You would also do well to note that the muscle layer replacing her fat layer is not only firmer, leaner, and more attractive, it improves insulin sensitivity rather than decreasing it, it maintains a higher metabolic rate for her even at rest, and it doesn't secrete hormones that may increase her likelihood of developing female cancers.
Jason writes:
"Faced with the facts above, basing your goals – or even worse, your happiness – on the number on your scale is absolutely ridiculous."
I found your site from another low carb site that linked to your blog and I thought I'd ask a question. I'm a 42 year old female. I've lost weight on low carb diets before but I have always gained the weight back. I'm in the process of trying to lose 30lbs of the original 70 I lost. I lost 14 lbs in the first week, doing paleo-high-fat-low carb, but now the scale is slowly creeping UP. I am distraught. Is my metabolism wrecked from doing low carb? I am not exercising so I know it's not the old "you're putting on muscle" thing.
-Marcia in Providence, RI
Dear Marcia,
You do not say whether or not you are measuring. Take your measurements every week at the same time of day. These are the only measures that matter in the slightest. I am sure you have heard the old adage, muscle weighs more than fat. That isn't quite accurate. Muscle is more dense than fat. A pound of muscle replacing a pound of fat takes up less room and makes you leaner. This is what you want. NOT a number on the scale.
You can find several body fat calculators on line that use your measurements. Use the body fat percentage and your measurements. The scale can be discouarging and it is a poor piece of data for measuring progress.
You may say--but I'm not exercising, how can I be gaining lean mass? Lean mass can be anything that is not fat: bone density, blood volume, fluid, and muscle. There are no studies that prove this, but our patient data suggested that even in the absence of serious exercise our patients were gaining lean mass. We don't know the reason for this. If it is actual muscle that we are seeing, our theory is that when people start feeling better on a low carb, high quality fat program that they become naturally more active and this, by itself, is exercise for those who have been living a life of fatigue and illness. Regardless, it is possible to be making small lean mass gains that, for a time, can outpace fat loss.
This "scale problem" happens much more frequently in females because a) their hormonal cycles cause frequent and sometimes severe fluid fluctuations and b) they generally lose fat slower than males. We had one case in which a female gained two pounds in a week that she had stayed on her low carb program to the letter. She was discouraged by the number of the scale, which seemed to erase the progress she had made the week before. However, when we measured her, she had lost inches everywhere including an half inch of her waist and a full inch and a quarter on her hips. Her body fat was down by over 1%. There was one area where she gained, however: her ankles. It turns out, she had spent the day in the car on a long trip the day before and was retaining fluid that collected in her ankles. Low carb helps with fluid retention but it doesn't solve an issue like gravity. We advised her to keep on her nutrition plan but ad more fluids to help with her temporary fluid retention. The following week the scale was down 4.5 lbs.
We have also noted that some people, not all, are not catabolic (breaking down tissue) and anabolic (building up tissue) at the same time. They build lean mass and burn fat at separate times. In these people, we see weeks where inches are going down but not pounds, and other weeks when pounds are going down but not inches.
The scale can provide a single data point at a single moment in time. It is limited and should not--especially in women--be the source of either dismay or delight. Inches, however, don't lie.
I met you in a social setting a long time ago and we discussed my Type I diabetes and my difficulty losing weight. You suggested I read Dr. Bernstein's Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars. I immediately went out and bought it the next day and it changed my life. I went from obsessively counting calories to enjoying as much meat, eggs, fish, dairy, and veggies as I wanted.
At that time I was 430 lbs. I'm now down to 300 lbs and feel younger than I have in years. However, I have been hovering at this same weight for some time and my sugars are again going up. Even though I am grateful for the lifestyle change, I do not want to be injecting more insulin, I would like to be a healthier weight, and I would also like to return to the blood sugar control that I had when I first started this WOE. [Ed Note: WOE is Way Of Eating].
I don't weigh or count calories any more but I'm fairly certain I do not eat more than 1600-1800 calories a day. Can you offer me any advice on how to get out of this stuck place?
--Stan in Newtown, MA
Dear Stan,
Congratulations on your significant loss. After such a great start I can imagine your frustration. I encourage you to discuss it with the doctor responsible for treating your diabetes, and there are a lot of missing pieces here that I can only guess about, but I have a few thoughts.
1) My first concern for you, if your food diary indeed confirmed that you are eating under 50 net carbs a day (a more important macronutrient calculation than "calories" would be an undetected, low-level infection. When blood sugars are inexplicably going up, infection is my first concern. Your doctor can test for an infection hrough a blood draw and urinalysis.
2) Check for adequate protein and fat in your food diary. Are you getting enough protein?
2) Also keep an insulin and blood sugar log during this time and see if you notice any correlation between certain foods and your readings. Some suspects in cases of unexplained poor blood control are dairy products, products with sugar alcohols, and even some kinds of vegetables. (I hope you are staying away from fruits except for the occasional bowl of berries.)
3) Begin tracking all of your measurements and use this as your primary guide in your progress. Measurements you should track weekly are:
4) You do not mention exercise and physical activity which is another factor, not so much in your weight loss, but in maintaining and building muscle mass and blood sugar control. Do not do cardio at anything more than low intensity and for longer than 20 minutes, and if you haven't started already, do a resistance training program. Go slow and steady.
5) Using these measurements above, track your lean mass and body fat using an online calculator.
6) It is worth repeating to discuss your blood sugar management with your doctor. Without knowing all the variables, like your A1C reading and other factors, I can't say what approach will work best.
7) Try adding coconut oil and grass fed butter. The fatty acid chains in these particular fats aid in metabolizing body fat.
The trouble with being insulin dependent is you can become Type II by developing resistance to your injected insulin. Being insulin depedent works against you but it isn't an impossible situation. Check back in with me and let me know how you are doing.
Nutrition is funny--it is probably the single most important factor in our health, yet it is one of the least studied or understood in medical circles.
Everyone thinks she's an expert on food--reading blogs and even premiere news outlets on nutrition are filled with misinformation and snarky, ignorant sniping against concepts that are either willfully misrepresented or simply misunderstood. (I recently read a blog post attacking Dr. Atkins that reported that his diet included fat marbled steak and an ice cream sundae every night. Had the writer even READ a sentence of Dr. Atkins' books?)
But the clinical evidence in favor of high-fat, adequate protein, low-carbohydrate nutritional plans keeps pouring in.
This study shows that the nutritional approach we favor reduces markers associated with aging and age related disease--independent of caloric intake. Which is another one of my mantras: calories are nearly meaningless.
In this study, body weight, serum leptin, insulin, fasting glucose, triglyceride, and free T3 significantly decreased as well as the triglyceride/high density lipoprotein ratios.
Dr. Oz recently did a show on genetics and weight loss--nutrigenomics, which was a combination of really good information and some not so good information.
There is something to the idea that your genetic make-up has a lot to do with what kind of diet you will respond to and how. While isolating the particular genes that identify which diet is best for you is somewhat new, the general hypothesis has been around for awhile in the form of both anthropological and ethnographic nutrition. Which is to say: we've often looked at our human ancestors in general, and our specific ancestors and their places of origin in order to determine what diets suit which people best.
This is the foundation for the paleolithic diet--eat only what the cave men ate, nuts, berries, leafy greens, and meat--and for the real food movement, which basically says, if it has a food label, you shouldn't eat it.
The nutrigenomic idea is slightly misleading--the report suggests you have a gene that tells us exactly what you should eat. This is not exactly the case. You have genes that tell us what sort of disease processes and metabolic tendencies that you've inherited. What diet that means you should have is, at best, a hypothesis, (what I like to call a SWAG, a scientific, wild-ass guess) much of it based on faulty premises, like the idea that low-fat dieting has a positive effect on stroke and heart-attack, or the idea of a calorie and its relationship to nutrition and obesity.
For that is the most potentially misleading part of Dr. Oz's report: the idea that the bottom-line is "calories in, calories out"--the laws of thermodynamics tell us that this is not the case. It takes more energy to process a protein "calorie" than a carbohydrate "calorie". I use calorie in quotes, because even the concept of a calorie is rather bizarre and very flawed.
One of the popular claims of the low-carb diet craze is that there is no hunger. For a long time people accepted that hunger was just a part of weight reduction--it turns out that it may only be a part of weight reduction that involves inadequate fat and protein.
Ghrelin, one of the hormones involved in regulation of appetite, is decreased by a high-fat diet, and increased in the presence of a low-protein diet. Furthermore, intravenous gherlin stimulates insulin secretion.
All of which supports the popular claim that low-carbohydrate eating actually suppresses your appetite. Or rather than suppressing it, it likely returns your appetite to its natural state.
OBJECTIVE Low-fat hypocaloric diets reduce insulin resistance and prevent type 2 diabetes in those at risk. Low-carbohydrate, high-fat diets are advocated as an alternative, but reciprocal increases in dietary fat may have detrimental effects on insulin resistance and offset the benefits of weight reduction.
So hold on--what's this? Low carb diets might have DETRIMENTAL EFFECTS on insulin resistance? Let's take a closer look.
Look at this sample menu below. You'll see that in the "low-carbohydrate" they have included, bread, white potatoes, bread crumbs, carrots. All foods that provoke insulin response. So what they've determined is that "calories in and calories out" works no matter what the quality of those calories are. Both diets reduced overall body mass and both diets resulted in increased insulin sensitivity.
This is not a low-carbohydrate diet in any sense of the term as it is understood clinically. Furthermore, it is a pro-inflammatory diet as it includes gluten, white potatoes, and high-glycemic vegetables.
Their conclusion that the insignificant findings on arterial health may become significant is speculative--and even more to the point, the pro-inflammatory effects of fat are only present in the presence of carbohydrates. While including pro-inflammatory foods like gluten, white potatoes, and carrots, you've tested nothing but the pro-inflammatory effects of those foods.
What is going on? When will they test a truly low-carbohydrate anti-inflammatory diet without reservation?
TABLE 1
Sample menus for a typical day on each intervention diet
Primary author Dr. Eric Braverman compared the BMI data -- a calculation that uses height and weight to determine amount of body fat -- to results on the study participants using Dual Energy X-ray Absorptiometry scans -- a direct measure of percentage body fat.
Our clients know that we consider the BMI charts useless--and here's more evidence that this is so. Using Dual Energy X-ray Absorptiometry scans to provide a direct measurement of body fat percentage, Dr. Eric Braverman tested the current criteria for diagnosing obesity used in American medicine and the World Health Organization for gathering obesity statistics.
We weren't surprised to discover that not only is the BMI chart (using height and weight to determine body fat) inaccurate, it is leading to massive under-diagnosis of obesity.
This is why we rely on our own formula for determining your body fat percentage, using abdominal circumference (your waist measurement) as our primary data point in determining the health of our patients.
The fact is, as with many things in the body, it's about ratios and relationships. It's about a ratio of fat to lean tissue, and it is very much about where your fat is concentrated. The key point here being, not that gaining abdominal fat makes you unhealthy but: when you are unhealthy you will have excess abdominal fat.
Here's where it gets to be a cycle: that fat layer, caused by disturbances in the health of the body, creates further disturbances in the body which lead to more fat storage. It's a feed back loop between the fat layer (I call it "the fat parasite") and the body that our protocol is designed to disrupt, to make returning to a state of health--and staying there--more likely than with other approaches.
This is one of the key points in our protocol. A loss on the scale isn't necessarily a good measure of your increased health and fitness. In fact, it is quite possible to lose weight on the scale and be worse off, if that loss is lean tissue loss, while your adipose tissue stays the same or even increases.
Our protocol is designed to preserve lean mass and to target adipose tissue (fat) and this is why it stands out from other weight-loss methods.
It's interesting to note that the inaccuracy of BMI also works in reverse. It doesn't distinguish between healthy, lean tissue and body fat. So a healthy athletic individual (say a professional athlete) often qualifies as obese, when their abdominal circumference tells us otherwise.
So Braverman's ultimate conclusion--that the global obesity epidemic might be much bigger than the 300 million obese reported by the WHO--doesn't necessarily follow, though he may be correct. But the central point remains: BMI is a useless measure of health and fitness and should be placed in the round file of medical history once and for all.
. I immediately went out and bought it the next day and it changed my life. I went from obsessively counting calories to enjoying as much meat, eggs, fish, dairy, and veggies as I wanted. 
