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I find myself getting asked this question, or some variant of this question, with increasing frequency as I speak and write about the Alternative Hypothesis I find most compelling surrounding obesity and chronic disease. So back to this question — If carbohydrate reduction is so effective for weight loss, why are so many people still overweight?  Beyond being asked this question, personally (and frequently), one can see the same logic in the academic literature (see comment by George Bray in Obesity Reviews) and in the press (see comment by Gina Kolata in the New York Times). Gina Kolata: “Low-carbohydrate diets have been popularized periodically since the 19th century. Is this a valid criticism of carbohydrate restriction?  Perhaps, but to be sure let’s consider a few examples of this Principle. Polio no longer exists in the United States, thanks to the development of two types of vaccines to immunize people against the poliovirus. Smallpox, a viral disease estimated to have taken between 300 and 500 million human lives in total, no longer exists thanks to two vaccines that eradicated the disease in 1979. Breast cancer still exists, and in 2011 claimed the lives of 40,000 women in the United States alone.
So far the Principle seems pretty compelling.  Of course, to be an all-singing-all-dancing-universal-truth, there cannot be any exceptions to this Principle.  Do any such exceptions exist? HIV, when progressed to AIDS, is responsible for nearly 2 million annual deaths worldwide (about 16,000 deaths per year in the United States), yet transmission of the HIV virus – the causative agent – is entirely preventable.  Furthermore, the current drug regimen for HIV can prevent nearly all patients with HIV from progressing to AIDS, thereby rendering HIV a chronic disease. Polio, which has been eradicated in the Western world, is still prevalent in south Asia despite a clear method of prevention. Furthermore, the treatment for HIV using a treatment regimen called HAART (Highly Active Anti-Retroviral Therapy) has become highly efficacious at preventing HIV from even progressing to AIDS.   In other words, if one contracts HIV today, it’s quite likely to prevent HIV from progressing to AIDS. How can it be possible, you ask, that anyone can contract a disease that is so easily preventable?
One could (and I’m sure several have already done so) write an entire dissertation on this exact topic.  At the risk of oversimplifying, though, let me briefly explain why I believe a disease that has a preventable cause and effect can still exist. In the United States today, the group of people who contract HIV primarily because of what I call “poor information” is probably quite low.
The barriers to prevention and treatment are likely multi-faceted and complex (and highly dependent on the disease).
While I’ve only used HIV (and by extension, hepatitis C and hepatitis B) to illustrate this point, I hope I’ve given you some idea how someone can still “get” a disease, while living in the United States circa 2012, despite all of the good information and infrastructure to prevent it. As you undoubtedly know, the problem is far worse outside of the United States.  In many parts for the world the people being afflicted with HIV lack even the correct information, let alone a shred of infrastructure to combat the problem. Unlike HIV which, at least in the United States, is appropriately understood, the study of nutrition and obesity is a relative debacle.  The formal recommendation of the USDA, AHA, AMA, ADA, and others actually tell us to eat the foods that make approximately two-thirds of us overweight. Try asking your doctor for help, and you’re likely told to eat less food, eat less fat, eat more grains, and exercise more, stupid.
If you’re hungry in an airport or a mall (or virtually anywhere out of your own home), how easy is it to avoid sugars and simple carbohydrates? I don’t know how much of a role this feature will play when the former two features are one day corrected, but I’m sure fixing the former two will go a long way to reversing the epidemic we find ourselves living and dying in. Should we be surprised that 67% of Americans are overweight and that nearly 10% have diabetes?
We are outright told to eat the foods that make us fat via all formal and informal recommendations. I would also like to see more emphasis, in time, on *maintenance.* As you are well aware, big loss weight maintainers make up a 1% club.
I too am an RN, who struggled with the same issues of circadian disruption, elevated cortisol, metabolic disturbances just as you did.
A graduate student and I have done an extensive meta-analysis on the effects of shift work on cardiovascular health. For every 5 years that nurses perform rotating shift work, the risk of stroke goes up an additional 9%. I wish there was a local support group or doctor who understands low carb lifestyle, but I am taking comfort from this blog.


So glad your friend was able to introduce you to the alternative hypothesis of fat accumulation. I just had a conversation with my brother about lc paleo etc; I think our whole family is going to go Low Carb btw!
And don’t forget that bloggers, and the crowd that follows them, get bored with the same-old, same-old. The amount of carb loading you can safely engage in seems to be proportionate to the amount of lean muscle you have, so a fat, soft weakling would be advised to use this as a finishing touch, not the cornerstone of a new diet. I’d love to write it, but I would need to spend some time doing the research, including on myself. Basically, I eat as much fat as possible in one meal (90%+), and see how long I’m sated for. I don’t intend to fast on many of my open water sailing trips but find that when on the ocean, water is the only sustenance I need now that I am ketoadapted. When checked, Shutterstock's safe search screens restricted content and excludes it from your search results. You can still eat cottage cheese ie paneer – the vegetarian’s delight but given the condition that its made from full fat milk. What makes low carbing the most interesting lifestyle is that you don’t worry thinking about how much fat you have eaten. You can still enjoy eating grains like brown rice, oats, bran etc if you are good at controlling portions. A girl next door who ignored her health for studies , now seeks a healthy life in a leaner body n shares her journey online. Adnan { Hi Tarun, please suggest me what should i drink post workout Milk with type (full cream or Tond), Lassi or Buttermilk? Here on fitnessvsweightloss we write about fitness, weight loss,mobile app reviews,weight loss product reviews,Fitness studio review, dieticians etc. Bray is generally regarded as one of the most erudite authorities on obesity in the United States, while Ms. Furthermore, for those who have contracted the disease, how can so many go without treatments that would easily render their condition a chronic one – a condition that will not lead directly to their death — rather than a condition that will lead to their death? We are surrounded by food infrastructure that makes our “default” eating patterns in line with those (flawed) recommendations. Of all losers, perhaps 3-5% keep it off for 3 years or morem most regaining a at least a 3rd back by year one, and all back by a couple of years or less, with more added on.
We found increases in myocardial infarction, stroke and coronary events which were fairly consistent across studies.
I decided to take drastic steps & I started walking 20,000 steps per day (6-8 mile hiking, up major hills in any weather) logging my calories meticulously and the scale finally started to slowly go backwards. I started your 3 Week Diet system exactly 21 days ago, and today when I stepped on the scales. Many bloggers that I formerly enjoyed following have decided that it is wrong to demonize carbs and are promoting the idea of adding them back into the diet. This too is not new as it is basically a cyclical ketogenic diet that has been around in the bodybuilding community for some time. The second time I just ate until sated, and didn’t feel like eating again for 28 hours. When you transitioned into VLC you were not low enough to get into ketosis and not high enough to fully satisfy glucose needs. You don’t over spend on buying low fat foods, usually low fat food items are much more expensive! Kolata is one of the leading reporters on the topic – so we’re not just talking about “anyone” asking such questions. And for those of us who decide to go against the grain and overcome these two enormous hurdles, we are almost assuredly not supported.


Kolata’s commitment to fighting obesity, diabetes, and their associated chronic diseases, I reject their reasoning for why reducing carbohydrates is not one of the most effective treatments.
His clinical interests are nutrition, lipidology, endocrinology, and a few other cool things.
And I’ll be waiting in the wings in hope that you might address some of these issues which are real saboteurs for healthy weight loss maintenance and life!
The mechanism is likely as you suggested – circadian rhythm disruption, which drives cortisol over-exposure, which then drives overeating of carbohydrate-rich, convenient foods.
I realized that I can eat protein, fat & low carb veggies to my fill, but I rarely eat over 1100 calories per day. Since it is hard to find good information from doctors, governmental agencies and the like and as you mentioned, support from friends and family tends to be non-existent, I get a lot of my information and support online. I have been trying to play it safe and hit a carb intake range of between 60 – 80 grams per day. All you get to eat is meat and meat – This is what I have been hearing for over 2 years now.
However, people who are so called dieting akka tracking every calorie they eat consider eating cheese as a devil and eating cheese as a vice lol ?? . Even without the genetic predispostion, I think that the effects of chronic stress and the physiological dysregulation that shift work effects needs to be addressed more and in more detail. If I cut back on food amounts too much, I’ll lose more weight, but will feel horrible, have no energy, etc.
Thus people get metabolic syndrome, type 2 diabetes, hypertension and acute and chronic vascular diseases.
I called to make an appointment with a lap-band surgeon when I ran into a friend (with a PhD. A few years back when I tried low calorie diet to lose weight, my legs would cramp in the middle of night. You can eat the much nutritious yolk without of the fear of cholesterol when you are low carbing. In other words, we’re actually all on the same “team” – we desperately want to help people lead more fulfilling, healthy lives by improving their eating habits.  But we disagree on this point. Most of the posters in the comments section applaud their decision and report that they, too, have lost weight and attained a sunnier disposition by eating more carbs. I’d also like to talk with some of the other folks who know a lot about this, like Mike Eades, Robb Wolf, and others. So if you are on your journey to losing weight, you can’t have these foods whether its low carb or low calorie diet. In my maintenance years, I have only returned to shiftwork or being on 24 hour call twice, and those were the only timse when I had a significant regain of 16lbs over two years, despite continuing workouts and little change in eating. And it is essential on the weight loss road to establish a very workable plan that is *enjoyable for life* in the realm of exercise as well.
Years ago I even maintained a too-low weight, and had zero energy every single day, until I finally let up a little, and accepted a somewhat higher weight.
For the vast majority, thinking that it is going to work to set up a weight goal that requires 60-90min or more of intense exercise per day, is a recipe for disaster and injury, with inevitable weight gain while that foot or leg or back heals. With so little support for low-carbing available anyway, it’s discouraging to lose these formerly good sources. Do you have any thoughts as to why so many people are changing their mind about the proper human diet?
If carbs are the problem, how can so many people find good results through eating more of them?




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