You’d have to be living in a mole hole to not have heard of the ketogenic diet. Everyone knows someone who’s on it. What everyone wants to know is whether or not keto is safe and effective. Does the keto diet work for weight loss? Is it dangerous?  Is the keto diet nutritionally balanced? Is it easy to follow? There is SO much to say about keto so I’m going to make this post a quick overview. I’ll make more in-depth posts about these topics along the way (with a lot more references), so check back for more info!

What does the research say about the keto diet?

Research about the effectiveness of the keto diet (or similar low carb, high fat diets) for weight management is somewhat mixed. Most of the time, keto-like diets are successful at causing weight loss.^1-2 Unfortunately, the research also indicates that the success of keeping that weight off long term (1 year or more) is low (and no better than with other types of diets).^3-5

Research on keto’s effects on other health markers (cholesterol, blood glucose, insulin, inflammation, etc) is also mixed. Some studies show the keto diet improves cholesterol markers, others demonstrate that it makes them worse.^1,6 Research on inflammation is once again, annoyingly, unclear and conflicting.^6-7 For the most part, blood glucose and insulin levels do tend to improve^1,6, likely because carbohydrates (and therefore the need for insulin) are largely a non-factor in a ketogenic diet.

With all of the conflicting information, it’s no wonder everyone is so confused about the keto diet. In a future post, I will go much more in-depth about what the research says and what conclusions we can pull from it.

Is the keto diet dangerous?

This answer is a little convoluted (you’re shocked, I know). Short-to-moderate length studies looking to evaluate the safety of the ketogenic diet have mostly unearthed no dangerous results (other than those mentioned above).¹ However, few of those studies have looked at the long-term effects of the ketogenic diet (or similar very low carb diets) on metabolism.^2,8 By far and away, my largest caution with the keto diet is its long-term effects on metabolism. This is also the main reason I do not recommend the keto diet for my clients and I am not following the keto diet during this feature.

Eating so few carbs mimics a “famine” situation, causing your body to rely more on its body fat stores than on blood glucose. So far, that sounds great, right? But your body expects this to be temporary (think caveman days – in Spring/Summer, the carbs will come back!). After a while, if carbohydrates don’t increase, your body resorts to a more sustainable long-term plan. Your body knows it can’t keep burning through the fat stores – it would rather slow down metabolism and try to preserve its fat stores as much as possible. This nearly always leads to fatigue, brain fog, feeling cold, and a weight loss plateau. Often at this point people become frustrated with the lack of results and begin to eat more carbohydrate. Your body is jazzed – “Spring/Summer is here! We survived! Boy, that was a long one. Next time, we will be even more prepared for Winter.” Translation: we will store more fat. These shifts are backed by documented hormonal changes in mice and humans,^4,8-9   and are linked with the weight regain mentioned earlier.

The take-home message: In the long run, very low carb diets like keto teach your body how to store fat more effectively.

Is the keto diet nutritionally balanced?

The answer is a big it depends. I would venture to say that the average keto diet is not nutritionally balanced. I would follow that up by saying that it is possible to eat a nutritionally balanced keto diet, but it takes a lot of intention. Here are some of the nutritional weaknesses I see in keto diets:

• Fiber – Fiber is a type of carbohydrate that composes the structure of certain plant-based foods. Since fiber doesn’t break down into blood glucose, it is not actually limited on the ketogenic diet and will not interfere with ketosis. At the same time, it comes in primarily carbohydrate foods, so the carb limitations often make it quite tricky to get enough fiber while avoiding other carbohydrates. It can be done with certain high-fiber foods such as nuts and seeds, avocados, and berries.
• Vitamin C – While you can certainly get vitamin C from certain keto-friendly vegetables (hey, peppers!), a lot of the best vitamin C sources are fruits, which are very limited on a keto diet. You can definitely make a point to eat vitamin-C containing foods, but you have to make the point to do so.
• Saturated fat – These are the types of fats that are primarily found in animal foods. Being a high-fat diet, unless someone is being very intentional in their food choices, a keto diet is typically quite high in saturated fats. While there are some debates around the appropriate recommendations for saturated fat,¹⁰ most keto-dieters I’ve talked with are eating WAY more than even some of the higher evidence-based recommendations. High saturated fat intakes are associated with high levels of cholesterol and increased occurrence of dementia.^11-12 Keto dieters can buffer this impact by limiting intakes of high fat meats (sausage, bacon, ribs, hot dogs, etc) and dairy in favor of lean and grass-fed meats and reduced fat dairy. Focus on including a variety of plant-based fats like nuts, seeds, avocado, and olive oil.

Is the keto diet easy to follow?

This kind of depends (do you see a theme here? It seems nutrition rarely has a clear answer). Some people absolutely LOVE meat and veggies and aren’t so big on the carb-y stuff, and keto totally rocks their world. Others – most, if we’re honest – enjoy at least some carbohydrate foods (or the option to eat them without ruining ketosis) on a regular basis. With ketosis, it’s kind of an all-or-nothing thing. You either need to be in and mostly stay in ketosis or regularly meet your carbohydrate needs. Bouncing back and forth or riding the low-carb-but-not-quite-low-enough-for-ketosis train is generally not an enjoyable ride. Many clients complain about low energy, brain fog, fatigue, and weight fluctuations, particularly coming in and out of ketosis. Digestive disturbances come up frequently as well.

My average client finds keto to be a social and nutritional bummer, because it restricts a lot of foods – particularly delicious and commonly social foods. It can also be a challenge for some to consume enough fat to promote ketosis and meet caloric needs. I can’t even count how many clients and friends have followed keto for a few weeks or months, convinced it was going great, only to decide it was too restrictive and they weren’t enjoying their food quality of life or feeling their best. The same high dropout trend is commonly seen in studies about low-carbohydrate diets.³ When deciding about a diet, be sure to take the nutritional and safety factors into account as well as your personality, favorite foods, and family/friends.

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References

1. Dashti, Hussein M et al. “Long-term effects of a ketogenic diet in obese patients.” Experimental and clinical cardiology vol. 9,3 (2004): 200-5.
2. David S Ludwig, The Ketogenic Diet: Evidence for Optimism but High-Quality Research Needed, The Journal of Nutrition, nxz308, https://doi.org/10.1093/jn/nxz308
3. Phelan, S., Wyatt, H., Nassery, S., DiBello, J., Fava, J.L., Hill, J.O. and Wing, R.R. (2007), Three‐Year Weight Change in Successful Weight Losers Who Lost Weight on a Low‐Carbohydrate Diet. Obesity, 15: 2470-2477. doi:10.1038/oby.2007.293
4. Cardillo, S., Seshadri, P., Iqbal, N. The effects of a Low Carbohydrate vs. Low Fat Diet on adipocytikines in severely obese adults: a three-year-follow-up on a randomized control trial. Eur Rev Med Pharmacol Sci vol. 10 (2006): 99-106.
5. Foster, G., et al. A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med (2003); 348:2082-2090
   DOI: 10.1056/NEJMoa022207.
6. Rosenbaum, M., et al. Glucose and lipid homeostasis and inflammation in humans following an isocaloric ketogenic diet. Obesity. 2019 Jun;27(6):971-981. doi: 10.1002/oby.22468. Epub 2019 May 8.
7. Shen, Y., Kapfhamer, D., Minnella, A.M. et al. Bioenergetic state regulates innate inflammatory responses through the transcriptional co-repressor CtBP. Nat Commun 8, 624 (2017). https://doi.org/10.1038/s41467-017-00707-0
8. Goldberg, E.L., Shchukina, I., Asher, J.L. et al. Ketogenesis activates metabolically protective γδ T cells in visceral adipose tissue. Nat Metab 2, 50–61 (2020). https://doi.org/10.1038/s42255-019-0160-6
9. Cooper, E. The Metabolic Storm: The science of your metabolism and how its making you fat. Seattle Performance Medicine. 2015. 2nd edition.
10. Enos, R., et al. Influence of dietary saturated fat content on adiposity, macrophage behavior, inflammation, and metabolism: composition matters.
11. Enos, R., et al. Influence of  The Journal of Lipid Research. doi: 10.1194/jlr.M030700 (2013), 54, 152-163.
12. Greenwood, C., Winocur, G., High-fat diets, insulin resistance and declining cognitive function. Neurobiology of Aging. Volume 26, Issue 1, Supplement (2005) 42-45. https://doi.org/10.1016/j.neurobiolaging.2005.08.017.
13. Barnard, N. D., Bunner, A. E., Agarwal, U. Saturated and trans fats and dementia: a systematic review. Neurobiology of Aging. Volume 35, Supplement 2 (2014) S65-S73. https://doi.org/10.1016/j.neurobiolaging.2014.02.030.

I’m back with more Trim Healthy Mama posts! I’ve been in blogging limbo for the last couple of weeks because I’m working on moving my practice into a new office! It’s so exciting – check out the new space!

Anyway, that’s not why you’re here, is it? You’re here to find out whether or not Trim Healthy Mama is a good option for your life! Overall, the premise of the Trim Healthy Mama Plan is sound enough that if you want to lose weight, it will probably work. The benefit of THM is that it does a better job of switching from weight loss to maintenance than many other diets. It takes a unique approach and the authors provide several options for customization.

Like anything, eating plans are never one-size-fits-all. Some people will love the THM plan and others will struggle to follow it. After researching the plan and following it myself, I’ve put together some tips to help you decide if you are likely to be successful with THM.

You are likely to thrive on Trim Healthy Mama if…

 You are satisfied after eating low-carb meals (particularly if your goal is weight loss)

For some, grilled chicken on a large salad with dressing is a full meal. Others will still be asking for some fruit or a roll after they’re done. This is partly related to blood sugar regulation, partly to personal preference, and it’s very individual. If a steak and some roasted veggies sounds like all you need to be happy, you’ll do just fine in this area.

You aren’t a “social eater”

Social eaters get a large chunk of their enjoyment from food by sharing it with others (going to others’ houses, going to restaurants/parties, sharing meals, etc). Plans like THM that have a lot of “off limits” foods make this tricky unless you’re socializing with other people who are following the same plan. If you could care less about snacks at parties or don’t mind bringing your own thing, you’re good to go.

You like to cook/bake OR you don’t mind eating the same things from day to day

According to the THM authors, you don’t necessarily have to cook to follow the plan. After following it myself, I would say that’s true, but your options will be much more limited if you don’t.

You need a little guidance for moderation

If hearing the word “moderation” makes your eyes glaze, or if moderation just seems to be a nebulus concept, it may help you to have a structure like THM to guide you.

You’re interested in nutrition

This isn’t a must, but having an interest in the way the body works and how it interacts with food is helpful in understanding the plan. I haven’t even mentioned all of the supplementation or “add-in” recommendations the authors give in the book for boosting nutrition, but they are pretty in-depth. Some nutritional background or curiosity would be helpful for working through some of those more scientific chapters.

You might want to choose a different plan if…

You or your family have dietary restrictions different than those on the Trim Healthy Mama Plan

The THM plan is already more restrictive than is necessary to achieve most health goals, so if you’ve got other restrictions going on, this is going to make everything tougher. My philosophy is always to find the least restrictive way to head where you’re trying to go. Don’t make it harder on yourself than is necessary!

Being told you can’t have something makes you want it even more

There are quite a few “normal” foods that are not allowed on the THM plan, so if having those parameters makes you start jonesing for ice cream or a baked potato, this probably isn’t the plan for you.

You love baked goods

I’ve heard (and continue to hear) that there are tasty grain-free, sugar-free baked goods out there. I certainly won’t claim to have tried them all. In fact, I recently heard from a couple of experienced THM followers that the best results come not from any one wheat flour alternative but a blend of several. Regardless, baked goods were my biggest struggle following the plan (and I’m not a bakery junkie). I’m sure continued experimentation would yield better results than I achieved, but I’m pretty certain that even the best grain-free options aren’t going to equal the real deal. If baked goods are something you absolutely love, losing that aspect of your food quality of life would make following THM tough.

You dislike “diet lingo”

If learning a new system of numbers or language to track your health goals is not up your alley, this may or may not be for you. As with some other diets out there, Trim Healthy Mama has a language of its own – S meals, E meals, crossovers, S helpers, and fuel pulls are all part of the lingo in this case. For some people, learning these will be simple, make sense, and not be a problem, others just won’t want to mess with it. You know who you are!

So there you have it – a few tips to help you know if the Trim Healthy Mama Plan might be a good fit for you. It’s certainly not foolproof, but I want to acknowledge that every single person is different, and every approach to health and wellness is personal – it has to work for you and not against you.

I want to add a caveat here that I do have some concerns about a couple of the nutritional aspects of the Trim Healthy Mama Plan – not the entire framework itself, but some tweaks I would recommend to anyone who chooses to follow it to ensure they are making the most healthful choices for their lives. Those are coming in a future post, so stay tuned!

My three weeks on Trim Healthy Mama have finished and it was certainly a learning process! I wrapped up the whole experience with this tasty taco salad S meal at a friend’s taco birthday party.

The Good

The plan is cheaper overall than I anticipated – it only cost me extra the first week when I stocked up on some special ingredients.

I made two good baked things! If you’ve been following along, you know I’ve struggled to make edible baked goods on the Trim Healthy Mama Plan. I took a break from baking after a few flops my first week, but I got back to it this week. At first I had some duds – pumpkin chip breakfast cake was meh, and these lemon blueberry muffins (while pretty) were just not yummy.

The first delicious almond flour foods I made were these pizza puffs (for which I will soon provide you the recipe)! They were really tasty dipped into my 5-minute heart-healthy pizza sauce.

The second were these low-carb, gluten-free thin mint dupes from All Day I Dream About Food. The recipe was posted in a Trim Healthy Mama Facebook group and I had to give them a try. I thought they might be better than some of the other almond flour baked goods I’ve tried since the actual cookie part is so thin (and drenched in chocolate…kind of hard to go wrong with that!). They turned out so well! Yum!

The Bad

My primary nutrition concern with Trim Healthy Mama was my suspicion that it encouraged too much saturated fat intake, though I wanted to wait until the end of my three weeks to see how the actual numbers shook out. Excess saturated fat intake is associated with inflammation (which is linked to a myriad of health issues) and is typically found in solid animal-based fats. There is potential for excess saturated fat intake on the Trim Healthy Mama Plan, since the S meals often contain cheese, creamy sauces/dressings, and are cooked in butter. As yummy as stacking all those fatty goodies into one meal can be, from the get-go I have been concerned that the Trim Healthy Mama Plan would take this aspect a little too far.

To put numbers into the mix, my recommended daily saturated fat intake is 20 grams per day and while I was on the Trim Healthy Mama Plan, my daily average saturated fat intake was 31 grams. I have to say that I expected the average to be even higher than that, but regardless it is about 150% higher than current recommendations. Fortunately, the blood sugar regulation portion of the THM plan helps prevent inflammation, but the saturated fat aspect promotes it in another way. It would be best to reduce inflammation both through blood sugar regulation and moderation of saturated fat. If a client of mine is interested in following Trim Healthy Mama, I will encourage them to either limit S meals or to limit sources of saturated fats from S meals to prevent inflammation.

The Numbers

What I Learned

• • I do not like almond flour. I can’t help it. If I can taste the almond flour, there’s too much almond flour. Extracts and zests are helpful, but not enough to overcome the nasty that is almond flour in muffin form. I gleefully threw away the last little bit from the bottom of the bag this morning.

• I can definitely get by with fewer carbohydrates than I tended to eat before I started this project. It’s a good reminder to not let taste overcome true hunger!

Since my husband and I have met our wellness goals, we are not ready to watch our bodies creep back to where they were, but rather to maintain the progress we’ve made and go even further. How do we avoid becoming another statistic for weight regain or resume our couch-potatoing, Christmas cookie-eating ways? The vital keys to long-term success lie before and after the hard work of reaching your goals.

Key #1: Before you change anything

Decide carefully how you will achieve your goals. For many years, scientists have been studying methods for weight loss to find the “best” way to get pounds off. The surprising result of a lot of this research is that so many methods work. A lot of nutritionists have taken to saying, “diets don’t work.” It might be semantics but in general, if the goal is to lose weight – most fad diets do work. Whether it’s low carb, low fat, low calorie, or portion control – weight typically comes off.^1-5  If they didn’t work at all for losing weight, word would get around pretty quickly and they would never become popular.

Here’s the kicker (besides that many fad diets aren’t safe): the statistics for maintaining weight loss after a diet are horrendous. Long-term studies show that five years after short-term diets the result is an average regain to anywhere from a net loss of only 6 lbs to a gain of 10-21% of pre-diet weight.^2,6 Yikes!

Many fad diets can be extreme, overly restrictive, or just plain miserable (or option d, all of the above). Most people beginning a diet program are willing to commit to short-term pain for long-term gain. Unfortunately, the reality is that long-term dieting is generally not sustainable, and weight loss from short-term dieting is temporary.

But fear not – all hope is not lost! The National Weight Control Registry is comprised of people who have successfully lost at least 30 lbs and kept it off for at least a year, though most participants have lost an average of 72.6 lbs and kept it off for more than 5 years.⁷ Their participants report that ongoing, long-term participation in sustainable habit changes has been key to their success, as opposed to radical, short-term dieting. You can read more about their habit changes at the National Weight Control Registry website.

All these studies show that a pivotal ingredient for long-term success with wellness, weight loss, muscle gain, or any habit change is sustainability. One of my favorite quotes sums up the wisdom behind this:

“Begin as you mean to go on, and go on as you began, and let the Lord be all in all to you.”

-Charles H. Spurgeon

Some may wonder what the last phrase has to do with wellness, and personally I believe it is vitally important (and apparently so did Spurgeon since he tacked it on there), so I included it. Regardless of how you feel about God, however, the sentiment is to not even begin a habit change that you can’t commit to long-term. Find changes that work with your lifestyle, not against it.

Recognize that temporary habit changes create temporary results.  You can tweak them, change them, or adjust to the fluidity of life as needed, but if your habit changes disappear completely, so will the fruits of your labors.

Key #2: After you’ve met your goals

You’ve done it, congratulations! You’ve met your goal! You’ve placed a new brick in the healthy foundation upon which you can continue building the life you want. Guess what? You’re not done! If you want to continue to enjoy the benefits of your progress, you must grab hold of the second key to long-term success:

Always have a goal and a sustainable plan to achieve it.

Achieving a goal merits celebration, and also the exciting task of deciding what your next goal will be. It doesn’t have to be intense – your goal could be maintenance and your plan might be walking – but you need to have both or you’ll watch all your hard work and health benefits slip away. Living a healthy life is swimming upstream in our culture – you can not coast into good health.

So what’s next for Charlie and me?

My new goal: Maintain cardiovascular endurance and flexibility. Gain strength and muscular endurance (I want to be able to do 10 pull-ups or rock climb for an hour without getting pooped).

My new plan: Mindful, intuitive eating along with 30-40 minutes of cardio twice weekly, strength training 4 times weekly, and 10-20 minutes of yoga 5 days per week.

Charlie’s new goal: Maintain cardiovascular endurance and flexibility. Gain strength (he wants to be able to save people from burning buildings and stuff).

Charlie’s new plan: My Fitness Pal (with his calorie and macronutrient needs adjusted since he’s building muscle now), 30-40 minutes of cardio twice weekly, strength training 4 days per week, and 10-15 minutes of yoga before each workout as well as a longer practice twice weekly.

Have a goal of your own but need help finding a sustainable plan that fits your lifestyle? Contact me or schedule an appointment to start building a healthy foundation for the life you want!

1. https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2002-021480
2. http://onlinelibrary.wiley.com/doi/10.1038/oby.2001.134/full
3. http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/412650
4. http://onlinelibrary.wiley.com/doi/10.1038/oby.2004.61/full
5. http://ajcn.nutrition.org/content/53/5/1124.short
6. http://europepmc.org/abstract/med/2613427, http://ajcn.nutrition.org/content/74/5/579.short
7. http://ajcn.nutrition.org/content/82/1/222S.short