Long-term weight loss on keto: Maintaining a ‘no excuses’ attitude

How do you maintain a weight loss long-term on a keto low-carb diet? Tami Marino has a “no excuses” approach, which clearly works extremely well for her.

Indeed, this attitude helped her lose 170 pounds (77 kg) during perimenopause – a period of hormonal fluctuation that often involves weight gain.

However, for decades her life was consumed by yo-yo dieting, food addiction, and bingeing.

“I first became overweight during puberty and got up to 250 pounds (114 kg) in my teens. It was a really tough time,” Tami remembers. “My mom was always overweight and really concerned about my weight. She’d buy certain foods for my sister, who never had a weight problem, but they were off limits for me. I definitely felt a lot of pressure to lose weight. My grandparents would always say, ‘If you would just lose weight, I’ll take you shopping’ or ‘I’ll get you whatever you want if you just lose weight.’ And that made things very uncomfortable, and it’s probably what led me to start eating in secret.”

She struggled with her weight throughout her teens and into adulthood. Although she’d lose weight by following Weight Watchers or starvation diets, she always gained it back.

Although she didn’t develop gestational diabetes with any of her three pregnancies, when she was 40, Tami was diagnosed with type 2 diabetes. At the time her HbA1c was 9.4%, which reflects an estimated average blood sugar level of 223 mg/dL (12.4 mmol/L).

Her A1c continued to climb over the next several years, despite doing everything she was told to do, which included taking larger dosages of diabetes medications and following low-fat dietary recommendations. In addition, she developed fatty liver, high blood pressure, and severe depression.

The change

Then in May of 2014, everything changed following a visit to her doctor’s office.

“I’d been on metformin and glipizide for a while, and I’d also started taking Victoza injections a couple of times within the past month. I was really scared about taking that last medication because of some things I’d read about it. I remember my doctor telling me not to test my blood sugar at home, but I would test anyway. And even with all those meds, my blood sugar was still in the 300s mg/dl (16.7 mmol/L) and even in the 400s mg/dl (22.2 mmol/L) sometimes,” she recalls.

“Then I heard the doctor say, ‘Along with the meds you’re already taking, you’re going to need to take insulin.’ And that absolutely petrified me,” remembers Tami.

Unwilling to accept that she was destined to take multiple medications and insulin for the rest of her life, she began doing her own research online. She found a Facebook group called Type 2 Rebels and began to realize there might be a way to improve her blood sugar control and potentially even reverse her disease. It was in this group that she learned about the work of Dr. Richard K. Bernstein, a doctor with type 1 diabetes who follows and recommends a very low-carb diet for all types of diabetes.

“I read his book ‘Diabetes Solution,’ and although it made a lot of sense, I didn’t start following it immediately,” Tami admits. “It was just completely different than what I’d heard from my doctor and what I’d been told for years about nutrition, which was to eat low fat, lots of whole grains, and things like that.”

Although it took her about a month to fully embrace the concept of a very low-carb lifestyle, once she did, the results were dramatic and life changing.

“I couldn’t believe how much more stable my blood sugar was, as opposed to going up and down all day long like when I was on medication. I felt so much better, was less hungry, less depressed. It was amazing,” she remembers. “It took me about one year to get off all the meds, and by that time, my A1c had gone all the way down to 4.6%, where it’s stayed ever since. My fatty liver and sleep apnea went away as well.”

What’s more, she achieved her lowest weight of 133 pounds (61 kg) in May of 2016 and has maintained that loss within 11 pounds for the past 17 months.

Although exercise has become an integral part of her life in maintenance, Tami didn’t do much physical activity during her weight loss journey.

“I really didn’t exercise while I was losing weight, but I became more mobile. I had more energy and could move around a lot more easily,” she says.

The powerful changes in her blood sugar, weight and overall health help motivate her to remain low carb at all times. However, she has had several challenges over the past several months.

The challenges

“I’m now in menopause, which has been more of a struggle than I ever expected,” says Tami. “The hormone changes often lead to hunger and trigger binge-eating behaviors. I still eat only low-carb foods, but I sometimes eat too much. I’m not perfect, but I do the best I can.”

Additionally, a few financial setbacks have led to more limited food choices.

“I try to focus on less expensive low-carb options like eggs, canned fish, and chicken. I really can’t afford to have some of the foods I love very often, like steak and bacon. Those are like treats for me. But I won’t ever eat high-carb foods like rice or pasta, no matter how cheap they are. Staying low carb is my priority,”she states, confidently.

No matter what is going on in her life, Tami maintains her characteristic “no excuses” attitude. In fact, it’s a hashtag she uses on social media on a regular basis.

“It keeps me motivated and accountable,” she says. “Weight maintenance is a day-to-day thing. When things get especially stressful, jotting it down on Facebook or Instagram really helps me stay focused on what I need to do. There are days that I end up eating more food than I want to, because I’m human and it’s tough to ignore hunger, especially in menopause. But there’s no excuse to go crazy by eating high-carb stuff or not exercising. Years ago, I would have given up and gone back to where I started. But now I just won’t do that. No excuses allowed.”

Although she rarely tracks her food intake, Tami believes she stays below 20 grams of net carb per day as a rule. “Except when I eat almond butter,” she laughs. “That’s a tough food for me to consume in moderation, so I try to stay away from it most of the time.”

A typical day of eating for Tami

Breakfast (8:00 am):
Black coffee

Lunch (2:00-3:00 pm):
Hard-boiled eggs, avocado, flaxseed, pickles, salad

Dinner (6:00 pm):
Chicken or bunless burgers, vegetables or salad with olive oil or bleu cheese dressing

Snack (8:00-9:00 pm):
Sardines, salad, nuts

“I actually don’t add much fat to my meals,” she says. “ I cook veggies in a little olive oil or coconut oil, and I like bleu cheese dressing on a bacon cheeseburger sometimes.”

Treats are few and far between. “I’ll sometimes have almond butter or other nut butters when they’re on sale. I also like Quest bars because they don’t spike my blood sugar and they’re portion controlled, which really helps,” says Tami. “And once in a great while I’ll make a low-carb treat to bring to a holiday party. But overall, I try to keep things as simple as possible and really not focus on food too much because of my food addiction,” she says.

Exercise

In addition, she maintains the same “no excuses” attitude about exercise, which she finds extremely beneficial for mental, physical and emotional health.

“I work out 5-6 times a week, aiming for 6 whenever possible,” she says. “I prefer to do it first thing in the morning after having coffee. I walk on the treadmill for about an hour on the highest incline. Sometimes I’ll do a core class that has some cardio. I’ve tried yoga and Zumba, but I don’t like classes too much. I’ve figured out that I really like doing things at my own pace.”

And her favorite form of exercise?

“Oh, I absolutely love resistance training,” Tami says, enthusiastically. “I do at least an hour and lately often closer to two hours because I recently increased my reps. I can’t do free weights because I have a hernia, but I do leg presses, incline presses. I also have a good support system at the gym as far as the people who work there and friends I see there. On days I can’t get to the gym, I’ll do planks on the floor at home or get out and walk as much as I can. No matter what, I get some kind of physical activity in every day.”

Her best tips

Here are Tami’s tips for maintaining a “no excuses” attitude:

1. Don’t feel that your food has to be grass-fed or organic if you can’t afford it. “Yes, those are healthy and ideal, but you really just need to eat the right foods,” says Tami. “Don’t use the excuse that it’s too expensive to eat low carb, because it’s not.”
2. Jot down what you’re going to do and follow through. “This can really help keep you motivated more than anything, no matter what is going on,” she says.
3. Take it day by day and meal by meal. “Stuff happens with all of us” Tami admits. “One meal isn’t going to ruin you, so don’t make it a bigger deal than it is and go off plan altogether. Start right back at the next meal.”
4. No judging or comparing yourself to others. “Remember that the other person you’re looking at may have never struggled with weight or eating issues. It’s not a fair comparison,” Tami points out. “Do the best that you can do, and be proud of your own progress.”

You can follow Tami on her Instagram account, @tamis_fitlife.

—
Franziska Spritzler, RD

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