Retrospective #71: Weight Loss Maintenance (2012)

After losing 170 pounds by eating Very Low Carb, I later regained almost 70. And although I still ate Very Low Carb most of the time, and always at breakfast and lunch and dinners at home, I occasionally binged and usually cheated in restaurants. I also sometimes snacked after dinner even though I was not hungry.

Because of that, I ate more than my body needed. And cheating with carbs led to the loss of both ketosis and blood sugar control. My A1c went from 5.4 to 6.3%, and my blood pressure also went back to 130/90 from 110/70. My HDL and triglycerides were still hugely improved, but my doctor was urging me to start taking a statin again.

So, that is how I regained weight: Too many carbs (taking me out of ketosis), snacking after dinner, and occasional binging. It didn’t take much, but it was enough. It took almost four years to regain the weight, with a few ups and downs along the way. So, I finally decided: Enough is enough! It’s time to turn this boat around again. About a month ago I set a goal to lose 55 pounds: Thereafter, I would strive to keep my weight within 5 pounds of 225.

If this yo-yo sounds familiar, by all accounts it is. My situation is very common. People who find it easy to lose weight by any means, even a Very Low Carb diet, eventually relapse. Most gain back most of the weight they lost because they no longer follow the principles they used to lose the weight. That’s true of Very Low Carb eating too.

So, to lose the weight again, I am going to return to a slightly modified version of the Very Low Carb Ketogenic Diet (VLCKD) is used, starting 10 years ago, to lose 170 pounds. The Way of Eating I will use has 3 components: 1) Very Low Carb (VLC): you need to eat VLC to allow insulin to NOT BLOCK the breakdown of body fat in storage; 2) Restricted Calorie: you need to have a calorie deficit of food-by-mouth to create the need to burn body fat to maintain metabolic balance (homeostasis); and 3) Ketogenic: you need to make your body supply a) ketones from the breakup of body fat, and b) glucose from glycerol from fats and amino acids from protein via gluconeogenesis. These are called “complementary pathways,” where the body synthesizes glucose for some cells that require them.

This diet will be 1,200kcal/day comprised of 5% (15g) of carbohydrate, 20% (60g) of protein and 75% (100g) of fat.

The way I propose to then maintain my “goal weight” is described in Volek and Phinney’s, “The Art and Science of Low Carbohydrate Living.” They specifically describe, in terms of macronutrients, WHAT TO DO to maintain your “goal weight,” once you have reached it. Uniquely, this book also 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 Type 2 diabetics, Pre-diabetics, and the majority of overweight and obese people, as well as those who have Metabolic Syndrome. It likely applies to YOU.

The Chapter 16 title of Volek and Phinney’s book tells it all: “The Importance of Dietary Fat in Long-Term Maintenance.”  An excerpt from page 205: “Long term adherence to carbohydrate restriction is an important issue,” they say, “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…” – they’re saying, dietary carbohydrate intake cannot be increased in weight maintenance. So, then only protein and fat remain. And since about half of protein is glucogenic, i.e., can convert to glucose via 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. Therefore (page 206), “…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…the need [to increase} dietary fat while keeping carbohydrates within an acceptable level of tolerance in the long-term maintenance phase of carbohydrate restriction.” THE MACRO THAT MUST INCREASE IN THE MAINTENANCE DIET IS FAT.

I’m thinking maybe snacks of nuts and cheese once in a while. “Sugar plums,” metaphorically speaking.