose weight in an unhealthy way, because it's not about what you can lose, it's about what you can keep lost. If you can't keep body fat lost, then it's as if you lost nothing, because you are making your metabolism unable to lose it next time. There's going to come a time when you really need to lose body fat, and not because you want to be ready for bikini season, but because you are developing diabetes. When that time comes and you can no longer lose any fat.....well, you know what occurs then - neuropathy, retinopathy, nephropathy, anemia, sepsis, cardiovascular disease, fatty liver disease, Type I diabetes, dementia and finally death.