Let's Talk About Those Darn Plateaus!!!

Each month a new article will be chosen for discussion on the message board amongst members and me, the Exercise and Fitness Forum leader. This month we will be discussing Those Darn Plateaus by Dr. Terry Simpson M.D., F.A.C.S. Please take the time to read the article and then start posting right here. While you are reading about the above article, take the time to consider the following talking points: 1. Dr. Terry Simpson talks about post-operative weight loss and the combination of fat loss and muscle tissue loss that make up weight loss. Of course losing fat weight is a good thing but losing muscle is something you want to minimize. Dr. Simpson encourages individuals to start a walking program druing the first six weeks after surgery to help minimize the loss of muscle tissue. What are some nutritional considerations that would help minimize the loss of muscle tissue in addtition to starting a walking program? Furthermore, what else may help minimize muscle tissue loss and increase fat loss once you have been cleared to pariticpate in a self guided exercise program (this often occrus six weeks post op)? Remember, increasing muscle tissue and/or limiting the loss of muscle tissue helps you burn more calories even when you are watching TV and contributes greatly to long term succcess. 2. For individuals who have or have not had weight loss surgery, foods with a high glycemic index contribute considerably to weight gain.  Dr Simpson says, "Certain foods will slow down and even STOP weight loss. Foods with sugar (high glycemic), including things you may not think about like: fruits, fruit juices, condiments, potatoes, soft drinks, breads and past as. Check the label and see how many carbohydrates and how much sugar they contain."  With this said, I have a couple of questions for you:  - Should the sugars in fruit be considered or grouped in the same category as soft drinks, some juices and bread? Why or why not?  - What are some other things to look for on the nutrition lables of carbohydrate rich foods that may help you find foods with a lower glycemic index? 3. Something interesting here, while alcohol does have calories there is some evidence that moderate amoutns of alcohol may increase weight loss in individuals who have had LAP-BAND surgery. Do you know why? 4. Not all complex carbohydrates are created equal. What are some things to look for when choosing what complex carbohydrates are the right? This answer may have some similarities to those in question #2. 5.  For long term success keeping your caloric intake between 1000-1500 calories will help.  What realistic combination (in grams) of carbohydrate, protein and fat would a diet of 1000 calories a day consist of?  What realistic combination (in grams) of carbohydrate, protein and fat would a diet of 1500 calories a day consist of?  Ok, I think this will get us started. I look forward to interacting with all of you about this article. Please feel free to aks other questions, raise other issues and share whether you disagree or agree with the information contained in the article. 

Jeremy, Good info from the Doc, With the exception of the “3 Meals a-day,” He reinforces everything I’ve gotten from my doc. Here’s a Post concerning “Plateaus!” That I’ve posted several times over the last year or so… (It was originally a response to all of the “Plateau Buster?” Posts, that recommended a specific “Diet” to get the weight loss started again. You may have seen –“ To Break A Plateau:”) Sorry to just “Copy/Paste,” But it certainly saves Typing…. I hope there is some info in it that will help others get a clearer understanding Or even to foster additional questions………. -------------------------------------------------------------------------------- OK Folks, We see this all the time- “Plateau Buster! Will someone Re-post?” Sometimes in the past I’ve just copied the “Plateau Buster” From my hard drive and posted. More and more I started including the Caveat of- “Stalls or Plateaus are normal.  Stay with protein first And stay the course, but don’t fall back into the ‘Diet Mentality’ That didn’t work for you before WLS.”

 

Well, that’s not what they asked for, So who am I to “tag on” the little  But what to do?

 

Then it occurred to me….

 

What about a whole NEW PLATEAU BUSTER! A “Life-Style for Life.” Not just a terse little list that reinforces the Diet Mentality that “Yo-yoed” so many to where they needed WLS to get a new start.

 

I’m not sure about the feasibility of it at all. But Like Me, It’s a “Work in Progress.” :haha:

 

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To Break A Plateau:

 

BEFORE DOING ANYTHING- Realize many, in fact Most Post-Ops Share this common experience- Done everything right and lost weight steadily, Suddenly- the scale won't budge. Like many others, you've reached a plateau. When weight loss slows and comes to a stop.

 

Before you get discouraged and abandon Your long-term weight loss Strategy of life-style change, Understand that plateaus occur in any slimming-down process. Stick with the program and your weight loss will kick in again.

 

Before you rush to “prosecute,” And take drastic action, Do some investigation.

 

Figure out if you really are on a plateau. The scale may be a less than least reliable reflection of fat loss. Look at other indicators. Are you feeling better? Do your clothes feel looser? If you're losing inches but not pounds, Your fat cells are still shrinking/re-arranging location.

 

Figure in the duration of the stall. You're only on what could be called a “plateau” If there's NO change at all For more than four weeks. And even at 4 weeks, don’t “assume” anything. There may be a very Tangible Reason For the slowdown and Plateau. If you Truly want to BREAK a Plateau, Identify and understand the true “Culprit” Before you just “Open Fire!”

 

Get this one out of the way first By being scrupulously honest with yourself. Are you “Cheating?”  Cheating?  It’s not a Diet! Correct, But weight loss is directly the result of – Calories in versus Calories Used. Are you putting in any “unplanned” nutrition?  Empty Calories? A little thing will be the “tipping point.”

Emotional and compulsive behavior May allow you to “sabotage” yourself. It certainly does. For so many Pre-Op. Yes?  Look at what you are doing with Extreme Objective Scrutiny.

Then- Check for hidden sources of – Calories / Carbs / Sugars / Un-wanted Fats- Read Your Labels Carefully!  Sugar goes under many different names And in some cases does NOT appear as “sugar” on the label. Many vitamin tablets have sugar fillers. CHECK!

Conversely, Are you taking in too Little Nutrition? Many times you carry over habits from other diets & eat too little. EAT UP... Food is Necessary Fuel, not the Enemy! Don't skip meals.  Just eat Protein First, Higher nutrition, Lower Calorie Foods. Don't cut your caloric intake to less than 1000 calories per day. Increase the amount of protein in your meals. Don't starve yourself. Cutting calories to an extreme will eventually cause loss But at the expense of your health.  It Does Not Help you.

Try cutting excess fat and calories to a reasonable level (usually 1200 to 1800 calories a day, but determined by YOUR Size.) And divide these up into frequent small meals (of about 200 to 300 calories each) every few hours. Eat a decent amount of protein with each meal To help you feel satisfied longer. If you keep your carbohydrate intake to no more than 20 grams a day Your body will go into a state of Ketosis and it will be Very Hard Not to lose. The “Stalls”(lasting less than 3 weeks) are normal/typical. It’s really not even considered a true “Plateau” until it hits 4 weeks. Two of the major contributors to slowed loss seem to be-  (from reading the Boards for 4 years) Too many Higher Glycemic Carbs, And Not “Enough Calories?” The “Not Enough Calories” is the one that is very counterintuitive But, It’s fairly easy to explain….. AS the body starts to eliminate fat And Ketones from the body it goes through the liver Before moving onto the kidneys for elimination, They chemically trigger metabolic changes. This is what most people mean when they say “…the body senses…” If your body “senses” too low of a caloric intake, Hormones release signaling the liver To hold on to some extra energy, “to make it through the Famine.” This will create a stall or plateau. Upping the protein calories  (but not from fats) Signals the Liver too “turn loose” more stuff for elimination. This is why blood tests often show elevated liver functions As we drop the weight. There is a typical cycle between losing and storing in the liver That happens for most folks. That accounts for people losing inches and having loser clothes When the scale shows no change. Up your water intake to increase elimination As well as your calories.  Keep the Protein % high And the Carbs below 20gms a day And your body will drop into Ketosis And the weight will start coming off again. Our bodies use glycogen for short term energy storage. Glycogen is not very soluble, but it is stored in our muscles for quick energy  -- one pound of glycogen requires 4 lbs of water to keep it soluble, And the average glycogen storage capacity is about 2 lbs. So, when you are not getting in enough food, Your body turns first to stored glycogen, Which is easy to break down for energy. And when you use up 2 lbs of glycogen, you also lose 8 lbs of water That was used to store it -- Voila -- the "easy" 10 lbs that most people lose in the first week of a diet. As you stay in caloric deficit, however, Your body starts to realize that this is not a short term problem. You start mobilizing fat from your adipose tissue And burning fat for energy. But your body also “realizes” (chemical/hormonal triggers) That fat can't be used for short bursts of energy -- Like, to outrun a sabertooth tiger. So, it starts converting some of the fat into glycogen, And rebuilding the glycogen stores. And as it puts back the 2 lbs of glycogen into the muscle, 8 lbs of water has to be stored with it to keep it soluble. So, even though you might still be LOSING energy content to your body, Your weight will not go down or you might even GAIN for a while As you retain water to dissolve the glycogen that is being reformed and stored. A frequent eating schedule will provide a constant source of energy, Keep your metabolism higher without the insulin rebound. Six small feedings a day are better AT maintaining level metabolism Than 3 large meals. (notice I did not say that 6 meals are better than 3, just better at…)

Aim for foods with a lower glycemic index. Check into it at- http://www.glycemicindex.com/

You may have a mineral imbalance.  How’s your blood-work? Such as zinc/copper.  Or a trace mineral shortage. Such an imbalance can definitely slow the metabolism Reducing your “resting consumption” of calories. Certain nutrients are often recommended to aid in weight loss, Including chromium, pantethine, selenium, vanadium And biotin to help stabilize blood sugar and metabolize fat.

Getting enough Potassium? Potassium shortages are common For early out Post-Ops.  How’s your blood-work?

Exercise?  Exercise can improve circulation, Stabilize blood sugar & other important metabolic benefits. If you’re walking, great. But at some point in your loss, Walking becomes just Activity And no longer “Exercise.” Are you Breaking a Sweat? If you have been only walking or cycling, Try doing some weight lifts and vice versa. If you are not yet exercising Try to add some sort of activity to your regular schedule. At least 20 minutes a day is recommended for beginners. Walk, Walk, Water, Water…

There’s a reason for that “Mantra.”

Increase your water consumption to stimulate lipolysis (The breakdown of fat stored in fat cells ) And clean your system of excess ketones.

Many Nutritionists recommend Avoiding eating within 3 hours of bedtime. Especially avoid any foods that are higher in carbs As this can trigger insulin production which in turn Will inhibit fat-burning while you are asleep.

Have you considered Food Allergies? These may cause all sorts of problems, fatigue, headache, etc… Check possibility of such causes by dropping out one food From your diet and checking for changes in how you feel. The most common culprits are- Milk, Eggs, Nuts & Peanuts, Fish, Shellfish, Soy and Wheat. Perhaps checkout- http://www.foodallergy.org/allergens/index.html

Maybe you have issues with food additives. Some food colorings cause metabolic responses Such as sluggishness or hyperactivity in some sensitive children. Example-  YELLOW 5 ... Artificial coloring found in Jell-O, baked goods, etc... Causes mild allergic reactions, Primarily in aspirin-sensitive persons. Check some of the food additives that show up on your labels. Perhaps a look at- http://www.cspinet.org/foodsafety/index.html

Caffeine?  Yes, it’s a “fence sitter” when it comes to “Dieting” But- Coffee, cola & tea stimulate release of insulin With a temporary lift in energy, But followed by hunger, Fatigue & slower weight loss.

Are you Drinking Alcohol? Empty Calories and Alcohol stimulates insulin.

While we’re on “the bible-belt vices,” Smoking?  Smoking uses up vitamin C & stimulates the adrenal gland. Although quitting smoking is classically A cause for weight increase, Long term non-smoking, actually aids The metabolism to remain a constant fat-burning, healthy machine.

None of the above? It may be medications you are taking.

Many drugs, even aspirin, can cause or increase incidence of hypoglycemia. Watch out for hormones, amphetamines, diuretics, antihistamines, Anti-inflammatory drugs, analgesics, anticoagulants, antidiabetics, Antibiotics, tranquilizers, clofibrate, acetaminophen, and propanolol. Beta-blockers, can make your body extremely resistant to weight loss. Sometimes it isn't what you ARE taking But what you WERE taking that slows you down. Different meds last month?

Hormones?  They can slow down weight loss And stimulate the production of insulin. Estrogen (used in birth control pills) and Testosterone have much the same effect.

Too much Salt?  Typically early on this is not an issue, But later, excessive salt can cause some water retention.

What about ‘plain old’ portion sizes? Many people misinterpret the instructions regarding Eating as “Just Eat till you are Full!  The pouch size will ‘tell you’ when it’s too much.” That assumes you have “re-learned” the feeling of Satiety As opposed to “Full.”

You may need to track your caloric intake and exercise more closely. Many people find “tracking at fitday.com” a very useful tool. Check it out at- : http://fitday.com/

So you’ve made it through this long list and everything Checks out.  Perhaps you have a metabolic resistance to losing weight, And if that is the case, you must consider everything – Except giving up and admitting defeat.

 

Your Plateau, if it continues, could possibly require Medical attention. Continued thyroid problems would definitely call for medical solutions. Excessive yeast infestation may be part of your problem. Overgrowth of yeast in the digestive tract has been shown To provoke food intolerance, headaches and immune-system weakness, And can keep you from losing weight By causing unstable blood sugar.

If your plateau WON’T Break, Enlist your physician to help find the problem.

Done all of this and still looking for the “short list?”

Then what can I say- “Eat Meat, Cottage Cheese and water for 10 days! – NOTHING ELSE!  NO EXCEPTIONS! Just try Not to Think of it as a Diet.” (this is of course very tongue in cheek)

You will most likely get a “Bang!” That will jolt your metabolism into losing.

But if you want more than a bang, If you want a real “Chernobyl Nuclear Disaster” To make your system Un-inhabitable for excess fat, For generations to come, Then adjust your “Life-Style for Life.”

Best Wishes- Dx

Thanks Dx--I made a copy for future reference! Love, Jill

Good stuff here. I would also agree while much of the article contains solid information I do disagree with the "3 meals" thing. There is a logical reason for this other than the usual metabolic benfits of eating frequently throughout the day. Dr. Simpson is correct in saying that a diet containing 1000-1500 calories a day will help in regards to long term success. For most people who have had weight loss surgery it is not really difficult to consume 1000-1500 calories a day (unless recntly post op) but it is very hard and not suggested to consume this many calories in three meals. This would mean 300-500 calories per meal and that is a lot of food if you are eating clean coupled with the restrictive aspects of WLS.  I also have some issues with placing suggested total carbohydrate consumption at 60 grams a day. That is a mere 240 calories from carbohydrate and is pretty low if someone plans on adding a decent level of physical activity to their daily routine. 

Nearly a year after you posted this, I'm getting a great amount of information here. I've been on the low-carb pre-op diet for 3 days and feel heavy and my urine was dark, even though I drink 3+liters of liquids a day. This helped ease my concerns. Thank you.

Good article!   There's nothing earth shattering in what Dr. Simpson had to say.

If I agreed with one major theme of his article it would be his advocacy of walking.  I'm proud to say that the men of the Locker Room have also recognized how walking can aid in the success of their weight loss.  In the month of April, I threw out the 50 Mile Walking Challenge to encourage our members to commit to a regular walking program.  The Challenge is now in its eighth month and several thousand miles have been logged.  It's amazing!  Another result of the walking has been the interest it has sparked in other fitness activities like running, biking, swimming, weight/resistance training, etc.  The walking raised the level of physical fitness and mental well-being to the point that activities once impossible before were suddenly possible...and were actually enjoyable.  Who woulda thunk it???  So the good Doctor is right on target here!! 

In the beginning of the piece, Dr. Simpson mentioned that everyone experiences a plateau...well, that's not true.  While I experience periods where my weight loss proceeded at a slower rate than others, my loss never stopped or plateaued.  At each point when weight loss slowed, a slight increase of both calories and protein accelerated my weight loss to what I considered an acceptable rate.  I never once stopped my fitness routine which was a combination of weight/resistance training and cardio...this I feel had more impact than varying my consumption of carbohydrates.  So no, not all patients experience a plateau and there are others that will tell you the same.

Another area where I would disagree is the three meals a day rule.  What works for some may not work for others, but there are strong indications that those who eat several meals daily (6 small meals instead of 3) experience fewer plateaus and have a more consistent rate of weight loss with fewer peaks and valleys.  This is certainly the case in my personal experience.  There needs to be much more research here...too many schools of thought here.

Finally, I found it laughable that the article in two different places said the first six weeks after surgery is "fun".   Okay, now while I was certainly excited and optimistic about life as a post-op, there was NOTHING fun about it.  As each day passed things got better, but "fun"...hummm, I'm guessing Dr. Simpson himself is not a WLS patient!  Let's be realistic!!!

Thanks for sharing this article with us! 

Mike J...aka Cards Fan Springfield, MO

STEP OFF THE SIDELINES AND GET IN THE GAME!

Hello Mike, I agree with what you and DX have said. As I responded to DX, three meals a day is not realistic and for many the 60 grams a day of carbohydrate is not either.  Thanks for contributing. 

Good article. It’s not rocket science. Eat less, move more. I think the key point to me was it’s just another diet; it’s just easier after WLS.

 

 

It sounded like he's a low carb advocate. I find I lose fat better on low carbs, stay less hungry and my blood sugar levels off better. But it’s hard on a cookie freak like me.

 

 

3 meals a day vs 6 meals a day will get a fight started between WLS surgeons in a heartbeat. Go to a panel discussion and bring it up. I think 6 meals a day keep your blood sugar levels steady, keeps your metabolism jacked up and keeps your satiety level even. After WLS you can’t get in the nutrients you need to stay healthy in only 3 meals. Even if you count a protein shake as a meal. It’s still hard with only 3 meals to stay healthy after WLS.

 

 

Doctors generally have very little training in nutrition or dieting. Someone told me 1 class out of 8 years of schooling. I don’t trust everything a nutritionist tells me either. But I’ll listen to what they have to say.

Jeremy Great topic because I am tempted to freak out! I am plateaued and have been for 2 months at least. For several weeks I did no****ch my carbs closely. I am back to tracking my carbs very carefully on spark people. I typically come in at about 75 carbs a day in a 1100-1200 calories but most of them are complex carbs - like high fiber cereal. I cup of Kashi Go Lean has like 25 grams of carbs but 12 grams of dietary fiber which I am reluctant to give up. I don't eat that ever day but a couple of days a week. On other days I add 2 tblps of milled flax seed to scrambled eggs to get added fiber. Much of the rest of my carbs come from veggies. Occasionally sugar but that is a very small part of my overall carb intake. Ok, so in 1200 calories or so I also work out 5-6 days a week. I do strength training with personal trainer 3x/week and do 30 minutes of cardio at a heart rate of 165 bpm. On Tues/Thurs I do 50 minutes of cardio - 5 minutes of warm up, 40 or so minutes of cardio at my target heart rate and 5 minutes of cool down.  I do the elliptical most days of the week, I do spin class one day a week. My current plan is to increase my calories by about 200 and get strict about simple carbs. Maybe increase water intake. There isn't a lot more exercise I can add. I drink a glass or two of wine 2x a week but that is a lifestyle choice for me and I would really prefer not to give it up. Sorry but I really enjoy it. I honestly account for those calories.  Any thoughts on further ways to break this plateau?? Cheers, Susan

Susan, How close are you to goal weight, what do you weigh now, what type of surgery did you have and do you have a good amount of "loose skin?"