Episode Sixty Three

  • What a weight loss plateau is - a weight loss plateau is when weight loss stalls for a while, not for a few days or a week, but over a time period of at least a month.
  • Weight loss is not linear - you will not lose the same amount of weight per week in a linear fashion. Weight loss goes up, down and across, but hopefully the general trend is downward.
  • Weight is a rough estimate - the number on the scales is a rough estimate of what is going on in our body. What we are really after is fat loss, but the scales measure your total body mass, which can fluctuate due to things such as the contents of your bladder, stomach and intestines, your hydration levels, inflammation etc.
  • Focusing on non-scale victories as well - resolving fatty liver, improvement in measure of glucose control, lifting brain fog, muscle aches reducing, increased energy, reduced cravings, reduced hunger.
  • Breaking plateaus - take a good look at what you're eating. Look for things such as hidden carbs in food, snacking, and emotional eating. Be careful with things such as dairy and nuts as they are easy to snack on and can contribute to weight loss plateaus.
  • The power of fasting - this is an excellent tool for breaking plateaus, making sure you have your 'feeding' days and your 'fasting' days. 
  • Stress and sleep - reducing stress and optimising your sleep are also important parts of breaking plateaus.  

Show notes:

Weight Loss Plateaus


Dr Mary Barson: (0:11) Hello, my lovely listeners. I'm Dr. Mary Barson.


Dr Lucy Burns:(0:15) And I'm Dr. Lucy Burns. Welcome to this episode of Real Health and Weight Loss.


Dr Mary Barson: (0:21) Hello lovely listeners, Dr. Mary Barson here, and I am joined by the fabulous Dr. Lucy Burns. How are you my friend?


Dr Lucy Burns: (0:34) I'm super well, Dr. Mary and you're way too kind. Way too kind. 


Dr Mary Barson: (0:38) Not at all.


Dr Lucy Burns: (0:41) But you know, it's summertime here in Australia and I do love the Summer. I love the sunlight. I love the longer days that we have down here in Melbourne and just spending a bit more time outside, not so much in the heat of the day. I do turn into one of those sort of wilting lilies in the middle of the day. But I do, I love, I love a warm evening.


Dr Mary Barson: (1:04) Yes, I love Summer. I live by the beach on the southern coast of Australia where the water is always cold because it's chilled by that circum-Antarctic current, but I'm used to cold water. But it is beautiful. Something about the heat of the day and the cold water. I'm spending lots of time at the beach.


Dr Lucy Burns: (1:23) Embracing your inner Wim Hof.


Dr Mary Barson: (1:25) Yes, lots of cold therapy goes on around here. It's quite usual to see people in full length wetsuits in the middle of summer. Yes, it's beautiful.


Dr Lucy Burns: (1:34) Wonderful. So today, we've got a topic that a few people have written to us and asked us to discuss. So we thought, “Well, why not?” And that is the weight loss plateau. So you know, we get letters or emails.  ‘Letters’, God, listen to me! Letters written with a quill. We get emails asking us, “What should I do about my weight loss plateau?” So we thought, okay, let's chat about it today. So Mares, do you want to perhaps start with the definition of a weight loss plateau?


Dr Mary Barson: (2:06) I'd love to, especially since there isn't really one. So that's a trick question. So what is a weight loss plateau? Well, it's a term we use to describe when weight loss stalls for a while so people don't see the scales going down for a while. When do we call it a plateau? At what point are you plateauing? That is a matter for debate. Some people might say a month, other people might say three months, but it's certainly not a week or you know, 10 days. That's not a plateau, that's just perfectly normal. That's how our bodies lose weight, we don't lose weight in a straight, linear fashion.


Dr Lucy Burns: (2:53) I know. And it's really important to undo that myth, again, kind of brought about by, you know, diet culture, which is “You will lose half to one kilo a week, every week. And if you don't, you're doing something wrong”. And that's not at all true. So weight loss, we'll just say it again, weight loss is not linear, it goes up and down and across. But hopefully the trend is downwards. Much like the weather. So at the moment, it's warm. Not every day is warm. Some days are cool, but the trend in Summer is for warmth and the trend in Winter is for coolness. So again, with weight loss, the trend is going down until that trend stops and then that becomes the plateau.


Dr Mary Barson: (3:35) Absolutely, you just need to understand a few things. I think it's important to understand physiologically about weight loss. The first is that yes, we do not lose weight in a linear fashion. Some weeks, we might lose weight more quickly, other weeks, not at all. And that's normal and natural on a low carb real food diet. And if that's what's happening with you, it doesn't mean you're doing anything wrong. Got to let go of those toxic diet culture messages! The other important thing to recognise is that weight, like the weight, how much gravity is pulling you down to the centre of the Earth. The little measure that you get on the scale is rough. It's a very rough estimate of what is going on in your body because what we really want is fat loss. We want to reduce our fat stores when people say they want weight loss, that's what they really want. But the weight measures everything, every part of mass that is in and around our body at that time, and it can fluctuate a lot day to day, the contents of your bladder, the contents of your stomach, the contents of your intestines. All of these will make you weigh more or less on any given day. how hydrated you are will make To weigh more or less on any given day, so weight is rough. 


Dr Lucy Burns: (5:03) It is and you know it particularly women who you know perhaps have menstrual cycles, that plays enormous. You know you have enormous changes, several kilos for some women before they have their period. But also just inflammation, you know, if you've got inflammation going on that holds water, there is water with an inflammatory process. So that can be anything from having a cold, or, you know, having gastro you may have some inflammation Now admittedly with gastro you may also be dehydrated. But this idea that the scales purely measured the amount of fat on your body is rubbish,


Dr Mary Barson: (5:44) Absolute rubbish. If you're increasing your muscle mass and your bone mass, which is actually quite common on a low carb, real food diet, you're going to be increasing your weight, which is totally independent of what is happening with your fat stores.


Dr Lucy Burns: (6:01) Yep. And I think even some people will go,  “Well do your measurements.” But even measurements, you know, your waist circumference, which is one of the measurements that is often touted as being, you know, indicative of good health. That'll change depending on how much gas you have in your bowel. And we all know what it's like to feel bloated. And you suddenly think, “Oh, my God, I just look like I'm nine months pregnant.” But in fact, it's just guessing the bowel and when that gas moves on your waist shrinks.


Dr Mary Barson: (6:28) It does. So you've got to take a step back and look more broadly at your health. More broadly at your weight loss over time. And really also make sure that you are focusing in on those non scale victories, which we have certainly discussed before on this podcast. What kind of non scale victories are we talking about Dr. Lucy?


Dr Lucy Burns: (6:52) Ah, look, if you're working with a medical doctor, you may have some blood tests that will improve, particularly as you know, we're always talking about how your fatty liver will resolve very quickly. The liver is such a wonderful organ. If you have type two diabetes or prediabetes, you may have improvement in your what's called the HbA1c or your measure of glucose control over the preceding three months. But then there's all these other sorts of subtle, more subtle, but improving your actual quality of life. So people often talk about brain fog lifting, muscle aches reducing, increased energy, and just subjective feelings of well being.


Dr Mary Barson: (7:33) Yes and less irritable bowel syndromes, reduced hunger, reduced cravings, these things that really improve the quality of your life with low carb real food.


Dr Lucy Burns: (7:42) Absolutely. So let's say we have actually got a stall. So there might be somebody who, you know, maybe they've lost 10 kilos or whatever, an amount of weight, and they've been the same now for, let's say, eight weeks, we'd perhaps call that a stall, a plateau. What would your advice be for that Mares?


Dr Mary Barson: (8:04) Yeah, so taking into account everything that we've already discussed, if someone really is having a stall, and it's annoying them, then we'll take a deeper look into what is going on, is there something going on there that is preventing them from losing more fat, which they want to do. And there are some common themes, everybody's different, but there are definitely some common themes that we see pop up time and time again, with our beautiful patients and clients. One is to take an honest look at what you are eating and watch for the carb creep, because it really can happen. And you know that there can be hidden carbs in foods that people might not necessarily be aware of like, sausages are an example of that, maybe some more high carb veggies have snuck in, maybe there's more emotional eating and snacking, and maybe more snacking has snuck in. So we're just we would take a really honest appraisal of the food, the food might be fine. Like it could be a totally different cause. But that is certainly something that we would start to look at.


Dr Lucy Burns: (9:07) Absolutely. The sneaky snacks. And you know, I think for me, this is exactly, so you know, I'm probably a couple of kilos heavier than I would like to be at the moment. And if I have a look at what's happening, I'm not doing what I did to lose the weight. So to lose my weight. I did, you know, low carb, real food diet, of course, but I didn't have dessert. I never did the berries and cream. And I didn't because I just didn't really want it, like I had these beautiful satiating dinners, and I didn't, my brain wasn't asking for it. So I certainly wasn't going to introduce it. But now I've introduced it. And most nights I probably have some berries and cream and sometimes it's a normal sized little bowl and sometimes it feels like I'm eating a bucket. So for me what I know I will do at some stage when I'm ready. Again, there's no rush. When I'm ready, I will just let those berries go for a while and let this you know, nuts. Another thing for me that just sneaks in. So letting go of the berries and the nuts and doing what I did to lose the weight in the first place.


Dr Mary Barson: (10:19) You've articulated that perfectly. I think the second point that I would make, which you have made, beautiful human, is to be careful with the dairy and the nuts and then that's because they are so easy to overeat and to snack on. They’re very snackable foods. The cream in the coffee, the cream with the berries, the cheeses, the nuts, having handfuls of them as you walk past the pantry. And look, they're good for you. They're delicious, like they're real food. However, if you're snacking on them, or when you're eating them when you're not hungry, that could be contributing to a weight loss stall. And if you've got a weight loss stall that's annoying you, then that would be something to look at.


Dr Lucy Burns: (10:59) Absolutely. The other thing I did when I was losing my weight was I did a reasonable amount of fasting, which I must say I haven't done quite as much of lately. What are your thoughts on fasting Mares?


Dr Mary Barson: (11:14) I think fasting is fabulous. I'm not fasting at the moment because I'm pregnant. And that's one thing. It is exciting. Yes, it is good. It's wonderful, especially since I first passed the first trimester now and I’m just in what they call the golden trimester, I feel amazing like I could take on the world, this pregnancy, it's so easy. I don't know why people complain about it. That's how I feel right now. Ask me again in a few months.


Dr Lucy Burns: (11:42) Or six weeks ago!


Dr Mary Barson: (11:48) Absolutely! It was a struggle to keep my eyes open, for large portions of the day. 


Dr Lucy Burns: (11:53) Well, you were growing eyebrows from scratch. So, you know.


Dr Mary Barson: (11:55) Takes a lot of effort, that's right. But fasting generally speaking for most people is a fantastic way to lose weight, it's a very powerful way to reduce insulin, it is a very powerful way to speed up your metabolism, it's a very powerful way to open up your metaphorical wood shed full of all your stored logs of stored body fat and to start emptying them. And for many people, it is absolutely required for weight loss. So there are quite a few people who go low carb real food and maybe lose a bit of weight. But it's only once they start a regular and healthy safe pattern of intermittent fasting that the weight loss really takes off. And it is definitely something that we would address and look into if people are having a weight loss stall.


Dr Lucy Burns: (12:46) Absolutely, and the key to fasting high eating days and low eating days. If you just do low eating days, then basically you're doing chronic calorie restriction. And that can be associated then with a reduction in your metabolic rate. But when you do it intermittently, which is what it's called not, it's just not called fasting, you know, just doing fasting galore. Intermittent. So you have a period where you'll do a little bit of fasting, and that may be from, you know, anything from 16, 24, 36 hours, whatever you want to do. Whatever you feel good doing, that is really powerful. But then you balance it by not gorging yourself, not stuffing yourself but eating beautiful, balanced, low carb, real food, plenty of protein meals for a few days.


Dr Mary Barson: (13:38) You have your feeding days and your fasting days. That way your metabolism doesn't slow down as can happen with chronic calorie restriction. And when you fast during those short periods of time, where you just don't eat anything at all, you stop eating for a while, all these wonderful things happen in your metabolism. All these counterregulatory hormones are turned on. Your adrenaline, noradrenaline, cortisol, all of these fabulous things are happening, which actually speed up your metabolism. So fasting is a great way to lose weight and boost your metabolism at the same time.


Dr Lucy Burns: (14:16) And I think the thing, the caveat I would put over fasting is that it should feel easy. If it feels hard, or it feels like you're restricting yourself or punishing yourself for eating something, if that's not the right it's not the right tool for that. That's not what it's about. It's about giving your you know, I like to look at it as giving my gut a rest, and it does love a rest every now and then. But there are times where I've gone, you know what I'm gonna do a fast and I get halfway through and I go, I don't want to do it anymore. Well, you're allowed to stop. You're the boss of you. You don't have to do it if it's making you feel physically or psychologically bad.


Dr Mary Barson: (14:56) Yes, I totally agree. Fasting is free. It's always there. You know, I have seen pregnant women who are frustrated that they're not fasting right now or lactating women, you could do it later, it's always there. Previous to pregnancy, I would sometimes break my fast at work if it was a very stressful day. And just as the emotional stress of work added to, you know, the small physiological stress or fasting to my body meant that it just, I just felt icky, I didn't feel right. Things that would stress me out at work as if like, there's lots of patients coming into the emergency at the hospital attached to my work. And they are taking time and needing to be seen, but also having patients booked into the general practice and they’re needing time, and then just being in this possible situation of having to do too much with my time. Totally understandable and natural that I became stressed in this circumstances. And I would just eat. And to this end, I still keep canned fish in my cupboard at work, and I just eat. That's not the most inspiring of lunches, but it certainly did just nourish my body so that I could get on with my day without feeling icky.


Dr Lucy Burns: (16:08) Which I guess brings me to the next cause of a weight loss stall. And that is stress. For many of us. You know, people often joke. “I run on adrenaline”. It's not actually adrenaline you're running on, it's probably cortisol. And cortisol is one of our significant hormones that is designed. And I know we've talked a lot about this on the podcast. So please feel free to go back and have a listen to some of the others. But cortisol is supposed to be like everything. You have high patches and low patches, you're not supposed to have just chronically elevated cortisol. And when we do, it changes the way our metabolic hormones work. Would you like to explain that?


Dr Mary Barson: (16:51) Yes. So chronic stress can elevate cortisol, which can do lots of devastating things to our metabolism. This chronic stress is not good for us. It can increase carb cravings, it can increase our hunger hormone, it can decrease our satiety or feeling full hormones. It can elevate our blood sugar, which can elevate insulin, which is our fat storing hormone. Taken all together, chronic stress isn't good. And it is a real contributor to weight loss stalls, and indeed weight gain for some people, it also promotes that central weight gain, the central adiposity, the weight gain around our organs, which is exactly the weight gain we don't want.


Dr Lucy Burns: (17:40) I know that a lot of people really struggle with this idea that, you know, and they'll come and they'll go,”I'm eating all the right food, I'm walking and the weight’s not shifting”. And when I talk to them about stress, it's like, “No, no, it can't be that it must be something else”. But it's not. It truly is. Because we, you know, and we've talked about this before, but one of our beautiful friends has type one diabetes, and she wears CGM. So a continuous glucose monitor. And when she gets stressed her blood glucose goes up. And because she doesn't have a pancreas that works, she has to inject her own insulin. Now for the majority of us, this all happens under the hood. We don't even know about it. So your blood glucose comes up, insulin comes out and goes oh god, alright and sorts it all out for us, which is really kind, but certainly makes weight loss. trickier.


Dr Mary Barson: (18:33) Yes, and tied in with this whole elevated cortisol thing would be sleep. Chronic sleep deprivation can also affect our metabolic health and contribute to weight gain. So looking at your sleep hygiene, your habits around sleep and your caffeine consumption. And just having a really good look at the length and quality of your sleep is an important part of busting through weight loss stalls.


Dr Lucy Burns: (19:06) Absolutely. So I guess in summary, this is our little formula. If you feel like you've been having a stall, remember, a stall is a significant amount of time. It's not just you know, one or even two weeks, it's usually I'd say probably a month and then think about it. Have a look at your food. Okay, as the first thing, beware the carb creep and notice also that dairy and in fact, not just dairy, probably fats in general, that they can sneak in remembering that once your wood shed’s open, you don't need to add as much fat to your plate. So making sure that you're just looking at how much fat you're actually having. Second thing would be to have a look at your fasting. Are you doing any? If not, you can add that in, but it needs to feel beautiful, not punishment, not hard, and not make you feel psychologically unwell.  Third thing would be to look at your stress, you know, look at your life, look at your life, of course, but have a think about, “Are there aspects in your life that are causing your stress?” And the answer is probably yes. And then what are you going to do about them because you can change how you manage your stress. But you'll often need somebody to help you just help you focus on that by either changing your thoughts about the situation and coming up with various tools, meditation, mindfulness, yoga exercise, to help you with your stress. And then finally, making sure you go to bed. So simple, so simple, go to bed and get good sleep. And if you're having any trouble with that, go and see your doctor because there are plenty of people that have obstructive sleep apnea, which is a serious medical condition, and often treating the sleep apnea, it's chicken and egg, you treat the sleep apnea, the patient loses weight, and then they no longer need their sleep apnea treatment. So sometimes just getting in and getting that sorted can really be helpful as well. One of the things I find that happens a lot, and you probably do find this to Mares is that people that have trouble with their sleeping will often have a glass or two of wine to help them head off to sleep. What are your thoughts on alcohol and weight loss?


Dr Mary Barson: (21:25) Alcohol can be detrimental to weight loss. It's not an absolute, listeners, you can do whatever you want, because you are the boss of you. But alcohol is detrimental to your sleep in pretty significant ways. And alcohol is a fuel source without nutrition. So in that way it can slow weight loss. That alcohol-sleep connection is really interesting. The sleep that you get after alcohol, even small amounts of alcohol, it's not proper sleep. So there's a very specific pattern to our sleep that goes on our bodies, going through different phases in sleep associated with different brain waves. And each part of those are really, really important. And alcohol really affects that, particularly affects our ability to have good quality, rapid eye movement or REM sleep. Alcohol really just sort of a nice anesthetises us rather than letting us have a good quality sleep.


Dr Lucy Burns: (22:30) Absolutely. And if you're in the perimenopause slash menopause phase of life, I can tell you now that alcohol will definitely increase hot flushes at night or night sweats to lethal.


Dr Mary Barson: (22:43) Which is not good for anybody.


Dr Lucy Burns: (22:47) No. So in summary, if you've got a plateau, and as we mentioned, the plateau is a significant amount of time, there are things that you can do to have a look at, are look at your food honestly. Make sure that you don't have sneaky snacks, particularly nuts, dairy, cream, and that your fats again, aren't super high, because remember, once you've been doing low carb for a while your wood sheds open. So you want to be burning the fat off your body, not off your plate. So that means that you'll need to have plenty of protein, moderate fat and low carb, that's our little formula. But then look at fasting. If you haven't done any fasting, it's a wonderful tool, but only if it makes you feel good. Okay?  So, feel good physically and psychologically. The third thing is to look at stress, okay, and again, most of us do have stress in our lives, and it does impact our metabolic health significantly. Fourth is to look at sleep. And interestingly, which I don't think I mentioned, sleep, obstructive sleep apnea, or just sleep apnea, as people call it, is a significant impediment to weight loss. So weirdly, you treat the sleep apnea, the patient will lose weight, then they no longer need their sleep apnea treated because it gets better. So it really is a wonderful way to break that cycle if that's a problem. And then the last thing is looking at alcohol, and as we talked about, you can certainly still have alcohol on a low carb lifestyle. But it really does come down to the quantities and the frequency. And the way that it fits into the woodshed analogy is that drinking alcohol really is like dumping a big load of logs in front of your shed, your body needs to burn those first before it can burn the ones inside the shed. So again, you're the boss of you. It's not a no no, it's not naughty. It's just something that may not be helpful for your long term goals.


Dr Mary Barson: (24:47) And as ever, beautiful listeners. It is so important to focus on all aspects of your health and healing and not just that little number on the scale. That little number on the scale should not be powerful enough to dictate your sense of self worth.


Dr Lucy Burns: (25:05) Absolutely. Oh god Mares, I love that. You just made, I just got a few little goosebumps. People you are not defined by the number on the scales, they're just rubbish. And as you know, we often encourage our people to chuck the scales out. They don't help us. But you know, there are some people that do have an okay relationship. They just get on. It's like another data point. It's like having your blood pressure checked. Most people have their blood pressure checked and don't feel terrible about themselves if the number is a bit higher than normal. So if you can put it into that category where it's just merely another data point, then that's wonderful. But if it does dictate how your day goes, how you feel about yourself, chuck them in the bin.


Dr Mary Barson: (25:47) Chuck them in the bin. The scales aren't that important.


Dr Lucy Burns: (25:53) Wonderful, wonderful listeners. Have a beautiful rest of your day. And we will see.. You know.


Dr Mary Barson: (25:59)

We won't see you. You will hear us.  Yes!


Dr Lucy Burns: (26:02) Next week. Bye for now. Bye, everybody. Lovely listeners. As you know, we run the 12 week Mind Body rebalance three times a year. The next one starts in February. If you'd like to join the waitlist and get early access to bonus offers, head over to our website, rlmedicine.com. And join the waitlist today. So my lovely listeners that ends this episode of Real Health and Weight Loss. I'm Dr. Lucy Burns, and


Dr Mary Barson: (26:36) I'm Dr. Mary Barson we’re from Real Life Medicine. To contact us please visit rlmedicine.com.


Dr Lucy Burns: (26:46) And until next time, thanks for listening.


Dr Lucy Burns: (26:54) The information shared on the Real Health and Weight Loss podcast, including show notes and links provides general information only. It is not a substitute, nor is it intended to provide individualised medical advice, diagnosis or treatment, nor can it be construed as such. Please consult your doctor for any medical concerns.

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