Six common beliefs addressed, Part 266

1. My brother started with Type II diabetes. He had been drinking 21 sodas a day for several years before it began. He had a blood sugar of almost 1k mg/dL once and was hospitalized. Before then, he had had no symptoms. He wasn't even overweight or obese. During his hospitalization they discovered that his pancreas was no longer working as it should and couldn't make enough insulin anymore on its own. So he has basically progressed to Type I diabetes. He takes insulin injections daily and has had several bouts of keto acidosis which have nearly killed him. He is losing his sight and his liver and kidneys are failing. My brother cannot seem to get used to a healthy diet, which would help him tremendously. It's as if he doesn't understand what a healthy diet even is. For instance, he threw out the Debbie Snacks and Crispy Creme Donuts but kept the oatmeal with honey. For him that is a "healthy" choice. I don't know how to help him anymore.

Unfortunately, your brother is the victim of the pervasive misconception people have about diet and what's "healthy".

Oatmeal and honey are junk. But because oatmeal and honey are not a "highly processed", "fat loaded", "junk food", they are automatically put into the healthy category. I had written a post before stating that healthy is not "natural" nor "organic" nor "plant based" nor "low calorie". Healthy is only and exclusively a macronutrient profile that does not disrupt your blood glucose regulation. That's it. Blood glucose regulation is the only metric for what's healthy or not.

So the only way you can help your brother is by making him think of food in a completely different way. Healthy eating is not about "over consumption" or if food is "ultra processed" or "nutrient void". It's solely about how your blood glucose is affected because ultimately, that's all that matters.

2. I went on low carb in my forties and it caused me to lose my period for two months. I felt the best I have ever felt in my life. My period returned later and I have lost the energy and vitality I felt during that time. What happened?

I went through a four month bout of amenorrhea (loss of menstruation), when I started "keto", in my mid forties. Do not let the fact go over your head that the term "amenorrhea" starts with "amen". Amen indeed. I also felt better than I had ever felt before in my life. I had energy to spare. I even had certain lab markers, like my ANA (Antinuclear Antibody Test), which always would come back abnormal, completely normalize during this time. Unfortunately, my period returned and with it went my four month bliss streak and my normal ANA.

This is a controversial topic and I am not a doctor. I can only tell you what I know from what I have read and my own experience as a woman. Menstruating into your late forties and fifties is not a good thing. The toll hormonal imbalances cause on your body is dire to your well being. Perimenopause has caused me migraine with multiple different types of auras, cognitive issues and problems with my autonomic nervous system (dysautonomia). It's not fun and these issues can affect how you can treat your metabolic condition because they can very well impact your diet, exercise routine and systemic stress levels.

When you go on a low carb/"keto" diet and lose a large amount of body fat it can cause amenorrhea. Amenorrhea happens when the body goes through what it perceives as stress. Loss of body fat is stressful for the body. It doesn't want to lose it, particularly if you are a woman. Amenorrhea may be a bad thing for young women in their child bearing years but for many women like us, in our forties and fifties, it's a god send. Amenorrhea basically halts the hormonal onslaught that your body is going through during perimenopause. This is what causes an increase in energy and general well being. Once menstruation starts again, you can kiss those benefits goodbye.

There is nothing you can do about this. Your body was not going to keep losing body fat indefinitely. That was going to stop at some point and of course leptin was going to cause body fat to start increasing again. This makes the body feel safe to continue with menstruation and it will not stop until you finally reach menopause.

Menstruation is still considered the greatest thing that can happen to a woman so you will not find solutions for this in conventional medicine. If anything, they will try and pump you full of more hormones once menopause begins but for some women like us, menopause is the best thing that can happen to us. We just have to keep waiting for it.

3. I sometimes like to search diet and weight loss content on YouTube and I came across a channel where a fit guy was talking about "ultra processed" foods and giving stats on obesity and activity levels in Europe compared to the United States. Is any of this information relevant for weight loss?

History has told us it isn't.

First, lifestyle differences will absolutely affect a "lifestyle condition" like obesity so there are going to be regional differences in obesity statistics. That tells us nothing about the already obese. As long as you remain in the region, you are already in, you will most likely continue with the lifestyle you are accustomed to. The transit system, city planning, culture and amount of free time in your region are all designed to keep you in the same metabolic state you are already in. So these stats are useless for treatment. The only thing we know about the already obese, regardless of region, is that they remain obese.

Second, people like this fit athlete on YouTube have been expounding the dire effects of "processed foods", and now the new phrase "ultra processed" foods, to no avail. I only have one question for them - prove it. Prove that eating Twinkies has a worse outcome than eating yogurt. They can't because it was already done. People have lost weight on the Twinkie Diet and have remained obese on the yogurt one.

Obesity is not about processed foods, it's about blood glucose regulation. Like I have stated before, this is why someone can lose weight on the Twinkie Diet and someone can gain weight on yogurt. Blood glucose regulation reigns supreme as the determiner of what happens to your weight and many things affect it, including calorie restriction. So eating Twinkies, with enough calorie restriction, causes weight loss because it temporarily affects blood glucose, which lowers insulin and off comes all that water weight. But it takes a more sustained and prolonged effect on blood glucose to go beyond that and get to fat loss. That's why calorie restriction has been such a failure. It simply never reaches this sustained prolonged effect.

Eliminating "processed foods" is beneficial because it:

• Prevents snacking.
• Lowers fat and carb intake, particularly vegetable oils and sugar which are more detrimental to metabolism than other fats and carbs.
• Increases protein intake.

That's it. Those are the only three beneficial reasons, which by themselves mean nothing, but together help support healthy blood glucose control.

Not even the supposedly "nutrition void" claim of processed foods have been an issue since no one has developed beriberi from eating too many Snickers bars. There is nothing inherently evil in "ultra processed" foods. They simply negatively affect your overall eating habits and macronutrient composition which ultimately effects blood glucose regulation over time.

4. I buy plain, full fat yogurt but I wish I could eat it with granola. Is there a granola brand out there that's truly low carb friendly? I haven't found any at my store.

You will have to go to Amazon in order to find sugar free/grain free granola unless you have a specialty market in your area. As with all good quality products, it will be more expensive than conventional options. The best brand is Lakanto. They have several varieties of sugar free/grain free granola.

Stay away from cheap brands. Many cheaper choices advertise that they do not have any "added sugar" but no "added sugar" is very different from "sugar free". The brands with no added sugar do not add granulated sugar to their product but load it with dates or raisins instead, which is all sugar. Sugar by any other name..... You also want grain free granola because if the granola is loaded with whole wheat, oats or other cheap grains then you are still eating sugar by proxy.

When it comes to this type of stuff, price can tell you a lot. The cheaper it is, the more cheap ingredients it contains. Dried fruits and grains are very cheap so don't let the "organic", "healthy", "no added sugar", etc. label fool you. Low carb granola is sugar free and instead of cheap grains and dried fruits it's made of expensive nuts and seeds.

5. I'm sorry, this might be awkward because it's not really a question but I just need to get it off my chest. I was so disappointed and kind of depressed the other day when I went for coffee. I had forgotten to bring my special low carb nut bar with me, so I couldn't have anything with my coffee. I grabbed my plain, black, decaf coffee, because God forbid it be anything else, and put half and half in it. I was about to go and sit down when a woman behind me, slim as a rail, grabbed her specialty coffee and poured brown sugar into it. She then took her pastry and happily left with her coffee. She wasn't even a young woman. I sacrifice so much and still look like the average middle aged, slightly overweight woman who has the same health conditions as someone who goes to the Dunkin' Donuts daily. I don't look like Taylor Swift and I am certainly not slim nor healthy. Sometimes I swear the juice is not worth the squeeze.

All I can say is that I am sorry you are going through this or better yet, I am sorry you are realizing this because it was always there. The truth was just hidden from you because the diet/health industry is always selling you false treatments to what ails you. Not eating that cookie, will not make you slim, like the diet mongers promise you. Not eating it will simply not contribute to you getting fatter. You might still get fatter though, just not off the cookie. That is the hard truth. So the sacrifice gains you nothing. It simply removes one more thing from the table that can make you worse. The table is still full.

Nothing makes sense when it comes to obesity if you do not understand it's root cause. Until then, you will be forever left with the nagging and all to familiar questions - "Why do I sacrifice so much and get so little in return, while this brown sugar eating woman sacrifices nothing and has everything? If it's true what the diet/health industry is selling me, then how can a person like her even exist?" Because what they are selling you is not true. A perfect diet is not the potion for looking like Taylor Swift.

The truth only lies in blood glucose regulation. Who has it, who doesn't, who keeps it and who loses it. That's it. In all of obesity research its only consistent parameter, regardless of diet followed, is blood glucose regulation. Those who don't have it become obese and/or diabetic, those who do have it continue eating as they want while looking and feeling great. This means that in the vast majority of people diet is only a catalyst to an already existing hardwired problem.

Some people have a stress response that is honed and tuned to overreact to any dysregulation in their blood glucose, furthering its dysregulation over time. Chronic conditions, hormonal changes, systemic stress, age, injuries, metabolic shifts, etc. all cause them to create more glucose than normal and this slowly but surely deteriorates their insulin function over time. Certain lifestyle factors only exacerbate this further. This is why lifestyle factors can be corrected, but results are never guaranteed.

When you hear someone speak of obesity and "genetics" this is what they are referring to. It's in reference to the ability to retain your blood glucose regulation. Once it's lost, many systems in the body shift to accommodate its abnormality. This includes fat cells, mitochondrial function, glucoregulatory feedback loops, energy flux, etc. All these systems now work to make and keep you obese in response to your blood glucose. All of this doesn't even take into account how epigenetics affects insulin function, in the presence of blood glucose abnormalities, on such an individualized basis.

Lifestyle factors like diet are only palliative treatments for this condition. The condition persists through factors you can't control like simply becoming middle aged. The woman you saw was able to keep her blood glucose regulation intact for much longer than you were. Her insulin release/expression did not become abnormalized even if her blood glucose was not always in perfect homeostasis. Being middle aged has not affected this for her. Consuming brown sugar has not affected this for her. Whether she will ever be affected remains to be seen and only time will tell. She might die of something else well before we ever know for sure. As of right now, she is good to go. She didn't do anything magical and you didn't do anything wrong.

Now in order to determine if the "juice is worth the squeeze", you have to determine if what you are doing is effective and sustainable or not. Most importantly is it effective and sustainable for the long term. For example, if avoiding diet soda keeps my blood glucose under 140 mg/dL but drinking it keeps my blood glucose under 140 mg/dL then maybe the avoidance of diet soda is a hill that's not worth dying on. Some of these low carb people persist in thinking that the lower they can keep the carbs and the cleaner they can make the diet, then the better their outcomes will be but that's not true as they continue being obese and diabetic at 0 carbs. 'The Law of Diminished Returns' is always against us. There is only so much you can put into something until the returns become 0. That's when you start sacrificing a lot for nothing. That's what a lot of these low carb people do. They avoid the apple while still living off Metformin and remaining obese. Consuming the apple would have made 0 difference so they are torturing themselves for nothing. You very well could have found another bar or something else to eat with your coffee that would have also made 0 difference.

Don't make your life miserable because that will have you give up the lifestyle factors that are truly helpful in controlling the condition. Just because diet is palliative does not mean it's useless. Controlling your diet, controls the assault on your blood glucose regulation but only up to a certain point. You need to determine what that point is, so you don't burden yourself going beyond it. Revisit what you are doing and make sure that it is targeted and still effective.

6. My brother passed away last year at 715 lbs. He would eat massive amounts of food and would become aggressive if it was taken away. There would always be fast food bags littered all over the floor of his home. Two years before his death, he enrolled in a "fat farm" program which helped him lose 90 lbs. by eating mostly salads and vegetables. Once out of the program he gained 300 lbs. He lost his ability to move or take care of himself. Last year, he finally stopped breathing and died in my arms at only 26 years old. I read your blog in hopes of preventing his children from meeting this same fate. I am scared they are at risk since most of our family is overweight. No one is obese or as big as my brother had been but we tend to not be slim. Is my concern unfounded? What went wrong with my brother?

I am sorry for your loss.

Unfortunately, your brother was a victim of himself and the failed treatments they tried on him. They never really gave him a fighting chance because he never knew what was truly wrong with him. If you don't know what's wrong, then you can't treat it correctly.

"Fat farms" are notorious for using the failed calories in/calories out (CICO) approach for treating obesity. Hence all the salads and vegetables as they are "low calorie". We have seen this in popular shows like 'The Biggest Loser'. We have also seen how this practice has been the biggest failure, over and over again. Even the man who fasted for a year straight, and became slim under a blanket of skin, still died.

Basically using any starvation approach only causes the body to double down on its obesity over time and this is why your brother gained back 300 lbs. after only losing 90. This shows how his leptin was resistant to accept any starvation. Obesity is not an "in (eating) / out (burning)" problem. It is specifically an "out (burning)" problem. This is why obesity is a starvation adaptation and more starvation only reinforces it.

Of course your brother ate massive amounts of food. It takes a lot of energy to keep up with being 700+ lbs. This massive intake of food dysregulated his already abnormal blood glucose control. This is particularly true with the types of foods he was eating. Fast food is notorious for having a macronutrient profile that disrupts blood glucose.

I don't know what could have helped your brother because there is a lot of behavioral issues that had to be addressed and modified. No one could do those for him, but himself. What I can tell you is that it would have been extremely helpful for him to understand obesity and what caused it. Maybe it would have prevented him from feeling so helpless.

Most of the reluctance the obese have to diet modifications and/or other treatments is that they never work. They start feeling like nothing will ever work and they get scared of yet another failure. They start to give up. If your brother was given useful tools, like checking his blood glucose and targeting its regulation, rather than useless tools like targeting calories and checking their amounts, he would have had something to work with. If he would have been told that the weight he lost at that fat farm was mostly water and muscle and he would then gain back three times that amount as body fat, he would have understood that he needed to do much more than just eat salads to treat his condition. If he would have been helped to target the offending foods, rather than the calories in them, he would have been able to modify his diet effectively and without resistance. But he wasn't given any of these options. He was lied to.

His children are absolutely at risk for the development of intractable obesity. Not solely because they might have the same eating habits as your brother did but because fat cells are inherited from your parents and your brother's fat cells were particularly leptin resistant and insulin sensitive. They also seem to inherit their parent's insulin function. Children of obese parents start experiencing glucose abnormalities even at very young ages and fetuses of obese mothers are already producing higher than normal insulin while still in the womb. 

You are correct in being concerned. You have to be diligent in keeping the children's eating habits and their diet with foods that cause as little blood glucose dysregulation as possible. They have to keep a close eye on their blood glucose control. They also need to stay active to ensure their leptin keeps energy flux moving. They will simply have to do more than the average person to maintain a normal weight.

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 218

1. My HbA1c went up one point from 4.9 to 5.0. My C-Peptide and insulin are very low though. My fasting blood glucose is normal. 

The term "HbA1c" refers to "glycated hemoglobin". When a protein within red blood cells, joins with glucose in the blood, it becomes ‘glycated’. Measuring this glycated hemoglobin (HbA1c), helps determine what your average blood glucose levels have been over a period of time, usually about three months.

However, this absolute number can be up for interpretation because other things can affect it. For instance, if your red blood cells have a longer half-life, your absolute HbA1C will tend to be higher. Glycation damages red blood cells so diabetics tend to have red blood cells with a shorter half-life. People without diabetes tend to have red blood cells with a longer half-life.

So, a point or two difference in your HbA1C is not really a big deal. If you are on low carb and are in remission from diabetes/metabolic syndrome, your HbA1C might go up a point or two in accordance with a longer red blood cell half-life. 

2. My HbA1C and fasting blood glucose are higher than normal, but my insulin level is low, so this mean I am safe from diabetes.

That is ridiculous. Diabetes is a syndrome. This means there are several abnormalities present in it. It is not just one thing. That is why we always remind people that diabetes is not "a disease of high blood glucose". This is because high blood glucose alone does not signify diabetes, even though your doctor might give that one metric enough validity to diagnose you as such.

Diabetes is a condition of improper blood glucose regulation and for that to occur, multiple glucoregulatory and other metabolic systems, within the body, must fail. These systems are everything from the adrenals to the liver, to the fat cells, to the hypothalamus, and finally, to the mitochondria itself.

On this blog, we do not put that much weight on insulin levels and claim you do not have diabetes because your insulin is low. It doesn't work that way. Your pancreas can simply be "burned out" and no longer producing enough insulin to control its blood glucose correctly.

So, low insulin means nothing without a normal fasting/postprandial blood glucose and HbA1C. If your fasting blood glucose and HbA1C is above normal, you are presenting the symptoms which are typically found in the syndrome we call diabetes. You have to figure out what is happening to your metabolism and correct it right away.

3. I have a friend who does not want to be my friend anymore because I noticed and mentioned to her that she is extremely obese. It's not that I didn't realize she "knows" she weighs 400 pounds, but for me, it is like seeing someone bleeding and not trying to help them. I know you're not supposed to mention to obese people they are obese, but I see she is also setting her daughter up to have the same life she has. My friend told me that she has come to terms with her weight because she doesn't have the finances to "do anything about it." Does it cost a lot of money and doctors to lose weight? I think lack of finances are an excuse, but I could be wrong. 

It didn't cost me any money to lose weight and I didn't have to see any doctor. So, "lack of finances" can very well be an excuse as overweight/obesity is a lifestyle choice. You can clearly see this playing out in how your friend is causing for her daughter to be obese as well by passing down the same lifestyle choices she has. This is why I don't like to push the idea that obesity is a "diet disease". It is not.

There are many things that play into the development and upkeep of obesity. I still remember my obese/diabetic friend who often displayed the type of attitude that kept her obese. She had a grocery store across the street from her house and when I told she could walk to it, her reply was "Why do I have to go walking to a store?". When I told her that she shouldn't eat the cake at the office party, her reply was "Why do I have to be the only one that can't eat cake at a party?". Her sense of entitlement was more important than her health.

This is not uncommon. I have seen it over and over in the obese. The stereotype of "gluttony and sloth", which is usually given to the overweight/obese person, is not entirely incorrect. There is some grain of truth in it, but it goes way beyond just "being lazy and eating too much". It is an attitude that affects every aspect of their life. This is why obesity is treated wit ha lifestyle approach.

But let's give the devil its due. This 400 lbs. person has probably been duped many times into "weight loss programs" that have failed. Her doctor has most likely failed her too. She probably has no clue why she is obese and has tried everything she can think of to reverse it until she simply gave up. She probably does believe that losing the amount of weight she would have to lose, would take a lot of money in expensive medical procedures and trainers to hold her hand through it. This is most likely because she does not have the ability to do what she has to do on her own, without being babysat. Remember, the weight loss programs she's most likely tried, took minimal effort on her part and promised her the world. I doubt she has the will to try something difficult. Most chronic dieters do not. They gravitate to “easy fixes”. This is why they always jump on every fad diet they come across.

Unfortunately, this type of situation cannot be fixed. You can't save people from themselves. One of the biggest hurdles in the treatment of obesity is behavioral. Oftentimes, that cannot be overcome.

4. Lily's Chocolates are everywhere now, and people are raving about them. It's the only chocolate accepted in some weight loss programs.

Chocolate is one of the few, if not the only, "novelty" that is allowed, as long as it's 85% cocoa and above. Normally the higher the cocoa percentage, the less sugar. Lily's Chocolates have allowed a lower percentage of cocoa because they don't contain sugar. Lily's uses stevia, not added sugar, so this has allowed "milk chocolate" to be put back on the menu.

There is only one problem with this. Like I have emphasized many times before, obesity is not a disease of one sole cause. It is a syndrome of many. Sugar is not the only thing that makes you fat. Hypothalamic disruption also makes you fat and nothing disrupts it more than the taste of sweet. This effect is irrespective of calories because just like sugar, calories aren't the only thing that makes you fat. Especially not the calories of one sole item.

So, like I suggested to someone else a few posts back, if you are the type of person that can keep their novelty eating under control, then Lily's is fine on occasion. If you are the type of person that cannot, then stay away from it altogether. Novelties are not required.

There are many ways to make Lily's chocolates obesogenic. First, they are already obesogenic on their own since they are just an energy dense "food" with no protein. That, in itself, is a gateway for fatness. Aside from the obesogenic profile that these items already have, they can become fat making steroids by simply:

• Eating them out of mealtimes (snacking)
• Eating them instead of proper meals (Lily's molten chocolate cake for dinner)

Both are obesogenic eating practices that are all too commonly done.

5. I lost a lot of weight on low carb. I enjoy the diet and decided to continue on it simply because it is convenient, and I really like the food selection. The problem is that even while following the same diet that got me to slim, I am starting to see my weight creeping up anyway. I wish I was slimmer and back to my lowest weight. My metabolic markers have remained stable, and I continue to be in remission of metabolic syndrome. I just don't like my current weight. I am about twenty-five to thirty pounds over what I was before and preferred. 

I have gotten similar questions before, and the answer is always the same. The reason you are gaining weight is because you lost weight. In other words - leptin.

Leptin doesn't care about your diet. It doesn't care about its composition or its calories. All leptin cares about is that there was a challenge to the body's fat mass, and it will now purposely under express, in the brain, to prevent further fat loss and actually cause fat gain. You are experiencing what everyone will experience. All diets fail. The body is protective of its fat. That is the mechanism that keeps you from losing too much weight and dying. Body fat is the largest endocrine modulator in the body. It helps regulate a lot of necessary functions. The most important one is the prevention of death, during famine. Fat is very valuable to the body. It will sacrifice its muscle, for its fat.

For this reason, the only thing you can do now is to not get fatter. In other words, don't give up on your diet and end up tossing it because you feel it is no longer working and not worth the sacrifice. That is the absolute worse decision you can make at this point, but the most common one. Low leptin expression alongside "I feel scorned" chocolate cake are a recipe for disaster.

If the diet you are on got you to slim, then it's because it worked. It's not the diet that isn't working anymore. It's leptin that isn't cooperating anymore. Doubling down now, will only cause leptin to double down even further. You don't want to end up gaining everything back and then some. You have to maintain. Actually, the better word for that is to "control" because no one can maintain diddly squat. That's a lie. Leptin doesn't allow any weight maintenance. It's going to cause weight to go up, so you have to control that. Control is not changing your diet, adding some diet crap to it, extending your fasts or lowering more calories. All of that are main causes for weight rebound.

So, instead of struggling to get to the summit of the mountain (your lowest weight), try staying a few feet down (not overweight/obese). The higher up you are, the harder the fall. It's better to control your weight than be the size you wish you were. Like I have said before, you won't return to your lowest weight. Now your job is to prevent yourself from going back to your highest.

Your weight will stabilize at where your body feels comfortable. This shouldn't be obesity, of course. Obesity is never comfortable for the body. But it sure won't be your lowest weight. Where your weight eventually stabilizes is determined by many things, so there is no one hard line number to guide yourself by. It all depends on age, gender, metabolic state, hormonal state, previous history of obesity and activity level. All of those things control fat cell function.

Carrying around more body fat than you wish you had is not necessarily pathological, until it becomes overweight/obesity. So, don't fear that you have put on a few more pounds that you would like. As you can see, this hasn't affected your metabolic markers. They are still stable because the body doesn't consider itself to be over fat, though your eyes may beg to differ. Continue keeping metabolic markers stable as instability in blood glucose regulation is the engine towards obesity.

6. Snacks are allowed if they are low carb and low calorie.

We do not recommend "snacking". Snacking is an obesogenic habit to have, regardless of macronutrient composition or calories. Our metabolism was not designed for "grazing". We aren't ruminants. Snacking keeps you eating constantly which does not allow your body to regulate its blood glucose and insulin properly. This will eventually deteriorate the function of both over time.

Snacking was once seen as a good way to control weight because it was believed that having low calorie snacks between meals would prevent you from overeating at mealtimes. It didn't pan out that way, even though in the short term, snacking did produce results in some people. It did this by stimulating leptin expression in people who chronically dieted. When you are under chronic calorie restriction, an increase in calories produces weight loss for those who were leptin sensitive. This turned out to be an epic fail though, as chronic insulin dysfunction soon deteriorated this temporary increase in leptin expression and the weight began to pile on again.

If you cannot fast for 16/18 hours a day, then have three meals a day. Space them out so that you are not fasting for long periods of time, except for overnight. Remember when everyone ate breakfast, lunch and dinner, with nothing in between? Return to that.

Six common beliefs addressed, Part 212

1. I have been on a low carbohydrate protocol for a while now and I'm doing great. I have recently had some stress in my life due to relationship issues. This has "sidetracked" me. I do not have an issue with my protocol, I just have a hard time staying focused and not getting sidetracked easily. 

I have no clue as to how to reply to these types of questions and that's why I usually avoid them, even though I receive many of them weekly. I will make this one an example so that hopefully other people will not send me more of these vague issues for me to decipher.

If you have been consistently doing everything that you need to do, and you don't have an issue with your protocol, then what is the problem exactly?

I am not sure what type of "relationship issues" you have been having but life often carries lots of issues. I don't know what that has to do with your protocol though, since diet and exercise are actually a very small part of daily life. A lot occurs between these two events. To put it in context, you spend more of your life sleeping rather than eating and exercising.

I also do not understand why life stressors cause people to become sidetracked from their diet and exercise. Again, the two smallest parts of daily life. Why doesn't it affect everything else? I don't even know how "relationship issues" can affect your protocol to begin with. Though it's difficult to imagine how, I can still see it possibly taking time away from your exercise routine, but your diet? Don't you have to eat every day anyway, regardless of what's happening?

This is a blog that contains general information on strategies that might help treat or prevent metabolic disease. The first requirement, for anyone who reads this blog, is the ability to follow a protocol consistently. This is not a weight loss blog. This is a blog that requires a lot of reading, researching on your own and, most importantly, doing without excuses.

2. Should protein be determined by ounces or grams? 

Many people are having trouble trying to figure out protein. They just assume a piece of meat is "protein". It's not. Meat contains protein but it is also water and fat.

If your protocol uses ounces, then you determine whatever the recommended ounces of meat are, by using a food scale. If your protocol uses protein grams, then you have to determine how many grams of protein are in your chosen cut of meat. Type and cut of meat will affect how much protein it contains.

I know it's hard to determine this because often times real food doesn't have labels. Thank goodness most people have a smart phone, so you will have to do your Googles. You can use Google search or an app to determine how much protein is contained in your chosen cut of meat, depending on the amount. You can do this using ounces or pounds.

The good thing is that once you do this one time, you won't have to do it again, for the same cut of meat of the same amount. So, this isn't something that will be a continuous hassle for you.

3. I was told that low fat products are unhealthy because they are filled with sugar in order to make up for the missing fat. 

That is only true of processed foods. Let's be honest here, for something to be labeled as low fat/fat free, it must be processed by default because the only foods on planet earth that are naturally low fat/fat free, are most whole vegetables and fruits. These do not come with a label. Nothing else natural, except for water, is low fat/fat free.

So, for example, low fat/fat free cereals, snack bars, cookies, etc. are usually loaded with sugar in order to make up for any lowering or elimination of their fat content. It's a way to make these "foods" more palatable. These "foods" are also loaded with sugar because sweet things sell. If it wasn't for sugar, what would cereal taste like? None of these grain based, processed foods have any flavor to them. That is why sweet is the "go to" flavor added to all of these items in order to entice people to buy them.

Low fat/fat free labeled foods, like most dairy, are not loaded with sugar to make up for the missing fat. Yogurts are loaded with sugar because this dairy is sold as a "snack" so again, sweet things sell. The rest of low fat/fat free dairy usually does not have any added sugar.

The elimination of fat only concentrates the products own natural sugar, increasing its sugar content by volume, irrespective of calories. The more fat removed, the more concentrated the sugars become. This is why it is not a good idea to eat low fat/fat free versions of these foods as they were intended to come with fat. That's how the body recognizes them.

Artificially altering the macronutrient composition of food is never a good idea. The fat in full fat dairy should not be of any concern because dairy is to be used as a garnish only, not as a main meal, making its fat content irrelevant. There was a time when only full fat dairy was available, and obesity was very rare.

If your protocol is calling for low fat/fat free foods, it's because it is a calorie centered protocol. They are trying to manipulate daily calorie intake by reducing/eliminating the fat calories from food, simply because these low fat/fat free food versions are easily available as alternatives.

The best way to approach this problem is not through the consumption of altered Franken foods but by simply eating the real thing properly. You never want any food that is primarily fat or primarily carbohydrate to become the main course and replace protein.

4. I try to eat grass-fed meat whenever I can, but I really do not like it. It's not just me either. My entire family prefers conventional (grain-fed) meat. Grass-fed meat seems to be constantly pushed in low carb circles though.

You don't have to do a thing but regain leptin expression. Leptin doesn't care what meat you eat.

Yes, many low carb people push grass-fed meat, for varying reasons, but the main one is just to be trendy and "in the loop". Unfortunately, the more things try to change back, to how they once were, the more we are reminded as to why they changed in the first place.

Some people do not notice any difference between grass-fed meat and grain-fed. Others find they prefer the taste of grass-fed. People like you and me, really prefer grain-fed. I am sure there are a lot of people like us so I can see why grain-fed beef became so popular. Insulin resistance is truly delicious. Just ask the Wagyu ranchers.

I have tried all kinds of grass-fed meat from different sources. Some have been expensive, and others have been pretty economical. Regardless of where it comes from, grass-fed meat usually has a "gamey" after taste and dry texture which I don't particularly like. Even at the same fat percentage, grass-fed meat still has a drier texture than grain-fed. It's not bad enough to be intolerable, so I still occasionally buy grass-fed meat, but I do prefer grain-fed.

Aside from the palatability issue, let's talk about health. Grass-fed meat has a better fatty acid profile and ratio. There is no doubt about that. Grain-based fats interfere in lipolysis (the breakdown of fat). The fat in grain-fed meat, which is mostly corn derived, tends to increase liver fat, progressing metabolic syndrome further. The same does not occur with grass-fed meat of the same fat percentage. So, there is certainly something in grain-based fat that interferes with the liver's processing of fats. Of course, there is still a question as to how carbs in the diet, alongside grain-based fats, contribute to this effect.

For this reason, I wouldn't be too concerned over this. Diets that are low in carbs and eliminate grains and sugar, still produce metabolic benefits even in the presence of grain-based fats. So, whatever is going on with these fats, might simply be exacerbated due to a high carb diet.

All of this simply means that you don't have to eat grass-fed meat if you don't like it. You can replace it with wild game or try pastured meat. Pastured meat is usually a blend of grass and grain. The very best meat I ever ate was pastured, local meat. It tends to be expensive and/or difficult to find, depending on where you are, so that's something to keep in mind.

Other than that, you can simply continue eating grain-fed meat, just buy it leaner. The beauty of grain-fed meat is that even the leaner versions still have a great texture. That way you can limit the intake of their fatty acid profile.

Buy grass-fed dairy instead, to get their beneficial fatty acid profile. Dairy is naturally mostly fat so you will get more bang for your buck buying it grass-fed. Most people prefer grass-fed dairy once they've tried it. For example, I prefer the texture of grass-fed butter versus grain-fed butter. Conventional grain-fed butter has an oily texture which grass-fed does not. Grass-fed butter is very creamy instead. The taste of grass-fed whole milk is superior as well.

Doing it this way allows you to have the best of both worlds. You can get the taste you want from the grain-fed meat and the fatty acid profile you need from the grass-fed dairy. It might also give your wallet a break.

5. Type I diabetics do not have to be careful of their diet because they already have to take insulin anyway.

This blog's focus is not Type I diabetes but the answer to this question pertains to Type II and that's why I'm replying.

If a Type I diabetic has to continue dosing insulin to counteract ice cream sundaes, what will eventually occur is that they will lose control of their blood glucose regulation, gain body fat and develop Type II diabetes (double diabetes). It is very difficult to dose insulin correctly when you have such large disparities between postprandial and fasting blood glucose. This results in the need for more insulin than normal, postprandially, which causes frequent hypoglycemia during fasting.

It's this issue, which is the single most important clue we have, occurring in vivo, of how Type II diabetes develops. Type II diabetes develops when the body is under a high insulin demand in order to clear dietary (postprandial) blood glucose. This interferes with proper blood glucose regulation during fasting, which ultimately deteriorates insulin sensitivity and function in tissues and organs to varying degrees. It also abnormalizes insulin expression, making the fat mass particularly insulin sensitive at the expense of other tissues and organs.

Problems with blood glucose regulation, particularly while fasting (time in hypoglycemia), causes metabolism to go into a "pseudo starvation mode" that only helps spare and build body fat, while keeping the blood glucose set point very high. This puts an even larger demand for insulin and the cycle now feeds itself.

Whether insulin is being produced by your own body or being injected from an external source, a high insulin demand will eventually lead to Type II diabetes. You simply cannot regulate blood glucose properly in the presence of over expressed insulin.

6. Legumes are healthy and superior to grains.

No. Legumes, just like grains, disrupt proper blood glucose regulation over time because of their high carbohydrate content (starch). It doesn't matter what nutrients or fiber they contain. It doesn't matter that they have protein, and it certainly doesn't matter that they happen to be high in calories. They still have a lot of starch which is basically glucose. So, at the end of the day, they interfere with proper metabolic function and so they can never be "healthy".

Legumes also tend to replace animal protein containing foods because they are relatively inexpensive, compared to meat, and commonly found precooked making them more convenient than meat. Both of these cause legumes to not be eaten appropriately. The only appropriate way to eat legumes is to keep them a garnish only.

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.