Pro Tips from Ted Naiman MD and Virta Health


(PSackmann) #21

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

(PSackmann) #22

I think, because we’re all different, it’s an increase in intake up to BMR, which would be different for each of us. The number isn’t the real take-away for me, but the fact that intake will increase after initial induction as body fat is burned and no longer available for fuel, and that the intake should be a mix of carbs and fat. So, the progression would be decrease dietary fat after fat adaptation, then slowly increase carb intake and dietary fat as body fat is lost. It would mean having a good handle on your BMR as well as body fat percentage, to have a good idea of the amount of energy still stored versus metabolic needs. Maybe the advice at stalls shouldn’t automatically be to decrease fat and/or carbs, but to slightly increase to see if that helps?

(Eric - Slow down to speed up!) #23

I take a week off from fasting and sometimes even IF and eat some extra keto. Usually it is fat because I already get sufficient protein. My protein is higher than some because I do resistance training and I’m trying to avoid sarcopenia as I age. I’m 65yo. I think this is working but only time will tell.

I don’t want my BMR to go down more than what is needed for my weight.

(Karen) #24

I remember hearing her on Ketowoman the other day. She had lost some weight,and she was doing carnivore, but I think she said she was doing a 2 to 1 ratio. Not high fat like 4:1. She did say she did a high fat diet that she was going to post soon. Do you have that link? My ears perked up when I saw you had some weight loss, I always quickly look at to see who is posting and see if they are male or female. Was hoping you were female. Men seem to do a bit better on higher protein. I certainly agree with you that fat for fat sake doesn’t make any sense

(Karen) #25

Don’t go Regina , don’t give up. I think there’s some wise words here. I used to say I always lost weight on Atkins. At least the induction. I think it’s safe to say, in the last year I’ve been eating too much fat, I need to introduce more lean protein.


I am enjoying the discussion here and have some new ideas to consider. I’m also interested in learning just how much body fat a person can burn as fuel daily.

Since I still am very overweight, I don’t know if I really should start adding in more fat yet or not. But if, with my new, slightly more active habits, perhaps I need to do that. I think my protein is pretty high already, so I probably won’t mess with that.

I strongly suspect that I might have tested diabetic if I had tested before starting keto. However I didn’t test until 5 months in, so I am still shy of raising my carbs just yet. However I am suspicious that I do need more fat. I’d like to see my hair begin to grow back full and thick!

So many things to consider! I agree that we are each different in how we respond to this way of eating because of our physical and health needs.


Ah, that makes more sense now - and yeah, digital writing before morning brews will do that lolol.


Yes, makes sense. BMR does fluctuate depending on strength bearing activity, stress levels, hormonal state - and measuring it can prove tricky esp with females. It’s intriguing that brain-derived neurotrophic factor ( BDNF ) has been implicated in the modulation of several metabolic parameters in some disease models - and ketone production makes BDNF flourish. Naturally reduced energy intake (calorie restriction in other words, but due to satiety rather than eating disorder or self torture) prevents the age-related decline in oxidative metabolism in muscle - it’s great for mitochondria. But all in a natural, dynamic, pulsatile way rather than strictly regimented, which allows us to inhabit the ‘keto cusp’ as the Drs. Eades describe the well-adapted metabolism…

I don’t really believe in stalls per se - there’s always healing going under the surface. And often a leaner looking healthy woman will weigh more than a fatter person, due to muscle/bone mass. Thing is with midlife females, recomp in the midsection certainly is on hold until well into the post-menopausal phase (two years after last menses) when then it starts to pick up the pace apparently. In the meantime, high energy/food intake in this group on a regular basis - as well as lack of variability/pulsatility may well create additional fat ruts alas, which I’m trying to stay aware about… :face_with_raised_eyebrow:


Also, keep in mind that it takes a while for the glandular system to catch up and rebalance/integrate the massive change of the kind of fat weight loss your body is going through. You’re undergoing a major transformation in many bodily systems, having already lost 100 pounds. :sparkles:

For a time during fat-burning phase we experience a release of hormones stored in fat - and those hormones affect the whole glandular system, which only adds to the hormonal chaos depending on how healthy the endocrine system was to begin with (some obese folks are healthier on the inside than others depending on their food culture history and genetics etc).

Amy Berger talks about female hair loss as related to chronic hyperinsulinemia. Profound insulin resistance can happen in women that are not obese, as well as some women that are - but her bottom line is that low carb diets are ideal for restoration of normal hormone signaling and healthy reproductive function regardless of body weight or BMI. Over time it creates a beneficial cascading impact on the other hormonal abnormalities responsible for certains signs & symptoms like hair loss (I think she goes into hair loss more in another article about thyroid/pituitary stuff).


SlowBurnMary, Thank you for all that information! Excellent!

I don’t know HOW unhealthy I was a year ago, but I was always out of breath and lethargic. Now I can easily speed walk two miles without huffing and puffing. So, I’ve come a long way. Still, I have no doubt my body has lots of healing to do before I can claim health. Thank you for all the information and the links!

(LJ) #32

First, apologies – It looks like the post I decided to remove this morning thinking it added unnecessary traffic to the discussion…instead caused more traffic in a 24-hour notice flag. Newbie error & lesson learned. :hushed::confused: :nerd_face:

I am thoroughly appreciating this thread and look forward to looking further into Virta and Berger posts/vids. I’ve been peripherally aware of them but hadn’t placed how directly some of their work might fit where I’ve been struggling.

I am currently approaching 30lbs down with an anticipated 70lbs more needed. I’ve appreciated significant health regains after returning to wobbling low carb/keto in the last 4yrs. In that time I learned I felt much better at around 50g carbs except for the flirts at returned cravings, but wouldn’t shift ANY of this significant excess weight above 30g even as my mobility increased exponentially.

It helps strengthen my resolve to read of other women juggling the many facets of midlife weight loss and hormone (im)balances and the various other health issues that bring many of us to keto in the first place…and winning. I’m trusting I’m at the cusp of getting my outsides to match the significant gains that have been gained on my insides, despite impending menopause!


Today I finally opened my recently arrived New Atkins For A New You by Phinney/Volek/Westman and was not shocked to see that the index has no reference to females, women, or midlife even - though the Women’s Health Initiative is mentioned. At this point in my learning, I’d think the midlife female metabolism stuff deserves at least a special text box that alerts ladies to cortisol related differences that may be relevant for Phase II and Pre-Maintenance phases - and gives obese midlife ladies the reassurance that they won’t lower their metabolism by eating a naturally occurring (satiety-driven, not stagnation-driven) ‘low cal’ intake around 1000-1200 a day via OMAD/TMAD etc.

Midlife fat loss (because that’s what this is about way more than weight for the non-obese) for females is its own interesting area of specialization apparently. Some midlife females with metabolic derangement may take much longer to get 100% fat-adapted, and that also necessarily delays carb flex beyond the 20g. Others may get there quickly, but suffer from cortisol related glandular stress and benefit from more paleo-keto, higher intake of things like sweet potatoes or resistant starches or fibers - but may not easily find the information available to make an informed choice.

Regardless, whatever low carb fat-adaptation can be done before menopause the better, apparently!

For females who aren’t obese, the fact that the menopausal post-navel subcutaneous belly fat pad appears even in longterm LCHF/keto gals would indicate that mother nature thinks we need a shock absorber/hormonal backup all the ensuing change. And the belly “menopot” has a different relationship to bodily cortisol than other areas - so if a woman is otherwise on the lean side, “low fat” intake can wreak its own new havoc and is not advisable. It’s just that the boundary between “fat slathering” and “sufficient exogenous fat intake” can be confusing once the menopot has arrived. Even with keto gains, the belly fat get squishier and increases in water volume before it releases - which can be dramatic lol!

And as much as I love the complexity and adventure of body recomposition, I also recognize that the natural midlife female body at the apex of menopause until 2 years post- can have additional inside gains like patience, self-acceptance, new wisdom, gravitas, and stuff like that - all beneficial for physiology and cortisol & N.O. levels :yum:


@SlowBurnMary, thank you for this thread and the information you share on this forum - I’ve learned a lot from you (in a lurky kind of fashion :slight_smile: ).

I don’t mean to derail this thread, but do you have any further advice/suggestions (or can you point me in the direction of same) for a plump, peri-menopausal woman dealing with cortisol and sleep issues, who suddenly has a belly when she never used to (ah, I miss my old hourglass shape)? A summary of what you found worked for you, as a starting point for more investigation for me? :thinking:


Thanks for your kind words, what a happy surprise!

Hmm … summary? That is SO HARD lolol. I’ll try:

*Cortisol reduction assistance via adaptagens. Ginger is my fave - I try to take 2 caps with each meal, sometimes w/ TMAD that’s 4 caps, but with a surprise OMAD day it’s 2. Some days I just forget. Ginger is a vasodilator that increases nitrous oxide levels.

*Coconut oil, 1 tblsp, each morning in a hot drink (or you can cook with the refined C.O.) - helps my BDNF and mental clarity

*A serving of some kind of resistant starch daily if possible. There are 4 kinds of RS - veg/fruit fiber, insoluble cooked, chilled, and refried white basmati rice (only 2 tblsp) is another kind. There are some past posts here on the forum that go into RS details. I’ve distinctly noticed a mental boost from intentionally ensuring I get RS pretty regularly.

*strength-training weight lifting (I did 9 months of the 1x week slow burn program until I chose a hiatus due to compound stress). It’s fab for HGH, and mitochondrial biogenesis that assist the midlife lean mass.

*movement every 20-30 minutes - try to interrupt any screen-based work or sedentary work (like knitting, reading, etc) by getting up and doing a chore or taking a walk outside. Sometimes if we don’t have to go to the loo and are absorbed in mental/hand work, it multiplies sedentariness. Christiane Northrup MD writes somewhere about how regular movement breaks dramatically help manage cortisol! I’m getting better at it… am considering using a chime timer to further help me.

*Intentional carb flex with real foods and/or low-processed food a few times a month. 10 days ago I had the opportunity to eat fresh made tortilla chips and mole sauce along with grassfed steak fajitas from one of the oldest Mexican restaurants in the USA. I knew the event was coming - I looked forward to the indulgence. I ate about 3 handfuls/30 chips and a 1/2 cup of sweet mole sauce - also had white wine before. Low and behold, I felt fabulous the next morning.

*Explore water clearing assistance. Electrolytes help hydration, but certain other allies help move water out of the transforming fat tissues. Lately I’ve been either eating Parsley and Celery, or using Parsley tincture (root+leaf) w/ lemon water 1-2x a day to possible “help” the water cycle in the body. Along with the Ginger, this has helped my lower body feel lighter and avoid edema. Another good diuretic is white wine, for those whom fermented grape isn’t an addiction issue. Caveat is: make sure you’re well-hydrated and taking in enough salt, otherwise dehydration will happen. It’s a fine balance.

*Re Sleep: Make sure you’ve not eaten closer than 2 hours before hitting the sack. Make sure you’re supplementing with adaptogen/cortisol-reducers in foods or capsules. Use relaxant herbal essential oils like Lavender on your pillow or sniffed via a drop on a hankie. German Camomile, Roman Chamomile are also good. And, make sure you go to bed well hydrated, even if that means having to get up to pee. Hydration helps all systems of the body. If I’ve had wine with dinner, I esp make sure to drink water before bed.

*Also, for emotional support, investigate Motherwort. It also is great for general cardiac health and female nervous stability.

*Check out the menopause natural self-care authors like herbalist Susan Weed (The Menopausal Years) and MD Aviva Romm (Botanical Medicine For Women). LCHF nutritionist Louise Gittelman PhDs book Radical Metabolism is esp for midlife women, as well as Christiane Northrup MDs new edition of her menopause/ageing books. Lately (whilst contemplating my slowly firming menopot) I’ve also been enjoying focusing on the developmental psychology aspect of female midlife (Cambridge professor Terri Apter’s book Secret Paths is good, except for being mainly about white middle class women).

*Check out if you might have an underlying diastasis recti (apparently 99% of midlife adults do, due to overexertion or childbearing) - which can affect the menopot’s appearance and make it look bigger than it is. Some specialists (like Judith Tupler/Tupler Technique) teach programs focused on transverse ab muscle strengthening + collagen to strengthen the linea alba connective tissue, others like Katy Bowman, Rick Kaselj etc focus on psoas muscle and hip flexors repair/realignment). I’m fascinated with any and all approaches lol.

Your mileage may vary on some or all of the above - main thing is be very kind to yourself and love your abundant belly while figuring out the daily practices and resources that give you joy. The female midlife is “The Springtime of the rest of your life” as Dr. Northrup puts it. :bouquet:


Thank you so much, Mary - I greatly appreciate your generosity in sharing the above. :blush:

(Karen) #37

I did the change you for a while on your recommendation. Then I never refilled it. But having read this once again I picked up some ginger, and also enjoy a lemon ginger tea.

(Jane) #38

I was 58 when I started keto and my hunger disappeared after 6 weeks - kept forgetting to eat lunch and only had a fatty coffee for breakfast. It varies a lot but definitely seen people here in my age group become fat-adapted after 6 weeks.

(Eric - Slow down to speed up!) #39

I wish my appetite would disappear. Took me at least 6 weeks to be fat adapted and extended fasting to get where I have a sense of satiety. My sense of satiety disappears after maybe a week of not fasting.

(It's all about the bacon, baby) #40

I’ve noticed that every time someone posts Dr. Phinney’s graphic, it gets taken as normative and then people get upset that their calorie count doesn’t match.

It is important to remember that (a) this is a hypothetical example, and the numbers are made up; and (b) the point of the graphic is to illustrate the effect on appetite-regulation while eating a ketogenic diet to satiety. Notice that at first, the person has endogenous fat to consume, so that her body tells her to eat fewer calories. Her satiety signaling (principally leptin secreted by her adipose tissue) is what tells her how much to each. But gradually, as she consumes her excess fat while continuing to eat to satiety, her appetite increases until all her energy expenditure is coming from exogenous calories. Note also that calorie-counting and macro calculations are not part of the process.

(Eric - Slow down to speed up!) #41

What Paul says. :+1::+1::+1: