February 15, 2017

New Perspectives on Low Carb Diets for Weight Loss








As I wrote about in a recent post, I’ve finally gotten active in a few Facebook groups dedicated to low carb and ketogenic diets. There’s a world of good being done there, and heaps upon heaps of great information being shared—life-changing and life-saving information people aren’t hearing from their doctors. But there’s also a lot—and I mean a lot—of stuff that makes me want to: a) grab people tightly by the upper arms and shake some sense into them (because that’s more humane than ramming them head-first into a brick wall, which is what I’d really like to do in some cases), or b) wrap them in a long, warm hug, and help them feel better about things. I got all my keto-related anger out in the epic end-of-year rant I posted in December, so today, let’s focus on the kinder, gentler side of things.

I am paraphrasing, but here are a few examples of what I routinely read in various FB groups and blog comments:

  1. “I’ve been following a strict ketogenic diet for two months and have only lost 10 pounds. What am I doing wrong?”   
  2. “I’ve been doing strict keto for three months. I’m off my blood pressure medication and have reduced my insulin dose by half. I feel fantastic and have tons of energy, but I haven’t lost any weight. Why isn’t this working for me?” 
  3. “I’m doing a keto diet and I lost four pounds the first week, three the second week, then only two the third week, and now I’m up a pound. What did I do wrong?” 

Let’s address point number 3 first, since it’s the easiest to knock out of the way. As I wrote about back in this post, weight loss is almost never linear. It just isn’t. To expect it to be is an exercise in frustration and disappointment. If you want to be frustrated and disappointed, then by all means, go ahead and expect that your weight loss will be a straight decline, with absolutely no stalls, plateaus, gains, bumps, or hiccups along the way.  


When you want your weight loss to look like this…


…but it actually looks like this


  
…well, there’s nothing wrong, mysterious, or surprising about it. Not in the slightest. This is how it happens. If your weight loss is linear, especially over a long period of time, with no plateaus and no ups and downs, just downs, downs, downs, please see a doctor ASAP, because you might have some kind of terrible wasting disease and you should get that checked out STAT. Otherwise, ups and downs are normal. They’re angering, yes. They’re frustrating, yes, and disappointing, yes. But They. Are. Normal. Capice?  I could waste lots of time blathering on about why they’re normal, but my posts are already always too long, so if you want to pick my brain about that, feel free to book an appointment.  ;-)

Let’s look at that second weight loss graph.
As I explained a while back, 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. But when you look at the entire graph, the progression, over time, is downward.

But what happens when people trying to lose weight step on the scale every day? The small day-to-day fluctuations drive them absolutely crazy. Being “stalled” for a week or two—or a month or two—or gaining a pound or two or four, might even make them quit whatever program they’re following, when they’re actually doing just fine.  According to the good doctors Volek and Phinney, day-to-day fluctuations of as much as four pounds are totally normal. It is not reflective of fat loss or gain. (What could it be, then? Water, glycogen, karma, Saturn rising in Aquarius…) And I can’t find the reference at the moment, but I’m pretty sure I’ve heard Dr. Phinney say he doesn’t consider it a “stall” unless there’s been no change in weight or size (inches/cm) for more than eight weeks. Eight weeks! And most people posting on keto and low carb forums with woeful tales of stalled weight loss are frantic because it’s been one or two weeks. *Facepalm.*

Here’s another fun way to look at how weight loss works in the real world:


I saw this image on Facebook and saved it because it was so awesome. I don’t know who created it, though, so I can’t give credit where it is due. Please know that I am not trying to take credit for work that is not mine. If you happen to know who made this, let me know and I’ll update the source info.


On to points 1 and 2:

Here is my combined response to people who post similar tearful tales:

“You’ve lost 10 pounds in 2 months? You should be proud of yourself and celebrating, and instead youre beating yourself up and feeling like a failure. Please stop! Please think about it this way: if you had gained 10 pounds in 2 months, that would seem like a very, VERY BIG DEAL, right? So why is it not an equally big deal that you've lost that much? You said it yourself: you’ve already experienced a huge improvement medically and you feel fantastic. That says it all. Please, give yourself credit!”

Let’s focus on the sentence in bold. I emphasized it because I wish I could say this to everyone out there who’s fretting and feeling disappointed at what they perceive as a slow weight loss. Any loss -- any loss at all -- is proof that at least something you’re doing is effective. What if you’ve only lost eight pounds, instead of ten? Or you’ve lost six or just four pounds? You’ll beat yourself up for your perceived failure, when if you had gained four, six, or eight pounds in the same timeframe, you would ... well, you would beat yourself up for your perceived failure. (Why? Because eight, six, or even four pounds ARE a big deal! Got it? Good!)

About the second part—experiencing wonderful improvements in medical conditions, even when weight loss is slow or perhaps not even occurring at all: fat loss is a nice goal, but if you are living with metabolic syndrome, T2 diabetes, heart disease, PCOS, kidney dysfunction, hypertension, or any other condition currently believed to be intimately linked to insulin resistance, then your time and dietary efforts are better spent focusing on improving your health, rather than your weight. Low carbohydrate and ketogenic diets have many, many benefits beyond weight loss. In fact, some of the therapeutic effects are observed in people who don’t lose weight. So rest assured that in following a nutrient-dense low carb diet, your health is likely improving even when the dastardly scale would have you feel like a failure.

And remember—always, always remember—being “thin” is not indicative of being healthy. Body mass index and other metrics that take only body weight into account say absolutely nothing about someone’s metabolic health. I use the acronym “TOFI” pretty casually (thin outside, fat inside), but it’s actually a pretty big deal. To the extent that excess adiposity is reflective of insulin resistance and harmful metabolic dysregulation, then yes, losing some of that excess fat is probably a sign that you’re correcting some of that dysregulation. But in that case, the goal—the prize to keep your eyes on—is better health, not smaller pants.     


Easier said than done, I know. (Believe me, I know. I haven't learned all this by serendipity, y'know.) But just something to keep in mind, because it makes me sad when I see people feeling like low carb isn’t working for them when they’re actually doing beautifully.







Disclaimer: Amy Berger, MS, CNS, 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 and is not to be used as a substitute for the care and guidance of a physician. Links in this post and all others may direct you to amazon.com, where I will receive a small amount of the purchase price of any items you buy through my affiliate links.

21 comments:

  1. The psychological connect with weight loss and health is staggeringly strong. I have to reassure many people that compounding positive health changes far outweigh the immediate "negative" they're seeing. I'm practically self-diagnosed with body dysmorphia disorder and I have to therapize myself almost on a daily basis that fat loss isn't always the answer to my life's problems. I survived DKA + acute pancreatitis, successfully reversed T2D, hypertension, gout, became active and insulin sensitive, lost 130lbs and maintained that loss for 6+ years, and I *still* want more. And I know all this.

    Hearing the same kind of situation from others doesn't make me step outside myself to reassure them either - quite the opposite actually, since it seems to elicit an extrapolated response borne from my own insecurity - but throttling people isn't very appealing or professional lol. It's frustratingly relatable and understandable from my personal perspective.

    When is it okay to say, "I got my own problems, buddy?"
    ☜(˚▽˚)☞

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    1. No one ever said this stuff was easy. ;-) In fact, the physical process of fat loss and improving health in other ways is probably *easier* than the psychological aspects. I, too, have learned the hard way that fitting into smaller clothing was not the magical path to happiness in the rest of my life. If only it was!

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    2. @Anubis, your comment is truly awesome. You have Hero status in my book.
      And Amy, THANK YOU for posting this. You're amazing and I'm looking forward to reading your new book on Alzheimer's!

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  2. Another thing I think should be emphasized (which I'm sure you've done in other posts) is that weight can be misleading, what really counts is how you look in the mirror and how that weight is distributed. What we're trying to lose here is fat, not just weight. So just because your weight isn't changing much, or at all, doesn't mean you're not getting leaner.

    So look in the mirror (and maybe take pictures along the way, as difficult as that may be for many people) and see what's happening to your waist, etc. That will tell the real tale, as well as how you feel, what your fitness is, etc. Take measurements of your waist, hips, arms/legs if that's where your weight problem lies.

    Many people say to never weight yourself and only use the mirror and measuring tape. But of course the scale is easier and it's hard to ignore.

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  3. I'm a clinical psychologist on my own weight loss journey (-130 lbs over 5 years). I have moved to a ketogenic eating program with good success over the last 6 months. I have tried to read broadly to get a feel for both the scientific research and the applied and popular information available. I have been bothered by the unrealistic and unsustainable approaches that you point out. I appreciate your good advice in this article. Any change can be challenging, but change that happens at the level of identity and self-concept is very complicated and multi-faceted. Your thoughts are helpful and practical. I have bookmarked your site. Thanks. Pete Wilson, Psy.D drpfwilson@twitter.com

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    1. Thanks, Pete! I do try to be a voice of reason and sanity in all this. Lots of people are going off the deep end, I think.

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  4. One of the frustrations (for me anyway), is that things like test results improving are silent except for every six months or so when I get blood drawn. So my three months and counting stall had me wondering if anything positive was happening. I just got my labs drawn and trigs were way down and HDL was up significantly. So that provided a burst of encouragement but the impact of that will wane over time.

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    1. This is true -- when we gauge things by bloodwork, it's not the same kind of instant gratification that comes from the loss of a few pounds. I guess maybe just, day to day, feeling good, having steady energy, no major dips in cognition or focus...relief of chronic pain (if that was an issue) -- there are other things to look for to have proof this is effective, depending on the particular issues someone is/was dealing with. (Acne, PMS, headaches, etc.)

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  5. Fantastic article, Amy. Sharing on my page.

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  6. can you explain how good this diet is for a diabetic

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    1. In the briefest way I can, I believe a low carbohydrate diet is probably the #1 most effective intervention for type 2 *and* type 1 diabetes. For more in-depth information, there are approximately a zillion good books on the subject. Or start here: https://www.dietdoctor.com/diabetes

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  7. Hi Amy,
    You say it's actually quite possible to be thin on the outside and fat on the inside, which I totally agree with. The problem is, how do you know you're fat inside? I mean, being fat outside is as simple as looking in the mirror. Fat inside... do you need X-Rays?

    Thanks and keep up the good work!

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    1. X-rays? LOL, no. Go by bloodwork. "Fat inside" means that someone has the metabolic profile we would "expect" in someone who is overweight or obese (based on the [false] notion that body size alone is an indicator of one's health). You would want to look at triglycerides, HDL, fasting glucose, fasting insulin, liver enzymes, blood pressure, markers of inflammation, etc.

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    2. Symptoms too! As one of those annoying people who never gain weight (except after obeying a dietician!) I'm still much the same weight I've mostly been, but most of my symptoms have improved and many are completely eliminated. Bloods correlate closely to the symptoms, or lack thereof.

      At the moment weight loss means my hyperthyroid is undermedicated. Just one example of other players that may be on the field.

      chris c

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    3. Thanks Amy for the reply to my initial question.
      You're talking about blood test, which seems good... but aren't all those markers related to some other issues? You could have elevated liver enzymes because of hepatitis or high blood pressure because of sleep apnea.
      I could give my own example when I was having some health issues (won't talk a lot about them publicly) : low tryg, nice HDL, elevated liver enzymes (almost all of them), low blood pressure, some inflammation, low red-blood cells count, quite low white-blood cells count... so things not necessarily pointing in the same direction.

      Thanks again!

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    4. Yes, you're right (and very astute) -- various blood markers can be high or low for a number of reasons. This is why I advise against looking at any one number in isolation. Blood tests should be considered within the framework of "the whole person" -- the total picture of the biomarkers, plus the signs and symptoms a person exhibits, plus knowledge of someone's diet and lifestyle. In my opinion, this is what's missing from modern allopathic medicine -- way too much focus on one number to the exclusion of all else. High blood glucose? We give you insulin. High blood pressure? We give you a beta blocker. High cholesterol? Shove a statin at you. It's a rare doctor these days who looks at root causes and treats *people,* rather than treating numbers on a lab printout.

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  8. Thank you so much!! This just seemed to flip a switch in my thinking. I am going to do this...no matter the ups and downs. It is about consistency for me. And I love the "you're not in a plateau unless it has lasted 8 weeks"

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    1. :) Thanks for reading! I need to see if I can dig up the reference for the eight weeks thing, because I quote it often and would like to be able to back it up with the source when I find it again.

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  9. Such a great post to read. I've been explaining to my wife and even a few people how weight loss especially fat loss actually works. I'll have to send them this fantastic post which will hopefully open their eyes a bit more. Been keto for about 4 weeks now and I must say don't really care about the weight loss if it comes great. I focus on the amazing amount of energy I have and how great I feel.

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