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  #1   ^
Old Mon, Oct-05-09, 09:17
Merpig's Avatar
Merpig Merpig is offline
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Default Why Weight Loss Stops on Long Term Low Carb Diets

From Jenny's Diabetes blog at:
http://diabetesupdate.blogspot.com/...g-term-low.html
Quote:
The enthusiasm for the low carb diet as a weight loss diet arises in the first few weeks and months when most people experience dramatic weight loss.

What rarely gets mentioned--especially in the miracle weight loss books--is that very few low carb dieters ever get to their weight loss goal, especially those who start out with a lot of weight to lose.

I am enthusiastic about the power of carb restriction to lower blood sugar to normal or near normal levels. I am not as enthusiastic about low carbohydrate dieting as the solution to tough weight loss problems.

Because even the online low carb community tends to believe that people who stall out are "not doing the diet right" and respond to stall posts with that assumption, most people who do stall out long term leave the discussion boards, leaving only those who have succeeded to greet the newbies.

But as someone who stalled out for years on my own weight loss, and someone who has read the boards for years, I am convinced that permanent stalls are the norm and the people who get down to goal the exception--especially among those older than 45.

In this post I'm going to discuss a few reasons why this happens.

1. Thyroid slowing. Long term low carbing causes changes in T3 hormone levels which are often hard to diagnose. It can cause something called "Euthyroid syndrome." I learned about this from Lyle Macdonald's book, The Ketogenic Diet, which has cites to the relevant research. Getting help for this problem is very hard as your TSH will be fine and standard thyroid testing may not pick it up.

Physiologically what seems to happen is that your body responds to months of ketogenic dieting by assuming you are starving--people who are starving are in ketosis all the time too. So it turns down the thermostat to conserve your body mass so you don't die. If this happens to you you'll know it. You'll feel exhausted and dragged out all the time, and the burst of energy most people feel when they start out low carbing will be a distant memory.

Dr. Bernstein reports that many of his patients develop thyroid problems months after starting the LC diet, but he insists this is because they have developed autoimmune thyroid disease. I have to question this. Too many of us with no markers for any kind of autoimmune disease experience this metabolic slowdown on long term low carb diets. Whatever the explanation, once your thyroid slows, you weight loss will slow dramatically.

My take on this now is that it is a good idea to raise your carbohydrate intake over the ketogenic boundary from time to time. Where that boundary is varies from person to person. It's the point where after adding a few more grams of carbohydrate to your intake, you suddenly gain the 3-8 lbs you lost the first three days you were on the diet. That instant weight gain is not fat. It is the weight of the glycogen you've just restored to your liver and muscles.

Watch your calories closely when you raise your carbs this way and you shouldn't gain any weight. In fact if you watch calories and keep carbs just over the boundary while lowering your fat intake you might lose a pound or two.

Note: If you can't keep your blood sugar normal at an intake high enough to get you out of a ketogenic state it might be time to talk to an endocrinologist about safe drugs that can help. I personally maintain now at an intake that varies from 70-110 grams a day (my ketogenic boundary is at about 65 grams a day.) If I stay lower than 50 for six weeks I always develop that half dead feeling again. I need insulin at some of my meals to eat at this level, but I feel a lot better when I do. Metformin along with the insulin keeps me from gaining weight. In fact, I have been losing slowly and steadily over the past six months with the combination of lower fat/higher carbs, insulin and metformin.

2. Fat-induced insulin resistance. There is some interesting research that has been discussed on the Whole Health Source Blog about how, and more importantly, why, palmitic acid, a saturated fat might raise insulin resistance in rodents. There are a lot of other studies over the years that have demonstrated that high saturated fat intakes of all kinds increase insulin resistance too.

While I don't believe that high sat fat intake worsens heart disease or cholesterol, I think it is very possible that, for the reasons that Stephan Guyenet hypothesizes in the Whole Health Source post, long term high saturated fat intake does does increase insulin resistance, and that after many months of eating very high fat/low carb diets this increase in IR can become a huge problem especially when people experience "carb creep."

"Carb creep" is very common. Over time most of us end up eating more carbs than we think we do. A bit more here, a bit there, or perhaps we are eating larger portions of lower carb foods than we realize, so that 4 g intake is 8 g. Do that five times a day and you are eating a lot more carbs than you realize.

The cure for this is to weigh your portions for a while and get accurate carb counts. If you are eating over 60 grams a day, cut back on the saturated fat and see if that helps. I am starting to think the very high fat low carb diet is only appropriate with extremely low carb intake levels.

For those of us eating low carb to control blood sugar, a higher carb intake may be necessary to keep ourselves from experiencing diet burn out. If your blood sugar is under control at a higher carb intake, your health is fine. You may have to compromise on weight loss, though. Or perhaps cut back on the cheese, butter, nuts, meat fat and cream and see if cutting out some of that saturated fat helps.

3. Stalling Is Built Into the System. The 10% factor. High quality research which I've blogged about elsewhere suggests that when people have lost between 10-20% of their starting body weight they will experience metabolic slowdown no matter what diet they use.

When I polled the diabetes community last year about their own diet experiences, the single most often repeated report was that most people who cut carbs could lose and maintain the loss of 20% of their starting weight, but after that, forget it. This is better than Dr. Leibel's results with a mixed diet, where slowdown kicked in at 10%, but it's far less weight loss than most people who embark on a low carb diet hope to lose.

My belief is that if you stall the smartest thing you can do is declare victory and maintain your weight for a few months without attempting to lose more. Make your body feel safe, so your thyroid ramps up a bit and stops worrying about the next famine. If you can't maintain at your partial weight loss, you are not going to be able to maintain if you lose more.

In fact, the sanest goal would be to find the weight level at which you can maintain happily without feelings of deprivation and stay at that weight. Then you might just not become one of the many many low carb dieters who lose 100 lbs and gain back 120. There are far too many of them, most of them blaming themselves for weakness. My guess is it isn't weakness, it's the revenge of a metabolism that has been pushed too far and is now 100% dedicated to preparing you for the next massive famine.

4. Calories Do Count. There is a glorious period when people start their first low carb diet where they do seem to trick the body into dropping crazy amounts of real fat--despite eating relatively high calorie intakes. This passes. Oh, how it passes.

Once you have dropped that initial 10% or so the magic of low carb dieting wears off and the only way most of us (not all, but most) lose any more weight is by cutting back on our food intake.


To lose weight you do have to cut calories below some level which for many of us with metabolic problems or who are older is MUCH lower than what dietitians tell you or what you get when you use online calculators.

After years of thinking I couldn't lose weight cutting calories, I learned I can--thanks to a week long attack of stomach poisoning. It turns out all I have to do is cut my calories down to about 800 a day and I will lose. The calculators tell me I should lose on 1350. The nutritionist told me I should lose on even more than that. Twice this year I've been sick for a week unable to eat and both times I have lost a pound or so eating 800 calories--and most significantly, kept it off later on.

Do I want to keep eating like that to lose more? No. Because if there is one thing I've learned, it is that you maintain your weight loss on a diet only a few hundred calories higher than the one you ate while losing. I have no wish to have to eat 1,000 calories a day for the rest of my life.

Normal Blood Sugar Is The Best Goal To Chase. Most of us started obsessing about weight loss because doctors told us if we lost a lot of weight we'd stop being diabetic. This is absolute hogwash. Go look at my Type 2 Poll if you still believe this. It isn't the weight loss that controls blood sugar it is cutting out the carbs. No matter how thin we get, most of us will see diabetic blood sugars if we eat carbs.

If you understand this, but also understand that maintaining normal blood sugars no matter what you weigh will eliminate diabetic complications including heart disease, you should be able to accept whatever weight loss you can achieve and relax about the rest.

Carb restriction is a powerful tool for achieving normal health. It's a useful approach to weight loss, but like ALL diet approaches, it only goes so far. Yes, there are people who have huge low carb weight loss successes, but for every one of those there are hundreds who stall out at that 20% lost from starting weight. If you can get to even 15% lost, give yourself a big pat on the back, realize you are are normal if you stall, and get to work on maintaining that impressive weight loss for life.


Note, Stephan, from the Whole Health Source blog, whom Jenny mentioned above, made this comment on her blog:
Quote:
Just wanted to clarify something about my post on palmitic acid. Butter did not induce metabolic dysfunction in that rodent study when it was fed at an equal number of calories as the low-fat diet

In humans, the controlled feeding trials do not generally support the idea that saturated fat consumption leads to insulin resistance in either normoglycemics or diabetics. We don't have any long-term properly controlled trials. However, in the Women's Health Initiative dietary modification trial, reducing saturated fat by 24% (among other things) had no significant effect on insulin sensitivity measured by HOMA-IR (admittedly not the ideal measure).

Last edited by Merpig : Mon, Oct-05-09 at 09:48.
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  #2   ^
Old Mon, Oct-05-09, 09:35
kyrasdad's Avatar
kyrasdad kyrasdad is offline
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Plan: Atkins
Stats: 338/253/210 Male 5'11"
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Location: Broken Arrow, Oklahoma
Default

I think this is a really well thought out post. Thanks! I do not really see the energy dullness described, but I was hypothyroid for 15 years before I started low carbing in 2003. I've never really had an energy issue on low carb, but then I've been nearly 100 pounds lighter for all those years, so it may be that, and I could have relatively less energy.

I do agree that calories must be cut at a certain point. At least for me, that's been proven true.

I have stalled. I don't really adhere to the diet that well these days. I used to be religious about carbs, and now I experience carb creep. I know I'm doing it wrong, but I'm not gaining anymore. I could certainly stand to lose another 50 or so pounds.

Since I've had 5+ years of success (but not total success, as in having lost all I wanted to and kept it off) I'm probably not the kind of stall this article discusses. I lost steadily for about 2 years, and have kept most of that loss since.
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  #3   ^
Old Mon, Oct-05-09, 09:46
Nancy LC's Avatar
Nancy LC Nancy LC is offline
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Plan: DDF
Stats: 202/185.4/179 Female 67
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I find myself agreeing on much of this. After I'm done with the 6 week cure I'll try upping my carbs a bit. Maybe a very, very limited carb cycling. I tried major carb cycling once and it didn't work at all.
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  #4   ^
Old Mon, Oct-05-09, 10:00
Mrs. Skip's Avatar
Mrs. Skip Mrs. Skip is offline
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Plan: Primal/Paleo/MyOwn
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Well, I was hypothyroid BEFORE I started doing low-carb. And, I really do know why I am stalled...it's just plain eating way too much food and some carb creep. My body is generally much happier maintaining my weight than losing it. If I really buckle down and journal what I eat, etc., I can lose again...it's just harder to do, and I prefer to coast!
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  #5   ^
Old Mon, Oct-05-09, 10:06
Citruskiss Citruskiss is offline
I've decided
Posts: 16,864
 
Plan: LC
Stats: 235/137.6/130 Female 5' 5"
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Progress: 93%
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Thank you so much Merpig - for posting this here. It's something I really needed to read, because my husband has just discovered a 'thyroid problem' - and we've been on low carb for quite awhile.

Also - I stalled out too. On regular Atkins. When I added in more produce and started walking daily - the weight loss picked up again. When I joined the gym and began a weight training routine - I needed to eat more food, I stalled out for a bit and then dropped even more weight.

Things that worked in the beginning did *not* continue to work.

If I had just paid closer attention to DANDR - I might not have stalled out for so long. I didn't exactly make sure that 'most' of my carbs were coming from vegetables, and furthermore - I didn't move up the carb ladder. In fact, I went in the opposite direction, which worked...for a very short time.

Thanks again for posting this - I just printed it out - because it contains some very good advice
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  #6   ^
Old Mon, Oct-05-09, 10:07
LAwoman75's Avatar
LAwoman75 LAwoman75 is offline
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Plan: Whole food, semi low carb
Stats: 165/165/140 Female 5'6"
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Location: Ozark Mt's
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I agree with much of this article. I also thought what he said about internet forums was so true as well.

For me, I didn't feel well at all when my carb count was too low, and I also coudn't lose that way. I keep my carb count somewhere between 70-100. Most of that comes from fruit and veggies. I also do not eat a lot of fat. I do eat fat, but don't purposely add it, I don't eat heavy cream or gobs of butter. If we are having chicken thighs vs. breasts, I eat a chicken thigh....... but I don't smother it in bacon fat nor do I eat the skin. I reached my goal this way and so far have maintained for over a year, but still have low carbers tell me I'm doing it wrong. Go figure?

When I see someone here hit a long stall eating only 30g of carbs per day, and the advice they receive is to lower the carb count even further, I just don't believe that the reason they are stalled is because the whopping 30g of carbs they are taking in is just too high.
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  #7   ^
Old Mon, Oct-05-09, 10:18
Citruskiss Citruskiss is offline
I've decided
Posts: 16,864
 
Plan: LC
Stats: 235/137.6/130 Female 5' 5"
BF:haven't a clue
Progress: 93%
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Quote:
Originally Posted by LAwoman75
I agree with much of this article. I also thought what he said about internet forums was so true as well.

For me, I didn't feel well at all when my carb count was too low, and I also coudn't lose that way. I keep my carb count somewhere between 70-100. Most of that comes from fruit and veggies. I also do not eat a lot of fat. I do eat fat, but don't purposely add it, I don't eat heavy cream or gobs of butter. If we are having chicken thighs vs. breasts, I eat a chicken thigh....... but I don't smother it in bacon fat nor do I eat the skin. I reached my goal this way and so far have maintained for over a year, but still have low carbers tell me I'm doing it wrong. Go figure?


You are *not* wrong. I am similar in my approach to fats. Carb count is still pretty 'low' some days, but there are variations here and there. I'm impressed with your 70-100 carbs deal. I hope to get there someday too.
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  #8   ^
Old Mon, Oct-05-09, 10:32
Merpig's Avatar
Merpig Merpig is offline
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Plan: EF/Fung IDM/keto
Stats: 375/225.4/175 Female 66.5 inches
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Progress: 75%
Location: NE Florida
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Quote:
Originally Posted by LAwoman75
I reached my goal this way and so far have maintained for over a year, but still have low carbers tell me I'm doing it wrong. Go figure?

I don't see how anyone who has reached goal can be told they are doing it "wrong"! I mean I can see someone saying "I don't think your way would work for me", or "your food choices are not choices that I could live with" or some other similar wording, but clearly it can hardly be wrong for you since you have done so well on it.
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  #9   ^
Old Mon, Oct-05-09, 10:37
PhxSarah PhxSarah is offline
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Plan: my own
Stats: 225/208/135 Female 5'1"
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Progress: 19%
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Debbie, thanks for posting this.

And I really appreciate some of you big losers (Citruskiss, LAWoman) posting in replies. Your 'secrets' are in your journals (thanks for having journals!)

As I posted elsewhere (cause Debbie posted an extract in the 6week cure thread), the lower carb intake we adopted 5 years ago has kept DH's blood sugar readings consistently low. But higher calories, some cheats, etc have brought our weights back to where we started.

I'm happy DH is less likely to die or have a leg amputated or go blind due to high sugar and that's no small thing. But we both would like to be a lot thinner. I want to be able to run and play.

Keep up the posting and the discussion you guys! Thank you fr your contributions!

Sarah
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  #10   ^
Old Mon, Oct-05-09, 11:10
Hilary M's Avatar
Hilary M Hilary M is offline
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Plan: Whole foods moderation
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Quote:
My belief is that if you stall the smartest thing you can do is declare victory and maintain your weight for a few months without attempting to lose more. Make your body feel safe, so your thyroid ramps up a bit and stops worrying about the next famine.

I loved this whole post but this part especially spoke to me. I am slowly learning that being sane and not scale-obsessed and content with my eating choices is just as important to me as losing the rest of the weight is. If that means I have a half a sandwich at a company function where I'm "stuck" or I eat a piece of wedding cake on a weekend twice a year, that's fine. I'm trying to find a balance between weight loss and still living with food not freaking me out all the time.
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  #11   ^
Old Mon, Oct-05-09, 11:51
Nancy LC's Avatar
Nancy LC Nancy LC is offline
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Posts: 25,842
 
Plan: DDF
Stats: 202/185.4/179 Female 67
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Progress: 72%
Location: San Diego, CA
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Personally I feel like if one is going to raise carbs, do it by eating some of the starchier veggies or sweeter fruits, not by eating grains, juices, cereals, pasta, sugars and all that stuff.

I think it's time for me to experiment in this direction. I've done every variation of low carb changing around fat and protein %'s and haven't really had any luck with that in breaking my multi-year long stall.
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Old Mon, Oct-05-09, 12:02
PhxSarah PhxSarah is offline
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Posts: 329
 
Plan: my own
Stats: 225/208/135 Female 5'1"
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Progress: 19%
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Quote:
Originally Posted by Nancy LC
Personally I feel like if one is going to raise carbs, do it by eating some of the starchier veggies or sweeter fruits, not by eating grains, juices, cereals, pasta, sugars and all that stuff.

I think it's time for me to experiment in this direction. I've done every variation of low carb changing around fat and protein %'s and haven't really had any luck with that in breaking my multi-year long stall.


Judy from NYC has always said exactly that. She thinks a lot of longterm very low carb Atkinstype followers would benefit from transitioning to South Beach type eating.

I might look at that again after I lose 10% or more with the low carb again. Cause I'm not there yet. Just hit 5%.

My problem is, whenever I went to raise carbs in the past I immediately started eating more bad stuff (i.e., not sending away the breadbasket).

Sarah
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  #13   ^
Old Mon, Oct-05-09, 12:10
tiredangel tiredangel is offline
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Plan: Carnivore
Stats: 235/175/150 Female 5'7"
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Progress: 71%
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I agree about not adding in grains and juices. I've raised my carbs recently (harvest season) with potatoes (yes), sweet potatoes, and winter squash. Oh, and some chocolate with real sugar (in small amounts). I cannot eat wheat ever again -- that has always caused me to gain my weight back. Juice is nothing more than sugar water.

I DID lose more than 10% of my weight on VLC, however. I lost close to 50 pounds. about 20%. I only added carbs back in because I am a member of a couple of CSAs and was bringing potatoes and such home.

It's interesting that she mentions eating 5 meals a day. Could it be THAT is what causes so much weight gain? I love large meals, so I eat large meals. But I only eat two a day. I suppose the grazing is because of diabetes.
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  #14   ^
Old Mon, Oct-05-09, 13:57
Merpig's Avatar
Merpig Merpig is offline
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Posts: 7,582
 
Plan: EF/Fung IDM/keto
Stats: 375/225.4/175 Female 66.5 inches
BF:
Progress: 75%
Location: NE Florida
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Quote:
Originally Posted by tiredangel
It's interesting that she mentions eating 5 meals a day. Could it be THAT is what causes so much weight gain? I love large meals, so I eat large meals. But I only eat two a day. I suppose the grazing is because of diabetes.

I'm with you on that one. I love large meals too. Small meals just depress me and seem so deprivational. But I'm currently doing the same as you with just two meals a day - but those two seem hearty and filling. So far have dropped nine pounds since adopting this method.
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  #15   ^
Old Mon, Oct-05-09, 14:39
costello22's Avatar
costello22 costello22 is offline
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Posts: 2,544
 
Plan: VLC
Stats: 265.4/238.8/199 Female 5'5.5"
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Progress: 40%
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Thanks for posting this, Debbie. I too lost almost 20% of my original weight then stalled. It's been over a year now. I tend to think of it as maintaining rather than stalling. I'm very grateful the weight hasn't come back. But I'm so disappointed that I'm still so heavy.
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