In her weekly column, Bradford West Gwillimbury licensed nutritionist Nonie De Long looks at why keto might not be working anymore and why stress can impede your diet
I have been on keto for a long time now but it seems to me it doesn’t work for me anymore. I’m doing this Medi Weightloss which only allows you 500 to 900 protein calories a day and I’m very active. Seriously I’m very active. I don’t think how active I am. Before COVID I did cycling, MMA and pilates. During COVID, I work in healthcare so I was pulled on the floor and worked hard until things settled down. Went back to pilates, started swimming, and going back to MMA.
I have listened to Jillian Michaels that you shouldn’t cut out a macronutrient after all its low in fiber.
I’m so confused 🤷♀️.
Dear So Confused,
Your question is a bit tricky to answer because you’ve given me only pieces of information. I don’t know your age or body composition, nor how long you’ve been using this weight loss program or how much you’ve lost over what time. And I don’t know much about the program you’ve chosen. I also don’t know any underlying health conditions, nor medications. But I will address a few things related to plateauing in keto, weight loss overall, and my thoughts on injectable vitamins – which are used in this particular program.
I have concerns about injecting vitamins. Yes, it bypasses the digestive system so if there are problems with digestion and absorption you get around that. In the short term this may help with energy when starting a diet. But looking at creating health for life I think it’s important to address digestion and absorption issues as part of a responsible nutrition program.
We need to remember that nutrition is not about weight loss. A healthy body weight is a side effect of good nutrition. We mistakenly think skinny is synonymous with healthy. But it’s not. There are very skinny people who are very unhealthy. However, being overweight is never optimal for your health. But the goal of nutrition is a healthy body and mind. Having a healthy body weight is simply a side benefit of that!
Back to issues of digestion and absorption of nutrients, this is what a nutritionist does that other practitioners may not do. We specialize in understanding and correcting dysfunction of the gastro-intesinal system. In fact, you could say it’s the holy grail of nutrition studies! Why? We understand that the digestive system is the factory in which food is broken down to be transformed into energy and brain power and healthy tissues and immunity and hormones and resiliency! Without a properly functioning GI system, it’s impossible to build good health. With advances in research on the role of the gut microbiome in everything from mental health to immunity, this is more apparent than ever.
Humans are meant by design to get most of our nutrients from food. As such, when we bypass the digestive system to get nutrients, we can’t tell clearly if there is digestive dysfunction. In such a case, how do we know our macros are being absorbed properly? A dysfunctional digestive system almost always has problems breaking down carbs or proteins or both, so not addressing this can cause a host of problems. If the underlying issue of absorption of nutrients is not addressed, what happens when the injections stop? Are clients able to get adequate nutrients from food?
Injecting specific vitamins still leaves out all the other micronutrients which we don’t yet have as injectables. All nutrients do a dance of synergy. In foods they are packed together because they work together. In injections they are not as diverse and balanced. It is not wise to supplement long term with specific nutrients without understanding how they interplay with other supporting nutrients and what they can imbalance. As such, it’s my opinion that a good nutrition program should address the nutrient density of our foods and how to ensure we are absorbing said nutrients optimally. This establishes healthy habits for life.
As for plateauing on a ketogenic diet, it does happen and there are a few potential reasons why. An underlying gut biome imbalance is one. We know that certain gut bacteria protect mice from becoming obese. Low quality macros or not absorbing macros optimally is another. Nutrient imbalances are another. Hormone imbalances (think menopause) are another. Too much fat or too little fat for your needs are another. Not counting carbs accurately or hidden sources of carbs is another. Artificial sweeteners that spike insulin are another. Alcohol is another. Poor sleep is another. And excess stress is yet another.
In your case, I suspect stress and sleep are factors. Working on the front lines under the stress of the COVID-19 crisis has got to be difficult on the body’s stress management systems. This causes the body’s adrenal glands pump out a hormone called cortisol. And cortisol effectively blocks weight loss for a couple reasons.
Firstly, cortisol is a steroid hormone and causes fat to deposit around the middle to protect the organs, likely so the wild boar can’t get the important parts if he bites you. Or to make sure the baby is padded so the species lives on. Either way, it’s a hormone meant to help us survive short bursts of intense stress. But when stress is chronic, the body becomes locked in a fight or flight mode wherein cortisol is regularly high. This state is not conducive to proper digestion or sleep. And when we sleep poorly – or not enough – study after study shows us it’s harder to lose weight.
Cortisol can also cause the body to run on proteins for energy. This process is called gluconeogenesis and it’s not good. It transforms protein into sugars and spikes insulin, just like other sugars do, which takes us out of ketosis and causes us to pack those calories into fat cells. At the same time it robs the body of proteins that are necessary building blocks for healthy tissues. Add to this that our protein needs are greatly increased when we exercise a lot. So if we’re not adequately digesting the proteins we consume because our digestion is shut down from cortisol or our bodies are eating up the protein we do digest for energy because we’re not eating enough fat to sustain ketosis – this could be a real problem with getting enough protein for muscle recovery. And you are on a protein restricting plan with a great need for muscle recovery, if I understood your situation properly.
Sometimes people plateau on a ketogenic (or any other) diet because they are overtraining and not increasing their macros adequately. You see, cortisol can be spiked by aerobic and high intensity exercise. I regularly see clients in their middle years who can no longer keep the belly fat off with extreme exercise regimens. Often bringing the exercise program down a notch to include more slow strength training and deep breathing, with yoga or thai-chi or other calming exercise to down-regulate cortisol will help fix the problem. And making sure our protein consumption and assimilation is optimal for our level of training is key.
I also don’t advocate quitting a diet program that has got you results because of a bump in the road. I suggest working with the specialist you’ve consulted for help and clearly communicating your struggles.
Why do I say go back to them instead of finding someone new? Well first give them a chance to figure out what’s going on because you’ve already spent your money there and they know your history and lab results. They have gotten you some results and we should give them credit for that. If they can’t figure the problem out or help you get back into weight loss with some honest follow through on your part, then it’s time to start looking elsewhere. But let me tell you what stops progress more often than anything: diet jumping.
Readers need to understand that the most important part of any weight loss program is consistency.
The fact is, there are actually a lot of diets that can help us lose weight and maintain it for life. A high protein, moderate carb, and low fat diet can also do it. A high protein, no to very low carb, and moderate fat diet can do it. A high fat, moderate protein, and very low carb diet can do it. Limiting your portion size by using a smaller plate can also do it. Intermittent fasting can do it. Eating only meat can also do it. The key, however, is to find which one is best for you and stick to it. Only then will you get great results. If you find it doesn’t work after a good commitment and good communication with the nutrition specialist, try a new one you feel may be better. But again, commit. I believe you should get observable results within 90 days on any program, but weight loss can slow as you get closer to your target weight. That’s where hiring a licensed nutritionist who understands the reasons can be especially beneficial.
Just as an aside, the reason I recommend the diet I do is not because it works for weight loss. It does, but I advocate it because it’s the only diet I’ve found that also stabilizes mood and metabolic problems, reverses type II diabetes and many autoimmune conditions, and can even be used to manage seizures and psychosis. As I said, I believe weight is a side effect – not the end goal – of a healthy diet.
Dear reader, thank you for your question! I hope you’ll consider all the points herein and find ways to take the stress down a notch. And I hope you get back on track again and experience the results you’ve worked so hard for!
As always, if you have your own health/ nutrition questions, don’t hesitate to send me an email at firstname.lastname@example.org. Readers can find out more about my work and sign up for my newsletter at hopenotdope.ca.