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For doctorsHow to transition from weight loss to maintenance mode?
, medical content by Dr. Jason Fung, MD
in Dr. Jason Fung, High blood pressure, Intermittent fasting, Q&A, Weight loss 
How should you transition from weight loss to maintenance mode? Are there guidelines for fasting for health benefits and not weight loss? Is it true that we can never lose fat cells, but only shrink them? And can fasting cause high blood pressure?
It’s time for this week’s Q&A about intermittent fasting and low carb with Dr. Jason Fung:
Life-long maintenance
I do not see too much information about the transition from weight loss to life-long maintenance. It is possible I am just missing it. How do we know when to maintain and what is the recommended plan to do so? Some LCHF plans, like Atkins, give a path to maintenance. What are your thoughts on life-long maintenance?
Thank you,
Zack
There is no specific transition. Weight loss will generally plateau at a specific weight. Sometimes that weight is too high, and that means changing the dietary regimen. The principles all remain the same. Eat if you are hungry. Do not eat if you are not. If you want to lose more weight, increase fasting periods. Eat real foods. etc.
Dr. Jason Fung
Intermittent fasting for health benefits but NOT weight loss?
Hi there,
I have been following a ketogenic diet for 14 weeks and really enjoy it. I’ve lost about 15 lbs (7 kg) in that time and my BMI is now around 20. My main reason for starting the keto diet was for the health benefits (I have moderate ME/CFS) and I’ve seen an amazing reduction in brain fog and slightly less disturbed sleep. I’ve read about autophagy and I think it could really improve my health even further.
Having watched your (and other) videos on fasting, the emphasis tends to be on weight loss and my concern is that I don’t particularly have very much weight left to lose… but yet I really want to give intermittent fasting a try!
Is it possible to fast without invoking weight loss? Are there any particular guidelines available on fasting for autophagy and not weight loss?
Thanks!
Emma
Fasting is simply a part of a normal cycle – feeding and fasting. That is why there is the English word ‘breakfast’ or the meal that breaks your fast. You can’t break a fast if you are not fasting. If you are fasting more, you’ll lose weight. So limiting the fasting times or if your weight is too low, doing it less frequently allows you to fast without losing weight.
Dr. Jason Fung
Fat cells for life
Is it true that we keep all the excess fat cells we have ever generated and that lipolysis can only “shrink” the existing cells?
Andrea
I believe so. Even for those people with minimal visible fat, there is some fat stores. In extreme cases, perhaps it may not be true, for all practical purposes, yes. It doesn’t make any difference clinically, though.
Dr. Jason Fung
Fasting causing high blood pressure
Asking about possible reasons why blood pressure would increase during fasting. Not asking for medical advice.
Attempted 72-hour fast which had to be stopped at about 58 hours due to hypoglycemic symptoms; sweating, shakiness, fast heart rate & palpitations, weakness and headache. High blood pressure was noted and it took two weeks for systolic pressure to normalize and about four weeks for diastolic.
Currently fasting was tried again and stopped at 36 hours due to sweating and heart palpitations. Next day, normal feeding, then the next day fasting attempted again which was stopped at 19 hours due to headache and elevated blood pressure.
I have searched for information regarding this and it is limited, most discuss benefits of fasting to help lower blood pressure.
Your insights are greatly appreciated,
Christina
Fasting causes certain hormonal changes. Insulin goes down but other hormones (the counter regulatory hormones) go up. This includes sympathetic tone, noradrenalin, cortisol and growth hormone. It is possible that your body responds exuberantly to these hormones to cause the symptoms of hypoglycaemia. It is also possible that you are becoming hypoglycaemic and developing symptoms. High blood pressure may occur due to these hormonal changes.
Dr. Jason Fung
(If you have difficulty fasting or experience symptoms like this patient reports, we at Diet Doctor would recommend that you refrain from fasting until you have been evaluated by a qualified health care practitioner.)
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Here is my problem, was diagnosed with type 2 Diabetes 15 years ago, I'm 68 years old now , was only on Metformin which didn't waork after a while but was basically in denial about being diagnosed back then and really didn't take good care of myself. I did do a few years ago the Stanley Burroughs master cleanse and after 3 days my blood sugar went to 75, great number but when returning to solid food I gained the 18 pounds back and the blood sugars went back up because I didn't cleanup my diet.
Again a few years ago I didn't take care of myself and my A1c went to 12 and my blood sugar was 504! Scared the hell out of me so I did your fast where you have 2 meals on day and fast for 24 hours every other day after 3 months A1c went to 6 and blood sugar went to 112 did that for 3 months and lost 30lbs. Now I messed up again and this will be the last time, I have learned my lesson. When my blood sugar dropped so fast from 504 to in the 200's I wound up with blurred vision my eye doctor examined my eyes and said no damage had occurred. Took a month for my eyes to return to normal I'm at 20/30 vison.
I have cut out all bad food and I know which ones they are have done intermittent fasting and the problem I am having now is when I fast my blood sugar goes up, if I do eat something it will go down but even with fasting it seems like it's taking along time for the numbers to come down. I've gotten down to 169 but then it goes back to 234, I was wondering should I go on some insulin along with my fasting to get the numbers down faster and then go off the insulin once I'm stabilized? As these numbers stay high I know it's doing harm to my body and eyes and hats what's worried me I'm not a fan of taking insulin have never taken it before but it just seems it's taking forever to get these numbers down. What would you suggest? Thanks
With a blood sugar that high, please check in with your doctor to see if they recommend medication to bring the blood sugars down to a safe level.
I am 72 years old and have been very pleased with my weight loss, I seem to have plateaued at 161lbs. I am now looking to maintain that weight. Do I still need to have only 20 carbs per day and stay in Ketosis. Many thanks Liz
Dr Scher addresses this question at this link:
https://www.dietdoctor.com/how-to-quit-keto-without-gaining-back-weight