Thank you so much everyone for your comments and suggestions. I was curious to see how others would respond to this problem.
This post is a followup to my a senario that I was presented with – a new client who has been following a low carb diet and is doing 5 – 6 sessions of high intensity exercise – yet is not losing weight. paleozonenutrition.com/2013/02/10/crossfit-and-low-carb-paleo-why-isnt-this-client-losing-weight/
I’ll go through my thinking and consequent recommendations I gave this client at the initial consultation:
Body shape, waist to hip ratio:
First – I note that the this woman is fairly well muscled, (not the one in the pic – but my client), and her shape is pear, with a low waist to hip ratio linked with being sensitive to insulin. She is young and exercises regularly. Insulin resistance in on the other hand typically associated with an apple shape, so my client is therefore unlikely to be ‘carbohydrate resistant’. Yet – she is following a very low carb diet to lose weight; I believe is unnecessary.
She is doing 5 sessions of CrossFit per week, feels a lack of energy when training. Recovery is okay, could be better. Lets have a look at CrossFit. CrossFit is a very high intensity exercise. Workouts vary from weight lifting to bootcamp style with box jumps, kettlebells, pull-ups, push-ups, sprints etc. The primary fuel for this workout (for both intensity and the muscle fibres used) is glucose. This will come from muscle and liver glycogen and blood sugar. So every workout pulls a fair amount stored glucose (glycogen). Fats are not easily oxidised when exercise is this intense.
This woman is eating virtually no useable carbohydrates. So every workout decreases glycogen, yet it is not being replaced. Each workout requires glucose – yet she is not consuming it to keep glycogen full.
She is constantly craving carbohydrates, and every 2 or three days gives in to unbearable cravings and eats junk carbs (sugar, refined grains). To be honest this is probably saving her from completely crashing out.
The fallacy of using high carb = high insulin = fat storage theory
This woman considers these cravings a weakness, and because she is stuck in carbs = insulin = fat gain theory, and she is not losing weight, she cuts her carbs further. The result is that cravings and hunger are worse, so she listens to advice from low carb camps to ‘eat more fat’. Which she does, snacking on nuts, handfuls a day, and adds more fat to meals. Despite eating less than 50 grams of carbohydrates a day – there is no fat loss, if this theory were correct she should be losing weight.
Why high carbohydrate diets cause weight gain and moderate carb diets help weight loss
Here is why high carbohydrate diets trigger weight gain: A high carbohydrate meal increases blood glucose and insulin, and leads to a blood sugar crash, which in turn leads to hunger. Studies show when a person eats a high carb meal they get hungry sooner and eat more food. They eat excess fuel and this gets stored as fat. These graphs show this difference clearly: 2 different high carb meals compared to a moderate carb plus protein and fat meal. Each meal has identical calories, yet the mixed meal had completely different effects on blood sugar, satiety and hunger. Square = oats, quick cooked, circle = oats, slow cooked, triangle = eggs, vegetables and fruit.
(This is why calorie counting by itself is fairly useless, it does not take into account the effect of different foods on hormones, satiety or nutrient status.)
So yes – high carbohydrate diets can be a real problem as they cause overeating. The mistake many make is that they take this to an extreme – if a high carb meal increases insulin, then if we want to lose weight we should eat no carbohydrates. Where this may work for some, but it is a disaster for an athlete burning through carbohydrates for fuel every day. The meal in the above study that decreased eating by half, was a moderate carb meal, that contained both protein and fat also. When someone is craving carbohydrates immediately after a low carb meal and they are insulin sensitive, having a moderate amount usually fixes the problem.
(In fact long-term, even low-level exercisers may feel and be more healthy eating a moderate carbohydrate diet – see Paul Jaminet: Problems with very low and zero carb diets)
If you are eating right for YOU – you should not need to snack or have cravings
In my view – if you are fueling your body correctly you should have good satiety, good energy, good performance and no cravings or need to snack. And – be able to lose excess fat. When I see constant snacking and craving, I wonder if the fuel mix is wrong, the amount eaten is too little, or perhaps nutrients are missing.
Added to this picture – is a poor quality sleep. It could be alcohol or caffeine, however this is something I typically see in CrossFitters or those who exercise at a high intensity who go low carb.
So my thoughts – here is a person who is using carbs for fuel, yet trying to replace them with fat. And the more she craves the more fat she eats. Hmm, fats will never fill glycogen stores – they will to be shuttled into fat stores if there are excess for fuel needs. Time to switch out the fats for carbs, and get the fuel mix right.
My first recommendation?
Eat adequate carbohydrates, mainly glucose (starches) and some fructose (fruit) to replace the glycogen used from muscles and liver (fructose is good for replacing liver glycogen). How much? As a general rule a fist size of starch (kumara, taro, sweet potato, parsnip, beets etc) at each meal usually provides what your body needs. And after workouts a fist size with some protein. And 1 – 2 pieces of fruit. This works out at about 150 grams carbs a day.
Cut fats. I’m not talking low-fat – have added fat to meals, but cut the snacking on handfuls of nuts. If you eat more fat than you oxidise, it will be tucked away in fat cells.
As commenters have pointed out there are a number of other problems with her diet:
Excess omega 6.
Fatty meat, especially poultry and pork, and some nuts have high levels of omega 6. Omega 6 is the building block of primarily pro-inflammatory eicosanoid hormones. Yes we need some, about 5 – 8 grams a day. However just 100 grams of almonds will load you with 12 grams Omega 6. It is highly likely this woman’s high fat diet has up to 20 grams a day. Excess omega 6 is linked with inflammation and obesity.
Cut out the handfuls of nuts, eat nuts and fat low in omega 6: macadamia, hazelnuts, coconut and palm kernel oil, avocado are lowest. (Use this guide to reduce omega 6) Also choose low omega 6 protein sources: ruminant grass-fed animals (beef, lamb and venison) and seafood.
Need to increase food sources of omega 3
Omega 3 enhances fat loss – use seafood at one meal every day – fish, and shellfish, crustaceans, etc. The bonus is you get a lot of minerals in seafood as well, many of these are low in land based animals, e.g zinc, selenium, iodine, and trace minerals.
People assume because diet drinks are calorie free they wont contribute to weight gain. Research is showing that det drinks are linked with a number of problems. They increase your risk of type 2 diabetes and being overweight.
Alcohol decreases self-control and increases impulsiveness. So you go out for a meal, decide to eat well, and a couple of glasses later: I’ll eat the triple scoop ice-cream sundae, to hell with it – I’ve been good all week.
Alcohol is fuel. Once detoxified by your liver it goes into the cells where it is converted into ATP (the energy for your cells). (Alcohol metabolism) If cells have all the energy they need that ice-cream sundae is shunted into your fat cells.
My recommendation – cut down on alcohol, save it for social nights and when you do drink – drink a small amount (1 – 2 glasses), earlier in the evening, so it is less likely to interfere with sleep, OR cut alcohol out for a few weeks to reduce reliance on it. (If you can’t do this – you have an alcohol problem in my opinion)
Many people vastly underestimate the importance of sleep for weight loss and performance. Lack of sleep increases insulin resistance, increases hunger hormones, gives poorer appetite control, increases muscle loss and decreases fat loss. When college athletes slept more – their performances; both strength and fitness improved in this study. I recommend the client gets 8 hours sleep per night.
People’s responses to caffeine vary, however for some even one cup a day can affect sleep. If sleep does not improve with dietary changes I recommend removing all caffeine for a trial of 2 – 3 weeks.
I give this guide for portion control:
Protein – amount needed is approx 1.5 – 2 grams per kilo ideal body weight per day. For most people following this rule – 1 – 2 palms of protein food per meal just happens to work out very closely to this. (If you want to be more precise – use this as a guideline: Protein amounts in seafood, meat and dairy) I recommend ‘leanish’ protein as I’ve sometimes noticed excess fat in protein foods can keep fat cells topped up rather than allowing them to empty. Make one meal a day a seafood meal. Eggs, 3 per meal for most females.
Carbohydrate: for adequate carbohydrate – at least 100 grams per day, closer to 150 grams works for females doing a this amount exercise. A fist of starch at each meal and one post workout usually supplies enough. (For a more accurate guide to carb amounts use this: Paleo diet carb list and carb counter.)
The amount needed if you are exercising and insulin sensitive is from 2 – 6 grams/kg/day. Play around with this and see what makes you feel best.
What about fat? Eat about a thumb size at each meal. 2 – 3 teaspoons of added oil or fat, if nuts about 2 – 3 tablespoons, if avocado; 1/4 to 1/2. Make sure you eat low omega 6 fats and foods high in omega 3 (Use this as a guide: Omega 3 and 6 in fats, oils, meats and seafood)
Other food recommendations:
Eat organ meats for their high nutrient value once a week (liver, kidneys etc)
Make bone broth and drink a small cup most days, or use bony meats like ox tail and lamb necks in slow cooked casseroles. These are rich in collagen and glucosamine, good for joints and gut.
Probiotic foods: kefir, kimchi, sauerkraut for healthy gut bacteria
Non starch vegetables: Eat a lot for nutrient content, prebiotic fibre and polyphenols. At least one cup per meal in addition to starch. Try to get two cups per day from each of the sulphur group, green vegetables, and bright colours. Also add some sea vegetables for minerals.
Magnesium is useful for helping sleep improve. The more exercise you do the higher your magnesium requirement.
I also recommend a good quality multivitamin initially as it can help weight loss and reduce cravings linked to nutrient deficiencies.
I send my clients away with a meal template, specific recommendations and a paleo guidebook. And usually see them in a follow-up visit 2 weeks later.
This is what these clients typically tell me next visit:
Diet changes: The client was a highly motivated person and put in most of the diet changes I recommended above. She cut out the diet soda, followed the meal template, stopped snacking. She even cut out alcohol after realising subsequent to the visit on her first weekend of her new programme that she completely derailed herself with weekend drinking.
Lifestyle changes: She made an effort to get a minimum of 7 hours sleep a night, and found with the increased carbs and magnesium she slept soundly.
Exercise: She continued 5 sessions a week of CrossFit, and found she had no problem with this with the diet change, she hit PB’s and has greatly improved recovery
How is her sleep? much improved, sleeping far better and going to sleep more easily.
Any cravings? cravings gone, no need to eat between meals. “I feel SO much better eating more carbohydrates!”
How is performance? good, getting PB’s at the gym, great energy in workouts and good recovery. One client noted ” I thought it was normal to feel sore for days after a workout, with more carbohydrates this no longer happens” (Some commenters suggested cutting back on exercise, I prefer to see if the problem is a fuel issue before recommending that, in most cases like these it is, and correct fuel will fix the performance, energy and sleep issues)
Weight loss – slowly reducing (the best way), judged by measurements, not just scales
What if weight loss is not happening?
Occasionally a client will not have the expected fat loss, and then other factors need to be considered, like stress, over exercising, eating too much, hormonal imbalance, undiagnosed thyroid issues or adrenal fatigue (I usually recommend they see a holistic doctor for tests) Before that I suggest putting their meals in a diet analysis for 2 – 3 days – this usually pinpoints an overeating issue, which is easily fixed. I’m not a fan of counting calories but there have been times this helps a client. I much prefer adjusting meals and portions and judging the success by how they feel, sleep, and perform, plus giving fat loss.
There are a few articles others have written on this subject that I highly recommend you read:
Robb Wolf: Low Carb and Paleo: My Thoughts Part 1
Jamie Scott: Calorie Rants and Ketosis (part 1).