Pro Tips from Ted Naiman MD and Virta Health


(Karen) #42

What Paul says! :+1::+1:
I don’t eat anywhere near 2000 cal. And I’m not really quite sure how much fat I have. Some tests have suggested as high as 28 and others as low as 25% so… I’m taking a guess


I love this chart though because of how it illustrates the general process from an angle that many don’t have the visual understanding of when learning how to leverage satiety for max body recomp.

I don’t eat anywhere near 2000 cals either, and neither do I chase calories with fat bombs and snacking - but it took me awhile after having become 100% fat-adapted to learn how to stop the fat slathering I was doing (being more measured in the fat I use for cooking, not eating sides of sour cream or mayo, choosing to have a 1/2 avocado rather than 2 with my meal, not eating more than 4 oz of cheese per day, etc).

Our bodies tell us how much to eat - but many of us also are having to learn how to stop eating when initially filled (rather than overfilling), as well as food customs that don’t just smother with fat because the fat is around. This is where the menu examples in the various LCHF/keto books can be so helpful! Fat-slathering vs. well formulated dietary fat intake is a learning process about healthy boundaries/balance after having been fat-deprived via the typical SAD childhood.

Just today I was reading the Westman/Phinney/Volek New Atkins for a New You - and found a nice bolded section on page 69 called “Savor Don’t Smother” about properly relating to exogenous fat intake - and not creating a caloric bomb (their term). It can takes some time to cultivate awareness for what is “proper” and “balanced” for our bodies in our individual contexts. Most of us get good guidance from our natural appetite, but some don’t - and many who were raised to finish their plates and waste nothing may have to re-learn this thing about savoring without smothering.

For the fat-adapted with bodyfat to lose who also have a midlife metabolism - the pouring of pan fat drippings as daily gravy on meals or the eating of daily keto desserts/fat bombs or fatty coffees with fatty breakfasts (instead of one or the other) can be an easy habit to have and not stop because it is so… tasty! But staying close to satiety signals and conserving our fatty smothering with an awareness of energy density is also an option, one that can help midlife female metabolisms at least continue to recompose if even at a glacial pace.


When reading the Westman/Phinney/Volek New Atkins book today (the British/euro version of the mass produced paperback is what I unknowingly purchased on Ebay, even though I’m in the U.S.), I did find menopause mentioned within the book - it’s just not in the index.

"Hormonal changes such as the menopause can definitely slow your metabolism and make it more difficult to banish kilograms/pounds [or, I would add for the non-overweight, banishing the midlife middle].

Just remember that getting slim and trim isn’t a contest. Rather, it’s a process of discovering how your own body works."
p. 21

Thoughts… That said, the non-obese female midlife middle’s subcutaneous fat is not as readily accessible as an endogenous fat source - it’s the last to go (and may never become as lean as in youth without strength training/metabolic boosting). In the meantime, it serves a purpose as a source of backup estrogen and as a cortisol management shock-absorption system.


You’re very welcome!

Another thing for insomnia/sleep is Magnesium - a couple times a week I takeangstrom magnesium which is immediately absorbed and doesn’t create gut issues.


Yes, I have been taking magnesium at night for many years (experimenting with many and varied forms) - fortunately I don’t tend to have gut problems with it.

(Bob M) #47

The person in that chart only eats 90 grams of protein per day. I eat more than that, sometimes double that, for LUNCH. I also eat way, way more calories than that.

It’s really an innacurate depiction for me of what happens in my own life.

(Jane) #48

Well, obviously you aren’t a 5’ 6” woman going from 180 to 140 pounds then are ya?


(Bob M) #49

No, but this reliance on “macros” and treating everyone the same is idiotic. I have been low carb/keto since 1/1/14 and have never counted a macro. Ever. I just eat real food.

I hope to fast 36 hours this week on Monday. I will workout Tuesday morning, then have blunch as late in the day as possible. I’ll eat at least 12 ounces of london broil, top round:

That’s 712 calories, 120 grams of protein.

I’ll eat at least 4 ounces of beef liver:

That’s 216 calories, 33 grams protein.

A total of about 928 calories, 153 grams of protein. For lunch.

So, when I see the chart above, I know it’s completely wrong. It’s wrong. It’s never been correct. At least for me.

(Jane) #50

Fair enough. I’m not going to criticize a group that is using keto to treat their patients and collecting data nobody else is on effects of the ketogenic diet.

I’ve been keto 18 months and never tracked macros either. But I will say the intent of the graph worked for me. In other words I started out eating a lot more fat to keep from being hungry in between meals and be tempted to snack. As I became more fat-adapted and my hunger dropped I also cut back on the plate fat.

I was putting butter in my coffee 3 times a day - now only once in the morning.

The amount of protein I eat now compared to when I started is about the same and I also eat more carbs on maintenance than when I was trying to burn body fat so those parts of the graph are also accurate for me.

The numbers are meaningless and are used as an example to display the graph but the intention makes sense to me.

Question @ctviggen - has the amount of protein you eat changed much from when you started keto? What about the amount of fat and carbs? I know you said you never tracked macros but you should have a good idea of what you eat today vs when you stated keto since you’ve been at this so long.

(LJ) #51

Ditto. I found the picture of it very helpful in visualizing why fat is emphasized in the beginning with a progression to maintenance & kept that visualization when I stopped counting macros. I ignored the numbers having already learned I didn’t fit most numbers people posit anyway.

I still have significant amounts to lose so am progressing to leaner proteins instead of carbs. My runs at trying to implement Naiman’s P:E concept didn’t work until I allowed myself the longer, higher fat trends like the Virta shows – looking back, I didn’t know what ‘not hungry’ meant and kept dropping fat too soon, not knowing that I hadn’t adapted enough and that in true full adaptation gone really does mean gone. I’d been making runs at keto/low carb for years and bouncing off track at that wall; that graph helped all the other things I’d been reading & experiencing click for me.

(LJ) #52

This is exactly where my learnings in balance…and acceptance…are right now.

(It's all about the bacon, baby) #53

I had a very powerful experience soon after going full-bore keto (I had started by eliminating sugar and didn’t progress to limiting all carbohydrate until some time later), in which my leptin signaling suddenly reasserted itself. Two years later, I find myself skipping breakfast and not eating until mid-afternoon most days, though there are days in which I feel the need for more food, especially fat.

I definitely eat a lot more protein now than I did before changing my diet, because there were many days when I ate (and ate and ate and ate and ate) only carbohydrate. The difference now is that I stop being hungry, and when I stop being hungry I stop eating. No more eating until my stomach feels that it would burst if I ate even “wan waffer-theen meent.” I start gagging long before reaching that point.

Another difference now is that on the days that I eat more, my weight doesn’t change. I have been cycling within the same 10-pound range for the past 18 months. Sure, I’d be happy to lose another 60 pounds, and I’d love it if the sugar cravings went away, but on the whole, I’ll take what I’ve got, thank you very much.

(Kirk Wolak) #54

Do what you feel works for you… But before you go, read the post I did on the Levers of Weight Loss.

My view is that we all have different levers that work to different degrees. And it is a LOT like flying an airplane. You have to find the right combination of levers that works for you, and the ones that make it bearable. I still eat bacon because I LOVE bacon. (Cooking up 3lbs right now), but I know I should cut back on it.

The constant cravings for sugars are USUALLY a side effect from using Artificial Sweeteners (keeps addictions alive), and/or allergens (all of those seed flowers), as opposed to finding a path that works for you… Trying to hold on to the things you used to love eating… Anyways, throw comments on that Levers article as you see fit, I am hoping you find the path that works for you!

The Levers of Power (What to Measure, What to Control) to avoid stalling/stalls


More thoughts

The sheer wall of environmental & social stress facing many of us face - in cities and a frenetic industrial culture often disconnected from the natural world and its rhythms - seems to be mitigated to some degree by nutrient density in the right amount that allows for a healthy waistline and waist-to-height ratio. This is quite apart from physical weight - as apparently midlife and older folks do better stress-wise to maintain a non-obese but nonetheless substantial healthy mass weight (even when officially overweight, if biomarkers have improved and continue to do so). Apparently the body of even elders ca restores muscle mass and bone density through dietary formulation and/or strength training.

Our brains - as conductors of all this - thrive on MCTs, and I’ve advised myself to eat a tablespoon of coconut oil per day along with other fats in foods - and likewise use ghee for cooking when I can make it and have it on hand. But I’m less-casually slinging fat into smoothies or slathering my cooked meals in it, even when I have an OMAD day. As a 100% fat-adapted gal, am no longer having sides of sour cream or mayo for fun, etc. Finding the joy in slightly smaller portions (French style) is a new thing for me, that I feel happy to do, as culturally I can’t help but clean my plate. I avoid restaurants, but if in one, due to their typically huge servings, I will often reserve half my main dish to-go before I start - unless it’s a CELEBRATION in which case I feast LCHF with abandon. Key is to limit those celebrations to once a week or so - though the SAD tells us every day is a good day to supersize, lolol/sob.

Being that I’m particularly interested midlife female metabolic healing and recompostion, it’s apparent from many if not most midlife female LCHF/keto voices I’ve heard around here and elsewhere that 100% fat-adapted satiated not stagnated “undereating” calorically as a group norm may be a natural process due to slower metabolism and increased hormonal health - and a process that is helpful for continued fat recomp post-menopause. The many benefits for midlife females of naturally lowered but nutrient-dense energy intake and keeping protein on the low side with TMAD and/or fasting (as admin Brenda has done with remarkable evidence of no muscle loss) have yet to be thoroughly studied ofc. We’re not being told that if we’re sedentary, satiated well-formulated intake somewhere between 900-1200 is perfectly fine - but it really puts into play the ‘eat to satiety’ adage. I think the Westman/Phinney/Volek and Gittleman encouragement towards a base foundation that blesses leafy greens/salads/fruit is music to the ears of many a midlife woman who instinctively desires the antioxidants and alkalinization in the lowered metabolic state. And until controlled studies exist on this category of human, we are finding our own way, together.

In some other reading today I was reminded of the link between satiated undereating (via daily low protein and regular fasting) and longevity, as opposed to disease and earlier death associated with constant feasting/nutrient density for those midlife and older.

It’s pretty amazing how LCHF/keto satiation - for the fat-adapted and hormonally healed - lends itself to natural energy intake reduction, and being informed about it can make this path more fun and less worrisome. Seems to me that the older we are, the more frequently we can enjoy reduced energy intake and its recomp leveraging, in between times of feasting. As far as protein needs and levels go - for sedentary midlife folks who aren’t doing much weight-bearing physical work (going up and down a flight of stairs throughout the day is an excellent weight-bearing activity, it needn’t involve dumbells necessarily) it seems we are well equipped to reduce protein to minimal levels when not fasting. The less protein, the less acidic we are - which preserves bone density, especially in females.


Re menopausal/post-menopausal females and what is acceptable “less protein” when not fasting and when not doing extended intensive strength training… Something like 70g or much less apparently (admin Brenda has experienced no muscle mass loss at an average of around 45g per eating day combining w/ frequent fasting) - assuming one has sufficiently restored one’s health if one was chronically protein-deficient in previous decades. It could be that we are more efficient with the protein, due to the body’s conservation of… practically everything! In a 100% fat-adapted midlife female, satiation and easy fasting are indicators of that.

Midlife females who aren’t menstruating (as well as not-lactating) conserve a significant amount of energy/cals and minerals for starters. For this reason, we have a tendency towards excess or stubborn fat with even LCHF/keto nutrient density. Then there’s the fascinating female corpus callosum, which optimizes brain connectivity and BDNF when eating sufficient fat apart from water fasting (sufficient meaning prob more like 2-4 tblsp per day depending on how many meals - and not mindlessly gorging/slathering the equivalent of 10 tblsp fat just because one can).

All of this is mediated and optimized by stress coping skills of course, and the adaptogens that we consume and/or create, including the extent of additionally satiating oxytocin and Nitric Oxide in our physiologies (whether through meditation, sexual intimacy, laughter, singing and/or keeping up with longtime nurturing friendships) - which are so good for health when ones spirit is nourished! :sparkles: :sparkling_heart: :sparkles:

There are no quick fixes, but finding one’s way to sustainable health is a privilege and a tasty joy.

(Patricia) #57

I am pretty much confused now . First, I am probably one of the older people on this board at 67, and I am female. I have spent decades abusing my body with one diet or another and would be diabetic now if it weren’t for keto, so I am metabolically challenged. I started keto a little over 3 years ago and slowly lost about 55 pounds, but I feel I am still 20-30 pounds away from my goal. I have tried fasting, and it is really hard for me - even skipping lunch one day made me ravenously hungry at dinner, and I ate way too much. I have found that just watching macros is not enough for me to continue to lose weight, so I also count calories and try to stay under 1300 calories a day. However, I am frequently hungry doing this. I have also switched from counting net carbs to counting total carbs, and I still have plateaus for months at a time.

I have a lot of sagging skin now (that should be incentive for you youngsters to lose the weight now!), but I also have a large midsection, so I know that is not healthy and means I have to lose more.
So what now? More fat, less fat, a few more carbs, less protein, more protein? I am at a loss at how to proceed.


It would be ideal for you to work closely with a LCHF/keto medical case manager. There are various lab tests that can explain where your metabolic tendencies are at these days, and it can be so encouraging to work with a functional medicine MD and a peer support program like what Virta Health and Dr. Fung’s IDM provide.

Yes, after decades of abusing/malnourished the body there can be a lot of havoc - but the fact that you lost 55 pounds slowly would indicate that you are a champion!

The being 20-30 pounds away from one’s “goal” in the midlife and post-midlife years is a common refrain. The body’s set point of mass is real - and especially dug in if the body had decades of SAD dieting - and the only thing that seems to disrupt that is fasting from what I’ve read around here. Otherwise, Phinney/Volek/Westman in the New Atkins New You book (if you’ve not read, check it out! Along with Dr. Fung’s books and website) do encourage folks to accept that their midlife+ body may have a new set point and much slower change, and one that is healthy from the inside out for enjoying life!!!

If you’re frequently hungry, it’s def a sign that you’re recalibrated - and from what I’ve read, from age 65 on higher protein is needed, and along with the protein, a bit more fat? But if you can master small fasts (and appropriate refeeding feasts) it could be the special sauce you need.

There needs to be more LCHF/keto books just for midlife and beyond. I know the Drs Eades wrote “Losing the Midlife Middle” which involves a smoothies twice a day plus one meal - to lighten the digestive load, along with a number of nutritional supplements to boost recomp.


Also - since you’re post-post menopausal, you might do well with both INCREASING your LCHF energy intake along with carbs to pre-maintenance level, and also work with times of fasting. As Megan Ramos says, “change it up and keep the body guessing”.

Longer water fasts of 3 days help with loose skin recomposition via autophagy - and a few years hence you might well find yourself with another new body!

(Karen) #60

You know I wonder on the need for higher protein as we age. Is it because we’re not absorbing enough protein. Is it because our guts are leaky and the amount of protein we used to eat is no longer getting to where it needs to be. Dr. Gundry had some thoughts on this.

(Patricia) #61

I have definitely been getting the fasting vibe, so I will have to try that. As far as my goal weight, I wouldn’t be that concerned if it weren’t for the still large mid-section. My waist circumference is not what it should be, and clothes don’t fit well when one is round in the middle.