Tuesday, October 2, 2012

Fat Burning, Sugar Burning: An Expert's Thoughts

The other day I wrote to someone I highly respect, Dr. Barbara Berkeley, MD, author of an excellent weight maintenance blog (Refuse to Regain) and a book of the same title: Refuse to Regain!: 12 Tough Rules to Maintain the Body You've Earned! Barbara is a doctor who has specialized in the care of overweight and obese patients for more than 20 years. The email conversation we had was interesting and enlightening, especially given the struggles I have had to get weight off lately. I've been trying to cut my carb intake to 100g/day or less, but wondered if this was a wise choice given the success I had with Medifast on that carb level but the quick regain when I reintroduced carbs to my diet. With her permission, here is part of our exchange.

Barbara,
I have been reading a bit about reducing carbs significantly for weight loss. I wondered if you think that being in some state of ketosis (deep or mild) is important for efficient weight loss. Also, once one is in maintenance, do you think that changes? I ask because although I have lost and kept off 60+ pounds over the past five years, at one point I was down over 100 pounds and I have regained back 40ish. I was on Medifast in a state of "mild ketosis" at 900-1000 calories and 80-90 g carbs/day to lose that last 40. When I stopped Medifast and began to eat more carbs, the weight came back very fast. I have been trying to re-lose without being in ketosis, but wonder if you think that state would be better in the long term. I just worry about any health effects of being in ketosis long term, such as being unable to keep the weight off while eating a reasonable amount of food at maintenance. Any guidance would be appreciated!
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Her response:

It's not necessary to be "in ketosis" in order to either lose weight or maintain it. I don't advocate the use of ketosticks or any other method of monitoring ketones. Our patients lose large amounts of weight without showing ketones in the urine, so don't worry about this measure.

I think a better way to look at this is to say that you want to remain in a state of "keto adaptation". This is a term coined by researcher Stephen Phinney and what it means is that you want to keep your body in a state that preferentially burns fat over sugar. In order to do this, you have to keep carb consumption very low permanently. The key phrase in your email is: when I 'began to eat more carbs, the weight came back very fast'. This is what I see over and over again.

Your body is like a hybrid car that can run on one of two fuels. Sugar or fat. In America, we all run on sugar. Running on sugar produces insulin and insulin both promotes fat storage and prevents fat breakdown. Thus, once you start with carbs again, you will store fat and not be able to lose it. I also think that people who have been heavy in the past have a broken insulin system. They are exquisitely sensitive to carb consumption and it quickly boosts insulin levels in a way it might not with NOW (never overweight) people.

My advice would be to go back onto medifast to knock off some weight. After you've done that, I would meticulously document your critical carb level. This is a term Atkins used and I like it. For me, my CCL is about 100 grams/day. Any more than that and I will gain. It might be different for you. I would experiment with adding back only the carbs you REALLY need and see where you stabilize. Remember that grains, even whole ones, are carbs. Don't fall prey to them.

I'm currently reading The Art and Science of Low Carbohydrate Living by Phinney and Jeff Volek. I recommend it as something you might want to look at.
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In the exchange that followed, I asked Barbara another question:
In maintenance, do you think you (personally) are still in a state of burning fat over sugar? And if so do you need to eat a higher percentage of healthy fats for fuel, rather than increasing carbs?
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She replied:
The answer for me is that I eat fats but try to keep them modest because of the calories.  If you eat extremely minimal carbs, fats are fine.  I try to choose healthy fats, meaning the fats from fish and animal products that are well-raised (without grain) if possible... Remember that if you are basically a fat burner, your body always has access to about 40,000 calories available in energy (that's what is in your fat stores)!  You only need about 2000 a day to run everything!!   There is no need to increase calories to get fuel.  The problem is that the body cannot get into that fat bank when you are making a lot of insulin.  Instead, the body uses your sugar bank, which is only capable of storing about 1200 or so calories.  If you're running on sugar, when that 1200 gets low, you are in your pantry looking for carbs.  Cut the insulin and you will have more than enough to "eat". 
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I think she is right. I believe the key to getting this weight back off AND keeping it off has everything to do with the level of carbs I ingest. I know this is not the answer for everyone. Lots of folks eat plenty of whole grains and fruits and stay a healthy weight. But I think my years of binge eating sugary, carby junk really did mess up my insulin response. I believe it is essential for *me* to get under, and stay under, the critical carb level mentioned. How to do that... well, that's another post.



30 comments:

noceleryplease said...

I tend not to comment here because you have everyone and your cousin giving you advice already... But I will say - what she outlines and what you are talking about is what works for me now.

I have maintained a 110 pound loss for 10 years, and, lately, an additional 50 pound loss... (160 total gone over time).

Eating carbs and counting calories - yes - I maintained... but painful, painful. Always thinking about food - when I can next eat - how much can I have - what's my allotment? Years, I spent doing this.

Then, this year, I discovered low carb / primal.

I eat low carb. Probably about 70 to 100 a day (used to be around 250 - 300).

I am not longer CONSTANTLY hungry. I enjoy the food I eat. I lost an additional 10 pounds. (not even trying).

So the thing you just described - yeah - makes total sense to me... because that's what works for me.

Other people maybe not... everyone is different.

Taryl said...

I think Barbara is a very astute woman, especially given the desert of knowledge regarding nutrition in the medical field, in general. She gave you sound advice (of course I'd agree with it, though, as it is what I support, myself :) ).

Tiffany Campiotti said...

Thank you for sharing this! I love her answers.

sdani50 said...

This is great information, Lyn. Thanks for sharing. I started MF on August 28th and am down 15 pounds, thanks in part to you and your blog. Your MF recipies saved my life!~

Anonymous said...

Check out the Ideal Protein diet. Similar to Medifast, but the carbs are usually around <40 per day. I've gotten good results so far - 33 pounds in 10 weeks. The cravings for carbs are gone. I've yo-yo dieted my whole life, but it was so much harder losing anything once I hit 40. I'm now 50 and think I've finally found that the answer to my losing the weight is low-carb and low-fat. It's hard but seeing the results each week is totally worth it.

Anonymous said...

Have you ever thought of getting metabolic testing done so you know exactly how many calories you need? I know some gym's offer this.

i should be full said...

Thank you so much for posting this! It answered questions I've had for years about my own experience and observations about my own body.

She is describing me and my weight loss - regain - weight loss - regain yoyoing from my whole life!

I'm about to email this link to my husband so he can understand what I've been trying to tell him about myself for years.

I haven't shared with anyone the details of my own food plan because I haven't wanted anyone to think I am trying to tell them what to do. But after a 92 pound weight loss followed by a 45 pound regain, the only thing that has gotten me back to where I want to be is something called The Dukan Diet (you can find the book anywhere now). It was designed by a French doctor. It is all about eliminating sugars (not only refined) and sticking with low-fat protein.

I only mention it because it's the ONLY thing that has helped me in the past 5 years and it feels like a God-send. Maybe it will help you too.

Good luck, and thank you for sharing this.

debby said...

I can hardly believe that she recommended you go back on Medifast...

Someone else gave me this link. A really fair-minded discussion about low-carb eating (from a low-carb woman!) Its long, but so worth listening to. And I don't even do low carb myself!

http://www.askthelowcarbexperts.com/2012/09/27-jenny-ruhl-overcoming-the-problems-with-a-low-carb-diet/

Anonymous said...

have you read jimmy moore's n=1 experiment? he recommends the same book she does and monitors his blood ketones, i think...i'm not an expert, but whatever he's doing is working - it's just like what she said - http://livinlavidalowcarb.com/blog/jimmy-moores-n1-experiments-nutritional-ketosis-day-91-120/15560

Taryl said...

I thought of you when I read this - one of my favorite science-y blogs, Suppversity, breaks down studies and what they do or don't mean. Web it comes to high vs. low fat, I thought the comparisons here were interesting, especially regarding metabolic syndrome:

http://suppversity.blogspot.com/2012/10/fat-advantage-61-lower-rates-of.html

Cheers!

Anonymous said...

Thanks for sharing that, Lyn. Very interesting!

I've been wanting to comment on your belief that you can't sustain the amount of exercise you are doing on 1,200 calories a day, and it ties in to what Dr. Berkely said in her e-mail. I believe you can. I actually do most of my workouts in a fasted state (2-3 hour workouts sometimes, burning 2-3,000 calories). You would be surprised what you can do on an empty stomach.

Once your body is adapted to burning fat rather than carbohydrate for fuel, your workout isn't limited by what you eat beforehand. As Dr. Berkely pointed out, you basically have an unlimited amount of fuel stored on your body. It is still important to eat/drink some protein within 30 minutes or so afterward however, especially after a weight session.

As an aside, I saw a piece on the Dukan diet on Nightline. Even Dr. Dukan only recommends his diet be used for a short period (it is very restrictive and can be hard on the liver) so I don't believe this is a long term solution for you, Lyn.

I'm glad you are still searching for answers and not giving up!

Take care,
Rebecca

Anonymous said...

Lyn,

Thank you for posting this. I think for ME her description is spot on. I don't believe you have to go back on Medifast to achieve the nutritional breakdown she suggests... you can accomplish that with whole foods (although Medifast is great for simplicity).

One of the important things I noticed from Dr. Bernstein's Diabetes Solution as well as your own stint with Medifast is that any meal/snack is never more than ~15 carbs max. If you go over that number, you get too much of an insulin spike (which later results in the inability to access fat stores on the body and cravings for more carbs).

I have now been low carb (under 50, usually 35 gross Carbs per day) for about 6 weeks now, and it took 4 weeks before I started to function better on the low carb diet. (I suffered from headaches, lethargy, brain fog for about 4 weeks!) I expected this going into it, but was still surprised at the severity of it.

Interestingly, today my husband and I went to Golden Corral and I ate only low carb items (salad, broccoli, brussel sprouts, green beans & meat), but ate way to many (I figure I ate ~30-40 carbs in that meal). I had cravings for the first time in weeks about 1 hour and 15 minutes after eating! I couldn't believe that I still felt full, but had the urge to go rummage around in the refrigerator. I had definitely exceeded my per meal carb limit for containing my insulin levels.

Anyway, the only thing to point out, is that you will have to look deep within yourself and figure out if you are willing to commit to a low-carb life long-term. Because you will most likely immediately regain if you lose with that method of eating and then go back to eating a normal amount of carbs, despite strict calorie counting.

I am OK with it myself finally... but it took years to get here.

Heidi

Anonymous said...

To anonymous who posted about Jimmy Moore: Is his n=1 experiment really working? Have you seen how much weight he's put back on recently? I'd say it's absolutely not working.

LHA said...

This is so interesting! Thank you, Lyn, for posting your conversation and also to those who have posted. I have found also that I have to keep my carbs low in order to lose or even to maintain. My psychological problem was that after losing a lot of weight on a fairly low carb diet I couldn't control myself when I ate something with very many carbs (either not knowing it contained sugar like at a party or buffet, or as a special occasion food) and weight gain ensued. I still control my carbs closely but am not so strict that I psychologically feel deprived. It has been a hard road and many years of up and down to come to this place that feels right to me. All of the information you gave went right along with my own experiences and explained a lot. Thanks!

Anonymous said...

I can get my cravings perked up even with too much beef. I just replaced my dairy with veggies (low carb) and am doing much better. About to try Jimmy Moores supplement glyco-whats-it instead of metformin first , then move on to the drug if that doesnt work. Id guess ole JM and I have livers that convert protein to glucose at about 3 x s the normal rate. Self awareness is a must! JM just had the lowest ac1 test the doctor had ever seen. Just read his 90 day update , he's doing amazing!

Margaret said...

My experience after trying to go back on a MF type plan was that it didn't work a second time - and I was absolutely perfectly on program for six weeks. Didn't lose a single pound. It was a heart breaker.

Karen said...

Ack! I posted my comment on the wrong thread.

Anyhoo- check out my blog. I successfully transitioned from Medifast to Maintenance using the Refuse to Regain book.

I blog all about it over at
http://gardengirlkp.blogspot.com/

Read the archives. I've never felt better and I've maintained a 72 pound loss for 8 months.

It is a lot of work, but so worth it, so sustainable. And healthy. I have the lab work to prove it.

Karen P

timothy said...

fabulous so i'm on the right track with what i do and what i advised you to do! i kinda KNEW i could never go back and people freak when you dont eat carbs, i liked her insight! great post!

Anonymous said...

I know you're starting chromium supplements, but I would also research manganese, another trace mineral, and alpha lipoic acid. I have also messed up my system with years of binge eating, and found the above two supplements more effective than chromium. Manganese helps regulate insulin production, and ALA helps regulate your cells' sensitivity to glucose (so that your body can use it rather than storing it). I've found that taking these two with breakfast sets me up for a good day-- better energy, much less carb craving and hunger.

h2oratt said...

Thanks for sharing her response
I am on medifast now
I realize as I go into transition I will need to to be vigilant about adding back carbs

Taryl said...

Careful on the manganese! Magnesium is excellent and can be supplemented in fair quantities, but manganese quickly reaches toxicity and can cause nerve damage and permanently alter brain chemistry, in bad cases. The problem being that the individual theshold for supplemented manganese can be quite varied, and the effects quickly negative. That is one of the minerals best had from food sources, alone, unless you are tested and showing a clinical deficit.

Do your reading as always, Lyn :)

Anonymous said...

I've had good results with these 100 carbs daily: 1/3 two slices flourless bread at breakfast, 1/3 nightly yogurt and the other 1/3 fruit/veg. It seems to be low enough to aid weightloss but high enough to be sustainable.
Mary

CatherineMarie said...

Lyn, this scares me. Please give what you are doing ONE more month. Please do not go back on Medifast. You messed up your system with yo-yo dieting and Medifast.

And you need to be able to eat healthy meals in moderation, and be able to have fruit without worrying that you are going to put on 20 lbs.

A "Low-carb" doctor, who advocates low carb is, OF COURSE, going to suggest you eat low carb.

Please, please, please just stick with your current calorie level and exercise level.

Maybe get some "goal pants" or something that is not a scale to measure your weight loss for the next month. (that is the motivational tool that works for me, a pair of pants one size smaller than what you normally wear...because then you have one thing that fits)

16 blessings'mom said...

I am so thankful for reading this, I could cry! Thank you for sharing, Lyn! I have been finding out for myself that whenever I eat like "normal" people eat, I gain a few pounds immediately. It didn't make any sense, but the scale proves it time and time again. I know I have to lower my carbs to lose more weight, and that it will have to be like that for me always unless I want to gain it all back. BTW, I have lost almost 70 pounds in a year and a half, and have at least 50 more to go. The past few months have been frustrating for me, as I maintain, going up a few and down a few, but working so hard and just wanting to lose more.. I love reading your blog, and have been really rooting for you. Your perseverance has been a great help to me! Thank you again for this enlightening correspondence! Keep up the good work, and keep sharing!!!!

Della

Margaret said...

Maybe, exercise is compatible with maintenance, but not losing.

Siobhan said...

Thanks for the information, Lyn. I also found it interesting what somebody else said about no more than 15 carbs per snack/meal. That makes sense in terms of insulin release. I know for myself when I eliminate the high-GI foods, processed or unprocessed, I feel better and am not constantly thinking about my next meal.

Anonymous said...

Have you weighed since Sunday? I'm just curious if the two pound gain was just a temporary fluctuation or "real" weight.

Also, I noticed you haven't posted your stats for the last couple of days. Are you still counting calories?

Lyn said...

Anonymous~

I have not weighed, but am still counting calories. I am sooo busy... I just got home from school and the gym, ate, checked email and have to run back out to take lunch to one of my kids. Hopefully will have time to post later!

Janel said...

I don't chime in a lot because you have plenty of people doing that. But I do follow your blog regularly. I am an avid advocate of doing what works for YOU! So many people spew advice based on what they think to be true. I personally have to keep a low carb level to lose and maintain. Additionally, I feel better, keep a lower blood pressure and have more energy when I eat low carb. The moment I go back to eating carbs...I'm talking oatmeal, some fruits, and the supposed healthy whole grains my cravings return as well as the weight:( I spent so many years over weight I know that my metabolism and insulin response is screwed, lol! I finally embraced the low carb lifestyle (key word, lifestyle) and have managed to maintain a 107lb loss. I still need to lose around 15lbs or so, but that will come in time. I like peanut butter and cream cheese a little too much:) Bottom line, find what works for YOU and do that! I would however, recommend regular low carb vs medifast. I will always support REAL foods over fake meals full of chemicals:)

Anonymous said...

Low carb is the only thing that works for me to lose weight and cut cravings. I found that eating fruit is one of the worst things for my weight. We don't need fruit - we can get all the vitamins we need in our veggies. But of course fruit is sweet so I adore it.
Also interesting comments about Jimmy Moore. I have stopped reading his blog this past year or so because I heard he regained the weight. Or at least some of it. And I haven't seen any recent pics of him. By recent I mean in the last two years or so! So I don't know if he really is struggling with yo-yoing or if he simply gained a lot of weight back. I figured if he gained he should be completely open about it - all dieters have experienced this at some point and it's nothing to be ashamed of.