Six common beliefs addressed, Part 247

1. I recently had the flu, so I followed the advice in a fasting group to "fast it away". I ended up in the hospital with dehydration. The moment I ate again, my symptoms subsided, and I recovered quickly. My doctor told me I had done a dangerous thing. How do these people get away with giving this type of advice?

I hate to say it but if you play stupid games, you win stupid prizes.

Illnesses like the flu can cause serious dehydration and this in turn can result in electrolyte imbalances. You have to be well hydrated, but you also need proper nutrition because electrolytes are mostly controlled in the colon by what you eat. This is why you can get very sick when you fast, even if you drink suffice water. It's simply not enough.

Your immune system also needs protein to make antibodies and since stress causes for there to be a lot of lean muscle mass breakdown into sugar, you have to make sure you eat adequately to help your body fight off infection. In fact, access to nutrients has been a major factor in humans surviving infectious diseases like the flu. Malnutrition/not enough food is the main contributor of death in third world countries. The best and only support available for viral infections is proper electrolyte administration.

The reason these people get away with this type of advice is because others are foolish enough to follow. Don't blame the leaders, blame the followers. Anyone who goes online to seek medical advice, is basically a fool. I prefer for people to become educated and not follow idiots rather than censoring them. Let them give all of the advice they want but if no one follows, they will simply have to find another gimmick.

2. I have obesity and metabolic syndrome, so I have to be on a low carb diet in order to control these conditions. Unfortunately, I also have a genetic condition where I cannot metabolize fats very well, so I tend to get sick on a "high fat diet". The protocol for my particular condition recommends that I restrict fat to only 20 grams a day. When I remain low fat, I feel great. Is there a practical way of going low carb and low fat at the same time for the long term?

Yes. Low fat and low carb is basically a protein sparing modified fast protocol. You are restricting (fasting) the energy macros from your diet (fat and carbs) and keeping (sparing) the protein. There are multiple ways of applying this protocol because the macros can be modified depending on your goals. Hence the name of the diet.

But before I take a deep dive into your question, I want to address the "high fat diet" part. We do not recommend "high fat" protocols on this blog. Those are not legitimate protocols. This blog is all about low carbohydrate, not high of anything. I know there are some legitimate protocols out there that have unfortunately been described as "high fat" but those are false labels. The only "high fat diets" that exist are being followed by very obese, low carb advocates online that went rogue. No legitimate protocol endorses that way of eating.

When a protein sparing modified fast is being used for body fat loss, it is quite restrictive, making it very difficult to adhere to. It also cannot be used for the long term as it should no longer be followed once body fat goes below a healthy percentage.

• For a man, 2–5% fat is essential, 2–24% fat is considered healthy, and more than 25% classifies as obesity.
• For a woman, 10–13% fat is essential, 10–31% fat is healthy, and more than 32% classifies as obesity.

Of course, the obese will have a very difficult time getting to "essential" or "healthy" fat percentages, so they are pretty safe following protein sparing modified fasts for as long as they are still obese.

But of course, this diet can be modified. That's the operative word. It doesn't have to be so restrictive especially if you have to follow it for life. You can simply keep dietary fat up to 50 grams a day in order to give you some leeway. In your case, you can keep it at 20 grams a day so you feel your best. Keep your protein consumption adequate so that your body does not reinforce its starvation response. The carbs can go anywhere from 0 to 100 grams a day. Remember, the priority of this protocol is protein, not fat or carbs so they are irrelevant as long as they are kept low.

Practical ways of achieving this is avoiding dairy products, as they are very high in fat. If you wish to still consume them, you will have to get the 'low fat' or 'fat free' versions but watch your carbs if you do so. Buy 'lean' to 'extra lean' meats and add your own fat at home, if needed. Remember farm animals still contain a high amount of fat even when labeled lean. But adding your own fat to lean meats (preferably wild game) can help you control how much fat is in them without sacrificing protein which is your priority. Avoid unnecessary novelties like nut products and other "low carb" favorites which usually are more fat than anything else. Your priority is protein not fat.

Stay away from junk. Go for the naturally 'low fat', 'fat free' foods which are still whole and not processed or packaged. In other words, choose part-skim mozzarella and not fat free Oreo's. The premise of consuming whole foods still applies to low fat diets.

3. I was sitting at the grocery store and saw that nearly every obese person who passed by me, had a cart that was either empty or had very little food items in it. Yet, every single one of them went directly to the bakery to pick up a pie, cookies or a cake. The stereotype is always that a fat person would basically inhale the entire market, but their carts say otherwise. Strangely enough, every person who was slim bypassed the sweets and went to the bread aisle of the bakery instead. It was an eye-opening experience and I was wondering if you can opine on it.

You pretty much experienced the reality of the obese and why the calories in/calories out (CICO) approach as a treatment has failed so miserably. The obese are the least hungry people on earth. At least, for food. I will relay to you my own experience with this, and I have two examples.

Example 1: My husband's mother was morbidly obese and diabetic. When we would go out to eat, she would take two bites of her food and then stop. Then she would either bag it for the dogs or tell me I can have it. You would imagine, from simply looking at her, that she would wolf down the entire table of food but it never happened. She would blame her hiatal hernia for being unable to eat as it caused her to feel full prematurely but she would then order the dessert and eat it in its entirety by herself.

She would wake up in the morning with no hunger whatsoever and wouldn't eat a thing until almost evening. Of course her meal would consist of mango juice or a milk shake at the ice cream shop. I never saw her sit down to a real meal. Ever. Every time food was available, she was never hungry. She never even cooked. She lived off novelties.

This woman was well at or below her daily calories chronically but yet she was still obese. As you can see it wasn't the quantity of food she was eating that was causing her obesity but her disordered eating habits instead. She was on a high fat/high carb novelty diet and calories be damned.

Example 2: I had a friend who was overweight and diabetic. She did the exact same thing. Every time we would go out to eat, she would take two bites of the meal and then tell me to eat the rest. She blamed her missing gallbladder, but she always had room for dessert, the bread and the fries. She just could never stomach the meat and vegetables. She was never hungry but always had room for high carb "junk". Again, disordered eating habits.

This doesn't end at these Standard American Diet (SAD) followers. We also see this in the obese who follow "keto" or the fad low carb diets you find online. None of them ever sit down to a real meal. Their food always consists of fat. Cream cheese, butter, ice cream, fat bombs, bulletproof coffees, high fat sauces and novelties are considered "meals" for these people. They simply went from disordered eating habits which featured high carb foods to disordered eating habits which feature high fat foods, but the disordered eating habits remain. They were never changed and not even acknowledged.

So yes, I have also seen the very obese walking around the market with a skinless chicken breast, fat free milk and salt free broth in their cart, plus a package of brownies. I have also seen the obese live off salads and veggies because they refuse to eat a real meal. The obese have very strange eating patterns that go well beyond "overeating". Most of the time "overeating" isn't even on the docket. It's really overeating of sugar and under eating of real food or eating air. Real food is meat and vegetables. You know the type of stuff they consider boring and not fun. It's a chore to cook but a joy to open an Entenmann's Bakery box or drink of gallon of diet soda.

Of course, this is also a huge contentious topic with the obese as they do not like to be criticized for their eating habits. They rather blame someone else for their problems, like their doctors, fat free diet products or the Dietary Guidelines. Obesity is already very difficult to treat biologically, and this "victim" mentality and "don't fat shame me" attitude makes it all the more difficult. Behavior must be addressed when treating obesity or the condition will always return, no matter what amount of weight is lost. This is why "weight loss surgery" has been a failure as well.

Thin people heading to the bread aisle of the bakery is a much more complicated topic as bread is eaten around the world and obesity does not track with it. Obesity tracks with sugar intake, not bread. All cultures have their own bread recipes, and they are quite old, yet obesity is a modern condition.

Regardless, bread is a food item that is not recommended on this blog because it is very difficult for an overweight/obese/diabetic to control their blood glucose regulation while keeping bread in the diet. In fact, grains in general are to be avoided at all times. But we all know that bread is very different from doughnuts.

For a person who is still metabolically healthy, what will ward off disease is the overall macronutrient composition of their diet, eating habits and other lifestyle factors. A lot of these thin people, who are headed to the bread aisle of the bakery, are mostly using calorie restriction to maintain their metabolic health even though we know this will ultimately fail if they aren't watching their blood glucose as well. But they will be able to sustain their blood glucose regulation for longer if they continue to bypass the cupcakes and get a loaf of rye instead.

4. Are eggs and cream cheese a good meal to have? A lot of low carbers have told me it's really good.

Eggs and cream cheese are not a "meal". It's a novelty. This type of disordered eating will only make you fatter, especially if you have had a hard time losing weight since that is indicative of leptin resistance. Low carbers shouldn't be telling you that eggs and cream cheese are "really good". The only thing that's good is regaining and sustaining proper blood glucose regulation. That is the only lens you should be using to formulate your dietary choices because that is all that matters.

When you are leptin resistant, any fat you eat is stored and never burned. This causes for dietary fat to be extremely obesogenic as it only adds to your fat mass.

There is no reason to live off cream cheese. Low carb is not cream cheese. It's meat and vegetables. Eat a real meal.

5. Is it true that the purpose of "keto" is not weight loss?

The purpose of "keto" depends on your goals.

There are many iterations of a ketogenic diet. Each is designed for different goals. The classic ketogenic diet is for the treatment of cancer, seizures and other neurodegenerative conditions. There are ketogenic protocols for muscle gain, for weight gain, for the treatment of metabolic syndrome/diabetes and also for weight loss.

The fad "keto" protocol promoted online was marketed as a weight loss diet. This is what caused hordes of people to flock to it and give it a try. When it didn't work, suddenly the purpose was redefined.

Don't let these people gaslight you. This diet gained popularity as a weight loss tool, period. That is probably why you decided to follow it too. If it didn't work, dump it. No weight loss = no long term metabolic change. So who cares what it improves in the short term. Obesity can only be treated with long term changes.

6. Is it "healing" for the body to shift from burning glucose to fat and does this "cure" you of obesity?

As of this post, there is no known cure for overweight/obesity. There is nothing to "heal". Overweight/obesity is not a "disease" that requires "curing" or "healing". It is a metabolic state that requires changing.

Your obesity was not caused from "burning glucose". Your obesity was caused from not burning fat. Glucose burning can displace fat burning but that's meaningless in obesity. That happens to everyone. Our bodies are constantly burning both glucose and fat. It never does one or the other. It does them both at different rates.

For instance, athletes burn massive amounts of glucose all day and do not become obese from it even if it temporarily displaces fat burning. At the end of the day, when they reduce their glucose burning, they burn fat just fine and continue to do so while resting. The obese do not. They just simply don't burn enough fat to not be obese.

The obese also burn very little glucose. The glucose they have is turned into more fat instead. So, the obese are not burning much of anything. This is why they are constantly tired and growing fatter. In fact, most of the energy that the obese "burn", is from converting glucose into more fat. This is why some obese people have high metabolic rates but are still obese. It takes a lot of energy burning to be fat. Not only to they have to lug around gym weights in the form of body fat, but they have to keep converting glucose into more fat.

When the obese are starved of dietary glucose, they simply convert more lean muscle mass into glucose and continue expanding their fat mass from it. They do not magically start burning fat because there is no glucose in sight. There is always glucose. It never disappears just because it's not on your plate. The only thing that causes the obese to burn fat is an increase in leptin expression. This can occur through the normalization of other metabolic hormones but it's not guaranteed.

Six common beliefs addressed, Part 230

1. I follow my diet strictly, but I am still not seeing results. The only thing I don't like to do is exercise, but my diet is top notch. I don't understand how I am not having any success just because I don't exercise.

This reply is to remind everyone that - You will not reach your goals through diet alone! Metabolism is an input/output cycle. The body uses diet (input) to create energy for work (output). You can't just address one half of this cycle.

Metabolic hormones all work together to convert food into energy and then expend it. No matter how "healthy" your diet, you will not reach your weight loss or metabolic health goals without exercise. It just won't happen. You will not be able to reverse your metabolic dysfunction or get to lean sitting around. Everyone that I have seen fail in reaching their goals have all had one thing in common - refusal to exercise or improper exercise.

So, stop nitpicking your diet. The reason you aren't getting results is because you're not moving.

2. I was told by a "carnivore advocate" that protein sparing modified fasts (PSMFs) are "too extreme".

Absolutely not, but what do you expect a "carnivore advocate" to say? They have to say it's extreme, as they are pushing their own diet.

Protein sparing modified fasts are a low carb and low fat diet combined. Basically, they restrict the energy macronutrients (fat and carbs) while prioritizing protein. Some are also calorie restricted on top of that. But when these diets are implemented correctly, they are extraordinarily effective for the treatment of overweight/obesity, especially before bariatric surgery as these diets also aren't a "cure". They target two main hormones that are implicated in obesity - insulin (carbs) and leptin (fat).

Remember, there is no known cure for overweight/obesity. All diets are only palliative treatments but some work better than others. PSMFs work very well. PSMFs are reserved for people who are very overweight/obese as they will be the ones who will get maximum benefits with the least side effects.

So, there is nothing "extreme" about PSMFs. Overweight/obesity itself is extreme. It is the result of a very extreme diet filled with glucose and fat.

3. It is not possible for someone who is following "keto" to still have a fasting insulin of 20.

This could be the result of high body fat. The higher your body fat, the higher your fasting serum insulin, regardless of what you eat. This does not always correlate with every overweight/obese person as some are simply no longer producing enough insulin to have a very high serum level.

4. I was morbidly obese at over 250 lbs. I went on "keto" and dropped down to 110 lbs. I have found that I am slowly gaining weight even though I am still following my regimen diligently. I have gained about 30 pounds. I am going through menopause. 

I get this question a lot and there's a few things to unpack here.

When you drop that much weight and get to lean, as 110 lbs. obviously is, it means that the diet was a success, and you have good leptin expression. It responded to your dietary intervention and got you to lean. Of course, this very low weight, is not realistic. You won't be able to sustain it. The fact that you were able to reach it, kind of shows your metabolism is a little wonky. It was blind to the fact you were losing that much body fat and it will now compensate. This is why I always say that the cure for obesity is not weight loss.

You will always gain some of your weight back as your weight set point cannot be that low if you were once over 250 lbs. That type of low weight set point is only realistic for those that have never been overweight/obese and that's their normal. So, you can't expect to be able to stay at that weight. It's a nice place to visit, but you won't stay there.

Menopause could be contributing to your weight gain but it's not the "reason" for it. You say you have continued with the same "keto" regimen that you started with and that can be problematic because as you lose weight, you have to change your protocol since the leaner you are, the more you can eat. Some people continue to fast too long or eat too little and that can cause the body to under express leptin, more than normal, the thinner they become. This can cause weight regain. In order to keep your leptin expression, you have to eat enough.

Aside from all of this, I want to remind you and everyone that there is no known cure for overweight/obesity. Remember,"losing weight" is not the cure. Overweight/obesity is a metabolic adaptation towards starvation and losing weight does not stop this process. It just addressees one of the most obvious symptoms of it. Just like lowering your blood glucose is not curing diabetes, lowering your weight is not curing overweight/obesity.

The only thing you can do is not to strive to reach your lowest weight again but to avoid going back to your highest.

5. Fasting blood glucose and insulin levels are enough to give an indication of insulin resistance.

Insulin resistance is determined by the presence of metabolic syndrome. We only use the classic five criteria, which are present in metabolic syndrome:

• Waist circumference over 40 inches (men) or 35 inches (women)
• Blood pressure over 130/85 mmHg, fasting
• Triglyceride (TG) level over 150 mg/dl
• Fasting high-density lipoprotein (HDL) cholesterol level less than 40 mg/dl (men) or 50 mg/dl (women)
• Fasting blood sugar over 100 mg/dl

Nothing else determines "insulin resistance" unless you are already diabetic, which would mean you are at the end stage of metabolic syndrome.

6. A fasting blood glucose of 95 mg/dL is normal.

Fasting blood glucose should be around 84 mg/dL, so 95 mg/dL is too high. It is not at the point where a diagnosis of prediabetes can be made but it's getting there. It's giving you a heads up that something is wrong.

Six common beliefs addressed, Part 225

1. My sister eats chocolate chip cookies because she says it doesn't raise her blood glucose as much as bread or crackers. I'm scared to try this myself.

Listen, some people have simple goals and are satisfied with minimal results. If not being obese for you is anything under 300 lbs. and your idea of blood glucose control is not allowing it to go over 200 mg/dL, then that's what you will aim for and will only put in as much effort as it takes to achieve both. There are a lot of "low carb" followers who follow the diet in this manner. In fact, unfortunately, they make up the majority.

These people are satisfied with a "lowering" of blood glucose and weight. They never lower their blood glucose enough to put their condition into remission and they never lose weight enough to become lean, but they don't care. As long as they are able to continue eating the junk they have always eaten and acquire minimal benefits, that appear positive, they are fine.

That's not what we do here. You can do this in the multitude of other blogs and pages out there that claim to be low carb. Here the diet is followed correctly and consistently or it's not. I cannot offer even a glimmer of hope for anyone who follows low carb as described in your statement. Those people are hopeless.

2. I would like to follow "keto", but all of the "keto" advocates I've come across so far are either athletes or very obese. Every time I look for a recipe, so I can start my diet, the owner of the page is still fat. I'm scared of getting even fatter on this diet.

People tell me this all of the time because the protocols that I recommend are low carb. First, you do not need any recipe to start a low carb diet. You just eat meat and above ground vegetables. That is all.

I know there are some pretty hefty people in the low carb world, giving out bogus advice, but please understand that none of those people are following low carb as they should. They are following fad diets that fall under the banner of low carb simply because they are carb restricted in some form or another.

These people are still fat because they have always been fat, and they will forever be fat. A lot of these people can't follow a proper protocol unless it is some type of fad protocol, which they follow for a short while and then return to the Standard American Diet (SAD), while they wait for the next fad protocol to come around. They just want attention and to be in the loop. It helps them believe they are doing "something about their weight" while really doing nothing at all. Many of them have disordered eating conditions and, it doesn't matter what protocol they follow, they just can't seem to eat properly or follow the protocol correctly.

There are many reasons for this. Biological, psychological, behavioral and most of all, ignorance. These people don't understand how metabolism works so any charlatan can come along and throw a few "sciency" words at them, which appear to make sense, and their desperation causes them to believe it. Then they begin treating their problem incorrectly. You can't treat what you don't understand and many of these people simply don't understand and won't ever understand obesity.

Metabolism is very counter intuitive, complex and a difficult system to understand. Even young, athletic, seemingly "smart" people get it wrong so what do you expect from an older, obese, metabolically ill person who has a very hard time understanding basic biology? They will understand even less. They will also be less willing to do the work because the work required takes them out of their comfort zone. This is why they gravitate to protocols that are "simple" and allow them to keep some of their habitual fare.

This is why you shouldn't follow anyone. You need to learn how metabolism works for yourself and set up your own protocol based on goals and results. You won't get any answers to your problem from athletes or fad dieters. I have many meal ideas and recommended diets on the right-hand side column of this blog. 

Also, don't hold overweight/obesity against the person who is trying to give information on low carb diets. Yes, many of them are charlatans but don't assume that's the case with all. See what protocol they are following and what they are advising and let that determine if they are full of BS or not.

Some of these people are on their own journey and so it would make sense that they are still overweight/obese. Others are prime examples on how diet alone will not achieve proper blood glucose regulation in the vast majority of people. There are many other factors, besides diet, which affect blood glucose. Until they are addressed, the person can remain overweight/obese, never regaining proper leptin expression, while following a seemingly perfect diet. You do not have to be lean to give good information on obesity. There is plenty of bad information being given by very lean and healthy people.

3. I am following a "high vegetable" diet for the treatment of diabetes and obesity. It is similar to a protein sparing modified fast where vegetables are unlimited and the calories of both protein and fat are restricted. Since I started this diet, I have noticed my skin is no longer dry. I think the big bowl of vegetables I am eating is "nourishing" my skin and healing it.

This is all flim-flam, but congratulations. This is just anecdotal evidence and there is a lot of those circulating around when it comes to diet. There are many carnivore people who make the same claim, not only about skin but all sorts of different ailments that have been miraculously "cured" on their new diet.

Whatever benefits a person has from their new diet is almost exclusively caused by the elimination of something, rather than the addition of anything. If your new diet has eliminated the grains and sugar, that interfere with metabolism and cause all sorts of issues, then that's what's beneficial.

Who knows why your dry skin has suddenly healed but I can guarantee you that it wasn't the vegetables. Vegetables are very nutrient poor for humans. We basically can't use most of the nutrients contained in them. Bugs and herbivores can and then we can eat them and get the nutrients that way. But the human digestive system itself was not made to extract any nutrients from vegetables in any significant amount.

All of the vegetables in your supermarket weren't even around before the advent of agriculture. I hate to break this to you, but that big bowl of vegetables was not around before 12 thousand years ago. Remember humans have been around for 315'000 years. That's a lot of years with no vegetables in sight. So, 99% of our history had none of these vegetables around at all. We ate the fermented plant matter from the intestines of animals only. Plants are great when they are already digested for you.

Meat has all of the nutrients that humans need. That is why you can live off only meat, but you can't live off only vegetables. So, the best vegetables are the ones that have turned into meat. 

4. If someone is fat in a wheelchair, then they are fat because of lack of movement.

If that was the case, Stephen Hawking would have been 900 lbs. at death. Instead, he was probably close to 90 lbs. if even that.

There are obese people in wheelchairs and there are slim people in wheelchairs. Sometimes the condition that put them in a wheelchair influences their weight, but movement has nothing to do with this. In fact, this proves that being fat or lean is completely at the discretion of your neuroendocrine system. Not movement, not calories but what your body does with both.

There is no question that movement and diet can help influence your neuroendocrine system to work as it should and store/burn its calories efficiently, but neither is the be all/end all of obesity or leanness.

5. I was told by my coach that the body stores fat because it is "waiting for carbs to come in and be used for energy". 

Be careful with coaches, trainers and the like. They tend to take individual, textbook metabolic processes and apply them generally to the overall system. This completely ignores context and nuance that are necessary to understand a whole system in vivo.

Something is wrong with your statement. You might have misunderstood your coach. That is the utmost stupidest thing I have ever heard as of now, and considering what I have to deal with, that's quite a feat. Basically, if that was true, we could all eat nonstop loaves of Wonder Bread, in order to not store fat, since the body will store fat while waiting for you to eat the Wonder Bread. That's insane.

Let's get something clear, once and for all, because people seem to have a hard time understanding this. The body constantly uses both fat and glucose for energy. The body never puts to sleep its energy demands. It is always using energy unless you're dead. It just prioritizes energy differently, depending on the source and the task, but the body is a hybrid that can use both fat and glucose energy.

Fat is the body's most versatile energy because it is used for most of its functions, whether resting or not. It even burns fat while it sleeps. That's actually when it burns the most fat, while doing nothing at all. It burns so much of it that there is ketone spillover every night. Actually, it's simpler to say that the body uses fat for all its energy demands except when it requires explosive, high intensity activity.

High intensity activity is just that. High intensity. Think of HIIT (high intensity interval training) or a competitive sport like football or wrestling. Everything else is mostly run by fat, including all steady state activities of long duration, like gardening, walking, cycling and even jogging. The body uses fat for so many things that it must store fat in order to ensure it has it available when it demands it. Fat is so useful for the body that it will convert carbs into fat, so that it can store it for future use.

So no, the body does not "wait for carbs to come in". There is no need for that. The body can make its own carbs. The body always has a storage supply of glycogen available in case you do have to suddenly run from a lion or tackle a football. The body gets its carbs by converting protein and glycerin in fats into glucose which it can then store as glycogen. So even when no carbs are coming in, the body will always have glucose available to it anyway. It never runs out of glucose as there are certain cells that can only run on glucose and other cells which prefer it.

You need to get metabolic information from someone who understands human metabolism, as it works in practice, for the average non-athletic person and most importantly, for a person who is overweight/obese. A person who is overweight/obese/diabetic would only get worse or die on the diet of a football player, even though that is the diet that keeps football players healthy, at least in the interim, and able to play the game.

In overweight/obesity the entire mechanism, I just described above, goes haywire and no longer functions as it's supposed to. Instead of the body storing fat for future use, it stores it indefinitely and refuses to use it again, even when needed. It wants to live off glucose instead and it doesn't matter how many "carbs are coming in", it continues producing more of its own glucose through the uncontrolled catabolism of its lean muscle mass, primarily, converting it all into more fat.

Overweight/obesity is a fat sparing adaption. That is why it's called a "starvation adaptation" because it does exactly what it would do if it was starving. So, if you are someone who is in this metabolic state, you are making things worse by having "more carbs coming in".

6. Once I know my macros, can I follow them forever?

You need to recalculate your macros as you lose weight. The macros for a 300 lbs. person are not the same as for a 110 lb. person.

Six common beliefs addressed, Part 209

1. My trainer told me that they can't wait to get up in the morning and eat. They are hungry before their feet hit the ground but I am never hungry in the mornings. I have always skipped breakfast. My trainer is 110 lbs. of mostly muscle. I am obese. I have always been told that the obese have uncontrollable hunger, not the lean, so what happened to us?

Because you have been duped by the calories in/calories out (CICO) theory of obesity. It goes like this: Fat people are always hungry so they eat more calories than they burn. There is another one that goes as follows: Fat people are very lazy so they burn less calories than they eat. How well has that worked so far?

Look, there are some fat people who are always hungry but the vast majority of them aren't. Fat people are the most un-hungry people on the planet. They can literally spend hours without eating. The fat people who are always hungry, tend to be able to lose their weight effortlessly once they are on the right protocol. The fat people who are never hungry, tend to have intractable obesity. It all boils down to leptin. 

Your trainer has intact and proper leptin expression. In the mornings, they just woke up from an overnight fast. This means they are ready to eat since their metabolic hormones are communicating the right information to their brain about their current nutrient status. They have tapped into their fat stores enough. Now the body wants more fuel to burn. This is especially true since they are mostly burning body fat as they sleep. Their metabolism isn't going to let them deplete all of their body fat. They have to eat. This is again why early eating has been associated with leanness. You are suppose to be hungry after an overnight fast. That's how this works.

The obese can fast forever without hunger and not burn one single fat cell in the process. Most obese people wake up not hungry and skip breakfast. This is typical of poor leptin expression and active obesity. You are not burning any fuel and your body doesn't want any more because it won’t burn that either. Metabolism is slowed to a crawl.

I hate to break the news to you but there isn't much you can do about this. No one has been able to restore leptin expression in anyone. At least, not with what we know so far about the mechanisms of its under expression. The only thing you can do is try to keep your blood glucose steady to see if you can cause your leptin to function as it should. For this reason, you shouldn't skip breakfast.

2. It is easier to lose weight if you became fat from eating real food than it would for people who became fat from eating junk.

No. It's the same. Becoming overweight/obese is caused by the chronic disruption of blood glucose regulation, which abnormalizes insulin expression and ultimately chronically under expresses leptin. There are many ways this can happen because there are many ways to disrupt blood glucose homeostasis. Disruption to blood glucose homeostasis is the leading cause of leptin under expression which results in overweight/obesity.

Not all people are obese from eating junk. Many people are obese from simply eating inappropriately or not eating at all. That's why there are so many obese people who swear up and down they are "eating healthy" and they technically are. They are just not eating appropriately for metabolism to work properly since their eating habits are disrupting their blood glucose regulation. This can be done with simply the chronic consumption of caffeine with no junk food in sight. You would be surprised to know just how many diabetics caffeine has made.

The only fat that is hard to get rid of is fat from fructose because of the interference in hypothalamic cross talk which has life long repercussions. The liver fat fructose makes can be shed quite easily but its effects on the hypothalamic/pituitary/adrenal (HPA) axis is usually irreversible.

3. I don't know what's going on with me but I have been extended fasting for a long while now and my weight doesn't budge. It goes down a few pounds during the fast but then goes right back after. Will this fasting ever work? 

No. I am not afraid to say it won't. It never had and it never will. All you're doing is playing around with your water retention and teaching your fat cells to store more. You are absolutely yo-yoing.

What makes yo-yoing so dangerous if it's only water? It's an information your body is receiving that you are always at the brink of starvation. This is because starvation interferes with blood glucose regulation. That is why you lose water weight. Blood glucose plummets, insulin follows suit and retained water is lost. You would think this is a good thing because it allows you to button your pants, temporarily, but it actually reinforces the starvation response. After all, blood glucose and insulin only plummet due to starvation. This causes a sparing of fat mass.

Even though you are only going up and down in water weight, in the long run, you will store more fat when you do eat, making you fatter over time. Worse, this mechanism also makes it harder to lose your fat mass when you finally get serious about doing so.

4. I was recommended to eat large amounts of vegetables in order to feel full and not eat later. 

I have spoken about this before and it's shim-sham. Like I have said in other posts, eating mountains of vegetables alongside a controlled serving of meat is called a protein sparing modified fast (PSMF). It is very effective but there is no need to call it anything other than what it is. You don't have to pay to follow this type of protocol. They have many PSMF menus/programs online for free.

The reason they are making you eat mountains of vegetables is because vegetables have the least calories. You control your protein intake because meat is what has the calories. But eating a bucket of vegetables is eating a bucket of carbs. It fills you up momentarily and you will be starving in a few hours.

The macronutrient of satiety is protein. Until the body gets its daily dose of adequate protein, it will continue to be hungry. Now a lot of these programs do recommend adequate protein intake so they swear to you up and down that the reason you feel full is because of all those vegetables you ate. Wrong. You feel full because you ate enough protein for the day. This means you could have thrown those vegetables into the compost bin. They did nothing for you except give you gas and a psychological feeling that you are eating a lot because your plate is overflowing.

Don't eat like a cow. Just eat normal and focus on your protein intake, nothing else.

5. Obese people on "keto" are able to eat large amounts of fat and not get disgusted. Now the new thing are "Butter Bites". Who eats that?

People with severe eating disorders. You have to understand that a lot of these obese people never ate normally. Ever. When they were eating carbs they would eat whole bags of chips, bars of candies, boxes of crackers, loaves of bread. Their eating habits have not changed just because they switched from carbs to fat. They are still eating in the same exact way. So yes, these people can eat an entire bottle of ghee because they use to eat an entire package of mac n' cheese. Their issues continue. They just have a new target now.

People without eating disorders would absolutely be grossed out by eating a spoonful of butter. They wouldn't be able to eat a whole pound of bacon. They basically would not be able to keep up with this nonsense. But these are also the people who will be most successful with their dietary intervention. People with eating disorders are very likely to fail at their intervention because it doesn't matter what diet they follow, they tend to take their habits with them, ruining any chance of success they could have had.

That's why there is no one protocol for the treatment of obesity. It is not just as simple as following a diet or exercise program. There are many other things that have to be addressed as well and one of those is behavior.

6. Is there a protocol for people who don't like to cook?

No. People who don't like to cook are the fattest people around. A lot of people are under the assumption that if the person is obese, they must be a great cook....well...not exactly. Most of these people live off novelties, not real cooked meals.

You cannot eat in an appropriate manner without cooking unless you are eating raw meat, which we don't advocate on this blog. Protein is your most important macronutrient and it usually comes in a form that must be cooked - meat. So, you have to cook by default. Cooking meat extracts the most nutrients from it.

Eating bowls of raw salads, bunches of nuts, slabs of cheese and/or grinding fruits into smoothies are not appropriate ways to eat.

Six common beliefs addressed, Part 208

1. I am following a program which has a diet that is mostly veggies and protein with no added fats. It consists of two to three meals a day and a 1500 calorie "budget". 

I know your program director is patting themselves on the back and telling you this is some type of "miracle diet", they discovered, but it’s simply a protein sparing modified fast (PSMF). Any diet that prioritizes protein, while strictly restricting carbs and fat is a PSMF. Now, don't get me wrong, I'm not knocking this approach. PSMFs, whatever their iteration, are legitimate protocols that have been shown to be very effective for the reduction of body fat. They can also be used for training or for other health goals, besides weight loss, depending on how they are modified.

PSMFs target insulin and leptin. They stabilize blood glucose by restricting dietary carbs which lowers bolus (postprandial) insulin. The restriction of dietary fat lowers basal (fasting) insulin. Ultimately this affect on insulin allows for better blood glucose regulation and the preservation of insulin function. The premise is that this would regain proper leptin expression, since leptin is a slave to insulin. These diets obviously accomplish this since they are used successfully, in multiple settings, for the reduction of body fat, specifically. The overweight/obese need to lower body fat, specifically.

PSMFs are just hard to follow long term and if you have ever followed one correctly, you would know why, but I can break it down easily for you. If you think a low fat or a low carb or a caloric restricted diet is difficult to follow for the long term, then imagine a low fat, low carb and calories restricted diet combined. That's a PSMF. That's why they are usually not recommended for the long term. That is aside from the fact that the lower your body fat already is, the more problematic these diets can become, unless you watch your protein intake carefully and train properly.

I keep all options on the table for the overweight/obese because there is no one protocol for obesity with guaranteed results. That's why I have multiple recommended protocols which can all be combined in different ways to create your own. I prefer for you to be informed about your choices because most weight loss protocols are sold as the "miracle cure". Snake oil is not hard to sell to the desperate.

This is why it irks me when people bring up old methods, put them in a new shiny package and sell them to you as a new item. This is what happened with the whole "fasting" fad, remember? Well, just like fasting, PSMFs are not new either. They have been used by body builders forever. They are an old method of tricking the body into burning body fat. How long you can keep this up is completely individualized and results will vary, since it all depends on much proper blood glucose regulation you can regain and sustain. The healthier and leaner you are, the better the results because you already have proper leptin expression. The sicker and fatter you are the more varied results because you are trying to kick start proper leptin expression and that doesn't always happen. The long term results are unknown.

I would personally try it. This is because PSMFs have a very good track record of effecting leptin expression positively so you don't loose anything by giving it a go. You might actually lose some body fat. Just keep in mind, this isn't something exclusive to the program you are in. This is a very well known diet and you really don't have to pay for it. There are many free PSMF plans online.

2. I am currently on a weight loss journey and I refuse to let go of my "fat clothing". I don't know why exactly. I feel an extreme and unusual anxiety about throwing any of them out or giving them away. 

I haven't touched on the emotional and psychological stress related to overweight/obesity. That doesn't mean that it doesn't exist, it's just that it goes beyond the scope of this blog and the knowledge I have. I am not very familiar with this but I can give you my non-expert opinion.

Tackling overweight/obesity is extremely difficult. Many people's entire lives have been devoted to trying treatment after treatment, to try and reverse this condition, to no avail. It is very frightening to have to deal with something you have little control over and that will cause you expensive and serious health problems in the future. In fact, overweight/obesity is the main contributor to an early death, in some form or another.

Some people have become so paralyzed with the fear of yet another failure, that they simply have grown to accept their overweight/obesity and no matter what treatment they follow, they have the mindset that they will remain or return to being overweight/obese regardless. This is probably why you don't want to let go of your "fat clothing". It's scarier to fail and have to buy "fat clothing" all over again, which only makes the failure a more solid reality, than to fail and already have these clothes as if you never even intended to lose weight to begin with.

Fear of failure can result in many additional problems including eating disorders. You have to watch this carefully as people with current mental health issues like anxiety, depression and/or obsessive compulsive disorders are more at risk for developing these problems. Eating disorders are very serious and there are a lot of "fad diets" that only help perpetuate them by giving them legitimacy.

I suggest that if you are already experiencing severe anxiety, and exhibiting behaviors, like keeping "fat clothing", that doesn't fit you anymore, you should seek professional help. Being able to talk to someone can be very valuable in helping you address this issue before it gets worse.

3. I was told to eat between 150 - 200 grams of fat a day for maintenance but that seems like a lot to me. 

This recommendation is the standard for legitimate ketogenic protocols used for the treatment of overweight/obesity and metabolic disorders. Just keep in mind that it doesn't matter how legitimate and science based a protocol is, all protocols have had dismal long term success rates. Don't let the word "legitimate" fool you. Legitimate simply means that the protocol is not a "crash diet" or "fad diet" which can further harm your metabolism's function.

Will it work? That is very hard to say even for a legitimate protocol. Like I said above, all protocols have not only had dismal long term success rates, the successes and failures have not been well studied nor understood. It is very difficult to follow people around for the long term. It is also very difficult to know exactly what they did during that long term span of time. What people say and what they actually do, do not always coincide.

The premise of this recommendation is based on that, if you lost all the weight and are now lean and ready to be in maintenance, your insulin resistance is resolved and proper leptin expression has been restored. That's a pretty big premise to have since that's not really known. Remember, the cure for obesity is not weight loss. There is no known cure for obesity.

What we do know is that the fat cells of the once obese are not the same as the fat cells of the always lean but that's the assumption that is being made with this premise. They are assuming that you are now "cured" and your metabolism should perform as a healthy person's would. You increase fat intake for maintenance because it is being assumed you now have proper leptin expression and you wouldn't want to eat less than you should because this would cause a reversal and you would enter into starvation mode (low leptin expression) once again, storing fat and not burning it.

A healthy person can eat an astronomical amount of fat and hardly gain 25 lbs. Their leptin expression is intact and it simply won't allow for their weight to increase to any significant amount as they have a low weight set point. Their metabolic rate simply increases as their dietary fat does and they burn it all off. They will then get to the point where they simply cannot eat that much fat and they will naturally reject it. So they cannot eat astronomical amounts of fat chronically. The body has tight controls over its weight set point. It will increase metabolic rate, increase activity, decrease appetite, whatever it takes, to remain in weight homeostasis. For the overweight/obese things do not function quite like that. Instead, they have a very high weight set point and the body is doing everything it takes to maintain it.

So the only thing you can do is to try and see. Will your body burn enough stored body fat so the 200 grams of dietary fat simply replace what's being burned and you remain in homeostasis? Can you even keep up eating 200 grams of fat chronically without a large reduction in appetite? We don't know. Only you can find out.

Rarely overweight/obese people are able to acquire their leptin expression easily and keep it. Some will acquire it for a short time and then lose it again. Most will never acquire it at all. It all depends on how your individual fat cells are behaving and how your hypothalamus is reacting. How did the effects of overweight/obesity change both fat cells and hypothalamic function, for the long term, in you? You will soon find out. Keep us posted. I'm actually curious to know.

4. My triglycerides have doubled and my cholesterol has gone significantly up, within a six month period. I have never had these issues before. I already eat low carb and have been for many years. The only thing that has changed is that I am on Metformin. My doctor told me he put me on it for "insulin resistance". I am a Type II diabetic with pretty well controlled blood glucose. This is why I am only on a low dose of Metformin for now.

It is unusual for metabolic markers to change this quickly for absolutely no reason. This is why I am very leery when someone comes to me with this type of problem. This is because they usually tell their side of the story and not the whole story.

People will say they are “low carb” but I have no clue what that means. Low carb means different things for different people. I also take the claims that "nothing has changed" or "the only thing that changed is" with a grain of salt. People will swear up and down that “nothing has changed” but that's because they like to omit what actually changed. I am not accusing you of this but my personal experience has shown that most people lie when it comes to describing their diets. This is why I prefer hard numbers. I need actual macros in order to determine if you are truly low carb or not.

But for the sake of being able to answer this question, I am going to take it at face value and assume you are on a legitimate low carb protocol that has truly not changed at all, except for your use of Metformin. Let's unpack this piece by piece.

High cholesterol can either be a rise in HDL, LDL or both. You never said if yours was a rise in total cholesterol or in a specific lipoprotein. Most people experience no changes in their cholesterol due to saturated fat in the diet but a small segment does. Why this would be occurring to you now though, is unknown. This is usually seen immediately the moment you begin consuming saturated fats. You say you have been low carb "for years", so you would have seen this rise in cholesterol years ago, not six months ago. Cholesterol rises from diet occur within a few days.

High trigs are usually a sign of metabolic syndrome and as the condition progresses, they tend to increase further. It is not uncommon to see a diabetic with trigs in the 1K or more. This occurs slowly over time so if your increase was sudden, then something else could be going on. I am assuming you do not drink alcohol so fructose consumption would be the only thing that would rise trigs quickly. You would have to see if any products you are using, might contain fructose. Fructose does not cause a rise in blood glucose so it is usually used in diabetes products as it has a sweet taste without the “sugar”. Check your products for fructose, including any medications.

Both cholesterol and trigs are handled by the liver. You know what else is handled by the liver? Metformin. Metformin works with the liver to control glucose production causing a pseudo lowering of blood glucose. The effects this has in the liver remains unclear. Metformin is not considered intrinsically hepatotoxic but there has been conflicting evidence on its lipid-lowering effects and other claimed benefits, such as a treatment for fatty liver disease. In fact, The American Association for the Study of Liver Diseases, the American College of Gastroenterology, and the American Gastroenterological Association state that Metformin has “no significant effect on liver histology and is not recommended as a treatment for liver disease in adults with non-alcoholic steatohepatitis (fatty liver disease)”.

Though Metformin reduces insulin dependency in Type II diabetics it is unclear if this effect continues beyond the first year. No significant improvements in HbA1C are noted with Metformin use. I'm telling you all of this so that you can be a bit more critical when reading how great Metformin is. The truth is that they simply don't know because the long term studies have not been done as of this post.

You would need to look further into this and discuss it with your doctor. When you do, do not be gaslighted. Do not let your doctor tell you that "Metformin cannot possibly cause hyperlipidemia" because he doesn't know. You should also review other medications that you are taking as they might interfere with how Metformin works. I suggest you review your medications with your doctor and explain how this hyperlipidemia correlates with your Metformin usage. Your doctor should have a history of your previous blood work so he can note changes through a certain time period. Demand personalized health care, after all, you're paying for it.

On another note, I don't know why your doctor said he prescribed you Metformin for "insulin resistance". Instead, he should have told you that he prescribed you Metformin to lower your blood glucose. There is no pill that addresses "insulin resistance".

5. Some artificial sweeteners (AS) have calories.

Some AS have an effect on insulin. Others are converted back into sugar by the body. Most are mixed with fillers that have calories in the form of glucose. All of it is irrelevant. Whatever the case, the calories are so trivial that they can still label the product as having 0 calories. None of these are what make AS problematic.

Like I have stated before, the real problem with AS is in the sweet taste information they are giving your metabolism via the hypothalamus. Sweet taste means store more. This means that everything you eat, accompanied by AS, will be stored more than if AS was not included. This is most likely the reason why the introduction of AS, to the food supply, has done nothing to curb obesity or the incidents of diabetes. In fact, both have only increased.

6. I am never hungry and that's why I can fast so much but I have noticed that a lot of fasters are never hungry. Some of them are not even obese.

The obese are usually never hungry because they aren’t burning any fat due to poor leptin expression. You don't have to be obese to ruin your leptin expression. You can absolutely fast it away. The more you expose the body to starvation, the less willing it will be to burn body fat.

Thin fasters are simply training their body to under express leptin. That is why first-time fasters are very hungry in the beginning and then, over time, they find out they can fast forever. Soon these thin fasters will join their obese counterparts. Instead of body fat loss, they are simply losing leptin expression along with their muscle mass. Lack of hunger is a sign of things to come.

Six common beliefs addressed, Part 146

1. People can have different results, even while following the same diet.  

This is because some people are able to regain and sustain proper blood glucose regulation and others aren't. There can be genetic and epigenetic reasons for this. Of course, those cannot be controlled so we will only discuss what can be controlled here. 

 

First, low carb only works when it is followed correctly and adhered to consistently. People generally do not do this. If you want to regain and sustain proper blood glucose regulation, you have to stop the habits and behaviors that contribute to it. Here are some of the mistakes people make when following low carb and every single one of these affects blood glucose homeostasis to varying degrees and through different pathways: 

• Artificial sweeteners - This is not going to cut it, so cut it out. The taste of sweet is enough to continue dysregulating blood glucose.
• Snacking - Drop all the snack foods. Snacks have no place in a healthy diet. Eat real meals, at meal times only.
• Low carb recipes - Stay away from "recipes" and use meal ideas instead. Low carb is just different combinations of the same food items - meat and vegetables. 
• Reduction/introduction of junk food - Stop replacing the Ritz crackers with chaffles. It doesn't work that way. The diet is about elimination not replacement.
• Taking the weekends off - You are either on low carb or you're not. Low carb is a full time commitment, not a Monday through Friday hobby.
• Bouncing from one protocol to another - Choose a protocol and stick with it. Stop jumping from protocol to protocol aimlessly. Stay focused and work on getting results, not on "following a diet".
• Introducing dumbassery to the mix, like "fasting" - Don't layer one protocol on top of the other. Jumping from fad to fad is not going to achieve anything in the long run and obesity is a long term problem that requires a long term solution. Every time some new BS appears on social media, people are clamoring for it. If you are doing this, then it's because you can't commit to any protocol.
• Lack of exercise - You can't eat yourself to health. You have to rise from the recliner and get active.
• Caffeine - As long as you continue caffeinated drinks, coffee or tea, you will not be able to control blood glucose and so the problem will never get better. 

If none of the above is the issue, then you can focus on other factors that could be hindering progress such as: 

• Length of obesity - The longer you have been obese, the more difficult it is to reverse this adaptation. This is especially true when you have a history of yo-yo and crash dieting.
• Level of metabolic dysfunction - Metabolic syndrome is time dependent. The longer you have it, the more difficult it is to reverse. The closer you are to diabetes, the worse the outcome as there are several pathologies going on at once that cause metabolism to spare fat mass rather than lose it.
• Age - There is a natural increase in insulin resistance as you age. There is also greater tendency to lose muscle mass and have difficulty rebuilding it. All of this contributes to excess body fat and the inability to lose it easily.
• Hormonal status - Decreases and imbalance in sex hormones, as you age, make the loss of body fat even more difficult.
• Cause of obesity - Obesity from sugar is much more difficult to reverse than obesity from starch. The taste of sweet causes changes in the hypothalamus that impact the ability for the brain to gauge its fat stores and burn it.
• Co-morbid conditions/medications - Auto immune conditions and other inflammatory diseases, along with the medications used to treat them, interfere in the treatment of obesity. 

All of the above issues interfere with leptin expression and/or the stress response. No leptin expression = no fat loss. Greater stress response = more fat storage. You cannot control a lot of these but they can still be taken into consideration when choosing a treatment. For example, you may be getting older and this causes muscle mass loss, which can be reduced with the right supplementation of protein. You can also improve declining sex hormones with the help of a healthcare professional.

2. You have to eat liver and other organ meats on carnivore. 

You don't have to do anything but breathe. 

You can obtain a lot of nutrient density from eating organ meats but you don't have to. I know that we generally are not accustomed to these meats and forcing yourself to eat them can make meal times a nightmare. You don't want to discourage yourself further from low carb dieting by trying to down some pig kidneys. All you have to do is follow low carb period. 

If you have doubts about your nutrient status, get tested for deficiencies and/or take a good quality supplement. 

3. It is difficult to follow "keto" because "keto" products are expensive. 

You don't need to buy anything to follow a ketogenic diet and you certainly don't have to support any "keto" advocate either. Let them find a real job. Put that money towards your own food. Buy fresh meat and vegetables and nothing else is needed. 

4. Low carb advocates usually recommend to not use sunscreen.  

Most quacks advocate for low carb. They run the gamut from thyroid quacks, anti vax quacks, cholesterol denying quacks, supplement selling quacks - you name it, they are out there. This is precisely why these diets are not taken seriously. 

This blog isn't about skin care but since we advise on exercise, our recommendation has always been that you generally do not need to use sunscreen unless you are spending an excessive and prolonged amount of time in the sun. 

Like all other animals, when the sun begins to bother us, we seek out shade but some people are unable to do this because they work construction or landscaping, play certain sports, or perform some other outdoor activity where they have no choice but to remain in the sun, regardless of the heat. Any activity that forces the person to stay under the sun, with no shade, risks damage to the skin and these are the only people that should use sunscreen. 

Even better than sunscreen is protective clothing. So if your work forces you to be out in the sun for long periods of time, make sure you wear adequate clothing to protect yourself and/or use sunscreen. If you are fishing or spending time on the beach, also wear appropriate clothing and/or sunscreen. Take an umbrella or some other equipment with you that can provide shade. Exercise early in the morning or in the evening after sunset. 

Use common sense and avoid getting burned. Sun burns are not good. Not only are they very painful and uncomfortable, but all it takes is one third degree burn to damage the cells of that area of the skin for life, making them more susceptible to skin cancer in the future. 

5. Many food manufacturers are now making items labeled "keto". 

Food manufacturers are just that - food manufacturers. This means they are out to make money by selling you things. This is true of any company that manufactures things. There is no conspiracy theory behind it. 

Food manufacturers go wherever their customers go. It's a supply and demand chain. When everyone wanted low fat alternatives, these food manufactures came out with the demanded products. When people wanted more natural/organic alternatives, they did the same. Every time a new fad diet comes out, the food manufactures oblige. It just so happens that there is a "keto" craze going on right now, which is thankfully on the decline, so many food manufactures are following suit and producing "keto" products. 

This should not be of your concern. People have a right to eat as they wish and companies have a right to deliver what people want and make money off of it. It's called free market capitalism. Your concern is to stick to natural, non manufactured food - meat and vegetables. Your food should have no labels on it. You are only responsible for yourself. 

6. There is no way you can follow a protein sparing modified fast (PSMF) for the long term. 

Yes there is. Dr. Naiman's 'Low Energy Diet' takes the basic premise of a PSMF to create a protocol that can be followed long term. You can read about it here.

Six common beliefs addressed, Part 141

1. "Keto" followers love "keto" doughnuts because they make a great "healthy" snack. 

Of course people love them. They are all overweight/obese. When have you seen an overweight/obese person that doesn't love doughnuts? 

The question you should be asking yourself is not whether the doughnuts "are okay to eat", but whether you're okay with remaining fat. Some people are okay with that. In fact, more and more low carb advocates are settling for the idea that leanness should no longer even be the goal. This is because they can't let go of their doughnuts. 

Don't be one of those weak people that have decided to be victims of their fat for the rest of their lives. If you are here, it's because you want to actively do something about your fat. Doughnuts, of any kind, are never okay. 

2. Getting older does not effect metabolism.  

It does. Unfortunately, the advice that could have prevented this should have been given to you when you were in your twenties. The older you get the harder your journey. This is because: 

• The older you are the more insulin resistant you become irrespective of diet. Once the body no longer needs insulin to grow, a lot of its organs and tissues develop a natural inclination towards insulin resistance. This effects glucose homeostasis especially when the diet has a substantial glucose load. 
• The older you are the harder it is to grow and maintain lean muscle mass as the body continues resisting insulin making it difficult to synthesize protein. This causes a continuous loss of lean body mass and a difficult time rebuilding it. This is even worse when it's coupled by an over expression of catabolic hormones which is the case for people with metabolic syndrome/diabetes. 
• The older you are the harder it is to lose body fat as body fat is a tissue which maintains insulin sensitivity until the end. So, expect to continue building fat mass just fine well into old age, even if everything else deteriorates. 
• The older you are the more hormones will work against you. The loss of sex hormones causes for the body to shift its metabolism and promote even more fat storage. This is detrimental for males, but females don't have it any easier. Females begin having a male pattern fat storage, where they begin accumulating fat around the middle and in the viscera from the loss of estrogen, while males experience the opposite effect and become more estrogen dominant causing man boobs. Though man boobs can be embarrassing, they aren't the problem. The problem is the loss of testosterone. 
• The older you become, the more health issues you develop and this can affect your mobility, ability to adhere to a specific diet and/or have to use medications that can affect blood glucose further in order to treat chronic conditions. Also the older you become the more reluctant you will be to make a lifestyle change.
  

As you can see getting older means a much more difficult time trying to stay healthy. The only thing you can do is be consistent with your low carb diet and fasting protocol while staying as active as possible. If there is one thing that is helpful for staying young and managing weight, in older adults, it's exercise. Get an exercise regimen if you don't already have one. 

3. Feeling tired on "keto" is normal. 

Negative. Get off "keto" and go to a normal low carb diet. 

Though many things can be causing this, and you should consult a doctor if you haven't already, in the context of diet alone you might not be using fat for fuel efficiently. This is the result of poor leptin expression. This effects your ability to burn fat for fuel. 

Being tired on ketosis is also the result of the loss of lean muscle mass. You are either not in taking adequate amounts of protein or ketone presence in the body is causing it to go into stress, breaking down its lean muscle further, or both. For this reason, reformulate your diet so that it is adequate in protein and only causes mild/cyclical ketosis. 

4. There are no health advantages to consuming dairy on carnivore.

Dairy has always been advantageous and this is why most of us can still digest it well into adulthood. 

Dairy is a fermented food so it has helpful probiotics for gut health. Whey protein stimulates insulin for lean muscle mass growth. It is also a great simulator of glutathione, the most powerful antioxidant in the body. The fatty acids in diary, especially decanoic acid can cross the blood brain barrier. Dairy is a great way to increase ketones in people who have epilepsy and other disorders where they must keep ketone levels high. Dairy is also extremely nutritious, milk being the most nutritious food on the planet. 

As you can see, you get a lot of bang for your buck consuming dairy, sort of like when you consume organ meats. 

5. "Stress" and lack of sleep will effect blood glucose and insulin.

Stress effects insulin through the over expression of counter regulatory hormones, which release glucose into the blood stream. The more advanced your metabolic disease, the more exaggerated this effect is. Diabetics can dump quite a bit of glucose into their blood stream, driving their postprandial blood glucose well into the 500 mg/dL range and beyond, while dipping their fasting blood glucose to very low levels. Some diabetics are able to maintain high blood glucose all of the time. 

This of course, effects insulin levels as insulin will respond to this fluctuation in serum blood glucose to try and help clear it. The more blood glucose, the higher the insulin levels will have to be and the longer it must remain expressed in the body. This keeps insulin chronically high and over expressed. Keep in mind that the "stress" I am referring to is not "emotional" stress but metabolic stress. Such as when you eat a candy bar. The erratic ups and down in blood glucose, with high disparities between postprandial and fasting levels, are the main stress that the person with metabolic syndrome has. That is the pathological stress that they have to take control of. 

Emotional stress can effect blood glucose, especially when it is already not well regulated but no one becomes diabetic and/or obese from emotional stress alone. Emotional stress does not cause that type of pathology. Lack of sleep has been shown to effect insulin levels because it is a stressor for the body and also if you aren't sleeping, blood glucose will not lower enough as the body is still active and requiring fuel. Again, this keeps insulin levels higher than normal, when they should be low. 

Too much importance has been given to lack of sleep in blood glucose control, but again, insomnia does not cause diabetes/obesity. Just like emotional stress, it contributes to already poor glucose control but it is not the main driver of it. The main driver that effects blood glucose and insulin is lifestyle. 

6. You should never do a low carb and low fat diet at the same time. 

Of course you can do a low carb and low fat diet at the same time. That is basically the description of a protein sparing modified fast, the most powerful diet for body fat loss known so far. It is also the complete opposite of the Standard American Diet (SAD) which is both high in carbs and fat. Whoever told you that low carb and low fat shouldn't be done together is out of their mind or is selling another type of diet.

Six common beliefs addressed, Part 125

1. If you follow a protein sparing modified fast protocol (PSMF) for too long, it might damage the gallbladder or cause other health problems.

That is incorrect. Hunter/gatherers never used added fat on any of their food and they are perfectly healthy. PSMFs are low carb, low fat diets. It’s not a “no fat” diet. There is no such thing as a “no fat” diet. 

 

The only people who would have adverse effects, following these diets, for a prolonged period of time, are the ones who are only eating the muscle meat of very lean, wild game while having low body fat to begin with. So, if you are following a very low fat diet or PSMF, you are fine as long as you have excess body fat to lose.

2. The food industry continues to push grain products, which hurt people’s health.

This is because people want them. The operative word here is "industry". They make money selling products that people want. 

3. You should have your first meal at 12 noon. 

The problem with breakfast was never the breakfast. It was the breakfast foods. You would think that people would have figured this out by now. It's a no brainer. 

Like I have said before, it doesn’t matter what times you plan your meals or fasting. You can schedule it whichever way your circadian rhythm prefers. Just be consistent with your times and follow them daily. Do not be erratic. 

There is an advantage to earlier eating times, simply because of how insulin functions, coupled with the overnight fast. Not being hungry in the morning has always been associated with active obesity, but at the end of the day, it doesn’t much matter. Just be consistent and don’t deviate from your eating/fasting schedule. 

4. It is very dangerous to have low Vitamin D levels. 

Everyday a new quack is coming up with a new vitamin that they claim will save you from death and cure all your ailments. This seems to occur in cycles, like fashion designers who will periodically bring back bell bottoms. Sometimes its Vitamin C, other times its Vitamin E and I am sure we all remember the CoQ10 craze or the Vitamin K hysteria. It seems like Vitamin D is back in the mix of things. 

The bottom line is that the research hasn’t shown any significant difference in supplementing with Vitamin D or not, unless the person has rickets. No one knows exactly why this is the case. Genetics seems to play a big part on what your Vitamin D levels are and how its used in the body. Why some ancestries seem to maintain such low levels, while still being perfectly healthy, is not well understood. The only thing that is known, is that people with metabolic disease seem to deplete their B, C and D vitamins. It is very common for these individuals to have very low levels of these vitamins and that's due to metabolic dysfunction and the burden it puts on these specific vitamins. 

It also kind of explains why supplementing has not been shown to be effective. After all, if there is a hole in your sink and you are losing water, adding more water to the sink is not going to help. The more you add, the more you lose. Well if your metabolic function is depleting these vitamins, the more you supplement, the more the body will use and you are right back to square one again. You have to fix the hole in your sink, just like you have to fix what’s depleting your vitamins. So, you have to focus on fixing your metabolic dysfunction and if you want to supplement in the interim, go right ahead. 

We don’t discourage supplementation. We just don’t agree that these vitamins are the “cure all” of anything. They aren’t. Only a healthy metabolism improves your overall health significantly. 

5. If you follow "keto", you will not get diabetes. Especially if you keep carbohydrates below 20 grams a day and from above ground vegetables only. 

If you follow "keto" and it helps you obtain and sustain proper blood glucose regulation, you will not get diabetes. That is the only metric that matters - blood glucose. Nothing else does. It doesn't matter how you can obtain and sustain your blood glucose regulation. When it comes to metabolic health, the ends always justify the means.

6. A blood glucose level of 53 mg/dL is perfectly fine because your body is burning fat. That is why you have no symptoms of low blood glucose. 

That is hypoglycemia. Blood glucose should be around 84 mg/dL and not much lower than that. Unlike what “keto” advocates online say, having no symptoms from blood glucose that has dropped to hypoglycemic levels is not normal, as a blood glucose that low is not normal. 

It is not true that you are not having any symptoms because "you are running on fat". That is ridiculous and has nothing to do with what’s occurring because regardless of whether the body runs on fat or not, it likes to keep a very tight range of its blood glucose. That range is always around 84 mg/dL. So, even if you are running on 100% fat, your body will continue to keep its blood glucose at around 84 mg/dL, if it’s healthy. 

Having no symptoms of hypoglycemia is called ‘Hypoglycemia Associated Autonomic Failure’ or simply ‘Hypoglycemia Unawareness’. This is common in people with metabolic syndrome/diabetes, since their metabolism is adapted to the erratic highs and lows of blood glucose and their autonomic nervous system (ANS) no longer responds to drops in blood glucose levels by activating counter regulatory hormone action or any symptom of malaise. Many diabetics, unfortunately, die from this condition which tends to occur more often during the overnight fast. The exact mechanism of this phenomenon is still largely unknown. 

If you are experiencing this, you need to find out why your blood glucose is going so low. Get this checked out immediately by a healthcare professional in order to determine if your blood glucose is dropping because of some medication you might be on, while also following a low carbohydrate diet. Your medications might need to be changed, but you absolutely have to tell your doctor that you are experiencing no symptoms of this blood glucose drop.