Carole Freeman:
Our guest today, Brandy Wiltermuth, is a nurse practitioner and a certified obesity specialist. She’s been working in weight and metabolic disease management for more than 13 years and she is a partner at Three Health Medical Weight Loss Solutions, where their mission is to be the last stop in a person’s weight loss struggle. Welcome Brandy!

Brandy W.:
Thanks Carole. Thanks for having me. I really appreciate it.

Carole Freeman:
My pleasure.

Brandy W.:
You did a really good job introducing me. I guess something that I’d like to let people know is that I have always been using a low carb approach, and really we used a bunch of different ways to get people into ketosis, even 13 years ago, but we really didn’t call it that. And we didn’t get too obsessed about measuring ketones and that sort of thing. We could just kind of tell when people were having issues with some of the symptoms that they had achieved ketosis.

Brandy W.:
And even though we worked really hard at helping people avoid those symptoms, of course, not everybody takes the recommendations that you give them and they end up calling you and saying, “I’m having these terrible leg cramps and I’m so dizzy!” I’m like, “Congratulations! You are in ketosis.”

Brandy W.:
It’s interesting how that has blown up over the last couple years. But having been involved in it for quite a while, lots of different ways to skin the cat in terms of a low carb diet and getting people into ketosis, and it can be calorie restriction or it can be fasting or it can be what’s called a mimicking fast.

Brandy W.:
And ketogenic diets are really more of a mimicking of a fasting, because it’s suppressing your insulin so low. But you all know that, because you’re following Carole.

Carole Freeman:
Maybe. A lot of people don’t.

Brandy W.:
The best tool that I’ve ever seen for weight loss, and not just because of … usually pretty consistent and aggressive weight loss, but what we see happening in terms of brain chemistry and how the body likes to fight back against weight loss is generally different when there’s a low carb approach. And then also the fact that people generally have disrupted metabolic issues, like insulin resistance or hyperinsulinemia, whichever you want to call it.

Brandy W.:
Fortunately, we know biochemistry of humans and how food affects us, and so it’s just logical that we arrive at a carbohydrate restricted diet to help people lose weight, get insulin under control and preserve muscle.

Brandy W.:
So that has been my mission for the last 13 years and helping people do that and also diabetes management, blood pressure, and all the that go along with weight as the symptom of this problem. That means that I’ve seen a lot of people and there’s always this discussion when people start, “How long is this going to take?” And “What should I weigh?” And “How long is it going to take?”

Carole Freeman:
Well, before we get into that, I want to cover your story of how you got involved in doing what you’re doing, because you didn’t come right out of school and specialize in weight management. So you’ve got a really interesting story. Can you share your journey with us?

Brandy W.:
Yeah, sure. Sorry, I skipped that part.

Carole Freeman:
I know, you’re so passionate about educating and helping people you skipped over the …

Brandy W.:
Yeah. So I graduated as nurse practitioner and I was still working in the hospital and seeing these crazy people coming in with uncontrolled diabetes on dialysis and having limbs removed. It was very dramatic.

Brandy W.:
I knew all along this was something that people didn’t have to go through. I mean, they could have avoided some of these things, but at that point, 12, 13, 15 years ago, it was very much accepted that once you get diagnosed with Type 2 diabetes, you were going to have it and that was it. And the medical community went along with that and it was disturbing.

Brandy W.:
I had a full array of experience with that kind of stuff in the hospital and found it pretty unpleasant and thought, “God, there’s got to be a better way,” but I didn’t know what to do. When I graduated, I ended up taking a position in oncology, which is not my favorite thing. I really loved the people that can do it, but it just wasn’t for me and I found myself thinking, “I need to prevent this stuff from happening. That’s what I want to work on.”

Brandy W.:
So, I randomly looked in the paper at the time, that’s how you found a job, and there was … Or Monster, that was the other place that I found this ad-

Carole Freeman:
Yeah, [inaudible 00:06:25].

Brandy W.:
Right. And so there was this ad for nurse practitioner for a preventative health clinic, weight loss, metabolic disease and I thought, “Well this sounds pretty good.” So I answered the ad and I met Dr. Anne Hendricks who’s been in practice now doing specifically obesity medicine for 30 years now. It was 20-ish years when I got there, and it was a crash course in, “This is how we get people to lose weight. These are the tips and tricks and protein needs,” and all the things that you monitor and medications that help people continue to and maintain weight loss.

Brandy W.:
I got a good baseline there, and then I had this silly notion that probably I need to go get the hardcore education. I needed to earn my stripes, and that’s a big thing in the nursing world. I don’t know if it is in the nutrition world, but if you don’t suffer, then you didn’t do it right.

Brandy W.:
So I thought, “Well, I got to go suffer and learn this stuff and really become more confident in what I was doing.” So I ended up taking a position as an internal medicine in an internal medicine practice, and I was the nurse practitioner. Fortunately or unfortunately, the population that I was working with was there was a lot of diabetes.

Brandy W.:
So I was able to bring my experience of weight management and metabolic disease management to this community and got a dietician on board who helped teach the low carb diet to people. And interestingly, when I started, we did do pretty much a … I would assume it’s a moderate carb restriction now. And when I taught her what I wanted her to ask the patients to do, at first she was pretty resistant. And then I actually showed her the grams of things and all of that and she said, “Oh. Well, this is what we do with our gestational-ly diabetic patients.”

Brandy W.:
And I said, “Okay. Well, then we can agree that if it’s safe for a pregnant woman, then it should be pretty safe for anyone, right?” And she goes, “Yeah. That’s right.” So we started doing it and we had some really fantastic results. Eventually, I realized that I didn’t really want to have to deal with all the other stuff, I just wanted to work on weight and metabolic disease management.

Brandy W.:
So I left there and I started working in exclusively weight management, and that was great and I liked it. And I liked the doctor and the clinic and everything, but I started to … I was there for about four years and the longer you’re in a place, you see people come and go. They get really excited, they lose weight and then something happens and they drift away and then they come back. So I had the luxury of seeing these people over a period of time.

Brandy W.:
When they were losing weight and feeling good and all their metabolic markers were getting better, it was really fun and great. Then they would drift away and come back having regained all their weight. And I would ask them, not in an accusatory way but just, “Tell me what happened, because I need to understand how to help you better.” And it was never, “Oh, I just forgot that a low carb or a ketogenic diet was the best way for me to eat. I didn’t lose the knowledge, I didn’t learn something different that was opposing my experience.”

Brandy W.:
It was always an emotional or behavioral or social upheaval that threw them off track and then they were just unable to find their way back onto the plan. And mainly I realized that was because they were using food as a coping mechanism and hadn’t replaced it with something else.

Brandy W.:
I also realized that I was not the person to help them realize what these issues were and to help them overcome them, because I’m not a psychologist or a psychiatrist or a psychotherapist. And even if I would know what to do, I didn’t have the time the way that the appointments were structured. So I could help identify it, but I couldn’t really help people with the actual issues. And that led me to understand that if we were going to do this the right way, I needed a partner in that arena who was going to be able to focus on weight.

Brandy W.:
Because it isn’t as if there aren’t psychotherapists out there, but a lot of them I would refer out to the community, available psychotherapists, and they would not even address the issue of eating, or if they did, maybe they had some experience in eating disorders. But it didn’t work, and it was hard to get people to do it, to seek out care that way. And so-

Carole Freeman:
Well, if I can just interject here, in my experience of just going to therapy myself and in seeking out partners myself for my own work, it’s actually very common that therapists look at food as a good coping mechanism. They recommend that people … Food is thought to be neutral, it doesn’t really impact your health that much, it’s just about calories. And so I-

Brandy W.:
[crosstalk 00:12:08].

Carole Freeman:
… [crosstalk 00:12:08] said this, and then I’ve had other ones that say, “Oh, that’s good. It’s good that you’re using food to cope with your emotions. It’s so much better than drugs or alcohol or gambling,” or the other things. So it’s great that you recognize that and you’ve got a partner that also recognizes that, because that’s really rare.

Brandy W.:
Yeah. And so, I mean, I left that practice because I couldn’t convince the administrator to get somebody on board, and I felt like it was doing a disservice to the patients, because I knew that most of them were going to end up regaining their weight because they hadn’t dealt with their issues. And I just didn’t feel right about that.

Brandy W.:
And so I went to a practice where they did have psychotherapists and it was kind of crazy. It was a surgical practice and I was there as a medical provider and long story short, I found some really great psychotherapists and we left there and started our own practice, which is Three Health.

Carole Freeman:
Wow, that’s great. I want to ask a couple of questions here. These are phrases that practitioners throw out that-

Brandy W.:
Yeah, go for it.

Carole Freeman:
… for the people that are watching have no idea. We say it like it’s just the time of the day. But the phrase, first of all, “nurse practitioner.” What does that mean and how’s it different than a nurse or a doctor?

Brandy W.:
Okay. Nurse practitioners have an advanced degree. Most of them coming out of school now have a doctorate, I do not. I have a master’s degree in nursing and then I’m licensed as a nurse practitioner. So my training was RN, that took me longer than it should’ve, but it’s a four-year degree.

Brandy W.:
And then two-and-a-half year program as a master’s, and that’s where you do all your clinical and [inaudible 00:13:57] mentorship and you’re not at all ready to go out into the world and actually do your job, but you find places that are going to train you and you find your niche, and I’m so lucky I found what I did, even though I didn’t really realize it at the time.

Brandy W.:
So I can prescribe medications, I can diagnose, I can set treatment plans, I can do all those things. And I think the best thing about a nurse practitioner role is that for those many, many years that I worked in medicine and I didn’t have a prescription pad, you learn a lot about how to help people. But now I have the ability to use medicine as well, and it’s a pretty good combination, I think.

Brandy W.:
I think we don’t always jump to medication first, but we can use it if we need to. And that makes us kind of different than the medically trained model of physicians, and even sometimes PA’s come from more of, “This is your problem, this is your medication.” That’s the-

Carole Freeman:
Nice.

Brandy W.:
… basic difference.

Carole Freeman:
Excellent. And then the other one I wanted to have a definition for people listening, watching is “metabolic disease.” What does that mean and what are the …

Brandy W.:
So it’s a broad category, and basically it started when we started talking about something called metabolic syndrome. Now they call it syndrome X. But back when I was in school in 2004, they didn’t really have a name for it. They just said, “Well, obviously people who are overweight have diabetes and they also have blood pressure problems, and they also have hyperlipidemia. They also have all these other problems.”

Brandy W.:
And so over time, they kind of put these things into a constellation and said, “Well, if you have three of these things, then you have metabolic syndrome.” But metabolic just means how your metabolism is affected, and your metabolism is basically energy and how it’s used, how it’s conserved or expended. And it can become dysfunctional. And the core of that for most people is a dysfunctional regulation of insulin in the body, which starts down all of these different paths to cause disruption.

Brandy W.:
When we eat certain foods, it influences how our body is producing or utilizing the energy based on insulin and other hormones, but insulin is kind of the mothership. But there’s other things that can happen. There’s thyroid and other things that metabolism is influenced by that doesn’t have really much to do with insulin. But it’s that constellation of things. Does that clear it up or does it just make it muddier?

Carole Freeman:
Yeah, that’s great. No, that’s great. Let us know. As you’re watching this, put a comment below. If you still have questions about what that is, what that means-

Brandy W.:
It’s a vague description-

Carole Freeman:
[crosstalk 00:17:06].

Brandy W.:
Anyway-

Carole Freeman:
Oh, yeah. So next, let’s talk about how long does it take to lose weight on a keto diet? When it’s properly formulated, what do you see as initial in the first few months? And then more longterm, what do you see?

Brandy W.:
Okay. I hate to say this, but it generally depends on a lot of different factors. I can give you averages. But the way that we look at it is more of body fat percentage loss than pounds. Because we’re really concerned and want to focus on maintaining muscle, which helps us maintain that good metabolism, because muscle burns energy and fat doesn’t.

Brandy W.:
So when we see people, especially when people are overweight, they tend to have more muscle than their normal weighted counterpart. So there’s a woman same height, not weight as much, they’re not going to have as much muscle as the person who weighs more. So their needs are going to be different and their weight loss goals are going to be different because of that.

Brandy W.:
Long story short, I would say on average, if people are maintaining muscle and losing only body fat, what I generally see is women tend to have about a five to seven pound loss a month average, but most people will lose more than that in the first couple weeks because of the water weight loss.

Brandy W.:
And so when people say, “Oh, ketogenic diets don’t really work, you’re just losing water weight.” It’s true that you’re losing water weight that you don’t need and that happens up front, but then a continued weight loss tends to be about half of that amount. So if you lose five pounds in a week, the next week if you lose two-and-a-half pounds, we can pretty much bet that that’s coming from body fat, which is an aggressive amount of weight loss for most women.

Carole Freeman:
Yeah. Well, and I love that you brought that up too, that we need to make sure that … I actively with my clients try to watch my language about the difference of weight loss versus fat loss-

Brandy W.:
Body fat. Yes.

Carole Freeman:
People are so trained, it’s ingrained, they’re married to their scale. They just want to see that number going down no matter what and there can be changes on the scale that don’t have anything to do with fat loss. And so you can’t tell the whole picture. So we want to make sure people want fat loss, they don’t want necessarily weight loss, because you don’t want to lose muscle. You don’t want to lose bone. Those things are very important to hold onto.

Brandy W.:
It will make it much harder to maintain weight loss if your weight loss journey includes a lot of muscle. It’s basically destroying the ability to burn energy. And I feel like that’s what has happened to most people when they come in and say the typical story. They come in and say, “Yeah, I’ve lost weight before. A couple times I did all these protein shakes and they weighed me weekly and I lost 30 pounds pretty quick. And then it just stopped. And no matter what I did, I couldn’t lose anymore weight.”

Brandy W.:
And I usually say, “Well, what was happening there is your body got to a point where it’s like, ‘There’s just nothing else I can give. I can’t lose anymore muscle.'” And of course, there is some body fat loss too, but we do body composition tests every couple of months to make sure that there isn’t an excessive amount of muscle loss.

Brandy W.:
There’s also what’s considered acceptable amount of muscle loss, and usually I arrive at that number by looking at total weight loss divided by four. So for example, if somebody loses 20 pounds in three months, if five pounds comes from lean mass, that’s not great, but it’s acceptable. And some people who are really heavy, that have way more muscle than they probably should, that can be a problem too, because then joints and just the pressure of weight, no matter what it’s from, is also going to cause some problems.

Brandy W.:
So some people, especially bigger guys, can afford a little bit of muscle loss and that is okay. My most concerning is somebody that’s already pretty lean deficient and then they are really aggressively trying to restrict their calories. I see that that person is going to end up having a harder time not only achieving their goal weight based on body fat, but they’re going to get hungry and their body’s going to fight back a lot harder. So-

Carole Freeman:
Yeah, and it’s that counterintuitive that people that are overweight have more muscle, but it makes sense if you think about they’re carrying an extra 50 or 100 pounds, every day, your body’s going to have more muscle to be able just to carry that much weight around and move it around.

Brandy W.:
Right. And it’s not just muscle, because we have skeletal muscle that you can move and make do other things, but we have smooth muscle and cardiac muscle and you can’t really ask that to work harder and burn more energy. It’s just kind of there. But there’s also connective tissues and ligaments and all that kind of stuff. And all of that is lean mass, so we go by lean mass and our body breaks down skeletal muscle.

Brandy W.:
But generally, people are going to achieve a healthier weight by gaining muscle and/or preserving what they have and changing their body fat and decreasing their weight. In a lot of ways, our patients end up being kind of like body builders. It’s kind of crazy to say, but I explain it to my 60-year-old ladies who’ve never done any kind of resistance training before.

Brandy W.:
It’s like, “No, we’re building your body, because you’re going to be at risk for muscle loss as you get older and that’s how people get hurt.” It’s just a big mind shift too that they have to go through, because they came to lose weight and then they find out, “Okay, now I know I have pre-diabetes and I have high cholesterol and I have all these other medical issues related to weight,” but then we see these changes in the body that show up and they show up a lot better in the clothes and how people feel than they do on the scale.

Brandy W.:
The scale is, I always call it an evil liar of all lies, because it cannot tell you what’s going on in your body. And how many times do people come in and say, “I’m not losing weight. I’m so discouraged.” And then their pants are falling off as they’re walking out. You’re like, “Well, something’s happening.” But I think that’s how we have to assess it, is more by body composition, and getting people out of the dieter mentality, which is rampant. It’s rampant, and if that scale isn’t moving, then they’re doing it wrong and they are going to fail, and just another thing that they’ve tried that they can’t do. And we’ve got to start combating that from day one that, “Look, there are other things that we’re going to look at that are more important and that are going to tell you truly what’s happening in your body, apart from just the scale.”

Carole Freeman:
Oh, that’s great. And having that body composition tool in the office there is probably really powerful, where you can show them and convince them that, “Look, things are moving in the right direction.” Let’s see. There are some common things. There are stalls and plateaus in weight loss that’s a natural part of the process, how do you coach people through that? Because it can be a big part, like you’re saying, where they say, “Well, it’s not working. It’s not working. I might as well just quit.”

Brandy W.:
Right. And the social media aspect is a blessing and a curse at the same time and I’m sure you get this too, because I’ve had patients … I have patients who have lost 60 pounds on a ketogenic diet and they’re doing great and all of their markers look great, and metabolically, they’re so much healthier and happier. And they’re not struggling with addiction of food and sugar. But they compare themselves to these photos and stories on Facebook and Twitter and all this.

Brandy W.:
And then they feel like they’re not making any progress, and it’s just really … Those things can be inspiring and they are inspiring, and I support people promoting themselves and showing these things. But then everyone has to understand it’s their own journey, and everybody’s body’s different and it might take longer. It’s so individualized. There’s no way to predict how exactly things are going to go.

Brandy W.:
I try to be the rah-rah, that’s when my pom-poms come out. Ask anybody that knows me, I was a cheerleader, but the worst cheerleader you have ever met.

Carole Freeman:
Oh, that’s funny.

Brandy W.:
The worst. And everybody agrees. But I’m good at cheerleading this population, because we bring it back to reality and what’s happening in the body and how they feel and their energy, and all these other things that really matter in the big scheme of things.

Brandy W.:
Plateaus are going to happen, and that’s the other thing that I try to educate people up front about before it happens. “I don’t know when, but it will. And that’s going to be a test and we’re going to have to be crafty.” And there are ways to break plateaus that are pretty easy, I think. Number one is I always go back to the protein, always.

Brandy W.:
People come in now, my patients that have been with me for a while, and they don’t even say, “I don’t why I’m not losing weight.” They say, “I know. I haven’t been eating enough protein.” They’re trained now.

Carole Freeman:
And that’s so great, and I’m so glad you said that specific thing, because that’s, unfortunately, it’s a piece of misinformation that’s been like a game of telephone that’s been passed along. I can’t tell you how many people I start to work with and they put on their application, “I’m probably eating too much protein.”

Carole Freeman:
People fear protein in this keto thing. And keto for weight loss is very different than a therapeutic ketogenic diet for epilepsy or brain cancer. So protein is usually not anybody’s … Usually they’re under-eating protein than overeating protein.

Brandy W.:
Right. And it’s happened to me. Well, I’m getting my lunch ready and I’m like, “That’s probably enough.” And then there’s a tiny little voice in my head that says, “Why don’t you check, because you’ve been hungry lately.” And so I check and I’m like, “Oh yeah, that’s half of what I intended to be eating.” I think part of it is the dieter mentality, because we go back to eating less is going to make me lose weight faster. And then we find ourselves hungry and it’s just a natural thing that we do, because we have those tapes playing in our head that if I just eat less, I’ll do better.

Brandy W.:
But I always pound it into my patient’s head that, “You have to eat to lose weight. You have to eat to lose weight.” And they’re like, “I know.” That’s one of the biggest things that happens is people get to the point where they can tolerate more hunger, because they’re not on the blood sugar train anymore. They’re not going from high to low. So they can manage not eating as much. But then their weight loss slows down because it’s not enough to keep their metabolism going the way it should be going. And that’s a pretty consistent one. So, protein.

Brandy W.:
I think the other one that sneaks in is liquid calories, whether it’s in the form of alcohol or the spiced pumpkin latte or god forbid, too much heavy whipping cream in your coffee. It does add up and it does matter, so I go back and look at calories that are just liquid. I think that’s low hanging fruit for most people. And they’ll go, “Yeah, I guess I have done that a little bit more.”

Brandy W.:
And then soda, or diet soda sometimes or artificial sweeteners, a lot of times people don’t recognize that they’re triggered to find more sweet things, even if they don’t really have a sugar issue. But sweet and tasting sweet perpetuates craving for sweet. And it’s so insidious because you think, “Gosh, I’m making a really good choice here.” Diet soda or there’s a million drinks now that you can get without calories.

Brandy W.:
But for some people, and I have never been able to find the common link between people, but probably in 13 years, I’ve seen at least four or five, probably five people who just would not lose weight when they were drinking diet soda. And calorie-wise, it didn’t make any difference. They weren’t eating more calories, it was something about the sweetener itself and possibly its effect on your body thinking that it got sugar. The consistency wasn’t there. Like, “Oh, they were pre-diabetic.” Or they had high insulin, or they were a male in their 50s. It was just so random that I still don’t know what it is.

Brandy W.:
It’s probably some kind of enzyme that they don’t have to break it down. I don’t know. But that happens often, I think. First, it creates more cravings for sweet, and then some people just won’t lose weight period, because they’re having some kind of artificial sweetener and there’s an issue. I don’t really know.

Brandy W.:
Rarely do I have to tell people that they’re not eating enough vegetables, that doesn’t generally happen. People are pretty good at that. I often give people permission not to eat vegetables if they don’t like them and it’s turning into a hassle and they’re doing it because they think they have to be healthy. I just say, “Well, if you like them, eat them. If you don’t, okay. You might end up wanting more later at some point if your taste changes or seasons or whatever.”

Brandy W.:
Sometimes night eating, people get out of bed and eat, and they won’t really come forth with that. It’s really interesting. They’ll answer, they’ll admit to it and talk about it freely when I ask the question, but they won’t offer it sometimes. Like, “This could be a barrier to my weight loss.” And that is more common than you would think, actually. It’s really interesting. And it is an actual eating disorder.

Brandy W.:
But that’s fairly common. It tends to be more with women, and we think sometimes it’s more related to the fact that when women have babies, they’re on a 24-hour clock. So they don’t have bedtime and wake time and morning. It’s just an every two hour cycle. And so they’re up and they don’t have a schedule, so they eat. They’re breastfeeding or whatever, and then they just never go back to sleeping through the night and not eating. That’s fairly-

Carole Freeman:
Wow.

Brandy W.:
… common.

Carole Freeman:
That’s really interesting. I like that theory.

Brandy W.:
Some people do sleepwalk and eat, but they usually know, because their kitchen is destroyed and there’s food all over and they weren’t conscious of it. And that’s a pretty rare thing. Usually I don’t see too many people doing that. But people can eat a whole lot on Ambien and not remember.

Carole Freeman:
Oh, wow. Wow.

Brandy W.:
But, I mean, really, generally if you go back to the basics, there’s something like that. And then I have people who have inflammation, they have arthritis, and no matter what they do, if we don’t get that inflammation under control, they’re not going to lose weight.

Brandy W.:
People who have very poor sleeping habits or who have sleep apnea that’s undiagnosed, that really stresses the body and it just doesn’t want to give up anything. It’s already super fatigued and eating more is the only logical way to get energy. So you ask these people to do carb restriction or even reduce their portions and things like that, and they’re just too … All of those hunger signals are just too ramped up and they can’t do it.

Brandy W.:
But those are kind of rare. I think most of it is mindless and eating more, more often and the carb creep. I think someone at the keto meetup mentioned that, it just starts with one little thing and then before you know it, you’re eating a lot of carbs. It just happens insidiously. So we go back and check that.

Brandy W.:
But I almost think that if you maintain protein, carb creep is a lot less likely to happen, because you’re actually satiated. And if you’re being mindful of your protein, it’s just less likely that those carbs are going to sneak in without you knowing. Being logical about it, you can tell energy-wise and craving-wise when you hit that mark of too many carbohydrates for you personally.

Carole Freeman:
Oh, let’s see. It feels like we covered it pretty good about how long it takes to lose weight. We’ve got a quicker weight change in the beginning for more water weight that’s lost from the liver glycogen and then five to seven pounds of fat average per month. But plateaus are normal. Remember that. Plateaus are normal. It’s not if they’re going to happen, it’s when.

Brandy W.:
When.

Carole Freeman:
I’ve seen this, and human bodies are so fascinating and we’ve got all this science that shows all these things. And then we’ve got real life experience with real people. Not all of it fits with what we know in science. And so, have you seen that where sometimes people hit a plateau where it’s a weight that the body remembers from before, that whatever the weight was at, “Oh yeah, I was at that weight when I was 27 for five years.” Have you seen that?

Brandy W.:
I have. I think that’s more of a self-fulfilling prophecy for a lot of people. I think it’s just because mentally they know that that was a sticking point, or it was a weight that they had been at before. And so they kind of anticipate that it might be a place where they stop.

Brandy W.:
But if people aren’t weighing themselves that often or if they’re only relying on our scale, they’ll blow by it and not even know.

Carole Freeman:
So it sounds like you’re saying it’s more of a psychological or subconscious plateau. I have seen that, actually, where I’ve had clients that have said, “I’m afraid of this weight because something happened [crosstalk 00:37:01]-”

Brandy W.:
Exactly.

Carole Freeman:
“… before.” Or, “I’ve never been lower than that and I don’t know what’s going to happen.”

Brandy W.:
And the other part of it that’s fairly common is people will admit that, “Well, now that I’ve lost some weight, I’m starting to get attention and I’m not really excited about that.” And so they’re really, honestly debating whether they want to keep losing weight. I think that’s huge, and that’s why we have psychotherapists in our office.

Brandy W.:
I was going to say, the other thing that can help break plateaus is obviously changing the type and amounts of food that you eat at each meal. So I call it the shell game, where you just move things around. And so I make people eat dinner for breakfast and not eat dinner or skip lunch or whatever. We just change the pattern so that the body has a shock again and it can’t anticipate and be efficient, because we’re changing the amount of energy coming in and the timing of it.

Brandy W.:
And I think that’s really common, that people are like, “This is my plan.” And they’re married to it. This is what has been working for the last four months. And then it’s like, “Well, guess what? Your body’s way smarter than that. It knows how to adapt, and it’s been doing this … As humans, we’ve been doing this for a really long time, so you got to do something to shake it up.”

Brandy W.:
The other thing that I see interestingly is when people get really aggressive with their exercise, the weight plateaus even though they can recognize changes in their shape and their size, but that’s when we really have to consider, the scale probably isn’t going to be a very good way of measuring your progress at this point. And that’s unfortunate. You would hope for people that when they get active and they feel good enough to want to do those things that it would just perpetuate their weight loss or push them further.

Brandy W.:
But sometimes it backfires, and I think it might have more to do with the fact that people probably get hungrier, but they don’t respond to it appropriately. So they’re really just not getting enough in. Again, back to the protein, needing to go back to the protein.

Brandy W.:
The other thing that we do is prescribe medications, because people will want to do everything without help. They call it a crutch and they don’t want to use crutches and I say, “Well, if you broke your leg, you’d want them. So, it’s really no different.” But sometimes you don’t know what you are thinking and feeling around food and your appetite, that it is more mental or socially driven or whatever.

Brandy W.:
You don’t know when it’s different, when you’re not using a medication. Or a medication gives you awareness of habits and eating practices and social things and stress responses to things that you can’t know if you’ve never had the opportunity to feel different. And I think that the medications can be extremely helpful pushing people past that, because then they realize, “Yeah, my plan has been working. I’m doing this, I’m following it. It’s really good. But then I’m plateauing and I can’t tell what the difference is between me being physically hungry and wanting to eat because I like steak.”

Brandy W.:
They can’t really decipher it. And so sometimes the medications help us be more clear about its physical hunger, or you’re actually full and/or some other kind of driver to eat. It’s all kind of individual.

Carole Freeman:
Wonderful. I wonder just in closing, do you have an inspiring case study to share? A transformation of somebody you’ve worked with?

Brandy W.:
I’ve got a lot. There’s a guy that I’ve been seeing for a few years now. He came to me at the previous practice. He went there exploring gastric sleeve surgery, and I think he was close to … I think he was 420 when he started, and then he read the book, Always Hungry by David Ludwig, and he and his wife did that and he lost some weight.

Brandy W.:
But then it just stopped, he plateaued and he was on his own. So he went to the clinic and was considering bariatric surgery but really didn’t want to. He told them, “I don’t want to do this.” And so they referred him to the medical program and I saw him. Now he is 220, I think. And he’s off all of his Metformin, Statin, blood pressure, all that stuff. And he’s got a little ways to go, but pure keto.

Brandy W.:
He and his wife, they come in, I’m like, “Give me your keto recipes.” Because they’re constantly exploring and doing new things and they’re just rock stars. They did a whole keto thanksgiving dinner and everyone in the family loved it. It’s pretty great. So we see that kind of thing all the time.

Brandy W.:
But they’re the rock stars, really. The average person is going to get really good weight loss up front. They’re going to slow down and plateau, and the smaller you get, the harder it is. That’s just the truth, too. You’re not going to stay on these five pound, 10 pound a month trajectories of weight loss. But once in a while, you will get someone who’s been doing pretty good low carb keto, they’re stuck, and then we throw something like intermittent fasting at them. And then they start losing weight again in a pretty good manner. But that’s kind of unusual, too.

Carole Freeman:
I thought of one other question I wanted to ask as well.

Brandy W.:
Sure.

Carole Freeman:
Is there such a thing, can people be still overweight but metabolically healthy? Do people always have to get to a very lean body?

Brandy W.:
No, they don’t. And actually, that’s funny, because I was just looking at Twitter and Dr. Ted Naiman had this ideal body weight thing, and I was just like … I read all the comments on why body fat is more important and I’m like, “Yeah! Finally, somebody said it and I didn’t have to.”

Brandy W.:
What we do is we don’t really use BMI. I mean, we look at it because we can calculate it, but in my experience, if you’re looking for health, women do really well if they get to about 32% body fat. And this is a generalization. But the majority of our patients start somewhere around 40 to 50%, so that’s a huge reduction in body fat.

Brandy W.:
The crazy thing is that I like to play this game called If I Worked at the Circus, because when people come in and I calculate what their weight would be if they hit 32% body fat with maintaining their muscle, it’s almost always a weight where they say, “Oh. I weighed that once and I felt great.” And they were overweight on the BMI scale.

Brandy W.:
They’re usually bigger people anyway, just taller, bigger people. And in their heart, they know that that’s a good weight for them. No, you don’t have to be super lean to be metabolically healthy. Men, I try to get them under 25%. But we see really good improvements with even a 3% change in body fat. When people go from an A1C of 6.1 to 5.4 in a three month period and they’ve only lost 3% of their body fat, it’s like, we’ll take it. It’s improving.

Carole Freeman:
Oh, it’s so great. I love the work that you’re doing, and I didn’t mention at the beginning, but you’re in the Seattle area, which is wonderful. And I was so excited to get to meet you recently and discover that you’re right in my backyard and I get to [inaudible 00:45:58].

Carole Freeman:
Because we have so few qualified practitioners, or even practitioners that are keto friendly. To know what you’re doing is such a comprehensive model. It’s so wonderful and I imagine you’ve just got … I mean, it makes sense to me why you gave up the other focus you had and this has been such a passion for you, is because it’s changing lives. It’s improving people’s health and saving lives as well, too.

Carole Freeman:
Thank you so much for the work you’re doing. I have one final closing question. If we all knew that the meteor was coming at the earth today, today was going to be our final day on this planet, what would be your final meal?

Brandy W.:
Oh, definitely steak with a lot of butter, and I might have a salad. But probably not. Who’s got time for that? I’d definitely have a nice steak, for sure.

Carole Freeman:
Nice. All right. Well-

Brandy W.:
Thanks for having me, Carole. It’s been really fun.

Carole Freeman:
Yeah, thank you-

Brandy W.:
And thanks for the keto meetups. I really appreciate being a part of that. It’s really fun.

Carole Freeman:
Yeah. We’re going to keep growing those in the Seattle area, and we encourage you, wherever you’re watching this, seek out or start one yourself and just meet and hang out with those other people that are following this way of low carb keto way of living.

Carole Freeman:
We’re going to put your contact info in the show notes there below. Any quick little way that people can follow up or contact you?

Brandy W.:
Sure.

Carole Freeman:
Are you on social media or anything like that? Is there something you want to plug?

Brandy W.:
You can find us at Three Health pretty much across all media. If you Google “Three Health,” T-H-R-E-E Health, we’ll come up. Our website is www.three.health. Not dot com, people get that screwed up all the time. But it’s just dot health.

Carole Freeman:
Nice. Well, thank you so much again for being here. If you all enjoyed this interview, give us a thumbs up. Subscribe and hit the bell if you want to get notified when our next interviews come out. Thank you again for being here, and thank you for all the work that you’re doing in the world.

Brandy W.:
Absolutely. Thanks for having me, Carole. Bye-

Carole Freeman:
We’ll see you soon-

Brandy W.:
… bye.

Carole Freeman:
… come back soon. Bye!