Listener Q&A: Help! I’m Afraid to Eat Carbs After Keto

Today, we’re shaking things up with a different kind of episode. We’ve received a listener question that hits on a challenge many face: how to balance the urge for rapid weight loss with the realities of using weight loss medications and making sustainable dietary changes.

Our listener tried Wegovy, turned to keto for quicker results, and is now using Zepbound while trying to figure out how to reintroduce healthy carbs. They’re seeing some success but are unsure how to manage these changes effectively. In this episode, we’ll tackle the challenges of chasing quick fixes and how this approach can complicate your weight loss journey. We’ll dig into practical ways to balance weight loss meds with dietary changes and offer advice on how to smoothly transition back to a more balanced diet. Tune in now to learn how to navigate these adjustments for long-term success without getting caught in the trap of instant results.

Note: All of the information on this podcast is for general informational purposes only. Please talk to your physician and medical team about what is right for you. No medical advice is being given on this podcast.


References:

Click here to book a non-clinical 60 minute consultation call with Dr. Rentea

Ep. 79: Think You're a GLP-1 Non-Responder? Address These Key Issues First


Audio Stamps

03:05 - Dr. Rentea addresses a listener’s question about weight loss with Wegovy and ZepBound, encouraging us to focus on monitoring weight loss as a percentage of total body weight rather than focusing on absolute numbers.

06:19 - Dr. Rentea cautions against the rush to lose weight quickly, noting that extreme diets like keto are often unsustainable and create unnecessary fear of certain foods.

07:58 - Find out the ‘smartest’ way to eat on Zepbound.

12:00 - Dr. Rentea advises the listener to slowly reintroduce carbs, knowing that temporary weight fluctuations are normal.

15:45 - We learn why moving away from an all-or-nothing mentality is key for long-term success.


Quotes

“When you look at body composition testing, people that are losing weight too quickly, they're usually losing a huge percentage of muscle.” - Dr. Rentea

“We don't want to exceed 1 percent body weight loss per week, or 4 percent in a month.” - Dr. Rentea

“When someone says, ‘I want to lose weight fast’, to me that's usually a massive red flag. Why? What's the urgency here? Most people have struggled with this for life.” - Dr. Rentea

“You have got to get out of the fallacy thinking that the scale number at that moment is always accurate and the only truth.” - Dr. Rentea

“What is going to work for you is going to declare itself with time. You're not going to get this answer overnight.” - Dr. Rentea

All of the information on this podcast is for general informational purposes only. Please talk to your physician and medical team about what is right for you. No medical advice is being on this podcast.

If you live in Indiana or Illinois and want to work with doctor Matthea Rentea, you can find out more on www.RenteaClinic.com

Transcript

0:29

Welcome back to another episode of the podcast. I want to give a big, big, big, big, big thank you to all of you that are leaving reviews wherever you're listening. That has been so incredibly helpful and I appreciate you so much. So today we're doing a little bit of a different episode. I got a fan mail question here. So if you're, if you haven't seen this recently, right in the show notes, look below where you're listening, where there's a little descriptions right at the top, it says, Hey, send us a fan mail. And it's super easy. for you to just pop us a message. I do leave a reminder there. Hey, make sure to leave us an email if you want to hear back from us, because otherwise it's anonymous. So you can just leave your thoughts without us knowing. I know someone sent us a silly message that made no sense. So I appreciate those of you that are leaving normal comments and feedback, stuff like that. So I got a great question here that had so many things that I wanted to respond to, and I'm going to. Just give the briefest of briefest thoughts on all of this. I want to, for the 900th time, remind you, I'm a physician, but I'm not your physician. Some of you listening will be my patients, which is amazing. But if that's not you, if you're not under my medical care, please keep in mind that everything that I'm saying are just general observations and for informational purposes. There's no medical information given here. All of you have unique histories, you have unique genetics, you have unique situations, and I could not possibly, in a podcast like this, predict and go through all of that. What I will say is if you're someone, you know, so I have the Rhentia Metabolic Clinic, that's in Indiana, Illinois. If you want to see to work with me, go to rentierclinic. com and there's right on the first page right at the top it's schedule a meet and greet. So I kind of see as the, as the clinic fit right for you because we do things a little bit of a different way. But if you're someone that you're not fortunate enough to live in Indiana or Illinois to work with me, but you still, you think, yeah, I want to, I want to meet with her for an hour just to see, hey, what does she think about X, Y, Z? Now again, I would not be your physician, but. Some of these questions, you don't need me to be in a physician capacity to answer it. It's really their general health questions, things like that. So that's more of like a consulting hour. We'll make sure to put that link in the show notes. If you want to schedule that and you can just do a one off session. I am not your physician. There is no. patient physician relationship with making that consult. But there are people at times that just actually I have several that really like just once a month kind of checking in, seeing how they're doing. They might, you know, they have great physicians, things like that. But this is just this other aspect that there's a, there's just a lot of additional training that I've done. So some people for example will want to talk about body composition testing or different nutritional aspects or you know, the, the, it goes on and on, but I'm not writing medication for you. So A question like this, these are the kind of scenarios that I would typically work through with someone. So, this person said, I'm going to just fully read you the whole thing, and then I'm going to give you lots of my thoughts. Again, these are just a few here and there. This is not like everything that I would go over, because this would be like a three hour episode, and that's not helpful. So this person wrote in, I took Wigovi for a month. I was sick the whole time and only lost five pounds. I wanted to drop some weight fast, so I started keto while trying to get ZepBound approved. I have now been on keto for two months. I'm taking ZepBound for one month. I'm taking ZepBound with no side effects. I'm finally losing weight, and I want to let healthy carbs back in my life. But I'm, I, I don't know. And I want to let healthy carbs back in my life, but I'm afraid. What's the smartest way to eat on ZepBound? Okay. This is a great question. So I have a few thoughts here. Number one, you know, we definitely don't want to be sick the whole time on a med. So I don't know with We'll go be when that person was doing it for the first month. Was it that other things could have actually been adjusted because it seems like this person is probably getting little to no guidance with kind of, well, I felt bad here and then I only lost this and I switched to that and then I liked it Akito and you know, it's, so it's kind of like, it seems like it's kind of all over the place with this person's doing, but we definitely don't want to be sick of it. the whole time. So I'm really glad that a switchover helped. I did want to respond to one thing real quick. When, when this person said only losing five pounds, you know, again, this is relative. And so five pounds to me sounds fabulous. It sounds like a great job. It sounds amazing. I think we have a really unrealistic expectation of weight loss. When you look at body composition, testing people that are losing weight too quick, they're usually losing a huge percentage of muscle and those that are not, that are losing at a reasonable pace, they're doing just fine. They can maintain all their muscle if they're getting enough protein and doing a little bit of strength training. And so when someone says only five pounds, I think to myself, gosh, five is usually a lot. Five is a lot for the average person. Assuming that the weight set point isn't Very elevated with starting and so again what I always want to come back to here and we'll make sure to link this in the show notes the episode where we talk about this but I always encourage you to think about your weight loss and total body weight loss percentage. So the current weight where you are now over your starting weight you're going to get a percentage and I want you to look at so what was five pounds? Was that a two percent weight change? Was it a four percent? A one percent? What was it for you? And then you go based on those numbers so We don't want to exceed 1 percent body weight loss per week, 4 percent in a month. Can these are general numbers. There's always going to be exceptions. A lot of people, not a lot, but some people the first month will actually be hyper responders and lose more than other people. But most people that's not the case and they'll start losing and they'll continue losing and they'll be doing great. So again, five is just so relative. So I just want to stress know your total body weight loss percentage monthly so you can kind of compare because people have no concept of this and this is also How we know if you're actually clinically responding or not. So for example within a three to four month period I'll see have you actually lost 5 percent total body weight And if not, I say well these medications are really not effective for you and we will look at Changing things or doing things differently, but we're not gonna keep you on something that isn't working if it's only being used for weight management. So this person, then I really don't like when someone says, you know, I wanna lose weight fast. To me that's usually like a massive red flag because why? Like, you know, what's the urgency here? Most people have struggled with this for life. And when I hear that, I worry that people are going to step in the trap, which is what just happened here, where then they do something like keto, where they know it's not sustainable longterm. Most people, I just have yet to come across people that are really able to stick with keto for life. Now there's following a lower carb lifestyle, which a lot of us, me included, have such bad insulin resistance that if we don't do that, I mean, I've been having a, a really interesting time here recently wearing a CGM as part of this ZOE test, and if I don't really balance things and eat low carb and really make sure to get that protein fiber first and do this, do that, my sugar really goes up. There's a reality to it, but it's not the same thing as saying, When you say keto, a lot of the times that's actually less than 20 carbs per day. It's extremely low carb and most people just can't maintain it. And then what ends up happening? The thing that comes here, which is they're afraid. I'm afraid to put back in the good carbs, right? So there's lots of like food morality happening here. Where, you know, so here's what I, when I read through this, here's what I hear. The only part, like only losing five pounds, right? Then I hear here, why not drop weight fast? Then I hear here, uh, with the food, you know, being afraid of it. So like, why not put the good carbs, the healthy carbs back in, right? So lots of like good food, bad food. And so what ends up happening is there's lots of rules. There's lots of this and that. And it ends up just being a scenario where you're really like, Boxed in. You can't do it. So, but the ultimate question, though, had nothing to do with any of that, and that was all unsolicited feedback. So getting to the question here, what's the smartest way to eat on ZepBound? So the smartest way is going to depend on what your goal is. So, I will tell you from my perspective, when I am the physician for someone, and I'm overseeing them in my clinic, the Rentier Metabolic Clinic, I personally, one of my top priorities is to preserve muscle with fat loss. So that is really a top guiding principle for me. And so when I think about the smartest way to eat on ZepBound, I think, okay, we're on a medication where appetite is down, urges and cravings are down. Most people do not Naturally wanna have a bunch of protein. It's very rare. I do have them. I have a patient right now that just loves meat. This person actually craves it. They're like, I've always liked this. This is not a problem for me. I love that. For them, that's not the norm. So most people, we actually really need to look at the protein intake. If I had to, if I had to kind of guesstimate when people come in and they do a nutrition audit with me. I think most people are getting at best 50 to 60 grams of protein per day. So I'm really thinking about number one, are you getting enough protein needs for your body? That's the first thing that I always look at. And then I'm really focused at when you're on this medication, there's some of your body physiology that's changed. And so I want to make sure you don't get side effects. So things like constipation or nausea, things like that. And so nutritionally, these are all things we should always care about, but it's really heightened on the medications. We've got to make sure if we don't want you to get constipated, that you have your hydration, that we have your fiber. And then we might even need to change what kinds of fiber or what times you're having it. Or, you know, if you're doing a once a week shot, are we going to change the 1, 2, 3 days after it compared to all the rest of the days? So there's so much that needs to go into, are there other supplements that we're going to add? But to me, the smartest way to eat is to make sure you're getting that protein, make sure that you're getting that fiber, which is usually going to be your veggies, your beans, different types of seeds, like chia seeds, things like that. And then, um, You know, balancing the rest of the plate with good, with fats that really serve you, with carbohydrates that, that feel good to you. And that's going to be different for everyone. And so I'm really about a personalized approach where, you know, sometimes we'll use continuous glucose monitoring, CGM, things like that. But a lot of it's going to get down to how do you actually feel after a meal? Are you, how do you feel an hour after? Are you bloated and tired and this and that? Are you energetic and you can do things and you can last a few hours until the next meal and you're balancing things and you don't find that at the end of the day, everything gets eaten at the same time. Those are usually really good indicators for me that you're on the right track. So that's what I would say is quote unquote the smartest way to eat on zep bound. It's basically very balanced, but we're going to make sure you get enough protein so that you keep your muscle mass. And by the way, keep maintaining muscle mass. It's not just about long term being able to keep the weight off because your basal metabolic rate doesn't go down because it's a massive part of that maintaining your basal metabolic rate. The other reason we're going to do it, it's for longevity, it's for flexibility, it's for, you know, I always say I don't actually care about shape shifting, like amazing that, that your weight's going down and you might look like more what you're seeing in the mirror, but at the end of the day, I love that your pre diabetes reverses, that your triglyceride levels go down, that your sleep apnea improves, the fact that you can sleep better now, that you can walk around, that you worried, oh my gosh, in a few years I'm not going to be able to carry my groceries into the house, and now you're able to do all those things and you're not And so that, when you say the smartest way, I think what's the way that's going to maintain the muscle. I have to tell you a little nerdy moment here. Some of my patients can relate to this. We love this little moment where, when we're People are having fat loss, but when we look on their in bodies, their basal metabolic rate is actually going up because they might actually be gaining muscle. And so that's always such a little nerdy point that we have, that they're actually losing weight, but they potentially can eat more. So it's not the scenario where they have to eat less and less and less. And so that's just such a cool moment, right? That if you do this in a way that makes sense, that there's really hope on the other side of it. Okay, so there was another thing I wanted to get back to here, though, is Let's say that you're in this scenario where you've put yourself into a really restrictive eating pattern. That's what I consider keto. I want to put it this way, most people are going to feel restricted. Of course, everything is about your thoughts and how it makes you feel and then what you end up doing. But this person is feeling restricted because they, they want to, they want to let those things back in their life. So, I would start with, Looking at, okay, are there carbohydrates that they actually made you feel great in the past? Was it some sweet potato? Or was it some fruit? Or what was it where you at? Like, like a honey crisp apple. I'm going to give as an example for me. I love a good honey crisp apple. And in all, all things considered, it's not going to raise my sugar too high. Or some strawberries, things like that. If I have a balanced meal, that's not the thing that's going to break the bank. And so looking at, could I bring that in? And the reason I say slowly, it's because just know when you bring more carbs in, the scale's going to go up because your muscle's going to take in more glycogen and you're going to think, Oh my gosh, I'm starting to gain weight. And you know in your mind that you eating a fourth of a sweet potato is not the thing that's going to make the scale go up a pound or two, but you need to realize that there might be a period where the fluid fluctuations in your body change. So when you're going to do this, You need to have lots of compassion and curiosity, and you need to be in this for the long haul. So over a few weeks or months, realizing I'm going to do this in the name of being able to probably have more energy to work out and to do the things and to feel better or not feel so restricted, things like that. But realize that every time we do big swings, so whether we suddenly decrease carbs or increase carbs, or we suddenly increase exercise. The quote unquote, the net scale, that net number is always going to change. So I'll give you a different example here, just sorry if it's like TMI, but so I got my period today. Okay, so what ended up happening? The days prior, I'm very tired and I want more carbs, and it's not even overeating, but there might be a higher number of carbohydrates that are being eaten per day compared to normal. The scale today looked like it was up two pounds. I did not eat two extra pounds of food yesterday as far as calories. So all I need to do is just be level headed and realize that is literally just the fact that I had more carbs and I go on about my life, drink my water, eat my regular foods, do my thing, and in a day or two that's not going to be a thing. And this is just part of me being a woman and knowing my body at this point. Knowing when the fluctuation happens, knowing when it goes down. This is actually a really good skill too, because I think a lot of people think the first day it's like whoosh, after their period everything's gone. That doesn't really happen with everyone, sometimes it can be a few days. So really getting to know your body and being okay with that. And so you have got to get out of the fallacy thinking that the scale number. At that moment is always accurate and the only truth. I know this is hard to hear because you want to think that, well everything I'm like directly doing the day before directly reflects. No, there's about a two week delay usually. And I'm talking about real body composition changes. And so I don't want you just for half a moment to see a number on a scale. I want it to be real. I want it to be lasting. I want you overall to be able to keep doing this. So I would slowly bring these foods in. And I would keep a level head about not caring if the scale momentarily is going to change. It's not real. Just as you quickly lost this weight when you went to keto and you thought, Oh my gosh, here it is. You were not as hungry. You initially lost some water weight from the carbs. Then you, when you went into ketosis, your appetite went down. A lot of this is not reality long term, meaning to be able to actually sustain it. And so those are my thoughts on that. I hope that this was helpful today. Again, questions like this. I often will go over with people because people get themselves into a real pickle. And I get it because how often my brain has gone to, well, it'd be quicker if we X, Y, Z. And I know that just won't work long term. I know it would be amazing. So based on how insulin resistant I am, I always think if I just cut all carbs out ever and didn't ever do this and ever do that. And then I just realized, what are you doing? What, what mental, what thought is that? Bye bye. You can, you can come thought, but you're not reality. We're not going to hold on to you long term. Bye. The things need to be balanced. They need to make sense. I need to be able to live my life. That's where I'm at at the moment. So it doesn't make sense to never again eat a carbohydrate. It makes sense for me to be very strategic with what I pick. Things that are lower glycemic index. Things that, that, that if I can balance things properly, my sugar doesn't go through the roof. That stuff works for me. So what is going to work for you is going to declare itself with time. You're not going to get this answer overnight. I know this is frustrating because you want to yesterday have solved it. This person, they're three months in. Because if you did a month on Wegovy, then you did a month Keto, and then the next month you did Zep Bound. So you're three months in at this point, maybe four months by the time you're listening to this. And I want to tell you that it takes time. It takes time to figure this stuff out. And you know how I said one of my top goals in the clinic is really to keep, um, to keep muscle mass? One of my other top goals is for people to really start to understand themselves better and start to learn long term, right? What can work for me and how can I troubleshoot these scenarios and how can I figure these different things out? I had a really good moment here recently with my coach because I tend to lose about, this has always been my pattern, about a pound or two per month. And you know, this, this seems small right now. Granted, I've put on a bunch of muscle over the past year and I've done a lot of great things. And, um, And I was going through a moment of really mourning that food, a lot of the times, is not there for me like it was in the past, in the sense of being able to eat this food and just sort of, just, you know. Be zen and calm and, you know, just like at that moment that it sort of just zones you out and when you don't use food in that capacity anymore, so that's really getting rid of that emotional eating, it's, there's a gap there. And I've worked through this over the years, but I just, I don't know, it was just really at the surface and my coach really had a great And she really verbalized, well, you know, when is it worth it and when is it not? And so, really achieving that balance with time of realizing, yeah, majority of the time I don't do that because it doesn't work for my blood sugar and I don't feel good with it. But then there are going to be times when it is worth it, when I do want to do these things. And that balance takes a really long time. That's something that I've worked on for years. It's something that I get closer and closer to. It's something where I'll come back from a vacation and I won't feel this, oh my gosh, You know, everything is lost. No, we have a re entry plan. We have all the stuff there. I'm already not, not overeating on vacations anymore because there's no foods that we're not ever having. Maybe we don't have them as often, but there's nothing that's off limits. Like, I really have a brain that can go toward restriction and binging very easily. Like, it can really just go in that direction. And this is why a lot of people that work with me in the clinic, they might've even had, The history with disordered eating and we're not going to do anything that's ever going to pop them back into that. We're not doing calorie counting. We're being very add, don't subtract. We're taking these different approaches because it never worked doing it any other way. It never worked, right? And so what I want you to think about for yourself is if this was really a long game strategy for me, if I was really in this for the next decade, What today would make sense for me? Today does it make sense that I want to go do these things? Maybe it does. You want to go have some mac and cheese and whatever. You don't want to care about it. Whatever. It doesn't have the most protein. But maybe the other 19 out of 20 days. You're really caring about the protein intake. You're in a groove, you're doing your walks, you're doing your strength training, you, you join that new class that you really want to do. What makes sense and not figuring out that balance is going to take time. So I know we completely deviated away from what was here, but ultimately it's about dropping the all or nothing mentality. And that takes time and energy and a new relationship. It gets built over time. You literally need new neural networks in your brain. This does not happen overnight. You can one time do it, but for it to really be, we're just like effortlessly. You're always coming back to that. I don't all the way drop into deprivation. I don't all the way drop into not caring about all the things. Where do I keep myself so that Yes, I still feel like I'm moving forward. I'm doing the things that matter to me. Every day I reaffirm my commitment to this mattering, at least that's for me. Every day I'm like, darn, it's a lot of work that we got to do, but you know what? It matters. I want to be there for my family, my kid, maybe future grandkids. I don't know. I want to be able to keep walking around. I don't this, I don't that. These things matter to me. I feel better when I eat in this way. Every day recommitting, but it doesn't need to be. An extreme keto diet where you know that I'm fearful of all these things and what's going to happen. Alright, so we totally went off the beaten path. But I think this stuff matters that we go there. And so I want to just come back to this person that I want to leave with some highlights here. I think it's great that you didn't feel good on a med, you got yourself on another med. That you are searching, you're trying different things. I think it's great that now you're like, Oh, this actually isn't going to work. I want to back myself out of this. And all of this is possible. I think, honestly, we are always evolving and changing and trying different things. I'm about to record my thoughts on this different meal delivery service that I tried this past week. You're going to, this was one that I was like, I would never do it. And I have a lot of thoughts and, you know, I always say I can change my mind at any point. So. There, there's always, I'm always trying different things as well, and I think it's about just Again, always turning inside. Is this actually the way for me longterm? And if not, why am I even going to do this? And does it even make sense? Okay. All right. This was great that you are all here. I want to remind you if you're not on my email list, go to rentierclinic. com right at the bottom of the first page. There's a link. The link if you want to stick your email in there, we email you just once a week on Mondays. You know what the podcast is, that's an easy way to write me back or you can do it right here with fan mail if you have questions or comments or insights and I hope that you all have a great rest of the week. Take care.