March 3, 2016

Constitutional Obesity Resistance Vs. Constitutional Obesity Propensity

Although activity on my Facebook and Twitter accounts might suggest otherwise, I’m not a big fan of social media. I participate in it because I feel like I “have to,” not because I particularly enjoy it. Then again, as I am extremely introverted, it’s a great way to interact with people without having to really interact with them. I can unplug and disengage the second I start feeling uninterested, overwhelmed, or exhausted. That being said, one of the great things about Twitter is that I get to interact with some quite brilliant people whom I would never otherwise have “met,” and I am regularly presented with ideas that blow my mind. (That’s how I came across the stuff about Dr. Kraft’s insulin assays, which inspired the insulin series.) Often, these are ideas and concepts that should be pretty obvious to me, and the only reason they aren’t is that I’ve just never stopped to think about them. And not only are they pretty obvious, but they’re often put out there or tweeted about casually, as if the writer is saying something relatively simple. A one-off post or a couple of lines about something that seems like no big deal and is a total no-brainer to them, but which, upon reflection, turns out to be a huge deal to me.

For example: the registered nurse who goes by the online nickname “Woo” frequently drops knowledge bombs that send me into a hurricane of thoughts. She holds no punches and does not suffer fools. Her writing style takes some getting used to, but she is truly one of the most intelligent and insightful people currently writing about metabolism, endocrinology, calories, ketosis, fat adaptation, body weight regulation, PCOS, and lots of other things many of us are interested in. Time and time again, something she posts makes me see things in a new light. So much light, in fact, that she should buy stock in General Electric, Phillips, or some other company that manufactures lightbulbs, because that is how many of those things go on over my head when I read her work.

Case in point: a few days ago, Woo made the correct observation that, in many cases, children who are put on a ketogenic diet (KD) for epilepsy can actually stop the diet after a couple of years and remain seizure free for life. Something about staying on a KD for some period of time during one’s formative years seems to actually permanently correct the underlying problem, such that the diet can be abandoned later on and the seizures do not return.

Coupling this fact with some observations about people on low-carb and Paleo diets, she came to some rather fascinating conclusions, and proposed an observational study. First, I’ll tell you about the study, and then we’ll work through the rationale for it, via exploring some intriguing things about body weight, and why some of us are so incredibly prone to accumulating excess adipose tissue, while others are not.

The observational study would be intended to test the following hypothesis:

  • Children on a strict ketogenic diet for epilepsy (or some other condition) who are eventually able to return to a more “normal” diet and remain seizure free, are protected from developing obesity later in life. (I would venture to say we would likely observe the same outcome even among kids who follow a modified Atkins diet [a.k.a. “MAD”], and who were not strictly ketogenic.)

The study could be carried out in two ways:
  1. A retrospective cohort. Find as many teenagers and adults as possible who were on ketogenic diets as children, but who no longer follow a KD. Assess anthropometric parameters. (Body weight, body fat percentage, etc.) The older the people we can find, and the longer they've been off the diet. the better.
  2. A prospective cohort. Enroll as many children as possible who are currently using a strict KD or MAD to manage some sort of medical condition, and follow them for as long as possible after they abandon the special diet. Assess anthropometric parameters. Again, the longer we can follow them through their lives, the better.

To reiterate, the hypothesis is that these kids will remain lean into and throughout adulthood, even after returning to a more typical, Western-style, obesity-inducing diet. They will be what Woo (fabulously) calls “constitutionally obesity resistant.” (I love this phrase. Being “constitutionally lean” is one thing, but “constitutionally obesity resistant” really hammers home the point that it’s basically impossible for these people to become fat, even upon exposure to the same things that make the rest of us so.) I can’t speculate on whether they would remain free of the myriad other effects of the metabolic syndrome-inducing crap American diet, but it makes sense to me that, at the very least, they wouldn’t become obese.

Here’s the logic:

As we all know, there are people who can eat ungodly amounts of sugar and refined carb-laden junk food without gaining an ounce, while there are others who need to buy larger pants after merely looking at a cupcake. What gives? Could something in childhood or adolescence be “programming” us for these fates later on? How much does the dietary—and, therefore, hormonal—landscape of early life influence body weight regulation throughout the rest of one’s life?

These thoughts came to Woo because of very keen observations she’s made about some prominent figures in the low-carb and Paleo worlds. Some people can do just fine on a diet of 100-200g of carbs a day, while others—at least for the sole purpose of achieving and maintaining a significant fat loss—need to stay under 50g (or less!) forever. (Remember, in this post, I am referring only to weight issues. I am not talking about cognitive function, neurological health, diabetes, or some other condition that might benefit from a very low-carb or ketogenic diet for reasons that have nothing to do with body weight or fat mass. Those are separate issues, to which this logic might not apply.) To the hardcore low-carbers and keto dieters out there, 150g of carbs per day might sound like a lot, but compared to the standard American diet, it’s actually relatively low. (It’s 600 calories, which would be just 30% of a 2000 calorie per day diet. Compared to a diet of 50-65% carbs, 30% is low.) If you’re in the habit of reading the success stories & testimonials on Mark’s Daily Apple, or Robb Wolf’s site, then you’re familiar with the idea that some people can eat sweet potatoes, white rice, beans, gluten-free bread and pizza, and maybe even have a weekly or monthly “cheat meal” or splurge, without regaining any of the fat they lost by going Paleo or Primal. Who are these ninjas who get to have their cake and eat it, too have their cake and their steak, and eat them both?

Well, more often than not, these success stories—the ones where people have far more carb leeway than the rest of us—seem to be written by people whose extra weight/excess body fat was a temporary situation. Maybe it was the freshman fifteen, or post-baby weight, or some extra pounds that had come on due to very stressful life events: a divorce, a death in the family, loss of a job. These are people who were, for the most part, for most of their lives, lean. Being overweight was a blip on the radar, caused by something fairly easy to identify: lots of late-night study sessions over takeout and beer; a few months of drowning one’s fears and worries in a pint of ice cream and a family-size bag of chips (crisps, for my UK readers). Being heavier was not these people’s default state. So, when they cleaned up their diet—even just 80% of the time—their bodies easily returned to their naturally leaner state. Since being heavy was not the norm, getting back to a smaller size was easy, because it’s what the body wanted. (Maybe even what the body was programmed for.) In order to get back to a lower weight and body fat percentage, all they had to do was remove the stimuli that were moving things away from the norm, and it’s almost like the body automatically went back.

Never in my life have I been this ridiculously 
happy about an apple.
Woo observed that many of the Paleo success stories like this involve individuals who were vegetarian or vegan for some portion of their youth. Some also come from people with backgrounds of long-term disordered eating, mostly in the form of severe caloric restriction and/or exercise addiction. Now, vegetarian & vegan diets are not necessarily low­ insulin diets. If someone’s living off of bread, pasta, potatoes, and rice, then sure, they might end up with insulin and blood sugar issues. But plenty of vegetarians and vegans are not starch-a-tarians and grain-a-tarians. For the ones who eat mostly non-starchy vegetables, fruit, nuts, and maybe even beans, this is actually a very low insulin diet. (Even more so if it’s a raw vegan diet, because grains and dense starches must be cooked in order to be edible. Except for raw honey, there are almost no foods on a raw vegan diet that would spike insulin to any significant degree.) The effects on fuel partitioning are even more profound when we account for this also typically being an extremely low-fat and relatively low calorie diet. (Which is possible even on an omnivorous diet, so this isn’t limited to vegetarians and vegans. We could be talking about anyone who followed an extremely low-fat/low-calorie diet.) See, even if someone does have a big insulin spike, if there’s not a whole lot of food energy coming in to begin with, then there isn’t a whole lot for insulin to influence the storage of, regardless of the macronutrient composition of the diet. (To make this simple: If you were to eat a diet of 100% leafy greens, that’s almost 100% carbohydrate, but you will not get fat. Even if you were to eat a few potatoes or some rice along with that, you wouldn’t get fat. The total energy density of the diet is just too low. You can’t store anything when there isn’t enough coming in to be stored. BUT, keep in mind, I’m talking here about insulin-sensitive people. I am not talking about the constitutionally insulin resistant, which I’ll get to in a minute.)

It seems that these folks, the ones who lived for many years in a low-insulin state—particularly if this low insulin state was during the formative years, either early childhood or maybe into and throughout the teens—are almost “immune” to becoming obese. Their bodies simply won’t let them get there. Sure, they might gain a few pounds here and there after some period of time of especially debaucherous eating. Maybe they’ll gain, say, ten, twenty, or at the very most, thirty pounds. But their bodies simply will not allow them to accumulate 200, 300, 400+ pounds of excess adipose tissue. At their heaviest, these people will never be candidates for bariatric surgery. (Maybe they’re even protected against heart disease, Alzheimer’s, tinnitus, nephropathy, and some of the other conditions associated with caused [at least in part] by hyperinsulinemia, but again, I can’t speculate on that.)

Like the hypothesized long-term weight regulation effects of children on ketogenic diets, having spent at least some significant amount of time in a low insulin state may grant these people some degree of protection against amassing body fat as readily as other people do.

Okay. So what about those other people?

I am one of those other people. I am one of the ones who acquires an additional chin after just walking past a bakery. I am someone we might call “constitutionally overweight-prone,” or, “constitutionally resistant to remaining lean.” Right now, I’m not obese. I’m not obese, but I am a far cry from lean. (In fact, by the BMI chart, I am squarely in the overweight category. BMI is a terrible and unreliable metric, but still.) And it is my firm contention that the only reason I’m not obese is that I am keeping my biological propensity for the accumulation of inordinate amounts of adipose at bay via a low-carb diet. If I were to return to a diet of 50%+ carbohydrate, there is no doubt in my mind that I would be obese. Heck, I gain weight easily even just getting a little too casual with my diet now, and that’s not even coming close to a “normal” level of carb intake.

So the question is, why? What is it about me—and the other people who are constitutionally overweight or obesity-prone—that differs from the people who were heavy for only a short period of time, and whose accumulation of weight was easily reversed?

Well, I can’t speak for others, but here’s what happened with me. When I look at pictures of me from when I was a baby, and up until sometime in elementary school, I was thin. No sign of impending weight problems. But not long after that, my parents opened an ice cream store. They sold homemade ice cream, candy, cakes, novelties, etc. This store was a presence in my family for ten years. Every kid’s dream, right? Yes. ... If they want to fight their weight for the rest of their life, that is.

I take 100% responsibility for my dietary habits during that decade. Maybe my parents could have kept a better eye on me, but my father was working two jobs, and my mother was in the store seven days a week. Ultimately, the person who fed me all that junk food was me. Maybe, at nine years old, I didn’t understand that I was setting the stage for metabolic consequences I would face the rest of my life, but the ignorance of youth doesn’t absolve me of personal responsibility. So I blame no one but myself. Honestly, though, it doesn’t matter. It doesn’t matter how or why I’m in the metabolic pickle I’m in now. I’m in it, and there’s no way out of it. No permanent way, anyway. (More on this in a minute.)

Even after the store was a distant memory, my diet was high-carb. Not high-junk, but still high carb. I was a major starch-a-tarian in high school and college. Bread, cereal, pretzels, pasta, bagels, granola—hey, starchy foods are cheap, and they’re low in fat! It’s the double-score for a college girl! Because I spent so many of my formative years in a high insulin state, I am almost the opposite of the obesity-resistant. No, not “almost.” I am the opposite. I am obesity-prone. Unlike the people who gained a few pounds in college, or due to a stressful and unpleasant, but short-lived life situation, my body’s norm is not lean. My default state is chubby. While it’s (relatively) easy for the constitutionally lean to lose weight, it’s (extremely) easy for the constitutionally obesity-prone to gain weight. When a constitutionally lean person gains weight, the body wants to get rid of it. It wants to return to its “happy place” of a lower weight. When a constitutionally obesity-prone person loses weight, the body wants to regain it. It wants to return to its happy place of a higher weight.

I said above that there’s no permanent way to reverse my body’s proclivity toward accumulating fat. But there is, depending on how you look at it. I can manage my obesity-proneness via a permanent low-carb diet, relatively low stress, good sleep, and exercise. But I cannot reverse it. I can’t go back in time and erase having spent most of my adolescence and young adulthood awash in high insulin. Those effects are permanent, or, at least, they seem to be. This is why those of us who, for whatever reasons—be it mom & dad’s ice cream store, or lots of junk in the house, or the maternal diet/gestational diabetes exposing us to hyperinsulinemia in utero, or something else—now seem “programmed” to be heavier, and have to fight so hard to keep weight off and be so diligent about our diets. Yes, we can indulge here and there and not gain back fifty or a hundred pounds, but we can easily gain back at least a few. And the truth is, if we’re not careful, and those indulgences get out of hand for a long enough period of time, we will gain back fifty or a hundred pounds. 

There’s a reason this is so damn hard!
We are what Woo calls “weight-reduced obese (or overweight) people. We are fat people who happen to be, right now, at this moment in time, slimmer than our bodies’ biological norms. That fat is waiting in the wings to come back as soon as we give it the opportunity. This is why it is so much more difficult to maintain a significant weight loss than it is to lose the weight initially.

Those of us who were overweight or obese for a long period of time—especially if this time includes childhood—are capable of becoming lean. We can become lean, but we will never be as lean, nor maintain that leanness as effortlessly, as someone who was never obese at all. I think being awash in insulin during youth is especially problematic, and probably makes people especially prone toward overweight. But even if you were thin during your formative years, if you were obese in adulthood for a long period of time--decades, perhapsthen you will probably struggle just as mightily as those who were heavy in adolescence. This is especially troubling for the youth of today, who are, as Dr. Ted Naiman says, “marinating in insulin in the womb.” These kids are in trouble from minute one. Literally before they are even born, their bodies are being conditioned by a hyperinsulinemic environment. If you think the “diabesity” epidemic is bad now, just you wait. (Not to mention cancer, Alzheimer’s, and more.)

WHY is this all so difficult? WHY is it possible to “manage,” but not completely reverse the biological propensity toward accumulating excess adipose tissue?

Again, Woo, with her brilliant insights. (I would link to or embed her relevant tweets here, but her account is protected, so I can’t do that. She is extremely protective of her real life identity. My paraphrasing her and giving you the gist will have to suffice.) She posted this picture:

This is a photograph of a normal-sized man standing next to a man who had a growth hormone (GH)-secreting tumor earlier in life. A tumor that secretes inordinate amounts of GH prior to the closing/fusing of the epiphyseal plates will cause the bones (especially the long bones—femur, humerus, tibia, ulna, etc.) to be much longer and larger than normal. (The epiphyseal plates are the tissues between the long bones that remain soft and pliant during growth, but which eventually—sometime in the late teens or very early twenties, fuse and solidify, stopping further growth. Once your epiphyseal plates have closed, you can stop expecting your growth spurt. You’re as tall as you’re ever going to be without lifts in your shoes. [I have to admit, though, I’m 37, but at just 5’2”, I am confident my growth spurt is coming any day now!])

The point of this picture is to demonstrate that some of the endocrine influences early in life are irreversible. Their effects are permanent. Take the guy with the GH tumor: after doctors remove the tumor, it’s not like this guy is going to shrink back to a normal size. He is huge and will always be huge. You can take away the excess growth hormone, but he will still be 8 feet tall. He will still have enormous hands and a very deep voice. You can’t make those things go away. You remove the tumor, and the pathology is arrested (meaning, he's not going to get even taller), but the effects of that pathology are not reversible. This guy cannot be “cured” of his excessive tallness simply because we have removed the stimulus that made him tall. In the same regard, we can remove chronic hyperinsulinemia, but that does not automatically make us insulin-sensitive. It doesn't magically "undo" all those years of elevated insulin. The constitutionally obesity-prone cannot be cured of this propensity. We can only eat and live in such a way that we don’t trigger the effects. (And if you’re planning to have children, or you have young children already, you can do your best to prevent them from having this propensity in the first place. That’s probably the best place to start.)

I’ll paraphrase some of Woo’s tweets, since I can’t share them with you directly: 
  • Even though the insulin reducing protocol acts exactly like tumor surgeries in other endocrine diseases (in that it arrests the pathology), CICO-phants are too dense to understand and acknowledge the efficacy of low-carb diets and other insulin-reducing measures. 
  • When we see this phenomenon in obesity, ignoramuses think this is evidence that insulin must not cause obesity because low-carb diets are not a “cure.”
  • Insulin does not simply alter fuel use acutely, and drive growth or shrinkage of the adipocyte (fat cell). Insulin is to fat tissue as growth hormone is to the rest of the body. (Meaning, some of the effects will be permanent, especially if the chronically elevated insulin was present for a long period of time, and even more so if it was present during the formative years.) Therefore, even if you perform the obesity equivalent of a GH tumor removal surgery by putting someone on a diet to lower insulin, it’s still not a “cure.”
  • Depending on the nature of the problem—at what point in life did obesity develop, and for how long was it present—maybe an “ancestral” diet works. On the other hand, maybe not even a keto diet does. Meaning, for people who were only a little overweight, and maybe only for a few years, an “ancestral” diet works like magic. Beans, fruit, non-gluten grains, potatoes – it’s all good! No weight regain, no metabolic syndrome, no nothin’. But for others, who were very overweight for a longer period of time, maybe not even a low-carb diet works. Maybe not even a ketogenic diet works! (Not by itself, anyway.) Maybe those people need a ketogenic diet plus fasting, plus exercise, plus metformin, plus, plus, plus. And it is these people—the ones who struggle the most—who will be struggling their entire lives.

Then again, it depends on what we mean by “struggle,” right? Certainly, eating delicious pork chops, steaks, broccoli, Brussels sprouts, and cheese, isn’t exactly “struggling,” right? (“First World problems,” as they say.) And maybe being “forced” to get sufficient sleep, manage stress levels, and engage in physical activity more than the average person for the sole sake of preventing fat regain isn’t much of a struggle, either. But you know what I’m trying to say: the lifelong battle to prevent fat regain might not be a hero’s quest worthy of Greek mythology, but for the people who are constitutionally overweight- or obesity-prone, it is a lifelong battle. We will never be able to eat as casually or without thought to protein/fat/carbs as those who are constitutionally obesity-resistant.

Wow. So that was the [very] long way of offering at least one explanation for why some people do just fine on higher carbs, and others don’t. And also why, for many people, a low-carb diet, by itself, is not enough to lose weight and maintain that loss. (Also: just so we’re clear, when I talk about “higher carbs” and an “ancestral diet” as opposed to low-carb or ketogenic diets, I’m not talking about loads and loads of sugary breakfast cereals, toaster pastries, and other outright garbage. I’m talking about unprocessed, real foods, such as rice, potatoes, beets, and lentils, which are wholesome and nutritious foods that have nourished healthy and robust populations for centuries, but which just happen to be high-ish in carbohydrate. The people I referred to in the success stories on MDA and Robb Wolf’s site—the ones who thrive on 80/20—sure, sometimes, maybe they do a header into a tub of gelato, or hit up their favorite BBQ joint for some brown sugar-smothered ribs and a big, honkin’ piece of cornbread, but even they don’t do that every day. Now and then, yes. And they can get away with it, for reasons discussed here today. For the most part, though, their “higher carbs” still come from real foods.)

That’s all. Just a little more nuance to explain why people are so different with respect to weight gain, loss, and maintenance.

P.S. I am so tempted to name names – to say exactly who I mean when I referred to some of the well-known figures in the low-carb, Paleo, and ancestral nutrition worlds, and how some of them will never become effortlessly slim, while others will never become obese. Some of the heavier folks will get slimmER than they are naturally, but they will fight tooth and nail every day to stay that way. And some of the constitutionally lean may put on a few pounds once in a while, but those pounds will slide off easily with not much more effort than a couple sprinting sessions and dropping the coconut sugar-filled “Paleo treats.” Alas, I will not name names. Not my style. I avoid confrontation and controversy as much as possible. (Most of you know who I’m talking about anyway. :P) I do wish, however, that they were more careful not to extrapolate from their own personal experiences to everyone else. Guess what? If you were never overweight, or were only slightly overweight for a relatively short period of time, YOU DO NOT UNDERSTAND the metabolic challenges of someone who was overweight or morbidly obese for many years. And vice-versa: if you have battled weight for most of your life, you probably have a hard time understanding that there are, in fact, people who can eat beans, potatoes, bananas, and rice, and remain lean. All I know is, the closed-minded and angry rhetoric on both sides is getting uglier every day. I hope to remain true to the tagline at the top of my blogA source of sanity in the sea of nutritional madness.

Remember: Amy Berger, MS, CNS, NTP, is not a physician and Tuit Nutrition, LLC, is not a medical practice. The information contained on this site is not intended to diagnose, treat, cure, or prevent any medical condition and is not to be used as a substitute for the care and guidance of a physician. Links in this post and all others may direct you to, where I will receive a small amount of the purchase price of any items you buy through my affiliate links.


  1. Interesting thought about the children on ketogenic diets never gaining weight. My brother was born with pyloric stenosis, which I would guess would induce starvation ketosis since no significant food stays down. This was surgically corrected after a couple of months, but he remains extremely thin despite a high-junk-carb diet. I, on the other hand... not so much. Things that make you go "hmmm".

    1. Yep...very interesting. If he only had it for a few months, though...but who knows? (Or maybe he's just one of the lucky ones. So much we don't know about the hormonal milieu in utero that could affect siblings differently. What was mom eating? How stressed was she? All I know is, there is *a lot* we have no control over, and we just have to do the best we can with the hand we're dealt.)

  2. Amy, this is a great post, as always. I also read wooo and LOVE her stuff
    Confirmation: I am also a case like you and wooo (see how that rhymes):
    I suddenly gained massive amounts of weight at 14 (I went from 45 kg to 75 kg in less than a year) and stayed fat and struggling (at one point 90 kg) for the entire next 10 years. I ran, I exercised, I took diet pills (prescribed: amphetamines, ponderax, whatever), I cried, always hungry, eating at night in the kitchen, pretending it doesn’t count, and hated my body.
    In my twenties, dropped bread, milk and all sugar and started seeing some results, but never really got “lean”. Years again of exercise, run, F*ck, whatever, fitness trainers that works out the same stupid workout and nutrition plan for every client..
    Ffwd >>> I am 50 and a year ago, prediabetes (so, its been coming for YEARS), not surprised, T2D is a family issue. Enters Keto and Jason Fung (I know wooo is not a fan, but wow!) I finally dropped to a new body size.

    But, here’s the kicker: I have to fast regularly to keep my weight and Blood Sugar under control… it keeps climbing up and up and up. So, long, true story….but, I relate.

    1. I haven't done much fasting, but I will probably get into it pretty soon. Nothing extreme (like weeks), but 2-3 days here and there, yeah, it's worth a try. Lord knows I'm not gonna starve...plenty of stored fuel all over mama's hips & thighs! ;D

  3. Amy I love all of your work. I also think it will depend if you became obese as a young kid, if you came out of your mothers womb already insulin resistant. It will also depend on how large your adipose tissue got. The main thing that it has to do with is not just insulin resistance but also Leptin resistance. Leptin and insulin are the 2 hormones in charge of your colony of cells ( your whole body). Leptin would be the 4 star general, insulin the 3 star general in charge.

    1. Thanks for reading, Jeff. (As you know, I love *your* writing, too!) Sadly, what I know about leptin could fit inside a thimble and there would still be lots of room to spare. That's why I never write about it. I just honestly don't understand it at all. Haven't taken the time to delve into any research on it, and I probably won't anytime soon, unless someone offers a financial incentive to do so. That's the ugly truth of where I am at the moment. I can no longer afford to do unpaid work at the pace I've been doing it until now. :( If someone *else* would write something very logical and down-to-earth, yet comprehensive, on leptin, I'd happily read it and learn.

  4. Amy, short chubby women are awesome in my book.

    I agree with you on the inability in low carb communities to see anything other than the gospel according to that community.

    These dudes think they're gurus because they lost 10 or 20 pounds for a year.

    They have no clue.

    I've been low carb (and keto, and high protein) off and on over the past 12 years.

    I lost 130 pounds. Kept it off over 5 years and then tried following Ray Peat's advice. Huge mistake. I'm back at square one.

    Yep. I gained back every single last pound. If you are obese or were obese and someone says "Eat the food!" Run! Don't look back!

    There are more factors at play besides obesity in childhood.

    I was never breastfed, I was given soy formula. I think my biome and immune system were never properly initialized. I think I was exposed to high levels of phyto and xeno estrogens.

    I lived in a very abusive household to drug addicted parents as well. Studies show children of abuse tend to end up fat.

    There are so many things at play here.

    And for some 22 year old "guru" to claim they have all the answers is laughable.

    From what I've been able to discern, there is no one answer.

    And what worked yesterday will probably stop working for you at some point.

    My current WOE is lower fat, higher protein, some carbs (potatoes, peas, beans) mostly at night, and lots of fiber.

    I'm also using l-tyrosine to bump up dopamine levels to fight cravings.

    Anyway, thank you for writing this. You are one of the few sane and intelligent people writing in this arena.

    1. "Short chubby women are awesome in my book." Well, Cody, you are welcome to comment any time! ;D Agree with you about the young "gurus." I would like one of them to spend a week inside the body of a post-menopausal woman who had 3 kids. You are absolutely right: there is no one right answer for everyone. There's not even one right answer for the *same* person throughout their entire lives. Circumstances change, and the things we do dietarily and otherwise might have to change too, if we want to maintain the same shape. Like you said -- what worked at one point might not work 10 years later.

      Interesting about the Peat stuff. I haven't read any of his work, only what I hear secondhand when *other* people talk about it. Sounds like it works for a lot of people, so go figure.

      I don't feel as bad for my super-long posts as I used to. The truth is, this stuff is *not* simple, and if it's being boiled down to some 250-word thing, or a 10-word slogan, pieces are probably missing.

  5. Hi Amy,
    A great post, for me personally, Amy. Add me to the Woo and You cohort, even to the point of “ice cream in the formative years.” In 2002, after my doctor read Taubes’s seminal NYT piece, I started on Atkins Induction and later switched to Bernstein (I’ve been a T2 since ’86). I dropped 170 pounds (from 375 to 205) over a few years, but later regained 70. I am now working hard, and with great difficulty, to lose again. I lost 20 and then plateaued. I now incorporate IF, and my weight is just starting to move again.
    Fasting 7d/w is easy, I tell my readers, because I’m never hungry. If I eat lunch, it’s very small (sardines in EVOO or HB eggs) and then a small supper. I’m totally on board with respect your “prescription” of “a very low insulin diet,” and have bookmarked your insulin series to read. Thanks for this post in particular. You’re speaking to me, and you have helped me by sharing your (and Woo’s) insights and your personal revelations.
    Dan Brown
    PS: I saw you at the Metabolic Therapeutics Conference in Tampa in January, sitting next to Franzisca at the final session. Sorry we didn’t get to meet. Will you be going to Banff?

    1. Hey Dan, very cool that you were at the conference! Why didn't you say hello? I'm not sure about Banff. I might go to the Ancestral Health Symposium in CO in August. Honestly, I need to start growing my practice and seeing more clients so I can *apply* some of this knowledge before I keep going to conferences. (Also need to make more money! No one "sponsors" me to attend any of these things...all out of pocket. So CO is easier for me than Banff, but who knows, maybe I'll go. Heaven knows it's going to be a killer source for information & education.)

      You lost *170* pounds? WOW! Even if you gained some back, that's still a huge accomplishment, and it sounds like it's starting to come off again. It's frustrating that we have to come at this from multiple angles (low-carb, *plus* fasting, intense exercise, more sleep, or whatever else...take your pick), when other people don't give any thought to what's on their plate, or what their blood sugar is doing. It's difficult, and aggravating, but we're all in it together.

  6. Fascinating ideas. I have speculated about this for a long time. Thank you for putting into words. I am a constitutionally thin person. My mother was an obese dental hygienist concerned about my teeth, so she gave me very little sugar during the first 5 years of my life. I ate a lot of beans growing up (low insulin), then became a vegetarian at age 14 and also took up cross country running at that age. I have never been more that about 10 lbs over my ideal weight. However, I have also done a fair amount of water-only fasting throughout the past 25 years (several of which have lasted 2-4 weeks in length). I suspect that could have some very therapeutic and possibly long-lasting benefits for people who may have had a high-insulin childhood. That would be an interesting study also. My mother, who has been obese since age 5 has struggled with her weight her entire life, even though she has been a vegetarian for 30 years now.

    1. I wonder if longer term fasting would help. I'm not quite ready to try yet, but I'm willing to do some shorter fasts. You're an interesting case, though. Like you said on FB (I think I saw it there) -- you've been slim all your life, but you've faced some very gnarly *other* issues. So who knows how any of this really works? ;-) Some of your issues might have been due to malabsorption, so it's almost like regardless of what you ate, your body couldn't even *absorb* most of the calories it was getting. Some of us seem skewed in the other direction...we almost absorb *more* than what's on our plate, hehheh! But I appreciate you and your Zero Carb Zen site so much, because even though you've never had a weight problem, you at least acknowledge how complex and difficult it can be for others. Seems like people without personal experience in something find it almost impossible to even consider the other side's perspective. (Which is why I make it a point to mention people who *can* eat more starch and do just fine.) It's why I appreciate just about *anybody* who's naturally thin, but who understands that heavier folks aren't lazy pigs (to put it bluntly).

  7. Great post Amy. Very interesting theories. It would be great to see if those studies could be accomplished. I think post relates to what Tom Naughton touched on in Fat Head when he was talking about how some people's fat cells are more efficient than others and those others' fat cells have to be fuller to respond to hormones that release fat for energy.

  8. Great Post Amy! I have had the same theory in my head and you have been able to articulate it what the details of what I would have liked to say.

    I am one of those who are efficiently fat. I work hard at maintaining not being obese. It is such a struggle. I appreciate your insight in the article. Thank you so much!

    1. It *is* a struggle. Honestly, I'm on the verge of giving up the fight myself, right now! When I think about how much of my thoughts and emotional energy I've devoted to this ridiculousness for most of my life...oy! But I know I won't give up. I would like to learn to go a little easier on myself, though. If people could hear my inner monologue, they'd be horrified.

  9. Prof Tim Spector in England is doing a lot of research on the microbiome and is also a well respected researcher on identical twins. In a documentary called "It Takes Guts" (it's on Youtube), he discusses the (female) Mac Twins and their really awful Scottish SAD diet yet they remain lean. He has isolated a particular species of bacteria present in their guts that he suspects may be responsible for their obesity resistance. Can't recall the name off hand but it's worth watching the documentary just for that segment. Just to muddy the waters further :-)

    Would be great if you and Wooo could get that study done!

    1. Yeah, the gut thing could potentially be a huge player in all this. There's a reason I have no posts about it, though -- honestly, I'm just not that interested. I hope *other* people keep doing the research and writing about it, but for me, personally, there are other issues in nutrition/food/health that fascinate me way more than the gut biome. That's pretty far down on the list, but if they ever discover a fecal transplant or some kind of specialized probiotic supplement that can make me effortlessly slender without having to work ten times harder than other people (and still not even getting slender!!), I'll be one of the first in line for it. ;-)

  10. You made some great points, Amy! :-) Like many others, i get so annoyed by the gym-rats, male and female, who think that their experience is universal. We all have our unique genetics to start with, and THEN we add our different food experiences in infancy and childhood, PLUS illness/infection/injury which set off time-bombs of CFS/ME and food-intolerance.... The idea that ONE regimen will result in success for everyone is completely laughable.

    Wooo's work is extraordinarily brilliant -- i wish she'd blog more and twitter less, because she's so prolific there it's time-consuming to keep up! Between her professional education and experience, her outside literature-research, and her insightful observation of her personal experience, her voice has been one of the most valuable to me, in making sense of the bewildering complexity of our biology.

    1. Yes, Woo is a treasure in the sea of "bro science" and 24-year old fitness models trying to tell the rest of us how to lose weight and keep it off without making ourselves sick in the process (physically *or* psychologically). I try not to name names on my blog, but I love that Woo doesn't really care, and calls SG out when things border on the myopic, the moral judging, and the ridiculous. (Which is often.) I wish she would blog more, too. I try to keep up with Twitter feed at least once a day. Sometimes the golden nuggets about weight regulation/keto/hormones get lost in the sea of makeup, social politics, and kratom/family stuff, hehheh. But those stellar bits are usually worth sifting through all the other stuff to find. ;-)

  11. For the first 28 yrs of my life, I wanted to gain weight and couldn't. I was also a junk food feign and sugaraholic. At age 28 I was put on a medication that made me bloat and gain weight and have not been able to take it off permanently. I lose weidht on a low carb diet but have cheat days because of huge cravings. Now I decided to go on a zero carb diet to take back my life at age 60. I am doing as much research as possible and really learn with blogs such as yours. Thank you.

    1. I've considered doing the zero carb thing, myself, if only just as an experiment. Haven't done it yet, but it's definitely on the radar. Not as crazy as it sounds. I follow some of the FB groups and there's some very interesting stuff there. I'd like to write a few posts about the rationale for zero carb/carnivore, but there are a couple of things I'm going to get to first. How are you doing on ZC? (Or is it too soon to tell?)

    2. Amy, if you want to try ZC, i strongly urge you read and follow Donaldson (if you haven't already). Ignore his ban of salt, of course. ;-)

    3. First off, thank you for responding. It's too soon to tell as it has only been a week. Before that I threw away of all other foods in the house. This should be fairly easy because I love fat, fish and some meat. Found a place to buy lamb sweetbreads in order to get vitamin C in diet and liver and egg yolks for vitamin A. I have been researching what parts to buy for vitamins and minerals because that will be a huge part of doing the diet correctly. I am curious just how fast I will lose the weight since dealing with a few health issues and will I be able set my body back to it's original state within a few years of this diet. I've made a list of what maybe accomplished with the ZC diet. :-)

    4. Thanks, Tess. I'm not sure if I'm ever actually going to do it, but I do think about it from time to time.

  12. Hi Amy- think you're overweight? You don't look it in your pictures, in fact you look quite beautiful, I think.
    In any case, I've been following your blog for awhile (when I have time), but haven't commented until now. I thought I'd comment because I seem to be a "mixed case". As a baby, I was very fat- (my mother had been very skinny and malnourished as a child, and contracted tuberculosis as a teenager; so she force fed me, presumably to ensure that I didn't have the same problems as she did). Apparently I had to go on a diet at about the age of 4 months. So I was a very fat baby, but I guess I was a relatively normal child. As a young woman in my 20's (like many of us)- I decided to go on a low fat diet. However, it completely backfired! I not only put on weight, but my hormones got totally out of whack. (I fully agree with what Gary Taubes says about hormones and weight gain, I saw it happen to myself). In an attempt to lose the weight I was gaining, I started to restrict calories even more, then I started fasting, until I was eating almost nothing, but it seemed that the less I ate, the heavier I became. I was technically anorexic, but I didn't look it at all! (I wonder how many other cases like that there are in the world?) Luckily, at some point I stopped that madness, and my endocrine system got into balance again.

    Now years later, I eat low carb, high fat- (I started this mostly due to digestive issues). I feel great now, very healthy, and many problems I had previously have disappeared. However, I've now become very thin, and can't seem to gain weight no matter how hard I try; (I would like to have some of my womanly curves back again, but oh well....) When I was low fat, no matter how little I ate I couldn't lose, and now, I can eat loads of calories and not gain. I guess what I'm saying, in my long-winded way, is that a "calorie is definitely not a calorie", and, contrary to popular belief, it's not easy at all to "control" one's weight. I'm saddened to hear that many people don't understand this, and are hard on others.

    1. Wow, yes, you do sound pretty unique! If you are on the thin side now, I wouldn't worry, except if you are noticeably and/or uncomfortably *underweight.* If you have a hard time gaining *healthy* body mass, it could be a digestion & absorption issue. Good food doesn't do you much good if you're not actually breaking it down and absorbing it properly. Something to think about if you feel like you're wandering into "too thin" territory. You say you're eating LCHF and your digestive issues are better. It may have been a grain or dairy issue. Many people - especially ones trying to gain healthy weight - do just fine with a little more starch and naturally sweet vegetables, in the form of potatoes, sweet potatoes, parsnips, beets, butternut squash, etc.

      As for my own weight, well, thanks for the compliments. Certainly, I am not obese, but my scale weight puts me right at the line of being overweight. And no one looking at me in person would ever mistake me for being "slim." I wore sizes 12-16 through most of high school. I'm 5'2" and spent many years in the high 150s. Again, not obese, but not exactly slender. I've fought weight -- and even more so, body image -- my whole life. I have been happy with my shape for brief periods here and there, but even then, I still compared to myself to women who are taller, thinner, bigger boobs, etc. At my very best, I will still always feel as though I fall short. (No pun intended with being 5'2", hehheh.) I will probably always have some degree of body dysmorphia. It's a shame. The amount of headspace and emotional energy I give this cr@p is *ridiculous.* I will probably never quite see myself the way other people see me. I see only the flaws; they see only the beauty. (On very good days, I see it, but usually it's hard. I tend to avoid mirrors as much as possible.)

    2. Also, as for being "overweight," in this post, in particular, I was saying more that I am a naturally fat person who is keeping her propensity for fatness in check with a LC diet. If I ate "like a normal person" (cereal & toast for breakfast, sandwich & chips for lunch, Chinese takeout for dinner, my constitutional propensity would be showing itself for sure.) o_O ;-)

    3. Wow, thanks for the quick reply!

      My weight loss really began when I stopped eating sugar....yeah, the white stuff! And grains because yes, I do have a grain issue- (I'm a celiac, and I discovered- like many celiacs I've read about- that I feel better when I don't eat grains at all). Fermented dairy is no problem for me anymore (I guess the formerly damaged villi are no longer damaged), so I eat a reasonable amount of (mostly) goat cheese. I am also not "very low carb", just moderately low carb- (I try for about 72 grams a day, as recommended in the book "Life Without Bread". After reading about how Dr. Lutz cured his patients of all kinds of digestive problems with this diet, I was inspired to try, and it worked). In other words, that makes room for a few of the more "dense" carbs; I've mainly cut out grains and sugar, as well as some fruits and a few vegetables that I know I can't tolerate. I feel healthy, but according to my BMI I'm underweight. As you've mentioned, and I agree, maybe BMI is not the best way to judge, so....not sure what to think. Or if I should worry.....

      In any case, your post (as well as my odd "mixed" experience)- has caused me to think more about hormones and weight gain/loss. People mainly talk about insulin as being the deciding factor- (loved your "insulin" series, by the way!)- but I'm sure that for us women, there are many other hormonal issues at work here too, which would also affect weight gain or loss. We go through so many big hormonal changes in different times of our lives, and these changes obviously affect our metabolism. One thing that I notice in my reading of the subject is that not much seems to be known about women's bodies, how they function, what "works" for women. For instance, several authors have noted that middle aged women tend to put on weight, and that low carb doesn't always work in this case. But the mechanism as to what is really going on doesn't seem to be well understood- (in fact, menopause itself seems to be a "mystery"; most of the people who write about it don't seem to know what they're talking about!) My guess is that at some point in the future, we'll discover more about the workings of the female body, what other hormones might be affecting us (besides insulin; and I'm not convinced that it all boils down to "lack of estrogen" either, as this doesn't make sense.....aside from the fact that the "lack of estrogen" idea was a marketing ploy to promote hormones....) And this hormonal idea would apply to other times as well, pregnancy and beyond, etc. When I went through various weight gains in my life- (aside from when my mother was overfeeding me)- there was always something going on with my hormones; or I was taking hormone pills for various ailments; so I'm convinced it's connected. Eating, and calories, didn't seem to have any effect at all at these times. In any case, I'm inspired now to google this, see if I can find anything.....

      Now, as for you: yes, I did realize that the point you were making was that you were a "naturally overweight" person controlling your weight through low carb. But since you look young, beautiful and healthy to me, I was just surprised at that, so I thought I'd comment. Now that I'm a middle aged woman, I see all these younger women around me who have low body image, and don't seem to see the beauty that I see in them- (I am a dance teacher, and I'm working with many young women in their teens and early twenties). I guess I mention it because when I was young, I felt exactly the same way, and all of the things you've written above- well, that could have been me saying that, years ago! Oddly enough, I have much more confidence now, and don't seem to worry so much about my appearance. Trust me, I bet that will happen to you too someday.

  13. Thank you so much for this post.

    Susan Palmison

  14. Wow, somehow I overlooked this one. Just picked it up from the link in last week's low hemoglobin blog - thanks for the intriguing article.

    1. One of my favorites! I really think this explains why it's so difficult for some people to maintain large weight losses, and why some people will (almost) never become obese, even when eating and living in such a way that would result in a lot of weight gain for the rest of us.

      P.S. It was so nice meeting you at AHS! Glad you spotted me. :)

  15. Thanks for this. Whenever I read the next 'lose weight by just stop/reduce (insert here) desserts /sugar/ soda drinks / junk food/ bread) I either laugh or cry at the acceptability of making childish intellectual judgments in the weight loss world. It's been decades since I ate any of that stuff, lived sugar and grain free, low carb and still obese... Having read Cravings, and Jaminet, and come to believe that I have inherited multiple obesogenic factors (also a super-shortie at 5`0) , I have essentially accepted the condition as one requiring constant vigilance. I've had my greatest success with enduring steady weight reduction and body acceptance by joining OA, which was a great move, very transformational.

  16. When I read stuff like this it feels like a huge blow. It's basically saying hey you'll be fat forever, unless you forever eat less than everyone else and remain hypervigillant and give up whole food groups you love from fruits to breads and pasta. It just feels so hopeless. :(

    1. Please don't be discouraged. That is NOT what this blog post was about. It's saying that it will be more difficult for you to get to and maintain a lower weight -- it's NOT impossible, nor is it hopeless. But for most people, it will be more difficult, and will require more vigilance about food than for people who have been slim all their lives. I think low carb/keto plays a HUGE role here, as many thousands of people (myself included) have found it's much easier to maintain a weight loss over the long term when you permanently change your eating habits and make a point to stay within your own carb tolerance. As long as you *stick to* some degree of carbohydrate restriction, I think it's much easier to maintain weight loss. But you do have to stick to it.