 Healthy
Weight Loss
Ready to make the change?
Dr. Dunne’s 5-week structured weight loss plan is for those
folks with significant weight to lose who are ready, finally, to
get it done. Join up with a partner and you both get one free
follow up support visit (a $58 value)
What
we know is true about losing fat and keeping it off long term:
How we eat to lose weight is different from a healthy life long
diet.
Transitioning successfully from a fat loss diet to a healthy life
long diet is only beginning to be understood. Specifics for success
include a metabolic readjustment period (5 to 10 or more weeks),
and educational and psychological support that works with the habits
of thought and feelings around food, eating and exercise behaviors.
Transitioning to a life long healthy diet is a life long effort
that requires information, commitment to loving self discipline
and ongoing support.
Very regular exercise to maintain appropriate muscle strength and
tone is an absolute requirement. We can not eat a diet that is nutritious
enough on as few calories as would be required to maintain an appropriate
weight, especially as we age, if we are not active and strong.
90% of people who lose weight do not keep it off, because they do
not have the necessary long term support. In one study that was
typical of all similar studies:
Attending >75% of follow up support visits = 92% kept weight
off.
51 - 75% of follow up visits = 90% kept weight off.
<51% of follow up visits = 72% kept weight off.
Self monitored patients = zero kept weight off.
How we eat to lose weight
The most reliable and straightforward way is a ketogenic diet. Actually
every successful weight loss diet is a ketogenic diet. A ketogenic
diet is one in which we reduce our total calories eaten to below
the amount of calories our bodies use in a day, and therefore need
to call on the energy stored in our fat cells to provide fuel for
our muscles.
How we limit our intake of food, that is the macro-nutrients known
as fat, protein and carbohydrate, will have a lot to do with both
how we feel while using up this fat, and ultimately our long term
success at maintaining fat loss. Therefore, we recommend a ketogenic
diet in which you will limit the amount of carbohydrate you eat
so that a significant portion of your fuel for the day has to come
from fat converted to ketones. You can achieve fat burning on a
larger number of calories and with more satisfying food choices
when you adjust carbohydrates to protein and fat ratio in this way.
This type of ketogenic diet is not over-eating too large portions
of protein. It does not mean over-eating fat or completely eliminating
carbohydrates. Some people have abused the idea of lower carbohydrate
ketogenic diets, by misinterpreting the intention of the clinicians
promoting this method. As a result the media and some medical authorities
have seemed to emphasize the ‘dangers’ or failures that
followed the extreme behaviors chosen by some consumers. A lower
carbohydrate ketogenic diet is safe and effective for fat loss.
Remember, we can only lose fat by reducing our calories from food
to less than the amount of calories we use in our daily activities.
There are any number of additional details that make this strategy
more or less likely to succeed, especially over time. One crucial
aspect has to do with how we feel when we reduce calories. If we
just eat less, without regard to the composition of our diet—that
is, the fat, protein and carbohydrate content, as well as the vitamins,
minerals we need – we can have a pretty unpleasant experience,
including hunger, fatigue, headaches, muscle spasms, mental fogginess,
emotional depression or irritability and insomnia. We can also find
ourselves losing weight that includes our muscle mass, and not just
the fat we intended to lose.
A lower carbohydrate ketogenic diet, in which we reduce our calories
from carbohydrates in particular and nourish our selves with appropriate
amounts of water, vegetables, eggs, poultry, fish, meat, nuts and
good quality oils, creates fat loss without the usual unpleasant
side effects; it also helps identify problem foods, so that when
we transition from a fat loss to a healthy weight maintenance way
of eating, we can do so without returning to old problems.
Ketosis is not ketoacidosis
Ketones are a product of fat metabolism, and function as a source
of energy for the body. Our muscles and other tissues can use ketones
for fuel instead of glucose. Ketones are released from stored fat
and used for energy when there is insufficient glucose available.
The brain requires glucose for fuel, whereas muscle and other metabolic
processes will take up ketones instead. We can make glucose from
everything we eat, including by transforming proteins from animal
foods. We can not however, make protein for our bodies from plant
foods. What we make from the carbohydrates of plant food is fat.
The excess carbohydrates we eat every day beyond what we use in
the exercise of our muscles, is transformed to fat and stored. This
is a great system for people (like our human ancestors) who do not
have a reliable food supply and are subject to regular periods of
feast or famine. For most of us it means an ever enlarging “storage
bin” of accumulated fat.
There is confusion regarding the ketosis that occurs when we are
eating less carbohydrates than we need for daily fuel and begin
to burn stored fat instead, and a condition known as ketoacidosis.
Ketoacidosis occurs when people with blood sugar derangements produce
high levels of ketones while also having high levels of blood sugar.
People with diabetes do not produce enough insulin from their pancreas,
or have a condition called insulin resistance, in which the tissues
will no longer respond to the presence of insulin bearing glucose
to be delivered into storage. Ketones are formed in response to
the tissues need for some fuel other than the glucose, which is
collecting in the blood attached to insulin molecules but can’t
be delivered into cells any more. Normally our body will adjust
the blood pH level to balance this shifting chemistry. In diabetics
the imbalance is too great and ketoacidosis, or increased acidity
of the blood occurs. Metabolic ketoacidosis in people with diabetes
is a dangerous condition and should be avoided with very strict
control and attention to diet and blood sugar levels.
When a person with normal blood sugar levels is producing ketones
by breaking down fat for fuel, and is not eating excess carbohydrates,
the blood glucose is delivered elegantly, primarily to the brain,
and the rest of the body happily uses ketones to run the show.
Eating carbohydrate foods in amounts that allow for the release
of ketones from stored fat is a safe and effective way to reduce
body fat while maintaining an even blood sugar, having plenty of
physical energy, mental alertness and restful sleep. Most people
can eat this way for the rest of their life and be quite well, and,
most people will want to diversify their diet after having lost
excess fat. Broadening the diet to include fruits and grains can
be accomplished with out regaining fat. This transition has to be
done thoughtfully and with close attention to the impact of certain
foods. Some people will not be able to eat certain foods, ever,
without negative consequences, because of our genetic make up. All
of us have to reintroduce foods carefully and maintain exercise
levels life long, in order not to regain lost fat.
A ketogenic fat loss diet is not appropriate for pregnancy and breastfeeding,
a time when fat stores are very important to mother and baby’s
well being. People with kidney damage should not use this diet.
People with diabetes, epilepsy, and gall bladder problems need special
care and support to use a ketogenic diet successfully. Women lose
weight somewhat slower than men; feminine hormones effect how women
hold onto water and fat. Men in general have greater muscle mass,
even when quite fat, and this plus masculine hormones help them
burn fat somewhat more effectively than women. Regular exercise
is absolutely necessary for everyone’s long term health.
How we transition from fat loss to long term healthy diet determines
our success.
Whenever we let go of stored energy by reducing our caloric intake,
primitive protective mechanisms kick in. Our basic metabolic rate
starts to slow down to protect us from what our ancient brain thinks
is a famine. For the original humans, an unreliable food supply
made this mechanism essential for survival. For those of us whose
caloric restriction is a matter of choice, and whose work and family
demands are usually complex and can make an exercise routine hard
to establish, there has been a well established pattern of steady
weight gain, or yo-yo bouncing up and down with weight loss efforts
almost inevitably followed by regain.
Some people do not regain however and recent research has examined
what is different about them. In a nutshell, what these folks do
differently is to be acutely aware of small amounts regained, and
they return to their weight loss behaviors for brief periods of
time to correct the small regains. Eventually, as long as they maintain
essentially healthy habits, including their food choices and exercise
levels, the episodes of regain stop and they stabilize at their
new weight.
This means there is one way we need to eat to lose fat, and then
another, more generous and complex way we can eat once our goal
is attained. The nature of the transition between these two ways
of eating is essential to long term success. The ability to lose
weight, change the diet to a less stringent, more varied one and
return as often as needed to the weight loss regime for brief periods
until stabilized, is apparently a rare ability. Most people do not
seem to discover this behavior spontaneously. Thus long term guiding
support seems crucial. In fact a number of studies with weight loss
for people with Diabetes Type 2 have clarified that knowledgeable
support that helps people remember not only the basic straightforward
steps of the diet cha-cha, but also helps with the different stresses
that are triggered during the long term effort, is crucial.
We have many behaviors and beliefs that affect our sense of self
and our ability to pursue loving self discipline over a long term.
It is clear that ongoing and specific support, in the form of an
individual counseling relationship or a similar support group experience,
makes success much more likely. We encourage you to use both the
weight loss and maintenance aspects of the program described here,
and to make it all the more likely to be useful to you by adding
in regular exercise as well as regular contact with a knowledgeable
and skilled support system.
Nan Dunne, ND rev 2007 |
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