Can You Take the Weight Off and Keep It Off?

The barrage of ads for fat-burning diets are unavoidable whether it is on your phone, your tablet or just while waiting in the checkout line at the supermarket. Claims of shedding unwanted pounds from taking one miracle fat-burning pill a day are enticing, but is that sustainable? Shore Physicians Group Ambulatory Pharmacist, Dr. David Totton said, “Fat burning diets are thermogenic. That simply means ‘generating heat.’ Heat is a byproduct of al metabolic processes in the body, including fat breakdown. These diets and supplements aim to boost your metabolism, speed up the breakdown of fat and ultimately help you lose weight.”

Will Fat Burning Produce Weight Loss?

“Burning fat through these thermogenic diets is a quick way to shed some pounds,” said Dr. Totton. “However, for sustainable weight loss that lasts, lifestyle modification is necessary.” As Dr. Totton explained, “If you rely on a short-term, highly restrictive diet to lose weight and then return to normal eating habits once you reach your goal, there is a high probability that you will put the pounds back on over time. In addition, if you do not limit your caloric intake, it will still be difficult to lose weight no matter the diet you choose. This is why it is generally better to make smaller changes over time that you will be able to adhere to and move toward a healthier lifestyle overall.”

The fat burning weight loss programs claim they churn up the body’s metabolism to rapidly reach a state of ketosis and increase energy level and the ability to focus at the same time. But can the fat burning process aid in that? Dr. Totton said, “Yes and no. The body’s source of readily available energy typically comes from glucose which the product of carbohydrate metabolism. Since the keto diet entails greatly reducing carbohydrate consumption, this pushes the body to find alternative energy sources including the fat stores in the body. This fat is broken down into ketone bodies that are used as an alternative energy source in the absence of glucose. These ketones are used by the brain and heart for energy so it is very possible that patients feel energized and focused once they are stable on the keto diet. However, when starting the keto diet, or it your macronutrient ratios are off, you may experience what is known as ‘keto-flu.’ Dr. Totton explained, the “keto-flu” occurs because the body no longer has access to adequate glucose and has not yet ramped up the fat burning process leaving an available energy deficit. The “keto flu” typically causes mild, flu-like symptoms as well as upset stomach, dizziness, decreased energy and mood swings.

Will the Weight Come Back?

In general, the most effective and safe way to lose weight is caloric restriction along with an increase in aerobic activity, according to Dr. Totton. “Artificially boosting metabolic activity in the body without changing diet and exercise habits may produce a slight reduction in weight in the short-term, however this is likely unsustainable and once the supplement is stopped, the progress made will quickly be lost.”

Everyone is different and what works for one person may not work for everyone. Dr. Totton warned, Keto diets are notoriously hard to keep up with and typically require that a person get 70-90% of their total caloric intake from fats with only 5-10% coming from carbohydrate sources. This is very limiting and requires constant awareness of all components of the products you consume. In general, less restrictive diets relying on caloric deficit and increased activity will be easier to maintain and therefore, may be more effective in helping reach your weight goals.

Insulin Resistance

Looking to lay blame on gaining weight, some diet programs say insulin resistance is the reason you may be having difficulty losing weight. Dr. Totton explained, insulin is a hormone made by the pancreas that helps glucose in your blood enter cells in your muscle, fat and liver where it is used for energy. Insulin resistance, as the name implies, is when your body does not respond as well to insulin causing excess glucose to remain in the blood where it may contribute to weight gain and the risk of diabetes. We do know some of the factors linked to insulin resistance. These would include some that you cannot change such as genetics, family history and race as well as some that you can change such as being overweight and inactive in your daily life. Ultimately it is know that insulin resistance that is not addressed through healthy lifestyle modification puts you at a much higher risk of developing type 2 diabetes and obesity late in life and can definitely make it more difficult to lose weight going forward.

The Stress of Rapid Weight Loss of the Body

Dr. Totton explained that rapid weight loss through a keto or any intensive low-carb diet can definitely put a strain on the body. Both the liver and kidneys are involved in the metabolism and breakdown of fat and proteins in the body. Such rapid breakdown of fat and increased protein intake associate with these diets may put stress on these organs and make any underlying conditions worse. Another concern we have is an increase in LDL (or bad) cholesterol levels. If time and attention is not takento limit saturated fat consumption, this may lead to an increased risk of cardiovascular disease and stroke. Additionally, such a limiting diet can put you at risk of nutrient/vitamin deficiencies which can lead to a host of unwanted side effects including constipation, muscle cramps, heart palpitations, and in some severe cases, arrhythmias. “Given the risks associated with this diet it is highly recommended that you discuss with your doctor and possibly a nutritionist before starting a ketogenic diet in order to assess your specific needs and risk factors to determine if it is the right diet for you.

Organic Does Not Equate to Safe

Many of the weight loss supplements are organic. But does organic mean the product is safe? Dr. Totton said, “Organic is not always synonymous with safe. An organic product is produced without the use of chemical fertilizers, pesticides or other artificial agents. There are however plenty of naturally occurring substances that are detrimental to your health, and many synthetic and artificial ingredients that are completely safe to take.” The best way to know if a product is tested and safe to consume is to look for the United States Pharmacopeia (USP) seal on the bottle as well as only taking products that are recommended by your primary care provider that have gone through the rigorous FDA approval process. Many dietary supplements that are available online or over the counter do not require FDA approval and the companies are not required to show any safety or efficacy data before marketing and sale of the product, explained Dr. Totton.

Weight Loss Supplements and Prescription Meds

Anyone taking a prescription medication should be wary of introducing a weight loss supplement. Dr. Totton said, “Certain weight loss supplements can certainly interfere with prescription medications and may not be safe for patients with a history of cardiovascular disease or who are taking blood thinners. I would recommend that you discuss any supplements that you plan on taking with one of your healthcare providers prior to use.”

Is Rapid Weight Loss Sustainable?

Some people are able to rapidly lose weight and then maintain these changes for long periods of time. Unfortunately, this is usually the minority, according to Dr. Totton. “We have seen time and time again that small changes over time and consistency with your diet and exercise habits are the best way to achieve and maintain your weight loss goals. Even strong proponents of the keto diet will tell you that it is not intended to be a long-term solution.”

With respect to Keto-speed specifically, Dr. Totton explained, the supplement includes beta-hydroxybutyrate (BHB) which is one of the ketone bodies produced during the breakdown of fat in the body. It is thought that supplementing this product will cause the body to recognize that fats are being broken down and speed up ketosis. These products are also marketed as an energy supplement as you are introducing extra fuel into the body from the supplements. However, it has been found that BHB actually negatively reinforces fat breakdown, meaning that the more BHB that is present in the blood, the more your body wants to slow down fat burn so that you don’t go through your backup energy reserves too quickly. This means that artificially supplementing BHB may actually negatively impact your keto weight loss efforts and make it harder to burn your natural fat stores.

Dr. Totton went on to explain, another concern is that the BHB in these products is typically bound to electrolytes such as sodium, calcium and magnesium. The dosing recommended by the supplement manufacturers can often lead to excessive levels of these electrolytes in the blood which may lead to kidney stones, high blood pressure, muscle cramps, constipation/diarrhea and conduction abnormalities in the heart.

Additionally, those with diabetes will likely require a reduction in the dose of their medication given the strict carbohydrate limitations. If blood sugars are not closely monitored during initiation of a low-carb diet, these patients are at a very high risk of hypoglycemic episodes.

David Totton, PharmD, is the ambulatory care pharmacist on staff with Shore Physicians Group. He consults with physicians regularly about medication management, conducts Medicare annual wellness visits, provides comprehensive medication reviews, and more. Dr. Totton sees patients in Marmora, Ocean City, Somers Point, Margate and Northfield. CLICK HERE to learn more about how an Ambulatory Care Pharmacist can help you. To find an SPG primary care provider, click here.