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Obviously, if you want to lose weight, you need to "burn" (metabolize) your fat stores and the common wisdom is to eat less and exercise more.  If you don't succeed, you're obviously lazy and not trying hard enough.  However, this is supremely poor advice because it doesn't take into account your body's metabolism, which depends upon its metabolic state:  fed or fasted.  Your pancreas produces many hormones but the one that determines its metabolic state is INSULIN.  The FED state is characterized by high insulin while the FASTED state is characterized by low insulin.  One of insulin's jobs is to regulate blood sugar (ie, serum glucose) and the macronutrients (carbohydrate, protein, fat) in your meal have a huge effect on serum glucose.  The Randle Cycle describes the process the body uses to determine whether it is the fed or fasted state.

Besides determining the metabolic state, insulin has a major effect on the body's ability to shed weight because insulin is THE fat storage hormone.  When insulin is elevated, Lipoprotein Lipase (LPL) is activated which splits Triglyceride (TG)molecules into glycerin and fatty acids to allow fatty acids to diffuse into the fat and muscle cells.  Insulin also activates the GLUT4 transporter, which is the gate through which glucose enters fat and muscle cells.  When insulin is low, Hormone-Sensitive Lipase (HSL) allows fat cells to release TG back into the blood stream.  The net result is that you MUST have low insulin to lose weight.  Long-term caloric restriction (ie, eat less, move more) causes two more insults to dieters:  1) LPL becomes much more active when insulin is elevated, thereby making fat cells better at growing and 2) Ghrelin and Leptin (hunger hormones) also become more active.  The more and longer you increase the caloric deficit, the hungrier you and your fat cells become.  Low insulin inactivates LPL and actives HSL.  In addition, low insulin levels increase LPL activity in muscle cells, thereby helping them to shift to fatty acid metabolism.

Carbohydrate is the only macronutrient that contains sugar and this can take the form of monosaccrarides (ie, glucose, fructose, galactose) or disaccharides (ie, lactose, maltose, sucrose) or starches (long chains of glucose).  Since your body tries to tightly control serum glucose, insulin is used to store excess in muscle and fat tissue.  Protein isn't really a fuel (unless you're starving) and your body primarily uses protein to maintain its structure.  Depending upon the type of ingested fat (short, medium, or long-chain), your body will either preferentially metabolize it or store in fat tissue and fat elicits a much lower insulin response for storage than glucose.  Your microbiome ferments soluable fibre carbohydrate into short chain fatty acids but, with a rudamentary cecum (appendix), humans evolved away from herbivory.  Unlike most natural foods, dairy is the one food group that contains all 3 macronutrients and is beneficial for growth in children.  Lactose (milk sugar) definitely raises serum glucose, which will shift the body to the fed state.  To minimize this effect, fermented full-fat dairy products (cheese, yogurt, etc) are a better alternative to milk in adults because of reduced sugar content.  Fermented foods are generally beneficial because bacteria have converted sugars into short chain fatty acids.

In order to maintain a low insulin level, the obvious thing to do is minimize carbohydrate consumption and those on a carnivore diet avoid carbs completely.  This is contrary to government food guides but there are NO essential carbohydrates - only essential proteins and essential fats.  "Essential" means that the human body cannot synthesize these nutrients itself and requires their consumption.  If you don't eat carbs, you still need to maintain your body's caloric requirements so you need to get fuel from another source, which is fat.  Although some tissues in your body absolutely require glucose (ie, red blood cells and some brain cells), your body has the ability to manufacture ALL of the glucose it needs on demand from adipose tissue (fat cells) via gluconeogenesis in the fasted state.  Fat is also converted to ketone bodies (acetoacetate, beta-hydroxybutyrate, acetone) in the liver via ketogenesis and the brain readily switches over to ketolysis when ketones are available.

When fat is metabolized, ketones are produced and diets that maintain low insulin levels tend to result in ketone production from fat metabolism.  A ketogenic.diet (low carb, high fat) is essentially the opposite of the standard [American, Canadian, Australian, etc] diet (high carb, low fat) and is effectively the US Food Pyramid turned upside down.  Amber O'Hearn makes a good case that humans have evolved to become lipovores (fat eaters) rather than carnivores (meat eaters).  While it has been known a long time that insulin lowers the basal metabolic rate (BMR, ~ 300 calories/day difference between the fasted and fed states), Dr Ben Bikman's research has found that ketones increase the metabolic rate because they cause white adipose tissue to become uncoupled so that they generate heat like brown adipose tissue.  High ketone levels also tend to waste fat via respiration and urination while also improving metabolic health.

Many people believe that the reason that they've gained weight and have such a hard time losing weight is because their metabolic rate (how fast they're burning fuel) has slowed down as they've become older.  According to the 1992 Baltimore Longitudinal Study on Aging. a better predictor of weight gain (and loss) is the Fasting Respiratory Exchange Ratio (FRER), which is the ratio of CO2 exhaled to O2 inhaled and is reflective of the degree to which a person is burning glucose to fat.  Basically, burning more glucose increases FRER and burning more fat lowers FRER and the study showed that higher FRER results in the higher long-term weight gain and the lower FRER results in the lower long-term weight gain.  The actual metabolic rate (determined by body mass) had NO effect on long-term weight gain or loss.  Although increased muscle mass requires more energy, you lose more weight by burning fat rather than by how much fuel you're consuming.

Processed foods are typically made in factories by industrial processes and characteristically contain high amounts of carbohydrates and fats [usually in the form of industrial seed (vegetable) oils].  Besides the obvious high caloric content of processed foods, highly processed foods cause a much higher insulin response than those foods in their whole-food form due the disruption of their cellular structures.  A food's fibre content is more of marker of its degree of processing than its nutrition so added fibre is NOT beneficial. Vegetable oils also play a huge role in cardio-vascular disease, especially when they become oxidized from heating. Basically, if the food is manufactured, don't eat it - no matter how healthy it says on the label.

One of insulin's many effects is causing the kidney's to retain salt.  When lower insulin levels, your body will excrete more salt with an accompanying decrease in blood pressure.  If you're on hypertensive drugs, you may need to get your doctor to adjust your medication to prevent hypotension (low blood pressure).  You will need to consume more salt to prevent the "keto flu" (fatigue, brain fog, headaches, muscle cramps, etc).  Adequate salt consumption is necessary for good health so don't be afraid to add salt according to taste or have a glass of salty water if you're having keto flu symptons.  Adequate potassium intake is also beneficial and potassium-enriched salt may be helpful.  Cutting salt intake is ineffective at lowering blood pressure and it tends to worsen insulin resistance.  The net result is that cutting your salt intake could worsen your diabetes, which implies that insufficient salt could elevate insulin.  Again, only make electrolyte changes under the supervision of a doctor.

While exercise is highly beneficial for multitude of reasons, it is nowhere as effective at weight loss compared to diet.  Exercise doesn't burn-off nearly enough calories as you would want although you're probably not snacking while you're exercising. In addition to insulin's effect on the BMR, it's a lot more effective to avoid ingesting unnecessary calories than it is to metabolize them . For example, a 300 calorie doughnut will require about 60 minutes of walking (3.5 mph / 17 minutes/mile) or 30 minutes of running (5 mph / 12 minutes/mile) for a 155 lb person. See Calories burned in 30 minutes for people of three different weights.

Dr Ben Bikman recommends only consuming whole foods and has an easily-to-remember macronutrient alliteration for maintaining low insulin levels:

  1. Control Carbohydrates (< 50g/day from unprocessed, low glycemic index foods)
  2. Prioritize Protein (1-2g per kg of body weight per day)
  3. Fill with Fat (all remaining caloric needs from animal & fruit)

According to Dr Bikman, fat and protein should ideally be in a 1:1 ratio as is found in animal-sources food such as eggs and meat.  Keep in mind that your own body fat counts in your fat consumption, which is why you need to have sufficient protein intake for tissue maintenance and we need more protein as we become older (1.0-1.2 g/kg/day and 1.2-1.5 g/kg/day for those with acute or chronic diseases).  Since the body has no ability to store protein, excess protein is excreted and there appears to be no evidence that high levels of protein consumption is deleterious.  The healthy fats that we should be eating are saturated.  The degree of saturation depends upon the amount of hydrogen atoms that fatty acid chain contains and the difference between between beef tallow (containing stearic acid) and olive oil (containing oleic acid) is one carbon double-bond and 2 less hydrogen atoms, which makes olive oil a mono-unsaturated fat of the same 18-carbon chain length.  All of the body's nutritional needs can be supplied from animal-sourced foods and plant-sourced foods often have antinutrients in them, which makes them even less nutritious.  Another benefit of a high-fat diet is gall bladder health due to increased bile use.

Eat when you're hungry and don't when you're not.  Don't count calories.  A lean physique is a characteristic of metabolic health.  Rather than focussing on losing weight, it is far better to become healthy and the weight will come off and stay off.  To see how I've reversed my own Type 2 Diabetes, see Metabolic Health..