What We Know About Losing Fat and Keeping It Off
Nancy Dunne, ND
How we eat to lose weight is different from a healthy life long diet.
Friday, October 5, 2012
by: Nancy Dunne, ND

Section: Weight Loss

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Dr. Nancy Dunne

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Specifics for successful transitioning from a fat loss diet to a healthy life long diet include a metabolic readjustment period and educational and psychological support that works with our habits of thought and feelings around food, eating and exercise behaviors.

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 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 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 body can use ketones for fuel instead of glucose. 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. 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.

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 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.

90% of people who lose weight do not keep it off, because they do not have the necessary long term support.

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 diet is not appropriate for pregnancy and breastfeeding. 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. 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 

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 to a less stringent, more varied diet 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. A number of studies on 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. This technical, educational and emotional support is crucial lifelong health. 
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