Doubling Down on Atkins: The Atkins Diet’s Missing Phase

I have lost 55 pounds on The Atkins Diet, the most well-known low carb diet. I went from obese to a normal weight, I have improved all my risk factors for chronic disease, and I feel better than I have in years. You won’t find a more enthusiastic supporter of Dr. Atkins anywhere. At the same time I’ve done a ton of research on diet, nutrition and metabolism and I’ve come to believe that there is something missing from the Atkins diet.

The Atkins diet is a low carb, high-fat (LCHF) diet with four stages.

The first phase is called Induction; you limit yourself to less than 20g of carbs per day, mostly from vegetables, and you don’t count carbs from fiber. Induction is followed by Ongoing Weight Loss (OWL), a gradual increase in dietary carb content. After OWL comes Pre-maintenance, further adjustment of carb content until weight is stable at the dieter’s target weight. The final phase is Maintenance, a low carb diet strategy for the rest of your life.

The only problem is, I don’t know anyone who has made it past OWL. Not just among my personal friends and family (several on Atkins), but also among my Facebook friends, Google+ circles and Twitter. I’m sure there are some who have, but most of the long term Atkins dieters I know are experiencing weight loss stalls.

Not everyone agrees on what constitutes a diet stall. I consider a diet stall no weight loss for at least 6 weeks.

I find it easier to understand stalls if you visualize weight loss as a graph. The shape of the line that tracks your weight, starting high in the upper left and, over time, heading mostly down toward the bottom right is your diet trajectory.

The ideal Atkins diet trajectory (below, in red) would look something like this:

A steep slope to start, leveling out a bit during OWL, then finally flat-lining for pre maintenance and maintenance.

But it rarely works like that in the wild. My own trajectory (represented above, in blue) shows a rapid weight loss followed, briefly, by more gradual, weight loss, then a one-year stall with minor ups and downs.

If you look at the weight changes of low carb dieters in several of the published studies you’ll see that typical diet trajectories (represented above) include rapid weight loss followed by gradual weight loss, followed by a slight weight rebound.

If you look at the weight changes of low carb dieters in several of the published studies you’ll see that a typical diet trajectory includes rapid weight loss followed by gradual weight loss, followed by a slight weight rebound. In many cases dieters in these studies lose significant weight, more than on other diets studied, while improving their risk factors for chronic disease, but stall at a weight that’s higher than they desire.

It is important to note that Diet stalls, or plateaus, are not unique to Atkins or low carb dieting. They may be one reason why dieters on many different diets become discouraged and give up.

There are many factors that could be causing stalls: Insulin resistance; set points; hidden carbs; excess dietary protein leading to gluconeogenesis, where our bodies make carbs from protein or triglycerides. The cause could be a combination of those and other factors, or it could simply be that some of our target weights are just not realistic for our ages, our bodies and our metabolisms.

Whatever the cause, these diet stalls are a serious issue for many dieters and I’ve come to the conclusion that what’s needed is a new phase for the Atkins diet, designed to overcome stalls.

I don’t think I’m alone in thinking this. Several of the most prominent members of the low carb community, after experiencing their own stalls, or dealing with patients or clients who are stuck with more fat than they would like, have been experimenting with different versions of the Atkins diet’s missing phase.

Dana Carpender is following a version of the Fat Fast, an intermittent diet of 1000 calorie per day, for a few days at a time, with 90% of the calories coming from fat. The Fat Fast diet was recommended by Dr. Atkins as a last resort, but it’s not in the current Atkins diet book.

Jimmy Moore is conducting an experiment in nutritional ketosis, a diet strategy characterized by high fat content and almost no carbs, as in the Fat Fast, but Jimmy also keeps track of his progress by frequent testing of blood sugar and blood ketones.  He adjusts his fat, protein and carb intake to ensure his glucose and ketones stay at desired levels. His experiment was inspired largely by “The Art and Science of Low Carbohydrate Living” and “The Art and Science of Low Carbohydrate Performance” by Jeff Volek and Stephen Phinney, who are co-authors, along with Eric Westman, of “The New Atkins for a New You.”

Sweden’s Dr. Andreas Eenfeldt, AKA the Diet Doctor, is also experimenting with higher than the already high fat consumption in his LCHF diet, aiming for target insulin and ketone levels, as measured with frequent blood tests.

Shortly after Dana and Jimmy began their public experiments, I designed my own. I call it doubling-down on Atkins. (The term double-down comes from BlackJack, when you believe you have a winning hand you can double-down, raising the stakes, risking more, for a chance to win big.)

To double-down on Atkins, I ratcheted the carbs down to 15g per day (from about 30), increased my fat at every meal, and eased off a bit on my protein intake. I also went one step further. I cut out all artificial sweeteners; I eliminated the small amount of occasional fruit; dropped the low carb tortillas; eliminated nuts; and stopped drinking wine with dinner. I had enjoyed all of those during the 6 months where I lost most of my weight. It’s not quite the Atkins Fat Fast, or nutritional ketosis, but it has elements of both. I also check my blood sugar and ketones, but not as frequently as Jimmy or the Diet Doctor.

In two months of doubling-down, I’ve lost ten pounds. It’s nothing like the rapid weight loss I enjoyed when I started Atkins, but after a year-long stall, I think it’s just fine. If I can lose four or five pounds per month, I’ll be at my target weight by the holidays. (But how many times have I said that?)

There’s another benefit to this doubling-down on Atkins. Although I don’t think I could have tolerated this food when I first started Atkins, right now I’m fine with it. In fact, the best way I can describe how I eat is: I eat as much as I want of whatever I want, whenever I want to. But somehow I no longer “want” to eat foods that are not on my diet. I had cravings for sweets and missed bread for much of my time on Atkins. But not after I started doubling-down on Atkins. Jimmy and Dana are also reporting changes in their appetites and cravings.

Doubling-down, the Fat Fast, or nutritional ketosis, are all personal experiments, they’re not science. It’s n=1: One person trying one diet. Anecdotes at best. There is precious little science and study of overcoming stalls in dieting. Maybe if enough people report good results in these experiments on ourselves, we will pique the curiosity of researchers and grant-funders.

It’s too early to say exactly what this new Atkins phase would look like. My guess is that it would involve a fat percentage along the lines of the Fat Fast: 80 to 90% of calories from fat; careful testing of blood glucose and blood ketones; limited protein intake.

Of course, I still believe that the healthiest and most effective weight loss strategy is Atkins and the low carb high-fat lifestyle. But these long term stalls are more than discouraging. I spoke to someone a few days ago who told me of her experience with Atkins about 15 years earlier. Her diet trajectory was fairly typical: Rapid weight loss, followed by gradual weight loss, a stall and rebound. Without easy access to the kind of support and the community we have on the internet now, when she stalled and then began gaining weight back, she thought the diet had simply stopped working for her. She even tried the ketone urine test strips and, when they didn’t show ketosis, she gave up and eventually put the weight back on. She’s back on Atkins now, and if she hits another stall, at least this time she knows what’s happening.

In my case, I would be fine with being stuck 20 pounds above my target weight for the rest of my life. It sure beats being 70 pounds over. But some dieters have stalls when they’re still obese, many stall when they are still overweight. Sometimes the stalls break and weight loss resumes. Sometimes stalls don’t break. Sometimes people start to add weight, while some reach a set point while still heavier than than they want.

Long term stalls are a problem for many Atkins dieters, and I hope the authors of the next version of the diet consider adding a new phase specifically designed to overcome stalls. I wouldn’t expect big changes to the official Atkins diet anytime soon. Phinney, Volek and Westman wouldn’t add new Atkins phases willy-nilly. If they consider it appropriate, they’ll take a very careful and conservative approach based on the best science available.

But Atkins dieters experiencing long-term weight loss stalls are starting to find solutions compatible with the Atkins-based low carb high fat lifestyle.

Are you conducting your own low carb n=1 experiments? Let us know in the comments below.