84: Listener Q&A: Help! I’m Afraid to Eat Carbs After Keto

Today, we're tackling a listener's question that highlights a common challenge: balancing the desire for quick weight loss with the need for a sustainable, healthy eating pattern while using weight loss medications.

Let’s dive straight into the question:

"I took Wegovy for a month. I was sick the whole time and only lost five pounds. I wanted to drop some weight fast, so I started keto while trying to get Zepbound approved. I have now been on keto for two months. I've been taking Zepbound for one month with no side effects. I'm finally losing weight, and I want to let healthy carbs back in my life but I'm afraid. What's the smartest way to eat on Zepbound?"

Firstly, no one should have to feel sick the whole time on a medication. It sounds like this listener might not have had much guidance, bouncing between different approaches—Wegovy, keto, and now Zepbound. While I’m glad the switch to Zepbound is helping, there are some key elements to this query that I want to address.

How to Measure Success

The first is weight loss expectations. The listener mentioned losing “only five pounds,” but it’s important to recognize that five pounds can be a significant achievement, particularly in the early stages of treatment. Many people expect rapid results, but losing weight too quickly can result in muscle loss, which can negatively impact long-term health. A more sustainable approach focuses on preserving muscle mass while reducing fat, which can be supported by adequate protein intake and strength training.

Instead of focusing solely on the number of pounds lost, I always recommend evaluating weight loss progress as a percentage of total body weight (to calculate this, take the number of pounds lost, divide it by your starting weight, and then multiply by 100). If those five pounds represent a 2% or 4% reduction in total body weight, that’s a meaningful change. Generally, we advise aiming for no more than a 1% weight loss per week, or approximately 4% per month. While some individuals may experience quicker results, these cases are exceptions rather than the norm.

As a general benchmark, a 5% reduction in total body weight over a three- to four-month period is a good indicator of clinical success. If this milestone isn’t reached, it may be time to reassess the effectiveness of the treatment and consider alternative strategies. Tracking progress through these percentages allows for a more realistic and meaningful evaluation of long-term success.

The Problem with Quick Fixes and Extreme Diets

The next issue I want to address is the urgency of wanting to lose weight quickly. When someone says, "I want to lose weight fast," it often raises a red flag for me. Why does it need to happen so fast? Weight struggles are usually long-term, so pushing for rapid weight loss can lead to unsustainable decisions—like turning to extreme diets such as keto, which is exactly what happened here.

Keto is a restrictive, ultra-low-carb diet (often less than 20 grams of carbs per day), and while some may find temporary success with it, very few can maintain it long-term. In contrast, adopting a lower-carb lifestyle can be more sustainable, especially for those with insulin resistance. Personally, after wearing a continuous glucose monitor (CGM) as part of the ZOE test, I’ve seen how important it is for me to balance carbs with protein and fiber to keep blood sugar levels stable. But this is different from strict keto.

The issue with keto is that many people end up afraid to reintroduce healthy carbohydrates, falling into the trap of labeling foods as "good" or "bad." When I hear phrases like "wanting to drop weight fast," it’s a sign that restrictive rules are dictating the approach, rather than focusing on what’s sustainable and healthy. This can leave people feeling boxed in, overwhelmed by food rules, and afraid to bring back nutritious, balanced options like healthy carbs.

The Smartest Way to Eat on Zepbound

Let’s get back to the core of this listener’s question: What’s the smartest way to eat while on Zepbound? The approach largely depends on your goals, but from my perspective, the top priority is to preserve muscle mass while achieving fat loss.

Here’s a breakdown of what to focus on:

• Protein Intake: Ensure you’re getting enough protein. Many people, after a nutrition audit, are found to be consuming only 50 to 60 grams of protein per day, which isn’t enough. On Zepbound, with reduced appetite and cravings, it’s crucial to monitor and increase protein intake to support muscle preservation.
• Fiber and Hydration: Address potential side effects like constipation and nausea by maintaining adequate hydration and fiber intake. This might involve adjusting types of fiber or timing, especially around your medication schedule.
• Balanced Plate: Aim for a balanced plate that includes:
• Protein: Essential for muscle maintenance.
• Fiber: Found in vegetables, beans, and seeds like chia seeds.
• Fats and Carbohydrates: Choose healthy fats and carbohydrates that work for your body and energy levels.
• Personalized Approach: Tailor your diet to how you feel after meals. Monitor your energy levels and any bloating or fatigue. This can involve using tools like continuous glucose monitoring (CGM) to understand how different foods affect you.
• Long-Term Health: Focus not just on weight loss but on overall health improvements, such as reversing prediabetes, lowering triglycerides, improving sleep quality, and enhancing mobility. Maintaining muscle mass is crucial for a higher basal metabolic rate and long-term health benefits.

In essence, the smartest way to eat on Zepbound is to adopt a balanced, personalized approach that supports muscle retention and overall well-being. It's not just about losing weight but about doing so in a way that enhances your health and quality of life.

Reintroducing Carbohydrates After Restrictive Diets

If you’ve been on a restrictive diet like keto and want to reintroduce carbohydrates, it’s important to approach this transition thoughtfully. Start by incorporating carbs that you’ve enjoyed in the past and that have made you feel good—perhaps sweet potatoes or fruits like honey crisp apples or strawberries.

Here’s how to handle this transition:

• Start Slowly: When reintroducing carbs, expect some temporary weight fluctuations. As you add more carbs, your muscles will store more glycogen, which can cause the scale to go up due to water retention. This is a normal part of the process.
• Be Compassionate and Patient: Understand that weight changes from day to day can be due to various factors, not just diet. For example, hormonal changes can affect weight temporarily, as can increases in carbohydrate intake. Stay level-headed and remember that fluctuations are normal.
• Focus on Long-Term Trends: The scale may not reflect your true progress immediately. Real, lasting changes in body composition take time. Avoid getting discouraged by short-term fluctuations and focus on how you feel and your overall progress.
• Maintain a Balanced Perspective: Recognize that a balanced approach to diet, including moderate reintroduction of carbs, is often more sustainable than extreme restriction. This helps in managing energy levels and reducing feelings of restriction.

Reintroducing carbs should be done gradually and with an understanding that temporary scale changes are normal. Stay focused on your long-term goals and how your body feels overall.

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