It’s generally recommended that individuals cycle through the phases to gradually find their carb tolerance and learn good, sustainable eating habits, but this approach doesn’t work for everyone. An individual’s experience in Phase 2, Ongoing Weight Loss (OWL), is usually a barometer of how difficult or easy it will be to lose weight. It also usually predicts what his or her permanent diet will look like. One’s experience in OWL also determines to a large extent how he or she proceeds from that phase on.
Phase 3, Pre-Maintenance, is where most people lose their last excess pounds and segue into a permanent way of eating. If your patient has been losing steadily and is now close to his or her goal weight, encourage him or her to transition to Pre-Maintenance. Some patients may even be able to move on before they get to this point. Still others should wait until they are at their goal weight. You can introduce these options if you think one of them is appropriate. The following guidelines should help you make that determination:
Option 1: Move to Phase 3 Sooner
If a patient still has more than 10 pounds to go but wants more food choices, he or she can move from Phase 2 to Phase 3 under certain circumstances.
- It’s a go. Steady weight loss at 50 grams of Net Carbs per day or more without cravings and nagging hunger could green-light a move to Phase 2 before loss of all but the last 10 pounds. However, if weight loss ceases and any previous symptoms return, the individual should immediately return to Phase 2.
- It’s no go. If an individual’s weight loss has plateaued, certain foods still trigger cravings, she is eating inappropriate foods on occasion and/or her blood sugar and insulin levels have not yet normalized, counsel her to stay put. Any weight plateau eventually comes to its natural conclusion; adding carbs will not break it.
Option 2: Moving to Phase 3 on “Schedule”
This is the “standard” procedure. Wait until 10 pounds from goal weight and make sure cravings and other indicators are under control.
Option 3: Staying in Phase 2 Until Goal Weight
Some people find that they “stall out” somewhere south of 50 grams of Net Carbs in OWL. In that case, we recommend hanging tight rather than moving to Phase 3, Pre-Maintenance. The higher carb intake and introduction of new foods higher in carbs could prove a minefield in such cases. To decide whether a patient should stay in OWL until he or she reaches goal weight, ask these questions:
- Have you had a hard time getting much beyond Induction’s 20 grams of Net Carbs? Advancing every week or so by 5 daily grams of Net Carbs may have stalled weight loss or actually caused weight regain. Or perhaps all but 10 excess pounds have come off but progress was maddeningly slow. These are signs of very low carbohydrate tolerance.
- Have you encountered foods in OWL that you can’t handle or must eat with caution? Again, carb tolerance is low and certain foods must be consumed very carefully.
- Are you experiencing cravings and out-of-control appetite that disappeared in Induction? The return of such symptoms or midafternoon fatigue may be a signal that pushing carbohydrate intake too high is causing blood sugar levels to fluctuate..
- Has your blood sugar level risen after dropping when you started Atkins? Likewise, if metabolic syndrome has been an issue, it’s likely a patient will have to be very careful about introducing higher-carb foods.
- Did you achieve good results at first, but not later? If your patient lost weight in Induction and initially in OWL, only to gain some of it back, he may have moved beyond his carb threshold, known as the Carbohydrate Level for Losing (CLL).
Stay Put for Now
If the answers to any of these questions is yes and the individual’s CLL is 50 or less, it’s unlikely that moving to Pre-Maintenance, where higher carb foods are introduced in 10-gram increments, is the right move at this time. Even if a patient continues to lose weight, the destabilization of indicators recently been brought under control—whether hunger and cravings or blood pressure or blood sugar and insulin levels—, suggests she has exceeded her carbohydrate tolerance. Counsel her to back down 5 daily grams for one or two weeks to see how she feels and/or how health indicators respond. If necessary, she can then drop back another five.
If your patient has recently added new foods, one or more of them may be the culprit. By limiting it or them to a couple of servings a week or omitting for the time being, she should be able to eliminate the hunger or cravings. No new foods should be added until such symptoms disappear.
If these measures don’t produce results, even if a patient is within sight of her goal weight, counsel her to remain in OWL for the time being. She may be able to gradually increase her carb tolerance and introduce a few new carbohydrate foods—or not—but why invite frustration by trying to move up in 10-gram increments. Because such individuals are particularly sensitive to carbohydrates, they will have to continue to keep their intake low to avoid regaining weight and experiencing other harmful metabolic effects. Anxious as they may be to reach their goal weight, achieving it in a way that’s close to a permanent way of eating makes it more likely that they will keep the weight off long term.
Prematurely Hitting One’s ACE
Another possibility is that a patient whose weight loss has stalled in OWL may have unintentionally reached his Atkins Carbohydrate Equilibrium (ACE), which is the number of grams of Net Carbs one can consume without gaining or losing weight— typically found in Pre-Maintenance. ?In this case, the person may have simply increased carbohydrate intake too quickly for his metabolism. To find if this is the case, have the patient reduce his daily carb intake by 5 grams to see if weight loss resumes. If not, a drop by another five may reboot weight loss. Once the person is 10 pounds from goal weight and not experiencing cravings or extreme hunger, he can move to Pre-Maintenance.
The Lower-Carb Approach to Lifetime Maintenance
Once individuals with a CLL of 25–50 who decide to remain in OWL reach their goal weight, they should stay there one more month to stabilize their weight loss. They can then follow the lower-carb approach to Lifetime Maintenance explained in Phase 4. Make it clear that there’s nothing wrong with having a low carbohydrate threshold; rather, finding one’s individual carb tolerance allows for sustained weight management and avoidance of certain metabolic symptoms.