Episode 45: AMA | Skinny Fat, Gluten Allergies & Plateaus

Dr. Simonds and Michelle Kennedy were Live on Facebook answering your questions. In this show, we discuss weight loss, skinny fat, gluten allergies, restarting office visits, and more.

Q: My daughter has joined me on my quest to be healthy. She asks, “Does too much protein and not enough fat have a negative effect on ketosis and weight loss?” Also, “What’s the best way to get the proper amount of fat, w/o going over on net carbs/calories.”

A: As a general rule, we’re not too worried about too much protein intake having a negative impact on ketosis and weight loss. We’ve had very few patients that consume lean chicken and steak and think that’s the cause of their weight gain. Generally, this is not the norm. It’s usually because the protein is consumed with refined carbohydrates and sugars such as rolls, potatoes, and sugary drinks. We have plenty of patients that consume low carbohydrate, high protein, and low-fat diets that lose a lot of weight.

Taste buds will usually aid in the consumption of the correct amounts of fat and protein and as long as refined carbohydrates are eliminated, then the goal is achieved. The essence of the argument about much protein lies in the fact that there are some amino acids in the protein that we call insulinogenic amino acids. These are branched-chain amino acids that can raise your insulin levels, and too many of these can stop ketosis. It really takes an excess of protein consumption for this to happen and most folks will stop eating well before reaching this level of fullness.

If a patient is really insulin resistant, sometimes cutting back on the protein and increasing fat will help. Sometimes, we find that women do a little bit better with the calorie control that comes from moderating fat in a keto diet. Remember, this advice is general and each patient is different. We recommend seeking professional weight loss services for individualized guidance.

The best fat sources come from whole, unprocessed sources. It is so much harder to overeat items such as avocados, nuts, seeds, butter, ground beef, and other naturally occurring animal fats. You will feel satiated and satisfied with these high-quality fat sources.

Q: For someone that is experiencing a plateau during weight loss, what do you recommend?

A: For those experiencing a plateau, it means that something needs to be changed. Whether it’s dietary changes resulting in more or less of a certain macronutrient, more or fewer calories, shifting the timing of eating, or even addressing exercise. There may also need to be a change in weight loss medications. We use medications for weight loss because they are effective in treating these complex metabolic conditions. Sometimes the medications that you start with may not be effective to get you through a plateau.

There are many different factors that can be affecting your weight loss. If you’re struggling with a plateau, give us a call. We can help guide you through what may work for you as an individual.

Q: I always feel like I need to lose weight before coming back to the practice after falling off track. How can I work through this feeling?

A: We hear this multiple times a day from patients that are afraid to face the scale after taking a break from visits. You’re not alone and all of our patients tell us how happy they are that they decided to return. You don’t have to lose weight before returning to see us. That’s what we’re here for. Weight loss is really difficult and we will never judge, blame or shame you. This is a judgment-free zone and we mean it!

Obesity is a disease and is not a character flaw.  For example, take someone that has high blood pressure and is prescribed medication by their primary care doctor for treatment. If that person takes their medication and sees no improvement, their generally not ashamed to return for a follow-up visit, right? They wouldn’t feel shame and cancel their follow visit because they didn’t like their blood pressure numbers or are too embarrassed to see the doctor.

Obesity is a serious medical condition and should be treated as such with no shame or judgment. We encourage you to look at obesity as a medical problem that needs treatment.

There’s no extra cost to restart with us, no matter how long it’s been since your last visit. The cost is a regular follow-up visit. We make restarting easy! Contact us to get restarted.

Q: Are there significant benefits to a keto diet if you have gluten allergies?

A: Yes, a keto diet is naturally gluten-free! And, there are significant health benefits to a keto diet whether or not you have gluten allergies. Gluten is the protein that is found in grains and when you eliminate grains from your diet, you inevitably completely avoid the allergen.

It’s important to note that gluten-free and carbohydrate restriction are two entirely different things. So, yes a keto diet will fix a gluten allergy since you won’t be eating grains. Just be wary of gluten-free products because they are still very carbohydrate-heavy with low nutritional value and are sometimes even worse for you. Your gut health is very important and when it’s compromised, can lead to many health problems and consequences. A ketogenic diet has a lot of gut-healing properties from healthy fats and fibrous vegetables and can even help heal damage from eating a highly-processed diet.

Q: Should I worry about losing weight if I’m skinny fat?

A: Skinny fat is a term that is used when your body weight and BMI are not high, so you look thin, but the percentage of your body fat is high. This happens frequently and the clinical term is TOFI (thin-outside-fat-inside). A person can carry an excess amount of fat in the abdomen area around vital organs but still have thin legs or arms. The accumulated fat inside is very dangerous and even sends nasty messages to all the other organs. This is what makes obesity a disease. It’s not just the weight and the physical mass, it’s the fact that the fat cells are releasing substances and chemical messengers that hurt the heart, kidneys, liver, and brain. It’s really a toxic mess and you really can’t tell by looking at someone on the outside if they have this issue.

This is why we focus on more than just weight. It’s important to look at body fat as an organ. A person can be thinner with a smaller frame but still have excess body fat and become sick with all of the diseases that are associated with obesity such as type 2 diabetes, heart disease, and others. Just because someone is a normal weight does not mean that they are healthy. When someone is skinny fat, the focus should be on fat loss, not weight loss. It’s important to avoid foods that raise insulin levels since insulin is what makes someone store and hold on to fat. It’s okay to have subcutaneous fat, which is the fat you can pinch. Visceral fat, also known as ‘hidden’ fat, is fat stored deep inside the belly, wrapped around the organs, including the liver and intestines which is dangerous.

We specialize in helping patients lose body fat, not just weight.

Q: I’m Mexican-American. Do you treat many multicultural patients with keto?

A: Yes, we treat everyone with all kinds of backgrounds and ethnicities. We enjoy helping patients navigate diets and make food alterations to fit certain cuisines and heritage. We work with all kinds of diets and would never discourage you from the foods you enjoy. As a matter of fact, Mexican food can be very keto-friendly. The cuisine is filled with healthy animal proteins, guacamole, and fresh vegetables. We would suggest using low-carb tortillas or quest chips as substitutions for the traditional items.

We also have patient forms in Spanish on our website.

Q: Do you still offer telephone visits? Is there a cost difference?

A: Yes, telephone visits are still available and the cost is the same as a regular in-office follow-up visit. The only additional cost is the$15.00 shipping rate for medications. We do have a few requirements for patients to be eligible for telephone visits. You need to be an established patient where we have seen you at least once in the office and we would need to see you in the office at least once annually.