Richard, why do you think some people go on keto and lose crazy amounts of weight in a relatively short time period, while others plateau quite hard?
Centurians - people who have lost more than 100 lbs
Greengiant
(Ryan James Dansby)
#43
In my case and IMO, my weight loss had a lot to do with the dramatic change in lifestyle. I was a 12pk a day soda drinker who ate almost all carbs. Now I consume NO sugars and all my carbs come from green veggies.
Just my 2 cents.
Brenda
(8 year Ketogenic Veteran)
#44
In my case my female hormones kept me at the same weight for several months after starting Keto, but my depression was gone my type 2 diabetes was reversing I felt fantastic and my body shape was changing. So I didn’t worry about it and I kept calm and ketoed on!
richard
(Richard Morris)
#45
Obesity is a run away process in which adipose fills and becomes insulin resistant and starts spilling some of the fat it has stored, the pancreas responds to fat + glucose in circulation at the same time by making even more insulin, so more energy is stuffed into adipose until it becomes even more insulin resistant, etc
At the same time insulin is stopping cells from moving fatty acids rapidly (via the carnitine shuttle) into mitochondria to be burned, and instead they have to take a slower route (peroxisomal cleavage). So at this point any fatty acids spilling from fat cells unable to hold any more are not burned, but bundled into triglycerides and stuffed into LDL particles (yes @DaveKeto VLDLs really) which is why a diabetic has incredible levels of triglycerides. Mine were 1111 mg/dl.
That goes on for up to a decade, the pancreas making more insulin, the body desperately trying to make new adipose cells, and grow existing adipose cells which are becoming filled to bursting.
Then we go low carb and all of a sudden there is a LOT less glucose and the pancreas gets a break and insulin starts dropping and all of a sudden all your cells can burn fat at pace (the inhibition of the carnitine shuttle is relaxed) and as that insulin comes down your fat cells finally can start delivering energy into circulation - which is now being burned.
And with a great whoosh all that pent up energy is released - and THIS is why diabetics who go from a high carb to a low carb diet lose a lot of weight very quickly … and why it’s all fat and not lean tissue.
The real question is why do they stop losing weight? Why do they plateau with still some weight to lose before they are at an 8% body fat or whatever their ideal weight loss is.
The answer appears to be (this is my hypothesis that could well be wrong) that multiple tissues have independent insulin resistance levels and the one that drives the most secretion of insulin determines the amount of insulin secreted and that sets the insulin sensitivity of the rest of the tissues to perform their function. So even tho your adipose tissue no longer needs to be insulin resistant to hold onto more energy, some other tissue is holding insulin higher than your adipose tissue needs to hold onto energy.
So the simple way to explain this is that we plateau at our underlying level of insulin resistance after the Adipose tissue no longer gets a vote.
Why do some people plateau higher than others? They have higher fasted insulin. It might be tissue in an organ like the liver, or the alpha cells of the pancreas that’s requiring insulin to stay elevated, maybe it’s tissue in the hypothalamus that drives our energy signalling, maybe it’s muscle tissue, maybe a multiple.
The important thing is that Insulin exposure begets insulin resistance which begets even more insulin exposure … etc.
This is why we encourage people who plateau to keep calm and keto on because the longer they are at a lower level of insulin thanks to a ketogenic diet, the more likely the tissue keeping insulin higher becomes more insulin sensitive.
Sorry that’s a long complex answer to a simple question. The simple answer is people who plateau probably have fasting insulin over 14 mIU/l, and each us get there a different way.
Brenda
(8 year Ketogenic Veteran)
#46
This makes me happy. So glad I could be a source of inspiration for you. It is my greatest joy in life to positively affect the lives of others.
It’s a very powerful thing.
Brenda
(8 year Ketogenic Veteran)
#47
Wait wait wait.
LMFAOROFL.
OK. I’ll finish reading your post now.
8%. Hahahaha
akirby83
(Adam Kirby)
#48
No worries, always enjoy your big sciencey posts. I have wondered for a long time about the peeps who lose weight prodigiously vs those who lose a modest amount but are dogged by plateaus. I doubt it’s anything as simple as “well the big losers tracked their macros better.”
theuSeR
(Seth Rue)
#49
With some prodding from @Brenda I am sharing my story here.
Disclaimer I am only at around 90 pounds lost right now, and only half of it, 46 pounds to be exact, come from Keto
Disclaimer 2 I have actually lost 100 pounds on Keto before but I will get to that.
My story likely begins when I was growing up. I seemed to be naturally predisposed to gaining weight. Although my diet was not helping that in any way. But I have been overweight since I was 7 or so. And I never stopped piling it on until college. I went from being 380 out of high school to 45 by then end of freshman year. Wanting to undue that I worked out during the summer and by the middle of sophomore year came about I was back down to 380. This unfortunately didn’t last and by graduation I was up to around 480. Again I had a change though. For the first time I was able to buy my own food. At home my dad was the one who stocked the fridge and pantries, and in college we had a meal plan and I was too poor to get groceries, or so I thought while ordering a pizza or two every week.
When I graduated I moved back home and got a new job. This time however I brought my mini fridge home from college with me and I made myself a rule. I can only eat the things I take out of my fridge. This meant no food from dads fridge or the pantries. I ended up mainly stocking my fridge with meat cheese milk and veggies. Almost keto. Fortunately I used reddit a lot and heard so many keto success stories. I quickly dumped the fruit and choose keto things instead. And it worked. I ended up losing 100 pounds over the course of a year and a half. I was back down to 380.
Then I got a new job and moved. I left my accountability groups I had built up around me and entered the stress of a new job, and the stress of moving somewhere new. I fell off Keto and I fell off hard. For two years I went back to drinking alcohol, soda, ordering pizza, eating out. Some weekends my roommate and I would order pizza three times in the same day. I packed the pounds back on and started to get depressed.
April of 2017 however I had had enough. I had to go to the doctor because of an infection in my leg and I saw the scale sitting above 490. I refused to let it hit 500 and resolved to lose the weight again and this time to keep it off. I immediately quit drinking alcohol and getting back into a healthier eating pattern. On November 8th of 2017 I was fully back on Keto and looking to be as healthy as I could. As of Today January 10th I weighed in at 399.
My biggest hurdle has always been self-sabotage. And in that respect I have set up an accountability group. I now message around 15 friends and family every Wednesday morning, I update them on my weight and how I am feeling and other goals, and I ask them questions about how they are doing and their progress on goals. I am also super thankful for things like podcasts and forums where I can constantly immerse myself in the lifestyle. It helps to always be thinking about it as it keeps my goals fresh in my mind.
Me at my friends wedding close to 480, wish I still had my tux measurements to compare too.
Me trying on a reward shirt last week likely around 403. The bottoms still a little too tight.
A picture I took because people were telling me how nice I looked and for once I believed them. It felt good to be able to wear nicer clothes and look more professional for work.
richard
(Richard Morris)
#50
There is an alternate hypothesis - that if you are on a plateau you just need to eat less fat.
What that means in a ketogenic context where energy comes from fat is simply a restatement of Calories in: Calories out hypothesis AKA the low calorie diet … and we know what that does.
If you are at a plateau, your stored energy is not available to contribute to satiation or energy consumption. The technical reason is that your insulin is always above the level of inhibition of Lipolysis.
Thought Experiment: changing insulin
Let’s imagine your insulin is lowered a little, now your body fat can release a little energy, now you get satiated just a little sooner, and now you lose a little more weight.
Let’s imagine a new thought experiment where your insulin is raised a little, OK now the lid goes on your storage, and it is even dragging more energy our of circulation to store more under the instruction of insulin, now you have less energy from your plate to contribute to satiety, and you gain a little more weight.
You probably know that one. That was how most of us who were obese got obese in the first place.
So being at a plateau means that we are on the inhibition point of the curve. Lowering insulin means we draw down body fat.
Thought Experiment: changing calories in
So let’s say you are burning 2500 kCal/day and eating 2500 kCal/day, you are keto AND eating to satiety yet you are at a plateau. Necessarily your body fat is not contributing to your energy needs. Everything is balanced.
Now let’s say we suddenly eat 2000 kCal/day, but our bodies are used to burning 2500 kcal … so what happens. The first thing is we try to get some from storage … Oh no but the (insulin) lid is on that remember.
So the next thing our body does is look for budgetary savings it can make; Maybe it doesn’t need to warm your fingers and toes … let’s say that saves 100 kCal/day. How about if you only kill 80% of the foreign invaders, and run the immune system a little slower - we’d have to be unlucky to get a virus in the next day - so let’s say that’s another 100 kCal/day. Let’s say we can make another 100 kCal/day in savings by doing a hundred little tasks that each usually take 5 kCal at 80% efficiency … so each now takes 4 kCal. Well we’ve saved 300 kCal/day … but we are still short 200 kCal for the day.
Let’s see if we can find other sources of energy, we can’t get any from storage with insulin up like that, how about glucose … we got any of that? ummm no we’ve been keto for 6 months. No chance of any alcohol I guess. So the only other option is to burn amino-acids for energy, let’s look for protein in structures that are optional for immediate survival. How about those biceps, we can shave a little off those.
And that is how if you are plateaued and your fasted insulin is high that using fat as a lever will scavenge your lean mass and kneecap your metabolic rate, and you will eventually yoyo back up again.
And how if you have plateaued yet your fasted insulin is really quite low then you can eat less and draw down energy from storage. Heck you can probably eat just your essential nutrients (ie: 60g of protein and some vitamins and minerals) and let those fat bombs on your belly bring you into a graceful landing.
Introduction - 40yo male. On the right track?
Mglasbrener
(Mike Glasbrener)
#53
I lost ~120lbs 8-9 years ago as low fat (really low), moderate lean protein, high complex carbs, zero simple carbs except while training. The goal for first year was a scary one at the time, a 65 mile bike ride with ~4000ft climbing. The steepest being an avg 10% grade with pitches greater than 12%. Subsequent to that I did a few 100mile rides with ~10kft climbing and a 1/2 Ironman.
Work and life stress caused a decline nearly to where I was 9 years ago. Started training and low fat, zero simple carb about 14 months ago. I trained too aggressively and repeatedly tore my right quad. Started rehab about a year ago and continued zero simple carb high complex carb diet for about 2 months with good success. I learned about keto from a friend. Then about 2 keto dudes and I sought you out and listened to every podcast sequentially. What an inspiration loaded with information! It helped with focus in the beginning. During rehab my I discussed keto with my PT and he was mostly keto and saw nothing wrong with it. My doctor never discouraged it and as good blood work came through he said “keep doing what you’re doing”.
Anyhow, I’ve dropped about 75lbs through low carb and fasting. I stalled over the holidays and regressed a bit. However, I am in no way stressed. I’ve resumed good dietary and fasting practices (KCKO) and expect to continue on my journey. My exercise this time around is WAY down compared to before. My knees are aggravating things.
I will say without you guys in the beginning I doubt I would have flown down the rabbit hole as quickly or as deep. It’s quite inspiring to see the medical communities resistance to ketoish dietary practices fracturing some in the last year.
THANKS!
EDIT:
As low simple carb I was hungry all the time! I ate 3 meals and several snacks a day. Hunger became a familiar friend I learned to live with. Keto is so much different. I’m never starving and hunger is quite manageable.
Jennifer_Kleiman
(Jennifer Kleiman)
#54
My fasting insulin was tested at 2.5 so HOMA-IR at 0.5 is as low as it goes, and my last a1c at 4.6 makes me think I don’t have a whole lot of IR going on. However my weight’s been flatlined at 145lbs for the past 1.5 years, plus or minus a few lbs but extremely stable. I’d like it to be less as I feel I’ve still got a fair amount of fat around my waist. I’m 5’4" and my arms, legs, etc are visibly pretty lean but the pudge around the middle annoys me!
I just got a Freestyle Libre cgm and am trying to decipher my post-prandial glucose curves to figure out patterns and optimize things. I am considering picking up a blood ketone meter too… Also, starting 5 days ago I’ve been meticulously foodlogging with cronometer and food scale, and doing ADF/IF daily (no calories Mon/Wed/Fri and eating keto lunch & dinner the rest of the time). I’ve been very happy with maintaining at 145 but I’ve decided to lose that spare tire somehow.
I also had my thyroid & other hormones analyzed… turns out my T3 has been super, super low and I’m clinically anemic. I think this is probably the root cause of my stall, not insulin/glucose mechanics. I started on thyroid replacement therapy a month ago so if that’s the issue, well, hopefully I can fix it.
twistle
(Mary Kubasak)
#55
Hi Richard
Is the serum insulin level that will block lipolysis somewhat similar for everyone, or is it a number that everyone needs to find for themselves? - I was trying to work out whether there was a target fasting serum insulin level where almost everyone would be able to do some level of lipolysis, or if that target level is also one of those n=1 variables. (btw, I’ve got my fasted insulin level down from 36 in april '17 to 14 by the end of '17, and was wondering how soon I might be seeing a body that is willing to let go some more fat from adipose tissues 
)
lfod14
#57
Didn’t think about it this way but after reading some other posts of peoples losses prior I’ve definitely lost 100lbs doing this, just right NOW I’m a couple lbs under that again (it happens) but I’m estimating that I’m in the mid-high 90’s so I’m right there, but are these last ones a MF! I was right under 300 when I saw some pics of myself and snapped, and I was at 202lbs when I ended my fast last week. I can TASTE it!
KetoKnitterNZ
(Michele)
#58
So if I carry on this thought experiment - would it be that fat adaption is a multi phased process? Where stage one is where the tissue with the lowest IR becomes insulin sensitive and then the second lot of tissue that is more IR becomes IS and so on?
If that is the case then what would the n=1 experiment look like to wrestle back the sensitivity from IR tissues when we are genuinely sitting on a plateau? An IF/EF with adequate protein and ZC?
richard
(Richard Morris)
#61
Yes Jennifer, I totally agree.
When you have excluded the 800lb gorilla as a candidate, the remaining monkeys however lightweight are the most likely culprits.