Chris Kresser: Next from Jessica, “Looking for help setting initial eating plan. The patient is 44-year-old female with obesity. BMI at 33. Main complaint of resistant weight loss. Has tried lower-carb Paleo with little success recently. Read KetoFast and wonders about trying that.”
Yes, KetoFast is great. As you may recall, I had Dr. Mercola on the podcast to talk about it because it was actually very similar to a strategy that we had already been using in our clinic, and when he contacted me about the book and explained the strategy, I was like, “Oh, that’s almost the same as what we’re doing,” and so I think it’s a good approach. The addition of intermittent fasting and fasting and also refeeding can actually really help in those situations where the weight loss resistance is strong because particularly those refeed days help kind of interrupt that metabolic downregulation that can happen in those situations where the patient tends to hit a plateau and just can’t move forward beyond that.
Next question, Jessica. She is this following up about her weight loss case study question. She was at the IFM annual conference. A lot of clinicians are talking about female clients having more difficulty getting in ketosis and maintaining it for weight loss. Have I seen this?
Not necessarily so much getting into ketosis, but I’ve mentioned before that ketosis, particularly with fasting and intermittent fasting, can be perhaps more problematic for women for a number of reasons, some which we understand and some of which we probably don’t yet. Keto and fasting and intermittent fasting, they are all stressors, and as we cover in the course, you can have eustress, which is stress that has a hormetic and a positive effect, so that would be like exercise, appropriate amount of exercise, for example, and you can have distress. You can have stress that actually interferes with homeostasis and take someone in the wrong direction.
If a woman, let’s say she’s working full time, she’s a mother of a young kid, she’s doing CrossFit a couple times a week, she’s not sleeping enough and not sleeping well, she’s already going to be in a probably persistent catabolic state, which is a state of breakdown and overstress. If she then adds intermittent fasting, fasting ketosis, and especially doesn’t do it well and ends up eating fewer calories and goes hypocaloric, which is often what does happen in those cases, then that’s going to be a problem. It’s not only going to interfere with weight loss, but could potentially trigger amenorrhea or other kinds of hormonal problems and further sleep issues, etc. You just really have to consider how those interventions are benefiting the body, which is again, is like hormetic stressors, and then if you’re adding those against the backdrop of extreme stress, then that’s going to just add stress, and that will be problematic.