The ketogenic diet has helped many people lose a significant amount of weight. However, some find they hit a plateau and can’t seem to lose those last 10-20 pounds. In this article we shall discuss the science behind why this may happen and what can be done about it.
A common problem that many of people experience is they lose an impressive amount of weight on keto at first but then reach a plateau where the last bit of weight just won’t budge. What’s the key to finally losing that stubborn body fat.
The Science Behind Weight Loss Plateaus
Oral Glucose Tolerance Tests
- In these tests, fasting blood sugar is measured initially.
- The patient then ingests a standardized 75g glucose drink.
- Blood sugar is measured again at set intervals, such as 30 minutes and 2 hours.
- Looking at how blood sugar responds can reveal a lot about a person’s metabolic health. Many doctors just check at 0 and 2 hours.
- With only a small change in BMI between patients, there were dramatic differences in their blood sugar and insulin spikes and how long it took to return to baseline.
- The worse responses indicate insulin resistance. This wouldn’t be detected if only baseline and 2 hour blood sugars were checked.
Insulin Resistance Causes Cellular Starvation
So, what is happening at the cellular level in insulin resistant patients:
- Muscle cells are lined with a phospholipid bilayer membrane.
- Insulin binds to insulin receptors on the cell surface.
- This triggers glucose transporter proteins (GLUT4) to move to the membrane, acting as a gateway for glucose to enter the cell.
- In insulin resistance, high insulin triggers excess GLUT4 receptors. Achieving normal glucose entry requires more insulin binding.
- The mitochondria inside the cell are also dysfunctional. Instead of cleanly burning glucose for energy, the process leaks free radicals, damaging the cell.
- On a ketogenic diet, glucose and insulin levels drop. Now insufficient insulin is available to activate enough GLUT4 transporters. Glucose cannot adequately enter the cell, leaving the mitochondria starved for fuel.
- In response, the liver produces ketone bodies as an alternative fuel. This rescues the starving cells.
- Over time on keto, insulin resistance decreases. Excess GLUT4 receptors are cleared away, restoring more normal insulin signaling.
Why Reducing Insulin is Key for Weight Loss
These cellular processes explain why lowering insulin through keto is so effective for weight loss initially. However, the plateau many reach is driven by lingering insulin resistance.
- Monitoring post-meal blood sugar and ketones gives insight into your insulin levels.
- A normal metabolic response returns blood sugar rapidly to baseline with mild ketone elevation.
- People unable to lose the last 10-20 lbs likely have persistent insulin resistance. Their metabolic flexibility is impaired.
- Stressors like extended fasting can help break these plateaus by lowering insulin and forcing cells to burn fat again.
Long-Term Health Impacts of Insulin Resistance
Lingering insulin resistance is the hidden cause of plateaus when trying to lose the last 10-20 pounds on keto. Improving metabolic flexibility by reducing insulin secretion allows stored body fat to be tapped for fuel once again.
Strategies like fasting, meal timing, whole food nutrition, and activity all lower insulin over the long-term. This helps reverse insulin resistance at the cellular level and gives the metabolic boost needed to finally shed those last pounds.
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