This transcript is brought to you thanks to the hard work of Jeanne Wagner.
Do you think people with weight to lose need to consider calories if they are experiencing a long plateau when eating a ketogenic diet? It’s that dreaded word, isn’t it? Calories.
Calories. You know what? The answer is, maybe, maybe they do. There’s a whole long list of things that we can consider when somebody is experiencing a weight plateau and yeah, calories is one of them. So for example, if you are just taking in too much energy from fat or from protein or even from carbohydrate or alcohol, if you’re just taking in too much energy and pushing through those hunger and satiety signals, because you’re eating for all the raisins or whatever it may be, then definitely reducing calories and trying to tune back into those hunger and satiety signals might be a strategy. So that’s often why people will use something like intermittent fasting. You know, they’ll spend that period, whether it be three months or six months or whatever it is, or shorter to get themselves fat adapted. And then they start to notice that the appetite goes down, and so they’re like, okay, well now I’m ready to do something else.
And maybe the weight has plateaued. So then something like intermittent fasting where calories are being either spontaneously or purposely reduced by reducing meal frequency or reducing the eating window, can certainly be effective. But I guess as well, there’s so many other things to consider. It’s very easy just to default to the whole calories in, calories out thing. But you know, a lot of people, again, they try the calories in, calories out thing and it doesn’t work. So if it’s not working, well what else can we consider? And there’s a few little things that I look at in particular when it comes to weight loss resistance or weight plateaus. And one of them is iron levels. So if somebody is low in iron and it’s usually iron stores. So on the blood test, it’s called Ferritin, that’s your iron stores.
So if we’re low in iron, well that means we’re basically low in energy. So we need iron to transport oxygen around our body. And that’s how we produce energy. So if you’re trying to lose weight, you’re basically trying to get your body to expend energy to burn its stored energy. So it’s like a double whammy trying to get rid of energy from the body, but you don’t have enough iron to carry oxygen around the blood sufficiently. So the body is going to be like, well, hang on a second. We’re not getting rid of this precious energy that we have and we’re not gonna waste any energy burning fat because we don’t have enough iron. And it’s not like the body is consciously making that decision. It just can’t do it. And there’s the other theory as well where if the body is low in something like iron or one of those essential vitamins or minerals, it releases a bit of a low level stress response, which increases insulin resistance, which helps the body hold onto stored fat because any type of stress, it’s kind of like the body thinks it’s in a famine or in some sort of danger mode. So it’s not going to comfortably release any stored energy.
So iron is a big one, massive one. And that’s something I think people should check specially, women of childbearing age or people with gut problems. So if you’ve got any sort of gut issues like inflammatory bowel disease or IBS or something where your ability to absorb nutrients is hindered iron is usually one of those things that’s not absorbed very well in those sorts of people. And then other things too, so it could be magnesium, a inadequate intake of magnesium is very strongly linked to insulin resistance. So you could have the perfect diet in terms of your carbohydrate macros, carbohydrate, fat, protein macros, sorry. And you may even be eating low calorie or you may even be in a calorie deficit and you’re still not losing weight. And so magnesium is a huge one because if you’re deficient in magnesium, essentially what that means is that the insulin signaling becomes less efficient.
So you become insulin resistant and then being insulin resistant actually makes you more deficient in magnesium because you use up more magnesium to make more insulin that you need. And so it’s actually like a vicious cycle, whereas your body is making you more and more deficient in magnesium when you’ve really need magnesium to get out of there and maybe restart weight loss or something like that. And magnesium deficiency is common. I know, I mean, when I was going through my dietetics practice, I remember learning about magnesium and they just said to us, Oh, you don’t have to worry about this one because no one’s deficient in magnesium. And I was like…
I thought it was more a case of everyone pretty much.
I was like, whoa, whoa, whoa. So we just don’t worry about it? Like no one’s deficient? Have you surveyed me? You don’t know what I ate. You don’t know if I’m deficient. Like how do you know? And I was just like, that’s not right. And so I actually delved into it a bit deeper and what they were trying to say, in their defense, was that so many foods contain magnesium. It’s abundant in our food supply that it’s not likely someone’s going to under eat it. So like, you know, it’s not like as obvious. Whereas if you stop eating meat, you’re probably going to be deficient. And I, and there’s, you know, cause a lot of food groups have it. But I thought that was, you know, that’s still not enough to then be like, okay, well everybody’s going to be safe from a deficiency because what we know about magnesium is that we all have a different magnesium bucket that we’ve got to fill up.
And if you’re under a lot of stress, for example, which most of us are in this modern world, or you’re going through a very stressful period of work, or you’re doing a lot of fasting, which is a stress or whatever it may be, your magnesium bucket actually gets bigger. So now you’ve got to fill up a larger magnesium bucket so that you don’t have a deficiency. So trying to fill up a huge magnesium bucket -let’s say you’re really stressed at work, you’re also doing this fasting thing. Or maybe you’re doing a low calorie diet, they’re all stresses on the body and maybe you’re not sleeping well. Maybe you’re taking lots of medications- you’ve got this massive magnesium bucket and you just can’t, you can’t fill it. You can’t fill it up. So you become deficient. And that’s maybe where supplementation could be useful.
Because isn’t part of the argument, you mentioned that their argument was, that it’s really easy to get magnesium from foods. But I thought that that was one of the arguments actually that foods have less than less magnesium in them, so it is more difficult actually to get enough magnesium from the foods. Even if you’re eating a diet that is allegedly rich in magnesium.
Agreed. So the soils are becoming more and more deplete in magnesium. So we don’t even really know how much magnesium is in the food were eating, you know, from the vegetables and the seeds and all of that. You know, if a food is fortified with magnesium, which a lot of those packaged bread and cereal products are fortified with magnesium, well that’s kind of a supplement really. If it’s being fortified, it’s not in the food naturally. If you’re doing that, then yeah, you might be able to argue that you’re getting in enough magnesium.
But, you know, a lot of people particularly in this space aren’t eating those fortified breads and cereals and that’s when I think short term periods of supplementation can be warranted. So for this particular person who is trying to figure out why they are in this weight plateau, you’d go through those different types of things as well. So a lot of it is micro nutrient based, trying to figure out if somebody’s got a deficiency in one of these major micronutrients and if they do well, can we use short term supplementation, to help boost up the levels. And then once they are able to get things going again and we’ve seen adequacy in those micronutrients, then we can try and keep that there with food. So yeah, there’s, Oh my God, there’s so many others. Like I’m just thinking of more that I come into my head a well.
It can be difficult to test magnesium can’t it though. I seem to remember reading that the blood test to see if your levels of magnesium isn’t particularly accurate. Is it sometimes a case of sort of guessing what the problem might be in? I mean something like taking magnesium supplements is unlikely to do you any harm, is it? You just end up, you can tell if you’ve had too much because things tend to move through your system a little bit too quickly to put it a bit lightly.
Yeah, no, you’re right. So, a lot of the blood tests for vitamins and minerals are just completely inaccurate. Sodium magnesium is one of them. The blood tests for serum B12 is highly inaccurate and the reason the blood tests and the magnesium is inaccurate is because magnesium is stored in our bones. So it’s not really frolicking around our blood stream anyway. So it’s more used in the acute care setting where they’re trying to work out, um, people’s electrolyte balance and whether or not they need to give them supplementation to keep them alive and things like that. So that’s why the magnesium always appears on your blood test, but it’s actually not useful in determining whether or not you’ve got a deficiency.
The way I do it is by one trying to predict how large someone’s magnesium bucket is. So do they have higher requirements and if they have insulin resistance, if they’re taking multiple medications, if they’re under a lot of stress, if they’ve got anxiety, things like that, then I just make the assumption that they’ve got higher requirements for magnesium and then you can supplement based on that assumption alone and then just sort of track symptoms and see if things improve. But also the other thing is as well is that you can calculate people’s magnesium so you can sit down and you can go, well, what are they eating? How much of my magnesium are they eating and match it with your prediction for increased requirements.
But then the other factor that comes in, which is how this conversation all started, is that people are usually trying to lose weight as well. So if you’re trying to lose weight on top of an increased requirements for vitamins and minerals, sometimes you actually can’t eat enough food. Even if you’re eating all these magnesium rich foods, you can never get to that point where you’re going to meet your requirements because you’re also trying to lose weight and you’re trying to keep your food intake low. You don’t want to overeat. So that’s the other thing.
You know, sometimes when you sit down and you put together, well this is what you’d have to eat in the day to meet your magnesium requirements. Someone’s magnesium requirements are really high. They’re just like, I can’t eat all that. Like if I eat all they have, I’m gonna gain weight and they might be right. So that’s another thing that needs to be factored in. But there are some blood tests which are good. So you know, vitamin D is usually a pretty good correlator of your vitamin D levels and your vitamin D status, and also some other good ones. Iron is good.
The iron tests are reliable aren’t they?
Yeah. But like for the minerals, they’re all pretty basic. They’re not really going to tell you much about your actual diet. Another good one that I’ll share is that I think a really good blood test to request from your doctor is something called homocysteine. Have you heard of it?
I have. I couldn’t talk about it. I’ve definitely heard of it. So I’m fascinated. I know the word.
Yeah. Well, I mean, I didn’t learn about this at uni or anything either, and I don’t think a lot of people know about it, what it is or what it does, but I learned about it through my own sort of health journey as well, and then I dived into the research. So basically it’s a protein and it will build up in your blood if you have a deficiency in either folate, which is vitamin B nine or vitamin B12. So if you just got a blood test for vitamin B9 and they looked at serum B9, a lot of the times your blood has a lot of this serum B9 floating around a lot of B12 floating around and your doctor goes, oh, that’s good, you’ve got no deficiency. But those two vitamins need to be activated to actually be used by yourself.
So they can be floating around the blood and high amounts. But the question of whether or not your body is actually using those B vitamins can be answered by testing homocysteine. So if you test your homocysteine and your levels are elevated, you can assume that you’ve got a deficiency in either vitamin B9 or vitamin B12 or both. And you just sort of play around with that until you get the homocysteine levels down. So I think that’s a really good one because that definitely happened to me.
I you know, when I went through my kind of stage where I was doing a lot of restrictive eating, I ended up with nerve damage in my hands and my feet and they, all, the doctors tested me for vitamin B 12 because vitamin B 12 is linked with peripheral neuropathy, which is nerve damage in the hand of feet. And My B12, my serum B12 always came back high, you know, it was, it was always, Yup, you’re fine. It’s got to be something else. They called it idiopathic peripheral neuropathy. And you know, seven years passed before I finally found out that the B12 blood tests really just does not correlate to your B12 stores. And my body had a problem in activating B12. So even though it was in the blood, my body couldn’t get it into the cell.
And so I had to supplement with an activated form of B12 to help my body get that sort of B12 into the cell. And boy, I wish I knew about that seven years ago because maybe the nerve damage is permanent, and maybe that’s something I’m going to have to live with. And if I can prevent other people from having any permanent damage from a B12 deficiency or a folate deficiency, I’m going to spread that message. So homocysteine, get it tested.
That sounds like it’s potentially wrapped up with the problems that some people have with the MTHFR gene. Yeah, it sounds like it could be linked.
There’s a lot of different genes which are gonna affect your ability to activate B vitamins and other vitamins and minerals and so on. But yeah, so essentially when I say activation, that actually means methylation and the MTHFR gene mutation that you’re talking about, there’s a few different types, but one of the more well researched ones means that if you’ve got the mutation, then you have a reduced ability to methylate things in the body. So turning things on or turning things off like for example, being able to activate a B vitamin to get it into the cell, your body can’t do that very well. And you know there’s a lot of people walking around with these genetic mutations who have absolutely no problems.
And just because you have a genetic mutation doesn’t necessarily mean that you’re going to develop these medical problems from it. Everybody’s different. It’s kind of how it gets expressed in your body. I know with that particular mutation, a lot of people end up with miscarriages and problems with fertility because we know that folate, vitamin B9 is essential to grow in your human and to be fertile. And so if you’re not activating vitamin B9 and you’re not able to actually get that into your cells and tissues, then yeah, there could be problems with fertility and there could be problems with having a healthy baby, which is awful to think about and awful to think that there’s a lot of people that may have this mutation and may have those issues but don’t know it and don’t know how to actually test whether or not they are deficient in B12. I mean B9 or B12. So you can get tested for the mutation pretty easily and you just ask your doctor to throw on a test for MTHFR and they can just do it with your regular blood test and if you want to know about it, you can know about it.
I mean really the way you sort of manage that mutation is, is by checking on homocysteine anyway. So you know, it’s more linked to those deficiencies in B12 and B9 so if you’re looking at your homocysteine and keeping that am in a good range, then it doesn’t really matter whether you have the mutation or not kind of thing, but a lot of people like to delve into their health more. I would put a, a big beware sticker on that though because it is a little bit scary if you type in or if you Google the MTHFR genetic mutation… I don’t know, have you googled it?
Yeah, a whole slew.
Oh yeah. It’s like all the worst things, you know, just pop up like cancer, depression, stroke, miscarriage, nerve damage, Alzheimer’s. It’s like everything that you want to not get in life is what you’re now learning you’re at greater risk of. And so, you know, it was really scary finding out that I had that and I’m a health professional who’s able to look through the literature and kind of just cycle through it and figure out what I need to do. But there’s a lot of people that that would just completely overwhelm them and be far too much and maybe they don’t even need to worry about it. That’s the thing. It’s going to be a different outcome for different people depending on your lifestyle, you may have absolutely no problem whatsoever with the mutation or it could be something that’s crucial in your health journey to find out about.
Yeah, that’s the thing. I think it can totally be overwhelming, but it can also be that missing link for something like for example, when I interviewed Carrie Brown and when she discovered that there was this problem, it was suddenly, you know, light bulbs going on everywhere and gave her a way to treat and reverse, you know, her bipolar disorder along with eating Keto. It just, it suddenly, it’s a relief to somebody like that because they find out one of these root causes and the problems and it gives them a path for treatment. But yes, I can totally see the other way. If you’re not looking for something, if you’re not looking to try and fix a problem and you suddenly find out that potentially you’re vulnerable to a whole myriad of things, that could be very scary. So I suppose it depends what angle you’re coming at.
Yeah, that’s a good way of looking at it. And I’ll just quickly finish up by saying what you just said there about knowing she had the mutation and that knowledge and that management strategy in combination with the ketogenic diet is important actually because she may, let’s say as an example, never knew she had the mutation but when and changed her diet and she could still ended up improving her health with the same outcomes. It’s obviously going to depend, this is completely, I actually didn’t listen to the interview I don’t know her, but you don’t have to know you’ve got it. You can still just make the best decisions for your health and keep going on how you usually, you know, doing your, health goals and then working towards them, fixing your diet, whatever it is and you can still be fine. You don’t always have to know you have it. And so the ketogenic diet, the way it can help with the MTHFR mutation is by reducing or eliminating your intake of folic acid. Did she discuss this?
Not so much. It was more, she, well she found a big improvement just with the Ketogenic Diet and that really helped with her bipolar. But then it didn’t take her quite far enough. And by discovering that she had this gene mutation, that’s when she started supplementing with methylated B vitamins and noticed a huge improvement after doing it.
Yeah, that’s awesome. And so where that first benefit could have come in, obviously there’s all those mechanisms with the ketones that would be good for brain signaling and all of that. But as well if you go on a Ketogenic Diet you’re essentially getting rid of a lot of products containing wheat, and wheat is fortified, at least in Australia. Most countries is fortified with folic acid, which is the synthetic form of folate, which is actually really not good for somebody with an MTHFR mutation because you can’t process it. So you can’t activate that folic acid and turn it into the folate you actually need. It’s a synthetic form, which they say is very bioavailable. They say all folic acid, you can absorb it really well all as well, but you can ‘t actually then go and activate that if you’ve got this genetic mutation.
So having folic acid or a lot of folic acid can sometimes make your symptoms worse. So step one could be getting rid of the excess folic acid and then as Carrie has shared step two might then have to be going supplementing with those vitamins that you’ve been missing out on. And certainly that was the same with me. So I cut out my folic acid and had some benefit, not very noticeable with my nerve health. And then learning about this mutation and what it does with the activation of the vitamins just opened this whole new door for me cause I was at the point of my investigation of my nerve damage where I was kind of ready to give up. I was saying this is the last person I’m going to see about this and then I’m just never going to talk about it again. I’m just going to deal with the pain. But now it’s like I’ve got this, this hope again. So it is, yeah, it’s, it’s cool. But it is overwhelming.
So people out there, you know, if you’re going to test for genetics, take your genetic tests to somebody who knows how to deal with it and talk to you about it in a way that is applicable to you.
Yes. Real and practical solutions rather than being overwhelming. I think it’s fascinating how we start. I always wince when someone talks about calorie counting and and should I lower my calories? I get this reflex and I think straight away to start with, you started talking about energy intake and I think I prefer to to think of calories as energy intake. And yes, it might be necessary to literally reduce how much you’re eating, but I think it just goes to show and you’ve highlighted with potentially things that you need to supplement. I mean, and there are a whole load of other things that you could be looking at like stress and sleep and all kinds of things. But I think what’s so interesting is that we tend to jump straight to that conclusion because it’s been rammed into our brains that you’ve got to keep your calories down if you want to lose weight, but actually there’s a whole load of other things that you should be looking at first, and they all revolve around improving your health and well-being and actually it could be those that you need to look at probably are those that you need to look at rather than jumping straight on with cutting calories.
Exactly right. You said it. It was a really great question because it’s funny how we started with calories and then ended up with genetics. Sorry, just goes to show you know, there’s so many different things and I think it’s not a pretty answer when you can’t give a yes or no answer to that, you know, it’s not pretty, but it’s the truth.
Yeah. Just like you were saying in the interview, people generally, we all like a yes or no answer, but it’s just more complicated than that, isn’t it? That sort of, you know, it depends. Well maybe, but the other thing is what’s a plateau? You can get people saying they’re on a plateau they haven’t lost weight and you find out it’s just been a week. Well that’s certainly not what I think of as plateau. I mean I would go for months at a time without losing weight. Again, it’s just a natural part of the process, isn’t it? Just leveling out every now and then?
Yes. Super good point. I think that was my top tip on your last podcast. On our first interview. It was my top tip. I remember saying, you know, weight plateaus are a good thing or can be a good thing because yeah, we don’t just lose a kilo a week until we reach our goal. That’s not how our body works. We’re not machines. So having that period where you’ve lost some weight and then stabilizing so your whole energy homeostasis can reset and actually, you know, get that new set point and not work against you the whole time. Then can allow you to safely lose some more weight or more effectively lose weight, and keep it off.
Yeah, exactly, yeah.
Yeah. Instead of your body always wanting to revert back to the start weight, it will revert back to where it’s last got that homeostasis. If you do ever sort of revert, that’s because people are so afraid of putting all the weight back on and well, yeah, maybe if you lose it all at once by drastic measures, maybe you will put it back on. But if you do it slowly and gradually with those, you know, stepwise reductions and stabilizations in between, then you’re probably not going to put it back on.
Yes. I always think of it as your body just taking a bit of a breather. This whole losing weight business, it’s, you know, it takes quite a lot of work. It takes quite a lot out of the body. I just want to rest and sit where I am for the time being, but I love what you were saying about it’s a good way of just slowly bringing your set point down over time rather than your body wanting to go back up. But we do panic. I think if we’re someone who’s been overweight for a long period of time and we’re used to either gaining or losing weight, that’s what it’s always been. It’s been the cycle of one or the other and we lump maintaining a loss in with gaining because it’s not a loss. We shouldn’t, it’s a perfect place to be in just holding your weight.
MMM. You could argue the same for like HBA1C for example. If your HBA1C is 6.4 and then you get it tested, three years later and it’s still 6.4 I would be patting you on the back saying great, you’re doing something right. You know, cause it’s not progressively going up. Okay. But if we want to get it down, what can we do? And yeah, people are too quick to just find the negative in things and we need to look at outcomes not as like just good or bad. You know? We need to think of them more of sort of just like a continuum, like a scale.
So, oh my gosh, we’ve almost recorded another podcast here.
Yeah I know! I was just going to say thank you so much. This is all first bonus content package and what a bonus content it is. Thank you so much Jessica, for taking that extra time.
That’s all right. I think I was about to say something else and then I was like, you know what? I think my brains fried now. It’s my bed time, so…
I’ve been draining, I’ve been sucking the life out of your brain, and this is you. You recorded another podcast earlier as well, so you must be completely frazzled.
No, it’s fine. I loved it and I think this is fantastic to everyone who’s a patron of a Keto Woman. I think that’s great. So I, I’m happy to give this long interview at 11:30 at night.
Oh my goodness. Well, thank you so much. We’re going to switch off now and I’m going to let you get some sleep.
All right. Good night. Thank you so much for having me.