In the last post I made the claim that fasting and/or very low calorie diet was necessary for starting the apoptosis cascade. For some reason, low insulin does not in itself seem to be enough, otherwise we would expect ketogenic diet's to completely demolish bodyfat. But alot of people easily become weight stable on ketogenic diets, even at still elevated levels of adiposity ( I.E. famous weight loss stall ).
Perhaps part of the reason for this is that GLP-1 signalling in adipocytes also inhibits apoptosis. So even if you achieve very low insulin with ketogenic dieting, you will still inhibit apoptosis because with every meal you eat, you secrete GLP-1. I can't help but wonder if this is partly behind the reason why weight regain is so aggressive after cessation of low-carb dieting and trying to introduce carbs back onto the menu.
The low-carb dieting would likely favour reductions in adipocyte volume and perturb adipocyte apoptosis through continued GLP-1 secretion in response to meals.
There doesnt seem to be any easy way of getting rid of adipocyte over-growth sadly.
Something which has confused researchers for sometime is how shooting a bolus dose of leptin into the brain causes deletion of adipocytes by apoptosis. ( 1 )
Now that my understanding is more up to date, I expect the reason this is happening is because a sudden dose of leptin in the brain causes a sudden surge in sympathetic nervous system stimulation of lipolysis in adipocytes, leading to a surge in beta-oxidation and ROS production. This in turn, can induce apoptosis. ( 2 )