Robb Wolf’s has been a significant influence on my thinking and learning in the area of nutrition.
Around 2009, my dad mentioned that he’d been reading the transcripts for the Paleo Solution Podcast. I think Robb’s podcast with Andy Deas and then Greg Everett was the first podcast I listened to. I would like to think I was their sixth listener, but I could be wrong.
Robb is a research biochemist with some personal health challenges. His mum had some major autoimmune issues, and he’s been plagued with ulcerative colitis and the threat of a bowel resection in his mid-20s. He started the first and fourth CrossFit affiliate gyms. All this gives him a unique angle on health and nutrition. His 2010 book, The Paleo Solution, has become a definitive manuscript of both the Paleo and CrossFit communities and central to the massive growth of both.
Although there is sometimes disagreement between the Paleo and Low Carb communities, Robb has, from the outset, had a soft spot for low carb, keto, and fasting. It was through Robb that I learned about Dr Richard Bernstein and low carb to try to manage my wife Monica’s Type 1 Diabetes. He’s also been interested in the use of ketogenic diets for traumatic brain injury in his work with police, firefighters and military.
When I came across the insulin index data which highlights foods that provoke a low insulin response but do not contain a lot of vitamins and minerals, it was Robb Wolf and Mat Lalonde’s thinking on nutrient density that made me believe there might be a way to combine the two parameters, insulin load and nutrient density, to find the right balance for each individual.
What’s new different in Wired to Eat?
So how have Robb’s views changed in the last seven years since he wrote The Paleo Solution?
On a personal level, it seems he’s occasionally eating gelato with his two girls. With a few more years under his belt, Robb seems more conscious of his genetic diabetes risk. He is on a journey to find the optimal balance between low carb and strategic carb cycling to maximise mental and physical performance. A lot of that self-reflection and thinking is echoed in his new book, Wired to Eat, which was released in March 2017. The 7-day carb test is a great addition to his paleo formula to help people decide if they do well with fewer carbs.
Robb has spent less time dealing with performance athletes and more time dealing with police and firefighters who are often metabolically broken. This makes his new message even more relevant to the masses, who are more likely to be facing the challenges of diabesity rather than winning the CrossFit Games.
In his latest book, Wired to Eat, Robb has differentiated the ‘Paleo template’ depending on an individual’s carb tolerance. The 7 Day Carb Test protocol will help you assess whether you can tolerate Paleo-style carbs such as beets, squash, yams, and sweet potatoes.
“Personalised Nutrition” is a central theme of Robb’s new book. In Chapter 6, Robb delves into the Israeli study “Personalised Nutrition by Prediction of Glycemic Responses,” in which they correlated to blood glucose with gut microbiome parameters and identified optimal foods to rehabilitate the gut.
While still in its early days, eating to rebalance the gut microbiome is certainly a fascinating area of research. With his personal and professional background, Robb brings a new angle to the discussion.
The great thing about the Paleo template is that is that it eliminates most of the nutrient-poor foods that will spike your blood glucose and insulin levels as well as nutrient poor processed grains and sugars.
Nutrient-dense whole foods and the healthy dose of cellular carbohydrates also tend to feed a broad range of ‘good bacteria’ rather than the narrow band of pathogenic bacteria that can be fed by processed carbs and simple sugars. In the book, Robb tries to strike a balance between accessible mass market books and driving the science forward with novel and complex discussions. While he could ‘nerd out’ and ‘go down the rabbit hole’ he could make sure that his analysis and recommendations are simple enough to not lose people who are not steeped in evolutionary biology or nutrition science.
But is it Paleo?
An overly simplistic view of the Paleo diet led to a mindless process of asking “Is this food Paleo?” versus the more appropriate question “Is this food a good option for me?”
On the other hand, if the details on how the diet works starts to look like Advanced Chemistry, a typical reader would rather roll around naked in broken glass. I will aim to strike a balance between the two extremes, giving you sufficient information in a simple way so you understand how these choices will help you live a healthier life.
The overarching theme of the book is that we are Wired to Eat to ensure the survival of the species. Wanting a doughnut is not a moral failing that you should feel guilty for. From an ancestral perspective, it’s just how we’re programmed to perpetuate the survival of the species. Robb continues:
If you live in a modern, Westernized society of relative leisure and abundance but are not fat, sick and diabetic, you are, from a biological perspective, “screwing up.”
Our species is here today because our genes are wired to eat damn near everything that is not nailed down. Related to this is an expectation, again woven into our genes, that the process of finding food requires that we are active.
In unambiguous terms, we are genetically wired to eat simple, unprocessed foods, and to expend a fair amount of energy in the process (walk, run, lift, carry, dance).
But modern life affords us the luxury of sedentary and the most varied assortment of delectable food imaginable. It is now possible to order food to your door, work from home, and sit when we travel, while our not so distant ancestors routinely walked 5 to 10 miles per day. This is our conundrum.
The reason we get fat, sick, and broken, and the reason why it’s so hard to change our diet and lifestyle, is simple: our environment has changed while our bodies have not – at least not enough to forestall the development of a host of degenerative disease. Our genetics are wired for a time when our meals were relatively simple in terms of flavour and texture. We only had access to foods that changed with the seasons and we always had to expend some amount of energy to get the goods.
Robb draws the parallel between processed and manufactured “food porn” and, well, real porn.
Once we become overexposed to things that are impossible to achieve naturally (whether that be Doritos…
…49 chemically generated flavours of jelly beans…
…effortless ketones in a packet…
…or having fifty browser tabs open of surgically enhanced people performing superhuman feats of “intimacy”)…
…we lose our taste for and become desensitised to the real things that can be found in nature.
The modern environment stimulates the senses while delivering nothing
The problem with the surreal world we live in comes when the Doritos or the Jelly Beans don’t provide the nutrition that their chemically induced flavours promise, or when the surgically enhanced people and ‘social media’ don’t deliver the relationship, intimacy, and meaning that we’re really craving and adapted to thrive on.
Aside from food quality, Robb also addresses the mismatch between what our species are adapted to when it comes to movement, relationships, light, and sleep.
Studies have indicated that inadequate social connectivity increases early death potential as much as a pack-a-day smoking habit.
Although Rob is pro low carb for the right application, he’s also pragmatic about it. After being a low carb zealot and breaking a number of CrossFit clients, he understands that low carb isn’t optimal for everyone.
For some, a higher fat intake, particularly with adequate protein, causes a spontaneous reduction in calorie intake due to a profound sense of satiety. Folks who eat this way tend to experience fairly easy fat loss and dramatic improvements in health parameters such as blood sugar and inflammation.
Keep in mind, however that this might have nothing to do with the satiety of fat specifically and everything to do with removing junk carbs from the diet, which can hijack the neuro-regulation of appetite and make us feel hungry.
Some folks who really buy into the insulin hypothesis of obesity say that with elevated insulin levels we cannot get fats out of cells. Elevated insulin levels certainly play into the ease of liberating fat from adipocytes; this is why insulin sensitive people can lose body fat on relatively high-carb, low-fat diet.
Conversely, however, folks with insulin resistance will find the high-carb, low – fat approach almost impossible to lose weight on, but may thrive on a lower – carb, higher protein / fat mix. Once the underlying resistance has been addressed, these people may find they tolerate more carbs and can shift their diet accordingly but this is a highly individual thing.
Coming from a physical performance and diabetes headspace, Robb has a good grasp on the importance of muscle mass, blood glucose control, activity, and endocrinology.
The brain becomes leptin resistant and the muscles become insulin resistant. This fools the brain and the liver into believing we are starving. So, despite being awash in excess calories, the body releases glucagon, cortisol, and adrenaline, behaving as if would it we were in an underfed or starvation state.
The release of these catabolic hormones leads to a host of problems, not the least of which is muscle and bone wasting. This occurs in anyone with insulin resistance (estimates range as high as 50 percent of the US population) and particularly for diabetics. What’s worse, when you lose muscle mass, you have even fewer places to store glucose, which further exacerbates the problem of excess glucose storage.
High insulin levels downregulate insulin receptors, which increases insulin resistance and puts more and more stress on the pancreas. This is the race toward uncontrolled type 2 diabetes, accelerated aging, increased rates of cancer, neurodegenerative disease, cardiovascular disease and kidney failure.
Having higher levels of functional muscle mass means we don’t have to rely as heavily on our pancreas producing insulin.
The spread in macronutrients appears to have little if any impact on health as long as the foods are mostly unprocessed and the carbohydrate comes mainly from fruits, vegetables and tubers.
Food quality should be the greatest priority for most people before they start worrying about micromanaging macronutrients. Restriction of carbs should be one of the last lines of defence against high blood glucose levels after you’ve got the food quality, sleep, sunlight, stress, and relationship issues sorted.
If we restrict ourselves to nutrient dense, unprocessed foods that our ancestors would have recognised as food most of us won’t need to worry so much about macronutrients. If we limit our exposure to modern engineered foods, we can pretty much eat whatever we desire, letting our appetite and cravings lead us to the nutrients we need.
From a scientific perspective, this nutrient density topic is actually the most credible argument for the Paleo diet; it arrives at this position not from anthropological observations, but rather from the best that reductionist science has to offer.
But if you couldn’t be bothered with abstract concepts like nutrient density that require some faith in number crunching by geeks like me, just ask yourself, “Would my ancestors recognise this as food?“ or “Is it Paleo?”
Armed with the insights of Dr Kirk Parsley, Robb spends a chapter talking about the importance of sleep and light exposure on our hormones. Just drugging yourself with sedatives or alcohol doesn’t bring sleep but rather just a lack of consciousness. You need to manage your light exposure (more during the day, less at night) to make sure you get real quality sleep.
One of Robb’s major goals of the book is to blitz the morality and guilt that surround food. So often we think that our lack of physical awesomeness is due to our lack of willpower or moral failures. The reality is that it’s not entirely our fault. We are programmed to binge on that bag of Doritos, Snickers, cheesecake, or the Jellybeans if we’re left alone with them.
This biological love of simple sugars allowed our ancestors to make it through the impending winter and become our ancestors. The problem is, these days, winter never comes.
Now we’re surrounded by summer foods (fruit, jelly beans, and fairy floss) and summer (blue) light. We never have to go through the discomfort of winter (fasting), relying on less sugar (low carb), and perhaps our body’s fat stores (ketosis).
So, what’s the new Paleo Solution in Wired to Eat? The first step is to figure out where you’re at so you can manipulate your environment to push you back the other way towards optimal. This is the essence of Personalised Nutrition that is central to the book.
The key factor is to understand when it comes to low carb and blood sugars is that if exceeded your liver’s ability to process and store sugar we need to give it a break for a while. Meanwhile, if you’re insulin sensitive, you may benefit more from tweaking your diet towards more whole, unprocessed carbs and less fat.
The table below and the accompanying food lists are my attempt to identify the optimal (most nutrient dense) whole foods that will suit different people with different starting points and different goals. Rob takes a similar if maybe simpler approach in his book. He is conscious of not over complicating things.
It’s not primarily about self-discipline, guilt, calorie counting, or a one-size-fits-all dietary approach. Personalised nutrition is about understanding where you are now and where you want to be. You then need to actively “deprive yourself” of the foods that you are no match for and surround yourself with the environment that will help you reach your goals.
Resistance is useless when you’re surrounded by “food porn”, but you’re Wired to Eat.
Lately, I’ve seen a number of common themes come up at low carb conferences and online. The contentious questions tend to run along the lines of:
I did really well on a low carb diet initially, but my fat loss seems to have stalled. What gives? What should I do now?
If protein is insulinogenic should I actively avoid protein as well as carbs if my goal is to reduce insulin because low insulin = weight loss?
If eating more fat helped kick start my weight loss journey, then why does eating more fat seem to make me gain weight now?
This article outlines some quantitative parameters around these contentious questions and helps you chose the most appropriate nutritional approach.
the importance of monitoring blood glucose levels
Coming from a diabetes headspace, I’ve seen firsthand the power of a low carb diet in reducing blood glucose and insulin levels. As a Type 1 Diabetic, my wife Moni has been above to halve her insulin dose with a massive improvement in energy levels, body composition and mood.
If your blood glucose levels are high, then chances are your insulin levels are also high. Insulin is the hormonal “switch” that causes us to store excess energy as body fat in times of plenty. Lower levels of insulin in times of food scarcity then enable us to access to the stored energy on our body.
The chart below shows that our glucose response is fairly well predicted by the carbohydrates we eat. (note: The “glucose score” is the area under the curve of glucose response to various foods tested over the three hours relative to glucose which gets a score of 100%.) 
Having high blood glucose levels is bad news. The chart below shows the correlation between HbA1c (a measure of your average glucose levels over three months) and the diseases that will kill most of us, cardiovascular disease, coronary heart disease and stroke. It makes a lot of sense to do whatever it takes to reduce our blood glucose to the levels of a metabolically healthy person to postpone the major diseases of aging.
optimal ketone levels
Ketones in our blood rise when our insulin levels are low. As shown in the chart below, even better than carbohydrates, insulin levels are better predicted by the net carbohydrates plus about half the protein we eat.
The problem however with this chart is that it is difficult for most people to achieve “optimal ketone levels” (i.e. 1.5 to 3.0mmol/L) without fasting for a number of days or making a special effort to eat a lot of additional dietary fat (which may be counterproductive in the long run if you’re trying to lose weight).
Recently I had the privilege of having Steve Phinney stay at our house when he spoke at a Low Carb Down Under event in Brisbane (btw, he’s also a passionate cook if you let him loose in the kitchen). I quizzed Steve about the background to his optimal ketosis chart. He said it was based on two studies, one with cyclists who the adapted to ketosis over a period of six weeks and another ketogenic weight loss study. In both cases these ‘optimal ketone levels’ (i.e. between 1.5 to 3.0mmol/L) were observed in people who were transitioning into a state of nutritional ketosis.
Since the publication of this chart in the Art and Science books, Phinney has noted that well trained athletes who are long term fat adapted (e.g. the low carb athletes in the FASTER study) actually show lower levels of ketones than might be expected. It appears that over time many people, particularly athletes, move beyond simple keto adaption and are able to utilise fat as fuel even more efficiently and their ketone levels reduce further.
Metabolically flexible people are able to access and burn fat efficiently and hence only release free fatty acids or ketones into the bloodstream when they need the energy. If you’re metabolically healthy and can call on your fat stores as required there’s no need to be walking around with super high levels of glucose or ketones.
If you’ve been following a ketogenic diet for a while and/or are metabolically healthy then your ketone levels may not be as high as you might expect from looking at Volek and Phinney’s “optimal ketone zone” chart.
And as discussed in my Alkaline Diet vs Acidic Ketones article, higher ketone levels could even be an indication that you have some level of metabolic acidosis. People with untreated Type 1 Diabetes have very high ketone as well as blood glucose levels at the same time (i.e. ketoacidosis).
Phinney says he does not condone the “adolescent behaviour” of competing to see how high you can get your ketone levels and warns that you can risk a loss of lean body mass by chasing high ketone levels with an inappropriately low insulin load approach (i.e. very low carb and very low protein).
People with higher NAD+ levels (an important coenzyme which declines with ageing) and lower NADH levels are more likely to produce more breath acetone (which can be measured with the Ketonix) and fewer BHB ketones in the blood. Hence, higher consistent levels of breath acetone may be a more useful indicator than blood ketones that you are burning fat rather than just eating fat.
“The ratio of β-OHB to AcAc depends on the NADH/NAD+ ratio inside mitochondria; if NADH concentration is high, the liver releases a higher proportion of β-OHB.”
While I think it’s good to have some ketones in the blood as an indication that your insulin levels aren’t too high, it can be hard to interpret what high or low level of blood ketones mean.
As noted in Peter Attia’s Fat Flux article, the BHB ketones you measure in your blood is a function of:
the dietary fat that you’re eating,
plus the fat being liberated from your body fat (lipolysis),
minus the BHB being used by your muscles, heart and brain.
High blood ketones could mean that your insulin levels are low and your level of lipolysis is high (i.e. lots of fat is being released from your body). In this case, high ketones are an indicator of metabolic health and may facilitate healthy appetite regulation and enable you to burn your stored body fat.
However, high blood ketone levels could also mean that you are eating a lot of dietary fat (or consuming a lot of exogenous ketones) and your body isn’t well adapted to using ketones for fuel and hence unused ketones are building up in your blood stream. If this is the case, then loading up with more dietary fat in the pursuit of higher ketone levels may cause you to become more insulin resistant and inflamed as your ketone levels rise but the fat is not yet able to be efficiently oxidised for fuel.
The plot below shows a compilation of glucose and ketone values from a range of people following a low carb or “ketogenic” diet. It seems that the most metabolically healthy people have low blood glucose levels and moderate ketones at rest, however they can easily access plenty of glucose and fat from the body when required.
It makes sense to me from an evolutionary perspective that someone who is healthy would be able to conserve energy when not active (i.e. hiding in a cave) but then be able to quickly access stored energy when required (i.e. when being chased by a sabre-toothed tiger). The body doesn’t always need super high blood ketone levels and hence we secrete insulin to remove both glucose and ketones back into storage.
The exception to this seems to be in periods of extended fasting when the body is on high alert and we are in a super-fuelled state ready to chase down some food at a moment’s notice.
So, unless you’re fasting or exercising intensely, it seems that having a lower total energy (i.e. blood glucose plus blood ketones) might be a better place to be rather than having super high ketone levels.
There is also interesting emerging research suggesting that as we become more fat adapted we can obtain more fuel from fat and hence do not need to rely on ketones which are more of an emergency fuel source during starvation. It’s as if, just like in time we no longer measure high ketones in the urine as we utilise them better, we also start to show less ketones in the blood. Quoting my friend Mike Julian:
I think we become less ketogenic with further adaptation simply because as we improve our ability to utilize the fat we create spin off glucose from both glycerol and acetone that goes to restore beta oxidation of fatty acids.
The spin of glucose provides oxaloacetate and restores Krebs function in the liver and reduces ketogenesis in favour of complete oxidation of acetyl-CoA. In short, ketogenesis is a transitional state, not the end goal.
Ketones will be lower if you’re fit. Even Phinney has said that very adapted individuals are in ketosis starting at 0.3mmol. Look at how robust the GNG is in the low carb guys in the FASTER study. It is a direct result of the nearly doubled rate of fat oxidation.
All of the glycerol when fat is oxidised has to go somewhere and it is used to make glucose. This glucose is then used to restore the Krebs cycle which means that the can make even better use of fat etc, but reduces GNG via traditional means and in turn reduces ketogenesis.
It’s a system that feeds into itself. The better fat burner you are, the more glucose you make from fat, the better you are at fat burning and so on.
As we get better at fat utilisation we also get better at deriving glucose from fat metabolism. This source of glucose reduces the need for ketogenesis.
So overall, measuring blood ketones is intriguing, but not always the most reliable measure of where your metabolic health status. Moreover, eating more dietary fat in an effort to raise your blood ketone levels is no guarantee that you’re going to lose body fat.
You may be “ketogenic” in that you are able to generate ketones, though they may not necessarily show up in high levels in the blood if you are also athletic and able to use your blood glucose and ketones effectively for energy.
the relationship between ketones and glucose
The chart below shows the generalised relationship between blood glucose and blood ketones for different people with:
Type 2 Diabetes,
Mild insulin resistance, and
someone who is metabolically healthy.
(note: Someone with uncontrolled Type 1 Diabetes would be literally ‘off the chart’ with high blood glucose and high blood ketones.)
The table below shows the HbA1c incident rates for cardiovascular disease, stroke and coronary heart disease from the chart above to average blood glucose levels and the corresponding ketone levels and glucose : ketone index values. This gives us a useful understanding of what different HbA1c risk levels look like in terms of average blood glucose levels, ketones and the glucose : ketone index.
metabolic health level
average blood glucose
While it can be interesting to measure ketones, as a general rule, if you have consistently high blood glucose levels you are likely to be insulin resistant and hence will benefit from a higher fat dietary approach.
If you have high insulin and glucose levels, when transitioning to a high fat diet your glucose and insulin levels will likely plummet to be closer to the levels of a metabolically healthy person and suddenly you will be able to access your body fat stores for fuel. You might quickly find yourself losing weight like it was magic and you’ll think the keto diet is the best thing ever! Amazingly, lots of people find that they can “eat fat to satiety” and still lose weight (at least during this initial stage).
For the last four decades we’ve been told to avoid fat, particularly saturated fat. Imagine the excitement, enthusiasm, and maybe even anger, when someone who has been avoiding fat finds that they suddenly start losing weight when the do the opposite to what they’ve been told to do!
it works until it doesn’t
The problem with adding more dietary fat is that it works until it doesn’t.
Let’s say (based on the levels of metabolic health in the table above) you are able to successfully “level up” from the “danger zone” though “good” blood glucose control to “excellent” blood glucose levels with a high fat dietary approach, but then your weight loss slows and then stops well short of your optimal body fat levels.
What do you do now?
Do you listen to the people who say you should eat more fat or the people who say you should eat less fat?
It can be confusing on the interwebs!
I think the answer depends largely on whether you are insulin resistant or insulin sensitive. You should ‘level up’ to the most nutrient dense nutritional approach that your current level of insulin sensitivity allows.
It’s worth noting that while many people can achieve ‘excellent’ blood glucose levels through dietary manipulation, the people that I’ve seen get to truly optimal blood glucose control tend to be working hard with both their nutrition and training to maximise their lean body mass.
what is insulin resistance anyway?
In order to understand what we need to do when we stop losing weight on keto I think it’s important to understand what causes insulin resistance.
Many people think that people who are fat are simply insulin resistant. This is partly true. However, while insulin resistance and obesity are related, it’s not quite that simple. It’s useful to understand the difference.
A metabolically flexible insulin sensitive person stores excess energy eaten for later use in the fat stores on the body (i.e. adipose tissue). When they stop eating, someone who is insulin sensitive will experience a drop in blood glucose and insulin levels and stored body fat will be released. For the lucky people who are insulin sensitive, calories in calories out (CICO) largely works as advertised. They find it difficult to depart far from a healthy set point weight without a change in diet quality or insulin load.
However, as we keep eating more and more low nutrient density foods to obtain the micronutrients we need, we get to a point where the adipose tissue can no longer hold all that excess energy and starts to channel it into the organs because the fat stores are full.
The body knows that this isn’t such a great idea though because our vital organs are, well, vital, so the body becomes insulin resistant as a defence mechanism to avoid damage to vital organs, and hence the levels of sugar in our blood rise to avoid storing the extra energy in the organs. The body even starts dumping the excess sugar into the urine to avoid having to pump it into the liver, pancreas, eyes and brain.
The a of the major problems with insulin resistance is appetite dysregulation. That is, when you are insulin resistant your insulin levels stay higher for longer which then makes it harder for you to access your body fat for fuel between meals. As shown in this chart, if your blood glucose levels are high the release of fat from your body (ketones) will be low, ghrelin will kick in, and it will be hard to go very long without food. Your appetite will be more likely to win out over your willpower and thus make it hard to lose weight if your insulin levels are high.
Eating “low carb” or “keto” enables us to lower insulin levels to the point that our appetite works more in line with the way it’s meant to when we were metabolically healthy / insulin sensitive / metabolically flexible. Our appetite drives us to seek out nutrients and energy when required and stop when we have had enough. (note: keep in mind though that lower insulin levels are due to eating a lower dietary insulin load, not necessarily due to more dietary fat.)
Once our appetite is restored and we can more easily access our own body fat I think we need to change focus, especially if adding more fat isn’t moving you toward your weight loss goals.
be a nutrient chaser
Once your blood glucose levels are normalised but you’re stuck on a plateau and not sure where to turn I think it’s a good idea to turn your focus to chasing nutrients rather than ketones or even worrying about blood glucose levels quite so much.
As your blood glucose and insulin levels decrease, you should be able to release more body fat stores and hence have less need for dietary fat. When we focus on balancing micronutrients macronutrients largely look after themselves.
As well as adequate energy, the body works hard to make sure it gets the nutrients it needs to thrive. The vitamins and minerals that come with whole foods are like the spark that ignites the fuel they contain. We always get ourselves into trouble when we separate nutrients from energy. While refined sugars and grains are particularly problematic because they spike insulin, neither refined sugars or purified fats contain the same level of nutrients necessary to power our mitochondria that whole foods do.
The problem comes when we eat nutrient poor foods. We are left with a residual need for nutrients that are required to convert our food into energy (ATP). Our appetite will drive us to seek out more food to obtain the required nutrients.
“Added sugars displace nutritionally superior foods from the diet and at the same time increase nutritional requirements. Specifically, vitamins such as thiamine, riboflavin and niacin are necessary for the oxidation of glucose, and phosphates are stripped from ATP in order to metabolise fructose, which leads to cellular ATP depletion. The metabolism of fructose also leads to oxidative stress, inflammation and damage to the mitochondria, causing a state of ATP depletion. Hence, the liberation of calories from added sugars requires nutrients, and increases nutritional demands, but these sugars provide no additional nutrients. Thus, the more added sugars one consumes, the more nutritionally depleted one may become. This may be particularly extreme in individuals whose habitual diet is already lacking in key micronutrients.”
“A nourishing, balanced diet that provides all the required nutrients in the right proportions is the key to minimising appetite and eliminating hunger at minimal caloric intake.”
“To produce ATP efficiently, the mitochondria need particular things. Glucose or ketone bodies from fat and oxygen are primary. Your mitochondria can limp along, producing a few ATP on only these three things, but to really do the job right and produce the most ATP, your mitochondria also need thiamine, riboflavin, niacin, pantothenic acid, minerals (especially sulfur, zinc, magnesium, iron and manganese) and antioxidants. Mitochondria also need plenty of L-carnitine, alpha-lipoic acid, creatine, and ubiquinone (also called coenzyme Q) for peak efficiency.”
If we don’t get enough amino acids to prevent loss of lean muscle mass the body will also up-regulate appetite (i.e. protein leverage hypothesis). While we can track our food intake to try to actively manage our energy intake, in the end, appetite, driven by the body’s need for nutrients, tends to win out.
Even if we are successful in limiting our intake, our body senses an energy crisis and slows down to make sure it has enough energy and stored fat to run our inefficient metabolism. However, when we consume whole foods with a higher nutrient density our appetite tends to be satisfied with less energy because it can run more efficiently with an optimal balance of the nutrients it needs.
If we want to lose weight we need to find a way to provide the body with the nutrients it needs to function optimally with the minimum amount of energy intake while still maintaining low enough blood glucose and insulin levels to allow energy to flow out of our fat stores.
LCHF says calories don’t matter. But I still gain weight even when in ketosis. What’s up with that?
There was a range of responses from the panel of medical doctors, not all in agreement, but my favourite answer was from Dr Ted Naiman (pictured below on the cruise) who said:
I have tons of patients who absolutely plateau out on this diet. Everyone who goes on LCHF loses a ton of weight, and then hits a plateau. This is extremely common. Almost universal.
If you eat enough fat, the flow of fat into your adipose sites will equal the flow of fat out of your adipose sites and you’re just going to plateau.
My number one priority is nutrient density. Eat less fat bombs and instead eat the highest nutrient density foods you possibly can and then more of the fat that you’re burning comes from your internal body stores.
I recommend really high fat diets for people who are really glucose dependent to help them get fat adapted. Then, once you have reached your ideal body weight you have to eat a high fat diet then as well because you’re burning fat. But there is a period in the middle when you’re plateaued when you do want to eat less fat because you want your fat to come off stored body fat.
are you really insulin resistant?
I think the critical question here is whether you are really insulin resistant. The most useful measure is simply to test your blood glucose levels.
If you have been diagnosed with diabetes, then you will have a glucose meter and you’ll be able to easily test your blood glucose levels to know where you’re at. Glucometers are fairly cheap to purchase and often come with a rebate.
There are many people who are fatter than they want to be but still have reasonable insulin sensitivity and normal blood glucose. For these people, eating more fat doesn’t always get them where they want to be.
At the same time, many skinny people are actually insulin resistant (TOFI). It of depends on how much energy your belly is willing to store before it starts pumping the excess fat into your vital organs.
The irony here is that you may look healthier if you are skinny, but it may mean that your adipose tissue is able to store less energy before it transitions to start storing excess energy in your vital organs.
For those of you that don’t like testing your blood glucose level I have outlined a number of other ways to determine whether you are actually insulin resistant. This understanding can then be used to understand whether you may need more or less dietary fat.
oral glucose tolerance test
An Oral Glucose Tolerance Test (OGTT) is the generally accepted medical test for insulin resistance and diabetes. An OGTT measures someone’s rise in blood glucose in response to a large amount of ingested glucose. If it goes up too much after a standard amount of glucose then you are deemed to be insulin resistant.
The problem is most people following a low carb approach will likely fail an OGTT because of physiological insulin resistance. Someone following a low carb diet won’t have a lot of insulin circulating in their body, so when they ingest a large amount of fast acting glucose their pancreas will respond from a “standing start” and has to pump out a lot of insulin to respond to the glucose. The glucose levels of someone following a low carb dietary approach may rise quite a lot before the pancreas can catch up.
By comparison, someone eating more carbohydrates would have higher levels of insulin circulating that will act on the glucose as soon as it was ingested with only a little bit of extra insulin needing to be secreted in response to the food and hence the glucose response would be lower.
A Kraft Insulin Assay, which measures insulin response over time to a certain amount of glucose, will give you an accurate idea of whether you’re insulin resistant, however these tests are expensive and fairly hard to obtain. A Kraft Test might be a useful way to see if your are becoming insulin resistant even if your glucose levels are keeping up, for now.
oral protein tolerance test
Whether or not your blood glucose levels rise or decrease in response to a high protein meal with no carbohydrate is also a useful way to understand if you are insulin resistant.
Someone who is metabolically healthy will release glucagon and insulin in response to protein as it is metabolised to maintain a stable glucose level. Someone who is insulin resistant may not produce adequate insulin to counteract the glucagon released by the liver and hence they may see their blood glucose levels rise.
If you find your glucose levels do rise significantly response to protein, it may be a sign that you need to slow down a little on the protein (or at least limit processed protein powders and opt for whole food sources of protein which are harder to overeat).
Realistically though, unless you’re severely insulin resistant, have Type 1 Diabetes or are using therapeutic ketosis to manage a chronic health condition such as cancer, epilepsy, alzheimers or dementia, most people don’t need to micromanage their protein intake if they are eating a range of unprocessed whole foods.
Your ability to handle protein may improve with time as your insulin resistance improves or you build a bit more muscle mass. Actively avoiding protein to minimise insulin may be counterproductive in the long term if it leads to loss of lean body mass.
optimal dietary approach survey
While testing blood glucose is a pretty good indicator of your insulin resistance status, there are a number of reasons that you may not want to test, including:
you don’t yet own a blood glucose meter,
you don’t like the sight of your own blood, or
test strips can be expensive, especially if not covered by insurance.
Beyond testing your blood glucose and / or ketone levels, there are a wide range of other indicators that you may be insulin resistant and may need a higher fat dietary approach. I have prepared this multiple choice survey to help people better understand which dietary approach might be ideal for them based on their situation and goals.
You may be insulin resistant and / or benefit from a higher fat diet if you answer yes to most of these of these questions. If you answer no to most of these questions then you may do better if you focus on nutrient dense foods rather than more fat.
Do you have a chronic health condition such as cancer, epilepsy, dementia, Alzheimer’s, Parkinson’s, severe insulin resistance or traumatic brain injury?
Have you been diagnosed with diabetes?
Is your HbA1c greater than 6.4%?
Is your fasting glucose greater than 7.0 mmol/L?
Is your post meal glucose level greater than 11.0mmol/L or 200 mg/dL?
Is your triglyceride:HDL ratio greater than 3.0?
Are your triglycerides greater than 1.1mmol/L or 100mg/dL?
Are your blood ketone levels less than 0.3mmol/L?
Is your fasting insulin greater than 20 uIU/mL or 120 pmol/L?
Is your C-reactive protein greater than 1.0 mg/dL?
Does your blood glucose level rise significantlyafter eating a large protein only meal?
Do you have a big hard belly (fat stored around the organs , ot on the surface)?
can I take my insulin levels to zero?
You cannot eliminate your need for insulin by eating a 100% fat diet, or even not eating at all.
Back in the 70s Dr Richard Bernstein worked out by self experimentation that people with Type 1 Diabetes require both basal and bolus insulin. Basal insulin is required, regardless of food intake, to stop the body from breaking down its own lean body mass. Bolus insulin is required to metabolise the food eaten.
Someone on a typical western diet has about a 50:50 ratio of basal to bolus insulin. Someone on a low carb diet will require less insulin, however 80% of their insulin dose required as basal insulin and the remaining 20% for their food. While the body typically doesn’t secrete insulin in response to fat, and appetite is often reduced on a high fat diet, if we force an energy excess with high levels of processed fats there will always be enough basal insulin circulating in the blood to remove the excess energy to our fat stores.
Someone with Type 1 will modify their insulin sensitivity factor in their insulin pump to match their insulin sensitivity to optimise their blood glucose control. People without Type 1 Diabetes can change their insulin sensitivity (and hence require less insulin) by, amongst other things, being exposed to less insulin and improving our level of lean body mass (muscle) and mitochondrial function. It is important to ensure your diet has adequate protein to build muscle as well as exercising that muscle to make sure our body is well trained and efficient at using that energy.
Having well trained lean muscle mass is critical to glucose disposal and insulin action and thus reducing overall insulin levels. In addition to avoiding foods that quickly raise our blood glucose levels, we need to train our body to dispose of the glucose effectively and efficiently with less reliance on large amounts of insulin through building lean body mass. This is achieved by (amongst other things like sleep, sunlight, reduced stress etc) eating nutrient dense foods that power up the mitochondria to enable us to burn the energy efficiently.
so just tell me what to eat!
I have prepared the table below to guide people to the most optimal foods based on their blood glucose levels and current level of insulin resistance and whether you need to lose weight (based on your waist to height ratio).
There’s no nutrient poor processed grains or added sugars in any of these lists.
The therapeutic ketosis foods have higher levels of added fat. The nutrient dense weight loss foods contain more lean proteins and non-starchy veggies and less added fat.
Someone with poorly controlled Type 2 Diabetes may start out on a high fat ketogenic approach (say 2:1 fat to protein by weight), in time they should be able to progressively ‘level up’ to more nutrient dense foods as their insulin sensitivity improves and they find their blood glucose levels can tolerate it.
Someone who has long standing diabetes or who has Type 1 Diabetes may settle on a 1:1 for maintenance. Someone who becomes more insulin sensitive may be able to cut their dietary fat down even more as they are more easily able to release fat from their body fat stores. Even if someone wants to lose weight got down to a 1:0.5 protein to fat ratio by weight the majority of their energy is still coming from fat, they’re just given their body a better chance of needing to use dietary fat.
I hope this helps you find the optimal approach for you. I would love to hear how it goes.
“Complete abstinence is easier than perfect moderation.”
This article is a follow up to the “How to use your glucose metre as a fuel gauge” article, which has been quite popular, with lots of people reporting success in lowering their blood glucose and recalibrating their hunger signals by using the numbers they see on their glucose metre.
To recap, the process revolves around the idea that, perhaps even better than calorie counting or carbohydrate counting, the numbers you see on your blood glucose metre are a good indication of whether you are running low on fuel and need to eat or whether you are just eating out of habit, routine, social boredom or for entertainment.
While eating for pleasure occasionally or as part of a celebration is fine and part of enjoying life, in the long run, most of us need to find a way to obtain the nutrients we need with less energy if we want to avoid obesity, diabetes and all the associated negative consequences.
If we eat highly insulinogenic low nutrient density foods regularly our insulin levels stay high and our fat stays locked in storage and hunger drives us to eat more frequently. However, if we reverse this cycle to lower our glucose and insulin to normal levels we start to eat less frequently and we allow our stored energy to flow out of our fat cells, our appetite decrease and there is a good chance we will lose weight and gain health.
The table below shows the simple process whereby someone could decide if they really need to eat. Using this process would ensure that their blood glucose levels continue to trend down as their excess energy in their bloodstream and vital organs (pancreas, liver etc) flows out of storage.
> 7-day average, well slept and low-stress
delay eating and/or exercise and wait for blood glucose to come down
if hungry, eat higher insulin load foods and delay exercise
Using numerical outputs to guide our decision making
There is no end of debate as to whether a calorie is a calorie or whether calories matter. Rather than tracking estimates of inputs like calories eaten or calories burned in exercise, there is nothing like tracking outputs such as your blood glucose levels, waist or weight to understand what your body is doing with the food you are eating and whether you are eating too much or too little.
If your glucose levels, insulin, waist or weight are increasing then chances are you’re eating too much, too often or the wrong type of food.
The plot below is a stark reminder that our chances of living longer improve if we have lower body fat levels or a waist to height ratio close to 0.5.
The problem with tracking glucose levels
The ‘problem’ with tracking blood glucose levels is that, in time, with regular fasting, our glucose levels will normalise to healthy levels but we may still be left with excess weight. So where do we turn once our blood glucose levels are optimal but our body fat levels are still above optimal?
This brings us to the star of this article, Rebecca Latham, who is a great example of how you can use your body measurements to guide your feast / fast cycle to achieve your long-term goals.
After a stressful time towards the end of 2015 Rebecca Latham decided she needed to make a focused effort to her lose some extra weight that had crept on. Rebecca is also particularly motivated by her family history of ALS, Parkinson’s Disease, dementia and cancer and her own ongoing battle with Type 2 Diabetes.
On 1 January 2016, Rebecca set an initial goal to lose 0.2 pounds per day over three months. Rebecca was also eager to reduce her fasting blood glucose levels from the 100mg/dL back to the 70mg/dL that they had been at before she regained her weight.
Part of Rebecca’s inspiration comes from her uncle, Buell Carlton Cole.
He was general surgeon to the President of the United States, who would control his weight by simply not eating until he returned to his goal weight. I initially thought this was an unhealthy approach until I read up a more about intermittent fasting.
Rather than simply not eating until she achieved her goal weight, Rebecca’s system involved not eating on days when her weight in the morning was above her target weight. Her only exception was to be special occasions and celebrations.
Here are Rebecca’s weight loss results during her initial 90-day challenge. Initial weight loss can be quite quick as the insulin levels drop and the body releases water. However, it gets a bit harder to continue with straight line weight loss as time goes on as you can see towards the end.
After the reached her initial goal, Rebecca had some issues that she needed to look after and ended up regaining some of the weight as you can see in the plot below of her weight over the past year. However, once these challenges were behind her she got back on her program. For the final part leading up to the end of the year she has dropped her goal weight loss back to 0.06lbs per day to hit her goal on 31 December 2016. See if you can spot the few ‘blips’ around Thanksgiving and Christmas.
This chart shows that she needed to fast for about one day in three through the year to lose nearly a quarter of her body weight over the year!
Reflecting on her journey, Rebecca says:
I reached my highest lifetime weight in February 2009, when I weighed in at 158 pounds, with a body fat percentage of 43.7%. This is my scale weight chart for this past almost eight years since I started eating low carb high fat (LCHF) and nutritional ketosis.
Each time I lost weight and stopped tracking and weighing myself, I gradually put most of the weight back on again. As you can see by the chart, this happened several times, and the last few times it happened, my weight was going up a little higher each time.
On January 1, 2016, I developed and started using my Protocol. Since starting the Protocol, I took two breaks, once in May 2016 when my husband had a heart attack and I was too concerned with his health to care about my own, but I got back on the Protocol within a couple of weeks and started seeing success again.
The next time I took a break was in July 2016, when I had to eat high carb and not fast for a week in preparation for some metabolic testing. As soon as the testing was over, I was back on the Protocol and started losing again. I have been going strong ever since, with small gains here and there brought on by restaurant meals and Thanksgiving.
I have now I reached my ultimate goal for scale weight, weighing in at 122.4 pounds with a body fat percentage of 25.7%, which means that I have lost approximately 37.5 pounds of body fat. The Protocol is the only thing that has brought me sustained weight loss, and I plan to follow it for the rest of my life!
Many people have a love/hate or even just a hate/hate relationship with their bathroom scale. It would be nice if low carb or nutrient dense achieved optimal health outcomes without any restriction for everyone. However, unfortunately, sustaining weight loss in the long term often takes discipline, some form of accountability and some level of restriction for most of us.
While weighing yourself every day isn’t much fun, the national weight control registry data indicates that people who have successfully lost weight and kept it off weigh themselves regularly.   Rebecca’s intended long term maintenance plan will likely be to weigh herself regularly and fast again once her weight goes outside her target range.
Better than calorie counting?
Some people who first try low carb or keto find that they initially lose a lot of weight eating to satiety as their blood glucose and insulin levels drop to healthier levels. However, in the long term, many people find that they need to be more disciplined and mindful of how much and/or how often they are eating to reach their optimal level of body composition.
The great thing about combining fasting with working to a goal like this is that it makes sure you don’t overdo the feasting days. I’ve found personally that it can be hard to know how much to eat after a fast. A quantitative system like this helps to manage and calibrate your appetite when you’re feasting.
If you eat to satiety, and not beyond, then you won’t have to fast again as soon as compared to if you binge after your fast. Eating to satiety on a regular basis means that your body’s metabolism doesn’t slow and adjust in the same way that it would if you maintained a constant caloric restriction.
Life extension benefits
There are a number of benefits to fasting:
You can reduce your insulin levels more than if eating small but regular meals which keeps your insulin levels consistently elevated.
Fasting gives your body a chance to repair through a process called autophagy which is where the old cells are cleaned up which allow space for the fresh new cells to grow.
Fasting trains your body to become ‘metabolically flexible’ so you can use your body fat stores for and your food for fuel.
There is less need to focus on the quantity of food eaten at every single meal.
It’s not ideal to always be in growth mode with mTOR switched on. Alternating periods of growth and repair appear to be more beneficial in the long term.
Fasting makes sense from an ancestral point of view when we wouldn’t have had constant access to plentiful food the way we do now. Periods of intentional restriction mimic what we have become adapted to and follow the seasons of the past.
Fasting also seems to have some special anti-aging effects. When food is scarce your body senses an emergency, and sends out sirtuin proteins to maximise the health of our mitochondria to increase the chance that you will survive the famine and have the best chance of living to a time when food is more plentiful and you can reproduce and pass on your genes. Unfortunately, this emergency repair function doesn’t happen when food is plentiful.
Fasting and blood glucose levels
During the first three months following her protocol, Rebecca added a blood glucose target to also bring her blood sugar down by 0.25 mg/dL per day. As you can see in the chart below her blood glucose levels have dropped pretty much in parallel with her weight loss during this time.
More recently, she tested her blood glucose levels and found that they were consistently great so she ended up discontinuing the testing because it was becoming monotonous and not helping her make useful decisions.
While it’s useful to track a few things, it can be overwhelming and time-consuming to keep track of too many things at once and lead to analysis paralysis. It’s good to find a handful of things to track that will help you make useful decisions.
Do we lose fat or muscle during fasting?
One hot topic of discussion is the amount of lean mass (i.e. or muscle) that one may lose in long term fasting.
The reality is that any weight loss is going to consist of a combination of water, fat and muscle (or lean muscle mass). The chart below from Kevin Hall’s model shows that we initially lose a lot of carbohydrate (glycogen) and with it a lot of water.
Protein / muscle loss is the smallest component of loss from the body and this decreases as we adapt more to using fat and ketones rather than relying on glucose. It takes a few days to adapt to using fat and ketones, but in the long run they are by far the greatest proportion of energy used during fasting.
Rebecca’s experience aligns with this. She didn’t get a DEXA scan, but she does take regular body measurements which she uses to calculate her body fat percentage (see US Navy Circumference Method). Based on these measurements she lost 28.6 lbs of fat and 3.0 lbs of lean mass. So, more than 90% of her weight loss over the past year was fat.
“Problems” with fasting
Jason Fung has recently popularised the concept of fasting in the low carb community via his blog and videos and published The Complete Guide to Fasting. There is a ton of convincing evidence on the benefits of fasting which is an age old practice for a variety of reasons.
However, Dr Steve Phinney has come out highlighting his concerns with long term fasting with respect to loss of lean tissues as well as vitamins and minerals. A number of others have expressed concerns that fasting without due care and attention to refeeding will not be beneficial in the long term.
One way to reconcile the differences is to see these concerns as two ends of the spectrum. Jason’s focus is very sick people who come to him with major kidney issues due to their advanced Type 2 Diabetes, while Steve’s focus is more around maximising athletic performance for those whom maintaining muscle mass is critical to performance.
Also, if you are more fat adapted your body will be able to more easily draw energy from stored body fat rather than requiring glucose which can be drawn from the protein in your body via gluconeogenesis.
Most people don’t fit neatly into either of the extremes, so how do you refine the approach to suit your current situation? That is where optimising your food choices to suit your current situation comes in.
How much to eat after your fast?
Personally, one challenge I find with fasting is that it’s easy to overdo it when you get to eat again. I think some people experience this more than others. Dr Phinney made the analogy that telling someone not to binge at the end of a fast is like telling someone to hold their breath but then not to take too big a breath when they come up for air.
While some people can eat normally the next day after a fast, personally I find that it’s easy to reach for the energy dense lower nutrient dense foods or to give yourself liberty to eat foods that you may not normally eat if you were being disciplined all the time. By doing this, I’ve found it’s still possible to maintain or gain weight when fasting more days that you eat if you’re not disciplined with what you eat on your feasting days.
If you find yourself reaching for energy dense low nutrient density foods like processed carbs, a block of chocolate or litre of cream after your fast then you could take that as a sign that you need to revert to shorter fasting periods until you’re more fat adapted.
Another challenge with fasting is that it will deplete your system of vital nutrients in the long term meaning that you may be more inclined to binge when you do eat unless you’ve focusing on maximising nutrient density in your feasting periods.
What to eat after you fast
One of the unique things about fasting is that it forces your body into the cleansing process of autophagy and primes the body to rebuild. Hence, it’s especially important to feed the parts of the body you want to grow (lean muscle mass is critical for long term health) and maximise the nutrient density during the initial refeed.
In some ways, a fast is only as good as the feast afterwards that your body is highly primed to absorb. For me that means trying to plan some nutrient dense greens and a solid amount of protein for my first meal so I don’t end up reaching for the energy dense cream, butter or peanut butter or indulge in some junk carbage because I feel like I’ve earned it.
If your goal is to lose fat during the fast then it’s important to build back the essential vitamins, minerals and amino acids during the feeding period. The body will fight to get what it needs in the long run and I think you’ll have a better chance of avoiding cravings and involuntary binging if you maximise the essential nutrients of your food when you do this. And if you are using fasting to achieve long term weight loss I think it makes sense to try to get the maximum number of nutrients with the least amount of energy (a.k.a. avoiding empty calories and maximising nutrient density).
People looking to use fasting for long term weight loss may benefit from starting out with a higher fat dietary approach if they are very insulin resistant. However, as blood glucose levels progressively improve you should be able to transition to a more nutrient dense nutritional approach which will allow you to get your required nutrients with less energy.
I see a lot of arguments online regarding whether high fat keto or high protein is optimal. I think these arguments come down to context. The table below gives some guidance as to which approach might be right for you initially based on:
your blood glucose levels (if your glucose levels are high you will likely benefit from a higher fat keto approach, at least initially until your glucose levels start to normalise),
ketones (some is better than none, but there’s no need to chase high ketones with heaps of extra dietary fat, especially if you are trying to lose body fat), and
waist to height ratio (this is going to be more useful than the BMI chart to tell you if you still need to lose a bit of weight).
This graphic from Dr Ted Naiman demonstrates how foods are all somewhere on the sliding scale between maximum energy density and maximum nutrient density. If we are aiming for long term weight loss, we want to maximise nutrient density as much as we can while keeping blood glucose levels and insulin levels low. Then as we improve blood glucose levels and insulin sensitivity we will be able continue to move towards the right to more nutrient dense approaches which will help to provide satiety and adequate nutrition with less energy.
If / when we reach our ideal weight or level of body fat, we can afford to add back in some more energy dense foods because we are no longer trying to use the glucose in our liver (glycogen) and body fat from our belly. 
I originally started eating ketogenically a few years ago by eating very high fat, lower protein, and very low (sometimes zero) carbs. That worked for a while, and I lost weight, but as time went on, I found that I was eating so much fat and so little protein that I was getting hungry all the time.
I now get plenty of protein on my eating days. I am 5’3″ and eat 125g on the days that I feast. I find with this approach I am less hungry and my Protocol requires me to fast less often.
Losing lean muscle mass is bad news whether you’re a bodybuilder, a diabetic or an older person battling sarcopenia. Not only will losing muscle decrease your metabolic health, glucose disposal and metabolic rate, your body will also increase appetite to regain the muscle, making it harder to keep on losing the fat.
It’s not just about looking buff and building muscles, amino acids are critical to fueling mitochondrial function and creating neurotransmitters that assist in staying happy and sleeping well. For example, the amino acid tryptophan produces serotonin which makes us happy and melatonin which helps us sleep.
For reference, Rebecca’s 125g of protein per day ends up being 3g/kg LMB. This equates to 2g/kg LBM per day on average if you factor in the fact that she fasts every third day. This aligns with Volek and Phinney’s recommendations in the Art and Science of Low Carb Living (i.e. 1.5 – 2g/kg reference body weight) which equates to 1.7 to 2.2g/kg LBM . In Lyle McDondald’s Rapid Fat Loss Handbook he recommends between 1.8 to 4.4g/kg LBM protein, with a higher level of protein if you are lean and more active, and less if you are obese and inactive, to prevent muscle loss during a protein sparing modified fast.
The optimal food lists have been designed to help maximise nutrient density (including ensuring adequate amino acids) ideally without needing to rely on tracking calories. Rebecca does track what she eats, but mainly to make sure she is getting adequate protein on her feasting days.
The Protocol does not *require* tracking food intake, but I strongly recommend it. I found, for myself, that if I did not track on feast days, I ate too much fat and not enough protein, and I was having to fast a lot more to make my daily goals. Starting in April, I did start using the OKL macros and recommending the same to others.
Rebecca also practices early time restricted feeding (eTRF) which means she eats earlier in the day due to better insulin sensitivity which seems to be producing good results for a lot of people. I have heard a lot of reports from people that have found that eating earlier rather than later helps with sleep, appetite and blood sugar.
I encourage you to check out Rebecca’s Facebook group where she has documented her daily progress and learnings and supports others using the Protocol. You can download a spreadsheet and start tracking and sharing your own progress. Public accountability and a supportive community are always going to be helpful in achieving such a long-term goal.
Rebecca has ‘stacked’ several different techniques from her learnings to ensure her long term success this time around to fight her genetics and tendency to regain her weight.
Before launching in, there are several considerations to tailor Rebecca’s approach to suit your situation and goals such as:
Target rate of weight loss. Rebecca recommends that people aim for a maximum weight loss of 0.2lbs or 0.1kg per day. Anything more is typically hard to sustain in the long term. You might be feeling ambitious and this level might be easy to achieve when things are going well but it may be hard to sustain in the longer term, especially if you have a few social gatherings or parties that leave you with some catching up to do. As you approach your goal weight you may be glad you chose a less aggressive goal as the weight loss becomes a little harder to achieve.
Social context. This type of approach can be hard to work around family or social commitments. I like to enjoy good food with my family on the weekends and save my fasting for work days when it’s easier to skip food. When I’ve followed this protocol, it leaves me fasting Monday and Tuesday and eating dinner Tuesday night with the family or ideally a hearty breakfast Wednesday morning. Based on my scale weight I may end up fasting another day or two on Thursday and / or Friday.
What’s your maximum fasting tolerance? Fasting gets easier with practice. You might want to start with just skipping a couple of meals, then going for 36 hours, then a couple of days. If you find your cravings are leading you to binge or sacrifice food quality, then you may want to stick with shorter fasting periods or aim for a less aggressive target rate of weight loss.
What else do you want to measure? The good thing about measuring weight is that it’s easy. It can however be problematic in that there are a ton of things that influence your weight other than fat gain or loss (e.g. muscle, water, how full is your gut, when did you go to the toilet etc); it’s an easy way to measure your progress day to day. In the long term, you want to see a trend in the right direction. If you have diabetes, then you may also want to track your glucose and even your ketone levels. It will also be useful to track your waist measurement periodically to see whether you’re getting closer to your optimum waist to height ratio of 0.5, particularly if you are building muscle and hence the BMI chart categories won’t mean much for you. For reference, during 2016 Rebecca’s waist to height ratio went from 0.54 to 0.44.
How full is your stress bucket?
A word of warning, again from personal experience, is that this approach is simple, but it’s not necessarily easy. Wondering what number you will see on the scale each day can be exciting but a bit stressful. It can be frustrating when you see the number going in the wrong direction or not keeping up with your target rate of weight loss.
A regular fasting routine is another thing that you will add to your “stress bucket” and if you don’t already have your sleep, nutrition, relationships, stress, circadian rhythm and regular activity in check then the cortisol and related insulin spikes may make achieving long term success with this approach harder than it would otherwise be.
If you do have these things ticked off and you’re feeling relaxed after a Christmas holidays but may have overdone the celebratory food then you can download a copy of the spreadsheet from My Low Carb Road – Fasting Support and give it a go.