Pro Tips from Ted Naiman MD and Virta Health

[SlowBurnMary]

Sidenote: these pro tips are NOT for

• Newbies (give yourself 6 weeks of a well-formulated LCHF/keto way of eating to become 100% fat-adapted or nearly),

• Those with body dysmorphia (who are both regular participants and lurkers on the forum and in other keto groups),

• Those with an orthorexic or mental aversion to dietary fat per se.

• Those already at a healthy body weight/bodyfat percentage.

• Those who are actually underweight (lean mass is both muscle and bone density and healthy tendons along with microbiome).

• Those with certain neurological or disease conditions that would benefit from a therapeutic medical ketogenic diet (90% fat).

If you’re not one of the above people, this graphic from Dr. Naiman is for you! If you’re a midlife female with a naturally slower metabolism, this is especially for you! I’ve been learning this stuff for myself, and found it to be very true:

This begs the question “What is Really a High Fat body”? And, what is “Low Carb”.

To figure that out your body fat, determine your natural waist measurement (people’s belly buttons vary in location and some have longer ribs than others depending on ethnicity - so your natural waist is your skinniest area when you bend to the side - not everybody’s waist is at navel level), and your waist-to-height ratio. You can then refer to various charts. This does not apply to growing children or adolescents however, it’s just for adults

Waist-based measurements are much more accurate than BMI determination which does not distinguish between the proportion of weight due to fat or muscle and thus is a very faulty kind of guesstimation. FWIW, BMI is even LESS accurate in certain groups, including:

• certain ethnic groups/genetic heritage, such as Pacific Islander populations (including Torres Strait Islander peoples and Maori), Aboriginal peoples, South Asian, Chinese and Japanese
• body builders or weight lifters, some high-performance athletes
• pregnant women
• elders (65 and older)
• people with a physical disability
• eating disordered people
• under 18 year olds
• extreme obesity

What is pre-maintenance Low Carb for the fat-adapted beyond induction? According to the Drs. Eades, Dr. Atkins, Dr Phinney & Volek PhD - it varies, but is somewhere between 50-100 net carbs per day.

All that stated…

Exogenous fat SLATHERING may be interfering with your body’s capacity to draw on your own fat stores. I’ve experimented with this and found it to be true for me. Fat-slathering is NOT about fat sufficient for reasonable cooking, fatty cuts of meat, and fat-for-MCTs (extra coconut oil supplementation for insta-ketones)… LCHF/keto is not about fat-free. So what is fat-slathering? Here are some examples:

• Cooking your meat/eggs in the skillet with copious fat (like, 2-3 tblsp per person), removing the cooked food onto a plate, then pouring all the skillet fat all over your plate rather than saving the fat for the next meal’s cooking. You could do that as a newbie, but those days are over except if you’re doing OMAD (probably).

• Eating mountains of guac and/or sour cream or mayo as one of your regular condiments/side dishes,

• Making your fatty coffee/tea with 4+ tblsp of fat rather than 1 tblsp fat (w egg yolks if you’re not doing IF), and/or drinking fatty coffees/teas throughout your whole day

• Adding 4+ tblsp of fat to smoothies/shakes rather than 1. Making it worse by only having juice-type smoothies rather than rounding it out by adding high quality protein (grassfeed beef powder, undenatured grassfed whey, cottage cheese).

• Eating keto “fat bombs” and keto ice cream as a daily thing rather than weekend thing.

Virta Health/Phinney & Volek’s great graphic shows how when one is fat-adapted and one wants to lose bodily fat - one’s dietary intake of fat reduces so that the body’s own fat stores are used during first three stages. This also shows in the natural reduction of calories for their example given. If you stare at the graphic enough it’ll all make sense eventually lolol. It’s based on a case of a 5’6" woman’s journey to a healthy body mass of 140 lbs.

Additions/subtractions/stories/science?

[SlowBurnMary]

This article from Amy Berger MS, NTP is also great:

Stop Following a Medically Therapeutic Diet "Just 'Cuz" (a.k.a. The Keto...

[Regina]

Newbies (give yourself 6 weeks of a well-formulated LCHF/keto way of eating to become 100% fat-adapted or nearly),

I love, love your advice. But only an 18 year old could become fat-adapted at 6 weeks. I am 61 years old - It has taken over a year - and now I have fallen off. Because even fat adaption cannot assuage my hunger. Going back to carbs.

[KBG]

when one is fat-adapted and one wants to lose bodily fat - one’s dietary intake of fat reduces so that the body’s own fat stores are used during first three stages

Took me a minute to realize you are kind of looking at this graphic backwards, or in other words reading it from right to left, or back in time of the example subject. The way I first understood this was that as time goes by with a ketogenic WOE, a persons dietary fat intake will need to increase as they don’t have the body fat stores anymore to draw from.

This became clear to me early on when I noticed a friend (who was lean) needed fat bombs to get through the day but I (not lean) did not need them. Then my brain finally clicked and I had an aha moment when I saw Ted Naimans graphic, thankfully, soon after.

I can see how people could easily go down the wrong path. Keto is described as high fat, even very high fat. So if one is to start off too high and then keep increasing as time goes by, it makes sense results would be compromised or a perplexing stall would begin. Need to start off with dietary fat a bit lower (still high, just a lower high) and then increase as body fat is lost.

I myself fall into the category you mentioned below and know it’d be a good thing to remedy it, but it will take much will-power…

So what is fat-slathering?

drinking fatty coffees/teas throughout your whole day

[GreeneggsNham]

This is great! I’ve been looking at Virta Health’s graphic and am trying to figure out how or if it matches my own weight loss journey since my weight loss has slowed and sometimes halted over the last several months.

This graph appears to be using calories, unless I’m wrong. Last year, when I first started Keto and weighed 350 lbs (!) I ate a lot more fat and more “calories” total than I do now. Within several weeks I just couldn’t eat that much, so I began eating less fat and started following recommended macros for weight loss.

I know there are differing opinions on following macros, but I’ve never felt hungry, so this seems to work for me.

I don’t worry or track calories, but if I were to do that, I’ve come down from eating around 1500 (possibly more at the beginning) a day to eating around 1200 daily now. Sometimes I eat more, sometimes less. It varies. But the main thing is that I am not hungry and so I feel fully satisfied. (I’m using calories to compare with the graph above.)

I’ve been eating keto for nearly 11 months now, lost a lot of hair which I’m not sure is coming back yet, but otherwise I feel very good. I have high energy, can move and walk and work without feeling exhausted. I sleep well and always feel satisfied.

However, since my weight loss has slowed I’m trying to figure out what I need to get things moving again. So some days I eat a greater portion of fat, others I eat a greater portion of protein. Always, I stay under 20 grams of carbs.

I’d like to lose more than a pound a month, and I know some will say to be patient, etc., but… well it is difficult and I do want my hair to grow back. I track everything I eat, always.

Since I am no where near maintenance weight (I’m 212 lbs today, am 5’3" tall and female), I wonder if my metabolism has slowed.

Does Virta address things like metabolism? I haven’t looked, but I might see if I can find info on this. I read conflicting information constantly about how to get the weight loss moving again.

Anyway, this is just my experience. I won’t leave keto as I really do feel this is the healthiest way to eat, and hope someday to be able to be more flexible with what I eat (perhaps adding in a few more carbs occasionally). But I believe my body is healing and so here I stay.

[ctviggen]

I would try fasting. Take a look at Dr. Fung’s website (https://idmprogram.com/blog/).

As for the graph above, I think it’s simplistic. I ate low carb/keto, primarily higher fat, and lost weight. I’ve eaten very high fat and seemed to lose weight. I currently eat near to a Ted Naiman-style higher protein diet, and am losing weight. I’m down to my lowest weight in decades, but I’ve also gained muscle mass, so the actual scale weight loss isn’t as great as it could be. I look better though.

Contrast this with Siobhan Huggins, https://cholesterolcode.com/author/siobhanh/, who went on a high fat carnivore diet (from carnivore) and lost 7 pounds, which for her is a lot. That does not fit into those neat pictures.

I fully support that super high fat, gobbling down fat for no reason except to meet some arbitrary “macro”, can be problematic. In fact, I think that high blood ketones can simply be an indicator of excess fat your body has from exogenous fat. Lower ketones might be better than higher, under this theory.

But I think Ted Naiman’s graphs are also simplistic. His protein:energy ratio seems on the one hand reasonable, but on the other hand unrealistic. For instance, I don’t think if you venture into the low protein:energy ratio periodically that you immediately begin to gain weight. Certainly, that wasn’t true in Siobhan Huggins’s case.

I’m of the opinion that if higher fat no longer seems to be working, try higher protein, lower fat. I have found I feel better and get more full with protein than with fat. But, as with everything else, the answer is probably more complex and more individualized than what Virta and Ted Naiman portray it to be. It likely changes over time (maybe starting = higher fat is better but getting near goal = higher protein is better?), depends on the individual (Jimmy Moore has hypoglycemia if he eats too much protein), and may depend on exercise (if you’re lifting or running or cycling, maybe more protein is better?).

[BlueViolet]

@SlowBurnMary absolutely fab article Thank you!

[GreeneggsNham]

Bob M, I think you are right about fat loss being different with each person and with what his/her body is doing at a place in time.

I started out higher fat, and eat higher protein. I do agree that I should try a few fasts and see if that shakes things up for me. I’ll probably try a fast tomorrow since no one will be home for meals and I won’t be serving food to my family all day.

The diagram seems to show a large reduction in, for lack of a better term, calories or food. So one of the things I have been wondering is if a person, (like me), can slow metabolism by reducing how much is eaten once fat adapted. Some say “No.” and some say “Yes.”

I have switched to eating breakfast and lunch instead of eating lunch and dinner as per Dr. Boz’s instruction on Youtube. Not sure if I can do that long term as my husband really likes everyone to eat dinner together. It’s an important ritual for him. Haha! Anyway, I don’t mean to move the direction of this thread. Thanks for your thoughts!

I think I will go back over that article and see if I can glean anything more.

[SlowBurnMary]

Well, apparently something like 80% of folks are 100% fat-adapted by then - but who knows where that stat comes from - it prob comes from studying young males only! >_<

Yes, you gotta do what you gotta do - and you might in fact be one of those people who thrives on HCLF… Phinney & Volek, Amy Berger and others validate the fact that some 20% of folks - including some aboriginals who ate roots heavily - can apparently maintain metabolic health for a loooong time on real/whole foods HC!!!

As far as who is a ‘high fat’ sort of body - I’d venture to say that only having noticeable fat in the form of the midlife half-basketball belly prob doesn’t qualify as high in body fat if one has lost most excess fat everywhere else? Losing the excess midlife middle is it’s own huge subject - seems to involve vast amounts of patience as the belly transforms into squishiness before incremental swooshes. But if the belly is doing that, apparently it’s a sign that the visceral fat has all been transformed, which is a very very good thing!

[SlowBurnMary]

@KBG YESsss - it took me quite a awhile of studying the various aspects of that graphic and understanding fat-adaptation principles before comprehending the perspective on those phases! Seems lots more community education on the overview both directions is needed - judging by the continuous level of confusion seen in many who start LCHF/keto without having first read certain foundational guidebooks such as Protein Power, The Art & Science of Low Carbohydrate Living, and The New Atkins For A New You!

@Testudine _“First I stopped slathering…then I started leaving bits of fat…” lololol. That would make such a great title for a catchy community ed article on one of the keto blogs! I can relate to your fine-tunings. And when satiation is remaining stable enough for IF yet also without digestive sluggishness, it’s quite smooth sailing Supplementing with Ginger capsules for pro-enzymes, cortisol reduction, fibrin clearing, nitric oxide/vasodilation, and anti-inflammation boosting has been really supportive for me.

@GreeneggsNham WOW - om my goddess - you’ve lost over 100 pounds in just under a year of keto! You’ve gone from morbidly obese for your height to just overweight and you’ve healed so much. You’re right: after the most urgent weight & fat loss occurs (tons of visceral fat and thus tons of hormonal healing) is when further body recomposition of fat loss but slower weight/mass loss occurs because of muscle mass healing and other things. I think too that the glands (like the thyroid, pituitary, and adrenals) have to deal with all the change and detox. Your belief that you body is healing is a solid compass. You’ve had SO MUCH change in less than a year - give your body’s many systems (glandular, nervous, respiratory, etc) time to catch up in your new beautiful place of healing

The Virta Health blog is very good, so is Amy Berger’s blog!

Sounds like you’re on definitely on the right path with your nutrient density and energy intake - and remember that just moving around your 212 5’3" body is still a weight-bearing act, and no extra exercise is needed beyond a reasonably active daily life till you feel even lighter and have a natural desire to do so. From what I’ve read, metabolism doesn’t slow when your body is tapping its own fat and you’ve got a decent nutrient intake, which you seem to have. It’s interesting though that for midlife women (not sure if this applies to you) the more your glandular system may be helped by slightly higher carbs (according to Stephanie Roper, Amy Berger, and Leanne Vogel), along with continued pulsatility/randomness. Interestingly, staying at the “Induction” level of less than 20g real foods carbs a day can actually be stressful for midlife female cortisol and the thyroid for some gals (I know it is for me, so I try to have a few days of week with around 75 g carbs, helped by resistant starch, a few apples a week or a sweet potato, plent of good veggies etc - LCHF nutritionist Louise Gittelman PhD’s book Radical Metabolism goes into these as important natural sources of antioxidants, pectin, and vitamins for women).

@ctviggen Yes, these graphics are simplistic, which is why I really like 'em - a great way to get a community ed message across that is often sorely missed by many (judging from this forum’s posts as well as other commentaries). However - it sure would be fun to see these graphics in series created according to variables like IR, female vs. male, young vs. midlife, endurance athlete vs. moderate athlete etc. At the same time, lots is already spelled out in the foundational LCHF/keto books, but many folks don’t seem to be studying them (though used copies are available for cheap these days online)… Personally, I keep them on an endtable and am continuously revisiting them as there’s always something to learn and I’ve not memorized them yet lolol.

I often muse that the LCHF/keto world in the industrial west is still overwhelmingly well-fed and/or economically privileged - and I think lots of us 100% fat-adapted folks do or would gain psychological/spiritual benefits from exploring fasting a la Dr. Fung - just 24 hour fasts are amazingly energizing for me.

[Dipper_Actual]

Nicely put @slowburnmary I always enjoy your posts. Hopefully data mining the Virta data will show how different the female metabolism really is and we can have that paradigm shift in medicine, eh?

[David_Stilley]

I wonder if my metabolism has slowed.

Probably so, 1200 calories is pretty low and barely meeting metabolic needs if it’s doing even that. There’s such a thing as a caloric deficit. And then there’s also nutritional deficiency or starvation mode, and a fine line between the two. I think mixing your routine more would help. You can eat that low some days but probably not consistently since keeping your BMR up is important, which is a weight loss key that can be lost through caloric restriction.

[SlowBurnMary]

Apparently metabolic slowdown is not a risk when intake is well-formulated - particularly for satiated fat-burning IF/OMAD non-athlete females, esp midlife ones who walk the line between a natural metabolic slowdown coupled with increased cortisol and energy overload/excess calories. Might apply to other profiles too based on certain conditions.

When IF and/or OMAD/TMAD is practiced, the energy intake reqs changes without triggering starvation mode, as Dr. Fung is so good at explaining. Dr. Phinney talks about metabolic slowdown with fasting beyond 24 hours.

There have been some links about this on the forum, but I think the midlife female aspect is yet to be officially studied it’s mostly anecdotal experiences and/or common sense. Women & IF/OMAD/TMAD reduced intake has been explored by Mark Sisson, Stephanie Roper, Amy Berger, and others - but official research on it is lacking as usual.

[David_Stilley]

When IF and/or OMAD/TMAD is practiced, the energy intake reqs changes without triggering starvation mode, as Dr. Fung is so good at explaining.

I totally agree, but too much of a deficit can’t be supplemented by body fat. There’s a limited amount you can access daily for caloric burn. If you’re not supplying enough, over time, you will use less calories to fuel your metabolic function. The result will be a lowered BMR. That means less fat burning. It’s a tricky balance between the two I believe. As you stated too much fat slows or stops weight loss and may well cause weight gain. But there’s a flip side to that equation too. That’s why longer fasts have diminished returns compared to IF where you have autophagy daily and don’t suffer refeed gains as people do in EF. Of course I am no fasting expert but I have read a lot since being here, and plenty of people report that longer fasting is better for healing purposes and IF is better for weight loss. I know many have also experienced the opposite. It’s just what I concluded and practice. My daily calories vary between 1300 and 2100. I am about 12lbs from my goal weight which has changed, I was planning to be where I wanted to be 5 lbs ago. Anyway it’s not about weight, it’s about body fat percentage.

I actually liked what you posted @SlowBurnMary, I was just wondering about @GreeneggsNham’s stall doing what she’s doing, and her suspicion that she may have slowed down her BMR.

[GreeneggsNham]

SlowBurnMary, Thank you for stepping in here and sharing your thoughts and information. I very much appreciate this! I’m always revisiting what I’m doing and trying to make the best choices I can with what I learn. This is a great community!

I haven’t spent as much time reading Phinney & Volek or even watching Amy Berger as I have with others. I’ll try to catch up!

[GreeneggsNham]

David_Stilley, I’m still not certain about the whole issue on whether or not I can hurt my metabolism on keto. I never was one to go from one diet to the next, but rather, steadily gained weight each year.

I try to get enough nutrition from food, but I have added in days now and then when I eat closer to 1300 calories but it is hard as that feels like too much. I’m still reading and researching. I’d like to see studies on this.

Thank you!

[SlowBurnMary]

Came across this great video lecture from Dr. Phinney previously posted here on the forum - conveys more the angle on the energy intake reduction that occurs in folks who are 99-100% fat-adapted. Of course, this is based in clinical relationships of medical case management which also deal with food addictions and metabolic derangement which means that some of Virta Health’s more deranged or unhealthy patients don’t get fully fat-adapted for a year or more:

"When we take someone who is … 25kg/55lbs overweight and we tell them to cut their carbs to a level that allows them into nutritional ketosis, and keep your protein moderate - for this person that would be maybe 80-100g of protein a day intake, and tell them don’t restrict your calories … eat fat to satiety, don’t go away from the table hungry – most people will spontaneously limit their caloric intake to 1400-1500 kCal/day. So it’s not on purpose, they are not counting calories”.

[goohsmom]

The diagram seems to show a large reduction in, for lack of a better term, calories or food. So one of the things I have been wondering is if a person, (like me), can slow metabolism by reducing how much is eaten once fat adapted. Some say “No.” and some say “Yes.”

To me, the diagram shows an increase in intake as weight goes down, both in carbs and in fat. That makes sense, as less body fat is available to tap, more dietary fat must be consumed to continue fueling the body. Add in the exercise that comes to some of us, even if just resistance type, and protein should go up a bit. Makes me wonder, for those who have been doing this for a while and start to slow, should they start slowly increasing dietary fat to prevent their metabolism slowing?

Interestingly, staying at the “Induction” level of less than 20g real foods carbs a day can actually be stressful for midlife female cortisol and the thyroid for some gals (I know it is for me, so I try to have a few days of week with around 75 g carbs, helped by resistant starch, a few apples a week or a sweet potato, plent of good veggies etc - LCHF nutritionist Louise Gittelman PhD’s book Radical Metabolism goes into these as important natural sources of antioxidants, pectin, and vitamins for women).

This makes sense. I used to be on another forum that was mainly women doing LC, and a surprising majority of them would lose after being stalled by adding carbs in. Obviously this doesn’t work as well for those who need to be in nutritional ketosis for medical reasons, but it could be another explanation of why people stall in their weight-loss goals even while eating strict.

[SlowBurnMary]

Re the Virta Health graphic - yes, it’s an increase in intake - but only up to 2000 cals spread out over 3 meals a day plus snacks. So for fat-adapted folks who do IF or OMAD, intake may naturally be much less?
And different than adding in fat beyond cooking - taking in 500-600 cals extra in just additional fat snacks/slathering/mountains of guac/cream etc - I noticed for me when I was a bit more frugal with added fats, my recomp sped up.

I’m not understanding your example of the LC forum women - did you mean lost after being stalled? Seems to be a thing with fat-adapted midlife female, non-IRs. I do feel better/more chipper with a bit more whole foods carbs, that’s for sure. And whenever I’m at around 50-60g net carb for more than a day, my persistent little underarm rash in one armpit starts to disappear.

[goohsmom]

I’m not understanding your example of the LC forum women - did you mean lost after being stalled? Seems to be a thing with fat-adapted midlife female, non-IRs. I do feel better/more chipper with a bit more whole foods carbs, that’s for sure. And whenever I’m at around 50-60g net carb for more than a day, my persistent little underarm rash in one armpit starts to disappear.

Yes, they would lose after being stalled by adding healthy carbs. Evidently, staying at extremely low carb levels wasn’t working for them. Sorry, let me edit that original, I was still on my first cup of coffee