Most people who diet are typically lifelong dieters, and they go from one diet to the next. How is keto or low-carb different?
I think it’s different because you’re working with the body’s metabolism, not against it. In other words, if you’re a dieter, you’ve probably been trying to lose weight and struggling with that all your life. I hear that as the first words out of people’s mouths when they come to my office. I work at Duke University in an obesity medicine, keto medicine clinic. I’ll ask people for their story, and they’ll say, “I’ve been dieting all my life and nothing’s worked.” After listening for a while, I say, “Have you ever tried a low-carb or keto diet?” Surprisingly, a lot of people will say no. They’ve tried everything and yet, low-carb and keto don’t seem to be part of everything. Maybe because it hasn’t been recommended by the dietitians or the doctors. But it’s been around since 1863.
Part of the issue is these other diets. If you’re consuming carbohydrates and you’re sensitive to them – if you have extra weight on your body, you’re going to be one who stores carbohydrates – and if you eat carbs, it’s going to make you hungry. If you restrict the calories and go on a calorie-restricted, time-honored, low-fat diet, you’re going to be hungry. You’re going to be hungry, you’re going to want to eat, and then the diet is very difficult to do. You’ll think of a diet as something to get on and get off, get on, get off.
It’s very different on a keto program or a keto lifestyle because the hunger is gone. The reason for that is you’re working with your body, not against it. What I mean by that is you don’t fight hunger. You don’t have to have willpower to not eat things since your body becomes a fat-burning machine. It burns fat really well. If you have extra fat on your body, it starts burning it, and you’re just not hungry. You don’t have the same tug to the foods like other diet programs do. It’s fundamentally different from other diets. The low-carb keto diet cuts the hunger out in just a day or two. It’s really remarkable. The cravings go away very, very fast. With weight loss happening, if that’s why you’re doing it, it’s a pound or two per week, which is pretty noticeable, pretty fast. That’s five to ten pounds per month, fifty to a hundred per year – without hunger. And you get to eat wonderful foods. It’s very different, but there are some things you have to change in your mindset, no question.
There are so many things that we’ve been taught from a very young age. How do we change this behavior?
The best way is to follow an eating plan like keto, where you’re just not hungry. You might not even have a meal, let alone feel like you have to finish everything on your plate. There are a lot of things in terms of the types of foods we’ve been taught to eat and to not to eat, when to eat and not eat, how much to eat, and how little to eat – that pretty much all changes on a keto diet. People take time to get used to it because it’s so different in that you’re not hungry. One person even told me she must be sick. When I asked why, she said, “Because when I’m sick, I don’t eat, and I’m not eating much. I must be sick.” No, that’s the way this works as the hunger goes away and you eat less, automatically. But there are a lot of these emotional, even safety concerns because it’s so different.
You often say, “Listen to your body. When you’re hungry, eat, when you’re full, stop.” You don’t have to finish everything on your plate. If it means that at twelve o’clock or one o’clock in the middle of the day when it’s supposed to be lunchtime, you’re just not hungry, it’s okay not to eat.
Doesn’t it seem strange that I have to give people permission to not eat so much? But it’s like you’re carrying around backpacks of food on your body. If you have extra weight on your body, why aren’t you getting access to that? Why aren’t you using that stored fuel? I very quickly introduced the idea of eating only when you’re hungry. You don’t have to have breakfast. I’ll say that about 10 times because we’ve probably been told thousands of times that you have to have breakfast – “Breakfast is the most important meal of the day.” Your parents may have been worried about you going off to school and they don’t know what you’re going to be eating at school, so they force food into you, and that becomes a habit, and it gets all jumbled together with family life and comfort foods. For some people, it’s easy and none of this applies. For other people all of these things apply, and we work hard to introduce new ideas, a new mindset about what to eat, about when to eat, how much to eat, how often, and let your body be the guide. That’s the simple answer. It may take time for you to feel and learn what your body is saying because you’ve been eating all this junk food that messes up the signals for you to understand that.
What advice do you give people who use food as a crutch?
There are some very practical things that we’ve learned because we know about the hormonal effects of foods. It may seem like it’s not a big deal, but it is. You can always eat on a low-carb keto diet if the food has no carbs in it because that means it won’t raise your blood sugar. It won’t raise your insulin and it won’t stimulate the same hormonal change. One of the fundamental principles we have is, if you’re hungry and or you want to emotionally eat, you choose foods that have no carbs. What happens is it fades away over time because that emotional eating is not really giving you what you had before, although the behavior stays for a while.
It’s the same thing with sweets. We’ve learned practically that using non-sugary sweeteners is fine at least in the short run – and for some people in the long run – but to take people away from the sugar, allowing for sweet things without sugar is an important thing to have in your tool chest for people who are big sugar addicts. We do find substitutions or practical ways to handle the biggest things like that – allowing people to have sweet things and to eat frequently. It has to be food that doesn’t give that hormonal response, which will make the craving fade away over time.
How do you advise patients who feel pressure when eating out with friends and family?
It’s surprisingly fast, after a few days or a week for most people, you’re just not hungry, so keeping in mind that you can drink something that doesn’t have carbs; you could choose keto-friendly things, which are the zero-carb or very low-carb vegetables. We teach people to stick up for themselves, for what’s healthiest for them, and not to fall victim to what other people tell them they should do. You don’t have to please everyone and accept all of these other things. Sometimes around the holidays if your family is bringing the special pie that they always have and they don’t make a low-carb keto version – which there are lots of now – you just accept it and have a taste of whatever the thing is that other people feel you need to have. That’s a longer process, talking about love not being food; being together and sharing a meal regardless of what the meal is can be changed over time. The more you stay keto, a lot of these things will come naturally. If you want to be very diplomatic about things, you can. If you want to say, “I don’t eat that” or “I’m allergic to that,” some people will even go to the extreme of saying, “I can’t have that. Please respect that.” It really depends on the individual’s circumstances.
Some people may start a keto diet and be the only ones in the house doing it. How can they get the rest of the family on board?
I’ve seen it done in many ways. Sometimes it’s actually easy. It depends on the person. If your hunger is gone after a day or two, but your family still eats carbs, some people just aren’t attracted to those foods anymore and they can keep feeding the family those foods (without eating them, themselves.). At first, there’s an initial enthusiasm to want to change the whole family but we advise you to not become the zealot or the nag in the family. Let other people follow you; be the example to show other people how to do it and then usually there’s a three-to-six-month lag and people will follow along in the family because they see how well you’re doing.
There are some practical things. I point people to internet resources and cookbooks where if you make the meat, the veggie, and the starch as separate components of the meal on the plate it’s easier than to feed the family the starchy part. If they’re still having a sweet dessert you can just stay away from that. You wouldn’t want to do the old lasagna with pasta because that would be harder for you to separate out but you could do eggplant variations or zucchini lasagna without the pasta. A lot of substitutions can be made. A lot of the food that you can cook on a keto diet is delicious. One person was complaining, “How do I keep my food away from them?” and I just explained it’s healthy food for the kids if they want to eat the keto foods, meaning meat, poultry, fish and shellfish, eggs, and non-starchy vegetables. It depends on the factors in the home. Some people find it very easy. Other people will figure out ways to get the components of the food that they will eat and then have other people in the family eat the entire meal with the starch or the dessert that they don’t have.
Watch the full video on the keto mindset here.