Ketones: Alternative Energy for Your Body

While leptin is one of the most fascinating things I learned about nutrition, ketosis is the most fascinating. It's also a bit more complicated and there's not as much solid research on it as I would like, but in my mind, it's an incredible frontier. First I'll explain the how it works, but what I find much more interesting is the why and what it means for our long-term health.

The easiest way to explain ketones is with an analogy. Fats are to ketones what carbohydrates are to glucose (i.e., carbs :: glucose = fats :: ketones). Meaning, ketones are the energy source produced by your body from digesting fat molecules whereas glucose is the energy source produced by your body from digesting carbohydrate/sugar molecules.

**Note, for simplicity's sake, I call ketone bodies "ketones" but if you're curious about the semantics go here.

If you've ever tried a low carb, high fat diet (such as Atkins), you've probably experienced what's called nutritional ketosis. Nutritional ketosis is when your body burns fat for energy instead of carbs and sugar. For reasons that may seem obvious, this is good for weight loss -- fat stores are being burned, hallelujah! But the real reason your body does this is not to make you look better in a swim suit: it relates to our body's survival mechanisms.

When a person eats carbohydrates their body stores excess energy as fat through a process called de novo lipogenesis (aka "DNL" or simply "lipogenesis" and translated from latin as "new fat creation"). This is an evolutionary advantage for humans (and other animals as well) because it allows carbohydrates to be stored as fat, which is a much more energy-dense and efficient molecule than a carbohydrate (more on this another time), and to be used for energy when food is in scarce supply. The hormone insulin plays a key role in this process by regulating and promoting the absorption of sugar/carb molecules from the blood to fat tissue and to a lesser extent skeletal muscles. Insulin also signals to brain to KEEP EATING because this delicious carbohydrate/sugar treasure trove is a food source that can be stored by the body for energy later (in the form of adipose tissue aka love handles).

Conversely, when a person eats fat, leptin plays a greater role than insulin. Leptin, also known as the "satiety hormone," tells your brain you are full. Leptin is the reason you can drink an 8 oz glass of skim milk, but not of heavy cream (or if you do, you're not hungry after drinking that full glass of heavy cream). All that fat in heavy cream is causing leptin to hold up it's stop sign to the brain. (Fun fact: heavy cream does not have any milk sugar, aka lactose, whereas skim milk is full of it).

There's another important hormone at play here: ghrelin, also known as the "hunger hormone." When your stomach is empty, ghrelin sends a message to your brain that you need to look for food. If you go without food long enough, your body switches to a "starvation response" which is a set of adaptive biochemical and physiological changes that slow your metabolism in response to a lack of food.

Your body will also fall into starvation ketosis. Starvation ketosis is when your body burns your fat stores. However, starvation ketosis operates in tandem with your body's starvation response. Your body is burning your fat stores, but doing it slowly because it wants to prolong your energy stores as long as possible since it's received news that your next meal is uncertain.

From Dr. Attia: "The reason a starving person can live for 40-60 days is precisely because we can turn fat into ketones and convert ketones into substrate for the Krebs Cycle in the mitochondria of our neurons. In fact, the more fat you have on your body, the longer you can survive.  As an example of this, you may want to read this remarkable case report of a 382 day medically supervised fast (with only water and electrolytes)!  If we had to rely on glucose, we’d die in a few days.  If we could only rely on protein, we’d live a few more days but become completely debilitated with muscle wasting."

Dr. Attia again: "Why do we make ketones? For starters, it’s a vital evolutionary advantage.  Our brain can only function with glucose and ketones.  Since we can’t store more than about 24 hours worth of glucose, we would all die of hypoglycemia if ever forced to fast for more than 24 hours.  Fortunately, our liver can take fat and select amino acids (the building blocks of proteins) and turn them into ketones, first and foremost to feed our brains.  Hence, our body’s ability to produce ketones is required for basic survival."

As opposed to starvation ketosis, nutritional ketosis is when you are eating dietary fat and restricting carbohydrates to approximately 20-50 grams per day and maintaing modest (but not high) protein intake. When I first discovered nutritional ketosis (about two years ago now), I felt like I'd reached nutritional enlightenment. At times, I probably give ketosis too much credit, but I can say for certain that being in ketosis changed my body, my energy, and my life for the better. My experience with ketosis has been incredibly positive, perhaps that's not the case for everyone, but I also think we simply don't have enough research on the topic. Switching from a glucose-based diet to a ketogenic diet is not for the faint of heart: it requires a lot more preparation and research than simply eating bacon and butter. I hope this post was a good introduction to ketones and ketosis, but since it's fairly length already, I'll save the ins and outs of nutritional ketosis for my next post. Hopefully, this post helped get my writer's block out of the way and I can gain some momentum on this topic!

The (Actual) Basic Food Groups

Many people think their bodies run on calories. It doesn't matter the source -- put a "calorie" of any kind in your body and you'll either "burn" it or store it. It's a pretty simplistic view of the human body if you ask me. We don't even think about our cars the same way. Some cars take regular, some take premium, and some take diesel -- not to mention electric or solar-powered cars. You wouldn't expect a diesel engine to run on vegetable oil, even if you gave it the same "energy" equivalent in calories. Is the human body really simpler than an automobile?

What's the real story with your body? What kind of "fuel" makes it run efficiently and cleanly? Let's dig deeper into these the three main types of "human fuel" (also known as macronutrients) to answer this question: carbohydrates, protein, and fat. We also need to get intimately familiar with our food and what exactly it consists of by dragging up some chemistry that some of us (me) haven't studied since high school. I realize this is an extraordinary amount of detail on your food, but I think it's important in developing a solid scientific basis for good nutritional advice vs. bad nutritional advice.

The building blocks of nutrition (from your body's point of view)

Carbohydrates (aka hydrocarbons):

A "carb" is a molecule consisting of carbon (C), hydrogen (H), and oxygen (O) atoms. In chemistry, a hydrate is a substance that contains water or its essential elements (H₂O). Your body sees crackers and bread and really any food containing carbohydrates as these more basic elements: C_m(H₂O)_n, where m is the number of carbon atoms and n is the number of hydrates.

There are many different types of carbohydrates such as fruit sugar (fructose), table sugar (sucrose), milk sugar (lactose), starch, and fiber.

Dietary fats:

Fat molecules are formed when a glycerol molecule bonds to three fatty acids. In chemistry, glycerol is classified as an alcohol with three carbon atoms (C), five hydrogen atoms (H), and three hydroxyl (OH) groups. When glycerol joins up with a fatty acid the hydroxl group gets dropped in the process. The fatty acid chain joins up with the carbon atom in the glycerol molecule.

Here's what fat looks like to your body

A universal property of fats is that they are not soluble in water, which is because of the the type of bonds in their molecular structure (nonpolar covalent). Nonpolar bonds have equal shares of electrons (therefore there's no extra electron trying to link up with a proton). Covalent bonds are by definition stable. This is an interesting and important property of fat and how your body uses it.

There are also many different categorizations of fats: saturated vs. unsaturated, polysaturated vs. monosaturated, omega-3s vs. omega-6s, and cis fat vs. trans fat. To truly do fat justice, I'll devote a whole post to these different classifications.

Dietary proteins: 
Proteins consist of one or more chains of amino acid residues. All proteins contain the elements carbon, hydrogen, oxygen, nitrogen and sulfur some of these may also contain phosphorus, iodine, and traces of metals like ion, copper, zinc and manganese. There are approximately 20 amino acids that combine in different ways to make thousands of different types of proteins. The key elements of an amino acid are carbon (C), hydrogen (H), oxygen (O), and nitrogen (N). Some amino acids cannot be produced by your body, so it is essential that your diet include these. These are known as essential amino acids. From a molecular perspective, proteins are a bit more complex than carbohydrates and fats, but what's pertinent to know in relation to what you eat is what amino acids provide to your body.

Essential amino acids	Nonessential amino acids
Arginine	Alanine
Histidine	Asparagine
Isoleucine	Aspartic acid
Leucine	Citrulline
Lysine	Cysteine
Methionine	Glutamic acid
Phenylalanine	Glycine
Threoniwne	Hydroxyglutamic acid
Tryptophan	Norleucine
Valine	Proline
	Serine
	Tyrosine

The macronutrients referenced above are all in relation to what you ingest, which does NOT necessarily stay the same once processed by your body. In my next post, we'll delve deeper into the chemical reactions that occur during digestion of these different macronutrients and how your body uses them for different functions.

I hope everyone had a great weekend. Keep eating your brain food. :)

The Warburg Hypothesis

 "All science is all too human." 

—Hans Fischer

Our story starts in 1914 alongside a bright, young soldier in the First World War by the name of Otto Warburg. A talented equestrian and decorated cavalry solider in the Prussian Horse Guards, he receives a letter from a family friend -- by the name of Albert Einstein -- urging him to return to his position at the Kaiser Wilhelm Institute for Biology. Einstein says in his letter, "I hear that you are one of Germany's most talented younger biologists of great promise." Einstein's remark was not mere polite flattery, as Otto Warburg went on to win the Nobel Prize in Medicine in 1931 for the "discovery of the nature and mode of action of the respiratory enzyme." Moreover, "the great number and magnitude of his discoveries [sic] rank him as the most accomplished biochemist of all time." (Encyclopedia.com). He was nominated 47 times for a Nobel Prize over the course of his career.

For our current purposes, Warburg's most interesting work involves the respiration of tumor cells versus the respiration of healthy cells. Warburg himself gives the best explanation of the momentous implications of his research in a speech to 1966 Nobel Laureates.

"Cancer, above all other diseases, has countless secondary causes. But, even for cancer, there is only one prime cause. Summarized in a few words, the prime cause of cancer is the replacement of the respiration of oxygen in normal body cells by a fermentation of sugar. All normal body cells meet their energy needs by respiration of oxygen, whereas cancer cells meet their energy needs in great part by fermentation."

Later in his speech he proposes an action item for this information: "To prevent cancer it is therefore proposed first to keep the speed of the blood stream so high that the venous blood still contains sufficient oxygen; second, to keep high the concentration of hemoglobin in the blood; third, to add always to the food, even of healthy people, the active groups of the respiratory enzymes; and to increase the doses of these groups if a precancerous state has already developed. If, at the same time, exogenous carcinogens are excluded rigorously, then much of the endogenous cancer may be prevented today." (more on this later)

Finally, he concludes, "These proposals are in no way utopian. On the contrary, they may be realized by everybody, everywhere, at any hour. Unlike the prevention of many other diseases, the prevention of cancer requires no government help, and not much money... Nobody today can say that one does not know what the prime cause of cancer is. On the contrary, there is no disease whose prime cause is better known, so that today ignorance is no longer an excuse for avoiding measures for prevention. That the prevention of cancer will come there is no doubt. But how long prevention will be avoided depends on how long the prophets of agnosticism will succeed in inhibiting the application of scientific knowledge in the cancer field. In the meantime, millions of men and women must die of cancer unnecessarily." (Emphasis mine)

Essentially, Warburg's point of view is that there are all kinds of carcinogens in the world and instead of trying to fight each one individually, we should focus on feeding healthy cells what they truly need instead creating a ripe environment for cancer to thrive. Furthermore, because we know of this significant difference in how healthy cells are fueled versus how cancer cells are fed, we should target this unique cancer metabolism in order to cure cancer.

The next logical question is of course, what should one eat in order to properly feed healthy cells (and thus prevent cancer)? You may have guessed from the whole "sugar fermentation" that cancer cells preferred source of fuel is glucose. Glucose is a simple sugar that is created by our bodies after breaking down carbohydrates in the food that we eat. Too much glucose wreaks havoc on our bodies in many ways: diabetes, heart disease, Alzheimer's, cancer, and many other diseases all have growing bodies of research on the role of glucose and insulin (the hormone that breaks down glucose) in their development.

The Warburg hypothesis is just the beginning of the story of how nutrition can be used as a medical tool to cure and prevent disease. Next time, we'll take Warburg's research one step further and learn about an alternative source of cellular energy called ketones.

Here's to 2015

 I find beauty in the blank page. Resembling a blanket of freshly fallen snow, I can hear my own thoughts and as they start to unravel I make a slow, measured path down the page. This could also be why I love the start of a new year. It's like a blank canvas from Father Time. Wipe the slate clean and begin again, only this time wiser than before. 

My amateurish ventures into nutrition have definitely made me wiser. Although, sometimes I feel like I fell down a rabbit hole and perhaps ignorance really was bliss. But most of the time I don't believe that. As Maya Angelou loved to say, "When you know better, you do better." I do better for the most part. Sometimes I have to put a blindfold on part of my brain just to enjoy a chocolate chip cookie like a normal person instead of thinking of sugar addiction and the massive sugar industry and its infiltration of our food system and the massive health consequences facing humanity (BE QUIET BRAIN AND JUST ENJOY THE DAMN COOKIE!).

There's also the frustrating fact that for every question I've researched, I have at least 10 more questions once I find the answer. And I'll dig, and dig some more, and email some random doctor halfway around the world and get a thoughtful-but-not-altogether-illuminating reply... and then my questions keep multiplying but my options for answers run out. It's like reading a really suspenseful murder mystery and never finding out whodunnit.

So this year, I'm reeling myself in a little bit and just posting some of my thought process and questions from my forays into nutrition and health. Maybe I'll find the big answers, maybe I won't. But I think a lot of what I learned along the way is valuable.  I'll begin the year with the story of one of my main obsessions that got me on this path in the first place: ketones, glucose, and their relationship to the "emperor of all maladies."

Oh, Behave!

I can’t believe it’s been three months since my last post. Apologies to my loyal readers, I hope you know that I haven’t forgotten about you and I have been thinking about all kinds of different posts for quite some time, so hopefully it’s worth the wait. My absence is due to the fact that I have been studying for a finance industry credential and it has been taking up the vast majority of my free time (it’s called the CAIA in case you’re interested). Unfortunately my nutritional research hobby doesn’t advance my career or pay the bills, so…

I study on the plane, I study through the rain
I study in the pool and I study like a fool
I WILL PASS THE CAIA SAM-I-AM
I will pass it on a boat; “I will pass it,” you can quote
I will pass it through a cramp and I will pass it like a CHAMP

There are more verses, but I will spare you… hopefully you’ve forgiven me now? 

What’s incredibly interesting to me is the overlap between financial analysis and nutritional research. For instance, in evaluating an investment manager there are several behavioral biases that, if present, should raise red flags to a potential investor. If an investor ignores these biases, it could lead to financial ruin. In nutrition, I believe the stakes are even higher. Behavioral bias is one of the first key things I think we can learn from my forays into finance.

Expectation Bias

An example of this is expectation bias, which is the tendency of an investment manager to overemphasize information that is consistent with prior beliefs. In nutrition, we see this in calorie counting. We learn the first law of thermodynamics, which states that energy cannot be created or destroyed, only transferred. Then we see this principal erroneously applied as “all calories are created equal,” which ignores the way that energy is used and applied in the body. We are using a principal that is useful in one scenario (and emphasizing its merits) without noticing that it doesn't apply to this particular premise. A health researcher may conduct a study and then using the data, work backwards to show that the person who ate less calories lost more weight, all the while ignoring the very important question of "why?"

Confirmation Bias

Confirmation bias is rampant in nutrition (and one could argue in many other places in our society). Confirmation bias is when a manager or investor interprets data in a manner that supports their preexisting beliefs. An example of this in nutrition is when a major corporation sponsors research because they are looking for a particular result (e.g., a study on the health effects of sugar sponsored by Coca-Cola). For more on this topic, read this article on Mother Jones -- it actually blew my mind. The research by Ancel Keys in my last post is also a textbook example of confirmation bias.

Herd Behavior

This rather intuitively named bias refers to a tendency to follow the crowd. An investor may be friends with another investor who did due diligence on a manager and, instead of conducting their own due diligence review and conducting proprietary analysis, they invest in the manager’s investment product based on their friend's advice. So your friend is following a gluten-free diet and is seeing some great results, and, therefore, you decide to also become gluten-free. That’s not doing your due diligence, that’s following the herd. Don’t be a sheep!

Bias Blind Spot

Last, but not at all least, is the bias blind spot. I’m not gonna lie, this one can be painful and rather difficult to avoid (and admit). The bias blind spot is underestimating the influence of behavioral biases on one’s own behavior. It is much easier to spot in others than in oneself. To emphasize this point, I’ll use myself as an example. For a long time, I depended on authority figures to distinguish between healthy and unhealthy foods. To this day, I still have a tendency to believe someone with a bunch of fancy letters next to their name and a big diploma on their wall. I see this again and again in the nutritional debate, where attempts are made to prove an argument based on the reputation of the person stating their opinion. Instead of looking at the merits of the data and the logic of the opinion, we rely on ad hominem arguments.

I think I have somehow managed to integrate my studies into getting the blog back on track. I hope to post again soon, but until then… I will study in a tree, I will study by the sea, I will study like a dog and I will study on a log…

Another "Key" Piece of the Puzzle

Before I get into my planned post, I feel the need to address something that's been in the news a lot lately. Dozens of news outlets have picked up a story based on this publication from Cell & Metabolism that claims low protein intake aids overall mortality rates (but only if you are under the age of 65, some stories left that little nugget out). I could do a lengthy post on the compromised ethics and incompetent science that led to this conclusion, but an awesome British nutritionist has already posted a great analysis (http://www.zoeharcombe.com/2014/03/animal-protein-as-bad-as-smoking/).  Please read her post if you have even the slightest hesitation that this news story has even a grain of truth to it. For now, let this be a cautionary tale in our quest for nutritional facts. It's not the first time twisted and inaccurate data has been sensationalized by the media, and it certainly won't be the last. In life, in love, in war, and especially in nutrition, having a finely tuned bullshit detector is extremely helpful.

Speaking of which... Today we are moving away from the history books and into the science texts. I'll need you guys to keep your minds open and your B.S. antennae on high. Forget everything anyone has ever told you and start from the beginning. Build the facts slowly, like a jigsaw puzzle, and soon you'll sit back in satisfaction at the full picture. Remember what we're after here? Health. Longevity. Vitality. Joy. I promise, it's worth the effort.

In my last post, I mentioned the time period in the United States when we started forming our current nutritional recommendations and guidelines. In this post, I want to get into the science behind the scenes. Instead of adopting the opinions of others, let's take a closer look at the data and the scientific opinions surrounding it and form our own interpretations and conclusions. If we think about the continuum of scientific knowledge over the centuries, humans have made scientific laws based on relatively concrete facts, until those hypotheses got disproved, revised, and/or refined. (Remember learning about Galileo? He was tried as a heretic for saying the Earth orbited the Sun.) Human beings are constantly enhancing collective societal knowledge with each generation. Therefore, questioning the current state of things isn't so heretical when you pull back and think about the fact that this is what we as humans do... we take what we know and we build on it. Sometimes we get it wrong, sometimes we get it right, but it's a process that's refined by many people over time.

Bringing this back to the present... This is where people trying to lose weight and be healthy need help. The research is so conflicting and all over the map that it takes some real sifting to get through to the facts. And there's still a lot that we cannot neatly conclude, but we are certainly making progress.

American scientist Ancel Keys was at the forefront of the influence of diet on health in the 1950s. He had a particular interest in the epidemiology of cardiovascular disease (CVD) and its relationship to dietary fat. Among many highlights in his career, he developed the CVD-lipid hypothesis. Keys observed that the highest rates of CVD were among the most well-fed and affluent members of society and that incidents of CVD decreased during WWII. When he proposed the idea that fat causes CVD to a meeting of experts on heart disease at the World Health Organization in Geneva in 1955, his argument was swiftly dismantled. Two experts (Jacob Yerushalmy and Herman Hilleboe—Berkeley statistician and New York State Commissioner of Health) even went so far as to publish a chiding follow-up called "Fat in the Diet and Mortality from Heart Disease: a Methodological Note" (no open source, but if you have access: http://www.ncbi.nlm.nih.gov/pubmed/13441073). Here's a highlight: “….the evidence from 22 countries for which data are available indicates that the association between the percentage of fat calories available for consumption in the national diets and mortality from arteriosclerotic and degenerative heart disease is not valid; the association is specific neither for dietary fat nor for heart disease mortality. Clearly this tenuous association cannot serve as much support for the hypothesis which implicates fat as an etiologic factor in arteriosclerotic and degenerative heart disease.”

Undeterred, Keys pushed forward with his research.  His epidemiological studies, which began in 1958, lasted for decades. He gathered data on 12,000 healthy middle-aged men living in over 22 countries. He continued to observe a statistically significant association between higher intakes of saturated fats and heart disease. The problem with Keys's research is that we cannot prove causation from association. There are so many other compounding factors to this association. For instance, what other elements are involved in these individuals' diets? What other access do they have to healthcare and food? How long are they living compared to people not dying of CVD? (i.e., what is the correlation between fat and overall longevity?) How good are the cause of death records in these countries? Perhaps in countries with better records there are more cases of CVD?

Furthermore, when we look at Ancel Keys's raw data from the WHO presentation, we see a negative association between saturated fat consumption and all other deaths not from heart disease. We can also observe with high significance that those with a higher percent of calories from carbohydrates had the greatest mortality in men ages 55 to 59. In addition, overall, countries with higher average fat intake had the longest life expectancies. However, the only reason I'm presenting you with this information is to show how easily the statistics can be manipulated to prove a point. There are still many compounding factors, which is the great challenge nutritional data faces and a major reason why it's so all over the place.

I find the most compelling compounding factor for Key's research to be this (from Yerushalmy and Hilleboe): "The amount of fat and protein available for consumption is an index of a country’s development, industrially, nutritionally, medically, and no doubt in other respects as well."

In 1961, Ancel Keys was on the cover of TIME magazine for his research efforts. The food industry, and by natural domino effect, national health polices, followed suit. If you find this hard to believe, remember that industry has steered us down a dangerous path not so long ago. It was just at the end of the 20th century that our society recognized the ill-effects of smoking. Ad campaigns featuring physicians were prominent through the early 1950s, tobacco executives used the doctor image to assure the consumer that their respective brands were safe. From 1948 to 1954, Camel's advertising slogan was “More doctors smoke Camels than any other cigarette.” There was even a school of thought that cigarettes were a health aide and were recommended to patients for reducing anxiety and stress.

Our health system is not holistic, we look at a symptom and we treat the symptom, but we don't treat the entire person and we don't focus on prevention. The other major difficulty here is that we are not dealing with a singular "BIG" as in Big Tobacco. We are dealing with Big Pharma, Big Sugar, Big Soda, Big Food, Big Alcohol... the list goes on. This is a problem that has to be solved by educating the consumer (ourselves) and making economic choices that force change.

Keys didn't get it all wrong however. He lived to the age of 100 and was a big proponent of the Mediterranean diet. I'll discuss the Mediterranean diet in more detail later, but remember two key components of this diet are olive oil and fish. He and his wife retired comfortably to a villa in Naples and they certainly weren't eating low fat sugar-laden vanilla-flavored yogurt from Aisle 9. (Side note: I doubt that Keys partook in this, but cooking with lard was a huge part of the actual diet of people living in the Mediterranean region -- you won't find that in the diet book however.) 

SO... Keys is one piece of the puzzle, read up on him and his time period and you will get a much fuller picture of why our current health recommendations are what they are. If you enjoy a good drama, read about his feud with British scientist John Yudkin. However, Keys is not the whole picture. We haven't solved the mystery yet, but now we have a bit more background for our case.

Additional Sources and Further Reading:

If you don't read anything else here, read this post by Denise Minger of Raw Food SOS, she does an incredible job assembling Ancel Key's raw data and interpreting the results here: http://rawfoodsos.com/2011/12/22/the-truth-about-ancel-keys-weve-all-got-it-wrong/

http://www.epi.umn.edu/cvdepi/essay.asp?id=33
http://openheart.bmj.com/content/1/1/e000032.long
http://www.telegraph.co.uk/health/dietandfitness/10634081/John-Yudkin-the-man-who-tried-to-warn-us-about-sugar.html
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470496/
http://www.nytimes.com/2004/11/23/obituaries/23keys.html?_r=0

The #1 Reason You Can't Lose Weight

Thank you to Jared Lopez and my friends at Palm Beach County Boot Camp for all the encouragement on my health journey... Dedicating my post tonight to you guys!

***

We all know that there's an obesity epidemic in our country. We are reminded of it on the news, at the doctor's office, and especially on those teeny tiny seats on airplanes! The fact remains 34% of Americans are obese and two-thirds are overweight.

People have proposed a lot of reasons why this is so, the main one being "Americans are gluttonous and lazy." Here's my response to that: When and why, exactly, did our culture become exponentially more lazy and gluttonous? Personally, I don't see it. The people that I know who are overweight are hardworking and intelligent people. They don't want to diet because everything they've tried either doesn't work or makes them feel awful. Many of them still try different diets and exercise regularly. Furthermore, many people who work physically demanding jobs (landscaper, farm worker, busboy, etc.) also suffer from obesity and the associated health issues.

This made me curious. For one thing, I was working out and eating what I thought was a healthy diet and I was not losing weight. In fact, there were times when I was gaining weight even when I didn't change a darn thing. Talk about frustrating! I realized how brave it was for someone 50+ lbs overweight to try and lose it. If I was exhausting myself with calorie restriction and exercise and hardly seeing results, imagine how discouraging it would be to someone with even more weight to lose. This is what inspired me to share my story, and, if it only helps one other person, I'll be overjoyed.

Here's what I have found in my research:

The real reason individuals struggle to lose weight has to do with insulin. Understanding insulin is essential to understanding weight loss.

Seventy percent (70%!) of people who are overweight are insulin resistant. Insulin resistance is when your body (pancreas, specifically) produces insulin in such high amounts that your body becomes resistance to its effects. Remember the post on insulin vs. leptin? Let's refresh: Insulin is a hormone that communicates with your body when you ingest carbohydrates. It tells your brain to stop burning energy and to start storing energy. Furthermore, it tells your liver, muscle, and fat cells to absorb the broken-down form of carbohydrates (glucose). Insulin's job is to clear the bloodstream of any of these simple sugars, replenish glycogen where you need it (muscles), and store the rest for a rainy day (i.e. a day with no food). When your body becomes insulin resistant, your body requires more insulin to do the same job as before. Clearing the bloodstream of sugar is your body's priority and it is flushing your body with insulin to achieve this goal.

This makes it difficult to lose weight because those high insulin levels are interfering with other hormones doing their work, such as leptin (the hormone that tells your brain that you are full). So, when you are insulin resistant, your body is storing, storing, storing the food you are putting in your body as fat. Meanwhile, you are still hungry even though you have plenty of energy stored away because your body is not able to start the metabolic process of burning fat.

For many people, insulin resistance leads to type II diabetes. This is when your insulin levels remain high, but your blood glucose levels also remain high. I.e., no matter how much insulin your body produces, it is not able to clear your bloodstream of all the sugar molecules. Insulin resistance is not only bad because it makes you gain weight, it also can lead to heart disease, stroke, cancer,  Alzheimer's, and many other serious illnesses.

A strong case of insulin resistance also causes metabolic syndrome. Metabolic syndrome is a biomarker doctors use to assess your risk of heart disease, stroke, diabetes, certain types of cancer, etc. You have metabolic syndrome if you are overweight (particularly around the waist), have high blood pressure, and elevated levels of cholesterol and triglycerides in the blood. (Note, high triglyceride levels are strongly correlated with diets high in carbohydrates. More on this later.)

Was I insulin resistant? I think I was to a lesser extent. Although I was not overweight (yet): I have a family history of diabetes; I was constantly hungry; and I had very low energy levels. This was compounded by the fact that I had a vitamin deficiency, which I found out about after my doctor ran a blood test. Specifically, I had a vitamin deficiency from following a low-fat diet. We all think we get all of our vitamins and micronutrients from fruits and veggies, but let me tell you what, I ate a LOT of veggies and fruits -- none of which contain vitamin B12. Vitamin B12 is only found in animal products: beef, chicken, fish, seafood (clams), eggs, milk, cheese, and other all-natural, high-fat dairy products. B12 is also 100% essential to the body. It helps make DNA and keep cells healthy. It is also essential to the proper functioning of the central nervous system. A few other symptoms I had related to B12 deficiency included poor memory, pale skin/easily bruising, difficulty sleeping, moodiness, irritability, and mild depression. I also frequently got lightheaded when I was exercising.

B12 deficiency is not as common as insulin resistance. However, I want to make the point that if you are having trouble losing weight, it is most likely insulin-related, BUT it could also be a myriad of other reasons. Take the time to figure it out and you'll be really happy you did. You not only will look and feel much better, but your long-term health will be much improved. Talk to your doctor and have them run a few extra tests at your annual check-up. Do some independent research on the foods you eat. Critically assess all of your other potential symptoms. For me, I had been living with the forgetfulness and moodiness for so long that I just thought it was part of who I was, I didn't think it was related to my diet at all. Then I realized: MOST THINGS ARE RELATED TO YOUR DIET. Seriously. It's that important. Invest a little more time in taking care of yourself because YOU ARE WORTH IT.