"I hit a breaking point the other day and nearly threw the scale across the bathroom floor," my 36-year-old patient Genie confessed. After nearly a dozen consultations, I knew she wasn't being dramatic. During Genie's journey to heal Hashimoto's thyroiditis, she hit a frustrating weight-loss plateau and subsequently, as she described it, "tried every diet in the world."
As a medical doctor who specializes in gut health, I frequently have patients who hit stubborn plateaus as they work through their gut (or, in Genie's case, thyroid) issues. One day, they're sailing along losing weight; then one morning they get on the scale and…nothing. Maybe they've even gained a pound or two.
Weight-loss resistance can be unbelievably frustrating.
At this point, I tell them not to stress out (stress can make you gain weight, in fact!). But when this stall continues, they understandably get frustrated. After a week of working hard—eating clean, exercising smartly, getting super sleep, and otherwise doing everything correctly—and not getting results, I get why patients become upset.
As a last-ditch measure to lose 10 pounds for an upcoming high-school reunion, Genie dramatically cut her caloric intake. Doing 100-calorie protein shakes throughout the day indeed moved the scales again, but she was always hungry (or "hangry," as she called it) and miserable. When she visited me that following Monday, the scales had stalled again. "Calorie restriction is going to leave you feeling deprived and will also crash your metabolism pretty quickly," I told Genie. "Weight loss will come to a grinding halt, as you discovered this morning."
Here's what I tell my patients who can't seem to lose weight.
Fortunately, I have another tactic that almost always works when everything else has failed: intermittent fasting (IF). What is IF? Roger Collier, when talking about1 the future of intermittent fasting back in 2013, explained that "Some advocates recommend1 fasting every day for up to 16 hours and consuming food only during a short eating window. Others suggest going without food once or twice a week for 24-hour periods—having dinner one night, for example, and skipping breakfast, lunch, and snacks the next day, then eating a normal dinner (no gorging)."
Collier perfectly explains IF, though he goes on to say that many experts remain skeptical. Yet, as more studies show the benefits of fasting for everything from type 2 diabetes2to maintaining a healthy gut microbiome, those skeptics are slowly but surely becoming believers.
The many benefits of intermittent fasting
I've found patients who employ IF improve gut health—since fasting gives your digestive system a much-needed break. IF can even help you age more gracefully via a gene called sirtuin (SIRT1) that protects your mitochondria, those little energy plants within your cells. "Intermittent fasting turns on SIRT1 and turns off the mTOR gene," writes Sara Gottfried, M.D., in Younger. "When hyperactive, mTOR is associated with Alzheimer's disease, cancer, and early mortality."
Those benefits are great, but Genie gravitated to IF because every other weight-loss plan failed her. Studies support her decision. One 2015 systematic review of IF for weight management targeted six studies and reported an impressive average weight loss of nearly 3 percent after the first month, 9 percent after six months, and further average weight loss of about 8 percent after a month of weight maintenance. Participants also had improved blood pressure and insulin sensitivity.
Nine ways to optimize IF:
IF becomes ideal because it simplifies eating. My patients don't need to militantly weigh or count food. IF gives them a little more eating leeway when they're traveling or otherwise can't make optimal food choices. I utilize it regularly in my practice along with these expert tips…
1. Start slow if you're a newbie.
Leave alternate-day and 20-hour fasts to people who've done it for a while. If you're a beginner, even a 14- to 16-hour fasting window will do wonders for your waistline. You might close up the kitchen at 7 p.m. (after a big dinner) and resume eating at 10 a.m. or so the next morning. Easy—right?
2. Remember, zero means zero.
Fasting entails not consuming calories. That means something like a handful of nuts during fasting hours can knock you out of your fasting state. In the beginning, Genie found she added cream to her coffee without thinking, which explained why IF didn't work perfectly. She learned a big lesson: Be incredibly mindful about not consuming any calories during your fasting hours.
3. IF does not give you permission to gorge or cheat.
Sure, you can deep-dive into a pepperoni pizza during your "feeding hours," but you'll compromise weight loss and your health. IF does not give you a "get out of jail free" card to eat anything you want.
4. Go keto.
5. A food journal can keep you on track.
Writing down what you eat and (equally important) when you start and stop eating every day helps you pinpoint plateaus and other problems.
6. Exercise is your IF bestie.
Some patients find lifting heavy weights or doing burst training works better when they're fasting. They feel lighter and more focused. Others find a brisk walk becomes a great way to curb hunger during fasting hours. Regardless, exercise can get your mind off food.
7. The first few weeks might suck, but you'll adjust.
If you're used to starting your day with a banana nut muffin and latte, bypassing breakfast might initially feel like torture. Be patient and know you'll get through that hurdle. After a few weeks, many patients comment about how much easier IF gets (and how much better they feel).
8. Try these hacks when you stall.
Water becomes your best hunger-curbing friend when you're fasting. Surprisingly, peppermint tea both calms the nerves and curbs the appetite. Caffeine has a hunger-curbing, thermogenic (fat-burning) effect, but best to Zen out with green tea—rather than coffee—unless you want to be a jittery mess.
9. Lifestyle factors optimize IF.
Food (and food timing) isn't the only essential when you're intermittent fasting. Getting awesome sleep, controlling stress levels, supplementing smartly, and maintaining good gut health goes a long way toward helping you lose weight and making sure that you keep it off.
If you're looking for a place to start, I'd love to help you achieve your weight-loss goals by optimizing your gut health with my free Quick Start Guide to a Happy Gut.
Vincent M. Pedre, M.D., medical director of Pedre Integrative Health and president of Dr. Pedre Wellness, is a board-certified internist in private practice in New York City since 2004. He completed his bachelor’s degree in Biology at Cornell University before attending the University of Miami School of Medicine and completed his residency in Internal Medicine at the Mount Sinai School of Medicine. He has appeared on the Martha Stewart Show and ABC and is the author of Happy Gut: The Cleansing Program to Help You Lose Weight, Gain Energy, and Eliminate Pain. Dr. Pedre is a clinical instructor in medicine at the Mount Sinai School of Medicine and is certified in yoga and medical acupuncture.