November 16, 2015

The Truth About Weight Loss





Much to the detriment of my sanity—and several of my brain cells—I’ve been lurking on weight loss forums, keto forums, LCHF sites, various Facebook groups, and other places where many participants are aiming for weight loss. I’ve been reading the comments, and…well, it’s a jungle out there, folks. A jungle of wishful thinking, unrealistic expectations, and a somewhat alarming degree of ignorance about how the human body works.

This is not entirely surprising, though, and I can’t be too hard on people for their pie-in-the-sky notions about how weight loss happens. After all, when you read a “Friday Success Story” on Mark’s Daily Apple, featuring a 25-year old guy who woke up one day, realized the steady diet of pizza, beer, and Chinese takeout he’d been following since freshman year of college had landed him 40 pounds heavier, with heartburn, acne, and no libido, and he stumbles upon The Primal Blueprint and summarily loses those 40 pounds in about three months—even while still enjoying wine and a weekly “treat meal,” it’s very easy to be hypnotized into thinking it’s this quick & easy for everyone. And if it’s not this quick & easy for you, then you’re “doing it wrong.” If every pound—every ounce—is a struggle, even when you’re really, truly “doing everything right,” then it’s perfectly natural to feel like a failure. To feel demoralized. And if your nutritionist cares about you and wants to see you reach your goals, it’s perfectly natural for me him or her to be demoralized, too.

I have been through this with several clients—to the point that I almost decided to quit altogether. However, after giving it a lot of thought, and racking my brain to think of what I could be doing differently to help these people, and why good diet recommendations and supplements proven to be effective weren’t working, here’s what I’ve realized:



The clients who fit this scenario—doing “everything right,” but not losing weight—have all been women. All of them. Most of them have been peri- or post-menopausal women, but some have been younger, like in their thirties. More importantly, all of them—all of them—were transitioning to a Paleo or LCHF diet after many years—sometimes decades—of undereating, whether intentionally or unintentionally. Specifically, they have been undereating fat and protein. Whether it’s women’s fashion magazines, mainstream news outlets, or even their doctors, something made these women so terrified to put actual foodstuffs into their bodies, that they have been subsisting, long-term, on 800-1200 calories per day, largely of non-fat and low-fat “edible food-like substances.” (Cereal, skim milk, fat-free yogurt, skinless chicken breasts, granola bars…you know the drill.)

The end result of this is that, sadly, these women’s resting metabolic rates are in the toilet. Through so many years of what basically amounts to starvation, they have likely lost a great deal of muscle, and certainly a significant amount of bone mass. (The physiology of fasting is different. Full-on fasting is not the same, metabolically speaking, as a very low-calorie diet, and the effects on “muscle sparing” are different . My posts are always already too long, so I’m gonna have to skip the details on this for now.)

This brings us to two issues: 
  1. How weight loss happens in the body
  2. Why someone might not be losing weight, even on a well-planned Paleo, LCHF, or ketogenic diet 

We’ll address the first issue here, and we’ll tackle the second one in a separate post. (Maybe two or three separate posts, as I’ve already started jotting down notes, and there’s a lot to cover. Not as much as for insulin, though, thank goodness!)

Time for some more of my terrible homemade artwork!


Nice, huh? You change your diet, maybe you start walking a little more or hitting things harder at the gym, going to bed a bit earlier, and PRESTO! Magical weight loss. A straight, downward slope from the day you implement these changes until you reach your goal, with absolutely no bumps, glitches, plateaus, or backsliding along the way. Fewer carbs, more steak; reduce corn & soy oils, increase bacon. That’s all you ever needed to do; you just didn’t actually do it until you stumbled upon Wheat Belly Total Health, or The Paleo Solution, or The Art and Science of Low Carbohydrate Living. Once you got started, though, it was clear sailing all the way!

Um, yeah.

Actually, it does work this way for many people. But for plenty of other people—most people, I would venture to say—it goes more like this:
  


This hypothetical person has gone from 220 pounds to 170 pounds. That’s a loss of fifty pounds! (For my overseas readers, that’s almost 23kg!) Certainly a significant amount of weight to have lost, and something this person should feel great about!

But here’s the thing:

This is not a straight, downward slope. There are all kinds of hiccups along the way. We’ve got some stalls & plateaus, wherein weight stays the same for a while, and we’ve even got some weight gain here and there. (*Gasp!*) But when you look at the entire graph, the progression, over time, is downward.

What would have happened if this person had stepped on the scale every day during this time? The small day-to-day fluctuations would have driven them absolutely crazy. Being “stalled” for a week or two—or a month or two—or gaining a pound or two or four, might have even made him or her quit whatever program they were following, when, if they had just been patient, look where they would have been down the line.

This is what drives me crazy on those weight loss forums. Very few people seem to have an appreciation for the complex physiology of the human body, with its endless integrated connections and feedback loops. We are NOT calorimeters. We are NOT closed systems. You can’t provide an input somewhere and not have it adjusted for somewhere else. It’s like dropping a bowling ball onto a water bed; there is a ripple effect. (Or, to quote from one of the insulin posts, we are not cardboard boxes, where stuff gets put in, and stuff gets taken out, but nothing happens to it while it’s inside the box.)

Here are the two best pieces of advice I can give people who are struggling with weight loss—particularly if they are in the early stages of their LCHF/Paleo/Primal journey, and even more so if they are female, and are implementing one of these dietary strategies after many years of caloric (and PROTEIN!) deprivation: 
  • Be patient.
  • Stay off the  friggin' scale!


Looking back at that second graph—the one about how weight loss really works in most people—you can see that, by getting on the scale every day, there’s a good chance you’d be setting yourself up for disappointment, confusion, frustration, and totally misguided self-loathing. (I mean, if you're going to hate yourself, at least hate yourself for a legitimate reason!  =D)

And you know what? If you could go back in time and plot a chart of your weight gain over some period of time, it would probably look much like this, except in reverse. It would certainly resemble this one more than the first one, where weight gain would have proceeded at a constant rate with no stalls or losses along the way. The reason we don’t realize the weight gain happens the same way as weight loss—with lots of ups and downs and plateaus—is because most of us don’t bother getting on a scale on a regular basis unless we’re actively aiming for weight loss. If we’re not trying to lose weight, most of us don’t much care what our weight is from day to day. (And if we know we’re gaining weight, most of us would avoid the scale altogether. The pants that no longer fit and the belts that are too small are evidence enough.) If we had gained, say, 40 pounds, over some period of time, the graph would include day-to-day fluctuations. We’d be up a couple of pounds, we’d be back down a few, and we would have stayed the same for a while. But over time, the overall trend would be upward.

It’s almost time to wrap this one up, but before I do, let’s talk about why there are these bumps along the road—the occasional weight gains, in particular.

Attention grown women:
This is not a meal!
As I said, I’ve worked with women who, prior to adopting a diet based in whole, unprocessed, nutrient-dense foods, were starving at the cellular level. (Yes, even with a BMI in the “obese” category, on the inside, they were starving.) They were depriving their bodies of sufficient total calories, and protein calories, in particular. And remember—these women have broken down a fair bit of very important tissue just to keep critical metabolic processes running. Add to this another issue I frequently encounter: poor digestive function. So these women were not only undereating, but whatever paltry amount of nutrition was present in the foods they were consuming was not necessarily being absorbed and assimilated into their bodies. So, when they finally start nourishing themselves and we work on improving digestion, their cells get the nutrients and building blocks they need, and all the rebuilding and repairing that was put on hold when nutritional resources were insufficient can now get done. It’s the body’s way of prioritizing things.  

For example, if you lose your job and you don’t have a ton of savings in the bank, that is probably not the best time to redo your kitchen or install a hot tub in your backyard. You conserve. You save. You work with what you have and you use and reuse things until they fall apart. BUT, when you get a new job and are back to work—possibly with a better salary than before—now you’re golden. Now, you can do all the repairs and upgrades you had to put on hold when funds were low.

Your body works kind of the same way. If your body has to do triage, and attend first to what’s most important, guess which is more important, biologically speaking: restoring bone tissue that was broken down when you weren’t consuming (or absorbing/assimilating) enough protein, calcium, magnesium, boron, and vitamin K2—or making your *ss smaller and your thunder thighs a little less thunderous?

So, if you find yourself not losing any weight for a little while—or maybe gaining a couple of pounds—at the outset of transitioning to a higher-calorie, higher-fat & protein diet, and your dietary history fits the profile of the inadvertently starving female, thank your body for knowing what it’s doing. It is helping you. It is protecting you. It is making you healthy again. The fat will come off when there isn’t something physiologically more important to take care of first.


In posts to come, we’ll look at several answers to the question, Why am I not losing weight on a low-carb diet? We’ll also explore logical explanations for day-to-day multi-pound fluctuations in scale weight. (Another reason I need to stop reading forums & comments: poor, uninformed souls who lose all ability to think rationally when they find they’re up literally one or two pounds.)



NOTE: I have emphasized women in this post because I see this happening in women way more than in men. General consensus is that just about everything related to fat loss is more complicated for women. (Lucky us.) But men are not immune to this. If you’re a dude, and any of this resonates with you, right on! But it seems that men who stumble into LCHF/Paleo/Primal don’t usually come from a background of intentional or inadvertent caloric deprivation. Many of them were eating plenty; they were just eating the wrong things. If it doesn't resonate with you, sit tight. The "why am I not losing weight" posts will probably have more insights for you if youre struggling with fat loss.







Remember: Amy Berger, M.S., 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.

30 comments:

  1. Thank you, thank you! I'm exactly your "target audience" here--post menopausal, about 2 years. I was fortunate to lose 75 lbs immediately before menopause on LCHF (I think, actually, that LCHF helped the hormones do what they were supposed to do so I could finally go into full menopause after 10+ years of perimenopausal symptoms). But since my menses stopped, so has the weight loss, and I've gained back about 3 lbs despite all my best efforts. 3 lbs is paltry, but I'm working SO hard to hold it at that and no more.

    Healthwise I am 1000% better than when I started. I'm able to do things I couldn't do when I was really fat and sick, I feel spectacular, and I love not having menses anymore. But my belly is HUGE--I look like I'm pregnant with triplets--and everything I'm reading says that's the "bad kind of fat". (I eat no grains, very little dairy, exercise daily). I want that belly down and would like to lose about 40 more lbs. (That will still put me way above my "Ideal body weight"--I'm trying to be realistic. So if you have any suggestions, my ears are open.

    I'm a little wary of fasting (although I found it's pretty easy for me to fast dinner to dinner). Part of it is I have a 14 year old daughter, I don't want her to get the idea that starvation (even though planned fasting is NOT the same thing) is a good idea. We sit down to dinner EVERY night, and I don't want her to observe me not eating. They say when mothers diet it has a profound impact on a daughter's body image. She's already observed me restricting my diet for LCHF/Paleo, but we try hard to frame it in terms of health rather than weight loss.

    I'm also not 100% convinced that fasting doesn't add to the metabolic damage--although I keep reading and get the logic behind it. I'm interested very much in your experience with women like me.

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    1. Hey Jan, more to come on this. I'll have a couple more posts talking about specific things that can hinder fat loss, even on a good LCHF or Paleo diet. As for the belly shape -- honest question here -- would you say it's more squishy & pliable (almost like a water bed), or is tight and hard to press down on, like an over-inflated beach ball? (One would be more indicative of fat; the other is bloat/air...but I'd be surprised if that were the issue, if you're off grains and do little dairy.)

      You are definitely not alone. Peri- & post-menopausal women have the biggest uphill battles for fat loss. It's not impossible, but it does take a lot more effort & tweaking than just cutting out beer & dropping 20 pounds, like some men I know! I'm 37 years old and am already starting to worry if I'll be able to maintain things as I age, let alone dare hope for improvement. :-/

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    2. I think it's water bed squishy FAT, although at night (all my life even when I was very thin!) it's beach ball tight. Even with no grains and dairy now.

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  2. Weight weight weight, unless you are a weight class athlete(actually a height class in disguise) trying to make weight it is basically irrelevant compared to how you look in the mirror and/or how healthy you are.

    I have gained a fair amount of weight on a ad lib low carb diet over the years.
    Of course after my initial quick weight loss I started packing on lean mass, the inflammation that made resistance training while obese fairly useless started to work well once my visceral adipose deposits were greatly diminished.
    So 8 kg heavier than my lowest weight on low carb but a far lower body fat % and a smaller waist than I was at my lowest weight.
    Oh and my weight will vary +/- 2 kg on a weekly basis depending on training, it is only water fluctuations, my wife sees nearly the same water weight changes and she is a lot lighter so much bigger proportion to total body mass.

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    1. YES, absolutely. A couple of years ago, when I was in the best shape of my life (so far, anyway), I weighed more than I do now, but I was *leaner.* My body was smaller and stronger. I don't obsess over the scale, but millions of other people do -- especially my clients -- so I'm writing this for them. To bring some rational sense into things. (Desperately needed, if you ask me!)

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  3. You can weigh daily, I did & had a graph like your real life example. You need to use an app like Libra, which smooths out the "noise". Seeing the trend is really helpful & for someone with massive daily variation like me, was really useful. Started observing & learnt so much, calmed right down too. I think literature supports that long-term recorders have better long-term results but I think it has to be done right, esp for women with the app as even weekly or monthly weighing is subject to too much variation. Not weighing FOR ME doesn't work as I easily put on weight as I eat really well!

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    1. And good on ya. It sounds like you are able to use the scale in a healthy way -- that is, as a *tool* to provide information, and not as the daily arbiter of your self-worth as a human being, nor of the immediate efficacy of your diet. I have nothing against people using scales in a healthy way, but many people do *not* do this. If they don't normally eat seafood, but they eat 2 shrimp one evening and the scale is up 2 pounds the next day, they will interpret that to mean that shrimp needs to be added to their ever-growing list of "disallowed foods." *That* is the kind of thinking I'm up against as a nutritionist.

      If you can weigh yourself regularly and maintain your rationality and sanity, then I have nothing against it. And you're right -- people who've lost a lot of weight and continue to weigh themselves regularly do tend to keep the weight off better long-term. I still think clothing can be a good gauge too, but obviously, clothing tends to stretch out over time, and most of us have a bunch of clothing that's baggy or loose anyway. It's harder to kid yourself when you see the number in stark relief on the scale.

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  4. I'm one of those post-menopausal women who can't seem to lose weight, but I've never chronically undereaten in this lifetime. I don't think you get close to 400 pounds by overeating. :) Well. Okay I did lose 100 pounds on a LCHF diet, but have been stalled for 6 years now with at least 100 more I should lose, and even if I lose that 100 I'll still be "overweight" , just not "obese" or "morbidly obese" as I still am even after maintaining a 100-pound loss for 6 years.

    But one of the MAJOR things that at least keeps the 100 off is getting on the scale EVERY SINGLE DAY. Yes I have a chart, and yes it has WAY more zigzags than your sample chart. But daily weighing is the one thing that keeps me going. Sure it's frustrating to see the scale zigzag over a 5-20 pound range for years on end. But it keeps me honest. This is the first time in over 30 years of dieting that I've been able to maintain a loss this long. In all previous diets the first sign that it would fail and I would gain all the weight back and then some would be when I stopped weighing myself daily. Then I was in big trouble.

    Be interested in the rest of your series.

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    1. Right. Like I said in the comment above, I didn't mean to imply that no one should ever step on a scale. Of course it can be a helpful tool. But people need to learn a little more about how the body works, so that the day-today fluctuations of a few pounds don't drive them insane. It's fine to use a scale, as long as it's not the *only* way people measure progress. How are clothes fitting? How are energy levels? Mental outlook? Muscle & joint stiffness? Digestive function? Skin appearance? Obviously, if weight loss is the primary goal, then those other things will matter less to someone, and that's fine.

      I'm not completely opposed to people weighing themselves, be it daily, weekly, monthly, or whatever. I just wish people understood a little more about the myriad things that affect weight on day-to-day basis, so that they don'y rush to (usually incorrect) conclusions about their diet and exercise.

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  5. I'm 15 years post menopause, a lifetime of dieting but started 'getting serious' with health/weight loss at menopause and yet have GAINED 60 pounds in 15 years! Sugarbusters, Atkins, Southbeach, HCG, LCHF now (Week 12). No weight loss at all. I only stepped on a scale to make sure I wasn't GAINING MORE. Is there ever a point where there is just too many issues ... insulin resistance, hypothyroidism, chronic fatigue, depression ... to be 'fixed' by diet? At this point I'm thinking I'll be dead before I get healthy! (But I am determined to stay LCHF for life anyway.) GREAT ARTICLE and just what I needed today!

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    1. Do I think there's a point where things are just too complex & longstanding to be fixed by diet? Yes. By diet *alone,* that is. I think you'll find most people who have come through situations like you're describing and have gotten to a better place for themselves (however they might define that) have done so through diet PLUS appropriate supplements, the right type of physical activity for themselves, and possibly also pharmaceutical drugs and/or hormone replacement, and maybe even some other strategies that have more to do with the emotions than the physical body -- be it meditation, neurolinguistic programming (NLP), or something else along those lines. 15-years post-menopause, but you've only been on LCHF for 12 weeks. Yes, it would have been nice to see some weight loss during that time, but don't lose heart. If you're severely insulin resistant and also have a sluggish thyroid, you likely need more than "just" a dietary shift. That's the place to start, but not the place to stop!

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    2. Oh, I could have written that comment too - very interested in what the answer may be. I spent my 20's trying to lose weight on super restrictive low-fat low cal diets, gave those up during and between my pregnancies and now, postmenopause I am about 100 overweight and can't lose a single lb. on any plan -now it's more low carb, LCHF/Paleo but I think that everything is out of whack and broken!

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    3. I am unaware of any diet or lifestyle change that will make ovaries produce estrogen like they did before menopause, which is usually not the case with low T in men.
      HRT is probably the only real option to prevent the bone loss and general fat gain that accompanies menopause although the bone loss mostly occurs very early into menopause and therefore early treatment is considered best.
      Oral hormones not good due to increased clotting factors produced by the liver when it sees a high concentration arrive via the portal vein, creams or patches deliver systemically so liver only sees normal concentrations therefore not much clotting factors and risk of stroke etc.
      All the old studies which show increased risks done with oral doses.

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    4. Don't give up, Elena. It's not impossible, just much, *much* harder. Harder than most people are willing to work for it, I think. (And I say this without judgment. I hope I can keep on top of things as I get older, but I suspect I will struggle a great deal, myself.)

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    5. My first port of call would be getting Vitamin D3 status checked. I had been on a calorie controlled diet for months and lost only 2kgs. Blood test showed deficiency and almost as soon as I started supplementation, the weight loss started.

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  6. I have been in ketosis for 14 months now and lost over 50 lbs and regained my health. If I only get this far I'm happy!! But I realize that all the bad years will take time and better and better things await me!

    I am 65 and have had a hysterectomy because I actually went into menopause at 38. Long story but I have opted to start taking bioidentical hormones for several reasons. Will you be addressing hormones other than insulin?? I hope so.

    I appreciate your work greatly and look forward to learning with each post!!! Thank you so much for your passion and time!!

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    1. I'll be addressing hormones in general, but probably not in a lot of detail. It's not really my area of expertise. I know more about cortisol than the female hormones, although I did go through a bout of estrogen dominance a while back, and I believe it contributed to some fat gain. How long have you been on the hormones? Have you noticed any difference yet?

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  7. Thank you for your very interesting article, and I will be looking forward to more. I'm nearly 60, in menopause for 5 years and have gained 20 lbs after being thin my whole life. Even had a baby at age 44 and bounced back to 124 lbs within a few months! For two YEARS now I've been doing low carb, medium fat, high protein, and the scale has gone up-up-up. I've tried restricting calories and I've tried eating until I've felt full. I exercise at least a little every day, but to be honest it's mostly old-fashioned calisthenics. I am more muscular than I've ever been, but I have a spare tire and a rear end that needs directional signals, for Pete's sake. Thyroid is normal. I am about to go to the GYN and beg for HRT! Anyway--sorry for digressing,and thank you for thinking of us poor old gals!

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    1. Unknown, try eating high fat (mainly animal fat, some select other "oils" such as olive, avocado, coconut) and reducing your protein intake. Protein causes an insulin response, and if you're at all insulin resistant, that increase in insulin is not good. I try to eat 70-80% fat with each meal, if at all possible. So, I'll add butter to anything I can, add homemade mayo to anything I can, eat the fattiest pieces of meat, etc. Also, try to eat within a "window" of say 8 hours. This is intermittent fasting, and it helps to reduce insulin and insulin resistance. I've also eaten within a 5 or less hour window, not eaten for a day, not eaten for a few days, etc. All of that is to reduce insulin resistance. As an older male, all of this has helped me tremendously. For you, try it and see what happens.

      Also, as a "dude", I take my weight daily now at home (naked) and at the gym (in gym clothes). My weight is all over the place. For instance, two days ago at the gym, I weighed 205.0; today I weighed 201.5. The same happens at home: yesterday, I weighed 201.5 at home, and weighed 200.0 two days before that. I don't get overly concerned, as sometimes I feel as if I'm losing weight (perhaps my clothes fit better) but the scale doesn't move or even goes up.

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  8. Great article!!!! I am post menopausal for almost 5 years now. Was on hormone replacement for 4 years before my new Gyn took me off of them. No one will prescribe them after age 55. I felt so much better. I've gained 30 lbs in the last 2 years. Can exercise as much due to a back problem that started 2 years ago. I'm hypothyroid. Been on meds for 15 years. Hate taking pills. I know I need to take vitamins but don't know what and I really don't want to have to take 10 pills a day. I'm doing ADF right now. Have had a small weight loss. I just want to feel decent again!

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    1. I've had several clients on meds for thyroid, but they ARE NOT EFFECTIVE. Did you notice any *difference*/improvement in symptoms after starting them? Many people are not on the *right* meds for their particular issue, but they never raise questions with their doctors and try to find something that *works* for them. I'll try not to disappoint in the next few posts. Some strategies might suit you, some might not, but don't give up.

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  9. really enjoyed this article (found the link on the the UK diabetic site, LCHF forum). Post-menopausal and a yo-yo dieter for most of my adult life, what you've said has made a lot of sense. Looking forward to more on this lack of wieght loss area. But it's made me want to stick to it...so big thank you :)

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    1. :-) It's definitely not easy for older women, but I don't think it's impossible. Stay tuned!

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  10. Amy, this is in reply to all the comments on lack of weight loss in post menopausal women. Obesity is a sign and a consequence of sleep apnea, a diagnosis missed in women more often than not and also more commonly seen in the post menopause years. Any woman not losing weight on the usual diet should probably havea sleep study. I did use to keep a blog for a while, you might be able to find it in the archives, www.thesleepwell.org.

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    1. Oooh, good point, Maura! Thanks for bringing it up. I was going to talk about sleep in a future post, but I wasn't going to specifically mention apnea. I will now! You're absolutely right.

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  11. Low thyroid may also be a factor when you can't lose weight. It's very common in women and the older we get, the greater the chance.

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    1. Yes, of course. I have a couple of thyroid posts coming up in the next week or two. Huge issue for weight loss!

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  12. I have been working on weight loss since 6 months. But I didn't see any improvement. Later, I have purchased Garcinia Cambogia Ultra Slim 3+3 package. It worked so well. I suggest you guys to try this product.
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