Struggling to lose weight on a low carbohydrate, high fat diet?

“I’m a 5’10” guy who weighted 180 lbs. I run about once a week and honestly don’t do much else. I cut out beer and all refined sugars (which included a few servings/day of bread and pasta) and lost 15 pounds in 7 weeks.

I feel like a million bucks. It’s crazy how my legs and arms where there was seemingly no fat all became more defined and skinnier.

The best part – I make a full packet of bacon every Sunday and eat it over the course of the week and I absolutely stuff myself with the good stuff you’re supposed to eat – salted cashews, sweet potato fries, fruits and vegetables etc…”

– Taken from some random comments section from a blog (can’t remember where, sorry)

Not your experience? You’re not alone. Though I know those struggling to lose weight on a low carbohydrate high fat (LCHF) diet do feel they’re the only one not stripping off fat faster than they can pour the cream into their coffee. Unfortunately the mantra ‘fat doesn’t make you fat’ probably requires an asterisk, and an explanation. Along with ‘calories don’t count.’ These are related. A good friend of mine was struggling with unwanted weight gain on LCHF. She had listened to what people were doing with the diet and had swapped breakfast for a couple of coffees with cream, wasn’t eating lunch but perhaps grazing on some nuts or cheese during the day and having a big dinner at night that was eaten quite quickly because she hadn’t really had the pleasure of eating all day. Her one concession on LCHF was white wine and not that she drank often, but the couple of nights a week she did drink, it was definitely more than your standard two glasses. Lacking in energy, motivation, and frustrated with the betrayal of both her body and the diet, she asked for my advice. How come everyone else was losing weight but she wasn’t?

It’s too easy to think that the LCHF diet is the panacea for weight loss and weight maintenance – and absolutely, if you read my post a few weeks’ ago around LCHF diets for health and performance then you’ll know it’s at least as effective as your usual low fat regime. Certainly, too, for people I work with it’s an easier lifestyle approach to eating. If I had to put a number on it, about 75% of people I work with take the general guidelines of a LCHF diet, run with it and see considerable success. This includes people who have a history of weight loss, weight gain, and yo-yo dieting. However for some, the switch to a LCHF diet isn’t the magic bullet that it’s purported to be. After an initial drop in body weight (by perhaps 1-3 kg, largely attributable to fluid loss), the body seems to settle into a new ‘normal’ at that point and those last 5kg continue to remain elusive.

Is it the plan itself? No. Any plan that someone can adhere to is going to be successful. But there’s more to it than that. Even people who abide 100% to a LCHF approach can have weight loss stalls and, worse, begin to gain weight. Is it lack of sleep? Thyroid function? Work stress? Not enough exercise*? Too much exercise? Could be. But for some, it actually is the plan. Not in principle though, it’s how they execute the plan. And by all accounts, my good friend had also fallen into this trap.

Where once fat was vilified, it’s now carbohydrate that has been positioned as That Which Must Be Avoided. Problematic because actually there is no good or bad nutrient as a whole. Yes, there are certainly better choices within each obviously (i.e. butter is a much better choice than margarine, and potato or kumara will trump bread every time), but this blanket approach that demonizes an entire class of nutrients can set the scene for an unhelpful (and, at times unhealthy) approach to meals, snacks and eating behaviour. Carrots, pumpkin and beetroot – off the menu. Tomatoes are viewed with suspicion, onions don’t get a look in, and the rainbow of colour in a salad has now been limited to different shades of green and yellow. But it’s not from capsicum (too many carbs!) it’s from half a block of cheese. Now – I know that for some, this actually isn’t an issue and in fact, it’s the best thing they can do for their metabolic health. A LCHF diet makes perfect sense if someone is struggling with blood sugar and insulin control. In fact, for people with diabetes (type 1 and 2), having a very low carbohydrate diet is the best thing for them (why add fuel to an already out-of-control fire?) People either forget (or don’t realise that LCHF is generally 25% of so calories from carbohydrate which can still equate to a good amount of carbohydrate-containing foods. This all or nothing approach to carbohydrate (or… just nothing) is unnecessarily extreme for most people in my opinion. Like Weight Watcher’s ‘fat and fibre’ plan of the 90s, which saw meringue back on the menu for hundreds and thousands of delighted dieters worldwide (and unhelpful for most of those people), it is almost that the ‘no holds barred’ has been shifted from vegetables to foods high in fat. Cream in coffee, nuts in abundance, lashings of butter with everything – because ‘fat doesn’t make you fat’ and ‘calories don’t count.’ For those that can’t effortlessly lose weight with this approach and you have accounted for the lifestyle factors that I mentioned above (as my friend had), then actually you are eating more than you need. If that’s the case, then fat can make you fat and those calories do count.

So what now?

For my friend, and others who come to see me, what actually worked was taking another approach. Still LCHF. But not as LC. And not as HF. It also included a lot more protein. It is an­­ approach to eating that is sustainable in the long term. Remember that the premise of LCHF is a nutrient-dense, real food diet. For my friend:

• I got her to drop dairy – not because it is inherently bad, but because her sources of dairy were only high fat and in larger amounts than I think she was aware of. It was easier to omit entirely in this instance.
• I got her to start eating breakfast again and to include starchy carbohydrates. Not in large amounts! But enough to help her feel satisfied between her meals and also happy with a standard pour of wine from the bar and not a large. For some, restricting carbohydrate can lead to increased desire to drink more alcohol (or gave them licence to do so). This also helps people recognise that carbohydrates shouldn’t be vilified the way we did fats.
• I also got her to sit down when she ate and told her to eat slowly, enjoying her meals and to never eat standing up. That way she knew what (and how much) she was eating.
• I suggested that she cut nuts and seeds unless part of a salad meal and that she aimed for three meals a day and no snacks.
• If she was hungry in between meals, then I asked her to increase the protein portions of her food, as this would keep her satisfied. For my friend, it wouldn’t have been helpful to focus on increasing the fat as it didn’t work for her previously.
• The protein foods she ate weren’t necessarily lean, nor did she seek out the fattiest cuts she could find. She ate a broad spectrum of quality protein foods.
• She ate non-starchy vegetables in abundance.

While initially suspicious of this approach, she very quickly saw success. In fact, over the course of four weeks, she had dropped 5.5kg. Her meals were still lower in carbohydrate, and higher in fat – but also included good amounts of protein and a lot more nutrients overall. For my friend, this ‘back to basics’ approach to diet was just what she needed. It was both the food choices and the behaviour around food that we needed to change. Though weight was her initial measure, she told me the change in how she felt about herself and about the food was far more important.

If you are struggling to lose body fat with a LCHF diet, then remember the devil could be in the details. In my opinion it really is the panacea for optimising your body composition goals, but it might be that the way you execute it needs adjusting.

*fat doesn’t make you fat: unfortunately, eating too much fat could make you fat – because too much of anything can lead to an excess in energy that your body can’t burn and therefore it has to go somewhere – deposited into your fat tissue is the likely scenario.

*calories don’t count: calories do count. But the finer details relate to how your body burns those calories and available energy.

Type 1 diabetes, endurance sport and the LCHF approach: Lewis’ story.

I first met Lewis about a year ago when he came in to see me for a consultation. He will explain his story below, but the crux of it was that he wanted to ensure he was on the right track with his food intake as he started on a low carbohydrate, high fat (LCHF) diet to help his blood sugar control and his endurance sport. In reality, I merely confirmed what Lewis was already doing. Lewis had some trouble finding a lot of information for people with type 1 diabetes who undertake endurance sport, so felt the more he could share his experience, the better it will be for others looking to transition to a low carbohydrate, high fat diet for their blood sugar control. Despite what you may believe, it is not dangerous to follow an LCHF approach to diet if you have diabetes (type 1 or type 2). In fact, it’s quite the opposite. Thanks, Lewis, and over to you.

I was diagnosed with Type 1 diabetes 30 years ago, aged 9 years. I have always been a well-controlled diabetic, (according to the ‘diabetes guidelines’). About 3 years ago, I started training daily. It started out being just gym, then moved on to training for triathlons. Doing exercise is a vital part of a control plan for someone with type 1 diabetes, but it isn’t always easy to balance the amount of sugar, exercise and insulin. It is this balance between the amount of sugar, exercise and insulin that they call the ‘three legs of a stool’. They all are vital, and without any one of them, the chair will fall over. I try and keep my sugar levels above 4 and below 8 mmol/L, what is considered ‘normal’ and is typically controlled by the body’s natural hormonal processes in a person without diabetes.

What I found as I was training was that I was having to supplement large amounts of glucose whilst exercising to stop my sugar dropping. Then, after the exercise, my sugar levels would sky rocket to 15 mmol/L or higher. I would have to take extra insulin to counter the extra high blood sugar, and that would drive my sugar right down low again. It is this extreme roller-coaster of sugar levels that I interpreted as being necessary if one wanted to participate in endurance training. I would typically require a Gu gel every 20 – 30 minutes to stop my sugar dropping. On a four hour bike ride, that would be a massive (and expensive) 8 Gu gels, taking in approximately 160g of carbs. My sugars would be ok during the ride but then would skyrocket afterward.

Also, I had no confidence what my sugar level at any one time would be. If it was in the “good” range, was it only temporary? Was it on its way up, or on its way down? After having diabetes for 25 years, I still had no idea at all. I was thin, muscular, getting fitter and fitter. But my sugar levels were extremely erratic. I was pre-occupied with food, and was always hungry.

Then, a number of things happened all in the same month, October 2013:

1. I heard Grant Schofield speak about LCHF diets
2. I watched a Youtube clip of Dr Troy Stapleton, an Australian doctor who developed diabetes and eats LCHF. He said his inspiration was Dr Richard Bernstein’s Diabetes Solution.
3. I read that book, and it pretty much changed my life. Dr Bernstein is an engineer who was diagnosed with Diabetes in the 1950s. He was the first person to do “home glucose monitoring” and turned the industry on its head, saying patients needn’t go to hospital to check their blood sugar. He later became a doctor (in his 40’s) to specialise in diabetes, and further the cause for good blood control.

He was, and remains, and engineer at heart. His basis for blood sugar control is one only an engineer could come up with. In a nutshell, you can’t predict what your sugar level will do. You can’t get the balance right between sugar and insulin. You will always be wrong. If you happen to be right, it is only by accident. He was describing me, and my rollercoaster sugar control. He explains that if you don’t eat carbs, then you don’t need as much insulin. If you don’t take as much insulin, then you don’t need as much carbs. I switched to LCHF in October 2013, and did my first Half Ironman in Jan 2014. I had submitted a detailed race report to Grant about this race.  Fast forward a year later and I have never looked back.

In terms of the food, eating becomes easier and easier. I do the cooking at home, which is quite useful!

My typical breakfasts now comprise an omelette with 3 eggs, chopped mushroom and chopped tomato. Alternatively, I soft boil 3 eggs, and have them with an avo and tomato salad.

My typical lunch would comprise a green salad with left-overs from the night before. I take care to make enough supper to leave something for lunch the next day.

Typical suppers in our house are below; it is all organic, whole food and high in fat.

• Spaghetti bolognaise with low carb mung bean pasta (less than 5g net carbs for a big bowl of pasta). covered with olive oil and cheese.

• Pizza on pizza base made from 1 cup almond flour, 1 egg, 1tbs olive oil, 1 tsp salt. (makes enough for 2 pizzas. very filling)

• Hamburger on a bread roll made from 1/3 cup almond flour, 1/3 cup ground linseed, 1tsp baking powder, 1 egg, 1tbsp olive oil, 1tbsp cream, 1/2tsp salt. Baked in a mini-round tin, comes out like perfect soft bread roll.

• Creamed mushroom soup (lots of mushrooms, cream, soup stock) served with Almond bread toasted slices. I make a large almond and linseed loaf once a week, slice it and freeze the slices for ready toast.

• Bangers and mash (using cauliflower mash)

• Fried chicken thighs (fatty and juicy) served with a green salad laden with olives and cheese

• Fish fingers and “chips”. The fish finger batter is coconut flour and seasoning. Fried in Coconut oil. The chips are the same recipe as the pizza base but rolled thinner. Baked until brown and crispy. Add salt and the kids love it.

• Butter chicken and rice (using cauliflower rice)

• Taco night where it’s all the Mexican trimmings on either cauliflower tortillas, or large fresh crisp iceberg lettuce pieces as tortillas.

I try keep the level of protein at every single meal the same. Approximately the size of a deck of cards.

With regard to my sugar control and insulin levels during the year…

There is a test called HbA1c, which measures the average blood sugar over the last 3 months. The traditional diabetes practitioners (such as where I go at North Shore Hospital) have this range up, and the red oval shows where the practitioners try to have you aim your sugar levels.

A non-diabetic is supposed to be 5%. The reason the practitioners want us diabetics to be at an average of 8-10. (which is too high, as the non-diabetic body wants to be at 5%, is that (as a diabetic) when you eat regular carbs, you blood sugar will always rise after a meal. It can rise to 10 or 12, and then come back down again. This is “normal”. So, if your sugars are always rising to 10-12 after a meal, and your average is sitting at 5, it can only mean one thing. You have many many dangerous low blood sugar hypos.

I take 2 different insulin types. I take a long acting insulin called Lantis, which processes the natural sugars the body creates. (nothing to do with food). I also take a short-acting insulin (purpose made to handle carbs in food) each time I eat. My long acting Lantis dose has not really changed since going LCHF.

Now, when I was eating my traditionally healthy high carb low fat diet, I was taking between 10 and 12 units of short-acting Humalog each meal. My sugar would absolutely rise after the meal, then I would more likely than not correct it, then it would fall too low. Hence the terrible roller coaster. I assumed, as does the Diabetes Clinic, that to achieve non-diabetic levels of blood sugar control, it required a lot of low blood sugar hypos. I would have had to correct my low blood sugars hypos 3 – 4 times a day.

Nowadays, eating LCHF, I would typically take 1-2 units per meal. This is only for the hidden carbs in vegetables etc. If I was stricter in my eating, I could reduce that dose even further. I have since had to buy a “paediatric” insulin pen, which allows me to dose in half units. Which is quite something. My sugar never rises after a meal. Then, because I am taking very small insulin doses, it doesn’t drop down low either.

My last HbA1c reading was 5.6 and then 3 months later 5.3. A cause for celebration really, as this is approaching non-diabetic levels. The Diabetes Clinic sister on duty was extremely unhappy, and had to call a supervisor. They were not happy letting me drive home. They could only deduce that for my levels to be so low, I must have been having many many dangerous hypos.

I took it upon myself to explain diabetes to them. “If I take no carbs, then my sugar won’t go up. If take no insulin then my sugar won’t come down”. I can manage my sugar in a very accurate range. I have very few hypos, and when I do, their intensity to slight (ie, not powerful caused by large over-doses of insulin). And that by following their protocols, I would have many more.

Lewis completing the Auckland Marathon last weekend (November 2nd, 2014). Note the glucose monitor on his left arm.