- Get the right amount of protein
- Don’t eat too much fat
- Try intermittent fasting
- Watch out for the carb creep
- Cut out alcohol
- Avoid sweeteners
- Do weight training
- Get enough sleep
- Reduce stress
- Be realistic
Here, at Diet Doctor, we often get emails from frustrated or bewildered women, usually over the age of 40, who are doing everything they can to maintain a keto diet, but are still not losing weight.
Their urine usually shows they are in ketosis, they are following the recipes and guides, but not only are they not losing the expected pounds, sometimes they are even gaining weight.
Alas, as women get older, keeping off those pesky extra pounds often gets harder.
That’s why we’ve created this list of 10 things women ages 40+ can try to work into their routine to help maintain their weight or even break a weight loss stall — while still feeling their best.
Remember, we’re aiming for progress, here, not perfection. So if you can’t hit all 10 of the below takeaways, at all times, or if they don’t result in dropping pounds you are in no way a failure. After all, tip No. 10 is to be realistic.
A common problem
If this is happening to you, you are not alone. Over 40 million women in the US, 13 million in the UK, and many more millions around the world are estimated to be going through menopause, which usually occurs between ages 49 and 52.
Weight gain is very common during this transition, no matter what diet you are eating.
So along with delving into the research literature, we also tapped the knowledge and experience of some of our low-carb experts — Dr. Sarah Hallberg, Dr. Jason Fung, Dr. Eric Westman, Dr. Ted Naiman, and Atkins RN Jackie Eberstein.
These 10 tips can work for anyone in a stall, meaning they’re not just for perimenopausal women. “Menopausal women certainly can have problems with weight gain, but we see it in many others, too,” says Dr. Jason Fung.
1. Get the right amount of protein
For weight loss, protein should be adequate but not excessive.
“Women can much more easily over-consume protein compared to men,” says Dr. Sarah Hallberg. “If you and your husband are eating the same size steak, you are probably consuming too much.”
As for Dr. Naiman, he is less concerned with keeping protein intake modest.
As a whole, the general advice from our group of experts is to eat between 1.2 to 1.7 grams of protein per kilogram of reference body weight per day. So, a woman whose reference body weight (not actual body weight) is 70 kg (154 lbs) should aim for 70 to 119 grams of protein per day.
If you’re not really interested in counting grams, you may instead want to try a suggestion from Dr. Hallberg to do a “mindful week” and retrain your feelings of hunger and fullness. Here’s how Dr. Hallberg puts it:
“The problem and the struggle for all the people we see, not just menopausal women, is they don’t know what hunger and fullness really are.
These women come to us after years and decades of a low-fat, high-carb diet. So they are used to a feeling of fullness that is fuller than full. We need to retrain ourselves to understand that ‘full enough’ is the way you should feel.
Have a mindful week. What that is, in my mind, is that this patient is going to dedicate a week to this, because it takes time.
For example, if you’re used to having two eggs and two strips of bacon for breakfast, during the mindful week you’d only bring one egg and one piece of bacon to the table. And you would eat it.
Then, you have to wait 20 minutes — and that is where the time investment comes. Then think to yourself after 20 minutes, ‘am I actually still hungry?’
You have to give yourself time to learn how to tell if you are full or still hungry. And so you do that for each meal, for a week’s time.
You’ll begin to realize at some point that you’re eating the right amount, you’re eating too much, or you’re eating too little. You’ll realize at some meals, ‘I was eating too much. I didn’t need that second egg or whatever.’
It’s a way to eat mindfully without counting calories. Do it based on your body’s needs and to get in touch with your body’s needs.”
2. Don’t eat too much fat
Once you’re fat-adapted, it’s important to avoid consuming excess fat.
One of the great joys of low-carb, keto eating is including fat at every meal after years of avoiding it.
But a keto diet is not carte blanche to gorge yourself on fat, the experts note. If you want to lose weight, you have to burn your own fat stores for energy rather than consuming all the energy you need by eating fat. So if you’re struggling to lose weight, stop the bulletproof coffee and fat bombs for now.
Dr. Naiman notes that when people first start the low-carb keto diet, they’ve often been consuming lots of carbs and are very glucose dependent. Initially, he tells them to eat an unlimited amount of healthy fat until they are fully fat adapted. “You will know you are fat adapted because you can go a long time without eating,” he says.
Once they are primed to burn fat, however, he then scales back on fat so that they will access and burn their own fat stores.
So if you are experiencing a weight-loss stall, our experts recommend you look at how much fat you’re consuming and see where you might cut back without sacrificing fullness or triggering the return of cravings and blood sugar swings. Don’t starve yourself, but be mindful of excess fat. Samantha decided to cut out her bulletproof coffee for now.
Dr. Hallberg notes that it is easy to over-consume fat in liquids, especially full-fat whipping cream. “Someone will come in and say they are in a weight-loss plateau. We will look at their diet and see they are consuming six coffees, with two tablespoons of whipping cream in each one.” Cutting back on the whipping cream might help them get out of a stall.
“When you are at your ideal weight, you can add the fat back in and eat all the butter you want,” Dr. Naiman says.
Dr. Fung discussed this concept of excess fat consumption and how it applies to some people, including the role of leptin resistance in weight loss stalls, in a popular earlier post.
3. Try intermittent fasting
After becoming fat-adapted, you may find that your hunger pangs diminish, making it easy to go for longer periods without eating.
Many people naturally stop eating breakfast — they just aren’t hungry when they wake up. The number one rule of low-carb eating is to eat when you are hungry and stop when you are full. So if you are not hungry, try intermittent fasting (IF).
Start by skipping breakfast and just eating lunch and dinner within an 8-hour window, which is called a 16:8 fast. Or you can try eating dinner one night, then fasting until dinner the next night, which is known as a 24-hour fast.
Dr. Fung suggests not doing the same fasting routine day after day but to “switch it up.” For instance, do a 16:8 fast one day, a 24- hour fast the next, followed by a day of regular eating.
He states this is because the body has a strong physiological drive to seek homeostasis — energy balance. “Whenever the body is exposed to a constant stimulus, it will become acclimated to it,” he says.
Hallberg suggests caution, however, around very long fasts lasting multiple days.
“If you are skipping meals because you are not hungry while eating a proper low-carb, high-fat diet, that is just fine,” she says.
But she is concerned about very long fasts in which people are ignoring hunger signals, as well as the potential for a dangerous physiological fluid and electrolyte imbalance called refeeding syndrome that can arise after very long extended fasts lasting many days, once normal eating is resumed.
When people are doing low-carb, keto eating they are often not hungry for 16 or 24 hours. Such fasts are safe and healthy, as long as you have some weight to lose.
However, avoid fasting if you are underweight. Eat when you are hungry, don’t eat when you are not, and stop when you are full.
4. Watch out for the carb creep
If your weight loss has stalled, closely examine what you are eating and cut back to less than 20 grams of carbs again.
Nuts like cashews, almonds, and pistachios are easy to overeat and can contain enough carbs to contribute to a weight-loss stall. A cup of pistachios, for example, has 21 grams of carbs. Avoid carb cycling or cheat meals too, for now.
“For insulin resistant people, if they are in ketosis but eat one meal of carbohydrates, it may stop ketosis in some people for up to three weeks,” said Dr. Westman.
Keeping carbs below 20 grams will maximize weight loss with more control over hunger and cravings, says Jackie Eberstein.
5. Cut out alcohol
Many people love the fact that on a low-carb or keto diet they can have a glass of dry wine from time to time. However, if you are experiencing a weight-loss plateau or gaining weight, cut out all alcohol for now until weight loss starts again. Even a few drinks a week might cause a stall.
6. Avoid sweeteners
If you have been including artificial sweeteners like aspartame or sucralose in your low-carb or keto diet, our experts recommend you wean yourself off them.
While there are not a whole lot of scientific studies, anecdotally we find when people get rid of artificial sweeteners, they are able to lose weight. Come off them as soon as you can,” advises Dr. Westman.
7. Do weight training
While you can’t exercise your way out of a bad diet, adding in weight lifting will build muscle, which can help increase your metabolism.
“The more muscle you add, the better your insulin sensitivity, so any sort of resistant strain you can add to your muscle can be great for weight loss,” says Dr. Naiman.
The weight lifting doesn’t have to be excessive — 90 seconds per muscle group, twice a week, can do it. But he notes it has to be a heavy enough weight that after about to 10 to 15 lifts (reps) you cannot do another rep. This is called lifting to muscle failure.
“It is only if you go to absolute failure that you convince your body that you’re not strong enough. Your body won’t add muscle unless you send the message that it needs more,” Dr. Naiman says, noting that squats, push-ups and other body resistance methods can be just as effective as hand-held weights or weight machines.
Dr. Westman never brings up exercise as a first step in weight loss. He wants patients to focus on the diet first. “But later on, if things are no longer working well and there is still significant weight to lose, I bring up the E-word, exercise. But I try to get them back to things that are fun for them. Exercise can help you get through a plateau.”
Dr. Hallberg notes that vigorous exercise can sometimes create a false plateau. “If you are exercising to the point of getting sore, you are tearing muscle — which is a good thing. That is how we build muscle, by micro-tears.”
But in order to deal with that, the body sets off a small inflammatory response, which may cause people to retain fluid. “So after a vigorous workout you might jump up a few pounds overnight. It is not a real plateau, it is a pseudo plateau,” she says.
8. Get enough sleep
During menopause, many women find their quality of sleep sharply deteriorates, often because of hot flashes and night sweats.
Drs. Fung and Hallberg recommend that women in weight-loss plateaus aim to improve their sleep. Poor-quality sleep can increase levels of cortisol, a stress hormone associated with increased abdominal fat.
Tips for better sleep include:
- Sleep in a cool, dark room.
- Wear ear plugs and eye shades.
- Limit screen time and blue light before bed (or try the glasses that block blue light).
- Go to bed and get up at the same time each day.
- Stop drinking coffee by noon and limit caffeine consumption in all forms.
- Avoid alcohol before bed.
- Get exposure to natural daylight each day.
Read more here: National Sleep Foundation: Sleep Hygiene
9. Reduce stress
Examine the stresses in your life and see if you can do anything to alleviate some of them. Stress increases cortisol release, which may cause hunger and encourage your body to store abdominal fat.
But don’t stress about stress — that is a no-win. Many menopausal women find they are caught in the sandwich of still-dependent children and aging or ill parents. Death of loved ones may also become more common during the menopausal years.
“When we see people struggle and hit a plateau, or completely fall off the wagon, the number one cause is a life crisis of some sort,” says Dr. Hallberg. “We all have life crises, men and women — all our lives are managed chaos. We recommend people plan coping mechanisms to deal with stress.”
Stress can cause emotional eating, too, another cause of stalls or weight gain, Dr. Fung notes.
Try yoga, meditation and mindfulness techniques, relaxing walks or other pleasant diversions and hobbies. Dr. Hallberg recommends a week of slow and mindful eating, where you really pay attention to taste, textures, and hunger cues. Eat slowly, deliberately and mindfully.
Dr. Westman notes that even worrying about your weight can be a stressor. While tracking weight and food intake is often helpful, if it becomes too stressful, Dr. Westman suggests not monitoring these for a while and just going by how you feel.
10. Be realistic
Both Dr. Hallberg and Jackie Eberstein note that having realistic expectations is particularly important for women of all ages.
Some women are aiming for an arbitrary number on a scale, perhaps from a long time ago or an idealized weight they have never achieved — a number that has no real bearing or relationship to their actual health and wellness.
“This is one of the really big issues I see for women — it’s so much entwined with psychology, self-esteem, and societal pressure, and in many ways outside of women’s control, “says Dr. Hallberg. “They succumb to ways they think they need to be, rather than what is healthy for them. If you see victory as only a number on a scale, you are going to sabotage yourself.”
Jackie Eberstein agrees: “Measure your success by a loss of inches, rather than the scale.” She encourages accepting that weight loss in middle age will be slower than when you were younger.
“Remember that you’re in this for the long haul. It’s an investment in your health as you get older. Have patience. Your long-term goal is to make a permanent lifestyle change as well as lose the excess fat.”
Read more about weight, health and happiness in our evidence-based guide.
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