23: Long-Term Stalls & Weight Gain Even On A Well-Formulated Low-Carb Diet | Dr. Stephen Phinney

We’ve all run into those times during our healthy low-carb lifestyle when the weight loss just doesn’t want to cooperate with us despite doing everything the same as we always have when weight loss has happened before. You might be asking yourself what the heck is going on and what am I doing wrong? Has anybody ever felt that way before? Are you even living this in your own life RIGHT NOW? This week’s expert guest is here to help you circumnavigate through what might be happening to help you get on the right track again. He is low-carbohydrate diet researcher Dr. Stephen Phinney, the co-author of the 2010 New York Times bestselling book  in 2011 and  in 2012.

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Here are some of the questions we addressed in this podcast:
ELISABETH FROM SWEDEN ASKS:Hi Dr. Phinney, I live in Sweden and I follow the LCHF diet (low-carb high-fat). I’m a 5’10″ tall female and weigh 195 pounds. I am hypothyroid and am taking 25 mg Levaxin. For exercise, I perform high intensity training (boxing), workout at the gym, and running about 10-12 hours/week. I’d like to lose another 25 pounds so I can perform better at my sports activities, but I’ve always had a really hard time losing weight even on 1000 calories/day. My current macronutrient ratios have been about 80% fat, 16-20% protein and 1-4% carbs–in other words very ketogenic. In the beginning I felt very good because all my cravings went away and I felt good mentally.
After being faithfully ketogenic for the past five months I have:
a. Gained 18 pounds while consuming 2000-2500 calories a dayb. My TSH level increased 50%c. I lack energy, am fatigued and experience an elevated heart rate during workoutsd. I’m having difficulty falling asleep
If this really the optimal diet for everyone? Whenever I consume some carbohydrates one hour before my workouts my performance seems to get better. Maybe I should be eating more carbs and slightly less fat but I know I’ll be starving doing that. I just want to be at a healthy weight and feel good during my workouts. Any advice?
JIMMY ASKS:I’ve been off and on low-carb diets for many years and keep trying to lose my gut. But whenever I return to low-carb again I tend to lose weight quickly in about month which is great. But after about another month or so I tend to return to my old eating patterns and put on even more weight–and so the cycle continues. When I first started low-carbing I was about 40 years old and now I’m 62 and 224 pounds on my 5’10″ body. Do you think I should start from scratch with two weeks of a well-formulated low-carb ketogenic diet? But then what?
JOSH ASKS:Have you seen any successful methods for women wanting to lose weight in their abdomen after multiple pregnancies? Is a temporary or permanent change in their diet and exercise routine necessary to return to a normal weight again?
CAROL ASKS:I’m a 5′ tall, 60-year old woman and in the past two years I have lost 50 pounds–25 on Weight Watchers and when that stopped working, Atkins for the last 25 pounds. I still have about 15-20 pounds to reach my goal and I’ve been hovering at around 134 pounds for the past six months. I can’t seem to get past this point. I’ve tried the Atkins Fat Fast, counting total carbohydrates, avoiding sugar alcohols, gave up wine and even limited calories to 1200 daily–all to no avail. To say I’m frustrated is an understatement. Would going even lower than 25g carbs a day be worth trying?
MATT ASKS:I have been eating Paleo/low-carb for about 2 years after I found CrossFit. About eight months into my new way of eating, my CrossFit coaches encouraged me to reintroduce 16 ounces of milk and sweet potatoes post-workout. That was the end of my weight loss. My average daily intake consists of about 60-80g fat, less than 100g carb and 150g protein a day. I am very consistent with my meals. Breakfast is either eggs and a fruit or a protein drink with almond milk, lunch most of the time is a chicken breast and spinach, dinner is a meat and veggie. I do not use any form of sugar or substitutes and I get an average of 8 hours of sleep a night. Any thoughts?
ELLEN ASKS:My question pertains to tweaking the low-carb diet to work for a complete and total screwed up enigma…me! I’m a 44-year old woman in good overall health and taking no medications. I have struggled with my weight all my life and have seen success following the Richard Simmons Deal-A-Meal and Weight Watchers plans in the past. At the age of 35, I decided to become an amateur bodybuilder over a four-year period that had me on a calorie-restricted, high-protein, low-carb, zero fat diet. My coach put me on fat burners, diuretics and low-dose anabolic drugs for short periods of time. This was the biggest mistake of my life! I actually started gaining weight despite keeping calories very low and exercising excessively. I finally wised up and quit this insanity but now I’m 195 pounds on my 5’6″ body. I’m fairly muscular because of my weight training, but no amount of dieting helps me lose weight. I’ve tried raising calories, lowering calories, carb cycling, ketogenic…you name it. I am currently on a low-carb Paleo plan and I’ve also played around with various types and intensities of exercise. I feel generally well with good energy levels. But I’m afraid I’ve messed up my body forever. I refuse to give up, but I desperately need your help!
BARB ASKS:I understand that the body can and will make its own glucose if necessary. Is it correct to assume that the body will only make as much glucose as it needs or will it make an excessive amount of glucose if too much protein is consumed? Or will it only make as much glucose as is needed and convert the rest of the excess protein into fat? I have been told by my personal trainer that our bodies have a difficult time converting protein to fat. Is that true?
LAURA ASKS:I am a 33 year-old female with Type 1 diabetes and Hashimoto’s with normal thyroid panels. For the past two years I have followed a very low-carb diet as per Dr. Richard Bernstein’s recommendations in his book Diabetes Solution. My days my carb intakes stays at 30g or less and I believe my diet is ketogenic because I’m not eating more than moderate levels of protein. But in two years of low-carb eating, my weight has not changed at all and my body composition has not seemed to change either. I follow this way of eating due to the excellent diabetes control that it provides me. But I am surprised and a little bit frustrated that I have not lost any weight. I am not excessively overweight by any means but could afford to probably lose 10 pounds or so to be at a healthier weight. I recognize that body composition is a better way of measuring a healthy weight, but something’s gotta give. I walk quite a bit every single day as I live in a city but I have found it hard to find a routine that doesn’t adversely affect the stability of my blood sugar levels. I eat to satiety with a variety of low-carb vegetables, fattier cuts of meat, eggs, etc. What might the culprit in my weight loss struggles be? Is it due to excessive calories because of my high dietary fat intake? I have never lost a single pound following a low-carb diet.
MIRIAM ASKS:What other approaches would you suggest for obese people who do not seem to lose any weight despite keeping calories low along with their high-fat, moderate protein, low-carb diet with regular exercise? What other biological factors besides insulin resistance can prevent weight loss from happening?
SHIRLEY ASKS:Is it better to split up your protein intake on a low-carb over several meals throughout the day to prevent gluconeogenesis from creating too much glucose in the body that could stall weight loss?
EJA ASKS:I eat a handful each of almonds, walnuts, cashew nuts, flax seeds and Brazil nuts everyday. I’m trying to lose about 10 pounds and I eat a super-clean Paleo diet with zero processed food or anything with a label. Just protein, vegetables, fruit, nuts and seeds. But although I eat clean, my weight loss is completely stalled. Do you think I should totally give up the nuts and fruit as I’m sure I’m eating way too many calories and carbs a day from them. Is there anything in nuts and fruit that I really need that I can’t get elsewhere in my diet?
ANNE ASKS:My husband and I have been on low-carb for the past six weeks, but we’re not seeing any good results so far. I have lost 160 pounds with Weight Watchers in the past, but I gained 70 pounds back putting me at 220 pounds for a 5’5″ tall, 55-year old woman. My husband is currently 200 pounds at 5’8″ tall and 59 years old. We both are consuming 20g carbohydrates or less daily, so I’m thinking calories must be too high although I certainly don’t feel like I’m overeating. Is there a range of calories we should be striving for?
BARBRA ASKS:I’m a 50-year old woman (5’8” and 215 pounds) who has been on the low-carb lifestyle for over a decade. I started gaining weight in 2007 and put on 65 pounds by 2011 even on a very low-carb diet. I was recently diagnosed with T2 diabetes and started Metformin twice a day. I read a study last year that stated eating a 600 calorie low-carb diet could reverse diabetes, so I came up with a modified version of it for me that amounted to consuming 800 calories/day before returning to my 1400-1800 calorie low-carb plan again. I lost 31 pounds over a 10-week period and my blood sugars returned to normal for about 3 weeks after doing this. But then my weight started creeping up again and I’ve since gained back half of the weight I had lost. When I was on the 800-calorie diet, I noticed I had to keep my protein under 60 grams a day, so I’m wondering if it’s not just the carbs, but also the protein that is causing the problems for me. I’d like to think I can live on more than 800 calories a day for the rest of my life, so any solution you might have for me would be appreciated.
FORTUNE ASKS:I have a question that pertains to the ladies. I seem to stall out two weeks a month due to hormones and then lose weight for only two weeks. This is quite frustrating! What can I do to kick my ketone levels up higher so I can lose weight more steadily even through my menstrual cycle? Or is it natural for women to get kicked out of ketosis during this time that will obviously stall their weight loss progress?
LJ ASKS:If you’re eating a well-formulated low-carb diet where carbohydrates are less than 20g, protein is 85g or less and fat consists of at least 65% of calories, how is it possible to experience voracious hunger? I’ve been stalled out eating this way for nearly a year and perhaps I’m eating way too many calories. I’ve tried increasing or decreasing each of the three macronutrients at different times for at least two weeks at a time to see what works. For me, increasing protein seems to work best but it is temporary in keeping my hunger under control. Nothing seems to help for more than a week or two before the hunger bug comes on with a vengeance. This hunger is overwhelming unless I eat a LOT of food–upwards of 2500-3000 calories per day with at least 130g coming from protein. But this level of eating prevents me from losing weight. Calorie restriction means unbearable hunger for me and that’s absolutely unsustainable. The ketogenic recipe for blunting hunger and natural calorie control doesn’t seem to work for me. I know I’m not alone in this. What do you suggest for people like me?
JOSH ASKS:Do higher levels of ketosis mean you will experience more rapid weight loss? I’ve been measuring my blood ketones and wondered if readings over 2.0 millimolar meant that I was in the ideal range for optimal fat loss.
CATHY ASKS:I am a postmenopausal woman who lost 55 pounds in one year on the Atkins diet. I still have another 50 pounds to lose as I am still classified as obese. Unfortunately, I’ve been in a holding pattern for nearly two years despite attempting several strategies including the leptin reset, intermittent fasting, the Atkins fat fast, calorie cycling and most recently decreasing protein and upping my dietary fat intake. I walk everyday for exercise and I’ve actually regained about six pounds in the past 6 months. It’s obvious I’m still producing too much insulin in my body. What can I do to get better control of this besides a high-fat, adequate protein, low-carb nutritional approach. I think I may have morphed into a Zucker rat.
AMBERLY ASKS:I have heard from people in the Paleo community that a very low-carb diet can possibly interfere with thyroid function and/or stress the adrenals which may be a culprit in preventing weight loss from happening. Are you aware of any scientific evidence that supports or refutes this claim?
AVIV ASKS:I’m a competitive bike racer and putting on a few extra pounds led me start on a low-carb Paleo diet. I made the mistake of eating a lot of the “safe starches” with my high-fat intake and quickly gained 15-20 pounds. Needless to say, I stopped racing and started examining nutrition more closely. Through the work of Dr. Peter Attia, I found your books and immediately started following a ketogenic diet. But I’ve been having trouble getting into ketosis over the past 3-4 months and I find it hard to understand why I’m gaining weight or not losing on such a well-formulated low-carb diet. Maybe my body needs more time to adapt to this way of eating, but it looks like it will preferentially store fat from the diet rather than burn it. Despite this, I do believe becoming keto-adapted is the natural way for humans to live. Should I just hang in there eating this way to give my body more time to adjust and let the weight come down eventually? And what about using intermittent fasting to help kickstart the weight loss? It seems to be quite easy and natural to do when you eat a ketogenic diet.
CHRISTI ASKS:Have you seen any correlation between high blood ketone levels, normal blood sugar levels and weight loss? Also, what amount of protein is considered too little? What signs or symptoms should you look for? Finally, is it possible to eat too much dietary fat while on a ketogenic low-carb diet? Thanks for answering my questions!
SUZANNE ASKS:I am a relatively new convert to low-carb after having spent the last 25 years of my life as a low-fat, high-carb eating running machine. I converted to a low-carb diet 8 months ago because I’m a 52-year old woman who has seen my weight “creep up” slowly but surely mostly in my thighs and buttocks with the same amount of exercise in recent years. I am convinced I am one of those people who has a love/hate relationship with carbs and I cannot believe how much better I feel following a low-carb lifestyle. My question is this: how much do you think peri-menopause and the hormonal changes that go with that play a part in fat gain? Everything I’ve heard says the LAST thing a woman at this stage in her life should do is diet since the fat cells are genetically programmed to hang on to their fat in order to manufacture more estrogen to replace that which is not coming from the ovaries anymore. Am I on the right track in following the low-carb lifestyle in order to lose the 10 extra pounds I have put on?
WOODROW ASKS:Hey Dr. Phinney, I’ve read both of your “Art And Science” books and many others and I would love some clarification on how easy it is to lose keto-adaption and switch from fat burning to sugar burning. If you have a cheat day or a higher carb meal such as a pizza and a couple of beers for example weekly, will that take you out of keto-adaption and cause you to start over for 2-4 weeks every time you do it? How perfect do you need to be with carb intake to stay keto-adapted?
DANA ASKS:Does the body tend to want to be a certain weight? I am 24-year old female and slightly overweight. Even though I have lost a significant amount of weight before, I always seem to return to the initial weight that I started out with. I have been eating Paleo and low-carb between 50-100g daily but have not been ketogenic. Is it possible to reprogram the body to be comfortable at a new weight and make it stop trying to gain back the pounds?
NANCY ASKS:I’m a 5’8″ tall, 54-year old, 172-pound menopausal woman and a long-term failure at low-carb dieting. I have been doing some form of low-carb diet plan for more than seven years and I’m completely stalled at a good 20-30 pounds above my goal. The only way I’ve been able to lose weight was doing the hCG protocol, but I couldn’t maintain the loss even on strict low-carb. I have no functioning thyroid and take 1.5 grains of Armour thyroid. My hypothyroid is under control and my labs look good. My current eating plan has been to maintain nutritional ketosis for five days and then two days of semi-fasting low-carbing a week down to 500 calories. I’d been doing a rotation of calorie up days with those semi-fasting days as well, but even that hasn’t led to weight loss beyond a couple of pounds. This seems to be a frequent issue for older woman on the low-carb forum I visit, so any advice will be shared with others in my situation. Calories on my eating days fall around 1800-2000. Protein ranges from 70-100g. Net carbs after subtracting fiber are usually around 20-30g.
CATHY ASKS:I’m a 5’7″ tall, 49-year old woman who currently weighs 194 pounds. I’ve had low iron levels for 12 years and was recently diagnosed with iron deficient anemia. I’ve been on a low-carb diet for 1 1/2 years and haven’t lost more than a few pounds during that time. I’m pretty strict as far as my low-carb diet goes. We raise our own grass-finished cows, chickens and I eat tons of butter and other sources of fat. Do you think my iron problems have anything to do with my problem losing weight?
JOLYN ASKS:I’m a 350-pound, 63-year old female with Type 2 diabetes taking insulin once a day. Low-carb dieting alone doesn’t work for me anymore. As long as I stay very low-carb, I can maintain my weight but I don’t lose. Lately I’ve been examining the idea of a high-fat, low-carb plan. But I’ve also been hearing about Dr. Jack Kruse’s Leptin Reset plan in which you start out each day with a breakfast of 50 to 75 grams of protein within a half-hour of waking. I have thought about perhaps starting with his plan and then after six weeks transition to high-fat, low-carb. What added benefits would I get from just going on your high-fat, moderate protein, low-carb approach compared to this other plan?
KAREN ASKS:Is it possible that after being on a low-carb lifestyle for several years that your body can become resistant to weight loss? I’m consistently in ketosis according to the urine test sticks but I only experience very, very moderate weight loss. When I followed this lifestyle several years ago, I lost 30 pounds. But it has slowly come back on my body. I read your book The Art and Science of Low Carbohydrate Performance and increased my fat intake to 80% of calories, protein 11%/carbohydrates 8%. But so far I’ve only seen very modest weight loss. I’m concerned that I’m eating too much fat for my body to burn its own fat stores. I am very discouraged and wish I could just find a doctor who could help me. But I don’t know of any local physicians that would encourage a low-carb lifestyle. Does your body become resistant after awhile making it necessary to reduce dietary fat intake in order to see fat loss happen?
SANDRA ASKS:Do you have any suggestions for women in the midst of hot flash season during menopause with rebooting weight loss? I have plateaued many times with the last one being five weeks long. I have been trying to lose 80 pounds since February 2012 and have only lost a little over 25 pounds so far.
JILL ASKS:I’m a 53-year-old menopausal women who has recently found that eating low-carb is not working as well for me as it previously has. It started earlier this summer when I noticed that although my weight has been remaining fairly stable, I am actually adding body fat around my belly and back. I’ve been lucky my whole life to have been thin and active but noticed as I got in my upper 40s that I was putting on weight. Several years ago, I tried the South Beach diet after a friend had success on Atkins (I was too afraid of eating that much fat to try it). I lost 16 pounds on South Beach and was able to keep it off for a while. Then I read books by Gary Taubes and changed my eating to more of what he suggested. I am now eating the cleanest diet I’ve ever consumed in my life but my body is not responding the way it used to. Is this just the way it is when you get older?

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