Saturday, October 20, 2012

The Nutrition Debate #71: Weight Loss Maintenance

After losing 170 pounds on a Very Low Carb diet (first with Atkins and then Bernstein), I later regained 72. And although I still ate Very Low Carb most of the time, and always at breakfast and lunch, and most dinners, I occasionally “binged,” and I routinely ate too much dinner. I also sometimes snacked after dinner even though I was not hungry.

 Altogether, it was more than my body needed to maintain my weight, and it ultimately led to the loss of blood sugar control that I enjoyed while I was eating “strictly according to plan.” My A1c went from 5.4 to 6.3. And my blood pressure went back to 130/90 (with the same meds) from 110/70. My HDL and triglycerides were still very much improved, but my LDL had also begun to creep up. And my doctor was urging me to start statins again.

So, that is how I regained weight: Too much food, snacking after dinner, and occasional binging. It didn’t take “much” (the way I saw it), but it was enough. It took almost four years to regain the weight, with a few ups and downs along the way, and I’ve finally decided “enough is enough.” It’s time to turn it around again. About a month ago I set a goal to lose 55 pounds: 30 (to get to 247) by the end of the year (4 months’ time) and then 25 more (to get to 222) “eventually.” It’s my “let’s see how it goes approach.” Thereafter, I will strive to keep my weight within 5 pounds of 225.

By all accounts in the literature, my situation is very common. Many of those who find it easy to lose weight on a Very Low Carb eventually relapse and tumble into the same pitfall. Most gain back most of the weight they lost, especially if they abandon the principles of Very Low Carb eating. That’s a “fatal flaw” of any diet. But I didn’t, really (I tell myself). Why therefore did I fail? Everyone wants to know why they failed. And everyone wants to tell you. But nobody really knows for sure. Until now, maybe.

Before I share with you what I intend to do to maintain my weight loss (once I attain my goal weight of 225lbs.), I need to describe the diet I am using to lose weight again. I call it a Restricted Calorie Very Low Carb Ketogenic Diet.  It has 3 components: 1) Restricted Calorie: you need to have a calorie deficit to burn body fat; 2) Very Low Carb (VLC): you need to eat VLC to allow insulin to NOT BLOCK the breakdown of body fat in storage; and 3) Ketogenic: you need to supply ketone bodies from both dietary and body fat breakup, and glycerol and amino acids from fat and protein, to provide alternate fuels (e.g., ketone bodies) and mechanisms (gluconeogenesis) for synthesizing glucose for your central nervous system and other cells that require them. These processes and mechanisms are called “complementary pathways.”

For me this diet is 1,200kcal/day comprised of 5% (20g) of carbohydrate, 25% (75g) of protein and 70% (90g) of fat. This formulation produces a ketogenic/glucogenic (K/G) ratio of 1.66, and should produce a weight loss of 2 pounds per week. A 1,000 kcal/day calorie deficit x 7 days = 7,000 kcal/wk = 2 lbs., since there are 3,500 kcal/pound.

The way I propose to maintain my goal weight is described in “The Art and Science of Low Carbohydrate Living” by Jeff Volek and Stephen Phinney.  This is a very good book, but there are lots of good books out there about the Low Carb way of eating. However, none that I have read specifically describes in terms of macronutrients WHAT TO DO, once you have reached your “goal weight,” in order to maintain it. This book does, and it explains why. It describes the mechanisms and processes the body goes through ESPECIALLY WHEN YOU ARE CARBOHYDRATE INTOLERANT.  The authors use this new “buzz” phrase repeatedly. Accept it. It applies to all Type2 diabetics, pre-diabetics, and the majority of overweight, obese and morbidly obese people, as well as those who have Metabolic Syndrome. That means you.
The following excerpts from Chapter 16, “The Importance of Dietary Fat in Long-Term Maintenance,” outline Volek and Phinney’s rationale. The authors reason that “long term adherence to carbohydrate restriction is an important issue, and capturing the benefits of a low carb diet for the management of chronic conditions associated with insulin resistance requires that we address this challenge. Given the dramatic improvements in the dyslipidemia associated with metabolic syndrome, and the marked improvement in diabetes management when adequate carbohydrate restriction is sustained” (pg. 205), they conclude that dietary carbohydrate intake cannot be increased in weight maintenance. So, the need “…to feed the post-weight loss patient adequate energy for weight stability, while maintaining the degree of carbohydrate restriction necessary to sustain the diet’s benefits” (pg. 206), as carb intake must remain flat, then only protein and fat remain. And if about half of protein is glucogenic (can convert to glucose in a secondary process in the liver called gluconeogenesis), the amount of protein in the maintenance diet can only increase slightly and then only as an equal percentage of total energy intake in the maintenance diet as it was in the weight loss diet. Thus, the macronutrient that must increase in the maintenance diet, both as a percentage of total intake and in absolute calories, is fat.  I’m thinking ghee and coconut oil.  And maybe snacks of nuts and cheese once in a while. Wheeeeee...                                                    

 © Dan Brown 10/20/12


  1. Dan, I've had a terrible time keeping my weight from creeping up for the past year or so. I did NOT increase carbs, I was very careful what I ate, kept very good records (yes, I'm probably OC) but to no avail. Just recently I read Primal Body, Primal Mind by Nora Gedgaudas. It's a great book, but I read something there that I hadn't considered before: people who no longer have their gallbladders can't really digest fat properly. I have no gallbladder. So all my effort to eat a high fat, reduced calorie diet was probably in vain. Gedgaudas suggested taking ox bile capsules. I got some and within a week I lost the 5 or so pounds of chub I could really feel. That's just been 3 weeks now and I've lost maybe 2 more pounds. We'll see what happens in the long run. I have to wonder, though, how bile from a cow has the proper stuff to digest the fat in a carnivore's diet. Good wishes with your present diet, I know so well how disappointing it is to gain back weight despite your good efforts, and the fear that it will all come back no matter what you do.

    1. Hi Jan,
      I just lost a long reply. It is sooo frustrating.

      Thanks for the tip and the book recommendation. I've ordered it.

      I've written a few column on Paleo. My interest is from somewhat of a distance, though, since I am very carbohydrate intolerant. And I do eat some dairy. But I have to avoid the so-called 'good carbs.'

      If you haven't seen them, my Paleoo-related columns are 17 - 20, 38 - 39, and 54. You can access them through the Index of Columns (upper right hand corner of the blog) to see the titles and then either scroll down or Google the title (with my name?).

      I've also written a column on digestion (53) which is interesting. The gall bladder, btw, only stores and concentrates bile; it is produced in the liver. Also, if bile does not break down the dietary fat, it's not clear to me how the fat cells get into the lymph system and then into the blood and tissue. But, that's what I will learn from the book, among other things.

      Btw, here's an interesting line from the Wike on the gall bladder: "In 2009, it was proposed that the gallbladder can produce several pancreatic hormones, including insulin."