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 206

1. I have lost a lot of weight and eat two meals a day. Lately, I have found it works even better for my schedule to eat my two meals, very early in the day as I have a long work commute. I am basically done eating by 10:30 AM. I then won’t eat anything else until the following day. I am finding that I am slowly gaining weight. I don't understand. I have not veered off of my initial diet which helped me lose all of the weight and kept me in maintenance.

Your fasting times have increased and it seems like your body is not very happy with that. Remember, any treatment for obesity is in itself obesogenic. I know that's a terrible nightmare reality, but it’s true. Any challenge to fat mass only makes the body double down and try to hoard and store more of it.

You lost a significant amount of weight so you challenged your body’s fat mass as much as it will allow you to, especially if you reached leanness. It’s had enough and won’t accept more fasting. It has now shifted into active obesity mode and you are simply storing more fat than you should be from your two meals.

I suggest you either space out your two meals further apart or add a third one a bit later in the day. You have to make sure you keep your leptin expression going and not have it stall on you. The best way to do that is to increase your nutrient availability.

2. It is a “keto” myth that I can eat as much fat as I want and lose weight instead of gain.

Yes. At least, it becomes a myth at some point in your journey. It doesn't happen right away. 

Going "keto" helps regulate blood glucose better. This normalizes insulin function allowing the body to increase its leptin expression and burn body fat. Usually the fatter you are, the better this works. Unfortunately, the fatter you are the quicker it stops working because it's not enough to break the starvation adaptation. That can only occur from sustaining long term proper blood glucose regulation. 

"Keto", as it is followed online, never sustains proper blood glucose regulation in the long term. The diet is too low in protein, too high in fat and restricts the intake of carbs through "carb counting" individual food items, which is not the proper way to restrict carbs. It also usually incorporates "fasting" which is unnecessary as ketogenic protocols already mimic starvation. The massive amounts of fat eaten on this bastardized version of the diet, simply levels out with your weight set point and you remain less obese but obese none the less. This weight stall is when you can see your leptin is under expressed and does not react to the amount of fat you are consuming at all. Instead, it purposely under expresses further from the initial loss of body fat which occurred in the beginning. Worse. This stall also confirms that your blood glucose is not properly regulated. 

I am going to elaborate on this just a little because it is easy to believe two common fallacies when this weight stalling effect takes place:

• Fallacy 1 - The person is consuming too many calories and now they are stalling or regaining weight.
• Fallacy 2 - This shouldn't be happening at all because the thinner the person is becoming, the more fat they should be able to eat as their leptin is improving and their metabolic rate should be increasing.

Well, neither are correct. Fallacy 1 is not what’s occurring for the obvious reasons I have discussed throughout this blog. Fallacy 2 is much more interesting but it is unfortunately not the case for the overweight/obese. In fact, the opposite occurs to them. Weight loss is not making their metabolism work as a healthy person’s would. It is actually doubling down on their tendency to be obese.

Obesity is a starvation adaptation and any challenge to the fat mass reinforces this. This means that their leptin expression continues to be reduced or reduces further as they become lean. Their metabolism will not react positively to dietary fat like you would expect since that's what occurs to a healthy, lean person. Remember how difficult it is for the lean to become fat, especially from dietary fat intake. Well, your weight loss does not make you suddenly obesity resistant like the lean. This is why obesity is a life long problem, even after you become less obese.

This is why concentrating on proper blood glucose regulation, not eating fat, should supersede any other goal because abnormal blood glucose regulation is what set the adaptation in motion. 

3. You should "overeat" protein for extra energy.

The energy in protein is only used for the building of muscle mass. This is why people train for muscle building in a caloric surplus. The overweight/obese, who are not doing any significant training, should stick to their macros.

This is particularly true because most, who aren't athletes, do not know how to consume protein correctly and believe they can get “extra protein energy” by eating rib eyes. That’s not how it works. Protein comes with fat. This is why body builders use protein supplements not rib eyes, so they can avoid the fat.

4. They told me I shouldn't use coconut oil in coffee because it adds extra calories that I might not burn off.

"They" always get it wrong. 

You shouldn't consume coconut oil in coffee because we never evolved to do so. It has nothing to do with calories. The proper way to think about this is as follows - You don't want too much added fat because you most likely do not have suffice leptin expression to burn body fat in response to it. If you don't burn enough body fat, then the added dietary fat will just add to your fat stores.

5. Calories matter especially to an overweight person.

I want everyone to start thinking about obesity in a different way because the traditional way of thinking about it will not help you.

Where calories are coming from matters most, especially to an overweight/obese person because the "where" is what affects blood glucose regulation. You are better able to tackle obesity when you target methods that aren't generalized like calories are but instead target methods that improve blood glucose homeostasis. What, how and when you eat are better strategies for building a proper diet. Remember obesity is not a simple "in/out problem". It’s a very complicated "out" problem. Many factors effect this, not simply the availability of what’s going in and out. You must burn fat, not calories, in order to reverse obesity.

6. I was told that "insulin resistance" will reverse when I become lean. Overweight people have "insulin resistance" due to weight gain.

This is half true. I have explained before how the overweight/obese have a high insulin demand and so they tend to have high insulin levels in order to keep their fat mass locked down. This is only half their problem though as many people who are overweight/obese do not have high insulin levels at all. So it's not insulin levels but insulin function.

Sometimes insulin levels correlate with this dysfunction but not always. The insulin function of the overweight/obese deteriorated first, due to the blood glucose dysregulation most commonly caused by an inappropriate diet. It is this deterioration that now keeps the weight set point high because their body becomes adapted at hoarding fat and preventing the lowering of blood glucose. Now it's like a vicious circle. Diet started the problem and now body fat helps maintain it.

Six common beliefs addressed, Part 169

1. People who have lost a lot of weight are susceptible to weight regain.

Yes. This is the result of fat cell adaptation which affects leptin expression/sensitivity. This is precisely why, I describe people who have lost a lot of weight and are now thin, as still being obese, like myself. I am still obese, and forever will be, even though I lost all of the weight and hit rock bottom at 117 lbs. at one time.

The fat cells of a once obese person, remain honed and primed for expansion and proliferation, long after they have shrunk and decreased. Women are more susceptible to this than men because it appears that their fat cells have a longer "memory". This makes sense because women are much more "anti starvation" than men. They have to be, since they can get pregnant. This means they need added protection against famine.

Fat cell turnover varies and it can take anywhere from five to ten years for these fat cells to completely be replaced. Even when they are replaced, it is uncertain if they ever truly lose their "memory" as they are a product of previous fat cell division. I wrote a more detailed article about this here.

So, do not expect to remain at your lowest weight. Your weight will start going up again after a short time. You will never get back to morbid obesity, as long as you continue following your diet, but you also won't remain at your lowest weight either. The body has mechanisms in place to fight that.

2. If diet and exercise are enough to reverse overweight/obesity, it should always work. 

Correct, but it doesn't because that premise is false. Diet and exercise are not enough to reverse overweight/obesity. That is why it doesn't always work or will work for a while and then stop.

The only thing that reverses overweight/obesity and keeps it reversed is proper blood glucose regulation. How much of it can be regained and sustained is very individualized and this is why you see such varied outcomes in different people, even on the same treatment.  

How much blood glucose control you can regain and sustain is determined by genetics/epigenetics, which affects how the hypothalamic/pituitary/adrenal axis and fat cells function and adapt under certain conditions. Some people have a metabolism that simply does not adapt rapidly to blood glucose disparities. These people remain insulin and leptin sensitive for most of their life, if not all. They are obesity resistant. But the vast majority of people are highly adaptable and their metabolisms adapt quickly to blood glucose disparities, causing an adaptation towards starvation.

That's why, on this blog, we make no promises about diet and exercise. You can only use them in an effective way to keep you as healthy as you can be for as long as you can.

3. I see all kinds of reasons given for weight plateaus but they don't seem right to me. I've seen everything blamed from diary to nuts to meat itself. It's actually very confusing.

That's because it's all crock or rather BS. True plateaus are caused by leptin. Leptin is a starvation hormone. The way it works is a little counter intuitive and this is why there is so much misinformation surrounding it.

Leptin responds to long term nutrient availability. The way it detects this is through several mechanisms, including levels of certain metabolic hormones, primarily insulin. Leptin is suppressed in people who are overweight/obese. Because their metabolism is behaving as if they were starving, leptin expression is down regulated so that it doesn't burn stored fat, but spares it instead. This is why overweight/obese people tend to lose some weight but never get to slim as their weight set point is set to high on purpose. It is set to match their insulin function and glucose regulation. The body is actively preventing fat stores from lowering.

The next question is - Why would the body do this? Because it is simply reacting to dips in blood glucose. Dips in blood glucose signal starvation so the body is sparing fat mass to not starve. The pathology in blood glucose regulation is not in the hyperglycemia, per say, but the adaptation to it, which makes any dip in blood glucose adverse to the body.

So all those silly lists you see claiming to be causes of plateaus and how to "fix it", are total BS. The only thing the items in those lists do is, once again, effect insulin through blood glucose which in turn effects leptin but never profoundly enough to get you to slim. Getting to slim is not done with lists. It's done through a long term, consistent protocol that reverses the pathological adaptation towards obesity by primarily targeting blood glucose regulation.

4. Many people are slim in their arms and legs but have a large belly as if they are putting all of their weight on their mid section only.

This is the typical male pattern obesity. Slim in the extremities and a large, hard belly. This can also be seen in some menopausal women. Accumulation of fat around the mid section is common in metabolic syndrome.

Unless the male is estrogen dominant, testosterone will keep him slim for a long time but once it starts dropping with age, it will diverts fat into the viscera instead of the subcutaneous stores which is where it is suppose to go. That hard belly is simply ectopic fat, which is the most pathological.

5. A lot of low carb followers only focus on a few markers on their blood tests but ignore how fat they still are. They claim that weight can be ignored in lieu of "lower insulin levels" or "lower blood glucose".

Because they are full of BS. On this blog, we do not believe in that. As long as you have excess fat on your body, you are metabolically dysfunctional and at diabetes's door if you aren't already there. Markers such as insulin levels and blood glucose help you determine if you are heading in the right direction but they are not very meaningful as long as you are overweight/obese.

6. My doctor refuses to give me a C Peptide test.

C Peptide tests are usually ordered by an endocrinologist (endo). If you are diabetic, you should be seeing an endo already. If you have thyroid issues, you would be seeing an endo too and they sometimes order a C Peptide test, when you are a first time patient.

It's an interesting test to have but if you were already diagnosed as diabetic, there usually is no need to repeat it as the problem is already known. Many times the person is a full diabetic and still comes back with a normal C Peptide test. For this reason, HbA1C is the test that is most relied on as it's the most accurate for a diagnosis. Everything else is just extra information that cannot be interpreted on its own.

Six common beliefs addressed, Part 143

1. Going into ketosis stops my hunger cues and I begin feeling sick. 

If any diet is making you feel unwell, then you should stop it. I recommend you dump "keto", if that's what you're following, and follow a more moderate low carb diet. It works the same. 

Some people react very negatively to the presence of ketones and so they should never try to sustain ketosis for long periods of time but rather naturally cycle in and out instead. Cycling in and out of ketosis is the natural state we evolved in. This cycling does not require the introduction of any carbs into the diet. It occurs naturally through the adequate consumption of protein. 

2. You can not "overeat" and gain body fat on "keto". 

Ketogenic protocols can be used for weight gain as well as weight loss. Weight gain is much easier to achieve if you are already overweight/obese because of poor leptin expression (leptin resistance). You need to be leptin sensitive in order to burn fat. Fat is the main fuel used in ketogenic diets, whether dietary or from your own body. 

Any diet can cause you to gain weight but "overeating" is too generic of an explanation and might not help you target exactly what's going on. This is because overeating is usually measured using total daily calories. Total calories is a very blunt tool for measuring overeating. For instance, bodybuilders overeat all of the time but they do so in order to gain muscle. 

You can be disrupting your blood glucose without necessarily going over total daily calories. This occurs when the diet is composed primarily of the macronutrients carbs and/or fat, which disrupt blood glucose homeostasis and this shifts your metabolism to where it becomes easier and easier to gain body fat. For instance, high carb diets or high fat diets. 

"Keto" can do just that as it's usually followed as a high fat diet. This is especially true of the fad "keto" we see online that tries to address metabolic conditions with a bastardized version of the classic ketogenic diet for epilepsy. 

3. Should people with thyroid disease fast?

Fasting is not a good protocol for thyroid disease. The longest fast you should do is a 12 hour fast, which would basically only be an overnight fast. 

4. I lost a lot of weight on low carb in the beginning and reached goal weight, but I am now gaining while continuing to follow the same exact diet that helped me lose. 

What has happened is a decrease in leptin expression. This is normal as it occurs to everyone. It is the way that body weight is managed. But it has a pathological effect in people who are/were overweight/obese. 

People who are/were overweight/obese have a very difficult time sustaining leptin expression even when they temporarily acquire it during active fat loss. Once they lose a significant amount of body fat, their leptin expression reduces more than it should and they begin building fat mass once again. 

No one knows exactly why this occurs. It could be a long term adaptation of the fat cells or a defect in leptin communication in the brain itself or both. There is also some hypothalamic/pituitary/adrenal (HPA) axis abnormality that can play a role in this as well. The function of this axis is usually abnormal in people who are/were overweight/obese. 

No one knows how to resolve this. If they did then the problems with weight management would have been solved decades ago. There are a few things you can address to minimize this occurrence and/or prevent significant weight regain. 

• Electrolytes - Make sure that your electrolytes are not going down over time, especially potassium. Imbalanced or insufficient electrolytes can put the body under stress which in turn can ramp up glucose production and begin to interfere with insulin function once again. 
• Diet - Revisit your diet. You might think you are still following the same diet you were in the beginning but you would be surprised how very small changes can begin adding up. These changes usually occur when the person sees they are losing weight or have reached goal weight and they start loosening the reigns of what they include on their menu. 
• Not eating enough - Nothing effects leptin like not eating enough. You can almost describe weight gain from leptin as being under nutrition induced obesity, rather than over nutrition. Make sure that you are eating enough. The amounts you were consuming to lose weight may no longer be appropriate for weight maintenance. Leptin will stop body fat burning if it senses that not enough nutrients are coming in through the diet. If you stop burning fat, you will start seeing the results of its storage. The leaner you are the more calories you can consume from dietary fat. 

Other than that, other changes in your life could have taken place since your weight loss. Losing weight is a long term battle that can take many years, depending on how much weight you had to lose in the first place. This means that if you begin your journey in your mid forties, you might not reach your destination until your early fifties. By then, the natural hormonal changes of getting older will ultimately work against you and effect your results. 

You will also have other health issues that will come up as you get older and more time passes. This might cause you to have to modify your diet or exercise routine, which can effect your previous results. For instance, you might develop rheumatoid arthritis and can then no longer walk the distances you use to before or you might develop digestive issues which can force you to have to modify what you eat. Any of these might cause a set back in your previous achievement. You just have to choose your battles wisely and make sure to stay under obesity. This will always be a never ending work in progress. 

5. You should only eat red meat on carnivore and not chicken. 

Red meat has a better nutritional profile than poultry but poultry is just fine to consume. You don't have to only eat any one meat. You can eat whatever variety of meats you wish to. 

6. It is not difficult to get rid of fat from around the waist because visceral fat is the first to go. 

The waist is usually where subcutaneous fat is also stored. The body doesn't like storing fat on its limbs as this reduces mobility. This means that the waist is up for grabs. We can all reach down and grab some fat from around our middle. This is the normal location for fat storage. 

Women also store fat along the hips, buttocks and thighs because women have a body that is designed for more fat storage. So even if you lose all of your visceral fat, you might still have the infamous muffin top.