Six common beliefs addressed, Part 237

1. Is there a certain daily fat goal I have to reach on "keto"?

No. You have to follow your own individualized macros calculated from a reputable source. This can range anywhere between 50 to 150 grams of fat a day. No more, no less.

2. If you eat too many carbohydrates on low carb, will that cause a weight stall?

If you are following a low carb diet, which has eliminated all sugar and grains, then you will not see any long-term benefit between eating 100 grams of carbs a day or 20 grams of carbs a day. Stop chasing carbs. It's like chasing dragons. You won't reach a magical level of carb intake.

"How do you know this, Gina?" Because countless others have been down this trail before. They continue dropping carbs to try and increase benefits until they end up on carnivore and still fat. You have to understand that most serum glucose is not from dietary carbs, it's from the breakdown of your own lean muscle mass. So, you can drop your carbs to zero and still have enough blood glucose circulating to continue interfering with your insulin function as you keep storing/sparing fat.

Follow a normal low carb diet and address other factors in order to improve benefits.

3. I am diabetic, and peaches are in season. I asked my endocrinologist if I can eat them, and he said yes. He actually said that peaches "prevent obesity and diabetes" and are full of much needed "vitamins and minerals". The only caveat he gave was to just eat one or two whole peaches and not peaches in a can or a dessert. I wanted to double check with you, if that's okay.

This is what occurs when doctors are scared to tell their patients, or anyone for that matter, - NO. There is a big problem in society when people in authority cannot say NO. Well, I'm not in authority and I can easily tell you NO.

The advice your doctor is giving you is for someone who is not diabetic and would prefer they eat peaches rather than candy bars. This is what most dietary advice is based on - less bad, rather than actually good. 

If you weren't diabetic, then I would tell you that a whole peach is fine in season. Only eat whole peaches while keeping the rest of your diet very low in carbs. Only eat one or two peaches as a garnish on a salad or make fresh salsa out of them and never make them into a smoothie or dessert. But you are a diabetic and that changes everything.

"Why Gina? Peaches don't cause diabetes!" That's true but the person with diabetes already has a very high glucose load in the body and they don't need more coming in from diet. For this reason, do not waste your daily carb allotment on peaches. They aren't an ideal carb source.

Peaches do not prevent obesity or diabetes, any more than they cause either condition. The only time peaches can delay, not prevent, obesity and diabetes are when they replace chocolate cake. So, it's the elimination of the chocolate cake that prevents obesity and diabetes, not the addition of peaches. Addition never makes anything better unless you're adding meat to a meatless diet.

Also, peaches do not provide any "vitamins and minerals" that can't be obtained in meat. Every time someone tells you about vitamins and minerals in any plant source, remember that they are also contained in meat and in a much more bioavailable form without the added glucose. If you have doubts, take a supplement but don't use peaches.

4. Do I have to have protein at every meal? I was told that I don't.

You were told wrong. A meal without protein is a carb snack. Not only should your goal at every meal be to get adequate protein for the day but protein is what will create overall satiety and help mitigate the constant break down of your lean muscle mass caused by sarcopenic obesity (metabolic syndrome).

5. I was told that I can have snack foods as a meal, like berries. Is this true?

You were told wrong, just like the person above. A meal is not "berries" unless you're a monkey. Humans require protein and fat, not glucose and fiber. "Snack foods" have no place in legitimate protocols except to be used as garnishes to your main meal. Berries can go over your salad.

The goal of your eating should be to get and remain slim not to get and remain obese. So, every time you sit at the table, you have to ask yourself "Is this food contributing to me being slim or being obese?" Well, bowls of berries contribute to obesity because they are replacing nutrient dense foods that will keep blood glucose stable and satiety hormones balanced. It is also contributing to bad eating habits as sitting around eating snacks is not a proper way to eat. Stop eating just to eat. Eat like you mean it. Don't waste your mealtime with nonsense.

6. Are grain less tortillas okay to eat? My son is slim so I don't see how they could affect him. They are "gluten free".

Okay, here we go. There are three issues with this question, and it goes back to misunderstanding what obesity is and its causes. Let's break down this question and digest each part individually.

First, "grain less" tortillas are irrelevant for the treatment of overweight/obesity and metabolic syndrome. This product would only be useful for people who have celiac disease or some other condition that makes them allergic to grain proteins. Other than that, the effect they have on the overweight/obese is the same as if they were made of grains.

"Grain less" is still carbs. The effect on blood glucose is the same. You are wasting your money on an overpriced product that is the same to metabolism as if they were made of corn or wheat. If you're going to ruin your metabolism regardless, you might as well do it with the cheaper alternative of corn or wheat because you will need to save money for medical bills. They will also taste better as there's nothing like the real thing, baby.

Next, slimness does not equate to proper blood glucose control. You can be thin as a rail and still have blood glucose disparities while consuming "grain less" tortillas. There are plenty of skinny people who have metabolic syndrome and/or diabetes without ever becoming significantly fat. This shouldn't be surprising as you shouldn't be consuming any tortillas. I don't know why people equate "thin" with metabolic health because they don't go hand in hand. I know that people with metabolic syndrome/diabetes are usually overweight/obese, as the gaining and sparing of body fat is a common symptom of these conditions, but it is not necessary to be overweight/obese to be metabolically unhealthy.

We were all thin once. If you want to break your son's thinness, then feeding him grain less tortillas would be a good way to get the ball rolling and have him developing man boobs by the age of thirty. Being thin is not a pass for eating junk that causes metabolic pathology. The rules apply to everyone, fat or thin, when it comes to tortillas. This isn't a journey to metabolic health for the obese blog. The advice and information I provide is not specific to the obese only.

Finally, "gluten free" is meaningless for the prevention of overweight/obesity/diabetes. Like I mentioned above, gluten is only of concern for people with celiac disease or some other condition that causes an allergy to grain gluten, which is basically a fancy term for grain proteins.

You have to ditch the tortillas, grain less or not. They aren't necessary. Don't teach your kid to eat novelties. It's not a good habit to have. Once bad habits are carried into adulthood, they become very hard to break.

Six common beliefs addressed, Part 236

1. I recently opened a Facebook diet and exercise page which focuses on low carb dieting. The problem is that most of the memberships it's gained so far appears to be seniors. That is not exactly the type of crowd I wanted to attract as I don't believe I can be of much help. Why does "low carb" attract so many elderly and/or very obese people? If my page would have been focused on mostly exercise or conventional dieting, I am sure I would have attracted younger and more motivated people. These elderly/obese people are on dozens of other "low carb" pages, aside from mine, and I don't see many positive outcomes. Am I wrong for feeling this way?

This is the result of several things. First, Facebook is a platform that has been attracting an older crowd for a while now so if your page is being hosted on there, then you might want to go elsewhere if that's not your target audience.

I don't believe you are wrong for feeling how you do. I understand your concern. You might feel as if you are wasting your time trying to help such sick, obese and older people, especially if you are doing this for free to just get info out there. A lot of these people are into "page surfing" but won't really put in any work to gain results. They are just searching "feel good" information that helps ease their anxiety about their failing health. As long as they feel there is "something out there" that can "help" they think they have done something.

I have discussed many times how overweight/obesity/diabetes are time dependent conditions. The longer the person lives with these issues, the less likely they are to reverse them. They might be able to improve some things, but they won't be able to achieve true remission. There are just too many obstacles they will face - natural insulin resistance, hormones, loss of muscle mass, inability to do enough exercise, co-morbid conditions, intractable metabolic adaptation, etc.

In other words, if you want to maximize the rate of success, your target followers should ideally be between 30 - 55 years old. Once you start going beyond that, the rate of success drops significantly. Younger than 30 years old is a breeze unless there is some underlying eating disorder. Of course, prevention has the best outcomes but yet is often neglected.

Aside from the biology, there's the old adage of "you can't teach an old dog new tricks" and nothing can be truer when it comes to lifestyle changes. A lot of these older people are just looking for a magic pill, so they gravitate to protocols that replace carbs with fat or don't push them to get up from their recliners. We know that doesn't work. Elimination diets that require movement are very difficult for them to adhere to as they are inclined to continue with what they are familiar with. They are also reluctant to give up certain habits or food items they are used to, so they insist on keeping them in their new diet despite the hindrance in results. It's very frustrating.

All I can advise you is to either leave the Facebook platform or present a protocol that will naturally cause those who can't follow to drop it on their own and go elsewhere. That will happen automatically with your first exercise post or at the first mention of moderating fat intake. When someone asks you a question, just be upfront and honest with the answer instead of trying to find ways to "please" them. This will automatically thin the herd for you. Remember the majority of these people just want hand holding, excuses and sympathy. If there are none of those available, they will leave and seek it elsewhere which is exactly what you want.

2. My endocrinologist spoke about protein spiking glucose, and he said it was due to gluconeogenesis. He was very vague in his explanation, and I didn't quite understand it. He said that the amount of protein eaten in the US is "astronomical" and that the best way to handle this is through "portion control" but didn't specify how. He also showed a chart of blood glucose slowly creeping up with protein intake, hours after eating, which isn't what's happening to me. My protein spikes right after eating protein like it would carbs. Can you give more insight on this?

I have mentioned this before, many times, but I will address some key problems you mentioned.

Your doctor is correct. This is caused by gluconeogenesis "gone wild" known as hyperglucagonemia. In other words, the Type II diabetic does not have enough of a postprandial insulin spike to halt the catabolic effects of glucagon, so it breaks down too much glucose into the bloodstream. This can cause postprandial hyperglycemia for some hours after eating.

The same effect occurs to Type I diabetics because they have no insulin to halt glucagon so they must dose exogenous insulin to match carb and protein intake. Type I diabetics cannot resolve this without exogenous insulin. Their bodies will not magically correct this problem with diet over time. Type II diabetics can reverse this with diet over time as they regain insulin sensitivity which corrects their first phase insulin response.

But there are some issues with what your doctor said. First, the amount of protein eaten in the US is not "astronomical" at all. In fact, the US is protein deficient in its diet as is the rest of the world. The Standard American Diet (SAD) is not even adequate in protein, much less astronomical in it. But it is astronomically high in carbs and fat.

Second, your doctor is describing hyperglucagonemia as if it is a protein induced condition because of the "astronomical amounts" of protein eaten in the US. That's simply hogwash and will only cause his patients to become further protein averse causing increased protein deficiency and worsening of diabetes. He needs to get his stats correct.

Hyperglucagonemia is the result of metabolic syndrome/diabetes, period. In other words, poor insulin function due to insulin resistance. It is not a "protein disease" or a "carb disease". It is a pathological metabolic adaptation which was initially, most commonly triggered by the postprandial hyperglycemia of a high carb diet, not protein.

The chart he showed you of blood glucose slowly rising hours after protein intake is a little strange. Hyperglycemia occurs pretty quickly postprandial as you described it's happening to you. The person eats protein and when they check their blood glucose, two hours later, it's high. The effect is the same as with carbs. The only difference is that blood glucose usually does not rise as high with protein as with carbs and tends to lower sooner than it would with carbs as carbs interfere with blood glucose regulation for a longer period of time due to the added glucose load. That's why Type I diabetics dose insulin when they eat. They don't dose it hours later. They need to halt glucagon postprandial.

So, the chart he is showing you seems to be the effects of stress hormones during fasting, or what would be considered "Dawn Phenomenon". This has nothing to do with protein intake. This is counter regulatory hormones, mainly adrenals (stress), being triggered by a natural lowering of blood glucose in the presence of insulin. It's basically an adverse reaction to fasting.

Remember, metabolic syndrome/diabetes is a condition where the body actively tries to stop the lowering of blood glucose. So, the minute that begins to happen, during fasting, stress hormones pump out more blood glucose. I have no clue why your doctor is attributing that to protein, but you know how it is. Protein gets blamed for just about everything. But these are two different counter regulations to insulin.

Third, this "portion control" he's talking about is very vague and it's no wonder you were left confused. "Portion control" doesn't have anything to do with controlling diabetes. Ice cream is still ice cream, even at the right portion. I get the feeling that this is the type of doctor that blames overall calories for diabetes which is usually the case in conventional medicine. It's just not true.

Diabetes is poor glucose regulation of which carb calories are the culprit. If it wasn't for the disparities in blood glucose highs and lows caused by carb calories, there would be no diabetes. High insulin alone doesn't cause diabetes. High blood glucose alone doesn't cause diabetes. High body fat alone doesn't cause diabetes. Disparities in blood glucose highs and lows results in diabetes and that leads to high insulin, high blood glucose and high body fat which in turn exacerbate the condition and keeps it going.

Portion control will help you maintain a good insulin to glucagon ratio reducing disparities in blood glucose highs and low but not portion control of everything. You need portion control of only certain things. Like I said above, ice cream is still ice cream, and it will cause disparities in blood glucose even at the right portion. So, you want to eliminate ice cream and all carbs. There is no right portion for them. Then you want to divide your protein intake in order to not disrupt your insulin to glucagon ratio. I use Dr. Bernstein recommendation for this, which is:

• A recommended minimum daily consumption of 1.0 - 1.2 grams of protein, per kilogram of ideal body weight, for adults. You divide that amount into three meals as follows:
• Breakfast: 6 grams carbohydrate, 3 ounces protein.
• Lunch: 12 grams carbohydrate, 4 ounces protein.
• Dinner: 12 grams carbohydrate, 5 ounces protein.

3. Is Paleo a good protocol to follow? My mother-in-law follows Paleo and was able to drop her diabetes medications. I was thinking of doing the same thing to try and better my own health.

Yes. Paleo is a good protocol if followed correctly and without the concessions. Unfortunately, like most diets, many iterations of Paleo try to appease their followers with substitutions, recreations, alternatives, etc. of Standard American Diet (SAD) staples.

Stay away from "dessert centered Paleo". You never want to follow any protocol that makes excuses for its followers and allows them an exit. It may help them make more money, but it will only help you remain fat.

If you look at "paleolithic" art on cave walls, it tells you exactly what to eat. In fact, those cave paintings are basically a recipe book. This has caused for naysayers to criticize Paleo for not truly being "paleo". Paleo is just the name of the protocol and doesn't mean you will be eating truly as a caveman would since those times are long gone. Instead, Paleo is basically a meat and vegetables diet that eliminates all sugar and grains, but it is not exactly a "low carb" protocol. This is why I don't feature it in 'Recommended Diets'.

Paleo is primarily focused on whole, unprocessed foods, sort of like "going back to basics". So, what are the pitfalls of Paleo?

• Paleo allows honey and/or maple syrup which is a no-no. You never want to incorporate either, in any amount or form, into your diet. Sugar by any other name is still sugar. A lot of Paleo protocols use these sugars way too often simply to entice people to try the diet. Don't fall for that trick. Anyone who is trying to treat overweight/obesity/diabetes or does not want to have to treat them in the future, should not be consuming honey and/or maple syrup, no matter how "natural" they are.
• Paleo also allows root vegetables. If you are diabetic, you might have issues controlling your blood glucose if you include these so you should eliminate them until your health improves. Even then, they should always be restricted and never the main meal. All vegetables are only complimentary to meat. Keep your focus on protein.

4. Is it true that being fat by itself does not cause diabetes?

This is another "word play" type of question. I can understand how people become confused. This word play is used to keep the confusion going. Let me explain.

Being fat puts you at risk for diabetes because excess body fat is a signal/marker that there is something interfering with your metabolic homeostasis, and this will eventually lead to pathology. This is why the reduction of body fat is vital for remission as it means that metabolism is finally doing what it's supposed to. It's not the loss of body fat itself that causes benefits, instead it's the ability for your body to do so. Being able to lose body fat, means your metabolism is improving.

This is true whether the excess body fat can be seen externally or not. Some people appear thin on the outside but are actually very fat on the inside. This is because having a high body fat percentage does not always translate into the appearance of "fat". You can appear thin and still be mostly fat. This is why there are skinny Type II diabetics. But things are not quite that simple as there is more to this story. It's all about why you are getting fat rather than just being fat.

Diabetes is the end result of poor blood glucose regulation. Basically, the body can no longer properly control its blood glucose. This is most commonly the result of a poor diet that interferes with proper blood glucose regulation, but other things can also interfere with blood glucose homeostasis like certain chronic medical conditions and/or medications. Also, let's not forget caffeine. This stimulant is notorious for interfering with blood glucose, and it is hidden in many things that are consumed liberally in the modern diet.

Improper blood glucose regulation is the machine that causes weight gain through the increase and sparing of body fat specifically. Having high body fat further disrupts blood glucose regulation because it places a high insulin demand on the body. If your insulin is running too high and/or is over expressed, you will not be able to control your blood glucose properly.

So being fat, per say, does not cause diabetes. It is a marker that metabolism is headed in the direction of diabetes, and this is why being overweight/obese tracks closely with an increased risk of diabetes. Also, this is why lowering blood glucose, while remaining fat, will not stop diabetes. The only way to actually know you are fixing your damaged metabolism is when you start losing body fat.

So, don't let anyone tell you that being fat does not cause diabetes because it is actually the beginning stage of diabetes. But also, don't let anyone tell you that being fat alone causes diabetes because the actual culprit is the blood glucose dysregulation which is triggering the accumulation of fat to begin with. Do not miss the forest for the trees.

5. I have heard you mention that metabolic syndrome/diabetes are not "carbohydrate diseases" but yet carbs are what caused this process to occur.

I am reluctant to describe metabolic syndrome/diabetes as "carbohydrate diseases" because it is hyperbolic and doesn't help solve the problem one iota. In fact, it causes more harm than good. All you will get from it is obese people talking about how "Kellogg's is the devil" while still not losing a pound. Blaming carbs in this way causes several misconceptions which we see rampant in the low carb community today:

• It gives the impression that carb elimination will magically cure diabetes. It doesn't.
• It causes the belief that fat is benign and can be eaten ad libitum, safely replacing carbs. It can't.
• It creates the false assumption that nothing else has to be done besides the elimination of carbs from the diet. That's wrong.

All three of these notions set the stage for failure and worsening of overweight/obesity/diabetes over time without the person even being aware as their nose is plastered to their postprandial blood glucose after consuming one pound of bacon. That's why we see so many obese diabetics counting the carbs in a pimento or continually struggling to keep their hyperglucagonemia and Dawn Phenomenon under control to no avail. That's when they turn to protein restriction as well until there is nothing else left to restrict but fat and that doesn't help either. Back to Victoza.

But you are correct. Carbohydrate consumption is the most common cause of the initial condition (blood glucose dysregulation) which resulted in these pathologies, but it wasn't all carbs. Chronic and high consumption of sugar and grain based carbs specifically, are the true culprit.

When I say "high" consumption, I am not talking about "excess calories". I am talking about a macronutrient profile where carb calories dominate all other macronutrients irrespective of total calorie amounts. In other words, you can remain at your daily caloric requirement and still have a high carb diet because it is a diet where carb calories make up most of those total required calories. This causes illness over time unless some form of strict and chronic starvation is applied. You can be aware of all of this while also still being aware that metabolic syndrome/diabetes are much more complex conditions than just carbs as the story does not simply stop there.

Once this metabolic adaptation begins, the elimination of carbs is only a palliative treatment and much more than that has to be done to achieve remission.

6. Is it true that if you eat too much fat, you won't burn your own body fat causing a weight stall?

Ugh.... yes, but no. I know that these statements are repeated often but there's important nuance absent from them.

You cannot burn body fat without proper leptin expression regardless of whether you eat 0 fat a day. No leptin, no fat burning. Thin, obesity resistant (leptin sensitive) people can consume astronomical amounts of fat and burn it in a day and then some. Why am I saying this? Because I want people to understand that all body fat is mitigated by the state of your neuroendocrine system, not through nitpicking your diet constantly.

So, the correct idea is that if you are overweight/obese, you are most likely "leptin resistant". This is especially true if you cannot lose weight and/or suffer weight stalls and/or weight regains. You want to avoid excess dietary fat because you don't have enough leptin expression to burn it. That's the sole reason why you want to avoid it not because "eating too much fat prevents your body from burning its own". That's not correct. Fat consumption isn't what's "preventing" this. Poor leptin expression is, so you end up storing dietary fat on top of what you already have stored. It's Leptin. Only leptin.

"Gina, why is this so important to point out?" Because overweight/obese people will begin lowering their dietary fat to zero and still be fat. Then they will wonder what's happening, once again. It seems like overweight/obese people are constantly being directed into these endless mazes, by diet mongers, where they are told to eliminate this, restrict that, all to no avail. It doesn't matter how much they run in the maze, they never achieve results because they are being led wrong. The maze has no exits. It's a trick bag.

Yes, the thinner you are the more fat calories you can consume. Yes, the fatter you are the less fat calories you can consume but this is mitigated by leptin. What improves leptin expression? Not low fat, I can tell you that much. But these things do:

• Exercise. If you are overweight/obese and aren't eating excess dietary fat but still can't lose a pound it's because of poor leptin expression due to the fact that you aren't moving. Without exercise there is no leptin/adiponectin homeostasis.
• Insulin. Leptin is a slave to insulin. If you have not yet been able to properly regulate your blood glucose, then your insulin expression is also abnormal. This will only allow metabolism to continue on its trajectory of storing and sparing excess fat.

Six common beliefs addressed, Part 233

1. I have been following a protocol that has been able to get my weight to the lowest it's been in years, but I am still obese. I am also stalled. I need something to get me "over the hump" and "jump start" the weight loss again. 

There are no short cuts for getting "over the hump". The only way over it is to continue going.

When you find a protocol that has helped you lose weight, you have to stick to it and not jump around to something else. Jumping around will only reverse whatever progress you have made so far. Weight naturally stalls at intervals as it's being lost. This is the normal function of leptin. Doubling down will only cause this natural stall to be reinforced and become prolonged.

Also, small fluctuations in weight are not an indication of progress or failure. When losing weight, you have to look at overall, long term trends. This is why we don't recommend "daily weigh-ins". You check your progress once a month, at most.

2. I have lost weight following a calorie centered protocol but stalled. My coach told me to increase calories but that will only make me gain. I like the menu and don't want to change it, but I feel like I shouldn't add. I would feel safer "subtracting" instead. 

Usually, the coaches that run calorie centered protocols are full of BS but in this case, your coach is actually right on the money. As you lose weight, you should increase your calories to prevent weight regain. You cannot continue on the same calories that you started out with.

Calorie centered protocols, like all protocols, must change with weight change. Stalls can easily become weight regains on calorie centered protocols if these adjustments aren't made. Your coach seems knowledgeable about this effect and is trying to prevent it. That means they are aware of leptin and how it works. You don't need to "add or subtract" anything. What you need to do is trust the process and keep to the calorie goals that your coach has advised you on.

3. I was told that there is a way to increase lean muscle mass and lose body fat with no change in diet or lifestyle.

That's an obvious scam. When anyone tells you that you can achieve anything without putting in any work, they are obviously lying to you. If that was truly the case, then you would have already put on lean muscle mass and lost body fat doing what you are currently doing - nothing.

It’s hard to believe that with everything that’s currently known about overweight/obesity people are still being duped into "diet" and quack programs.

4. I had blood tests a week apart, from different doctors, and the first test had my triglycerides (trigs) at 133 and the other at 150. I am on a calorie centered protocol where my two main meals basically equate to about a quarter pound of meat and one pound of vegetables. I am still obese but have lost some inches and pounds. I am now fluctuating up and down the same pounds every week as I'm stalled.

Let's go through some issues I see here.

First, you need to tell, whichever doctor you see last, that the previous one already ordered the same blood tests for you so they can get the results from those. You never want to take the same blood tests back-to-back, because it will create conflicting results. This is especially true if each doctor uses a different lab and the tests being ordered are for things that naturally fluctuate on a daily basis like trigs, insulin and blood glucose. Take to your doctor the result of one blood test. It's ridiculous that they would make you go through the wringer twice for the same exact test. You're the one getting poked.

Aside from that, there isn't much of a difference between 133 and 150. It is totally irrelevant so there is no need to get caught up with minutia. The only relevancy in both of these readings is that your trigs are high. They aren't incredibly high, but they are higher than they should be. This is typical of high body fat but also the diet you are following.

One pound of vegetables is basically one pound of carbs. Carb centric diets tend to increase trigs. Since the protocol you are following is also calorie restricted, then I am sure it is low fat to boot. So, it should not be surprising that your trigs are higher than they should be. When you starve, you release trigs.

The only diets that drop trigs are very low carb diets like "keto". High carb/low fat diets increase trigs and decrease cholesterol while low carb/high fat diets decrease trigs and increase cholesterol. You can't win for losing so you are only left to mitigate your losses and focus on your goals. If a healthy metabolism is your goal, then it is more metabolically sound to have high cholesterol than high trigs. High trigs are really bad. High cholesterol, it depends.

High trigs are not indicative of weight loss on the type of protocol you are following. In fact, high trigs are generally not indicative of any weight loss. I lost all of my weight and my trigs never went up once. But if you were following "keto", then I would have advised you to keep an eye on the downward trend of your trigs if you were actively losing a significant amount of weight. Since then, you could make an argument that the temporary high trigs are caused by a liver dump of fat, but you aren't following "keto" and you aren't losing a significant amount of weight. So, neither applies to you.

Seesawing up and down a few pounds every week, is not significant weight loss. In fact, it's active obesity. You yourself admitted to being stalled.

So, I wouldn't worry about these trig results. They aren't astronomically high and the difference between the two readings is insignificant. The tests were also not properly done. You are obviously following a diet that you can sustain and has gotten you some results so just continue with what you're doing.

5. I have end stage kidney disease. My doctor told me to limit the amount of protein I consume but an online "low carb doctor" told me to eat all the protein I want. I don't know what to do.

You need to follow your doctor's orders. You are his patient. He has seen, examined and diagnosed you. No one online, even if they have a medical degree, can diagnose or treat you without seeing you in person. So whatever low carb doctor told you this, should have his license taken as what he is doing is unethical and illegal. Why you would even consider following the advice of someone online, who you haven't even met for a condition this serious, is beyond my comprehension.

Consumption of protein does not cause kidney disease but for people who already have kidney disease, protein consumption can add an extra burden on their already failing kidneys. There are studies that haven't shown any benefit in the reduction or elimination of protein for kidney patients but why take that risk when we know the biological mechanism of how the kidneys handle protein metabolism? I personally wouldn't. End stage kidney disease is nothing to play around with.

6. Sugar and "junk food" the only things that cause diabetes.

Wrong. Anything that disrupts proper blood glucose regulation can end in diabetes. What "causes" diabetes are large disparities between blood glucose highs and lows. In other words, between postprandial and fasting blood glucose. Postprandial blood glucose is affected by carbs in the diet and fasting blood glucose is dropped by an over expression of insulin in response to the postprandial blood glucose.

Sugar and junk food aren't the only things that can cause this disparity. "Healthy" foods like grains can cause it too, particularly in modernity where there is no forced, long term, chronic calorie restriction. Lack of exercise also eventually causes this disparity, because it disrupts metabolic homeostasis. Chronic conditions and medications can too. Sugar and junk food can accelerate the process, but as you can see, they aren't always the only cause.

Six common beliefs addressed, Part 210

1. Bariatric surgery should never be pursued.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

People who have:

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

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

Six common beliefs addressed, Part 181

1. On “keto” you have to stay under a certain amount of protein macros and you should do the same on carnivore. 

On a classic ketogenic protocol, for the treatment of intractable epilepsy or neurodegenerative conditions, protein macros are monitored and kept under a certain amount to minimize the body converting protein into glucose, a completely natural and normal process that is highly regulated. Since chronic ketone presence is a strong signal to the body that it is "starving", it tends to ramp up its stress response and convert itself and everything that's eaten into glucose at a higher rate than normal. This stress response will reduce ketone production.

The people on classic ketogenic diets need ketones because that's what they are forcing their brain to use for fuel in order to prevent symptoms. This is precisely why classic ketogenic protocols need to be monitored by a healthcare provider to ensure that the person does not lose lean body mass, develop a deficiency and/or gain weight. Classic ketogenic protocols are not only protein restricted but calorically restricted as well. They are very difficult diets to follow without professional guidance.

Ketogenic protocols for the treatment of overweight/obesity and/or metabolic dysfunction do not restrict protein. These diets induce ketosis through the severe restriction of carbohydrate. Protein macros are followed to ensure you are getting enough protein, since most people do not.

The reason protein does not have to be restricted is because protein is not a macronutrient of concern as it is not the cause of overweight/obesity and/or metabolic dysfunction. Having chronic ketone presence is also not the goal of these protocols because lack of ketones is not the cause of overweight/obesity and or metabolic dysfunction so their presence is not the cure.

Now a lot of people tend to take this information to mean they can eat all the meat they want, since it’s "protein" but meat is not just protein. It is also fat. For this reason, though protein on its own is not restricted, protein as meat is, since you can easily go over your fat macros depending on the type and cut of meat you are consuming. You have to calculate the protein to fat content in your chosen cut of meat when following carnivore, to ensure you are getting enough protein and not too much fat.

2. Too much protein will stall weight loss.

There is no such thing as "too much protein" but there is such a thing as too much fat, which usually comes with the protein. For this reason, you have to make sure you track your macros carefully and stick to your fat macro allotment.

People with metabolic syndrome who have hyperglucagonemia make a lot of sugar after eating anything, including protein, which could stall their weight loss for a period of time until this condition normalizes. This condition only normalizes once you can regain insulin/leptin sensitivity and function. Restricting protein achieves neither.

3. Red meat "stays in your system" for 2 weeks.

False. The body uses protein to build itself, so technically meat "stays in your system" until you are dead.

4. Some low carb doctors discuss cancer because some of their patients have gone into remission. 

No one knows exactly what causes cancer to go into remission or why remission occurs to some people and not others. So far, studies suggest that a person’s initial immune response, to the cancer, has a lot to do with their remission outcome.

Many conventional doctors have had their patients go into remission. In fact, the bulk of cancer patients in remission have done so using conventional treatments. Anyone can go into cancer remission and anyone can also die from cancer. Like I mentioned above, your immune response appears to be the main determiner of this and you have no control over it.

As of this post, no cure for cancer has been discovered. We know of some risk factors for certain cancers but, again, they have not been proven to be linearly causative. So a low carb doctor boasting that he has some cancer patients in remission is completely meaningless as any doctor can boast that.

5. "Certain bacteria” causes obesity.

No. What causes obesity is not a mystery. It is well known that obesity is caused by metabolic dysfunction through blood glucose dysregulation which ultimately deteriorates insulin function and leptin expression. This not only leads to overweight/obesity but eventually to diabetes. The accumulation of high body fat, caused by metabolic syndrome, is the result of a complex hormonal interplay exacerbated by certain lifestyle factors, of which there are many.

So, the debate as to what causes obesity has long been settled but for some odd reason, it appears to not have reached the masses. Very few people understand obesity, which is a shame considering that obesity is now at epidemic levels. You can not treat what you don’t understand. I believe it is this lack of understanding that has allowed obesity to spread, unabated, and made it easier for charlatans to sell you “magical cures”.

What hasn't been settled with obesity is its treatment. This is because of the complex hormonal interplay, which I mentioned above, which is extremely difficult to reverse. This is because obesity is a metabolic adaptation and not a real “disease” so there technically is nothing to "cure". Your body is doing exactly what it's suppose to do under the conditions it's been subjected to.

There are microbiome changes seen in the overweight/obese and this is mostly related to diet type and immune function. High body fat affects the immune system. But no, bacteria itself does not make you obese. To be obese you need poor functioning and abnormal insulin which affects leptin expression and in turn deteriorates proper metabolic function over time.

6. The American Diabetes Association (ADA) refuses to tell people that they can “reverse their diabetes”.

This is because, as of this writing, there is no “cure” for diabetes. The ADA has a lot of issues in its organization but quackery isn't one of them. The most the person with diabetes can hope for is remission but long term remission has still been difficult to acquire for most.

I am sure that you may have heard a low carb doctor say he can "reverse your diabetes" but he simply cannot. He can only lower your blood glucose but so can I. On this blog, low blood glucose is not reversal of diabetes. That is the mistake conventional medicine makes when they diagnose diabetes with simply high blood glucose. Their treatment, which is to lower your blood glucose, hasn't really made much of a difference has it? Of course not. That is because diabetes is not a disease of high blood glucose. This means diabetes reversal is not acquired through lower blood glucose.

We stay away from the blood glucose seesaw on this blog. Diabetes is a very complex metabolic dysfunction that involves multiple energy regulating systems in the body. It is extremely difficult to put into remission so avoiding getting diabetes, in the first place, should always be the first course of action. This is why you are never too healthy to follow a healthy lifestyle.

Six common beliefs addressed, Part 177

1. If you eat protein, without a lot of fat, it causes metabolism to stall.

Negative. As long as you are getting suffice calories, metabolism does not stall. In fact, during "rabbit starvation", metabolism keeps tracking along, completely depleting your body fat, until you die, with no slow down. This is precisely why diets like protein sparing modified fasts should not be followed by anyone with a low body fat percentage. As long as the body is getting enough protein, it continues burning through body fat. So, I don't know where these people get this stuff from. The only thing that causes "metabolism to stall" is leptin.

Protein prevents metabolic slowdown. The body recognizes its calories. The body just refuses to store the excess and refrains from using it for energy. This is because protein is extremely valuable as it is needed to rebuild your cells. Also protein increases metabolic rate, more than any other macronutrient, through the "thermic effect of food" as breaking down protein requires 20 - 35% of the energy consumed and because it takes a while to break down, it continues to keep resting metabolic rate high.

Now that we have cleared that up, it is extremely difficult to follow a diet that is mostly protein with very little fat, so no one is at risk of "rabbit starvation". The only way to accomplish that is to eat very lean, wild game, and nothing else, for a prolonged period of time. The alternative would be to live off whey protein powders, and eat nothing else, for a prolonged period of time. You also have to start out with normal to low body fat. No one eats this way and most people do not have normal to low body fat.

If you are eating farm animal meat, even if you do not add any fat to it, it will never be lacking in fat. Ever. So this is a moot subject matter.

2. My own N=1 tells me that it’s possible for "some" Type II diabetics to achieve "normal blood sugars", with no medications, by following a very low carb diet.

You aren't saying anything new. Everyone knows that a low carb diet is a palliative treatment for diabetes and can therefore lower blood glucose. Lower blood glucose does not mean "normal blood glucose". Lower blood glucose also does not mean your diabetes is "cured" as diabetes is not a disease of high blood glucose. It's a condition of poor blood glucose regulation.

The only diabetics that can achieve normal blood glucose by lowering it are Type I diabetics. Once Type I diabetics find their proper insulin requirement and maintain it through a supportive diet, they can achieve completely normal blood glucose regulation. This is because the only issue that Type I diabetics have is a lack of insulin. Once that's corrected, the problem is solved. Type II diabetes is not Type I. Type II diabetics have insulin resistance so they cannot achieve proper blood glucose regulation by merely lowering their blood glucose or dosing more insulin. This blog's focus is only on Type II diabetes, not Type I.

The fact you had to mention that "some" Type II diabetics see a benefit through diet is very telling. If some and not all see benefits, then it means another mechanism is at play besides diet. This is why your doctor does not promote any diet as a possible "cure" for your "disease".

3. If I want to lose weight, I need to not eat carbs. 

Incorrect. You can still lose weight while eating carbs. It's called caloric restriction. This will only work in the short term and the weight lost will not be body fat.

4. Depending on low carb to lose weight is "magical thinking".

Depending on anything besides leptin, for the loss of body fat, is magical thinking.

5. Dr. Spencer Nadolsky's approach makes sense.

Nadolsky's popularity has been gaining momentum as more and more people jump ship from the sinking low carb cruise, that was driven into an iceberg by the obese, and quacks who overtook it. But leaving one charlatan to follow another is not going to help you.

Nadolsky doesn't have an approach. He is a walking contradiction and all you have to do is read three of his posts to come to that realization. He doesn't know what to advise because he doesn't have a clue about obesity. He is just throwing as much crap as he can to see what sticks. That's his con. It allows him to not have to stand behind anything he says. Jack of all trades and master of none.

Nadolsky is a big calorie in/calorie out (CICO) proponent who insists that overweight/obesity is very difficult to tackle, yet it is as simple as sustaining a caloric deficit. If you think that doesn't make any sense, then try to decipher his other popular beliefs:

• Overweight/obesity has to be treated with a lifestyle approach even though calories are the main determiner of your weight.
• Carbs have nothing to do with weight loss even though macronutrients do change body composition.
• Sugar is absolutely benign even though he doesn't recommend it.

This goes on and on, in every one of his posts, with the occasional corny meme thrown in for comedic relief. They aren't needed. The content is comedic enough.

Don't get sucked into that BS storm. Leave these doctors, coaches, program directors, dietitians, etc. alone. Go directly to obesity research studies and not to crack pots. None of these people has been able to put a dent in the obesity epidemic and they have been trying to for decades. This guy is saying nothing different than all the others who came before him. Remember, they all only get richer while you get fatter.

6. Weight loss should be the least benefit you get from ketosis.

No. It should be the main benefit you get from ketosis. On this blog, the main objective for bettering metabolic function is weight loss, exclusively body fat loss. If you are following a ketogenic protocol, for the betterment of metabolic function, and it is not producing fat loss, then you need to find another protocol.

Six common beliefs addressed, Part 174

1. People say they love "keto" because they can "eat as much as they want". 

I hate to be sarcastic but that's not surprising. Like I have said before, behavioral issues go hand in hand with obesity as much as biological issues do. Obesity is a mind/body problem.

That is not the correct way of following the diet or any diet for that manner. You cannot solve obesity with the same behaviors that got you to it but the reality is that many of these people will remain obese on "keto" and they won't care because their HbA1C dropped three points.

2. My blood glucose is still in the 200 mg/dL on carnivore but I fast for 16 hours. Does this mean I need to fast longer?

No. If you fast longer you will increase this problem over time, regardless of any short term benefits you might see. You are a full blown diabetic and your blood glucose is being driven primarily by an adrenal stress response, not the individual foods you eat.

The only thing you can do is mitigate this stress response by getting rid of every little thing that can contribute to it, incrementally, in order to try and get it under control. Each little thing you address will help cause a cumulative effect to try and drive down this stress. At least, that's the goal.

I recommend you drop carnivore. It is exacerbating the stress response but since I don't know your exact protocol, I can't tell you why. There are a multitude of ways you could be doing this diet incorrectly. Carnivore diets are very difficult to follow. For that reason, you shouldn't follow them at all, if they aren't producing significant results. 

• Go to a basic, low carb diet, Atkins style instead.
• Stop the fasting. Ditch the 16 hours and go to a 12 hour fasting schedule instead. This means you should be eating three meals a day. Do not snack.
• Make sure you do not over exercise but you still exercise. Exercises that are steady state, low to moderate intensity, like walking, are best as it helps to mitigate stress hormones.
• Also, keep your eating, fasting and exercise schedules consistent daily, with no deviation.

3. I am very cold when I fast. The longer I fast, the colder I get. 

Your metabolic rate is dropping and you aren't burning any body fat. You are only further disrupting leptin expression and thyroid function. And no, iodine will not save you.

It is mind boggling how people will insist on doing something, that is not only failing, but making them feel like crap to boot.

Shorten your fasts to only 12 hours a day, basically an overnight fast. Eat three meals a day with no snacks in between. See if that helps.

4. "Keto" will help change your relationship with food.

No. Your relationship with food has nothing to do with what foods you eat, but how you eat. Many people bring the same eating habits into their new diet which they carried over from the past one. "Keto" is a protocol that helps address the symptoms caused by metabolic syndrome. It addresses the biology but not the behavior.

5. The body will get use to a consistent fasting schedule and this will cause a weight loss stall. You should always "change it up" instead.

The body always compensates to calories coming in. This is why you need to avoid long fasts as they technically cause the same problems as caloric restriction since that's basically what long fasts are - a method of restricting calories (starvation). "Changing it up" is not the solution for this.

The body does not "get used to your fasting schedule". It gets used to fasting, period. That is why fasts have to be of short duration so that this adaptation does not occur.

6. Stress responses do not change over time.

They absolutely can. Losing a lot of body fat can trigger an abnormal stress response while keeping it on does the same thing. We usually only think of stress responses in the context of diabetes and metabolic syndrome but the cure to these problems can induce a stress response as well.

Some people see their blood glucose begin to rise as they lose more and more body fat. They might also feel jittery. They might even begin to gain weight, after they have lost a significant amount, due to a change in leptin and cortisol expression. Their energy levels might drop as well.

Unfortunately, nothing can be done about this. The body simply does not like a challenge to its body fat, especially if it has always had excess body fat. For chronically obese people, certain hormonal functions cause for their weight set point to always be higher than it should be. So, you just have to continue with the protocol that got you to lean and move forward.

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 135

1. My fasting insulin is 25 and I have to do extended fasts and very low carb in order to lose weight. 

"Extended fasts and very low carb" is not an appropriate protocol for addressing obesity. But, if it's true that you have to do extended fasts and very low carb in order to lose weight, then you would have already reached "goal weight", since the protocol would have worked. If it worked, then I wouldn't be addressing this on here. So, obviously it doesn't work, (no surprise there), and the "weight loss" you are describing is simply water weight ups and downs. When something works, it gets you to slim, not just a few pounds lighter. A few pounds lighter doesn't address obesity. So, what you are doing appears to be "working", but it's not doing a thing. 

The fact that your fasting insulin is still 25, and you are unable to get to slim, on a real protocol, (not the one you are on), are all signs of active obesity. Your body simply doesn't want to lose weight and it's fighting you tooth and nail not to. You have to keep pushing that line on the sand, further and further, in order to get it to comply. Soon it will show you whose boss by not complying anymore, regardless of whether you start drawing the line in the ocean. This is not the proper way of addressing metabolic dysfunction and obesity. This is only a recipe to remain sick and fat. 

Stop with the silly protocols and pseudo "weight loss" because they won't achieve long term weight maintenance. You need to start getting serious about addressing these issues for real, not for show. You can start by getting a little educated on what obesity and metabolic issues are by reading this blog. It's free. 

2. Should you adjust macros for perimenopause and menopause? 

There is no way to do that. Macro values are based on body fat since that's what you want to get rid of. 

3. Can too much protein cause a stall?

No. Too much fat can cause a stall. 

4. Is it more important to reach your fat goals than your protein?

Both. Macros work in conjunction. You want to hit your protein goals and you also don't want to overdo your fat. Either one of these can cause issues. 

5. The American College of Cardiology said that saturated fat is fine to consume. 

No. It actually said: 

"Most recent meta-analyses of randomized trials and observational studies found no beneficial effects of reducing saturated fatty acid intake on cardiovascular disease (CVD) and total mortality, and instead found protective effects against stroke." 

The entire study is basically a summary of Nina Teicholz and Gary Taubes book, put together, and this is not surprising since its funding came from 'The Nutrition Coalition', whose sole purpose of existence is to "change" the dietary guidelines. The "change" they want to make is not entirely clear, but they certainly aren't happy with the guidelines as they stand. 

What we do know is that people aren't going to give up the junk food they love and if this junk food is changed into high saturated fat fare, there's going to be a lot of dead people out there. Remember, saturated fat is only benign in the context of a low carb diet. Not everyone in the United States cares to follow low carb. Of course, the zealots don't care about what you want. 

The only thing you need to know is that if you eat too much fat, you will remain fat and/or get fatter. Everything else is irrelevant. So, make sure that you keep focused on your metabolic health, based on your results, and not these low carb "characters". They won't help you get to slim, as that's not what they care about, since they already know they can't make you lose a pound. 

6. Every time I eat protein, my blood glucose drops to the 70s mg/dL and I start feeling lightheaded and weak. I have to eat fat in order to prevent my "symptoms". 

First, a blood glucose drop into the 70s mg/dL is not true hypoglycemia. You did not provide the number it dropped from, so we don't know how big of a drop you're experiencing. 

Regardless, this drop is caused by a rise in insulin, in response to protein. Normally, the counter regulatory hormone glucagon would kick in at that point, causing a rise in blood glucose in order to counter act this release of insulin. The body likes keeping a tight, narrow range for blood glucose, at all times, and prevents insulin from clearing too much glucose from the blood. For people with metabolic syndrome, this counter regulation is usually over expressed, postprandial, and they see a spike in their blood glucose instead of a drop, which is described as hyperglucagonemia. This is because the person with metabolic syndrome does not have sufficient first phase insulin response to control glucagon. 

In this case, this is not what's occurring. Rather, blood glucose is dropping to a lower level. This is usually caused by an under expressed glucagon response, which is also typical in people with metabolic syndrome. It can be described as a "hypoglucagonemia". 

Aside from all of this, you should not be having hypoglycemic symptoms with a blood glucose in the 70s mg/dL. It would have to get a bit lower than that before symptoms occur. This means that whatever protocol you were on, did nothing to improve your condition. 

The most interesting aspect of this problem is that the consumption of fat does nothing to improve hypoglycemic symptoms. Diabetics do not walk around with fat capsules in order to counteract the hypoglycemia caused by their injectable insulin. They walk around with sugar pills instead, as sugar is what halts hypoglycemia. So, biologically, what you are describing is impossible. 

This further confirms these are not symptoms of true "hypoglycemia", as I stated above, since this is not very low blood glucose. Instead, this is a symptom of a body that is starving because it cannot access its fat stores. The minute that serum glucose lowers, the body has no more fuel to use. It is always running on empty. Feeding it dietary fat is not going to resolve the problem as it will, once again, do with the fat what it did with the carbs - use what's in the blood temporarily and store the rest. 

You have to correct this problem by improving your leptin expression because dosing fat to stop your "pseudo hypoglycemia" is not going to help you resolve your metabolic issues. Eating excess fat causes a rise in basal insulin levels as the body stores it into your fat mass. Getting fatter will only put a higher insulin demand on the body and this disrupts leptin further. Leptin is a slave to insulin. Stay on a true low carb protocol, which limits fat, and incorporate steady state exercises into your daily routine in order to improve leptin expression.

Six common beliefs addressed, Part 134

1. You should use a scale that calculates metabolic rate. 

The only thing you should be tracking are results. Results are seen in inches lost and improved metabolic markers. Better yet, the results are seen when you stand naked in front of a mirror and are pleased. After all, if you are getting lean, then your metabolic rate is working to keep you that way and if you are obese, your metabolic rate is working to keep you that way. Your metabolism is always working to keep you in the state you are currently in. 

• Having a high metabolic rate, while being obese, means that your body is working hard at putting on the pounds. 
• Having a low metabolic rate, while being obese, means that your body is hardly working so it can keep those pounds on. 
• Having a high metabolic rate, while being lean, means that your body is working hard at keeping the pounds off. 
• Having a low metabolic rate, while being lean, means that your body is hardly working at putting on the pounds. 

At the end of the day, body fat determines what your metabolic rate is doing. What it's doing is ultimately all you care about. How fast or slow it is doing this, is irrelevant. Speed doesn't change the outcome. 

2. I can eat a whole steak and a pound of ground beef in one sitting. Though I have lost weight, I am now stalled at 20 pounds from "goal weight". 

It doesn't matter if you can eat a side of cow, if you are losing weight and/or keeping it off. How much you eat is irrelevant, in that context, but if you are stalled and/or gaining weight then you have to lay off on the amount of fat you are in taking, if you are already low carb. 

Dietary fat is the Achilles Heal of low carb diets. The carbs are gone, so they aren't the ones adding to the pounds. The fat remained or has increased and so that is definitely the culprit of a weight stall or gain. Eat leaner meats. Make sure your steak is sirloin and not rib eye. Make sure your ground beef is marked lean and not chuck. See if that makes a difference. Also, scan your diet for any other fat that you might be in taking in the form of dairy or added fats like butter or oils. Cut back on them. 

Check your diet for other culprits that can be interfering with your blood glucose, like too much fasting, erratic meal times, not enough exercise or the wrong kind of exercise, too much artificial sweeteners and in taking caffeine. All of these dysregulate blood glucose regulation and will sabotage your results.

I hate the term "goal weight". Your goal is not necessarily your body's goal. It is very common to stall 20 - 25 pounds from "goal weight" simply because the body refuses to go too low on its body fat. This is especially true of women. Let your body decide how much weight it wants to lose. Being 20 - 25 lbs. from "goal weight" is not stalling like it would be at 50 or 100 lbs. from it. I have seen people complain over being 5 lbs. from goal weight, if you can believe it. 

We only deal with serious overweight/obesity, on this blog, not vanity weight. Vanity weight can be reduced with simple caloric restriction. 

3. If you just eat rib eyes, you will be fine. 

Unfortunately there are two types of low carbers out there, that always want to throw in their two cents, when they should really just keep their coins to themselves. On this blog, there are no slots to put them in. The vending machine is closed. These two nickel and dimers are: 

• The low carber who is not truly overweight/obese, but wants to trail the bandwagon anyway - This type of person can basically eat rib eyes until the cows come home. Literally. They aren't stalled. They aren't gaining weight. Everything is happy in the Land of Obesity Resistance. Yet, they want to take their experience and pass it on to you, making you fatter in the end. 
• The low carber who was once a diabetic and now has "lower blood glucose" - This type of person is basically happier than a pea in a pod because their blood glucose runs at 120 mg/dL instead of their usual 200 mg/dL. They still suffer from morning and postprandial highs, but who cares when their HbA1C is now two points under the diabetic range and their doctor removed them from diabetes medications. Hint - Their still diabetic, but it hasn't gotten bad enough to require medications.... yet. Of course this person will tell you that rib eyes "cured" them and now wants you to do the same. 

Don't follow these fools or you will be going off the cliff with them. The reality is that your overall dietary composition is king in determining what you can eat. If all you eat are rib eyes and you never have dairy, nuts or use added cooking fats, then there is a possibility you will get results and you just might be able to sustain them. Of course, time will be the determining factor of that, but let's just assume you really could sustain results long term, for argument's sake. On the other hand, if you are eating rib eyes, adding a stick of butter to cook them in, frying up bacon and drinking half a carton of cream with your coffee, rib eyes are guaranteed to not get you sustained results long term. 

So, If you are truly serious about your metabolic health and the direction it will take, in the future, you would not guide yourself by temporary successes or failures, but rather by an overall progress that can be sustained. For this, you should be moderating the fat in your diet and making sure you are prioritizing protein. That is the only way to not end up like the failures we see daily, who follow low carb and remain semi sick and absolutely still obese. 

4. I have been trying to stick to "keto/carnivore", but I always end up sabotaging myself. The sugar and bread addiction is so hard to break. 

First, we don't believe in a "sugar and bread addiction" on this blog. Second, you need to find another type of diet. There are many different diets, out there, that address metabolic dysfunction, from caloric restriction to vegan/vegetarian to low fat. I don't know why you want to narrow down your choice of diet to only "keto/carnivore" if it's obvious you can't follow it. 

Low carb diets are elimination diets. Whoever tells you that's not true is because they are either lying to you on purpose, in order to sell you snake oil, or they simply don't know how to follow a proper low carb diet. With low carb diets you have to severely restrict and/or eliminate an entire macronutrient - carbohydrates. The least restrictive of all low carb diets is Atkins because that diet simply keeps carbs under 100 grams a day and they can come from any source you want, including sugar. Other than that, you will be completely eliminating sugar and grains, in all of their forms, and the only carbs left will be non starchy vegetables. This has to be sustained for the long term as metabolic/obesity treatments only work when followed for the long term. This means that low carb is not only restrictive, but it's a commitment to boot. This isn't a "7 day fat loss diet" like you read in a tabloid. Low carb is a lifestyle. 

Many people simply can't do it and so it's best they don't even try. I am going to elaborate as to why. If you follow low carb and are actually able to sustain it, for some months, and you end up losing a lot of weight, improving your metabolic makers, but end up eating sugar and bread again because of your "addiction", you will quickly regain all of the weight you lost and it will be twice as hard to get rid of again. Going up and down in weight (yo-yo dieting) is detrimental to metabolic function. You are better off remaining consistently obese than to lose weight to only become obese again. That only ends up training your fat cells to grow even larger with each subsequent weight regain and losing weight will start becoming impossible as you completely annihilate your leptin expression. So, instead of fooling around, you should find a diet that you can stick to and follow consistently. 

5. Will "keto" always correct triglyceride (trigs) levels?

Keep an eye on your trigs to see if they are on a downward trend. Sometimes it takes time for the liver to stop dumping fat, from within itself, into the bloodstream. That's a good thing because you want the fat out of your liver. 

But if your trigs stall and remain high, then lower your dietary fat intake and see if that makes a difference. Usually the type of "keto" that is followed advises on way too much dietary fat. Trigs are a measure of too much energy in the blood, whether from carbs or fat. Carbs have a more profound effect on trigs, but that doesn't mean fat is exempt. 

Other than that, there are certain genetic profiles that cause for some people to run very high trigs, even on a healthy diet. 

6. Insulin resistance is a precursor to diabetes. 

Diabetes is the end stage of poor blood glucose regulation. Once you develop diabetes, blood glucose remains high all of the time. There are people with poor blood glucose regulation that do not ever develop diabetes or will only develop it very late in life. Insulin resistance can be described as a condition of poor insulin function as a result of poor blood glucose regulation. This can result in diabetes if it reaches its end stage.

Six common beliefs addressed, Part 121

1. You do not need to count calories if you eat to satiety. 

If you have to eat beyond your macros in order to achieve satiety, then you are eating in excess and your satiety point is set too high. In this case, you either scrap eating to satiety and follow your macros diligently or you can also include calories, along with your macros, to make sure you are keeping to them. 

Calories are great for monitoring overall nutrient intake, which is useless for addressing obesity and body fat in particular, as different nutrients affect body composition in different ways. But calories can be included, to macronutrient tracking, if the person has absolutely no satiety signaling and/or certain 'disordered eating' habits, which cause them to veer off their macros. This can go both ways, by the way. They can be eating to excess, but they also may not be eating enough. Tracking calories would help you know if you are eating too little, which a lot of obese people tend to do. 

2. If you do One Meal A Day (OMAD) and can get about 1K calories, then you are okay if you have no symptoms of metabolic slowdown. 

We never advise OMAD, on this blog, especially if you are overweight/obese. It is very difficult to get enough food in one meal, particularly protein, and trying to do so will only cause you to overeat in one sitting, aggravating glucagon to insulin ratios. OMADs also push you into too long of a fast, increasing your time in hypoglycemia, which only reinforces the starvation adaptation.

 

You should be having two to three meals a day. The number of calories needed a day, varies by individual and metabolic state. OMADs might not have an immediate negative effect. In fact, they might have a temporary beneficial one, but treating obesity is not temporary. Temporary solutions do not reverse this condition. Obesity only responds to long term treatments and OMAD is not a proper, long term treatment. 

3. There is no way to tell if you are temporarily stalled or have just stopped losing weight.

If you are still overweight/obese and stopped losing weight, you are stalled. If you are of normal weight, then you simply stopped losing weight. Overweight/obese people have a very high weight set point, so they will lose up to that set point and then won't lose anymore. This is why, though they lose weight, they remain overweight/obese. This is all caused by leptin. I recommend you read my article on leptin.

4. "Keto" is the correct diet for children.

The advice we provide, on this blog, is solely for adults with obesity/metabolic syndrome/diabetes. We do not provide advice for children, pets, athletes, pregnant women or breastfeeding women. Our advice also is not for any other condition or disease that is not metabolic in nature. 

 

Talk to your healthcare provider or seek alternative, licensed dietitians/nutritionists for advice on low carb children’s diets. 

5. The only cannabidiol (CBD) available is in gummy form, but its still okay to take.  

I recommend you start smoking it or using it in oil form, as gummies are not recommended. It's best to take your CBD without the added sugar or sweetness. 

6. Your diet should be working, even if you use artificial sweeteners. 

Artificial sweeteners interfere with fat loss, by adversely affecting hypothalamic dopamine/leptin cross talk. 

 

Even though artificial sweeteners do not have calories, they cause for the body to store everything else that does. This is why calories are such an incomplete way of addressing obesity, as many other things influence the body's storage and burning of fuel besides its amount. The taste of sweet is one of those things. You have to stop tasting sweet things or your body will continue storing for winter.

Six common beliefs addressed, Part 77

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

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

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

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

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

2. Pregnant and breastfeeding women require more carbohydrates. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What contributes to this?

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

What else contributes to this?

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

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

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

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