Since I started the previous post on this subject with a letter, I’ll do the same for part 2. God knows we have enough like these to fill a book. In fact, this one was in a book. We published the portion below in The Protein Power LifePlan.

A lady from New England wrote to us complaining that she had diligently followed our low-carb diet to the letter yet,  had lost only four pounds over the first few weeks of the program. She included her food diary to show that she was indeed doing a low-carb diet. Here it is:

BREAKFAST: a four-egg omelet with cream cheese, five or six pieces of bacon or sausage, and coffee.

MID-MORNING SNACK: 4 ounces of nuts and 2 to 4 ounces of cheese.

LUNCH: a large bowl of tune or ham or chicken salad make with real mayonnaise, a bag of pork rinds, and a diet drink.

MID-AFTERNOON SNACK: nuts and cheese again.

DINNER: a 16 ounce piece of prime rib, a green vegetable, and a small salad.

DESSERT: sugar-free gelatin and whipped cream and coffee.

When we received this letter MD and I wanted to shake this woman and say: Does it not surprise you that you’re not gaining weight on your diet? I’m sure the only reason she lost the 4 pounds was that she dumped a bunch of excess fluid as a result of her insulin falling. If you run the calculations you will find that this woman was eating somewhere around 5,000 calories per day. She was definitely not creating a deficit. And she wasn’t losing…but she wasn’t gaining either.

The difficult part of any diet – including a low-carb diet – is the bucking up and staying with it during the weight loss phase. It’s pretty easy for most people right at the start because the weight comes off quickly at first, and most people feel so much better just getting off the carbs. As the early days turn into weeks and (in some cases) months, the diet becomes monotonous for many. Weight loss slows down, the great feelings of renewed health and more energy are still there, but have become the norm instead of something new and exciting, and the urge to expand the palate becomes intense.

First, it’s a little nibbling here and there of the forbidden foods, leading a carb creep. And, as I pointed out in the earlier post, many start snacking on calorically dense, low-carb foods, with cheese and nuts being the greatest offenders. Ultimately the weight loss goes from a crawl to stopping altogether. Frustration sets in, and many people bolt from the program saying: Hey, if this isn’t working for me, why am I torturing myself with it? From this mindset it’s a short hop to being face down in the donuts.

I can tell you from both personal experience and the experiences of thousands of patients that this middle time of low-carb dieting (the time between the heady early days and maintenance) can be a drag. And can be fraught with weight-gain peril if you get sloppy with your carb and/or calorie counting. But if you hang in there, you will be rewarded with great dividends.

Once you’ve reached maintenance you can pretty much eat all you want without gaining as long as you watch your carb intake. Like the lady who wrote the letter above, you can feast on all kinds of cheese, nuts, meats, etc. while remaining at your new lowered weight. The calories that come from these sources will sabotage your weight loss if you eat too many of them, but won’t make you gain weight as long as you keep your insulin low.

As you may recall from the earlier post, a lowered insulin levels opens the door to the fat cells, allowing fat to come out to be burned. If your dietary intake meets all your body’s energy needs, however, your body will simply use these dietary calories and leave the calories in your fat cells alone. And you won’t lose. But lowered insulin levels pretty much prevents fat from going into the fat cells, so even if your caloric intake goes up – as long as your insulin stays low – you won’t store more fat in the fat cells. And your weight will stay the same.

How can this be?

The phenomenon is pretty vividly demonstrated in people with type I diabetes, the type of diabetes in which no (or very little) insulin is produced. Most of the time these people get their diagnosis of diabetes when they come to the doctor because they are losing weight like crazy while eating everything in sight. It’s not all that unusual for a person with new onset type I diabetes (who isn’t aware of having the disorder) to lose 40 pounds in a month. These people have no insulin and a lot of glucagon. Without the insulin they can’t store fat, so they dump fat from their fat cells. Much of this fat is converted to ketones since there is no insulin to shut off the process. The glucagon makes them convert muscle protein to sugar even though their blood sugar levels are already sky high. The end result is that these people have elevated levels of sugar in their blood and elevated levels of ketones. They dump both sugar and ketones in their urine, but not enough to account for the amount of weight they lose. The combination of calories lost to ketones and urine can add up to a few pounds per month, but not 40. Other factors are at work. The body has the ability to waste calories, but doesn’t usually do so unless it has to. In the case of type I diabetes it has to. And people with uncontrolled type I diabetes eat and eat and eat and lose and lose and lose.

The same phenomenon holds true in low-carb dieting. Insulin is low and glucagon is high, making it difficult to gain weight. That’s not to say it can’t be done, but it is difficult. Which means that once you lose your weight and get to maintenance, if you keeps your carbs (and thus your insulin) low you can pretty much go back to snacking on cheese, nuts and other high-fat, high-caloric density foods without the fear of gaining. You won’t lose, but you don’t want to lose on maintenance. You simply want to maintain.

You will ditch these extra calories by a number of means. Your caloric-wasting systems will be going full blast. You will be futile cycling, increasing the mitochondrial proton leak, increasing the number of uncoupling proteins, and spending extra energy converting protein to glucose. You will also increase your NEAT. What’s NEAT? It’s Non-Exercise Activity Thermogenesis. Your total energy expenditure is composed of four things: resting metabolic rate, the thermogenic effect from food (the energy required to metabolize what you eat), thermogenesis from exercise and activity, and NEAT. NEAT is from all the little things you do without conscious effort – fidgeting, moving more, moving more briskly, stretching, standing more, etc. These are activities that you don’t really think about but that you perform to dissipate extra energy. It’s why you feel more like exercising after you get going on a low-carb diet; it’s why you perceive your energy levels to be higher. And it’s why you’re less hungry.  Your body has access to its stored fat and is using it and even wasting it. As Key’s showed in his semi-starvation studies, subjects on low-fat, reduced-calorie diets pretty much got rid of most of their NEAT in an effort to conserve energy. The opposite happens on a higher-calorie low-carb diet.

Blowing off this excess energy is what allows you (and the woman who wrote the letter at the start of this post) to eat a lot yet still maintain. But it comes at a price. There is a caveat.

If you crank up your intake of fat calories and at the same time increase your carb intake you are going to gain like crazy. Why? Because you will increase your insulin levels and drive this fat into the fat cells. And it will happen quickly.

Most people reading this will probably say, that would never happen to me. But it can and does. Especially when people start guestimating how many carbs they’re eating. A couple of years ago I posted about a survey done at the peak of the low-carb diet mania showing that people who thought they were on low-carb diets really weren’t. They were cutting the carbs, but not enough to bring about insulin lowering to the point required to enjoy the benefits of low-carb dieting. Men who claimed to be on low-carb diets were consuming on average about 145 grams (3/4 cup sugar equivalent) of carbs per day while women were eating on average 109 grams of carb per day. For most people this is way too much.

So, if you keep carbs low and keep calories in check you will lose weight. If you keep carbs low and don’t worry about the calories you will maintain. A commenter on the earlier post put it brilliantly and succinctly:

Eat low carb = you CAN’T GAIN fat.

Eat low carb ≠ you WILL LOSE fat. [unless, of course, you create a caloric deficit]

I noticed that in a number of comments about this post people had come to the same conclusion empirically. They wrote that whenever they jacked up their consumption of cheese, nuts and other calorically-dense low-carb foods their weight loss stalled. But as long as they kept the carbs low, they didn’t gain. As always, I welcome comments on this issue. I’m keen to hear the experiences of all.