Do you have trouble losing weight? Or would you like to lose faster? You’ve come to the right place. Get ready for weight loss without hunger.

The sad truth is that conventional ideas – eat less, run more – rarely work long term. Counting calories, exercising for hours every day and trying to ignore your hunger? That’s needless suffering, and likely a waste of your time and precious energy. It’s weight loss for masochists.

Eventually people often give up, so an excessive focus on counting calories may be one reason for the current obesity epidemic.1 Fortunately there may be a better way.

The bottom line? Your weight is hormonally regulated. If you reduce the levels of your fat-storing hormone, insulin, you’ll likely have an easier time losing excess weight.2

Top 18 weight-loss tips

Are you ready? Here we go. Start at the top of the list (most important) and go down as far as you need. Click on any tip to read all about it. Perhaps you only need the first piece of advice?

  1. Choose a low-carb diet
  2. Eat when hungry
  3. Eat real food
  4. Eat only when hungry
  5. Measure your progress wisely
  6. Be persistent
  7. Avoid fruit
  8. Avoid beer
  9. Avoid artificial sweeteners
  10. Review any medications
  11. Stress less, sleep more
  12. Eat less of dairy products and nuts
  13. Supplement vitamins and minerals
  14. Use intermittent fasting
  15. Exercise wisely
  16. Achieve optimal ketosis
  17. Get your hormones checked
  18. Consider weight-loss pills (if desperate)

 
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Disclaimer: In this weight-loss guide, we recommend a low-carb diet, as it appears to be more effective than other diets.3 While a low-carb diet has many proven benefits, it’s still controversial. The main potential danger regards medications, especially for diabetes, where doses may need to be adapted. Discuss any changes in medication and relevant lifestyle changes with your doctor. Full disclaimer

This guide is written for adults with health issues, including obesity, that could benefit from losing weight.

We don’t recommend counting calories, which is controversial. To learn more about the rationale for this, see our guide on restricting calories for weight loss.

Controversial topics related to a low-carb diet, and our take on them, include saturated fats, cholesterol, whole grains, red meat and whether the brain needs carbohydrates.

1. Choose a low-carb diet

Keto Cobb salad with ranch dressing

If you want to lose weight, consider starting by avoiding sugar and starch (like bread, pasta and potatoes). This is an old idea: for 150 years or more there have been a huge number of weight-loss diets based on eating fewer carbs. What’s new is that dozens of modern scientific studies have proven that, yes, on average low carb can be the most effective way to lose weight.4

Obviously, it’s still possible to lose weight on any diet – just eat fewer calories than you burn, right? The problem with this simplistic advice is that it ignores the elephant in the room: hunger. Most people don’t like to “just eat less”, as it may result in having to go hungry forever. Sooner or later, a normal person will likely give up and eat, hence the prevalence of “yo-yo dieting”.5 While it should be possible to lose weight on any diet, some appear to make it easier and some to make it much harder.

The main advantage of the low-carb diet is that it may cause you to want to eat less. Even without counting calories overweight people tend to eat fewer calories on low carb.6

Sugar and starch may increase your hunger, while avoiding them may decrease your appetite to a more adequate level.7 If your body wants to have an appropriate number of calories you don’t need to bother counting them. Thus, calories count, but you don’t need to count them.

A 2012 study also showed that people who had lost weight  experienced far less reduction in total energy expenditure (the number of calories burned within a 24-hour period) when they followed a low-carb diet compared to a low-fat diet during weight maintenance — a 300-calorie difference, in fact.8

According to one of the Harvard professors behind the study this advantage “would equal the number of calories typically burned in an hour of moderate-intensity physical activity”. Imagine that: an entire bonus hour of exercise every day, without actually exercising.

Recently, an even larger and more carefully conducted study confirmed this metabolism-sparing effect, with different groups of people who had lost weight burning an average of between 200 and almost 500 extra calories per day on a low-carb maintenance diet compared to a high-carb or moderate-carb diet.9

Bottom line: A low-carb diet can reduce your hunger, making it easier to eat less. And it might even increase your fat burning at rest. Study after study shows that low carb works for weight loss and that on average it improves important health markers.10


Learn more about keto and low-carb

Do you want to know more about exactly what to eat on low carb, exactly how to do it, potential problems and solutions… and lots of great recipes? Check out our keto for beginners guide. Alternatively, you can make low carb even simpler by signing up for our free two-week keto challenge.

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How to eat keto video course

Low-carb video course

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2. Eat when hungry

Eat when hungry
Don’t be hungry. The most common mistake when starting a low carb diet: reducing carb intake while still being afraid of fat. Carbs and fat are the body’s two main energy sources, and it needs at least one of them.

Low carb AND low fat = starvation

Avoiding both carbs and fat can result in hunger, cravings and fatigue. Sooner or later many people can’t stand it and give up. The solution can be to eat more natural fat until you feel satisfied. For example:

  • Butter
  • Full-fat cream
  • Olive oil
  • Meat (including the fat)
  • Fatty fish
  • Bacon
  • Eggs
  • Coconut oil, etc.

Top 10 ways to eat more fat

Always eat enough, so that you feel satisfied, especially in the beginning of the weight-loss process. Doing this on a low-carb diet means that the fat you eat will be burned as fuel by your body, as your levels of the fat storing hormone insulin will be lowered.11

You’ll become a fat-burning machine. You’ll lose excess weight without hunger.12

Do you still fear saturated fat? You may want to reconsider that. The fear of saturated fat is based on theories that recent studies suggest are misguided and incorrect. 13

Butter is a fine food. However, feel free to eat mostly unsaturated fat (e.g. olive oil, avocado, fatty fish) if you prefer. This could be called a Mediterranean low-carb diet and works great too.14

Eating when hungry also implies something else: if you’re not hungry you probably don’t need to eat yet. When on a keto diet you can trust your feelings of hunger and satiety again. Feel free to eat as many times per day that works best for you.

Some people eat three times a day and occasionally snack in between (note that frequent snacking could mean that you’d benefit from adding fat to your meals, to increase satiety). However, there’s some evidence that frequent snacking isn’t wise when trying to lose weight.15 Some people only eat once or twice a day and never snack. Whatever works for you. Just eat when you’re hungry.

Read more about why eating when hungry is smarter than counting calories

Learn more about fuelling your body with fat

3. Eat real food

Woman grocery shopping
Another common mistake when eating a low-carb diet is getting fooled by the creative marketing of special “low-carb” products.

Remember:  an effective low-carb diet for weight loss should be based on real food.

Real food is what humans have been eating for thousands or likely (even better) millions of years, e.g. meat, fish, vegetables, eggs, butter, olive oil, nuts etc.16

If you want to lose weight, avoid special “low-carb” products that are full of carbs. This should be obvious, but creative marketers are doing all they can to fool you (and get your money). They will tell you that you can eat cookies, pasta, ice cream, bread and plenty of chocolate on a low-carb diet, as long as you buy their brand. They’re often full of carbohydrates. Don’t be fooled.

How about low-carb bread? Be careful: if it’s baked with grains it’s certainly not low carb. But some companies still try to sell it to you as a low-carb option.

Low-carb chocolate is usually full of sugar alcohols, which the manufacturer does not count as carbs. But roughly half of these carbs may be absorbed, raising blood sugar and insulin.17 The remaining carbs end up in the colon, potentially causing gas and diarrhea. Furthermore, any sweeteners can maintain sugar cravings.18

Here are three examples of what to avoid:

  1. Atkins’ fairy-tale cookies
  2. Julian Bakery’s high-carb low-carb bread
  3. The Dreamfields pasta fraud (that finally resulted in an 8 million dollar fine!)

These three companies are not unique. There are thousands of similar companies who may be trying to trick you into buying their “low-carb” products, that often contain starch, sugar alcohols, wheat flour, sweeteners and other additives.

Two simple rules to avoid this:

  • Don’t eat “low carb” versions of high carb stuff, like cookies, bars, chocolate, bread, pasta or ice cream – unless you are sure of the ingredients (ideally, by making it yourself).
  • Avoid products with the words “net carbs” on them. That may be a way to deceive you.

Focus on eating good quality, minimally processed real food. Ideally the food you buy shouldn’t even have a list of ingredients (or it should be very short).

Read more about fake low-carb products

Read more about sweeteners

Less moderation, more quality

Finally – you may want to forget about the old “everything in moderation” diet motto. It isn’t necessarily helpful advice for people who struggle with weight – in fact, it may be exactly the opposite.19

Don’t eat everything in moderation. Eat as much healthy food as you can, whenever you are hungry. Eat as little unhealthy food as you can – if possible, none at all.

4. Eat only when hungry

Woman snacking on nuts
On a low-carb diet you should aim to eat when hungry (see tip #2 above). And if you’re not hungry? Don’t eat. Frequently eating more food than you need to stay satisfied will slow down weight loss.20 This, in fact, is so important that it’s worth this section of its own.

Limit unnecessary snacking

Unnecessary snacking can be a problem on a keto diet too. Some things are easy to eat just because they’re tasty and readily available. Here are three common traps to watch out for on a keto or low-carb diet:

  1. Dairy products such as cream and cheeses. They work well in cooking, as they satisfy. The problem is if you’re munching a lot of cheese in front of the TV in the evening… without being hungry. Be careful with that. Or lots of cream with dessert, when you’re actually already full and just keep eating because it tastes good. Or another common culprit: loads of heavy cream in the coffee, many times per day.
  2. Nuts. It’s very easy to eat until the nuts are gone, regardless of how full you are. A tip: According to science, salted nuts are harder to stop eating than unsalted nuts.21 Salted nuts tempt you to more overeating. Good to know. Another tip: Avoid bringing the entire bag to the couch, preferably choose a small bowl instead. Personally I often eat all the nuts in front of me, whether I’m hungry or not.
  3. Low-carb baking. Even if you’re only using almond flour and sweeteners, snacking on baked goods and cookies usually provides additional eating when you’re not hungry… and yes, this will slow down weight loss.

Feel free to skip meals

Do you have to eat breakfast? Research has confirmed that the answer is no.22 Don’t eat if you’re not hungry. And this goes for any meal.

On a strict keto diet the hunger and urge to eat tend to decrease a lot, especially if you have excess weight to lose.23 Your body may be happily burning your fat stores, reducing the need to eat.

If this happens, be happy! Don’t fight it by eating food you don’t want. Instead, wait for the hunger to return before you eat again. This will save you both time and money, while speeding up your weight loss.

Some people fear that they will lose control if they don’t eat every three hours, thus making them eat thousands of calories and blowing their diets completely. So they might obsessively snack all the time.

This constant snacking may be necessary on a diet high in sugar/processed carbs to control hunger cravings, but it’s usually unnecessary on a keto diet. Hunger will only slowly return and you should have plenty of time to prepare food or grab a snack.

Bottom line: To lose weight in a sustainable way, eat when you’re hungry – but only when you’re hungry. Forget the clock and listen to your body instead.

Learn more

Breakfast! Is It Really That Important? – Dr. Jason Fung
The Key to Obesity – Dr. Jason Fung
The 7 Benefits of Fasting – Dr. Jason Fung


5. Measure your progress wisely

Man measuring his belly

Tracking successful weight loss is sometimes trickier than you’d think. Focusing primarily on weight and stepping on the scale every day might be misleading, cause unnecessary anxiety and undermine your motivation for no good reason.

The scale is not necessarily your friend. You may want to lose fat – but the scale measures muscles, bone and internal organs as well. Gaining muscle is a good thing. Thus weight or BMI are imperfect ways to measure your progress. This is especially true if you’re just coming off a long period of semi-starvation (calorie counting), as your body may want to restore lost muscles etc. Starting weight training and gaining muscle can also hide your fat loss.

Losing fat and gaining muscles means great progress, but you may miss this if you only measure your weight. Thus it’s smart to also track the disappearance of your belly fat, by measuring your waist circumference.

Here’s how to do it:

  1. Put the measuring tape around your middle, slightly above your belly button (to be exact: at the midpoint between your lowest rib and the top of your hipbone, at your side)
  2. Exhale and relax (don’t suck in your stomach)
  3. Make sure the measuring tape fits snuggly, without compressing your skin
  4. Measure

Compare your result to these recommendations:

  Good  Decent  Too high
Women below 31.5 inches  31.5-35 inches  over 35 inches 
  (80 cm) (80-88 cm) (88 cm)
       
Men below 37 inches  37-40 inches  over 40 inches 
  (94 cm) (94-102 cm) (102 cm)

I recommend aiming for “excellent” but it’s not always realistic. Young people can usually achieve this, but for some middle-aged or older women it may be a major victory to get all the way to “decent”.24

Measuring progress

I suggest measuring your waist circumference and weight before starting your weight-loss journey and then perhaps once a week or once a month. Write the results down so that you can track your progress. If you want, you can measure more areas: around the buttocks, the chest, the arms, legs, etc.

Please note that your weight can fluctuate up and down several pounds from day to day, depending on fluid balance and digestive system contents: Don’t worry about short-term changes, follow the long-term trend instead.

If you can, try to check other important health markers when starting out, like these:

  • Blood pressure
  • Blood sugar (fasting blood glucose and/or HbA1c)
  • Cholesterol profile (including HDL, triglycerides)

These markers are almost universally improved on a low carb diet, even before major weight loss.25 Re-checking these health markers after a few months can be great for your motivation as they’ll usually show that you’re not just losing weight, you’re gaining health too.

PS: Don’t have a measuring tape at home? Try these options:

  • Use any piece of string. Wrap the string around your waist and cut the string to fit your waist on day one. This string could magically appear to become longer and longer every week you wrap it around your waist. 
  • Comparing how an old pair of jeans fits is also a good option.

6. Be persistent

Don't give up

It usually takes years or decades to gain a lot of weight. Trying to lose it all as quickly as possible by starving yourself does not necessarily work well long term; instead it may be a recipe for “yo-yo dieting”.26 To succeed, you need something that works long term.

What to aim for

It’s common to lose 2-6 pounds (1-3 kg) within the first week on a strict low-carb diet, and then on average about one pound (0.5 kg) per week as long as you have a lot of weight remaining to lose.27 This translates into about 50 pounds (23 kilos) per year. However, weight loss doesn’t occur at this rate in everyone.

Every 5 pounds of fat loss roughly equals 1 inch lost around the waist (1 kilo = 1 cm).

Young males sometimes lose weight faster than this, perhaps twice as fast.28 Post-menopausal women may lose at a slower pace.29 People on a very strict low-carb diet may lose weight quicker, as well as those who exercise a lot (a bonus).30 And if you have an enormous amount of excess weight to lose you could start out much faster — although initially, some of the weight you lose will be due to water loss.

As you get closer to your ideal weight the loss may slow down, until you stabilize at a weight that your body feels is right. Very few people become underweight on a low-carb diet – as long as they eat when hungry.

Read other peoples’ stories

Initial stalls

Are you coming off a period of semi-starvation (calorie counting)? Focus on your waist circumference and health markers (see advice #4) at first as it sometimes takes several weeks before weight loss is apparent.31

Weight-loss plateaus

Expect weight-loss plateaus: days or weeks where nothing seems to happen on the scale. Everybody hits them.32 Stay calm. Keep doing what you’re doing and eventually things should start happening again (if not, check out the other 17 tips).

More: Why the scale may be lying to you, by Dr. Èvelyne Bourdua-Roy

How to keep the weight off long term

Losing a lot of weight long term and keeping it off will likely not happen unless you change your habits forever. If you lose weight and then return to living exactly the way you did when you gained weight, don’t be surprised when the excess weight returns. It normally will.

Maintaining weight loss usually requires long-term change and patience. As tempting as it may be, don’t fall for one of these magical diet scams.

Forget quick fixes: If you lose some weight every month, eventually you may get rid of all your excess weight. That’s inevitable progress. That’s what you want.

PS: Long-term change is hardest in the beginning, especially during the first couple of weeks. It’s like quitting smoking. Once you develop new habits it becomes easier and easier every week. Eventually it may come naturally.

For inspiration and tips, check out some of our long-term weight maintenance success stories:

How to lose weight faster

Keep reading!


7. Avoid eating fruit

This piece of advice is controversial as fruit has an almost magical health aura today. People may believe that fruit is nutritious but unfortunately fruit contains a lot of sugar – around 10% by weight (the rest is mostly water). Just taste an orange or a grape. Sweet, right?

Five servings of fruit per day are equivalent to the amount of sugar in 16 ounces of soda (500 ml).33 Contrary to what many people believe, the natural sugar in fruit is more or less identical to the sugar in soda and other sweet beverages (about 50% glucose, 50% fructose).

Sugar from fruit can shut down fat burning. Eating a lot of fruit can increase your hunger and slow your weight loss.34 For best results, you may want to avoid fruit – or enjoy it occasionally as a treat.

Bottom line: Fruit is candy from nature.

Isn’t fruit natural?

Most people believe that fruit is natural, but today’s fruits in the grocery store have very little in common with what fruits looked like before they were cultured. There’s a lot more sugar in modern domesticated fruits.

banana1banana2

What fruits and vegetables looked like before


8. Avoid drinking beer

Beer contains rapidly digested carbs that shut down fat burning. That may be why beer is sometimes referred to as “liquid bread”. There’s a good reason for the term “beer belly”.35

Here are smarter (lower-carb) alcoholic options for losing weight:

  • Wine (red or dry white)
  • Dry champagne
  • Hard liquor like whisky, cognac, vodka (avoid sweetened cocktails – try vodka, soda water, lime instead)

These drinks hardly contain any sugar/carbohydrates so they’re better than beer. However, large amounts of alcohol might slow weight loss somewhat, so moderation is still a good idea.

Low-Carb Fruits
Low‑carb alcohol –
the best and the worst


9. Avoid artificial sweeteners

Artificial sweeteners
Many people replace sugar with artificial sweeteners in the belief that this will reduce their calorie intake and cause weight loss. It sounds plausible. Several studies, however, have failed to show obvious positive effect on weight loss by consuming artificial sweeteners instead of plain sugar.36

According to scientific studies, artificial sweeteners may increase appetite and maintain cravings for sweet food.37 And one recent independent study showed that switching drinks with artificial sweeteners to water helped women lose weight:38

Study: Avoiding diet beverages helps women lose weight

This might be because the body increases insulin secretion in anticipation that sugar will appear in the blood. When this doesn’t happen, blood sugar drops and hunger increases. Whether this chain of events regularly takes place is unclear. Something odd happened when I tested Pepsi Max though, and there are well-designed studies showing increased insulin response when using artificial sweeteners.39

Additionaly, artificial sweeteners can maintain an addiction to sweets and lead to snack cravings. And the long-term effects of consuming artificial sweeteners are unknown.

Studies claiming to show neutral or positive effects of sweeteners are often funded by the beverage industry.40

By the way, Stevia is marketed as a natural alternative to artificial sweeteners. That’s marketing talk. It’s not obvious what is natural about a processed super-sweet white powder like Stevia.

If you’re having trouble losing weight, I suggest that you avoid sweeteners. As a bonus you’ll likely find it easier to enjoy the natural sweetness of real food, once you’re no longer adapted to the overpowering artificial sweetness of processed low-carb food products and “diet” sodas.

Sugar addiction

Do you find the idea of avoiding sweeteners almost impossible to imagine? Addiction to sugar and carbohydrate-rich foods is very common, but it’s possible to overcome. Check out our video course with addiction specialist Bitten Jonsson, RN

What Is Sugar Addiction? – Bitten Jonsson
Read more about artificial sweeteners


10. Review any medications

Many prescription drugs can stall your weight loss. Discuss any change in treatment with your doctor. Here are the three most common offenders:

  • Insulin injections, especially at higher doses, are probably the worst obstacle for weight loss for many people.41 There are three ways to reduce your need for insulin:
    A. Eat fewer carbs, which makes it easier to lose weight. The fewer carbs you eat the less insulin you need.42 Remember to lower your doses if you can.
    B. If this isn’t enough, treatment with metformin tablets (at a dose of 2–3 grams/day) can decrease the need for insulin (at least for people with type 2 diabetes).43

    C. If this is not enough to get off insulin (again, for people with type 2 diabetes) you could try newer promising drugs like Victoza/Saxenda (liraglitude) or Byetta (exenatide). These reduce the need for insulin and may cause weight loss, but possible long-term side effects are still unknown.

  • PillsOther diabetes medications. Insulin-releasing tablets (e.g. sulfonylureas) often lead to weight gain.44 These include: Minodiab (glipizide), Euglucon (glibenclamide), and Daonil (glyburide). Tablets like Avandia, Actos, Starlix and NovoNorm also encourage weight gain. But not metformin. More on diabetes
  • Cortisone as an oral drug is another common issue (e.g. prednisolone). Cortisone may cause weight gain in the long run, especially at higher doses (e.g. more than 5 mg prednisolone per day).45 Unfortunately, cortisone is often an essential medication for those who are prescribed it, but the dose should be adjusted frequently so you don’t take more than you need. Asthma inhalers and other local cortisone treatments, like creams or nose sprays, hardly affect weight.

These other medications can also cause problems:

  • Neuroleptics/antipsychotic drugs, can often encourage weight gain, especially newer drugs like Zyprexa (olanzapine).
  • Some antidepressant medications can cause weight gain, especially the older tricyclic antidepressants (TCAs) such as Tryptizol/Saroten (amitriptyline), and Anafranil (clomipramine); as well as newer drugs such as Remeron (mirtazapine).46 Lithium (for manic-depressive disorder) often causes weight gain. The most common antidepressants known as SSRI’s, for example, Celexa (citalopram) and Zoloft (sertraline) do not appear to impact weight significantly.47 More on depression
  • Some contraceptives may contribute to a slight weight gain, primarily those that contain only progesterone and no estrogen, for example the mini-pill, the contraceptive injection, or a contraceptive implant.48 More on fertility
  • Blood pressure medication in the form of beta blockers may lead to weight gain in some individuals. These drugs include: Seloken, Lopressor (metoprolol), and Tenormin (atenolol). More on high blood pressure
  • Epilepsy drugs may cause weight gain (e.g. carbamazepine and valproate).
  • Allergy medications, antihistamines can interfere with weight loss, especially at high doses. Cortisone is even worse (see above). More on allergies
  • Antibiotics may possibly lead to a temporary weight gain by disturbing the gut microbiota and increasing the amount of energy we absorb from food.49 This is still speculative for humans but it’s a reason not to use antibiotics unless you truly need it.


11. Stress less, sleep more

Relaxed couple in bed

Have you ever wished for more hours of sleep, and a less stressful life in general? Most people have – stress and lack of sleep can be bad news for their weight.

Chronic stress and inadequate sleep may increase levels of stress hormones such as cortisol in your body. This can cause increased hunger and may result in weight gain.50 If you’re looking to lose weight, you should review possible ways to decrease or better handle excessive stress in your life. Although this often demands substantial changes, it may immediately affect your stress hormone levels, and perhaps your weight.

You should also make an effort to get enough good sleep, preferably every night. Strive to wake up refreshed of your own accord, independently of the alarm clock. If you’re the kind of person who always gets brutally woken up by the alarm ringing, you might never be giving your body completely adequate rest.

One way to combat this is to go to bed early enough for your body to wake up autonomously before the alarm clock goes off. Letting yourself get a good night’s sleep is another way of reducing stress hormone levels.

Sleep deprivation, on the other hand, goes hand in hand with sugar cravings.51 It also has an adverse effect on self-discipline and makes it painfully easy to give in to temptation (it’s no coincidence that induced sleep deprivation is a common interrogation technique). Similarly, sleep deprivation weakens your resolve to work out.

Sleep issues?

Do you have trouble sleeping even if there’s ample time for it? Here are five tips from an expert:

  1. Stick to the same bedtime every evening. In the long run, this will help your body prepare for sleep at that time.
  2. No coffee after 2 pm. Just don’t – and remember that it takes time for caffeine to leave your body.
  3. Limit your alcohol intake to three hours before bedtime. While booze might make you woozy, it worsens quality of sleep.
  4. Limit exercise in the four hours before bedtime. Physical activity can make you wound up and make it difficult to go to sleep for several hours afterwards.
  5. Get 15 minutes of sunlight every day. This is good for your circadian rhythm (your “body clock”).

Finally, make sure that your bedroom is dark enough, and stays at a pleasant temperature. Sleep well!

Difficult, but worthwhile

Many may find the above guidelines difficult to follow, perhaps because of a lack of time (or the equivalent – small children!). But stressing less and sleeping more doesn’t just feel good. It can also play a part in helping you get leaner.

Read more about the benefits of sleep


12. Eat less of dairy products and nuts

Smoothie bowl

Can you eat as much as you like, and still lose weight? This often works well with a low-carbohydrate diet, as appetite regulation often improves.52

However, despite the fact that a low-carbohydrate diet generally makes it easier to eat just enough, there are foods classified as low carb which become a problem in larger quantities. If you find yourself having a hard time losing weight on a low carb diet, you could try to be more careful with:

  • Dairy products (yogurt, cream, cheese)
  • Nuts

Dairy products contain varying amounts of lactose (milk sugar), which could potentially slow down weight loss. What’s more, part of the protein in milk generates a moderate insulin response, which might have the same effect on weight.53 Consequently, cutting back on dairy products may accelerate weight loss.

This applies especially to dairy products typically lacking in fat, such as regular milk and various yogurts. But be careful with full-fat dairy such as cream and cheese all the same, as they are easy to overindulge in. And don’t forget whey protein powder, which is pure milk protein and has been shown to produce a strong insulin response.54

Exempt from all these dairy-product warnings is butter, which is almost pure fat. Generally speaking, butter may be consumed as desired – but pay attention to fullness cues if your goal is weight loss.

Low-carb and dairy-free recipes

Nuts, the second food to watch, contain a fair amount of carbohydrate, and it’s very easy to unwittingly scarf down large quantities.55 Cashew nuts are among the worst carb-wise – you’ll find that they contain around 20% carbohydrate by weight.

For someone following a strict keto diet with a 20 grams of carbs per day allowance, this means that consuming 100 grams of cashews (which happens in a flash!) will have filled their daily quota. Peanuts tend to be around 10-15% carbohydrate – not putting them in the clear either.

So, for those of you having trouble losing weight: use nuts sparingly. When in a situation where nuts are an absolute must, know that the most harmless ones carb-wise are macadamia nuts (usually around 5% carbs), or Brazil nuts (4%).


13. Supplement vitamins and minerals

Vitamins and other supplements on a keto diet

Your body needs a certain amount of essential vitamins and minerals to function properly. What happens when you don’t get enough of them? What happens when you eat too little food, or when the food you eat isn’t sufficiently nutritious? Perhaps our bodies catch on and reply by increasing hunger levels.

After all – if we eat more, we increase the chances of consuming enough of whatever nutrient we are lacking. On the other hand, reliable access to vitamins and minerals could perhaps mean decreased hunger levels and decreased cravings, thereby promoting weight loss.

The above is speculation. But there are well-performed studies which suggest it might not be far from the truth.

Vitamin D

A lack of vitamin D is probably the most common deficiency in northern countries such as Canada, or most of the US. Three recent studies indicate that, when compared to a placebo, a vitamin D supplement can decrease your fat weight or waist measurement.56

In one of the studies, 77 overweight or obese women received either a supplement of 1000 units of vitamin D, or a placebo, every day for 3 months. Those who took the vitamin D supplement decreased their body fat by 2.7 kg (6 pounds), on average – significantly more than the placebo group, whose average fat loss was only 0.4 kg (less than 1 pound).57

Multivitamins

A study from 2010 involved around a hundred women with weight issues, separating them into three groups. One group received a daily multivitamin supplement, the other a daily calcium supplement, and the last group only a placebo. The study went on for six months.

Unsurprisingly, the results showed that nothing had happened to the weight of the women receiving calcium or the placebo. However, the group that took the multivitamin lost more weight – an average of 3.6 kg (8 pounds) more – and improved several of their health markers. Among other things, their basal metabolic rate (the rate at which the body burns calories when at rest) increased.58

Furthermore, another earlier study found that subjects experienced a decrease in hunger levels by taking multivitamin supplements during starvation diets, compared to a placebo.59

Conclusion

Nutrient-dense, good food is certainly the foundation of weight loss. But an adequate amount of vitamin D can be difficult to ingest via food, especially for those who are vegetarian or don’t eat fatty fish (the main dietary source of vitamin D) on a regular basis. In the case of a lack of sun (such as during the darker months of fall and winter), it’s wise to supplement for multiple health reasons – and perhaps even for your weight.

If you’re overweight and not entirely sure that your diet provides enough nutrients, it may be worthwhile to take a multivitamin pill. Unfortunately, they still contain only minimal doses of vitamin D, so you may need to take both for the full effect.

14. Use intermittent fasting

Intermittent fasting and keto

There are many things to consider before moving on to this tip #14, but don’t let this concern you. This is one of the most effective weapons available to lose weight. It may be perfect if you are stuck at a weight-loss plateau despite “doing everything right” – or to speed up your weight loss.60

This weapon is called intermittent fasting. It means exactly what it sounds like… not eating, during a specified time interval.

Recommended first option – 16:8

Probably the most popular option is fasting for 16 hours (including sleep), which is usually easy to do on a keto diet. It requires trading breakfast for a cup of coffee (or some other non-caloric fluid) and having lunch as the first meal of the day. Fasting from 8 pm to 12 noon – for example – equals 16 hours of fasting. Another option is to skip dinner: eat breakfast and lunch within 8 hours — for instance, 8 am to 2 pm — and then don’t eat again until 8 am the next morning.

There are many other versions of intermittent fasting, but this 16:8 method (16 hours of not eating with an 8-hour eating window) is the one we recommend as a first option. It’s often effective, generally easy to do and does not require counting calories.

You can do a 16:8 fast as often as you like. For example twice a week, or on weekdays only… or every single day. The more often you do it, the more effective it may be.61

In fact, on a keto diet some people spontaneously fall into this habit, as their appetite is reduced (see weight loss tip #4, eat only when hungry).

Other kinds of intermittent fasting

There are many other options. Basically, the longer periods are harder to do but could potentially be more effective. Here are two more common options:

  • Fasting for 24 hours (often dinner – dinner) once or twice a week. Effective and can be easy to do for some people, especially on a keto diet, which usually reduces appetite.
  • The 5:2 diet. Eat as much as you need to feel satisfied 5 days of the week and then eat calorie-restricted on two days (500 calories per day for women, 600 calories for men). This requires calorie counting and more planning, but some people still find they enjoy it.

What about eating when hungry?

Doesn’t advice on intermittent fasting contradict the advice to eat when hungry? Yes it does, somewhat.

We recommend eating when hungry as a first option, and we recommend always eating until you feel satisfied at meals. But if this is not effective enough, then intermittent fasting is a very powerful addition. Remember – and this is crucial – that between fasting periods you’re still supposed to eat until satisfied.

Intermittent fasting is not the same thing as obsessively counting calories and starving yourself 24-7. Starving yourself may be a recipe for misery and failure.

Intermittent fasting is about eating all that your body needs… while still allowing it to sometimes briefly rest from constant feeding.

What’s acceptable to drink during fasts?

During a fast you can’t eat, but you should definitely drink. Water is the drink of choice, but coffee and tea are also great options. During longer fasts it can be wise to add some salt too, or drink bouillon.

Anything you drink should ideally be zero calories. But it may be acceptable to cheat by adding a small amount of milk or cream in your coffee or tea – if you absolutely need it to enjoy your drink.

What to eat between fasts

So what should you eat when you are not fasting? Well, if your goal is to lose weight, we suggest following all the tips above, including eating a low-carb diet. Combining this with intermittent fasting is a great combination.

On a low-carb diet your hunger is reduced and it’s much easier to do a period of fasting. Also, your fat burning is already increased – so when fasting you’ll more easily burn plenty of fat.62

So, while on a low-carb diet the fasting periods may become both easier to do and more effective. 1 + 1 equals 3.

Who should not do intermittent fasting

Intermittent fasting can be a great idea, but not everyone should do it:

  • If you are addicted to food or sugar then intermittent fasting may increase food cravings and increases the risk of a relapse… so be very careful. We recommend always eating when hungry in this situation.
  • If you are totally stressed out or sleep deprived then take care or that problem first (see weight loss tip #11) or fasting may be too stressful for your body.
  • If you are on any medication – especially insulin – the doses may need to be adjusted when fasting. Discuss this with your doctor first.
  • Growing children, pregnant women and breastfeeding women should not do longer fasting periods, as they have an increased need of nutrients. We recommend eating when hungry and using the 14 tips above if you need to lose weight.

More

Intermittent fasting for beginners

Video

For more on fasting check out our material with our top fasting expert, Dr. Jason Fung:

What is Fasting? – Dr. Jason Fung
How to Maximize Fat Burning – Dr. Jason Fung
How to Fast – The Different Options – Dr. Jason Fung
The 7 Benefits of Fasting – Dr. Jason Fung
The Top 5 Myths of Fasting – Dr. Jason Fung
Breakfast! Is It Really That Important? – Dr. Jason Fung
The Perfect Treatment for Weight Loss and Diabetes – Dr. Jason Fung
The Key to Obesity – Dr. Jason Fung
Ask Dr. Jason Fung


15. Exercise wisely

Exercise on a keto diet

Do you wonder why this weight-loss tip doesn’t show up until number 15 on the list? It’s because few things are so overrated for weight loss as exercise is.63

Have you ever watched “The Biggest Loser”? The participants take leave from their jobs (and family) for months. They are allowed only small portions of food, and work out as though it were their full-time job – 40 hours a week, sometimes more. This method is clearly unsustainable for the average person in the long run.

Just taking the stairs instead of the elevator, or getting off the bus one stop earlier, is probably not going to change the numbers on your bathroom scale. It’s a myth. Studies show that if you just start exercising, you’re likely going to need at least 30-60 minutes of workouts per day to noticeably lose weight.64 Part of the reason is that exercise makes people hungrier, and eating more reduces the effect on weight.65

Basically, the effect of exercise on our weight is overrated. That’s why it’s only number 15 on this list. There are other things you may need to take care of first. It’s not a good idea to eat unhealthy processed food, drink sugar water (so-called “sports drinks”) or be on medications which can force you to exercise for hours daily just to compensate. Metaphorically that’s like digging a hole, into which you put your ladder, on which you stand and paint the basement-level windows of your house.

Exercise cannot compensate for other behaviors or issues in your life. Those must be addressed first.

The good news

If, on the other hand, you’ve already taken care of steps 1-14, you should have a rested and recharged body which is already happily burning fat. In this case, increased activity will accelerate your weight loss, and act as a nice bonus.66 You’ll be burning even more fat from the very first step.

For example, you could take long walks (golf), cycle, dance, or play any sport you’re happy and comfortable with.

Exercise also burns the body’s glycogen stores, which are essentially carbohydrates stored in the liver. This means that after a workout, you might be able to eat a little more carbs than you otherwise can permit yourself, without negative effects on insulin or fat storage. Also, don’t forget that the non-weight-related health effects of exercise are quite impressive.

Hormonal effects

For even more impressive effects on body composition, aim for exercise forms which elicit a positive hormonal response. This means lifting really heavy things (strength training), or interval training. Such exercise increases levels of the sex hormone testosterone (primarily in men) as well as growth hormone.67 Not only do greater levels of these hormones increase your muscle mass, but they also decrease your visceral fat (belly fat) in the long term.

As a final bonus, exercise can both make you feel and look better.

What kind of activity fits you?


16. Achieve optimal ketosis

blood-ketone-test-16-9
Warning: Not recommended for people with type 1 diabetes, see below.

We’ve now arrived at tip number 16. If you’re still having trouble losing weight, despite following the 15 pieces of advice listed above, it might be a good idea to bring out the heavy artillery: optimal ketosis. Many people stalling at weight plateaus while on a low-carb diet have reported finding optimal ketosis helpful. It’s what can melt the fat off once again.

So how does this work? A quick run-through: The first tip was to eat low carb. This is because a low-carb diet lowers your levels of the fat-storing hormone insulin, allowing your fat deposits to shrink and release their stored energy.68

This tends to cause you to want to consume fewer calories than you expend – without hunger – and lose weight.69 Several of the tips mentioned above are about fine-tuning your diet to better this effect.

How do you know you’re getting the maximum hormonal impact from your low-carb diet? You do that by achieving what’s known as “optimal ketosis”. 

Ketosis

Ketosis is a state where the body is burning fat at an extremely high rate. Even the brain runs on fat, via ketone bodies. These are energy molecules in the blood (like blood sugar) which become fuel for our brains after being converted from fat by the liver.70

To encourage ketone production, the amount of insulin in your bloodstream must be low. The lower your insulin, the higher your ketone production. And when you have a well-controlled, sufficiently large amount of ketones in your blood, it’s basically proof that your insulin is very low – and therefore, that you’re enjoying the maximum effect of your low-carbohydrate diet. That’s what’s called optimal ketosis.71

Measuring ketones

Today, there are reasonably-priced gadgets available for measuring ketone levels at home. One needle prick of the finger, and in just a few seconds you’ll know your blood ketone level.

Blood ketones are best measured on a fasted stomach in the morning (before breakfast, that is). Here are a few pointers on how to interpret the result:

  • Below 0.5 mmol/L is not considered “ketosis”. At this level, you’re far away from maximum fat-burning.
  • Between 0.5-1.5 mmol/L is light nutritional ketosis. You’ll be getting a good effect on your weight, but not optimal.72
  • Around 1.5-3 mmol/L is what’s called optimal ketosis and is recommended for maximum weight loss.73
  • Numbers over 3 mmol/L aren’t necessary. That is, they will achieve neither better nor worse results than being at the 1.5-3 mmol/L level. Higher numbers can also sometimes mean that you’re not getting enough food. For people with type 1 diabetes, this can be caused by a severe lack of insulin (see below).

Ketones in urine

Ketone levels can also be measured in a more old-fashioned way, with urine test sticks (sold prescription-free in pharmacies or on Amazon74). Ketone sticks give less reliable results for several reasons, and the above recommendations can’t be straightforwardly applied to them. They are, however, much cheaper.

My personal experience

Feel free to read my accounts of a two-month personal trial:

  1. Experiment: Optimal ketosis for weight loss and increased performance
  2. Four weeks of strict keto and ketone monitoring
  3. Final report: Two months of strict keto and ketone monitoring

Although I was quite happy with my weight before these trials, they resulted in a further loss of 4.5 kg (10 pounds) and 7 cm (3 inches) around my waist – without additional exercise or even the slightest resemblance of hunger.

How to achieve optimal ketosis

Many who firmly believe they are eating a strict low-carb diet are surprised when they measure their blood ketones. They may be at around only 0.2 or 0.5 – quite far off from the sweet spot! Why?

The trick here is not only to avoid all obvious sources of carbohydrate (sweets, bread, spaghetti, rice, potatoes), but also to be careful with your protein intake. If you eat large amounts of meat, eggs and the like, the excess protein will be converted into glucose in your body.75 Large amounts of protein can also raise your insulin levels somewhat.76 This compromises optimal ketosis.

The secret to getting around this is usually to eat your fill with more fat. For example, if you add a bigger helping of herb butter to your steak, you might not feel like having a second steak, and instead feel satisfied after the first one.

A popular trick people use to ingest more fat is “fat coffee” (sometimes called “Bulletproof Coffee” or BPC). It involves adding one tablespoon of butter and one tablespoon of coconut oil to your (morning) coffee, and requires a food blender for the right texture.

More fat in your food will fill you up more. This will ensure that you eat less protein, and even fewer carbohydrates. Your insulin will drop and, hopefully, you’ll be able to reach optimal ketosis. And that’s when many people find that a stubborn weight plateau is overcome.

If it doesn’t work

Being in optimal ketosis for a prolonged period of time (say, a month) will ensure that you experience the maximal hormonal effect from eating a low-carb diet. If this doesn’t result in noticeable weight loss, you can be fairly certain that too many carbs are not part of your weight issue and not the obstacle to your weight loss. There are, in fact, other causes of obesity and being overweight. The next two tips in this series might help you.

Try it

Order a ketone meter online and start measuring. There are a few different models. The most popular one is probably the Precision Xtra ketone meter.77 Unfortunately these meters are all quite expensive to use, as the test strips can cost about $5 per test. However, a new company, Keto-Mojo, offers a meter with test strips that are only $0.99 each.

Here’s a complete package78 with everything you need to check your blood ketone levels.

More

Learn much more about ketogenic diets and ketosis:

A quick guide to ketogenic diets

Watch my video interview with the American doctor Peter Attia, on a strictly ketogenic low-carb diet: Very Low Carb Performance

A word of warning

If you have type 1 diabetes, you should not follow the above advice on optimal ketosis – it may be risky. If you have ketones in your blood at all, you must be sure that your blood sugar levels are normal. If they are, you’re in normal ketosis – just like the ketosis of non-diabetic people who stick to a strict low-carb diet.

High blood sugar levels coupled with high blood ketones, on the other hand, will mean that you have a pathologically low level of insulin – something non-diabetics do not suffer from. This can lead to ketoacidosis – a potentially life-threatening condition. If this happens, you’ll need to inject more insulin; if you’re at all unsure of what to do, contact a medical professional or have someone take you to the hospital to be checked out. Coveting really high blood ketones for weight control is not worth the risk for people with type 1 diabetes.


17. Get your hormones checked

Test your hormones

So you’ve followed the previous tips, implemented major lifestyle changes and established that neither medication nor vitamin deficiency is an issue. You’ve even tried being in optimal ketosis for a while (ensuring low insulin levels). And you still can’t hit the normal weight mark?

If this applies to you, it may be time to consider the possibility that hormonal imbalances are the cause of your troubles. There are three common problem areas:

  1. Thyroid hormone
  2. Sex hormones
  3. Stress hormones

Thyroid hormone

Some people, most often women, can suffer decreased metabolism as a result of thyroid hormone deficiency – hypothyroidism. Common symptoms are:

  • Fatigue
  • Cold intolerance
  • Constipation
  • Dry skin
  • Weight gain

In these cases, weight gain resulting from decreased metabolism usually does not exceed 15 pounds.79

Your doctor can easily arrange for you to take a blood test to measure the concentration of thyroid stimulating hormone (TSH). If the test comes back and everything looks good, your thyroid gland is probably fine. For a more exact diagnosis, you can ask them to measure the actual levels of thyroid hormones in the blood (T3 and T4), as sometimes these are low even if the TSH is within the fairly broad normal range.80

Two ways to avoid becoming deficient in thyroid hormone:

  1. Make sure you consume enough iodine, which is a building block of thyroid hormone. Good sources are fish, shellfish, sea vegetables (seaweed) and iodised salt (or iodised sea salt).
  2. Very low levels of thyroid hormone usually indicate an autoimmune reaction to the thyroid gland itself. This means you’ll have to take thyroid hormone supplements orally, usually the stable form T4 (Levaxin), which your doctor can prescribe for you. Your body will transform this into the active T3 hormone when necessary. The supplement dose should be adjusted so that you reach normal hormone levels (TSH, T3, T4) and sufficiently alleviate symptoms – though a few people may feel best when keeping TSH slightly below normal.

Some people feel better supplementing the already active T3 (sometimes prepared from pig thyroid glands), as it can give a stronger effect than the T4 hormone, but its effect is often harder to control.81 Most health professionals rarely prescribe or offer such T3 treatment, as it appears to lack significant advantages and may pose a risk when doses are high for an extended period of time. However, T3 replacement is popular among some functional medicine practitioners and naturopathic doctors. Regardless, the key is making sure you follow your levels and symptoms to make sure you aren’t over- or under-replacing thyroid hormones.

Sex hormones

Sex hormones also affect your weight:

Women: Women can suffer from the endocrine disorder PCOS – polycystic ovarian syndrome – which elevates testosterone and insulin levels. This can mean weight gain and menstrual disorders (very common), infertility, acne and male pattern hair growth (such as facial hair). A low-carbohydrate diet may help treat this condition.82 More on PCOS.

During menopause, a woman’s level of the female sex hormone estrogen drops. This often results in some weight gain, especially around the gut (so-called central obesity).

Learn more: Top 10 tips to lose weight on low carb for women 40+

Men: From middle age and onwards, men usually experience gradually declining levels of the male sex hormone testosterone. This can lead to slight weight gain, also typically around the gut, and decreased muscle mass.83

What can you do about sex hormones? Testosterone deficiency can be at least partially treated naturally by engaging in smart exercise routines and supplementing vitamin D.84

You can also increase low testosterone levels by getting your doctor to prescribe a testosterone supplement (a blood test will confirm any deficiency). Women can use estrogen supplementation for menopause problems.

It’s important you take into account, however, that supplementation of testosterone or estrogen for years on end, in doses that are abnormally large for your age, might increase the risk of prostate cancer (in men) and breast cancer (in women).

It may be wise to accept that you don’t (and shouldn’t!) have the body of a 20-year-old when you’re at least twice that age. A better option might be to try to focus on a healthy lifestyle instead, and to be as happy and grateful as you can for the body you have.

Stress hormones

The final possible issue behind stubborn weight issues may be the main stress hormone, cortisol. Too much cortisol will increase hunger levels, bringing along subsequent weight gain, especially around the midsection.85 The most common cause of elevated cortisol is chronic stress and lack of sleep (see tip #11), or cortisone medication (tip #10). It’s a good idea to try your best to do something about this.

In rare and extreme cases, you could be dealing with a specific kind of tumor that drives cortisol production. The condition is called Cushing’s syndrome. If you suspect you’re suffering from this, consult your doctor, who will run appropriate tests.
 
 

18. Consider weight-loss pills (if desperate)

Weight Loss Pills

It sounds like a dream. Keep living like you already do, take a daily pill, and effortlessly lose your excess weight. This is why weight-loss pills are a billion dollar industry.

So do they work? Yes, somewhat. But they’re not very effective.

There are many drugs that result in a modest weight loss (a few pounds on average), often at the expense of significant side effects.

Prescription-free supplements

The internet is full of claims of magic supplements that can make you thin. Unfortunately, the only thing they’ll make thin is your wallet. This is true even if they were once mentioned on Dr. Oz – you know that’s an entertainment show, right?

Any prescription-free supplements for sale that are not dangerous or illegal are likely to have a small or negligible effect on your weight.

This is true even for the vitamin supplements mentioned in advice #13 – the effect is definitely small, but in that case it’s also safe – maybe even healthy – and also dirt cheap, making it a potentially smart bonus (note that we sell no supplements whatsoever and make no money from this piece of advice).

There are also prescription free “carb blockers” out there, that are supposed to stop the body from absorbing carbs we eat. The effects tend to be relatively tiny though, even in studies funded by the companies selling the products.86 It’s definitely more effective to not eat the carbs in the first place (it’s also free).

Older appetite suppressants

PhentermineIn the US, it’s still possible to get amphetamine-like appetite suppressants prescribed for short-term use (weeks). As they are only for short-term use they are not used for long-term weight control. These drugs are not approved in the EU.

These drugs have side effects like insomnia, heart palpitations and elevated blood pressure. It’s also possible to become addicted to them and thus they require a special controlled-substance prescription. Examples include:

  • Adipex-P or Suprenza (phentermine)
  • Bondril (phendiametrazine)
  • Didrex (benzphetamine)

The effect of these drugs is decidedly modest and short term, and it’s not clear they outweig their risks. We do not recommend them.

The “oily discharge” pill

alli

Let’s move on to another older drug, Xenical (orlistat), lately for sale prescription-free as “Alli” and with a falling popularity.

This drug prevents the body from digesting fat in the intestines. Instead it just passes through you and ends up in the toilet… or (worst case) in your pants.

Side effects include stomach cramping, gas, leaking oily stool and being unable to control bowel movements. And finally the so called “oily discharge” that can result when people think they are just passing some gas.

This pill is not compatible with eating fat. Thus it’s not compatible with a low-carb diet. 
You may want to forget about this drug. Many doctors already have.

The stupid pill

StupidIs there a worse option than Xenical/Alli? One candidate is called Qsymia.

Qsymia is available in the US, but it got rejected in Europe (where the side effects were judged worse than the benefits). I prefer to label this drug the “stupid pill”.

Qsymia combines a tiny amount of the old phentermine (see Appetite Suppressants above) with a small dose of topiramate, an anti-seizure drug.

The problem? Common side effects of topiramate include drowsiness, fatigue, depression, attention disturbance, memory impairment, cognitive disorder, impaired psychomotor skills (i.e. becoming clumsy), lethargy, balance disorder, sedation and gait abnormality (i.e. walking like you’re drunk).

Basically, this drug slows down your brain, like alcohol or sedatives. Are you really going to do that to lose a few pounds, that you’ll regain once you stop taking the drug?

The “meh” pills

Two more weight-control drugs were approved in the US in 2012 and are now available, Belviq and Contrave.

Belvic has been rejected in Europe because of safety concerns. Contrave was recently approved (under the name Mysimba).

These two drugs work on different receptors in the brain to control appetite. The effect is modest – 6 to 8 pounds (2.7 to 3.6 kg) lost in a year, with partial regain after that.

There are ongoing safety concerns with both drugs and a definite risk of side effects (for Contrave) like nausea, constipation, headache, risk of suicidal thoughts and seizures.

It seems like these modest benefits do not necessarily outweigh the risk of side effects.

The reigning champion

And then there is only one more approved weight loss drug left. Fortunately this one actually shows some promise and can speed up weight loss significantly.

This drug is an injected variant of a satiety hormone called GLP-1. It slows down how quickly the stomach empties and tells the brain that you don’t need to eat yet – not a bad idea for losing weight. As a bonus this drug works fine while one is on the keto diet and it works even better with intermittent fasting – for a rapid weight loss with no hunger.

This drug was initially used to control blood sugar in type 2 diabetes – under the brand name Victoza – where it has the nice side effect of significant weight loss.87

Testing on people with obesity (without diabetes) shows that at higher doses the drug is fairly effective as a pure weight loss treatment, with patients losing on average 12.3 pounds (5.6 kilos) more than a placebo group after one year.88

Saxenda

This drug has recently been approved in both the US and in Europe for weight loss, under the name Saxenda. There are many other similar GLP-1 drugs for treating diabetes type 2, but none of them have been carefully tested or approved for treating obesity yet.

Saxenda is already available at the fantastic cost of about $1,000 per month.

In both the US and in Europe another option is Victoza, which is the exact same drug at half the dose and half the price. At this lower dose the resulting weight loss is about 75% of the weight loss when one is on Saxenda. Victoza is approved only for treating type 2 diabetes.89

The main side effect of Saxenda/Victoza is what happens if the satiety effect becomes too strong: nausea and vomiting. This is quite common when starting out, so it’s necessary to start with a low dose and then slowly increase it as the body adapts to the medication.

The bonus

If you have type 2 diabetes there is another diabetes drug that can result in noticeable weight loss: the “low-carb in a pill” drug Farxiga (called Forxiga in Europe). Unfortunately, this pill has an increased risk of ketoacidosis, probably especially for people on strict low-carb or keto diets, and it’s not recommended to take this drug while on a strict low-carb diet.90

The bottom line

There is no pill that easily makes people thin. These drugs all have side effects and none are very effective.

The only possible exception is Saxenda – and this is a daily injection, not a pill.

The downside to Saxenda is the very high price – insurance may only cover part of it – and the nausea that people often experience on it.

It’s also clear from my own and other people’s experience treating patients with it that it does not work well for everyone. Some people experience only minimal weight loss. Other people lose a lot more than the additional 12 pounds lost in a recent study – this is only an average.

Finally, Saxenda only works as long as you use it. Once you stop, the weight tends to return. So is losing about 12 pounds worth $1,000 per month and the risk of nausea? Only you can decide.

Most people who want to lose weight have more than 12 pounds to lose. That’s why even the best weight loss drug in the world can only be an optional complement to other treatment. That’s why this piece of advice is number 18 out of 18. It may be a helpful addition for some people, but the advice higher on the list is what can make the biggest difference, by far.

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  1. In recent years, researchers have found that chronic calorie restriction and dieting often fail to achieve sustainable weight loss:

    Perspectives on Psychological Science 2017: Reducing calorie intake may not help you lose body weight [overview article; ungraded]

    Repeated dieting attempts may actually lead to gaining more weight over time:

    Obesity Reviews 2015: Pathways from dieting to weight regain, to obesity and to the metabolic syndrome: an overview [overview article; ungraded]

  2. Results from studies in obese people with high insulin levels (hyperinsulinemia) suggest that lowering insulin may promote weight loss and improved insulin sensitivity:

    Endocrinology 2017: A causal role for hyperinsulinemia in obesity [overview article; ungraded]

    The Journal of Medical Practice Management 2016: Ketogenic weight loss: the lowering of insulin levels is the sleeping giant in patient care [overview article; ungraded]

  3. Obesity Reviews 2016: Impact of low-carbohydrate diet on body composition: meta-analysis of randomized controlled studies [strong evidence]

    The British Journal of Nutrition 2016: Effects of low-carbohydrate diets v. low-fat diets on body weight and cardiovascular risk factors: a meta-analysis of randomized controlled trials [strong evidence]

  4. This has been shown in meta-analyses of randomized controlled trials — considered the strongest, most robust type of evidence — comparing low-carb diets to low-fat and other diets:

    PloS One 2015: Dietary intervention for overweight and obese adults: comparison of low-carbohydrate and low-fat diets. A meta-analysis [strong evidence]

    The British Journal of Nutrition 2016: Effects of low-carbohydrate diets v. low-fat diets on body weight and cardiovascular risk factors: a meta-analysis of randomized controlled trials [strong evidence]

    The British Journal of Nutrition 2013: Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials [strong evidence]

  5. Perspectives on Psychological Science 2017: Reducing calorie intake may not help you lose body weight
    [overview article; ungraded]

  6. Several studies have reported that calorie intake spontaneously decreases when very few carbs are consumed:

    Nutrition and Metabolism 2008:: The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus [randomized controlled trial; moderate evidence]

    The American Journal of Clinical Nutrition 2008: Effects of a high-protein ketogenic diet on hunger, appetite, and weight loss in obese men feeding ad libitum [randomized controlled trial; moderate evidence]

    The Journal of Medical Internet Research 2017: An online intervention comparing a very low-carbohydrate ketogenic diet and lifestyle recommendations versus a plate method diet in overweight individuals with type 2 diabetes: a randomized controlled trial [moderate evidence]

    In one small study, 10 obese adults with type 2 diabetes who followed a non-calorie-restricted very-low-carb diet ended up eating about 1,000 calories less, on average — even though they were permitted unrestricted intake of fat and protein foods:

    Annals of Internal Medicine 2005: Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes [non-controlled study; weak evidence]

  7. Obesity Reviews 2014: Do ketogenic diets really suppress appetite? A systematic review and meta-analysis [strong evidence]

  8. Journal of the American Medical Association 2012: Effects of dietary composition during weight loss maintenance: a controlled feeding study [randomized trial; moderate evidence]

  9. British Medical Journal 2018: Effects of a low carbohydrate diet on energy expenditure during weight loss maintenance: randomized trial [moderate evidence]

    Learn more

  10. Obesity Reviews 2016: Impact of low-carbohydrate diet on body composition: meta-analysis of randomized controlled studies [strong evidence]

    The British Journal of Nutrition 2016: Effects of low-carbohydrate diets v. low-fat diets on body weight and cardiovascular risk factors: a meta-analysis of randomized controlled trials [strong evidence]

  11. Several studies have shown that lowering carbs reduces insulin levels in people who are overweight and have type 2 diabetes or metabolic syndrome:

    Metabolism 2015: Comparison of a carbohydrate-free diet vs. fasting on plasma glucose, insulin and glucagon in type 2 diabetes [randomized trial; moderate evidence]

    PloS One 2013: A randomized cross-over trial of the postprandial effects of three different diets in patients with type 2 diabetes [moderate evidence]

    Lipids 2009: Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet [non-controlled study; weak evidence]

  12. A review of multiple high-quality studies has confirmed that following a very-low-carb, high-fat ketogenic diet can significantly decrease appetite and promote natural weight loss:

    Obesity Reviews 2015: Do ketogenic diets really suppress appetite? A systematic review and meta-analysis [strong evidence]

  13. Although some controversy remains, several recent systematic reviews of randomized controlled trials and large observational studies have failed to show a connection between saturated fat consumption and increased heart disease risk:

    Open Heart 2016: Evidence from randomised controlled trials does not support current dietary fat guidelines: a systematic review and meta-analysis [strong evidence]

    Nutrition Journal 2017: The effect of replacing saturated fat with mostly n-6 polyunsaturated fat on coronary heart disease: a meta-analyses of randomised controlled trials [strong evidence]

    Annals of Nutrition & Metabolism 2009: Dietary fat and coronary heart disease: summary of evidence from prospective cohort and randomized controlled trials [moderate evidence]

    Annals of Internal Medicine 2014: Association of dietary, circulating, and supplement fatty acids with coronary risk: A systematic review and meta-analysis [moderate evidence]

  14. Low-carb Mediterranean diets have been found highly effective for weight loss, as well as reducing heart disease risk factors and helping to resolve metabolic syndrome:

    Diabetes, Obesity and Metabolism 2010: A low carbohydrate Mediterranean diet improves cardiovascular risk factors and diabetes control among overweight patients with type 2 diabetes mellitus: a 1-year prospective randomized intervention study [moderate evidence]

    Journal of Medicinal Food 2011: A pilot study of the Spanish ketogenic Mediterranean diet: an effective therapy for the metabolic syndrome [non-controlled study; weak evidence]

  15. Diabetalogia 2014: Eating two larger meals a day (breakfast and lunch) is more effective than six smaller meals in a reduced-energy regimen for patients with type 2 diabetes: a randomised crossover study [moderate evidence]

    PloS One 2012: Effects of meal frequency on metabolic profiles and substrate partitioning in lean healthy males [randomized trial; moderate evidence]

  16. Annual Review of Nutrition 2010: Evolutionary adaptations to dietary changes [overview article; ungraded]

  17. By far the most common sugar alcohol used in low-carb chocolate and candy is maltitol. Studies confirm that it has a high glycemic and insulin index and that a large portion is absorbed into the bloodstream:

    Nutrition Research Reviews 2003: Health potential of polyols as sugar replacers, with emphasis on low glycaemic properties [overview article; ungraded]

    European Journal of Clinical Nutrition 1994: Digestion and absorption of sorbitol, maltitol and isomalt from the small bowel: a study in ileostomy subjects [randomized trial; moderate evidence]

    Gastroentérologie Clinique et Biologique 1991: Clinical tolerance, intestinal absorption, and energy value of four sugar alcohols taken on an empty stomach [randomized trial; moderate evidence]

  18. The Yale Journal of Biology and Medicine 2010: Gain weight by “going diet?” Artificial sweeteners and the neurobiology of sugar cravings [overview article; ungraded]

  19. Some research shows an association between eating a wide variety of different foods and abdominal weight gain, as well as greater diabetes risk:

    PloS One 2015: Everything in moderation – dietary diversity and quality, central obesity and risk of diabetes [observational study; very weak evidence]

  20. Eating less often may be more beneficial when it comes to weight loss and metabolic health:

    Diabetalogia 2014: Eating two larger meals a day (breakfast and lunch) is more effective than six smaller meals in a reduced-energy regimen for patients with type 2 diabetes: a randomised crossover study [moderate evidence]

    PloS One 2012: Effects of meal frequency on metabolic profiles and substrate partitioning in lean healthy males [randomized trial; moderate evidence]

  21. Medical Hypothesis 2009: The salted food addiction hypothesis may explain overeating and the obesity epidemic [overview article; ungraded]

  22. It’s often claimed that eating breakfast is good for weight control. That appears to be false:

    British Medical Journal 2019: Effect of breakfast on weight and energy intake: systematic review and meta-analysis of randomised controlled trials [strong evidence]

    The American Journal of Clinical Nutrition 2009: The effectiveness of breakfast recommendations on weight loss: a randomized controlled trial [moderate evidence]

  23. A review of multiple high-quality studies has confirmed that following a very-low-carb, high-fat ketogenic diet can significantly decrease appetite and promote natural weight loss:

    Obesity Reviews 2015: Do ketogenic diets really suppress appetite? A systematic review and meta-analysis [strong evidence]

  24. Evidence-Based Physical Diagnosis (Fourth Edition) 2018: Chapter 13: Obesity [textbook; ungraded]

  25. Nutrition Reviews 2019: Effects of carbohydrate-restricted diets on low-density lipoprotein cholesterol levels in overweight and obese adults: a systematic review and meta-analysis [strong evidence]

    Diabetes Research and Clinical Practice 2018: Effect of dietary carbohydrate restriction on glycemic control in adults with diabetes: a systematic review and meta-analysis [strong evidence]

    Obesity Reviews 2012: Systematic review and meta-analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors [strong evidence]

  26. Obesity Reviews 2015: Pathways from dieting to weight regain, to obesity and to the metabolic syndrome: an overview [overview article; ungraded]

  27. How much weight do people lose on low carb?

  28. This is based on clinical experience. [weak evidence]

  29. This is based on clinical experience. [weak evidence]

  30. Diabetes & Metabolic Syndrome 2017: Induced and controlled dietary ketosis as a regulator of obesity and metabolic syndrome pathologies [randomized trial; moderate evidence]

  31. This is based on clinical experience. [weak evidence]

  32. This is based on clinical experience. [weak evidence]

  33. This depends to some extent on the type of fruit; for instance, berries are much lower in sugar than oranges, pineapple, bananas, and most other fruits.

  34. In addition to glucose, which raises blood sugar and insulin levels, fruit is high in fructose, which has been linked to obesity, diabetes and other diseases when consumed in excess:

    Nutrients 2017: Fructose consumption, lipogenesis, and non-alcoholic fatty liver disease [overview article; ungraded]

  35. Although study results are inconsistent, frequent beer intake has been linked to excess abdominal fat, at least in men:

    Nutrition Reviews 2013: Is beer consumption related to measures of abdominal and general obesity? A systematic review and meta-analysis [Systematic review of experimental and observational studies; moderate evidence]

  36. Canadian Medical Association Journal 2017: Nonnutritive sweeteners and cardiometabolic health: a systematic review and meta-analysis of randomized controlled trials and prospective cohort studies [systematic review; moderate evidence]

    PLOS Medicine 2017: Artificially sweetened beverages and the response to the global obesity crisis [overview article; ungraded]

  37. These sweeteners appear to partially activate the “food reward” pathway responsible for cravings:

    The Yale Journal of Biology and Medicine 2010: Gain weight by “going diet?” Artificial sweeteners and the neurobiology of sugar cravings [overview article; ungraded]

    Physiology & Behavior 2016: Recent studies of the effects of sugars on brain systems involved in energy balance and reward; relevance to low calorie sweeteners [overview article; ungraded]

  38. In this 12-week study, women assigned to drink only water lost more weight than those who drank diet sodas for 12 weeks – even though both groups followed the same weight-loss plan throughout the study.

    American Journal of Clinical Nutrition 2015: Effects on weight loss in adults of replacing diet beverages with water during a hypoenergetic diet: a randomized, 24-wk clinical trial [moderate evidence]

  39. Diabetes Care 2013: Sucralose affects glycemic and hormonal responses to an oral glucose load [randomized trial; moderate evidence]

    International Journal of Obesity 2017: Effects of aspartame-, monk fruit-, stevia- and sucrose-sweetened beverages on postprandial glucose, insulin and energy intak [randomized trial; moderate evidence]

  40. A 2016 systematic review found that industry-sponsored reviews were much more positive about artificially sweetened beverages than non-industry-sponsored reviews, due to greater conflict of interest and research bias.

    PloS Medicine 2016: Relationship between research outcomes and risk of bias, study sponsorship, and author financial conflicts of interest in reviews of the effects of artificially sweetened beverages on weight outcomes: a systematic review of reviews [strong evidence]

  41. Insulin therapy often promotes gain rather than loss, especially among those who are overweight or obese:

    Journal of Diabetes 2017: Prediction of excessive weight gain in insulin treated patients with type 2 diabetes [randomized trial; moderate evidence]

  42. In several trials, people with type 2 diabetes have been able to discontinue or dramatically reduce their insulin dosage by eating a very-low-carb diet:

    Nutrition & Metabolism 2008: The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus [randomized trial; moderate evidence]

    Nutrition 2012: Effect of low-calorie versus low-carbohydrate ketogenic diet in type 2 diabetes [non-controlled study; weak evidence]

    Diabetes Therapy 2018: Effectiveness and safety of a novel care model for the management of type 2 diabetes at 1 year: an open-label, non-randomized, controlled study [weak evidence]

  43. Diabetes Care 2012: Quantifying the effect of metformin treatment and dose on glycemic control [systematic review of randomized trials; strong evidence]

  44. Expert Opinion on Pharmacotherapy 2018: Understanding the impact of commonly utilized, non-insulin, glucose-lowering drugs on body weight in patients with type 2 diabetes [overview article; ungraded]

  45. Nature Partners Journal Digitial Medicine 2019: Frequent discussion of insomnia and weight gain with glucocorticoid therapy: An analysis of Twitter posts [overview article; ungraded]

  46. Journal of Affective Disorders 1984: Weight gain. A side-effect of tricyclic antidepressants. [weak evidence]

  47. Note that there is some evidence that long-term use of SSRIs is associated with weight gain, but it’s not known if this is causation or just correlation:

    Translational Psychiatry 2016: Is increased antidepressant exposure a contributory factor to the obesity pandemic? [overview article]

    BMJ Open 2017: SSRI antidepressant use potentiates weight gain in the context of unhealthy lifestyles: results from a 4-year Australian follow-up study [very weak evidence]

  48. While the available evidence is not conclusive, studies indicate that progesterone-only birth control might result in a few kilos of weight gain, on average:

    Cochrane Database Systematic Review 2016: Progestin-only contraceptives: effects on weight. [moderate evidence due to limitations of studies]

    Combination contraceptives, containing both oestrogen and progesterone, do not appear to have a clear or major effect on body weight:

    Cochrane Database Systematic Review 2014: Combination contraceptives: effects on weight. [moderate evidence due to limitations of studies]

  49. Annals of Internal Medicine 2017: Historical perspective on the rise and fall and rise of antibiotics and human weight gain [overview article; ungraded]

  50. Physiology & Behavior 2018: Effect of sleep curtailment on dietary behavior and physical activity: a randomized crossover trial [moderate evidence]

    Obesity (Silver Spring) 2017: Stress, cortisol, and other appetite-related hormones: Prospective prediction of 6-month changes in food cravings and weight [non-controlled study; weak evidence]

  51. This effect has been shown in studies of both adults and children:

    Nutrients 2019: Increased hunger, food cravings, food reward, and portion size selection after sleep curtailment in women without obesity [randomized trial; moderate evidence]

    Sleep 2017: Short sleep duration is associated with eating more carbohydrates and less dietary fat in Mexican American children [observational study; weak evidence]

  52. Obesity Reviews 2015: Do ketogenic diets really suppress appetite? A systematic review and meta-analysis [strong evidence]

  53. Although low-lactose dairy products like cheese contain very few carbs, consuming them can raise blood insulin levels modestly. For example, researchers report that a 200-calorie serving of cheese raises insulin more than eggs but less than beef and fish:

    The American Journal of Clinical Nutrition 1997: An insulin index of foods: the insulin demand generated by 1000-kJ portions of common foods [non-controlled study; weak evidence]

  54. Nutrition & Metabolism 2016: Insulinotropic effects of whey: mechanisms of action, recent clinical trials, and clinical applications [overview article; ungraded]

  55. According to a recent review, overweight people have been found to end up taking in more calories overall when they eat nuts – although this doesn’t seem to occur in people of normal weight:

    Critical Reviews in Food Science and Nutrition 2018: Effect of nuts on energy intake, hunger, and fullness; a systematic review and meta-analysis of randomized clinical trial [strong evidence]

  56. Nutrition Journal 2012: A 12-week double-blind randomized clinical trial of vitamin D3 supplementation on body fat mass in healthy overweight and obese women [moderate evidence]

    The American Journal of Clinical Nutrition 2012: Calcium and vitamin D supplementation is associated with decreased abdominal visceral adipose tissue in overweight and obese adults [randomized trial; moderate evidence]

    Clinical Nutrition 2013: Impact of vitamin D supplementation during a resistance training intervention on body composition, muscle function, and glucose tolerance in overweight and obese adults [randomized trial; moderate evidence]

  57. Nutrition Journal 2012: A 12-week double-blind randomized clinical trial of vitamin D3 supplementation on body fat mass in healthy overweight and obese women [moderate evidence]

  58. International Journal of Obesity 2010: Effects of multivitamin and mineral supplementation on adiposity, energy expenditure and lipid profiles in obese Chinese women [randomized trial; moderate evidence]

  59. The British Journal of Nutrition 2008: Multivitamin and dietary supplements, body weight and appetite: results from a cross-sectional and a randomised double-blind placebo-controlled study [moderate evidence]

  60. Several studies support the use of intermittent fasting for losing weight and providing other metabolic benefits, such as improved insulin sensitivity and lower insulin levels:

    Cureus 2018: Intermittent fasting: the choice for a healthier lifestyle [systematic review of randomized trials; strong evidence]

    International Journal of Obesity 2011: The effects of intermittent or continuous energy restriction on weight loss and metabolic disease risk markers: a randomised trial in young overweight women [moderate evidence]

    Obesity (Silver Spring) 2016: A randomized pilot study comparing zero-calorie alternate-day fasting to daily caloric restriction in adults with obesity [moderate evidence]

  61. Journal of Translational Medicine 2016: Effects of eight weeks of time-restricted feeding (16/8) on basal metabolism, maximal strength, body composition, inflammation, and cardiovascular risk factors in resistance-trained males [randomized trial; moderate evidence]

  62. Obesity (Silver Spring) 2018: Flipping the metabolic switch: understanding and applying health benefits of fasting [overview article; ungraded]

  63. Exercise is likely good for health and wellbeing in many ways. It also has some effect on weight loss – but probably a smaller effect than most people expect:

    The American Journal of Medicine 2011: Isolated aerobic exercise and weight loss: a systematic review and meta-analysis of randomized controlled trials [strong evidence for about 1-2 kilos of weight loss]

    Cochrane Database of Systematic Reviews 2006: Exercise for overweight or obesity [strong evidence for about 1-1.5 kilos of weight loss]

    Exercise interventions might be a bit more effective for overweight and obese adolescents (10-19 years of age):

    Sports Medicine 2016: Efficacy of exercise intervention for weight loss in overweight and obese adolescents: meta-analysis and implications [strong evidence for several kilos of weight loss]

  64. Progress in Cardiovascular Diseases 2014: The role of exercise and physical activity in weight loss and maintenance [overview article; ungraded]

  65. AJCN 2019: Effect of different doses of supervised exercise on food intake, metabolism, and non-exercise physical activity: The E-MECHANIC randomized controlled trial [moderate evidence]

  66. The American Journal of Clinical Nutrition 1995: Effects of aerobic exercise and dietary carbohydrate on energy expenditure and body composition during weight reduction in obese women [randomized trial; moderate evidence]

    Military Medicine 2019: Extended ketogenic diet and physical training intervention in military personnel [non-controlled study; weak evidence]

  67. Journal of Strength and Conditioning Research 2017: Exercise-induced hormone elevations are related to muscle growth [randomized trial; moderate evidence]

  68. The Journal of Nutrition 2015: A lower-carbohydrate, higher-fat diet reduces abdominal and intermuscular fat and increases insulin sensitivity in adults at risk of type 2 diabetes [randomized trial; moderate evidence]

    Annals of Internal Medicine 2005: Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes [non-controlled study; weak evidence]

  69. Journal of the American Dietetic Association 2005: Perceived hunger is lower and weight loss is greater in overweight premenopausal women consuming a low-carbohydrate/high-protein vs high-carbohydrate/low-fat diet [randomized trial; moderate evidence]

  70. Food for thought: Does the brain need carbs?

  71. Current Nutrition Reports 2018: Nutritional ketosis for weight management and reversal of metabolic syndrome [overview article; ungraded]

  72. In some cases, it can be sufficient for weight loss, though. In one study, people with type 2 diabetes who maintained light ketosis (just below 0.6 mmol/L) lost 12% of their body weight, on average, over the course of one year:

    Diabetes Therapy 2018: Effectiveness and safety of a novel care model for the management of type 2 diabetes at 1 year: an open-label, non-randomized, controlled study [weak evidence]

  73. This is based on the clinical experience and research of low-carb practitioners. [weak evidence]

  74. Diet Doctor will not benefit from your purchases. We do not show ads, use any affiliate links, sell products or take money from industry. Instead we’re funded by the people, via our optional membership. Learn more

  75. Although responses vary from person to person, studies have shown that very high protein intake may increase rates of gluconeogenesis, or “making new glucose” in the liver:

    Diabetologia 2000: Effect of long-term dietary protein intake on glucose metabolism in humans [non-controlled study; weak evidence]

    International Journal for Vitamin and Nutrition Research 2011: Protein turnover, ureagenesis and gluconeogenesis [overview article; ungraded]

  76. Protein foods like beef, chicken, and dairy have been shown to modestly increase insulin levels:

    The American Journal of Clinical Nutrition 199: An insulin index of foods: the insulin demand generated by 1000-kJ portions of common foods [non-controlled study; weak evidence]

  77. Diet Doctor will not benefit from your purchases. We do not show ads, use any affiliate links, sell products or take money from industry. Instead we’re funded by the people, via our optional membership. Learn more

  78. Diet Doctor will not benefit from your purchases. We do not show ads, use any affiliate links, sell products or take money from industry. Instead we’re funded by the people, via our optional membership. Learn more

  79. In hypothyroidism, metabolic rate slows down, which can lead to weight gain of about 11 pounds (5 kg):

    European Thyroid Journal 2012: Thyroid function and obesity [overview article; ungraded]

  80. Best Practice & Research, Clinical Endocrinology & Metabolism 2013: Pitfalls in the measurement and interpretation of thyroid function tests [overview article; ungraded]

  81. Thyroid Research 2018: Management of hypothyroidism with combination thyroxine (T4) and triiodothyronine (T3) hormone replacement in clinical practice: a review of suggested guidance [overview article; ungraded]

  82. In a 6-month study, 11 women with PCOS who ate less 20 grams per day lost 11% of their body weight, on average, along with reducing their fasting insulin levels and improving their reproductive hormone balance:

    Nutrition & Metabolism 2005: The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: a pilot study [non-randomized trial; weak evidence]

    A more recent study also reported excellent weight loss and other benefits of low-carb in women with PCOS:

    Journal of Obesity & Weight Loss Therapy 2015: Low starch/low dairy diet results in successful treatment of obesity and co-morbidities linked to polycystic ovary syndrome (PCOS) [non-controlled study; weak evidence]

  83. Current Pharmaceutical Design 2017: Low testosterone levels and metabolic syndrome in aging male [overview article; ungraded]

  84. Journal of Strength and Conditioning Research 2017: Exercise-induced hormone elevations are related to muscle growth [randomized trial; moderate evidence]

  85. Psychoneuroendocrinology 2001: Stress may add bite to appetite in women: a laboratory study of stress-induced cortisol and eating behavior [randomized trial; moderate evidence]

  86. The British Journal of Nutrition 2011: The efficacy of Phaseolus vulgaris as a weight-loss supplement: a systematic review and meta-analysis of randomised clinical trials [strong evidence]

  87. JAMA Network 2015: Efficacy of liraglutide for weight loss among patients with type 2 diabetes [randomized trial; moderate evidence]

  88. The New England Journal of Medicine 2015: A randomized, controlled trial of 3.0 mg of liraglutide in weight management [moderate evidence]

  89. International Journal of Obesity 2012: Safety, tolerability and sustained weight loss over 2 years with the once-daily human GLP-1 analog, liraglutide [randomized trial; moderate evidence]

  90. This is based on the clinical experience. [weak evidence]