In Phase 2, Ongoing Weight Loss (OWL), some of “new” carbohydrate foods are reintroduced, typically in the following order:
- Nuts and seeds, nut and seed butters and nut and seed flours
- Berries, cherries and melon (but not watermelon)
- Plain, unsweetened whole-milk yogurt, cottage cheese and ricotta
- Legumes such as chickpeas, lentils, etc.
- Tomato and vegetable juice “cocktail”
Not everyone can add back all these foods; others may be able to add only small portions or have them only occasionally. There are five important points to understand when reintroducing carbohydrate foods:
1. Count carbs. If an individual has been strictly following a meal plan or estimating grams of Net Carbs in Phase 1, Induction, now is the time to start counting them.
2. One at a time. Only one new food within a rung on the Carb Ladder should be reintroduced each day or several days. That way, if a food reawakens cravings or uncontrollable hunger, causes gastric distress or stalls or reverses weight loss, the patient can easily identify it—and back off for the time being. So, for example, at rung 4 he or she might start with a small portion of blueberries. Assuming no problems, it would be fine to move on to strawberries a couple of days later. In OWL, most people can also consume additional low-carb specialty foods beyond those suitable for Induction. Again, they should be introduced one at a time to assess any reactions.
3. More variety, not more food. The range of foods is increasing, but the amount of food being consumed each day is not, or at least not very much. As an individual continues to add small amounts of carbohydrate foods, he or she doesn’t have to do anything other than make sure he or she is not overdoing protein intake (typically 4–6 ounces at each meal). Patients should be guided by their appetite and distinguish it from habit. The moment they feel they’ve had enough, they should stop eating. Staying well hydrated also helps moderate appetite.
4. Stay with foundation vegetables. As your patients add new foods, they’ll substitute some of them for other carb foods they’re already eating, but not the 12–15 grams of Net Carbs from foundation vegetables. For example, a person can now have cottage cheese in lieu of some of the hard cheese she’s been eating in Induction. Instead of an afternoon snack of green olives, another person might switch off with macadamias. They both will still be eating those Induction-friendly foods, but they can branch out a bit. As long as individuals track their carb intake, eat the recommended amount of vegetables and feel pleasantly full but not stuffed, they should do fine.
5. Write it down. The process of adding back foods doesn’t always happen smoothly. It’s essential to understand which food is causing a negative response, such as the return of cravings or uncontrollable hunger. That tells a person to back off it. Counsel your patients to continue to note what they’re adding, how much and their reactions, if any, in their diet journal.